PMID- OWN - STAT- DA - 20240101 IS - IS - VI - 81 IP - DP - 2024 Jan 01 TI - Chronic occupational exposures to irritants and asthma in the CONSTANCES cohort PG - 129-135 AB - Objectives The impact of chronic occupational exposures to irritants on asthma remains discussed. We studied the associations between occupational exposures and asthma, with specific interest for chronic exposure to irritants, including disinfectants and cleaning products (DCPs) and solvents. Methods Cross-sectional analyses included 115?540 adults (55%?women, mean age 43 years, 10% current asthma) working at inclusion in the French population-based CONSTANCES cohort (2012–2020). Current asthma was defined by ever asthma with symptoms, medication or asthma attacks (past 12 months), and the asthma symptom score by the sum of 5 respiratory symptoms (past 12 months). Both lifetime and current occupational exposures were assessed by the Occupational Asthma-specific Job-Exposure Matrix. Associations were evaluated by gender using logistic and binomial negative regressions adjusted for age, smoking status and body mass index. Results In women, associations were observed between current asthma and lifetime exposure to irritants (OR 1.05, 95% CI 1.00 to 1.11), DCPs (1.06, 95% CI 1.00 to 1.12) and solvents (1.06, 95% CI 0.98 to 1.14). In men, only lifetime exposure to DCPs (1.10, 95% CI 1.01 to 1.20) was associated with current asthma. Lifetime exposure to irritants was associated with higher asthma symptom score both in women (mean score ratio: 1.08, 95% CI 1.05 to 1.11) and men (1.11, 95% CI 1.07 to 1.15), especially for DCPs (women: 1.09, 95% CI 1.06 to 1.13, men: 1.21, 95% CI 1.15 to 1.27) and solvents (women 1.14, 95% CI 1.10 to 1.19, men: 1.10, 95% CI 1.05 to 1.15). For current exposures, no consistent associations were observed with current asthma and asthma symptom score. Conclusions Lifetime occupational exposures to irritants were associated with current asthma and higher asthma symptom score. These exposures should be carefully considered in asthma management. AU - Sit G AU - Orsi L AU - Iwatsubo Y AU - Dananché B Orsi F AU - Goldberg M AU - Leynaert B AU - Nadif R AU - Ribet C AU - Roche N AU - Roquelaure Y AU - Varraso R AU - Zin M AU - Pilorget C AU - Le Moual N AU - Dumas O LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20240101 IS - IS - VI - 81 IP - DP - 2024 Jan 01 TI - Trends in work-related respiratory diseases attributed to nickel, chromium and cobalt in the UK: descriptive findings from The Health and Occupation Research (THOR) network 1996–2019 PG - 220-224 AB - Background Occupational exposure to metals can be associated with respiratory diseases which can adversely affect the individual’s health, finances and employment. Despite this, little is known about the incidence of these respiratory conditions over prolonged periods of time. Aims This study aimed to investigate the trends in the incidence of work-related respiratory diseases attributed to nickel, chromium and cobalt in the UK. Methods Cases of occupational respiratory diseases caused by nickel, chromium or cobalt reported to Surveillance of Work-related and Occupational Respiratory Disease (SWORD), the UK-based surveillance scheme between 1996 and 2019 (inclusive), were extracted and grouped into six 4-year time periods. Cases were characterised by causative metal exposure, occupational and industrial sector. Incidence rates diseases (adjusted for physician participation and response rate) were calculated using ONS employment data. Results Of cases reported to SWORD during the study period, 1% (173 actual cases) of respiratory problems were attributed to nickel, chromium or cobalt. Diagnoses of asthma compromised the largest proportion of diagnoses (74.4%), followed by lung cancer (8.9%) and pneumoconiosis (6.7%). Cases had a mean age of 47 years (SD 13); 93% were men. The annual incidence fell from 1.6 per million employed in the first 4-year period, to 0.2 in the most recent period. Conclusions Over 24 years, a decline in the incidence of metal-related occupational respiratory diseases was observed in the UK. This could be attributed to improvements in working conditions which resulted in reduced metal exposure but could also be due to closure of industries that might have generated case returns. AU - Iskandar IYK AU - Gawkrodger DJ AU - Byrne L AU - Matthew Gittins M AU - Carder M AU - Fishwick D AU - van Tongeren M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20240101 IS - IS - VI - IP - DP - 2024 Jan 01 TI - Artificial stone silicosis: a UK case series PG - AB - Silicosis due to artificial stone (AS) has emerged over the last decade as an increasing global issue. We report the first eight UK cases. All were men; median age was 34 years (range 27–56) and median stone dust exposure was 12.5 years (range 4–40) but in 4 cases was 4–8 years. One is deceased; two were referred for lung transplant assessment. All cases were dry cutting and polishing AS worktops with inadequate safety measures. Clinical features of silicosis can closely mimic sarcoidosis. UK cases are likely to increase, with urgent action needed to identify cases and enforce regulations. AU - Feary J AU - Devaraj A AU - Burton M AU - Chua F AU - Coker RK AU - Datta A AU - Hewitt R AU - Kokosi M AU - Kouranos V AU - Reynolds CJ AU - Ross CL AU - Smith V AU - Ward K AU - Wickremasinghe M AU - Szram J LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20240101 IS - IS - VI - 154 IP - DP - 2024 Jan 01 TI - Indoor air pollution and airway health PG - 835-846 AB - Because of the disproportionate amount of time that people spend indoors and the complexities of air pollutant exposures found there, indoor air pollution is a growing concern for airway health. Both infiltration of outdoor air pollution into the indoor space and indoor sources (such as smoke from tobacco products, cooking or heating practices and combustion of associated fuels, and household materials) contribute to unique exposure mixtures. Although there is substantial literature on the chemistry of indoor air pollution, research focused on health effects is only beginning to emerge and remains an important area of need to protect public health. We provide a review of emerging literature spanning the past 3 years and relating indoor air exposures to airway health, with a specific focus on the impact of either individual pollutant exposures or common combustion sources on the lower airways. Factors defining susceptibility and/or vulnerability are reviewed with consideration for priority populations and modifiable risk factors that may be targeted to advance health equity. AU - Radbel J AU - Rebuli ME AU - Kipen H AU - Brigham E LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20240101 IS - IS - VI - 154 IP - DP - 2024 Jan 01 TI - Cleaning indoor air—what works for respiratory health: An updated literature review and recommendations PG - 847-860 AB - Indoor air pollution is a growing public health concern globally and is associated with increased respiratory symptoms and morbidity. Individuals spend most of their time indoors, and pollutant-related health effects are often driven by the indoor environment. Understanding effective interventions to improve indoor air quality and their impact on respiratory outcomes is key to decreasing the burden of air pollution for high-risk populations across the life-span. This review applies a hierarchy of interventions framework specific to respiratory health effects and focuses on recent studies of interventions to improve indoor air quality among high-risk populations with chronic respiratory disease published in the past 3 years. While policy and source control interventions are likely the most effective and equitable approaches to improve indoor air quality and benefit population health, these were less extensively investigated. Engineering interventions, such as air cleaner interventions, were the most widely studied. Several studies, including those focused on asthma and chronic obstructive pulmonary disease, demonstrated improvement in symptoms and medication receipt with interventions in both home- and school-based settings. Combined multilevel interventions with engineering and behavioral interventions led to improved respiratory outcomes in some, but not all, studies. Placing the recent work in the context of the broader literature, we identify gaps in research. Further research is needed to understand intervention effectiveness over time and an increased focus on policy and source control interventions that can mitigate risk in vulnerable populations. AU - Robertson NM AU - Qiu A AU - Raju S AU - McCormack MC AU - Koehler K LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20230101 IS - IS - VI - 24 IP - DP - 2023 Jan 01 TI - Reported Cases and Diagnostics of Occupational Insect Allergy: A Systematic Review PG - 86 AB - A significant part of adult-onset asthma is caused by occupational exposure to both high- and low-molecular-mass agents. Insects are occasionally described to cause occupational allergy in professions including anglers and fishers, laboratory workers, employees of aquaculture companies, farmers, bakers, sericulture workers and pet shop workers. Occupational insect allergies are often respiratory, causing asthma or rhinoconjunctivitis, but can be cutaneous as well. The European Union recently approved three insect species for human consumption, enabling an industry to develop where more employees could be exposed to insect products. This review overviews knowledge on occupational insect allergy risks and the tools used to diagnose employees. Despite the limited availability of commercial occupational insect allergy diagnostics, 60.9% of 164 included reports used skin prick tests and 63.4% of reports used specific IgE tests. In 21.9% of reports, a more elaborate diagnosis of occupational asthma was made by specific inhalation challenges or peak expiratory flow measurements at the workplace. In some work environments, 57% of employees were sensitized, and no less than 60% of employees reported work-related symptoms. Further development and optimization of specific diagnostics, together with strong primary prevention, may be vital to the health conditions of workers in the developing insect industry. AU - Ganseman E AU - Gouwy M AU - Bullens D AU - Breynaert C AU - Schrijvers R AU - Proost P LA - PT - DEP - TA - Int. J. Mol. Sci. JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20230101 IS - IS - VI - 27 IP - DP - 2023 Jan 01 TI - Investigating the Effect of Welding Fume in Pulmonary Function of Welders in an Automobile Industry PG - 166-171 AB - Context: Respiratory exposure to welding fumes directly or indirectly, in the long run, can lead to systematic effects among welders. Aims: This study aimed to investigate respiratory symptoms and pulmonary function parameters among welders working in the automotive industry. Material and Methods: This cross-sectional study was performed among 2304 workers from two groups in the manufacturing and administrative staff (as exposure and control groups). Pulmonary function parameters and respiratory symptoms were collected through periodic spirometry examinations and a standard respiratory symptoms questionnaire. Exposure to welding fumes was obtained from the annual measurement data based on the NIOSH7300 method. Data were analyzed using SPSS software version 22 and linear and multiple regression statistical tests. Results: The mean age of the subjects in the case and control groups were 37.5 and 38.5 years, respectively. All the apparent symptoms of respiratory diseases (cough, sputum) in the welder’s group were more than in the control group. Also, there was a significant difference between the respiratory symptoms in the two groups (P < 0.001). The mean value of all spirometric parameters (FVC, FEV1, FEV1/FVC, FEF25-75, PEF) in the case group (welders) was significantly lower than the control group. Conclusion: The results of this study revealed that the variables of age and work experience effectively reduce all spirometric parameters of welders. Also, regarding the effect of metal vapors, a significant relationship has been seen between Cu in welding fume and FEF25-75 and FEV1 spirometric parameters. AU - Saadiani E AU - Hosseinkhani Z AU - Safari-Variani A LA - PT - DEP - TA - Indian Journal of Occupational and Environmental Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20230101 IS - IS - VI - 80 IP - DP - 2023 Jan 01 TI - Impact of occupational asthma on health and employment status: a long-term follow-up study PG - 70-76 AB - Objectives The aim of this study was to assess the predictors of a favourable prognosis of occupational asthma (OA) and the employment status of patients with OA at least 2 years after diagnosis. Methods We collected data from 204 patients who had a diagnosis of OA confirmed by a positive specific inhalation challenge. We defined OA remission as meeting the following three criteria: no asthma symptoms, no antiasthma therapy for the last year and having normal lung function at the end of follow-up. A logistic regression analysis was performed to estimate the effects of the covariates. Results At 10.6±7.8-year follow-up, 60 of 204 possible patients participated in the study, and among them 17 showed OA remission. When compared with the 43 patients with persistent OA, these patients exhibited at diagnosis younger age (p=0.0039), shorter duration of symptomatic exposure (p=0.0512), better lung function expressed by higher forced vital capacity (FVC%) predicted (p=0.0164), forced expiratory volume in 1 s (FEV1) % predicted (p=0.0066) and FEV1/FVC% (p=0.0132), and less bronchial hyper-responsiveness (p=0.0118). Nevertheless, in the multivariable model, no variables were significantly associated with OA remission. At follow-up, three individuals have retired; among the remaining 57 workers, 91.2% were still employed and 43.8% of them had continued working in the same factory after ceasing exposure to the causative agent. Conclusions This monocentric study did not identify a strong predictor of OA remission, but documented a high employment rate and a good job preservation over a long timeframe after diagnosis of OA mainly induced by low molecular weight agents. AU - Mason P AU - Liviero F AU - Paccagnella ER AU - Biasioli M AU - Maestrelli P AU - Frigo AC LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20230101 IS - IS - VI - IP - DP - 2023 Jan 01 TI - Job and exposure intensity among hospital cleaning staff adversely affects respiratory health. PG - 1-13 AB - Background Occupational exposure to various types of cleaning agents may increase the risk of adverse respiratory health among cleaners. This study investigated the relationship between exposure to cleaning and disinfecting agents, using a job-task and exposure intensity metric, and respiratory outcomes among cleaners. Methods A sample of 174 cleaners was selected from three public hospitals in Durban. A questionnaire was used to collect demographic and occupational information, and spirometry, including post-bronchodilator measures, was conducted according to the American Thoracic Society guidelines and skin prick testing were performed. Exposure metrics for job tasks and chemical exposures were created using frequency and employment-lifetime duration of exposure. Multivariate analysis regression models used job task and exposure intensity metrics. Results Doctor-diagnosed asthma prevalence was 9.8%. Breathlessness with wheeze (22.4%) was the prevalent respiratory symptom. Positive responses to skin prick testing were seen in 74 (43.2%). There was a statistically significant increased risk for shortness of breath with exposure to quaternary ammonium compounds (odds ratio [OR]: 3.44; 95% confidence interval [CI]: 1.13–10.5) and breathlessness with exposure to multipurpose cleaner (OR: 0.34; CI: 0.12–0.92). The losses in percent-predicted forced expiratory volume in 1?s (FEV1) ranged from 0.3%–6.7%. Results among the bronchodilator-positive (8.6%) showed lung function losses twofold greater when compared to the total study population with percentage predicted FEV1 (-22.6 %; p?<?0.000). Conclusion Exposure to certain cleaning and disinfectant agents adversely affects respiratory health, particularly lung function. This effect, while seen generally among cleaning workers, is more pronounced among those with pre-existing reversible obstructive lung disease. AU - Ndlela NH AU - Naidoo RN LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20230101 IS - IS - VI - 222 IP - DP - 2023 Jan 01 TI - The impact of occupational exposure to crystalline silica dust on respiratory function (airway obstruction and FEF25-75) in the French general population PG - 115382 AB - Introduction Although several studies have studied the relationship between occupational exposure to crystalline silica dust and respiratory mortality, few have examined the relationship with impairments in respiratory function and the exposure threshold triggering spirometric monitoring in exposed workers. The objective of the present study was to evaluate the impact of exposure to crystalline silica dust on respiratory function. Methods We included 1428 male participants (aged 40 to 65) recruited from the French general population, at random from electoral rolls, in the cross-sectional ELISABET study and for whom data on forced expiratory flow-volume curve indices z-scores (calculated using the Global Lung Function Initiative 2012 equations) and exposure (via a questionnaire) were available. A cumulative exposure index (CEI) for crystalline silica dust (CEIsilica, expressed in mg.m-3.year) was calculated using the Matgéné occupational exposure matrix. Results 293 of the 1428 participants (20.52%) reported exposure to silica dust. We found that the adjusted z-scores for the forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) ratio decreased significantly as CEIsilica increased. After adjustment, the adjusted z-scores for FEV1/FVC (ß: -0.426 (95% confidence interval (CI): -0.792, -0.060) per 1 mg m-3.year increment) and the mean forced expiratory flow between 25 and 75% of the forced vital capacity (FEF25-75) (ß: -0.552 (95% CI: -0.947, -0.157)) were significantly lower in the participants with CEIsilica =1 mg m-3.year than in non-exposed participants. The likelihoods of having airway obstruction (odds ratio (OR): 3.056 (95% CI: 1.107, 7.626)) or having an impaired FEF25-75 (OR: 4.305 (95% CI: 1.393, 11.79)) were also significantly higher in participants with CEIsilica =1 mg m-3.year. Conclusion Our results emphasize the importance of spirometry-based monitoring in workers exposed to more than 1 mg m-3.year of crystalline silica dust, in order to identify small airway obstruction or airway obstruction as early as possible. Keywords: Crystalline silica dust; Occupational exposure; Spirometry; GLI-2012; FEF25-75; Airway obstruction AU - Wardyn P AU - Edme J AU - de Broucker V AU - Cherot-Kornobis N AU - Ringeval D AU - Amouyel P AU - Sobaszek A AU - Dauchet L AU - Hulo S LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20230101 IS - IS - VI - 13 IP - DP - 2023 Jan 01 TI - Association of p-phenylenediamine exposure with alterations of pulmonary function, pruritus and health-related quality of life in hair dye factory workers: a cross-sectional study PG - 2623 AB - P-Phenylenediamine (PPD) is a common component of hair dye, which can cause skin contact allergy and asthma with impaired pulmonary function. However, the adverse effects of occupational exposure to different dose PPD was rarely mentioned. We recruited 124 workers from a hair dye factory to explore the association of occupational PPD exposure on pulmonary function, pruritus and health related quality of life (HRQL). We categorized exposure to PPD into 3 levels: lower exposure group (<?0.00001 mg/m3); middle exposure group (0.00001–0.00033 mg/m3); higher exposure group (0.00033–0.047 mg/m3). The HRQL and subjective pruritus of the workers were assessed by the short form 36 health survey (SF-36) and Visual analogue scale (VAS) of pruritus, respectively. In the high PPD-exposed group, the percentage of FEV1 (FEV1%) was lower in higher exposure group compared with lower exposure group. The FEV1/FVC was also lower in comparison to the higher exposure and middle exposure groups (p?<?0.05). PPD levels were negatively correlated with vitality and mental health (p?<?0.01). The structural equation model showed the positive effects of PPD on VAS level (ß?=?0.213, p?<?0.001), and indicated partly negtive effects of PPD on total score of SF-36 (ß?=?- 0.465, p?=?0.002), respectively. Our results indicate that occupational exposure to PPD might be associated with pulmonary function impairment, poor HRQL, and subjective pruritus of the workers. AU - Zhang M AU - Lin D AU - Zhang N LA - PT - DEP - TA - Sci Rep JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20230101 IS - IS - VI - 80 IP - DP - 2023 Jan 01 TI - Longitudinal associations of household use of cleaning agents and asthma symptoms in women: the EGEA study PG - 218-224 AB - Objective To evaluate the associations between the evolution of household use of cleaning products with the asthma symptom score and its evolution over 8 years. Methods Our study is based on 509?women participating in the last two surveys of the Epidemiological study on the Genetics and Environment of Asthma (EGEA) study (EGEA2: 2003–2007 (44 years, 19% current smokers) and EGEA3: 2011–2013). We assessed an asthma symptom score and the use of household cleaning products through standardised questionnaires. We studied longitudinal associations of the evolution of weekly use of irritant or spayed cleaning products with (1) the asthma symptom score at EGEA3 and a stable symptom score between EGEA2-EGEA3 (negative binomial models) and (2) the incidence/evolution of asthma symptoms between EGEA2-EGEA3 (logistic/polytomous logistic regressions). Models accounted for familial dependence and were adjusted for age, smoking status, body mass index and occupational exposure to asthmagens. Results Persistent and increased (40% and 16%, respectively) weekly use of irritants or sprays were associated with a higher risk of asthma symptoms at EGEA3 (Mean Score Ratio (MSR)=1.51 (95% CI 1.06 to 2.14) and 1.33 (95% CI 0.85 to 2.08), respectively). A decreased use (19%) was associated with a lower risk of symptoms at EGEA3, compared with a persistent use (MSR=0.59 (95% CI 0.39 to 0.88)). We also observed an association between an increased use of sprays and the incidence of asthma symptoms (OR=2.30 (95% CI 1.08 to 4.91)), compared with no weekly use of irritants/sprays. Conclusions This longitudinal study, with repeated assessment of exposure and respiratory health, supports the hypothesis that a persistent or increased weekly use of sprayed cleaning products over time may have an adverse effect on the evolution of asthma symptoms. AU - Pacheco Da Silva E AU - Ngutuka M AU - Dumas O AU - Orsi L AU - Ait-hadad W AU - Lemire P AU - Quentin J AU - Pin I AU - Varraso R AU - Siroux V AU - LeMoual N LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20230101 IS - IS - VI - IP - DP - 2023 Jan 01 TI - All-cause and cause-specific mortality in a cohort of WTC-exposed and non-WTC-exposed firefighters. PG - AB - OBJECTIVE: To compare mortality rates in World Trade Center (WTC)-exposed Fire Department of the City of New York (FDNY) firefighters with rates in similarly healthy, non-WTC-exposed/non-FDNY firefighters, and compare mortality in each firefighter cohort with the general population. METHODS: 10?786 male WTC-exposed FDNY firefighters and 8813 male non-WTC-exposed firefighters from other urban fire departments who were employed on 11 September 2001 were included in the analyses. Only WTC-exposed firefighters received health monitoring via the WTC Health Programme (WTCHP). Follow-up began 11 September 2001 and ended at the earlier of death date or 31 December 2016. Death data were obtained from the National Death Index and demographics from the fire departments. We estimated standardised mortality ratios (SMRs) in each firefighter cohort versus US males using demographic-specific US mortality rates. Poisson regression models estimated relative rates (RRs) of all-cause and cause-specific mortality in WTC-exposed versus non-WTC-exposed firefighters, controlling for age and race. RESULTS: Between 11 September 2001 and 31 December 2016, there were 261 deaths among WTC-exposed firefighters and 605 among non-WTC-exposed. Both cohorts had reduced all-cause mortality compared with US males (SMR (95%?CI)=0.30 (0.26 to 0.34) and 0.60 (0.55 to 0.65) in WTC-exposed and non-WTC-exposed, respectively). WTC-exposed firefighters also had lower rates of all-cause mortality (RR=0.54, 95% CI=0.49 to 0.59) and cancer-specific, cardiovascular-specific and respiratory disease-specific mortality compared with non-WTC-exposed firefighters. CONCLUSION: Both firefighter cohorts had lower than expected all-cause mortality. Fifteen years post 11 September 2001, mortality was lower in WTC-exposed versus non-WTC-exposed firefighters. Lower mortality in the WTC-exposed suggests not just a healthy worker effect, but additional factors such as greater access to free health monitoring and treatment that they receive via the WTCHP. AU - Singh A AU - Zeig-Owens R AU - Cannon M AU - Webber MP AU - Goldfarb DG AU - Daniels RD AU - Prezant DJ AU - Boffetta P AU - Hall CB LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20230101 IS - IS - VI - IP - DP - 2023 Jan 01 TI - Frequent allergic sensitization to farmed edible insects in exposed employees PG - AB - Background Exposure to insects used in pet food, scientific research or live fish bait can cause occupational allergy. The recent shift towards enhanced insect production for human consumption and animal feed will likely expose more employees. Objective To investigate sensitization and symptoms in employees exposed to edible insects in Flanders. Methods Fifteen insect-exposed employees were recruited and sensitization was explored by skin prick test (SPT), basophil activation test (BAT), and immunoblotting. Lung function, fractional exhaled nitric oxide (FeNO), histamine provocation and sputum induction were studied. Airborne dust sampling was performed and proteins were studied by silver stain and immunoblotting. Results Sixty percent of employees self-reported upper respiratory tract symptoms related to insect exposure. Ten employees (71.4%) had a positive histamine provocation test (PC20 <8 mg/mL) and four (26.7%) had FeNO levels above 25 ppb. Four employees (30.7%) had a positive SPT for at least one insect, and seven (58.3%) had a positive BAT. In 8 participants with insect sensitization, 4 (50%) had co-occurring house dust mite sensitization. Two participants had strong IgE binding to a 50 kDa migratory locust allergen, one participant to a 25 kDa mealworm allergen and one participant to mealworm alpha-amylase. In one center, facility adjustment resulted in a substantial decrease of the inhalable dust fraction. Conclusion Insect exposure leads to high levels of sensitization among employees. Most employees reported symptoms of the upper respiratory system and two thirds of the employees had bronchial hyperreactivity. Prevention and health surveillance will be key in the developing insect-rearing industry. AU - Ganseman E AU - Goossens J AU - Blanter M AU - Jonckheere A-C AU - Bergmans N AU - Vanbrabant L AU - Gouwy M AU - Ronsmans S AU - Vandenbroeck S AU - Dupont LJ AU - Vanoirbeek J AU - Bullens DMA AU - Breynaert AU - C AU - Proost P AU - Schrijvers RN LA - PT - DEP - TA - he Journal of Allergy and Clinical Immunology: In Practice JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20230101 IS - IS - VI - 80 IP - DP - 2023 Jan 01 TI - Airborne occupational exposures associated with pulmonary sarcoidosis: a systematic review and meta-analysis PG - 580-589 AB - The aetiology and pathophysiology of sarcoidosis is ill defined—current hypotheses centre on complex genetic–immune–environmental interactions in an individual, triggering a granulomatous process. The aim of this systematic review is to define and describe which airborne occupational exposures (aOE) are associated with and precede a diagnosis of pulmonary sarcoidosis. The methodology adopted for the purpose was systematic review and meta-analyses of ORs for specified aOE associated with pulmonary sarcoidosis (DerSimonian Laird random effects model (pooled log estimate of OR)). Standard search terms and dual review at each stage occurred. A compendium of aOE associated with pulmonary sarcoidosis was assembled, including mineralogical studies of sarcoidosis granulomas. N=81?aOE were associated with pulmonary sarcoidosis across all study designs. Occupational silica, pesticide and mould or mildew exposures were associated with increased odds of pulmonary sarcoidosis. Occupational nickel and aluminium exposure were associated with a non-statistically significant increase in the odds of pulmonary sarcoidosis. Silica exposure associated with pulmonary sarcoidosis was reported most frequently in the compendium (n=33 studies) and was the most common mineral identified in granulomas. It was concluded that aOE to silica, pesticides and mould or mildew are associated with increased odds of pulmonary sarcoidosis. Equipoise remains concerning the association and relationship of metal dusts with pulmonary sarcoidosis. AU - Huntley CC AU - Patel K AU - Mughal AZ AU - Coelho S AU - Burge PS AU - Turner AM AU - Walters GI LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20230101 IS - IS - VI - 80 IP - DP - 2023 Jan 01 TI - Irritant asthma and work: cases from the UK SWORD reporting scheme from 1999 to 2018 PG - 553-557 AB - Background Acute irritant asthma is a preventable health consequence of a workplace exposure and has a number of adverse outcomes. While cases and case series are reported, little is known about the causes and incidence of this condition over prolonged periods of time. Aims We aimed to estimate the reported incidence of irritant asthma referred to a national reporting scheme, and how this has changed over time. Methods Cases of irritant asthma reported to SWORD, the UK-based Surveillance of Work-related Occupational Respiratory Diseases scheme, were grouped into four 5-year time periods from 1999 onwards. Likely causative exposures, job, work sector and incidence rates were analysed over time. Results 307 actual cases equated to 1066 estimated cases; actual cases had a mean age of 46 years (SD 17.8); 70.7% were male. The annual incidence fell from 1.98 per million employed in the first 5-year period, to 0.56 in the most recent. Eleven occupational codes were associated with six or more attributed cases, and between them accounted for 38% of all cases. Thirteen exposure categories were associated with five or more cases. These were formaldehyde (n=5), cutting oils and coolants (n=6), isocyanates (n=6), pesticides and herbicides (n=6), welding fumes (n=7), paints (n=7), solder and colophony (n=7), solvents (n=9), fuel oil, diesel and ill-defined fumes (n=10), chlorine and hypochlorites (n=15), acids (n=23), smoke (n=25) and cleaning products and sterilising agents (n=39). Conclusions While the incidence of irritant asthma may have fallen, cases are persistently attributed to well-described causes. A persistence of cases attributed to cleaning agents was seen. AU - Fishwick D AU - Carder M AU - Iskandar I AU - Fishwick BC AU - van Tongeren M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20230101 IS - IS - VI - IP - DP - 2023 Jan 01 TI - A cluster randomised controlled trial to reduce respiratory effects of cotton dust exposure among textile workers – the MultiTex RCT study PG - AB - Background We determined the effectiveness of an intervention to reduce cotton dust-related respiratory symptoms and improve lung function of textile workers. Methods We undertook a cluster-randomised, controlled trial at 38 textile mills in Karachi. The intervention comprised: training in occupational health for all workers; formation of workplace committees to promote a health and safety plan that included wet mopping, safe disposal of cotton dust, simple face masks, and further publicity about the risks from cotton dust. Participating mills were randomised following baseline data collection. The impact of the intervention was measured through surveys at 3, 12 and 18 months using questionnaires, spirometry, and dust measurements. The primary outcomes were (1) changes in prevalence of a composite respiratory symptom variable; (2) changes in post-bronchodilator percentage-predicted forced expiratory volume in the first second (FEV1), and (3) changes in cotton dust levels. These were assessed using two-level mixed-effects linear and logistic regression. Results Of 2031 participants recruited at baseline, 807 (40%) were available at the third follow-up. At that point, workers in the intervention arm were more likely to report an improvement in respiratory symptoms (OR=1.58; 95% CI: 1.06–2.37) and lung function (%predicted FEV1, ß=1.31%; 95% CI: 0.04–2.57). Personal dust levels decreased, more so in intervention mills, although we did not observe this in adjusted models due to the small number of samples. Conclusion We found the intervention to be effective in improving the respiratory health of textile workers and recommend scaling-up of such simple and feasible interventions in low- and middle-income countries. AU - Nafees AA AU - Allana A AU - Kadir MM AU - Potts J AU - Minelli C AU - Semple S AU - Matteis SD AU - Burney P AU - Cullinan P LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20230101 IS - IS - VI - IP - DP - 2023 Jan 01 TI - E-cigarette vapor renders neutrophils dysfunctional due to filamentous actin accumulation PG - AB - Background Electronic cigarette (e-cigarette) use continues to rise despite concerns of long-term effects, especially the risk of developing lung diseases such as chronic obstructive pulmonary disease. Neutrophils are central to the pathogenesis of chronic obstructive pulmonary disease, with changes in phenotype and function implicated in tissue damage. Objective We sought to measure the impact of direct exposure to nicotine-containing and nicotine-free e-cigarette vapor on human neutrophil function and phenotype. Methods Neutrophils were isolated from the whole blood of self-reported nonsmoking, nonvaping healthy volunteers. Neutrophils were exposed to 40 puffs of e-cigarette vapor generated from e-cigarette devices using flavorless e-cigarette liquids with and without nicotine before functions, deformability, and phenotype were assessed. Results Neutrophil surface marker expression was altered, with CD62L and CXCR2 expression significantly reduced in neutrophils treated with e-cigarette vapor containing nicotine. Neutrophil migration to IL-8, phagocytosis of Escherichia coli and Staphylococcus aureus pHrodo bioparticles, oxidative burst response, and phorbol 12-myristate 13-acetate–stimulated neutrophil extracellular trap formation were all significantly reduced by e-cigarette vapor treatments, independent of nicotine content. E-cigarette vapor induced increased levels of baseline polymerized filamentous actin levels in the cytoplasm, compared with untreated controls. Conclusions The significant reduction in effector neutrophil functions after exposure to high-power e-cigarette devices, even in the absence of nicotine, is associated with excessive filamentous actin polymerization. This highlights the potentially damaging impact of vaping on respiratory health and reinforces the urgency of research to uncover the long-term health implications of e-cigarettes. AU - Jasper AE AU - Faniyi AA AU - Davis LC AU - Grudzinska FS AU - Halston R AU - Hazeldine J AU - Parekh D AU - Sapey E AU - Thickett DR AU - Scott A LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 149 IP - DP - 2022 Jan 01 TI - Maternal preconception occupational exposure to cleaning products and disinfectants and offspring asthma. PG - 422-431 AB - BACKGROUND: Emerging research suggests health effects in offspring after parental chemical exposures before conception. Many future mothers are exposed to potent chemicals at work, but potential offspring health effects are hardly investigated. OBJECTIVE: We sought to investigate childhood asthma in relation to mother's occupational exposure to cleaning products and disinfectants before conception. METHODS: The multicenter Respiratory Health In Northern Europe/Respiratory Health In Northern Europe, Spain and Australia generation study investigated asthma and wheeze starting at age less than 10 years in 3318 mother-offspring pairs. From an asthma-specific Job-Exposure Matrix and mothers' occupational history, we defined maternal occupational exposure to indoor cleaning agents (cleaning products/detergents and disinfectants) starting before conception, in the 2-year period around conception and pregnancy, or after birth. Never-employed mothers were excluded. Exposed groups include cleaners, health care workers, cooks, and so forth. Associations were analyzed using mixed-effects logistic regression and ordinary logistic regression with clustered robust SEs and adjustment for maternal education. RESULTS: Maternal occupational exposure to indoor cleaning starting preconception and continuing (n = 610) was associated with offspring's childhood asthma: odds ratio 1.56 (95% CI, 1.05-2.31), childhood asthma with nasal allergies: 1.77 (1.13-2.77), and childhood wheeze and/or asthma: 1.71 (95% CI, 1.19-2.44). Exposure starting around conception and pregnancy (n = 77) was associated with increased childhood wheeze and/or asthma: 2.25 (95% CI, 1.03-4.91). Exposure starting after birth was not associated with asthma outcomes (1.13 [95% CI, 0.71-1.80], 1.15 [95% CI, 0.67-1.97], 1.08 [95% CI, 0.69-1.67]). CONCLUSIONS: Mother's occupational exposure to indoor cleaning agents starting before conception, or around conception and pregnancy, was associated with more childhood asthma and wheeze in offspring. Considering potential implications for vast numbers of women in childbearing age using cleaning agents, and their children, further research is imperative. AU - Tjalvin G AU - Svanes Ø AU - Igland J AU - Bertelsen RJ AU - Benediktsdóttir B AU - Dharmage S AU - Forsberg B AU - Holm M AU - Janson C AU - Jõgi NO AU - Johannessen A AU - Malinovschi A AU - Pape K AU - Real FG AU - Sigsgaard T AU - Torén K AU - Vindenes HK AU - Zock JP AU - Schlünssen V AU - Svanes C LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 79 IP - DP - 2022 Jan 01 TI - Association of occupational and environmental clinics exposure code system and criteria for substances that cause work-related asthma PG - 287-288 AB - In 1991, the AOEC developed a database system for use by AOEC clinics to help identify emerging occupational and environmental health concerns. This database included diagnostic and exposure data on occupational and environmental illnesses and injuries for patients seen in member clinics. The clinical information in the database is not available to all practitioners due to privacy concerns. By 1993, AOEC recognised the need for a more standardised and flexible coding system for exposures in clinical settings. In 1995, an epidemiologist, and an industrial hygienist, developed an exposure classification (EC) system for use by clinicians that included not only chemicals but other hazards (Hunting, McDonald, 1995).1 The EC-List is not an official document of any governmental agency and is available without charge at www.aoecdata.org . The EC-List is searchable, downloadable and an open source. Roughly half of the exposures have no Chemical Abstracts Service (CAS) number. Synonyms include common commercial names. Not all substances with CAS numbers are listed in the EC-List primarily since only substances that have been associated with adverse health effects by users of the list are on the EC-List. The EC-List is currently used by several states involved in surveillance for example, California, Massachusetts, New York, and Washington as well as AOEC member clinics and other clinicians. As part of their Occupational Data for Health (ODH) initiative, the National Institute for Occupational Safety and Health (NIOSH) has developed a system to be incorporated into commercial software to translate industry narrative into the North American Industry Classification System (NAICS) and the occupation narrative into the Standard Occupational Classification.2 However, the NIOSH system does not include classification of exposures. There have been two primary systems used for coding exposure, the NIOSH: Registry of Toxic Effects of Chemical Substances (RTECS) numbers and the American Chemical Society CAS registry numbers. The RTECS system was last updated by NIOSH in January 1997 and currently available only by subscription or fee. CAS numbers is the more commonly used system. However, when used in clinical applications CAS has limitations as the CAS registry numbers only apply to chemicals and not to other exposures such as animal, plants or physical hazards such as heat or noise. Additionally, most exposures are not composed of a single chemical. Exposures tend to be complex, and the CAS numbers cannot be easily grouped for analysis. Internet resources such as https://commonchemistry.cas.org/ used to identify CAS numbers also reveal that entering a commercial name such as the commonly used herbicide Round Up yields no results. The design of the EC-list was developed to meet the following criteria. Toxicologically similar exposures must be grouped by chemical structure or other determinants of toxicologic effect. Physical hazards need to be included in system. Codes must allow precise classification of discrete exposures likely to be reported by clinicians but must also be flexible enough for broad definitions. Each exposure code entry follows the following four rules: Everything with a unique CAS # has a unique AOEC code. Every synonym is listed only one time. Every primary name has one code. Each primary name has itself as a synonym. In 1994, there were 750 exposures in 38 categories and there are now over 2000. Requests for additions are made to the AOEC. In the past 12 months, there have been 26 new codes added and 9 revised. Revisions may be due to changes in asthmagen status, primary name, or synonyms to make searches easier for clinicians. A substance may also be reviewed or re-evaluated by request of a clinic or state entity. Initially, AOEC hoped to designate exposures that were a pesticide, solvent or asthmagen. Since most AOEC clinics see only adults, the asthmagen designation was limited to those substances causing work-related asthma (WRA). After several years, due to the volume of pesticides and toxicological complexities, it was decided the EPA listings of pesticides was a more efficient tool for clinicians. Solvents also proved a difficult designation to work with as solvents range throughout numerous categories: from 060.00 to 322.22. However, the WRA designation proved to be both clinically useful and within the scope of the listing. In 2002, AOEC developed the first criteria for classifying a substance as causing WRA. These criteria were revised in 2006 and the last time in 2008.7 The 2008 revision included criteria for substances that cause Reactive Airways Disease Syndrome. The original protocol and all revisions were reviewed/edited by AOEC members and approved by the Board of Directors and the clinic members of AOEC.3 All but 20 of the exposures originally designated in Asthma in the Workplace6 as causing WRA have been reviewed using the AOEC criteria. The AOEC database and EC-List has received funding from NIOSH. The criteria for WRA and designation are strictly funded and approved through AOEC. 7 Beckett WS . Revised protocol: criteria for Designating substances as occupational Asthmagens on the AOEC list of exposure codes. Available: http://www.aoec.org/tools.htm AU - Kirkland KH AU - Rosenman KD LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 77 IP - DP - 2022 Jan 01 TI - British Thoracic Society Clinical Statement on occupational asthma PG - 433-442 AB - Section 3—diagnosis ? Many patients with OA in the UK are diagnosed at a late stage; healthcare professionals should be aware of the important benefits of recognising cases early. ? All patients of working age with new symptoms suggestive of asthma, reappearance of childhood asthma, deteriorating asthma control or unexplained airflow obstruction should be asked about their job, and whether their symptoms are the same, better or worse on days away from work (eg, rest days or holidays). ? Symptomatic asthma patients in high-risk jobs, and those reporting improvement away from work, should be referred as quickly as possible for specialist assessment (where possible, directly to a specialist occupational lung disease service) ? A diagnosis of OA has important health and employment implications and should not be made based on a compatible history alone. ? The diagnosis of OA is most easily made prior to workplace adaptations and starting maintenance treatment. ? Objective tests commonly used in the UK include skin prick tests (SPTs), specific IgE antibody levels and serial measures of peak expiratory flow (PEF) or airway responsiveness; workplace and specific inhalation challenges (SIC) are less commonly required for OA diagnosis. Section 4—management ? Managing patients with OA can be complex and should wherever possible be carried out by a physician with specialist expertise in this condition. ? It is important to educate patients with OA that the best opportunity for improved asthma control comes from early, and complete, cessation of exposure to the cause. ? Management of OA includes standard pharmacotherapy, asthma education and smoking cessation advice, following national guidelines. ? Patients with OA may have coexisting and related conditions (eg, occupational rhinitis, breathing pattern disorder, inducible laryngeal obstruction (ILO), anxiety and depression) that require assessment and treatment. ? Clinicians should work in partnership with patients to develop (and adapt as necessary) a personalised management plan aiming for the best possible balance between long-term health and employment outcomes.Where consent is given, liaising directly with occupational health providers and/or employers gives the best chance of suitable workplace adaptations being made, to keep patients and their coworkers safely employed. ? Patients with OA should be provided with written information confirming their diagnosis, the implications this has on their current and future jobs as well as Industrial Injuries Disablement Benefit (IIDB) and civil compensation advice. ? While there is potential for ongoing exposure to the cause, patients with OA should remain under specialist follow-up to monitor asthma control, lung function and the impact of any workplace interventions. AU - Barber CM AU - Cullinan P AU - Feary J AU - Fishwick D AU - Hoyle J AU - Mainman H AU - Walters GI LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 77 IP - DP - 2022 Jan 01 TI - Common idiopathic pulmonary fibrosis risk variants are associated with hypersensitivity pneumonitis PG - 508-510 AB - A subset of patients with hypersensitivity pneumonitis (HP) develop lung fibrosis that is clinically similar to idiopathic pulmonary fibrosis (IPF). To address the aetiological determinants of fibrotic HP, we investigated whether the common IPF genetic risk variants were also relevant in study subjects with fibrotic HP. Our findings indicate that common genetic variants in TERC, DSP, MUC5B and IVD were significantly associated with fibrotic HP. These findings provide support for a shared etiology and pathogenesis between fibrotic HP and IPF. AU - Furusawa H AU - Peljto AL AU - Walts AD AU - Cardwell J AU - Molyneaux PL AU - Lee JS AU - Pérez ERF AU - Wolters PJ AU - Yang IV AU - Schwartz DA LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 79 IP - DP - 2022 Jan 01 TI - Impact of using different predictive equations on the prevalence of chronic byssinosis in textile workers in Pakistan PG - 242-244 AB - Objective Byssinosis remains a significant problem among textile workers in low/middle-income countries. Here we share our experience of using different prediction equations for assessing ‘chronic’ byssinosis according to the standard WHO classification using measurements of forced expiratory volume in 1s (FEV1). Methods We enrolled 1910 workers in a randomised controlled trial of an intervention to improve the health of textile workers in Pakistan. We included in analyses the 1724 (90%) men who performed pre-bronchodilator spirometry tests of acceptable quality. We compared four different equations for deriving lung function percentage predicted values among those with symptoms-based byssinosis: the third US National Health and Nutrition Examination Survey (NHANES-III, with ‘North Indian and Pakistani’ conversion factor); the Global Lung Function Initiative (GLI, ‘other or mixed ethnicities’); a recent equation derived from survey of a western Indian population; and one based on an older and smaller survey of Karachi residents. Results 58 men (3.4%) had symptoms-based byssinosis according to WHO criteria. Of these, the proportions with a reduced FEV1 (<80% predicted) identified using NHANES and GLI; Indian and Pakistani reference equations were 40%, 41%, 14% and 12%, respectively. Much of this variation was eliminated when we substituted FEV1/forced vital capacity (FVC) ratio (less than lower limit of normality) as a measure of airway obstruction. Conclusion Accurate measures of occupational disease frequency and distribution require approaches that are both standardised and meaningful. We should reconsider the WHO definition of ‘chronic’ byssinosis based on changes in FEV1, and instead use the FEV1/FVC. AU - Nafees AA AU - Muneer MZ AU - Matteis SD AU - Amaral A AU - Burney P AU - Cullinan P LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 72 IP - DP - 2022 Jan 01 TI - Assessment and outcomes of firefighter applicants with possible asthma PG - 118-124 AB - Background Firefighter applicants (FFAs) with a history of asthma may be refused entry to the fire service because of potentially putting themselves and others at risk. Aims We undertook a service evaluation to identify respiratory and employment outcomes of FFAs with a history of asthma who had undergone additional respiratory assessment at our specialist occupational lung disease clinic during 2005–19. Methods We reviewed FFA medical records and categorized them as having either no current asthma or definite/probable asthma at the time of clinic assessment. ‘No current asthma’ was defined as negative non-specific bronchial hyper-responsiveness (BHR) to histamine/methacholine, and no symptoms or treatment within the 2 years before clinic. ‘Definite/probable current asthma’ was defined as either positive BHR, or negative BHR with symptoms and/or treatment within the previous 2 years. Around 1 year later, we contacted FFAs to enquire about their application outcome and current respiratory symptoms. Results Data were available on 116 applicants; of whom, 45% (n = 52) had definite/probable current asthma and were significantly more likely to be older, atopic to common aeroallergens, report atopic disease and have a lower forced expiratory volume in one second/forced vital capacity ratio compared with applicants with no current asthma. Only two individuals’ applications were rejected due to asthma. At follow-up, just 2 (2%) of the 90 operational firefighters reported any recent trouble with asthma. Conclusions A history of asthma alone is not sufficient to determine current asthma in FFAs. Even with a diagnosis of current asthma, FFAs are mostly successful in their application to join the fire service. AU - Kabir T AU - Schofield S AU - Fitzgerald B AU - Cannon J AU - Szram J AU - Feary J LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 72 IP - DP - 2022 Jan 01 TI - Occupational asthma in office workers PG - 414 AB - Background Office work has a relative perception of safety for the worker. Data from surveillance schemes and population-based epidemiological studies suggest that office work carries a low risk of occupational asthma (OA). Office workers are frequently used as comparators in studies of occupational exposure and respiratory disease. Aims We aimed to describe and illustrate our tertiary clinical experience of diagnosing OA in office workers. Methods We searched the Birmingham NHS Occupational Lung Disease Service clinical database for cases of occupational respiratory disease diagnosed between 2002 and 2020, caused by office work or in office workers. For patients with OA, we gathered existing data on demographics, diagnostic tests including Occupational Asthma SYStem (OASYS) analysis of serial peak expiratory flow and specific inhalational challenge, and employment outcome. We summarised data and displayed them alongside illustrative cases. Results There were 47 cases of OA (5% of all asthma) confirmed using OASYS analysis of PEFs in the majority. Sixty percent of cases occurred in healthcare, education and government sectors. The most frequently implicated causative exposures or agents were: indoor air (9), printing, copying and laminating (7), cleaning chemicals (4), mould and damp (4), and acrylic flooring and adhesives (4). Exposures were grouped into internal office environment, office ventilation-related and adjacent environment. Conclusions Clinicians should be vigilant for exposures associated with OA in office workers who present with work-related symptoms, where respiratory sensitizing agents may be present. A structured approach to assessment of the workplace is recommended Occupational asthma in office workersGet accessArrow C C Huntley, P S Burge, V C Moore, A S Robertson, G I Walters Occupational Medicine, Volume 72, Issue 6, July 2022, Pages 411–414, https://doi.org/10.1093/occmed/kqac023 AU - Huntley CC AU - Burge PS AU - Moore VC AU - Robertson AS AU - Walters GI LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 17 IP - DP - 2022 Jan 01 TI - Respiratory symptoms and use of dust-control measures in New Zealand construction workers – A cross-sectional study. PG - e0266668 AB - Dust-exposed construction workers have an increased risk of respiratory symptoms, but the efficacy of dust-control measures remains unclear. This study compared respiratory symptoms, using a modified European Community Respiratory Health Survey questionnaire, between construction workers (n = 208) and a reference group of bus drivers and retail workers (n = 142). Within the construction workers, we assessed the effect of collective (on-tool vacuum/’wet-cut’ systems) and personal (respirators) exposure controls on symptom prevalence. Logistic regression assessed differences between groups, adjusted for age, ethnicity, and smoking status. Construction workers were more likely to cough with phlegm at least once a week (OR 2.4, 95% CI 1.2–4.7) and cough with phlegm =3 months/year for =2 years (OR 2.8, CI 1.2–7.0), but they had similar or fewer asthma symptoms. Construction workers who had worked for 11–20 years reported more cough/phlegm symptoms (OR 5.1, 1.7–15.0 for cough with phlegm =3 months/year for =2 years) than those who had worked <10 years (OR 1.9, 0.6–5.8), when compared to the reference group. Those who used ‘wet-cut’ methods reported less cough with phlegm, although the evidence for this association was weak (OR 0.4, CI 0.2–1.1 for cough with phlegm at least once a week); use of on-tool extraction showed a similar trend. No associations between respiratory protective equipment-use and symptoms were found. In conclusion, construction workers reported more symptoms suggestive of bronchitis, particularly those employed in the industry for >10 years. Use of collective dust exposure controls might protect against these symptoms, but this requires confirmation in a larger study. AU - Keer S AU - Brooks C AU - Glass B AU - McLean D AU - Harding E AU - Douwes J LA - PT - DEP - TA - Plos one JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - IP - DP - 2022 Jan 01 TI - Cannabis-related allergies: An international overview and consensus recommendations PG - AB - Cannabis is the most widely used recreational drug in the world. Cannabis sativa and Cannabis indica have been selectively bred to develop their psychoactive properties. The increasing use in many countries has been accelerated by the COVID-19 pandemic. Cannabis can provoke both type 1 and type 4 allergic reactions. Officially recognized allergens include a pathogenesis-related class 10 allergen, profilin, and a nonspecific lipid transfer protein. Other allergens may also be relevant, and recognition of allergens may vary between countries and continents. Cannabis also has the potential to provoke allergic cross-reactions to plant foods. Since cannabis is an illegal substance in many countries, research has been hampered, leading to challenges in diagnosis since no commercial extracts are available for testing. Even in countries such as Canada, where cannabis is legalized, diagnosis may rely solely on the purchase of cannabis for prick-to-prick skin tests. Management consists of avoidance, with legal issues hindering the development of other treatments such as immunotherapy. Education of healthcare professionals is similarly lacking. This review aimed to summarize the current status of cannabis allergy and proposes recommendations for the future management of this global issue. AU - Skypala IJ AU - Jeimy S AU - Brucker H AU - Nayak AP AU - Decuyper II AU - Bernstein JA AU - Connors L AU - Kanani A AU - Klimek L AU - Lo SCR AU - Murphy KR AU - Nanda A AU - Poole JA AU - Walusiak-Skorupa J AU - Sussman G AU - Zeiger JS AU - Goodman RE AU - Ellis AK AU - Silvers WS AU - Ebo DG LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - IP - DP - 2022 Jan 01 TI - Two-year follow-up of exposure, engineering controls, respiratory protection and respiratory health among workers at an indium-tin oxide (ITO) production and reclamation facility PG - AB - Harvey RR, Virji MA, Blackley BH, et al Two-year follow-up of exposure, engineering controls, respiratory protection and respiratory health among workers at an indium-tin oxide (ITO) production and reclamation facility Occupational and Environmental Medicine Published Online First: 12 April 2022. doi: 10.1136/oemed-2021-107897 AU - Harvey RR AU - Virji MA AU - Blackley BH AU - Stanton ML AU - Trapnell BC AU - Carey B AU - Healey T AU - Cummings KJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 79 IP - DP - 2022 Jan 01 TI - Coal mine dust lung disease in miners killed in the Upper Big Branch disaster: a review of lung pathology and contemporary respirable dust levels in underground US coal mines PG - 319-325 AB - Objectives In 2010, 29 coal miners died due to an explosion at the Upper Big Branch (UBB) mine in West Virginia, USA. Autopsy examinations of 24 individuals with evaluable lung tissue identified 17 considered to have coal workers’ pneumoconiosis (CWP). The objectives of this study were to characterise histopathological findings of lung tissue from a sample of UBB fatalities and better understand the respirable dust concentrations experienced by these miners at UBB relative to other US coal mines. Methods Occupational pulmonary pathologists evaluated lung tissue specimens from UBB fatalities for the presence of features of pneumoconiosis. Respirable dust and quartz samples submitted for regulatory compliance from all US underground coal mines prior to the disaster were analysed. Results Families of seven UBB fatalities provided consent for the study. Histopathologic evidence of CWP was found in all seven cases. For the USA, central Appalachia and UBB, compliance dust samples showed the geometric mean for respirable dust was 0.468, 0.420 and 0.518 mg/m3, respectively, and respirable quartz concentrations were 0.030, 0.038 and 0.061 mg/m3. After adjusting for quartz concentrations, UBB exceeded the US permissible exposure limit (PEL) for respirable dust in 28% of samples. Conclusions Although higher than average respirable dust and quartz levels were observed at UBB, over 200 US underground coal mines had higher dust concentrations than UBB and over 100 exceeded the PEL more frequently. Together with lung histopathological findings among UBB fatalities, these data suggest exposures leading to CWP in the USA are more prevalent than previously understood. AU - Go LHT AU - Green FHY AU - Abraham JL AU - Churg A LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 212 IP - DP - 2022 Jan 01 TI - Transferring from moisture damaged school building to clean facilities – The avoidance of mold exposure induces a decline in symptoms and improvement in lung function among personnel PG - 113598 AB - Working in a moisture-damaged building can cause different symptoms and effects on lung functions. Moving to a clean environment, it is believed to reduce symptoms and alleviate potential adverse health effects. This case study monitors the health effects of personnel in one school building before and after all school activities were transferred from a moisture-damaged school building to clean premises. The whole school staff was invited to attend this follow-up study. All participants (N = 45) were interviewed, and pulmonary functions were measured by spirometry and exhaled nitric oxide testing (FENO) before transferring the school activities to a new building and the control measurements were performed twice; three months and six months after the transfer. After transferring to temporary facilities, 82% of participants felt that their symptoms were improved or resolved and the pulmonary functions were improved; 50% of those who had decreased pulmonary functions at the beginning, their pulmonary function values returned to normal after three months. Over the next six months, the perceived symptoms continued to reduce so that 93% of the respondents felt fully asymptomatic with respect to indoor air, and the spirometry results improved further. Transferring workers from the damaged building to healthy environment provided beneficial health effects on pulmonary functions and to perceived symptoms even in a relatively short time period. Based on this study, and from the perspective of promoting and protecting the health and well-being of personnel, transferring school activities from a moisture damaged building to clean facilities brought considerable advantages, despite the possible cost and difficulties of finding AU - Vilén L AU - Päivinen M AU - Atosuo J AU - Putus T LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 10 IP - DP - 2022 Jan 01 TI - Acute eosinophilic pneumonia caused by nicotine-free vaping in an adolescent patient: A case report PG - e0961 AB - An 18-year-old man was admitted to our hospital with pneumonia 4?days after he initiated vaping. The patient did not show improvement after ceftriaxone and azithromycin treatment. The cell count of the bronchoalveolar lavage fluid (BALF) revealed 64% eosinophils and 18% lymphocytes. Based on the BALF findings, the patient met the current diagnostic criteria and was diagnosed with vaping-induced acute eosinophilic pneumonia (AEP). AEP caused by nicotine-free vaping is rare in Japan. Thus, in cases of AEP, the patient's history of cigarette smoking as well as vaping should be considered. AU - Takigawa Y AU - Sato K AU - Inoue A AU - Nagae M AU - Inoue T AU - Onishi K AU - Mitsumune S AU - Watanabe H AU - Kudo K AU - Sato A AU - Fujiwara K AU - Shibayama T LA - PT - DEP - TA - Respirology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - IP - DP - 2022 Jan 01 TI - Occupational inhalational accidents: analysis of cases from the UK SWORD reporting scheme from 1999 to 2018 PG - AB - OBJECTIVE: To estimate the reported UK incidence of occupational inhalation accidents, and to consider changes of incidence and potential causes over time. METHODS: Cases of occupational inhalation accident reported to Surveillance of Work Related Occupational Respiratory Diseases (SWORD) over 20 years were grouped into four 5-year time periods. Cases were characterised by causative exposure, occupation and industrial sector. Incidence rates were calculated using Office of National Statistics employment data. RESULTS: The 172 actual cases reported to SWORD equated to an estimated 502 cases after adjusting for reporting frequency. Their mean age was 41.3 years (SD 12.3); 77% were male. The annual incidence fell from 1.7 per million employed in the first 5-year period, to 0.5 in the most recent. The most common occupations, responsible for 35% of all cases, were in descending order (number, % of total cases): Labourers in process and plant operations (8, 4.7), welding trades (8, 4.7), fire service officers (8, 4.7), heavy goods vehicle drivers (7, 4.1), metal working production and maintenance fitters (7, 4.1), civil service administrative officers and assistants (7, 4.1), food, drink and tobacco process operatives (6, 3.5), and three summated categories of elementary and service occupations including cleaners and domestics (10, 5.8).Three of 40 exposure categories were common to all time periods; acids (19.6% of all cases 1999-2004, 2.3% 2005-2009, 6.3% 2010-2013, 6.3% 2014-2018), chlorine/hypochlorites (7.2%, 7.0%, 2.5%, 6.3%, respectively) and solvents (14.4%, 11.6%, 12.5%, 6.3%, respectively). CONCLUSIONS: The incidence of inhalation accidents appears to have fallen, although certain exposures appear to be persistently linked to cases. AU - Fishwick D AU - Carder M AU - Iskandar I AU - Fishwick BC AU - van Tongeren M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 72 IP - DP - 2022 Jan 01 TI - Occupational contact urticaria to cannabis sativa PG - 273-275 AB - Cannabis allergy is not commonly reported, perhaps due to the legal status of cannabis use and the difficulties of obtaining permission to test it. We report 3 cases of work-related cannabis allergy with features suggestive of a dermatitis, rather than a contact urticaria. Only prick tests were able to confirm the diagnosis. Identification of the cause of the rash was essential to direct work re-deployment. AU - Yeo L AU - Debusscher C AU - White JML LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 10 IP - DP - 2022 Jan 01 TI - Clinical Characteristics of Irritant-Induced Occupational Asthma PG - 1554-1561 AB - Background Work is a substantial contributing factor of adult-onset asthma. A subtype of occupational asthma (OA) is caused by irritant agents, but knowledge of the clinical outcomes of irritant-induced asthma (IIA) is incomplete. Objectives To evaluate whether the clinical picture of IIA differs from that of sensitizer-induced OA. Methods This retrospective study analyzed acute and subacute IIA patients diagnosed in an occupational medicine clinic during 2004 to 2018. Sixty-nine patients fulfilled the inclusion criteria, and their characteristics were analyzed at the time of the diagnosis and 6 months later. The results were compared with those of 2 subgroups of sensitizer-induced OA: 69 high-molecular-weight (HMW) and 89 low-molecular-weight (LMW) agent-induced OA patients. Results Six months after the diagnosis, 30% of the patients with IIA needed daily short-acting ß-agonists (SABA), 68% were treated with Global Initiative for Asthma, 2020 report (GINA) step 4-5 medication, and 24% of the patients had asthma exacerbation after the first appointment. IIA depicted inferiority to LMW-induced OA in daily need for SABA (odds ratio [OR]: 3.80, 95% confidence interval [CI]: 1.38-10.46), treatment with GINA step 4-5 medication (OR: 2.22, 95% CI: 1.08-4.57), and exacerbation (OR: 3.85, 95% CI: 1.35-11.04). IIA showed poorer results than HMW-induced OA in the latter 2 of these features (OR: 2.49, 95% CI: 1.07-5.79 and OR: 6.29, 95% CI: 1.53-25.83, respectively). Conclusions Six months after the OA diagnosis, a significant proportion of the patients with IIA remain symptomatic and the majority of these patients use asthma medications extensively suggesting uncontrolled asthma. The short-term outcomes of IIA appear poorer than that of sensitizer-induced OA. AU - Lantto J AU - Suojalehto H AU - Karvala K AU - Remes J AU - Soini S AU - Suuronen K AU - Lindström I LA - PT - DEP - TA - J Allergy Clin Immunol Pract JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - IP - DP - 2022 Jan 01 TI - Is Occupational Asthma Caused by Low-Molecular-Weight Chemicals Associated With Contact Dermatitis? A Retrospective Study PG - AB - Background Occupational asthma (OA) may have different etiologies, but it is not clear whether the etiologic agents influence the clinical presentation, especially the co-occurrence of skin lesions. Objective To determine the impact of different asthmagens on the characteristics of OA, with a focus on the occurrence of prior or concomitant skin disorders. Methods In a retrospective analysis of patients who visited the Occupational and Environmental Disease Clinic of a tertiary referral hospital from 2009 to 2019, we classified patients into definite, probable, or possible OA according to prespecified diagnostic guidelines. In multivariate logistic regression with sensitivity analysis, we examined the relation of high- and low-molecular-weight (HMW and LMW) agents with the clinical presentation. Results Of 209 cases of OA, 66 were caused by HMW agents and 143 by LMW agents. Patients with OA exposed to LMW agents had higher odds of having (had) allergic contact dermatitis (odds ratio, 5.45 [1.80-23.70]; P < .01), compared with patients exposed to HMW agents. Conversely, HMW agents were associated with higher odds of rhinitis symptoms (odds ratio of LMW/HMW, 0.33 [0.17-0.63]; P < .001) and high total IgE (odds ratio of LMW/HMW, 0.35 [0.17-0.70]; P < .01). Risk factors for having coexisting contact dermatitis included construction work, hairdressing, and exposure to metals or epoxy resins. Conclusions Among patients with OA, exposure to specific LMW agents was associated with a high frequency of contact dermatitis. Different types of asthmagens within HMW or LMW agents appear to determine the phenotype and comorbidity of OA. AU - Tsui H-C AU - Ronsmans S AU - Hoet PHM AU - Nemery B AU - Vanoirbeek JAJ LA - PT - DEP - TA - The Journal of Allergy and Clinical Immunology: In Practice JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - IP - DP - 2022 Jan 01 TI - Molecular Allergology User’s Guide 2.0 PG - 1-574 AB - ISBN 978-3-9524815-4-7 AU - Hoffmann K AU - Hilger C AU - Santos A AU - las de Vecillas L AU - Dramburg S LA - PT - DEP - TA - Pediatric Allergy and Immunology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 298 IP - DP - 2022 Jan 01 TI - Associations of multiple metals with lung function in welders by four statistical models PG - 13402 AB - Background Exposure to heavy metals has been related to decreased lung function in workers. However, due to limitations in statistical methods for mixtures, previous studies mainly focused on single or several toxic metals, with few studies involving metal exposome and lung function. Objectives The study aimed to evaluate the effects of co-exposure to the metal mixtures on multiple parameters of pulmonary function tests and to identify the elements that play an essential role in elastic-net regression (ENET), multivariate linear regression, bayesian kernel machine regression (BKMR), and quantile g-computation (QG-C) models. Methods We have recruited 186 welders from Anhui (China) in 2019. And their end-of-shift urine and lung function measure data were collected with informed consent. The urinary concentrations of 23 metals were measured by inductively coupled urinary mass spectrometry. The lung function measures including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and peak expiratory flow (PEF) were also detected as outcome indicators. Four statistical methods, ENET, multivariate linear regression, BKMR, and QG-C models were used to evaluate the associations of element mixtures on lung function comprehensively. Results Lead and cadmium were negatively associated with FVC and FEV1, nickel and chromium were inversely associated with PEF, and strontium showed significant positive effects in linear regression models, which were consistent with the results in BKMR and QG-C models. Both BKMR and QG-C models showed a significantly negative overall effect of metal mixtures on lung function parameters (FVC, FEV1, and PEF). Meanwhile, BKMR showed the non-linear relationships of cadmium with FVC. Conclusion Multi-pollutant mixtures of metals were negatively associated with lung function. Lead, cadmium, nickel, and strontium might be crucial elements. Our findings highlight a need to prioritize workers' environmental health, and guide future research into the toxic mechanisms of metal-mediated lung function injury. Keywords: Multiple metals; Welders; Lung function; Bayesian kernel machine regression; Quantile g-computation AU - Wu L AU - Cui F AU - Ma J AU - Huang Z AU - Zhang S AU - Xiao Z AU - Li J AU - Ding X AU - Niu P LA - PT - DEP - TA - Chemosphere JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 32 IP - DP - 2022 Jan 01 TI - Modification of cleaning product formulations could improve indoor air quality PG - e13021 AB - leaning products contain numerous individual chemicals, which can be liberated on use. These species can react in air to form new chemical species, some of which are harmful to health. This paper uses a detailed chemical model for indoor air chemistry, to understand the chemical reactions that can occur following cleaning, assuming cleaning products with different proportions of limonene, a-pinene, and ß-pinene are used. The tests included the pure compounds, 50:50 mixtures and mixtures in proportion to the rates of reaction with ozone and the hydroxyl radical. For the 3 h following cleaning, pure a-pinene was most efficient at producing particles, pure limonene for nitrated organic material, and a 50:50 mixture of ß-pinene and limonene for formaldehyde, leading to enhancements of 1.1 µg/m3, 400 ppt, and 1.8 ppb, respectively, compared to no cleaning. Cleaning in the afternoon enhanced concentrations of secondary pollutants for all the mixtures, owing to higher outdoor and hence indoor ozone compared to the morning. These enhancements in concentrations lasted several hours, despite the cleaning emissions only lasting for 10 min. Doubling the air exchange rate enhanced concentrations of formaldehyde and particulate matter by ~15% while reducing that of nitrated organic material by 13%. Changing product formulations has the potential to change the resulting indoor air quality and consequently, impacts on health. Changing the formulation of terpene-based cleaning products leads to changes in the resulting secondary pollutant composition that is observed. Some of the secondary pollutants that are formed following the use of such products can be harmful to human health, such as particulate matter and formaldehyde. The results from this study suggest that it is possible to vary the proportion of terpenes within cleaning and other consumer products to produce lower concentrations of potentially harmful pollutants indoors. AU - Carslaw N AU - Shaw D LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 65 IP - DP - 2022 Jan 01 TI - Work-related allergy and asthma associated with cleaning agents in health workers in Southern African tertiary hospitals. PG - 382-395 AB - BACKGROUND: Health workers (HWs) are exposed to diverse cleaning agents in large hospitals. This study determined the prevalence of work-related symptoms, allergic sensitization, and lung function abnormalities in HWs of two tertiary hospitals in Southern Africa. METHODS: A cross-sectional study of 699 HWs (South Africa: SAH, n?=?346; Tanzania: TAH, n?=?353) was conducted. Health outcomes were assessed using a standardized ECRHS questionnaire, immunological tests (specific IgE antibody to common aero-allergens and to occupational allergens: natural rubber latex [NRL] Hev b5 and Hev b6.02, chlorhexidine, and ortho-phthalaldehyde [OPA]), spirometry [pre-and post- bronchodilator], methacholine challenge, and fractional exhaled nitric oxide (FeNO). RESULTS: A large proportion of participants (78%) were women. Median age was 42 years, with 76% nurses, 12% cleaners, and 5% administrative workers. Current smoking was more common in SAHWs (12%) than TAHWs (1%). The overall prevalence of doctor-diagnosed asthma was 7%. Atopy was present in 43% of HWs, while 4% were sensitized to OPA, 2% to NRL, and 1% to chlorhexidine. Prevalence of work-related ocular-nasal symptoms (16%) was higher than skin (12%) and chest (7%) symptoms. TAHWs had significantly lower mean lung volumes, higher degrees of significant airflow obstruction and impaired lung function. The prevalence of bronchial hyperresponsiveness in SAHWs (14%) was high. Overall, 23% of HWs had abnormal FeNO; 6% having high (>50 ppb) levels. FeNO was positively associated with sensitization to occupational allergens, primarily OPA and NRL. CONCLUSIONS: HWs from both hospitals had similar prevalence of work-related respiratory symptoms. Sensitization to OPA and NRL appears to be contributing to allergic airway inflammation in these HWs. AU - Mwanga HH AU - Baatjies R AU - Singh T AU - Jeebhay MF LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 77 IP - DP - 2022 Jan 01 TI - Are aerosols generated during lung function testing in patients and healthy volunteers? Results from the AERATOR study PG - 292-294 AB - Pulmonary function tests are fundamental to the diagnosis and monitoring of respiratory diseases. There is uncertainty around whether potentially infectious aerosols are produced during testing and there are limited data on mitigation strategies to reduce risk to staff. Healthy volunteers and patients with lung disease underwent standardised spirometry, peak flow and FENO assessments. Aerosol number concentration was sampled using an aerodynamic particle sizer and an optical particle sizer. Measured aerosol concentrations were compared with breathing, speaking and voluntary coughing. Mitigation strategies included a standard viral filter and a full-face mask normally used for exercise testing (to mitigate induced coughing). 147 measures were collected from 33 healthy volunteers and 10 patients with lung disease. The aerosol number concentration was highest in coughs (1.45–1.61 particles/cm3), followed by unfiltered peak flow (0.37–0.76 particles/cm3). Addition of a viral filter to peak flow reduced aerosol emission by a factor of 10 without affecting the results. On average, coughs produced 22 times more aerosols than standard spirometry (with filter) in patients and 56 times more aerosols in healthy volunteers. FENO measurement produced negligible aerosols. Cardiopulmonary exercise test (CPET) masks reduced aerosol emission when breathing, speaking and coughing significantly. Lung function testing produces less aerosols than voluntary coughing. CPET masks may be used to reduce aerosol emission from induced coughing. Standard viral filters are sufficiently effective to allow guidelines to remove lung function testing from the list of aerosol-generating procedures. AU - Sheikh S AU - Hamilton FW AU - Nava GW AU - Gregson FKA AU - Arnold DT AU - Riley C AU - Brown J AU - Reid JP AU - Bzdek BR AU - Maskell NA AU - Dodd JW LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 79 IP - DP - 2022 Jan 01 TI - Prenatal occupational disinfectant exposure and childhood allergies: the Japan Environment and Children's study PG - 521-526 AB - Background: Disinfectants are widely used in the medical field, particularly recently because of the coronavirus pandemic, which has led to an increase in their use by both medical professionals and the general population. The objective of this study was to examine whether occupational disinfectant use during pregnancy was associated with the development of allergic disease in offspring at 3 years. Methods: We used data from 78 915 mother/child pairs who participated in the Japan Environment and Children's Study, which is a prospective birth cohort recruited between January 2011 and March 2014. We examined the associations between maternal disinfectant use during pregnancy and allergic diseases (asthma, eczema and food allergies) in children after adjustment for covariates including maternal postnatal return to work when the child was 1 year old by multivariate logistic regression. Results: Compared with those who never used disinfectants, participants who used disinfectant every day had a significantly higher risk of asthma in their offspring (adjusted OR 1.18, 95% CI 1.05 to 1.33 for 1-6 times a week; adjusted OR 1.26, 95% CI 1.05 to 1.52 for every day). The associations between disinfectant exposure and eczema were similar to those of asthma (adjusted OR 1.16, 95% CI 1.02 to 1.31 for 1-6 times a week; adjusted OR 1.29, 95% CI 1.06 to 1.57 for every day). We found a significant exposure-dependent relationship (p for trend <0.01). There were no significant associations between disinfectant use and food allergies. Conclusion: Disinfectant use by pregnant women may be a risk factor for asthma and eczema in offspring. As disinfectants are an effective tool in the prevention of infectious diseases, replication of this study and further research into the mechanisms are warranted. AU - Kojima R AU - Shinohara R AU - Kushima M AU - Horiuchi S AU - Otawa S AU - Yokomichi H AU - Akiyama Y AU - Ooka T AU - Miyake K AU - Yamagata LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 72 IP - DP - 2022 Jan 01 TI - Skin and respiratory ill-health attributed to occupational face mask use PG - 339-342 AB - Background Face mask use in the workplace has become widespread since the onset of the Covid-19 pandemic and has been anecdotally linked to adverse health consequences. Aims To examine reports of adverse health consequences of occupational face mask use received by The Health and Occupation Research (THOR) network before and after the pandemic onset. Methods THOR databases were searched to identify all cases of ill-health attributed to ‘face mask’ or similar suspected causative agent between 1 January 2010 and 30 June 2021. Results Thirty two cases were identified in total, 18 reported by occupational physicians and 14 by dermatologists. Seventy-five per cent of cases were reported after the pandemic onset and 91% cases were in the health and social care sector. 25 of the 35 (71%) diagnoses were dermatological, the most frequent diagnoses being contact dermatitis (14 cases) and folliculitis/acne (6 cases). Of the seven respiratory diagnoses, four were exacerbation of pre-existing asthma. Conclusions There is evidence of an abrupt increase in reports of predominantly dermatological ill-health attributed to occupational face mask use since the start of the pandemic. Respiratory presentations have also occurred. AU - Seed MJ AU - Fowler K AU - Byrne L AU - Carder M AU - Daniels S AU - Iskandar IYK AU - Feary J AU - Gawkrodger DJ AU - van Tongeren M LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 10 IP - DP - 2022 Jan 01 TI - Risk for lung-related diseases associated with welding fumes in an occupational population: Evidence from a Cox model. PG - 990547 AB - Background: Welding fumes are a risk factor for welder pneumoconiosis. However, there is a lack of population information on the occurrence of welding fume-induced lung cancer, and little is known about the welding fume pathogenesis. Methods: Welding fume and metal ion concentrations were assessed in a vehicle factory in Wuhan. A Cox regression model estimated lung-related disease risk in workers by independent and combined factors. Results: Workers' exposures were divided into four grades; the highest exposure was among the welders in the maintenance workshop, the highest Mn and Fe exposure was 4 grades, and the highest Cr exposure was 3 grades. Subgroup analysis found that the risk of lung-related disease was 2.17 (95% CI: 1.31-3.57, p < 0.05) in welders compared with non-welders, and the risk of pulmonary disease in male welders was 2.24 (95% CI: 1.34-3.73, p < 0.05) compared to non-welders. Smoking welders had a 2.44 (95% CI: 1.32-4.51, p < 0.01) higher incidence of lung-related diseases than non-welders. Total years of work as an independent protective factor for lung-related disease risk was 0.72 (95% CI: 0.66-0.78, p < 0.01). As an independent risk factor, high-high and high-low exposure had a 5.39 (95% CI: 2.52-11.52, p < 0.001) and 2.17 (95% CI: 1.07-4.41, p < 0.05) higher risk for lung-related diseases, respectively. Conclusions: High welding fume exposure is a significant risk factor for lung-related disease in workers. PMID: 36091502 AU - Li G AU - Jiang J AU - Liao Y AU - Wan S AU - Yao Y AU - Luo Y AU - Chen X AU - Qian H AU - Dai X AU - Yin W AU - Min Z AU - Yi G AU - Tan X LA - PT - DEP - TA - Front Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 60 IP - DP - 2022 Jan 01 TI - Antigen identification and avoidance on outcomes in fibrotic hypersensitivity pneumonitis PG - 2101336 AB - Background: Suspected causative antigens may be unidentified in 30-50% of patients with fibrotic hypersensitivity pneumonitis (f-HP). It is unclear whether antigen identification and avoidance in this setting offer any additional clinical benefit. We hypothesised that antigen identification and avoidance may improve the clinical course of patients with fibrotic disease. Methods: Patients meeting recent international practice guidance for f-HP diagnosis evaluated at Mayo Clinic Rochester from January 2005 to December 2018 were included. Causative antigen and antigen avoidance were specifically defined and ascertained through review of the medical records. Cox proportional-hazards regression was performed to assess antigen identification and avoidance as predictors of either all-cause mortality or lung transplantation. Results: 377 patients were included. Of these, suspected causative antigen was identified in 225 (60%). Identification of a suspected antigen (adjusted hazard ratio (HR) 0.69, 95% CI 0.48-0.99; p=0.04) and subsequent antigen avoidance (adjusted HR 0.47, 95% CI 0.31-0.71; p<0.001) were associated with decreased all-cause mortality and transplantation. Both those with suspected antigen identification but nonavoidance and those with unidentifiable antigen had increased risk of all-cause mortality or transplantation (adjusted HR 2.22, 95% CI 1.34-3.69; p=0.002 versus adjusted HR 2.09, 95% CI 1.34-3.26; p=0.001, respectively). Exposure to avian antigen was associated with better outcome compared to other antigen subtypes (adjusted HR 0.63, 95% CI 0.43-0.93; p=0.02). Conclusion: Our findings suggest that antigen identification and antigen avoidance remain relevant even in patients with fibrotic disease, where both appear to be associated with improved outcomes. AU - Petnak T AU - Thongprayoon C AU - Baqir M AU - Ryu JH AU - Moua T LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 150 IP - DP - 2022 Jan 01 TI - Farm living and allergic rhinitis from childhood to young adulthood: Prospective results of the GABRIEL study PG - 1209 - 1215.e2 AB - Background Growing up on a farm is associated with a reduced prevalence of respiratory allergies in childhood. Whether this protective effect remains into adulthood is unknown. Objectives We aimed to prospectively investigate the relationship between farm exposure and prevalence of allergic rhinitis and wheeze from childhood to early adulthood. Methods Participants from phase 2 of the Multidisciplinary Study to Identify the Genetic and Environmental Causes of Asthma in the European Community (GABRIEL) who were living in southern Germany (aged 6-11 years at baseline and 20-25 years at follow-up) were invited to complete a questionnaire on sociodemographic data, farm contact, respiratory symptoms, and potential confounders. Odds ratios (ORs) with 95% CIs were modeled by using generalized estimating equations. Results Of the 2276 phase 2 participants, 1501 (66%) answered the follow-up questionnaire, of whom 1333 could be included in the analyses. Living on a farm was associated with reduced prevalence of allergic rhinitis (OR with persistent farm living = 0.4 [95% CI = 0.2-0.6]; OR with farm living at baseline only = 0.4 [95% CI = 0.2-0.8]). The OR for development of symptoms from baseline to follow-up was almost 3 (OR = 2.7 [95% CI = 2.1-3.3]) irrespective of farm living. For symptoms of wheeze, no statistically significant association with farm living was observed. Conclusions The protective effect of farm living on allergic rhinitis persists from childhood to early adulthood. Continuing exposure over puberty does not add to the effect. This confirms that the window of opportunity for a protective effect might be found in childhood. AU - Strieker PGS AU - Weinmann T AU - Gerlich J AU - von Mutius E AU - Nowak D AU - Radon K AU - Wengenroth L LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 72 IP - DP - 2022 Jan 01 TI - Occupational asthma in teachers. PG - 541-549 AB - BACKGROUND: Work-related asthma symptoms are common in teachers and teaching assistants, there are few studies evaluating their causes. AIMS: To identify causes of occupational asthma in teachers and teaching assistants referred to the Birmingham Occupational Lung Disease clinic 2000-20 using evaluation of serial Peak Expiratory Flow (PEF) records. METHODS: Teachers and teaching assistants with possible occupational asthma were asked to record PEF 2-hourly at home and work for 4 weeks. Their records were evaluated with the Oasys programme. Those with a positive score for any of the three scores (area between curves (ABC), timepoint and Oasys score from discriminant analysis) were included. Repeat records were made as indicated to help identify the cause and the effects of remedial actions. RESULTS: Thirty-eight teachers or teaching assistants met the inclusion criteria with all three Oasys scores positive in 24, 2/3 scores in nine and 1/3 in five. The building was the likely cause in 17 (in new builds particularly acrylates from carpet adhesives and in old buildings mould and construction dust), bystander exposure to agents in the schools in 12 (cleaning agents, acrylates from photocopiers and chloramines from indoor pools) and materials used in the classroom in 9 (most commonly MDF in design and technology classes). We illustrate how the PEF records helped identify the cause. CONCLUSIONS: Oasys analysis of PEF records is a useful method of evaluating occupational asthma in teachers and identified difficult to confirm causes where successful remediation or redeployment was achieved. AU - Burge S AU - Moore V AU - Burge C AU - Robertson A AU - Huntley C AU - Walters G LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - IP - DP - 2022 Jan 01 TI - Biomonitor Workers Exposed to 1,6-Hexamethylene Diisocyanate PG - AB - Isocyanates such as 1,6-hexamethylene diisocyanate (HDI), 4,4'-methylenediphenyl diisocyanate, and toluene diisocyanate are highly reactive compounds that have a variety of commercial applications, including manufacturing polyurethane foam, elastomers, paints, adhesives, coatings, insecticides, and many other products. Their primary route of occupational exposure is through inhalation. Due to their high chemical reactivity, they are toxic and have adverse effects at the cellular and subcellular levels, leading to irritative and immunological reactions associated with lung disease. High concentrations of isocyanates are strong respiratory irritants. Bronchial sensitization and asthma are among the major adverse clinical reactions associated with low-level chronic exposure to isocyanates. Albumin adducts have been linked to the mechanism of occupational asthma caused by isocyanates. Isocyanates react in vivo with albumin, which is recognized by the immune system. Albumin adducts of isocyanates trigger immune responses and are probably the antigenic basis for isocyanate asthma. Sensitization to isocyanates is the main pathway for adverse health effects. Therefore, markers for the biologically effective dose such as albumin adducts of HDI are needed. A new isocyanate adduct of HDI with lysine-Ne-[(6-amino-hexyl-amino)carbonyl]-lysine (HDI-Lys)-was synthesized and characterized by 1H-NMR, 13C-NMR, and mass spectrometry (MS). Appropriate internal standards-HDI-Lys-4,4'-5,5'-d4 (HDI-d4-Lys) and Ne-[(7-amino-heptyl-amino)carbonyl]-lysine (Hep-Lys)-were synthesized to establish a LC–MS/MS method for the analysis of HDI adducts in in vitro modified albumin and in workers. The presence of HDI-Lys was found after pronase digestion of albumin and confirmed by two independent chromatographic approaches: with a C8 reversed-phase column and with a hydrophilic interaction liquid chromatography column. Quantification was performed with positive electrospray ionization (ESI)–MS. The adduct peak found in vivo was confirmed with the less sensitive negative ESI–MS. In summary, these are new compounds and methods to determine isocyanate-specific adducts with albumin in workers exposed to HDI. AU - Sabbioni G AU - Sabbioni G LA - PT - DEP - TA - Chem. Res. Toxicol. JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 12 IP - DP - 2022 Jan 01 TI - Influence of the environment on the characteristics of asthma PG - 20522 AB - Few studies have compared the prevalence of asthma in urban and rural settings or explored the issue of whether these two manifestations of the disease may represent different phenotypes. The aim of this study was: (a) to establish whether the prevalence of asthma differs between rural and urban settings, and b) to identify differences in the clinical presentation of asthma in these two environments. Descriptive epidemiological study involving individuals aged 18 or over from a rural (n?=?516) and an urban population (n?=?522). In the first phase, individuals were contacted by letter in order to organize the administration of a first validated questionnaire (Q1) designed to establish the possible prevalence of bronchial asthma. In the second phase, patients who had presented association patterns in the set of variables related to asthma in Q1 completed a second validated questionnaire (Q2), designed to identify the characteristics of asthma. According to Q1, the prevalence of asthma was 15% (n?=?78) and 11% (n?=?59) in rural and urban populations respectively. Sixty-five individuals with asthma from the rural population and all 59 individuals from the urban population were contacted and administered the Q2. Thirty-seven per cent of the individuals surveyed had previously been diagnosed with bronchial asthma (35% in the rural population and 40% in the urban setting). In the urban asthmatic population there was a predominance of women, a greater personal history of allergic rhinitis and a family history of allergic rhinitis and/or eczema. Asthma was diagnosed in adulthood in 74.8% of the patients, with no significant differences between the two populations. Regarding symptoms, cough (morning, daytime and night) and expectoration were more frequent in the urban population. The prevalence of asthma does not differ between urban and rural settings. The differences in exposure that characterize each environment may lead to different manifestations of the disease and may also affect its severity. AU - Romero-Mesones C AU - Ojanguren I AU - Espejo D AU - Granados G AU - González-Barcala F AU - Cruz M AU - Muñoz X LA - PT - DEP - TA - Sci Rep JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 19 IP - DP - 2022 Jan 01 TI - he Effect of Fire Smoke Exposure on Firefighters’ Lung Function: A Meta-Analysis PG - 16799 AB - Firefighters are exposed to a range of harmful substances during firefighting. Exposure to fire smoke has been associated with a decrease in their lung function. However, the cause–effect relationship between those two factors is not yet demonstrated. This meta-analysis aimed to evaluate the potential associations between firefighters’ occupational exposure and their lung function deterioration. Studies were identified from PubMed, Web of Science, Scopus and Science Direct databases (August 1990–March 2021). The studies were included when reporting the lung function values of Forced Expiratory Volume in 1 s (FEV1) or Forced Vital Capacity (FVC). The meta-analyses were performed using the generic inverse variance in R software with a random-effects model. Subgroup analysis was used to determine if the lung function was influenced by a potential study effect or by the participants’ characteristics. A total of 5562 participants from 24 studies were included. No significant difference was found between firefighters’ predicted FEV1 from wildland, 97.64% (95% CI: 91.45–103.82%; I2 = 99%), and urban fires, 99.71% (95% CI: 96.75–102.67%; I2 = 98%). Similar results were found for the predicted FVC. Nevertheless, the mean values of firefighters’ predicted lung function varied significantly among studies, suggesting many confounders, such as trials’ design, statistical methods, methodologies applied, firefighters’ daily exposure and career length, hindering an appropriate comparison between the studies. AU - Barbosa JV AU - Farraia M AU - Branco PTBS AU - Alvim-Ferraz MCM AU - Martins FG AU - Annesi-Maesano I AU - Sousa SIV LA - PT - DEP - TA - Int. J. Environ. Res. Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 2022.12.00 IP - DP - 2022 Jan 01 TI - Long-term outcome of occupational asthma from irritants and low-molecular-weight sensitizers PG - AB - BACKGROUND: The short-term asthma outcome of irritant-induced asthma (IIA) is poorer than that of low-molecular-weight (LMW) sensitizer-induced occupational asthma (OA). OBJECTIVES: To evaluate the long-term asthma outcome of IIA and LMW-induced OA and to determine which baseline features are associated with poor long-term outcome. METHODS: This follow-up questionnaire study assessed 43 patients diagnosed with IIA and 43 patients with LMW-induced OA at the Finnish Institute of Occupational Health in 2004-2018. The baseline results were analyzed to detect features associated with uncontrolled asthma (Asthma Control Test (ACT) score of = 19 or; = 2 exacerbations or = 1 serious exacerbation within 1 year) at follow-up. RESULTS: The median interval since OA diagnosis was 6.3 years (interquartile range (IQR) 4.4-11.3). Uncontrolled asthma was more frequent with IIA than with LMW-induced OA (58% vs. 40%, adjusted odds ratio (OR) 3.60, 95% confidence interval (CI) 1.20-10.81). Poor symptom control was the main factor for this difference (median (IQR) ACT score of 18 (15-22) vs. 21 (18-23), P=0.036, respectively). Among all participants, older age (OR 1.08 per year, 95% CI 1.02-1.15), a fractional exhaled nitric oxide (FeNO) value < 20 ppb (OR 5.08, 95% CI 1.45-17.80) and uncontrolled asthma at baseline (OR 3.94, 95% CI 1.31-11.88) were associated with uncontrolled asthma at follow-up. CONCLUSIONS: Long-term asthma control of IIA appears to be inferior to that of LMW-induced OA. Older age, a low FeNO value and uncontrolled asthma at baseline might indicate worse long-term outcome among those with IIA and LMW-induced OA. AU - Lantto J AU - Suojalehto H AU - Lindström I AU - LA - PT - DEP - TA - The Journal of Allergy and Clinical Immunology: In Practice JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 72 IP - DP - 2022 Jan 01 TI - Machine operator’s lung outbreak due to Eikenella corrodens PG - 522-526 AB - Outbreaks of hypersensitivity pneumonitis (HP) are not uncommon in workplaces where metalworking fluids (MWFs) are used. The recirculation of MWFs leads to microbiological contamination, which is responsible for outbreaks. Most outbreak reports come from USA and the UK; however, no similar reports have been published from Central Europe. Aims To describe an outbreak of MWF-associated HP in workers from a compressor assembly manufacturing facility in Slovak Republic and to identify the potential antigens responsible for the outbreak. Methods We investigated the history of worker’s symptoms, physical examinations, lung function tests, radiographic scans and lung biopsies. The MWF samples were analysed for different strains of bacteria and fungi. Antigen extracts were produced from the microorganisms isolated from MWFs, and positive precipitin reactions were evaluated. Results MWF-associated HP was diagnosed in 21 men and 6 women. All workers had work-related dyspnoea and cough with abnormal pulmonary diffusing capacity. Twenty-four cases had evidence of interstitial lung disease. Four cases were classified as having fibrotic HP. Nineteen microbial isolates (12 bacteria and 7 fungi) were cultured from the MWFs. Twenty-five cases had a positive response to at least one isolate. Eikenella corrodens and Bacillus subtilis were the most frequently reacting antigens (in 15 and 12 workers, respectively). Conclusions Despite decreasing reports of MWF-associated HP outbreaks over the past several decades, we describe one of the largest outbreaks in Europe. While the bacterium E. corrodens was found in the MWF samples, its relationship to the disease should be further investigated. AU - Perecinský S AU - Murínová L AU - Tomcová J AU - Polanová M AU - Legáth L LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20220101 IS - IS - VI - 72 IP - DP - 2022 Jan 01 TI - Flour exposure, sensitization and respiratory health among Alberta trainee bakers PG - 559-565 AB - Sensitization to allergens encountered in baking, and allergic disease including asthma and rhinitis, is recognized. Attempts to reduce this risk have been instituted in some workplaces, but awareness remains low. This study aimed to quantify the current risk among Alberta bakers.To estimate the onset of sensitization to bakery allergens and allergic disease among trainee bakers at the outset of their career.Trainees attending one of the two bakery programmes were recruited between 2015 and 2018. At entry, an interview was held and spirometry and skin prick tests were performed. Participants were contacted every 6 months by telephone or online interview for 3 years to update work and health information. An exit interview was completed between 2018 and 2019 for all who could be contacted. Exposure was estimated using collected work history and a job exposure matrix was prepared for this study.A total of 220 individuals participated in the entry interview, 204 completed one or more periodic interviews and 113 completed the exit interview. Six who completed exit testing developed new sensitization to bakery antigens, an incidence of 2.49/100 person-years. Positive skin prick tests for bakery antigens were associated with bread making. Rhinitis symptoms were associated with total flour dust and new-onset rhinitis to months in trade. New-onset asthma was related to cumulative exposure to flour improvers.Trainee bakers in Alberta remain at risk of sensitization and occupational respiratory disease. AU - Beach J AU - Galarneau J-M AU - Cherry N LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 5 IP - DP - 2021 Jan 01 TI - Workplace-related inhalation test - Specific inhalation challenge: S2k Guideline of the German Society for Occupational and Environmental Medicine e.V. (DGAUM), the German Society for Pneumology and Respiratory Medicine e.V. (DGP) and the German Society for Allergology and Clinical Immunology e.V. (DGAKI). PG - 315-334 AB - This guideline describes the workplace-related inhalation test, in German named “Arbeitsplatz-bezogener Inhalationtest (AIT)” for the identification of allergic or immunological asthma and hypersensitivity pneumonitis (also called exogenous allergic alveolitis) in patients with symptoms such as cough, wheezing or shortness of breath in the workplace, including delayed reactions. The AIT or workplace-related inhalation test is an elaborate specific test in which the sick person is exposed in a controlled manner under laboratory conditions to an agent present in his or her workplace. Common synonyms for the workplace-related inhalation test or, in international usage, “specific inhalation challenge” (SIC) include “specific bronchial provocation testing” and “occupational-type challenge testing” [41]. Woitowitz (Germany 1970) [45] and Pepys (UK 1975) [24] are considered early developers of the AIT and SIC, respectively. The SIC is now well established in occupational health diagnostics; its implementation has been refined. It is an important component in the diagnosis of workplace-related asthma; it can also be used in the diagnosis of hypersensitivity pneumonitis when the diagnosis cannot be confirmed otherwise. The SIC remains the best method for identifying and documenting the allergological relevance of new working materials to the upper and lower respiratory tract. The concept of SIC on which the guideline is based allows the use of native agents as well as allergen solutions to detect or exclude characteristic reactions in the area of the deeper airways and the upper respiratory tract, i.e. the nasal mucosa. The aim and purpose of this guideline is to describe the SIC based on the current state of knowledge in occupational medicine and pneumology. It is intended to provide guidance for the diagnosis of workplace-related respiratory diseases. The SIC allows the verification of the probable causal relationship between workplace-related inhalation exposure and a respiratory or lung disease. It is therefore an important component for answering the question of whether, from a preventive point of view, it is medically justifiable for the sick person to continue to be exposed at the workplace. In addition to a review of the scientific literature, this guideline also contains practical advice on the implementation of SIC. Go to: 2. Methodology of guideline development The guideline on SIC was compiled according to the guidelines for the development of medical guidelines of the Association of the Scientific Medical Societies in Germany (AWMF, www. awmf.org). According to the three-stage concept of the AWMF, the present guideline corresponds to the S2k evidence grading. The following professional societies were involved in the development of the guideline: German Society for Occupational and Environmental Medicine e. V. (DGAUM, notifying professional society) German Society for Pneumology and Respiratory Medicine e. V. (DGP) German Society for Allergology and Clinical Immunology e. V. (DGAKI) as well as the German Respiratory League e. V. (GRL) as further professional representation. The individual mandated representatives of the professional societies are named under the authorship on the first page. The recommendations formulated in the course of guideline development are based on two sources. First, the assessment of existing guidelines, in particular the comprehensive recommendations on the implementation of SIC published in 2014 by a task force of the European Respiratory Society (ERS) [41] and the German guideline from 2010 [3]. Second, an updated systematic literature search conducted for the period January 2013 – June 2018 using the bibliographic search terms published by the ERS Task Force [41, Appendix A] and updated until August 2020. In addition to the evaluation of existing guidelines and the scientific literature, the clinical experience of the group members and theoretical considerations have also been incorporated into the recommendations. The consensus-building process took place through two face-to-face meetings of the group members on October 6, 2017 (Wiesbaden) and March 8, 2018 (Munich), repeated voting via video conferences and e-mails, and a final written circulation procedure (Delphi procedure) in accordance with the recommendations of the AWMF. AU - Preisser AM AU - Koschel D AU - Merget R AU - Nowak D AU - Raulf M AU - Heidrich J. LA - PT - DEP - TA - Allergol Select. JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 2 IP - DP - 2021 Jan 01 TI - Rhino Conjunctivitis and Asthma Among Seafood Processing Workers in Greenland. A Cross-Sectional Study PG - 747011 AB - Introduction: The fishing- and the seafood processing industries are the largest industrial sectors in Greenland. Despite this, only a few cases of occupational diseases in this industry have been reported to the Danish Labor Market Insurance. Occupational asthma and allergy are well-known occupational diseases in the seafood processing industry worldwide and underreporting of occupational diseases in Greenland is suspected. Objective: The aim of the current study was to examine the associations between job exposures and occupational asthma and rhino conjunctivitis in workers in the Greenlandic seafood processing industry and to compare the prevalence of sensitization by type and degree of exposure to snow crab, shrimp, fish, and the fish parasite, Anisakis simplex. Methods: Data from 382 Greenlandic seafood processing workers were collected during 2016-2018. Data included questionnaire answers, lung function measurements, skin prick tests, and blood samples with ImmunoCAP. For all analyses, p < 0.05 was considered the level of significance. Results: 5.5% of the workers had occupational asthma and 4.6% had occupational rhino conjunctivitis. A large proportion of the workers were sensitized to allergens specific to the workplace; 18.1% to snow crab, 13.6% to shrimp, 1.4% to fish, and 32.6% to the fish parasite, A. simplex. We found a dose-response relationship between the risk of being sensitized to snow crab and A. simplex and years of exposure to the allergens in the seafood processing industry. Conclusion: This study showed that a considerable proportion of workers in the Greenlandic seafood processing industry had occupational asthma and rhino conjunctivitis. Additionally, the study showed high sensitization levels toward snow crab, shrimp, and the fish parasite, A. simplex. This supports the hypothesis of a considerable degree of underreporting of occupational allergic airway disease in the Greenlandic seafood processing industry. Prospectively, it is important to inform workers, leaders, and health care professionals of the health problems and the law on worker's compensation, and to initiate preventive actions at factory and trawler level. AU - Laustsen BH AU - Omland Ø AU - Würtz ET AU - Sigsgaard T AU - Ebbehøj NE AU - Carstensen O AU - Rasmussen K AU - Kamath SD AU - Lopata AL AU - Bønløkke JH LA - PT - DEP - TA - Front.Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 18 IP - DP - 2021 Jan 01 TI - Occupational Exposures to Organic Solvents and Asthma Symptoms in the CONSTANCES Cohort. PG - 9258 AB - Solvents are used in many workplaces and may be airway irritants but few studies have examined their association with asthma. We studied this question in CONSTANCES (cohort of 'CONSulTANts des Centres d'Examens de Santé'), a large French cohort. Current asthma and asthma symptom scores were defined by participant-reported respiratory symptoms, asthma medication or attacks, and the sum of 5 symptoms, in the past 12 months, respectively. Lifetime exposures to 5 organic solvents, paints and inks were assessed by questionnaire and a population-based Job-Exposure Matrix (JEM). Cross-sectional associations between exposures and outcomes were evaluated by gender using logistic and negative binomial regressions adjusted for age, smoking habits and body mass index. Analyses included 115,757 adults (54% women, mean age 47 years, 9% current asthma). Self-reported exposure to =1 solvent was significantly associated with current asthma in men and women, whereas using the JEM, a significant association was observed only in women. Significant associations between exposures to =1 solvent and asthma symptom score were observed for both self-report (mean score ratio, 95%CI, women: 1.36, 1.31-1.42; men: 1.34, 1.30-1.40) and JEM (women: 1.10, 1.07-1.15; men: 1.14, 1.09-1.18). Exposure to specific solvents was significantly associated with higher asthma symptom score. Occupational exposure to solvents should be systematically sought when caring for asthma. AU - Sit G AU - Letellier N AU - Iwatsubo Y AU - Goldberg M AU - Leynaert B AU - Nadif R AU - Ribet C AU - Roche N AU - Roquelaure Y AU - Varraso R AU - Zins M AU - Descatha A AU - Le Moual N AU - Dumas O. LA - PT - DEP - TA - Int J Environ Res Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 26 IP - DP - 2021 Jan 01 TI - Proportion of occupational progressive fibrosing interstitial lung diseases in the tertiary hospitals of Thailand PG - APST-26-04-07 AB - Idiopathic pulmonary fibrosis (IPF)-the prototypical progressive fibrosing interstitial lung diseases (PF-ILDs)-is associated with occupational exposure. Other unidentified PF-ILDs may also be work-related. This study aimed to evaluate the magnitude of occupational related causes in unknown aetiology PF-ILDs. We conducted a descriptive study with a sample of 112 patients in two tertiary hospitals in Khon Kaen, Thailand, between 2016 and 2020. Descriptive statistics were used to analyse the findings. The response rate was 26.8% (30/112). Demographic data and clinical information were reviewed from medical records. Telephone interviews were used to explore occupational histories. A multi-disciplinary team (MDT) was held to reach a consensus on the final diagnosis of 8 participants who had significant exposure per their respective interview. The result demonstrated that 16.7% (5/30) of respondents were possible occupational related PF-ILDs and the majority (3/5) were due to metal dust exposure. The result is inconsistent with the occupational burden related to the IPF but resembles the proportion of occupational ILDs in USA and Europe. Moreover, we found that only 23.7% (7/30) had occupational histories taken by their treating physician. Therefore, a multi-disciplinary approach with an occupational physician in the team was used to precisely diagnose occupational related unknown ILDs. AU - Rittidet C AU - Chaiear N AU - Tumsatan P AU - Domthong P AU - Sukkasem W AU - Burge PS LA - PT - DEP - TA - Asia-Pacific Journal of Science and Technology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 26 IP - DP - 2021 Jan 01 TI - Developing a web application to provide information on common work-related asthma causative agents PG - APST-26-04-13 AB - Occupational asthma (OA) is one of the most common occupational lung diseases. There are currently about 300 documented asthmagens. Patients have a chance to be cured if the OA is handled correctly. Diagnostic delay is often due to the attending not taking the occupational history. The aim of our study was to develop a web application that would deliver fast and accurate information. Methodology: The three phases of web application development were included. Sourcing input data from a systematic review of 1,403 studies found when searching for review and systematic review and full text and inclusion criteria. A total of 276 eligible studies were selected, and after reviewing abstract, 25 were fully reviewed and summarized into 2 groups-14 high molecular weight agents and 14 low molecular weight agents. The industrial code was then reviewed, and prototypes developed. Evaluation of prototypes for System Usability Scale (SUS) by experts was performed. The expert suggestions were reviewed and revised to create a second prototype. Trialing web application for use by primary care physicians. The final web application was evaluated by primary care physicians was implemented. The median of SUS was 75, which is greater than the average. In future, we seek to develop tools for analyzing the probability of diagnosing OA, which would help making diagnosis more convenient. The earlier diagnosis can be achieved, the better the prognosis. AU - Sangjumrus N AU - Chaiear N AU - Saikaew K AU - So-ngern A AU - Burge PS LA - PT - DEP - TA - Asia-Pacific Journal of Science and Technology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 79 IP - DP - 2021 Jan 01 TI - Association between occupational exposure to irritant agents and a distinct asthma endotype in adults. PG - 155 AB - AIM: The biological mechanisms of work-related asthma induced by irritants remain unclear. We investigated the associations between occupational exposure to irritants and respiratory endotypes previously identified among never asthmatics (NA) and current asthmatics (CA) integrating clinical characteristics and biomarkers related to oxidative stress and inflammation. METHODS: We used cross-sectional data from 999 adults (mean 45 years old, 46% men) from the case-control and familial Epidemiological study on the Genetics and Environments of Asthma (EGEA) study. Five respiratory endotypes have been identified using a cluster-based approach: NA1 (n=463) asymptomatic, NA2 (n=169) with respiratory symptoms, CA1 (n=50) with active treated adult-onset asthma, poor lung function, high blood neutrophil counts and high fluorescent oxidation products level, CA2 (n=203) with mild middle-age asthma, rhinitis and low immunoglobulin E level, and CA3 (n=114) with inactive/mild untreated allergic childhood-onset asthma. Occupational exposure to irritants during the current or last held job was assessed by the updated occupational asthma-specific job-exposure matrix (levels of exposure: no/medium/high). Associations between irritants and each respiratory endotype (NA1 asymptomatic as reference) were studied using logistic regressions adjusted for age, sex and smoking status. RESULTS: Prevalence of high occupational exposure to irritants was 7% in NA1, 6% in NA2, 16% in CA1, 7% in CA2 and 10% in CA3. High exposure to irritants was associated with CA1 (adjusted OR aOR, (95% CI) 2.7 (1.0 to 7.3)). Exposure to irritants was not significantly associated with other endotypes (aOR range: 0.8 to 1.5). CONCLUSION: Occupational exposure to irritants was associated with a distinct respiratory endotype suggesting oxidative stress and neutrophilic inflammation as potential associated biological mechanisms. AU - Andrianjafimasy MV AU - Febrissy M AU - Zerimech F AU - Dananché B AU - Kromhout H AU - Matran R AU - Nadif M AU - Oberson-Geneste D AU - Quinot C AU - Schlünssen V AU - Siroux V AU - Zock JP AU - Le Moual N AU - Nadif R AU - Dumas O LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 4 IP - DP - 2021 Jan 01 TI - Association of occupational exposure to inhaled agents in operating rooms with incidence of chronic obstructive pulmonary disease among US female nurses PG - e2125749 AB - Importance: Employment in operating rooms (ORs) may involve exposure to several inhaled agents, including surgical smoke and disinfectants, which are associated with adverse respiratory health effects. However, the association of long-term employment in ORs and chronic obstructive pulmonary disease (COPD) remains unknown. Objective: To examine the association of working in an OR with incidence of COPD among female nurses in the US. Design, Setting, and Participants: This cohort study used data from the Nurses' Health Study for US female registered nurses who provided information on questionnaires regarding OR employment history in 1984 and job type in 1982 and who had no history of COPD in 1984 (baseline). Data analyses were conducted from April 1, 2020, to January 31, 2021. Exposures: Duration of nursing in the OR and job type. Main Outcomes and Measures: The associations of any employment as an OR nurse, duration of employment, and duration and job type with incidence of self-reported, physician-diagnosed COPD. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards regression models stratified by age and calendar year. Models were adjusted for covariates, with model 1 adjusting for age, model 2 also adjusting for cigarette smoking status and pack-year of smoking, and model 3 also adjusting for race and ethnicity, US Census region, and body mass index. Results: Among 75?011 female nurses included in the analyses, the mean (SD) age at baseline was 50.5 (7.2) years; 29% had a history of employment in an OR, and 3% had 15 or more years of OR experience. In model 3, employment in an OR for 15 or more years was associated with a 46% increased risk of developing COPD compared with no history of OR employment (HR, 1.46; 95% CI, 1.10-1.93). Compared with nurses who never worked in an OR and had an administrative or nursing education function or a nonnursing job in 1982, the risk of developing COPD was greater among nurses who provided outpatient care (HR, 1.24; 95% CI, 1.04-1.47) and nurses employed in inpatient units (HR, 1.31; 95% CI, 1.07-1.59) who had no history of OR employment and was 69% greater among nurses with OR experience of 15 years or more (HR, 1.69; 95% CI, 1.25-2.28). Conclusions and Relevance: In this cohort study, OR employment of 15 years or more was associated with an increased risk of developing COPD among female nurses. Additional studies with more recent and direct environmental monitoring data of multiple occupational exposures are needed to assess the relative role of exposure to surgical smoke and disinfectants in the observed association. AU - Xie W AU - Dumas O AU - Varraso R AU - Boggs KM AU - Camargo AU - CA AU - Stokes AC LA - PT - DEP - TA - JAMA Netw Open JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 18 IP - DP - 2021 Jan 01 TI - Cotton Dust-Related Allergic Asthma: Prevalence and Associated Factors among Textile Workers in Nam Dinh Province, Vietnam PG - 9813 AB - Objective: To determine the prevalence of cotton dust-related allergic asthma and associated factors among textile workers in Nam Dinh province, Vietnam. Methods: A cross-sectional study was performed with 1082 workers in two textile garment companies using the asthma diagnostic criteria of the GINA (Global Initiative for Asthma) 2016 guidelines. Results: Among study participants, 11.9% had suspected asthma symptoms, 7.4% were diagnosed with asthma, and 4.3% (3.6% in men and 4.5% in women) were diagnosed with cotton dust-related allergic asthma. Overweight, seniority more than 10 years, history of asthma, allergic rhinitis, family history of allergy, and exposure to cotton dust from more than one hour per day in the working environment were found to be important predictors of cotton dust-related allergic asthma among textile workers. Conclusions: Textile workers in two companies in Nam Dinh, Vietnam had a high prevalence of dust-related allergic asthma compared to estimates from the general population. There is a need to design appropriate measures of prevention, screening, and care for dust-related asthma in the textile industry. Further evaluation with better exposure assessment is necessary AU - Ha AU - TTT AU - Hanh BM AU - Van Son N AU - Giang HT AU - Hai NT AU - Thuc VM AU - Khue PM LA - PT - DEP - TA - Int. J. Environ. Res. Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 22 IP - DP - 2021 Jan 01 TI - Transcriptomic Profiling of Adult-Onset Asthma Related to Damp and Moldy Buildings and Idiopathic Environmental Intolerance PG - 10679 AB - A subset of adult-onset asthma patients attribute their symptoms to damp and moldy buildings. Symptoms of idiopathic environmental intolerance (IEI) may resemble asthma and these two entities overlap. We aimed to evaluate if a distinct clinical subtype of asthma related to damp and moldy buildings can be identified, to unravel its corresponding pathomechanistic gene signatures, and to investigate potential molecular similarities with IEI. Fifty female adult-onset asthma patients were categorized based on exposure to building dampness and molds during disease initiation. IEI patients (n = 17) and healthy subjects (n = 21) were also included yielding 88 study subjects. IEI was scored with the Quick Environmental Exposure and Sensitivity Inventory (QEESI) questionnaire. Inflammation was evaluated by blood cell type profiling and cytokine measurements. Disease mechanisms were investigated via gene set variation analysis of RNA from nasal biopsies and peripheral blood mononuclear cells. Nasal biopsy gene expression and plasma cytokine profiles suggested airway and systemic inflammation in asthma without exposure to dampness (AND). Similar evidence of inflammation was absent in patients with dampness-and-mold-related asthma (AAD). Gene expression signatures revealed a greater degree of similarity between IEI and dampness-related asthma than between IEI patients and asthma not associated to dampness and mold. Blood cell transcriptome of IEI subjects showed strong suppression of immune cell activation, migration, and movement. QEESI scores correlated to blood cell gene expression of all study subjects. Transcriptomic analysis revealed clear pathomechanisms for AND but not AAD patients. Furthermore, we found a distinct molecular pathological profile in nasal and blood immune cells of IEI subjects, including several differentially expressed genes that were also identified in AAD samples, suggesting IEI-type mechanisms. AU - Suojalehto H AU - Ndika J AU - Lindström I AU - Airaksinen L AU - Karvala K AU - Kauppi P AU - Lauerma A AU - Toppila-Salmi S AU - Karisola P AU - Alenius H LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 71 IP - DP - 2021 Jan 01 TI - Occupational causes of hypersensitivity pneumonitis: a systematic review and compendium PG - 255-259 AB - Background Hypersensitivity pneumonitis (HP) is caused by a variety of antigens and low-molecular-weight chemicals, often through occupational exposure. Making a diagnosis of HP and identifying a cause are challenging. Cryptogenic cases are frequently reported, and missing or incomplete exposure histories can cause misclassification. Aims To provide an evidence-based compendium of sources of exposure and causes of HP for the clinician, through systematic review of medical literature. Methods Articles related to HP causative agents and occupational exposure were searched from the databases OVID Medline (1946 to October 2020) and EMBASE (1974 to October 2020). Abstracts and full texts of articles were screened by two reviewers. Data on causative antigens, occupational source of exposure and any associated eponymous name were extracted and grouped according to source of exposure. Results A total of 1790 articles were identified, from which 305 articles met the inclusion criteria. An additional 22 articles were identified from citation lists of the selected review articles. Sources of exposure identified for HP were sorted into 14 categories of work (agricultural, plant matter processing, wood, animal-related, foodstuff, food processing, metal processing, polymers, other manufacturing, chemicals, aerosolized water, service, waste and sewage and wind instruments). Conclusions This work is a comprehensive list of occupational causative agents and exposures causing HP. Cases are grouped by source of exposure, allowing an immediately accessible compendium of causes for use during occupational exposure assessment, which could also form the basis for a clinical questionnaire. AU - Kongsupon N AU - Walters GI AU - Sadhra SS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 11 IP - DP - 2021 Jan 01 TI - Characteristics and risk assessment of occupational exposure to ultrafine particles generated from cooking in the Chinese restaurant. PG - 15586 AB - Ultrafine particles have been increasingly linked to adverse health effects in restaurant workers. This study aimed to clarify the exposure characteristics and risks of ultrafine particles during the cooking process, and to provide a reasonable standard for protecting the workers in the Chinese restaurant. The temporal variations in particle concentrations (number concentration (NC), mass concentration (MC), surface area concentration (SAC), and personal NC), and size distributions by number were measured by real-time system. The hazard, exposure, and risk levels of ultrafine particles were analyzed using the control banding tools. The NC, MC, and SAC increased during the cooking period and decreased gradually to background levels post-operation. The concentration ratios of MC, total NC, SAC, and personal NC ranged from 3.82 to 9.35. The ultrafine particles were mainly gathered at 10.4 and 100 nm during cooking. The exposure, hazard and risk levels of the ultrafine particles were high. These findings indicated that the workers during cooking were at high risk due to exposure to high levels of ultrafine particles associated with working activity and with a bimodal size distribution. The existing control strategies, including engineering control, management control, and personal protection equipment need to be improved to reduce the risk. Characteristics and risk assessment of occupational exposure to ultrafine particles generated from cooking in the Chinese restaurant. Gao X, Zhang M, Zou H, Zhou Z, Yuan W, Quan C, Cao Y. AU - Gao X AU - Zhang M AU - Zou H AU - Zhou Z AU - Yuan W AU - Quan C AU - Cao Y. LA - PT - DEP - TA - Sci Rep JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 447 IP - DP - 2021 Jan 01 TI - Chitin induces accumulation in tissue of innate immune cells associated with allergy. PG - 92-96 AB - Allergic and parasitic worm immunity is characterized by infiltration of tissues with interleukin (IL)-4- and IL-13-expressing cells, including T-helper-2 cells, eosinophils and basophils1. Tissue macrophages assume a distinct phenotype, designated alternatively activated macrophages2. Relatively little is known about the factors that trigger these host responses. Chitin, a widespread environmental biopolymer of N-acetyl-ß-D-glucosamine, provides structural rigidity to fungi, crustaceans, helminths and insects3. Here, we show that chitin induces the accumulation in tissue of IL-4-expressing innate immune cells, including eosinophils and basophils, when given to mice. Tissue infiltration was unaffected by the absence of Toll-like-receptor-mediated lipopolysaccharide recognition but did not occur if the injected chitin was pre-treated with the IL-4- and IL-13-inducible mammalian chitinase, AMCase4, or if the chitin was injected into mice that overexpressed AMCase. Chitin mediated alternative macrophage activation in vivo and the production of leukotriene B4, which was required for optimal immune cell recruitment. Chitin is a recognition element for tissue infiltration by innate cells implicated in allergic and helminth immunity and this process can be negatively regulated by a vertebrate chitinase. AU - Reese TA AU - Liang H AU - Tager AM AU - Luster AD AU - Rooijen NV AU - Voehringer D AU - Locksley RM LA - PT - DEP - TA - Nature JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 76 IP - DP - 2021 Jan 01 TI - Health effects of exposure to chlorination by-products in swimming pools. PG - 3257-3275 AB - Concerns have been raised regarding the potential negative effects on human health of water disinfectants used in swimming pools. Among the disinfection options, the approaches using chlorine-based products have been typically preferred. Chlorine readily reacts with natural organic matter that are introduced in the water mainly through the bathers, leading to the formation of potentially harmful chlorination by-products (CBPs). The formation of CBPs is of particular concern since some have been epidemiologically associated with the development of various clinical manifestations. The higher the concentration of volatile CBPs in the water, the higher their concentration in the air above the pool, and different routes of exposure to chemicals in swimming pools (water ingestion, skin absorption, and inhalation) contribute to the individual exposome. Some CBPs may affect the respiratory and skin health of those who stay indoor for long periods, such as swimming instructors, pool staff, and competitive swimmers. Whether those who use chlorinated pools as customers, particularly children, may also be affected has been a matter of debate. In this article, we discuss the current evidence regarding the health effects of both acute and chronic exposures in different populations (work-related exposures, intensive sports, and recreational attendance) and identify the main recommendations and unmet needs for research in this area. AU - Couto M AU - Bernard A AU - Delgado L AU - Drobnic F AU - Kurowski M AU - Moreira A AU - Rodrigues-Alves R AU - Rukhadze M AU - Seys S AU - Wiszniewska M AU - Quirce S LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 2 IP - DP - 2021 Jan 01 TI - Case reports of indium lung disease in Taiwan PG - 893-898 AB - The production of indium-tin oxide has increased in the past decades due to the increased manufacture of liquid crystal displays (LCD). Taiwan is one of the highest indium-consuming countries worldwide. After repeated inhalation, indium oxide (In2O3) particles would accumulate in the lungs, resulting in severe lung effects. We report two workers of an LCD producing facility with elevated serum indium level up to 149 and 73.8 µg/L (normal value <3.5 µg/L), which was much higher than that observed in previous case reports in Taiwan. We collected their detailed working history, symptoms, pulmonary function, radiologic findings, and followed up for more than one year. We also performed workplace evaluation of the facility. We observed that sandblasters who clean components of ITO thin-film production machinery by sandblasting with aluminum oxide tend to have higher indium exposure with worse pulmonary functions and HRCT findings. AU - Tsao Y AU - Fan H AU - Luo JJ LA - PT - DEP - TA - Journal of the Formosan Medical Association JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - IP - DP - 2021 Jan 01 TI - Lung function assessment and its association with blood chromium in a chromate exposed population PG - 151741 AB - Hexavalent chromium [Cr(VI)] and its compounds have been associated with various respiratory diseases, while few studies have attempted to determine its adverse effect on lung function. To explore the potential early indicators of health surveillance for respiratory diseases induced by chromate exposure, a longitudinal cohort study including 515 workers with 918 measurements across 2010–2017 was conducted to investigate the impact of individual internal exposure on lung function. Inductively coupled plasma mass spectrometry (ICP-MS) and spirometry were used to measure whole blood chromium (blood Cr) and lung function respectively. In the linear mixed-effects analysis, each 1- unit increase in Ln- transformed blood Cr was significantly associated with estimated effect percentage decreases of 1.80 (0.35, 3.15) % in FEV1, 0.77 (0.10, 1.43) % in FEV1/FVC, 2.78 (0.55, 4.98) % in PEF, and 2.73 (0.59, 4.71) % in FEF25–75% after adjusting for related covariates. Exposure- response curve depicted the reduction of lung function with blood Cr increase, and the reference value of blood Cr was proposed as 6 µg/L considering the lung function as health outcome. Based on the repeated-measure analysis, compared with the low frequency group, subjects with high frequency of high exposure across 2010–2017 had an additional reduction of 5.65 (0, 11.3) % in FVC. Subjects with medium frequency showed more obvious declines of 9.48 (4.16, 14.87) % in FVC, 8.63 (3.49, 13.97) % in FEV1, 12.94 (3.34, 22.53) % in PEF and 10.97 (3.63, 18.30) % in MVV. These findings suggested that short- term high exposure to Cr associated with obstructive ventilatory impairment, and long- term exposure further led to restrictive ventilatory impairment. AU - Zhang Y AU - Su Z AU - Hu G AU - Hong S AU - Long C AU - Zhang Q AU - Zheng P AU - Wang T AU - Yu S AU - Yuan F AU - Zhu X AU - Jia G LA - PT - DEP - TA - Science of The Total Environment JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - IP - DP - 2021 Jan 01 TI - Aerosol generation during pulmonary function testing: Monitoring during different testing modalities PG - 1965926 AB - The coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has severely restricted pulmonary diagnostic testing because of the concern of droplet and aerosol generation by procedures conducted in small test rooms. SARS-CoV-2 infection is characterized by viral shedding from the upper and lower respiratory tracts; in addition, SARS-CoV-2 RNA has been detected in sampled air throughout a hospital, which leads to this concern (1–4). Pulmonary function laboratories are justifiably concerned because test maneuvers involve forceful breathing, which may generate infectious particles. Normal speaking has also been reported to generate small-droplet aerosols, increasing the potential exposure risk in close contact with infected individuals (5–7). Currently, there are no studies evaluating particle generation during pulmonary function tests (PFTs). To better understand the risk associated with PFTs, we sought to quantify and characterize the amount of detectable aerosol and droplet generation during routine pulmonary function studies at prespecified distances. AU - Wu JKY AU - Ryan M AU - Hiebert RJ AU - Han Z AU - Liu A AU - Jeong C-H AU - Mubareka S AU - Evans GJ AU - Chow C-W LA - PT - DEP - TA - Canadian Journal of Respiratory, Critical Care, and Sleep Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - IP - DP - 2021 Jan 01 TI - Asthma: diagnosis, monitoring and chronic asthma management PG - AB - Occupational asthma 1.1.10 Check for possible occupational asthma by asking employed people with suspected new-onset asthma, or established asthma that is poorly controlled: • Are symptoms better on days away from work? • Are symptoms better when on holiday (time away from work longer than usual breaks at weekends or between shifts)? Make sure all answers are recorded for later review. [2017] 1.1.11 Refer people with suspected occupational asthma to an occupational asthma specialist. [2017] AU - NICE LA - PT - DEP - TA - NICE JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 18 IP - DP - 2021 Jan 01 TI - Is Isocyanate Exposure and Occupational Asthma Still a Major Occupational Health Concern? Systematic Literature Review PG - 13181 AB - Isocyanate, whose disease-inducing mechanism is poorly understood, with poor prognosis, is widely used. Asthma is the most frequent manifestation of prolonged exposure. We assessed the evolution of the incidence of isocyanate-induced occupational asthma over time. PubMed and Cochrane databases were systematically searched for studies published since 1990 that assessed the relationship between occupational exposure to isocyanates and asthma. We identified 39 studies: five retrospective cohort studies, seven prospective cohort studies, three of which were inception cohorts), seven observational cross-sectional studies, five literature reviews, two case series, and 13 registry studies. The incidence of occupational asthma secondary to isocyanate exposure has decreased from more than 5% in the early 1990s to 0.9% in 2017 in the United States. Despite the wide use of optimal collective and individual protection measures, the risk of occupational asthma has stabilized. Occupational asthma risk can be assessed with good sensitivity using self-questionnaires and pulmonary function tests. Occupational avoidance should be implemented as soon as possible after the first symptoms appear because the prognosis becomes increasingly poor with the persistence of exposure. It is now necessary to study specifically cutaneous sensitization to isocyanates and to define what protective equipment is effective against this mode of exposure. AU - Coureau E AU - Fontana L AU - Lamouroux C AU - Pélissier C AU - Charbotel B LA - PT - DEP - TA - Int. J. Environ. Res. Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - IP - DP - 2021 Jan 01 TI - obacco Worker’s Lung: A Neglected Subtype of Hypersensitivity Pneumonitis PG - AB - Tobacco worker’s lung (TWL) is a type of hypersensitivity pneumonitis (HP) affecting workers exposed to tobacco leaves and molds in the humidified environment of the tobacco production industry. Limited epidemiological data point to a prevalence of TWL that is not negligible and probably underestimated. As in other types of HP, an acute vs. chronic presentation depends on the pattern of the exposure. Therefore, the clinical presentation can vary from an acute influenza-like syndrome, mostly self-limiting with the removal of the exposure, to an insidious onset of cough, exertional dyspnea, fatigue and weight loss in chronic presentations, where fibrotic changes may be observed. The main treatment strategy is the removal of the exposure to tobacco dust and molds, while the main aim of corticosteroid therapy is to reduce morbidity and prevent complications, namely the development of pulmonary fibrosis and permanent lung dysfunction. Despite the fact that TWL is quite well described, preventive measures are not usually adopted in the tobacco production industry. We present here a state of the art review of this neglected, preventable, but still prevalent and occupational-related subtype of HP. AU - Zagà V AU - DellOmo M AU - Murgia N AU - Mura M LA - PT - DEP - TA - Lung JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - IP - DP - 2021 Jan 01 TI - Practical considerations for spirometry during the COVID-19 outbreak: Literature review and insights PG - AB - Background As the Coronavirus disease 2019 (COVID-19) is spreading worldwide, countries are dealing with different phases of the pandemic. Lately, scientific evidence has been growing about the measures for reopening respiratory outpatient services during the COVID-19 pandemic. We aim to summarize the key differences and similarities among recommendations by different national and international organizations. Methods We searched on Google and Pubmed for recently published National and International Recommendations/Guidelines/Position Papers from professional organizations and societies, offering a guidance to physicians on how to safely perform pulmonary function testing during COVID-19 pandemic. We also searched for spirometry manufacturers' operational indications. Results Indications on spirometry were released by the Chinese Task force, the American Thoracic Society, the European Respiratory Society, the Thoracic Society of Australia and New Zealand, the Société de Pneumologie de Langue Française, the Spanish Societies (Sociedad Espanola de Neumologia y Cirugia Toracica, Sociedad Espanola de Alergologia e Inmunologia Clinica, Asociacion de Especialistas en Enfermeria del trabajo, Asociacion de Enfermeria Comunitaria), the Sociedade Portuguesa de Pneumologia, the British Thoracic Society/Association for Respiratory Technology & Physiology, the Irish Thoracic Society, the Sociedad Uruguaya de Neumologia, the Italian Thoracic Society and the Italian Respiratory Society, Cleveland Clinic and Nebraska Medical Center. Detailed technical recommendations were found on manufacturers’ websites. We found several similarities across available guidelines for safely resuming pulmonary function services, as well as differences in criteria for selecting eligible patients for which spirometry is deemed essential and advice which was not homogenous on room ventilation precautions. Conclusions This study shows a synthesis of national/international guidelines allowing practicing physicians to adapt and shape the way to organize their outpatient services locally. There is generally good agreement on the importance of limiting pulmonary function testing to selected cases only. However, significant differences concerning the subsets of candidate patients, as well as on the management of adequate room ventilation, were observed. AU - Crimi C AU - Impellizzeri P AU - Campisi R AU - SantiNolasco AU - Spanevello A AU - Crimi N LA - PT - DEP - TA - Pulmonology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - IP - DP - 2021 Jan 01 TI - An update on hypersensitivity pneumonitis, what a clinician wants to know PG - AB - Purpose of review A recent international collaboration has updated the clinical definition and diagnostic recommendations for hypersensitivity pneumonitis, focusing on fibrotic and non-fibrotic phenotypes. However, how these transfer to clinical practice and their impact upon clinical management and prognosis of hypersensitivity pneumonitis is unclear. This review will focus on recent advances in the understanding of the clinical aspects of hypersensitivity pneumonitis, predominantly its epidemiology, diagnosis, classification and treatment. Recent findings Hypersensitivity pneumonitis is a rare disease within the general population, with variable geographical incidence because of environmental, cultural and occupational factors. Confidence in diagnosis relies upon the presence of clinical features with a temporal relationship to an associated exposure, radiological and histopathological features, bronchiolo-alveolar lavage lymphocytosis and precipitating antibodies/specific immunoglobulin G to antigens. Although emerging evidence regarding nintedanib use in progressive fibrotic interstitial lung disease is promising, the majority of therapies (corticosteroids and immunosuppressive agents) used traditionally in hypersensitivity pneumonitis lack a robust evidence base. Summary With a clear definition of fibrotic and nonfibrotic hypersensitivity pneumonitis phenotypes now established, clinical research trials (predominantly randomized controlled trials) should clarify and resolve the discussion regarding antigen avoidance, corticosteroid therapy, immunosuppressive therapy and antifibrotic therapy in fibrotic and nonfibrotic subtypes of hypersensitivity pneumonitis. AU - Huntley CC AU - Walters GI LA - PT - DEP - TA - Curr Opin Pulm Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 78 IP - DP - 2021 Jan 01 TI - Occurrence of respiratory symptoms and lung function deficits among fruit and vegetable market workers PG - 262-268 AB - Objective The objective of this study was to investigate the potential effects of occupational exposures among fruit and vegetable market workers on the occurrence of respiratory symptoms and on the level of lung function parameters. Methods We conducted a cross-sectional study of 140 men working as fruit and vegetable market workers (response rate 100%) and a reference group of 77 male office workers as the reference group (response rate 55%) from Shiraz, Iran. The outcomes of interest included occurrence of respiratory symptoms assessed by a standard respiratory questionnaire and lung function assessed by spirometry. Results In Poisson regression analyses, the exposed group showed increased prevalence ratio (PR) of wheezing (adjusted PR 5.32, 95%?CI 1.40 to 20.26), after controlling for confounding. Cough (PR 3.30, 95%?CI 1.16 to 9.40) and wheezing (PR 9.40, 95%?CI 2.28 to 38.64) showed increased PRs among vegetable distributors. Forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity were significantly decreased among exposed workers after controlling for confounders. The absolute value of FEV1 level was reduced significantly among fruit and vegetable carters (-0.99, 95%?CI -1.68 to -0.32) and vegetable (-0.51, 95%?CI -0.93 to -0.10) and fruit (-0.51, 95%?CI -0.86 to -0.15) distributors in comparison with the reference group in the adjusted full model. Conclusions This study provides evidence that fruit and vegetable market workers are at an increased risk of respiratory symptoms and reduced lung function. Workplace conditions and safety training clearly need improvement, and there is a likely role for proper use of personal protective equipment. AU - Heibati B AU - Jaakkola MS AU - Lajunen TK AU - Ducatman A AU - Zafari Z AU - Yekkalam M AU - Karimi A AU - Jaakkola JJK LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 78 IP - DP - 2021 Jan 01 TI - Insufficient respiratory hazard identification in the safety data sheets for cleaning and disinfection products used in healthcare organisations across England and Wales. PG - 293-295 AB - BACKGROUND: Exposure to cleaning and disinfection products has been associated with respiratory disorders such as asthma in cleaning and healthcare workers. Safety data sheets (SDSs) provide information on hazardous chemicals that are present in products to help users with risk assessment and implement appropriate control measures. However, they have potential limitations in identifying respiratory hazards due to a lack of regulatory test methods for respiratory sensitisation and irritation of chemicals. METHODS: SDSs were first used to identify chemicals on the database as respiratory sensitisers and irritants. A quantitative structure-activity relationship (QSAR) model and an asthmagen list established by the Association of Occupational and Environmental Clinics (AOEC) were used to identify potential respiratory sensitisers and irritants (by the AOEC list only) in the cleaning and disinfection products. RESULTS: From a total of 459 cleaning and disinfection products used in healthcare organisations across England and Wales, 35 respiratory sensitisers not labelled as such on the SDS were identified by QSAR or AOEC. Only 2% of cleaning and disinfection products contained at least one respiratory sensitiser as identified by their SDSs; this was increased to 37.7% of products when the QSAR or the AOEC list was used. CONCLUSIONS: A significantly higher proportion of cleaning products contain respiratory hazardous chemicals, particularly respiratory sensitisers than would be expected from the information provided by SDSs alone. Cleaners and healthcare workers may, therefore, be insufficiently protected. AU - Lee S AU - Povey AC AU - Seed MJ AU - van Tongeren M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 78 IP - DP - 2021 Jan 01 TI - Exposure to additives or multigrain flour is associated with high risk of work-related allergic symptoms among bakers PG - 112-116 AB - Objectives Wheat flour exposure in bakers can elicit respiratory and skin symptoms. Scarce data are available on the prevalence of such conditions in bakers. We investigated the prevalence of work-related rhinitis, asthma-like symptoms and dermatitis in bakers according to job task and type of allergens involved. Methods Of the 229 traditional bakeries in Verona area who were invited to participate in a cross-sectional survey, 211 (92%) accepted; 727 employees in these bakeries answered a modified version of a questionnaire on job tasks; allergen exposure within the bakery; and work-related nasal, asthma-like and skin symptoms during 2010–2014. Determinants of work-related nasal, asthma-like or skin disorders were separately evaluated using different logistic models. Results The prevalence of work-related nasal and asthma-like symptoms was, respectively, 15.1% and 4.2% in bakery shop assistants, increasing to 25.7% and 9.5% in bakers using only wheat flour, and further to 31.8% and 13.6% in bakers using flour and additives, and then to 34.1% and 18.2% in bakers using flour with additives and multigrain (p<0.001). The risk of work-related asthma-like symptoms was more than doubled in bakers using additives without or with multigrain than in shop assistants (OR 2.3, 95%?CI 1.0 to 5.5 and OR 3.4, 95%?CI 1.1 to 10.8, respectively). Making bread with additives alone or with multigrain significantly increased the risk of work-related nasal symptoms in shop assistants, while the risk of skin symptoms was not significantly affected. Conclusions Bakers using additives alone or with multigrain are at a high risk of experiencing nasal and asthma-like symptoms. AU - Olivieri M AU - Murgia N AU - Spiteri G AU - Biscardo CA AU - Marchetti P AU - Folletti I AU - Verlato G LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 04 IP - DP - 2021 Jan 01 TI - Long-Term Follow-Up of Cluster-Based Diisocyanate Asthma Phenotypes PG - 040 AB - Objective To assess the impact of being part of a specific cluster at diagnosis on the long-term outcome of diisocyanate-induced OA. Methods We collected data from 56 patients who had a diagnosis of OA confirmed by a positive specific inhalation challenge. Patients sensitized to toluene diisocyanate were allocated to cluster 1 or 2 based on a tree analysis, using the 3 variables relevant for cluster segregation identified in a previous study: age, body mass index, and forced expiratory volume in 1 second/forced vital capacity at diagnosis. Patients sensitized to methylene diisocyanate were allocated to cluster 3, as in previous study. We defined OA remission when a patient had met a total of 3 criteria: no asthma symptoms and no antiasthma therapy for the last year, as well as having normal lung function. Results At follow-up, 16 patients showed OA remission. They exhibited better lung function, less bronchial hyperreactivity, as well as younger age at diagnosis. Twenty-eight patients were allocated to cluster 1, 10 to cluster 2, and 18 to cluster 3. The percentage of patients with OA remission was higher in cluster 2 (50% vs 25% in cluster 1 and 22.5% in cluster 3), although the difference was not statistically significant (P = .2789). Conclusions Age at diagnosis was a strong predictor of OA remission. The outcome of diisocyanate OA tended to be more favorable for patients with toluene diisocyanate OA allocated in cluster 2, but this finding needs to be validated by further data. AU - Mason P AU - Liviero F AU - Maestrelli P AU - Frigo AC LA - PT - DEP - TA - J Allergy Clin Immunol Pract JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - IP - DP - 2021 Jan 01 TI - Occupational asthma caused by quaternary ammonium compounds: A multicenter cohort study. PG - AB - BACKGROUND: Quaternary ammonium compounds (QACs) are used extensively for cleaning and disinfection and have been documented in scattered reports as a cause of occupational asthma (OA) through bronchoprovocation tests (BPT). OBJECTIVE: To examine the clinical, functional, and inflammatory profile of QAC-induced OA compared to OA caused by other low-molecular-weight (LMW) agents. METHODS: The study was conducted in a retrospective multicenter cohort of 871 subjects with OA ascertained by a positive BPT. Subjects with QAC-induced OA (n=22) were identified based on a positive BPT to QACs, after exclusion of those challenged with cleaning products or disinfectants that contained other potential respiratory sensitizers, and they were compared to 289 subjects with OA caused by other LMW agents. RESULTS: Most subjects with QAC-induced OA were working in the healthcare sector (n=14). A =2-fold increase in the postchallenge level of nonspecific bronchial hyperresponsiveness was recorded in 8 of 11 (72.7%) subjects with QAC-induced OA, and in 49.7% of those with OA due to other LMW agents. Although sputum assessment was available in only 8 subjects with QAC-induced OA, they showed a significantly greater median (interquartile) increase in sputum eosinophils (18.1% [12.1 to 21.1]) compared to those with OA due to other LMW agents (2.0% [0 to 5.2], P< 0.001). CONCLUSION: This study indicates that QAC-induced OA is associated with a highly eosinophilic pattern of airway response and provides further evidence supporting the sensitizing potential of QACs. The findings highlight the heterogeneous nature of the pathobiological pathways involved in OA caused by LMW agents. AU - Migueres N AU - Debaille C AU - Walusiak-Skorupa J AU - Lipinska-Ojrzanowska A AU - Munoz X AU - van Kampen V AU - Suojalehto H AU - Suuronen K AU - Seed M AU - Lee S AU - Rifflart C AU - Godet J AU - de Blay F AU - Vandenplas O LA - PT - DEP - TA - J Allergy Clin Immunol Pract. JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - IP - DP - 2021 Jan 01 TI - A quantitative analysis of surgical smoke exposure as an occupational hazard. PG - AB - OBJECTIVE: We hypothesized that operating room (OR) airborne particulate matter (PM) was different in quantity and mutagenic potential than office air and cigarette smoke. SUMMARY BACKGROUND DATA: Exposure to surgical smoke has been equated to cigarette smoking and thought to be hazardous to health care workers despite limited data. METHODS: PM was measured during 15 operations in ORs with 24.8?±?2.0 air changes/hour, and in controls (cigarettes, office air with 1.9-2.9 air changes/hour). Mutagenic potential was assessed by ?H2AX staining of DNA damage in small airway epithelial cells co-cultured with PM. RESULTS: Average PM concentration during surgery was 0.002?±?0.002?mg/m3 with maximum values at 1.08?±?1.30?mg/m3. Greater PM correlated with more diathermy (? = 0.69, p = 0.006). Values were most often near zero, resulting in OR average values similar to office air (0.002?±?0.001?mg/m3) (p = 0.32). Cigarette smoke average PM concentration was significantly higher, 4.8?±?5.6?mg/m3 (p < 0.001). PM collected from 14 days of OR air caused DNA damage to 1.6?±?2.7% of cultured cells, significantly less than that from office air (27.7?±?11.7%, p = 0.02), and cigarette smoke (61.3?±?14.3%, p < 0.001). CONCLUSIONS: The air we breathe during surgery has negligible quantities of PM and mutagenic potential, likely due to low frequency of diathermy use coupled with high airflow. This suggests that exposure to surgical smoke is associated with minimal occupational risk. AU - Stewart CL AU - Raoof M AU - Lingeman R AU - Malkas L AU - Flores V AU - Caldwell K AU - Fong Y AU - Melstrom K LA - PT - DEP - TA - Ann Surg. JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 184 IP - DP - 2021 Jan 01 TI - Exposures and associations with clinical phenotypes in hypersensitivity pneumonitis: A scoping review, PG - AB - Antigen identification is important for establishing a confident diagnosis of hypersensitivity pneumonitis (HP). There are no systematically curated lists of HP-associated exposures that inform clinical relevance or disease phenotype. We sought to systematically identify all reported causes of HP in the literature and evaluate their clinical relevance. A scoping review was performed to identify all publications describing HP cases and their associated exposures (even if unknown) from Jan 1990–June 2020. Frequencies of exposures and meta-analysis of proportions for registry-based studies were determined for specific exposure categories, and associations with fibrotic and non-fibrotic HP were assessed. 24,138 publications were identified, with 967 publications included in the final analysis, representing 62 unique exposures associated with HP. Certain exposures were more frequently reported than others, including birds (comprising 32% of HP cases in registry-based studies) and mould (17% registry study HP cases). Antigen-indeterminate HP comprised 15–24% of registry-based studies. Limited data found contaminated metal-working fluids, isocyanate exposure, and hot tub lung were rarely associated with fibrotic features, whereas antigen-indeterminate HP cases were more frequently associated with fibrosis. There was heterogeneity in HP case definition and how causative exposures were identified. We identified 62 unique exposures associated with HP, with specific exposures associated with clinical phenotypes. These data may inform clinical assessment and the development of questionnaires to identify antigens in the diagnostic evaluation of suspected HP. Open sciences framework registration osf.io/4aq5m. AU - Barnes H AU - Lu J AU - Glaspole I AU - Collard HR AU - Johannson KA LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - IP - DP - 2021 Jan 01 TI - A case of lipoid pneumonia associated with occupational exposure to solvents in a dry-cleaning worke PG - AB - Lipoid pneumonia can develop from exposure to different types of oil, but occupational exposure is rare. A 58-year-old woman was referred to our hospital for patchy airspace opacities in the lungs with lower lobe predominance on chest computed tomography. She was diagnosed with non-Hodgkin's lymphoma seven years ago, but was in complete remission. She had mild cough and sputum, but no history of taking any lipid-containing agents. The bronchoalveolar lavage fluid revealed lipid-laden macrophages with Oil Red O staining, which led to the suspicion of lipoid pneumonia. Re-evaluation of her personal history revealed that she was a dry-cleaning worker who worked with organic solvent sprayers. Her condition was successfully managed with corticosteroids and avoidance of further occupational exposure to the substance. This rare case of occupational exogenous lipoid pneumonia in a dry-cleaning worker suggests the importance of considering a patient's occupational history during diagnosis. worked with hydrocarbon-based solvent sprayers to remove dirt stains from clothes before putting them in a dry-cleaning machine daily for several years AU - Park S AU - Park JE AU - Lee J LA - PT - DEP - TA - Respirology Case Reports JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 22 IP - DP - 2021 Jan 01 TI - Acute exacerbation of fibrotic hypersensitivity pneumonitis: incidence and outcomes PG - 152 AB - Background Patients with fibrotic hypersensitivity pneumonitis (HP) show variable clinical courses, and some experience rapid deterioration (RD), including acute exacerbation (AE). However, little is known about AE in fibrotic HP. Here, we retrospectively examined the incidence, risk factors, and outcomes of AE in fibrotic HP. Methods The incidence rates of AE were calculated in 101 patients with biopsy-proven HP. AE was defined as the worsening of dyspnoea within 30 days, with new bilateral lung infiltration and no evidence of infection or other causes of dyspnoea. Results During follow-up (median: 30 months), 18 (17.8%) patients experienced AE. The 1, 3, and 5 year incidence rates of AE were 6.0, 13.6, and 22.8%, respectively. Lower diffusing capacity of the lung for carbon monoxide (DLCO) and a radiologic usual interstitial pneumonia (UIP)-like pattern were risk factors for AE. In-hospital mortality after AE was 44.4%. Median survival from diagnosis was significantly shorter in patients with AE (26.0 months) than in those with no-AE RD (55.0 months; p?=?0.008) or no RD (not reached; p?<?0.001). AE remained a significant predictor of all-cause mortality (hazard ratio, 8.641; 95% confidence interval, 3.388–22.040; p?<?0.001) after adjustment for age, body mass index, lung function, lymphocyte levels in bronchoalveolar lavage fluid, and the presence of a UIP-like pattern. Conclusions AE was not uncommon among patients with fibrotic HP and significantly affected prognosis. A lower DLCO value and radiologic UIP-like pattern at diagnosis were associated with the development AE in patients with fibrotic HP. AU - Kang J AU - Kim YJ AU - Choe J AU - Chae EJ AU - Song JW LA - PT - DEP - TA - Respiratory Research JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 63 IP - DP - 2021 Jan 01 TI - Lung disorders induced by respirable organic chemicals PG - e12240 AB - Respirable organic chemicals were originally thought to cause allergic respiratory diseases, such as bronchial asthma and hypersensitivity pneumonitis, and believed not to cause lung disorders derived from inflammatory or fibrotic processes such as pulmonary fibrosis and interstitial pneumonitis. It has recently been reported, however, that exposure to organic chemicals can cause interstitial lung diseases. In this review, we discuss the clinical features of occupational asthma and hypersensitivity pneumonitis, as well as other lung disorders, including interstitial pneumonitis, caused by humidifier disinfectants in Korea and by a cross-linked acrylic acid-based polymer (CL-PAA) in Japan AU - Morimoto Y AU - Nishida C AU - Tomonaga T AU - Izumi H AU - Yatera K AU - Sakurai K AU - Kim Y LA - PT - DEP - TA - J Occup Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 85 IP - DP - 2021 Jan 01 TI - Clinical Manifestations and Patch test Results for Facial Dermatitis Associated with use of Disposable Face Masks during the COVID-19 Outbreak : A case-control study PG - 719-721 AB - Here, we did an observational study to investigate the clinical manifestation and patch test results of patients with facial dermatitis induced by wearing of disposable masks. Korean patients over age 18 with facial dermatitis diagnosed by dermatologists at the Department of Dermatology, Kangnam Sacred Heart Hospital after the outbreak of COVID-19 between January 2020 and July 2020 were included. Clinically, 27 patients whose lesions and symptoms worsened after wearing a mask were set as the mask group, and 70 patients who developed facial dermatitis due to other causes were set as the control group. We recruited and distinguished both groups by questionnaire. Demographic features, clinical manifestations, objective bioengineering measurements (Transepidermal water loss [TEWL] and stratum corneum [SC] hydration), and patch test (Korean standard series) results were analyzed in this study. Among the patients in the mask group, the mean duration of diseases was 6.24 months, while the duration in the control group was 22.87 months (Table I). The distribution of skin lesions was similar in both groups except for the chin area where skin lesions were more frequently observed in the mask group (14.81% [4/27]). Erythema and papules were the most common characteristics of the skin lesions in both groups, however, hyperkeratosis (22.22%, [6/27]) and xerosis (11.11%, [3/27]) were significantly more frequent in the mask group. In patch test results, the mask patch tested positive more frequently to potassium dichromate (25.92%, [7/27]) and 4-tert-butylphenol-formaldehyde resin (PTBP) (14.81%, [4/27]) (Table ll). Positive reactions to N-Isopropyl-N-phenyl-4-phenylenediamine (IPPD) (7.40% [2/27]), formaldehyde 4 (11.11%, [3/27]), and thimerosal (14.81%, [4/27]) were more common in the mask group, but the difference was not statistically significant. Interestingly, these substances are known components of disposable facial masks. In addition, 11 patients in the control group (15.71% [11/70]) had negative reactions to all the items in the patch tests, while only one patient in the mask group did (3.70%, [1/27]). These results would infer that the chemical components of disposable masks and residues of disinfectants or cosmetics can cause allergic and irritant reactions. Further, given the occlusive, humid environment within a facial mask, it can be assumed that these substances could more easily penetrate the skin and cause facial dermatitis. After the COVID-19 pandemic, our living and medical environments have significantly changed and so have the frequency and types of exposure to allergens. Consequently, patch tests are essential for determining the correct diagnosis in patients with facial dermatitis. Our study could be a useful index for determining the causative allergens in patients with facial dermatitis induced by disposable masks. AU - Kang SY AU - Chung BY AU - Kim JC AU - Park CW AU - Kim HO LA - PT - DEP - TA - Journal of the American Academy of Dermatology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 78 IP - DP - 2021 Jan 01 TI - Occupation and subcategories of asthma: a population-based incident case–control study PG - 661-668 AB - Background We hypothesised that occupational exposures differently affect subtypes of adult-onset asthma. Objective We investigated potential relations between occupation and three subtypes of adult asthma, namely atopic asthma, non-atopic asthma and asthma–COPD overlap syndrome (ACOS). Methods This is a population-based case–control study of incident asthma among working-age adults living in Pirkanmaa Hospital District in Southern Finland. The determinant of interest was occupation at the time of diagnosis of asthma or the job that the subject had quit due to respiratory symptoms. Asthma was divided into three mutually exclusive subtypes on the basis of any positive IgE antibody (atopic and non-atopic asthma) and presence of persistent airways obstruction in spirometry (ACOS). We applied unconditional logistic regression analysis to estimate adjusted OR (aOR), taking into account gender, age and smoking. Results The following occupational groups showed significantly increased risk of atopic asthma: chemical industry workers (aOR 15.76, 95%?CI 2.64 to 94.12), bakers and food processors (aOR 4.69, 95%?CI 1.18 to 18.69), waiters (aOR 4.67, 95%?CI 1.40 to 15.56) and those unemployed (aOR 3.06, 95%?CI 1.52 to 6.17). The following occupations showed clearly increased risk of non-atopic asthma: metal workers (aOR 8.37, 95%?CI 3.77 to 18.59) and farmers and other agricultural workers (aOR 2.36, 95%?CI 1.10 to 5.06). Some occupational groups showed statistically significantly increased OR of ACOS: electrical and electronic production workers (aOR 30.6, 95%?CI 6.10 to 153.35), fur and leather workers (aOR 16.41, 95%?CI 1.25 to 215.85) and those retired (aOR 5.55, 95%?CI 1.63 to 18.97). Conclusions Our results show that different occupations are associated with different subtypes of adult-onset asthma. AU - Jaakkola MS AU - Lajunen TK AU - Heibati B AU - Wang Y AU - Lai C AU - Jaakkola JJK LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 148 IP - DP - 2021 Jan 01 TI - Endotyping asthma related to three different work exposures PG - 1070-1080 AB - Background Work exposures play a significant role in adult-onset asthma, but mechanisms of work-related asthma are not fully elucidated. Objective We aimed to reveal the molecular mechanisms of work-related asthma associated with flour (FA), isocyanate (IA) or welding fume (WA) exposures and identify potential biomarkers that distinguish these groups from each other. Methods We used a combination of clinical tests, transcriptomic analysis and associated pathway analyses to investigate underlying disease mechanisms of the blood immune cells and the airway epithelium of 61 men. Results Compared to the healthy controls, the WA patients had more differentially expressed genes than the FA and IA patients both in the airway epithelia and in the blood immune cells. In the airway epithelia, active inflammation was detected only in WA patients. In contrast, large number of differentially expressed genes were detected in all asthma groups in blood cells. Disease-related immune functions in blood cells were suppressed in all the asthma groups including leukocyte migration and inflammatory responses and decreased expression of upstream cytokines such as TNF and IFN?. In transcriptome-phenotype correlations, hyperresponsiveness (R~|0.6|) had the highest clinical relevance and associated with a set of exposure-group specific genes. Finally, biomarker subsets of only 5 genes specifically distinguished each of the asthma exposure group. Conclusions This study provides novel data on the molecular mechanisms underlying work-related asthma. We identified set of 5 promising biomarkers in asthma related to flour, isocyanate and welding exposure to be tested and clinically validated in future studies. AU - Suojalehto H AU - Ndika J AU - Lindström I AU - Airaksinen L AU - Karisola P AU - Alenius H LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 22 IP - DP - 2021 Jan 01 TI - Associations between occupational and environmental exposures and organ involvement in sarcoidosis: a retrospective case-case analysis PG - 224 AB - Background Sarcoidosis most commonly affects lungs and intrathoracic lymph nodes, but any other organ can be involved. In epidemiological studies, many occupational and environmental exposures have been linked to sarcoidosis but their relationship with the disease phenotype has barely been studied. Objective To investigate how occupational and environmental exposures prior to diagnosis relate to organ involvement in patients with sarcoidosis Methods We retrospectively studied patients seen at a sarcoidosis clinic between 2017 and 2020. Patients were included if they had a clinical presentation consistent with sarcoidosis and histologically confirmed epithelioid granulomas or had Löfgren syndrome. In a case–case analysis using multivariable logistic regression we calculated odds ratios (OR) of prespecified exposure categories (based on expert ascertainment) for cases with a given organ involvement versus cases without this organ involvement. Results We included 238 sarcoidosis patients. Sarcoidosis limited to pulmonary involvement was associated with exposure to inorganic dust prior to diagnosis (OR 2.11; 95% confidence interval [CI] 1.11–4.17). Patients with liver involvement had higher odds of contact with livestock (OR 3.68; 95% CI 0.91–12.7) or having jobs with close human contact (OR 4.33; 95% CI 1.57–11.3) than patients without liver involvement. Similar associations were found for splenic involvement (livestock: OR 4.94, 95% CI 1.46–16.1; close human contact: OR 3.78; 95% CI 1.47–9.46). Cardiac sarcoidosis was associated with exposure to reactive chemicals (OR 5.08; 95% CI 1.28–19.2) or livestock (OR 9.86; 95% CI 1.95–49.0). Active smokers had more ocular sarcoidosis (OR 3.26; 95% CI 1.33–7.79). Conclusions Our study indicates that, in sarcoidosis patients, different exposures might be related to different organ involvements—hereby providing support for the hypothesis that sarcoidosis has more than one cause, each of which may promote a different disease phenotype. AU - Ronsmans S AU - Ridder JD AU - Vandebroek E AU - Keirsbilck S AU - Nemery B AU - Hoet PHM AU - Vanderschueren S AU - Wuyts WA AU - Yserbyt J LA - PT - DEP - TA - Respiratory Research JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 160 IP - DP - 2021 Jan 01 TI - Diagnosis and Evaluation of Hypersensitivity Pneumonitis: CHEST Guideline and Expert Panel Report PG - 595-615 AB - Summary of Recommendations 1. In patients with suspected hypersensitivity pneumonitis (HP), we suggest gathering a thorough clinical history of exposures focused on establishing the type, extent, and temporal relationship of exposure(s) to symptoms (Ungraded Consensus-Based Statement). Remarks: Accurate and timely HP diagnosis relies on gathering and integrating a detailed and comprehensive exposure history. Although an important factor in reducing diagnostic uncertainty is the identification of a compelling exposure, an unrevealing exposure history does not exclude HP. If the exposure history is unclear, the process of exposure history gathering, integration, and interpretation of possible exposure data should continue until an HP diagnosis or its exclusion is more certain. All patients should complete a comprehensive environmental and occupational questionnaire tailored to the geographic region. Remarks: During the diagnostic workup of a patient with suspected HP, interpretation of a positive or negative diagnostic test is dependent upon the presence or absence of an identifiable exposure and disease prevalence (pretest probability). 2. In patients with suspected HP, if the inciting antigen (IA) is thought to be related to an occupational exposure, we suggest considering the inclusion of an occupational medicine specialist and an environmental hygienist during the multidisciplinary diagnostic workup, especially when the source of exposure is obscure or unverified (Ungraded Consensus-Based Statement). 3. In patients with suspected HP, we suggest classifying patients based on the likelihood of an occupational or environmental inciting antigen exposure (Weak Recommendation, Very Low-Quality Evidence). Remarks: Correct identification of the IA and the subsequent elimination of that exposure facilitates the management and helps determine the prognosis of HP. Unless a thorough exposure history is performed, the IA may go unrecognized with resultant ongoing exposure possibly adversely impacting disease progression and survival. In some scenarios, the disease may flare or continue to progress despite apparent remediation of the suspected exposure(s). This suggests that other factors may be associated with disease progression, and/or that other exposure(s) may be contributing. Remarks: Given the prognostic importance of antigen identification and avoidance, surveillance for exposure and patient education focused on antigen avoidance at every visit is the highest priority. This is particularly important for those unwilling to remove the antigen source despite the negative clinical consequences, patients with disease progression despite pharmacological or environmental management, those with a recurrence of symptoms after an initial appropriate response, in cases of disease clustering (e.g., multiple cases identified in one geographic area), and when symptoms are attributed to an occupational or suspected but unverified exposure. While the prognostic implications of a suspected but unverified exposure remain unclear, additional investigative strategies to identify a potential exposure (e.g., workplace inspection) may support the diagnosis and help guide management decisions. 4. For patients with either newly diagnosed or a working diagnosis of HP, we suggest classifying the disease as fibrotic or nonfibrotic based on the presence or absence of fibrosis on high-resolution computed tomography (HRCT) of the chest (Weak Recommendation, Very Low-Quality Evidence). Remarks: HRCT findings indicative of lung fibrosis include one or more of the following: reticular abnormality or ground-glass opacity associated with traction bronchiectasis, honeycombing, and loss of lobar volume. Remarks: Several studies demonstrate that the presence or absence of lung fibrosis provides important prognostic information. Further, as chronic HP does not always follow acute disease and only a subgroup of HP patients with chronic disease will develop lung fibrosis, a time-based classification scheme (eg, acute, subacute, chronic) is inferior to the identification of the presence or absence of fibrosis as a prognostic marker. Furthermore, in addition to prognosis, both fibrosis and antigen characterization have important diagnostic and treatment implications. 5. In patients with suspected HP, if an IA exposure is identified and then completely avoided, we suggest using clinical improvement with antigen avoidance to support the diagnosis of HP, but not relying solely on the lack of clinical improvement with antigen avoidance to rule out the diagnosis of HP (Weak Recommendation, Very Low-Quality Evidence). Remarks: Clinically appreciable improvement in symptomatic, physiologic, and radiographic features may be seen only in patients with non-fibrotic HP. Measurable clinical improvement may not occur if the remediated antigen is not causative, if there are multiple exposures causing disease, if complete avoidance cannot be achieved, or in subjects with severe or progressive pulmonary fibrosis. Moreover, in a significant proportion of patients with fibrotic HP, an antigen will not be identified. Therefore, clinical improvement with antigen avoidance may support the diagnosis of HP, but the absence of clinical improvement does not rule it out. 6. For patients with suspected HP, we suggest not relying solely on clinical improvement with medical therapy to confirm a diagnosis of HP or on the lack of clinical improvement with medical therapy alone to rule out the diagnosis of HP (Weak Recommendation, Very Low-Quality Evidence). Remarks: Clinical improvement refers to improvement in physiologic and radiologic features. Failure to respond to medical treatment (eg, systemic corticosteroids) alone does not necessarily exclude the diagnosis of HP as the response rate to medical therapy can be highly variable. For example, clinical improvement with medical treatment appears to occur frequently in nonfibrotic HP, while the lack of clinical improvement, regardless of therapy, is common in fibrotic HP. Clinical improvement with medical therapy supports but does not confirm the diagnosis of HP as other interstitial lung diseases with similar presentations, such as idiopathic NSIP, may also improve with immunosuppressive treatment. 7. For patients with suspected HP, we suggest not relying solely on serum antigen-specific immunoglobulin G (IgG) or immunoglobulin A (IgA) testing to confirm or rule out the diagnosis of HP (Weak Recommendation, Very Low-Quality Evidence). Remarks: Major limitations to the diagnostic utility of serum antigen-specific IgG/IgA testing in HP are the lack of standardized antigen preparations for most IAs, the lack of standardized immunoassays techniques, variable diagnostic cutoff thresholds for quantitative IgG assays, and validation of serum antigen-specific IgG test performance in limited population settings. Remarks: When there is a questionable exposure based on the history (eg, indoor musty odor but no visible mold or the occasional exposure to mold with the significance of exposure uncertain), the detection of serum antigen-specific IgG/IgA may suggest a putative exposure and in the setting of other supporting diagnostic tests (eg, typical HRCT) or environmental assessment data (eg, indoor visual inspection, surface sampling, and culture), may raise the likelihood of HP. However, there is a lack of data consistently supporting the test as a reproducible and accurate diagnostic tool. 8. For patients with suspected HP, we suggest not performing antigen-specific inhalation challenge testing to support the diagnosis of HP (Weak Recommendation, Very Low-Quality Evidence). Remarks: Major limitations to the diagnostic utility of antigen-specific inhalation challenge testing in HP are the lack of standardized and validated antigen preparations for most IAs, the lack of standardized challenge techniques (eg, challenge chamber, nebulization of suspected IA), and the absence of validated criteria for defining a positive response. Also, there is limited world-wide availability of appropriate facilities to perform the test and absence of studies evaluating the additional value of antigen-specific inhalation challenge in modifying the likelihood of suspected HP (eg, unidentified IA) during the multidisciplinary diagnostic process. 9. For patients with suspected HP, we suggest not performing antigen-specific lymphocyte proliferation testing to support the diagnosis of HP (Weak Recommendation, Very Low-Quality Evidence). Remarks: Major limitations to the diagnostic utility of antigen-specific lymphocyte proliferation testing in HP include: the lack of standardized and validated antigen preparations for most IAs, the lack of standardized lymphocyte proliferation techniques, absence of validated criteria for defining a positive response, and the absence of studies evaluating the additional value of antigen-specific lymphocyte proliferation testing in modifying the likelihood of HP during the diagnostic process. 10. For patients with suspected HP, we suggest the integration of HRCT findings characteristic of HP with clinical findings to support the diagnosis of HP, but not using the CT findings in isolation to make a definite diagnosis (Weak Recommendation, Very Low-Quality Evidence). Remarks: High-resolution CT findings characteristic of HP include profuse centrilobular nodules of ground glass attenuation, inspiratory mosaic attenuation and air-trapping, and the three-density sign. Remarks: Assessment of the overall probability of HP should consider the prevalence of the disease in the particular setting (eg, referral center or primary care clinic, farming region), the clinical context, the exposure history, and the information contributed by the HRCT. 11. For patients with suspected HP, we suggest using a multidisciplinary discussion (MDD) for diagnostic decision-making (Weak Recommendation, Very Low-Quality Evidence). Remarks: If a high confidence diagnosis cannot be established by combining the history and clinical context, consider case discussion in the setting of an MDD. Remarks: The inter-observer agreement for HP diagnosis between MDD and individual clinicians for typical HP cases (respiratory symptoms, known temporal relationship with a specific IA exposure, characteristic CT chest and histopathological findings) is unknown. However, in uncertain cases, MDD may increase diagnostic confidence and/or guide the appropriate use of subsequent tests such as bronchoscopy or surgical lung biopsy (SLB). 12. For patients with suspected HP who have a compelling exposure history within the appropriate clinical context and a chest HRCT pattern typical for HP, we suggest not routinely using BAL fluid analysis to confirm a diagnosis of HP (Weak Recommendation, Very Low-Quality Evidence). Remarks: BAL fluid analysis can narrow the differential diagnosis by excluding competing causes, particularly in nonfibrotic HP (eg, infection). However, in patients with a high pretest probability of HP, the BAL cellular differential generally does not significantly alter the post-test probability and as a result adds little additional diagnostic information. In the appropriate clinical context, a history of clinically relevant exposure to a compelling IA with a typical high-resolution CT pattern allows for a confident diagnosis of HP. Remarks: Lymphocytic alveolitis is not consistently present in patients with fibrotic HP and BAL fluid lymphocytosis is not sufficiently sensitive or specific to rule in or rule out the diagnosis of fibrotic HP. However, BAL fluid lymphocytosis may increase diagnostic confidence when the IA is identified and HRCT findings are compatible with HP. It may also increase diagnostic confidence and should be considered when the exposure history and imaging data are discordant (eg, unidentified exposure and typical CT for HP-provisional diagnosis), and may exclude common alternative diagnoses, such as IPF, when the lymphocyte differential count is high (eg, =40%). 13. In patients with suspected HP, we suggest considering histological lung biopsy for additional diagnostic evaluation when all available data such as clinical, laboratory and radiologic findings along with bronchoscopic results do not yield a confident diagnosis and results may help guide management (Weak Recommendation, Very Low-Quality Evidence). Remarks: When possible, a consensus MDD should be considered before an SLB or TBC. SLB, TBC, and transbronchial biopsies (TBBs) have different diagnostic yields and benefit-risk profiles. The harm from the procedure must be weighed against the potentially useful information that can be gained, particularly in suspected non-fibrotic or advanced fibrotic HP cases. Remarks: Some patients with fibrotic HP may show histopathologic findings of nonspecific interstitial pneumonia or usual interstitial pneumonia (UIP) pattern. Samples should be carefully examined for findings consistent with HP (eg, poorly formed non-necrotizing granulomas and/or multinucleated giant cells and fibrotic bronchiolocentric accentuation). Thus, when lung biopsy is performed, the histopathological information requires multidisciplinary reconciliation with the clinical and radiological information. 14. For patients with suspected HP, we suggest integrating biopsy findings with clinical and radiological findings to support the diagnosis of HP in the context of the MDD (Weak Recommendation, Very Low-Quality Evidence). Remarks: Pathologic findings characteristic of HP typically include a combination of cellular and/or fibrosing interstitial pneumonia with bronchiolocentric accentuation, poorly formed non-necrotizing granulomas with or without giant cells, with or without peribronchiolar metaplasia, and/or small foci of organizing pneumonia. Isolated histopathological findings such as non-necrotizing granulomas or inconspicuous foci of organizing pneumonia can occasionally be seen in other ILDs and are not specific enough for a diagnosis of HP. Potential limitations of lung biopsy include interobserver variation in the pathologic interpretation, biopsy size and number of specimens affecting the diagnostic yield of the biopsy procedure, sampling error, and the occasional presence of atypical findings such as NSIP or UIP-like patterns. Biopsy findings of HP or occasional isolated atypical patterns produced by HP require MDD to confirm the diagnosis. AU - Pérez ERF AU - Travis WD AU - Lynch DA AU - Brown KK AU - Johannson KA AU - Selman M AU - Ryu JH AU - Wells AU AU - Huang YT AU - Pereira CAC AU - Scholand M AU - Villar A AU - Inase N AU - Evans RB AU - Mette SA AU - Frazer-Green L LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - IP - DP - 2021 Jan 01 TI - Household cleaning and poor asthma control among elderly women. PG - AB - BACKGROUND: Asthma control is suboptimal in nearly half of adults with asthma. Household exposure to disinfectants and cleaning products (DCP) has been associated with adverse respiratory effects, but data on their association with asthma control are scant. OBJECTIVES: To investigate the association between household use of DCP and asthma control in a large cohort of French elderly women. METHODS: We used data from a case-control study on asthma (2011-2013) nested in the E3N cohort. Among 3,023 women with current asthma, asthma control was defined by the Asthma Control Test (ACT). We used a standardized questionnaire to assess the frequency of cleaning tasks and DCP use. We also identified household cleaning patterns using a clustering approach. Associations between DCP and ACT were adjusted for age, smoking status, body mass index and education. RESULTS: Data on ACT and DCP use were available for 2,223 women (70±6 years old). Asthma was controlled (ACT=25), partly controlled (ACT=20-24) and poorly controlled (ACT=19) in 29%, 46% and 25% of the participants, respectively. Weekly use of sprays and chemicals were associated with poorly controlled asthma (odds ratio [95%CI]: 1 spray: 1.31 [0.94-1.84], =2 sprays: 1.65 [1.07-2.53], P-trend: 0.01; 1 chemical: 1.24 [0.94-1.64], =2 chemicals: 1.47 [1.03-2.09], P-trend: 0.02). Risk for poor asthma control increased with the patterns "very frequent use of products" (1.74 [1.13-2.70]) and "infrequent cleaning tasks and intermediate use of products" (1.62 [1.05-2.51]). CONCLUSION: Regular use of DCP may contribute to poor asthma control in elderly women. Limiting their use may help improve asthma management. AU - OrianneDumas AU - Bédard A AU - Marbac M AU - Sedk M AU - SofiaTemam AU - Chanoine S AU - Severi G AU - Boutron-Ruault M AU - Garcia-Aymerich J AU - Siroux V AU - Varraso R AU - Moual NL LA - PT - DEP - TA - J Allergy Clin Immunol Pract JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 18 IP - DP - 2021 Jan 01 TI - Pulmonary Function Testing in Work-Related Asthma: An Overview from Spirometry to Specific Inhalation Challenge PG - 2325 AB - Work-related asthma (WRA) is a very frequent condition in the occupational setting, and refers either to asthma induced (occupational asthma, OA) or worsened (work-exacerbated asthma, WEA) by exposure to allergens (or other sensitizing agents) or to irritant agents at work. Diagnosis of WRA is frequently missed and should take into account clinical features and objective evaluation of lung function. The aim of this overview on pulmonary function testing in the field of WRA is to summarize the different available tests that should be considered in order to accurately diagnose WRA. When WRA is suspected, initial assessment should be carried out with spirometry and bronchodilator responsiveness testing coupled with first-step bronchial provocation testing to assess non-specific bronchial hyper-responsiveness (NSBHR). Further investigations should then refer to specialists with specific functional respiratory tests aiming to consolidate WRA diagnosis and helping to differentiate OA from WEA. Serial peak expiratory flow (PEF) with calculation of the occupation asthma system (OASYS) score as well as serial NSBHR challenge during the working period compared to the off work period are highly informative in the management of WRA. Finally, specific inhalation challenge (SIC) is considered as the reference standard and represents the best way to confirm the specific cause of WRA. Overall, clinicians should be aware that all pulmonary function tests should be standardized in accordance with current guidelines. AU - Poussel M AU - Thaon I AU - Penven E AU - Tiotiu AI LA - PT - DEP - TA - Int. J. Environ. Res. Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 159 IP - DP - 2021 Jan 01 TI - A Cluster of Beryllium Sensitization Traced to the Presence of Beryllium in Concrete Dust PG - 1084-1093 AB - Background Chronic beryllium disease (CBD), a granulomatous disease with similarities to sarcoidosis, arises only in individuals exposed to beryllium. Inhaled beryllium can elicit a T-cell-dominated alveolitis leading nonnecrotizing granulomata. CBD can be distinguished from sarcoidosis by demonstrating beryllium sensitization in a lymphocyte proliferation test. Research Question Beryllium exposure usually occurs in an occupational setting. Because of the diagnosis of CBD in a patient without evident beryllium exposure, we performed a beryllium-lymphocyte proliferation test (BeLPT) among his work colleagues. Study Design and Methods This field study investigated a cohort of work colleagues without obvious beryllium exposure. Twenty-one of 30 individuals were assessed in our outpatient clinic for beryllium sensitization. Therefore, BeLPT was performed with freshly collected peripheral blood mononuclear cells. Data were extracted from clinical charts, including geographical data. Beryllium content in dust samples collected at the workplace was measured by graphite-furnace atomic absorption spectroscopy and was compared with samples from different areas of Germany. Results For the initial patient, the diagnosis of sarcoidosis was reclassified as CBD based on two positive BeLPT results. Assessment of his workplace did not identify a source of beryllium. However, BeLPTs performed on his workmates demonstrated beryllium sensitization in 5 of 21 individuals, suggesting a local beryllium source. Concrete dust obtained from the building yard, the workplace of the index patient, contained high amounts of beryllium (1138 ± 162 µg/kg), whereas dust from other localities (control samples) showed much lower beryllium content (range, 147 ± 18-452 ± 206 µg/kg). Notably, the control dust collected from different places all over Germany exhibit different beryllium concentrations. Interpretation We describe a cluster of beryllium-sensitized workers from an industry not related to beryllium caused by environmental exposure to beryllium-containing concrete dust, which exhibited markedly elevated beryllium content. Importantly, analyses of dust samples collected from different localities showed that they contain markedly different amounts of beryllium. Thus, besides workplace-related exposure, environmental factors also are capable of eliciting a beryllium sensitization. AU - Frye BC AU - Quartucci MC AU - Rakete MS AU - Grubanovic PA AU - Höhne MK AU - Mangold PF AU - Gieré MR AU - Müller-Quernheim PJ AU - Zissel MG AU - PhD LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 12;100(10) IP - DP - 2021 Jan 01 TI - Waterproofing spray-associated pneumonitis review: Comparison with acute eosinophilic pneumonia and hypersensitivity pneumonitis PG - :e25054 AB - Waterproofing spray-associated pneumonitis (WAP) proceeds to acute respiratory failure and is characterized by diffuse bilateral ground-glass opacities on computed tomography; however, the detailed characteristics of WAP are unknown. Therefore, this study identified the characteristics of WAP from comparisons with those of acute eosinophilic pneumonia (AEP) and hypersensitivity pneumonitis (HP), which show similar features to WAP.Adult patients with WAP, AEP, and HP treated in Fukujuji Hospital from 1990 to 2018 were retrospectively enrolled. Furthermore, data from patients with WAP were collected from publications in PubMed and the Japan Medical Abstracts Society and combined with data from our patients.Thirty-three patients with WAP, eleven patients with AEP, and thirty patients with HP were reviewed. Regarding age, sex, smoking habit, and laboratory findings (white blood cell count, C-reactive protein level, and serum Krebs von den Lungen-6 level), WAP and AEP were not significantly different, while WAP and HP were significantly different. The duration from symptom appearance to hospital visit was shorter in patients with WAP (median 1 day) than in patients with AEP (median 3 days, P = .006) or HP (median 30 days, P < .001). The dominant cells in the bronchoalveolar lavage fluid of patients with WAP, AEP, and HP were different (macrophages, eosinophils, and lymphocytes, respectively).The characteristic features of WAP were rapid disease progression and macrophage dominance in the bronchoalveolar lavage fluid, and these characteristics can be used to distinguish among WAP, AEP, and HP. AU - ShimodaMorimoto M AU - Yano R AU - Kokutou H AU - Yoshimori K AU - Ohta K AU - Tanaka Y AU - Fujiwara K AU - Furuuchi K AU - Osawa T AU - Kozo LA - PT - DEP - TA - Review Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - 78 IP - DP - 2021 Jan 01 TI - Occupations and exposure events in acute and subacute irritant-induced asthma PG - 793-800 AB - Background Exposures leading to irritant-induced asthma (IIA) are poorly documented. Methods We retrospectively screened the medical records of patients with IIA diagnosed in an occupational medicine clinic during 2000–2018. We classified the cases into acute (onset after single exposure) and subacute (onset after multiple exposures) IIA. We analysed in detail, occupations, causative agents and their air levels in the workplace, exposure events and the root causes of high exposure. Results Altogether 69 patients were diagnosed with IIA, 30 with acute and 39 with subacute IIA. The most common occupational groups were industrial operators (n=23, 33%), metal and machinery workers (n=16, 11%) and construction workers (n=12, 8%). Among industrial operators significantly more cases had subacute IIA than acute IIA (p=0.002). Forty cases (57%) were attributable to some type of corrosive acidic or alkaline chemical. Acute IIA followed accidents at work in different types of occupation, while subacute IIA was typical among industrial operators performing their normal work tasks under poor work hygiene conditions. The most common root cause was lack of information or false guidance in acute IIA (n=11, 36%) and neglect of workplace hygiene measures in subacute IIA (n=29, 74%). Conclusions Accidents are the main causes of acute IIA, whereas subacute IIA can develop in normal work in risk trades with poor work hygiene. Airborne strong acids or bases seem to be the most important causative agents of acute and subacute IIA. The different risk profiles of acute and subacute IIA should be considered in the prevention and identification of the cases. AU - Lindström I AU - Lantto J AU - Karvala K AU - Soini S AU - Ylinen K AU - Suojalehto H AU - Suuronen K LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20210101 IS - IS - VI - IP - DP - 2021 Jan 01 TI - Allergens and their associated small molecule ligands - their dual role in sensitization PG - AB - Many allergens feature hydrophobic cavities that allow the binding of primarily hydrophobic small molecule ligands. Ligand-binding specificities can be strict or promiscuous. Serum albumins from mammals and birds can assume multiple conformations that facilitate the binding of a broad spectrum of compounds. Pollen and plant food allergens of the family 10 of pathogenesis-related proteins bind a variety of small molecules such as glycosylated flavonoid derivatives, flavonoids, cytokinins, and steroids in vitro. However, their natural ligand-binding was reported to be highly specific. Insect and mammalian lipocalins transport odorants, pheromones, catecholamines, and fatty acids with a similar level of specificity, while the food allergen ß-lactoglobulin from cow's milk is notably more promiscuous. Non-specific lipid transfer proteins from pollen and plant foods bind a wide variety of lipids, from phospholipids to fatty acids, as well as sterols and prostaglandin B2, aided by the high plasticity and flexibility displayed by their lipid-binding cavities. Ligands increase the stability of allergens to thermal and proteolyticdegradation. They can also act as immunomodulatory agents that favor a Th2 polarization. In summary, ligand-binding allergens expose the immune system to a variety of biologically active compounds whose impact on the sensitization process has not been well studied thus far. AU - Chruszcz M AU - Chew FT AU - Hoffmann-Sommergruber K AU - Hurlburt BK AU - Mueller GA AU - Pomés A AU - Rouvinen J AU - Villalba M AU - Wöhrl BM AU - Breiteneder H LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - IP - DP - 2020 Jan 01 TI - The impact of the aetiology of COPD, bronchitis and bronchiolitis PG - 86-103 AB - COPD, a leading cause of death worldwide, is defined as the presence of a relevant respiratory symptom plus spirometrically proven irreversible airways obstruction in the absence of other diseases. Environmental exposures are the main contributors to COPD and chronic bronchitis. Smoking is the most influential risk factor in high-income countries, whereas biofuel smoke is a major risk factor in low- and middle-income countries. Environmental exposures result in an accelerated decline in lung function. Importantly, environmental exposures early in life including infections and smoking may hamper the maximally attained lung function, resulting in COPD without an accelerated decline in lung function. An important proportion of COPD, chronic bronchitis and bronchiolitis cases are due to occupational exposure to vapour, gases, dust and fumes, and this aspect presents an unsolved challenge for epidemiology and occupational medicine. Knowledge of the impact of specific exposures and exposure levels is urgently needed in order to implement an effective strategy for prevention. AU - Schlunssen V AU - Wurtz ET AU - Hansen MRH AU - Miller M AU - Sigsgaard T AU - Omland O LA - PT - DEP - TA - In: Feary J, Suojalehto H, Cullinan P, eds. Occupational and Environmental Lung Disease (ERS Monogra JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 78 IP - DP - 2020 Jan 01 TI - Occupational use of high-level disinfectants and asthma incidence in early- to mid-career female nurses: a prospective cohort study. PG - 237-243 AB - OBJECTIVES: Occupational use of disinfectants among healthcare workers has been associated with asthma. However, most studies are cross-sectional, and longitudinal studies are not entirely consistent. To limit the healthy worker effect, it is important to conduct studies among early- to mid-career workers. We investigated the prospective association between use of disinfectants and asthma incidence in a large cohort of early- to mid-career female nurses. METHODS: The Nurses' Health Study 3 is an ongoing, prospective, internet-based cohort of female nurses in the USA and Canada (2010-present). Analyses included 17?280 participants without a history of asthma at study entry (mean age: 34 years) and who had completed =1 follow-up questionnaire (sent every 6 months). Occupational use of high-level disinfectants (HLDs) was evaluated by questionnaire. We examined the association between HLD use and asthma development, adjusted for age, race, ethnicity, smoking status and body mass index. RESULTS: During 67?392 person-years of follow-up, 391 nurses reported incident clinician-diagnosed asthma. Compared with nurses who reported =5 years of HLD use (89%), those with >5 years of HLD use (11%) had increased risk of incident asthma (adjusted HR (95%?CI), 1.39 (1.04 to 1.86)). The risk of incident asthma was elevated but not statistically significant in those reporting >5 years of HLD use and current use of =2 products (1.72 (0.88 to 3.34)); asthma risk was significantly elevated in women with >5 years of HLD use but no current use (1.46 (1.00 to 2.12)). CONCLUSIONS: Occupational use of HLDs was prospectively associated with increased asthma incidence in early- to mid-career nurses. AU - Dumas O AU - Gaskins AJ AU - Boggs KM AU - Henn SA AU - Moual NL AU - Varraso R AU - Chavarro JE AU - Camargo CA LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 56 Suppl 6 IP - DP - 2020 Jan 01 TI - Breathing pattern disorder masquerading as occupational asthma PG - 652 AB - Background: Serial peak flow monitoring is commonly used to diagnose occupational asthma (OA). Methods: A laboratory animal (LA) worker presented with work-related dyspnoea triggered by talking, dust and modest exertion. It was also present, to a lesser extent, away from work. She recorded her peak flow (PF) =4 times a day on consecutive days for 4 weeks. The values were plotted using specialist software. Results: Spirometry was normal (FEV1 2.98 (105%) and FVC 3.41 (106%)). PF plot showed striking work-related variability (fig 1); OASYS score was 3.91 and ABC score was 95 indicating >90% probability of OA. Serum specific IgE and skin prick tests to LA allergens were negative. There was no exposure to other respiratory sensitisers. Respiratory physiotherapy assessment identified breathing pattern disorder (Nijmegen Questionnaire score 46/64). We explained she did not have OA; her symptoms were managed with physiotherapy and she continued working in her existing role. AU - Feary J AU - Cannon J AU - Cullinan P LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 21 IP - DP - 2020 Jan 01 TI - Drive thru spirometry - the next direction to go in? PG - 31-34 AB - Introduction Workplaces are struggling to carry out testing to the same capacity as they did pre-COVID, or even perform it at all, so we have to think outside of the box. We were given the opportunity to hold out-patient clinics close to the Birmingham Nightingale at a cold site with plenty of space for distancing, but the vailability was short term. We decided to use this space to test patients who had been shielding and therefore could not attend a hospital setting. The patients attending required Forced Vital Capacity (FVC) monitoring to determine if they were eligible for certain treatments, but aerosol generating procedures were not allowed in the building. We were given 3 weeks notice and had to make it happen. The only real solution: drive-thru spirometry. AU - Moore V.C. LA - PT - DEP - TA - Inspire JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - acccessed IP - DP - 2020 Jan 01 TI - Guidelines for recommencing physiological services during the Coronavirus Disease 2019 (COVID-19) endemic phase version 5.1 PG - . AB - The role of respiratory and sleep diagnostics in the diagnosis, prevention and treatment of disease is widely known and it is of vital importance that diagnostic services are reintroduced to prevent delays in patient care. This document provides essential advice and guidance on restoring respiratory physiological services during the COVID endemic phase and adds to the suite of COVID-19 information developed by ARTP and ratified by leading UK professional groups. This document presents a risk mitigation approach to reinstating and maintaining services using a 3P’s (patient, procedure, plant) methodology. This approach will allow local flexibility in the delivery of respiratory services without compromising the safety of patients and healthcare staff. Pre-screening of patients should always be undertaken to reduce risk and it is recommended that respiratory function tests (RFTs) should only be undertaken when it will definitively inform or change a patient’s management. It acknowledges that service delivery must be responsive to local and national lockdowns due to spikes in COVID-19 prevalence and provides a risk stratified approach to infection control for respiratory function testing and sleep diagnostics that can be stepped up or down dependant on local conditions. The document also considers what are termed ‘Special Cases’ and provides specific advice and recommendations for paediatric and community settings using the most recent evidence base. This guidance should form the basis of local standard operating procedures, developed in conjunction with infection prevention and control teams, which facilitate rapid responses in an ever-evolving situation. AU - ARTP COVID-19 Group LA - PT - DEP - TA - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - accessed 1 IP - DP - 2020 Jan 01 TI - COVID-19 infection prevention and control guidance: aerosol generating procedures Updated 20 October 2020 PG - AB - An aerosol generating procedure (AGP) is a medical procedure that can result in the release of airborne particles (aerosols) from the respiratory tract when treating someone who is suspected or known to be suffering from an infectious agent transmitted wholly or partly by the airborne or droplet route. This is the list of medical procedures for COVID-19 that have been reported to be aerosol generating and are associated with an increased risk of respiratory transmission: tracheal intubation and extubation manual ventilation tracheotomy or tracheostomy procedures (insertion or removal) bronchoscopy dental procedures (using high speed devices, for example ultrasonic scalers/high speed drills non-invasive ventilation (NIV); Bi-level Positive Airway Pressure Ventilation (BiPAP) and Continuous Positive Airway Pressure Ventilation (CPAP) high flow nasal oxygen (HFNO) high frequency oscillatory ventilation (HFOV) induction of sputum using nebulised saline respiratory tract suctioning upper ENT airway procedures that involve respiratory suctioning upper gastro-intestinal endoscopy where open suction of the upper respiratory tract occurs high speed cutting in surgery/post-mortem procedures if respiratory tract/paranasal sinuses involved Certain other procedures or equipment may generate an aerosol from material other than patient secretions but are not considered to represent a significant infectious risk for COVID-19. Procedures in this category include administration of humidified oxygen, administration of Entonox or medication via nebulisation. The New and Emerging Respiratory Viral Threat Assessment Group (NERVTAG) advised that during nebulisation, the aerosol derives from a non-patient source (the fluid in the nebuliser chamber) and does not carry patient-derived viral particles. If a particle in the aerosol coalesces with a contaminated mucous membrane, it will cease to be airborne and therefore will not be part of an aerosol. Staff should use appropriate hand hygiene when helping patients to remove nebulisers and oxygen masks. In addition, the current expert consensus from NERVTAG is that chest compressions are not considered to be procedures that pose a higher risk for respiratory infections including COVID-19. AU - GOV.UK LA - PT - DEP - TA - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 202 IP - DP - 2020 Jan 01 TI - Home Monitoring in Patients with Idiopathic Pulmonary Fibrosis A Randomized Controlled Trial PG - 393-401 AB - Rationale: Idiopathic pulmonary fibrosis (IPF) is a deadly disease with increasingly impaired health-related quality of life (HRQOL). eHealth technologies facilitate collection of physiological outcomes and patient-reported outcomes at home, but randomized controlled trials (RCTs) on the effects of eHealth are scarce. Objectives: To investigate whether a home monitoring program improves HRQOL and medication use for patients with IPF. Methods: We performed a multicenter RCT in newly treated patients with IPF. Patients were randomly assigned to standard care or a home monitoring program on top of standard care for 24 weeks. The home monitoring program included home spirometry, reporting of symptoms and side effects, patient-reported outcomes, information, a medication coach, and eConsultations. The primary endpoint was between-group difference in change in King’s Brief Interstitial Lung Disease Questionnaire (K-BILD) score at 24 weeks. Measurements and Main Results: A total of 90 patients were randomized (46 assigned to the home monitoring group and 44 to the standard care group). After 24 weeks, no statistically significant difference was found in K-BILD total score, with a 2.70-point increase in the home monitoring group (SD = 9.5) and a 0.03-point increase in the standard care group (SD = 10.4); between-group difference was 2.67 points (95% confidence interval [CI], 21.85 to 7.17; P = 0.24). Between-group difference in psychological domain score was 5.6 points (95% CI, 21.13 to 12.3; P = 0.10), with an increase of 5.12 points in the home monitoring group (SD = 15.8) and a decline of 0.48 points in the standard care group (SD = 13.3). In the home monitoring group, medication was more often adjusted (1 vs. 0.3 adjustments per patient; 95% CI, 0.2 to 1.3; P = 0.027). Patient satisfaction with the home monitoring program was high. Home-based spirometry was highly correlated with hospital-based spirometry over time. Conclusions: The results of this first-ever eHealth RCT in IPF showed that a comprehensive home monitoring program did not improve overall HRQOL measured with K-BILD but tended to improve psychological well-being. Home monitoring was greatly appreciated by patients and allowed for individually tailored medication adjustments. AU - Moor CC AU - Mostard RLM AU - Grutters JC AU - Bresser P AU - Aerts JGJV AU - Chavannes NH AU - Wijsenbeek MS LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - - IP - DP - 2020 Jan 01 TI - https://doi.org/10.1097/ACI.0000000000000716 PG - - AB - Purpose of review: The purpose of this review was to list all new confirmed cases of immunological occupational asthma (IOA) described between mid-2014 and April 2020. Findings: Several new agents, both of high and low molecular weight, have been identified in the last 6 years as potential respiratory sensitizers being able to induce immunological occupational asthma. This review confirms that new causes of IOA are still identified regularly, particularly in subjects exposed to high molecular agents, in the food industry (farming, pest control, food processing), pharmaceutical industry (antibiotics, various drugs) and cosmetic environment (dyes, powders). Summary: It stressed the need for clinicians to stay alert and suspect occupational asthma in any adult with new onset asthma or newly uncontrolled asthma. AU - Cartier A LA - PT - DEP - TA - Curr Opin Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 93 IP - DP - 2020 Jan 01 TI - Work environment factors and respiratory complaints in Norwegian cooks PG - 205-212 AB - Purpose Norwegian cooks exhibit relatively high mortality, particularly from respiratory diseases. Both occupational hazards and lifestyle factors have been suggested as possible explanations. Negative health effects from exposure to cooking fumes are well documented in non-Western populations, and it has been claimed that cooking fumes in Western style cooking might be substantially different. We hypothesise that exposure to cooking fumes contributes to respiratory diseases also in professional cooks in Western countries. The aim of this study was to elucidate if specific work environment factors related to cooking fume exposure are determinants for respiratory morbidity in Norwegian cooks. Methods We surveyed specific work environment factors and respiratory complaints in 553 subjects that were currently working as skilled cooks. Inclusion was based on the register of people that had graduated as skilled cooks in central Norway between 1988 and 2008. Determinants for the occurrence of respiratory complaints were explored by logistic regression. Results Overall, 17.2% of subjects reported respiratory complaints at work, while 8.1% had chronic bronchitis. Those who performed frying for over half of their workday exhibited an increased odds ratio for having chronic bronchitis of 2.5 (95% CI 1.2–5.3). Using gas for frying and using a fryer in the kitchen were also related to the occurrence of respiratory complaints. Conclusions This study in Norwegian cooks demonstrates a relationship between the extent of frying and the occurrence of work-related respiratory complaints. Therefore, reducing exposure to cooking fumes could reduce respiratory complaints in cooks, and potentially help alleviate excess morbidity and mortality in this occupation. AU - Svedahl SR AU - Hilt B AU - Svendsen K LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 77 IP - DP - 2020 Jan 01 TI - Work-related adverse respiratory health outcomes at a machine manufacturing facility with a cluster of bronchiolitis, alveolar ductitis and emphysema (BADE) PG - 386-392. AB - Objectives Four machine manufacturing facility workers had a novel occupational lung disease of uncertain aetiology characterised by lymphocytic bronchiolitis, alveolar ductitis and emphysema (BADE). We aimed to evaluate current workers’ respiratory health in relation to job category and relative exposure to endotoxin, which is aerosolised from in-use metalworking fluid. Methods We offered a questionnaire and spirometry at baseline and 3.5?year follow-up. Endotoxin exposures were quantified for 16 production and non-production job groups. Forced expiratory volume in one second (FEV1) decline =10% was considered excessive. We examined SMRs compared with US adults, adjusted prevalence ratios (aPRs) for health outcomes by endotoxin exposure tertiles and predictors of excessive FEV1 decline. Results Among 388 (89%) baseline participants, SMRs were elevated for wheeze (2.5 (95% CI 2.1 to 3.0)), but not obstruction (0.5 (95% CI 0.3 to 1.1)). Mean endotoxin exposures (range: 0.09–28.4 EU/m3) were highest for machine shop jobs. Higher exposure was associated with exertional dyspnea (aPR=2.8 (95% CI 1.4 to 5.7)), but not lung function. Of 250 (64%) follow-up participants, 11 (4%) had excessive FEV1 decline (range: 403–2074?mL); 10 worked in production. Wheeze (aPR=3.6 (95% CI 1.1 to 12.1)) and medium (1.3–7.5 EU/m3) endotoxin exposure (aPR=10.5 (95% CI 1.3 to 83.1)) at baseline were associated with excessive decline. One production worker with excessive decline had BADE on subsequent lung biopsy. Conclusions Lung function loss and BADE were associated with production work. Relationships with relative endotoxin exposure indicate work-related adverse respiratory health outcomes beyond the sentinel disease cluster, including an incident BADE case. Until causative factors and effective preventive strategies for BADE are determined, exposure minimisation and medical surveillance of affected workforces are recommended. AU - Cummings KJ AU - Stanton ML AU - Kreiss K AU - Boylstein RJ AU - Park J AU - Cox-Ganser JM AU - Virji MA AU - Edwards NT AU - Segal LN AU - Blaser MJ AU - Weissman DN AU - Nett RJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 77 IP - DP - 2020 Jan 01 TI - Severe asthma due to occupational exposure to Guar Gum: is Lipid Transfer Protein involved? PG - 427 AB - Difficult-to-control asthma may be associated with continuous exposure to allergens, particularly professional ones, presence of comorbidities and lack of adherence to therapy. A component-resolved approach can provide an invaluable support to the diagnosis of allergic asthma.1 On the other hand, molecular diagnosis also underlines new questions, as described here. An otherwise healthy nurse, aged 28 years, experienced onset of asthma symptoms soon after being located to a healthcare facility, hosting patients with disabling neuromuscular diseases. ImmunoCap (ThermoFisher Scientific, Uppsala, Sweden) revealed the presence of IgE specific to latex and its main allergic component, Hev b 5 (table 1), the clinical significance of which was uncertain since the patient did not report urticaria on contact with latex gloves and had been previously exposed to latex without clinical events. Sensitisation to peach lipid transfer protein (LTP), Pru p 3, a member of the non-specific lipid transfer protein (nsLTP) superfamily, was detected as well but it was judged clinically irrelevant, since the patient tolerated the ingestion of LTP-containing foods. Despite full compliance with measures to avoid latex exposure and with optimised Global Initiative for Asthma (GINA) step 4 asthma treatment,2 wheezing episodes continued to occur and the patient was referred to our centre for further investigation. We soon discovered she used to feed patients with dysphagia with guar gum-thickened liquid foods. Prick-by-prick test with guar flour resulted positive (5/10?mm) and an increase in antiguar gum IgE title (table 1) was documented. Since daily exposure to guar flour was closely related to appearance of symptoms, a diagnostic specific bronchial challenge with guar flour was considered unnecessary. The patient was relocated to another unit, where she had no further exposure to guar flour, with prompt remission of asthma symptoms. Table 1 Allergenic components Specific IgE (kUa/L) Pru p 1 <0.1 Pru p 3 (peach LTP) 0.84 Pru p 4 <0.1 Hev b 1 <0.1 Hev b 3 <0.1 Hev b 5 3.6 Hev b 6.01 <0.1 Hev b 6.02 <0.1 Hev b 8 <0.1 Hev b 9 <0.1 Hev b 11 <0.1 Phl p 1 <0.1 Phl p 12 <0.1 Allergenic extracts Latex 2.34 Dermatophagoides pter. <0.1 Dermatophagoides far. <0.1 Timothy grass <0.1 Alternaria alternata <0.1 Guar gum (E412) 6.34 Carob gum (E410) 0.14 Arabic gum (E414) <0.1 Tragacanth gum (E413) <0.1 Bold type are positive results LTP, lipid transfer protein. Guar gum, a powder obtained from the seeds of Cyamopsis tetragonolobus is used as a thickener in commercial food processing and has been recognised as a cause of occupational rhinitis3 and asthma.4 Galactomannan, a carbohydrate which constitutes 90%–95% of guar flour, is presumed to be its major allergen but the protein fraction may also contain minor allergens. We speculate that our patient’s sensitisation to peach LTP might be underpinned by primary sensitisation to a yet to be discovered guar LTP. Indeed, a protein component with molecular weight and disulfide bonds resembling those of nsLTPs has been described in the foaming fraction of guar meal,5 by which the gum might be contaminated during the extraction process. To summarise, a detailed and timely allergy investigation, extended to unusual aeroallergens, is mandatory whenever new respiratory symptoms ensue after a variation in patients’ habits or occupation. Especially in the setting of work-related asthma, difficult-to-control asthma can be associated with exposure to unknown or hidden occupational allergens. We also suggest that positive testing for extracts or molecular components without straight clinical correlates should not be overlooked as it might underpin a breakdown in immune tolerance worthy of additional investigation. We propose that guar gum-related occupational asthma might be caused by an LTP component, similarly to wheat LTP-associated bakers’ asthma.6 References 1. Raulf M, Quirce S , Vandenplas O . Addressing molecular diagnosis of occupational allergies. Curr Allergy Asthma Rep 2018;18:6.doi:10.1007/s11882-018-0759-9 2. Global Initiative for Asthma. Global strategy for asthma management and prevention, 2019 3. Kanerva L , Tupasela O , Jolanki R , et al . Occupational allergic rhinitis from guar gum. Clin Allergy 1988;18:245–52.doi:10.1111/j.1365-2222.1988.tb02866.x 4. Lagier F , Cartier A , Somer J , et al . Occupational asthma caused by guar gum. J Allergy Clin Immunol 1990;85:785–90.doi:10.1016/0091-6749(90)90199-E 5. Shimoyama A , Kido S , Kinekawa Y-ichi , et al . Guar foaming albumin: a low molecular mass protein with high foaming activity and foam stability isolated from guar meal. J Agric Food Chem 2008;56:9200–5.doi:10.1021/jf8010323 PubMedGoogle Scholar 6. Armentia A , Garrido-Arandia M , Cubells-Baeza N , et al . Bronchial challenge with tri a 14 as an alternative diagnostic test for baker's asthma. J Investig Allergol Clin Immunol 2015;25:352–7.Google Scholar AU - Crivellaro MA AU - Malipiero G AU - Maculan P AU - Senna G AU - Passalacqua G AU - Maestrelli P LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 55 IP - DP - 2020 Jan 01 TI - Innate lymphoid cells in isocyanate-induced asthma: role of microRNA-155 PG - AB - BACKGROUND: Occupational asthma, induced by workplace exposures to low molecular weight (LMW) agents such as toluene 2,4-diisocyanate (TDI), causes a significant burden to patients and society. Little is known about innate lymphoid cells (ILC) in TDI-induced asthma. A critical regulator of ILC function is microRNA-155, a microRNA associated with asthma. OBJECTIVE: Determine whether TDI exposure modifies the number of ILC in the lung and whether microRNA-155 contributes to TDI-induced airway inflammation and hyperresponsiveness. METHODS: C57BL/6 wild-type and microRNA-155 knockout mice were sensitised and challenged with TDI or vehicle. Intracellular cytokine expression in ILC and T cells was evaluated in bronchoalveolar lavage fluid (BAL) by flow cytometry. Peribronchial eosinophilia and goblet cells were evaluated on lung tissue and airway hyperresponsiveness was measured with the forced oscillation technique. Putative ILC2 cells were identified in bronchial biopsies of subjects with TDI-induced occupational asthma using immunohistochemistry. Human bronchial epithelial cells were exposed to TDI or vehicle. RESULTS: TDI-exposed mice had higher numbers of airway goblet cells, BAL eosinophils, CD4+ T cells and ILC, with a predominant type 2 response and tended to have airway hyperresponsiveness. In TDI-exposed microRNA-155 knockout mice, inflammation and airway hyperresponsiveness was attenuated. TDI exposure induced IL-33 expression in human bronchial epithelial cells and in murine lungs, which was microRNA-155 dependent in mice. GATA3+CD3- cells, presumably ILC2, were present in bronchial biopsies. CONCLUSION: TDI exposure is associated with increased numbers of ILC. The proinflammatory microRNA-155 is crucial in a murine model of TDI asthma, suggesting its involvement in the pathogenesis of occupational asthma due to LMW agents. AU - Blomme EE AU - Provoost S AU - Bazzan E AU - Van Eeckhoutte HP AU - Roffel MP AU - Pollaris L AU - Bontinck A AU - Bonato M AU - Vandenbroucke L AU - Verhamme F AU - Joos GF AU - Cosio MG AU - Vanoirbeek JAJ AU - Brusselle GG AU - Saetta M AU - Maes T. LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 70 IP - DP - 2020 Jan 01 TI - Follow-up survey of patients with occupational asthma PG - 231-234 AB - Background Occupational asthma (OA) is often associated with a poor prognosis and the impact of a diagnosis on an individual’s career and income can be significant. Aims We sought to understand the consequences of a diagnosis of OA to patients attending our clinic. Methods Using a postal questionnaire, we surveyed all patients attending our specialist occupational lung disease clinic 1 year after having received a diagnosis of OA due to a sensitizer (n = 125). We enquired about their current health and employment status and impact of their diagnosis on various aspects of their life. Additional information was collected by review of clinical records. Results We received responses from 71 (57%) patients; 77% were referred by an occupational health (OH) provider. The median duration of symptoms prior to referral was 18 months (interquartile range (IQR) 8–48). At 1 year, 79% respondents were no longer exposed to the causal agent. Whilst the unexposed patients reported an improvement in symptoms compared with those still exposed (82% versus 53%; P = 0.023), they had poorer outcomes in terms of career, income and how they felt treated by their employer; particularly those not currently employed. Almost all (>90%) of those still employed had been referred by an OH provider compared with 56% of those currently unemployed (P = 0.002)x. Conclusions The negative impact of OA on people’s careers, livelihood and quality of life should not be underestimated. However, with early detection and specialist care, the prognosis is often good and particularly so for those with access to occupational health. AU - Feary J AU - Cannon J AU - Fitzgerald B AU - Szram J AU - Scofield S AU - Cullinan P LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 77 IP - DP - 2020 Jan 01 TI - Predictive value of non-specific bronchial challenge testing for respiratory symptoms and lung function in aluminium smelter workers PG - 535-539 AB - Objective To assess the predictive value of bronchial hyper-responsiveness (BHR) for the subsequent development of respiratory symptoms, airflow limitation and decline in lung function among aluminium smelter workers. Methods An inception cohort study of new employees at two Australian aluminium smelters was conducted. Participants completed a modified British Medical Research Council respiratory questionnaire, spirometry and a methacholine bronchial challenge test at baseline and at annual follow-up reviews. BHR was defined as PD20 =4000?µg. Poisson and mixed effects models were fitted to respiratory symptoms and lung function (forced expiratory volume in 1?s (FEV1) and FEV1/forced vital capacity (FVC)). Results Baseline interview and lung function testing were completed by 278 workers, who were followed for a median of 4 years. BHR at baseline, present in 82 workers, was not associated with incident wheeze risk ratio (RR)=1.07 (95% CI 0.74 to 1.55) and cough RR=0.78 (95% CI 0.45, 1.35), but there was some increased risk of chest tightness RR=1.40 (95% CI 0.99, 1.98) after adjustment for age, sex, smoking and atopy. BHR at baseline was associated with lower FEV1 and FVC, although the rate of annual decline in FEV1 or FVC was similar between those with or without BHR. The specificity of BHR was 77% for wheeze, 70% for cough and 77% for chest tightness, but the sensitivity was poor, at 33%, 24% and 39%, respectively. Conclusion Methacholine challenge testing at entry to employment was not sufficiently predictive of later adverse respiratory outcomes, and notwithstanding the study limitations is unlikely to be a useful pre-employment or preplacement screening test in the aluminium smelting industry. AU - Abramson MJ AU - Gwini SM AU - de Klerk NH AU - Monaco AD AU - Dennekamp M AU - Fritschi L AU - Dimitriadis C AU - Mohebbi M AU - Musk AW AU - Sim MR LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 17 IP - DP - 2020 Jan 01 TI - Occupational Exposure to Flour Dust. Exposure Assessment and Effectiveness of Control Measures PG - 5182 AB - The adverse effects associated with exposure to flour dust have been known since the 1700s. The aim of the study was to assess the occupational exposure to flour dust in Italian facilities, identify the activities characterized by the highest exposure, and provide information to reduce workers’ exposure. The study was performed in different facilities such as flourmills (n = 2), confectioneries (n = 2), bakeries (n = 24), and pizzerias (n = 2). Inhalable flour dust was assessed by personal and area samplings (n = 250) using IOM (Institute of Occupational Medicine) samplers. The results showed personal occupational exposure to flour dust over the American Conference of Governmental Industrial Hygiene (ACGIH) and the Scientific Committee on Occupational Exposure Limit (SCOEL) occupational limits (mean 1.987 mg/m3; range 0.093–14.055 mg/m3). The levels were significantly higher for dough makers in comparison to the dough formers and packaging area subjects. In four bakeries the industrial hygiene surveys were re-performed after some control measures, such as installation of a sleeve to the end of pipeline, a lid on the mixer tub or local exhaust ventilation system, were installed. The exposure levels were significantly lower than those measured before the introduction of control measures. The exposure level reduction was observed not only in the dough making area but also in all bakeries locals AU - Martinelli A AU - Salamon F AU - Scapellato ML AU - Trevisan A AU - Vianello L AU - Bizzotto R AU - Crivellaro MA AU - Carrieri M LA - PT - DEP - TA - Int. J. Environ. Res. Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 77 IP - DP - 2020 Jan 01 TI - Identification of late asthmatic reactions following specific inhalation challenge PG - 728-731 AB - Specific inhalation challenge (SIC) is the reference standard for the diagnosis of occupational asthma. Current guidelines for identifying late asthmatic reactions are not evidence based. Objectives To identify the fall in forced expiratory volume in 1 s (FEV1) required following SIC to exceed the 95%?CI for control days, factors which influence this and to show how this can be applied in routine practice using a statistical method based on the pooled SD for FEV1 from three control days. Methods Fifty consecutive workers being investigated for occupational asthma were asked to self-record FEV1 hourly for 2 days before admission for SIC. These 2?days were added to the in-hospital control day to calculate the pooled SD and 95%?CI. Results 45/50 kept adequate measurements. The pooled 95%?CI was 385?mL (SD 126), or 14.2% (SD 6.2) of the baseline FEV1, but was unrelated to the baseline FEV1 (r=0.06, p=0.68), or gender, atopy, smoking, non-specific reactivity or treatment before or during SIC. Thirteen workers had a late asthmatic reaction with =2 consecutive FEV1 measurements below the 95%?CI for pooled control days, 4/13 had <15%?and 9/13 >15%?late fall from baseline. The four workers with =2 values below the 95%?CI all had independent evidence of occupational asthma. Conclusion The pooled SD method for defining late asthmatic reactions has scientific validity, accounts for interpatient spirometric variability and diurnal variation and can identify clinically relevant late asthmatic reactions from smaller exposures. For baseline FEV1 <2.5?L, a 15% fall is within the 95%?CI AU - Moore VC AU - Walters GI AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 75 IP - DP - 2020 Jan 01 TI - The validity of the Canadian clinical scores for occupational asthma in European populations PG - 2124-2126 AB - Based on available resources, diagnostic tests are used in a stepwise approach starting with a detailed medical and occupational history; assessment of nonspecific bronchial hyperresponsiveness (NSBHR); and immunological sensitization with skin-prick tests (SPT) or specific immunoglobulin E to workplace agent when available. The second step includes serial assessments of NSBHR and peak expiratory flow at work and off-work, or specific inhalation challenge (SIC). As the reference test for diagnosing OA, SIC is only available in a few centers around the world. Therefore, Suarthana and colleagues developed non–SIC-based diagnostic models for OA using Quebec data of 160 symptomatic subjects who completed an SIC procedure (ie, development set).These subjects were exposed to high-molecular-weight (HMW) protein agents such as flour, laboratory animal allergens, and latex. OA was defined as a positive SIC, namely a sustained fall in forced expiratory volume in one second (FEV1) >20% from baseline value after exposure to the suspected occupational agent. The final predictive model included age (>40 vs. =40 years); agent type (flour vs. other HMW agents); the presence of work-related rhinoconjunctivitis (yes/no); inhaled corticosteroid use (yes/no); positive SPT reaction to the specific occupational agent(s) (yes/no); and the presence of NSBHR (defined as the provocative concentration of histamine/methacholine causing a 20% decrease in FEV1 (PC20) =16 mg/mL). This final model demonstrated a good accuracy and internal validity. To facilitate its use, it was transformed into clinical scores equipped with the corresponding predicted probability of OA. Sum scores = 150 with a corresponding predicted probability of OA > 0.25 were recommended for referral cutoff with a sensitivity of 96%, specificity 59%, positive predicted value 72%, and negative predicted value 94%. To externally validate the model, first, we calculated individual probabilities in European data using the equation from the Canadian model without any adjustments (no update method). The model demonstrated good discrimination in European data although lower than in Canadian (AUC 0.83 vs. 0.89, respectively). The Brier score was also higher in European data (0.171 vs. 0.121), but the model was still informative (ie, the maximum score for a noninformative model in a population with a 57.5% prevalence of OA was 0.24). Second, we recalibrated the intercept of the model. Finally, the intercept and coefficients were re-estimated (refitting method). Both methods did not improve the discriminative ability of the model: The AUC remained the same, although the Brier score slightly improved. AU - Suarthana E AU - Taghiakbari M AU - Saha-Chaudhuri P AU - Rifflart C AU - Suojalehto H AU - Hölttä P AU - Walusiak-Skorupa J AU - Wiszniewska M AU - Muñoz X AU - Romero-Mesones C AU - Sastre J AU - Rial MJ AU - Henneberger PK AU - Vandenplas O LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - IP - DP - 2020 Jan 01 TI - Characterization of Occupational Eosinophilic Bronchitis in a Multicenter Cohort of Subjects with Work-Related Asthma Symptoms PG - AB - Background Occupational eosinophilic bronchitis (OEB) has been described only as anecdotal case reports. Objective We investigated the clinical and inflammatory characteristics of subjects with OEB identified in a cohort of subjects who completed a specific inhalation challenge (SIC) with occupational agents. Methods In this retrospective multicenter study, OEB was defined by: 1) a fall in FEV1 <15% during the SIC and the absence of nonspecific bronchial hyperresponsiveness (NSBH) both before after the SIC; and 2) a post-challenge increase in sputum eosinophils =3%. The subjects who fulfilled these criteria were compared to 226 subjects with a negative SIC and 30 subjects with a positive SIC who failed to show baseline NSBH. Results An isolated increase in post-challenge sputum eosinophils was documented in 33 of 259 subjects (13%) with a negative SIC. These subjects reported significantly more often an isolated cough at work compared with the negative and positive SIC controls. When compared with positive SIC controls, the subjects with OEB experienced less frequently work-related wheezing and reported a shorter duration of symptoms at work. The sensitivity of the post-SIC increase in FeNO in identifying OEB among subjects with a negative SIC was low, ranging from 43% to 24% using cutoff values of 8 ppb to 17.5 ppb, while the specificity was high (90% to 97%). Conclusion This study highlights the relevance of induced sputum analysis in the investigation of work-related asthma symptoms in order to identify isolated increases in sputum eosinophils that are consistent with a diagnosis of OEB. AU - Wiszniewska M AU - Dellis P AU - van Kampen V AU - Suojalehto H AU - Munoz X AU - Walusiak-Skorupa J AU - Lindström I AU - Merget R AU - Romero-Mesones C AU - Sastre J AU - Quirce S AU - Mason P AU - Rifflart C AU - Godet J AU - de Blay F AU - Vandenplas O AU - European network for the PHenotyping of OCcupational ASthma (E-PHOCAS); LA - PT - DEP - TA - J Allergy Clin Immunol Pract. JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - IP - DP - 2020 Jan 01 TI - A systematically derived exposure assessment instrument for Chronic Hypersensitivity Pneumonitis PG - AB - Background Chronic hypersensitivity pneumonitis (CHP) is an immune mediated interstitial lung disease, caused by inhalational exposure to environmental antigens, resulting in parenchymal fibrosis. By definition, a diagnosis of CHP assumes a history of antigen exposure, but only half of all patients eventually diagnosed with CHP will have a causative antigen identified. Individual clinician variation in eliciting a history of antigen exposure may affect the frequency and confidence of CHP diagnosis. Methods A list of potential causative exposures were derived from a systematic review of the literature. A Delphi method was applied to an international panel of ILD experts, to obtain consensus regarding technique for the elicitation of exposure to antigens relevant to a diagnosis of CHP. The consensus threshold was set at 80% agreement, and median = 2, IQR = 0 on a five-point Likert scale (1: strongly agree, 2: tend to agree, 3: neither agree nor disagree, 4: disagree, 5: strongly disagree). Results In two rounds, 36/40 experts participated. Experts agreed on 18 exposure items to ask every patient with suspected CHP. Themes included CHP inducing exposures, features that contribute to an exposure’s relevance, and quantification of a relevant exposure. Based on the results from the literature review and Delphi process, a CHP exposure assessment instrument was derived. Using cognitive interviews, the instrument was revised by ILD patients for readability and usability. Conclusions This Delphi survey provides items that ILD experts agree are important to ask in all patients presenting with suspected CHP and provides basis for a systematically derived CHP exposure assessment instrument. Clinical utility of this exposure assessment instrument may be affected by different local prevalence patterns of exposures. Ongoing research is required to clinically validate these items and consider their impact in more geographically diverse settings. AU - Barnes H AU - Morisset J AU - Molyneaux P AU - Westall G AU - Glaspole I AU - Collard HR LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - IP - DP - 2020 Jan 01 TI - Ammonia Toxicity PG - AB - Ammonia (NH) is a colorless irritant gas with a pungent order that is readily soluble in water to generate ammonium (NH) ions[1] Ammonia is a natural by-product in the human body as an intermediate in several metabolic reactions primarily involving amino acid synthesis[2] It also gets produced in the human gut as a result of various enzymatic actions of bacteria.[3] However, as a result of the highly toxic nature of ammonia, it is quickly metabolized into urea in the liver by urea cycle and excreted by the kidneys.[4][5] The blood ammonia level in a healthy adult is in a range of 15 to 45 micrograms/dL.[6] Ammonia toxicity occurs when the ammonia content in the blood supersedes the liver’s capacity to eliminate it; this could be a result of either overproduction such as in congenital hyperammonemia or under-elimination such as in liver cirrhosis.[7][8] This discussion will only focus on the various means in which the human body suffers exposure to external sources of ammonia and the multiple mechanisms of its toxicity. The injury from ammonia commonly occurs via the following methods: Inhalation of anhydrous ammonia gas or vapors of liquid ammonia Ingestion of ammonia-containing liquids Direct contact of anhydrous ammonia gas with skin or eyes AU - Padappayil RP AU - Borger J. LA - PT - DEP - TA - StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 25 IP - DP - 2020 Jan 01 TI - Silo-Filler’s Disease: One Health System’s Experience and an Update of the Literatur PG - 8-13 AB - Silo-filler’s disease, a life-threatening condition from exposure to silage gas in recently filled silos, has been known for over 5 decades now. However, farm workers remain exposed to this preventable condition. We describe the index presentations and subsequent changes among 19 patients managed within our health system over a 61-year period and highlight the need for ongoing education on minimizing exposure to silo gas. AU - Amaza IP AU - Kreidy MP LA - PT - DEP - TA - Journal of Agromedicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - IP - DP - 2020 Jan 01 TI - Impact of BAL lymphocytosis and presence of honeycombing on corticosteroid treatment effect in Fibrotic Hypersensitivity Pneumonitis: a retrospective cohort study PG - AB - According to a survey study of Wijsenbeek and colleagues 76% of respiratory physicians believe fibrotic Hypersensitivity Pneumonitis (fibrotic HP, fHP) should be treated with corticosteroids (CS) as first line treatment. However, data to support such a strategy are limited and confined to acute farmer’s lung. Classically, HP patients are classified according to symptom chronicity in acute and chronic HP. Based on new data, however, a stratification according to the (radiological) presence of fibrosis seems more in line with prognosis. In an earlier study we demonstrated that CS treatment was only beneficial in non-fibrotic HP (nfHP) while CS was not effective in fHP, both in terms of survival, FVC% decline and DLCO% decline. In this study, we determined whether the presence of broncho-alveolar lavage lymphocytosis (BAL Lymphocytosis, BALL) or honeycombing (HC) influences the treatment effect of CS in fHP patients. We included all fHP patients followed in the University Hospitals Leuven between 2005 and 2016. Patients without BAL were excluded. Validation of HP diagnosis was performed using symptoms, CT findings and pathological findings as described previously. As only fibrotic patients were included, CT scans were reviewed for the presence of extensive reticulation, traction bronchiectasis or honeycombing (as defined by the Fleischner Society). BALL was dichotomized as ‘high’ when >20% and ‘low’ when =20%. We analyzed the survival effect of both BALL and HC presence using a cox proportional hazards model corrected for age, gender and baseline FVC%. The effect of corticosteroid treatment on pulmonary function (PFT) was analyzed using mixed models comparing FVC% and DLCO% trajectories before treatment initiation with post-treatment FVC% and DLCO% trajectories. CS use was included both with and without time-dependent covariate. Age, gender, active exposure and use of second line immunosuppressive treatment (the latter as time-dependent covariate) were included as fixed effect. Subject and the PFT test-performing hospital were included as random effects (the former as random intercept and independent random slope, the latter as random intercept). PFT tests were included from 5 years before treatment initiation until 1 year after initiation or until treatment interruption. 91 fHP patients were included in the study. Mean age was 64.6 (±11.9), 32 patients (35.2%) were female. Baseline FVC% and DLCO% were 73.6% (±21.7%) and 46.7 (±17.8%) respectively. 67 patients (73.6%) were treated with corticosteroids, 20 patients (21.9%) received concomitant 2nd line immunosuppressive drugs; 36 patients (40%) had high BALL, 55 had low BALL (60%); 58 patients (64%) had no HC, 33 patients (36%) had HC. Low BALL was associated with increased HC presence (low vs high BALL: 50.9% vs 13.9%, p<0.001). No other differences in baseline characteristics were noted between low and high BALL patients. HC presence was associated with decreased BAL lymphocytosis (HC present vs absent: 11.8% vs 24.1%, p=0.002) and lower DLCO% (40.7% vs 49.8%, p=0.025). No other differences in baseline characteristics were noted between patients with and without HC. Exposure type (mold vs birds vs other vs unknown exposure) was not associated with BALL (p=0.37), HC presence (p=0.21) or death (p=0.2). Both low BALL and HC presence were associated with poor 10-year survival (low BALL: HR 2.66, CI 1.05-6.73, p=0.038; HC presence: HR 3.80, CI 1.66-8.73, p=0.002) as depicted in Figure 1A and 1B. In a cox proportional hazards model including both BALL and HC presence (corrected for age, gender and baseline FVC%), only HC was associated with poor outcome (HC: HR 2.68, CI 1.02-7.06, p=0.046; BALL: HR 1.4, CI 0.51-4.09, p=0.49). Patients with high BALL experienced an FVC% increase of 5.66% (p=0.004) after CS initiation, although FVC% decline (i.e. the slope of the mixed model) was similar (- 6.6%/year before vs -5.3%/year after CS initiation, p=0.77). No effect on DLCO was observed (main effect (i.e. the intercept): p=0.29, decline (i.e. slope of the model): p=0.50). No CS effect was seen in the low-BALL group (FVC% main effect: p=0.93; FVC% decline: p=0.96; DLCO% main effect: p=0.50; DLCO% decline: p=0.33). Patients without HC experienced a trend towards FVC% increase of 4.21% (p=0.07) after CS initiation, although FVC% decline was not affected (-1.4 %/year before vs - 2.82%/year after CS initiation, p=0.78). No effect on DLCO was observed (main effect: p=0.12, decline: p=0.91). No CS effect was seen in the group with HC (FVC% main effect: p=0.80; FVC% decline: p=0.57; DLCO% main effect: p=0.33; DLCO% decline: p=0.24). Pulmonary function trajectories are depicted in Figure 1C and 1D. While CS initiation had a marginal effect on FVC when BALL was high and when HC was absent, no effect was seen when BALL was low or when HC was present. However, this single center retrospective study has some limitations. As BAL lymphocytosis and HC were correlated in this cohort of 91 patients, there was a lack of statistical power to assess the differential contribution of both variables on FVC increase after treatment initiation. Hence, it is unclear whether the increase of FVC in patients without HC is attributable to the absence of HC or the associated presence of high BALL. Larger multicenter trials are needed to address this question. As no generally accepted cut-off for high BAL Lymphocytosis exists, we opted for the cut-off used in our ILD clinic (i.e. 20%). Moreover, analysis of c-indices showed a 20% cut-off yielded the best prognostic separation (c-index = 0.635); better compared to a 25% cut-off (c-index 0.59, p=0.029), a 30% cut-off (c-index 0.60, p=0.084) and a 40% cut-off (c-index 0.51). We strongly believe that the risks of initiating CS therapy should be balanced against the marginal gains in the subgroup with high BALL/no HC. The recently published Nintedanib trial in progressive fibrosing ILDs (PF-ILDs) complicates the decision to initiate CS in fHP patients with high BALL or absence of HC even more. In order to assess whether fHP patients are progressive (which would indicate antifibrotics are warranted), a careful observation of FVC% decline of at least 5% is warranted, based on the Nintedanib tria. The marginal increase in FVC% after CS initiation would postpone the moment reaching a 5% decline in FVC% since diagnosis (while CS does not alter the progressive nature of the disease itself), merely delaying the start of antifibrotic treatment. As the gains of CS initiation in high BALL fHP patients and/or patients without HC are expected in the early stage of treatment and side-effects become more frequent as treatment duration increases, we believe these data do not support a long-term corticosteroid treatment. However, multi-center randomized controlled trials are needed to assess this question. In conclusion, both low BAL lymphocytosis and HC presence predict poor outcome and absence of CS treatment effect. In fHP patients with high BALL or HC absence, a marginal increase in FVC was seen, although FVC decline nor DLCO decline changed after CS treatment initiation AU - Sadeleer LJD AU - Hermans F AU - Dycker ED AU - Yserbyt J AU - Verschakelen JA AU - Verbeken EK AU - Verleden GM AU - Verleden SE AU - Wuyts WA LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 70 IP - DP - 2020 Jan 01 TI - Cutaneous sensitization to aziridine preceding the onset of occupational asthma. PG - 135-138 AB - We describe a 47-year-old non-atopic woman, working as a spray painter in a tannery for 23 years, with a 16-year history of cutaneous symptoms and a subsequent 2-year history of asthmatic symptoms after exposure to aerosol and vapour of polyfunctional aziridine (PFA) at work. To confirm the occupational origin of the dermatitis and asthma we performed a skin prick test with PFA and a specific inhalation challenge (SIC) with PFA. Prick test with PFA elicited an immediate positive skin reaction. She developed an immediate asthmatic reaction upon SIC with PFA. The onset of occupational dermatitis before asthma is consistent with the hypothesis that the sensitization to PFA was triggered in the skin. The observation that the reactions elicited in skin and airways upon exposure to PFA exhibited the same time course, suggests a similar mechanism at both sites. Thus, the avoidance of both skin and airway exposure to PFA should be recommended in workplace hygiene practice. AU - Mason P AU - Liviero F AU - Crivellaro M AU - Maculan P AU - Maestrelli P AU - Guarnieri G LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 62 IP - DP - 2020 Jan 01 TI - Cleaning Products and Work-Related Asthma, 10 Year Update PG - 130-137 AB - Objective: To describe the frequency of work-related asthma (WRA) and characteristics of individuals with exposure to cleaning products 1998 to 2012, compared with 1993 to 1997. Methods: Cases of WRA from products used for cleaning or disinfecting surfaces were identified from California, Massachusetts, Michigan (1998 to 2012), New Jersey (1998 to 2011), and New York (2009 to 2012). Results: There were 1199 (12.4%) cleaning product cases among all 9667 WRA cases; 77.8% women, 62.1% white non-Hispanic, and average age of 43 years. The highest percentages worked in healthcare (41.1%), and were building cleaners (20.3%), or registered nurses (14.1%). Conclusions: The percentage of WRA cases from exposure to cleaning products from 1998 to 2012 was unchanged from 1993 to 1997 indicating that continued and additional prevention efforts are needed to reduce unnecessary use, identify safer products, and implement safer work processes. AU - Rosenman K AU - Reilly MJ AU - Pechter E AU - Fitzsimmons K AU - Flattery J AU - Weinberg J AU - Cummings K AU - Borjan M AU - Lumia M AU - Harrison R AU - Dodd K AU - Schleiff P LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 319 IP - DP - 2020 Jan 01 TI - Long-term Respiratory Effects of Mustard Vesicants PG - 168-174 AB - Sulfur mustard and related vesicants are cytotoxic alkylating agents that cause severe damage to the respiratory tract. Injury is progressive leading, over time, to asthma, bronchitis, bronchiectasis, airway stenosis, and pulmonary fibrosis. As there are no specific therapeutics available for victims of mustard gas poisoning, current clinical treatments mostly provide only symptomatic relief. In this article, the long-term effects of mustards on the respiratory tract are described in humans and experimental animal models in an effort to define cellular and molecular mechanisms contributing to lung injury and disease pathogenesis. A better understanding of mechanisms underlying pulmonary toxicity induced by mustards may help in identifying potential targets for the development of effective clinical therapeutics aimed at mitigating their adverse effects. AU - Malaviya R AU - Laskin JD AU - Laskin DL LA - PT - DEP - TA - Toxicology Letters JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - IP - DP - 2020 Jan 01 TI - Asthma Symptoms in Bakeries at Parakou, Benin PG - 3767382 AB - Background and Objectives. There is a dearth of information on asthma among bakers in low-income settings. The objectives of this study were to determine (i) the prevalence of asthma symptoms, (ii) factors associated with probable occupational asthma (OA), and (iii) work habits that might lead to a dusty workplace environment, Parakou, Benin. Materials and Methods. This was a mixed methods (cross-sectional quantitative and qualitative) study carried out between March and September 2018. RESULTS: Of 210 employees/apprentices in 26 bakeries, 190 (91.48%) were included in the study: median age was 25.50 (IQR = 22 - 32) years, 157 (82.63%) were aged <40 years, and the male-to-female ratio was 26.14. Of these, 111 (58.42%) worked in a salted bread and 79 (41.58%) in a sweet bread bakery. An asthma history was reported by 3.68%. Symptoms consistent with asthma, work-related asthma, OA, and work-aggravated asthma were found in 13.68%, 12.63%, 10%, and 2.63%, respectively. Asthma confirmation was obtained in 15.79% of bakers with probable OA and in 23.08% of all bakers with suspected asthma. A history of allergic rhinoconjunctivitis was associated with probable OA (aOR = 106; 95%CI = 17.79 - 2093; p < 0.001). Of the 24 bakers with probable work-related asthma, 3 (12.50%) were prescribed a short-acting beta2-agonist and 2 (8.33%) an inhaled corticosteroid. No worker had had a systematically planned annual medical visit; some habits at work were identified as leading to flour and dust suspension at the workplace. CONCLUSION: Clinical manifestations of OA were common among bakers in Parakou and were associated with allergic rhinoconjunctivitis. There is a need to improve technical preventive measures and treatment, as well as to institute systematic medical visits for these workers. AU - Ade S AU - Adjobimey M AU - Agodokpessi G AU - Kouassi MS AU - Gounongbe FA AU - Cisse I AU - Hounkpatin SHR LA - PT - DEP - TA - Pulm Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 8 IP - DP - 2020 Jan 01 TI - The Burden of Respiratory Abnormalities Among Workers at Coffee Roasting and Packaging Facilities PG - 5 AB - Introduction: Respiratory hazards in the coffee roasting and packaging industry can include asthmagens such as green coffee bean and other dust and alpha-diketones such as diacetyl and 2,3-pentanedione that can occur naturally from roasting coffee or artificially from addition of flavoring to coffee. We sought to describe the burden of respiratory abnormalities among workers at 17 coffee roasting and packaging facilities. Methods: We completed medical surveys at 17 coffee roasting and packaging facilities that included interviewer-administered questionnaires and pulmonary function testing. We summarized work-related symptoms, diagnoses, and spirometry testing results among all participants. We compared health outcomes between participants who worked near flavoring and who did not. Results: Participants most commonly reported nose and eye symptoms, and wheeze, with a work-related pattern for some. Symptoms and pulmonary function tests were consistent with work-related asthma in some participants. About 5% of workers had abnormal spirometry and most improved after bronchodilator. Health outcomes were similar between employees who worked near flavoring and who did not, except employees who worked near flavoring reported more chronic bronchitis and ever receiving a diagnosis of asthma than those who did not work near flavoring. Conclusion: The symptoms and patterns likely represent overlapping health effects of different respiratory hazards, including green coffee bean and other dust that can contribute to work-related asthma, and diacetyl and 2,3-pentanedione that can contribute to obliterative bronchiolitis. Healthcare providers and occupational health and safety practitioners should be aware that workers at coffee roasting and packaging facilities are potentially at risk for occupational lung diseases. AU - Harvey RR AU - Fechter-Leggett ED AU - Bailey RL AU - Edwards NT AU - Fedan KB AU - Virji MA AU - Nett RJ AU - Cox-Ganser JM AU - Cummings KJ LA - PT - DEP - TA - Front Pub Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 38 IP - DP - 2020 Jan 01 TI - Occupational asthma caused by welding dust: a case report PG - 50 AU - Zhai ZH AU - Yu JH AU - Hu XL AU - Song LL AU - Ji ZX LA - PT - DEP - TA - Chinese journal of industrial hygiene and occupational diseases JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 17 IP - DP - 2020 Jan 01 TI - Occupational Exposure to Dust Produced when Milling Thermally Modified Wood. PG - 1478 AB - During production, thermally modified wood is processed using the same machining operations as unmodified wood. Machining wood is always accompanied with the creation of dust particles. The smaller they become, the more hazardous they are. Employees are exposed to a greater health hazard when machining thermally modified wood because a considerable amount of fine dust is produced under the same processing conditions than in the case of unmodified wood. The International Agency for Research on Cancer (IARC) states that wood dust causes cancer of the nasal cavity and paranasal sinuses and of the nasopharynx. Wood dust is also associated with toxic effects, irritation of the eyes, nose and throat, dermatitis, and respiratory system effects which include decreased lung capacity, chronic obstructive pulmonary disease, asthma and allergic reactions. In our research, granular composition of particles resulting from the process of longitudinal milling of heat-treated oak and spruce wood under variable conditions (i.e., the temperature of modification of 160, 180, 200 and 220 °C and feed rate of 6, 10 and 15 m.min-1) are presented in the paper. Sieve analysis was used to determine the granular composition of particles. An increase in fine particle fraction when the temperature of modification rises was confirmed by the research. This can be due to the lower strength of thermally modified wood. Moreover, a different effect of the temperature modification on granularity due to the tree species was observed. In the case of oak wood, changes occurred at a temperature of 160 °C and in the case of spruce wood, changes occurred at the temperatures of 200 and 220 °C. At the temperatures of modification of 200 and 220 °C, the dust fraction (i.e., that occurred in the mesh sieves, particles with the size = 0.08 mm) ranged from 2.99% (oak wood, feed rate of 10 m.min-1) to 8.07% (spruce wood, feed rate of 6 m.min-1). Such particles might have a harmful effect on employee health in wood-processing facilities. AU - Ockajová A AU - Kucerka M AU - Kminiak R AU - Krišták L AU - Igaz R AU - Réh R. LA - PT - DEP - TA - Int J Environ Res Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 382 IP - DP - 2020 Jan 01 TI - Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI PG - 697-705 AB - BACKGROUND The causative agents for the current national outbreak of electronic-cigarette, or vaping, product use–associated lung injury (EVALI) have not been established. Detection of toxicants in bronchoalveolar-lavage (BAL) fluid from patients with EVALI can provide direct information on exposure within the lung. METHODS BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nonsmokers, exclusive users of e-cigarettes or vaping products, and exclusive cigarette smokers that was initiated in 2015. Using the BAL fluid, we performed isotope dilution mass spectrometry to measure several priority toxicants: vitamin E acetate, plant oils, medium-chain triglyceride oil, coconut oil, petroleum distillates, and diluent terpenes. RESULTS State and local health departments assigned EVALI case status as confirmed for 25 patients and as probable for 26 patients. Vitamin E acetate was identified in BAL fluid obtained from 48 of 51 case patients (94%) in 16 states but not in such fluid obtained from the healthy comparator group. No other priority toxicants were found in BAL fluid from the case patients or the comparator group, except for coconut oil and limonene, which were found in 1 patient each. Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness. Nicotine or its metabolites were detected in 30 of 47 of the case patients (64%). CONCLUSIONS Vitamin E acetate was associated with EVALI in a convenience sample of 51 patients in 16 states across the United States. (Funded by the National Cancer Institute and others.) AU - Blount BC AU - Karwowski MP AU - Shields PG AU - Morel-Espinosa M AU - Valentin-Blasini L AU - Gardner M AU - Braselton M AU - Brosius CR AU - Caron KT AU - Chambers D AU - Corstvet J AU - Cowan E AU - De Jesús VR AU - Espinosa P AU - Fernandez C AU - Holder C AU - Kuklenyik Z AU - Kusovschi JD AU - Newman C AU - Reis GB AU - Rees J AU - Reese C AU - Silva L AU - Seyler T AU - Song M-A AU - Sosnoff C AU - Spitzer CR AU - Tevis D AU - Wang L AU - Watson C AU - Wewers MD AU - Xia B AU - Heitkemper DT AU - Ghinai I AU - Layden J AU - Briss P AU - King BA AU - Delaney LJ AU - Jones CM AU - Baldwin GT AU - Patel A AU - Meaney-Delman D AU - Rose D AU - Krishnasamy V AU - Barr JR AU - Thomas J AU - Pirkle JL LA - PT - DEP - TA - New England Journal of Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 382 IP - DP - 2020 Jan 01 TI - Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Final Report PG - 903-916 AB - BACKGROUND E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of lung injury associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation. METHODS We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools. RESULTS There were 98 case patients, 79% of whom were male; the median age of the patients was 21 years. The majority of patients presented with respiratory symptoms (97%), gastrointestinal symptoms (77%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging. A total of 95% of the patients were hospitalized, 26% underwent intubation and mechanical ventilation, and two deaths were reported. A total of 89% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018. CONCLUSIONS Case patients presented with similar clinical characteristics. Although the definitive substance or substances contributing to injury have not been determined, this initial cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes. AU - Layden JE AU - Ghinai I AU - Pray I AU - Kimball A AU - Layer M AU - Tenforde MW AU - Navon L AU - Hoots B AU - Salvatore PP AU - Elderbrook M AU - Haupt T AU - Kanne J AU - Patel MT AU - Saathoff-Huber L AU - King BA AU - Schier JG AU - Mikosz CA AU - Meiman J LA - PT - DEP - TA - New England Journal of Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 77 IP - DP - 2020 Jan 01 TI - Global and regional burden of chronic respiratory disease in 2016 arising from non-infectious airborne occupational exposures: a systematic analysis for the Global Burden of Disease Study 2016 PG - 142-150 AB - OBJECTIVES: This paper presents detailed analysis of the global and regional burden of chronic respiratory disease arising from occupational airborne exposures, as estimated in the Global Burden of Disease 2016 study. METHODS: The burden of chronic obstructive pulmonary disease (COPD) due to occupational exposure to particulate matter, gases and fumes, and secondhand smoke, and the burden of asthma resulting from occupational exposure to asthmagens, was estimated using the population attributable fraction (PAF), calculated using exposure prevalence and relative risks from the literature. PAFs were applied to the number of deaths and disability-adjusted life years (DALYs) for COPD and asthma. Pneumoconioses were estimated directly from cause of death data. Age-standardised rates were based only on persons aged 15 years and above. RESULTS: The estimated PAFs (based on DALYs) were 17% (95% uncertainty interval (UI) 14%-20%) for COPD and 10% (95% UI 9%-11%) for asthma. There were estimated to be 519?000 (95% UI 441,000-609,000) deaths from chronic respiratory disease in 2016 due to occupational airborne risk factors (COPD: 460,100 [95% UI 382,000-551,000]; asthma: 37,600 [95% UI 28,400-47,900]; pneumoconioses: 21,500 [95% UI 17,900-25,400]. The equivalent overall burden estimate was 13.6?million (95% UI 11.9-15.5?million); DALYs (COPD: 10.7 [95% UI 9.0-12.5]?million; asthma: 2.3 [95% UI 1.9-2.9]?million; pneumoconioses: 0.58 [95% UI 0.46-0.67]?million). Rates were highest in males; older persons and mainly in Oceania, Asia and sub-Saharan Africa; and decreased from 1990 to 2016. CONCLUSIONS: Workplace exposures resulting in COPD, asthma and pneumoconiosis continue to be important contributors to the burden of disease in all regions of the world. This should be reducible through improved prevention and control of relevant exposures. AU - GBD 2016 Occupational Chronic Respiratory Risk Factors Collaborators LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 17(4) IP - DP - 2020 Jan 01 TI - Determination of Propane-1,3-sultone in Workplace Air for Occupational Exposure Assessment PG - 1660-4601 AB - Propane-1,3-sultone (PS) is an alkylating substance used in the production of polymers, fungicides, insecticides, dyes, and detergents. It is absorbed into the human body by inhalation, digestion, and through the skin; it is also a possible carcinogen. Occupational exposure to this substance may occur on industrial or laboratory contact. In Poland, the maximum allowable concentration (MAC) for PS in workplace air is 7 &micro;g/m3. The paper presents a method for determination of PS in workplace air using a gas chromatograph coupled with a mass spectrometer (GC-MS). Air containing PS is passed through a glass tube containing a glass fiber filter and two layers of silica gel. The substance is washed with acetonitrile and the solution obtained analysed using GC-MS. The measuring range for an air sample of 360 L is 0.7 &divide; 14 &micro;g/m3. The limit of detection (LOD) is 13 ng/m3, limit of quantification (LOQ) is 40 ng/m3. AU - Jezewska AU - Anna LA - PT - DEP - TA - International Journal of Environmental Research and Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 25 IP - DP - 2020 Jan 01 TI - Proportion of workers having work-related asthma symptoms in a cassava factory, Nakhon Ratchasima province, Thailand PG - APST-25-02-08 AB - Introduction: Flour dust is one of work-related asthma (WRA) allergens. Few researches have been done on WRA symptoms in workers exposed to cassava starch. Objective: The aim of this study was to determine the proportion of WRA symptoms and definite WRA in a cassava factory. Methodology: We conducted a descriptive study in which a sample of 148 employees was identified at a cassava factory in Nakhon Ratchasima. All had worked 6 months or longer. The study included: 1) screening for asthma-like symptoms using a modified ECRHS questionnaire; 2) screening for WRA symptoms using a questionnaire and physical examination by an occupational medicine doctor; and, 3) diagnosis confirmation using serial peak expiratory flow interpreted by OASYS-2 software. Descriptive statistics were used to assess the findings. Results: The response rate was 87.2% (129/148)—males comprised 72.1% (93/129) of the sample. The proportion of asthma-like symptoms was 58.1% (75/129). Among 129, WRA symptoms was 11.6% (95%CI: 6.6, 17.3) and definite WRA was 3.1% (95%CI: 0.7, 6.5). In the 15 cases of WRA symptoms, 60% had a job task with high exposure to cassava starch. In cases of respiratory symptoms, most (86.7%) had upper respiratory symptoms and all had lower respiratory symptoms. Cough and dyspnea were the most common lower respiratory symptoms (each was 60%) followed by chest tightness (53.3%) and wheezing (26.7%). Conclusion: WRA symptoms and definite WRA constituted 11.6% and 3.1% in a cassava starch factory, respectively. The results showed a consistence with previous studies in developing nations. Cassava starch, like wheat flour, may cause WRA. AU - Nirarach K AU - Chaiear N AU - Kawamatawong T AU - Krisorn P AU - Burge PS LA - PT - DEP - TA - Asia-Pacific Journal of Science and Tech JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 723 IP - DP - 2020 Jan 01 TI - Covariation amongst pool management, trichloramine exposure and asthma for swimmers in Norway PG - 138070 AB - The association between asthma and exposure to the air in swimming facilities has been acknowledged. However, the variation in, long-term exposure to and management of the respiratory irritant trichloramine (NCl3) is not well understood. In this study, 313 swimmers above 18 years of age licensed by the Norwegian Swimming Association answered a questionnaire about health and swimming. The prevalence of asthma amongst the most-exposed swimmers was 36%. Two facilities, those with the highest and lowest reported prevalence of asthma, were chosen for further investigation. For each facility, a one-week-long monitoring campaign was performed, during which pool management, air and water quality were investigated. The results of this study showed that time of day, occupancy and pool management affect the concentration of NCl3, which ranged from 58 µg/m3 to 461 µg/m3. Furthermore, in one of the facilities, the concentration of CO2 was measured to evaluate whether this contaminant could be used to predict the number of pool occupants as well as the concentration of NCl3 in the air. The concentration of CO2 was significantly correlated with occupancy level (? = 0.82, p = 0.01) and NCl3 concentration (r = 0.80, p = 0.01). Furthermore, according to the random intercept model the concentration of CO2 explained 52% of the variation observed in the air concentration of NCl3. CO2 sensors to control the air supply can help reduce the air concentrations of NCl3 and balance the air supply based on occupancy level. AU - Nitter AU - TB AU - Hirsch Svendsen KV LA - PT - DEP - TA - Science of The Total Environment JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 77 IP - DP - 2020 Jan 01 TI - Occupational exposure to soft paper dust and mortality PG - 549-554 AB - Objectives Occupational exposure to soft paper dust is associated with impaired lung function. Whether there is an increased risk for asthma or chronic obstructive pulmonary disease (COPD) is unclear. Methods We studied 7870 workers from three Swedish soft paper mills, and defined high-exposed workers, as having been exposed to soft paper dust exceeding 5?mg/m3 for at least 5 years. The remaining workers were classified as ‘low exposed’. Person-years at risk were calculated and stratified according to gender, age and calendar-year. The follow-up time was from 1960 to 2013. The expected numbers of deaths were calculated using the Swedish population as reference and standardised mortality ratios (SMRs) with 95% CIs were assessed. Results There was an increased mortality due to obstructive lung disease (asthma and COPD), among high-exposed workers, SMR 1.89, 95%?CI 1.20 to 2.83, based on 23 observed cases. High-exposed workers had an increased mortality from asthma, SMR 4.13, 95%?CI 1.78 to 8.14, based on eight observed cases. The increased asthma mortality was also observed among high-exposed men, SMR 4.38, 95%?CI 1.42 to 10.2, based on five observed cases. The asthma mortality among low-exposed workers, both men and women, was not increased. The COPD mortality was not clearly increased among high-exposed workers (SMR 1.52, 95%?CI 0.85 to 2.50). Conclusion High occupational exposure to soft paper dust increases the mortality due to asthma, and the results suggest that soft paper dust levels in workplaces should be below 5?mg/m3. AU - Torén K AU - Neitzel R AU - Sallsten G AU - Andersson E LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 55 IP - DP - 2020 Jan 01 TI - A major genetic determinant of autoimmune diseases is associated with the presence of autoantibodies in Hypersensitivity Pneumonitis. PG - AB - BACKGROUND: Hypersensitivity pneumonitis (HP) is an immune-mediated disease triggered by exposure to organic particles in susceptible individuals. It has been reported that a subgroup of patients with HP develops autoantibodies with or without clinical manifestations of autoimmune disease. However, the mechanisms involved in this process and the effect of the autoantibodies on clinical course in HP is unknown. We evaluated the association between HLA class II alleles and HP patients with and without autoantibodies. METHODS: One hundred seventy HP patients were included. We analysed the presence of antinuclear antibodies, rheumatoid factor, anti-SSA/Ro, anti-SSB/La, and anti-CCP at the time of diagnosis. In addition, in a subset of patients, we evaluated anti-Scl-70, ANCA, and anti-DNA. HLA typing was performed by PCR-SSP in a high-resolution modality, including HLA-DRB1 and HLA-DQB1 loci. Statistical analysis was performed employing Epi-Info v7 and SPSSv20. RESULTS: Sixty HP patients showed sera autoantibodies (HPAbs+), and 110 HP patients did not (HPAbs-). The frequency of the allele HLA-DRB1*03:01 was remarkably increased in the HPAbs+ group (10.8% versus 0.45%; OR=30.14, 95%CI 3.83-237.1; p=1.65E-04 after Bonferroni's correction). Likewise, we found that the haplotype DRB1*03:01-DQB1*02:01, which is part of the 8.1 ancestral haplotype, a major genetic determinant of autoimmune diseases confers significant risk to develop autoantibodies (OR=19.23, 95%CI 2.37-155.9; p=0.0088 after Bonferroni's correction). Also, the HLA-DRB1*03:01 allele was associated with higher mortality in patients with HP (adjusted OR=5.9, 95%IC 1.05-33.05; p=0.043). CONCLUSIONS: A subset of HP patients presents circulating autoantibodies and higher mortality, that are associated with some alleles of 8.1 ancestral haplotype. AU - Buendía-Roldán I AU - Santiago-Ruiz L AU - Pérez-Rubio G AU - Mejía M AU - Rojas-Serrano J AU - Ambrocio-Ortiz E AU - Benítez-Valdez G AU - Selman M AU - Ramcés F LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - - IP - DP - 2020 Jan 01 TI - Work-related asthma in the USA: nationally representative estimates with extended follow-up PG - - AB - Objective We studied the associations of working in occupations with high asthma trigger exposures with the prevalence and incidence of asthma, and with ever reporting an asthma diagnosis throughout working life. Methods We used the nationally representative Panel Study of Income Dynamics (1968–2015; n=13?957; 205?498 person-years), with annual reports of occupation and asthma diagnoses across 48 years. We compared asthma outcomes in occupations likely to have asthma trigger exposures with those in occupations with limited trigger exposures. We estimated the prevalence ratios and the incidence risk ratios using log-binomial regression adjusted for age, sex, race/ethnicity, education, and current and past atopy and smoking, and accounting for the survey design and sampling weights. We calculated the attributable risk fractions and population attributable risks, and used multinomial logistic Markov models and microsimulation to estimate the percentage of people ever diagnosed with asthma during working life. Results The adjusted prevalence ratio comparing high-risk occupations with low-risk was 4.1 (95% CI 3.5 to 4.8); the adjusted risk ratio was 2.6 (CI 1.8 to 3.9). The attributable risk was 16.7% (CI 8.5 to 23.6); the population attributable risk was 11.3% (CI 5.0 to 17.2). In microsimulations, 14.9% (CI 13.4 to 16.3) with low trigger exposure risk reported asthma at least once, ages 18–65, compared with 23.9% (CI 22.3 to 26.0) with high exposure risk. Conclusion Adults were more than twice as likely to report a new asthma diagnosis if their occupation involved asthma triggers. Work exposures to asthma triggers may cause or aggravate about 11% of all adult asthma and increase the risk of work-life asthma by 60%. AU - Laditka JN AU - Laditka SB AU - Arif AA AU - Hoyle JN. LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - IP - DP - 2020 Jan 01 TI - The Role of Immunotherapy and Biologic Treatments in Occupational Allergic Disease PG - AB - Occupational exposures are estimated to account for 15% to 25% of all adult asthma in the general population. In some cases, workplace allergen exposures can be reduced but not entirely eliminated. Given the potentially significant impact of job change, some workers may choose to continue working in a job in which there is an ongoing occupational allergen exposure. In these cases, a combined approach including personal safety measures, pharmacotherapy, and allergen immunotherapy may result in the best clinical outcomes. This review presents existing evidence for the use of immunotherapy and biologic treatments in occupational allergic disease for various occupational allergens, including wheat flour, mammalian proteins, natural rubber latex, and Hymenoptera venom. There is increasing but modest evidence on beneficial short-term and long-term effects of allergen immunotherapy and safety in worker populations. Available data suggest that allergen immunotherapy can reduce skin and respiratory symptoms and therefore allow workers to continue their current occupation Occupational exposures are estimated to account for 15% to 25% of all adult asthma in the general population. In some cases, workplace allergen exposures can be reduced but not entirely eliminated. Given the potentially significant impact of job change, some workers may choose to continue working in a job in which there is an ongoing occupational allergen exposure. In these cases, a combined approach including personal safety measures, pharmacotherapy, and allergen immunotherapy may result in the best clinical outcomes. This review presents existing evidence for the use of immunotherapy and biologic treatments in occupational allergic disease for various occupational allergens, including wheat flour, mammalian proteins, natural rubber latex, and Hymenoptera venom. There is increasing but modest evidence on beneficial short-term and long-term effects of allergen immunotherapy and safety in worker populations. Available data suggest that allergen immunotherapy can reduce skin and respiratory symptoms and therefore allow workers to continue their current occupation. AU - Smith AM AU - Sastre J LA - PT - DEP - TA - Journal of Allergy and Clinical Immunology: In Practice JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 70 IP - DP - 2020 Jan 01 TI - Why are Cases of Occupational Asthma on the Rise?? PG - 399 AU - Williams N LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 17 IP - DP - 2020 Jan 01 TI - Upper and Lower Respiratory Signs and Symptoms in Workers Occupationally Exposed to Flour Dust PG - 7075 AB - A group of 142 bakers was studied in order to investigate the relationship between higher/lower respiratory signs/symptoms and inflammation biomarkers and occupational exposure to flour dust. A complete upper and lower respiratory tract evaluation was performed. Seven percent of bakers complained of lower respiratory symptoms, while 22% of them complained of upper respiratory symptoms. Fifty five percent of the bakers were allergic, and 37.1% showed sensitization to occupational allergens. Abnormal spirometries were found in 15% of bakers, while fractional exhaled nitric oxide (FeNO) was above the normal reference in 24.5% of them. Moreover, 23.8% of bakers were found to be hyposmic. Population mean peak nasal inspiratory flow (PNIF) was in the normal range even if almost all the workers suffered from neutrophilic rhinitis at nasal cytology with the number of nasal neutrophils increasing with the increase of the duration of exposure to flour dust (p = 0.03). PNIF and FEV1 (forced expiratory volume in the 1st second) showed a positive correlation (p = 0.03; r = 0.19). The Tiffeneau index decreased with the increase of dust (p = 0.017). A similar result was obtained once we divided our population into smokers and non-smokers (p = 0.021). Long-term exposure to bakery dusts can lead to a status of minimal nasal inflammation and allergy AU - Crivellaro MA AU - Ottaviano G AU - Maculan P AU - Pendolino AL AU - Vianello L AU - Mason P AU - Gioffrè F AU - Bizzotto R AU - Scarpa B AU - Simoni E AU - Astolfi L AU - Maestrelli P AU - Scapellato ML AU - Carrieri M AU - Trevisan A LA - PT - DEP - TA - Int. J. Environ. Res. Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 77 IP - DP - 2020 Jan 01 TI - Diagnosis of occupational asthma from serial measurements of forced expiratory volume in 1 s (FEV1) using the Area Between Curves (ABC) score from the Oasys plotter PG - 801-805 AB - Objectives To identify the changes in serial 2-hourly forced expiratory volume in 1 s (FEV1) measurements required to identify occupational asthma (OA) using the Oasys Area Between Curves (ABC) score. Methods The ABC score from 2-hourly measurements of FEV1 was compared between workers with confirmed OA and asthmatics without occupational exposure to identify the optimum separation using receiver operator characteristic (ROC) analysis. Separate analyses were made for plots using clock time and time from waking to allow for use in shift workers. Minimum record criteria were =6 readings per day, >4?day shifts and >4?rest days (or >9 days for controls). Results A retrospective analysis identified 22 workers with OA and 30 control asthmatics whose records reached the quality standards. Median FEV1 diurnal variation was 20.3% (IQR 16.1–32.6) for OA and 19.5% (IQR 14.5–26.1) for asthmatic controls. ROC curve analysis identified that a difference of 0.056?L/hour gave a ROC score of 0.821 for clock time and 0.768 for time from waking with a sensitivity of 73% and a specificity of 93% for the diagnosis of OA. Conclusions The diagnosis of OA requires objective confirmation. Unsupervised serial FEV1 measurements are more difficult to obtain reliably than measurements of peak expiratory flow, which are likely to remain the standard for general use. A FEV1 ABC score >0.056?L/hour provides a valid cut-off for those who wish to use FEV1 rather than peak expiratory flow. AU - Parkes ED AU - Moore VC AU - Walters GI AU - Burge PS LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 77 IP - DP - 2020 Jan 01 TI - Prunus persica 9, a new occupational allergen from peach tree pollen involved in rhinitis and asthma PG - 10.1136/oemed-2020-1 AB - Objectives Several studies have described peach tree (PT) as an occupational allergen. The aim of this work was to assess the effect of Prunus persica 9 (Pru p 9), a recently identified allergen from PT pollen, in exposed workers. Methods The study included people who reported respiratory symptoms after handling PT in orchards during the flowering period (Blanca village, Murcia region, south-east Spain). After completing a detailed questionnaire, participants underwent skin prick test (SPT) and nasal provocation test (NPT). The IgE response was analysed by SDS-PAGE and immunoblotting assays. Results A total of 21 cases were included (mean age 45 years; 57% women). Most were polysensitised to common pollens, although one person was sensitised only to PT pollen. All cases had a positive SPT to this pollen, and 43% also to Pru p 9. All participants reported having rhinitis, and six participants reported having also asthma. Immunoblotting showed a heterogeneous IgE pattern for several proteins, with Pru p 9 recognised in nine cases. Most participants sensitised to PT pollen and Pru p 9 had positive NPTs, while those who were not sensitised to Pru p 9 tested negative. Conclusions We demonstrate for the first time that Pru p 9, an allergen from PT pollen, can induce respiratory symptoms following occupational exposure. This must be considered a relevant allergen when people working with PT cultivars develop respiratory symptoms. AU - Victorio-Puche L AU - Somoza ML AU - Martin-Pedraza L AU - Fernandez-Caldas E AU - Fernandez EA AU - Moran M AU - Subiza JL AU - Lopez-Sanchez JD AU - Villalba M AU - Blanca M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 29 IP - DP - 2020 Jan 01 TI - Sick building symptoms among hospital workers associated with indoor air quality and personal factors PG - 645-655 AB - https://doi.org/10.1177/1420326X19855117 This study assesses the interior air quality and infective factors in a hospital in Turkey to provide data about air quality to protect hospital workers. This study measured indoor air quality in eight different locations in a hospital, including particulate matter (PM2.5 and PM1), carbon dioxide, carbon monoxide, temperature, humidity and microbiological matter. The highest PM2.5 and PM1 concentrations were in emergency service, and the highest CO2 was measured in the paediatric clinic. The poor interior air quality results are the most important cross-sectional data. For all participants, the prevalence of eye, upper respiratory tract, lower respiratory tract, skin and non-specific sick building syndrome symptoms were 23.0%, 40.7%, 22.5%, 36.3% and 63.7%, respectively. When sick building syndrome symptoms and environmental factors were investigated, skin symptoms increased 1.82 times in areas with stagnant air flow (p?=?0.046; OR?=?1.823; 95% CI: 1.010–3.290). Non-specific symptoms increased 2.17 times in locations with dry indoor air (p?=?0.039; OR?=?2.176; 95% CI: 1.041–4.549). Hospital workers are exposed to conditions that may increase the risk of a variety of sick building syndrome symptoms. Although the air quality measurements were not above the recommended limits in the hospital, long-term exposures should be considered for those experiencing sick building syndrome-related symptoms. AU - Babaoglu UT AU - Sezgin FM AU - Yag F LA - PT - DEP - TA - Indoor Built Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - IP - DP - 2020 Jan 01 PG - 2329-6933 AB - Rationale: Few longitudinal studies have assessed the relationship between occupational exposures and lung function decline in the general population, with sufficiently long follow-up. Objectives: Our objective was to examine this potential association in two large cohorts (ECRHS and SAPALDIA). Methods: General population samples aged 18 to 62 were randomly selected in 1991-1993, and followed up approximately 10 and 20 years later. Spirometry (without bronchodilation) was performed at each visit. Coded complete job histories during follow-up visits were linked to a Job-Exposure Matrix, generating cumulative exposure estimates for 12 occupational exposures. FEV1 and FVC were jointly modelled in linear mixed-effects models, fitted in a Bayesian framework, taking into account age and smoking. Results: A total of 40,024 lung function measurements from 17,833 study participants were analyzed. We found accelerated declines in FEV1 and the FEV1/FVC ratio for exposure to biological dust, mineral dust and metals (FEV1 -15.1ml, -14.4ml and -18.7ml respectively, and FEV1/FVC -0.52%, -0.43% and -0.36% respectively, per 25 intensity-years of exposure). These declines were comparable in magnitude to those associated with long-term smoking. No effect modification by sex or smoking status was identified. Findings were similar between the ECRHS and SAPALDIA cohorts. Conclusions: Our results greatly strengthen the evidence base implicating occupation, independent of smoking, as a risk factor for lung function decline. This highlights the need to prevent or control these exposures in the workplace. AU - Lytras AU - Theodore AU - Beckmeyer-Borowko AU - Anna AU - Kogevinas AU - Manolis AU - Kromhout AU - Hans AU - Carsin AU - Anne-Elie AU - Antó AU - Josep Maria AU - Bentouhami AU - Hayat AU - Weyler AU - Joost AU - Heinrich AU - Joachim AU - Nowak AU - Dennis AU - Urrutia AU - Isabel AU - Martínez-Moratalla AU - Jesús AU - Gullón AU - José Antonio AU - Pereira Vega AU - Antonio AU - Raherison Semjen AU - Chantal AU - Pin AU - Isabelle AU - Demoly AU - Pascal AU - Leynaert AU - Bénédicte AU - Villani AU - Simona AU - Gislason AU - Thorarinn AU - Svanes AU - Øistein AU - Holm AU - Mathias AU - Forsberg AU - Bertil AU - Norbäck AU - Dan AU - Mehta AU - Amar J AU - Keidel AU - Dirk AU - Vernez AU - David AU - Benke AU - Geza AU - Jõgi AU - Rain AU - Torén AU - Kjell AU - Sigsgaard AU - Torben AU - Schlünssen AU - Vivi AU - Olivieri AU - Mario AU - Blanc AU - Paul D. AU - Watkins AU - John AU - Bono AU - Roberto AU - Squillacioti AU - Giulia AU - Buist AU - A. Sonia AU - Vermeulen AU - Roel AU - Jarvis AU - Deborah AU - Probst-Hensch AU - Nicole AU - Zock AU - Jan-Paul LA - PT - DEP - TA - Annals of the American Thoracic Society JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 202002-113 IP - DP - 2020 Jan 01 TI - Cumulative Occupational Exposures and Lung Function Decline in Two Large General Population Cohorts PG - 202002-113OC AB - Rationale: Few longitudinal studies have assessed the relationship between occupational exposures and lung function decline in the general population, with sufficiently long follow-up. Objectives: Our objective was to examine this potential association in two large cohorts (ECRHS and SAPALDIA). Methods: General population samples aged 18 to 62 were randomly selected in 1991-1993, and followed up approximately 10 and 20 years later. Spirometry (without bronchodilation) was performed at each visit. Coded complete job histories during follow-up visits were linked to a Job-Exposure Matrix, generating cumulative exposure estimates for 12 occupational exposures. FEV1 and FVC were jointly modelled in linear mixed-effects models, fitted in a Bayesian framework, taking into account age and smoking. Results: A total of 40,024 lung function measurements from 17,833 study participants were analyzed. We found accelerated declines in FEV1 and the FEV1/FVC ratio for exposure to biological dust, mineral dust and metals (FEV1 -15.1ml, -14.4ml and -18.7ml respectively, and FEV1/FVC -0.52%, -0.43% and -0.36% respectively, per 25 intensity-years of exposure). These declines were comparable in magnitude to those associated with long-term smoking. No effect modification by sex or smoking status was identified. Findings were similar between the ECRHS and SAPALDIA cohorts. Conclusions: Our results greatly strengthen the evidence base implicating occupation, independent of smoking, as a risk factor for lung function decline. This highlights the need to prevent or control these exposures in the workplace. AU - Lytras T AU - Beckmeyer-Borowko A AU - Kogevinas M AU - Kromhout H AU - Carsin A AU - Antó JM AU - Bentouhami H AU - Weyler J AU - Heinrich J AU - Nowak D AU - Urrutia I AU - Martínez-Moratalla J AU - Gullón JA AU - Vega AP AU - Semjen CR AU - Pin I AU - Demoly P AU - Leynaert B AU - Villani S AU - Gislason T AU - Svanes Ø AU - Holm M AU - Forsberg B AU - Norbäck D AU - Mehta AJ AU - Keidel D AU - Vernez D AU - Benke G AU - Jõgi R AU - Torén K AU - Sigsgaard T AU - Schlünssen V AU - Olivieri M AU - Blanc PD AU - Watkins J AU - Bono R AU - Squillacioti G AU - Buist AS AU - Vermeulen R AU - Jarvis D AU - Probst-Hensch N AU - Zock J LA - PT - DEP - TA - Ann Am Thorac Soc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - IP - DP - 2020 Jan 01 TI - Leukocyte Telomere Length and Mycophenolate Therapy in Chronic Hypersensitivity Pneumonitis PG - AB - Recent prospective clinical trials have shown antifibrotic therapies slow lung function decline in patients with idiopathic pulmonary fibrosis (IPF) [1, 2] and progressive fibrosing interstitial lung disease (ILD). Similar findings were demonstrated in scleroderma-associated ILD [3] despite use of the immunosuppressive therapy mycophenolate mofetil (MMF). Prospective data for the treatment of other forms of ILD, such as chronic hypersensitivity pneumonitis (CHP) are lacking. Our groups previously reported that the treatment of CHP with MMF was associated with a decreased incidence of adverse events, a reduction in prednisone dose, and improved lung function when compared to prednisone alone [4, 5], but prospective studies are needed to confirm these findings. Short leukocyte telomere length (TL) is associated with increased mortality in patients with ILD, including CHP and IPF [6–8]. A recent investigation also showed TL may influence the response to immunosuppressive therapy. In that study, patients with IPF and short TL had a higher risk of death, lung transplantation, and forced vital capacity (FVC) decline, when exposed to immunosuppressive therapy, including MMF [9]. In this investigation we sought to determine whether similar findings occurred in patients with CHP. We hypothesised that patients with CHP and short TL would experience a higher prevalence of death and disease progression when compared to those with longer TL. AU - Adegunsoye A AU - Morisset J AU - Newton CA AU - Oldham JM AU - Vittinghoff E AU - Linderholm AL AU - Strek ME AU - Noth I AU - Garcia CK AU - Wolters PJ AU - Ley B LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 158 IP - DP - 2020 Jan 01 TI - Vaping-Related Acute Parenchymal Lung Injury A Systematic Review PG - 1555-1565 AB - The outbreak of vaping-related acute lung injury in the United States, named EVALI (e-cigarette or vaping product use associated acute lung injury), has reignited concerns about the health effects of vaping. Initial case reports of vaping-related lung injury date back to 2012, but the ongoing outbreak of EVALI began in the summer of 2019 and has been implicated in 2,807 cases and 68 deaths as of this writing. Review of the scientific literature revealed 216 patient cases that spanned 41 reports of parenchymal lung injury attributed to vaping. In this review, we detail the clinical, radiographic, and pathologic patterns of lung injury that are attributable to vaping and provide an overview of the scientific literature to date on the effects of vaping on respiratory health. Tetrahydrocannabinol was the most commonly vaped substance, and vitamin E acetate was found in BAL specimens from many affected individuals. However, no specific component or contaminant has been identified conclusively to date as the cause for the injury. Patients present with cough, dyspnea, constitutional symptoms, and GI symptoms. Radiologic and histopathologic findings demonstrate a spectrum of nonspecific acute injury patterns. A high index of suspicion combined with a good history are the keys to an accurate diagnosis. Treatment is supportive; the mortality rate is low, and most patients recover. Corticosteroids have been used with apparent success in patients with severe disease, but more rigorous studies are needed to clarify their role in the treatment of vaping-related lung injury. AU - Jonas AM AU - Raj R LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 70 IP - DP - 2020 Jan 01 TI - Updated review of reported cases of reactive airways dysfunction syndrome PG - 490-495 AB - Background A previous systematic review of the diagnosis of reactive airways dysfunction syndrome (RADS), undertaken from 1985 to 2004, found a lack of standardization of case reporting, thus misattribution of symptoms can occur. Aims We aimed to update the systematic review, update the list of reported causes and see whether a more structured approach to reporting has been adopted. Methods We undertook a systematic literature review, using the databases EMBASE and Ovid MEDLINE, with search terms ‘reactive airways dysfunction syndrome’ or ‘asthma AND acute irritant’, and reported according to PRISMA guidelines. We included papers and abstracts published from January 2005 to September 2019, and articles were grouped by the presence or absence of diagnostic features: ‘definite’ RADS (met Brooks’ criteria) or ‘possible’ RADS (Brooks’ criteria not met or insufficient data). We collected demographic and diagnostic data for cases, where given. Results Eleven papers and six conference abstracts met the inclusion criteria, 13 of which were case series or reports, and comprised 752 cases in total; seven articles met Brooks’ criteria for RADS diagnosis. A variety of agents were implicated, with chlorine or chlorine-releasing molecules most frequently reported. Conclusions A lack of standardized reporting of RADS remains. The majority of published articles and conference abstracts either do not meet, or contain insufficient data to judge against, Brooks’ criteria, particularly in relation to onset of symptoms and bronchial hyper-reactivity or variability of airflow obstruction. Some novel agents are described, in keeping with recognized structural taxonomies. AU - Walters GI AU - Huntley CC LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 202 IP - DP - 2020 Jan 01 TI - Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline PG - e36-e69 AB - Background: This guideline addresses the diagnosis of hypersensitivity pneumonitis (HP). It represents a collaborative effort among the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax. Methods: Systematic reviews were performed for six questions. The evidence was discussed, and then recommendations were formulated by a multidisciplinary committee of experts in the field of interstitial lung disease and HP using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Results: The guideline committee defined HP, and clinical, radiographic, and pathological features were described. HP was classified into nonfibrotic and fibrotic phenotypes. There was limited evidence that was directly applicable to all questions. The need for a thorough history and a validated questionnaire to identify potential exposures was agreed on. Serum IgG testing against potential antigens associated with HP was suggested to identify potential exposures. For patients with nonfibrotic HP, a recommendation was made in favor of obtaining bronchoalveolar lavage (BAL) fluid for lymphocyte cellular analysis, and suggestions for transbronchial lung biopsy and surgical lung biopsy were also made. For patients with fibrotic HP, suggestions were made in favor of obtaining BAL for lymphocyte cellular analysis, transbronchial lung cryobiopsy, and surgical lung biopsy. Diagnostic criteria were established, and a diagnostic algorithm was created by expert consensus. Knowledge gaps were identified as future research directions. Conclusions: The guideline committee developed a systematic approach to the diagnosis of HP. The approach should be reevaluated as new evidence accumulates. AU - Raghu G AU - Remy-Jardin M AU - Ryerson CJ AU - Myers JL AU - Kreuter M AU - Vasakova M AU - Bargagli E AU - Chung JH AU - Collins BF AU - Bendstrup E AU - Chami HA AU - Chua AT AU - Corte TJ AU - Dalphin J AU - Danoff SK AU - Diaz-Mendoza J AU - Duggal A AU - Egashira R AU - Ewing T AU - Gulati M AU - Inoue Y AU - Jenkins AR AU - Johannson KA AU - Johkoh T AU - Tamae-Kakazu M AU - Kitaichi M AU - Knight SL AU - Koschel D AU - Lederer DJ AU - Mageto Y AU - Maier LA AU - Matiz C AU - Morell F AU - Nicholson AG AU - Patolia S AU - Pereira CA AU - Renzoni EA AU - Salisbury ML AU - Selman M AU - Walsh SLF AU - Wuyts WA AU - and Wilson KC LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 8 IP - DP - 2020 Jan 01 TI - Nintedanib in patients with progressive fibrosing interstitial lung diseases—subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial PG - 453-460 AB - Background The INBUILD trial investigated the efficacy and safety of nintedanib versus placebo in patients with progressive fibrosing interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF). We aimed to establish the effects of nintedanib in subgroups based on ILD diagnosis. Methods The INBUILD trial was a randomised, double-blind, placebo-controlled, parallel group trial done at 153 sites in 15 countries. Participants had an investigator-diagnosed fibrosing ILD other than IPF, with chest imaging features of fibrosis of more than 10% extent on high resolution CT (HRCT), forced vital capacity (FVC) of 45% or more predicted, and diffusing capacity of the lung for carbon monoxide (DLco) of at least 30% and less than 80% predicted. Participants fulfilled protocol-defined criteria for ILD progression in the 24 months before screening, despite management considered appropriate in clinical practice for the individual ILD. Participants were randomly assigned 1:1 by means of a pseudo-random number generator to receive nintedanib 150 mg twice daily or placebo for at least 52 weeks. Participants, investigators, and other personnel involved in the trial and analysis were masked to treatment assignment until after database lock. In this subgroup analysis, we assessed the rate of decline in FVC (mL/year) over 52 weeks in patients who received at least one dose of nintedanib or placebo in five prespecified subgroups based on the ILD diagnoses documented by the investigators: hypersensitivity pneumonitis, autoimmune ILDs, idiopathic non-specific interstitial pneumonia, unclassifiable idiopathic interstitial pneumonia, and other ILDs. The trial has been completed and is registered with ClinicalTrials.gov, number NCT02999178. Findings Participants were recruited between Feb 23, 2017, and April 27, 2018. Of 663 participants who received at least one dose of nintedanib or placebo, 173 (26%) had chronic hypersensitivity pneumonitis, 170 (26%) an autoimmune ILD, 125 (19%) idiopathic non-specific interstitial pneumonia, 114 (17%) unclassifiable idiopathic interstitial pneumonia, and 81 (12%) other ILDs. The effect of nintedanib versus placebo on reducing the rate of FVC decline (mL/year) was consistent across the five subgroups by ILD diagnosis in the overall population (hypersensitivity pneumonitis 73·1 [95% CI -8·6 to 154·8]; autoimmune ILDs 104·0 [21·1 to 186·9]; idiopathic non-specific interstitial pneumonia 141·6 [46·0 to 237·2]; unclassifiable idiopathic interstitial pneumonia 68·3 [-31·4 to 168·1]; and other ILDs 197·1 [77·6 to 316·7]; p=0·41 for treatment by subgroup by time interaction). Adverse events reported in the subgroups were consistent with those reported in the overall population. Interpretation The INBUILD trial was not designed or powered to provide evidence for a benefit of nintedanib in specific diagnostic subgroups. However, its results suggest that nintedanib reduces the rate of ILD progression, as measured by FVC decline, in patients who have a chronic fibrosing ILD and progressive phenotype, irrespective of the underlying ILD diagnosis. AU - Wells AU AU - Flaherty KR AU - Brown KK AU - Inoue Y AU - Devaraj A AU - Richeldi L AU - Moua T AU - Crestani B AU - Wuyts WA AU - Stowasser S AU - Quaresma M AU - Goeldner R-G AU - Schlenker-Herceg R AU - Kolb M AU - Abe S AU - Aburto M AU - Acosta O AU - Andrews C AU - Antin-Ozerkis D AU - Arce G AU - Arias M AU - Avdeev S AU - Barczyk A AU - Bascom R AU - Bazdyrev E AU - Beirne P AU - Belloli E AU - Bergna MA AU - Bergot E AU - Bhatt N AU - Blaas S AU - Bondue B AU - Bonella F AU - Britt E AU - Buch K AU - Burk J AU - Cai H AU - Cantin A AU - Castillo Villegas DM AU - Cazaux A AU - Cerri S AU - Chaaban S AU - Chaudhuri N AU - Cottin V AU - Crestani B AU - Criner G AU - Dahlqvist C AU - Danoff S AU - Dematte DAmico J AU - Dilling D AU - Elias P AU - Ettinger N AU - Falk J AU - Fernández Pérez ER AU - Gamez-Dubuis A AU - Giessel G AU - Gifford A AU - Glassberg M AU - Glazer C AU - Golden J AU - Gómez Carrera L AU - Guiot J AU - Hallowell R AU - Hayashi H AU - Hetzel J AU - Hirani N AU - Homik L AU - Hope-Gill B AU - Hotchkin D AU - Ichikado K AU - Ilkovich M AU - Inoue Y AU - Izumi S AU - Jassem E AU - Jones L AU - Jouneau S AU - Kaner R AU - Kang J AU - Kawamura T AU - Kessler R AU - LA - PT - DEP - TA - Lancet Respiratory Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - IP - DP - 2020 Jan 01 TI - Cleaning products and respiratory health outcomes in occupational cleaners: a systematic review and meta-analysis PG - AB - There is consistent evidence of increased respiratory symptoms in occupational cleaners; however, uncertainty remains on type of respiratory health effects, underlying causal agents, mechanisms and respiratory phenotypes. We aimed to conduct a systematic review and if possible, a meta-analysis of the available literature to characterise and quantify the cleaning-related respiratory health effects. We searched MEDLINE and EMBASE databases and included studies that evaluated the association of any respiratory health outcome with exposure to cleaning occupation or products in occupational cleaners. A modified GRADE was used to appraise the quality of included studies. We retrieved 1124 articles, and after applying our inclusion criteria, 39 were selected for the systematic review. We performed a meta-analysis of the 21 studies evaluating asthma which showed a 50% increased pooled relative risk in cleaners (meta-relative risk (RR)=1.50; 95%?CI 1.44 to 1.56). Population-based cross-sectional studies showed more stable associations with asthma risk. No evidence of atopic asthma as dominant phenotype emerged. Also, we estimated a 43% increased risk (meta-RR=1.43; 95%?CI 1.31 to 1.56) of chronic obstructive pulmonary disease. Evidence for associations with bronchial-hyper-responsiveness, lung function decline, rhinitis, upper and lower respiratory tract symptoms was weaker. In our systematic review and meta-analysis, we found that working as a cleaner is associated with an increased risk of reversible and even irreversible obstructive airway diseases. All studies lacked quantitative exposure assessment to cleaning products; this would help elucidate underlying causal agents and mechanisms. Exposure control and respiratory surveillance among cleaners is warranted to prevent the associated respiratory health burden. AU - Archangelidi O AU - Sathiyajit S AU - Consonni D AU - Jarvis D AU - Matteis SD LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 17 IP - DP - 2020 Jan 01 TI - A Potential Health Risk to Occupational User from Exposure to Biocidal Active Chemicals PG - 23 AB - Biocidal active chemicals have potential health risks associated with exposure to retail biocide products such as disinfectants for COVID-19. Reliable exposure assessment was investigated to understand the exposure pattern of biocidal products used by occupational workers in their place of occupation, multi-use facilities, and general facilities. The interview-survey approach was taken to obtain the database about several subcategories of twelve occupational groups, the use pattern, and the exposure information of non-human hygiene disinfectant and insecticide products in workplaces. Furthermore, we investigated valuable exposure factors, e.g., the patterns of use, exposure routes, and quantifying potential hazardous chemical intake, on biocidal active ingredients. We focused on biocidal active-ingredient exposure from products used by twelve occupational worker groups. The 685 non-human hygiene disinfectants and 763 insecticides identified contained 152 and 97 different active-ingredient chemicals, respectively. The toxicity values and clinical health effects of total twelve ingredient chemicals were determined through a brief overview of toxicity studies aimed at estimating human health risks. To estimate actual exposure amounts divided by twelve occupational groups, the time spent to apply the products was investigated from the beginning to end of the product use. This study investigated the exposure assessment of occupational exposure to biocidal products used in workplaces, multi-use facilities, and general facilities. Furthermore, this study provides valuable information on occupational exposure that may be useful to conduct accurate exposure assessment and to manage products used for quarantine in general facilities. AU - Kim J AU - Hwang M AU - Kim Y LA - PT - DEP - TA - Int J Environ Res Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 145 IP - DP - 2020 Jan 01 TI - E-cigarettes, vaping-related pulmonary illnesses, and asthma: A perspective from inhalation toxicologists PG - 97-99 AB - The recent outbreak of e-cigarette or vaping-product use–associated lung injury (EVALI) is alarming. As of October 18, 2019, 33 deaths and nearly 1500 hospitalizations associated with e-cigarette use have been reported in 49 states and the US Virgin Islands. Initial epidemiologic investigations of EVALI cases in Illinois and Wisconsin identified that more than 80% of the reported cases occurred in young white male subjects who presented with respiratory, gastrointestinal, and constitutional symptoms that rapidly progressed to severe acute lung injury.1 Interestingly, underlying asthma was reported in 30% of these cases, which is much higher than the 8% to 10% of asthmatic patients seen in the general population. Although many questions regarding the safety of e-cigarettes have come to the forefront with the emergence of EVALI, health care providers and concerned parents are also asking what might be causing this outbreak and who might be susceptible to EVALI. AU - Clapp PW AU - Peden DB AU - Jaspers I LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 12 IP - DP - 2020 Jan 01 TI - Bronchial response to high and low molecular weight occupational inhalant allergens. PG - 164-170 AB - PURPOSE: Occupational asthma may be induced by high- or low-molecular weight allergens (HMWA or LMWA, respectively). The study was conducted to compare the pattern of bronchial response in 200 HMWA-induced asthmatics (n = 130) and LMWA-induced asthmatics (n = 70). METHODS: The study participants underwent a single-blind, placebo-controlled specific inhalation challenge (SIC) with workplace allergens, accompanied by evaluation of non-specific bronchial hyperresponsiveness (NSBHR) with methacholine before and after the SIC. RESULTS: A single early bronchial response more frequently occurred in HMWA-induced asthmatics than in LMWA-induced asthmatics (86.2% vs. 20%). An isolated late bronchial response or atypical patterns were more frequently observed in LMWA-induced asthmatics than in LMWA-induced asthmatics (45.7% vs. 3.8% or 34.3% vs. 10%, respectively). Baseline NSBHR before SIC was more often detected in LMWA-induced asthmatics than in HMWA-induced asthmatics (81.4% vs. 54.6%), and the median value of the provocation concentration of methacholine was relevantly lower in these patients before and after SIC. A significant 3-fold increase in NSBHR after SIC was observed more often in LMWA-induced asthmatics than in HMWA-induced asthmatics (82.8% vs. 66.1%). In addition, compared to LMWA-induced asthmatics, HMWA-induced asthmatics were older, were more frequently active smokers, showed lower level of NSBHR, and more frequently continued their work in harmful occupational exposure. CONCLUSIONS: The results of this study suggest that HMWA-induced asthmatics may have milder clinical courses and that there is a possibility of job continuation despite asthma exacerbation requiring medical surveillance. AU - Lipinska-Ojrzanowska A AU - Nowakowska-Swirta E AU - Wiszniewska M AU - Walusiak-Skorupa J LA - PT - DEP - TA - Allergy Asthma Immunol Res. 202 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 68 IP - DP - 2020 Jan 01 TI - Interim Guidance for Health Care Professionals Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use-Associated Lung Injury and for Reducing the Risk for Rehospitalization and Death Following Hospital Discharge PG - 1189-1194 AB - Response Clinical Working Group, to update guidance regarding timing of the initial postdischarge follow-up of hospitalized EVALI patients and other EVALI patient management. Updates to current clinical guidance include recommendations for discharge planning and optimized follow-up and case management after discharge that might reduce risk of rehospitalization and avert postdischarge mortality among patients hospitalized for EVALI. Specifically, guidance updates include 1) confirming no clinically significant fluctuations in vital signs for at least 24–48 hours before discharge; 2) ensuring outpatient primary care or pulmonary specialist follow-up, optimally within 48 hours of discharge (previously recommended within 2 weeks of discharge); 3) planning for discharge care, early follow-up, and management of any comorbidities; 4) arranging posthospitalization specialty care; 5) following best practices for medication adherence; and 6) ensuring social support and access to mental and behavioral health and substance use disorder services. As of December 10, 2019, a total of 2,409 hospitalized EVALI cases have been reported to CDC, including 52 (2%) deaths among EVALI patients. Among 1,139 reported cases with patient hospital discharge by October 31, 2019, 31 (2.7%) patients were rehospitalized after initial discharge (median time to readmission: 4 days [interquartile range: 2–20 days]), and seven patients died following discharge after an EVALI hospitalization (median time to death: 3 days [interquartile range 2–13 days]) (9). Characteristics of EVALI patients who were rehospitalized or died following hospital discharge indicate that some chronic medical conditions, including cardiac disease, chronic pulmonary disease (e.g., chronic obstructive pulmonary disease and obstructive sleep apnea), and diabetes, and increasing age are risk factors leading to higher morbidity and mortality among some EVALI patients. For example, 70.6% of patients who were rehospitalized and 83.3 (five of six) of patients who died had one or more chronic conditions, compared with 25.6% of patients who were neither rehospitalized nor died (9). EVALI patients who were rehospitalized or died after discharge were older: the median ages of patients who died, were rehospitalized, and who neither died nor were rehospitalized were 54, 27, and 23 years, respectively (9). Confirming stability of certain clinical parameters without clinically significant fluctuations in vital signs before discharge and careful hospital discharge and transition planning might help prevent rehospitalization or death, particularly among those patients with cardiac or chronic respiratory comorbidities who are at higher risk for rehospitalization or death. In addition, anxiety, depression, attention-deficit/hyperactivity disorder, and other mental or behavioral health conditions were common among all EVALI patients. Based on the high prevalence of these conditions, appropriate engagement with social and behavioral health services during care transition from hospital to the outpatient setting is also important. AU - Evans ME AU - Twentyman E AU - Click ES AU - Alyson B AU - Goodman DN AU - Kiernan E AU - Hocevar SA AU - Mikosz CA AU - Danielson M AU - Anderson KN AU - Ellington S AU - Lozier MJ AU - Pollack LA AU - Rose DA AU - Krishnasamy V AU - Jones CM AU - Briss P AU - King BA AU - Wiltz AU - JL LA - PT - DEP - TA - MMWR CDC Surveill Summ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 10.1164/rc IP - DP - 2020 Jan 01 TI - Are Electronic Cigarette Users at Risk for Lipid-Mediated Lung Injury? PG - 10.1164/ AB - Recent case series and related commentary published in the AJRCCM, highlights the recent epidemic of acute lung injury associated with e-cigarettes use, and its remaining obscure nature. While this cluster is novel, pulmonary illness associated with e-cigarette use is not new: there are at least seven published case reports from 2012-2018 describing similar conditions in e-cigarette users and with no identifiable infectious etiology (i.e., acute lung injury, atypical pneumonitis, eosinophilic pneumonia, hypersensitivity pneumonia, lipoid pneumonia). Interestingly, of these seven reported cases, lung cell samples obtained via lavage or biopsy were available for five3-7, and all five exhibited abnormally lipid-laden macrophages. Lipid-laden macrophages were also a prominent feature (> 50%) in BAL of more recent case series from Utah. Such macrophages can trigger an inflammatory immune response leading to lipoid pneumonia, and other pneumonitis-like reactions. One report suggested that vegetable glycerin (VG) derived from vegetable oil and found in virtually all e-cigarette liquids is likely to be the exogenous source of lipid in an e-cigarette user diagnosed with lipoid pneumonia. However, most of the publications related to this new entity focused on tetrahydrocannabinol (THC), and a recent case series from the Mayo Clinic suggests chemical pneumonitis as a more probable etio-pathology. The fact that not all e-cigarette related lung injury cases were associated with THC use, and that THC “vaping” usually involves an oil vehicle (e.g. butane hash oils) do not rule out an important role for lipid-mediated lung injury in this clinical entity. This is particularly important to keep in mind given that most e-cigarette liquids contain VG as an essential component (helps make the e-cigarette aerosol visible). The implication is that many e-cigarette users, currently asymptomatic (or experiencing milder symptoms for which they do not seek medical attention), maybe undergoing lipid deposition in their airway, with concomitant inflammatory changes induced by lipid-laden macrophages and other immune cells. Therefore, we urge clinicians treating patients with acute and unexplained pulmonary complaints to identify if the patient is an e-cigarette user and, if so, to obtain detailed history about their use, and when possible to collect cell samples to determine if evidence of lipid exposure is present. Similarly, we urge researchers to investigate lipid exposure and inhaled toxic substances in e-cigarette users systematically. Most importantly, we call for regulators to implement immediately strict regulation that prevents lipid and inhaled toxicants emissions from all e-cigarettes sold in the US. AU - Eissenberg T AU - Wasim Maziak W LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 29 IP - DP - 2020 Jan 01 TI - Vaping-induced diffuse alveolar hemorrhage PG - 100996 AB - There are growing reports of adverse health effects from e-cigarette use or vaping. The U.S. Centers for Disease Control and Prevention has reported 2409 cases and 52 deaths associated with e-cigarette use as of December 10, 2019. Vaping has been associated with acute eosinophilic pneumonia, organizing pneumonia, lipoid pneumonia, diffuse alveolar damage, acute respiratory distress syndrome, hypersensitivity pneumonia, and giant cell interstitial pneumonitis. Here we present a case of vaping-associated diffuse alveolar hemorrhage. She vaped 17 ml of 3 mg/ml nicotine-containing fiery cinnamon flavored e-liquid daily AU - Edmonds PJ AU - Copeland C AU - Conger A AU - Richmond BW LA - PT - DEP - TA - Respiratory Medicine Case Reports JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 17 IP - DP - 2020 Jan 01 TI - Welding fumes, a risk factor for lung diseases. PG - 2552 AB - Background: Welding fumes (WFs) are composed of fine and ultrafine particles, which may reach the distal airways and represent a risk factor for respiratory diseases. Methods: In vitro and in vivo studies to understand WFs pathogenesis were selected. Epidemiological studies, original articles, review, and meta-analysis to examine solely respiratory disease in welders were included. A systematic literature search, using PubMed, National Institute for Occupational Safety and Health Technical Information Center (NIOSHTIC), andWeb of Science databases, was performed. Results: Dose, time of exposure, and composition of WFs affect lung injury. Inflammation, lung defence suppression, oxidative stress, DNA damage, and genotoxic effects were observed after exposure both to mild and stainless steel WFs. Conclusions: The detection of lung diseases associated with specific occupational exposure is crucial as complete avoidance or reduction of the exposure is difficult to achieve. Further studies in the area of particle research may aid the understanding of mechanisms involved in welding-related lung disease and to expand knowledge in welding-related cardiovascular diseases. AU - Riccelli MG AU - Goldoni M AU - Poli D AU - Mozzoni P AU - Cavallo D AU - & Corradi M LA - PT - DEP - TA - nternational journal of environmental research and public health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 75 IP - DP - 2020 Jan 01 TI - IgE-mediated chlorhexidine allergy—Cross-reactivity with other biguanide disinfectants. PG - 3237-3247 AB - Background Chlorhexidine (CHX) is a widely utilized disinfectant that can cause IgE-mediated urticaria/anaphylaxis. The cross-reactivity of patients with IgE-mediated CHX allergy with other disinfectants, which share structural similarities with CHX like polyhexanide (polyhexamethylene biguanide; PHMB), alexidine (ALX), or octenidine (OCT), is unknown. Methods Forty-four patients with anaphylaxis or urticaria upon CHX exposure and positive skin prick test (SPT) and/or positive CHX ImmunoCAP test (Phadia TFS, Uppsala, Sweden) were recruited. IgE to the biguanide and/or hexamethylene structure was investigated with PHMB ImmunoCAP (n = 32) and by basophil activation tests (BAT) with CHX and ALX (n = 37). Inhibition tests of CHX and PHMB ImmunoCAPs by CHX, ALX, PHMB, and OCT were performed. Results IgE reactivity to PHMB as surrogate marker for biguanide/hexamethylene reactivity was detected in 5/32 sera. Seven of 37 patients showed a positive BAT with ALX, but only under optimized conditions. Binding to CHX ImmunoCAP was inhibited by ALX in 1/32 sera, and binding to PHMB was blocked by ALX (1/5) and by OCT in another (1/5). In SPT, 9/10 patients were positive for CHX and 3 of them with ALX (only at highest concentration at 5 mg/mL). A further patient reacted primarily with OCT and showed IgE cross-reactivity with CHX, ALX, and PHMB. Conclusion The IgE response to CHX seems polyclonal. The chloroguanide ending of CHX is the main epitope for the IgE and is suitable as screening assay to detect CHX reactivity. IgE-reactivities with the biguanide or hexamethylene components of other disinfectants (ALX, PHMB) can be detected by SPT, PHMB ImmunoCAP, and ALX-BAT in 15%-33% of CHX- AU - Mueller-Wirth N AU - Buenter A AU - Jörg L AU - Ebo DG AU - Glatz M AU - Fernando SL AU - Spoerl D AU - Helbling A AU - Hausmann O AU - Gupta N AU - Pichler WJ LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 17 IP - DP - 2020 Jan 01 TI - Aerosol Generation during Spirometry PG - 1637-1639 AB - The coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has severely restricted pulmonary diagnostic testing because of the concern of droplet and aerosol generation by procedures conducted in small test rooms. SARS-CoV-2 infection is characterized by viral shedding from the upper and lower respiratory tracts; in addition, SARS-CoV-2 RNA has been detected in sampled air throughout a hospital, which leads to this concern (1–4). Pulmonary function laboratories are justifiably concerned because test maneuvers involve forceful breathing, which may generate infectious particles. Normal speaking has also been reported to generate small-droplet aerosols, increasing the potential exposure risk in close contact with infected individuals (5–7). Currently, there are no studies evaluating particle generation during pulmonary function tests (PFTs). To better understand the risk associated with PFTs, we sought to quantify and characterize the amount of detectable aerosol and droplet generation during routine pulmonary function studies at prespecified distances. AU - Helgeson SA AU - Lim KG AU - Lee AS AU - Niven AS AU - Patel NM LA - PT - DEP - TA - Annals of the American Thoracic Society JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20200101 IS - IS - VI - 0000 0005 IP - DP - 2020 Jan 01 TI - Laboratory animal allergy : a changing world PG - AB - Between 12,000 to 17,000 people in the UK work with laboratory animals and are at risk of developing laboratory animal allergy (LAA), the major risk factor is exposure to laboratory animals (LA's). Though much research has been carried out, there is a lot we do not understand about LAA. In addition, in recent years there has been a shift away from the use of rats in open cages to mice in individually ventilated cages (IVCs). Studies suggest that this change has altered LA exposure patterns. As a result, past research has become outdated. SPIRAL (Safe Practice In Reducing Allergy in Laboratories) is a large cross-sectional study which investigated the risk of mouse work in modern research units. Between 2014 and 2017, 750 LA workers from seven UK research institutes were surveyed. Participants were tested for sensitisation to mice using a specific-IgE (S-IgE) assay and skin prick test (SPT). Participants also completed an online questionnaire and measurements of mouse allergen were collected from research facilities. Data from SPIRAL was used in this work. The thesis aim was to further the understanding of LAA immunology with an emphasis on diagnostic testing and the role of IgG4 in LAA. Identifying mouse-sensitised workers and reducing their exposure to mice is important for the prevention of disease progression. However, there is no gold-standard diagnostic test for sensitisation to mice, nor are there any recommendations on which mouse allergens/extracts should be used. In this work, common diagnostic tests for mouse sensitisation were compared: LA workers were tested for sensitisation to a commercial mouse epithelium SPT and for S-IgE to three ImmunoCAP mouse extracts; epithelium (e71); urine (e72); and a "combined" extract containing urine, epithelium and serum proteins (e88). 10.3% (n=62) of workers were sensitised to mice according to at least one diagnostic test (S-IgE assay and SPT). Of these, 32.3% (n=20) had a positive result for both tests (SPT and S-IgE to any ImmunoCAP extract), 64.5% (n=40) were positive for S-IgE to at least one of the ImmunoCAP extracts (e71, e72, e88) but had a negative SPT result, and two participants only had a positive SPT. Of the 60 workers positive for S-IgE to ImmunoCAP mouse extracts, the following were positive for S-IgE to the epithelium (e71, n=54), "combined" (e88, n=53) and urine (e72, n=42) extracts. The data indicated firstly that there was discordance between the two diagnostic tests, with the ImmunoCAP assay better than the SPT at detecting cases of sensitisation. Secondly, that results can vary depending on which ImmunoCAP extract is used. In support of this, western blots showed that (sensitised) SPIRAL participants had highly variable IgE-binding patterns to mouse allergens. In addition, three participants who had a negative SPT result but were positive for S-IgE to mouse epithelium (e71) had visible IgE-binding to mouse allergens: this suggested that additional cases of sensitisation detected by the ImmunoCAP assay were not false positives. Rodent specific IgG4 (S-IgG4) antibodies may have a role in tolerance to mouse allergy but study findings are inconsistent. SPIRAL participants were tested for mouse S-IgG4 and 28.2% (n=181) had detectable levels. Mouse S-IgG4 positive participants worked for significantly more years (8.62 years) with mice compared to IgG4 negative participants (5.38 years) (p<0.001), and technicians had significantly higher levels of S-IgG4 (7.00 AU/ml) compared to participants in other job roles (2.2 AU/ml) (p<0.001). Levels of mouse S-IgG4 were also higher in participants who were mouse-sensitised (p<0.001) and in those who reported one or more work-related symptoms (p<0.001). However, participants who were not sensitised to mice (p<0.001) and did not report work-related symptoms (p<0.001) had higher ratios of S-IgG4/IgE. The IgE-FAB assay is an in vitro model IgE-facilitated binding of allergen to CD23+ B cells. Inhibition of IgE-allergen binding to B cells was compared between two groups of SPIRAL participants: workers with the highest levels of mouse S-IgG4 (n=44) and workers who were negative for S-IgG4 (n=47). Workers with the highest levels of S-IgG4 inhibited IgE-allergen binding significantly more (72.6%) than S-IgG4 negative workers (14.1%) (p<0.001). Findings suggest that high exposures to mouse allergen may lead to the production of mouse S-IgG4 which through inhibition of allergic immune mechanisms may induce allergic tolerance. There is currently a need for a rapid, easy to use point-of-care (POC) test for mouse sensitisation. In this work, a lateral flow dipstick assay (LFDA) (precursor POC test) was developed and tested. The LFDA contained a test and control line. Preliminary data showed that the control line of the assay worked well, results also suggest that the test line of the assay was able to detect mouse specific IgE in serum. However, further work needs to be done to confirm these results and develop the assay further. The SPIRAL population was an accurate representation of LA workers across different research institutes, working practices and mouse exposures, which is the main strength of this work. The main limitation is that due to the limited volume of LA worker serum, assay repeats and experiment optimizations could not be repeated in some instances. Ideal future work would involve a longitudinal multicentred follow-up study of newly exposed LA workers; with periodic testing for mouse S-IgG4 and IgE; objective allergen exposure measurements; and real-time measures of physiological changes (i.e. lung function). AU - Canizales J LA - PT - DEP - TA - EThOS JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 78 IP - DP - 2019 Jan 01 TI - Exploring the Utility of Noninvasive Type 2 Inflammatory Markers for Prediction of Severe Asthma Exacerbations in Children and Adolescents PG - 2624-2633 AB - Background. Non-invasive markers of Type-2 inflammation are needed to identify children and adolescents who might benefit from personalized biologic therapy. Objective. We hypothesized that blood eosinophil counts would predict one or more acute visits for asthma and that prediction could be improved with the addition of a second, non-invasive Type-2 inflammatory biomarker. Methods. Children and adolescents 5 to 21 years (N=589) with an asthma exacerbation necessitating systemic corticosteroid treatment in the previous year completed a characterization visit and telephone calls at 6 and 12 months. The primary outcome was an acute visit for asthma with receipt of systemic corticosteroids. Acute visits were verified by medical record review. Exploratory outcomes included time to first acute visit and hospitalization. Results. Acute visits occurred in 106 (35.5%) children and 72 (24.8%) adolescents. Elevated blood eosinophils were associated with increased odds and shorter time to first acute visit, but optimal cut-points differed by age (=150 vs. =300 cells/microliter for children vs. adolescents, respectively). Addition of a second marker of Type-2 inflammation did not improve prediction in children, but increased the odds and hazard of an acute visit up to 16.2% and 11.9%, respectively, in adolescents. Similar trends were noted for hospitalizations. Conclusion. Blood eosinophils and other non-invasive markers of Type-2 inflammation may be useful in the clinical assessment of children and adolescents with asthma. However, features of Type-2 inflammation vary by age. Whether children and adolescents also respond differently to management of Type-2 inflammation is unclear and warrants further evaluation. AU - Shah SP AU - Grunwell J AU - Shih J AU - Stephenson S AU - Fitzpatrick AM LA - PT - DEP - TA - J Allergy Clin Immunol Pract JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 19 IP - DP - 2019 Jan 01 TI - Comparison of bench test results measuring the accuracy of peak flow meters PG - 74 AB - Background The study evaluates and compares the accuracy of nine peak flow meters (“PFMs”) and spirometers that are currently available in Europe and have Conformité Européene (“CE”) marking. The CE marking is a manufacturer’s declaration that their product complies with European health regulations and it is a requirement for marketing medical devices in Europe. Methods The nine devices were selected as they all had received or were in the process of receiving CE approval in Europe and were readily obtainable. The devices were bench tested following the ISO 23747:2015 accuracy guidelines for medical devices measuring peak flow. All standards, including accuracy, from these guidelines must be met to obtain CE marking. This study was performed with a certified piston pump testing apparatus. The apparatus chosen was the pulmonary waveform generator manufactured by Piston Medical Ltd. Using predefined flow (time) and volume (time) waveforms, peak flow meters and spirometers were tested for validation and calibration. Three CE guideline tests were utilised, and standards require that all three tests are passed for the device to obtain certification. Results Of the nine devices that were tested, two passed and seven failed. The devices that passed the tests were the Smart Peak Flow® and the Mini Wright®. Conclusions A high percentage of devices failed accuracy testing in this study. This is a concern as the CE marking is a manufacturer’s certification documenting the accuracy, reliability and safety of devices. Of the seven devices that failed all have the CE marking. All tested devices are on the market in Europe based upon studies conducted by each of the manufacturers. The data used to obtain CE certification of these devices, however, are not in the public domain. AU - VanZeller C AU - Williams A AU - Pollock I LA - PT - DEP - TA - BMC Pulmonary Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 158 IP - DP - 2019 Jan 01 TI - British guideline on the management of asthma PG - AB - Key recommendations 2.1 Diagnosis C Compare the results of diagnostic tests undertaken whilst a patient is asymptomatic with those undertaken when a patient is symptomatic to detect variation over time. D Carry out quality-assured spirometry using the lower limit of normal to demonstrate airway obstruction, provide a baseline for assessing response to initiation of treatment and exclude alternative diagnoses. • Obstructive spirometry with positive bronchodilator reversibility increases the probability of asthma. • Normal spirometry in an asymptomatic patient does not rule out the diagnosis of asthma. D Undertake a structured clinical assessment to assess the initial probability of asthma. This should be based on: • a history of recurrent episodes (attacks) of symptoms, ideally corroborated by variable peak flow when symptomatic and asymptomatic • symptoms of wheeze, cough, breathlessness and chest tightness that vary over time • recorded observation of wheeze heard by a healthcare professional • personal/family history of other atopic conditions (in particular, atopic eczema/dermatitis, allergic rhinitis) • no symptoms/signs to suggest alternative diagnoses. ? In patients with a high probability of asthma: • record the patient as likely to have asthma and commence a carefully monitored initiation of treatment (typically six weeks of inhaled corticosteroids) • assess the patient’s status with a validated symptom questionnaire, ideally corroborated by lung function tests (FEV1 at clinic visits or by domiciliary serial peak flows to capture times with/without symptoms) • with a good symptomatic and objective response to treatment, confirm the diagnosis of asthma and record the basis on which the diagnosis was made • if the response is poor or equivocal, check inhaler technique and adherence, arrange further tests and consider alternative diagnoses. Key recommendations 2.2 Monitoring >12 5-12 <5 yrs yrs yrs D B D Assess risk of future asthma attacks at every asthma review by asking about history of previous attacks, objectively assessing current asthma control, and reviewing reliever use. 2.3 Supported self management A All people with asthma (and/or their parents or carers) should be offered self-management education, which should include a written personalised asthma action plan and be supported by regular professional review. A Prior to discharge, inpatients should receive written personalised asthma action plans, given by healthcare professionals with expertise in providing asthma education. D Adherence to long-term asthma treatment should be routinely and regularly addressed by all healthcare professionals within the context of a comprehensive programme of accessible proactive asthma care. 2.4 Non-pharmacological management B People with asthma and parents of children with asthma should be advised about the dangers of smoking and second-hand tobacco smoke exposure, and be offered appropriate support to stop smoking. B Weight loss interventions (including dietary and exercise-based programmes) should be considered for overweight and obese adults and children with asthma to improve asthma control. A Breathing exercise programmes (including face-to-face physiotherapist taught methods and audiovisual programmes) can be offered to adults with asthma as an adjuvant to pharmacological treatment to improve quality of life and reduce symptoms. 2.5 Pharmacological management ? Before initiating a new drug therapy practitioners should check adherence with existing therapies, check inhaler technique, and eliminate trigger factors. A A A Inhaled corticosteroids are the recommended preventer drug for adults and children for achieving overall treatment goals. A The first choice as add-on therapy to inhaled corticosteroids in adults is an inhaled long-acting ß2 agonist, which should be considered before increasing the dose of inhaled corticosteroids. D D I f asthma control remains suboptimal after the addition of an inhaled long-acting ß2 agonist then: • increase the dose of inhaled corticosteroids from low dose to medium dose in adults or from very low dose to low dose in children (5–12 years), if not already on these doses. • consider adding a leukotriene receptor antagonist. 2.6 Inhaler devices B ? ? Prescribe inhalers only after patients have received training in the use of the device and have demonstrated satisfactory technique. ? Generic prescribing of inhalers should be avoided as this might lead to people with asthma being given an unfamiliar inhaler device which they are not able to use properly. ? In young children, a pMDI and spacer is the preferred method of delivery of ß2 agonists and inhaled corticosteroids. A face mask is required until the child can breathe reproducibly using the spacer mouthpiece. Where this is ineffective a nebuliser may be required. 2.7 Acute asthma 2.7.1 Adults D Refer to hospital any patients with features of acute severe or life threatening asthma. C Give controlled supplementary oxygen to all hypoxaemic patients with acute severe asthma titrated to maintain an SpO2 level of 94–98%. Do not delay oxygen administration in the absence of pulse oximetry but commence monitoring of SpO2 as soon as it becomes available. A Use high-dose inhaled ß2 agonists as first-line agents in patients with acute asthma and administer as early as possible. Reserve intravenous ß2 agonists for those patients in whom inhaled therapy cannot be used reliably. A Give steroids in adequate doses to all patients with an acute asthma attack. 2.7.2 Children ? Children with life-threatening asthma or SpO2 <94% should receive high-flow oxygen via a tight-fitting face mask or nasal cannula at sufficient flow rates to achieve normal saturations of 94–98%. A Inhaled ß2 agonists are the first-line treatment for acute asthma in children. A Give oral steroids early in the treatment of acute asthma attacks in children. 2.7.3 All patients ? It is essential that the patient’s primary care practice is informed within 24 hours of discharge from the emergency department or hospital following an asthma attack. Ideally this communication should be directly with a named individual responsible for asthma care within the practice. 9 2.8 Difficult asthma D Patients with difficult asthma should be systematically evaluated, including: • confirmation of the diagnosis of asthma, and • identification of the mechanism of persisting symptoms and assessment of adherence to therapy. 2.9 Asthma in pregnancy B Women should be advised of the importance of maintaining good control of their asthma during pregnancy to avoid problems for both mother and baby. C Counsel women with asthma regarding the importance and safety of continuing their asthma medications during pregnancy to ensure good asthma control. 2.10 Occupational asthma B In patients with adult onset, or reappearance of childhood asthma, healthcare professionals should consider that there may be an occupational cause. ? Adults with suspected asthma or unexplained airflow obstruction should be asked: • Are you the same, better, or worse on days away from work? • Are you the same, better, or worse on holiday? Those with positive answers should be investigated for occupational asthma. AU - Scottish Intercollegiate Guidelines Network British Thoracic Society LA - PT - DEP - TA - Scottish Intercollegiate Guidelines Network JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 158 IP - DP - 2019 Jan 01 TI - British guideline on the management of asthma PG - AB - Key recommendations 2.1 Diagnosis C Compare the results of diagnostic tests undertaken whilst a patient is asymptomatic with those undertaken when a patient is symptomatic to detect variation over time. D Carry out quality-assured spirometry using the lower limit of normal to demonstrate airway obstruction, provide a baseline for assessing response to initiation of treatment and exclude alternative diagnoses. • Obstructive spirometry with positive bronchodilator reversibility increases the probability of asthma. • Normal spirometry in an asymptomatic patient does not rule out the diagnosis of asthma. D Undertake a structured clinical assessment to assess the initial probability of asthma. This should be based on: • a history of recurrent episodes (attacks) of symptoms, ideally corroborated by variable peak flow when symptomatic and asymptomatic • symptoms of wheeze, cough, breathlessness and chest tightness that vary over time • recorded observation of wheeze heard by a healthcare professional • personal/family history of other atopic conditions (in particular, atopic eczema/dermatitis, allergic rhinitis) • no symptoms/signs to suggest alternative diagnoses. ? In patients with a high probability of asthma: • record the patient as likely to have asthma and commence a carefully monitored initiation of treatment (typically six weeks of inhaled corticosteroids) • assess the patient’s status with a validated symptom questionnaire, ideally corroborated by lung function tests (FEV1 at clinic visits or by domiciliary serial peak flows to capture times with/without symptoms) • with a good symptomatic and objective response to treatment, confirm the diagnosis of asthma and record the basis on which the diagnosis was made • if the response is poor or equivocal, check inhaler technique and adherence, arrange further tests and consider alternative diagnoses. Key recommendations 2.2 Monitoring >12 5-12 <5 yrs yrs yrs D B D Assess risk of future asthma attacks at every asthma review by asking about history of previous attacks, objectively assessing current asthma control, and reviewing reliever use. 2.3 Supported self management A All people with asthma (and/or their parents or carers) should be offered self-management education, which should include a written personalised asthma action plan and be supported by regular professional review. A Prior to discharge, inpatients should receive written personalised asthma action plans, given by healthcare professionals with expertise in providing asthma education. D Adherence to long-term asthma treatment should be routinely and regularly addressed by all healthcare professionals within the context of a comprehensive programme of accessible proactive asthma care. 2.4 Non-pharmacological management B People with asthma and parents of children with asthma should be advised about the dangers of smoking and second-hand tobacco smoke exposure, and be offered appropriate support to stop smoking. B Weight loss interventions (including dietary and exercise-based programmes) should be considered for overweight and obese adults and children with asthma to improve asthma control. A Breathing exercise programmes (including face-to-face physiotherapist taught methods and audiovisual programmes) can be offered to adults with asthma as an adjuvant to pharmacological treatment to improve quality of life and reduce symptoms. 2.5 Pharmacological management ? Before initiating a new drug therapy practitioners should check adherence with existing therapies, check inhaler technique, and eliminate trigger factors. A A A Inhaled corticosteroids are the recommended preventer drug for adults and children for achieving overall treatment goals. A The first choice as add-on therapy to inhaled corticosteroids in adults is an inhaled long-acting ß2 agonist, which should be considered before increasing the dose of inhaled corticosteroids. D D I f asthma control remains suboptimal after the addition of an inhaled long-acting ß2 agonist then: • increase the dose of inhaled corticosteroids from low dose to medium dose in adults or from very low dose to low dose in children (5–12 years), if not already on these doses. • consider adding a leukotriene receptor antagonist. 2.6 Inhaler devices B ? ? Prescribe inhalers only after patients have received training in the use of the device and have demonstrated satisfactory technique. ? Generic prescribing of inhalers should be avoided as this might lead to people with asthma being given an unfamiliar inhaler device which they are not able to use properly. ? In young children, a pMDI and spacer is the preferred method of delivery of ß2 agonists and inhaled corticosteroids. A face mask is required until the child can breathe reproducibly using the spacer mouthpiece. Where this is ineffective a nebuliser may be required. 2.7 Acute asthma 2.7.1 Adults D Refer to hospital any patients with features of acute severe or life threatening asthma. C Give controlled supplementary oxygen to all hypoxaemic patients with acute severe asthma titrated to maintain an SpO2 level of 94–98%. Do not delay oxygen administration in the absence of pulse oximetry but commence monitoring of SpO2 as soon as it becomes available. A Use high-dose inhaled ß2 agonists as first-line agents in patients with acute asthma and administer as early as possible. Reserve intravenous ß2 agonists for those patients in whom inhaled therapy cannot be used reliably. A Give steroids in adequate doses to all patients with an acute asthma attack. 2.7.2 Children ? Children with life-threatening asthma or SpO2 <94% should receive high-flow oxygen via a tight-fitting face mask or nasal cannula at sufficient flow rates to achieve normal saturations of 94–98%. A Inhaled ß2 agonists are the first-line treatment for acute asthma in children. A Give oral steroids early in the treatment of acute asthma attacks in children. 2.7.3 All patients ? It is essential that the patient’s primary care practice is informed within 24 hours of discharge from the emergency department or hospital following an asthma attack. Ideally this communication should be directly with a named individual responsible for asthma care within the practice. 9 2.8 Difficult asthma D Patients with difficult asthma should be systematically evaluated, including: • confirmation of the diagnosis of asthma, and • identification of the mechanism of persisting symptoms and assessment of adherence to therapy. 2.9 Asthma in pregnancy B Women should be advised of the importance of maintaining good control of their asthma during pregnancy to avoid problems for both mother and baby. C Counsel women with asthma regarding the importance and safety of continuing their asthma medications during pregnancy to ensure good asthma control. 2.10 Occupational asthma B In patients with adult onset, or reappearance of childhood asthma, healthcare professionals should consider that there may be an occupational cause. ? Adults with suspected asthma or unexplained airflow obstruction should be asked: • Are you the same, better, or worse on days away from work? • Are you the same, better, or worse on holiday? Those with positive answers should be investigated for occupational asthma. AU - Scottish Intercollegiate Guidelines Network British Thoracic Society LA - PT - DEP - TA - Scottish Intercollegiate Guidelines Network JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 222 IP - DP - 2019 Jan 01 TI - Bioaerosol exposure from composting facilities and health outcomes in workers and in the community: A systematic review update PG - 364-386 AB - Background Rapid population growth and urbanisation around the world has led to increasing waste generation rates. Composting of organic waste in large-scale facilities is part of a growing trend in the UK, and elsewhere, to better manage and re-use the organic waste. However, composting inevitably generates bioaerosols, which have been associated with human health effects. In 2015, we reported that there was some, albeit limited, qualitative evidence linking bioaerosol emissions from composting facilities to poor respiratory health in nearby residents. However, the limited evidence precluded any quantitative assessment. Since then, the number of operational industrial-scale composting facilities in England has increased by 9% - nearly twice the growth from 2012 to 2014. At the same time, rapid urbanisation has led to expansion of city borders with more people living near large composting facilities and exposed to bioaerosol pollution. It is essential that regulatory authorities have access to the most up to date and accurate information. Objective In this update of a systematic review published in 2015, we review and summarise the evidence from more recent studies that have assessed bioaerosol exposures within and near composting facilities and their associated health effects in both community and occupational health settings. Specifically, we wanted to find out if new evidence has emerged since the previous review to strengthen and confirm its conclusions. Material and methods Two electronic databases (Medline and Embase) and bibliographies were searched for studies reporting on health outcomes and/or exposure to bioaerosols from composting facilities published between 1 January 2014 and 15 June 2018. Identification of relevant articles and data extraction was undertaken and studies were assessed for risk of bias. Results 23 studies met the inclusion criteria (15 exposure studies, 4 health studies, 4 health and exposure studies (one of which used an exposure proxy)). The majority of studies were conducted in occupational settings, and over short time periods. Some progress has been made in the characterisation of bioaerosol emissions from these composting facilities, with the application of molecular-based methods. Whilst the latest health studies do not rely solely on subjective self-reported measures of health status but include more objective health measures, these studies were almost exclusively carried out in compost workers and were characterised by profound methodological limitations. Only one community health study was identified and used a proxy measure of bioaerosol exposure. Conclusions Although this review identified an additional 23 studies since the earlier review, the conclusions remain largely unchanged. Given the absence of any consistent evidence on the toxicity of bioaerosols from composting facilities, there is insufficient evidence to provide a quantitative comment on the risk to nearby residents from exposure to compost bioaerosols. To improve risk assessment and to best advise on risk management, it is important to ensure that the research recommendations outlined in this review are addressed. AU - Robertson S AU - Douglas P AU - Jarvis D AU - Marczylo E LA - PT - DEP - TA - Int J Hyg Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 381 IP - DP - 2019 Jan 01 TI - Pulmonary Lipid-Laden Macrophages and Vaping PG - 1488-1489 AB - Recent case clusters of a respiratory syndrome associated with e-cigarette use (vaping) have been identified. We describe clinical features of six cases in Utah that help characterize this nascent syndrome. We present the most severe case in our series here; A previously healthy 21-year-old man who had been vaping nicotine and tetrahydrocannabinol (THC) daily presented with 1 week of dyspnea, cough, abdominal pain, nausea, and vomiting. He had bilateral interstitial opacities on chest radiography and was empirically treated for bacterial pneumonia. His condition deteriorated, and he was intubated for acute respiratory distress syndrome. Chest computed tomography (CT) showed diffuse consolidative opacities (Fig. S1 in the Supplementary Appendix). Laboratory studies were notable for negative HIV testing and a markedly elevated level of C-reactive protein (30.7 mg per deciliter). Bronchoalveolar lavage (BAL) fluid showed neutrophilic predominance (49%) and more than 50% lipid-laden macrophages by oil red O staining. Testing of this fluid by culture and polymerase-chain-reaction assay for bacterial, fungal, and viral pathogens did not reveal any evidence of infection. Methylprednisolone (1 mg per kilogram of body weight) was administered, but refractory hypoxemia developed, and the patient was treated with venovenous extracorporeal membrane oxygenation (ECMO). During the next 7 days, his condition improved, with resolution of radiographic opacities, and he was extubated and weaned from ECMO. He was discharged home without supplemental oxygen 2 weeks after initial presentation. A notable and consistent feature of the cases we report is the presence of lipid-laden macrophages seen with oil red O staining in BAL samples that are not attributable to aspiration of exogenous lipoid material. In addition, the diffuse parenchymal opacities seen on CT scans did not have low attenuation (in Hounsfield units) consistent with classic lipoid pneumonia.Although the pathophysiological significance of these lipid-laden macrophages and their relation to the cause of this syndrome are not yet known, we posit that they may be a useful marker of this disease.3-5 Further work is needed to characterize the sensitivity and specificity of lipid-laden macrophages for vaping-related lung injury, and at this stage they cannot be used to confirm or exclude this syndrome. However, when vaping-related lung injury is suspected and infectious causes have been excluded, the presence of lipid-laden macrophages in BAL fluid may suggest vaping-related lung injury as a provisional diagnosis. AU - Maddock AU - Sean D. AU - Cirulis AU - Meghan M. AU - Callahan AU - Sean J. AU - Keenan AU - Lynn M. AU - Pirozzi AU - Cheryl S. AU - Raman AU - Sanjeev M. AU - Aberegg AU - Scott K. LA - PT - DEP - TA - New England Journal of Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 7 IP - DP - 2019 Jan 01 TI - Variations in coil temperature/power and e-liquid constituents change size and lung deposition of particles emitted by an electronic cigarette PG - e14093 AB - Electronic cigarette uses propylene glycol and glycerol to deliver nicotine and flavors to the lungs. Given the hundreds of different brands, the thousands of flavors available and the variations in nicotine concentrations, it is likely that electronic cigarette settings and e-liquid composition affect the size distribution of particles emitted and ultimately pulmonary deposition. We used the inExpose e-cigarette extension to study two separate modes of operation of electronic cigarettes, namely power-controlled and the temperature-controlled. We also assessed several e-liquids based on propylene glycol and glycerol concentrations, nicotine content, and selected monomolecular flavoring agents (menthol, vanillin, and maltol). Particle size distribution was measured using a Condensation Particle Counter and a Scanning Mobility Particle Sizer spectrometer. Lung deposition was predicted using the International Commission on Radiological Protection model. For all resistance coils, increase in power delivery generated larger particles while maintaining a higher coil temperature generated smaller particles. Increase in glycerol concentration led to the generation of larger particles. With regard to flavors, we showed that despite minor effect of menthol and maltol, vanillin dramatically increased particle size. Presence of nicotine also increased particle size. Finally, particles emitted by the electronic cigarette were predicted to mainly deposit in the alveoli and conditions generating larger particle sizes led to a reduction in predicted lung deposition. This study shows that coil temperature, propylene glycol and glycerol concentrations, presence of nicotine, and flavors affect the size of particles emitted by an electronic cigarette, directly affecting predicted lung deposition of these particles. AU - Lechasseur A AU - Altmejd S AU - Turgeon N AU - Buonanno G AU - Morawska L AU - Brunet D AU - Duchaine C AU - Morissette MC LA - PT - DEP - TA - Physiol Rep. JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Aerotoxic syndrome, discussion of possible diagnostic criteria PG - 1649419 AB - Introduction: The term aerotoxic syndrome (ATS) was proposed 20 years ago to describe a constellation of symptoms reported by pilots and cabin crew following exposure to hydraulic fluids, engine oil, and pyrolysis products during flight. Hydraulic fluids and engine oil contain a large number of potentially toxic chemicals, including various organophosphate compounds (OPCs). However, ATS is not yet recognised as a valid diagnosis in aviation or general medicine, because the incidence and aetiology continues to be debated. Discussion: Early studies report findings from symptom surveys or cognitive assessments of small samples of self-selected aircrew, but objective measures of exposure were lacking. Over the last decade, researchers have used more sophisticated techniques to measure exposure, such as on board monitoring studies and biomarkers of exposure (e.g., reduced levels of serum butyrylcholinesterases [BChE]) and more sophisticated techniques to detect nervous system injuries such as fMRI and autoantibody testing. Consideration has also been given to inter-individual differences in the ability to metabolise certain chemical compounds as a result of genetic polymorphisms and exclusion of other potential causes of ill health. Conclusions: We discuss factors which suggest a diagnosis of probable ATS; recommend an assessment protocol which incorporates the aforementioned techniques; and propose diagnostic criteria for probable ATS, based on our previously reported findings in aircrew and the results of recent studies. AU - Hageman G AU - Pal TM AU - Nihom J AU - Ross SJM AU - den van Berg M LA - PT - DEP - TA - Clin Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Toxicological investigations in a fatal and non-fatal accident due to hydrogen sulphide (H2S) poisoning PG - e4-e8 AB - Hydrogen sulphide (H2S) is one of the most toxic natural gas and represents a not rare cause of fatal events in workplaces. We report here a serious accidental poisoning by hydrogen sulphide inhalation involving six sailors. Three of them died while the other three survived and were transported to the emergency room. No greenish discolouration of the body, that could be a feature of these type of deaths, was observed at autopsy. Given that blood and/or urine H2S detection does not allow to discriminate if it is related to inhalation or to putrefactive processes, the determination of thiosulphate, H2S main metabolite, is decisive. The succession of fatal events reported here can be rebuilt by toxicological data interpretation: the subject 1 died after a longer interval of time as demonstrated by the highest blood and urine thiosulfate concentrations; the subject 2 died after a short interval of time as showed by a lower blood and urine thiosulfate concentrations than subject 1; the subject 3 died almost immediately after H2S inhalation since he showed the lowest blood thiosulfate concentration, and no trace of sulphide and thiosulfate was found in the urine. AU - Spagnolo EV AU - Romano G AU - Zuccarello P AU - Laudani A AU - Mondello C AU - Argo A AU - Zerbo S AU - Barbera N LA - PT - DEP - TA - Forensic Science International JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - usz453 IP - DP - 2019 Jan 01 TI - Primary Blast Lung Injury: The UK Military Experience PG - AB - INTRODUCTION: Primary blast lung injury occurs when an explosive shock wave passes through the thorax and transits through tissues of varying densities. It requires close proximity to an explosion and presents quick with respiratory distress in survivors. MATERIALS AND METHODS: The Joint Theatre Trauma Registry and the Defence Statistics (Health) Database were interrogated for casualties injured as a result of an explosion during the conflict in Afghanistan. The case notes and imaging of casualties meeting the criteria for diagnosis were reviewed. Demographic and clinical data on casualties with primary blast lung injury were analyzed. RESULTS: 848 blast-exposed casualties survived to discharge from intensive care, and 238 blast-exposed casualties were killed in action. Following exclusions, 111 case notes and all postmortem reports were reviewed in detail. About, 25 casualties had isolated primary blast lung injury (2.9% of casualties surviving to discharge from intensive care) and 31 nonsurvivors (13% of nonsurvivors) had the disease documented at postmortem. Severe cases of primary blast lung injury required an estimated average of 4.5 days of conventional mechanical ventilation. CONCLUSIONS: 8.1% of blast exposed casualties suffered primary blast lung injury. It was a less severe disease than other nontraumatic forms of acute lung injury and did not cause deaths once a casualty had reached a combat support hospital. It was well managed with a relatively brief period of conventional mechanical ventilation. AU - Scott TE AU - Johnston AM AU - Keene DD AU - Rana M AU - Mahoney PF LA - PT - DEP - TA - Mil Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 394 IP - DP - 2019 Jan 01 TI - Clinical presentation, treatment, and short-term outcomes of lung injury associated with e-cigarettes or vaping: a prospective observational cohort study PG - 2073-2083 AB - Background An ongoing outbreak of lung injury associated with e-cigarettes or vaping (also known as E-VALI or VALI) started in March, 2019, in the USA. The cause, diagnosis, treatment, and course of this disease remains unknown. Methods In this multicentre, prospective, observational, cohort study, we collected data on all patients with lung injury associated with e-cigarettes or vaping seen in Intermountain Healthcare, an integrated health system based in Utah, USA, between June 27 and Oct 4, 2019. Telecritical care, based in Salt Lake City, UT, USA, was used as the central repository for case validation, public reporting, and system-wide dissemination of expertise, which included a proposed diagnosis and treatment guideline for lung injury associated with e-cigarettes or vaping. We extracted data on patient presentation, treatment, and short-term follow-up (2 weeks after discharge) from chart review and interviews with patients undertaken by the Utah Department of Health (Salt Lake City, UT, USA). Findings 60 patients presented with lung injury associated with e-cigarettes or vaping at 13 hospitals or outpatient clinics in the integrated health system. 33 (55%) of 60 were admitted to an intensive care unit (ICU). 53 (88%) of 60 patients presented with constitutional symptoms, 59 (98%) with respiratory symptoms, and 54 (90%) with gastrointestinal symptoms. 54 (90%) of 60 were given antibiotics and 57 (95%) were given steroids. Six (10%) of 60 patients were readmitted to an ICU or hospital within 2 weeks, three (50%) of whom had relapsed with vaping or e-cigarette use. Of 26 patients who were followed up within 2 weeks, despite clinical and radiographic improvement in all, many had residual abnormalities on chest radiographs (ten [67%] of 15) and pulmonary function tests (six [67%] of nine). Two patients died and lung injury associated with e-cigarettes or vaping was thought to be a contributing factor, but not the cause of death, for both. Interpretation Lung injury associated with e-cigarettes or vaping is an emerging illness associated with severe lung injury and constitutional and gastrointestinal symptoms. Increased awareness has led to identification of a broad spectrum of severity of illness in patients who were treated with antibiotics and steroids. Despite improvement, at short-term follow-up many patients had residual abnormalities. Lung injury associated with e-cigarettes or vaping remains a clinical diagnosis with symptoms that overlap infectious and other lung diseases. Maintaining a high index of suspicion for this disease is important as work continues in understanding the cause or causes, optimal therapy, and long-term outcomes of these patients. AU - Blagev DP AU - Harris D AU - Dunn AC AU - Guidry DW AU - Grissom CK AU - Lanspa MJ LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 381 IP - DP - 2019 Jan 01 TI - Pathology of Vaping-Associated Lung Injury PG - 1780-1781 AB - Despite the accumulating data on the clinical and imaging features of vaping-associated lung injury,1,2 its pathology is poorly understood. We reviewed lung biopsies from 17 patients (13 men; median age, 35 years [range, 19–67]), all of whom had a history of vaping (71% with marijuana or cannabis oils) and were clinically suspected to have vaping-associated lung injury. Presentation was acute or subacute in all cases, with bilateral pulmonary opacities; all but two patients presented in 2019. Eleven met the criteria for a “confirmed” diagnosis of vaping-related lung injury; the remaining six met the criteria for a “probable” designation. In all cases, histopathological findings showed patterns of acute lung injury, including acute fibrinous pneumonitis, diffuse alveolar damage, or organizing pneumonia, usually bronchiolocentric and accompanied by bronchiolitis (Figure 1; also see the Supplementary Appendix, available with the full text of this letter at NEJM.org). No histologic findings were specific, but foamy macrophages and pneumocyte vacuolization were seen in all cases and may be useful diagnostic clues in an appropriate clinical context. Pigmented macrophages were sometimes present but were never a dominant feature. Neutrophils were often prominent, but eosinophils were rare and granulomas were not seen. In two cases, bronchioloalveolar lavage fluid was available and contained abundant foamy macrophages. Despite treatment with glucocorticoids and maximum supportive care, two patients with diffuse alveolar damage died. To date, few reports of vaping-associated lung injury have included histopathological findings. Our cases corroborate many of these descriptions and provide some preliminary insight into the pathogenesis of this injury. Much recent attention has been given to the possibility that vaping-associated lung injury may represent exogenous lipoid pneumonia.3 However, none of our cases showed histologic evidence of exogenous lipoid pneumonia and no radiologic evidence thereof has been found2; this calls into question the diagnostic utility of identifying lipid-laden macrophages or performing oil red O staining on bronchioloalveolar lavage fluid as a marker of vaping-associated lung injury, as has been proposed.3,4 The significance of this observation remains unclear, particularly in patients with a known vaping history; until more data accumulate, our observations suggest that this finding should be interpreted with caution, as it may simply be a marker of exposure and not necessarily a marker of toxicity. Although it is difficult to discount the potential role of lipid, we believe that the histologic changes instead suggest that vaping-associated lung injury represents a form of airway-centered chemical pneumonitis from one or more inhaled toxic substances rather than exogenous lipoid pneumonia as such, but the agents responsible remain unknown. AU - Butt YM. AU - Smith AU - Maxwell L. AU - Tazelaar HD. AU - Vaszar LT AU - Swanson KL AU - Cecchini MJ AU - Boland JM AU - Bois MC. AU - Boyum JH AU - Froemming AT AU - Khoor A AU - Mira-Avendano I AU - Patel A AU - Larsen BT LA - PT - DEP - TA - New England Journal of Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 381 IP - DP - 2019 Jan 01 TI - Imaging of Vaping-Associated Lung Disease PG - 1486-1487 AB - Lung injury associated with vaping — the use of electronic nicotine delivery systems (ENDS) — has been recognized in the medical literature,1,2 and a case series of such injuries is now published in the Journal.3 If vaping is the proximal cause of lung injury, the mechanism leading to such injury is not certain. Unlike traditional cigarettes, ENDS use solvents to heat and aerosolize the flavorants (known as “juices”),4 which consist of various aldehydes and alcohols, and complications can arise as the mixing and aerosolization of these components create new compounds. Moreover, ENDS are increasingly used to deliver cannabis oils and concentrates. We have collectively seen 19 cases and reviewed the literature regarding another 15 cases. All met the case definition of vaping-associated lung injury, which includes “abnormalities on chest imaging.” We identified four imaging patterns that correlated with pathological findings attributable to vaping, including acute eosinophilic pneumonia, diffuse alveolar damage, organizing pneumonia, and lipoid pneumonia. In addition, some cases were associated with variegated imaging patterns. Through clinical and pathological investigations, patterns of giant-cell interstitial pneumonia, hypersensitivity pneumonitis, and diffuse alveolar hemorrhage were identified. Although the variety of imaging patterns suggests different mechanisms of injury, and more patterns will probably be reported, most of the patterns have basilar-predominant consolidation and ground-glass opacity, often with areas of lobular or subpleural sparing. Rapidly developing acute lung injuries (e.g., acute eosinophilic pneumonia and diffuse alveolar damage) are associated with inhalational injuries and have overlapping pathological and imaging findings,5 and they have been reported to occur with vaping.1 Hypersensitivity pneumonitis is an immune response to an environmental antigen, but the antigens related to vaping are unknown. Lipoid pneumonia is an inflammatory response to the presence of lipids within the alveolar space and typically results from aspiration of hydrocarbons or oil-based products, but it has now been seen with vaping. We have not observed the computed tomographic finding of fat attenuation in the lung, which is a hallmark of lipoid pneumonia, in these cases of vaping-associated lung injury. Not all cases are acute; organizing pneumonia often develops subacutely, over a period of days to weeks, and the one case of giant-cell interstitial pneumonia (a rare fibrosing interstitial lung disease) that was correlated with hard metals in ENDS developed over a period of 6 months. AU - Henry AU - Travis S. AU - Kanne AU - Jeffrey P. AU - Kligerman AU - Seth J. LA - PT - DEP - TA - New England Journal of Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 27 IP - DP - 2019 Jan 01 TI - Acute eosinophilic pneumonia following electronic cigarette use. PG - 100825 AB - Electronic cigarette (e-cigarette) use, or vaping, is gaining widespread popularity among adults aged 18-35. Vaping is commercially promoted as a safer alternative to traditional cigarette smoking. Previous studies have reported a close relationship between conventional cigarette smoking and acute eosinophilic pneumonia (AEP), but only one case report to date associates vaping with AEP in a male patient. We present the first case of AEP involving a young female after use of e-cigarettes. Clinicians should consider AEP when evaluating young patients with hypoxic respiratory failure and a recent history of e-cigarette use. This case highlights the need for more research into the relationship between e-cigarettes and AEP. AU - Arter ZL AU - Wiggins A AU - Hudspath C AU - Kisling A AU - Hostler DC AU - Hostler JM. LA - PT - DEP - TA - Respir Med Case Rep. JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 68 IP - DP - 2019 Jan 01 TI - Evaluation of Bronchoalveolar Lavage Fluid from Patients in an Outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury - 10 States PG - 1040-1041 AB - Bronchoscopy and bronchoalveolar lavage (BAL) can be part of the clinical and diagnostic workup of EVALI patients. The decision to perform this procedure is made by the clinical team on a case-by-case basis. During August–October 2019, BAL fluid specimens were collected by clinical teams caring for hospitalized EVALI patients. Public health laboratories and health departments from 10 states (California, Connecticut, Hawaii, Illinois, Maryland, Michigan, Minnesota, Texas, Utah, and Wisconsin) coordinated the submission of residual BAL fluid specimens from 29 patients to CDC. To better characterize exposure among EVALI patients, CDC developed and validated isotope dilution mass spectrometry methods to analyze specific toxicants of concern and active compounds in case-associated BAL fluid. These CDC analytic methods can identify vitamin E acetate, MCT oil (medium chain triglycerides), plant oils (long chain triglycerides), petroleum distillates (including mineral oil), diluent terpenes, cannabinoids, and nicotine in BAL fluid. The quality of case-associated BAL specimens was assessed by measuring dipalmitoylphosphatidylcholine (DPPC), the principal phospholipid in naturally-occurring lung surfactant: the presence of acceptable levels of DPPC confirms that the lavage procedure recovered adequate pulmonary epithelial fluid. When specimen volume was insufficient to perform all planned analyses, analysis of vitamin E acetate and cannabinoids was prioritized. Among the 27 BAL fluid specimens with sufficient volume for testing, all had measurable levels of DPPC. Overall, 21 (72%) patients with available specimens were male, and their median age was 23 years (range = 16–67 years), which is consistent with the sex and age patterns of EVALI patients reported to CDC to date (1). Two of the patients died. Vitamin E acetate was detected in all 29 patient BAL samples. Among 23 patients for whom self-reported THC use information was available, 20 reported using THC-containing products. THC or its metabolites were detected in 23 of 28 patient BAL samples, including in those of three patients who said they did not use THC products. Nicotine metabolites were detected in 16 of 26 patient BAL specimens. Results for plant oils, MCT oil, petroleum distillates, and diluent terpenes were all below analyte-specific levels of detection (typically in the low ng/mL range). This is the first reported identification of a potential toxicant of concern (vitamin E acetate) in biologic specimens obtained from EVALI patients. These findings provide direct evidence of vitamin E acetate at the primary site of injury among EVALI patients and are consistent with FDA product testing and media reports of state public health laboratory testing documenting vitamin E acetate in product samples used by EVALI patients (2,3) (Personal communication, D.T. Heitkemper, FDA Forensic Chemistry Center, November 2019). Other diluents and additives of concern (e.g., plant oils, MCT oil, petroleum distillates, and diluent terpenes) were notably not detected in BAL fluid specimens from EVALI patients. Although vitamin E acetate was detected in all specimens in this analysis of a convenience sample of 29 EVALI case-associated BAL specimens, additional studies are needed, including comparison with BAL fluid specimens from healthy volunteers and animal studies using controlled exposures to establish whether a causal link exists between this exposure and EVALI. Based on these data from 29 patients, it appears that vitamin E acetate is associated with EVALI; however, it is possible that more than one compound or ingredient could be a cause of lung injury, and evidence is not yet sufficient to rule out contribution of other toxicants to EVALI. These findings reinforce CDC’s recommendation that persons should not use e-cigarette, or vaping, products containing THC, especially those obtained from informal sources such as friends or family, or those from the illicit market, where product ingredients are unknown or can be highly variable. Until the relationship of vitamin E acetate and lung health is better characterized, it is important that vitamin E acetate not be added to e-cigarette, or vaping, products. CDC will continue to update guidance, as appropriate, as new data become available from this outbreak investigation. AU - Blount B C AU - Karwowski MP AU - Morel-Espinosa M AU - Rees J AU - Sosnoff C AU - Cowan E AU - Pirkle JL LA - PT - DEP - TA - MMWR CDC Surveill Summ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Amid vape pen lung disease deaths: what exactly is vitamin E oil? PG - AB - Vitamin E oil has natural or synthetic sources. Vitamin E is the common name for several similar types of chemicals called “tocopherols”. They’re commonly found in corn and other vegetable oil or made synthetically from petroleum. We often eat tocopherols as a dietary supplement, and manufacturers put tocopherols in food and cosmetics. Eight main types of tocopherol exist, from alpha-tocopherol all the way through gamma-tocopherol. The most relevant vitamin E compound is alpha-tocopherol since it is the most abundant and potent of the group. The main difference between naturally occurring vitamin E and synthetic vitamin E is the presence of stereoisomers. Naturally occurring vitamin E will only contain the D-isomer (i.e. D-alpha-tocopherol). Synthetic vitamin E will typically be a mix of the D- and L–isomers (DL-alpha-tocopherol). Tocopheryl-acetate is the ester form of tocopherol. Tocopheryl-acetate is more stable towards oxidation and will typically have longer shelf life than tocopherol. AU - Downs D. LA - PT - DEP - TA - Leafy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin — Preliminary Report PG - AB - BACKGROUND E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of pulmonary disease associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation. METHODS We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools. RESULTS There were 53 case patients, 83% of whom were male; the median age of the patients was 19 years. The majority of patients presented with respiratory symptoms (98%), gastrointestinal symptoms (81%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging (which was part of the case definition). A total of 94% of the patients were hospitalized, 32% underwent intubation and mechanical ventilation, and one death was reported. A total of 84% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018. CONCLUSIONS Case patients presented with similar clinical characteristics. Although the features of e-cigarette use that were responsible for injury have not been identified, this cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes. AU - Layden JE AU - Ghinai I AU - Pray I AU - Kimball M AU - Layer M AU - Tenforde M AU - Navon L AU - Hoots B AU - Salvatore PP AU - Elderbrook M AU - Haupt T AU - Kanne J AU - Patel MT AU - Saathoff-Huber L AU - King BA AU - Schier JG AU - Mikosz CA AU - Meiman J LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 21 IP - DP - 2019 Jan 01 TI - Sentinel approach to detect emerging causes of work-related respiratory diseases. PG - AB - BACKGROUND: The world of work is continually changing, and this could result in new and emerging risks being introduced, including those that may cause work-related respiratory diseases (WRRD). AIMS: To describe recently emerging and new cases of WRRD and the relevant methodology using data in a national occupational respiratory disease surveillance scheme in the UK. METHODS: Incident cases of respiratory diseases reported by physicians to the Surveillance of Work-related and Occupational Respiratory Disease (SWORD) between January 2015 and December 2017 were included. Potentially emerging respiratory hazards manifesting in SWORD data were identified with the following hierarchical approach: (i) new respiratory disease not previously associated with work, (ii) specific exposure/agent not previously associated with WRRD and (iii) industry and/or occupation not previously associated with WRRD. RESULTS: A total of 1215 cases of WRRD were reported to SWORD between January 2015 and December 2017. No new WRRD were identified. Thirteen potentially emerging causes of occupational asthma were identified, including exposures to agents such as ninhydrin. Four potential new causes were identified for interstitial pneumonia, which included wood and brass dust. Two potentially emerging causes of WRRD were identified for inhalational accidents (green coffee and nitrocellulose), hypersensitivity pneumonitis (diphenylmethane diisocyanate and salami mould), rhinitis (morphine and Amaranthus quitensis) and sarcoidosis (prions and horses). CONCLUSIONS: Continuous monitoring and reporting of any new work-related disease is a critical function of any occupational disease reporting scheme. Potential emerging causes of work-related health risks have been identified by using a simple and systematic way of detecting emerging causes of WRRDs. AU - Zhou AY AU - Seed M AU - Carder M AU - Money A AU - Van Tongeren M AU - Agius R. LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 76 IP - DP - 2019 Jan 01 TI - Performance of specific immunoglobulin E tests for diagnosing occupational asthma: a systematic review and meta-analysis. PG - 269-278 AB - OBJECTIVES: To determine the test performance parameters for the retrievable range of high-molecular-weight (HMW) and low-molecular-weight (LMW) occupational allergens and to evaluate the impact of allergenic components and the implementation of measures for test validation. METHODS: A protocol with predefined objectives and inclusion criteria was the basis of an electronic literature search of MEDLINE and EMBASE (time period 1967-2016). The specific inhalation challenge and serial peak flow measurements were the reference standards for the specific IgE (sIgE) test parameters. All of the review procedures were reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS: Seventy-one studies were selected, and 62 entered meta-analysis. Pooled pairs analysis indicated a sensitivity of 0.74(95% CI 0.66 to 0.80) and specificity of 0.71(95% CI 0.63 to 0.77) for HMW allergens and a sensitivity of 0.28(95% CI 0.18 to 0.40) and specificity of 0.89(95% CI 0.77 to 0.95) for LMW allergens. Component-specific analysis improved the test parameters for some allergens. Test validation was handled heterogeneously among studies. CONCLUSION: sIgE test performance is rather satisfactory for a wide range of HMW allergens with the potential for component-specific approaches, whereas sensitivity for LMW allergens is considerably lower, indicating methodological complications and/or divergent pathomechanisms. A common standard for test validation is needed. AU - Lux H AU - Lenz K AU - Budnik LT AU - Baur X LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 150 IP - DP - 2019 Jan 01 TI - Hypersensitivity pneumonitis: A new strategy for serodiagnosis and environmental surveys PG - 101-106 AB - We propose a strategy for serodiagnosis of hypersensitivity pneumonitis (HP): 1) question patients about their private or occupational activity, or visit him on site; 2) select panels of six somatic specific antigens appropriate for each type of exposure; 3) and use ELISA to test concomitantly two recombinant antigens highly specific to Farmer's lung, Metalworking-fluid HP, and for Bird fancier's lung. The serodiagnosis provides an immunological argument that may complete radiological, functional lung exploration and clinical features; 4) If the serodiagnosis is negative but the suspicion of HP is strong, a microbial analysis of the patient's specific exposure is conducted; 5) “A la carte” antigens are produced from the microorganisms isolated in the patient's environment sample and tested; 6) Finally, the patient may be asked to undergo a specific inhalation challenge with the offending antigens in a safety cabin, or to avoid his usual environment for a few days. AU - Bellanger A AU - Reboux G AU - Rouzet A AU - Barrera C AU - Rocchi S AU - Scherer E AU - Millon L LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 144 IP - DP - 2019 Jan 01 TI - Early-onset airway damage in early-career elite athletes: A risk factor for exercise-induced bronchoconstriction PG - 1423–1425.e9 AU - Jonckheere A AU - Seys S AU - Dilissen E AU - Schelpe A AU - der Eycken SV AU - Corthout S AU - Verhalle T AU - Goossens J AU - Vanbelle V AU - Aertgeerts S AU - Troosters T AU - Peers K AU - Dupont L AU - Bullens D LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Phenotyping occupational asthma caused by acrylates in a multicentre cohort study. PG - AB - BACKGROUND: While acrylates are well-known skin sensitisers, they are not classified as respiratory sensitisers although several cases of acrylate-induced occupational asthma (OA) have been reported. OBJECTIVES: The aim of this study was to evaluate the characteristics of acrylate-induced OA in a large series of cases and compare those with OA induced by other low-molecular-weight (LMW) agents. METHODS: Jobs and exposures, clinical and functional characteristics, and markers of airway inflammation were analysed in an international, multicentre, retrospective cohort of subjects with OA ascertained by a positive inhalation challenge to acrylates (n= 55) or other LMW agents (n=418) including isocyanates (n=125). RESULTS: Acrylate-containing glues were the most prevalent products and industrial manufacturing, dental work and beauty care were typical occupations causing OA. Work related rhinitis was more common in acrylate than isocyanate-induced asthma (p< 0.001). The increase in post-challenge fractional exhaled nitric oxide (FeNO) was significantly greater in acrylate-induced OA (26.0, 8.2-38.0 ppb) than in OA induced by other LMW agents (3.0, -1.0-10.0 ppb, p< 0.001) or isocyanates (5.0, 2.0-16.0 ppb, p=0.010). Multivariable models confirmed that OA induced by acrylates was significantly and independently associated with a post-challenge increase in FeNO (=17.5 ppb). CONCLUSIONS: Acrylate-induced OA shows specific characteristics, concomitant work-related rhinitis and exposure-related increases in FeNO, suggesting that acrylates may induce asthma through different immunological mechanisms than other LMW agents. Our findings reinforce the need for a re-evaluation of the hazard classification of acrylates, and further investigation of the pathophysiological mechanisms underlying their respiratory sensitizing potential. AU - Suojalehto H AU - Suuronen K AU - Cullinan P AU - Lindström I AU - Sastre J AU - Walusiak-Skorupa J AU - Munoz X AU - Talini D AU - Klusackova P AU - Moore V AU - Merget R AU - Svanes C AU - Mason P AU - dell'Omo M AU - Moscato G AU - Quirce S AU - Hoyle J AU - Sherson D AU - Preisser A AU - Seed M AU - Rifflart C AU - Godet J AU - de Blay F AU - Vandenplas O AU - European network for the Phenotyping of Occupational Asthma (E-PHOCAS) investigators. LA - PT - DEP - TA - J Allergy Clin Immunol Pract JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - The Burden of Work-Related Asthma in Michigan, 1988-2018. PG - AB - RATIONALE: Exposure to a variety of substances in the workplace can cause new-onset asthma or aggravate pre-existing asthma, both of which are considered work-related asthma (WRA). Understanding trends in the nature and causes of WRA can assist in the diagnosis and management of adult patients with asthma. OBJECTIVE: To describe trends over 31 years of WRA surveillance in Michigan. METHODS: Michigan law requires reporting of all known or suspected cases of occupational disease. WRA was confirmed by review of a standardized telephone interview and patient medical records. Enforcement inspections at the workplaces of the WRA cases included air monitoring and evaluation for asthma and asthma symptoms among co-workers. RESULTS: The Michigan surveillance program identified 3,634 WRA cases from 1988-2018, including nine deaths. The cumulative incidence rate of WRA decreased from 3.5 to 2.0 cases per 100,000 workers. Cases most frequently worked in manufacturing (56%), healthcare (12%) and education (4%). The cumulative incidence rate of WRA decreased in each of those three industries, while increasing in retail trade and accommodations and food services. The most common exposures to known asthma-inducers were to cleaning agents and isocyanates; the percentage exposed to cleaning agents increased from 5% to 20%, while the percentage exposed to isocyanates decreased from 20% to 7%. Fifty-one percent had not applied for workers' compensation (WC) benefits. Only 5% of the 571 workplaces where air sampling was performed were above the allowable exposure limit. Fifteen percent (1,622 of 10,493) of co-workers of the index cases reported onset of asthma since beginning to work at the facility or being bothered at work by daily or weekly chest tightness, shortness of breath or wheezing. CONCLUSIONS: The industries and exposures where Michigan adults develop WRA have changed during the past 31 years. The identification of WRA cases, including WRA deaths, underscores the need for continued vigilance to monitor changes in where and how workers are exposed to asthma-causing agents, physician consideration of workplace exposures in new-onset or worsening adult asthma, and adoption of workplace standards that reduce exposure and require workplace medical monitoring to prevent and reduce the morbidity and mortality of WRA. AU - Reilly MJ AU - Wang L AU - Rosenman KD LA - PT - DEP - TA - Ann Am Thorac Soc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 54 IP - DP - 2019 Jan 01 TI - Giant cell interstitial pneumonia secondary to cobalt exposure from e-cigarette use PG - 1901922 AB - The spectrum of pulmonary disease caused by e-cigarette use is currently emerging and appears to be multifaceted [1]. We describe a patient who developed pathologically documented giant cell interstitial pneumonia following regular use of an e-cigarette. This disorder has been termed hard metal pneumoconiosis, or cobalt lung, due to its close association with exposure to hard metal (cemented tungsten carbide with cobalt) [2]. Analysis of the device's e-liquid revealed significant levels of cobalt, supporting a diagnosis of giant cell interstitial pneumonia associated with inhaled cobalt from regular e-cigarette use. The e-liquid from the ZenPen micro-vaporiser belonging to the patient was analysed using inductively coupled plasma mass spectrometry (ICP-MS). The patient's ZenPen micro-vaporiser was sent for analysis by ICP-MS at the Dept of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. The metals detected were nickel (mean concentration 30?443 ppb), aluminium (15?360 ppb), manganese (3231 ppb), lead (1652 ppb), cobalt (654 ppb) and chromium (381 ppb). Tungsten was not detected. The cobalt probably came from the heating coil which needed to be hotter than for nicotine to vaporise cannabis oil AU - Elliott DRF AU - Shah R AU - Hess CA AU - Elicker B AU - Henry TS AU - Rule AM AU - Chen R AU - Golozar M AU - Jones KD LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 6 IP - DP - 2019 Jan 01 TI - Identifying causation in hypersensitivity pneumonitis: a British perspective PG - e000469 AB - Background Establishing whether patients are exposed to a ‘known cause’ is a key element in both the diagnostic assessment and the subsequent management of hypersensitivity pneumonitis (HP). Objective This study surveyed British interstitial lung disease (ILD) specialists to document current practice and opinion in relation to establishing causation in HP. Methods British ILD consultants (pulmonologists) were invited by email to take part in a structured questionnaire survey, to provide estimates of demographic data relating to their service and to rate their level of agreement with a series of statements. A priori ‘consensus agreement’ was defined as at least 70% of participants replying that they ‘Strongly agree’ or ‘Tend to agree’. Results 54 consultants took part in the survey from 27 ILD multidisciplinary teams. Participants estimated that 20% of the patients in their ILD service have HP, and of these, a cause is identifiable in 32% of cases. For patients with confirmed HP, an estimated 40% have had a bronchoalveolar lavage for differential cell counts, and 10% a surgical biopsy. Consensus agreement was reached for 25 of 33 statements relating to causation and either the assessment of unexplained ILD or management of confirmed HP. Conclusions This survey has demonstrated that although there is a degree of variation in the diagnostic approach for patients with suspected HP in Britain, there is consensus opinion for some key areas of practice. There are several factors in clinical practice that currently act as potential barriers to identifying the cause for British HP patients. AU - Barber CM AU - Burge PS AU - Feary JR AU - Parfrey H AU - Renzoni EA AU - Spencer LG AU - Walters GI AU - Wiggans RE AU - the of behalf on Participants GHS LA - PT - DEP - TA - BMJ Open Respiratory Research JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 76 IP - DP - 2019 Jan 01 TI - Accelerated lung function decline in an aluminium manufacturing industry cohort exposed to PM2.5: an application of the parametric g-formula. PG - 888-894 AB - OBJECTIVE: Occupational dust exposure has been associated with accelerated lung function decline, which in turn is associated with overall morbidity and mortality. In the current study, we assess potential benefits on lung function of hypothetical interventions that would reduce occupational exposure to fine particulate matter (PM2.5) while adjusting for the healthy worker survivor effect. METHODS: Analyses were performed in a cohort of 6485 hourly male workers in an aluminium manufacturing company in the USA, followed between 1996 and 2013. We used the parametric g-formula to assess lung function decline over time under hypothetical interventions while also addressing time-varying confounding by underlying health status, using a composite risk score based on health insurance claims. RESULTS: A counterfactual scenario envisioning a limit on exposure equivalent to the 10th percentile of the observed exposure distribution of 0.05 mg/m(3) was associated with an improvement in forced expiratory volume in one second (FEV1) equivalent to 37.6 mL (95% CI 13.6 to 61.6) after 10 years of follow-up when compared with the observed. Assuming a linear decrease and (from NHANES reference values), a 20 mL decrease per year for a 1.8 m-tall man as they age, this 37.6 mL FEV1 loss over 10 years associated with observed exposure would translate to approximately a 19% increase to the already expected loss per year from age alone. CONCLUSIONS: Our results indicate that occupational PM2.5 exposure in the aluminium industry accelerates lung function decline over age. Reduction in exposure may mitigate accelerated loss of lung function over time in the industry. AU - Neophytou AM AU - Costello S AU - Picciotto S AU - Noth EM AU - Liu S AU - Lutzker L AU - Balmes JR AU - Hammond K AU - Cullen MR AU - Eisen EA LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 26 IP - DP - 2019 Jan 01 TI - Acute hypersensitivity pneumonitis in woodworkers caused by inhalation of birch dust contaminated with Pantoea agglomerans and Microbacterium barkeri PG - 644-655 AB - Case description. Five workers (2 males and 3 females) employed in a furniture factory located in eastern Poland developed hypersensitivity pneumonitis (HP) after the pine wood used for furniture production was replaced by birch wood. All of them reported onset of respiratory and general symptoms (cough, shortness of breath, general malaise) after inhalation exposure to birch dust, showed crackles at auscultation, ground-glass attenuations in HRCT examination, and lymphocytosis in the BAL examination. The diagnosis of acute HP was set in 4 persons and the diagnosis of subacute HP in one. Identification of specific allergen. Samples of birch wood associated with evoking disease symptoms were subjected to microbiological analysis with the conventional and molecular methods. Two bacterial isolates were found to occur in large quantities (of the order 108 CFU/g) in examined samples: Gram-negative bacterium of the species Pantoea agglomerans and a non-filamentous Gram-positive actinobacterium of the species Microbacterium barkeri. In the test for inhibition of leukocyte migration, 4 out of 5 examined patients showed a positive reaction in the presence of P. agglomerans and 2 in the presence of M. barkeri. Only one person showed the presence of precipitins to P. agglomerans and none to M. barkeri. In the inhalation challenge, which is the most relevant allergological test in the HP diagnostics, all patients reacted positively to P. agglomerans and only one to M. barkeri. The results indicate that P. agglomerans developing in birch wood was the main agent causing HP in the workers exposed to the inhalation of dust from this wood, while the etiologic role of M. barkeri is probably secondary. Conclusion. The results demonstrate that apart from fungi and filamentous actinobacteria, regarded until recently as causative agents of HP in woodworkers, Gram-negative bacteria and non-filamentous actinobacteria may also elicit disease symptoms in the workers processing wood infected with large amounts of these microorganisms. The results obtained also seem to indicate that cellular-mediated reactions are more significant for causing disease symptoms compared to those that are precipitin-mediated. AU - Mackiewicz B AU - Dutkiewicz J AU - Siwiec J AU - Kucharczyk T AU - Siek E AU - Wójcik-Fatla A AU - Cholewa G AU - Cholewa A AU - Pasciak M AU - Pawlik K AU - Szponar B AU - Milanowski J LA - PT - DEP - TA - Annals of Agricultural and Environmental Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Adult Asthma among Workers in Ontario: Results from the Occupational Disease Surveillance System. PG - AB - RATIONALE: Given that approximately 15% of new onset adult asthma cases originate due to exposures in the workplace, there is a need for systematic and ongoing monitoring of risk among workers. OBJECTIVES: To characterize the risk of new onset adult asthma among workers in Ontario. METHODS: We utilized 575,379 provincial accepted time-loss workers' compensation claimants data linked to physician billing data. Workers at-risk of new onset adult asthma were followed from cohort entry date to date of diagnosis, emigration, age 65, death, or end of study period. The case definition required 2+ records for asthma within a 12-month period, within a 3-year time window following cohort entry. Cox regression models were used to generate birth year and sex-adjusted hazard ratios (HR) by occupation, industry and exposures identified using a job exposure matrix (JEM). Sex-stratified risk estimates were also generated. RESULTS: Increased risks were detected among well-recognized groups including bakers (HR 1.60, 95% confidence interval (CI)=1.22-2.09) and painters and decorators (HR 1.67, 95% CI=1.23-2.28). In the JEM analysis, flour and isocyanates were associated with increased risk of asthma. Concrete finishers (HR 1.93, 95% CI=1.12-3.32) and shipping and receiving clerks (HR 1.21, 95% CI=1.03-1.43) also showed elevated risk, while results varied across woodworker groups. Decreased risks were detected for nursing and farming groups. CONCLUSIONS: This practical data linkage approach was successful for examining associations across hundreds of jobs. Unexpected and previously unrecognized findings deserve further investigation and emphasize the importance of an ongoing system to guide research, as well as prevention. AU - Logar-Henderson C AU - MacLeod JS AU - Arrandale VH AU - Holness DL AU - McLeod CB AU - Peter A AU - Demers PA LA - PT - DEP - TA - Ann Am Thorac Soc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 53 IP - DP - 2019 Jan 01 TI - Dampness, mould, onset and remission of adult respiratory symptoms, asthma and rhinitis PG - 1801921 AB - Study question Is dampness and indoor mould associated with onset and remission of respiratory symptoms, asthma and rhinitis among adults? Materials and methods Associations between dampness, mould and mould odour at home and at work and respiratory health were investigated in a cohort of 11?506 adults from Iceland, Norway, Sweden, Denmark and Estonia. They answered a questionnaire at baseline and 10 years later, with questions on respiratory health, home and work environment. Results Baseline water damage, floor dampness, mould and mould odour at home were associated with onset of respiratory symptoms and asthma (OR 1.23–2.24). Dampness at home during follow-up was associated with onset of respiratory symptoms, asthma and rhinitis (OR 1.21–1.52). Dampness at work during follow-up was associated with onset of respiratory symptoms, asthma and rhinitis (OR 1.31–1.50). Combined dampness at home and at work increased the risk of onset of respiratory symptoms and rhinitis. Dampness and mould at home and at work decreased remission of respiratory symptoms and rhinitis. The answer to the question Dampness and mould at home and at work can increase onset of respiratory symptoms, asthma and rhinitis, and decrease remission. AU - Wang J AU - Pindus M AU - Janson C AU - Sigsgaard T AU - Kim J AU - Holm M AU - Sommar J AU - Orru H AU - Gislason T AU - Johannessen A AU - Bertelsen RJ AU - Norbäck D LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 54 IP - DP - 2019 Jan 01 TI - Specific challenge testing for occupational asthma: revised handbook PG - 1901026 AB - Specific inhalation challenge is considered a reference standard in the diagnosis of occupational asthma. An updated handbook of challenge techniques for a large number of sensitising agents from 11 European centres is now available. http://bit.ly/2XVpW1P When undertaken carefully, and in experienced hands, specific inhalation challenge (SIC) testing is widely considered to be the reference standard in the diagnosis of occupational asthma. In 2013 the European Respiratory Society commissioned a pan-European task force to produce standards for the conduct and interpretation of SIC with the aim of sharing expertise among those centres who offer the service and with centres who wish to develop a new service. The findings and recommendations of the taskforce were published in the European Respiratory Journal [1]. Alongside the main report, we produced a handbook of challenge techniques for a large number of different sensitising agents, including both those of high and low molecular mass. We committed ourselves to provide an update within 5 years; this has been completed, as planned, and is presented as a supplementary file to this editorial. The techniques are those used in 11 specialist centres and are listed by agent category with contact information for each centre should practitioners require more detailed information; the occupational asthma community in Europe prides itself on being collaborative, and collectively is happy to share its experience and expertise. Controlled, experimental SIC was first developed – formally, as a diagnostic tool for occupational asthma – around 50 years ago, in a single centre. Its practice has flourished and spread since but it is fair to say that access remains patchy, with some European countries, and many regions within them, having no provision at all. This disadvantages patients who require the highest standard of diagnostic accuracy, employers who need to know which of the agents in their workplaces is giving rise to disease in their workers, and regulators charged with controlling what is essentially a preventable disease. Moreover, it hampers the identification of novel sensitisers and the exploration of the mechanisms behind their sensitising properties; this is, perhaps, especially important in the study of chemical sensitisers and particularly so since, rightly or wrongly, they are now considered Substances of Very High Concern under REACH. For these reasons we encourage respiratory physicians and the commissioners of healthcare to familiarise themselves with the relevant guidelines and to consider the equitable provision of SIC across Europe wherever the resources to perform SIC safely and with high quality can be ensured. AU - Suojalehto H AU - Suuronen K AU - Cullinan P LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 69 IP - DP - 2019 Jan 01 TI - Delayed occupational asthma from epoxy exposure. PG - 511-514 AB - BACKGROUND: A delayed asthma reaction occurring several hours after exposure is difficult to diagnose. AIMS: To confirm a delayed asthma reaction in five workers following epoxy exposure. CASE REPORT: Working conditions with exposure to epoxy encountered at the workplace were reproduced in a challenge chamber. Specific inhalation challenge (SIC) with epoxy was compared to a control challenge. All five cases had delayed a asthma response 6-15 h after epoxy exposure. CONCLUSIONS: Our study confirms that SIC is a useful tool in diagnosing delayed asthma response. AU - Brock Jacobsen I AU - Baelum J AU - Carstensen O AU - Skadhauge LR AU - Feary J AU - Cullinan P AU - Sherson DL. LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 69 IP - DP - 2019 Jan 01 TI - Occupational asthma; the limited role of air-fed respiratory protective equipment PG - 329-335 AB - Background Evidence-based reviews have found that evidence for the efficacy of respiratory protective equipment (RPE) in the management of occupational asthma (OA) is lacking. Aims To quantify the effectiveness of air-fed RPE in workers with sensitizer-induced OA exposed to metal-working fluid aerosols in a car engine and transmission manufacturing facility. Methods All workers from an outbreak of metal-working fluid-induced OA who had continuing peak expiratory flow (PEF) evidence of sensitizer-induced OA after steam cleaning and replacement of all metal-working fluid were included. Workers kept 2-hourly PEF measurements at home and work, before and after a strictly enforced programme of RPE with air-fed respirators with charcoal filters. The area-between-curve (ABC) score from the Oasys plotter was used to assess the effectiveness of the RPE. Results Twenty workers met the inclusion criteria. Records were kept for a mean of 24.6 day shifts and rest days before and 24.7 after the institution of RPE. The ABC score improved from 26.6 (SD 16.2) to 17.7 (SD 25.4) l/min/h (P > 0.05) post-RPE; however, work-related decline was <15 l/min/h in only 12 of 20 workers, despite increased asthma treatment in 5 workers. Conclusions Serial PEF measurements assessed with the ABC score from the Oasys system allowed quantification of the effect of RPE in sensitized workers. The RPE reduced falls in PEF associated with work exposure, but this was rarely complete. This study suggests that RPE use cannot be relied on to replace source control in workers with OA, and that monitoring post-RPE introduction is needed. AU - Ilgaz A AU - Moore VC AU - Robertson AS AU - Walters GI AU - Burge PS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 16 IP - DP - 2019 Jan 01 TI - Costs of isocyanate-related occupational diseases: A systematic review. PG - 446-466 AB - Although isocyanates are increasingly used in manufacturing and workplace exposure to isocyanates is widely recognized as one of the most frequent causes for occupational lung and skin diseases, little is known about the economic burden on the affected individual and the society. This study provides an overview on costs of occupational diseases related to isocyanates. We performed a systematic literature search of studies in the electronic databases of the German Institute of Medical Documentation and Information, and the Canadian Centre for Occupational Health and Safety. We extracted the key characteristics of the studies and performed a study quality assessment. We identified eight studies on the costs of illness, of which five focused on occupational lung diseases and three on occupational skin diseases. Further, eight studies calculated loss of income/compensation payments. Out of the 16 identified articles, only two reported costs directly attributable to isocyanate-induced diseases (asthma). Studies were hardly comparable because they differed substantially in their methodological approaches. Moreover, the quality assessment of the studies revealed substantial limitations. While a wide range of isocyanate-related costs was identified, consequences of isocyanate-related occupational diseases were considerable in terms of societal costs and loss of income. In most studies, indirect costs were the main cost driver. There is a need for high-quality cost of illness studies on isocyanate-induced diseases stratified by degree of severity and sex. Such studies provide valuable information to develop preventive strategies and set priorities for measures to lower the burden of professional health risks. AU - Kreis K AU - Aumann-Suslin I AU - Lüdeke A AU - Wegewitz U AU - Zeidler J AU - Graf von der Schulenburg JM LA - PT - DEP - TA - J Occup Environ Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Workplace interventions for treatment of occupational asthma. PG - 10:CD006308 AB - BACKGROUND: The impact of workplace interventions on the outcome of occupational asthma is not well understood. OBJECTIVES: To evaluate the effectiveness of workplace interventions on occupational asthma. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); EMBASE(Ovid); NIOSHTIC-2; and CISILO (CCOHS) up to July 31, 2019. SELECTION CRITERIA: We included all eligible randomized controlled trials, controlled before and after studies and interrupted time-series of workplace interventions for occupational asthma. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study eligibility and risk of bias, and extracted data. MAIN RESULTS: We included 26 non-randomized controlled before and after studies with 1,695 participants that reported on three comparisons: complete removal from exposure and reduced exposure compared to continued exposure, and complete removal from exposure compared to reduced exposure. Reduction of exposure was achieved by limiting use of the agent, improving ventilation, or using protective equipment in the same job; by changing to another job with intermittent exposure; or by implementing education programs. For continued exposure, 56 per 1000 workers reported absence of symptoms at follow-up, the decrease in forced expiratory volume in one second as a percentage of a reference value (FEV1 %) was 5.4% during follow-up, and the standardized change in non-specific bronchial hyperreactivity (NSBH) was -0.18.In 18 studies, authors compared removal from exposure to continued exposure. Removal may increase the likelihood of reporting absence of asthma symptoms, with risk ratio (RR) 4.80 (95% confidence interval (CI) 1.67 to 13.86), and it may improve asthma symptoms, with RR 2.47 (95% CI 1.26 to 4.84), compared to continued exposure. Change in FEV1 % may be better with removal from exposure, with a mean difference (MD) of 4.23 % (95% CI 1.14 to 7.31) compared to continued exposure. NSBH may improve with removal from exposure, with standardized mean difference (SMD) 0.43 (95% CI 0.03 to 0.82).In seven studies, authors compared reduction of exposure to continued exposure. Reduction of exposure may increase the likelihood of reporting absence of symptoms, with RR 2.65 (95% CI 1.24 to 5.68). There may be no considerable difference in FEV1 % between reduction and continued exposure, with MD 2.76 % (95% CI -1.53 to 7.04) . No studies reported or enabled calculation of change in NSBH.In ten studies, authors compared removal from exposure to reduction of exposure. Following removal from exposure there may be no increase in the likelihood of reporting absence of symptoms, with RR 6.05 (95% CI 0.86 to 42.34), and improvement in symptoms, with RR 1.11 (95% CI 0.84 to 1.47), as well as no considerable change in FEV1 %, with MD 2.58 % (95% CI -3.02 to 8.17). However, with all three outcomes, there may be improved results for removal from exposure in the subset of patients exposed to low molecular weight agents. No studies reported or enabled calculation of change in NSBH.In two studies, authors reported that the risk of unemployment after removal from exposure may increase compared with reduction of exposure, with RR 14.28 (95% CI 2.06 to 99.16). Four studies reported a decrease in income of 20% to 50% after removal from exposure.The quality of the evidence is very low for all outcomes. AUTHORS' CONCLUSIONS: Both removal from exposure and reduction of exposure may improve asthma symptoms compared with continued exposure. Removal from exposure, but not reduction of exposure, may improve lung function compared to continued exposure. When we compared removal from exposure directly to reduction of exposure, the former may improve symptoms and lung function more among patients exposed to low molecular weight agents. Removal from exposure may also increase the risk of unemployment. Care providers should balance the potential clinical benefits of removal from exposure or reduction of exposure with potential detrimental effects of unemployment. Additional high-quality studies are needed to evaluate the effectiveness of workplace interventions for occupational asthma. AU - Henneberger PK AU - Patel JR AU - de Groene GJ AU - Beach J AU - Tarlo SM AU - Pal TM AU - Curti S. LA - PT - DEP - TA - Cochrane Database Syst Rev. JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 62 IP - DP - 2019 Jan 01 TI - Severe lung disease characterized by lymphocytic bronchiolitis, alveolar ductitis, and emphysema (BADE) in industrial machine-manufacturing workers PG - 927- AB - Background A cluster of severe lung disease occurred at a manufacturing facility making industrial machines. We aimed to describe disease features and workplace exposures. Methods Clinical, functional, radiologic, and histopathologic features were characterized. Airborne concentrations of thoracic aerosol, metalworking fluid, endotoxin, metals, and volatile organic compounds were measured. Facility airflow was assessed using tracer gas. Process fluids were examined using culture, polymerase chain reaction, and 16S ribosomal RNA sequencing. Results Five previously healthy male never-smokers, ages 27 to 50, developed chest symptoms from 1995 to 2012 while working in the facility's production areas. Patients had an insidious onset of cough, wheeze, and exertional dyspnea; airflow obstruction (mean FEV1?=?44% predicted) and reduced diffusing capacity (mean?=?53% predicted); and radiologic centrilobular emphysema. Lung tissue demonstrated a unique pattern of bronchiolitis and alveolar ductitis with B-cell follicles lacking germinal centers, and significant emphysema for never-smokers. All had chronic dyspnea, three had a progressive functional decline, and one underwent lung transplantation. Patients reported no unusual nonoccupational exposures. No cases were identified among nonproduction workers or in the community. Endotoxin concentrations were elevated in two air samples; otherwise, exposures were below occupational limits. Air flowed from areas where machining occurred to other production areas. Metalworking fluid primarily grew Pseudomonas pseudoalcaligenes and lacked mycobacterial DNA, but 16S analysis revealed more complex bacterial communities. Conclusion This cluster indicates a previously unrecognized occupational lung disease of yet uncertain etiology that should be considered in manufacturing workers (particularly never-smokers) with airflow obstruction and centrilobular emphysema. Investigation of additional cases in other settings could clarify the cause and guide prevention. AU - Cummings KJ AU - Stanton ML AU - LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Asthma and rhinitis in Greek furniture workers PG - AB - Objective: The detection of asthma and rhinitis in furniture workers exposed to chemicals in the area of Thessaloniki Greece and the determination of the most useful tests for diagnosing the above occupational diseases. Methods: Eighty-three workers (76 men), 35 exposed to chemicals (CW), 23 to wood dust (WW), and 25 office workers (OW), serving as controls, filled in a specialized European Community Respiratory Health Survey (ECRHS) questionnaire for asthma and were submitted to clinical evaluation, spirometry, bronchodilation test, PEF computer algorithm OASYS-2, FeNO, skin prick tests (SPTs), rhinomanometry and methacholine inhalation challenge. Working conditions and protective measurements were also recorded. According to the results of all conducted tests, each subject was distributed to a subgroup: (a) normal, (b) asthma, (c) rhinitis, (d) asthma and rhinitis. Comparisons were performed among work groups. Results: The presence of asthma and/or rhinitis was higher among CW and WW compared to OW (p?=?0.004). Significant differences among groups were observed in the questions «better weekend» (p?<?0.034) and "improvement on vacation» (p?<?0.000), in OASYS-2 Score (p?<?0.000), in ABC Score (p?<?0.000), and in methacholine score (p?<?0.022). Rhinomanometry, FeNO, spirometry, and spirometry after bronchodilation had no significant differences among groups. Working conditions, ventilation system, work practice, use and type of mask revealed no significant differences. Conclusion: Asthma and rhinitis are significantly common among CW. Protective measurements used were not adequate to prevent asthma and or work related rhinitis. Early diagnosis might contribute to disease prevention and control. AU - Paraskevaidou K AU - Porpodis K AU - Kontakiotis T AU - Kioumis I AU - Spyratos D AU - Papakosta D LA - PT - DEP - TA - J Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 10 IP - DP - 2019 Jan 01 TI - Comparative Review of Asthma in Farmers and Horses PG - 50 AB - Farmers are routinely exposed to organic dusts and aeroallergens that can have adverse respiratory health effects including asthma. Horses are farm-reared large animals with similar exposures and can develop equine asthma syndrome (EAS). This review aims to compare the etiology, pathophysiology, and immunology of asthma in horses compared to farmers and highlights the horse as a potential translational animal model for organic dust-induced asthma in humans. RECENT FINDINGS: Severe EAS shares many clinical and pathological features with various phenotypes of human asthma including allergic, non-allergic, late onset, and severe asthma. EAS disease features include variable airflow obstruction, cough, airway hyperresponsiveness, airway inflammation/remodeling, neutrophilic infiltrates, excess mucus production, and chronic innate immune activation. Severe EAS is a naturally occurring and biologically relevant, translational animal disease model that could contribute to a more thorough understanding of the environmental and immunologic factors contributing to organic dust-induced asthma in humans. AU - Sheats MK AU - Davis KU AU - Poole JA LA - PT - DEP - TA - Curr Allergy Asthma Rep JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 20 IP - DP - 2019 Jan 01 TI - Work-Related Symptoms of Patients with Asthma: A Multicenter Study PG - 241-247 AB - OBJECTIVES: It is considered that occupational exposure accounts for up to 25% of all cases of adult asthma. We need detailed individual-level data regarding the relationship between asthma, occupation, and work-related symptoms in Turkey to inform policies on workplace safety. This study aimed to investigate the association between asthma symptoms, occupation type, and workplace exposure in patients with asthma. MATERIALS AND METHODS: In this cross-sectional multicenter study, adult patients with asthma were investigated by a questionnaire in terms of relationship between asthma symptoms and workplace exposure. The study population was adult patients who had been diagnosed with asthma for at least six months prior to study and who were under follow-up in Ankara, Istanbul, Erzurum, Düzce, Trabzon, Denizli, and Diyarbakir. RESULTS: The mean age of the 345 cases (188 females) was 41±13 years. The majority of the patients (36.8%) were "housewives"; other common occupations were office workers (6.7%), textile workers (4%), students (3.8%), hospital staff (3.5%), and cleaners (2.9%). Thirty-five percent of patients described worsening of asthma during working periods. Among patients with a history of increased symptoms in workplace, 100 (83%) developed asthma after starting work, while 20 patients (17%) had pre-existing asthma. Half of the patients described workplace exposure to dust, fume, and gases. Exposure to cleaning supplies at home was present in 43% of the subjects. Of all housewives, 12% (n=15) described an increase in their asthma symptoms during housework. The frequency of bleach or hydrochloric acid use alone among housewives was 60% and 34%, which was significantly higher than other occupations. The FEV1/FVC ratio of housewives who frequently used hydrochloric acid (FEV1/FVC=71.5) was lower than that of non-users (FEV1/FVC=74.9) (p=0.024). CONCLUSION: Patients with asthma experience significant workplace exposures that exacerbate their symptoms. Housewives experience significant exposure that triggers allergic and asthma symptoms. It is important to raise awareness about the prevalence and risks of occupational (including in-home) exposures in asthmatics patients and physicians to minimize asthma triggers and exacerbations. AU - Mungan D AU - Özmen I AU - Evyapan F AU - Topçu F AU - Akgün M AU - Arbak P AU - Bülbül Y LA - PT - DEP - TA - Turk Thorac J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 7 IP - DP - 2019 Jan 01 TI - Occupational asthma from epoxy compounds. PG - 191-198 AB - BACKGROUND: Two-component epoxy resin systems (ERS) composed of epoxy resin and polyamine hardeners are extensively used in industrial and construction coating. Triglycidyl isocyanurate (TGIC) is another type of epoxy derivative, mostly encountered in polyester powder paints. Epoxy compounds are well known skin sensitizers, but their respiratory sensitizing potential is largely unknown. OBJECTIVES: We report patients examined for occupational asthma from epoxy compounds. METHODS: We retrospectively reviewed patient files of cases tested with a placebo-controlled specific inhalation challenge (SIC) according to their workplace exposure: either by mixing epoxy resin and the polyamine hardener of a two-component paint or by dusting or heating TGIC-containing powder paint. The data were collected from the Finnish Institute of Occupational Health and at the Fundación Jiménez Díaz Hospital, Spain, in 1997-2018. We also measured airborne polyamine and solvent vapours at the workplace and during SIC with ERS. RESULTS: Altogether 113 patients with work-related asthma symptoms underwent SIC with ERS. Fifteen cases (13%) had positive SIC reactions confirming occupational asthma; in 12 cases reactions were late type, in one case early and in two cases combined. The median duration of exposure of occupational asthma patients was ten years, two of them (13%) had a diagnosis of allergic contact dermatitis from ERS compounds. In addition, three cases had a positive SIC reaction to TGIC. The airborne polyamine levels measured were low. CONCLUSIONS: ERS and TGIC can cause sensitizer-induced occupational asthma in some exposed workers. Respiratory exposure to ERS is difficult to demonstrate using air measuremen AU - Suojalehto H AU - Sastre J AU - Merimaa E AU - Lindström I AU - Suuronen K. LA - PT - DEP - TA - J Allergy Clin Immunol Pract JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Hypersensitivity pneumonitis and its correlation with ambient air pollution in urban India PG - AB - A higher proportion of patients diagnosed with hypersensitivity pneumonitis (HP) live in cities with higher levels of air pollutants, according to new research published in the European Respiratory Journal. The study used prospective data from patients diagnosed with HP taken from the India Interstitial Lung Diseases (ILD) registry, to assess whether there is an association between the proportions of HP cases in various Indian cities, and the levels of ambient fine particulate matter (PM2.5). Lead researcher Professor Ganesh Raghu, MD, explains the rationale behind the research: “We discovered that the majority of patients with HP in India were living in urban cities, prompting an investigation into the link between ambient air pollution in urban India and the high incidence of HP.” Multiple logistic regression analyses revealed that increases in PM2.5 levels were associated with an increase in the risk of developing HP more frequently than any other ILD. The researchers say the data shows that the odds of developing HP were 7% greater for every 10 µg/m3 increase in the levels of PM2.5 in cities. This study raises concerns for people living in polluted urban areas, who are also exposed to other environmental factors such as birds, mould, and manifesting respiratory problems. AU - Singh S AU - Collins BF AU - Bairwa M AU - Joshi JM AU - Talwar D AU - Singh N AU - Samaria JK AU - Mangal DK AU - Singh V AU - Raghu G LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 76 IP - DP - 2019 Jan 01 TI - Occupational cannabis exposure and allergy risks PG - 78-82 AB - Objectives Cannabis allergy has mainly been described following recreational use but some cases also point to cannabis sensitisation as a result of occupational exposure. As a consequence, little is known on the prevalence and clinical phenotype of occupational cannabis allergy. Therefore, this study aims to explore the allergy-associated health risks of occupational cannabis exposure in Belgian police force personnel. Methods 81 participants, active in the police force, reporting regular occupational cannabis exposure during the past 12?months, were included. History was combined with a standardised questionnaire on allergies and cannabis exposure. Basophil activation tests (BATs) with a crude cannabis extract and rCan s 3 were performed. In addition, specific (s)IgE rCan s 3 as well as sIgE to house dust mite, six pollen and three mould allergens were quantified. Results Although 42% of the participants reported respiratory and/or cutaneous symptoms on occupational cannabis exposure, all cannabis diagnostics were entirely negative, except one symptomatic case demonstrating a borderline result. Furthermore, there is no significant difference between the groups with and without symptoms on cannabis exposure in terms of allergenic sensitisations. Conclusions The origins of the reported respiratory and cutaneous symptoms during cannabis exposure remain elusive but are probably due to non-immune reactions. It should be noted that the study was volunteer-based possibly reflecting an excessive number of symptomatic individuals. Nevertheless, as only one participant reported using fully protective gear, much improvement is needed for reducing the number of symptoms reported on duty, independent of their origin. AU - Decuyper II AU - Gasse AV AU - Faber MA AU - Mertens C AU - Elst J AU - Rihs H AU - Sabato V AU - Lapeere H AU - Hagendorens M AU - Bridts C AU - Clerck LD AU - Ebo D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 76 IP - DP - 2019 Jan 01 TI - Pyromellitic dianhydride (PMDA) may cause occupational asthma PG - 175-177 AB - INTRODUCTION: Anhydrides are widely used as cross-linking agents in epoxy resins and alkyd production, for example, as coatings and adhesives in plastic products. Sensitisation to several anhydrides is known to cause occupational asthma. There are indications that the lesser known pyromellitic dianhydride (PMDA) can cause irritative respiratory symptoms and possibly asthma. We report three cases of workers from a plastic foil manufacturing plant, who developed asthma when exposed to PMDA during specific inhalation challenge (SIC). METHODS: SIC was performed over 2 days according to recommendations of European Respiratory Society. Lactose powder was used in control challenges and a mixture of 10% PMDA and 90% lactose powder in active challenges. RESULTS: All cases experienced a delayed decrease in forced expiratory flow in 1?s (FEV1) 4-12?hours after active challenge. FEV1 decreased by 19%, 15% and 16%, respectively. After 21?hours, FEV1 decreased by 24% in one worker. DISCUSSION: Respiratory symptoms after working hours may represent delayed work-related asthma. During SIC, the three patients developed lower respiratory symptoms and a delayed decrease in FEV1 which suggest sensitisation. The mechanism of anhydride-related asthma is not well understood. Anhydrides are known irritants and hence an irritative response cannot be excluded. The company improved ventilation and enforced the use of respiratory protection equipment, and finally phased out PMDA. Occupational workplace risk identification may help to identify exposures. SIC can contribute to improving working conditions, by identifying and confirming asthmogens in the environment. AU - Madsen MT AU - Skadhauge LR AU - Nielsen AD AU - Baelum J AU - Sherson DL. LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 69 IP - DP - 2019 Jan 01 TI - Occupational asthma caused by peracetic acid-hydrogen peroxide mixture PG - 294-297 AB - BACKGROUND: Healthcare practice in the UK has moved away from using aldehyde disinfectants for the decontamination of endoscopes, in part due to the risk of respiratory sensitization. Peracetic acid (PAA) in combination with hydrogen peroxide (HP) is a commonly used alternative. AIM: We describe a case of occupational asthma (OA) diagnosed at our specialist occupational lung disease clinic and caused by occupational exposure to PAA-HP mixture, used as a disinfectant in an endoscope washer-disinfector machine. CASE REPORT: A 48-year-old man employed as a mycologist and environmental microbiologist at a Birmingham city hospital, UK, presented following an acute exposure to PAA-HP mixture causing lacrimation, burning optic pain and headache. He had also experienced symptoms suggestive of OA for the preceding 10 months, and the diagnosis was confirmed through OASYS analysis of serial peak expiratory flow measurements. He had been exposed to PAA-HP mixture whilst working in the endoscopy department for 12 months prior to the acute episode, and a subsequent specific inhalation challenge test was positive with a late asthmatic response to PAA-HP mixture. CONCLUSION: This case provides evidence for a sensitization mechanism in OA caused by PAA-HP mixture AU - Walters GI AU - Burge PS AU - Moore VC AU - Thomas MO AU - Robertson AS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 76 IP - DP - 2019 Jan 01 TI - Emerging trends in the UK incidence of occupational asthma: should we be worried? PG - 396-397 AB - While 15% of adult-onset asthma is estimated to have an occupational cause, there has been evidence of a downward trend in occupational asthma incidence in several European countries since the start of this millennium. However, recent data from The Health and Occupation Reporting network in the UK have suggested a possible reversal of this downward trend since 2014. We present these data and discuss possible explanations for this observed change in incidence trend. A high index of suspicion of occupational causation in new-onset asthma cases continues to be important, whether or not the recently observed increase in occupational asthma incidence in the UK is real or artefactual. AU - Seed MJ AU - Carder M AU - Gittins M AU - Sen D AU - Money A AU - Fishwick D AU - Barber CM AU - van Tongeren M. LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Food processing and Occupational Respiratory Allergy - a EAACI Position Paper PG - AB - Occupational exposure to foods is responsible for up to 25% of cases of occupational asthma and rhinitis. Animal and vegetable high-molecular weight proteins present in aerosolized foods during food processing, additives, preservatives, antioxidants and food contaminants are the main inhalant allergen sources. Most agents typically cause IgE-mediated allergic reactions, causing a distinct form of food allergy (Class 3 food allergy). The allergenicity of a food protein, allergen exposure levels and atopy are important risk factors. Diagnosis relies on a thorough medical and occupational history, functional assessment, assessment of sensitization, including component resolved diagnostics where appropriate, and in selected cases specific inhalation tests. Exposure assessment, including allergen determination, is a cornerstone for establishing preventive measures. Management includes allergen exposure avoidance or reduction (second best option), pharmacological treatment, assessment of impairment and worker's compensation. Further studies are needed to identify and characterise major food allergens and define occupational exposure limits, evaluate the relative contribution of respiratory versus cutaneous sensitization to food antigens, evaluate the role of raw versus cooked food in influencing risk, and define the absolute or relative contraindication of patients with ingestion-related food allergy, pollinosis or oral allergy syndrome continuing to work with exposure to aerosolised food allergens AU - Jeebhay F AU - Moscato G AU - Bang BE AU - Folletti I AU - Lipinska-Ojrzanowska A AU - Lopata AL AU - Pala G AU - Quirce S AU - Raulf M AU - Sastre J AU - Swoboda I AU - Walusiak-Skorupa J AU - Siracusa A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 143 IP - DP - 2019 Jan 01 TI - Laundry detergents and detergent residue after rinsing directly disrupt tight junction barrier integrity in human bronchial epithelial cells PG - 1892-1903 AB - Background Defects in the epithelial barrier have recently been associated with asthma and other allergies. The influence of laundry detergents on human bronchial epithelial cells (HBECs) and their barrier function remain unknown. Objective We investigated the effects of laundry detergents on cytotoxicity, barrier function, the transcriptome, and the epigenome in HBECs. Methods Air-liquid interface cultures of primary HBECs from healthy control subjects, patients with asthma, and patients with chronic obstructive pulmonary disease were exposed to laundry detergents and detergent residue after rinsing. Cytotoxicity and epithelial barrier function were evaluated. RNA sequencing, Assay for Transposase Accessible Chromatin with high-throughput sequencing, and DNA methylation arrays were used for checking the transcriptome and epigenome. Results Laundry detergents and rinse residue showed dose-dependent toxic effects on HBECs, with irregular cell shape and leakage of lactate dehydrogenase after 24 hours of exposure. A disrupted epithelial barrier function was found with decreased transepithelial electrical resistance, increased paracellular flux, and stratified tight junction (TJ) immunostaining in HBECs exposed to laundry detergent at 1:25,000 dilutions or rinse residue at further 1:10 dilutions. RNA sequencing analysis showed that lipid metabolism, apoptosis progress, and epithelially derived alarmin-related gene expression were upregulated, whereas cell adhesion–related gene expression was downregulated by laundry detergent at 1:50,000 dilutions after 24 hours of exposure without substantially affecting chromatin accessibility and DNA methylation. Conclusion Our data demonstrate that laundry detergents, even at a very high dilution, and rinse residue show significant cell-toxic and directly disruptive effects on the TJ barrier integrity of HBECs without affecting the epigenome and TJ gene expression. AU - Wang M AU - Tan G AU - Eljaszewicz A AU - Meng Y AU - Wawrzyniak P AU - Acharya S AU - Altunbulakli C AU - Westermann P AU - Dreher A AU - Yan L AU - Wang C AU - Akdis M AU - Zhang L AU - Nadeau KC AU - Akdis CA LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Novel clinical scores for occupational asthma due to exposure to high-molecular-weight agents PG - AB - OBJECTIVE: Specific inhalation challenge (SIC) as the reference diagnostic test for occupational asthma (OA) is not widely available worldwide. We aimed to develop non-SIC-based models for OA. METHODS: Of 427 workers who were exposed to high-molecular-weight agents and referred to OA clinic at Montréal Sacré-Cœur Hospital between 1983 and 2016, we analysed 160 workers who completed non-specific bronchial hyper-responsiveness (NSBHR) tests and still worked 1?month before SIC. OA was defined as positive SIC. Logistic regression models were developed. The accuracy of the models was quantified using calibration and discrimination measures. Their internal validity was evaluated with bootstrapping procedures. The final models were translated into clinical scores and stratified into probability groups. RESULTS: The final model, which included age =40 years, rhinoconjunctivitis, inhaled corticosteroid use, agent type, NSBHR, and work-specific sensitisation had a reasonable internal validity. The area under the receiver operating characteristics curve (AUC) was 0.91 (95% CI 0.86 to 0.95), statistically significantly higher than the combination of positive NSBHR and work-specific sensitisation (AUC=0.84). The top 70% of the clinical scores (ie, the high probability group) showed a significantly higher sensitivity (96.4%vs86.9%) and negative predictive value (93.6%vs84.1%) than the combination of positive NSBHR and work-specific sensitisation (p value < 0.001). CONCLUSIONS: We developed novel scores for OA induced by high-molecular-weight agents with excellent discrimination. It could be helpful for secondary-care physicians who have access to pulmonary function test and allergy testing in identifying subjects at a high risk of having OA and in deciding on appropriate referral to a tertiary centre AU - Taghiakbari M AU - Pralong JA AU - Lemière C AU - Moullec G AU - Saha-Chaudhuri P AU - Cartier A AU - Castano R AU - Suarthana E. LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Occupational contact dermatitis caused by opioids: a case series. PG - AB - BACKGROUND: Opioid-manufacturing facility workers are at risk of developing occupational contact dermatitis. OBJECTIVES: To describe the causes of occupational allergic contact dermatitis to opioids in an opioid-manufacturing facility. MATERIALS AND METHODS: A retrospective review was performed of patients assessed at the Occupational Dermatology Clinic in Melbourne, Australia from 2004 to 2017. RESULTS: Fifteen workers from an opioid-manufacturing facility were assessed in our clinic over a period of 14 years. Of these, 11 individuals were diagnosed with occupational allergic contact dermatitis to opioids, with 7 reacting to thebaine, 5 to morphine, 4 to norhydroxymorphinone, 2 to codeine and 2 to oripavine. Two people were suspected of having immediate hypersensitivity reaction to opioids, including one who had allergic contact dermatitis as well. Two patients were diagnosed with urticaria, aggravated at work. One patient was diagnosed with a non-occupational rash. CONCLUSIONS: We report a case series of workers with allergic contact dermatitis to opioids in a manufacturing facility. With greater awareness, including implementation of an educational programme and improved skin protection, the number of cases declined over time. Interestingly, norhydroxymorphinone had not been reported as an allergen before. Further testing is required to establish optimal patch test concentrations of all opiates. This article is protected by copyright. All rights reserved. AU - Flury U AU - Cahill J JL AU - Nixon RL. LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Immunological methods for diagnosis and monitoring of IgE-mediated allergy caused by industrial sensitizing agents PG - AB - Industrial sensitizing agents (allergens) in living and working environments play an important role in eliciting type I allergic disorders including asthma and allergic rhinitis. Successful management of allergic diseases necessitates identifying their specific causes (i.e. identify the causative agent(s) and the route of contact to allergen: airborne, or skin contact) to avoid further exposure. Identification of sensitization by a sensitive and validated measurement of specific-IgE is an important step in the diagnosis. However, only a limited number of environmental and occupational allergens are available on the market for use in sIgE testing. Accordingly, specific in-house testing by individual diagnostic and laboratory centers is often required. Currently, different immunological tests are in use at various diagnostic centers that often produce considerably divergent results, mostly due to lack of standardized allergen preparation and standardized procedures as well as inadequate quality control. Our review and meta-analysis exhibited satisfactory performance of s IgE detection test for most high molecular weight (HMW) allergens with a pooled sensitivity of 0.74 and specificity of 0.71. However, for low molecular weight (LMW) allergens, pooled sensitivity is generally lower (0.28) and specificity higher (0.89) than for HMW tests. Major recommendations based on the presented data include diagnostic use of sIgE to HMW allergens. A negative sIgE results for LMW agents does not exclude sensitization. In addition, the requirements for full transparency of the content of allergen preparations with details on standardization and quality control is underlined. Development of standard operating procedures for in-house sIgE assays, and clinical validation, centralized quality control and audits are emphasized. There is also a need for specialized laboratories to provide a custom service for the development of tests for the measurement of putative novel occupational allergens that are not commercially available. AU - Baur X AU - Akdis CA AU - Budnik LT AU - Cruz MJ AU - Fischer A AU - Förster-Ruhrmann U AU - Göen T AU - Goksel O AU - Heutelbeck AR AU - Jones M AU - Lux H AU - Maestrelli P AU - Munoz X AU - Nemery B AU - Schlünssen V AU - Sigsgaard T AU - Traidl-Hoffmann C AU - Siegel P. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 74 IP - DP - 2019 Jan 01 TI - Cleanliness, hygienic habits, and aeroallergen sensitization: German Bitterfeld 3 study PG - 1017-1019 AB - This paper reports the association between infrequent showering or bathing (maximum 1-2 per week) and atopy. German children aged 11-15 who had no evidence of allergic disease who were Infrequent bathers (213/756) had a 31% lower prevalence of aeroallergen sensitisation (measured by specific IgE) than more frequent washers. They postulate that this supports the hygiene theory for the acquisition of atopy, and that the microbiome of the skin may be altered by biocides commonly present in shampoos, soaps and shower gels AU - Markevych I AU - Bowatte G AU - Standl M AU - Heinrich J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 74 IP - DP - 2019 Jan 01 TI - Long-term outcomes in chronic hypersensitivity pneumonitis PG - `944-952 AB - Introduction The objective of this study was to analyze mortality, possible predictors of long-term survival, and health-related quality of life of a large chronic hypersensitivity pneumonitis (CHP) patient sample. Methods Longitudinal study in patients diagnosed with CHP during 2004-2013, followed for at least 1 year. Patients remaining alive and consenting to participate had a follow-up visit during 2015, including a complete pulmonary function study and the EuroQol-5D and Beck Depression and Anxiety Inventories. Results Out of the 160 patients finally included, 87 remained alive. Seventy-three had died or underwent lung transplantation at the time of the study with a median survival of 7.0 (4.4-14.5) years. A Cox proportional risk model showed that factors associated with lower survival were as follows: increased age, a low percentage of lymphocytes in bronchoalveolar lavage (BAL), a decreased transfer factor of the lung for carbonmonoxide (DLCO), presence of honeycomb in the high-resolution chest scan (HRCT), and the usual interstitial pneumonia (UIP) histologic pattern. At follow-up, all patients presented an EuroQol-5D score <0.8 and 21(50%) and 9(28.6%) subjects presented a probable anxiety and depressive syndrome, respectively. Conclusion CHP is a severe disease with a bad mid-term prognosis. Lymphocyte values in BAL and DLCO values at baseline, presence of honeycomb in HRCT, and UIP histologic pattern were found to be predictors of survival. Early accurate diagnosis of the disease is fundamental for prompt initiation of antigen avoidance. AU - Ojanguren I AU - Morell F AU - Ramón M AU - Villar A AU - Romero C AU - Cruz MJ AU - Muñoz X LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 681 IP - DP - 2019 Jan 01 TI - Occupational exposure during treatment of offshore drilling waste and characterization of microbiological diversity. PG - 533-540 AB - The exposure for workers handling and recycling offshore drilling waste are previously not described, and given the potential for exposure to hazardous components, there is a need for characterizing this occupational exposure. In this study five plants recycling offshore drilling waste with different techniques were included. Measurements were conducted in both winter and summer to include seasonal exposure variations. Altogether >200 personal air-exposure measurements for oil mist, oil vapor, volatile organic compounds (VOC), hydrogen sulfide (H2S) and solvents were carried out respectively. Microorganisms related to drilling waste were identified in bulk samples and in stationary air measurements from two of the plants. The exposure to oil mist and oil vapor were below 10% of the current Norwegian occupational exposure limits (OEL) for all measured components. The plants using the Resoil or TCC method had a statistically significant higher exposure to oil vapor than the plant using complete combustion (p-value < 0.05). No statistically significant difference was found between the different treatment methods for oil mist. The exposure to solvents was generally low (additive factor?< ?0.03). Endotoxin measurements done during winter showed a median concentration of 5.4 endotoxin units (EU)/m3. Levels of H2S above the odor threshold of 0.1?ppm were measured at four plants. Both drill mud and slop water contained a high number and diversity of bacteria (2-4?×?104 colony forming unit (CFU)/mL), where a large fraction was Gram-negative species. Some of the identified microorganisms are classified as potentially infectious pathogens for humans and thus might be a hazard to workers. AU - Daae HL AU - Heldal KK AU - Madsen AM AU - Olsen R AU - Skaugset NP AU - Graff P. LA - PT - DEP - TA - Sci Total Environ. JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 61 IP - DP - 2019 Jan 01 TI - Association Between Depression, Lung Function, and Inflammatory Markers in Patients with Asthma and Occupational Asthma PG - 453-460 AB - OBJECTIVE: Depression is associated with autonomic and immune dysregulation, yet this remains poorly explored in asthma. We assessed associations between depressive disorder, lung function, and inflammatory markers in patients under investigation for occupational asthma (OA). METHODS: One hundred twelve patients under investigation for OA (60% men) underwent a psychiatric interview to assess depressive disorder, and spirometry, a methacholine test, sputum induction, and specific inhalation challenge (SIC) to assess OA. Blood and sputum inflammatory markers were assessed. RESULTS: There was a statistically significant association between depressive disorder (P?=?0.0195) and forced expiratory volume in 1?second (FEV1) responses, with the drop in FEV1 post-SIC smaller in patients with OA and depression, versus OA with no depression (P?< ?0.001). CONCLUSION: The presence of depressive disorder may influence FEV1 in patients with OA, which may be via autonomic pathways. However, further studies are warranted in order to determine the mechanisms that underlie these effects. AU - Paine NJ AU - Joseph MF AU - Bacon SL AU - Julien CA AU - Cartier A AU - Ditto B AU - Favreau H AU - Lavoie KL LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Non-invasive tools beyond lung function before and after specific inhalation challenges for diagnosing occupational asthma PG - AB - PURPOSE: Increases of fractional exhaled nitric oxide (FeNO), sputum eosinophils, and methacholine responsiveness have been described after specific inhalation challenges (SIC) with occupational allergens, but limited information is available about their comparative performance. It was the aim of the study to assess the diagnostic accuracy of these non-invasive tests before and after SIC for the diagnosis of occupational asthma (OA). METHODS: A total of 122 subjects with work-related shortness of breath were included. The 'gold standard' was defined as airway obstruction (pulmonary responders) and/or an increase of FeNO of at least 13 ppb after SIC. The results were compared with those obtained using the pulmonary responder status alone as 'gold standard'. RESULTS: If the pulmonary responder status and/or an increase of FeNO was used as 'gold standard' for SIC, 28 out of 39 positives (72%), but also 20 out of 83 negatives (24%) showed an increase of sputum eosinophils and/or bronchial hyperresponsiveness after SIC. If the pulmonary responder status alone was used as 'gold standard', an increase of FeNO with a sensitivity of 0.57 and a specificity of 0.82 showed a higher accuracy than increases of sputum eosinophils (0.52/0.75) or bronchial hyperresponsiveness (0.43/0.87). Individual case analyses suggest that a few cases of OA may be detected by increases of sputum eosinophils or bronchial hyperresponsiveness alone, but probably false-positive tests dominate. CONCLUSION: It is recommended to use both lung function and increase of FeNO as primary effect parameters of SIC. Changes of sputum eosinophils and bronchial hyperresponsiveness after SIC have a low additional diagnostic value, but may be useful in individual cases. AU - Engel J AU - van Kampen V AU - Gering V AU - Hagemeyer O AU - Brüning T AU - Raulf M AU - Merget R LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 19 IP - DP - 2019 Jan 01 TI - The moderating effect of childhood disadvantage on the associations between smoking and occupational exposure and lung function; a cross sectional analysis of the UK Household Longitudinal Study (UKHLS) PG - 690 AB - BACKGROUND: Lung function is lower in people with disadvantaged socio-economic position (SEP) and is associated with hazardous health behaviours and exposures. The associations are likely to be interactive, for example, exposure to socially patterned environmental tobacco smoke (ETS) in childhood is associated with an increased effect of smoking in adulthood. We hypothesise that disadvantaged childhood SEP increases susceptibility to the effects of hazards in adulthood for lung function. We test whether disadvantaged childhood SEP moderates smoking, physical activity, obesity, occupational exposures, ETS and air pollution's associations with lung function. METHODS: Data are from the Nurse Health Assessment (NHA) in waves two and three of the United Kingdom Household Longitudinal Study (UKHLS). Analysis is restricted to English residents aged at least 20 for women and 25 for men, producing a study population of 16,339. Lung function is measured with forced expiratory volume in the first second (FEV1) and standardised to the percentage of expected FEV1 for a healthy non-smoker of equivalent age, gender, height and ethnicity (FEV1%). Using STATA 14, a mixed linear model was fitted with interaction terms between childhood SEP and health behaviours and occupational exposures. Cross level interactions tested whether childhood SEP moderated household ETS and neighbourhood air pollution's associations with FEV1%. RESULTS: SEP, smoking, physical activity, obesity, occupational exposures and air pollution were associated with lung function. Interaction terms indicated a significantly stronger negative association between disadvantaged childhood SEP and currently smoking (coefficient -6.47 %, 95% confidence intervals (CI): 9.51 %, 3.42 %) as well as with formerly smoking and occupational exposures. Significant interactions were not found with physical activity, obesity, ETS and air pollution. CONCLUSION: The findings suggest that disadvantaged SEP in childhood may make people's lung function more susceptible to the negative effects of smoking and occupational exposures in adulthood. This is important as those most likely to encounter these exposures are at greater risk to their effects. Policy to alleviate this inequality requires intervention in health behaviours through public health campaigns and in occupational health via health and safety legislation. AU - Carney C AU - Benzeval M. LA - PT - DEP - TA - BMC Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 199 IP - DP - 2019 Jan 01 TI - The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement PG - 1312-1334 AB - Rationale: Workplace inhalational hazards remain common worldwide, even though they are ameliorable. Previous American Thoracic Society documents have assessed the contribution of workplace exposures to asthma and chronic obstructive pulmonary disease on a population level, but not to other chronic respiratory diseases. The goal of this document is to report an in-depth literature review and data synthesis of the occupational contribution to the burden of the major nonmalignant respiratory diseases, including airway diseases; interstitial fibrosis; hypersensitivity pneumonitis; other noninfectious granulomatous lung diseases, including sarcoidosis; and selected respiratory infections. Methods: Relevant literature was identified for each respiratory condition. The occupational population attributable fraction (PAF) was estimated for those conditions for which there were sufficient population-based studies to allow pooled estimates. For the other conditions, the occupational burden of disease was estimated on the basis of attribution in case series, incidence rate ratios, or attributable fraction within an exposed group. Results: Workplace exposures contribute substantially to the burden of multiple chronic respiratory diseases, including asthma (PAF, 16%); chronic obstructive pulmonary disease (PAF, 14%); chronic bronchitis (PAF, 13%); idiopathic pulmonary fibrosis (PAF, 26%); hypersensitivity pneumonitis (occupational burden, 19%); other granulomatous diseases, including sarcoidosis (occupational burden, 30%); pulmonary alveolar proteinosis (occupational burden, 29%); tuberculosis (occupational burden, 2.3% in silica-exposed workers and 1% in healthcare workers); and community-acquired pneumonia in working-age adults (PAF, 10%). Conclusions: Workplace exposures contribute to the burden of disease across a range of nonmalignant lung conditions in adults (in addition to the 100% burden for the classic occupational pneumoconioses). This burden has important clinical, research, and policy implications. There is a pressing need to improve clinical recognition and public health awareness of the contribution of occupational factors across a range of nonmalignant respiratory diseases. AU - Blanc PD AU - Annesi-Maesano I AU - Balmes JR AU - Cummings KJ AU - Fishwick D AU - Miedinger D AU - Murgia N AU - Naidoo RN AU - Reynolds CJ AU - Sigsgaard T AU - Torén K AU - Vinnikov D AU - and Redlich CA LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 76 IP - DP - 2019 Jan 01 TI - Occupational and work-related respiratory disease attributed to cleaning product PG - 530-536 AB - Objectives Exposure to cleaning products has been associated with adverse respiratory outcomes. This study aimed to investigate the medically reported incidence, trends in incidence and occupational determinants of work-related respiratory disorders attributed to cleaning agents and to explore the role of ‘Quantitative Structure Activity Relationships’ (QSAR) in corroborating the identification of chemical respiratory sensitisers. Methods Respiratory diagnoses attributed to cleaning agents were extracted from The Health and Occupation Research (THOR) surveillance network, 1989–2017. Incidence, trends in incidence and incidence rate ratios by occupation were investigated. Agents were classified by chemical type and QSAR hazard indices were determined for specific organic chemicals. Results Approximately 6% (779 cases) of the (non-asbestos) THOR respiratory cases were attributed to cleaning agents. Diagnoses were predominantly asthma (58%) and inhalation accidents (27%) with frequently reported chemical categories being aldehydes (30%) and chlorine/its releasers (26%). No significant trend in asthma incidence (1999–2017) was observed (annual average change of -1.1% (95% CI -4.4 to 2.4)). This contrasted with a statistically significant annual decline in asthma incidence (-6.8% (95% CI -8.0 to -5.6)) for non-cleaning agents. There was a large variation in risk between occupations. 7 of the 15 organic chemicals specifically identified had a QSAR generated hazard index consistent with being a respiratory sensitiser. Conclusion Specific occupations appear to be at increased risk of adverse respiratory outcomes attributed to cleaning agents. While exposure to agents such as glutaraldehyde have been addressed, other exposures, such as to chlorine, remain important. Chemical features of the cleaning agents helped distinguish between sensitising and irritant agents. AU - Carder M AU - Seed MJ AU - Money A AU - Agius RM AU - van Tongeren M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Association Between Occupational Exposure to Disinfectants and Asthma in Young Adults Working in Cleaning or Health Services - Results From A Cross-Sectional Analysis in Germany. PG - AB - OBJECTIVE: To analyse the association of occupational disinfectants use with asthma and wheezing in young professionals. METHODS: 365 participants from the German Study on Occupational Allergy Risks II aged 20 to 24 years and working in cleaning or health services answered a questionnaire on respiratory health, occupational exposure to disinfectants, and potential confounders. By logistic regression we calculated the association between duration of occupational disinfectants exposure and doctor-diagnosed asthma, current asthma, and current wheezing. RESULTS: Individuals exposed to disinfectants for more than twelve months had almost three times the odds of doctor-diagnosed asthma compared to those not exposed (OR: 2.99, 95% CI: 1.36-6.55). CONCLUSIONS: Our findings provide some further evidence for an association between occupational exposure to disinfectants and asthma, indicating that this association can be seen already after the first year of exposure. AU - Weinmann T AU - Forster F AU - von Mutius E AU - Vogelberg C AU - Genuneit J AU - Windstetter D AU - Nowak D AU - Radon K AU - Gerlich J. LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 16 IP - DP - 2019 Jan 01 TI - High Prevalence of Respiratory Symptoms among Particleboard Workers in Ethiopia: A Cross-Sectional Study PG - AB - Work in the wood industry might be associated with respiratory health problems. The production of particleboard used for furniture making and construction is increasing in many countries, and cause dust, endotoxin and formaldehyde exposure of the workers. The aim of the study was to assess the prevalence of respiratory symptoms and to measure lung function among Ethiopian particleboard workers using Eucalyptus trees as the raw material. In total 147 workers, 74 from particleboard production and 73 controls, participated in the study. Mean wood dust in the particleboard factories was measured to be above recommended limit values. Particleboard workers had a mean age of 28 years and the controls were 25 years. They had been working for 4 and 2 years, respectively. Lung function test was done using spirometry following American Thoracic Society (ATS) recommendations. Respiratory symptoms were collected using a standard questionnaire of ATS. Particleboard workers had higher prevalence of wheezing, cough, cough with sputum production, phlegm, and shortness of breath compared to controls. Lung function status was similar in the two groups. The symptoms might be related to the work in the factories. Longitudinal studies are recommended to explore the chronic impact of work in particleboard factories on respiratory health. AU - Asgedom AA AU - Bråtveit M AU - Moen BE LA - PT - DEP - TA - Int J Environ Res Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 53 IP - DP - 2019 Jan 01 TI - Laboratory animal allergy is preventable in modern research facilities PG - 1900171 AB - Background Historical data suggest 15% of laboratory animal workers develop IgE sensitisation and 10% symptoms of laboratory animal allergy (LAA), including occupational asthma. Individually ventilated cages (IVCs) are replacing conventional open cages; we sought to evaluate their impact on the development of LAA. Methods We surveyed 750 laboratory animal workers and measured airborne Mus m 1 (mouse allergen) levels in seven UK institutions. We compared the prevalence of sensitisation to mouse proteins (by specific IgE assay or skin prick test) and of work-related allergic symptoms in IVC-only and open cage units. Results Full-shift Mus m 1 levels were lower in IVC than open cage units (geometric mean 1.00 (95% CI 0.73–1.36) versus 8.35 (95% CI 6.97–9.95) ng·m-3; p<0.001), but varied eight-fold across the IVC units (geometric mean range 0.33–4.12 ng·m-3). Primary analyses on data from 216 participants with =3 years exposure to mice revealed a lower prevalence of sensitisation in those working in IVC units compared with conventional cage units (2.4% (n=2) versus 9.8% (n=13); p=0.052). Sensitisation in IVC units varied from 0% to 12.5%; the use of fitted respiratory protection was less common in IVC units where prevalence of sensitisation was higher. Work-related allergy symptoms were more frequently reported by mouse-sensitised individuals (46.7% versus 10.9%; p<0.001) and only by those working in open cage units. Conclusion In contemporary practice, LAA is now largely preventable with the use of IVC systems and the judicious use of appropriate respiratory protection. AU - Feary JR AU - Schofield SJ AU - Canizales J AU - Fitzgerald B AU - Potts J AU - Jones M AU - Cullinan P LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Hospital attendances and acute admissions preceding a diagnosis of occupational asthma PG - AB - PURPOSE: Occupational exposures are a common cause of adult-onset asthma; rapid removal from exposure to the causative agent offers the best chance of a good outcome. Despite this, occupational asthma (OA) is widely underdiagnosed. We aimed to see whether chances of diagnosis were missed during acute hospital attendances in the period between symptom onset and the diagnosis of OA. METHODS: Patients diagnosed with OA at the regional occupational lung disease service in Birmingham between 2007 and 2018 whose home address had a Birmingham postcode were included. Emergency department (ED) attendances and acute admission data were retrieved from acute hospitals in the Birmingham conurbation for the period between symptom onset and diagnosis. RESULTS: OA was diagnosed in 406 patients, 147 having a Birmingham postcode. Thirty-four percent (50/147) had acute hospital attendances to a Birmingham conurbation hospital preceding their diagnosis of OA, including 35 (24%) with respiratory illnesses, which resulted in referral for investigation of possible OA in 2/35. The median delay between symptom onset and diagnosis of OA was 30 months (IQR?=?13-60) and between first hospital attendance with respiratory illness and diagnosis 12 months (IQR?=?12-48, range 3-96 months) CONCLUSIONS: The chance to reduce the delay in the diagnosis of OA was missed in 33/35 patients admitted or seen in ED with respiratory symptoms in the period between symptom onset and diagnosis of OA. The diagnosis of OA was delayed by a median of 12 months by failure to ask about employment and work relationship of symptoms. AU - Walters GI AU - Burge PS AU - Sahal A AU - Robertson AS AU - Moore VC LA - PT - DEP - TA - Lung JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 155 IP - DP - 2019 Jan 01 TI - Characteristics of hypersensitivity pneumonitis diagnosed by interstitial and occupational lung disease multi-disciplinary team consensus PG - 19-25 AB - Introduction The causes of hypersensitivity pneumonitis (HP) in the UK are changing as working practices evolve, and metalworking fluid (MWF) is now a frequently reported causative exposure. We aimed to review and describe all cases of HP from our UK regional service, with respect to the causative exposure and diagnostic characteristics. Methods In a retrospective, cross-sectional study, we collected patient data for all 206 cases of HP diagnosed within our UK-based regional NHS interstitial and occupational lung disease service, 2002–17. This included demographics, environmental and occupational exposures, clinical features, and diagnostic tests (CT imaging, bronchiolo-alveolar cell count, lung function, histology). We grouped the data by cause (occupational, non-occupational and unknown) and by presence or absence of fibrosis on CT, in order to undertake hypothesis testing. Results Cases were occupational (n?=?50), non-occupational (n?=?56) or cryptogenic (n?=?100) in aetiology. The commonest causes were birds?=?37 (18%) and MWF?=?36 (17%). Other occupational causes included humidifiers and household or commercial waste, but only one case of farmers’ lung. Cryptogenic cases were associated with significantly older age, female gender, lower lung function parameters, fewer alveolar lymphocyte counts >20%, and fibrosis on CT; exposure information was missing in 22–33% of cryptogenic cases. Conclusion MWF is the commonest occupational cause of HP, where workers usually present with more acute/subacute features and less fibrosis on CT; refuse work is an emerging cause. Cryptogenic HP has a fibrotic phenotype, and a full occupational history should be taken, as historical workplace exposures may be relevant. AU - Walters GI AU - Mokhlis JM AU - Moore VC AU - Robertson AS AU - Burge GA AU - Bhomra PS AU - Burge PS LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 19 IP - DP - 2019 Jan 01 TI - Influence of childhood asthma and allergies on occupational exposure in early adulthood: A prospective cohort study PG - 16 (12) AB - We aimed to determine whether history of asthma/allergies in childhood was associated with avoidance of jobs with exposure to asthmagens in early adulthood. The Melbourne Atopic Cohort Study recruited 620 children at high risk of allergic diseases at birth (1990-1994). Asthma, hay fever and eczema were evaluated by questionnaires during childhood. A follow-up in early adulthood (mean age: 18 years) collected information on the current job. Occupational exposure to asthmagens/irritants was evaluated using a job-exposure matrix. The association between history of asthma/allergies in childhood and working in a job with exposure to asthmagens/irritants was evaluated by logistic regression, adjusted for age, sex and parental education. Among 363 participants followed-up until early adulthood, 17% worked in a job with exposure to asthmagens/irritants. History of asthma (35%) was not associated with working in an exposed job (adjusted OR: 1.16, 95% CI: 0.65-2.09). Subjects with history of hay fever (37%) and eczema (40%) were more likely to enter exposed jobs (significant for hay fever: 1.78, 1.00-3.17; but not eczema: 1.62, 0.91-2.87). In conclusion, young adults with history of allergies were more likely to enter exposed jobs, suggesting no avoidance of potentially hazardous exposures. Improved counselling against high risk jobs may be needed for young adults with these conditions. A AU - Dumas O AU - Le Moual N AU - Lowe AJ AU - Lodge CJ AU - Zock JP AU - Kromhout H AU - Erbas B AU - Perret JL AU - Dharmage SC AU - Benke G AU - Abramson MJ LA - PT - DEP - TA - Int J Environ Res Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - The occupations at increased risk of chronic obstructive pulmonary disease (COPD): analysis of lifetime job-histories in the population-based UK Biobank Cohort. PG - AB - Occupational exposures are important, preventable causes of chronic obstructive pulmonary disease (COPD). Identification of COPD high-risk jobs is key to focus preventive strategies, but a definitive job-list is unavailable.We addressed this issue by evaluating the association of lifetime job-histories and lung function data in the population-based UK Biobank cohort, whose unprecedented sample size allowed analyses restricted to never-smokers to rule out the most important confounder, tobacco smoking. COPD was spirometrically-defined as forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < lower limit of normal (LLN). Lifetime job-histories were collected via OSCAR, a new validated online-tool that automatically codes jobs into the UK Standard Occupational Classification v.2000. Prevalence ratios for COPD by employment duration in each job compared to lifetime office workers were estimated using robust Poisson regression adjusted for age, sex, centre and smoking. Only associations confirmed among never-smokers and never-asthmatics were considered reliable.From the 116?375 participants with complete job-histories, 94?551 had acceptable/repeatable spirometry data and smoking information and were included in the analysis. Six occupations showed an increased COPD risk also among never-smokers and never-asthmatics; most of these also with positive exposure-response trends. Interesting new findings included sculptors, gardeners, and warehouse workers.COPD patients, especially never-smokers, should be asked about their job-history for better disease management. Focussed preventive strategies in COPD high-risk jobs are warranted. AU - De Matteis S AU - Jarvis D AU - Darnton A AU - Hutchings S AU - Sadhra S AU - Fishwick D AU - Rushton L AU - Cullinan P LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Risk of adult-onset asthma increases with the number of allergic multimorbidities and decreases with age. PG - AB - BACKGROUND: The aim was to study the association between allergic multimorbidity and adult-onset asthma considering the number of allergic diseases and the age effect. METHODS: We used population-based data from Finnish national registers including 1205 adults over 30 years of age with recently diagnosed asthma (age range: 30-93), matched for gender, age, and living region with one or two controls (n=2050). Allergic rhinitis (AR), allergic conjunctivitis (AC) and allergic dermatitis (AD), was defined from self-completed questionnaire. Conditional logistic regression adjusted on potential confounders (smoking, growing in countryside, childhood hospitalized infection/pneumonia, parental asthma/allergy, parental smoking, education level, professional training, number of siblings, and birth order) was applied to estimate the asthma risk associated with allergic multimorbidity. RESULTS: 1118 cases with asthma and 1772 matched controls were included [mean (sd, min-max) 53 (11, 31-71) years, 37% men)]. AR, AC or AD were reported by 50.2%, 39.6%, 33.8%, respectively among subjects with asthma and 26.1%, 20.0%, 23.5%, among controls. Compared to non-atopics, adult-onset asthma increased with the number of allergic diseases; adjusted OR for asthma [CI95%] associated with 1, 2, and 3 allergic diseases were 1.95 [1.52-2.49], 2.87 [2.19-3.77], and 4.26 [3.07-5.90], respectively. The association between adult-onset asthma and =1 allergic multimorbidity decreased with increasing age (3.52 [2.51-4.94], 2.44 [1.74-3.42] and 1.68 [1.04-2.71]) in subjects < 50 years, 50-62 years and >62 years, respectively (p for age*=1 allergic multimorbidity interaction, .002). CONCLUSIONS: Adult-onset asthma was positively associated with the number of allergic diseases and this association decreases with age AU - Toppila-Salmi S AU - Chanoine S AU - Karjalainen J AU - Pekkanen J AU - Bousquet J AU - Siroux V LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Prognostic significance of chronic respiratory symptoms in individuals with normal spirometry. PG - AB - A normal spirometry is often used to preclude airway disease in individuals with unspecific respiratory symptoms. We tested the hypothesis that chronic respiratory symptoms are associated with respiratory hospitalisations and death in individuals with normal spirometry without known airway disease. We included 108,246 randomly chosen individuals aged 20-100 from a Danish population-based cohort study. Normal spirometry was defined as a pre-bronchodilator forced expiratory volume in 1s(FEV1)/forced vital capacity(FVC)=0.70. Chronic respiratory symptoms included dyspnoea, chronic mucus hypersecretion, wheezing, and cough. Individuals with known airway disease, i.e. chronic obstructive pulmonary disease and/or asthma, were excluded (n=10,291). We assessed risk of hospitalisations due to exacerbations of airway disease and pneumonia, and respiratory and all-cause mortality from 2003 through 2018. 52,999 had normal spirometry without chronic respiratory symptoms and 30,890 had normal spirometry with chronic respiratory symptoms. During follow-up, we observed 1037 hospitalisations with exacerbation of airway disease, 5743 hospitalisations with pneumonia, and 8750 deaths, of which 463 were due to respiratory disease. Compared to individuals with normal spirometry without chronic respiratory symptoms, multivariable adjusted hazard ratios for individuals with normal spirometry with chronic respiratory symptoms were 1.62(95% confidence interval:1.20-2.18) for exacerbation hospitalisations, 1.26(1.17-1.37) for pneumonia hospitalisations, 1.59(1.22-2.06) for respiratory mortality, and 1.19(1.13-1.25) for all-cause mortality. There was a positive dose-response relationship between number of symptoms and risk of outcomes. Results were similar after 2 years follow-up, for never-smokers alone, and for each symptom separately. Chronic respiratory symptoms are associated with respiratory hospitalisations and death in individuals with normal spirometry without known airway disease. AU - Çolak Y AU - Nordestgaard BG AU - Vestbo J AU - Lange P AU - Afzal S LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 69 IP - DP - 2019 Jan 01 TI - Hypersensitivity pneumonitis in a cystic fibrosis patient PG - 523-524 AB - Hypersensitivity pneumonitis (HP) is a chronic inflammatory lung disease caused by repeated inhalation of antigenic substances. We present a case of metalworking fluids (MWFs)-HP sensitized to Pseudomonas oleovorans in a cystic fibrosis patient. This case illustrates that HP diagnosis remains challenging, especially in patients with another pulmonary disease, and that serodiagnosis contributes to identifying the precise microorganism involved. It also demonstrates that P. oleovorans is an important secondary aetiological agent in MWF-HP, less known than Mycobacterium immunogenum. AU - Bellanger AP AU - Morisse-Pradier H AU - Reboux G AU - Scherer E AU - Pramil S AU - Dominique S AU - Millon L LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 200 IP - DP - 2019 Jan 01 TI - Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society PG - e70–e88 AB - Background: Spirometry is the most common pulmonary function test. It is widely used in the assessment of lung function to provide objective information used in the diagnosis of lung diseases and monitoring lung health. In 2005, the American Thoracic Society and the European Respiratory Society jointly adopted technical standards for conducting spirometry. Improvements in instrumentation and computational capabilities, together with new research studies and enhanced quality assurance approaches, have led to the need to update the 2005 technical standards for spirometry to take full advantage of current technical capabilities. Methods: This spirometry technical standards document was developed by an international joint task force, appointed by the American Thoracic Society and the European Respiratory Society, with expertise in conducting and analyzing pulmonary function tests, laboratory quality assurance, and developing international standards. A comprehensive review of published evidence was performed. A patient survey was developed to capture patients’ experiences. Results: Revisions to the 2005 technical standards for spirometry were made, including the addition of factors that were not previously considered. Evidence to support the revisions was cited when applicable. The experience and expertise of task force members were used to develop recommended best practices. Conclusions: Standards and consensus recommendations are presented for manufacturers, clinicians, operators, and researchers with the aims of increasing the accuracy, precision, and quality of spirometric measurements and improving the patient experience. A comprehensive guide to aid in the implementation of these standards was developed as an online supplement. AU - Graham BL AU - Steenbruggen I AU - Miller MR AU - Barjaktarevic IZ AU - Cooper BG AU - Hall GL AU - Hallstrand TS AU - Kaminsky DA AU - McCarthy K AU - McCormack MC AU - Oropez CE AU - Rosenfeld M AU - Stanojevic S AU - Swanney MP AU - Thompson BR LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 8 IP - DP - 2019 Jan 01 TI - Effects of Corticosteroid Treatment and Antigen Avoidance in a Large Hypersensitivity Pneumonitis Cohort: A Single-Centre Cohort Study PG - AB - Background: Although the third most frequent interstitial lung disease, hypersensitivity pneumonitis (HP) remains an enigmatic disease without clear diagnostic and therapeutic guidelines. We assessed the effect of the commonly used therapeutic interventions (i.e. exposure avoidance and corticosteroid treatment) in an HP cohort. Methods: We collected clinical data of all HP patients followed at our centre between January 1, 2005, and December 31, 2016. HP patients were stratified according to the presence of fibrosis on chest CT. Survival was analysed using the multivariate Cox proportional hazards model. Forced vital capacity (percent predicted, FVC%) and diffusing capacity of the lung for carbon monoxide (percent predicted, DLCO%) evolution were analysed using linear mixed-effect models. Results: Two hundred and two HP patients were identified: 93 non-fibrotic HP (nfHP) and 109 fibrotic HP (fHP), experiencing a monthly FVC% decline before treatment of 0.93% and 0.56%, respectively. While nfHP had an excellent survival, fHP patients experienced a median survival of 9.2 years. Corticosteroid treatment and exposure avoidance did not result in survival differences. Although nfHP patients showed FVC% and DLCO% increase after corticosteroid initiation, no therapeutic effect was seen in fHP patients. FVC% and DLCO% increased in nfHP patients after exposure avoidance, while a positive numerical trend was seen for FVC% after exposure avoidance in fHP patients (p = 0.15). Conclusions: nfHP patients experienced an excellent survival with good therapeutic effect on pulmonary function tests with both corticosteroid initiation as well as antigen avoidance. In contrast, fHP patients experienced a dismal prognosis (median survival of 9.2 years) without any therapeutic effect of corticosteroid treatment. Whether antigen avoidance is useful in fHP patients is still unclear. AU - Sadeleer LJD AU - Hermans F AU - Dycker ED AU - Yserbyt J AU - Verschakelen JA AU - Verbeken EK AU - Verleden GM AU - Wuyts WA LA - PT - DEP - TA - J Clin Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 165 IP - DP - 2019 Jan 01 TI - Phosgene use in World War 1 and early evaluations of pathophysiology PG - 183-187 AB - World War 1 ended 100 years ago. The aftermath included the consolidation of significant advances in medical care of casualties. Some of these advances were made in the care of chemical casualties, in particular the mechanisms of toxicity and treatment of phosgene exposure. Phosgene, or carbonyl chloride, is an extremely poisonous vapour that was used to devastating effect during World War 1. Observations made of acutely poisoned casualties formed the basis of much research in the early post-World War 1 era. Some extremely elegant experiments, some at the nascent Porton Down research facility, further evaluated the toxin and defences against it. Researchers drew on knowledge that was later forgotten and has since been relearnt later in the 20th century and made many correct assumptions. Their work is the bedrock of our understanding of phosgene toxicity that survives to this day. The horrors of chemical warfare prompted the Geneva Protocol of 1925, prohibiting the use of chemical agents in warfare, and chemical warfare on this scale has not been repeated. The ease with which phosgene can be synthesised requires healthcare providers to be familiar with its effects. AU - Nicholson-Roberts TC LA - PT - DEP - TA - BMJ Military Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - IP - DP - 2019 Jan 01 TI - Health surveillance for those exposed to respirable crystalline silica (RCS). Guidance for occupational health professionals. PG - AB - This supplement should be read and used within the context of the generalguidance on health surveillance for those exposed to RCS found in HSE’s COSHH essentials sheet G404 (www.hse.gov.uk/pubns/guidance/g404.pdf). This supplement provides an example of a health surveillance programme for silicosis for occupational health providers and employers to consider. It provides advice on: ¦ who to include in a health surveillance programme; and ¦ who the ‘competent person’ should be for carrying out each stage of the health surveillance programme. Who should be included in the health surveillance programme? Health surveillance for silicosis should be considered for workers who are involved in high-risk occupations, including construction, foundry work, brick and tile work, ceramics, slate, manufacturing, quarries and stonework. Where workers are regularly exposed to RCS dust and there is a reasonable likelihood that silicosis may develop, health surveillance must be provided. Further examples of where health surveillance for silicosis may be appropriate include: ¦ where there have been previous cases of work-related ill-health in the workplace; ¦ where there is reliance on RPE as an exposure control measure for silica; or ¦ where there is evidence of work-related ill health in the industry. Chronic obstructive pulmonary disease The questionnaire and lung function testing elements of the health surveillance should help in identifying chronic obstructive pulmonary disease (COPD) which is also associated with exposure to RCS. Tuberculosis There is no current evidence to support the regular use of tuberculosis testing for silica-exposed workers. Any worker suspected of having tuberculosis should be referred by their GP to the local NHS TB service. Use of chest X-rays It is the responsibility of the employer to involve a health professional and discuss the need for posterior anterior (PA) chest X-rays as part of a health surveillance programme for silicosis. As chest X-rays carry risks associated with the use of ionising radiation, their use always needs to be justified on health grounds even though the actual dose of radiation required to carry out a single chest X-ray is very low. Periodic chest X-rays at the intervals described in the following section below are justified. Any X-rays need to be accessible for 40 years. These are likely now to be in a digital form. Computerised tomography (CT) scanning can also be used, but this is currently normally reserved for those with an abnormal chest X-ray. There may be increased use of CT in the future for screening when the technology has improved. Some employers have found that it is feasible to contract a provider to carry out X-rays using mobile services brought on to site, although a certain amount of space is required to set up on site. X-rays should be of sufficiently good quality to interpret and should be read by a suitably experienced radiologist. Baseline assessment for new entrants, before or shortly after first exposure to RCS, would include: ¦ respiratory questionnaire (Example 1); ¦ lung function testing (spirometry) to measure forced expiratory volume (FEV1) and forced vital capacity (FVC). FEV1 is measured to within current American Thoracic Society (ATS)/European Respiratory Society (ERS) stipulated accuracy of 150 mls (or 100 mls if below 1 litre). The results should be recorded tomonitor how values change with time (see Example 1B); and ¦ consideration of a baseline chest X-ray for comparison with future chest X-rays. After that, for both new-entrant and pre-existing employees, annual health surveillance would include: ¦ respiratory questionnaire; and ¦ lung function testing. After 15 years of exposure to RCS For employees who have had 15 years of exposure to RCS while working for oneor more employer(s), the health surveillance for that year would include: ¦ respiratory questionnaire; ¦ lung function testing; and ¦ PA chest X-ray. (This includes pre-existing employees with previous RCS exposure of 15 or moreyears at the time of introducing the health surveillance programme.) Thereafter Subsequent health surveillance (as detailed in Example 2) would be repeated annually (or earlier if indicated by the results of health surveillance or if a worker complained of symptoms in the intervening period). The employer may appoint a Health and Safety Executive responsible person (supported by an appropriate health professional) so that workers can report symptoms. Annual health surveillance would include: ¦ respiratory questionnaire; ¦ lung function testing; and ¦ every 3 years, a PA chest X-ray. AU - HSE LA - PT - DEP - TA - HSE Publications JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20190101 IS - IS - VI - 50 IP - DP - 2019 Jan 01 TI - WORK-RELATED SYMPTOMS DUE TO CHEMICAL USE AMONG HAIRDRESSERS IN BANGKOK, THAILAND PG - 191-199 AB - Hairdressers are exposed to various work related chemicals contained in hair products that may affect their health. We conducted a cross-sectional survey of symptoms reported by hairdressers in Bangkok, Thailand and their associated factors in order to guide prevention efforts. We calculated 380 subjects were need for the study. Subjects were selected by stratified random sampling to be recruited for the study. Inclusion criteria were hairdressers with at least oneyear experience in this career and were willing to participate in the study. The exclusion criterion was hairdressers who were current smokers. Each subject was asked to complete a questionnaire that asked about demographics, symptoms and potential associated factors. The questionnaire had a reliability coefficient range of 0.7-0.8. Logistic regression analysis was used to identify factors associated with symptoms. A total of 380 subjects were included in the study; 80.3% were female; the average subject was aged 38 years. Sixty-eight point seven percent of subjects had worked as a hairdresser for 1-10 years. Ninety-six point eight percent had no respiratory symptoms prior to beginning work as a hairdresser. Ninety-seven point nine percent had no chemical protection training. Sixty point three percent had a poor level of preventive behavior when using hair products. Thirty-nine point five percent reported having health symptoms in the previous three months. Forty-nine point five percent of these episodes were respiratory symptoms that included nasal irritation, rhinorrhea, cough and dyspnea. Eighteen point seven percent had skin symptoms, including rash, erythema and edema. Sixteen point nine percent had eye irritation. Factors significantly associated with symptoms included having a previous medical condition, exposure to hair dyes, exposure to hair straightening solutions, frequency of hair dying, duration of hair shampooing, duration of hair dying, using preventive measures with hair products, and using general exhaust ventilation. Hairdressers in Bangkok, Thailand frequently have symptoms caused by chemical exposure in their work. Preventive measures need to be used consistently. Further studies are needed to determine the most effective methods for reducing symptoms and their efficiencies. AU - Jirapongsuwan A AU - Luengumporn P AU - Kalampakorn S AU - Arphorn S LA - PT - DEP - TA - Southeast Asian J Trop Med Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 6 IP - DP - 2018 Jan 01 TI - Occupations and Causative Agents among Work-Related Asthma Patients in Easy Asthma Clinic, Srinagarind PG - 111-116 AB - Background: Work-related asthma (WRA) is the most common chronic occupational lung disease in developing countries and the second most common in developed countries. The median attributable risk of occupational asthma for the population is estimated to be 25%. In Thailand, there are no details on occupational and causative agents vis-à-vis WRA. Aims: Our aim was to describe the occupational and causative agents for WRA patients who attended the Easy Asthma Clinic (EAC), Srinagarind Hospital, Khon Kaen, Thailand. Methods: This was a descriptive study: 323 participants at the Easy Asthma Clinics were identified and interviewed prior to obtaining information related to WRA symptoms and its suspected causative agents. Descriptive statistics were used for proportions. Results: The proportion of asthma patients with WRA was 16.7%. The top three occupations that carried the highest risk were (a) school workers, (b) skilled agriculture, forestry, and fishery workers, and (c) manufacturing and wood workers. The top three most identified causative agents were chalk powder, smoke from burning grass/tree, and fumes from stainless steel production. Some 63.0% of WRA patients did not wear respiratory protection equipment at work and among those who did, none wore it correctly. Conclusions: Occupational history, causative agents, and history of asthma symptoms related to work help to determine the proportion of WRA patients. The results of the current study should thus encourage physicians to record patient occupation(s) and job descriptions, so as to remove identifiable factors, before airway remodelling occurs, which makes treatment more difficult and costly. AU - Jongkumchok W AU - Chaiear N AU - Boonsawat W AU - Chaisuksant S LA - PT - DEP - TA - American Journal of Public Health Research JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - IP - DP - 2018 Jan 01 TI - Occupational asthma. List of agents causing occupational asthma with references. PG - AB - website http://www.csst.qc.ca/en/prevention/reptox/occupational-asthma/Documents/AgentsAn glais.pdf. AU - Commission des normes AU - de l'équité AU - de la santé et de la sécurité du travail LA - PT - DEP - TA - website JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 15 IP - DP - 2018 Jan 01 TI - Asthma among World Trade Center First Responders: A Qualitative Synthesis and Bias Assessment PG - 1053 AB - The World Trade Center (WTC) disaster exposed the responders to several hazards. Three cohorts i.e., the Fire Department of New York (FDNY), the General Responder Cohort GRC), and the WTC Health Registry (WTCHR) surveyed the exposed responder population. We searched Pubmed andWeb of Science for literature on a well-published association between the WTC exposures and asthma, focusing on new-onset self-reported physician-diagnosed asthma. The resulting five articles were qualitatively assessed for potential biases. These papers were independently reviewed by the co-authors, and conclusions were derived after discussions. While, the cohorts had well-defined eligibility criteria, they lacked information about the entire exposed population. We conclude that selection and surveillance biases may have occurred in the GRC and WTCHR cohorts, but were likely to have been minimal in the FDNY cohort. Health care benefits available to responders may have increased the reporting of both exposure and outcome in the former, and decreased outcome reporting in the FDNY cohort. Irrespective of the biases, the studies showed similar findings, confirming the association between WTC exposure and self-reported physician-diagnosed asthma among responders. This suggests that health data gathered under great duress and for purposes other than epidemiology can yield sound conclusions. Potential biases can, however, be minimized by having validated survey instruments and worker registries in place before events occur. AU - Kim H AU - Baidwan NK AU - Kriebel D AU - Cifuentes M AU - Baron S LA - PT - DEP - TA - International Journal of Environmental Research and Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 25 IP - DP - 2018 Jan 01 TI - Changes in occupational asthma during four decades in Slovakia, Central Europe PG - 437-442 AB - Introduction: Occupational asthma (OA) is the most common occupational lung disease in industrialized countries; however, in Western Europe, a decline in the prevalence of OA and changes in etiological factors has been recorded. Data from Central Europe, where in the past healthcare and economy sectors were different, are rare. Objective: The aim of this study was to discover the changes related to OA during a four decade long period in the Slovak Republic. Material and methods: The study included patients whom OA was reported during 1980–2016. All cases of OA were divided into four decades. The prevalence of OA, changes in etiological factors and key diagnostic methods were evaluated. All decades were analysed separately and compared to one another. Results: During 1980–2016, OA was reported in 155 patients. OA was most often found in the second decade (6.4 cases per year), the lowest number of cases was diagnosed in the third decade (2.1 cases per year). Since 1988, an increasing prevalence of OA was observed with the peak in 1992, followed by the significantly progressive decrease during subsequent years. In the fourth decade, a mild increase in OA causes was recorded again. In the first and second decades, agricultural allergens were the dominant agents, which were replaced by chemical factors in the last decade. The most frequently used key diagnostic methods in 1980–2009 were skin tests, during the fourth decade the importance of this method declined. However, specific BPT a serial BPT were more frequently used in the fourth decade Conclusion: The number of OA cases induced by agricultural allergens declined, which was connected with a decrease of total OA cases. The current problem is the OA induced by the chemicals, which increased significantly in the last decade, even the possibility of underdiagnosed OA cases still exists. AU - Perecinský S AU - Murínová L AU - Kalanin P AU - Jancová A AU - Legáth L LA - PT - DEP - TA - Ann Agric Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 54 IP - DP - 2018 Jan 01 TI - The Role of Occupational and Environmental Exposures in the Pathogenesis of Idiopathic Pulmonary Fibrosis: A Narrative Literature Review PG - 108 AB - diopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease characterised by a progressive and irreversible decline in lung function, which is associated with poor long-term survival. The pathogenesis of IPF is incompletely understood. An accumulating body of evidence, obtained over the past three decades, suggests that occupational and environmental exposures may play a role in the development of IPF. This narrative literature review aims to summarise current understanding and the areas of ongoing research into the role of occupational and environmental exposures in the pathogenesis of IPF. AU - Trethewey SP AU - Walters GI LA - PT - DEP - TA - Medicina JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 6 IP - DP - 2018 Jan 01 TI - Occupational allergic respiratory disease (rinoconjunctivitis and asthma) in a cheese factory worker PG - 1416-1418 AB - This is the first report of occupational IgE-mediated allergic respiratory disease caused by chymosin, an enzyme present in rennet used for the coagulation of milk in the production of cheese. The disease was severe and could be controlled only with omalizumab (decrease in symptoms, improvement in respiratory auscultation and spirometry), in addition to reducing exposure to the agent (use of mask) and pharmacological treatment (salmeterol/fluticasone, 500 µg/12 h and montelukast 10 mg/d). AU - Torrijos G AU - Rodriguez G AU - Perez V AU - Bartolome AU - Barragan P LA - PT - DEP - TA - Journal of Allergy and Clinical Immunology: In Pra JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 120 IP - DP - 2018 Jan 01 TI - Efficacy of omalizumab treatment in a man with occupational asthma and eosinophilic granulomatosis with polyangioitis. PG - 209-211 AB - Annals of Allergy, Asthma and Immunology. 120 (2) (pp 209-211), 2018. AU - Caruso C. AU - Gencarelli G. AU - Gaeta F. AU - Valluzzi R.L. AU - Rumi G. AU - Romano A. LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 15 IP - DP - 2018 Jan 01 TI - Reduced Lung Function among Workers in Primary Coffee Processing Factories in Ethiopia: A Cross Sectional Study. PG - 2415 AB - ABSTRACT Dust exposure is one of the major risk factors for respiratory health in many workplaces, including coffee factories. The aim of this study was to assess the prevalence of respiratory symptoms and lung function reduction among workers in Ethiopian primary coffee processing factories, compared to a control group of workers. A total of 115 coffee workers and 110 water bottling workers were involved in this study, from 12 coffee and 3 water bottling factories in Ethiopia, respectively. The chronic respiratory symptoms were assessed using a structured interview, using a standardized questionnaire adopted from the American Thoracic Society (ATS). The lung function tests were performed according to the ATS recommendation for spirometry. The coffee workers had a significantly higher prevalence of coughing, coughing with sputum, breathlessness, work-related shortness of breath, and wheezing compared with the controls. The prevalence ratio of work-related shortness of breath (PR = 3.7, 95% CI: 1.6-8.7) and wheezing (PR = 3.3, 95% CI: 1.3-8.4) was significantly higher for the coffee workers compared to the controls. The coffee workers in the age groups 28-39 years and >40 years, had a significantly lower forced vital capacity and forced expiratory volume in 1 s compared to the controls in the similar age groups. The findings indicated the need for longitudinal studies on the possible effect of coffee dust on respiratory health of coffee production workers. AU - Abaya SW AU - Bråtveit M AU - Deressa W AU - Kumie A AU - Moen BE LA - PT - DEP - TA - Int J Environ Res Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 8 IP - DP - 2018 Jan 01 TI - Identification of Pen m 4 as a potential cause of occupational asthma to Gammarus shrimp PG - 46 AB - We present the case of a 34-year-old male patient employed for 8 years in a company manufacturing and packaging animal feed. The patient developed occupational asthma to dry Gammarus powder. The diagnosis was confirmed by specific bronchial provocation test. The determination of specific IgE antibodies was positive for Pen m 4, a sarcoplasmic calcium binding protein, with a level of 6.7 ISU-E. The sensitization to Pen m 4 described here may identify a new allergen causing occupational asthma in these workers. AU - Sogo A AU - Cruz MJ AU - Amengual MJ AU - Muñoz X LA - PT - DEP - TA - Clinical and Translational Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 75 IP - DP - 2018 Jan 01 TI - Burden of respiratory abnormalities in microwave popcorn and flavouring manufacturing workers. PG - 709-715 AB - OBJECTIVES: Diacetyl, a butter flavour compound used in food and flavouring production, is a respiratory toxin. We characterised the burden of respiratory abnormalities in workers at popcorn and flavouring manufacturing facilities that used diacetyl as evaluated through US National Institute for Occupational Safety and Health (NIOSH) health hazard evaluations. METHODS: We performed analyses describing the number and percentage of current and former workers from popcorn and flavouring manufacturing facilities where NIOSH administered a respiratory health questionnaire and spirometry testing who met case definitions of suspected flavouring-related lung disease. Case definitions were pathologist reported: lung biopsy pathology report stating supportive of/consistent with constrictive bronchiolitis or bronchiolitis obliterans; probable: obstructive/mixed spirometric pattern with forced expiratory volume in 1?s (FEV1) < 60% predicted; possible: obstructive/mixed spirometric pattern with FEV1 =60%?or any spirometric restriction; symptoms only: normal spirometry plus exertional dyspnoea or usual cough. RESULTS: During 2000-2012, NIOSH collected questionnaire and spirometry data on 1407 workers (87.0% current, 13.0% former) at nine facilities in eight states. After applying case definitions, 4 (0.3%) were classified as pathologist reported, 48 (3.4%) as probable, 234 (16.6%) as possible and 404 (28.7%) as symptoms only. The remaining 717 (51.0%) workers had normal spirometry without exertional dyspnoea or usual cough. Seven of 11 workers with biopsies did not meet the pathologist-reported case definition, although four met probable and three met possible. CONCLUSIONS: This approach demonstrates the substantial burden of respiratory abnormalities in these workers. A similar approach could quantify the burden of respiratory abnormalities in other industries that use diacetyl. AU - Fechter-Leggett ED AU - White SK AU - Fedan KB AU - Cox-Ganser JM AU - Cummings KJ. LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 68 IP - DP - 2018 Jan 01 TI - Work-related asthma from cleaning agents versus other agents. PG - 587-592 AB - Background: Cleaning agents have been commonly implicated as causative or triggering factors in work-related asthma (WRA), mainly from epidemiologic studies. Relatively few clinical series have been reported. Aims: We aimed to compare socio-demographic and clinical features among tertiary clinic patients with WRA exposed to cleaning and non-cleaning products. Methods: Analyses were conducted on a patient database containing 208 patients with probable WRA referred to the asthma and airway centre at a tertiary centre hospital in Canada from 2000 to 2014. Chi-squared and independent samples t-tests were used to analyse categorical and continuous data, respectively. Results: Twenty-two (11%) WRA cases were attributed to a variety of cleaning product exposures, 12 were diagnosed as occupational asthma (OA) and 10 as work-exacerbated asthma (WEA) (10% of all OA and 11% of all WEA). There were multiple exposures and the responsible agent(s) could seldom be clearly identified. Most frequent categories of exposure were surfactants, alcohols, disinfectants and acids. Compared to WRA with other exposures, those with cleaning agent exposures had a significantly larger proportion of females (82 versus 35%, P < 0.001), included a higher percentage of workers in healthcare (41 versus 4%, P < 0.001), and submitted more workers' compensation claims (86 versus 64%, P = 0.05). Other characteristics were comparable. Conclusions: In a tertiary referral clinic, patients with WRA from cleaning agent exposure had clinical characteristics that were similar to those with WRA from other causes. Most frequent exposures were surfactants, alcohols, disinfectants and acids. AU - Li RWH AU - Lipszyc JC AU - Prasad S AU - Tarlo SM. LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 52 IP - DP - 2018 Jan 01 TI - Development and validation of a radiological diagnosis model for hypersensitivity pneumonitis PG - 1800443 AB - High-resolution computed tomography (HRCT) may be useful for diagnosing hypersensitivity pneumonitis. Here, we develop and validate a radiological diagnosis model and model-based points score. Patients with interstitial lung disease seen at the University of Michigan Health System (derivation cohort) or enrolling in the Lung Tissue Research Consortium (validation cohort) were included. A thin-section, inspiratory HRCT scan was required. Thoracic radiologists documented radiological features. The derivation cohort comprised 356 subjects (33.9% hypersensitivity pneumonitis) and the validation cohort comprised 424 subjects (15.5% hypersensitivity pneumonitis). An age-, sex- and smoking status-adjusted logistic regression model identified extent of mosaic attenuation or air trapping greater than that of reticulation (“MA-AT>Reticulation”; OR 6.20, 95% CI 3.53–10.90; p<0.0001) and diffuse axial disease distribution (OR 2.33, 95% CI 1.31–4.16; p=0.004) as hypersensitivity pneumonitis predictors (area under the receiver operating characteristic curve 0.814). A model-based score >2 (1 point for axial distribution, 2 points for “MA-AT>Reticulation”) has specificity 90% and positive predictive value (PPV) 74% in the derivation cohort and specificity 96% and PPV 44% in the validation cohort. Similar model performance is seen with population restriction to those reporting no exposure (score >2: specificity 91%). When radiological mosaic attenuation or air trapping are more extensive than reticulation and disease has diffuse axial distribution, hypersensitivity pneumonitis specificity is high and false diagnosis risk low (<10%), but PPV is diminished in a low-prevalence setting. AU - Salisbury ML AU - Gross BH AU - Chughtai A AU - Sayyouh M AU - Kazerooni EA AU - Bartholmai BJ AU - Xia M AU - Murray S AU - Myers JL AU - Lagstein A AU - Konopka KE AU - Belloli EA AU - Sheth JS AU - White ES AU - Holtze C AU - Martinez FJ AU - Flaherty KR LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 68 IP - DP - 2018 Jan 01 TI - Cleaning agent occupational asthma in the West Midlands, UK: 2000-16. PG - 530-536 AB - Background: Cleaning agents are now a common cause of occupational asthma (OA) worldwide. Irritant airway and sensitization mechanisms are implicated for a variety of old and new agents. Aims: To describe the exposures responsible for cleaning agent OA diagnosed within a UK specialist occupational lung disease service between 2000 and 2016. Methods: The Birmingham NHS Occupational Lung Disease Service clinical database was searched for cases of OA caused by cleaning agents, and data were gathered on age, gender, atopic status, smoking history, symptom onset, diagnostic investigations (including Occupational Asthma SYStem analysis of workplace serial peak expiratory flow measurements and specific inhalational challenge), proposed mechanism, industry, occupation and causative agent. Results: Eighty patients with cleaning agent OA (77% female, 76% arising de novo) were identified. The median annual number of cases was 4 (interquartile range = 2-7). The commonest cleaning agents causing OA were chloramines (31%), glutaraldehyde (26%) and quaternary ammonium compounds (11%) and frequently implicated industries were healthcare (55%), education (18%) and leisure (8%). Conclusions: Certain cleaning agents in common usage, such as chlorine-releasing agents, quaternary ammonium compounds and aldehydes, are associated with sensitization and asthma. Their use alters over time, and this is particularly evident in UK healthcare where cleaning and decontamination practice and policy have changed. Vigilance for OA in workplaces such as hospitals, nursing homes, leisure centres and swimming pools, where these cleaning agents are regularly used, is therefore essential. AU - Walters GI AU - Burge PS AU - Moore VC AU - Robertson AS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 73 IP - DP - 2018 Jan 01 TI - Cannabis allergy: A diagnostic challenge PG - 19114-1914 AB - First published: 30 May 2018 https://doi.org/10.1111/all.13491 AU - Decuyper II AU - Faber MA AU - Lapeere H AU - Mertens C AU - Rihs HP AU - Van Gasse AL AU - Hagendorens MM AU - SabatoV AU - Bridts CH AU - De Clerck L AU - Ebo DG LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 68 IP - DP - 2018 Jan 01 TI - Do exposures to aerosols pose a risk to dental professionals? PG - 454-458 AB - J Kobza J S Pastuszka E Bragoszewska Occupational Medicine, Volume 68, Issue 7, 13 September 2018, Pages 454–458, https://doi.org/10.1093/occmed/kqy095 Published: 20 June 2018 Split View PDF Cite Permissions Share search filter search input Abstract Background Dental care professionals are exposed to aerosols from the oral cavity of patients containing several pathogenic microorganisms. Bioaerosols generated during dental treatment are a potential hazard to dental staff, and there have been growing concerns about their role in transmission of various airborne infections and about reducing the risk of contamination. Aims To investigate qualitatively and quantitatively the bacterial and fungal aerosols before and during clinical sessions in two dental offices compared with controls. Methods An extra-oral evacuator system was used to measure bacterial and fungal aerosols. Macroscopic and microscopic analysis of bacterial species and fungal strains was performed and strains of bacteria and fungi were identified based on their metabolic properties using biochemical tests. Results Thirty-three bioaerosol samples were obtained. Quantitative and qualitative evaluation showed that during treatment, there is a significant increase in airborne concentration of bacteria and fungi. The microflora included mainly gram-positive organisms (Staphylococcus epidermidis and Micrococcus spp.), gram-positive rod-shaped bacteria and those creating endospores as well as non-porous bacteria and mould fungi (Cladosporium and Penicillium). Conclusions Exposure to the microorganisms identified is not a significant occupational hazard for dental care professionals; however, evidence-based prevention measures are recommended. AU - Kobza J AU - Pastuszka JS AU - Bragoszewska E LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 4 IP - DP - 2018 Jan 01 TI - Hypersensitivity pneumonitis in fish processing workers diagnosed by inhalation challenge. PG - 4 AB - Workers in the fish processing industry have increased risk of developing respiratory diseases due to occupational exposure to bioaerosols and related allergens [1–4]. The literature reports more occupational asthma in workers handling salmon [2, 5], and an exposure–response relationship between total protein exposure and cross-shift changes in forced expiratory volume in 1 s (FEV1) and lower respiratory tract symptoms [6]. To our knowledge, there are no published reports on hypersensitivity pneumonitis from this industry. Hypersensitivity pneumonitis is a complex disease for which there are no generally accepted diagnostic criteria, particularly at earlier stages of the disease. We present the case of a fish processing worker diagnosed with hypersensitivity pneumonitis caused by proteins from salmon, in which the aetiology was established using specific inhalation challenge (SIC) as a diagnostic tool. Processing of salmon includes two main processes: 1) in the slaughtering department, the fish are slaughtered, sorted, automatically or manually gutted, and washed before further processing; and 2) in the filleting department, the salmon is filleted and skinned by machines before manual trimming of the fillets [2]. The main source of exposure to fish proteins is by inhalation of wet bioaerosols containing a heterogeneous mixture of proteins, enzymes, endotoxins and moulds [1, 2, 6, 7]. A never-smoking man in his 40s with no history of allergies or respiratory symptoms/disease started experiencing cough, wheezing, dyspnoea, and general symptoms including fatigue, nausea and fever (38–40°C) at work, after being employed at a salmon processing plant for ~3 years. The symptoms typically started 3–4 h after starting a work shift, and continued throughout the afternoon, evening and night. He felt better the next morning, and during weekends and holidays. He also experienced suspected pneumonias up to four times a year and eventually, increasing dyspnoea during physical activity. When he was referred to our clinic, he had been employed as a process worker for 6 years, mainly in the slaughtering department as a gutter. He had no known exposure to other causative factors of hypersensitivity pneumonitis during his spare time [8]. At the time of referral, two other patients from the same plant had been diagnosed with occupational asthma caused by exposure to salmon proteins. The airborne concentration of total protein in the slaughtering department (inlet, automatically or manually gutting) ranged between not detected and 20.4 µg·m-3 (six full-shift stationary measurements), compatible with the higher range of previously reported exposure levels (personal samples) in this industry [6]. Hypersensitivity pneumonitis is an inflammatory disease involving the small airways and interstitium that can be caused by sensitisation to a wide array of antigens, mostly proteins. The clinical presentation of hypersensitivity pneumonitis is variable and there is no consensus regarding disease definition [8]. Proposed diagnostic criteria include: 1) exposure to an offending agent; 2) clinical, radiographic and physiological findings compatible with hypersensitivity pneumonitis; 3) bronchoalveolar lavage reveals lymphocytosis; 4) positive SIC; and 5) compatible histopathology [9]. SIC is a well-established method for the diagnosis of occupational asthma [10] and a modified protocol is used to diagnose hypersensitivity pneumonitis. This protocol is less standardised [11] and a variety of diagnostic criteria for test positivity has been proposed [12]. We used criteria proposed by Morell et al. [13], defining a test positive for hypersensitivity pneumonitis as follows: 1) forced vital capacity (FVC) decrease >15% or diffusing capacity of the lung for carbon monoxide (DLCO) decrease >20% compared with baseline values; or 2) FVC decrease 10–15% and at least one of a) white blood cell increase =20%, b) peripheral oxygen saturation (SpO2) decrease =3%, c) significant radiological changes, d) rise in body temperature >0.5°C and e) clinical symptoms (e.g. cough or dyspnoea); or 3) FVC decrease <10% and at least three of criteria 2a–e. To reproduce the patient's working conditions and to ensure a sufficient level of bioaerosol in the challenge chamber, the patient filleted salmon in the chamber for 15 min and subsequently sprayed a dispersion of salmon meat on a surface ~30 cm from his face for 5 min. Following the challenge, spirometry, DLCO, symptoms, physical examination, temperature and SpO2 were recorded after 30 min, and then hourly for the next 6 h. A white blood cell count was performed before and after the challenge. At baseline, a physical examination including auscultation did not show abnormalities. Pulmonary function tests were within the normal range; however, there was a tendency for low DLCO (74% of predicted) [14] and spirometry indicating a restrictive pattern (FEV1 3.29 L, 81% of predicted; FVC 3.91 L, 80% of predicted; FEV1/FVC 84%) [15]. The patient had no symptoms, total IgE 7 kU·L-1, and negative specific IgE towards parvalbumin and common airways allergens. High-resolution computed tomography (HRCT) of the lungs showed localised slight ground-glass opacities and mild traction bronchiectasis in the lower lobes, compatible with hypersensitivity pneumonitis. After inhalation challenge with salmon, the patient developed influenza-like symptoms and dyspnoea. Compared to baseline values, he experienced a fall in DLCO and FVC of 15% and 13%, respectively, 5 h post-challenge (figure 1). SpO2 decreased by 4% and fine crackles were heard by auscultation. There were no significant changes in white blood cell count or temperature. AU - Tjalvin G AU - Svanes Ø AU - Bertelsen RJ AU - Hollund BE AU - Aasen TB AU - Svanes C AU - Kirkeleit J. LA - PT - DEP - TA - ERJ Open Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 197 IP - DP - 2018 Jan 01 TI - Identification of Diagnostic Criteria for Chronic Hypersensitivity Pneumonitis. An International Modified Delphi Survey PG - 1036-1044 AB - Rationale: Current diagnosis of chronic hypersensitivity pneumonitis (cHP) involves considering a combination of clinical, radiological, and pathological information in multidisciplinary team discussions. However, this approach is highly variable with poor agreement between centers. Objectives: We aimed to identify diagnostic criteria for cHP that reach consensus among international experts. Methods: A three-round modified Delphi survey was conducted between April and August 2017. A total of 45 experts in interstitial lung disease from 14 countries participated in the online survey. Diagnostic items included in round 1 were generated using expert interviews and literature review. During rounds 1 and 2, experts rated the importance of each diagnostic item on a 5-point Likert scale. The a priori threshold of consensus was 75% or greater of experts rating a diagnostic item as very important or important. In the third round, experts graded the items that met consensus as important and provided their level of diagnostic confidence for a series of clinical scenarios. Measurements and Main Results: Consensus was achieved on 18 of the 40 diagnostic items. Among these, experts gave the highest level of importance to the identification of a causative antigen, time relation between exposure and disease, mosaic attenuation on chest imaging, and poorly formed nonnecrotizing granulomas on pathology. In clinical scenarios, the diagnostic confidence of experts in cHP was heightened by the presence of these diagnostic items. Conclusions: This consensus-based approach for the diagnosis of cHP represents a first step toward the development of international guidelines for the diagnosis of cHP. AU - Morisset J AU - Johannson KA AU - Jones KD AU - Wolters PJ AU - Collard HR AU - Walsh SLF AU - Ley B LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 8 IP - DP - 2018 Jan 01 TI - Assessing the chronic respiratory health risk associated with inhalation exposure to powdered toner for printing in actual working conditions: a cohort study on occupationally exposed workers over 10 years PG - e022049 AB - Background Little epidemiological evidence exists regarding the chronic respiratory effects of inhaled powdered toner exposure in humans, although several case reports have suggested the existence of lung disorders that might be related to exposure to toner dust. Objective W e aimed to estimate the chronic health risk to humans associated with routine toner dust exposure in copier industry workers under current actual work conditions. Design A prospective observational cohort study of occupational population. Methods Changes in chest radiogram, spirometry measurements and serum and urine biomarkers of biomedical responses to extrinsic stress, as well as subjective symptoms were longitudinally observed for up to 10 years in Japanese copier industry workers responsible for the manufacturing, maintenance or recycling of powdered toner or toner-using machines. A total of 694 subjects who did not change their work category during the follow-up and were free from chronic respiratory diseases at the baseline survey provided reliable results on at least three survey occasions during 3 years or more of follow-up. Results Typical fibrosis findings associated with pneumoconiosis was not observed on chest radiograms. No significant differences associated with toner exposure were noted in the frequency of new incidence of either non-specific findings on chest radiogram or serum fibrosis biomarkers (sialylated carbohydrate antigen KL-6 and surfactant protein D). However, the exposed subjects tended to show increases in the frequency of respiratory symptoms and reduced spirometry results during the follow-up compared with the control group, although significant differences were only seen in chronic cough. Conclusions Under the current reasonably controlled work environmental conditions, lung fibrotic changes caused by inhaled dust exposure, including powdered toner, appear to be relatively uncommon; however, non-specific temporal irritation causing subjective symptoms and inflammatory responses might exist. AU - Nakadate T AU - Yamano Y AU - Yamauchi T AU - Okubo S AU - Nagashima D LA - PT - DEP - TA - BMJ Open JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 75 IP - DP - 2018 Jan 01 TI - Exposure, respiratory symptoms, lung function and inflammation response of road-paving asphalt workers PG - 494-500 AB - Background Controversy exists as to the health effects of exposure to asphalt and crumb rubber modified (CRM) asphalt, which contains recycled rubber tyres. Objective To assess exposures and effects on airway symptoms, lung function and inflammation biomarkers in conventional and CRM asphalt road pavers. Methods 116 conventional asphalt workers, 51 CRM asphalt workers and 100 controls were investigated. A repeated-measures analysis included 31 workers paving with both types of asphalt. Exposure to dust, nitrosamines, benzothiazole and polycyclic aromatic hydrocarbon (PAH) was measured in worksites. Self-reported symptoms, spirometry test and blood sampling were conducted prework and postwork. Symptoms were further collected during off-season for asphalt paving. Results Dust, PAHs and nitrosamine exposure was highly varied, without difference between conventional and CRM asphalt workers. Benzothiazole was higher in CRM asphalt workers (p<0.001). Higher proportions of asphalt workers than controls reported eye symptoms with onset in the current job. Decreased lung function from preworking to postworking was found in CRM asphalt workers and controls. Preworking interleukin-8 was higher in CRM asphalt workers than in the controls, followed by a decrement after 4?days of working. No differences in any studied effects were found between conventional and CRM asphalt paving. Conclusion CRM asphalt workers are exposed to higher benzothiazole. Further studies are needed to identify the source of nitrosamines in conventional asphalt. Mild decrease in lung function in CRM asphalt workers and work-related eye symptoms in both asphalt workers were observed. However, our study did not find strong evidence for severe respiratory symptoms and inflammation response among asphalt workers. AU - Xu Y AU - Kåredal M AU - Nielsen J AU - Adlercreutz M AU - Bergendorf U AU - Strandberg B AU - Antonsson A AU - Tinnerberg H AU - Albin M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 75 IP - DP - 2018 Jan 01 TI - Update of an occupational asthma-specific job exposure matrix to assess exposure to 30 specific agents PG - 507-514 AB - Objectives We aimed to update an asthmagen job exposure matrix (JEM) developed in the late 1990s. Main reasons were: the number of suspected and recognised asthmagens has since tripled; understanding of the aetiological role of irritants in asthma and methodological insights in application of JEMs have emerged in the period. Methods For each agent of the new occupational asthma-specific JEM (OAsJEM), a working group of three experts out of eight evaluated exposure for each International Standard Classification of Occupations, 1988 (ISCO-88) job code into three categories: ‘high’ (high probability of exposure and moderate-to-high intensity), ‘medium’ (low-to-moderate probability or low intensity) and ‘unexposed’. Within a working group, experts evaluated exposures independently from each other. If expert assessments were inconsistent the final decision was taken by consensus. Specificity was favoured over sensitivity, that is, jobs were classified with high exposure only if the probability of exposure was high and the intensity moderate-to-high. In the final review, all experts checked assigned exposures and proposed/improved recommendations for expert re-evaluation after default application of the JEM. Results The OAsJEM covers exposures to 30 sensitisers/irritants, including 12 newly recognised, classified into seven broad groups. Initial agreement between the three experts was mostly fair to moderate (k values 0.2–0.5). Out of 506 ISCO-88 codes, the majority was classified as unexposed (from 82.6% (organic solvents) to 99.8% (persulfates)) and a minority as ‘high-exposed’ (0.2% (persulfates) to 2.6% (organic solvents)). Conclusions The OAsJEM developed to improve occupational exposure assessment may improve evaluations of associations with asthma in epidemiological studies and contribute to assessment of the burden of work-related asthma. AU - Moual NL AU - Zock J AU - Dumas O AU - Lytras T AU - Andersson E AU - Lillienberg L AU - Schlünssen V AU - Benke G AU - Kromhout H LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 74 IP - DP - 2018 Jan 01 TI - Are high- and low-molecular-weight sensitizing agents associated with different clinical phenotypes of occupational asthma? PG - 261-272 AB - BACKGROUND: High-molecular-weight (HMW) proteins and low-molecular-weight (LMW) chemicals can cause occupational asthma (OA) although few studies have thoroughly compared the clinical, physiological, and inflammatory patterns associated with these different types of agents. The aim of this study was to determine whether OA induced by HMW and LMW agents show distinct phenotypic profiles. METHODS: Clinical and functional characteristics, and markers of airway inflammation were analyzed in an international, multicenter, retrospective cohort of subjects with OA ascertained by a positive inhalation challenge response to HMW (n=544) and LMW (n=635) agents. RESULTS: Multivariate logistic regression analysis showed significant associations between OA caused by HMW agents and work-related rhinitis (OR [95% CI]: 4.79 [3.28-7.12]), conjunctivitis (2.13 [1.52-2.98]), atopy (1.49 [1.09-2.05]), and early asthmatic reactions (2.86 [1.98-4.16]). By contrast, OA due to LMW agents was associated with chest tightness at work (2.22 [1.59-3.03]), daily sputum (1.69 [1.19-2.38]), and late asthmatic reactions (1.52 [1.09-2.08]). Furthermore, OA caused by HMW agents showed a higher risk of airflow limitation (1.76 [1.07-2.91]) whereas OA due to LMW agents exhibited a higher risk of severe exacerbations (1.32 [1.01-1.69]). There were no differences between the two types of agents in the baseline sputum inflammatory profiles, but OA caused by HMW agents showed higher baseline blood eosinophilia and a greater post-challenge increase in fractional nitric oxide. CONCLUSION: This large cohort study describes distinct phenotypic profiles in OA caused by HMW and LMW agents, There is a need to further explore differences in underlying pathophysiological pathways and outcome after environmental interventions. AU - Vandenplas O AU - Godet J AU - Hurdubaea L AU - Rifflart C AU - Suojalehto H AU - Wiszniewska M AU - Munoz X AU - Sastre J AU - Klusackova P AU - Moore V AU - Merget R AU - Talini D AU - Svanes C AU - Mason P AU - dell'Omo M AU - Cullinan P AU - Moscato G AU - Quirce S AU - Hoyle J AU - Sherson D AU - Kauppi P AU - Preisser A AU - Meyer N AU - de Blay F AU - European network for the PHenotyping of OCcupational ASthma (E-PHOCAS) investigators. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - IP - DP - 2018 Jan 01 TI - Genetic Variants with Gene Regulatory Effects are Associated with Diisocyanate Asthma PG - AB - BACKGROUND: Isocyanates are major causes of occupational asthma but susceptibility and mechanisms of Diisocyanate Asthma (DA) remain uncertain. OBJECTIVE: The aim of this study is to identify DA-associated functional genetic variants via next generation sequencing (NGS), bioinformatics, and functional assays. METHODS: NGS was performed in 91 workers with DA. Fourteen loci with known DA associated single nucleotide polymorphisms (SNPs) were sequenced and compared to data from 238 unexposed subjects. Ranking of DA associated SNPs based on their likelihood to affect gene regulatory mechanisms in the lung yielded 21 prioritized SNPs. Risk (R) and non-risk (NR) oligonucleotides were tested for binding of nuclear extracts from A549, BEAS 2B, and IMR-90 lung cell lines by electrophoretic mobility shift assays (EMSA). DNA constructs were cloned into a pGL3-promoter vector for luciferase gene reporter assays. RESULTS: NGS detected 130 risk variants associated with DA (3.1 x10-6 - 6.21x10-4), of which 129 were located in non-coding regions. The 21 SNPs prioritized by functional genomic data sets were in or proximal to five genes: CDH17 (n=10), ATF3 (n=7), FAM71A (n=2), TACR1 (n=1), and ZBTB16 (n=1). EMSA detected allele-dependent nuclear protein binding in A549 cells for 8 of 21 variants. In the luciferase assay, 4 of the 21 SNPs exhibited allele-dependent changes in gene expression. DNA affinity precipitation and mass spectroscopy of rs147978008 revealed allele-dependent binding of H1 histones, which was confirmed by Western blot. CONCLUSIONS: We identified five DA associated potential regulatory SNPs. Four variants exhibited effects on gene regulation (ATF rs11571537, CDH17 rs2446824, rs2513789, and TACR1 rs2287231). A fifth variant (FAM71A rs147978008) showed non-risk allele preferential binding to H1 histones. These results demonstrate that many DA-associated genetic variants likely act by modulating gene regulation. AU - Bernstein DI AU - Lummus ZL AU - Kesavalu B AU - Yao J AU - Kottyan L AU - Miller D AU - Cartier A AU - Cruz MJ AU - Lemiere C AU - Muñoz X AU - Quirce S AU - Tarlo S AU - Sastre J AU - Boulet LP AU - Weirauch MT AU - Kaufman K LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 68 IP - DP - 2018 Jan 01 TI - Missed opportunities to identify occupational asthma in acute secondary care PG - 56-59 AB - Background Occupational asthma (OA) accounts for one in six cases of new-onset adult asthma. Despite this it remains under-recognized in the UK. Delayed and missed diagnoses of OA lead to poor health outcomes for workers at significant cost to the UK economy. The burden of occupational aetiology on hospital admissions with asthma is not known. Aims To measure how frequently medical professionals consider occupational aetiology in patients presenting to secondary care with acute asthma symptoms. Methods We reviewed electronic records of working-age patients with asthma symptoms, presenting to three sites at a large West Midlands acute hospital NHS trust. We searched emergency department (ED) and acute medical unit (AMU) admission documents, looking specifically at documentation of employment status, job role and work effect on symptoms. We also examined the effect of using a prompt for enquiry about occupation contained within the clerking pro-forma. Results We searched 100 ED and 100 AMU admission documents. Employment status was established in only 20–31% of patients and none were asked about the effect of their work on current asthma symptoms. The use of a clerking pro-forma, including a prompt for occupation, increased documentation to 63% from 10 to 14% where an enhanced pro-forma was not used. Conclusions Enquiry into employment status and work effect in working-age patients with asthma symptoms presenting to the ED and the AMU is poor. These may be missed opportunities to identify OA. We propose medical education about high-risk exposures and the use of pro-formas including prompts about occupational exposures. AU - Ellis PR AU - Walters GI LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 13 IP - DP - 2018 Jan 01 TI - Clinical and inflammatory characteristics of Asthma-COPD overlap in workers with occupational asthma PG - e0193144 AB - INTRODUCTION: Although Asthma-COPD Overlap (ACO) has been described among populations of subjects with COPD or asthma, ACO has never been described among a population of subjects with occupational asthma (OA). OBJECTIVES: The aims of this study were to: 1. identify ACO in a population of subjects with OA; and 2. compare the clinical characteristics between ACO and OA. METHODS: This retrospective study included all subjects diagnosed with OA between 2000 and 2017 in an OA referral center. Occupational Asthma-COPD Overlap (OACO) was defined as post-bronchodilator FEV1/FVC < 70% and smoking history = 10 pack-years, along with a diagnosis of OA. RESULTS: Three hundred and four subjects were included, 262 (86.2%) were classified as OA and 42 (13.8%) as OACO. OA subjects presented higher sputum eosinophil counts after a specific-inhalation challenge than subjects with OACO (median [IQR]: 6.5 [17.0] vs 2.3 [3.5]). After adjusting for confounding factors, subjects with OACO were older (OR: 1.10 [1.05; 1.14]) and were taking higher doses of inhaled corticosteroids than OA subjects (OR, 5.20 [1.77; 16.48]). Subjects with OACO were less often atopic than OA subjects (OR, 0.19 [0.07; 0.62]). CONCLUSIONS: Subjects with OACO constitute a distinct clinical and inflammatory phenotype from subjects with OA. AU - Ojanguren I AU - Moullec G AU - Hobeika J AU - Miravitlles M AU - Lemiere C. LA - PT - DEP - TA - Plos One JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 137 IP - DP - 2018 Jan 01 TI - Can the ceramic industry be a new and hazardous sector for work-related asthma? PG - 176-180 AB - BACKGROUND: Work-related asthma (WRA) constitutes a significant proportion of all asthma cases and continues to be reported from different industries. The aim of the study was to identify the occupations that can be related to WRA and diagnostic steps used in suspected WRA patients. METHODS: We retrospectively reviewed the clinical records of WRA suspected patients who were referred to Ankara Occupational and Environmental Diseases Hospital, Turkey from January 2015 to January 2017. Detailed occupational history, the diagnostic steps such as pulmonary function testing (PFT), peak expiratory flow (PEF) monitoring and nonspecific bronchial provocation tests (NSBPT) were recorded. RESULTS: Among 160 patients, 148 were male and 12 were female. Only 2 of them were diagnosed as work-exacerbated asthma (WEA). Diagnosis of asthma was based on using reversible airflow limitation 28.8% (n?=?46) or NSBPT 31.9% (n?=?51). Toxicological analysis showed that 28 patients had heavy metal poisoning, 9 patients had solvent poisoning, 4 patients had both. According to occupations, 32 of them were ceramic workers (20.0%) and 27 of them were metal workers (16.9%). Plastic workers (4?±?2.8 years), cleaners (6.2?±?5.7 years), metal workers (7.4?±?5.4 years), painters (10?±?5.2 years), ceramic workers (10.8?±?5.9 years) had the shortest exposure durations for development of occupational asthma (OA). An analysis of variance showed that the effect of heavy metal and solvent poisoning on mean time for onset of OA was not significant. CONCLUSIONS: The results demonstrate that besides the sectors known to cause WRA, ceramic and metal industries can be related to important exposures related to WRA. Medical surveillance of employees in this sector is important in early detection. AU - Kurt OK AU - Ergun D AU - Basaran N. LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - IP - DP - 2018 Jan 01 TI - Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction. PG - AB - RATIONALE: Cleaning tasks may imply exposure to chemical agents with potential harmful effects to the respiratory system, and increased risk of asthma and respiratory symptoms among professional cleaners and in persons cleaning at home has been reported. The long-term consequences of cleaning agents on respiratory health are, however, not well described. OBJECTIVES: This paper aims to investigate long-term effects of occupational cleaning and cleaning at home on lung function decline and chronic airway obstruction. METHODS: The ECRHS study has investigated a multi-centre population based cohort at three time points over twenty years. 6230 participants with at least one lung function measurements from 22 study centres, who in ECRHS II responded to questionnaire modules concerning cleaning activities between ECRHS I and ECRHS II were included. The data were analysed with mixed linear models adjusting for potential confounders. MAIN RESULTS: As compared to women not engaged in cleaning (FEV1=-18.5 ml/year), FEV1 declined more rapidly in women responsible for cleaning at home (-22.1, p=0.01) and occupational cleaners (-22.4, p=0.03). The same was found for decline in FVC (FVC-=8.8 ml/year; -13.1, p=0.02 and -15.9, p=0.002, respectively). Both cleaning sprays and other cleaning agents were associated with accelerated FEV1 decline (-22.0, p=0.04 and -22.9, p=0.004, respectively). Cleaning was not significantly associated with lung function decline in men or with chronic airway obstruction. CONCLUSIONS: Women cleaning at home or working as occupational cleaners had accelerated decline in lung function, suggesting that exposures related to cleaning activities may constitute a risk to long-term respiratory health. AU - Svanes Ø AU - Bertelsen RJ AU - Lygre SH AU - Carsin AE AU - Antó J AU - Forsberg B AU - García-García JM AU - Gullón JA AU - Heinrich J AU - Holm M AU - Kogevinas M AU - Urrutia I AU - Leynaert B AU - Moratalla JM AU - Le Moual N AU - Lytras T AU - Norbäck D AU - Nowak D11 AU - Olivieri M AU - Pin I AU - Probst-Hensch N AU - Schlünssen V AU - Sigsgaard T AU - Skorge TD AU - Villani S AU - Jarvis D AU - Zock JP AU - Svanes C. LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 73 IP - DP - 2018 Jan 01 TI - Change in FVC and survival in chronic fibrotic hypersensitivity pneumonitis PG - 391-394 AB - The predictive value of the decline in FVC by =10% on survival in patients with fibrotic hypersensitivity pneumonitis is unknown. Of 112 patients included, 66 (59%) had surgical lung biopsies. Patients with =10%?decline in predicted FVC after 6–12 months had a significantly increased risk of all-cause mortality (median survival 53 months, 95% CI 37 to 69?vs 139 months, 95%?CI 66 to 212 months, p=0.007). On multivariate analysis remained associated with increasing mortality: decline in FVC by =10% (HR 4.13, 95%?CI 1.96 to 8.70, p=0.005), lower FVC% (HR 1.03, 95% CI 1.01 to 1.05, p=0.003) and with decreasing mortality improvement with antigen avoidance (HR 0.18, 95%?CI 0.04 to 0.77, p=0.021). AU - Gimenez A AU - Storrer K AU - Kuranishi L AU - Soares MR AU - Ferreira RG AU - Pereira CAC LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 68 IP - DP - 2018 Jan 01 TI - Underestimation of spirometry if recommended testing guidance is not followed PG - 126-128 AB - Background Lung function measured at work is used to make important employment decisions. Improving its quality will reduce misclassification and allow more accurate longitudinal interpretation over time. Aims To assess the amount by which lung function (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC]) values will be underestimated if recommended spirometry testing guidance is not followed. Methods Lung function was measured in a population of workers. Knowledge of the final reproducible FEV1 and FVC for each worker allowed estimation of the underestimates that would have occurred if less forced manoeuvres than recommended had been performed. Results A total of 667 workers (661 males, mean age 43 years, range 18–66) participated. Among them, 560 (84%) achieved reproducible results for both FEV1 and FVC; 470 (84%) of these did so after three technically acceptable forced expiratory manoeuvres, a cumulative total of 533 after four, 548 after five, 557 after six, 559 after seven and 560 after eight blows. If only one (or first two) technically acceptable blow(s) had been performed, mean underestimates were calculated for FEV1 of 115.1 ml (35.4 ml) and for FVC of 143.4 ml (42.3 ml). Conclusions In this study, reproducible spirometry was achievable in most workers. Not adhering to standards underestimates lung function by clinically significant amounts. AU - Sumner J AU - Robinson E AU - Bradshaw L AU - Lewis L AU - Warren N AU - Young C AU - Fishwick D LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 51 IP - DP - 2018 Jan 01 TI - Do laboratory challenge tests for occupational asthma represent what happens in the workplace? PG - 1800059 AB - INTRODUCTION: Specific inhalation challenge (SIC) is the diagnostic reference standard for occupational asthma, however the significance of a positive test is doubtful unless it can be reproduced by usual work exposures. We have compared the timing and responses during SIC in hospital to Oasys analysis of serial PEF during usual work exposures. METHODS: All workers with a positive SIC to occupational agents between 2006 and 2015 were asked to measure PEF 2-hourly from waking to sleeping for 4 weeks during usual occupational exposures. Responses were compared between the laboratory challenge and the real-world exposures at work. RESULTS: All 53 workers with positive SIC were included. 49/53 had records suitable for Oasys analysis, 14 requiring >1 attempt, all confirmed occupational work-related changes in PEF. There was a significant correlation between immediate SIC reactors and deterioration within the first 2 hours of starting work with early recovery, and between late SIC reactors and a delayed start to workplace deterioration and delayed recovery. Dual SIC reactions had features of immediate or late SIC reactions at work rather than dual reactions. CONCLUSION: The concordance of timings of reactions during SIC and at work provide further validation for the clinical significance of each test. AU - Burge PS AU - Moore VC AU - Robertson AS AU - Walters GI LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 68 IP - DP - 2018 Jan 01 TI - Health survey of employees regularly using 3D printers PG - 207-210 AB - 10.1093/occmed/kqy042 Background 3D printers emit potentially hazardous ultrafine particles and volatile organic compounds. Workers using 3D printing technologies may be at risk of respiratory illness from occupational exposure. Aims To assess whether 3D printing is associated with health effects in occupational users. Methods This was a preliminary survey. Workers in 17 companies using 3D printing, including commercial prototyping businesses, educational institutions and public libraries, in the Greater Toronto Area, Canada, were asked to complete survey questionnaires concerning demographic, occupational and health information. Associations between self-reported health history variables and occupational characteristics were examined by chi-square and Fisher’s exact tests. Results Among 46 surveyed workers, 27 (59% of participants) reported having respiratory symptoms at least once per week in the past year. Working more than 40 h per week with 3D printers was significantly associated with having been given a respiratory-related diagnosis (asthma or allergic rhinitis) (P < 0.05). We observed a wide variation in occupational hygiene practices in the 17 printing workplaces that we surveyed. Conclusions Our finding of frequently reported respiratory symptoms suggests a need for additional studies on exposed workers in this field. AU - Chan FL AU - House R AU - Kudla I AU - Lipszyc JC AU - Rajaram N AU - Tarlo AU - SM LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 75 IP - DP - 2018 Jan 01 TI - Urinary excretion of platinum from South African precious metals refinery workers PG - 436-442 AB - Background Urinary platinum (Pt) excretion is a reliable biomarker for occupational Pt exposure and has been previously reported for precious metals refinery workers in Europe but not for South Africa, the world’s largest producer of Pt. Objective This study aimed to quantify the urinary Pt excretion of South African precious metals refinery workers. Methods Spot urine samples were collected from 40 workers (directly and indirectly exposed to Pt) at two South African precious metals refineries on three consecutive mornings prior to their shifts. Urine samples were analysed for Pt using inductively coupled plasma-mass spectrometry and were corrected for creatinine content. Results The urinary Pt excretion of workers did not differ significantly between sampling days. Urinary Pt excretions ranged from <0.1?to 3.0?µg Pt/g creatinine with a geometric mean of 0.21?µg Pt/g creatinine (95% CI 0.17 to 0.26?µg Pt/g creatinine). The work area (P=0.0006; ?2=0.567) and the number of years workers were employed at the refineries (P=0.003; ?2=0.261) influenced their urinary Pt excretion according to effect size analyses. Directly exposed workers had significantly higher urinary Pt excretion compared with indirectly exposed workers (P=0.007). Conclusion The urinary Pt excretion of South African precious metals refinery workers reported in this study is comparable with that of seven other studies conducted in precious metals refineries and automotive catalyst plants in Europe. The Pt body burden of workers is predominantly determined by their work area, years of employment in the refineries and whether they are directly or indirectly exposed to Pt. AU - Linde SJL AU - Franken A AU - du Plessis JL LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 139 IP - DP - 2018 Jan 01 TI - Asthma trigger perceptions are associated with work disability. PG - 19-26 AB - OBJECTIVE: To study the association between perceptions of various triggers of asthma and employment status. METHODS: A questionnaire was administered to all those adults living in the city of Tampere, Finland, who were entitled to special reimbursement for asthma medication by the Social Insurance Institution (n?=?2613). The response rate was 79%. The study population (n?=?1657) consisted of individuals who worked full-time (n?=?967), were unemployed (n?=?197), had all-cause work disability (n?=?334), or were retired due to old age (n?=?159). Given a list of potential asthma triggers, the respondents were asked how often (never/sometimes/often) the trigger caused or worsened their asthma symptoms during leisure time. RESULTS: After adjusting for background variables (age, sex, smoking, and professional status), frequency of asthma symptoms, and the use of asthma medication during the last year, any individual trigger identified as asthma-relevant was associated with having work disability (vs. working full-time). The highest odds ratio (OR) was found for vehicle exhaust (OR 5.0, CI 2.2-11.4). We found similar but less consistent associations between asthma trigger perceptions and unemployment. No elevated ORs were found regarding asthma trigger perceptions for old-age retirement. CONCLUSIONS: Perceptions of asthma triggers are associated with all-cause work disability. Our findings suggest that asthmatics have excess trigger perceptions that are not explained by asthma alone. Asthmatics need to be informed that inaccurate trigger perceptions may develop, and how they are induced, because unnecessary trigger avoidance may interfere with work life. AU - Karvala K AU - Uitti J AU - Taponen S AU - Luukkonen R AU - Lehtimäki L. LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 61 IP - DP - 2018 Jan 01 TI - Occupational asthma associated with bleached chlorine-free cellulose dust in a sanitary pad production plant. PG - 952-958 AB - BACKGROUND: Cellulose is an insoluble plant polysaccharide produced from soft-wood pulp. Although chronic respiratory effects associated with high cellulose-based dust levels have been previously described, occupational asthma has not. A 37 year old machine operator in a sanitary pad production factory presented with new-onset work-related asthma symptoms for two years. METHODS: The worker underwent clinical, pulmonological and immunological (skin prick tests, serum specific IgE determinations) evaluation using standardised procedures. The cellulose product was subjected to scanning electron microscopy (SEM) examination. A specific inhalation challenge test performed with the cellulose product ensured that dust concentrations were kept below 5mg/m3 . RESULTS: The subject was not atopic and did not have elevated IgE to pine wood or xylanase. The cellulose product appeared to be free of protein contaminants on SEM. The Work Effect Index computed on serial PEF recordings was elevated (WEI=3.8).Specific inhalational challenge with the cellulose product dust revealed a late bronchial response (39% drop in FEV1 at 3 hours post challenge). CONCLUSION: This is the first reported case of occupational asthma to a cellulose fibre product. A non-specific immune reaction or irritant response seems likely. These fibres may therefore not be biologically inert. The occupational exposure limit of 10mg/m3 generally used for cellulose dust appears to be non-protective. AU - Knight D AU - Lopata AL AU - Nieuwenhuizen N AU - Jeebhay MF. LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 68 IP - DP - 2018 Jan 01 TI - Exploring a rare case of occupational senna allergy PG - 641-643 AB - Background Cassia angustifolia, or senna, is a plant belonging to the Fabaceae family, widely used as a laxative and as a colouring agent in hair dyes. Senna is rarely reported as an occupational allergic sensitizer in the current literature. Aims To describe the case and diagnostic approach of a suspected occupational senna allergy. Case report A male phytopharmaceutical warehouse worker reported bronchial, conjunctival and nasal symptoms immediately upon exposure to senna. We were able to document in vitro sensitization, finding IgE-binding proteins in senna, and in vivo sensitization through positive skin tests and conjunctival provocation test. Conclusion Our study confirms that senna may cause occupational rhinoconjunctivitis symptoms with an IgE-dependent mechanism and is the first to confirm it through specific conjunctival provocation test. AU - Carneiro-Leão L AU - Amaral L AU - Silva D AU - Bartolomé B AU - Miranda M LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 73 IP - DP - 2018 Jan 01 TI - Occupational exposures and 20-year incidence of COPD: the European Community Respiratory Health Survey PG - 1008-1015 AB - Objectives Chronic bronchitis (CB) is an important chronic obstructive pulmonary disease (COPD)-related phenotype, with distinct clinical features and prognostic implications. Occupational exposures have been previously associated with increased risk of CB but few studies have examined this association prospectively using objective exposure assessment. We examined the effect of occupational exposures on CB incidence in the European Community Respiratory Health Survey. Methods Population samples aged 20–44 were randomly selected in 1991–1993, and followed up twice over 20 years. Participants without chronic cough or phlegm at baseline were analysed. Coded job histories during follow-up were linked to the ALOHA Job Exposure Matrix, generating occupational exposure estimates to 12 categories of chemical agents. Their association with CB incidence over both follow-ups was examined with Poisson models using generalised estimating equations. Results 8794 participants fulfilled the inclusion criteria, contributing 13?185 observations. Only participants exposed to metals had a higher incidence of CB (relative risk (RR) 1.70, 95%?CI 1.16 to 2.50) compared with non-exposed to metals. Mineral dust exposure increased the incidence of chronic phlegm (RR 1.72, 95%?CI 1.43 to 2.06). Incidence of chronic phlegm was increased in men exposed to gases/fumes and to solvents and in women exposed to pesticides. Conclusions Occupational exposures are associated with chronic phlegm and CB, and the evidence is strongest for metals and mineral dust exposure. The observed differences between men and women warrant further investigation. AU - Lytras T AU - Kogevinas M AU - Kromhout H AU - Carsin A AU - Antó JM AU - Bentouhami H AU - Weyler J AU - Heinrich J AU - Nowak D AU - Urrutia I AU - Martinez-Moratalla J AU - Gullón JA AU - Pereira-Vega A AU - Raherison-Semjen C AU - Pin I AU - Demoly P AU - Leynaert B AU - Villani S AU - Gislason T AU - Svanes C AU - Holm M AU - Forsberg B AU - Norbäck D AU - Mehta AJ AU - Probst-Hensch N AU - Benke G AU - Jogi R AU - Torén K AU - Sigsgaard T AU - Schlünssen V AU - Olivieri M AU - Blanc PD AU - Vermeulen R AU - Garcia-Aymerich J AU - Jarvis D AU - Zock J LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 75 IP - DP - 2018 Jan 01 TI - Development of a bar code-based exposure assessment method to evaluate occupational exposure to disinfectants and cleaning products: a pilot study PG - 338-674 AB - Objective Healthcare workers are highly exposed to various types of disinfectants and cleaning products. Assessment of exposure to these products remains a challenge. We aimed to investigate the feasibility of a method, based on a smartphone application and bar codes, to improve occupational exposure assessment among hospital/cleaning workers in epidemiological studies. Methods A database of disinfectants and cleaning products used in French hospitals, including their names, bar codes and composition, was developed using several sources: ProdHyBase (a database of disinfectants managed by hospital hygiene experts), and specific regulatory agencies and industrial websites. A smartphone application has been created to scan bar codes of products and fill a short questionnaire. The application was tested in a French hospital. The ease of use and the ability to record information through this new approach were estimated. Results The method was tested in a French hospital (7 units, 14 participants). Through the application, 126 records (one record referred to one product entered by one participant/unit) were registered, majority of which were liquids (55.5%) or sprays (23.8%); 20.6% were used to clean surfaces and 15.9% to clean toilets. Workers used mostly products with alcohol and quaternary ammonium compounds (>90% with weekly use), followed by hypochlorite bleach and hydrogen peroxide (28.6%). For most records, information was available on the name (93.7%) and bar code (77.0%). Information on product compounds was available for all products and recorded in the database. Conclusion This innovative and easy-to-use method could help to improve the assessment of occupational exposure to disinfectants/cleaning products in epidemiological studies. AU - Quinot C AU - Amsellem-Dubourget S AU - Temam S AU - Sevin E AU - Barreto C AU - Tackin A AU - Félicité J AU - Siroux SLV AU - Girard R AU - Descatha A AU - Moual NL AU - Dumas O LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - bcr-2018-2 IP - DP - 2018 Jan 01 TI - Respiratory failure caused by lipoid pneumonia from vaping e-cigarettes PG - AB - A young female vaper presented with insidious onset cough, progressive dyspnoea on exertion, fever, night sweats and was in respiratory failure when admitted to hospital. Clinical examination was unremarkable. Haematological tests revealed only thrombocytopenia, which was long standing, and her biochemical and inflammatory markers were normal. Chest radiograph and high-resolution CT showed diffuse ground-glass infiltrates with reticulation. She was initially treated with empirical steroids and there was improvement in her oxygenation, which facilitated further tests. Since the bronchoscopy and high-volume lavage was unyielding, a video-assisted thoracoscopic surgical biopsy was done later and was suggestive of lipoid pneumonia. The only source of lipid was the vegetable glycerine found in e-cigarette (EC). Despite our advice to quit vaping, she continued to use EC with different flavours and there is not much improvement in her clinical and spirometric parameters. AU - Viswam D AU - Trotter S AU - Burge PS AU - Walters GI LA - PT - DEP - TA - Case Reports JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 4 IP - DP - 2018 Jan 01 TI - A Study of Serum Cholinesterase Activity with Clinical Correlation in Patients with Acute Organophosphorous Poisoning PG - 219-222 AB - Background: Organophosphorus (OP) compounds acts by inhibiting cholinesterase activity. Estimation of serum AChE levels is done to assess the severity of OP poisoning. This study was planned to evaluate the correlation between the level of serum AChE enzyme and the clinical outcome so that the findings can be used for management of these critical patients. Material and methods: A prospective study was conducted on 100 patients with OP compound poisoning. Serum AChE levels were estimated in all patients before administration of any treatment. Patients were classified into 4 grades of severity of poisoning as per the Namba et al. criteria and were treated accordingly. Results: Serum AChE level in patients with the latent grade of poisoning was 5643.76± 1627.83 IU/L, in patients with a mild grade of poisoning was 3178.8±530.30 IU/L, in patients with moderate grade of poisoning was 2360±273.12 IU/L and in the severe grade of poisoning was 521.68±288.8 IU/L. Out of 48 patients with latent grade of poisoning 91.66% recovered. In a moderate grade of poisoning, 50% recovered while 30% died and with severe grade of poisoning 32.43% patients recovered while 51.35% patients died. Conclusion: Estimation of serum AChE level on admission act as a good tool to predict the prognosis of the patient as low levels of serum AChE are associated with bad prognosis and higher chances of mortality. AU - Agrawal V AU - Agrawal S AU - Agrawal U AU - Kshirsagar A AU - Patil V LA - PT - DEP - TA - J Med Research JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 121 IP - DP - 2018 Jan 01 TI - Chemical warfare agent NOVICHOK - mini-review of available data PG - 343-350 AB - The Cold War period is characterized by the infighting between the Western countries and the USSR in diverse areas. One of such fields was development of the weapons of mass destruction. Within various programs on both sides, a wide scale of different agents have been developed. However, information about some of them are still protected under the designation “top secret”. Notwithstanding, in history several cases are known when such information beheld the daylight. One of such cases was the program FOLIANT and NOVICHOK. Both programs were developed by the USSR as a reaction to English/American invention of VX agent. If at least a part of available information is truthful, we can allege that these compounds belong among the most toxic synthetic agents ever. Within this contribution, we have reviewed available Eastern and Western data about the A-agents and their precursors, so-called NOVICHOKs, including their history, synthesis, physical-chemical properties, pharmacological characteristics and clinical manifestation. AU - Nepovimova E AU - Kuca K LA - PT - DEP - TA - Food and Chemical Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 56 IP - DP - 2018 Jan 01 TI - Novichok: a murderous nerve agent attack in the UK PG - 1093-1097 AB - The Novichok, or “newcomer” class of nerve agents are lesser characterized, weaponized organophosphate agents. The use of known Novichok agents in warfare is banned under the Chemical Weapons Convention of 1997. Novichok agents are considered more potent than VX gas and can be applied in unitary and binary forms. Like other nerve agents, Novichok agents irreversibly bind acetylcholinesterase and produce a cholinergic toxidrome. Uniquely, these agents are thought to also target neurons in the peripheral nervous system. Delayed treatment or massive exposure may therefore cause a debilitating neuropathy. The recent 2018 assassination attempt of Russian dissident Sergei Skripal and his daughter Yulia in the United Kingdom highlights the importance of recognizing the potential lethal effects of these nerve agents. Treatment of Novichok agent poisoning is similar to management of other nerve agents. Given increasing worldwide incidents attributed to chemical weapons such as Novichok agents, clinicians should know how to rapidly recognize symptoms of acute poisoning and administer life-saving antidotal therapy, when indicated. AU - Vale JA AU - Marrs TC AU - Maynard RL LA - PT - DEP - TA - Clin Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - IP - DP - 2018 Jan 01 TI - Is a Cumulative Exposure to a Background Aerosol of Nanoparticles Part of the Causal Mechanism of Aerotoxic Syndrome PG - JNAN-139. AB - We present strong evidence for the presence of aerosols of Nano-particles (also termed Ultrafine Particles (UFPs) in aerosol science) in the breathing air of commercial aircraft using engine bleed air architecture. The physical and chemical nature of engine oils and the high temperatures attained in aircraft jet engines (up to 1700° C in the oil circulation and up to 30,000°C in the bearings) explain why UFPs are to be expected. A discussion of oil seals used in gas turbine engines concludes that they will permit UFPs to cross them and enter the breathing air supply, in conjunction with a complex mixture of chemicals such triaryl phosphates which are neurotoxic. A consideration of the toxicology of Nano-particles concludes that their continual presence over a typical working lifetime of up to 20,000 hours in aircrew will predispose them to chronic respiratory problems and will exacerbate the translocation of neurotoxic substances across the blood brain barrier AU - Howard CV AU - Johnson DW AU - Morton J AU - Michaelis S AU - Supplee D AU - Burdon J LA - PT - DEP - TA - J Nanomed Nanosci: JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 73 IP - DP - 2018 Jan 01 TI - Metal worker’s lung: spatial association with Mycobacterium avium PG - 151-156 AB - Background Outbreaks of hypersensitivity pneumonitis (HP) are not uncommon in workplaces where metal working fluid (MWF) is used to facilitate metal turning. Inhalation of microbe-contaminated MWF has been assumed to be the cause, but previous investigations have failed to establish a spatial relationship between a contaminated source and an outbreak. Objectives After an outbreak of five cases of HP in a UK factory, we carried out blinded, molecular-based microbiological investigation of MWF samples in order to identify potential links between specific microbial taxa and machines in the outbreak zone. Methods Custom-quantitative PCR assays, microscopy and phylogenetic analyses were performed on blinded MWF samples to quantify microbial burden and identify potential aetiological agents of HP in metal workers. Measurements and main results MWF from machines fed by a central sump, but not those with an isolated supply, was contaminated by mycobacteria. The factory sump and a single linked machine at the centre of the outbreak zone, known to be the workstation of the index cases, had very high levels of detectable organisms. Phylogenetic placement of mycobacterial taxonomic marker genes generated from these samples indicated that the contaminating organisms were closely related to Mycobacterium avium. Conclusions We describe, for the first time, a close spatial relationship between the abundance of a mycobacterium-like organism, most probably M. avium, and a localised outbreak of MWF-associated HP. The further development of sequence-based analytic techniques should assist in the prevention of this important occupational disease. Metal worker’s lung: spatial association with Mycobacterium avium Phillip L James, Julie Cannon, Christopher M Barber, Laura Crawford, Heather Hughes, Meinir Jones, Joanna Szram, Steven Cowman, William O C Cookson, Miriam F Moffatt, Paul Cullinan doi: 10.1136/thoraxjnl-2017-210226 AU - James PL AU - Cannon J AU - Barber CM AU - Crawford L AU - Hughes H AU - Jones M AU - Szram J AU - Cowman S AU - Cookson WOC AU - Moffatt MF AU - Cullinan P LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 75 IP - DP - 2018 Jan 01 TI - Artificial stone-associated silicosis: a rapidly emerging occupational lung disease PG - 3-5 AB - Introduction Artificial stone is an increasingly popular material used to fabricate kitchen and bathroom benchtops. Cutting and grinding artificial stone is associated with generation of very high levels of respirable crystalline silica, and the frequency of cases of severe silicosis associated with this exposure is rapidly increasing. Aim To report the characteristics of a clinical series of Australian workers with artificial stone-associated silicosis. Methods Respiratory physicians voluntarily reported cases of artificial stone-associated silicosis identified in their clinical practices. Physicians provided information including occupational histories, respiratory function tests, chest radiology and histopathology reports, when available. results Seven male patients were identified with a median age of 44 years (range 26–61). All were employed in small kitchen and bathroom benchtop fabrication businesses with an average of eight employees (range 2–20). All workplaces primarily used artificial stone, and dust control measures were poor. All patients were involved in dry cutting artificial stone. The median duration of exposure prior to symptoms was 7 years (range 4–10). Six patients demonstrated radiological features of progressive massive fibrosis. These individuals followed up over a median follow-up period of 16 months (IQR 21 months) demonstrated rapid decline in prebronchodilator forced expiratory volume in 1 s of 386 mL/year (SD 204 mL) and forced vital capacity of 448 mL/year (SD 312 mL). conclusions This series of silicosis in Australian workers further demonstrates the risk-associated highsilica content artificial stone. Effective dust control and health surveillance measures need to be stringently implemented and enforced in this industry. AU - Hoy RF AU - Baird T AU - Hammerschlag G AU - Hart D AU - Johnson AR AU - King P AU - Putt M AU - Yates DH LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 75 IP - DP - 2018 Jan 01 TI - 3-(Bromomethyl)-2-chloro-4-(methylsulfonyl)- benzoic acid: a new cause of sensitiser induced occupational asthma, rhinitis and urticaria PG - 277-282 AB - Objectives 3-(Bromomethyl)-2-chloro-4-(methylsulfonyl)-benzoic acid (BCMBA) has not previously been identified as a respiratory sensitiser. We detected two cases who presented respiratory and urticaria symptoms related to BCMBA and had positive skin prick tests to the agent. Subsequently, we conducted outbreak investigations at the BCMBA-producing factory and performed clinical examinations to confirm occupational diseases. Methods The outbreak investigations included observations of work processes, assessment of exposure, a medical survey with a questionnaire and skin prick tests with 0.5% BCMBA water solution on 85 exposed workers and 9 unexposed workers. We used specific inhalation or nasal challenge and open skin application test to investigate BCMBA-related occupational asthma, rhinitis and contact urticaria. Results We identified nine workers with respiratory and/or skin symptoms and positive skin prick tests to BCMBA in a chemical factory. A survey among chemical factory workers indicated a BCMBA-related sensitisation rate of 8% among all exposed workers; the rate was highest (25%) among production workers in the production hall. Sensitisation was detected only in workers with the estimated highest exposure levels. Six cases of occupational asthma, rhinitis and/or contact urticaria caused by BCMBA were confirmed with challenge tests. Asthma-provoking doses in specific inhalation challenges were very low (0.03% or 0.3% BCMBA in lactose). Conclusions We identified a new low molecular weight agent causing occupational asthma, rhinitis and contact urticaria. A typical clinical picture of allergic diseases and positive skin prick tests suggest underlying IgE-mediated disease mechanisms. Stringent exposure control measures are needed in order to prevent BCMBA-related diseases. AU - Suojalehto H AU - Karvala K AU - Ahonen S AU - Ylinen K AU - Airaksinen L AU - Suuronen K AU - Suomela S AU - Lindström I LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 2017 IP - DP - 2018 Jan 01 TI - Prevalence of occupational exposure to asthmagens derived from animals, fish and/or shellfish among Australian workers PG - 104459 AB - Objective Several animal, fish and/or shellfish derived substances encountered in the workplace can initiate or exacerbate asthma. The aims of this study were: to produce a population-based estimate of the current prevalence of occupational exposure to animal, fish and/or shellfish derived asthmagens, to identify the main circumstances of exposures and to identify occupations with the highest proportions of exposed respondents. Methods We used data from the Australian Work Exposure Study-Asthma, a national telephone survey that investigated the current prevalence of occupational exposure to asthmagens among Australian workers. A web-based tool was used to collect job task information and assign exposure to asthmagens, including animal, fish and/or shellfish derived asthmagens. Prevalence ratios to determine risk factors for exposure were estimated using modified Poisson regression. Results Of the 4878 respondents, 12.4% were exposed to asthmagens derived from animals, fish and/or shellfish. Exposure to these asthmagens was significantly higher in workers residing in regional and remote areas, compared with major cities. The main circumstance of exposure to animal derived asthmagens was through cleaning up rat/mice infestations, while the main circumstance of exposure to fish and/or shellfish derived asthmagens was through preparing and cooking salmon. Occupational groups with the highest proportion of exposure to animal or fish and/or shellfish derived asthmagens were farmers/animal workers and food workers, respectively. Conclusions This is the first study investigating occupational exposure to animal, fish and/or shellfish derived asthmagens in a nationwide working population. The results of this study can be used to inform the direction of occupational interventions and policies to reduce work-related asthma. AU - El-Zaemey S AU - Carey RN AU - Darcey E AU - Reid A AU - Glass DC AU - Benke GP AU - Driscoll TR AU - Peters S AU - Si S AU - Abramson MJ AU - Fritschi L LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 67 IP - DP - 2018 Jan 01 TI - Asthma Mortality Among Persons Aged 15-64 Years, by Industry and Occupation - United States, 1999-2016. PG - 60-65 AB - In 2015, an estimated 18.4 million U.S. adults had current asthma, and 3,396 adult asthma deaths were reported (1). An estimated 11%–21% of asthma deaths might be attributable to occupational exposures (2). To describe asthma mortality among persons aged 15–64 years,* CDC analyzed multiple cause-of-death data† for 1999–2016 and industry and occupation information collected from 26 states§ for the years 1999, 2003, 2004, and 2007–2012. Proportionate mortality ratios (PMRs)¶ for asthma among persons aged 15–64 years were calculated. During 1999–2016, a total of 14,296 (42.9%) asthma deaths occurred among males and 19,011 (57.1%) occurred among females. Based on an estimate that 11%–21% of asthma deaths might be related to occupational exposures, during this 18-year period, 1,573–3,002 asthma deaths in males and 2,091–3,992 deaths in females might have resulted from occupational exposures. Some of these deaths might have been averted by instituting measures to prevent potential workplace exposures. The annual age-adjusted asthma death rate** per 1 million persons aged 15–64 years declined from 13.59 in 1999 to 9.34 in 2016 (p<0.001) among females, and from 9.14 (1999) to 7.78 (2016) (p<0.05) among males. The highest significantly elevated asthma PMRs for males were for those in the food, beverage, and tobacco products manufacturing industry (1.82) and for females were for those in the social assistance industry (1.35) and those in community and social services occupations (1.46). Elevated asthma mortality among workers in certain industries and occupations underscores the importance of optimal asthma management and identification and prevention of potential workplace exposures. National Vital Statistics System’s multiple cause-of-death data for 1999–2016 were analyzed to examine asthma mortality among persons aged 15–64 years. Asthma deaths were identified from death certificates using International Classification of Diseases, 10th Revision underlying cause-of-death codes J45 (asthma) and J46 (status asthmaticus). Death rates per 1 million persons aged 15–64 years by sex, race, ethnicity, and year were age-adjusted using the 2000 U.S. Census standard population. Time trends were assessed using a first-order autoregressive linear regression model to account for the serial correlation. Industry and occupation information available from 26 states for the years 1999, 2003, 2004, and 2007–2012†† was coded§§ using the U.S. Census 2000 Industry and Occupation Classification System. PMRs, adjusted by 5-year age groups and race, were generated by industry and occupation for males and females. In addition, 95% confidence intervals (CIs) were calculated assuming Poisson distribution of the data. Retired, unemployed, and nonpaid workers and those with information that was unknown or not reported for industry or occupation were excluded from PMR analyses. During 1999–2016, a total of 33,307 U.S. decedents aged 15–64 years had asthma or status asthmaticus assigned as the underlying cause of death (Table 1) for an overall death rate of 8.89 per 1 million persons. The highest asthma death rates were among adults aged 55–64 years (16.32 per 1 million persons), females (9.95 per 1 million persons), persons who were not Hispanic or Latino (9.39 per 1 million), and blacks or African Americans (25.60 per 1 million persons). The age-adjusted asthma death rate per 1 million persons aged 15–64 years decreased 24.6% from 11.41 in 1999 to 8.60 in 2016 (p<0.01). The age-adjusted asthma death rates among females aged 15–64 years decreased from 13.59 per 1 million in 1999 to 9.34 in 2016 (p<0.001), and among males decreased from 9.14 (1999) to 7.78 (2016) (p<0.05). By state, annualized age-adjusted asthma death rates ranged from 4.59 per 1 million in Maine to 14.72 in the District of Columbia for males and from 6.70 per 1 million in North Dakota to 15.30 in Mississippi for females (Figure). Industry and occupation data were available for 3,393¶¶ (97.2%) of 3,491 asthma deaths, (1,398 of 1,435 [97.4%] males and 1,995 of 2,056 [97.0%] females) among persons aged 15–64 years that occurred in residents of 26 states during 1999, 2003, 2004, and 2007–2012 (Table 2). By industry, the highest number of asthma deaths occurred among males in the construction industry (184; 13.2% of asthma deaths in males) and among females in the health care industry (279; 14.0% of asthma deaths in females). By occupation, the highest number of asthma deaths occurred among male construction trades workers (149; 10.7%) and among female office and administrative support workers (186; 9.3%). By industry, PMRs were significantly elevated among males working in food, beverage, and tobacco products manufacturing (1.82; CI = 1.22–2.61), other retail trade (1.65; CI = 1.29–2.10), and miscellaneous manufacturing (1.45; CI = 1.13–1.86); and among females working in social assistance (e.g., individual and family services and child day care services) (1.35; CI = 1.00–1.79). By occupation, the PMR was significantly elevated among female community and social services workers (1.46; CI = 1.02–2.01). AU - Patel O AU - Syamlal G AU - Wood J AU - Dodd KE AU - Mazurek JM LA - PT - DEP - TA - MMWR CDC Surveill Summ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 51 IP - DP - 2018 Jan 01 TI - Sputum proteomics and airway cell transcripts of current and ex-smokers with severe asthma in U-BIOPRED: an exploratory analysis PG - 1702173 AB - Severe asthma patients with a significant smoking history have airflow obstruction with reported neutrophilia. We hypothesise that multi-omic analysis will enable the definition of smoking and ex-smoking severe asthma molecular phenotypes. The U-BIOPRED cohort of severe asthma patients, containing current-smokers (CSA), ex-smokers (ESA), nonsmokers and healthy nonsmokers was examined. Blood and sputum cell counts, fractional exhaled nitric oxide and spirometry were obtained. Exploratory proteomic analysis of sputum supernatants and transcriptomic analysis of bronchial brushings, biopsies and sputum cells was performed. Colony-stimulating factor (CSF)2 protein levels were increased in CSA sputum supernatants, with azurocidin 1, neutrophil elastase and CXCL8 upregulated in ESA. Phagocytosis and innate immune pathways were associated with neutrophilic inflammation in ESA. Gene set variation analysis of bronchial epithelial cell transcriptome from CSA showed enrichment of xenobiotic metabolism, oxidative stress and endoplasmic reticulum stress compared to other groups. CXCL5 and matrix metallopeptidase 12 genes were upregulated in ESA and the epithelial protective genes, mucin 2 and cystatin SN, were downregulated. Despite little difference in clinical characteristics, CSA were distinguishable from ESA subjects at the sputum proteomic level, with CSA patients having increased CSF2 expression and ESA patients showing sustained loss of epithelial barrier processes. AU - Takahashi K AU - Pavlidis S AU - Kwong FNK AU - Hoda U AU - Rossios C AU - Sun K AU - Loza M AU - Baribaud F AU - Chanez P AU - Fowler SJ AU - Horvath I AU - Montuschi P AU - Singer F AU - Musial J AU - Dahlen B AU - Dahlen S AU - Krug N AU - Sandstrom T AU - Shaw DE AU - Lutter R AU - Bakke P AU - Fleming LJ AU - Howarth PH AU - Caruso M AU - Sousa AR AU - Corfield J AU - Auffray C AU - Meulder BD AU - Lefaudeux D AU - Djukanovic R AU - Sterk PJ AU - Guo Y AU - Adcock IM AU - Chung KF LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 8 IP - DP - 2018 Jan 01 TI - Effects of Corticosteroid Treatment and Antigen Avoidance in a Large Hypersensitivity Pneumonitis Cohort: A Single-Centre Cohort Study. PG - 14 AB - Background: Although the third most frequent interstitial lung disease, hypersensitivity pneumonitis (HP) remains an enigmatic disease without clear diagnostic and therapeutic guidelines. We assessed the effect of the commonly used therapeutic interventions (i.e. exposure avoidance and corticosteroid treatment) in an HP cohort. Methods: We collected clinical data of all HP patients followed at our centre between January 1, 2005, and December 31, 2016. HP patients were stratified according to the presence of fibrosis on chest CT. Survival was analysed using the multivariate Cox proportional hazards model. Forced vital capacity (percent predicted, FVC%) and diffusing capacity of the lung for carbon monoxide (percent predicted, DLCO%) evolution were analysed using linear mixed-effect models. Results: Two hundred and two HP patients were identified: 93 non-fibrotic HP (nfHP) and 109 fibrotic HP (fHP), experiencing a monthly FVC% decline before treatment of 0.93% and 0.56%, respectively. While nfHP had an excellent survival, fHP patients experienced a median survival of 9.2 years. Corticosteroid treatment and exposure avoidance did not result in survival differences. Although nfHP patients showed FVC% and DLCO% increase after corticosteroid initiation, no therapeutic effect was seen in fHP patients. FVC% and DLCO% increased in nfHP patients after exposure avoidance, while a positive numerical trend was seen for FVC% after exposure avoidance in fHP patients (p = 0.15). Conclusions: nfHP patients experienced an excellent survival with good therapeutic effect on pulmonary function tests with both corticosteroid initiation as well as antigen avoidance. In contrast, fHP patients experienced a dismal prognosis (median survival of 9.2 years) without any therapeutic effect of corticosteroid treatment. Whether antigen avoidance is useful in fHP patients is still unclear. AU - De Sadeleer LJ AU - Hermans F AU - De Dycker E AU - Yserbyt J AU - Verschakelen JA AU - Verbeken EK AU - Verleden GM AU - Wuyts WA LA - PT - DEP - TA - J Clin Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 143 IP - DP - 2018 Jan 01 TI - Disconnect of type 2 biomarkers in severe asthma; dominated by FeNO as a predictor of exacerbations and periostin as predictor of reduced lung function PG - 31-38 AB - Background biomarkers of Type 2 (T2) inflammation may predict asthma control and exacerbation risk. However, the relationships between individual T2 biomarkers to exacerbations and lung function in severe asthma remain uncertain. Objectives to explore the roles played by T2 biomarkers individually and as a composite score in predicting clinical outcomes in severe asthma. Methods unselected severe asthma patients were enrolled in this cross sectional real life study. Participants were clinically characterised and the following measurements were obtained: the frequency of exacerbations requiring oral corticosteroids (OCS), asthma control (Juniper ACQ6-7), lung function, Fraction exhaled Nitric Oxide (FeNO), peripheral blood eosinophils (PBE), and serum periostin. Results A total of 115 patients were recruited [mean age 45 years (range 18–70), 80 (69.6%) females, mean forced expiratory volume in first second (FEV1) %predicted was 68%?±?24.7, mean inhaled corticosteroids (ICS) 1.96?±?0.82?mg/day. FeNO correlated significantly with PBE (r?=?0.35, p?=?0.0004), but not with periostin (r?=?0.22, p?=?0.065) and there was no significant correlation between PBE and periostin. FeNO correlation with exacerbations (r?=?0.42, p?=?0.0008) was stronger than PBE and periostin. A composite score of the 3 biomarkers correlated with exacerbations in a dose-dependent manner but multiple regression analysis did not confirm an added benefit. Only periostin demonstrated a significant correlation with FEV1% predicted (r?=?-0.34, p?=?0.004) with ROC-AUC 0.7. Conclusion FeNO demonstrated stronger correlation with asthma exacerbations than PBE or periostin with no definite added benefit from a composite score of the 3 biomarkers. Only periostin showed significant association with reduced lung function raising its potential as a biomarker of airway remodeling. AU - Mansur AH AU - Srivastava S AU - Sahal A LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20180101 IS - IS - VI - 68 IP - DP - 2018 Jan 01 TI - Welding fume exposure is associated with inflammation: a global metabolomics profiling study PG - AB - Background Increasing evidence suggests that welding fume exposure is associated with systemic inflammation. Although celluar metabolites may be associated with inflammation, there is limited information on metabolomic changes during welding fume exposure. Such changes may play an important role in the occurrence, development, and prevention of metal-associated diseases. We aim to investigate human metabolomics changes pre- and post-welding fume exposure. Methods This study included 52 boilermakers totally. We collected plasma samples pre- and post-shift welding fume exposure and prepared samples using the automated MicroLab STAR® system. Metabolite concentrations were measured using ultra performance liquid chromatography - tandem mass spectrometer (UPLC-MS/MS) methods. Two-way analysis of variance was used to test the significance of metabolite changes with false discovery rate correction. Results Analysis detected several metabolic changes after welding fume exposure, mainly involved in the lipid pathway [glucocorticoid class (cortisol, corticosterone, and cortisone), acylcarnitine class, and DiHOME species (9,10-DiHOME and 12,13-DiHOME)], amino acid utilization (isoleucine, proline and phenylalanine), and S-(3-hydroxypropyl) mercapturic acid (3-HPMA). These compounds are all associated with inflammation according to previous studies. Further, additive interaction effects linked smoking and 3-HPMA levels. In the metabolite set enrichment analysis for diseases, the top two disease-associated metabolite pathways were systemic inflammation-related diseases including rheumatoid arthritis and systemic lupus erythematosus. Conclusions This global metabolomics study shows evidence that metabolite changes during welding fume exposure are closely associated with systemic inflammation. The altered metabolites detected may be potential health monitoring biomarkers for boilermakers, especially for inflammation-related disease prevention AU - Shen S AU - Zhang R AU - Zhang J AU - Wei Y AU - Guo Y AU - Su L AU - Chen F AU - Christiani DC LA - PT - DEP - TA - Environmental Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 195 IP - DP - 2017 Jan 01 TI - Dysanapsis—Once Believed to be a Physiological Curiosity—Is Now Clinically Important PG - 277-278 AB - In respiratory physiology, there is always the tension between what is part of the normal continuum and where to draw the line in the sand to define disease. The area of lung growth, and the pattern of growth, is no different. We assume that as the lung grows and matures, the length and diameter of the airways grow in similar proportions, making the resistance to airflow similar across individuals. For example, it does not really matter what an individual’s vital capacity is; they should be able to forcefully blow out roughly 80% of their vital capacity in 1 second—that is, the FEV1/FVC should be roughly 0.8. In reality, that is not necessarily the case, as the relationship between airway caliber and lung volume is not consistent. We have reference values (1) based on normal population data that determine what the FEV1, FVC, and FEV1/FVC should be. What happens, however, when the lung size (VC or FVC) and FEV1 are within normal limits, but there is clinically significant airflow obstruction (FEV1/FVC less than the lower limit of normal or using the fixed cut-off of FEV1/FVC?<?0.7 or 0.8)? Is this truly airflow obstruction or part of the normal continuum? Is it indeed a problem? The concept of the disproportionate growth between lung size and airway caliber was termed “dysanaptic growth” by Green and colleagues in 1974 (2), who described the wide variations in maximum expiratory flows in normal subjects with similar lung size. They postulated that the differences in maximum expiratory flows noted were due to between-individual differences in airway caliber and geometry (caliber vs. length) and suggested that the proposed disconnect between lung size and airway size was indeed a normal variant and may have an embryological basis. Mead (3) continued with this work and demonstrated that there was no association between airway caliber (estimated as maximal expiratory flow/static recoil pressure at 50% vital capacity) and lung size. However, there were differences in airway caliber between male and female individuals with comparable lung volumes and, importantly, boys and men with comparable lung volumes. The work of Green and colleagues (2) and Mead (3) has been confirmed and further developed using more sophisticated techniques, such as acoustic reflectance and computed tomography–based techniques (4, 5). This is all physiologically interesting; however, is it clinically important? In this edition of the Journal, Forno and colleagues (pp. 314–323) present a comprehensive study looking at the question of whether airway dysanapsis is associated with asthma morbidity in obese children (6). To do this, the authors used six large cohorts of subjects from separate childhood studies. They then looked for associations between obesity and dysanapsis in children with and without asthma and the association between dysanapsis and clinical outcomes. The results are compelling, and the authors clearly demonstrate that there was an association with airway dysanapsis and overweight or obese as children with or without asthma. Moreover, in overweight children with asthma, there was an association with airway dysanapsis and clinical outcomes. A potential issue with this kind of analysis is determining the cutoffs that are going to be used to define disease. This is important as the definition can potentially force the results toward a preconceived notion. The physiological phenomenon described by Green and colleagues (2) and Mead (3) did not ever describe a line in the sand between normality and abnormality, but more that dysanapsis was a physiological description of why there is the variation in expiratory resistance to flow for a given lung size. Forward this work on 25 years, and Pellegrino and colleagues in the American Thoracic Society/European Respiratory Society lung function interpretation document (7) define dysanapsis as airflow obstruction (FEV1/FVC less than the lower limit of normal) in the presence of an FEV1 greater than or equal to 100% predicted normal. It is not clear where this definition came from, and following back the references they ended up with Green and colleagues (2) and Mead (3). Clearly, this definition could force the results. Furthermore, defining airflow obstruction either as a fixed cutoff or as a lower limit of normal (8) could also force the results. So there is a disconnect between the concept of “airflow obstruction” (FEV1/FVC less than the lower limit of normal) in the presence of a normal FEV1 and what Green and colleagues (2) and Mead (3) describe. The authors are well aware of this issue and used a sensitivity analysis to address it head on. No matter what definition (lower limit of normal or various percent predicted cutoffs) was used for FEV1/FVC, FEV1, and FVC to describe dysanapsis, the results were essentially the same. Clearly, in some definitions data were lost; however, this did not affect the main outcomes providing a very strong and robust message. Finally, the authors studied the relationships as a cross-section and longitudinally, and again the relationships hold. It is sometimes interesting in science to look back over a journey. Some 42 years ago, a very interesting, well-conducted study posed the notion that there was no association between airway caliber and lung size. This was demonstrated to be the case over the years using more sophisticated techniques. However, there are differences in airway caliber between men and women, and there is incongruence of growth between airway caliber and lung parenchyma. Importantly, this so-called dysanapsis was the explanation of why airflow obstruction in the presence of a normal FEV1 and FVC is potentially a normal variant. The current data demonstrating that dysanapsis is related to obese/overweight children, and that in children who are obese/overweight dysanapsis is associated with symptoms, medication use, and exacerbations, provide a strong reason for us to suggest that dysanapsis is not normal. These are the sorts of data that will lead many to scramble to their computers and start interrogating their respiratory function databases to look for associations between dysanapsis and other respiratory diseases. The hitch is, if dysanapsis is a problem, what do we do about it? The next 40 years can sort that out. AU - Thompson BR LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 54 IP - DP - 2017 Jan 01 TI - Fragrances and work-related asthma–California surveillance data, 1993–201 PG - 1041-1050 AB - Objective: Fragrance chemicals are used in a large array of products. Workers may be exposed to these chemicals in the workplace directly when used as air fresheners, or indirectly in personal care products used by coworkers or others. This study characterizes work-related asthma (WRA) cases associated with fragrance exposures in California workplaces from 1993 through 2012. Methods: We used the California Work-Related Asthma Prevention Program's surveillance database to identify individuals with physician-diagnosed WRA associated with the use of air fresheners and scented personal care products (perfumes, colognes, etc.). Cases were classified using previously published, standardized surveillance methods. Results: Perfume was the ninth most common exposure identified from 1993 through 2012. A total of 270 WRA cases associated with fragrance exposure were reported during this period, representing 3.8% of all confirmed cases. These 270 cases included 242 associated with perfume or cologne, 32 associated with air freshener, and 4 associated with both. Similar to non-fragrance cases, nearly a quarter of fragrance-associated cases were classified as new-onset asthma. Fragrance-associated cases were significantly more likely to be in office, health, and education jobs than non-fragrance-associated cases. When compared to non-fragrance cases, fragrance cases were significantly more likely to be female (94% vs 62%) and be classified as having work-aggravated asthma (38% vs 20%), yet had similar outcomes compared with cases associated with other exposures. Conclusions: Our surveillance data show that fragrance use in the workplace is associated with WRA. Prevention methods include employee education, enforced fragrance-free policies, well-designed ventilation systems, and good building maintenance. AU - Weinberg JL AU - Flattery J AU - Harrison R LA - PT - DEP - TA - J Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 5 IP - DP - 2017 Jan 01 TI - Respiratory bronchiolitis-associated interstitial lung disease secondary to electronic nicotine delivery system use confirmed with open lung biopsy PG - AB - As a modern phenomenon, there is currently limited understanding of the possible toxic effects and broader implications of electronic nicotine delivery systems (ENDS). Large volumes of aerosolized particles are inhaled during “vaping” and there are now an increasing number of case reports demonstrating toxic effects of ENDS, as well as human studies demonstrating impaired lung function in users. This article presents a case of respiratory bronchiolitis interstitial lung disease (RB-ILD) precipitated by vaping in a 33-year-old male with 10 pack years of traditional cigarette and prior treatment for mixed germ cell tumour. The patient had started vaping 10–15 times per day while continuing to smoke 10 traditional cigarettes per day. After 3 months of exposure to e-cigarette vapour, chest computed tomography demonstrated multiple new poorly defined pulmonary nodules with fluffy parenchyma opacification centred along the terminal bronchovascular units. Video-assisted thoracoscopy with lung biopsy of the right upper and right middle lobes was undertaken. The microscopic findings were overall consistent with RB-ILD. This case demonstrates toxicity with use of ENDS on open lung biopsy with resolution of radiographic findings on cessation. We believe that this is the first case where open lung biopsy has demonstrated this and our findings are consistent with RB-ILD. AU - Flower M AU - Nandakumar L AU - Singh M AU - Wyld D AU - Windsor M AU - Fielding D LA - PT - DEP - TA - Respirology case reports JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - IP - DP - 2017 Jan 01 TI - Assessment of eosinophilic airway inflammation as a contribution to the diagnosis of occupational asthma. PG - AB - BACKGROUND: Ascertaining the presence of asthma through the assessment of nonspecific bronchial hyperresponsiveness (NSBH) is a key step in the diagnosis of occupational asthma (OA). We aimed at investigating whether indices of airway inflammation including fractional exhaled nitric oxide (FeNO) and sputum eosinophils would be useful adjuncts to the measurement of NSBH in diagnosing OA defined as a positive specific inhalation challenge (SIC). METHODS: The study included 240 consecutive subjects with a suspicion of OA who completed a SIC, of whom 133 showed a positive response. The sensitivity, specificity, and predictive values of NSBH, and FeNO, as well as sputum eosinophil counts assessed at baseline of the SIC were determined. RESULTS: A concentration of histamine inducing a 20% decline in FEV1 (PC20 ) =16 mg/mL showed a sensitivity of 87% and a specificity of 36%. A FeNO level =25 ppb and a sputum eosinophil count = 2% provided lower sensitivity rates (47% and 39%, respectively) than the PC20 value. Eight of the 17 subjects without baseline NSBH despite a positive SIC showed a sputum eosinophil count =2%, a FeNO level =25 ppb or both outcomes. Combining either a PC20 value =16mg/mL or a FeNO =25 ppb increased the sensitivity to 91%. Using either a PC20 =16mg/mL or a sputum eosinophil count =1% increased the sensitivity to 94%. CONCLUSION: Adding the assessment of FeNO level and sputum eosinophils to NSBH improves the identification of subjects who may have OA and require further objective testing before excluding the possibility of OA. This article is protected by copyright. All rights reserved AU - Beretta C AU - Rifflart C AU - Evrard G AU - Jamart J AU - Thimpont J AU - Vandenplas O LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 26 IP - DP - 2017 Jan 01 TI - The impact of renovation on indoor airborne bacterial and fungal populations PG - 1351-1361 AB - We undertook an extensive study of population and type of viable microorganisms at several indoor construction sites in a 50-year-old chemical building which housed both laboratory and office spaces. Results were compared to neighbouring public buildings (office and shopping malls), as well as outdoor (green areas and traffic zones) in downtown Montreal, (45?°30'N, 73?°35'W). The highest number of microorganisms was observed in the major shopping street (bacteria: 602,865?cfu/m3; fungi: 109,612?cfu/m3). During moving/construction process, the mean population of airborne bacteria and fungi were 89,281 and 50,386?cfu/m3, respectively. Mean bacterial and fungal population in demolished laboratory sites were 37,127 and 17,679?cfu/m3, respectively. After the termination of laboratory renovations, continued elevation of airborne taxa population (bacteria: 25,635?cfu/m3; fungi: 6188?cfu/m3) was observed. At the construction site, the 16S rDNA sequence of bacteria isolates, R. equi, was identified as human pathogen and R. jostii RHA1 in an organic demolished laboratory site, with the ability to degrade a variety of xenobiotic compounds such as polychlorinated biphenyls. Our study showed that renovation/construction activities could create a distinct large pool of microorganisms that could be released into indoor environments which may persist even after the completion of renovations. Potential health effects and suggestions for future research are discussed in this paper. AU - Mortazavi R AU - Ariya PA LA - PT - DEP - TA - Indoor Built Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 74 IP - DP - 2017 Jan 01 TI - Factors associated with work productivity among people with COPD: Birmingham COPD Cohort PG - 859-867 AB - Background Patients with chronic obstructive pulmonary disease (COPD) are more likely to take time off work (absenteeism) and report poor performance at work (presenteeism) compared to those without COPD. Little is known about the modifiable factors associated with these work productivity outcomes. Aim To assess the factors associated with work productivity among COPD patients. Methods Cross-sectional analysis of baseline data from a subsample (those in paid employment) of the Birmingham COPD Cohort study. Absenteeism was defined by self-report over the previous 12 months. Presenteeism was assessed using the Stanford Presenteeism Scale. Logistic regression analysis was used to assess the effects of sociodemographic, clinical and occupational characteristics on work productivity. Results Among 348 included participants, increasing dyspnoea was the only factor associated with both absenteeism and presenteeism (p for trend<0.01). Additionally, increasing history of occupational exposure to vapours, gases, dusts or fumes (VGDF) was independently associated with presenteeism (p for trend<0.01). Conclusions This is the first study to identify important factors associated with poor work productivity among patients with COPD. Future studies should evaluate interventions aimed at managing breathlessness and reducing occupational exposures to VGDF on work productivity among patients with COPD. AU - Rai KK AU - Adab P AU - Ayres JG AU - Siebert WS AU - Sadhra SS AU - Sitch AJ AU - Fitzmaurice DA LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 67 IP - DP - 2017 Jan 01 TI - Occupational asthma caused by an epoxy amine hardener, isophorone diamine (IPDA) PG - 722-724 AB - We describe a 43-year-old epoxy floor layer who developed work-related asthma while exposed to an epoxy hardener based on isophorone diamine (IPDA). Challenge exposures to the curing of the epoxy resin system and subsequently to the polyfunctional amine hardener containing IPDA both elicited delayed asthmatic reactions. This report further indicates that exposure to epoxy hardeners containing polyfunctional amines should be considered as a potential cause of occupational asthma. Appropriate work hygiene measures should be implemented to minimize airborne exposure to these volatile compounds. AU - Vandenplas O AU - Rifflart C AU - Evrard G AU - Thimpont J AU - Seed M AU - Agius R LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 67 IP - DP - 2017 Jan 01 TI - Occupational illness in the waste and recycling sector PG - 626-636 AB - Background The waste and recycling sector is a growing part of industry. Whether health surveillance is indicated and how it should be undertaken is unclear. Aims To undertake a review of the literature to identify hazards to health, biological effects and occupational illnesses for workers in the sector. Methods A systematic review of the published literature and two UK databases. Results Rates of fatal, non-fatal injuries and self-reported work-related illness were found to be higher in the waste and recycling sector than in UK industry as a whole. There was an increased prevalence of respiratory, gastro-intestinal and skin complaints in workers exposed to compost relative to controls. They may also be at increased risk of extrinsic allergic alveolitis, allergic bronchopulmonary aspergillosis, occupational asthma and abnormalities of lung function. Workers involved with the recycling of batteries and cables may be at risk of lead poisoning and exposure to other heavy metals. There were case reports of mercury poisoning from the recycling of fluorescent lights. Cases of occupational asthma have been reported in association with wood and paper recycling. The recycling of e-waste may cause exposure to heavy metals and organic pollutants, such as polybrominated diphenyl ethers, dioxins and polyaromatic hydrocarbons, which have been associated with damage to DNA and adverse neonatal outcomes. Conclusions Ill-health and adverse biological effects have been described in waste and recycling workers, but their true prevalence has probably not been captured. Targeted health surveillance may be required to assess exposure and to identify occupational illness. AU - Poole CJM AU - Basu S LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 67 IP - DP - 2017 Jan 01 TI - Case report of asthma associated with 3D printing PG - 652-654 AB - Background Three-dimensional (3D) printing is being increasingly used in manufacturing and by small business entrepreneurs and home hobbyists. Exposure to airborne emissions during 3D printing raises the issue of whether there may be adverse health effects associated with these emissions. Aims We present a case of a worker who developed asthma while using 3D printers, which illustrates that respiratory problems may be associated with 3D printer emissions. Case report The patient was a 28-year-old self-employed businessman with a past history of asthma in childhood, which had resolved completely by the age of eight. He started using 10 fused deposition modelling 3D printers with acrylonitrile-butadiene-styrene filaments in a small work area of approximately 3000 cubic feet. Ten days later, he began to experience recurrent chest tightness, shortness of breath and coughing at work. After 3 months, his work environment was modified by reducing the number of printers, changing to polylactic acid filaments and using an air purifier with an high-efficiency particulate air filter and organic cartridge. His symptoms improved gradually, although he still needed periodic treatment with a salbutamol inhaler. While still symptomatic, a methacholine challenge indicated a provocation concentration causing a 20% fall in FEV1 (PC20) of 4 mg/ml, consistent with mild asthma. Eventually, his symptoms resolved completely and a second methacholine challenge after symptom resolution was normal (PC20 > 16 mg/ml). Conclusions This case indicates that workers may develop respiratory problems, including asthma when using 3D printers. Further investigation of the specific airborne emissions and health problems from 3D printing is warranted. AU - House R AU - Rajaram N AU - Tarlo SM LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 14 IP - DP - 2017 Jan 01 TI - Is 3D printing safe? Analysis of the thermal treatment of thermoplastics: ABS, PLA, PET, and nylon PG - D80-D85 AB - The fast development of low-cost desktop three-dimensional (3D) printers has made those devices widely accessible for goods manufacturing at home. However, is it safe? Users may belittle the effects or influences of pollutants (organic compounds and ultrafine particles) generated by the devices in question. Within the scope of this study, the authors attempt to investigate thermal decomposition of the following commonly used, commercially available thermoplastic filaments: acrylonitrile-butadiene-styrene (ABS), polylactic acid (PLA), polyethylene terephthalate (PET), and nylon. Thermogravimetric analysis has shown the detailed thermal patterns of their behavior upon increasing temperature in neutral atmosphere, while GC analysis of organic vapors emitted during the process of heating thermoplastics have made it possible to obtain crucial pieces of information about the toxicity of 3D printing process. The conducted study has shown that ABS is significantly more toxic than PLA. The emission of volatile organic compounds (VOC) has been in the range of 0.50 µmol/h. Styrene has accounted for more than 30% of total VOC emitted from ABS, while for PLA, methyl methacrylate has been detected as the predominant compound (44% of total VOCs emission). Moreover, the authors have summarized available or applicable methods that can eliminate formed pollutants and protect the users of 3D printers. This article summarizes theoretical knowledge on thermal degradation of polymers used for 3D printers and shows results of authors’ investigation, as well as presents forward-looking solutions that may increase the safety of utilization of 3D printers. AU - Wojtyla S AU - Baran PKT LA - PT - DEP - TA - Journal of Occupational and Environmental Hygiene JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 74 IP - DP - 2017 Jan 01 TI - Specific inhalation challenge: the relationship between response, clinical variables and lung function PG - 586-591 AB - Introduction The specific inhalation challenge (SIC) is considered the gold standard for the diagnosis of occupational asthma (OA). However, its use is not standardised, and the intensity of exposure is regulated empirically. The aim of this study was to identify clinical variables and/or pulmonary function variables able to predict the scale of patients’ response to SIC. Material and methods All patients who underwent SIC at our centre between 2005 and 2013 were studied. Anthropometric characteristics, atopic status, type of causal agent, latency times, pulmonary function tests and SIC results were analysed. Results Two hundred and one patients (51% men) were assessed, of whom 86 (43%) had positive SIC. In the patients with positive results, 29 (34%) were exposed to high molecular weight (HMW) agents and 57 (64%) to low molecular weight (LMW) agents. Patients with a positive SIC exposed to HMW agents had a higher fall in FEV1 after SIC compared with those exposed to LMW agents (p=0.036). The type of asthmatic reaction after SIC also differed between the groups (p=0.020). The logistic regression analysis showed that patients with a higher PC20 before SIC were less likely to have severe decreases in FEV1 after SIC after adjusting for potential confounders (OR=0.771, 95% CI 0.618 to 0.961, p=0.021). Conclusions The scale of the response to SIC is influenced mainly by the degree of bronchial hyper-responsiveness, regardless of whether the causative agent is HMW or LMW, or whether the response is early or late. AU - Hu C AU - Cruz M AU - Ojanguren I AU - de Homdedeu M AU - Gonzalez-Barcala F AU - Munoz X LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 140 IP - DP - 2017 Jan 01 TI - Primary respiratory and food allergy to mealworm PG - 600-603 AB - Mealworm (Tenebrio molitor L.) has great potential as a new sustainable protein and is currently introduced in commercially available burgers in a number of European countries. Recently, we showed there is risk of mealworm allergy in the majority of patients with shrimp allergy.1 Here we address the risk of mealworm sensitization and allergy in subjects without shrimp allergy. We evaluated primary sensitization in mice (C3H/HeOuJ) and allergy in 4 domestic and professional mealworm breeders with allergic symptoms on occupational exposure or ingestion. Mealworm (Tenebrio molitor L.) has great potential as a new sustainable protein and is currently introduced in commercially available burgers in a number of European countries. Recently, we showed there is risk of mealworm allergy in the majority of patients with shrimp allergy.1 Here we address the risk of mealworm sensitization and allergy in subjects without shrimp allergy. We evaluated primary sensitization in mice (C3H/HeOuJ) and allergy in 4 domestic and professional mealworm breeders with allergic symptoms on occupational exposure or ingestion. Mealworm or shrimp extract in PBS (20 mg of protein) with 10 mg of cholera toxin (CT; List Biological Laboratories, Campbell, Calif) was administered by means of gavage. Control animals received PBS and CT only. Sensitization profiles (specific IgE [sIgE], immunoblot, and the basophil activation test [BAT]), allergens involved (liquid chromatography–mass spectrometry) and the development of clinical allergy to shrimp (open food challenge) and mealworm (double-blind, placebo-controlled food challenger [DBPCFC]) were investigated (for details, see the Methods section in this article’s Online Repository at www.jacionline.org). The study was approved by the local ethics committee (NL43731.041.13). Mealworm induced extract–specific IgG1 in 3 of 6 animals and extract-specific IgE in 2 of 6 animals (Fig 1). Shrimp led to the induction of extract-specific IgG1 and IgE in 5 of 6 animals, illustrating the potency of both extracts to induce primary sensitization. We used a model previously described by Bowman and Selgrade,2 which is known to successfully differentiate between known allergenic proteins (eg, Ara h 1 and b-lactoglobulin) and low/nonallergenic proteins (eg, gelatin and beef tropomyosin) in C3H/HeOuJ mice. All 4 human subjects had mealworm allergy during professional or domestic mealworm breeding. The 2 professional breeders had symptoms of inhalant allergy when entering the mealworm rearing room. They sporadically consumed mealworms in small amounts without symptoms (2-5 years of exposure and sporadic ingestion of ;1 g of mealworm per serving). One of the domestic breeders (subject 4) had rhinoconjunctivitis after 2 years of exposure, which progressed to dyspnea after starting domestic rearing. Both domestic breeders consumed higher amounts of mealworm than the professional farmers and encountered progressive food-induced allergic symptoms when eating mealworm (7-9 years of exposure and 10-50 g of mealworm per serving on 5-10 occasions); anaphylaxis did not occur. None reported shrimp or any other food allergy. Only subject 4 had mild rhinoconjunctivitis to house dust mite (HDM) and birch pollen (Fig 2 and see Table E1 in this article’s Online Repository at www.jacionline.org). All 4 were sensitized to mealworm in CAP tests, skin prick tests (SPTs; Fig 2), and BATs. Only subject 2 showed minor sensitization with no clinical allergy to shrimp. Although all subjects were sensitized to some common inhalant allergens (tree and grass pollen and animal dander), titers were very low (see Table E1). Immunoblotting showed that IgE from all subjects bound to similar proteins in mealworm, although with different intensities (Fig 1). When comparing the subjects with a reported respiratory allergy to mealworm (subjects 1 and 2) with those with food allergy (subjects 3 and 4), on the immunoblot of subject 3, additional 15-kDa and 10-kDa proteins were observed in the immunoblot of subject 4. All subjects had a negative oral food challenge result for shrimp, and only subject 3 and 4 had positive DBPCFC results for mealworm. Because 3 of our subjects had higher sIgE levels to mealworm than to any other food or inhalant allergen, mealworm might be the primary sensitizer. Although subject 4 showed slightly higher HDM sensitization compared with mealworm sensitization, this subject had IgE to Der p 1 and 2 (fecal components), but not Der p 10 (tropomyosin) and arginine kinase, which makes cross-reactivity to HDM less likely. Furthermore, immunoblots from patients with shrimp allergy1 showed different binding patterns compared with those from the 4 primary patients with mealworm allergy, and their basophil activation to mealworm was stronger than for shrimp (see Fig E1 in this article’s Online Repository at www.jacionline.org). Because levels of sIgE to shrimp and HDM were low, inhibition studies were not feasible. However, a role for shrimp as a sensitizer was unlikely because results of food challenges with shrimp were negative. The 2 subjects with food allergy had higher sIgE levels to mealworm, consumed larger amounts of mealworm (up to c50 g per meal), and were exposed for a longer period of time (7-9 years) than the 2 subjects with respiratory allergy (c1 g of mealworm and 2-5 years of exposure). This might suggest that occupational exposure for longer periods or oral exposure with higher doses are required for development of mealworm allergy. In line with our study, long occupational exposure resulted in respiratory allergy to mealworm, green bottle fly, and waxmoth.3,4 For both mice and human subjects, IgE binding was shown to known allergens, such as tropomyosin, arginine kinase, and the myosin light and heavy chains (see Tables E2 and E3 in this article’s Online Repository at www.jacionline.org). Additionally,both mouse and human IgE recognized 3 new allergens with convincingly high scores and high sequence coverage (c90%). They were identified as highly the homologous (>88% sequence identity) mealworm larval cuticle proteins (LCPs) A1A, A2B, and A3A. IgE binding to LCP A1A was confirmed in 3 of the 4 subjects by using immunoblotting (see Fig E2 in this article’s Online Repository at www.jacionline.org). LCPs might be the dominant allergens in primary mealworm allergy, which is in contrast to cross-reactive mealworm allergy, where the panallergens tropomyosin, arginine kinase, and myosin heavy chain were dominant.1 LCPs have not been previously identified as allergens in insects or crustaceans. LCPs are proteins from the mealworm with a conserved domain in arthropod cuticles known as R&R consensus, and they bind chitin.5 The chitin-binding complex links the soft internal tissue to the exoskeleton of the larvae. LCPs from mealworm are most likely both inhalant and food allergens since they were identified (in the Methods section in this article’s Online Repository at www.jacionline.org) in subjects with respiratory as well as food allergy to mealworm. In conclusion, mealworm exposure can lead to primary sensitization in both a mouse model and human subjects and can result in both food and inhalant allergy. LCPs might be major allergens in patients with mealworm allergy. AU - Broekman HCHP AU - Knulst AC AU - Jager CFH AU - Bilsen JHM AU - Raymakers FML AU - Kruizinga RAG AU - Gaspari M AU - Gabriele PC AU - Bruijnzeel-Koomen PCAFM AU - Houben GF AU - Verhoeckx KCM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - IP - DP - 2017 Jan 01 TI - An Official American Thoracic Society Workshop Report: Presentations and Discussion of the Sixth Jack Pepys Workshop on Asthma in the Workplace PG - AB - The Sixth Jack Pepys Workshop on Asthma in the Workplace focused on six key themes regarding the recognition and assessment of work-related asthma and airway diseases: (1) cleaning agents and disinfectants (including in swimming pools) as irritants and sensitizers: how to evaluate types of bronchial reactions and reduce risks; (2) population-based studies of occupational obstructive diseases: use of databanks, advantages and pitfalls, what strategies to deal with biases and confounding?; (3) damp environments, dilapidated buildings, recycling processes, and molds, an increasing problem: mechanisms, how to assess causality and diagnosis; (4) diagnosis of occupational asthma and rhinitis: how useful are recombinant allergens (component-resolved diagnosis), metabolomics, and other new tests?; (5) how does exposure to gas, dust, and fumes enhance sensitization and asthma?; and (6) how to determine probability of occupational causality in chronic obstructive pulmonary disease: epidemiological and clinical, confirmation, and compensation aspects. A summary of the presentations and discussion is provided in this proceedings document. Increased knowledge has been gained in each topic over the past few years, but there remain aspects of controversy and uncertainty requiring further research. AU - Tarlo SM AU - Malo J AU - de Blay F AU - Moual NL AU - Henneberger P AU - Heederik D AU - Raulf M AU - Carlsten C AU - and Cartier A AU - LA - PT - DEP - TA - Annals ATS JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 67 IP - DP - 2017 Jan 01 TI - Occupational rhinoconjunctivitis caused by the common indoor plant, Hoya compacta PG - 490-492 AB - Background Allergic reactions to the common house plant Hoya compacta (HC) have not previously been described. Aims To confirm HC as the cause of rhinoconjunctivitis in three horticultural workers. Methods Greenhouse working conditions were reproduced in our challenge chamber. Results All three cases developed rhinoconjunctivitis when working with HC plants. A control challenge was performed in two cases with iceberg lettuce causing no symptoms. Nasal volume measured by acoustic rhinometry (AR) fell after all three active challenges, but also after one of the control challenges. Conclusions Our study confirms that HC may cause occupational rhinoconjunctivitis and asthma through a Type I hypersensitivity reaction. Specific inhalation challenges, nasal nitric oxide measurement and AR may be useful additional tools in supporting such diagnoses for occupational physicians to consider. AU - Sherson D AU - Nielsen AD AU - Mortz CG AU - Vestergaard L AU - Brandt LPA AU - Jørs E AU - Bælum J LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 67 IP - DP - 2017 Jan 01 TI - Comparison of clinic models for patients with work-related asthma PG - 477-483 AB - Background Work-related asthma (WRA) is a prevalent occupational lung disease that is associated with undesirable effects on psychological status, quality of life (QoL), workplace activity and socioeconomic status. Previous studies have also indicated that clinic structure may impact outcomes among patients with asthma. Aims To identify the impact of clinic structure on psychological status, QoL, workplace limitations and socioeconomic status of patients with WRA among two different tertiary clinic models. Methods We performed a cross-sectional analysis between two tertiary clinics: clinic 1 had a traditional referral base and clinical staffing while clinic 2 entirely comprised Worker’s Compensation System referrals and included an occupational hygienist and a return-to-work coordinator. Beck Anxiety and Depression II Inventories (BAI and BDI-II), Marks’ Asthma Quality of Life Questionnaire (M-AQLQ) and Work Limitation Questionnaire (WLQ) were used to assess outcomes for patients with WRA. Results Clinic 2 participants had a better psychological status across the four instruments compared with clinic 1 (for Beck ‘Anxiety’: P < 0.001 and ‘Depression’: P < 0.01, ‘Mood’ domain of M-AQLQ: NS and ‘Mental Demands’ domain of WLQ: P < 0.01). Clinic 2 had a greater proportion of participants with reduced income. Conclusions Our study indicates that clinic structure may play a role in outcomes. Future research should examine this in larger sample sizes. AU - Lipszyc JC AU - Silverman F AU - Holness DL AU - Liss GM AU - Lavoie KL AU - Tarlo SM LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 229 IP - DP - 2017 Jan 01 TI - Phthalate esters and childhood asthma: A systematic review and congener-specific meta-analysis PG - 655-660 AB - Introduction Exposure to phthalate esters (PAEs) has been associated with childhood asthma, but the congener-specific effects of PAEs on childhood asthma were unclear. We aimed to systematically review and meta-analyze observational studies on the associations between specific effects of PAEs and the risk of childhood asthma. Material and methods Relevant studies were identified by searching three databases up to October 20, 2016. The reference lists of the retrieved articles were also reviewed. We included observational studies that reported risk estimates with 95% confidence intervals (CIs) for the associations between phthalate exposure and the risk of childhood asthma. Fixed-effects models were generally applied to calculate pooled risk estimates. When heterogeneity was present, random-effects models were applied. Results A total of nine studies featuring 43 data points were included in our final meta-analyses. Results indicated that the benzyl butyl phthalate (BBzP) exposure had a significant association with the risk of childhood asthma. The Odd Ratios (ORs) were from 1.39 to 1.41 for different combination strategies. Subgroup analyses by different exposure period or samples used showed that prenatal exposure to BBzP had a stronger association with the risk of childhood asthma (OR = 1.38, 95% CI = 1.09–1.75), compared to those with postnatal exposure. Besides, the association was evident when the phthalate exposure was measured from dust samples. The OR for the associations between di-2-ethylhexyl phthalate (DEHP) in dust and childhood asthma was 2.71 (95% CI = 1.39–5.28), and 2.08 (95% CI = 1.10–3.92) for BBzP. Conclusions Our study suggested a positive association between DEHP and BBzP exposure and childhood asthma. Future studies are warranted to identify the underlying mechanisms of the association. AU - Li M AU - Chen C AU - Guo YL LA - PT - DEP - TA - Environmental pollution JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 59 IP - DP - 2017 Jan 01 TI - Distinct Clinical Phenotypes of Occupational Asthma due to Diisocyanates PG - 539-542 AB - Objective: To assess whether diisocyanate occupational asthma represents a unique phenotype. Methods: We studied 187 patients with diagnosis of asthma due to diisocyanates confirmed by a positive specific inhalation challenge. The simplified algorithm from severe asthma research program (SARP) (Moore et al, 2010) was applied to classify patients into five clusters. Results: Our patients were allocated in three of the five clusters described in common asthma, since the most severe Clusters (4 and 5) were not represented. Cluster 2 was the most populated, as in common asthma, and included the youngest patients with the shortest duration of exposure to the sensitizers. Cluster 3 included older men patients with worse lung function and longer occupational exposure. Conclusions: Diisocyanate asthma is a heterogeneous disease. Differences across clusters include demographic characteristics, lung function, and chronology of diisocyanate exposure. AU - Mason P AU - Scarpa AU - MC AU - Liviero F AU - Guarnieri G AU - Maestrelli AU - P LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 53 IP - DP - 2017 Jan 01 TI - Non-IgE-Mediated Asthma after Zinc Exposure PG - 346-347 AB - Various metals have been described as causing occupational asthma (OA), mostly chromium, nickel, and cobalt. The mechanism of action by which these metals can produce OA is generally immunological, either IgE-mediated or not.1,2To date, only 2 cases of OA caused by zinc have been described, and in both cases, an IgE-dependent mechanism was involved in the pathogenesis of the disorder.We describe, for the first time, a worker exposed to zinc who developed OA via a non-IgE-mediated immunological mechanism. Our patient was a 30-year-old man, former smoker of 5 pack-years, whose only clinical history consisted of a diagnosis of bronchial asthma in childhood, which had remitted, and for which he had not required treatment for 15 years. He had been working for 4 years as an industrial mechanic, making metal parts, and was in regular contact with copper, cadmium, zinc, and manganese dust. The patient consulted due to a 5-month history of cough, expectoration, wheezing, and dyspnoea. Symptoms appeared some time after start of exposure and improved during the weekends and periods of sick leave. He had had to attend the emergency department on 5 occa-sions since the onset of symptoms. Chest radiograph was normal. Clinical laboratory tests showed a total IgE of 140 kU/l. Skin tests for airborne allergens were positive for house dust mites, while contact skin tests for metal, including nickel sulfate, potassium dichromate, cadmium, cobalt chloride, and zinc 2.5%, were negative. Forced spirometry showed FVC 6360 ml (112%), FEV14390 ml (98%), andFEV1/FVC 69%. A methacholine challenge was positive with a PC20of4 mg/ml. A provocation test was performed, according to standard methodology for testing metals,1,5for which concentrations of 0.1 mg/ml, 1 mg/ml, and 10 mg/ml of zinc sulfate were prepared. The 0.1 mg/ml solution was nebulized for a total of 5 min, split into periods of 1, 2, and 2 min. Four hours after exposure, a 23% reduction in FEV1from baseline was observed (Fig. 1), along with cough, wheezing, and dyspnoea. These symptoms abated after administration of a ß2 agonist. Ten hours after exposure, the patient presented the same symptoms, with a 29% reduction in FEV1, requiring administration of intravenous corticosteroids in addition to ß2 agonist, and a 12-h stay in the emergency department AU - Leal A AU - Caselles I AU - Rodriguez-Bayarri MJ AU - Muñoz X LA - PT - DEP - TA - Archivos de Bronconeumología (English Edition JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 72 IP - DP - 2017 Jan 01 TI - Work productivity in rhinitis using cell phones: The MASK pilot study PG - 1475-1484 AB - Allergic rhinitis often impairs social life and performance. The aim of this cross-sectional study was to use cell phone data to assess the impact on work productivity of uncontrolled rhinitis assessed by visual analogue scale (VAS). A mobile phone app (Allergy Diary, Google Play Store and Apple App Store) collects data from daily visual analogue scales (VAS) for overall allergic symptoms (VAS-global measured), nasal (VAS-nasal), ocular (VAS-ocular) and asthma symptoms (VAS-asthma) as well as work (VAS-work). A combined nasal-ocular score is calculated. The Allergy Diary is available in 21 countries. The app includes the Work Productivity and Activity Impairment Allergic Specific Questionnaire (WPAI:AS) in six EU countries. All consecutive users who completed the VAS-work from 1 June to 31 October 2016 were included in the study. A total of 1136 users filled in 5818 days of VAS-work. Symptoms of allergic rhinitis were controlled (VAS-global <20) in approximately 60% of the days. In users with uncontrolled rhinitis, approximately 90% had some work impairment and over 50% had severe work impairment (VAS-work >50). There was a significant correlation between VAS-global calculated and VAS-work (Rho=0.83, P<0.00001, Spearman's rank test). In 144 users, there was a significant correlation between VAS-work and WPAI:AS (Rho=0.53, P<0.0001). This pilot study provides not only proof-of-concept data on the work impairment collected with the app but also data on the app itself, especially the distribution of responses for the VAS. This supports the interpretation that persons with rhinitis report both the presence and the absence of symptoms. AU - Bousquet J AU - Bewick M AU - Arnavielhe S AU - Mathieu-Dupas E AU - Murray R AU - Bedbrook A AU - Caimmi DP AU - Vandenplas O AU - Hellings PW AU - Bachert C AU - Anto JM AU - Bergmann KC AU - Bindslev-Jensen C AU - Bosnic-Anticevich S AU - Bouchard J AU - Canonica GW AU - Chavannes NH AU - Cruz AA AU - Dahl R AU - Demoly P AU - De Vries G AU - Devillier P AU - Fink-Wagner A AU - Fokkens WJ AU - Fonseca J AU - Guldemond NA AU - Haahtela T AU - Hellqvist-Dahl B AU - Just J AU - Keil T AU - Klimek L AU - Kowalski ML AU - Kuna P AU - Kvedariene V AU - Laune D AU - Larenas-Linnemann D AU - Mullol J AU - Pereira AM AU - Carreiro-Martins P AU - Melén E AU - Morais-Almeida M AU - Nogueira-Silva L AU - OHehir RE AU - Papadopoulos NG AU - Passalacqua G AU - Portejoie F AU - Price D AU - Ryan D AU - Samolinski B AU - Sheikh A AU - Simons FER AU - Spranger O AU - Todo Bom A AU - Tomazic PV AU - Triggiani M AU - Valero A AU - Valovirta E AU - Valiulis A AU - van Eerd M AU - Wickman M AU - Young I AU - Zuberbier T LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 72 IP - DP - 2017 Jan 01 TI - Prevalence of type I sensitization to alpha-gal in forest service employees and hunters PG - 1540-1547 AB - Background The production of IgE molecules specific to the carbohydrate galactose-a-1,3-galactose (alpha-gal) is known to induce delayed anaphylaxis against mammalian meat. Tick bites constitute the primary sensitization source, as ticks transfer alpha-gal in their saliva to a host during a bite. The reported prevalence of alpha-gal-specific IgE (alpha-gal-sIgE) positivity varies between different populations from diverse geographic regions. Objective To investigate the prevalence of alpha-gal-sIgE positivity in a population of forest service employees who are highly exposed to ticks in comparison with a residential population and a historic sample. Methods A cross-sectional study evaluating 300 forest service employees and hunters from southwest Germany was performed. Alpha-gal-sIgE levels were assessed by ImmunoCAP assay. The prevalence of alpha-gal-sIgE-positive individuals was compared with a matched cohort composed of a residential population and blood samples from forest service employees collected 15 years ago. Results In the study population, the prevalence of alpha-gal-sIgE-positive (=0.10 kUA/L) individuals was 35.0%, whereas the prevalence of individuals with alpha-gal-sIgE levels =0.35 kUA/L was 19.3%. Alpha-gal-sIgE positivity was associated with total IgE levels and recent tick bites. Mammalian meat-induced delayed anaphylaxis was found in 8.6% of the participants with alpha-gal-sIgE levels =0.35 kUA/L. For forest service employees and hunters, the odds ratio for alpha-gal-sIgE positivity was 2.48 compared to the residential population. The prevalence of alpha-gal-sIgE positivity in the current and historic cohort was comparable. Conclusion Forest service employees and hunters compose a population with a high prevalence of alpha-gal-sIgE positivity and carry a considerable risk of red meat allergy. AU - Fischer J AU - Lupberger E AU - Hebsaker J AU - Blumenstock G AU - Aichinger E AU - Yazdi AS AU - Reick D AU - Oehme R AU - Biedermann T LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 50 IP - DP - 2017 Jan 01 TI - Occupational exposure to disinfectants and asthma control in US nurses PG - 1700237 AB - Disinfectant use has been associated with adverse respiratory effects among healthcare workers. However, the specific harmful agents have not been elucidated. We examined the association between occupational exposure to disinfectants and asthma control in the Nurses' Health Study II, a large cohort of female nurses. Nurses with asthma were invited in 2014 to complete two questionnaires on their current occupation and asthma (response rate 80%). Asthma control was defined by the Asthma Control Test (ACT). Exposure to major disinfectants was evaluated by a job–task–exposure matrix (JTEM). Analyses included 4102 nurses with asthma (mean age 58 years). Asthma control was poor (ACT score 16–19) in 12% of nurses and very poor (ACT score =15) in 6% of nurses. Use of disinfectants to clean medical instruments (19% exposed) was associated with poorly (OR 1.37; 95% CI 1.05–1.79) and very poorly (OR 1.88, 95% CI 1.38–2.56) controlled asthma (ptrend=0.004, after adjustment for potential confounders). Using JTEM estimates, exposure to formaldehyde, glutaraldehyde, hypochlorite bleach, hydrogen peroxide and enzymatic cleaners was associated with poor asthma control (all ptrend<0.05); exposure to quaternary ammonium compounds and alcohol was not. Use of several disinfectants was associated with poor asthma control. Our findings suggest targets for future efforts to prevent worsening of asthma control in healthcare workers AU - Dumas O AU - Wiley AS AU - Quinot C AU - Varraso R AU - Zock J AU - Henneberger PK AU - Speizer FE AU - Moual NL AU - Camargo CA LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 21 IP - DP - 2017 Jan 01 TI - FeNO levels increase with degree of sensitisation in apprentices at risk of occupational asthma PG - 1194-1200 AB - BACKGROUND: Atopy has emerged as a major determinant of airway inflammation. OBJECTIVE: To examine whether early markers of occupational asthma increase with degree of sensitisation. METHOD: This study was a prospective follow-up study of apprentices in baking, pastry-cooking and hairdressing during their 2-year apprenticeship. Four visits were conducted to administer a standardised questionnaire, a methacholine challenge test to assess bronchial hyperresponsiveness (BHR) and to measure fractional exhaled nitric oxide (FeNO). Degree of sensitisation was estimated based on the number of positive skin prick tests (SPTs) for 12 common allergens. Mixed-effect models were applied to examine the association between the degree of sensitisation and FeNO levels, BHR and eosinophilic status (more than 3% of cells in nasal lavage fluid). RESULTS: Of the 441 apprentices who agreed to take part in the study, 417 had at least one SPT session providing usable results. Degree of sensitization was related to BHR and FeNO levels. Compared to non-sensitised subjects, FeNO levels were 83% higher (P < 0.01) in highly sensitised subjects and 30% higher (P < 0.01) in weakly sensitised subjects. However, the degree of sensitisation was not predictive of the evolution of these markers. CONCLUSION: Degree of sensitisation is related to early markers of airway AU - Wild P AU - Méve H AU - Penven E AU - Zmirou-Navier D AU - Barbaud A AU - Bohadana A AU - Paris C LA - PT - DEP - TA - Int J Tuberc Lung Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 47 IP - DP - 2017 Jan 01 TI - Allergic sensitization to laboratory animals is more associated with asthma, rhinitis, and skin symptoms than sensitization to common allergens PG - 1436-1444 AB - Background Workers exposed to laboratory animals have a high risk of developing laboratory animal allergy (LAA). Atopy seems to be the main risk factor for LAA. We hypothesized that occupational sensitization is a better predictor for the development of asthma, rhinitis, and bronchial hyperresponsiveness (BHR) than common sensitization. Objective To investigate the association between occupational sensitization to laboratory animals and clinical outcomes. Methods This was a cross-sectional study performed at two universities on students and employees dealing with small rodents. The subjects were allocated in groups: non-sensitized, common sensitization, or occupational sensitization, according to the results of the skin prick test (SPT). All subjects answered a questionnaire about animal exposures, symptoms, allergic diseases, and underwent spirometry and bronchial challenge test with mannitol. Multivariate analysis was performed using Poisson regression to estimate the prevalence ratio (PR). Results Data from 453 volunteers were analysed. Non-sensitized group comprised 237 subjects; common sensitization group, 142 subjects; and occupational sensitization group, 74 subjects. Occupational sensitization was associated with greater risk for all outcomes studied. When the common sensitization group was reference, skin symptoms had PR of 1.36, 95% confidence interval (CI): 1.01-1.85; wheezing had PR of 1.75, CI 95%: 1.21-2.53; rhinitis had PR of 1.25, 95%: 1.11-1.40; nocturnal dyspnoea had PR of 2.40, 95% CI: 1.31-4.40; bronchial hyperresponsiveness (BHR) had PR of 2.47, 95% CI: 1.50-4.09; and confirmed asthma had PR of 2.65, 95% CI: 1.45-4.85. In addition, the overlap of asthma, rhinitis, and skin symptoms in a same subject was significantly more prevalent in the occupational sensitization group, 16.2% versus 4.9% in the common sensitization group. Conclusion and Clinical Relevance Occupational sensitization is associated with allergic symptoms and respiratory diseases. SPT with occupational allergens along with other parameters may contribute to detection of risk for allergic and respiratory diseases associated with exposure to laboratory animals. AU - Simoneti CS AU - Ferraz E AU - de Menezes MB AU - Bagatin E AU - Arruda LK AU - Vianna EO LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 72 IP - DP - 2017 Jan 01 TI - Occupational pesticide exposure and respiratory health: a large-scale cross-sectional study in three commercial farming systems in Ethiopia PG - 522-529 AB - Rationale In the last decade, due to expansion of greenhouses and irrigated farms, the use of pesticides in Ethiopia has increased 6–13-fold leading to potential health risks. Objective To investigate if occupational exposure to pesticides is associated with respiratory health effects in farmers and farm workers from commercial farming systems. Methods We performed two cross-sectional surveys comprising different farming systems. In the first survey we studied respiratory symptoms among 1104 subjects of which 601 were occupationally exposed to pesticides (ie, 256 pesticide applicators, 345 re-entry workers) and 503 unexposed individuals. The second survey, carried out 2 years later in the same farming regions, additionally included lung function measurement and comprised a total of 387 study subjects of which 206 were occupationally exposed to pesticides (142 applicators and 64 re-entry workers) and 180 unexposed individuals. Results We observed increased risks for chronic cough and shortness of breath (OR=3.15, 95% CI 1.56 to 6.36 and OR=6.67, 95% CI 2.60 to 17.58) among the exposed subjects as compared with unexposed individuals in the first survey. These results were corroborated in the second survey where we also observed reductions in FEV1 (140 mL), forced expiratory flow 25%–75% (550 mL/s) and risk of FEV1/FVC ratio <0.8 (OR=4.31, 95% CI 2.11 to 8.81) among pesticide exposed workers. Conclusions These findings indicate an increased risk of adverse respiratory health among workers exposed to pesticides. As those effects occurred in young workers (mean age 27 years) and within a relative short duration of exposure (4 years) implementation of stringent occupational health measures are warranted. AU - Negatu B AU - Kromhout H AU - Mekonnen Y AU - Vermeulen R LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 74 IP - DP - 2017 Jan 01 TI - Association of household cleaning agents and disinfectants with asthma in young German adults. PG - 652-658 AB - OBJECTIVES: We scrutinised the association of private use of household sprays and disinfectants with asthma incidence in young adults in the transition from school to working life. METHODS: Between 2007 and 2009,2051 young adults aged 19-24 years living in two major German cities took part in the Study on Occupational Allergy Risks II. Self-reported exposure to household sprays and disinfectants was characterised according to a composite score for frequency of use as no use (score=0), low use (score between 1 and the median), medium use (score between the median and the 90th percentile) and high use (score above the 90th percentile). Two outcome variables (current asthma and current wheezing) with four mutually exclusive categories (never, incident, persistent and remittent) were used for the risk analyses. Multinomial logistic regression models examined the association between the frequency of using household sprays and disinfectants with asthma and wheezing adjusting for potential confounders. RESULTS: Compared with no use, high use of disinfectants was associated with a more than twofold increased odds of incident asthma (OR 2.79, 95% CI 1.14 to 6.83). In addition, low/medium use of disinfectants was associated with remittent asthma (OR 2.39, 95%?CI 1.29 to 4.47). The evidence for an association between high usage of household sprays and asthma incidence was weak (OR 2.79, 95%?CI 0.84 to 9.20). CONCLUSION: Our results support the hypothesis of an association between the use of cleaning products and elevated risks for asthma and wheezing in young adults at the start of working life. AU - Weinmann T AU - Gerlich J AU - Heinrich S AU - Nowak D AU - Mutius EV AU - Vogelberg C AU - Genuneit J AU - Lanzinger S AU - Al-Khadra S AU - Lohse T AU - Motoc I AU - Walter V AU - Radon K. LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 74 IP - DP - 2017 Jan 01 TI - Occupational allergy to fruit flies (Drosophila melanogaster) in laboratory workers PG - 422-425 AB - Objectives Drosophila melanogaster (the ‘fruit fly’) is commonly used in genetic research, but there is only one report of IgE-associated allergy in exposed workers. 4 newly identified cases prompted us to examine the extent of this problem in a university laboratory. Our aim in this study is to determine the prevalence and determinants of sensitisation to fruit flies in a population of exposed workers. Methods In a cross-sectional study, we surveyed 286 employees working in a department carrying out research involving D. melanogaster. Sensitisation was assessed by specific IgE measurement in serum and examined in relation to symptoms and to estimated exposure to fruit flies. Results The overall prevalence of specific sensitisation was 6% with a clear relationship to increasing frequency/intensity of exposure (p trend<0.001). Work-related eye/nose, chest or skin symptoms were reported by substantial proportions of participants but for most of these there was no evidence of specific sensitisation to fruit fly. The overall prevalence of any work-related symptoms and sensitisation was 2.4%, rising to 7.1% in those working in high exposure groups. Conclusions We were able to demonstrate, for the first time, a clear exposure–response relationship between fruit fly exposure and specific sensitisation. Facilities housing fruit flies should carefully consider methods to reduce exposure levels in the workplace. AU - Jones M AU - Blair S AU - MacNeill S AU - Welch J AU - Hole A AU - Baxter P AU - Cullinan P LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 67 IP - DP - 2017 Jan 01 TI - Occupational asthma caused by acrylic compounds from SHIELD surveillance (1989–2014) PG - 282-289 AB - Background Acrylic monomers (acrylates), methacrylates and cyanoacrylates all cause asthma by respiratory sensitization. Occupational inhalation exposures occur across a variety of industries including health care and dental work, beauty, laboratory science, assembly and plastic moulding. Aims To examine notifications of occupational asthma caused by acrylic compounds from a UK-based regional surveillance scheme, in order to highlight prevalent exposures and trends in presentation. Methods Retrospective review of all cases reported to the SHIELD surveillance scheme for occupational asthma, West Midlands, UK between 1989 and 2014. Patient data were gathered on demographics, employment, asthma symptoms and diagnostic investigations including serum immunological testing, serial peak flow analysis and specific inhalation challenge tests. Descriptive statistics were used to illustrate worker characteristics and evidence for sensitization to acrylic compounds. Results There were 20 affected patients out of 1790 total cases of occupational asthma (1%); all cases were confirmed by OASYS (Occupational Asthma SYStem) analysis of serial peak flow measurements, with three additional positive specific inhalation challenge tests. Three out of 20 (15%) patients were current smokers and 11/20 (55%) were atopic. A variety of exposures and industries were implicated including: manufacturing, health care, beauty and printing and a novel presentation seen in teachers exposed to floor adhesives. Conclusions This is the largest reported series of occupational asthma caused by acrylic compounds, which remain an important aetiological factor in this disease. Exposure occurs in a variety of industries, particularly in manufacturing and is seen with other, perhaps better recognized sensitizing agents such as isocyanates and epoxy resins. AU - Walters GI AU - Robertson AS AU - Moore VC AU - Burge PS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 74 IP - DP - 2017 Jan 01 TI - Epidemiology of occupational hypersensitivity pneumonitis; reports from the SWORD scheme in the UK from 1996 to 2015 PG - 528-530 AB - Objective To estimate the reported incidence of occupational hypersensitivity pneumonitis (OHP) in the UK and to consider whether the pattern of attributed causation has changed over time. Methods All cases of OHP reported to the SWORD scheme between January 1996 and December 2015 were classified into 1 of 10 categories of the suspected agent. Cases were grouped into four 5-year time periods to examine any changing pattern in incidence or suspected causation. For each time period, the annual incidence was calculated using the estimated number of reported cases and the working population of the UK. Results Between 1996 and 2015, there were 202 actual cases of OHP reported to SWORD, equating to an estimated 818 cases, when adjusting for the sampling ratio. Over this period, the annual UK incidence was 1.4 per million workers. The mean (SD) age of reported cases was 52 (13) years, and cases were four-times more likely to be men than women. Over the study period, there was a fall in the proportion of cases reported to be due to agricultural exposures (44–12%), and an increase in cases due to metalworking fluids (MWFs, 2–45%). Conclusions Over the last 20 years, the incidence of OHP in the UK has been ~1–2 cases per million workers per year. Working with water-based MWFs is now the most commonly suspected causative exposure for OHP cases reported to the SWORD scheme in the UK. AU - Barber CM AU - Wiggans RE AU - Carder M AU - Agius R LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 67 IP - DP - 2017 Jan 01 TI - Unabated occupational risk in a patient with rheumatoid pulmonary fibrosis PG - 311-313 AB - Background This case highlights the importance of considering hypersensitivity pneumonitis (HP) in the differential diagnosis of interstitial lung disease (ILD) and of obtaining an occupational history so that remediable risk factors may be identified and managed. Aims To report a case of a chicken sexer with severe rheumatoid arthritis (RA) who developed progressively worsening dyspnoea and restrictive lung disease associated with pulmonary fibrosis. Methods Clinical investigation included physical examination, occupational history, pulmonary function tests (PFTs), chest imaging and bronchoalveolar lavage (BAL), as well as serological tests including standard IgE bird feather mixture and local IgG precipitin preparation to chicken excrement. Lung histopathology was examined post-mortem. Results The patient had worked as a chicken sexer for 29 years with limited control of exposure to chicken bioaerosols. PFTs initially showed mild restriction with a moderate gas transfer defect and computerized tomography of the chest exhibited extensive interstitial infiltrates throughout with severe honeycombing at the bases. Cytology from a BAL revealed multinucleated giant cells (MNGs). Specific serologic tests for bird antigens were negative. Histopathology demonstrated diffuse interstitial fibrosis with honeycombing, poorly formed granulomas and MNGs. Conclusions Findings were consistent with a diagnosis of HP with RA-associated ILD. The patient’s history of severe RA biased the diagnosis to one of RA-associated ILD and her occupational risk had been less emphatically addressed. Obtaining a thorough occupational history can uncover exposures to workplace respiratory hazards and may create opportunities for intervention to limit morbidity from chronic lung disease. AU - Holden VK AU - Kligerman SJ AU - Hastings TG AU - Hines SE LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 74 IP - DP - 2017 Jan 01 TI - Sensitising effects of genetically modified enzymes used in flavour, fragrance, detergence and pharmaceutical production: cross-sectional study PG - 39-45 AB - Objectives The use of genetically engineered enzymes in the synthesis of flavourings, fragrances and other applications has increased tremendously. There is, however, a paucity of data on sensitisation and/or allergy to the finished products. We aimed to review the use of genetically modified enzymes and the enormous challenges in human biomonitoring studies with suitable assays of specific IgE to a variety of modified enzyme proteins in occupational settings and measure specific IgE to modified enzymes in exposed workers. Methods Specific IgE antibodies against workplace specific individual enzymes were measured by the specific fluorescence enzyme-labelled immunoassay in 813 exposed workers seen in cross-sectional surveys. Results Twenty-three per cent of all exposed workers showed type I sensitisation with IgE antibodies directed against respective workplace-specific enzymes. The highest sensitisation frequencies observed were for workers exposed enzymes derived from a-amylase (44%), followed by stainzyme (41%), pancreatinin (35%), savinase (31%), papain (31%), ovozyme (28%), phytase (16%), trypsin (15%) and lipase (4%). The highest individual antibody levels (up to 110 kU/L) were detected in workers exposed to phytase, xylanase and glucanase. In a subgroup comprising 134 workers, detailed clinical diagnostics confirmed work-related symptoms. There was a strong correlation (r=0.75, p<0.0001) between the symptoms and antibody levels. Workers with work-related respiratory symptoms showed a higher prevalence for the presence of specific IgE antibodies against workplace-specific enzymes than asymptomatic exposed workers (likelihood ratio 2.32, sensitivity 0.92, specificity 0.6). Conclusions Our data confirm the previous findings showing that genetically engineered enzymes are potent allergens eliciting immediate-type sensitisation. Owing to lack of commercial diagnostic tests, few of those exposed receive regular surveillance including biomonitoring with relevant specific IgE assays. AU - Budnik LT AU - Scheer E AU - Burge PS AU - Baur X LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 74 IP - DP - 2017 Jan 01 TI - Development of a job-task-exposure matrix to assess occupational exposure to disinfectants among US nurses PG - 130-137 AB - Objectives Occupational exposure to disinfectants is associated with work-related asthma, especially in healthcare workers. However, little is known about the specific products involved. To evaluate disinfectant exposures, we designed job-exposure (JEM) and job-task-exposure (JTEM) matrices, which are thought to be less prone to differential misclassification bias than self-reported exposure. We then compared the three assessment methods: self-reported exposure, JEM and JTEM. Methods Disinfectant use was assessed by an occupational questionnaire in 9073 US female registered nurses without asthma, aged 49–68 years, drawn from the Nurses' Health Study II. A JEM was created based on self-reported frequency of use (1–3, 4–7 days/week) of 7 disinfectants and sprays in 8 nursing jobs. We then created a JTEM combining jobs and disinfection tasks to further reduce misclassification. Exposure was evaluated in 3 classes (low, medium, high) using product-specific cut-offs (eg, <30%, 30–49.9%, =50%, respectively, for alcohol); the cut-offs were defined from the distribution of self-reported exposure per job/task. Results The most frequently reported disinfectants were alcohol (weekly use: 39%), bleach (22%) and sprays (20%). More nurses were classified as highly exposed by JTEM (alcohol 41%, sprays 41%, bleach 34%) than by JEM (21%, 30%, 26%, respectively). Agreement between JEM and JTEM was fair-to-moderate (? 0.3–0.5) for most disinfectants. JEM and JTEM exposure estimates were heterogeneous in most nursing jobs, except in emergency room and education/administration. Conclusions The JTEM may provide more accurate estimates than the JEM, especially for nursing jobs with heterogeneous tasks. Use of the JTEM is likely to reduce exposure misclassification. AU - Quinot C AU - Dumas O AU - Henneberger PK AU - Varraso R AU - Wiley AS AU - Speizer FE AU - Goldberg M AU - Zock JP AU - Camargo Jr CA AU - Le Moual N LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 72 IP - DP - 2017 Jan 01 TI - Histologist's original opinion compared with multidisciplinary team in determining diagnosis in interstitial lung disease PG - 280-281 AB - Guidelines recommend that multidisciplinary interstitial lung disease meeting (ILD MDT) decisions become the gold standard for diagnosis, replacing the histologist from this position, and identify this as requiring supportive evidence. We have compared diagnoses from lung biopsy material made by expert histologists with the subsequent consensus opinion from a properly constituted ILD MDT in 71 consecutive patients referred to a regional thoracic unit. MDT changed the original histological diagnoses in 30% (95% CI 19.3% to 41.6%) and strengthened the diagnoses from probable to confident in a further 17% (95% CI 9.1% to 27.7%). The assessment of hypersensitivity pneumonitis, non-necrotising granulomas and organising pneumonia accounted for the majority of the changes. AU - Burge PS AU - Reynolds J AU - Trotter S AU - Burge GA AU - Walters G LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 72 IP - DP - 2017 Jan 01 TI - Occupational respiratory allergy in peach crop workers. PG - 1556--1564 AB - BACKGROUND: Occupational respiratory diseases in workers of peach tree crops have been reported punctually and have been associated with sensitization to proteins present in both pollen and leaf tree. We report the study of 37 workers with respiratory symptoms related to occupational exposure to peach trees. METHODS: Prick tests and specific IgE determinations were performed with extracts from leaves and branches of peach tree. Immunodetection in leaf extract was realized by SDS-PAGE-immunoblotting with patient sera and rabbit serum anti-Pru p 3. Immunodetection inhibition was performed with rPru p 3 and pollen profilins. The clinical relevance of sensitization was demonstrated by specific bronchial challenge test (SBCT) with peach leaf extract. RESULTS: Most patients suffered symptoms when peach trees had leaves, specifically during thinning and harvesting fruit (rhinoconjunctivitis: 100% and asthma: 67.5%). Sensitization to leaf extract was demonstrated in 86% of patients. IgE-immunoblotting with peach leaf extract revealed in 6 patient sera a pair of bands of 10 and 16 kDa, and in 9 a 16 kDa band. Those bands could be two isoforms of peach leaf LTP, so the recognition frequency of some LTP isoform by our patient sera was 42%. 33% of the sera recognized a doubled band of about 14.5 kDa and this recognition was inhibited by nPho d 2. The SBCT with peach leaf extract was positive in the asthmatic sensitized patients tested. CONCLUSIONS: Sensitization to peach leaves was the cause of occupational respiratory symptoms in our patients. Some patient sera revealed IgE-binding proteins matching LTP and/or profilin. AU - Pérez-Calderón R AU - Gonzalo-Garijo MÁ AU - Rodríguez-Velasco FJ AU - Sánchez-Vega S AU - Bartolomé-Zavala B. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 7 IP - DP - 2017 Jan 01 TI - Association of respiratory symptoms and asthma with occupational exposures: findings from a population-based cross-sectional survey in Telemark, Norway. PG - e014018 AB - OBJECTIVES: The aim of this study was to estimate the prevalence of respiratory symptoms and physician-diagnosed asthma and assess the impact of current occupational exposure. DESIGN: Cross-sectional analyses of the prevalence of self-reported respiratory health and association with current occupational exposure in a random sample of the general population in Telemark County, Norway. SETTINGS: In 2013, a self-administered questionnaire was mailed to a random sample of the general population, aged 16-50, in Telemark, Norway. The overall response rate was 33%, comprising 16 099 responders. OUTCOME MEASURES: The prevalence for respiratory symptoms and asthma, and OR of respiratory symptoms and asthma for occupational groups and exposures were calculated. Occupational exposures were assessed using self-reported exposure and an asthma-specific job-exposure matrix (JEM). RESULTS: The prevalence of physician-diagnosed asthma was 11.5%. For the occupational groups, the category with agriculture/fishery workers and craft/related trade workers was associated with wheezing and asthma attack in the past 12 months, showing OR 1.3 (1.1 to 1.6) and 1.9 (1.2 to 2.8), respectively. The group including technicians and associated professionals was also associated with wheezing OR 1.2 (1.0 to 1.3) and asthma attack OR 1.4 (1.1 to 1.9). The JEM data show that exposure to flour was associated with wheezing OR 3.2 (1.4 to 7.3) and woken with dyspnoea OR 3.5 (1.3 to 9.5), whereas exposures to diisocyanates, welding/soldering fumes and exposure to vehicle/motor exhaust were associated with dyspnoea OR 2.9 (1.5 to 5.7), 3.2 (1.6 to 6.4) and 1.4 (1.0 to 1.8), respectively. CONCLUSIONS: The observed prevalence of physician-diagnosed asthma was 11.5%. The 'manual' occupations were associated with respiratory symptoms. Occupational exposure to flour, diisocyanates, welding/soldering fumes and vehicle/motor exhaust was associated with respiratory symptoms in the past 12 months and use of asthma medication. However, prospective data are needed to confirm the observed associations. AU - Abrahamsen R AU - Fell AK AU - Svendsen MV AU - Andersson E AU - Torén K AU - Henneberger PK AU - Kongerud J. LA - PT - DEP - TA - BMJ Open JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 74 IP - DP - 2017 Jan 01 TI - Predicting occupational asthma and rhinitis in bakery workers referred for clinical evaluation. PG - 564-572 AB - BACKGROUND: Occupational allergic diseases are a major problem in some workplaces like in the baking industry. Diagnostic rules have been used in surveillance but not yet in the occupational respiratory clinic. OBJECTIVE: To develop diagnostic models predicting baker's asthma and rhinitis among bakery workers at high risk of sensitisation to bakery allergens referred to a specialised clinic. METHODS: As part of a medical surveillance programme, clinical evaluation was performed on 436 referred Dutch bakery workers at high risk for sensitisation to bakery allergens. Multivariable logistic regression analyses were developed to identify the predictors of onset of baker's asthma and rhinitis using a self-administered questionnaire and compared using a structured medical history. Performance of models was assessed by discrimination (area under the receiver operating characteristics curve) and calibration (Hosmer-Lemeshow test). Internal validity of the models was assessed by a bootstrapping procedure. RESULTS: The prediction models included the predictors of work-related upper and lower respiratory symptoms, the presence of allergy and allergic symptoms, use of medication (last year), type of job, type of shift and working years with symptoms (=10 years). The developed models derived from both self-administered questionnaire and the medical history showed a relatively good discrimination and calibration. The internal validity showed that the models developed had satisfactory discrimination. To improve calibrations of models, shrinkage factors were applied to model coefficients. CONCLUSION: The probability of allergic asthma and rhinitis in referred bakers could be estimated by diagnostic models based on both a self-administered questionnaire and by taking a structured medical history. AU - Jonaid BS AU - Rooyackers J AU - Stigter E AU - Portengen L AU - Krop E AU - Heederik D. LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 118 IP - DP - 2017 Jan 01 TI - Occupational asthma caused by sensitization to a cleaning product containing triclosan, Antibac, (2,4,4’-trichloro-2’-hydroxydiphenyl ether), nurse, cleaner, PG - 370-371 AB - A recent consensus statement has highlighted the increased risk of developing asthma after exposure to workplace and domestic cleaning products. Specific cleaning agents, such as benzylalkonium chloride, have been recognized as causes of occupational asthma by sensitization and now comprise a significant burden of work-related asthma. European Respiratory Society guidelines recommend that sensitizer-induced occupational asthma should be diagnosed by identifying the workplace as the cause and confirming sensitization to an asthmagen by specific inhalation challenge (SIC) in the absence of any available specific IgE tests. We present the first case of occupational asthma caused by the biocide triclosan, commonly used in cleaning and personal care products. A 26-year-old woman presented with a 7-month history of cough, wheeze, and chest tightness that became progressively worse throughout the working week and better on days away from work. She required treatment with a symbicort inhaler, 400/12 mg twice a day. She had childhood eczema and asthma and previous anaphylaxis caused by peanuts at the age of 16 years. She had been employed as a nursery nurse for 12 months, caring for 30 children aged 2 to 3 years. Her work tasks involved mopping using 5% trisodium nitrilotriacetate (Versatile) cleaner daily and cleaning tables using liquid cleaner containing 0.05% triclosan (Antibac; pH 7.0). She used latex gloves and a gel containing 70% ethanol for hand cleaning (Proform, Gompels Healthcare Ltd, Melksham, United Kingdom). Clinical examination and chest radiographic findings were unremarkable, and spirometry results were normal (forced expiratory volume in 1 second [FEV1], 3.55 L [103% predicted]; forced vital capacity [FVC], 4.05 L [103% predicted]). Total IgE level was less than 2 kU/L, the results of testing for serum specific IgE to latex were negative, and the eosinophil count was 0.02  109/L. Two-hourly peak flow measurements made at home and work for 4 weeks were analyzed using the OASYS computer program. The OASYS score was 3.5 and the area between the curves score was 27 L/min per hour, both confirming a significant work effect. The patient underwent SIC testing, with negative control challenges to both the hand gel and 5% trisodium nitrilotriacetate cleaner (diluted to 1:100). She was subsequently exposed to triclosan surface cleaner diluted to 1:60 with water by painting on cardboard for a total of 30 minutes and experienced a sustained, immediate decrease in FEV1 by 24% from a baseline of 3.42 L (Fig 1), consistent with sensitization.4 There was no clinically significant change in fractional exhaled nitric oxide (FeNO) (pre-SIC, 9 ppb; 24 hours after SIC, 9 ppb); all measurements were performed according to European Respiratory Society/American Thoracic Society guidelines. Nonspecific bronchial reactivity (NSBR) by methacholine challenge, using the Jaeger dosimeter, was normal (provocation dosage that caused a decrease in FEV1 of 20%, >2.1 mg) before and 24 hours after SIC. After the diagnosis of occupational asthma, the patient remained employed in the same role, the liquid cleaner containing 0.05% triclosan (Antibac) cleaner having been substituted in the workplace. She remained relatively symptom free with 400/12 mg of inhaled symbicort twice a day, and spirometry performed 24 months after diagnosis revealed an FEV1 of 3.24 L (96% predicted) and an FVC of 3.87 L (100% predicted). A further serial peak expiratory flow analysis at this time revealed an OASYS score of 2.5 and an ABC score of 2 L/min per hour. Triclosan (2,4,4’-trichloro-2’-hydroxydiphenyl ether) AU - Walters GI AU - Robertson AS AU - Moore VC AU - Burge PS LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 67 IP - DP - 2017 Jan 01 TI - Biopsy-proven hypersensitivity pneumonitis caused by a fluorocarbon waterproofing spray. PG - 308-310 AB - Background: We present the case of a 35-year-old male who developed a chronic hypersensitivity pneumonitis (HP) following inhalational exposure to a fluorocarbon waterproofing aerosol spray, caused by his work for an upholstery and soft furnishings retailer. This is the first case report from inhalational fluorocarbon exposure with histological evidence of chronic HP. This is then discussed in the context of previous reports of interstitial lung disease and lung injury, caused by similar occupational and non-occupational exposures. AU - Walters GI AU - Trotter 2 AU - Sinha B AU - Richmond Z AU - Burge PS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - IP - DP - 2017 Jan 01 TI - Diagnostic accuracy of inflammatory markers for diagnosing occupational asthma. PG - AB - ABSTRACT BACKGROUND: The assessment of airway responsiveness and inflammation is key to the investigation of occupational asthma (OA). OBJECTIVE: We sought to assess and compare the diagnostic accuracies of the blood and sputum eosinophil counts and the methacholine challenge for the diagnosis of OA. METHODS: We conducted a retrospective study assessing 618 patients who underwent specific inhalation challenges (SICs) for symptoms suggestive of OA between 2000 and 2015. A sputum induction and a methacholine challenge were performed before and after SICs. Blood samples were collected in all subjects before the SICs and in 100 subjects before and after SICs. The diagnostic accuracies of blood and sputum eosinophil counts and methacholine challenge were calculated for diagnosing OA. RESULTS: The change in blood eosinophil count failed to differentiate workers with positive and negative SICs. The change in sputum eosinophil counts induced by the exposure to the offending agent had the highest diagnostic accuracy (receiver operating characteristic area under the curve: 86% [95% confidence interval: 0.8-0.9, P < .001]) for diagnosing OA compared with changes in concentration of methacholine inducing a 20% fall in forced expiratory volume in 1 second (PC20) and blood eosinophils. Combining a 2-fold or greater decrease in PC20 or a 3% or greater increase in sputum eosinophil count achieved a sensitivity of 84% and a specificity of 74% with a negative predictive value of 91% for the diagnosis of OA. CONCLUSIONS: Blood eosinophil counts do not appear to be an effective aid for diagnosing OA. The performance of both sputum cell count analysis and a methacholine challenge before and after exposure to the offending agent may represent an effective alternative in diagnosing OA when SICs are unavailable. AU - Racine G AU - Castano R AU - Cartier A AU - Lemiere C. LA - PT - DEP - TA - J Allergy Clin Immunol Pract JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 72 IP - DP - 2017 Jan 01 TI - Original article: The effects of growing up on a farm on adult lung function and allergic phenotypes: an international population-based study PG - 236-244 AB - Rationale Evidence has suggested that exposure to environmental or microbial biodiversity in early life may impact subsequent lung function and allergic disease risk. Objectives To investigate the influence of childhood living environment and biodiversity indicators on atopy, asthma and lung function in adulthood. Methods and measurements The European Community Respiratory Health Survey II investigated ~10 201 participants aged 26–54 years from 14 countries, including participants' place of upbringing (farm, rural environment or inner city) before age 5 years. A ‘biodiversity score’ was created based on childhood exposure to cats, dogs, day care, bedroom sharing and older siblings. Associations with lung function, bronchial hyper-responsiveness (BHR), allergic sensitisation, asthma and rhinitis were analysed. Main results As compared with a city upbringing, those with early-life farm exposure had less atopic sensitisation (adjusted OR 0.46, 95% CI 0.37 to 0.58), atopic BHR (0.54 (0.35 to 0.83)), atopic asthma (0.47 (0.28 to 0.81)) and atopic rhinitis (0.43 (0.32 to 0.57)), but not non-atopic outcomes. Less pronounced protective effects were observed for rural environment exposures. Women with a farm upbringing had higher FEV1 (adjusted difference 110 mL (64 to 157)), independent of sensitisation and asthma. In an inner city environment, a higher biodiversity score was related to less allergic sensitisation. Conclusions This is the first study to report beneficial effects of growing up on a farm on adult FEV1. Our study confirmed the beneficial effects of early farm life on sensitisation, asthma and rhinitis, and found a similar association for BHR. In persons with an urban upbringing, a higher biodiversity score predicted less allergic sensitisation, but to a lesser magnitude than a childhood farm environment. AU - Campbell B AU - Raherison C AU - Lodge CJ AU - Lowe AJ AU - Gislason T AU - Heinrich J AU - Sunyer J AU - Gómez Real F AU - Norbäck D AU - Matheson MC AU - Wjst M AU - Dratva J AU - de Marco R AU - Jarvis D AU - Schlünssen V AU - Janson C AU - Leynaert B AU - Svanes C AU - Dharmage SC LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 17 IP - DP - 2017 Jan 01 TI - Cooking smoke and respiratory symptoms of restaurant workers in Thailand PG - 41 AB - Background Restaurant workers are at risk from exposure to toxic compounds from burning of fuel and fumes from cooking. However, the literature is almost silent on the issue. What discussion that can be found in the literature focuses on the potential effects from biomass smoke exposure in the home kitchen, and does not address the problem as occurring in the workplace, particularly in restaurants. Methods This was a cross-sectional survey of 224 worker from 142 food restaurants in the Tha Pho sub-district of Phitsanulok, a province in Thailand. The standard questionnaire from the British Medical Research Council was used to collect data on chronic respiratory symptoms, including cough, phlegm, dyspnea, severe dyspnea, stuffy nose in the participating workers. Data on their health symptoms experienced in the past 30 days was also asked. A constructed questionnaire was used to collect exposure data, including type of job, time in the kitchen, the frequency of frying food, tears while cooking (TWC), the type of restaurant, fuel used for cooking, the size and location of the kitchen, and the exhaust system and ventilation. The prevalence of the symptoms was compared with those obtained from 395 controls, who were neighbors of the participants who do not work in a restaurant. Results In comparison to the control group, the restaurant workers had twice or more the prevalence on most of the chronic health symptoms. Men had a higher risk for “dyspnea”, “stuffy nose” and “wheeze” while women had higher risk of “cough”. A Rate Ratio (RR) of susceptibility was established, which ranged from 1.4 up to 9.9. The minimum RR was for women with “severe dyspnea” (RR of 1.4, 95%CI 0.8, 2.5) while the men showed the maximum RR of 9.9 (95%CI 4.5–22.0) for “wheeze”. Possible risk factors identified were job description, job period, size of restaurant, kitchen location, type of cooking oil, hours of stay in the kitchen area, number of fry dishes prepared, frequency of occurrence of TWC, and additional cooking at home. Working for 6–10 year increased the risk of “cough” with an Odd Ratio (OR) of 3.19 (P?<?0.01) while working for more than 10 years increased the risk of “cough” (OR?=?3.27, P?<?0.01), “phlegm” (OR?=?3.87, P?=?0.01) and “wheeze” (OR?=?2.38, P?=?0.05). Working as a chef had a higher risk of “cough” by 2.33 (P?=?0.01) as comparing to other jobs. Workers in a relatively large restaurant using 4 or more stoves had increased risk of “wheeze” with OR of 3.81 (P?<?0.01) and “stuffy nose” with OR of 3.56 (P?<?0.01). Using vegetable oil increased the risk of “stuffy nose” by 2.94 (P?<?0.01). Every 10 h of stay in the kitchen area was associated with a minimal increase in the risk of “cough”, “wheeze” and “symptoms in the past 30 days” by 1.15 (P?=?0.02), 1.16 (P?=?0.01) and 1.16 (P?=?0.02), respectively. Conclusions Restaurant workers are at risk of respiratory symptoms caused by exposure to toxic compounds from cooking fumes. Job description, job period, size of restaurant, kitchen location, type of cooking oil, hours of stay in the kitchen area, number of fry dishes prepared, frequency of occurrence of TWC, and additional cooking at home were the predictive factors. Workplace Health and Safety protection of restaurant worker is urgently needed and the issue should receive more public attention. AU - Juntarawijit C AU - Juntarawijit Y LA - PT - DEP - TA - BMC Pulmonary Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 67 IP - DP - 2017 Jan 01 TI - Medical surveillance for occupational asthma—how are cases detected? PG - 159-162 AB - H. Suojalehto; K. Karvala; J. Haramo; M. Korhonen; M. Saarinen ... Abstract Background In Finland, medical surveillance, including spirometry, is periodically performed for workers who are exposed to agents capable of causing occupational asthma (OA). Although it has been shown that surveillance can detect OA at an early stage, few studies have assessed its benefits or the role of surveillance spirometry. Aims To assess the role of surveillance and spirometry in detecting OA and to evaluate the quality of spirometry. Methods We retrospectively reviewed the medical files of patients in health surveillance programmes who were diagnosed with sensitizer-induced OA at the Finnish Institute of Occupational Health in 2012?14. We collected information on work exposure, respiratory symptoms, healthcare visits that initiated the diagnostic process, first spirometry and other diagnostic tests. Results Sixty files were reviewed. Medical surveillance detected 11 cases (18%) and 49 cases (82%) were detected at doctors’ appointments that were not related to surveillance. The median delay from the onset of asthma symptoms to diagnosis was 2.2 years. Delay did not differ between these groups. No cases were detected on the basis of abnormal spirometry without respiratory symptoms. However, five patients (8%) initially reported solely work-related rhinitis symptoms. Spirometry was normal in half of the cases and quality criteria were fulfilled in 86% of the tests. Conclusions Fewer than one in five OA cases were detected through medical surveillance. Investigations were initiated by respiratory symptoms. No asymptomatic worker was referred because of abnormal spirometry. Our results highlight the importance of work-related nasal symptoms in detecting OA. AU - Suojalehto H AU - Karvala K AU - Haramo J AU - Korhonen M AU - Saarinen M AU - Lindström I LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 72 IP - DP - 2017 Jan 01 TI - Bagpipe lung; a new type of interstitial lung disease? PG - 380-382 AB - Hypersensitivity pneumonitis (HP) is an inflammatory lung disease mediated by an immunological response to an inhaled antigen and can progress to disabling or fatal lung disease. It is related to occupational or other environmental exposures. In a significant proportion of patients, the antigen is often difficult to identify from the clinical history.1 This case highlights the importance of a careful clinical history including hobbies, because in this case, playing the bagpipes, we feel, was very relevant to the development of HP. We were able to isolate various fungal species from the bagpipes. There have been isolated case reports of musicians developing HP. Clinicians need to be aware of this potential trigger for developing HP, and wind instrument players need to be aware of the importance of regularly cleaning their instruments to minimise this risk. AU - King J AU - Richardson M AU - Quinn A AU - Holme J AU - Chaudhuri N LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 72 IP - DP - 2017 Jan 01 TI - Effect of anti-IgE in occupational asthma caused by exposure to low molecular weight agents. PG - 1720-1727 AB - BACKGROUND: The role of immunoglobulin (Ig)-E in occupational asthma (OA) due to low molecular weight (LMW) agents is not well established compared to classical atopic asthma. In the present study we evaluate whether anti-IgE monoclonal antibody (mAb) has an effect in a mouse model of OA, using persulfate salts. METHODS: On days 1 and 8, BALB/C mice were dermally sensitized with 5% ammonium persulfate (AP) or dimethyl sulfoxide (DMSO). On days 15, 18 and 21 animals were injected intraperitoneally with anti-IgE mAb or PBS 6 hours before challenge with AP or saline. Airway hyperresponsiveness (AHR) using a methacholine test, airway inflammation in bronchoalveolar lavage (BAL) and lung tissue and total free IgE in serum samples were analyzed 24, 48 and 96 hours after the last challenge. RESULTS: Anti-IgE mAb treatment almost completely neutralized free serum IgE. In AP sensitized and challenged mice, anti-IgE mAb treatment abolished AHR 24h and 48h after the last challenge and significantly reduced the total number of eosinophils and neutrophils 48h and 96h after the last AP challenge compared with non-treated mice. Levels of interleukin (IL)-13 in BAL were also significantly decreased after anti-IgE administration 24h and 48h after the last AP challenge. Histological analysis of the lung sections from anti-IgE-treated mice revealed normal inflammatory patterns similar to control groups 48h after the last challenge. CONCLUSIONS: Anti-IgE-treated mice showed a significant improvement in asthma features related to the AHR and airway inflammation. Anti-IgE mAb has positive effects in OA induced by persulfate salts. This article is protected by copyright. All rights reserved. AU - Ollé-Monge M AU - Cruz MJ AU - Gomez-Ollés S AU - Ojanguren I AU - Vanoirbeek J AU - Muñoz X LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - IP - DP - 2017 Jan 01 TI - Opportunities and obstacles in translating evidence to policy in occupational asthma PG - AB - Occupational asthma (OA), a common respiratory disorder in Western countries, is caused by exposures at the workplace. It is part of a broader definition of work-related asthma (WRA) that also includes pre-existing asthma aggravated by substances present in the workplace environment, and it is potentially preventable. The purpose of this paper is to illustrate preventive measures for occupational asthma by case studies. Methods In three case studies we discuss preventive measures that have been associated with reductions in incidence of occupational asthma from natural rubber latex and from diisocyanates as supported by published literature. We also discuss challenges in relation to asthma from cleaning products in healthcare work. Results and conclusions Several preventive measures have been associated with reduction in incidence of occupational asthma from natural rubber latex and from diisocyanates, and may provide lessons for prevention of other causes of occupational asthma. Cleaning products remain an unresolved problem at present with respect to asthma risks but potential measures include the use of safer products and safer applications such as avoidance of spray products, use of occupational hygiene methods such as improving local ventilation, and when appropriate, the use of personal protective devices. AU - Tarlo SM AU - Arif AA AU - Delclos GL AU - Henneberger P AU - Patel J LA - PT - DEP - TA - Annals of Epidemiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - IP - DP - 2017 Jan 01 TI - Can serum cytokine profile discriminate irritant-induced and allergen-induced symptoms? A cross-sectional study in workers mostly exposed to laboratory animals. PG - AB - BACKGROUND: In workers exposed mostly to laboratory animals (LA), symptoms may be due to irritants or allergens. Correct aetiological diagnosis is important for health surveillance. OBJECTIVES: This study aims to test whether work-related (WR) allergen-induced symptoms are associated with a cytokine profile distinct from that due to irritants. METHODS: In a cross-sectional study (n=114), WR respiratory and/or skin symptoms were assessed through a standardised clinical examination and sensitisation to rat and/or mouse allergen determined by serum immunoglobulin E. Serum cytokine concentrations were measured by multiplex assays. The predefined cytokine profiles 'sensitiser' (interleukin (IL)-4, IL-5, IL-13, eotaxin-1) and 'irritation' (IL-8, IL-17A, IL-17F, IL-22) were considered positive, when =3 concentrations exceeded the 95th percentile of the asymptomatic non-sensitised group. Results were examined by hierarchical clustering analyses (HCA) and multiple linear regression. Explorative analyses were carried out for nine additional cytokines. Exposure to allergens and endotoxin was assessed in a subpopulation. RESULTS: The prevalence of the profile 'irritation' was comparable in 28 symptomatic non-sensitised workers and 71 asymptomatic non-sensitised workers. HCA showed that nearly all symptomatic non-sensitised workers were gathered in two subclusters, characterised by high IL-17A levels, but different IL-8 levels. Multiple linear regression identified drug consumption and current complaints as confounders. Sensitised subjects were too few (n=14) for testing the profile 'sensitiser'. CONCLUSIONS: In this unselected population of LA workers, the profile 'irritation' did not prove to be a valuable health surveillance tool. Low power precluded assessment of the profile 'sensitiser'. The increased IL-17A concentration may originate from irritative constituents of organic dust. AU - Lemaire M AU - Oppliger A AU - Hotz P AU - Renauld JC AU - Braun J AU - Maggi M AU - Barresi F AU - Schmid-Grendelmeier P AU - Huaux F AU - Dressel H. LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 74 IP - DP - 2017 Jan 01 TI - Military small arms fire in association with acute decrements in lung function PG - 639-644 AB - Objective After introduction of unleaded ammunition, Norwegian Armed Forces received reports of acute respiratory symptoms in soldiers after exposure to fumes from firing the standard weapon, HK416. The aim of the present study was to examine lung function before and after exposure to fumes from HK416 in a double-blinded standardised study design using three different types of ammunition. Methods Fifty-four healthy, non-smoking male volunteers (19–62 years) fired the weapons for 60?min with either leaded, unleaded or ‘modified’ unleaded ammunition. Gaseous and particulate emissions were monitored. Spirometry and exhaled nitric oxide (eNO) were performed within 14 days before (T0), shortly after (T1) and 24?hours after (T2) shooting. Methacholine provocation and diffusing capacity of carbon monoxide (DLCO) were carried out at T0 and T2. Results The mean forced expiratory volume in 1 s on a group level was significantly reduced both at T1 and T2 compared with T0, with means and 95%?CI of 226?mL (158 to 294 mL) and 285?mL (218 to 351 mL), respectively. The same significant pattern was seen for DLCO, forced vital capacity and eNO. The methacholine test indicated a slight increase in bronchial hyper-reactivity. However, there were no significant differences between types of ammunition used. Conclusion Exposure to fumes from military weapons might be a respiratory hazard for soldiers who do live-fire training regularly or are in a closed combat environment AU - Borander AK AU - Voie ØA AU - Longva K AU - Danielsen TE AU - Grahnstedt S AU - Sandvik L AU - Kongerud J AU - Sikkeland LIB LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 72 IP - DP - 2017 Jan 01 TI - Six years without pholcodine; Norwegians are significantly less IgE-sensitized and clinically more tolerant to neuromuscular blocking agents PG - 813-819 AB - Background As a strong inducer of IgE antibodies to substituted ammonium ion epitopes (QAI), pholcodine (PHO) is a postulated cause of allergic anaphylaxis to neuromuscular blocking agents (NMBAs). Three years after withdrawal of PHO in Norway, a significant reduction in IgE sensitization and anaphylaxis reporting was seen. Objective Six-year follow-up study on the effects of PHO withdrawal on IgE sensitization and anaphylaxis reporting. Methods From 650 acute consecutive reports (2005–2013) to the Norwegian Network for Anaphylaxis under Anaesthesia (NARA), total number of reports on suspected anaphylactic reactions, number of reactions where NMBAs were administered, number of reactions where serum IgE antibodies (=0.35 kUA/l) to suxamethonium (SUX) and PHO were present at time of reaction and anaphylaxis severity grades were retrieved. In addition, NMBA sales and prevalence of IgE sensitization to PHO and SUX among ‘allergics’ were monitored. Results From baseline period P0 (PHO on the market) through the first (P1) and second (P2), three-year periods after withdrawal, significant falls in total reports (P < 0.001) and reports with IgE antibodies to PHO (P = 0.008) and SUX (P = 0.001) at time of reaction were found. Total NMBA sales in P2 were 83% of P0, and SUX and rocuronium (ROC) together made up 86% of sales throughout the study. Five NMBA-related anaphylactic deaths occurred during P0 and P1 and, however, none during P2. Prevalence of IgE sensitization to SUX in ‘allergics’ fell to 0% at 4 and 5 years after withdrawal. Conclusions Six years after PHO withdrawal, the Norwegian population has become significantly less IgE-sensitized and clinically more tolerant to NMBAs. AU - de Pater GH AU - Florvaag E AU - Johansson SGO AU - Irgens Å AU - Petersen MNH AU - Guttormsen AB LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 72 IP - DP - 2017 Jan 01 TI - What causes occupational asthma in cleaners? PG - 581–583. AB - Lessons SIC tests to the chlorine-releasing agent and urine individually produced negative results. However, the combination of urine with the chlorine-releasing agent, replicating the actual workplace exposure, produced a positive asthmatic reaction. It is likely that the chlorine and urine mixture produced chloramines. Chloramines are known sensitisers causing occupational asthma in swimming pool attendants and teachers, where SICs have shown chloramines to be the cause.3 We believe that this explains the previous negative tests to chlorine-releasing agents alone in healthcare workers, where chloramines produced in cleaning operations at work are the likely cause of much of their occupational asthma. Any SIC tests to chlorine tablets should be performed with a nitrogen source when exposures to the chlorine-releasing substance alone do not elicit an asthmatic reaction. The optimal management of a worker with occupational asthma requires identification of the specific cause, so that exposures can be reduced for others and eliminated for the sensitised worker. In this case, the cause was identified but unfortunately removal from direct exposure was insufficient to eliminate all work-related symptoms and small changes in peak flow (as shown by the positive timepoint analysis). With the help of her occupational health department, our patient decided to retire on medical grounds, which is sometimes the best solution. AU - Moore VC AU - Burge PS AU - Robertson AS AU - Walters GI LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 3 IP - DP - 2017 Jan 01 TI - Aerotoxic syndrome: a new occupational disease? PG - 198-211 AB - Background: Concerns related to adverse health effects experienced by aircrew exposed to aircraft contaminated air have been ongoing for over 6 decades. Unfiltered breathing air is supplied to the cabin via the engine compressor. The likelihood that oil leaking over the engine oil seals may enter the cabin air supply has prompted continuing debate about the hazards associated with exposure to neurotoxic substances and to the thermally degraded or pyrolysed mixture. In this study, we undertook an in-depth investigation of aircrew involved in suspected aircraft contaminated air events. Methods: Two studies were conducted to review the circumstances and symptoms of a cohort of aircrew working in the pressurized air environment of aircraft. A table of effects was then used for categorizing symptoms and reviewing other sources of data related to aircraft fluids and selected other conditions. Results: Both acute and chronic exposures to neurotoxic and a wide range of thermally degraded substances were confirmed, along with a clear pattern of acute and chronic adverse effects. The latter were supported by medical findings and diagnoses, notably involving the neurological, neurobehavioural and respiratory systems. Conclusion: A clear cause and effect relationship has been identified linking the symptoms, diagnoses and findings to the occupational environment. Recognition of this new occupational disorder and a clear medical investigation protocol are urgently needed. PUBLIC HEALTH PANORAMA VOLUME 3 | ISSUE 2 | JUNE 2017 | 141-356 AU - Michaelis S AU - Burdon J AU - Howard CV LA - PT - DEP - TA - Public Health Panorama JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 10.1111/jn IP - DP - 2017 Jan 01 TI - Cholinesterase reactivators and bioscavengers for pre- and post-exposure treatments of organophosphorus poisoning PG - AB - Organophosphorus agents (OPs) irreversibly inhibit acetylcholinesterase (AChE) causing a major cholinergic syndrome. The medical counter-measures of OP poisoning have not evolved for the last 30 years with carbamates for pretreatment, pyridinium oximes-based AChE reactivators, antimuscarinic drugs and neuroprotective benzodiazepines for postexposure treatment. These drugs ensure protection of peripheral nervous system and mitigate acute effects of OP lethal doses. However, they have significant limitations. Pyridostigmine and oximes do not protect/reactivate central AChE. Oximes poorly reactivate AChE inhibited by phosphoramidates. In addition, current neuroprotectants do not protect the central nervous system shortly after the onset of seizures when brain damage becomes irreversible. New therapeutic approaches for pre- and post-exposure treatments involve detoxification of OP molecules before they reach their molecular targets by administrating catalytic bioscavengers, among them phosphotriesterases are the most promising. Novel generation of broad spectrum reactivators are designed for crossing the blood–brain barrier and reactivate central AChE. AU - Masson P AU - Nachon F LA - PT - DEP - TA - J Neurochem JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 118 IP - DP - 2017 Jan 01 TI - Primary blast lung injury-a review PG - 311-316 AB - Bomb or explosion-blast injuries are likely to be increasingly encountered as terrorist activity increases and pre-hospital medical care improves. We therefore reviewed the epidemiology, pathophysiology and treatment of primary blast lung injury. In addition to contemporary military publications and expert recommendation, an EMBASE and MEDLINE search of English speaking journals was undertaken using the medical subject headings (MeSHs) ‘blast injury’ and ‘lung injury’. Review articles, retrospective case series, and controlled animal modelling studies published since 2000 were evaluated. 6-11% of military casualties in recent conflicts have suffered primary blast lung injury but the incidence increases to more than 90% in terrorist attacks occurring in enclosed spaces such as trains. The majority of victims require mechanical ventilation and intensive care management. Specific therapies do not exist and treatment is supportive utilizing current best practice. Understanding the consequences and supportive therapies available to treat primary blast lung injury are important for anaesthetists. AU - Scott TE AU - Kirkman E AU - Haque M AU - Gibb IE AU - Mahoney P AU - Hardman JG LA - PT - DEP - TA - British Journal of Anaesthesia JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 30 IP - DP - 2017 Jan 01 TI - The airway in inhalational injury: diagnosis and management PG - 24-29 AB - It is estimated that 13.000 to 22.000 individuals suffer from inhalational burns each year in the United States alone. Despite these high numbers, inhalational burns remain a major challenge to otolaryngologists. In this paper, a review of literature is presented in order to provide otolaryngologists with a systematic approach to patients with inhalational burns to optimize treatment, cost, morbidity and, most importantly, mortality. For this purpose, a broad PubMed search was conducted. The available literature was found to highlight the importance of airway management in terms of the timing of intubation, method of intubation, trachea-esophageal (TE) fistula formation and TE rupture. It also emphasizes the importance of carbon monoxide intoxication and prompt correction. Drugs such as heparin sulfate, N-acetylcysteine and albuterol have been proven to help in the treatment of patients with inhalational burns, and more research is currently underway with the purpose of developing chelating drugs that scavenge the toxic substances in the smoke before they can damage the airway. AU - Sabri A AU - Dabbous H AU - Dowli A AU - Barazi R LA - PT - DEP - TA - Ann Burns Fire Disasters JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - IP - DP - 2017 Jan 01 TI - Emphysema in active farmer’s lung disease PG - AB - Background Farmer’s lung (FL) is a common type of hypersensitivity pneumonitis. It is often considered that fibrosis is the most frequent finding in chronic FL. Nevertheless, three cohort studies have suggested that some patients with chronic FL may develop emphysema. We aimed to evaluate the current prevalence of emphysema in active FL, to describe the radiological and functional features of emphysema in active FL, and to identify risk factors associated with emphysema in this population. Methods Patients aged over 18 years with active FL were prospectively recruited through the SOPHIA study (CPP Est; P-2009-521), between 2007 and 2015. Each patient had complete medical history screening, clinical examination, high resolution computed tomodensitometry, bronchoalveolar lavage, pulmonary function tests and serum precipitins. Results Among 33 patients with active FL, the prevalence of emphysema in this series of incident active FL cases was higher (48.5%) than that of fibrosis (12%) and was not dependent on smoking habits. Most patients with emphysema did not have lung hyperinflation. The possible risk factors for emphysema in active FL were a longer duration of exposure to organic dusts, and at a higher level. Conclusion Emphysema is found in half of patients with active FL and may be influenced by exposure patterns. AU - Soumagne T AU - Chardon M AU - Dournes G AU - Laurent L AU - Degano B AU - Laurent F AU - Dalphin JC LA - PT - DEP - TA - Plos One JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 49 IP - DP - 2017 Jan 01 TI - ERS technical standard on bronchial challenge testing: general considerations and performance of methacholine challenge tests PG - 1601529 AB - This international task force report updates general considerations for bronchial challenge testing and the performance of the methacholine challenge test. There are notable changes from prior recommendations in order to accommodate newer delivery devices. Rather than basing the test result upon a methacholine concentration (provocative concentration (PC20) causing a 20% fall in forced expiratory volume in 1 s (FEV1)), the new recommendations base the result upon the delivered dose of methacholine causing a 20% fall in FEV1 (provocative dose (PD20)). This end-point allows comparable results from different devices or protocols, thus any suitable nebuliser or dosimeter may be used, so long as the delivery characteristics are known. Inhalation may be by tidal breathing using a breath-actuated or continuous nebuliser for 1 min (or more), or by a dosimeter with a suitable breath count. Tests requiring maximal inhalations to total lung capacity are not recommended because the bronchoprotective effect of a deep breath reduces the sensitivity of the test. AU - Coates AL AU - Wanger J AU - Cockcroft DW AU - Culver BH AU - Carlsen KH AU - Diamant Z AU - Gauvreau G AU - Hall GL AU - Hallstrand TS AU - Horvath I AU - de Jongh FHC AU - Joos G AU - Kaminsky DA AU - Laube BL AU - Leuppi JD AU - Sterk PJ LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 195 IP - DP - 2017 Jan 01 TI - Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy PG - 596-606 AB - Carbon monoxide (CO) poisoning affects 50,000 people a year in the United States. The clinical presentation runs a spectrum, ranging from headache and dizziness to coma and death, with a mortality rate ranging from 1 to 3%. A significant number of patients who survive CO poisoning suffer from long-term neurological and affective sequelae. The neurologic deficits do not necessarily correlate with blood CO levels but likely result from the pleiotropic effects of CO on cellular mitochondrial respiration, cellular energy utilization, inflammation, and free radical generation, especially in the brain and heart. Long-term neurocognitive deficits occur in 15–40% of patients, whereas approximately one-third of moderate to severely poisoned patients exhibit cardiac dysfunction, including arrhythmia, left ventricular systolic dysfunction, and myocardial infarction. Imaging studies reveal cerebral white matter hyperintensities, with delayed posthypoxic leukoencephalopathy or diffuse brain atrophy. Management of these patients requires the identification of accompanying drug ingestions, especially in the setting of intentional poisoning, fire-related toxic gas exposures, and inhalational injuries. Conventional therapy is limited to normobaric and hyperbaric oxygen, with no available antidotal therapy. Although hyperbaric oxygen significantly reduces the permanent neurological and affective effects of CO poisoning, a portion of survivors still have substantial morbidity. There has been some early success in therapies targeting the downstream inflammatory and oxidative effects of CO poisoning. New methods to directly target the toxic effect of CO, such as CO scavenging agents, are currently under development. AU - Rose JJ AU - Wang L AU - Xu Q AU - McTiernan CF AU - Shiva S AU - Tejero J AU - Gladwin MT LA - PT - DEP - TA - American Journal of Respiratory and Critical Care JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 65 IP - DP - 2017 Jan 01 TI - An analysis of the emergency response system of the 1996 Channel tunnel fire PG - 121-139 AB - The paper presents the results of an analysis of the ‘emergency response system’ at the time of the 1996 Channel tunnel fire accident. In particular, the analysis focuses on the events that unfolded once the incident train had stopped; i.e., the evacuation of the passengers and the train crew. The approach has been the use of a ‘Tunnel Fire Safety Management System’ (‘TFSMS’) Model as a ‘template’ for comparison with the ‘emergency system’ in place at the time. In particular, responding to the following question being addressed: could the time of evacuation of the incident train crew and passengers be less that the time it took? The answer is Yes. Some relevant findings associated with the deficiencies in the existing 'system' have been highlighted by the model. AU - Santos-Reyes J AU - Beard AN LA - PT - DEP - TA - Tunnelling and Underground Space Technology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20170101 IS - IS - VI - 388 IP - DP - 2017 Jan 01 TI - Respiratory toxicology of Diacetyl and related dione flavorings PG - 9-14 AB - Inhalation of diacetyl-containing products is associated with risk for occupational bronchiolitis obliterans (BO) and fixed airways obstruction, particularly in workers exposed to heated liquids and powdered formulations. This review describes the occupational settings in which diacetyl-related lung disease has been reported and the clinical presentation of disease, along with an approach to diagnosis and management. The importance of early disease recognition, appropriate removal from exposure, and medical monitoring to optimize prognosis is reviewed. The roles of public health follow-up and medical surveillance for primary and secondary prevention are discussed. AU - Rose CS LA - PT - DEP - TA - Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 39 IP - DP - 2016 Jan 01 TI - Assessment of Respiratory Distress by the Roth Score PG - 636–639 AB - Introduction: Health care demand is increasing due to greater longevity of patients with chronic comorbidities. This increasing demand is occurring in a setting of resource scarcity. To address these changes, high-value care initiatives, such as telemedicine, are valuable resourcepreservation strategies. This study introduces the Roth score as a telemedicine tool that uses patient counting times to accurately risk-stratify dyspnea severity in terms of hypoxia. Hypothesis: The Roth score has correlation with dyspnea severity. Methods: This is a prospective, controlled-cohort study. Roth score index is measured by having the patient count from 1 to 30 in their native language, in a single breath, as rapidly as possible. The primary result of the Roth score is the duration of time and the highest number reached. Results: There was a strongly positive correlation between pulse oximetry and both maximal count achieved in 1 breath (r = 0.67; P < 0.001) and counting time (r = 0.59; P < 0.001). For oxygen saturation <95%, the maximal count number area under the curve is 0.828 and counting time area under the curve is 0.764. Counting time >8 seconds had a sensitivity of 78% and specificity of 73% for pulse oximetry <95%. Conclusions: The Roth score has strong correlation with dyspnea severity as determined by hypoxia. This tool is reproducible, low resource-utilization, and amenable to telemedicine. It is not intended to replace full clinical workup and diagnosis of respiratory distress AU - Chorin E AU - Padegimas A AU - Havakuk O AU - Birati EY AU - Shacham Y AU - Milman A AU - Topaz G AU - Flint N AU - Keren G AU - Rogowski O LA - PT - DEP - TA - Clinical Cardiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 150 IP - DP - 2016 Jan 01 TI - Trends in Occupations and Work Sectors Among Patients With Work-Related Asthma at a Canadian Tertiary Care Clinic PG - 811-818 AB - Background Work-related asthma (WRA) is the most common chronic occupational lung disease in the developed world. Several factors including sociodemographic status and occupation/industry increase the risks of developing WRA. In this study, we sought to identify changes in patterns and characteristics among patients with WRA over a 15-year period in an occupational lung disease clinic. Methods We performed a retrospective analysis of patients with WRA charts at the Occupational Lung Disease Clinic of a University Hospital in Toronto, Canada. Patients were divided into two periods classified by first attendance at the clinic 2000 through 2007 and 2008 through 2015. Comparisons between the two periods included: sociodemographic characteristics, smoking status, occupations, exposures, and submitted workers’ compensation claims. Results Fewer occupational asthma cases were seen in the more recent period vs the earlier period (40 vs 74 cases), with a smaller reduction in work-exacerbated asthma cases (40 vs 58). The recent period included a significantly smaller proportion employed in the manufacturing industry and isocyanate-induced cases compared with the earlier period. An increased proportion were employed in health-care and education industries (primarily cleaners and teachers) in the recent period, consistent with a corresponding increased frequency of cleaning agents and dust exposures. Conclusions The changes observed in work sectors in the patients with WRA in this clinic in Toronto are consistent with reductions reported in Ontario workers’ compensation claims for occupational asthma and may relate to preventive measures. Cleaners and teachers should be a focus of further intervention measures for work-related asthma. AU - Gotzev S AU - Joshua S AU - Lipszyc C AU - DaleConnor AU - Tarlo SM LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 3705824 IP - DP - 2016 Jan 01 TI - "Respiratory Symptoms due to Occupational Exposure to Formaldehyde and MDF Dust in a MDF Furniture Factory in Eastern Thailand PG - 3705824 AB - The study aimed to investigate factors associated with respiratory symptoms in workers in a medium-density fiberboard (MDF) furniture factory in Eastern Thailand. Data were collected from 439 employees exposed to formaldehyde and MDF dust using questionnaire and personal sampler (Institute of Occupational Medicine; IOM). The average concentration of formaldehyde from MDF dust was 2.62?ppm (SD 367), whereas the average concentration of MDF dust itself was 7.67?mg/m3 (SD 3.63). Atopic allergic history was a factor associated with respiratory irritation symptoms and allergic symptoms among the workers exposed to formaldehyde and were associated with respiratory irritation symptoms and allergic symptoms among those exposed to MDF dust. Exposure to MDF dust at high level (>5?mg/m3) was associated with respiratory irritation symptoms and allergic symptoms. Excluding allergic workers from the study population produced the same kind of results in the analysis as in all workers. The symptoms were associated with the high concentrations of formaldehyde and MDF dust in this factory. If the concentration of MDF dust was >5?mg/m3, the risk of irritation and allergic symptoms in the respiratory system increased. The respiratory health of the employees with atopic allergic history exposed to formaldehyde and MDF dust should be monitored closely. AU - Thetkathuek A AU - Yingratanasuk T AU - Ekburanawa W LA - PT - DEP - TA - Advances in Preventive Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 4 IP - DP - 2016 Jan 01 TI - Food allergy to wheat, soybean and cassava in Benin: Literature Revie PG - 713-723 AB - Despite, the range of products derived from cassava, its consumption today may induce an allergic reaction cross with the latex food group. In fact, people allergic to latex can also develop an allergy to boiled cassava. The Association of latex allergy and allergy to vegetable provenance food is called latex syndrome - fruit. An increasing number of vegetables sources (such as cassava) have been associated with this potentially fatal disease (A. Gaspar et al., 2003; M. Ibero et al., 2007). The first cases of allergic reactions after the ingestion of boiled cassava have been reported in Brazil and Mozambique respectively in 2004 and 2007 (K. S. Santos et al., 2011) . Man e5 is the first allergen purified from the cassava which demonstrates a cross reactivity of IgE with Hev b 5 which is the responsible allergen for latex allergy. The data suggest that Hev b 5 could act as primary sensitizer and could therefore lead to allergic manifestations on the consumption of manioc without prior exposure (K. S. Santos et al., 2013). In Benin, no case of food allergy in cassava has been raised. AU - DJOGBE AA AU - BOKOSSA Y AU - TCHEKESSI CK AU - OUENDO E-M AU - SACHI P AU - BANON J AU - BLEOUSSI R AU - MENSAH GA LA - PT - DEP - TA - International Journal of Multidisciplinary and Current Research JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 6 IP - DP - 2016 Jan 01 TI - Sensitization to silk allergen among workers of silk filatures in India: a comparative study PG - 90-93 AU - Gowda G AU - Shivalingaiah AH AU - Vijayeendra AM AU - Sarkar N AU - Nagaraj C AU - Masthi NRR LA - PT - DEP - TA - ASIA PACIFIC ALLERGY JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 194 IP - DP - 2016 Jan 01 TI - Daily Home Spirometry: An Effective Tool for Detecting Progression in Idiopathic Pulmonary Fibrosis PG - 989-997 AB - Rationale: Recent clinical trial successes have created an urgent need for earlier and more sensitive endpoints of disease progression in idiopathic pulmonary fibrosis (IPF). Domiciliary spirometry permits more frequent measurement of FVC than does hospital-based assessment, which therefore affords the opportunity for a more granular insight into changes in IPF progression. Objectives: To determine the feasibility and reliability of measuring daily FVC in individuals with IPF. Methods: Subjects with IPF were given handheld spirometers and instruction on how to self-administer spirometry. Subjects recorded daily FEV1 and FVC for up to 490 days. Clinical assessment and hospital-based spirometry was undertaken at 6 and 12 months, and outcome data were collected for 3 years. Measurements and Main Results: Daily spirometry was recorded by 50 subjects for a median period of 279 days (range, 13–490 d). There were 18 deaths during the active study period. Home spirometry showed excellent correlation with hospital-obtained readings. The rate of decline in FVC was highly predictive of outcome and subsequent mortality when measured at 3 months (hazard ratio [HR], 1.040; 95% confidence interval [CI], 1.021–1.062; P?=?0.001), 6 months (HR, 1.024; 95% CI, 1.014–1.033; P?<?0.001), and 12 months (HR, 1.012; 95% CI, 1.007–1.016; P?=?0.001). Conclusions: Measurement of daily home spirometry in patients with IPF is highly clinically informative and is feasible to perform for most of these patients. The relationship between mortality and rate of change of FVC at 3 months suggests that daily FVC may be of value as a primary endpoint in short proof-of-concept IPF studies. AU - Russell A AU - Adamali H AU - Molyneaux PL AU - Lukey PT AU - Marshall RP AU - Renzoni EA AU - Wells AU AU - Maher TM LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 65 IP - DP - 2016 Jan 01 TI - Asthma Among Employed Adults, by Industry and Occupation — 21 States, 2013 PG - 1325-1331 AB - Workers in various industries and occupations are at risk for work-related asthma* (1). Data from the 2006–2007 adult Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey (ACBS), an in-depth asthma survey conducted with respondents who report an asthma diagnosis, from 33 states indicated that up to 48% of adult current asthma might be related to work and could therefore potentially be prevented (2). Identification of the industries and occupations with increased prevalence of asthma might inform work-related asthma intervention and prevention efforts. To assess the industry-specific and occupation-specific proportions of adults with current asthma by state, CDC analyzed data from the 2013 BRFSS industry and occupation module, collected from 21 states for participants aged =18 years who, at the time of the survey interview, were employed or had been out of work for <12 months. Among these respondents, 7.7% had current asthma; based on the Asthma Call-back Survey results, this finding means as many as 2.7 million U.S. workers might have asthma caused by or exacerbated by workplace conditions. State-specific variations in the prevalence of current asthma by industry and occupation were observed. By state, current asthma prevalence was highest among workers in the information industry (18.0%) in Massachusetts and in health care support occupations (21.5%) in Michigan. Analysis of BRFSS industry and occupation and optional asthma modules can be used to identify industries and occupations to assess for asthma among workers, identify workplace exposures, and guide the design and evaluation of effective work-related asthma prevention and education programs (1). BRFSS is a state-based, random-digit–dialed telephone survey of the noninstitutionalized U.S. population aged =18 years that collects information on health risk factors, preventive health practices, and disease status. The survey includes core questions, optional modules, and state-specific questions.† During 2013, the industry and occupation module§ was administered for the first time in 19 states. The module collected information on the industry and occupation of respondents employed in the 12 months preceding the interview for their current or most recent job. Two additional states (Washington¶ and Wyoming**) collected industry and occupation information using state-added questions. The median American Association of Public Opinion Research response rate among the 21 states collecting information on industry and occupation was 44.0% (range = 31.1%–59.2%).†† BRFSS participants who responded “yes” to both questions: “Has a doctor, nurse, or other health professional ever told you that you had asthma?” and “Do you still have asthma?” were considered to have current asthma. Participants who, at the time of the interview, indicated that they were employed for wages, out of work for <1 year, or self-employed were considered employed in the 12 months before the interview. Information on respondent’s industry of employment and occupation was coded by CDC coders based on the 2002 North American Industry Classification System and the 2000 Standard Occupational Classification System, respectively.§§ The current analysis used 21 industry categories and 23 occupation categories. Landline and cellular telephone household data were weighted to produce estimates representative of the state populations using the survey sample weight for each BRFSS participant. Estimated proportions with corresponding 95% confidence intervals (CIs) were calculated. Statistically significant differences in distribution were determined using the Rao-Scott chi-square test with statistical significance at p=0.05. A sample of 208,788 adults in the 21 states, representing an estimated 125 million persons, participated in BRFSS and completed the industry and occupation module. Among these participants, 107,327 adults, representing an estimated 74 million persons (59.8% of the estimated survey population) were employed in the 12 months before the interview during 2013. Among adults employed at any time in the 12 months preceding the interview, 7.7% had current asthma. The proportion of workers with current asthma differed significantly by age, sex, race/ethnicity, household income, and state (Table 1). Overall, prevalence of current asthma among workers ranged from 5.0% in Mississippi to 10.0% in Michigan, and was highest in the health care and social assistance industry (10.7%) and in health care support occupations (12.4%) (Table 2). Industry-specific, and occupation-specific prevalence of current asthma was highest among workers in the information industry (18.0%) in Massachusetts and in health care support occupations (21.5%) in Michigan (Table 3). Among the five industries with the highest current asthma prevalence, health care and social assistance was identified in 20 of the 21 states, retail trade in 16 states, and education in 14 states. Among the five occupations with the highest current asthma prevalence, office and administrative support was identified in 16 of the 21 states, health care practitioners and technical in 15 states, and sales and related in 13 states. Discussion The findings in this report provide the first state-specific estimates of current asthma by industry and occupation category for 21 states administering BRFSS and collecting industry and occupation data, and indicate state-specific variations in current asthma prevalence by industry and occupation. These variations are consistent with previous findings (3) and likely reflect differences in the characteristics of state working populations (e.g., age, race/ethnicity, and education), socioeconomic factors (e.g., state-specific distribution of industries and occupations and unemployment rate), health insurance coverage (e.g., type of insurance and access to medical care), state laws (e.g., workers’ compensation), geographic differences in prevalence of sensitization to aeroallergens (4,5), and risk for exposure to agents causing asthma in the workplace. For example, sales and related occupations were the top employers in 2015 for all 21 states assessed in this study according to the Bureau of Labor and Statistics (http://www.bls.gov/home.htm) and that might explain why this occupation appears consistently across several states. Work-related asthma includes occupational asthma (i.e., new-onset asthma caused by factors related to work) and work-exacerbated asthma (i.e., preexisting or current asthma worsened by factors related to work) (1). Persons with work-related asthma have more symptomatic days, use more health care resources, and have lower quality of life (6). Moreover, asthma exacerbations accelerate decline in lung function (7). Each of the industries and occupations identified in this report is associated with a specific set of existing and emerging workplace exposures, including irritant chemicals, dusts, secondhand smoke, allergens, emotional stress, temperature, and physical exertion, that have been associated with new-onset and work-exacerbated asthma (8,9). For example, it is well recognized that workers in the health care and social assistance industry who are exposed to cleaning and disinfection products, powdered latex gloves, and aerosolized medications have a twofold increased likelihood of new-onset asthma (9). A previous study reported that as much as 48% of adult asthma is caused or made worse by work (2); therefore, as many as 2.7 million workers might have asthma caused or exacerbated by workplace conditions in these 21 states. To assist clinicians in assessing potential workplace exposures among employed patients with new-onset or exacerbated asthma, the Association of Occupational and Environmental Clinics published a list of substances that meet criteria for causing work-related asthma by sensitization or acute irritant-induced asthma.¶¶ The findings in this report are subject to at least four limitations. First, information on asthma was self-reported and not validated by medical records or follow-up with health care providers; thus, estimates might be subject to misclassification. Second, although the BRFSS optional ACBS collects detailed information on asthma (e.g., work-related asthma), it was not possible to determine whether the current asthma was associated with work using 1 year of data because of the small number of respondents with both information on work-related asthma diagnosis and industry and occupation. Also, small sample sizes resulted in unreliable estimates for some industries and occupations. Combining multiple years of data from ACBS and industry and occupation module is needed to estimate the state-specific work-related asthma prevalence by industry and occupation. Third, workers with current asthma might leave employment in industries and occupations with workplace exposures that exacerbate their asthma (i.e., the healthy worker effect); thus, industry and occupation in this report might not accurately represent the industries and occupations where exposures occur. Finally, because data are limited to 21 states, the results might not be nationally representative or representative of nonparticipating states. Physicians should consider collecting a detailed occupational history among adults with asthma because this is critical for making a work-related asthma diagnosis and recommending optimal treatment and management (1). Reduction or elimination of workplace exposures (i.e., substitution of hazardous products with nonhazardous products or improved ventilation) or removal of the worker from the environment might be necessary for management of asthma symptoms related to work (1,10). For example, reduction in exposure to latex allergens by replacing powdered latex gloves with powder-free natural rubber latex or nonlatex gloves considerably reduced work-related asthma in the health care industry (10). Twenty-two Healthy People 2020 respiratory disease objectives*** for asthma address prevention, detection, treatment, and education efforts; in 2009, CDC funded 34 states, the District of Columbia, and Puerto Rico to help meet these objectives.††† The Council of State and Territorial Epidemiologists in its 2010 Position Statement§§§ recommends continued surveillance for and evaluation of the burden of asthma, including work-related asthma, to help target prevention programs and activities. BRFSS data provide a unique opportunity to assess state-level asthma prevalence by industry and occupation. The findings in this report might assist physicians and state public health officials in identifying workers in industries and occupations with a high current asthma prevalence who should be evaluated for work-related asthma in order to plan and target interventions. Potential work-related asthma exposures can be identified, and effective prevention and education strategies can be implemented (8). Routine collection of industry and occupation information is needed to estimate state-specific work-related asthma prevalence by respondents’ industry and occupation. AU - Dodd KE AU - Mazurek JM LA - PT - DEP - TA - MMWR Morb Mortal Wkly Rep JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 73 IP - DP - 2016 Jan 01 TI - Effects of bioaerosol exposure on respiratory health in compost workers: a 13-year follow-up study PG - 829-837 AB - Objectives To determine the risk of German compost workers developing chronic respiratory effects from long-term exposure to bioaerosols. Methods Respiratory health was determined in 74 currently exposed compost workers and 37 non-exposed controls after 13 years of follow-up. In addition, 42 former compost workers (drop-outs) who left their work during the follow-up period were also examined. Respiratory symptoms and working conditions were assessed using identical questionnaires as at baseline. In addition, lung function was measured using the same spirometer as in the initial study. Sera from both surveys were tested for specific IgE and IgG antibodies to moulds and the risk of work-related symptoms was evaluated using regression approaches for prospective studies with binary data. Results In the follow-up period, the number of participants reporting cough significantly increased in compost workers and drop-outs compared to the controls. Working as a compost worker for at least 5 years increased the relative risk for cough (RR 1.28; 95% CI 1.2 to 1.4) and for cough with phlegm (RR 1.32; 95% CI 1.2 to 1.5). Current and former compost workers had slightly lower predicted percentage of forced expiratory volume in 1 s and predicted percentage of forced vital capacity than controls, but decrease in lung function during follow-up was not different among the 3 groups. In addition, no significant changes could be detected in antibody concentrations. Conclusions Our results suggest that chronic exposure to bioaerosols in composting plants is related to a significantly higher risk for cough with phlegm, indicating chronic bronchitis. However, compost workers showed no higher incidence of deterioration of pulmonary function over the study. AU - van Kampen V AU - Hoffmeyer F AU - Deckert A AU - Kendzia B AU - Casjens S AU - Neumann HD AU - Buxtrup M AU - Willer E AU - Felten C AU - Schöneich R AU - Brüning T AU - Raulf M AU - Bünger J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 73 IP - DP - 2016 Jan 01 TI - Comparing plasma, serum and whole blood indium concentrations from workers at an indium-tin oxide (ITO) production facility PG - 864-867 AB - Objective Occupational exposure to indium compounds including indium-tin oxide (ITO) can result in potentially fatal indium lung disease. We compared plasma, serum and whole blood indium concentrations (InP, InS and InB) from workers at a single ITO production facility to assess the comparability of these matrices used for biological monitoring of indium exposure. Method InP, InS and InB were measured using inductively coupled mass spectrometry from consenting workers at an ITO production facility with specimen collection occurring during June-July 2014. Matched pairs from workers were assessed to determine the matrix relationships using the Pearson correlation, paired t-tests, per cent difference, linear regression and ? statistics. Results Indium matrices were collected from 80 workers. Mean (SD) InP, InS and InB were 3.48 (3.84), 3.90 (4.15) and 4.66 (5.32) mcg/L, respectively. The InS-InP difference was 14%; InS was higher in all but two workers. InP and InS were highly correlated (r=>0.99). The InB-InS difference was 19%; InB was higher in 85% of workers. The InB-InP difference was 34%; InB was higher in 66% of workers. InB was highly correlated with both InP and InS (r=0.97 and 0.96, respectively). ? Statistics were 0.84, 0.83 and 0.82 for InP, InS and InB, respectively, for individuals with each matrix =1 mcg/L (p<0.01). Conclusions While all matrices were highly correlated, we encourage the use of InP and InS to reliably compare studies across different populations using different matrices. The higher per cent difference and increased variability of InB may limit its utility in comparisons with InP and InS in different populations. AU - Harvey RR AU - Virji MA AU - Edwards NT AU - Cummings KJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - IP - DP - 2016 Jan 01 TI - Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study. PG - 557-565 AB - BACKGROUND: Diffuse parenchymal lung disease represents a diverse and challenging group of pulmonary disorders. A consistent diagnostic approach to diffuse parenchymal lung disease is crucial if clinical trial data are to be applied to individual patients. We aimed to evaluate inter-multidisciplinary team agreement for the diagnosis of diffuse parenchymal lung disease. METHODS: We did a multicentre evaluation of clinical data of patients who presented to the interstitial lung disease unit of the Royal Brompton and Harefield NHS Foundation Trust (London, UK; host institution) and required multidisciplinary team meeting (MDTM) characterisation between March 1, 2010, and Aug 31, 2010. Only patients whose baseline clinical, radiological, and, if biopsy was taken, pathological data were undertaken at the host institution were included. Seven MDTMs, consisting of at least one clinician, radiologist, and pathologist, from seven countries (Denmark, France, Italy, Japan, Netherlands, Portugal, and the UK) evaluated cases of diffuse parenchymal lung disease in a two-stage process between Jan 1, and Oct 15, 2015. First, the clinician, radiologist, and pathologist (if lung biopsy was completed) independently evaluated each case, selected up to five differential diagnoses from a choice of diffuse lung diseases, and chose likelihoods (censored at 5% and summing to 100% in each case) for each of their differential diagnoses, without inter-disciplinary consultation. Second, these specialists convened at an MDTM and reviewed all data, selected up to five differential diagnoses, and chose diagnosis likelihoods. We compared inter-observer and inter-MDTM agreements on patient first-choice diagnoses using Cohen's kappa coefficient (?). We then estimated inter-observer and inter-MDTM agreement on the probability of diagnosis using weighted kappa coefficient (?w). We compared inter-observer and inter-MDTM confidence of patient first-choice diagnosis. Finally, we evaluated the prognostic significance of a first-choice diagnosis of idiopathic pulmonary fibrosis (IPF) versus not IPF for MDTMs, clinicians, and radiologists, using univariate Cox regression analysis. FINDINGS: 70 patients were included in the final study cohort. Clinicians, radiologists, pathologists, and the MDTMs assigned their patient diagnoses between Jan 1, and Oct 15, 2015. IPF made up 88 (18%) of all 490 MDTM first-choice diagnoses. Inter-MDTM agreement for first-choice diagnoses overall was moderate (?=0·50). Inter-MDTM agreement on diagnostic likelihoods was good for IPF (?w=0·71 [IQR 0·64-0·77]) and connective tissue disease-related interstitial lung disease (?w=0·73 [0·68-0·78]); moderate for non-specific interstitial pneumonia (NSIP; ?w=0·42 [0·37-0·49]); and fair for hypersensitivity pneumonitis (?w=0·29 [0·24-0·40]). High-confidence diagnoses (>65% likelihood) of IPF were given in 68 (77%) of 88 cases by MDTMs, 62 (65%) of 96 cases by clinicians, and in 57 (66%) of 86 cases by radiologists. Greater prognostic separation was shown for an MDTM diagnosis of IPF than compared with individual clinician's diagnosis of this disease in five of seven MDTMs, and radiologist's diagnosis of IPF in four of seven MDTMs. INTERPRETATION: Agreement between MDTMs for diagnosis in diffuse lung disease is acceptable and good for a diagnosis of IPF, as validated by the non-significant greater prognostic separation of an IPF diagnosis made by MDTMs than the separation of a diagnosis made by individual clinicians or radiologists. Furthermore, MDTMs made the diagnosis of IPF with higher confidence and more frequently than did clinicians or radiologists. This difference is of particular importance, because accurate and consistent diagnoses of IPF are needed if clinical outcomes are to be optimised. Inter-multidisciplinary team agreement for a diagnosis of hypersensitivity pneumonitis is low, highlighting an urgent need for standardised diagnostic guidelines for this disease. AU - Walsh SL AU - Wells AU AU - Desai SR AU - Poletti V AU - Piciucchi S AU - Dubini A AU - Nunes H AU - Valeyre D AU - Brillet PY AU - Kambouchner M AU - Morais A AU - Pereira JM AU - Moura CS AU - Grutters JC AU - van den Heuvel DA AU - van Es HW AU - van Oosterhout MF AU - Seldenrijk CA AU - Bendstrup E AU - Rasmussen F AU - Madsen LB AU - Gooptu B AU - Pomplun S AU - Taniguchi H AU - Fukuoka J AU - Johkoh T AU - Nicholson AG AU - Sayer C AU - Edmunds L AU - Jacob J AU - Kokosi MA AU - Myers JL AU - Flaherty KR AU - Hansell DM LA - PT - DEP - TA - Lancet respiratory JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 137 IP - DP - 2016 Jan 01 TI - Majority of shrimp allergic patients are allergic to mealworm. PG - 1261-1263 AU - Broekman H AU - Verhoeckx KC AU - den Hartog Jager CF AU - Kruizinga AG AU - Pronk-Kleinjan M AU - Remington BC AU - et al LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 193 IP - DP - 2016 Jan 01 TI - Chronic Hypersensitivity Pneumonitis Associated with Inhaled Exposure to Nylon Powder for 3-D Printing: A Variant of Nylon Flock Worker's Lung Disease? PG - A7071 AB - Case report with lung biopsy showing HP, progressed to lung transplant. Cause and effect not clearly shown AU - Johannes J AU - Rezayat T AU - Wallace WD AU - Lynch JP LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 71 IP - DP - 2016 Jan 01 TI - A diagnostic model for chronic hypersensitivity pneumonitis PG - a AB - The objective of this study was to develop a diagnostic model that allows for a highly specific diagnosis of chronic hypersensitivity pneumonitis using clinical and radiological variables alone. Chronic hypersensitivity pneumonitis and other interstitial lung disease cases were retrospectively identified from a longitudinal database. High-resolution CT scans were blindly scored for radiographic features (eg, ground-glass opacity, mosaic perfusion) as well as the radiologist's diagnostic impression. Candidate models were developed then evaluated using clinical and radiographic variables and assessed by the cross-validated C-statistic. Forty-four chronic hypersensitivity pneumonitis and eighty other interstitial lung disease cases were identified. Two models were selected based on their statistical performance, clinical applicability and face validity. Key model variables included age, down feather and/or bird exposure, radiographic presence of ground-glass opacity and mosaic perfusion and moderate or high confidence in the radiographic impression of chronic hypersensitivity pneumonitis. Models were internally validated with good performance, and cut-off values were established that resulted in high specificity for a diagnosis of chronic hypersensitivity pneumonitis. AU - Jones KD AU - King TE AU - Koth LL AU - Lee JS AU - Ley B AU - Wolters PJ AU - Collard HR LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 4 IP - DP - 2016 Jan 01 TI - Occupational hypersensitivity pneumonitis in a green tea manufacturer PG - e00152 AB - Hypersensitivity pneumonitis (HP) is caused by numerous agents, and one of its histopathological features is poorly formed granulomas. We report here a rare case of occupational HP caused by green tea, showing well-formed granulomas. The patient, a 54-year-old woman who had worked for 15 years in a green tea factory, was referred for abnormal chest X-ray shadows with cough and breathlessness over a 2-month period. The chest X-ray and high-resolution computed tomography showed diffuse bilateral ground-glass opacities and poorly defined centrilobular nodules. Histopathological examination of the thoracoscopic lung biopsy specimens showed bronchiolocentric interstitial pneumonia with well-formed granulomas. Although the form of granulomas were atypical, laboratory data, CT findings, and intradermal skin testing suggested the diagnosis of subacute HP caused by green tea. After transfer to a different department, her condition improved markedly. Taking a precise medical history and avoidance of the suspected environmental agent proved useful in diagnosing this condition. AU - Tanaka Y AU - Shirai T AU - Enomoto N AU - Asada K AU - Oyama Y AU - Suda T LA - PT - DEP - TA - Respirology Case Reports JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 23 IP - DP - 2016 Jan 01 TI - Molecular characterization of microbial communities and quantification of Mycobacterium immunogenum in metal removal fluids and their associated biofilms PG - 4086-4094 AB - A number of human health effects have been associated with exposure to metal removal fluids (MRFs). Multiple lines of research suggest that a newly identified organism, Mycobacterium immunogenum (MI), appears to have an etiologic role in hypersensitivity pneumonitis (HP) in case of MRFs exposed workers. However, our knowledge of this organism, other possible causative agents (e.g., Pseudomonads), and the microbial ecology of MRFs in general, is limited. In this study, culture-based methods and small subunit ribosomal RNA gene clone library approach were used to characterize microbial communities in MRF bulk fluid and associated biofilm samples collected from fluid systems in an automobile engine plant. PCR amplification data using universal primers indicate that all samples had bacterial and fungal contaminated. Five among 15 samples formed colonies on the Mycobacteria agar 7H9 suggesting the likely presence of Mycobacteria in these five samples. This observation was confirmed with PCR amplification of 16S rRNA gene fragment using Mycobacteria specific primers. Two additional samples, Biofilm-1 and Biofilm-3, were positive in PCR amplification for Mycobacteria, yet no colonies formed on the 7H9 cultivation agar plates. Real-time PCR was used to quantify the abundance of M. immunogenum in these samples, and the data showed that the copies of M. immunogenum 16S rRNA gene in the samples ranges from 4.33?×?104 copy/ml to 4.61?×?107 copy/ml. Clone library analysis revealed that Paecilomyces sp. and Acremonium sp. and Acremonium-like were dominant fungi in MRF samples. Various bacterial species from the major phylum of proteobacteria were found and Pseudomonas is the dominant bacterial genus in these samples. Mycobacteria (more specifically MI) were found in all biofilm samples, including biofilms collected from inside the MRF systems and from adjacent environmental surfaces, suggesting that biofilms may play an important role in microbial ecology in MRFs. Biofilms may provide a shield or sheltered microenvironment for the growth and/or colonization of Mycobacteria in MRFs. AU - Wu J AU - Franzblau A AU - Xi C LA - PT - DEP - TA - Environmental Science and Pollution Research JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 66 IP - DP - 2016 Jan 01 TI - Development of an occupational airborne chemical exposure matrix PG - 358-364 AB - Background Population-based studies of the occupational contribution to chronic obstructive pulmonary disease generally rely on self-reported exposures to vapours, gases, dusts and fumes (VGDF), which are susceptible to misclassification. Aims To develop an airborne chemical job exposure matrix (ACE JEM) for use with the UK Standard Occupational Classification (SOC 2000) system. Methods We developed the ACE JEM in stages: (i) agreement of definitions, (ii) a binary assignation of exposed/not exposed to VGDF, fibres or mists (VGDFFiM), for each of the individual 353 SOC codes and (iii) assignation of levels of exposure (L; low, medium and high) and (iv) the proportion of workers (P) likely to be exposed in each code. We then expanded the estimated exposures to include biological dusts, mineral dusts, metals, diesel fumes and asthmagens. Results We assigned 186 (53%) of all SOC codes as exposed to at least one category of VGDFFiM, with 23% assigned as having medium or high exposure. We assigned over 68% of all codes as not being exposed to fibres, gases or mists. The most common exposure was to dusts (22% of codes with >50% exposed); 12% of codes were assigned exposure to fibres. We assigned higher percentages of the codes as exposed to diesel fumes (14%) compared with metals (8%). Conclusions We developed an expert-derived JEM, using a strict set of a priori defined rules. The ACE JEM could also be applied to studies to assess risks of diseases where the main route of occupational exposure is via inhalation. AU - S. S. Sadhra AU - O. P. Kurmi AU - H. Chambers AU - K. B. H. Lam AU - D. Fishwick AU - and The Occupational COPD Research Group LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 66 IP - DP - 2016 Jan 01 TI - Health surveillance for occupational asthma in the UK PG - 365-370 AB - Background Periodic health surveillance (HS) of workers can identify early cases of occupational asthma. Information about its uptake and its content in the UK is lacking. Aims To identify the overall levels of uptake and quality of HS for occupational asthma within three high-risk industry sectors in the UK. Methods A telephone survey of employers, and their occupational health (OH) professionals, carried out in three sectors with exposures potentially capable of causing occupational asthma (bakeries, wood working and motor vehicle repair). Results A total of 457 organizations participated (31% response rate). About 77% employed <10 people, 17% between 10 and 50 and 6% >50. Risk assessments were common (67%) and 14% carried out some form of HS for occupational asthma, rising to 19% if only organizations reporting asthma hazards and risks were considered. HS was carried out both by in-house (31%) and external providers (69%). Organizational policies were often used to define HS approaches (80%), but infrequently shared with the OH provider. OH providers described considerable variation in practice. Record keeping was universal, but worker-held records were not reported. HS tools were generally developed in-house. Lung function was commonly measured, but only limited interpretation evident. Referral of workers to local specialist respiratory services was variable. Conclusions This study provided new insights into the real world of HS for occupational asthma. We consider that future work could and should define simpler, more practical and evidence-based approaches to HS to ensure maximal consistency and use of high-quality approaches. AU - Fishwick D AU - Sen D AU - Barker P AU - Codling A AU - Fox D AU - Naylor S LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 73 IP - DP - 2016 Jan 01 TI - Sputum neutrophils are elevated in smelter workers, and systemic neutrophils are associated with rapid decline in FEV1 PG - 459-466 AB - Objectives In a previous study on smelter workers we, found significant relationship between exposure to dust and accelerated annual decline in forced expiratory volume in 1 s (FEV1). In this cross-sectional study at the end of a follow-up, we aimed to investigate the possible association between annual decline in FEV1 and markers of airways, and systemic inflammation in smelter workers. Methods Employees (n=76 (27 current smokers)) who had been part of a longitudinal study (9–13 years) that included spirometry (>6 measurements) and respiratory questionnaires, performed induced sputum, exhaled NO and had blood drawn. Participants with annual decline in FEV1=45 mL were compared with participants with annual decline <45 mL; also 26 non-exposed controls were included. Results Compared with non-exposed controls, smelter workers demonstrated a significantly increased percentage of neutrophils (mean (SD)) (57% (17) vs 31% (15)) and matrix metalloproteinases 8 (MMP-8) levels in sputum, and MMP-9, surfactant protein D (SpD) and transforming growth factor ß (TGFb) levels in blood. A significant association in FEV1=45 mL was found for blood neutrophils when controlling for smoking habits (OR=1.7 (95% CI 1.0 to 2.8), p=0.045). Airway and blood protein markers were not associated with annual decline in FEV1. Conclusions All workers displayed airway and systemic inflammation characterised by increased levels of neutrophils and MMP-8 in sputum, and MMP-9, SpD and TGFß in blood compared with non-exposed controls. Blood neutrophils in particular were significantly elevated in those workers with the most rapid decline in lung function. A similar observation was not seen with airway neutrophils. In the present study, we were able to identify systemic but not airway inflammatory markers that can predict increased decline in FEV1 in smelter workers. AU - Sikkeland LIB AU - Johnsen HL AU - Riste TB AU - Alexis NE AU - Halvorsen B AU - Søyseth V AU - Kongerud J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 66 IP - DP - 2016 Jan 01 TI - Asthma in furniture and wood processing workers: a systematic review PG - 193-201 AB - Background Wood dust is a common cause of occupational asthma. There is potential for high exposure to wood dust during furniture and wood manufacturing processes. Aims To evaluate the evidence for non-neoplastic respiratory ill health associated with work in the furniture and wood manufacturing sector. Methods A systematic review was performed according to PRISMA guidelines. Articles were graded using SIGN (Scottish Intercollegiate Guideline Network) and MERGE (Methods for Evaluating Research Guidelines and Evidence) criteria, with data grouped by study outcome. Results Initial searches identified 1328 references, from which 55 articles were included in the review. Fourteen studies were graded A using MERGE or >2++ using SIGN. All but one paper describing airway symptoms reported an increased risk in higher wood dust exposed workers in comparison to lower or non-exposed groups. Five studies reporting asthma examined dose response; three found a positive effect. The relative risk for asthma in exposed workers in the single meta-analysis was 1.5 (95% CI 1.25–1.87). Two studies reported more obstructive lung function (forced expiratory volume in 1 s [FEV1]/forced vital capacity < 0.7) in exposed populations. Excess longitudinal FEV1 decline was reported in female smokers with high wood dust exposures in one study population. Where measured, work-related respiratory symptoms did not clearly relate to specific wood immunoglobulin E positivity. Conclusions Work in this sector was associated with a significantly increased risk of respiratory symptoms and asthma. The evidence for wood dust exposure causing impaired lung function is less clearly established. Further study is required to better understand the prevalence, and causes, of respiratory problems within this sector. AU - Wiggans RE AU - Evans G AU - Fishwick D AU - Barber CM LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 66 IP - DP - 2016 Jan 01 TI - UK asbestos imports and mortality due to idiopathic pulmonary fibrosis PG - 106-111 AB - Background Previous studies have demonstrated that the rising mortality due to mesothelioma and asbestosis can be predicted from historic asbestos usage. Mortality due to idiopathic pulmonary fibrosis (IPF) is also rising, without any apparent explanation. Aims To compare mortality due to these conditions and examine the relationship between mortality and national asbestos imports. Methods Mortality data for IPF and asbestosis in England and Wales were available from the Office for National Statistics. Data for mesothelioma deaths in England and Wales and historic UK asbestos import data were available from the Health & Safety Executive. The numbers of annual deaths due to each condition were plotted separately by gender, against UK asbestos imports 48 years earlier. Linear regression models were constructed. Results For mesothelioma and IPF, there was a significant linear relationship between the number of male and female deaths each year and historic UK asbestos imports. For asbestosis mortality, a similar relationship was found for male but not female deaths. The annual numbers of deaths due to asbestosis in both sexes were lower than for IPF and mesothelioma. Conclusions The strength of the association between IPF mortality and historic asbestos imports was similar to that seen in an established asbestos-related disease, i.e. mesothelioma. This finding could in part be explained by diagnostic difficulties in separating asbestosis from IPF and highlights the need for a more accurate method of assessing lifetime occupational asbestos exposure. AU - Barber CM AU - Wiggans RE AU - Young C AU - Fishwick D LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 73 IP - DP - 2016 Jan 01 TI - Breath-taking jobs: a case-control study of respiratory work disability by occupation in Norway PG - 600-606 AB - BACKGROUND: The current knowledge on respiratory work disability is based on studies that used crude categories of exposure. This may lead to a loss of power, and does not provide sufficient information to allow targeted workplace interventions and follow-up of patients with respiratory symptoms. OBJECTIVES: The aim of this study was to identify occupations and specific exposures associated with respiratory work disability. METHODS: In 2013, a self-administered questionnaire was mailed to a random sample of the general population, aged 16-50, in Telemark County, Norway. We defined respiratory work disability as a positive response to the survey question: 'Have you ever had to change or leave your job because it affected your breathing?' Occupational exposures were assessed using an asthma-specific job-exposure matrix, and comparison of risks was made for cases and a median of 50 controls per case. RESULTS: 247 workers had changed their work because of respiratory symptoms, accounting for 1.7% of the respondents ever employed. The 'breath-taking jobs' were cooks/chefs: adjusted OR 3.6 (95% CI 1.6 to 8.0); welders: 5.2 (2.0 to 14); gardeners: 4.5 (1.3 to 15); sheet metal workers: 5.4 (2.0 to 14); cleaners: 5.0 (2.2 to 11); hairdressers: 6.4 (2.5 to 17); and agricultural labourers: 7.4 (2.5 to 22). Job changes were also associated with a variety of occupational exposures, with some differences between men and women. CONCLUSIONS: Self-report and job-exposure matrix data showed similar findings. For the occupations and exposures associated with job change, preventive measures should be implemented.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing AU - Fell A AU - Abrahamsen R AU - Henneberger PK AU - Svendsen MV AU - Andersson E AU - Torén K AU - Kongerud J. LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 71 IP - DP - 2016 Jan 01 TI - Prevalence of sensitization to ‘improver’ enzymes in UK supermarket bakers PG - 997-1000 AB - Background Supermarket bakers are exposed not only to flour and alpha-amylase but also to other ‘improver’ enzymes, the nature of which is usually shrouded by commercial sensitivity. We aimed to determine the prevalence of sensitization to ‘improver’ enzymes in UK supermarket bakers. Methods We examined the prevalence of sensitization to enzymes in 300 bakers, employed by one of two large supermarket bakeries, who had declared work-related respiratory symptoms during routine health surveillance. Sensitization was determined using radioallergosorbent assay to eight individual enzymes contained in the specific ‘improver’ mix used by each supermarket. Results The prevalence of sensitization to ‘improver’ enzymes ranged from 5% to 15%. Sensitization was far more likely if the baker was sensitized also to either flour or alpha-amylase. The prevalence of sensitization to an ‘improver’ enzyme did not appear to be related to the concentration of that enzyme in the mix. Conclusions We report substantial rates of sensitization to enzymes other than alpha-amylase in UK supermarket bakers; in only a small proportion of bakers was there evidence of sensitization to ‘improver mix’ enzymes without sensitization to either alpha-amylase or flour. The clinical significance of these findings needs further investigation, but our findings indicate that specific sensitization in symptomatic bakers may not be identified without consideration of a wide range of workplace antigens AU - Jones M AU - Welch J AU - Turvey J AU - Cannon J AU - Clark P AU - Szram J AU - Cullinan P LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 194 IP - DP - 2016 Jan 01 TI - Occupational Asthma Due to Inhalation of Aerosolized Lipophilic Coating Materials. PG - 787-78 AB - We present a case of onset of severe asthma in a 59-year-old patient who worked in an aerospace plant. He was noted to have wheezing on exam and obstruction on PFTs. Review of his occupational history revealed exposure to lipophilic industrial compounds. We outline the radiographic and histologic findings that were found in the patient, and discuss occupational asthma due to inhalation of lipophilic compounds. DOI 10.1007/s00408-016-9919-7 AU - Suresh K AU - Belchis D AU - Askin F AU - Pearse DB AU - Terry PB. LA - PT - DEP - TA - Lung JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 50 (13), p IP - DP - 2016 Jan 01 TI - Contribution of Direct and Indirect Exposure to Human Serum Concentrations of Perfluorooctanoic Acid in an Occupationally Exposed Group of Ski Waxers PG - 7037-7040 AB - The contribution of direct (i.e., uptake of perfluorooctanoic acid (PFOA) itself) and indirect (i.e., uptake of 8:2 fluorotelomer alcohol (FTOH) and metabolism to PFOA) exposure to PFOA serum concentrations was investigated using a dynamic one-compartment pharmacokinetic (PK) model. The PK model was applied to six occupationally exposed ski waxers for whom direct and indirect exposures via inhalation were characterized using multiple measurements with personal air sampling devices. The model was able to predict the diverging individual temporal trends of PFOA in serum with correlation coefficients of 0.82-0.94. For the four technicians with high initial concentrations of PFOA in serum (250-1050 ng/mL), the ongoing occupational exposure (both direct and indirect) was of minor importance and net depuration of PFOA was observed throughout the ski season. An estimated average intrinsic elimination half-life of 2.4 years (1.8-3.1 years accounting for variation between technicians and model uncertainty) was derived for these technicians. The remaining two technicians, who had much lower initial serum concentrations (10-17 ng/mL), were strongly influenced by exposure during the ski season with indirect exposure contributing to 45% of PFOA serum concentrations. On the basis of these model simulations, an average metabolism yield of 0.003 (molar concentration basis; uncertainty range of 0.0006-0.01) was derived for transformation of 8:2 FTOH to PFOA. An uncertainty analysis was performed, and it was determined that the input parameters quantifying the intake of PFOA were mainly responsible for the uncertainty of the metabolism yield and the initial concentration of PFOA in serum was mainly contributing to the uncertainty of estimated serum half-lives. AU - Gomis MI AU - Vestergren R AU - Nilsson H AU - Cousins IT. LA - PT - DEP - TA - Environ Sci Technol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 11 IP - DP - 2016 Jan 01 TI - Do Low Molecular Weight Agents Cause More Severe Asthma than High Molecular Weight Agents? PG - e0156141 AB - INTRODUCTION: The aim of this study was to analyse whether patients with occupational asthma (OA) caused by low molecular weight (LMW) agents differed from patients with OA caused by high molecular weight (HMW) with regard to risk factors, asthma presentation and severity, and response to various diagnostic tests. METHODS: Seventy-eight patients with OA diagnosed by positive specific inhalation challenge (SIC) were included. Anthropometric characteristics, atopic status, occupation, latency periods, asthma severity according to the Global Initiative for Asthma (GINA) control classification, lung function tests and SIC results were analysed. RESULTS: OA was induced by an HMW agent in 23 patients (29%) and by an LMW agent in 55 (71%). A logistic regression analysis confirmed that patients with OA caused by LMW agents had a significantly higher risk of severity according to the GINA classification after adjusting for potential confounders (OR = 3.579, 95% CI 1.136-11.280; p = 0.029). During the SIC, most patients with OA caused by HMW agents presented an early reaction (82%), while in patients with OA caused by LMW agents the response was mainly late (73%) (p = 0.0001). Similarly, patients with OA caused by LMW agents experienced a greater degree of bronchial hyperresponsiveness, measured as the difference in the methacholine dose-response ratio (DRR) before and after SIC (1.77, range 0-16), compared with patients with OA caused by HMW agents (0.87, range 0-72), (p = 0.024). CONCLUSIONS: OA caused by LMW agents may be more severe than that caused by HMW agents. The severity of the condition may be determined by the different mechanisms of action of these agents. AU - Meca O AU - Cruz MJ AU - Sánchez-Ortiz M AU - González-Barcala FJ AU - Ojanguren I AU - Munoz X. LA - PT - DEP - TA - Plos one JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - IP - DP - 2016 Jan 01 TI - Occupational Exposure to Bioaerosols in Norwegian Crab Processing Plants PG - AB - INTRODUCTION: Aerosolization of components when processing king crab (Paralithodes camtschaticus) and edible crab (Cancer pagurus) may cause occupational health problems when inhaled by workers. METHODS: A cross-sectional study was carried out in three king crab plants and one edible crab plant. Personal exposure measurements were performed throughout work shifts. Air was collected for measurement of tropomyosin, total protein, endotoxin, trypsin, and N-acetyl-ß-d-glucosaminidase (NAGase). T-tests and ANOVAs were used to compare the levels of exposure in the different plants and areas in the plants. RESULTS: Total protein and tropomyosin levels were highest in the edible crab plant, endotoxin levels were highest in king crab plants. King crab exposure levels were highest during raw processing. Tropomyosin levels were highest during raw king crab processing with geometric mean (GM) 9.6 versus 2.5ng m(-3) during cooked processing. Conversely, edible crab tropomyosin levels were highest during cooked processing with GM 45.4 versus 8.7ng m(-3) during raw processing. Endotoxin levels were higher in king crab plants than in the edible crab plant with GM = 6285.5 endotoxin units (EU) m(-3) versus 72 EU m(-3). In the edible crab plant, NAGase levels were highest during raw processing with GM = 853 pmol4-methylumbelliferone (MU) m(-3) versus 422 pmol4-MU m(-3) during cooked processing. Trypsin activity was found in both king crab and edible crab plants and levels were higher in raw than cooked processing. Differences in exposure levels between plants and worker groups (raw and cooked processing) were identified. CONCLUSIONS: Norwegian crab processing workers are exposed to airborne proteins, tropomyosin, endotoxins, trypsin, and NAGase in their breathing zone. Levels vary between worker groups and factories.© The Author 2016. Published by Oxford University Press on behalf of the British Occupational Hygiene Society. AU - Thomassen MR AU - Kamath SD AU - Lopata AL AU - Madsen AM AU - Eduard W AU - Bang BE AU - Aasmoe L. LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - IP - DP - 2016 Jan 01 TI - IgE Reactivity, Work Related Allergic Symptoms, Asthma Severity, and Quality of Life in Bakers with Occupational Asthma. PG - AB - In Germany, bakers with occupational asthma willing to stay in their job are included in an interdisciplinary program of the Social Accident Insurance for Foodstuff and Catering Industry (BGN). The primary aim is to reduce flour dust exposure, and to provide adequate medical treatment. Our aim was to evaluate the program's effect on the disease's course using routinely collected data. Forty three bakers with allergic occupational asthma and with the available baseline level of IgE (f4, f5) were investigated. Changes in IgE related to wheat and rye flour exposure were measured by ImmunoCAP test during follow-up visits. A questionnaire on work-related allergic complaints (WRAC), the Asthma Control Test (ACT), a 10-point scale of asthma severity grade, and quality of life instruments (EQ-5D-5L, Mini-AQLQ) were administered. We found an improvement of asthma severity in 88.4 % of the bakers. WRAC were reported by 65 %; 77 % had good asthma control (ACT = 20); and 81 % had regular asthma medication. A relevant reduction of =2 CAP-classes for both allergens was seen in 12 % of the subjects. Health-related and asthma-specific quality of life was high. We conclude that satisfactory asthma control is probably the result of adequate medical management. In a subgroup of bakers with decreased specific IgE, it may also be attributed to reduced allergen exposure. AU - Bittner C AU - Garrido MV AU - Harth V AU - Preisser AM. LA - PT - DEP - TA - Adv Exp Med Biol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 66 IP - DP - 2016 Jan 01 TI - Alveolar proteinosis associated with aluminium dust inhalation PG - 492-494 AB - Abstract Secondary alveolar proteinosis is a rare lung disease which may be triggered by a variety of inhaled particles. The diagnosis is made by detection of anti-granulocyte-macrophage colony-stimulating factor antibodies in bronchoalveolar lavage fluid, which appears milky white and contains lamellar bodies. Aluminium has been suggested as a possible cause, but there is little evidence in the literature to support this assertion. We report the case of a 46-year-old former boilermaker and boat builder who developed secondary alveolar proteinosis following sustained heavy aluminium exposure. The presence of aluminium was confirmed both by histological examination and metallurgical analysis of a mediastinal lymph node. Despite cessation of exposure to aluminium and treatment with whole-lung lavage which normally results in improvements in both symptoms and lung function, the outcome was poor and novel therapies are now being used for this patient. It may be that the natural history in aluminium-related alveolar proteinosis is different, with the metal playing a mediating role in the disease process. Our case further supports the link between aluminium and secondary alveolar proteinosis and highlights the need for measures to prevent excessive aluminium inhalation in relevant industries. AU - Chew R AU - Nigam S AU - Sivakumaran P LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 16 IP - DP - 2016 Jan 01 TI - Exogenous lipid pneumonia related to long-term use of Vicks VapoRub® by an adult patient: a case report PG - 11 AB - Background: Use of petroleum-based over the counter remedies such as Vicks VapoRub to alleviate symptoms of rhinitis is common and can be effective, but carries under-appreciated risks of adverse side effects. In this case report we highlight Exogenous Lipoid Pneumonia (ELP), an uncommon condition that results from accumulation of exogenous lipids in the alveoli, as an adverse side effect of long-term Vicks VapoRub use. Case presentation: We present the case of an 85-year-old female patient with ELP apparently due to continuous application of Vicks VapoRub® to her nostrils to alleviate chronic rhinitis. She was diagnosed incidentally via chest radiograph and computed tomography (CT) scan done as follow up to finding elevated C-reactive Protein during a routine exam. The CT scan revealed a pulmonary consolidation in the lower lobe of the right lung with fat density combined with low density areas associated with focal ground-glass opacities. The patient was advised to discontinue use of petroleum-based products, and was prescribed intranasal corticosteroids for her rhinitis. Follow up 2 years later showed that the lipid consolidation had diminished in size by approximately 10 %. Conclusion: Physicians must be aware that ELP can develop as a result of long-term application of petroleumbased oils and ointments to the nose and discourage such use of these products. Patients who have used petroleum-based products in this way should be screened for ELP. CT scan is the best imaging modality for establishing the diagnosis. The treatment of this condition is not well defined, but, as shown in this case, the size of the lipid mass can decrease after use of petroleum based substances is discontinued. AU - Cherrez Ojeda I AU - Calderon JC AU - Guevara J AU - Cabrera D AU - Calero E AU - Cherrez A LA - PT - DEP - TA - BMC Ear, Nose and Throat Disorders JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 1 IP - DP - 2016 Jan 01 TI - Hypersensitivity Pneumonitis Due to Metalworking Fluid Aerosols PG - 59 AB - Purpose of Review This review summarises the clinical knowledge of hypersensitivity pneumonitis in workers exposed to aerosols of metalworking fluid, reviewing published outbreaks and clinical cases. Recent Findings Metalworking fluid exposure has become the commonest recognised cause of occupational hypersensitivity pneumonitis, having been rare before 2000. There are many possible agents in the metalworking fluid which may be the cause of disease including bacteria, mycobacteria, fungae, biocides, emulsifiers, reodorants and dissolved chrome and cobalt. Causes are likely to be different in different outbreaks. Mycobacteria growing in the metalworking fluid have generated immune responses in some workers, but their role in disease causation is not yet established. Many outbreaks have been identified in large workplaces using common sumps. Summary It is not possible to prevent microbial contamination of metalworking fluids in use. Disease prevention should focus on stopping inhalation of aerosols, particularly by re-engineering to remove recirculation. AU - Burge PS LA - PT - DEP - TA - Curr Allergy Asthma Rep JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 73 IP - DP - 2016 Jan 01 TI - Environmental factors associated with baseline and serial changes in fractional exhaled nitric oxide (FeNO) in spice mill workers PG - 614-620 AB - Background This study evaluated the determinants of high fractional exhaled nitric oxide (FeNO; >50 ppb) and serial changes in FeNO over a 24-hour period in spice mill workers at risk of work-related allergic respiratory disease and asthma. Methods A cross-sectional study of 150 workers used European Community Respiratory Health Survey (ECRHS) questionnaires, Phadiatop, serum-specific IgE (garlic, chilli pepper, wheat; Phadia, ImmunoCAP), spirometry and FeNO. A hand-held portable nitric oxide sampling device (NIOX MINO, Aerocrine AB) measured FeNO before and after the 8-hour shift and after 24 hours from baseline. Results The mean age of workers was 33 years; 71% were male, 46% current smokers and 45% atopic. Among workers with garlic sensitisation, 13% were monosensitised and 6% were co-sensitised to chilli pepper. Baseline preshift FeNO geometric mean (GM=14.9 ppb) was similar to the mean change across shift (GM=15.4 ppb) and across the 24-hour period (GM=15.8 ppb). In multivariate linear models, smoking (ß=-0.507) and atopy (ß=0.433) were strongly associated with FeNO. High FeNO (>50 ppb) was significantly associated with asthma-like symptoms due to spice dust (OR=5.38, CI 1.01 to 28.95). Sensitisation to chilli pepper was more strongly correlated with FeNO (r=0.32) and FeNO>50 ppb (OR=17.04, p=0.005) than garlic. FeNO increase (>12%) across 24 hours demonstrated a strong association with elevated exposures to spice dust particulate (OR=3.77, CI 1.01 to 14.24). Conclusions This study suggests that chilli pepper sensitisation is associated with high FeNO (>50 ppb), more strongly compared with garlic, despite the low prevalence of sensitisation to chilli. Elevated inhalant spice dust particulate is associated with a delayed elevation of FeNO across the 24-hour period. AU - van der Walt A AU - Baatjies R AU - Singh T AU - Jeebhay MF LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - IP - DP - 2016 Jan 01 TI - Genes Interacting with Occupational Exposures to Low Molecular Weight Agents and Irritants on Adult-Onset Asthma in Three European Studies PG - AB - BACKGROUND: The biological mechanisms by which cleaning products and disinfectants - an emerging risk factor - affect respiratory health remain incompletely evaluated. Studying genes by environment interactions (GxE) may help identify new genes related to adult-onset asthma. OBJECTIVES: To identify interactions between genetic polymorphisms of a large set of genes involved in the response to oxidative stress, and occupational exposures to low molecular weight (LMW) agents or irritants on adult-onset asthma. METHODS: Data came from three large European cohorts: EGEA, SAPALDIA, and ECRHS. A candidate pathway-based strategy identified 163 genes involved in response to oxidative stress and potentially related with exposures to LMW agents/irritants. Occupational exposures were evaluated using an asthma job-exposure matrix and job-specific questionnaires for cleaners and healthcare workers. Logistic regression models were used to detect GxE interactions, adjusted for age, sex and population ancestry in 2599 adults (Mean age: 47 years, 60% women, 36% exposed, 18% asthmatics). P-values were corrected for multiple comparisons. RESULTS: Ever exposure to LMW agents/irritants was associated with current adult-onset asthma (OR(95%CI)=1.28(1.04,1.58)). Eight SNP by exposure interactions at five loci were found at p<0.005: PLA2G4A (rs932476, chromosome 1), near PLA2R1 (rs2667026, chromosome 2), near RELA (rs931127, rs7949980, chromosome 11), PRKD1 (rs1958980, rs11847351, rs1958987, chromosome 14), and PRKCA (rs6504453, chromosome 17). Results were consistent across the three studies and after accounting for smoking. CONCLUSIONS: Using a pathway-based selection process, we identified novel genes potentially involved in the adult asthma in relation with occupational exposure. These genes play a role in the NF-kB pathway involved in inflammation. AU - Rava M AU - Ahmed I AU - Kogevinas M AU - Le Moual N AU - Bouzigon E AU - Curjuric I AU - Dizier MH AU - Dumas O AU - Gonzalez JR AU - Imboden M AU - Mehta AJ AU - Tubert-Bitter P AU - Zock JP AU - Jarvis D AU - Probst-Hensch NM AU - Demenais F AU - Nadif R. LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 48 IP - DP - 2016 Jan 01 TI - Risk of hypersensitivity pneumonitis and interstitial lung diseases among pigeon breeders PG - 818-825 AB - We studied the risk of hypersensitivity pneumonitis and other interstitial lung diseases (ILDs) among pigeon breeders. This is a retrospective follow-up study from 1980 to 2013 of 6920 pigeon breeders identified in the records of the Danish Racing Pigeon Association. They were compared with 276?800 individually matched referents randomly drawn from the Danish population. Hospital based diagnoses of hypersensitivity pneumonitis and other ILDs were identified in the National Patient Registry 1977–2013. Stratified Cox regression analyses estimated the hazard ratios (HR) of hypersensitivity pneumonitis and other ILDs adjusted for occupation, residence and redeemed prescription of medication with ILDs as a possible side-effect. Subjects were censored at death, emigration or a diagnosis of connective tissue disease. The overall incidence rate of ILD was 77.4 per 100?000 person-years among the pigeon breeders and 50.0 among the referents. This difference corresponded to an adjusted HR of 1.56 (95% CI 1.26–1.94). The adjusted HRs of hypersensitivity pneumonitis and other ILDs for pigeon breeders were 14.36 (95% CI 8.10–25.44) and 1.33 (95% CI 1.05–1.69), respectively. This study shows an increased risk of ILD among pigeon breeders compared with the referent population. Protective measures are recommended even though ILD leading to hospital contact remains rare among pigeon breeders. AU - Cramer C AU - Schlünssen V AU - Bendstrup E AU - Stokholm ZA AU - Vestergaard JM AU - Frydenberg M AU - Kolstad HA LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 118 IP - DP - 2016 Jan 01 TI - Asthma prevalence in German Olympic athletes: A comparison of winter and summer sport disciplines PG - 15-21 AB - BACKGROUND: Prevalence of asthma in elite athletes shows very wide ranges. It remains unclear to what extent this is influenced by the competition season (winter vs. summer) or the ventilation rate achieved during competition. The aim of this study was to evaluate prevalence of asthma in German elite winter and summer athletes from a wide range of sport disciplines and to identify high risk groups. METHODS: In total, 265 German elite winter athletes (response 77%) and 283 German elite summer athletes (response 64%) answered validated respiratory questionnaires. Using logistic regression, the asthma risks associated with competition season and ventilation rate during competition, respectively, were investigated. A subset of winter athletes was also examined for their FENO-levels and lung function. RESULTS: With respect to all asthma outcomes, no association was found with the competition season. Regarding the ventilation rate, athletes in high ventilation sports were at increased risk of asthma, as compared to athletes in low ventilation sports (doctors' diagnosed asthma: OR 2.32, 95% CI 1.19-4.53; use of asthma medication: OR 4.46, 95% CI 1.52-13.10; current wheeze or use of asthma medication: OR 2.78, 95% CI 1.34-5.76). Athletes with doctors' diagnosed asthma were at an approximate four-fold risk of elevated FENO-values. CONCLUSIONS: The clinically relevant finding of this study is that athletes' asthma seems to be more common in sports with high ventilation during competition, whereas the summer or winter season had no impact on the frequency of the disease. Among winter athletes, elevated FENO suggested suboptimal control of asthma. AU - Selge C AU - Thomas S AU - Nowak D AU - Radon K AU - Wolfarth B. LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 71 IP - DP - 2016 Jan 01 TI - A diagnostic model for chronic hypersensitivity pneumonitis PG - 951-954 AB - The objective of this study was to develop a diagnostic model that allows for a highly specific diagnosis of chronic hypersensitivity pneumonitis using clinical and radiological variables alone. Chronic hypersensitivity pneumonitis and other interstitial lung disease cases were retrospectively identified from a longitudinal database. High-resolution CT scans were blindly scored for radiographic features (eg, ground-glass opacity, mosaic perfusion) as well as the radiologist's diagnostic impression. Candidate models were developed then evaluated using clinical and radiographic variables and assessed by the cross-validated C-statistic. Forty-four chronic hypersensitivity pneumonitis and eighty other interstitial lung disease cases were identified. Two models were selected based on their statistical performance, clinical applicability and face validity. Key model variables included age, down feather and/or bird exposure, radiographic presence of ground-glass opacity and mosaic perfusion and moderate or high confidence in the radiographic impression of chronic hypersensitivity pneumonitis. Models were internally validated with good performance, and cut-off values were established that resulted in high specificity for a diagnosis of chronic hypersensitivity pneumonitis. AU - Johannson KA AU - Elicker BM AU - Vittinghoff E AU - Assayag D AU - de Boer K AU - Golden JA AU - Jones KD AU - King TE AU - Koth LL AU - Lee JS AU - Ley B AU - Wolters PJ AU - Collard HR LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 47 IP - DP - 2016 Jan 01 TI - Prevalence and risk factors for COPD in farmers: a cross-sectional controlled study PG - 95-103 AB - There are conflicting data regarding the magnitude and determinants of chronic obstructive pulmonary disease (COPD) risk in farmers. In a cross-sectional study of 917 nonfarming working controls and 3787 farmers aged 40–75 years, we assessed respiratory symptoms, tobacco exposure, job history (without direct exposure measurement) and lung function. COPD was defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criterion (post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) less than 0.70) and by the Quanjer reference equation (post-bronchodilator FEV1/FVC < lower limit of normal (LLN)). The prevalence (95% CI) of COPD according to the GOLD criterion was 5.1% (4.4–5.8%) and 2.9% (1.8–4.0%) in farmers and controls, respectively (p=0.005), and 3.1% (2.5–3.6%) and 1.5% (0.7–2.3%), respectively, for the LLN criterion (p< 0.01). For both COPD criteria after adjustment for age, sex and smoking status, COPD prevalence was similar in controls and crop farmers. Compared to controls, four job categories had a higher prevalence of COPD according to the GOLD criterion, namely, cattle breeders, swine breeders, poultry breeders and breeders of two or more livestock types. Among cattle breeders, only those from Franche-Comté had higher prevalence of COPD according to both GOLD and LLN criteria. The prevalence of COPD in farmers is higher than in nonfarming working controls, and depends on the farming activity, the region and the criterion used to define COPD. AU - Guillien A AU - Puyraveau M AU - Soumagne T AU - Guillot S AU - Rannou F AU - Marquette D AU - Berger P AU - Jouneau S AU - Monnet E AU - Mauny F AU - Laplante J-J AU - Dalphin J-C AU - Degano B LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - IP - DP - 2016 Jan 01 TI - Inflammation in induced sputum after aluminium oxide exposure: an experimental chamber study. PG - AB - INTRODUCTION: Workers in aluminium production are exposed to a complex mixture of particles and gases potentially harmful to the airways, among them aluminium oxide (Al2O3). With the use of an exposure chamber, we aimed to examine the effects of short-term controlled exposure to Al2O3 on lung function and inflammatory markers in healthy volunteers. METHODS: 15 men (age 19-31) were exposed in random order to clean air or Al2O3 particles (3.8-4.0 mg/m(3)) for 2 h including 30 min exercise (stationary bike, 75 W). The permissible exposure level (PEL) for Al2O3 by Occupational Safety and Health Administration, USA, is 5 mg/m(3) time weighted average (TWA). Sham and particle exposures were separated by at least 2 weeks. Spirometry was carried out, and induced sputum and blood samples were collected 48 h before and 4 and 24 h after exposure. RESULTS: Levels of sputum neutrophils (mean (±SEM)) was increased 24 h post-Al2O3 vs pre-Al2O3 exposure (43% (4) vs 31% (4), p=0.01) and the protein level of interleukin (IL)-8 had a 4.8 (0.9)-fold change increase 24 h after exposure (p<0.01). Following Al2O3 exposure, gene signatures in sputum were significantly increased related to several pathways. CONCLUSIONS: The present study suggests that controlled exposure to Al2O3 particles at levels below PEL (TWA) induces airway inflammation in healthy humans marked by elevated neutrophils and elevated IL-8. In addition, increased expression of genes associated with several biological processes was observed in sputum. Interestingly, inhaled Al2O3-induced effects were localised to the airways and not systemic. AU - Sikkeland L AU - Alexis NE AU - Fry RC AU - Martin E AU - Danielsen TE AU - Søstrand P AU - Kongerud J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 137 IP - DP - 2016 Jan 01 TI - Predictive value of nonspecific bronchial responsiveness in occupational asthma PG - 412-416 AB - Background The diagnosis of occupational asthma (OA) can be challenging and needs a stepwise approach. However, the predictive value of the methacholine challenge has never been addressed specifically in this context. Objective We sought to evaluate the sensitivity, specificity, and positive and negative predictive values of the methacholine challenge in OA. Methods A Canadian database was used to review 1012 cases of workers referred for a suspicion of OA between 1983 and 2011 and having had a specific inhalation challenge. We calculated the sensitivity, specificity, and positive and negative predictive values of methacholine challenges at baseline of the specific inhalation challenge, at the workplace, and outside work. Results At baseline, the methacholine challenge showed an overall sensitivity of 80.2% and a specificity of 47.1%, with positive and negative predictive values of 36.5% and 86.3%, respectively. Among the 430 subjects who were still working, the baseline measures displayed a sensitivity of 95.4%, a specificity of 40.1%, and positive and negative predictive values of 41.1% and 95.2%, respectively. Among the 582 subjects tested outside work, the baseline measures demonstrated a sensitivity and specificity of 66.7% and 52%, respectively, and positive and negative predictive values of 31.9% and 82.2%, respectively. When considering all subjects tested by a methacholine challenge at least once while at work (479), the sensitivity, specificity, and positive and negative predictive values were 98.1%, 39.1%, and 44.0% and 97.7%, respectively. Conclusion A negative methacholine challenge in a patient still exposed to the causative agent at work makes the diagnosis of OA very unlikely. AU - Pralong JA AU - Lemière C AU - Rochat T AU - L'Archevêque J AU - Labrecque M AU - Cartier A LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - IP - DP - 2016 Jan 01 TI - Worldwide trends in incidence in occupational allergy and asthma. PG - AB - PURPOSE OF REVIEW: Recent improvements in the methods for analyzing trends in occupational health surveillance and the prospect of future improvements in the collecting and sharing of electronic data alongside increasing availability of linked datasets make this a good time to review the existing literature on trends in occupational allergy and asthma (OAA). RECENT FINDINGS: There is a notable lack of reports of recent trends in OAA in the academic literature and much of the published work comes from European countries. The incidence of OAA appears to be declining based on physician-reporting or recognized compensation claims for the countries with published data. However, we need to be cautious in interpreting this as a decline in the 'true' incidence of OAA. Few of the studies adjusted appropriately for changes in the population at risk and one of the most robust study designs showed no change in the incidence of allergic contact dermatitis in contrast to the other studies. SUMMARY: Many existing datasets have the potential to be used to examine trends, and studies from Canada show the potential of using linked databases for surveillance. We hope that this review will encourage improvements in the analysis, and more dissemination, of trends. AU - Stocks SJ AU - Bensefa-Colas L AU - Berk SF LA - PT - DEP - TA - Curr Opin Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - IP - DP - 2016 Jan 01 TI - Identification of metal sensitization in sarcoid-like metal-exposed patients by the MELISA® lymphocyte proliferation test — a pilot study PG - AB - Background Pulmonary function is often affected by the inhalation of metal particles. The resulting pathology might trigger various lung diseases, e.g., parenchymal lung fibrosis and granulomatous lung disorders. We previously demonstrated that 6 % of tissue-proven sarcoid patients had a positive beryllium lymphocyte proliferation test (BeLPT), thus correcting the diagnosis to chronic beryllium disease. The aim of this study was to examine if MEmory Lymphocyte Immnuno Stimulation Assay (MELISA®), currently used for non-pulmonary diseases, can identify metals other than beryllium that can also trigger sensitization and induce granulomatous disease. Methods This pilot study included 13 sarcoid-like patients who underwent MELISA®. Eleven patients also underwent BeLPT. Biopsy samples were tested for metal content by scanning electron microscope. Eleven study patients had been exposed to metals at the workplace and 2 had silicone implants. Results Two patients who had undergone BeLPT were positive for beryllium. MELISA® detected 9 patients (9/13, 69 %) who were positive for at least one of the tested metals: 4 reacted positively to nickel, 4 to titanium, 2 to chromium, 2 to beryllium, 2 to silica, and one each to palladium, mercury and lead. Conclusion It is proposed that MELISA® can be exploited to also identify specific sensitization in individuals exposed to inhaled particles from a variety of metals. AU - Firemanr E AU - Shai AB AU - Alcalay Y AU - Ophir N AU - Kivity S AU - Stejskal V LA - PT - DEP - TA - Journal of Occupational Medicine and Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 67 IP - DP - 2016 Jan 01 TI - PAPAIN-INDUCED OCCUPATIONAL RHINOCONJUNCTIVITIS AND ASTHMA – A CASE REPORT PG - 109-112 AB - This report presents a case of occupational asthma, rhinitis and conjunctivitis to papain in a 50-year-old herbs and spices packer, with documented increased eosinophilia in induced sputum and in the nasal lavage fluids after a specific inhalation challenge test (SICT) and specific nasal challenge test (SNCT) with this enzyme. Immunoglobulin E-mediated (IgE) sensitization to papain was confirmed by positive results of a skin prick test with specific solution. Specific inhalation and nasal challenge tests demonstrated a direct and significant link between the exposure to this protease and the allergic response from the respiratory system. Additionally, the SNCT induced a severe reaction of the conjunctivae and a significant increase in the count of eosinophils in tears, despite the lack of direct contact of the allergen with the conjunctiva. Med Pr 2016;67(1):109–112 AU - ZAWODOWA A AU - PAPAINA W AU - PRZYPADKU O LA - PT - DEP - TA - Med Pracy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 67 IP - DP - 2016 Jan 01 TI - PAPAIN-INDUCED OCCUPATIONAL RHINOCONJUNCTIVITIS AND ASTHMA – A CASE REPORT PG - 109-112 AB - This report presents a case of occupational asthma, rhinitis and conjunctivitis to papain in a 50-year-old herbs and spices packer, with documented increased eosinophilia in induced sputum and in the nasal lavage fluids after a specific inhalation challenge test (SICT) and specific nasal challenge test (SNCT) with this enzyme. Immunoglobulin E-mediated (IgE) sensitization to papain was confirmed by positive results of a skin prick test with specific solution. Specific inhalation and nasal challenge tests demonstrated a direct and significant link between the exposure to this protease and the allergic response from the respiratory system. Additionally, the SNCT induced a severe reaction of the conjunctivae and a significant increase in the count of eosinophils in tears, despite the lack of direct contact of the allergen with the conjunctiva. Med Pr 2016;67(1):109–112 AU - ZAWODOWA A AU - PAPAINA W AU - PRZYPADKU O LA - PT - DEP - TA - Med Pracy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 107 IP - DP - 2016 Jan 01 TI - Occupational asthma in a fruit and vegetables vendor. PG - 87-91 AB - BACKGROUND: This study presents a case report of a woman running a fruit and vegetables market stall, occupationally exposed to mushroom spores, who developed asthmatic symptoms. Basidiospores are allergens that can give rise to sensitization and subsequently trigger an allergic reaction, such as contact dermatitis, rhino-conjunctivitis, asthma and hypersensitivity pneumonitis. METHODS: A 40-year-old atopic woman, who had worked at a market stall selling fruit and vegetables for the past 26 years in a small town market in southern Italy, came to our attention at the Occupational Medicine Unit, complaining of a 3-year history of dyspnoea, cough, and wheezing during autumn and winter. RESULTS: Spirometry showed a severe mixed type respiratory deficit with a significant bronchodilator response obtained with salbutamol administration. Skin prick tests to common aeroallergens were negative. Prick-to-prick test with fresh Pleurotus ostreatus was positive. We evaluated the size of the skin wheals and compared them to the positive control according to the Skin Index. An on-the-spot inspection of her store was performed and environmental conditions were identified that did not allow a satisfactory air exchange. CONCLUSIONS: The clinical history and the results of the allergologic investigations, plus an on-the-spot inspection, permitted us to ascertain that this subject had developed occupational asthma due to Pleurotus ostreatus spores. We advised her to stop handling and selling mushrooms, and she has no longer suffered asthmatic symptoms, over seven years of follow-up, and regularly continued to work without needing to take anti-asthma drugs. AU - Baldassarre A AU - Dragonieri S AU - Luisi V AU - Musti M AU - Vimercati L LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 113 IP - DP - 2016 Jan 01 TI - Asthma control and cold weather-related respiratory symptoms PG - 1-7 AB - BACKGROUND: In the northern hemisphere people are exposed recurrently to cold air and asthmatics experience more respiratory symptoms. We hypothesized that subjects with poor asthma control are more prone to experience cold weather-related respiratory symptoms than those with good asthma control. METHODS: A population-based cross-sectional study of 1995 adult asthmatics (response rate 40.4%) living in the Northern Finland was conducted using a questionnaire where cold weather-related respiratory symptoms as well as questions related to asthma control were inquired. The Asthma Control Test (ACT) was defined based on five questions (disadvantage and occurrence of asthma symptoms, waking up because of asthma symptoms, use of rescue medication and self-assessment of asthma control during the past 4 weeks), and was divided into quartiles. RESULTS: Cold weather-related respiratory symptoms were more frequent among asthmatics with poorly controlled asthma (ACT Q1 vs. ACT Q4); adjusted prevalence ratio (PR) for shortness of breath (men 1.47, 95% confidence interval 1.22-1.77; women 1.18, 1.07-1.30), cough (men 1.10, 0.91-1.34; women 1.18, 1.08-1.30), wheezing (men 1.91, 1.31-2.78; women 1.48, 1.17-1.87), phlegm production (men 1.51, 1.06-2.14; women 1.62, 1.27-2.08) and chest pain (men 4.47, 1.89-10.56; women 2.60, 1.64-4.12). The relations between asthma control and symptom occurrence seemed stronger among smokers than never smokers and subjects with body mass index (BMI) below and above 25-30. CONCLUSIONS: Our study provides new evidence that subjects whose asthma is poorly controlled are more prone to experience cold weather-related respiratory symptoms and even a slight worsening of asthma control increases symptom prevalences. AU - Hyrkäs H AU - Ikäheimo TM AU - Jaakkola JJ AU - Jaakkola MS. LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - IP - DP - 2016 Jan 01 TI - Zoonotic tuberculosis in occupationally exposed groups in Pakistan. PG - AB - BACKGROUND: Bovine tuberculosis (bTB) remains a public health threat in low-income countries. Data on human tuberculosis (TB) due to Mycobacterium bovis are poorly documented in developing countries. AIMS: To determine the occurrence of active pulmonary TB due to M. bovis in abattoir workers, butchers, livestock farmers and veterinarians and to document their knowledge and practices regarding bTB. METHODS: A cross-sectional study of abattoir workers, butchers, livestock farmers, veterinary doctors and veterinary assistants, which obtained data on socio-demographic conditions, knowledge and practices regarding TB. Sputum samples were collected from respondents with a chronic cough. The chi-squared test was used for statistical analysis. RESULTS: A total of 141 abattoir workers, 317 butchers, 50 livestock farmers, five veterinary doctors and three veterinary assistants took part. Four out of 16 abattoir workers and 1 out of 50 livestock farmers were positive for M. bovis by PCR analysis. Duration of work as an abattoir worker was significantly associated (P < 0.05) with prevalence of zoonotic TB. The knowledge of abattoir workers, butchers, livestock farmers and veterinary assistants regarding transmission of bTB from animals to humans and the symptoms of TB in humans was very poor. Most of these workers did not use protective equipment and appropriate safe working techniques and were considered at high risk of acquiring zoonotic TB. CONCLUSIONS: Zoonotic TB is a significant public health issue among professionally exposed groups in Peshawar, Pakistan and suggests a need for further detailed investigations of the disease in this and similar areas. AU - Khattak I AU - Mushtaq MH AU - Ahmad MU AU - Khan MS AU - Haider J. LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - IP - DP - 2016 Jan 01 TI - The role of allergen components for the diagnosis of latex-induced occupational asthma PG - AB - BACKGROUND: Recombinant Hevea brasiliensis (rHev b) natural rubber latex (NRL) allergen components have been developed to assess the patients' allergen sensitization profile and to improve the diagnosis of NRL allergy. OBJECTIVE: To examine whether the determination of specific IgE (sIgE) reactivity to a panel of recombinant allergen components would be helpful for diagnosing NRL-induced occupational asthma (OA) in predicting the outcome of a specific inhalation test. METHOD S: sIgE levels to NRL extract and 12 recombinant NRL allergen components were assessed in 82 subjects with OA ascertained by a positive specific inhalation challenge (SIC) with NRL gloves and in 25 symptomatic subjects with a negative challenge. RES ULTS: The sensitivity, specificity, positive predictive value and negative predictive value of a NRL-sIgE level =0.35 kUA /L as compared to the result of SICs were 94%, 48%, 86%, and 71%, respectively. The positive predictive value increased above 95% when increasing the cut-off value to 5.41 kUA /L. Subjects with a positive SIC showed a significantly higher rate of sIgE reactivity to rHev b 5, 6.01, 6.02 and 11 than those with a negative SIC. A sIgE sum score against rHev b 5 plus 6.01/6.02 =1.46 kUA /L provided a positive predictive value >95% with a higher sensitivity (79%) and diagnostic efficiency (Youden index: 0.67) as compared with a NRL-sIgE =5.41 kUA /L (49% and 0.41, respectively). CONCLUSION: In suspected OA, high levels of sIgE against rHev b 5 combined with rHev b 6.01 or 6.02 are the most efficient predictors of a bronchial response to NRL. AU - Vandenplas O AU - Froidure A AU - Meurer U AU - Rihs HP AU - Rifflart C AU - Soetaert S AU - Jamart J AU - Pilette C AU - Raulf M. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - IP - DP - 2016 Jan 01 TI - Occupational hypersensitivity pneumonitis: An EAACI Position paper PG - AB - The aim of this document is to provide a critical review of the current knowledge on hypersensitivity pneumonitis caused by the occupational environment and to propose practical guidance for the diagnosis and management of this condition. Occupational hypersensitivity pneumonitis (OHP) is an immunologic lung disease resulting from lymphocytic and frequently granulomatous inflammation of the peripheral airways, alveoli and surrounding interstitial tissue which develops as the result of a non-IgE mediated allergic reaction to a variety of organic materials or low-molecular-weight agents that are present in the workplace. The offending agents can be classified into six broad categories that include bacteria, fungi, animal proteins, plant proteins, low-molecular-weight chemicals, and metals. The diagnosis of OHP requires a multidisciplinary approach and relies on a combination of diagnostic tests in order to ascertain the work-relatedness of the disease. Both the clinical and the occupational history are keys to the diagnosis and often will lead to the initial suspicion. Diagnostic criteria adapted to OHP are proposed. The cornerstone of treatment is early removal from exposure to the eliciting antigen, although the disease may show an adverse outcome even after avoidance of exposure to the causal agent. AU - Quirce S AU - Vandenplas O AU - Campo P AU - Cruz MJ AU - de Blay F AU - Koschel D AU - Moscato G AU - Pala G AU - M R AU - Sastre J AU - Siracusa A AU - Tarlo SM AU - Walusiak-Skorupa J AU - Cormier Y LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 94 IP - DP - 2016 Jan 01 TI - Occupational exposure to asthmagens and adult onset wheeze and lung function in people who did not have childhood wheeze: A 50-year cohort study PG - 60-68 AB - Background There are few prospective studies that relate the development of adult respiratory disease with exposure to occupational asthmagens. Objective To evaluate the risk of adult onset wheeze (AOW) and obstructive lung function associated with occupational exposures over 50 years. Methods A population-based randomly selected cohort of children who had not had asthma or wheezing illness, recruited in 1964 at age 10–15 years, was followed-up in 1989, 1995, 2001 and 2014 by spirometry and respiratory questionnaire. Occupational histories were obtained in 2014 and occupational exposures determined with an asthma-specific job exposure matrix. The risk of AOW and lung function impairment was analysed in subjects without childhood wheeze using logistic regression and linear mixed effects models. Results All 237 subjects (mean age: 61 years, 47% male, 52% ever smoked) who took part in the 2014 follow-up had completed spirometry. Among those who did not have childhood wheeze, spirometry was measured in 93 subjects in 1989, in 312 in 1995 and in 270 subjects in 2001 follow-up. For longitudinal analysis of changes in FEV1 between 1989 and 2014 spirometry records were available on 191 subjects at three time points and on 45 subjects at two time points, with a total number of 663 records. AOW and FEV1 < LLN were associated with occupational exposure to food-related asthmagens (adjusted odds ratios (adjORs) 95% CI: 2.7 [1.4, 5.1] and 2.9 [1.1, 7.7]) and biocides/fungicides (adjOR 95% CI: 1.8 [1.1, 3.1] and 3.4 [1.1, 10.8]), with evident dose-response effect (p-trends < 0.05). Exposure to food-related asthmagens was also associated with reduced FEV1, FVC and FEF25–75% (adjusted regression coefficients 95% CI: - 7.2 [- 12.0, - 2.4], - 6.2 [- 10.9, - 1.4], and - 13.3[- 23.4, - 3.3]). Exposure to wood dust was independently associated with AOW, obstructive lung function and reduced FEF25–75%. Excess FEV1 decline of 6-8ml/year was observed with occupational exposure to any asthmagen, biocides/fungicides and food-related asthmagens (p < 0.05). Conclusions This longitudinal study confirmed previous findings of increased risks of adult onset wheezing illness with occupational exposure to specific asthmagens. A novel finding was the identification of food-related asthmagens and biocides/fungicides as potential new occupational risk factors for lung function impairment in adults without childhood wheeze. AU - Tagiyeva N AU - Teo E AU - Fielding S AU - Devereux G AU - Semple S AU - Douglas G LA - PT - DEP - TA - Environ Int JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 116 IP - DP - 2016 Jan 01 TI - Overlap of atopic, eosinophilic, and TH2-high asthma phenotypes in a general population with current asthma PG - 37-42 AB - Background Atopic, eosinophilic, and TH2-high asthma phenotypes may overlap, but the extent is unknown. Understanding the overlap across these phenotypes may be useful in guiding asthma patient care. Objective To examine the frequency and overlap of atopic, eosinophilic, and TH2-high asthma phenotypes. Methods We analyzed 2005 to 2006 data from the National Health and Nutrition Examination Survey. Patients with asthma were identified based on the participant self-report. Eosinophilic asthma was defined as a blood eosinophil cutoff point of =150, 300, or 400/µL. Atopic asthma was defined as having an allergen-specific IgE level of =0.35 IU/mL for any of the 9 perennial allergens tested. TH2-high asthma was defined as a total serum IgE of =100 IU/mL and a blood eosinophil count of =140/µL. Results The study included 269 children and 310 adults. Depending on the eosinophil cutoff used, 31% to 78% of children and 21% to 69% of adults with asthma were classified as having eosinophilic asthma. In addition, 63% of children and 61% of adults were classified as having atopic disease and 48% of children and 37% of adults as having TH2-high asthma. At a higher eosinophil cutoff point, a greater proportion of eosinophilic asthma can be classified as atopic or TH2 high, but a lower proportion of atopic or TH2-high asthma can be classified as eosinophilic. Approximately 70% or more of children and adults with asthma were 1 of these 3 phenotypes. Conclusion A considerable overlap among eosinophilic, atopic, and TH2-high asthma phenotypes exists in a general asthma population. AU - Tran TN AU - Zeiger RS AU - Peters SP AU - Colice G AU - Newbold P AU - Goldman M AU - Chipps BE LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20160101 IS - IS - VI - 112 IP - DP - 2016 Jan 01 TI - What are the characteristics of asthma patients with elevated serum IgG4 levels? PG - 39-44 AB - Introduction IgG4 has recently been a subject of great interest in human pathology. No data are available about the characteristics of asthma patients with elevated IgG4 levels. Population and methods An observational study was conducted from January 2006 to March 2015 in a difficult-to-treat population of asthma patients. Twenty-six difficult-to-treat asthma patients with elevated serum IgG4 levels (IgG4/IgG ratio up to 10%) were compared with a control population of 98 difficult-to-treat asthma patients with normal serum IgG4. Blood eosinophilia, total IgE and FeNO were compared between groups to better characterize asthma patients with elevated serum IgG4 levels. Results Median IgG4 concentrations were 1.72 g/l [1.19–2.36] and 0.22 g/l [0.10–0.49] in the elevated IgG4 group and normal Ig4 group, respectively. Median blood eosinophilia was more than three times higher in patients with elevated serum IgG4 levels than in controls (0.75 109/L [IQR 0.54–1.78] vs 0.22 109/L [IQR 0.09–0.54] respectively, p < 0.0001). Total IgE was twice as high (264.5 kUI/l [IQR 166.3–779] vs 126 kUI/l [IQR 26–350] respectively; p < 0.05) and FeNO was nearly twice as high (61 [IQR 41–111] ppb vs 35 [IQR 23–51] ppb, p < 0.001). Allergic broncho-pulmonary aspergillosis (ABPA) and eosinophilic granulomatosis with polyangiitis (EGPA) were observed in the asthma patients with elevated serum IgG4. Ten patients had unexplained increased blood eosinophilia. Conclusion Asthma patients with elevated IgG4 levels have significantly higher blood eosinophilia, total IgE and FeNO. ABPA and EGPA are observed in patients with elevated serum IgG4. Keywords: Asthma; IgG4; Allergic broncho-pulmonary aspergillosis; Eosinophilic granulomatosis with polyangiitis AU - Flament T AU - Marchand-Adam S AU - Gatault P AU - Dupin C AU - Diot P AU - Guilleminault L LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - IP - DP - 2015 Jan 01 TI - Sauropus androgynus (L.) Merr. Induced Bronchiolitis Obliterans: From Botanical Studies to Toxicology PG - 714158 AB - Sauropus androgynus L. Merr. is one of the most popular herbs in South Asia, Southeast Asia, and China where it was known as a slimming agent until two outbreaks of pulmonary dysfunction were reported in Taiwan and Japan in 1995 and 2005, respectively. Several studies described that the excessive consumption of Sauropus androgynus could cause drowsiness, constipation, and bronchiolitis obliterans and may lead to respiratory failure. Interestingly, this herb has been used in Malaysia and Indonesia in cooking and is commonly called the “multigreen” or “multivitamin” plant due to its high nutritive value and inexpensive source of dietary protein. The plant is widely used in traditional medicine for wound healing, inducing lactation, relief of urinary disorders, as an antidiabetic cure and also fever reduction. Besides these medicinal uses, the plant can also be used as colouring agent in food. This review will explore and compile the fragmented knowledge available on the botany, ethnobotany, chemical constitutes, pharmacological properties, and toxicological aspects of this plant. This comprehensive review will give readers the fundamental, comprehensive, and current knowledge regarding Sauropus androgynus L. Merr. AU - Bunawan H AU - Bunawan SN AU - Baharum SN AU - Noor NM LA - PT - DEP - TA - Evidence-Based Complementary and Alternative Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 27 IP - DP - 2015 Jan 01 TI - Nitrogen dioxide exposure and airway responsiveness in individuals with asthma PG - 1-14 AB - Controlled human exposure studies evaluating the effect of inhaled nitrogen dioxide (NO2) on the inherent responsiveness of the airways to challenge by broncho-constricting agents have had mixed results. In general, existing meta-analyses show statistically significant effects of NO2 on the airway responsiveness of individuals with asthma. However, no meta-analysis has provided a comprehensive assessment of the clinical relevance of changes in airway responsiveness, the potential for methodological biases in the original papers, and the distribution of responses. This paper provides analyses showing that a statistically significant fraction (i.e. 70% of individuals with asthma exposed to NO2 at rest) experience increases in airway responsiveness following 30-min exposures to NO2 in the range of 200 to 300?ppb and following 60-min exposures to 100?ppb. The distribution of changes in airway responsiveness is log-normally distributed with a median change of 0.75 (provocative dose following NO2 divided by provocative dose following filtered air exposure) and geometric standard deviation of 1.88. About a quarter of the exposed individuals experience a clinically relevant reduction in their provocative dose due to NO2 relative to air exposure. The fraction experiencing an increase in responsiveness was statistically significant and robust to exclusion of individual studies. Results showed minimal change in airway responsiveness for individuals exposed to NO2 during exercise AU - Brown JS LA - PT - DEP - TA - Inhalation Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 18 IP - DP - 2015 Jan 01 TI - Exposures and Health Outcomes in Relation to Bioaerosol Emissions From Composting Facilities: A Systematic Review of Occupational and Community Studies PG - 43-69 AB - The number of composting sites in Europe is rapidly increasing, due to efforts to reduce the fraction of waste destined for landfill, but evidence on possible health impacts is limited. This article systematically reviews studies related to bioaerosol exposures within and near composting facilities and associated health effects in both community and occupational health settings. Six electronic databases and bibliographies from January 1960 to July 2014 were searched for studies reporting on health outcomes and/or bioaerosol emissions related to composting sites. Risk of bias was assessed using a customized score. Five hundred and thirty-six papers were identified and reviewed, and 66 articles met the inclusion criteria (48 exposure studies, 9 health studies, 9 health and exposure studies). Exposure information was limited, with most measurements taken in occupational settings and for limited time periods. Bioaerosol concentrations were highest on-site during agitation activities (turning, shredding, and screening). Six studies detected concentrations of either Aspergillus fumigatus or total bacteria above the English Environment Agency’s recommended threshold levels beyond 250 m from the site. Occupational studies of compost workers suggested elevated risks of respiratory illnesses with higher bioaerosol exposures. Elevated airway irritation was reported in residents near composting sites, but this may have been affected by reporting bias. The evidence base on health effects of bioaerosol emissions from composting facilities is still limited, although there is sufficient evidence to support a precautionary approach for regulatory purposes. While data to date are suggestive of possible respiratory effects, further study is needed to confirm this and to explore other health outcomes. AU - Pearson C AU - Littlewood E AU - Douglas P AU - Robertson S AU - Gant TW AU - Hansell AL LA - PT - DEP - TA - J Toxicology Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 88 IP - DP - 2015 Jan 01 TI - Redemption of asthma pharmaceuticals among stainless steel and mild steel welders: a nationwide follow-up study. PG - 743-750 AB - Purpose The purpose was to examine bronchial asthma according to cumulative exposure to fume particulates conferred by stainless steel and mild steel welding through a proxy of redeemed prescribed asthma pharmaceuticals. Methods A Danish national company-based historical cohort of 5,303 male ever-welders was followed from 1995 to 2011 in the Danish Medicinal Product Registry to identify the first-time redemption of asthma pharmaceuticals including beta-2-adrenoreceptor agonists, adrenergic drugs for obstructive airway diseases and inhalable glucocorticoids. Lifetime exposure to welding fume particulates was estimated by combining questionnaire data on welding work with a welding exposure matrix. The estimated exposure accounted for calendar time, welding intermittence, type of steel, welding methods, local exhaustion and welding in confined spaces. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated using a Cox proportional hazards model adjusting for potential confounders and taking modifying effects of smoking into account. Results The average incidence of redemption of asthma pharmaceuticals in the cohort was 16 per 1,000 person year (95 % CI 10–23 per 1,000 person year). A moderate nonsignificant increased rate of redemption of asthma medicine was observed among high-level exposed stainless steel welders in comparison with low-level exposed welders (HR 1.54, 95 % CI 0.76–3.13). This risk increase was driven by an increase risk among non-smoking stainless steel welders (HR 1.46, 95 % CI 1.06–2.02). Mild steel welding was not associated with increased risk of use asthma pharmaceuticals. Conclusion The present study indicates that long-term exposure to stainless steel welding is related to increased risk of asthma in non-smokers. AU - Kristiansen P AU - Jørgensen KT AU - Hansen J AU - Bonde JP LA - PT - DEP - TA - Int J Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 72 IP - DP - 2015 Jan 01 TI - Twenty years of SHIELD: decreasing incidence of occupational asthma in the West Midlands, UK? PG - 304-310 AB - Introduction Since 2000 a decline in the incidence of occupational asthma (OA) has been reported in the UK and Europe. We aimed to describe and account for trends in the incidence of OA in the West Midlands, UK using annual notification data from the SHIELD voluntary surveillance scheme over the period 1991–2011. Methods All notifications to the SHIELD database between January 1991 and December 2011 were identified, along with patients’ demographic data, occupations, causative agents and confirmatory tests. Annual notifications were scaled to give an annual count per million workers, giving a measure of incidence, and also standardised against those of bakers’ asthma. Non-parametric analyses were undertaken between annual incidence and time (years) for common causative agents using (1) a negative binomial regression univariate model and (2) a logistic regression model calculating annual reporting ORs. A step-change analysis was used to examine time points at which there were marked reductions in incidence. Results A decrease in annual incidence of OA was observed over the study period (incident rate ratio=0.945; 95% CI 0.933 to 0.957; p<0.0001), an effect that was lost after standardising for bakers’ asthma. Decreases in incidence were seen for most common causative agents, with only cleaning product-related OA increasing over 21 years. Marked fall in incidence was seen in 2004 for isocyanates, and in 1995 for latex. Most notifications came from a regional specialist occupational lung disease unit, with notifications from other sites falling from 16 cases/million workers/annum in 1995 to 0 in 2004. Conclusions Reporter fatigue and increasing under-recognition of OA are both factors which contribute to the apparent fall in incidence of OA in the West Midlands. There is a future need for interventions that enable health professionals to identify potential cases of OA in the workplace and in healthcare settings. AU - Walters GI AU - Kirkham A AU - McGrath EE AU - Moore VC AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 137 IP - DP - 2015 Jan 01 TI - Exposure-response analyses for platinum salt-exposed workers and sensitization: A retrospective cohort study among newly exposed workers using routinely collected surveillance data. PG - 922-929 AB - BACKGROUND: Chloroplatinate salts are well-known respiratory sensitizing agents leading to work-related sensitization and allergies in the work environment. No quantitative exposure-response relation has been described for chloroplatinate salts. OBJECTIVE: We sought to evaluate the quantitative exposure-response relation between occupational chloroplatinate exposure and sensitization. METHODS: A retrospective cohort study was conducted using routinely collected health surveillance data and chloroplatinate exposure data. Workers who newly entered work between January 1, 2000, and December 31, 2010, were included, and the relation between measured chloroplatinate exposure and sensitization (as determined by skin prick test responses) was analyzed in more than 1000 refinery workers from 5 refineries for whom a total of more than 1700 personal exposure measurements were available. RESULTS: A clear exposure-response relation was observed, most strongly for more recent platinum salt exposure. Average or cumulative exposure over the follow-up period was less strongly associated with sensitization risk. The exposure-response relation was modified by smoking and atopy. CONCLUSIONS: Indications exist that recent exposure explains the risk of platinum salt sensitization most strongly. The precision of the estimate of the exposure-response relation derived from this data set appears superior to previous epidemiologic studies conducted on platinum salt sensitization and as a result, might have possible utility for the development of preventive strategies. AU - Heederik D AU - Jacobs J AU - Samadi S AU - van Rooy F AU - Portengen L AU - Houba R. LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - IP - DP - 2015 Jan 01 TI - The Australian Work Exposures Study: Prevalence of Occupational Exposure to Formaldehyde. PG - AB - INTRODUCTION: The aims of this study were to produce a population-based estimate of the prevalence of work-related exposure to formaldehyde, to identify the main circumstances of exposure and to describe the use of workplace control measures designed to decrease those exposures. METHODS: The analysis used data from the Australian Workplace Exposures Study, a nationwide telephone survey, which investigated the current prevalence and exposure circumstances of work-related exposure to 38 known or suspected carcinogens, including formaldehyde, among Australian workers aged 18-65 years. Using the web-based tool OccIDEAS, semi-quantitative information was collected about exposures in the current job held by the respondent. Questions were addressed primarily at tasks undertaken rather than about self-reported exposures. RESULTS: Of the 4993 included respondents, 124 (2.5%) were identified as probably being exposed to formaldehyde in the course of their work [extrapolated to 2.6% of the Australian working population-265 000 (95% confidence interval 221 000-316 000) workers]. Most (87.1%) were male. About half worked in technical and trades occupations. In terms of industry, about half worked in the construction industry. The main circumstances of exposure were working with particle board or plywood typically through carpentry work, building maintenance, or sanding prior to painting; with the more common of other exposures circumstances being firefighters involved in fighting fires, fire overhaul, and clean-up or back-burning; and health workers using formaldehyde when sterilizing equipment or in a pathology laboratory setting. The use of control measures was inconsistent. CONCLUSION: Workers are exposed to formaldehyde in many different occupational circumstances. Information on the exposure circumstances can be used to support decisions on appropriate priorities for intervention and control of occupational AU - Driscoll TR AU - Carey RN AU - Peters S AU - Glass DC AU - Benke G AU - Reid A AU - Fritschi L. LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 136 IP - DP - 2015 Jan 01 TI - Prevalence and characteristics of asthma in the aquatic disciplines PG - 588-594 AB - Background Despite the health benefits of swimming as a form of exercise, evidence exists that both the swimming pool environment and endurance exercise are etiologic factors in the development of asthma. The prevalence of asthma in swimmers is high compared with that in participants in other Olympic sport disciplines. There are no publications comparing the prevalence of asthma in the 5 aquatic disciplines. Objective The purpose of this study is to examine and compare the prevalence of asthma in the aquatic disciplines and in contrast with other Olympic sports. Methods Therapeutic Use Exemptions containing objective evidence of athlete asthma/airway hyperresponsiveness (AHR) were collected for all aquatic athletes participating in swimming, diving, synchronized swimming, water polo, and open water swimming for major events during the time period from 2004-2009. The prevalence of asthma/AHR in the aquatic disciplines was analyzed for statistical significance (with 95% CIs) and also compared with that in other Olympic sports. Results Swimming had the highest prevalence of asthma/AHR in comparison with the other aquatic disciplines. The endurance aquatic disciplines have a higher prevalence of asthma/AHR than the aquatic nonendurance disciplines. Asthma/AHR is more common in Oceania, Europe, and North America than in Asia, Africa, and South America. In comparison with other Olympic sports, swimming, synchronized swimming, and open water swimming were among the top 5 sports for asthma/AHR prevalence. Conclusion Asthma/AHR in the endurance aquatic disciplines is common at the elite level and has a varied geographic distribution. Findings from this study demonstrate the need for development of aquatic discipline–specific prevention, screening, and treatment regimens AU - Mountjoy M AU - Fitch K AU - Boulet L AU - Bougault V AU - van Mechelen W AU - Verhagen E LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 45 IP - DP - 2015 Jan 01 TI - Prevalence of cross-reactive carbohydrate determinants in UK bakers PG - 1613-1615 AB - In conclusion, only a minority of bakers had detectable CCD-specific IgE, and all were cosensitised to wheat flour and grass pollen. Cross-reactive carbohydrate determinants are likely to play a role in crossreactivity between wheat flour and grass pollen in the minority of bakers who have CCD-specific IgE. Overall, the risk of CCDs interfering in wheat flour-specific IgE assays is very low. AU - H. Howarth AU - S. Schofield AU - J. Cannon AU - M. Jones LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 72 IP - DP - 2015 Jan 01 TI - Cleaning products and short-term respiratory effects among female cleaners with asthma PG - 757-763 AB - Objective We evaluated the short-term effects of exposure to cleaning products on lung function and respiratory symptoms among professional cleaning women. Methods Twenty-one women with current asthma and employed as professional cleaners participated in a 15-day panel study. During 312 person-days of data collection, participants self-reported their use of cleaning products and respiratory symptoms in daily diaries and recorded their forced expiratory volume in 1 s (FEV1) and peak expiratory flow (PEF) three times per day using a handheld spirometer. We evaluated associations of cleaning product use with upper and lower respiratory tract symptoms using Poisson mixed regression models and with changes in FEV1 and PEF using linear mixed regression analyses. Results Participants reported using an average of 2.4 cleaning products per day, with exposure to at least one strong irritant (eg, ammonia, bleach, hydrochloric acid) on 56% of person-days. Among participants without atopy, lower respiratory tract symptoms were associated with the use of hydrochloric acid and detergents. Measurements of FEV1 and PEF taken in the evening were 174 mL (95% CI 34 to 314) and 37 L/min (CI 4 to 70), respectively, lower on days when three or more sprays were used. Evening and next morning FEV1 were both lower following the use of hydrochloric acid (-616 and -526 mL, respectively) and solvents (-751 and -1059 mL, respectively). Diurnal variation in FEV1 and PEF increased on days when ammonia and lime-scale removers were used. Conclusions The use of specific cleaning products at work, mainly irritants and sprays, may exacerbate asthma. AU - Vizcaya D AU - Mirabelli MC AU - Gimeno D AU - Antó J AU - Delclos GL AU - Rivera M AU - Orriols R AU - Arjona L AU - Burgos F LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 65 IP - DP - 2015 Jan 01 TI - The surveillance of occupational diseases in Italy: the MALPROF system PG - 632-637 AB - Background Occupational diseases data can guide efforts to improve worker’s health and safety. Aims To describe MALPROF, the Italian system for surveillance of work-related diseases collected by the subregional Department of Prevention. Methods The MALPROF system started in 1999 with contributions from Lombardy and Tuscany and spread in the following years to collect contributions from 14 out of the 20 Italian regions. MALPROF data were explored to follow-up work-related diseases and to detect emerging occupational health risks by calculating proportional reporting ratio (PRR), as in pharmacosurveillance. It classified work-related diseases according to economic sector and job activity in which the exposure occurred. Occupational physicians of the Italian National Health Service evaluate the possible causal relationship with occupational exposures and store the data in a centralized database. Results From 1999 to 2012, the MALPROF system collected about 112000 cases of workers’ diseases. In 2010, more than 13000 cases of occupational diseases were reported. The most frequently reported diseases were hearing loss (n = 4378, 32%), spine disorders (n = 2394, 17%) and carpal tunnel syndrome (n = 1560, 11%). The PRR calculated for cervical disc herniation, a disease whose occupational origin has to be studied, in 1999–2010 was 2.47 [95% confidence interval (CI) 1.76–3.47] for drivers and 36.64 (95% CI 22.03–60.93) for air transport workers. Conclusions MALPROF is a sensitive system for identifying possible associations between occupational risks and diseases, it can contribute to the development of preventive measures, to evaluate the effectiveness of preventive interventions and to stimulate research on new occupational risks and diseases. AU - Campo G AU - Papale A AU - Baldasseroni A AU - Di Leone G AU - Magna B AU - Martini B AU - Mattioli S LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 65 IP - DP - 2015 Jan 01 TI - A review of occupational disease surveillance systems in Modernet countries PG - 615-625 AB - Background To improve occupational health public policies and to facilitate coordinated research within the European Union to reduce the incidence of occupational diseases (ODs), it is important to know what OD surveillance systems exist and how they compare. Monitoring trends in occupational diseases and tracing new and emerging risks in a network (Modernet) participants are well placed to provide this information as most either contribute data to and/or are involved in the management of OD systems. Aims To identify and describe OD surveillance systems in Modernet countries with the longer-term objective of identifying a core template to be used on a large scale. Methods A questionnaire sent to Modernet participants, seeking structured information about the OD surveillance system(s) in their country. Results Overall 14 countries (70%) provided information for 33 OD systems, among them 11 compensation-based (CB) systems. Six countries provided information for non-CB systems reporting for any type of OD. The other systems reported either only ODs from a prescribed list, or specific diagnoses or diagnostic groups, with reports to most schemes being physician-based. Data collected varied but all systems collected diagnosis, age, gender, date reported and occupation (and/or industry) and most collected information on exposure. Conclusions This review provides information beneficial to both policy makers and researchers by identifying data sources useable to measure OD trends in European countries and opening the way to future work, both on trend comparisons within Europe and on the definition of a core template to extend OD surveillance on a larger scale. AU - Carder M AU - Bensefa-Colas L AU - Mattioli S AU - Noone P AU - Stikova E AU - Valenty M AU - Telle-Lamberton M LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 65 IP - DP - 2015 Jan 01 TI - Surveillance programme for uncompensated work-related diseases in France PG - 642-650 AB - Background The surveillance programme for uncompensated work-related diseases (UWRDs) in France relies on a network of occupational physicians (OPs) who volunteer to report all UWRDs diagnosed during a biannual 2-week observation period. Aims To describe this programme and the usefulness of its results. Methods During the observation period, OPs record job title and employment sector for each worker. For each potential UWRD, they complete a one-page report form. Results Between 2007 and 2012, the number of reporting OPs ranged from 705 to 965 and they saw between 78884 and 114154 employees annually. The UWRD incidence rate reports varied from 5 to 5.3% for men and from 6.5 to 7.7% for women, with musculoskeletal disorders (MSDs) being most frequent, followed by mental ill-health. Incidence rates, except for hearing loss, were higher for women than men in all categories and, in 2012, were twice as high for women (3.1%) as for men (1.4%) for mental ill-health. Incidence rates in every category increased with age up to 54 years. The highest rates for MSDs were observed among blue-collar workers (6.9% in women and 4% in men in 2012) and the lowest rates in professionals/managers (1.1 and 0.4%, respectively). Conversely, the latter had the highest incidence of mental health disorders (5.9 and 3.3%). Conclusions This ‘Fortnight’ protocol provides useful data on the frequency of diseases linked to employment and allows us to estimate the incidence of UWRDs, whether recognized as compensable or not, as well as their trends over time. AU - Valenty M AU - Homère J AU - Lemaitre A AU - Plaine J AU - Ruhlman M AU - Cohidon C AU - Imbernon E LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 65 IP - DP - 2015 Jan 01 TI - A refined QSAR model for prediction of chemical asthma hazard PG - 659-666 AB - Background A previously developed quantitative structure–activity relationship (QSAR) model has been extern ally validated as a good predictor of chemical asthma hazard (sensitivity: 79–86%, specificity: 93–99%). Aims To develop and validate a second version of this model. Methods Learning dataset asthmagenic chemicals with molecular weight (MW) <1kDa were identified from reports published in the peer-reviewed literature before the end of 2012. Control chemicals for which no reported case(s) of occupational asthma had been identified were selected at random from UK and US occupational exposure limit tables. MW banding was used in an attempt to categorically match the control group for MW distribution of the asthmagens. About 10% of chemicals in each MW category were excluded for use as an external validation set. An independent researcher utilized a logistic regression approach to compare the molecular descriptors present in asthmagens and controls. The resulting equation generated a hazard index (HI), with a value between zero and one, as an estimate of the probability that the chemical had asthmagenic potential. The HI was determined for each compound in the external validation set. Results The model development sets comprised 99 chemical asthmagens and 204 controls. The external validation showed that using a cut-point HI of 0.39, 9/10 asthmagenic (sensitivity: 90%) and 23/24 non-asthmagenic (specificity: 96%) compounds were correctly predicted. The new QSAR model showed a better receiver operating characteristic plot than the original. Conclusions QSAR refinement by iteration has resulted in an improved model for the prediction of chemical asthma hazard. AU - Jarvis J AU - Seed MJ AU - Stocks SJ AU - Agius RM LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 65 IP - DP - 2015 Jan 01 TI - Chemical determinants of occupational hypersensitivity pneumonitis PG - 673-681 AB - Background Workplace inhalational exposures to low molecular weight (LMW) chemicals cause hypersensitivity pneumonitis (HP) as well as the more common manifestation of respiratory hypersensitivity, occupational asthma (OA). Aims To explore whether chemical causation of HP is associated with different structural and physico-chemical determinants from OA. Methods Chemical causes of human cases of HP and OA were identified from searches of peer-reviewed literature up to the end of 2011. Each chemical was categorized according to whether or not it had been the attributed cause of at least one case of HP. The predicted asthma hazard was determined for each chemical using a previously developed quantitative structure–activity relationship (QSAR) model. The chemicals in both sets were independently and ‘blindly’ analysed by an expert in mech anistic chemistry for a qualitative prediction of protein cross-linking potential and determination of lipophilicity (log K ow). Results Ten HP-causing chemicals were identified and had a higher median QSAR predicted asthma hazard than the control group of 101 OA-causing chemicals (P < 0.01). Nine of 10 HP-causing chemicals were predicted to be protein cross-linkers compared with 24/92 controls (P < 0.001). The distributions of log K ow indicated higher values for the HP list (median 3.47) compared with controls (median 0.81) (P < 0.05). Conclusions These findings suggest that chemicals capable of causing HP tend to have higher predicted asthma hazard, are more lipophilic and are more likely to be protein cross-linkers than those causing OA. AU - Seed MJ AU - Enoch SJ AU - Agius RM LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 5 IP - DP - 2015 Jan 01 TI - Work-related allergies to storage mites in Parma (Italy) ham workers PG - e007502 AB - Objectives To investigate the role of storage mites in the development of allergic diseases among ham production workers, and to search for early alterations in lung function tests and early inflammation markers in exhaled air. Respiratory allergies due to storage mites have been reported in people with various occupations but, although such mites are unavoidable when curing ham, there are no published data concerning ham production workers. Setting Secondary care. Design Experimental cross-sectional study. Participants 220 participants (110 ham production workers and 110 controls) were recruited. Primary and secondary outcome measures Workers answered a medical questionnaire, and underwent spirometry and fraction of exhaled nitric oxide at 50 mL/s (FeNO50) measurements. Those with allergic symptoms also underwent skin prick tests to determine their sensitisation to airborne allergens. A methacholine test was performed in symptomatic participants when spirometry was normal to assess airways hyper-responsiveness. Results Symptomatic storage mite sensitisation was observed in 16 workers (14.5%) (rhinoconjunctivitis in 15 (63%) and asthma in (4%)) and 2 controls (1.8%; p=0.001). Higher FeNO50 values in exposed symptomatic workers compared with healthy control participants (34.65±7.49 vs 13.29±4.29 ppb; p<0.001) suggested bronchial and nasal involvement, although their lung function parameters were normal. Regardless of exposure, a FeNO50 value of 22.5 ppb seems to be 100% sensitive and 99.4% specific in distinguishing allergic and non-allergic participants. Multivariate analysis of FeNO50 values in the symptomatic participants showed that they were positively influenced by IgE-mediated allergy (p=0.001) and reported symptom severity (p=0.041), and negatively by smoking status (p=0.049). Conclusions Ham processing workers, as well as workers involved in any meat processing work that includes curing, should be informed about the occupational risk of sensitisation to mites. AU - Tafuro F AU - Ridolo E AU - Goldoni M AU - Montagni M AU - Mutti A AU - Corradi M LA - PT - DEP - TA - BMJ Open JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 71 IP - DP - 2015 Jan 01 TI - First evidence of occupational asthma to argan powder in a cosmetic factory. PG - 550-555 AB - BACKGROUND: Argan is used worldwide in numerous cosmetic products, as this fruit is supposed to have many beneficial properties on health. New cases of allergy can be expected with the growing use of argan. We investigated all workers (9) employed by a cosmetic factory and exposed to argan powder to identify possible allergies related to exposure to argan powder. METHODS: Patients were investigated in the occupational disease department and, according to their symptoms, underwent pulmonary function testing, methacholine challenge, specific inhalation challenge to argan powder, skin prick tests and immunoblotting analysis. RESULTS: We report three cases of occupational asthma to argan powder and a probable case of rhinitis. Fifteen argan proteins were recognized by the patients' IgE. Identification of proteins, cross-reactions to nuts and ELISA inhibition tests suggested that some argan allergens can cross-react in vitro with hazelnut allergens, including 11S globulin and vicilin. CONCLUSION: High-level exposure to argan powder should be considered to be a potential cause of IgE-mediated allergy and workers handling argan powder should be carefully investigated. AU - Paris C AU - Herin F AU - Penven E AU - Thaon I AU - Richard C AU - Jacquenet S AU - Barbaud A AU - Poussel M. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 65 IP - DP - 2015 Jan 01 TI - Isocyanate exposure and asthma in the UK vehicle repair industry PG - 713-718 AB - Background Organic diisocyanates are a common cause of occupational asthma, particularly in motor vehicle repair (MVR) workers. The UK Health & Safety Laboratory provides screening for urinary hexamethylenediamine (UHDA), a biomarker of exposure to 1,6-hexamethylene diisocyanate (HDI). The UK Surveillance of Work-related and Occupational Respiratory Disease scheme (SWORD) has collected reports of occupational asthma since 1996. Aims To compare trends in HDI exposure with trends in the incidence of work-related asthma attributed to isocyanates or paint spraying in MVR workers reported to SWORD. Methods Two-level regression models were used to estimate trends in UHDA levels and work-related asthma in MVR workers reported to SWORD. The direction and magnitude of the trends were compared descriptively. Results From 2006 to 2014, there was a significant decline in the number of urine samples with detectable levels of UHDA (odds ratio = 0.96; 95% confidence intervals 0.94–0.98) and minimal change in those over the guidance value (1.03; 1.00–1.06). Over the same period, there was a significant decline in all asthma cases attributed to isocyanates or paint spraying reported to SWORD (0.90; 0.86–0.94) and a non-significant decline among MVR workers (0.94; 0.86–1.02). Conclusions The simultaneous decrease in HDI exposure and incident cases of asthma reported to SWORD is temporally consistent with a reduction in exposure to airborne isocyanate leading to a reduction in asthma. Although this is not direct evidence of a causal relationship between the two trends, it is suggestive. AU - Stocks SJ AU - Jones K AU - Piney M AU - Agius RM LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 65 IP - DP - 2015 Jan 01 TI - Hypersensitivity pneumonitis in a high school teacher PG - 598-600 AB - Hypersensitivity pneumonitis (HP) is an inflammatory lung disease mediated by an immunological response to an inhaled antigen. Outbreaks of HP have been reported in industrial settings where manufacturing workers are exposed to water-based metalworking fluids (MWFs). Water-based MWFs promote growth of microorganisms and can be easily aerosolized and are thus potential aetiological agents of HP. We present a case of HP caused by exposure to water-based MWF in a vocational high school teacher. Culture of MWF used at his school grew Pseudomonas pseudoalcaligenes. This is the first known report of MWF-induced HP outside an industrial setting. The growth of Pseudomonas spp in this case recalls the earliest reports of the microbiology of MWF-induced HP and suggests that routine bacterial culture may be useful in the diagnosis of HP in workplaces without standard cleaning and biocide regulations. AU - Moniodis A AU - Hamilton T AU - Racila E AU - Cockrill B AU - McCunney R LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 45 IP - DP - 2015 Jan 01 TI - Outcome of work-related asthma exacerbations in Quebec and Ontario PG - 266-268 AB - In conclusion, the diagnosis and management of workers with work-related asthma was associated with a significant subsequent decrease in the health service utilisation related to asthma independently of the investigations performed in Ontario and Quebec. Occupational asthma patients in Quebec showed better outcomes at 1 year post-diagnosis, while work-exacerbated asthma patients in Ontario fared better at 2 years post-diagnosis. Both provinces showed similar change in health services used at 2 years post-diagnosis in patients with occupational asthma patients and at 1 year post-diagnosis in work-exacerbated asthma patients. The pattern of change of acute health resource utilisation in subjects with occupational asthma was different in Quebec than in Ontario, with higher pre-diagnosis health resource utilisation and a greater fall in these post-diagnosis. This difference might relate to the type of investigation conducted for diagnosing occupational asthma or to other differences in the populations between these provinces that might not have been accounted for in the statistical model. AU - Lemière C AU - To T AU - de Olim C AU - Ribeiro M AU - Liss G AU - Lougheed MD AU - Hoy R AU - Forget A AU - Blais L AU - Zhu J AU - Tarlo SM LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 135 IP - DP - 2015 Jan 01 TI - Indoor fungal diversity and asthma: A meta-analysis and systematic review of risk factors PG - 110-122 AB - Background Indoor dampness increases the risk of indoor fungal growth. A complex interaction between occupant behaviors and the built environment are thought to affect indoor fungal concentrations and species diversity, which are believed to increase the risk of having asthma, exacerbation of asthma symptoms, or both. To date, no systematic review has investigated this relationship. Objective This review aims to assess the relationship between exposure to indoor fungi identified to the genera or species level on asthma outcomes in children and adults. Methods Ten databases were systematically searched on April 18, 2013, and limited to articles published since 1990. Reference lists were independently screened by 2 reviewers, and authors were contacted to identify relevant articles. Data were extracted from included studies meeting our eligibility criteria by 2 reviewers and quality assessed by using the Newcastle-Ottawa scale designed for assessment of case-control and cohort studies. Results Cladosporium, Alternaria, Aspergillus, and Penicillium species were found to be present in higher concentrations in homes of asthmatic participants. Exposure to Penicillium, Aspergillus, and Cladosporium species were found to be associated with increased risk of reporting asthma symptoms by a limited number of studies. The presence of Cladosporium, Alternaria, Aspergillus, and Penicillium species increased the exacerbation of current asthma symptoms by 36% to 48% compared with those exposed to lower concentrations of these fungi, as shown by using random-effect estimates. Studies were of medium quality and showed medium-high heterogeneity, but evidence concerning the specific role of fungal species was limited. Conclusion Longitudinal studies assessing increased exposure to indoor fungi before the development of asthma symptoms suggests that Penicillium, Aspergillus, and Cladosporium species pose a respiratory health risk in susceptible populations. Increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium, Aspergillus, Cladosporium, and Alternaria species, although further work should consider the role of fungal diversity and increased exposure to other fungal species. AU - Sharpe RA AU - Bearman N AU - Thornton CR AU - Husk K AU - Osborne NJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - IP - DP - 2015 Jan 01 TI - Trends in incidence of occupational asthma, contact dermatitis, noise-induced hearing loss, carpal tunnel syndrome and upper limb musculoskeletal disorders in European countries from 2000 to 2012 PG - AB - The European Union (EU) strategy for health and safety at work underlines the need to reduce the incidence of occupational diseases (OD), but European statistics to evaluate this common goal are scarce. We aim to estimate and compare changes in incidence over time for occupational asthma, contact dermatitis, noise-induced hearing loss (NIHL), carpal tunnel syndrome (CTS) and upper limb musculoskeletal disorders across 10 European countries. OD surveillance systems that potentially reflected nationally representative trends in incidence within Belgium, the Czech Republic, Finland, France, Italy, the Netherlands, Norway, Spain, Switzerland and the UK provided data. Case counts were analysed using a negative binomial regression model with year as the main covariate. Many systems collected data from networks of 'centres', requiring the use of a multilevel negative binomial model. Some models made allowance for changes in compensation or reporting rules. Reports of contact dermatitis and asthma, conditions with shorter time between exposure to causal substances and OD, were consistently declining with only a few exceptions. For OD with physical causal exposures there was more variation between countries. Reported NIHL was increasing in Belgium, Spain, Switzerland and the Netherlands and decreasing elsewhere. Trends in CTS and upper limb musculoskeletal disorders varied widely within and between countries. This is the first direct comparison of trends in OD within Europe and is consistent with a positive impact of European initiatives addressing exposures relevant to asthma and contact dermatitis. Taking a more flexible approach allowed comparisons of surveillance data between and within countries without harmonisation of data collection methods. AU - Stocks SJ AU - McNamee R AU - der van Molen HF AU - Paris C AU - Urban P AU - Campo G AU - Sauni R AU - Jarreta BM AU - Valenty M AU - Godderis L AU - Miedinger D AU - Jacquetin P AU - Gravseth HM AU - Bonneterre V AU - Telle-Lamberton M AU - Bensefa-Colas L AU - Faye S AU - Mylle G AU - Wannag A AU - Samant Y AU - Pal T AU - Scholz-Odermatt S AU - Papale A AU - Schouteden M AU - Colosio C AU - Mattioli S AU - Agius R LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 70 IP - DP - 2015 Jan 01 TI - Pneumococcal vaccination for welders PG - 198-199 AB - Over the past 20 years, evidence has accumulated that occupations entailing exposure to metal fume (principally welders) are at increased risk of developing and dying from pneumococcal and unspecified lobar pneumonia.1–9 The hazard is apparent in people working with ferrous metal,2 ,4 may extend to other metals4 and is reversible following cessation of exposure.1 ,4 ,5 There are indications that the ultrafine particles in welding fume promote adherence of pneumococci to bronchial epithelium,10 but the underlying mechanisms are not yet well established. Nevertheless, in 2011, the independent Joint Committee on Vaccination at the English Department of Health (DH) judged that the evidence of increased risk was sufficient to recommend that employers offer welders vaccination against pneumococcus.11 This was a new measure that had not previously been applied in other countries. Subsequently, on the advice of the UK Health and Safety Executive (HSE), the DH weakened its recommendation, stating only that vaccination ‘should be considered for those at risk of frequent or continuous occupational exposure to metal fume (e.g. welders), taking into account the exposure control measures in place’.12 Then after some delay, HSE published guidance for employers in which they were advised to prioritise controls on exposure and to take the efficacy of such controls into account when deciding whether or not to offer vaccination.13 The guidance emphasised that vaccination was not a regulatory requirement, provided that an adequate risk assessment could demonstrate that fume was effectively controlled. A fundamental flaw of this approach is that, as the HSE's guidance acknowledges, ‘there are no research studies which specify how much exposure to welding or metal fume (dose) will result in an increased susceptibility to pneumonia (response)’.13 It follows that there is no evidential basis for determining whether exposures are sufficiently controlled to eliminate the risk. When challenged on the matter, HSE responded that despite the admitted absence of evidence, ‘we do know what constitutes effective controls in relation to welding and those are intended to prevent all health-related end-points’ (J Delic, personal communication). They also suggested that exposures should have reduced over time, although they had no supporting empirical evidence. New data have now become available on mortality by occupation in England and Wales during 2001–2010, and we used them to explore whether the excess risk of pneumonia in welders had persisted into the new century. The Office for National Statistics provided us with the numbers of deaths in England and Wales during 2001–2010 at ages 16–74 years, broken down by combinations of sex, age (in 5-year bands), occupation (in 143 categories), social class (eight categories) and underlying cause of death (229 categories). All of this information came originally from death certificates. The data were used to calculate proportional mortality ratios (PMRs) for pneumococcal and unspecified lobar pneumonia (categories J13 and J18.1 in the 10th revision of the International Classification of Diseases) in welders, standardised for age and social class. CIs for PMRs were based on the Poisson distribution. Results were compared with those derived previously by a similar method for the period 1991–2000 when pneumococcal and unspecified lobar pneumonia was classified to a single category (481) in the ninth revision of the International Classification of Diseases.14 During 2001–2010, there were 2863 male deaths from pneumococcal and unspecified pneumonia at ages 16–74 in all occupations combined compared with 3234 during 1991–2000. The corresponding numbers of deaths from all causes were 927 152 (including 8160 in welders) during 2001–2010 and 1 202 888 (10 455 in welders) during 1991–2000. As in 1991–2000, mortality from pneumococcal and unspecified lobar pneumonia during 2001–2010 was significantly elevated in welders of working age (table 1), with a particularly high PMR for pneumococcal pneumonia specifically (3.58, 95% CI 1.44 to 7.37). The estimated excess of deaths from pneumococcal and unspecified lobar during 2001–2010 was 10.9 compared with 18.8 during 1991–2000. The propoeional mortality from pneumococcal pneumonia was.58 in ages 16-64 and 0 aged 64-74 AU - Coggon D AU - Harris EC AU - Cox V AU - Palmer KT LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 72 IP - DP - 2015 Jan 01 TI - Short-term lung function decline in tunnel construction workers PG - 108-113 AB - Objectives Tunnel construction workers are exposed to particulate and gaseous air contaminants. Previous studies carried out in the 1990s showed that tunnel construction workers were at increased risk of both short-term and long-term lung function decline. Since then, efforts have been made to reduce exposure. The objective of the present study was to investigate if current exposure may still cause short-term lung function impairment. Methods Tunnel workers work 12 days consecutively, and then they are off for 9 days. Ninety tunnel workers and 51 referents were examined with spirometry and questionnaires before their work period started and again 11 days later. Personal exposure to particles and a-quartz in the thoracic aerosol subfraction, elemental carbon and organic carbon, oil mist, nitrogen dioxide and ammonia was assessed on two consecutive days between the two health examinations. Results The geometric means air concentrations for particulate matter in the thoracic mass aerosol subfraction, a-quartz, oil mist, organic carbon and elemental carbon for all workers were 561, 63, 210, 146 and 35 µg/m3, respectively. After 11 days of work, the mean forced expiratory volume in 1 s (FEV1) in healthy participants had declined 73 mL (SD 173), p<0.001 in the tunnel workers, compared to 3 mL (SD 21), p=0.9 in the referents. Also, forced vital capacity (FVC) had declined significantly. Declines in FVC and FEV1 were significantly associated with exposure to organic carbon. Conclusions In spite of reduced levels of exposure in modern tunnelling operations, a negative impact on lung function was still observed. AU - Ulvestad B AU - Lund MB AU - Bakke B AU - Thomassen Y AU - Ellingsen DG LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 70 IP - DP - 2015 Jan 01 TI - Occupational anaphylaxis – an EAACI task force consensus statement. PG - 141-152 AB - Anaphylaxis is a systemic allergic reaction, potentially life-threatening that can be due to nonoccupational or, less commonly, to occupational triggers. Occupational anaphylaxis (OcAn) could be defined as anaphylaxis arising out of triggers and conditions attributable to a particular work environment. Hymenoptera stings and natural rubber latex are the commonest triggers of OcAn. Other triggers include food, medications, insect/mammal/snake bites, and chemicals. The underlying mechanisms of anaphylactic reactions due to occupational exposure are usually IgE-mediated and less frequently non-IgE-mediated allergy or nonallergic. Some aspects of work-related allergen exposure, such as route and frequency of exposure, type of allergens, and cofactors may explain the variability of symptoms in contrast to the nonoccupational setting. When assessing OcAn, both confirmation of the diagnosis of anaphylactic reaction and identification of the trigger are required. Prevention of further episodes is important and is based on removal from further exposure. Workers with a history of OcAn should immediately be provided with a written emergency management plan and an adrenaline auto-injector and educated to its use. Immunotherapy is recommended only for OcAn due to Hymenoptera stings. AU - Siracusa A AU - Folletti I AU - Gerth van Wijk R AU - Jeebhay MF AU - Moscato G AU - Quirce S AU - Raulf M AU - Ruëff F AU - Walusiak-Skorupa J AU - Whitaker P AU - Tarlo SM. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 70 IP - DP - 2015 Jan 01 TI - Damage-associated molecular pattern and innate cytokine release in the airways of competitive swimmers PG - 187-194 AB - Background Daily intensive exercise by elite athletes can result in exercise-induced asthma especially in elite swimmers and this may be linked to epithelial damage. Objective To study airway epithelial damage and release of damage-associated molecular patterns (DAMPs) after intensive exercise in elite athletes and controls. Methods We recruited competitive swimmers (n = 26), competitive indoor athletes (n = 13) and controls (n = 15) without any history of asthma. Lung function was measured before, immediately after and 24 h after a 90-min intensive exercise protocol. Sputum induction was performed at baseline and 24 h after exercise. Exercise-induced bronchoconstriction (EIB) was assessed by the eucapnic voluntary hyperventilation test. Results Baseline sputum uric acid, high mobility group box-1, CXCL8 mRNA, sputum neutrophils and serum Clara cell protein-16 (CC-16) were significantly higher in competitive swimmers compared with controls. Intensive swimming for 90 min resulted in an increase of sputum IL-1ß, IL-6 and TNF mRNA in competitive swimmers, and of sputum IL-6 mRNA and sputum neutrophils in controls. Although all participants were asymptomatic, seven competitive swimmers, one indoor athlete and one control met the criteria for EIB. Conclusion Our findings show that the intensive training combined with exposure to by-products of chlorination induces airway epithelial damage in competitive swimmers. This is associated with increased damage-associated molecular patterns, innate cytokine release and neutrophilic airway inflammation. AU - Seys SF AU - Hox V AU - Van Gerven L AU - Dilissen E AU - Marijsse G AU - Peeters E AU - Dekimpe E AU - Kasran A AU - Aertgeerts S AU - Troosters T AU - Vanbelle V AU - Peers K AU - Ceuppens JL AU - Hellings PW AU - Dupont LJ AU - Bullens DM LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 33 IP - DP - 2015 Jan 01 TI - Risk of asthma in relation to occupation: A hospital-based case-control study PG - 152-160 AB - Background Asthma is a common occupational lung disease and is preventable by removing identifiable allergens. Objectives (1) To assess the relationship between occupation and asthma (2) To determine the agents associated with asthma Methods This hospital-based, case-control study interviewed 153 cases from the Asthma Clinic and 306 non-asthmatic controls from Srinagarind Hospital, Thailand. Crude odds ratios (COR), 95% confidence intervals (95% CI) and adjusted ORs (AOR) for multiple logistic regression were calculated. Results The 153 cases, 70.6% were females with median age of 53 (IQR-14). The 306 controls 62.4% were females with median age of 56 (IQR-16). The highest risk of asthma was family history of asthma and history of atopy [AOR 11.16 (95% CI 4.33, 28.74) and AOR 8.03 (95% CI 4.90, 13.19)], respectively. If only occupations were considered, healthcare workers had the highest risk [AOR 4.08 (95% CI 1.35, 12.30)] followed by textile workers [AOR 3.34 (95% CI 1.07, 10.47)] and school workers AOR 2.40 (95% CI 1.31, 4.41). When subgroups of non-atopy were considered, school workers had a significant association with asthma [COR 3.18 (95% CI 1.48, 6.83)]. When no family history of asthma was considered, school and textile workers had the most significant association with asthma [COR 3.10 (95% CI 1.87, 5.13) and COR 3.06 (95% CI 1.15, 8.13), respectively]. Inorganic dust was the agent most significantly associated with asthma (COR 1.89 (95% CI 1.25, 2.82). Conclusion School textile and healthcare workers had the greatest risk of asthma. Family history of asthma and being atopic would also promote asthma in relation to occupation. AU - Wortong D AU - Chaiear N AU - Boonsawat W LA - PT - DEP - TA - Asian Pacific Journal of allergy and Immunology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 10 IP - DP - 2015 Jan 01 TI - Respiratory Health in Cleaners in Northern Europe: Is Susceptibility Established in Early Life? PG - e0131959 AB - Rationale There is some evidence that maternal smoking increases susceptibility to personal smoking’s detrimental effects. One might question whether early life disadvantage might influence susceptibility to occupational exposure. Objectives In this cross-sectional study we investigated respiratory symptoms, asthma and self-reported chronic obstructive pulmonary disease (COPD) as related to working as a cleaner in Northern European populations, and whether early life factors influenced susceptibility to occupational cleaning’s unhealthy effects. Methods The RHINE III questionnaire study assessed occupational cleaning in 13,499 participants. Associations with respiratory symptoms, asthma and self-reported COPD were analysed with multiple logistic regressions, adjusting for sex, age, smoking, educational level, parent´s educational level, BMI and participating centre. Interaction of occupational cleaning with early life disadvantage (maternal smoking, severe respiratory infection <5 years, born during winter months, maternal age at birth >35 years) was investigated. Main Results Among 2138 ever-cleaners the risks of wheeze (OR 1.4, 95% CI 1.3–1.6), adult-onset asthma (1.5 [1.2–1.8]) and self-reported COPD (1.7 [1.3–2.2]) were increased. The risk increased with years in occupational cleaning (adult-onset asthma: =1 year 0.9 [0.7–1.3]; 1–4 years 1.5 [1.1–2.0]; =4 years 1.6 [1.2–2.1]). The association of wheeze with cleaning activity =4 years was significantly stronger for those with early life disadvantage than in those without (1.8 [1.5–2.3] vs. 1.3 [0.96–1.8]; pinteraction 0.035). Conclusions Occupational cleaners had increased risk of asthma and self-reported COPD. Respiratory symptom risk was particularly increased in persons with factors suggestive of early life disadvantage. We hypothesize that early life disadvantage may increase airway vulnerability to harmful exposure from cleaning agents later in life. AU - Svanes Ø AU - Skorge TD AU - Johannessen A AU - Bertelsen RJ AU - Bråtveit M AU - Forsberg B AU - Gislason T AU - Holm M AU - Janson C AU - Jögi R AU - Macsali F AU - Norbäck D AU - Omenaas ER AU - Real FG AU - Schlünssen V AU - Sigsgaard T AU - Wieslander G AU - Zock J AU - Aasen T AU - Dratva J AU - Svanes C LA - PT - DEP - TA - PLoS ONE JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 52 IP - DP - 2015 Jan 01 TI - Swimming facilities and work-related asthma PG - 52-58 AB - Background: Exposure to chlorinated water in swimming facilities may aggravate preexisting asthma or cause new onset asthma. This may be a particular problem for individuals who work and therefore spend prolonged time at swimming facilities. Chloramines formed by the interaction of chlorine-based disinfection products with the nitrogen in water from human sweat, urine and skin cells are the suspected causal agents. Methods: Cases were reviewed from the state surveillance systems in California (CA), Michigan (MI) and New Jersey (NJ) to identify individuals with confirmed work-related asthma (WRA) attributed to exposures in swimming pools, water parks or hydrotherapy spas. A standardized method was used to confirm cases. Results: A total of 44 confirmed cases of WRA were identified; 17 from 1994 to 2011 in CA, 15 from 1991 to 2012 in MI and 12 from 1990 to 2011 in NJ. A majority (52.2%) of the cases were new onset; 31.8% secondary to an acute exposure incident and 20.4% to repeated exposure. These represented 0.3–1.6% of all confirmed cases of WRA received during these time periods. Maintenance workers (34.9%) and lifeguards (31.8%) were the most common occupations. Conclusions: Swimming pool workers were identified from three states where the pool environment was either a trigger of preexisting asthma or associated with new onset of WRA. Regulations to require air monitoring and improvements in ventilation are recommended to reduce exposure levels of chloramines, the presumed etiologic agents. Clinical assessment of patients with asthma should include consideration of the effect on respiratory symptoms from exposures in a swimming pool environment. AU - Rosenman KD AU - Millerick-May M AU - Reilly MJ AU - Flattery J AU - Weinberg J AU - Harrison R AU - Lumia M AU - Stephens AC AU - Borjan M LA - PT - DEP - TA - J Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 70 suppl1 IP - DP - 2015 Jan 01 TI - Is respiratory protective equipment effective in abolishing the work effect in patients sensitised to metal working fluid? PG - A108 AB - Background Removing exposure to the causative agent in workers with occupational asthma or hypersensitivity pneumonitis is the main goal. The effectiveness of Respiratory Protective Equipment (RPE) in sensitised workers with usual exposures in their workplace is not known. We aimed to assess changes in serial peak expiratory flow (PEF) in workers with sensitisation to metal working fluid before and after the introduction of RPE. Methods Workers who had been requested to keep 2-hourly PEF measurements before and after the introduction of RPE at a particular engine manufacturing plant were searched for on the Oasys PEF database. Those who had completed a minimum of 1 week before and after the introduction of RPE and had a positive area between curves (ABC) score for occupational effect from Oasys analysis (= 15 L/min/hr) on either record were included. All PEF measurements were made outside the working area where the RPE could be removed. Workers who remained symptomatic after cleaning and replacement of the metal-working fluid were only allowed to continue work if they complied with the strict use of respiratory protective equipment (RPE) using powered filtration and external changing facilities. Results 19 workers fulfilled the inclusion criteria. The mean ABC score before RPE use was 27.85 L/min/hr (SD 17.69) and after RPE use was 19.65 L/min/hr (SD 22.77) showing a mean overall decrease of 8.20 L/min/hr (SD 28.60). 9 workers (47%) no longer showed an occupational effect on their PEF record once RPE was instated, 7 workers continued to show an occupational effect and 3 workers showed a new occupational effect which was not present before RPE use. Conclusion Serial PEF measurements assessed with the ABC score from the Oasys system allowed quantification of the effect of RPE in sensitised workers. The RPE abolished falls in PEF associated with work exposure in 47% of workers, the remaining 10 workers had significant falls in PEF despite rigorously applied RPE. RPE should still remain a last resort in the hierarchy of control for occupational health. AU - Ilgaz A AU - Moore VC AU - Robertson W AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 70 Suppl 1 IP - DP - 2015 Jan 01 TI - Interstitial Lung Disease MDT presentations post VATS lung biopsy changes the original histological diagnosis in 30% PG - A27 AB - Introduction NICE recommends MDT presentation of all patients with suspected ILD. Any benefit of representation post VATS biopsy is unknown. Methods Our hospital (BHH) provides a regional service for thoracic surgery. All VATS lung biopsies for interstitial lung diseases carried out in 2013 were identified. They were presented post surgery at the ILD MDT where their history, physiology, immunology, original CTs and pathology were reviewed by a fully constituted MDT team including ILD specialist histopathologists, radiologists, clinicians and CNS’. The MDT diagnosis was compared with the original specialist pulmonary histopathology report. Results 71 patients had qualifying VATS biopsies in 2013. In 21 patients (30%) the MDT diagnosis differed significantly from the original histology report. In a further 12 patients the MDT altered a probable to a definite diagnosis. In 3 patients the MDT reduced the confidence of the histological diagnosis. Hypersensitivity pneumonitis was diagnosed much more confidently by the MDT than the histologist alone. The interpretation of necrotising granuloma was a particular problem from the histology alone; the MDT confirming diagnoses of rheumatoid lung, sarcoidosis or no ILD. It was also possible to achieve specific diagnoses in 5 patients whose biopsies were reported as non-specific fibrosis; NSIP (2), UIP (2), HP (1), and in 2 in whom the original report was resolving pneumonia (both HP). In 10/21 patients there was sufficient evidence to classify the UIP as IPF (7), collagen vascular disease UIP (1), chronic HP UIP (1), and drug induced UIP (1). There was often insufficient exposure and immunological data for the MDT to further characterise UIP and NSIP. Conclusions The post biopsy MDT changed the diagnosis in 30% compared with the histology report alone. An ILD MDT review with the combination of radiology and pathology and an expert team provided significant extra benefit in terms of a precise diagnosis in patients biopsied with interstitial lung disease in whom the referring physician thought that a diagnosis was not possible without a biopsy. This is not surprising as the histologist is limited by sampling, the radiologist by resolution, and both by the lack of physiology, exposure history and immunology. AU - Burge GA AU - Okiror L AU - Trotter S AU - Langman G AU - Payyappilly S AU - Naidoo P AU - Reynolds J AU - Djearman M AU - Hussain S AU - Hoey E AU - Steyn R AU - Rajesh P AU - Bishay E AU - Naidu B AU - Kalkat M AU - Petkova D AU - Ghani S AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 65 IP - DP - 2015 Jan 01 TI - Can serial PEF measurements separate occupational asthma from allergic alveolitis? PG - 251-255 AB - Background Occupational asthma commonly results in work-related changes in serial peak expiratory flow (PEF) measurements. Whether alveolitis can result in similar changes is unknown. Aims To identify differences and similarities of serial PEF between workers with occupational alveolitis and asthma seen during an outbreak investigation in a factory with metal-working fluid exposure. Methods Workers with respiratory symptoms and rest-day improvement were identified by questionnaire. Each was asked to measure PEF 8 times daily for 4 weeks at home and work. Alveolitis was subsequently diagnosed from a validated scoring system including radiological changes, carbon monoxide diffusing capacity, bronchoalveolar lavage and biopsy results. Occupational asthma was confirmed with a positive Oasys score >2.5 and a mean rest-work PEF >16 l/min from serial 2-hourly PEF measurements. The Oasys PEF plotter calculated differences between rest and workdays for mean PEF, diurnal variation and the scores were used to confirm an occupational effect (Oasys, area between curve and time point). Records were compared between the alveolitis group and the group with occupational asthma without alveolitis. Results Forty workers with occupational asthma and 16 with alveolitis had indistinguishable PEF changes on workdays in terms of magnitude (median reduction 18.5 and 16.1 l/min, respectively) and diurnal variation. Immediate reactions were more common with occupational asthma and late reactions more common with alveolitis. ConclusionsPEF responses to metal-working fluid aerosols do not distinguish occupational asthma from alveolitis except in timing. They can be used to identify the workplace as the cause of asthma and also alveolitis. AU - Burge PS AU - Moore VC AU - Burge CBSG AU - Vellore AD AU - Robertson AS AU - Robertson W LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 191 IP - DP - 2015 Jan 01 TI - Molecular Detection of Mycobacterium Avium in Aerosolised Metal Working Fluid is Linked to a Localised Outbreak of Extrinsic Allergic Alveolitis in Factory Workers PG - A2578 AB - Molecular Detection of Mycobacterium Avium in Aerosolised Metal Working Fluid is Linked to a Localised Outbreak of Extrinsic Allergic Alveolitis in Factory Workers Phillip L. James, Julie Cannon, Laura Crawford, Eva D'Souza, Chris Barber, , Steve Cowman, William O. Cookson, Miriam F. Moffatt, Paul Cullinan B25. OCCUPATIONAL RESPIRATORY DISEASES: NOVEL EPIDEMIOLOGY AND MECHANISMS, 2015: A2578, 10.1164/ajrccm-conference.2015.191.1_MeetingAbstracts.A2578 AU - James PL AU - Cannon J AU - Crawford L AU - DSouza E AU - Barber C AU - Cowman S AU - Cookson WO AU - Moffatt MF AU - Cullinan P LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 46 Suppl 5 IP - DP - 2015 Jan 01 TI - Development of the interstitial lung disease multidiciplinary team meeting 2005-2013 PG - PA333 AB - Introduction: NICE made recommendations for MDT management of IPF in 2013 against which we have audited our results. Methods: Following presentation of the history, examination, physiology, immunology and any biopsies, the MDT decides whether there is sufficient evidence to make a confident diagnosis; if not it recommends further investigations that should lead to a definitive diagnosis. If the disease is too advanced for safe further investigations the MDT makes a most likely diagnosis. Results: Patients discussed have risen from 81 in 2005 to 203 in 2013. The commonest diagnoses in 2013 were IPF (60), NSIP alone (19), Sarcoidosis (25), HP (17), ILD with CVD (12) and Asbestosis (9). The proportion where VATS was recommended or carried out for UIP has reduced from 41% in 2007 to 22% in 2013. Histological confirmation of sarcoidsis was low (12/25). Only 15 of the 51 patients with definite IPF had FVC <80% required for Pirfenidone prescription in the UK. Fig 1 shows the relationship between VC and DLCO % pedicted for IPF patients at presentation. Conclusions: The prescription criteria for Pirfenidone in the UK exclude most patients with IPF. Compared with guidelines the biopsy rate for probable sarcoidosis is low (48%). The workup of patients with possible chronic HP/NSIP is often hampered by the lack of occupational, environmental, drug and immunological data. AU - Burge G AU - Ghani S AU - Petkova D AU - Reynolds J AU - Djearman M AU - Hussain S AU - Hoey E AU - Trotter S AU - Langman G AU - Faizal A AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - RR1044 IP - DP - 2015 Jan 01 TI - RR1044 Consultation on monitoring of water-miscible metalworking fluid (MWF) mists PG - 1-43 AB - The aim of this research was to examine metal working fluid (MWF) exposure limits and guidance set by other countries, summarise studies and investigations that examined water-miscible MWF mist as well as new techniques to monitor mist. The following conclusions were drawn: The majority of guidance levels or exposure limits for MWF mist relate to mineral oil and not watermiscible fluids. Certain recommended exposure limits (RELs) such as those set by NIOSH (USA) and INRS (France) relate to all MWFs. European countries, with the exception of the UK, and the USA monitor all forms of MWF mist by capture onto filters (with or without subsequent chemical extraction steps), followed by gravimetric analysis or the use of infra-red spectroscopy. Historically, average mist levels have not changed over time; the majority were below the previous UK guidance value of 1.0 mg/m3 with a large proportion below the NIOSH REL of 0.5 mg/m3. This suggests that as ill health was reported at these low levels of mist, the exposure limits have no relevance to health risk. A different approach to MWF mist monitoring may be required based on good practice. The question is whether the use of monitoring devices or internationally recognised methods (eg gravimetric analysis) might help to determine the effectiveness of this control strategy. AU - Senior H AU - Evans G LA - PT - DEP - TA - Health and Safety Exexutive JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 114 IP - DP - 2015 Jan 01 TI - Novel antigens of Mycobacterium immunogenum relevant in serodiagnosis of occupational hypersensitivity pneumonitis in machinists PG - 525-526 AU - Chandra H AU - Lockey J AU - Yadav JS LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 72 IP - DP - 2015 Jan 01 TI - Metalworking fluids: a new cause of occupational non-asthmatic eosinophilic bronchitis PG - 579-580 AB - A 52-year-old man was referred with chronic cough of increasing severity over the last 4 years. The cough was productive of green sputum and he experienced coughing attacks weekly. He reported no other respiratory symptoms. He had a sore throat following coughing bouts but denied other upper airway complaints. He was otherwise well with no systemic symptoms. His cough had improved following a 2-week summer holiday, and subsequently deteriorated following his return to work. A chest X-ray organised in primary care was normal. Three years earlier, his general practitioner increased his lansoprazole from 15 to 30 mg once daily for cough. This had not helped although treatment continued. His past medical history included treated obstructive sleep apnoea and hypertension for which he took bendroflumethiazide and losartan; the latter substituted for his ACE inhibitor 3 years earlier. He recalled no personal or family history of asthma or atopy and was a lifelong non-smoker. He had kept budgerigars until 6 months previously when the last bird died. He had worked for 12 years as a computer numerical control (CNC) machine setter and operator, machining metal parts used to make tools for woodworking. He machined bronze, brass, leaded mild steel, high-speed steel and aluminium pieces to the desired specification. He operated five machines in a single area of the factory, adjacent to where ash handles were turned. He was the sole CNC operator turning metal components in the factory and was not aware of any colleagues reporting respiratory symptoms. Water-based metalworking fluids (MWFs) were used on all five machines. Each machine collected and recirculated MWFs via its own sump. For the last 4 years, the fluids had occasionally become ‘foul smelling’ and sometimes changed colour from a translucent blue to a chocolate brown. The worksite did not perform dip-slide fluid analysis or use biocide contrary to agreed industry practice. The patient reported exposure to MWF mist when opening the machine doors and cleaning with compressed air. He wore a non-fit tested disposable paper mask for respiratory protective equipment. Physical examination of the patient was normal. Spirometry revealed an FEV1 of 3.17 L (83% predicted), FVC of 3.9 L (81%) and a FEV1/FVC ratio of 104%. FENO was 92 parts per billion (ppb). TLCO was 12.4 (116%) mmol/min/kPa and KCO 2.29 (160%) mmol/min/kPa/L. Total IgE was raised at 122 KU/L, peripheral eosinophils normal at 0.13×109/L and specific IgG to aspergillus, budgerigar and pigeon within normal limits. A high resolution CT (HRCT) performed midway through a normal working week revealed mild gas trapping on expiratory views. Two months later, his OASYS demonstrated minimal diurnal variation (DV) at and away from work (5.6% and 6.5%, respectively), with a maximal DV of 13%. The work-effect index (WEI) was negative at 1.64. As the WEI was negative but DV borderline, a mannitol challenge was requested to look for further evidence of airway hyperresponsiveness. The test was performed during a routine working week on no inhaled corticosteroids (ICS). The maximum % change in FEV1 was 2.8 following the complete dose of 635 mg osmohale, with a maximum FEV1 change between doses of -1.4%. A repeat FENO taken midway through the working week was 94 ppb. An induced sputum sample done at the same time contained 14% eosinophils. Occupational eosinophilic bronchitis was suspected, and the patient returned following a week off work for a repeat FENO. At this point, FENO had dropped to 11 ppb. A diagnosis of occupational non-asthmatic eosinophilic bronchitis (NAEB) was made and the patient commenced on ICS. He was provided with written confirmation of the diagnosis and recommendations about how to reduce further MWF exposures. Work provided fit-tested half-face disposable masks and the patient reduced his use of compressed air. At his next appointment, a midweek FENO on ICS was 18 ppb and his cough had almost disappeared. AU - Wiggans RE AU - Barber CM LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 10 IP - DP - 2015 Jan 01 TI - Q Fever Outbreak among Workers at a Waste-Sorting Plant. PG - e0138817 AB - An outbreak of Q fever occurred in February–April 2014 among workers at a waste-sorting plant in Bilbao (Spain). The outbreak affected 58.5% of investigated employees, 47.2% as confirmed cases (PCR and/or serology) and 11.3% as probable cases (symptoms without laboratory confirmation). Only employees who had no-access to the waste processing areas of the plant were not affected and incidence of infection was significantly higher among workers not using respiratory protection masks. Detection by qPCR of Coxiella burnetii in dust collected from surfaces of the plant facilities confirmed exposure of workers inside the plant. Animal remains sporadically detected among the residues received for waste-sorting were the most probable source of infection. After cleaning and disinfection, all environmental samples tested negative. Personal protection measures were reinforced and made compulsory for the staff and actions were taken to raise farmers’ awareness of the biological risk of discharging animal carcasses as urban waste. AU - Alonso E AU - Lopez-Etxaniz I AU - Hurtado A AU - Liendo P AU - Urbaneja F AU - et al. LA - PT - DEP - TA - Plos One JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 45 IP - DP - 2015 Jan 01 TI - Allergen-induced early and late asthmatic responses to inhaled seasonal and perennial allergens PG - 1647-1653 AB - Background The allergen bronchoprovocation (ABP) test is a validated model to study asthma pathophysiology and response to treatments. The inhibitory effect of agents on the allergen-induced late asthmatic response (LAR) is a predictor of their ef?cacy in asthma treatment. However, it is dif?cult to predict the magnitude of a LAR, which may vary according to immune responsiveness and the type of allergen used for ABP. Aim To determine the relationship between the magnitudes of early asthmatic response (EAR) and LAR in mild asthmatic subjects according to the type of allergen inhaled and its determinants. Methods This is a retrospective analysis of a large database of ABPs, all performed with a common standardized methodology. Patients were either challenged with house dust mites (HDMs), animals or pollens allergens. EAR was de?ned as a = 20% fall in forced expiratory volume in 1 s (FEV1) < 3 h following ABP and LAR as a = 15% fall in FEV1 between 3 and 7 h post-ABP. The ratio of EAR % fall in FEV1/LAR % fall in FEV1 was compared between the groups of subjects according to the allergen used for ABP. Results Data from 290 subjects were analysed: 87 had an isolated EAR and 203 had a dual response (EAR + LAR). Dual responders had a signi?cantly lower baseline PC20,a more marked fall in FEV1 at EAR, and a trend towards higher baseline sputum eosinophil percentages. The ratio of EAR over LAR was signi?cantly lower in HDM compared with pollen ABP, indicating a larger LAR for a similar EAR. No correlations were observed between the ratio of EAR over LAR and the various parameters recorded in the different groups analysed. Conclusion Different mechanisms may be involved in modulating the magnitude of the LAR, according to the type of allergen. HDM seems to induce a stronger LAR than pollens, animal allergens being intermediary in this regard. AU - Boulet L-P AU - Gauvreau G AU - Boulay M-£E AU - O'Byrne PM AU - Cockroft DW LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 70 IP - DP - 2015 Jan 01 TI - High levels of indium exposure relate to progressive emphysematous changes: a 9-year longitudinal surveillance of indium workers PG - 1040-1046 AB - Background During the last decade it has been clarified that the inhalation of indium compounds can evoke alveolar proteinosis, cholesterol granuloma, pulmonary fibrosis and emphysema. In this study, we aimed to elucidate the characteristics and time course of pulmonary disorders among indium workers using comprehensive pulmonary examinations at an indium-processing factory. Methods Data for 84 male workers who underwent the examinations for nine consecutive years from 2002 to 2010 were analysed regarding their symptoms, serum indium concentration (sIn), serum markers of interstitial pneumonia, pulmonary function test parameters and high-resolution CT (HRCT) findings of the lungs. Results In association with improvements in the work environment and work practice, the sIn levels decreased with significant reductions in the KL-6 and surfactant protein D (SP-D) levels. Regarding the HRCT findings, the interstitial lesions regressed partially, whereas emphysematous lesions increased progressively in the workers with high sIn values. FEV1/FVC decreased with the years and the rate of decrease was significantly greater in those with high sIn. The biological half-life of sIn was estimated to be 8.09 years. Conclusions The present findings suggest that the sIn, SP-D, KL-6 levels and radiological interstitial changes can be reduced in indium workers by alleviating exposure to indium, whereas emphysematous lesions can progress among those with a history of heavy exposure. AU - Amata A AU - Chonan T AU - Omae K AU - Nodera H AU - Tatsumi JTK LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 15 IP - DP - 2015 Jan 01 TI - Laboratory Animal Allergy in the Modern Era PG - 73 AB - Laboratory animal workers face a high risk of developing laboratory animal allergy as a consequence of inhaling animal proteins at work; this has serious consequences for their health and future employment. Exposure to animal allergen remains to be the greatest risk factor although the relationship is complex, with attenuation at high allergen exposure. Recent evidence suggests that this may be due to a form of natural immunotolerance. Furthermore, the pattern of exposure to allergen may also be important in determining whether an allergic or a tolerant immune response is initiated. Risk associated with specific tasks in the laboratory need to be determined to provide evidence to devise a code of best practice for working within modern laboratory animal facilities. Recent evidence suggests that members of lipocalin allergens, such as Mus m 1, may act as immunomodulatory proteins, triggering innate immune receptors through toll-like receptors and promoting airway laboratory animal allergy. This highlights the need to understand the relationship between endotoxin, animal allergen and development of laboratory animal allergy to provide a safe working environment for all laboratory animal workers. AU - Jones M LA - PT - DEP - TA - Curr Allergy Asthma Rep JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 65 IP - DP - 2015 Jan 01 TI - Occupational asthma from tafenoquine in the pharmaceutical industry: implications for QSAR PG - 256-258 AB - We report occupational asthma and rhinitis in a formulation pharmacist, employed in the development of tafenoquine. Tafenoquine is a new anti-malarial drug in development; the pure drug substance has an asthma hazard index of zero and previously was not known to be a respiratory sensitizing agent. The implications of this finding for the refinement of quantitative structural analysis of asthmagenic chemicals are discussed. AU - Cannon J AU - Fitzgerald B AU - Seed M AU - Agius R AU - Jiwany A AU - Cullinan P LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 13 IP - DP - 2015 Jan 01 TI - Respiratory Tract Problems among Wood Furniture Manufacturing Factory Workers in the Northeast of Thailand PG - 125-129 AB - Background: Wood furniture manufacturing factory workers are at high risk of exposure to wood dust in wood working processes. Wood dust exposure could cause respiratory symptoms, such as reduce lung function, chronic bronchitis, and asthma. The Northeast region of Thailand has many wood furniture manufacturing factories. However, limited studies were carried out to explore the effect of wood dust exposure on workers. Objective: This study aimed to assess the respiratory symptoms and determine factors associated with these symptoms among wood furniture manufacturing factory workers. Method: This cross-sectional analytical research used a multistage random sampling to select 511 workers from three provinces in the Northeast of Thailand. The data was collected using a structured questionnaire interview. The content validity of questionnaire was tested by 3 experts and had a Cronbach's alpha coefficient of 0.82. Data were analyzed using descriptive statistics and multiple logistic regressions. Result: The result indicated that 29.94% of these workers had respiratory symptoms, including coughing(18.79%), nasal secretion (15.66%), and stuffy nose (15.07%). Factors that were significantly associated with respiratory symptoms (p-value < 0.05) were (a) not always wearing mask (adjusted OR=2.26;95% CI=1.37-3.72), (b) low to medium level of knowledge on dust prevention (adjusted OR=1.83;95% CI=1.23- 2.73) and (c) contacted softwood dust (adjusted OR=1.97;95% CI= 1.06-3.64). Conclusion: About 30% of wood furniture manufacturing factory workers had respiratory symptoms with related to both personal preventive behaviors and their working environments. Therefore, the raising awareness for using personal protective equipment during work will help them to prevent from various respiratory track problems.. AU - Soongkhang I AU - Laohasiriwong W. LA - PT - DEP - TA - Kathmandu Univ Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 15 IP - DP - 2015 Jan 01 TI - Work-associated irritable larynx syndrome PG - 150-155 AB - Purpose of review The purpose of this study is to review the relevant literature concerning work-associated irritable larynx syndrome (WILS), a hyperkinetic laryngeal disorder associated with occupational irritant exposure. Clinical symptoms are variable and include dysphonia, cough, dyspnoea and globus pharyngeus. WILS is a clinical diagnosis and can be difficult to differentiate from asthma. Treatment options for WILS include medical and behavioural therapy. Recent findings Laryngeal-centred upper airway symptoms secondary to airborne irritants have been documented in the literature under a variety of diagnostic labels, including WILS, vocal cord dysfunction (VCD), laryngeal hypersensitivity and laryngeal neuropathy and many others. The underlying pathophysiology is as yet poorly understood; however, the clinical scenario suggests a multifactorial nature to the disorder. More recent literature indicates that central neuronal plasticity, inflammatory processes and psychological factors are all likely contributors. Summary Possible mechanisms for WILS include central neuronal network plasticity after noxious exposure and/or viral infection, inflammation (i.e. reflux disease) and intrinsic patient factors such a psychological state. Treatment is individualized and frequently includes one or more of the following: environmental changes in the workplace, GERD therapy, behavioural/speech therapy, psychotherapy counselling and neural modifiers. AU - Anderson JA LA - PT - DEP - TA - Current Opinion in Allergy and Clinical Immunology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20150101 IS - IS - VI - 24 IP - DP - 2015 Jan 01 TI - Occupational exposure to pesticides and respiratory health PG - 306--319 AB - This article aims to review the available literature regarding the link between occupational exposure to pesticides and respiratory symptoms or diseases. Identification of epidemiological studies was performed using PubMed. 41 articles were included, 36 regarding agricultural workers and five regarding industry workers. Among the 15 cross-sectional studies focusing on respiratory symptoms and agricultural pesticide exposure, 12 found significant associations with chronic cough, wheeze, dyspnoea, breathlessness or chest tightness. All four studies on asthma found a relationship with occupational exposure, as did all three studies on chronic bronchitis. The four studies that performed spirometry reported impaired respiratory function linked to pesticide exposure, suggestive of either obstructive or restrictive syndrome according to the chemical class of pesticide. 12 papers reported results from cohort studies. Three out of nine found a significant relationship with increased risk of wheeze, five out of nine with asthma and three out of three with chronic bronchitis. In workers employed in pesticide production, elevated risks of chronic obstructive pulmonary disease (two studies out of three) and impaired respiratory function suggestive of an obstructive syndrome (two studies out of two) were reported. In conclusion, this article suggests that occupational exposure to pesticides is associated with an increased risk of respiratory symptoms, asthma and chronic bronchitis, but the causal relationship is still under debate. A review of occupational (agricultural and industry) exposure to pesticides and associated respiratory health effects http:///ow.ly/M09Gc AU - Mamane AU - Ali AU - Baldi AU - Isabelle AU - Tessier AU - Jean-François AU - Raherison AU - Chantal AU - Bouvier AU - Ghislaine LA - PT - DEP - TA - European Respiratory Review JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 231 IP - DP - 2014 Jan 01 TI - Case studies of hydrogen sulphide occupational exposure incidents in the UK PG - 374-377 AB - The UK Health and Safety Executive has investigated several incidents of workplace accidents involving hydrogen sulphide exposure in recent years. Biological monitoring has been used in some incidents to determine the cause of unconsciousness resulting from these incidents and as a supporting evidence in regulatory enforcement. This paper reports on three case incidents and discusses the use of biological monitoring in such cases. Biological monitoring has a role in identifying hydrogen sulphide exposure in incidents, whether these are occupational or in the wider environment. Sample type, time of collection and sample storage are important factors in the applicability of this technique. For non-fatal incidents, multiple urine samples are recommended at two or more time points between the incident and 15h post-exposure. For routine occupational monitoring, post-shift samples should be adequate. Due to endogenous levels of urinary thiosulphate, it is likely that exposures in excess of 12ppm for 30min (or 360ppm/min equivalent) would be detectable using biological monitoring. This is within the Acute Exposure Guideline Level 2 (the level of the chemical in air at or above which there may be irreversible or other serious long-lasting effects or impaired ability to escape) for hydrogen sulphide. AU - Jones K LA - PT - DEP - TA - Toxicol Lett JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - IP - DP - 2014 Jan 01 TI - Initial clinical management of patients exposed to chemical weapons: interim guidance document PG - 1-35 AB - This interim guidance is aimed at healthcare workers who may receive patients exposed to chemical weapons at their healthcare facilities. The guidance follows the case management flowchart on the next page. It provides questions to guide the identification of contaminated patients, recommendations on personal protection, procedures for decontamination, guidance for triage and identification of categories of exposure, and treatment regimens for individual chemicals. Users should study the contents of this document carefully and apply the principles and framework to their own situation and health care facilities. Clinical work in this field should be accompanied with complete and practical training. PROTECT YOURSELF AND OTHER PERSONNEL KEY PRINCIPLES > Healthcare workers are mainly exposed to toxic chemicals through direct contact with the agent on patients’ skin / clothing or by inhalation or mucosal contact with a vapour hazard. > The effective use of PPE is dependent on availability, training and an understanding of the mechanisms of secondary exposure. > Appropriate standards and levels of PPE are dependent on the resources at different healthcare facilities and on the properties of the chemical agent. > All PPE confers a loss of mobility, dexterity, vision and ability to communicate freely. PPE also places an increased physiological burden on the user. > Even at higher levels of protection, PPE does not completely eliminate the risk of agent penetration due to eventual break-down in protective barriers. > PPE should be removed carefully to avoid touching contaminated areas. It should be removed in a designated location and disposed of as hazardous waste General principles should be employed to provide a minimum level of staff p Personal Protective Equipment (PPE) is essential to first responders and personnel responsible for decontamination, triage and emergency treatment at the healthcare facility. The main contact hazard can be prevented by wearing appropriate gloves (nitrile or butyl rubber, not latex). The number and thickness of the gloves used will depend on the dexterity required by the user. Chemically-resistant clothing should also be worn if available. If not available, then as a minimum disposable, fluidresistant clothing or gowns should be utilized and regularly changed. Standard medical and surgical masks offer no respiratory or mucous membrane protection from toxic vapours. An air-purifying respirator, e.g. with an activated charcoal filter, or selfcontained breathing apparatus is required. Respirators require training, safety testing and fit testing. They can only be worn by users for limited time periods. AU - WHO LA - PT - DEP - TA - WHO/HSE/GCR/2014.3 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 4 IP - DP - 2014 Jan 01 TI - A new colorimetric fluorescent sensor for ratiometric detection of cyanide in solution, test strips, and in cells PG - 8295-8299 AB - A new high selective and sensitive fluorescent sensor for the detection of cyanide was developed based on the nucleophilic attack of CN- with a color change from purple to colourless. The chemosensor was used for fabrication of test strips that can detect cyanide in aqueous samples. The living animal fluorescence experiment demonstrated the practical value of the sensor in tracing the CN- in biological systems. AU - Sun M AU - Wang S AU - Yang Q AU - Fei X AU - Lia Y AU - Li Y LA - PT - DEP - TA - RSC Adv JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 87 IP - DP - 2014 Jan 01 TI - Asthma related to workplace dampness and impaired work ability PG - 1-11 AB - Purpose To examine the long-term effects on work ability among patients previously diagnosed with occupational asthma (OA) or work-exacerbated asthma (WEA) or symptoms in relation to workplace dampness. Methods A questionnaire follow-up was used to study 1,098 patients (of whom 87 % were female) examined because of a suspected occupational respiratory disease caused by building dampness and mold. Self-rated work ability and early withdrawal from work were the two outcomes of the study. As determinants, we investigated the influence of the asthma diagnosis given in the initial examinations (OA or WEA), the number of persistent indoor air symptoms, and the psychosocial factors at work. Results With a mean follow-up of 7.8 years, 40 % of the OA patients, under 65 years of age, were outside worklife versus 23 % of the WEA patients and 15 % of the patients with only upper respiratory symptoms at baseline. The diagnosis of OA was associated with a nearly sixfold risk for early withdrawal from work in a comparison with a reference group with upper respiratory symptoms. A perceived poor social climate at work and poor experiences with supervisory co-operation were associated with impaired work ability outcomes. Those with multiple, long-term indoor air symptoms considerably more often perceived their work ability to be poor when compared with those with less significant symptoms. Conclusions Adverse work ability outcomes are associated with asthma in relation to workplace dampness. The study raises the need for effective preventive measures in order to help workers with indoor air symptoms sustain their work ability. AU - Karvala K AU - Nordman H AU - Luukkonen R AU - Uitti J LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 43 IP - DP - 2014 Jan 01 TI - COPD prognosis in relation to diagnostic criteria for airflow obstruction in smokers PG - 54-63 AB - The aim of this study was to establish which cut-off point for the forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio (i.e. fixed 0.70 or lower limit of normal (LLN) cut-off point) best predicts accelerated lung function decline and exacerbations in middle-aged smokers. We performed secondary analyses on the Lung Health Study dataset. 4045 smokers aged 35–60 years with mild-to-moderate obstructive pulmonary disease were subdivided into categories based on presence or absence of obstruction according to both FEV1/FVC cut-off points. Post-bronchodilator FEV1 decline served as the primary outcome to compare subjects between the categories. 583 (14.4%) subjects were nonobstructed and 3230 (79.8%) subjects were obstructed according to both FEV1/FVC cut-off points. 173 (4.3%) subjects were obstructed according to the fixed cut-off point, but not according to the LLN cut-off point (‘‘discordant’’ subjects). Mean¡SE post-bronchodilator FEV1 decline was 41.8¡2.0 mL?year-1 in nonobstructed subjects, 43.8¡3.8 mL?year-1 in discordant subjects and 53.5¡0.9 mL?year-1 in obstructed subjects (p,0.001). Our study showed that FEV1 decline in subjects deemed obstructed according to a fixed criterion (FEV1/FVC ,0.70), but non-obstructed by a sex- and age-specific criterion (LLN) closely resembles FEV1 decline in subjects designated as non-obstructed by both criteria. Sex and age should be taken into account when assessing airflow obstruction in middle-aged smokers. European Respiratory Journal 2014 43: 54-63; DOI: 10.1183/09031936.00158212 AU - Akkermans RP AU - Biermans M AU - Robberts B AU - ter Riet G AU - Jacobs A AU - van Weel C AU - Wensing M AU - Schermer T LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 43 IP - DP - 2014 Jan 01 TI - Grading the severity of airways obstruction: new wine in new bottles PG - 505-512 AB - The objective of this study was to redesign the current grading of obstructive lung disease so that it is clinically relevant and free of biases related to age, height, sex and ethnic group. Spirometric records from 17 880 subjects (50.4% female) from hospitals in Australia and Poland, and 21 191 records (53.0% female) from two epidemiological studies (age range 18–95 years) were analysed. We adopted the American Thoracic Society(ATS)/European Respiratory Society (ERS) criteria for airways obstruction based on an forced expiratory volume in 1 s (FEV1)/(forced) vital capacity ((F)VC) ratio below the fifth percentile and graded the severity of pulmonary function impairment using z-scores for FEV1, which signify how many standard deviations a result is from the mean predicted value. Using the lower limit of normal for FEV1/(F)VC and z-scores for FEV1 of -2, -2.5, -3 and -4 to delineate severity grades of airflow limitation leads to close agreement with ATS/ERS severity classifications and removes age, sex and height related bias. The new classification system is simple, easily memorised and clinically valid. It retains previously established associations with clinical outcomes and avoids biases due to the use of per cent predicted FEV1. Combined with the Global Lung Function prediction equations it provides a worldwide diagnostic standard, free of bias due to age, height, sex and ethnic group. Tweetable abstract @ AU - Quanjer PH AU - Pretto JJ AU - Brazzale DJ AU - Boros PW LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - IP - DP - 2014 Jan 01 TI - Regulation (EU) 528/2012 concerning the making available on the market and use of biocidal products Aseessment report n,n-methylenebismorpholine PG - AU - European Parliament LA - PT - DEP - TA - Europeam Parliament JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 5 IP - DP - 2014 Jan 01 TI - A 4-Year Follow-up Cohort Study of the Respiratory Functions in Toner-handling Workers PG - 222-226 AB - Background Focusing on the respiratory function for health effect indices, we conducted a cross-sectional study on workers who did and did not handle toner to compare the longitudinal changes. Methods Among 116 individuals who worked for a Japanese business equipment manufacturer and participated in the study, the analysis included 69 male workers who we were able to follow up for 4 years. We categorized the 40 workers engaged in toner-handling work as the exposed group and the 29 workers not engaged in these tasks as the referent group, and compared their respiratory function test results: peak expiratory flow rate (PEFR), vital capacity (VC), predicted vital capacity (%VC), forced expiratory volume in 1 second (FEV1), and forced expiratory volume in 1 second as a percent of forced vital capacity (FEV1%). Results The cross-sectional study of the respiratory function test results at the baseline and at the 5th year showed no statistically significant differences in PEFR, VC, %VC, FEV1, and FEV1% between the exposed and referent workers. Also, respiratory function time-course for 4 years was calculated and compared between the groups. No statistically significant differences were shown. Conclusion Our study does not suggest any toner exposure effects on respiratory function. However, the number of subjects was small in our study; studies of larger populations will be desired in the future. AU - Yanagi N AU - Kitamura H AU - Mizuno M AU - Hata K AU - Uchiyama T AU - Kuga H AU - Matsushita T AU - Kurosaki S AU - Uehara M AU - Ogami A AU - Higashi T LA - PT - DEP - TA - Safety and Health at work JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 189 IP - DP - 2014 Jan 01 TI - Can Serial FEV1 Identify Work-Related Asthma Cases Missed By Serial Peak Expiratory Flow? PG - A4594 AB - Background: Existing analyses to identify work-related asthma (WRA) using serial peak expiratory flow (PEF) include the area between the curve (ABC) score that characterizes the difference between summary curves of hourly PEF on rest days and work days. The cutoff value for WRA using the PEF-ABC score is 15 liters/minute/hour (l/min/hr). Many portable devices that measure serial PEF also concurrently measure and record the forced expiratory volume in one second (FEV1). Serial FEV1 might facilitate the identification of WRA cases, although currently there are no validated criteria to judge work-related status using this metric. We used serial spirometry data from adults with asthma to examine whether ABC scores based on FEV1 (FEV1-ABC) might identify the same or different WRA cases as those implicated by PEF-ABC scores. Methods: The study sample comprised 95 working adults with asthma who were enrolled in a health maintenance organization in the US state of Massachusetts and participated in a study of asthma. Each participant completed at least two weeks of self-testing using a portable spirometer that recorded and time/date stamped PEF and FEV1. We calculated PEF-ABC scores and applied the existing cutoff point of 15 l/min/hour for a positive work-related status, which was fulfilled by 7 participants. Without validated criteria to interpret FEV1-ABC scores, we compared the participants with the 7 highest FEV1-ABC scores (>=0.06 l/hour) to the group of 7 with PEF-ABC scores >=15. Results: The 95 asthma cases were 71% female with a mean age of 34 years, and worked predominantly in management, professional, and business (48%) and sales and office (28%) occupations. Their PEF-ABC values ranged from -50 to +50 with median=-1.97, and FEV1-ABC values ranged from -0.33 to +0.26 with median=-0.04. The two groups (n=7 in each) with high ABC scores shared 4 participants in common. The three cases with evidence for WRA based only on an elevated PEF-ABC score were in the 9th (n=1) and 8th (n=2) deciles of FEV1-ABC scores. The three cases with evidence for WRA based only on an elevated FEV1-ABC score were in the 10th, 8th, and 3rd deciles of PEF-ABC scores. Conclusion: Serial FEV1 might help to identify WRA cases when used in conjunction with serial PEF. However, further work is needed to establish and validate criteria for WRA using serial FEV1. AU - Henneberger PK AU - Cox-Ganser J AU - Moore VC AU - Burge CBSG AU - Liang X AU - Burge PS LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - a IP - DP - 2014 Jan 01 TI - A Techno-Health Study of the Use of Cutting Fluids and Future Alternatives PG - a AB - The health issues associated with exposure to cutting fluids is an increasing concern among occupational health researchers. However, this issue has been overlooked in manufacturing enterprises from engineering prospective. The aim of this paper is to provide a multi-disciplinary review of the health issues related to the use of cutting fluids in machining companies and provides some alternative solutions through a series of case studies. The studies indicated that minimum quantity lubrication, biostable oils, cryogenic machining and dry machining are potential alternatives to traditional flood cooling with potential to improve machinability. AU - Shokrani A AU - Dhokia V AU - Newman ST LA - PT - DEP - TA - 24th International Conference on Flexible Automation and Intelligent Manufacturing (FAIM 2014) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 15 IP - DP - 2014 Jan 01 TI - Immunoproteomics for Serological Diagnosis of Hypersensitivity Pneumonitis Caused by Environmental Microorganisms PG - 430-436 AB - Diagnosis of immunoallergenic pathologies due to microorganisms such as hypersensitivity pneumonitis includes detection of circulating specific antibodies. Detection of precipitins has classically been performed using immunoprecipitation techniques with crude antigenic extracts from microorganisms implicated as etiologic agents. However, these techniques lack standardization because of the different composition of fungal antigenic extracts from one batch to another. Therefore, there is high interest in developing standardized serological diagnostic methods using recombinant antigens. Immunoproteomics have proved to be useful for identifying the immunogenic proteins in several microorganisms linked to hypersensitivity pneumonitis. With this approach, the causative microorganisms are first isolated from the environment of patients. Then the proteins are separated by two-dimensional electrophoresis and revealed by Western blotting with sera of different patients suffering from the disease compared to sera of asymptomatic exposed controls. Immunoreactive proteins are identified by mass spectrometry. Identified immunoreactive proteins found to be specific markers for the disease could be subsequently produced as recombinant antigens using various expression systems to develop ELISA tests. Using recombinant antigens, standardized ELISA techniques can be developed, with sensitivity and specificity reaching 80% and 90%, respectively, and more if using a combination of several antigens. Immunoproteomics can be applied to any environmental microorganisms, with the aim of proposing panels of recombinant antigens able to improve the sensitivity and standardization of serologic diagnosis of hypersensitivity pneumonitis, but also other mold-induced allergic diseases such as allergic broncho pulmonary aspergillosis or asthma. AU - Millon L AU - Reboux G AU - Barrera C AU - Rognon B AU - Roussel S AU - Monod M LA - PT - DEP - TA - Protein and Peptide Science JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 57 IP - DP - 2014 Jan 01 TI - External validation of recombinant antigens for serodiagnosis of machine operator's lung PG - 195-201 AB - Background Machine operator's lung (MOL) is a hypersensitivity pneumonitis the diagnosis of which is difficult. Our laboratory previously developed an ELISA test using recombinant antigens from Mycobacterium immunogenum isolated in French plant. The objective was to validate the previous ELISA results with ten new suspected cases from Germany. Methods Two serological analyses were performed: ELISA with the six recombinant antigens, and electrosyneresis with crude antigens of M. immunogenum and three other main species isolated from contaminated metalworking fluids. Results The two recombinant antigens acyl-CoA dehydrogenase and dihydrolipoyl dehydrogenase, combined together, and electrosyneresis are useful in making the diagnosis regardless of the clinical and radiological data. Finally 9 out of the 10 suspected cases were declared as MOL. Conclusions Despite the geographical distance, the crude and recombinant antigens produced to investigate the clustered French cases also proved to be useful in diagnosing the suspected cases in Germany AU - Barrera C AU - Reboux G AU - Warfolomeow I AU - Rognon B AU - Millon L AU - Roussel S LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 87 IP - DP - 2014 Jan 01 TI - Extended tracking of the microbial community structure and dynamics in an industrial synthetic metalworking fluid system PG - 664-667 AB - Understanding of the occupational exposure risk scenario and disease etiology associated with industrial metalworking fluids (MWFs) requires knowledge of the development and composition of their microbial diversity in relation to the underlying fluid management factors. In this study, a managed synthetic MWF operation freshly recharged following the dumping, cleaning, and recharge (DCR) process was tracked in real time for microbial community changes over a period of 1.25 years (65 weeks). The recharged fluid developed very high bacterial counts (viable and nonviable) fairly quickly after the DCR process, indicating its inadequacy. Genus-/group-specific real-time qPCR confirmed the prevalence of six potentially pathogenic/immunogenic microbial genera/groups, viz. pseudomonads, enterics, mycobacteria, legionellae, actinomycetes, and fungi. Selective culturing revealed Acinetobacter and Bacillus as the most frequently isolated Gram-negative and Gram-positive genera, respectively, in addition to the presence of fungi and actinomycetes. Endotoxin perturbations (< 1000 to > 100 000 EU mL-1) coincided with temporal increases in Gram-negative bacteria and/or periodic biocide additions. PCR-DGGE-sequencing revealed an expanded estimated bacterial richness (up to 23 bands per sample). Of the 16 dominant bacterial phylotypes identified, the majority were detected for the first time in MWF. Interestingly, the study revealed a crucial role for MWF brand, among other fluid factors, in modulating the community structure and dynamics. AU - Kapoor R AU - Selvaraju SB AU - Yadav JS LA - PT - DEP - TA - FEMS Microbiology Ecology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 64 IP - DP - 2014 Jan 01 TI - Cobalt asthma in metalworkers from an automotive engine valve manufacturer PG - 358-364 AB - Background Cobalt asthma has previously been described in cobalt production workers, diamond polishers and glassware manufacturers. Aims To describe a case series of occupational asthma (OA) due to cobalt, identified at the Birmingham Heartlands Occupational Lung Disease Unit, West Midlands, UK. Methods Cases of cobalt asthma from a West Midlands’ manufacturer of automotive engine valves, diagnosed between 1996 and 2005, were identified from the SHIELD database of OA. Case note data on demographics, employment status, asthma symptoms and diagnostic tests, including spirometry, peak expiratory flow (PEF) measurements, skin prick testing (SPT) and specific inhalational challenge (SIC) tests to cobalt chloride, were gathered, and descriptive statistics used to illustrate the data. Results The natural history of presentations has been described in detail, as well as a case study of one of the affected workers. Fourteen metalworkers (86% male; mean age 44.9 years) were diagnosed with cobalt asthma between 1996 and 2005. Workers were principally stellite grinders, stellite welders or machine setter-operators. All workers had positive Occupational Asthma SYStem analyses of serial PEF measurements, and sensitization to cobalt chloride was demonstrated in nine workers, by SPT or SIC. Conclusions We have described a series of 14 workers with cobalt asthma from the automotive manufacturing industry, with objective evidence for sensitization. Health care workers should remain vigilant for cobalt asthma in the automotive manufacturing industry. AU - Walters GI AU - Robertson AS AU - Moore VC AU - Burge PS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 57 IP - DP - 2014 Jan 01 TI - Hypersensitivity pneumonitis in workers exposed to metalworking fluids PG - 872-880 AB - BACKGROUND: This study used data from a large UK outbreak investigation, to develop and validate a new case definition for hypersensitivity pneumonitis due to metalworking fluid exposure (MWF-HP). METHODS: The clinical data from all workers with suspected MWF-HP were reviewed by an experienced panel of clinicians. A new MWF-HP Score was then developed to match the "gold standard" clinical opinion as closely as possible, using standard diagnostic criteria that were relatively weighted by their positive predictive value. RESULTS: The new case definition was reproducible, and agreed with expert panel opinion in 30/37 cases. This level of agreement was greater than with any of the three previously utilized case definitions (agreement in 16-24 cases). Where it was possible to calculate, the MWF-HP Score also performed well when applied to 50 unrelated MWF-HP cases. CONCLUSIONS: The MWF-HP Score offers a new case definition for use in future outbreaks. AU - Barber CM AU - Burton CM AU - Hendrick DJ AU - Pickering CA AU - Robertson AS AU - Robertson W AU - Burge PS LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 9 IP - DP - 2014 Jan 01 TI - Diisocyanate-induced asthma in Switzerland: long-term course and patients' self-assessment after a 12-year follow-up PG - 21 AB - Background Isocyanates are among the most common causes of occupational asthma (OA) in Switzerland. Patients with OA have been shown to have unfavourable medical, socioeconomic and psychological outcomes. We investigated long-term asthma and the socio-economic outcomes of diisocyanate-induced asthma (DIA) in Switzerland. Patients and methods: We conducted an observational study on 49 patients with DIA and followed 35 of these patients over a mean exposure-free interval of 12 +/- 0.5 (range 11.0-13.0) years. At the initial and follow-up examinations, we recorded data on respiratory symptoms and asthma medication; measured the lung function; and tested for bronchial hyperreactivity. We allowed the patients to assess their state of health and overall satisfaction using a visual analogue scale (VAS) at these visits. Results The 35 patients whom we could follow had a median symptomatic exposure time of 12 months, interquartile range (IQR) 26 months and a median overall exposure time of 51 (IQR 104) months. Their subjective symptoms (p < 0.001) and the use of asthma medication (p = 0.002), particularly the use of inhaled corticosteroids (p < 0.001), decreased by nearly 50%. At the same time, the self-assessment of the patients' state of health and overall satisfaction increased considerably according to both symptomatology and income. In contrast, slight reductions in terms of FVC% predicted from 102% to 96% (p = 0.04), of FEV1% predicted from 91% to 87% (p = 0.06) and of the FEV1/FVC ratio of 3%; (p = 0.01) were observed while NSBHR positivity did not change significantly. In univariate as well as multivariate logistic analyses we showed significant associations between age, duration of exposure and FEV1/FVC ratio with persistent asthma symptoms and NSBHR. Conclusions We found that the patients' symptoms, the extent of their therapy and the decrease in their lung volumes during the follow-up period were similar to the findings in the literature. The same hold true for some prognostic factors, whereas the patients' self-assessment of their state of health and overall satisfaction improved considerably. AU - Rüegger M AU - Droste D AU - Hofmann M AU - Jost M AU - Miedinger D LA - PT - DEP - TA - Journal of Occupational Medicine and Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 43 IP - DP - 2014 Jan 01 TI - HANDBOOK OF PROCEDURES FOR SPECIFIC INHALATION CHALLENGE TESTING IN THE DIAGNOSIS OF OCCUPATIONAL ASTHMA PG - online supplement AB - This handbook is a product of a pan-European taskforce on specific inhalation challenge (SIC) testing in the diagnosis of occupational asthma. It was compiled from information provided by twelve specialist clinical centres under the direction of Katri Suuronen. Our purpose was to provide to others information on the techniques used in each centre for SIC with different occupational agents. The tables below include information on the form and nature of the active and control agents and on methods, quantities and duration of delivery; where appropriate ’comments’ and references are provided. The information here is not intended as a set of full ’recipes’ but as a guide; the handbook should be read in concert with the full taskforce report (reference). Readers are reminded that the general safety requirements, contra-indications and precautions described in the full report should be strictly applied in order to minimise the risk of severe adverse events; that the duration and/or concentration of exposure to occupational agents should only be gradually increased under close monitoring of functional parameters; that the starting doses listed here are a guide only and should be adjusted in light of a particular patient’s circumstances; and that a control challenge test with a 6-8 hour period of spirometric monitoring on a separate day is required for the interpretation of the SIC results. Further information can be obtained from any of the centres listed and contact details are provided (page 3). AU - Suuronen K AU - Suojalehto H AU - Cullinan P on behalf of the ERS Task Force on Specific Inhalation Challenges with Occupational Agents LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 69 IP - DP - 2014 Jan 01 TI - Job strain and the risk of severe asthma exacerbations: a meta-analysis of individual-participant data from 100 000 European men and women. PG - 775-783 AB - Background Many patients and healthcare professionals believe that work-related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations in working-age European men and women. Methods We analysed individual-level data, collected between 1985 and 2010, from 102 175 working-age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self-reported at baseline. Incident severe asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study-specific findings combined using random-effects meta-analyses. Results During a median follow-up of 10 years, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age- and sex-adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95% confidence interval, CI: 1.00, 1.61). This association attenuated towards the null after adjustment for potential confounders (HR: 1.22, 95% CI: 0.96, 1.55). No association was observed in the analyses with asthma defined using any diagnostic code (HR: 1.01, 95% CI: 0.86, 1.19). Conclusions Our findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death. AU - Heikkilä K AU - Madsen IEH AU - Nyberg ST AU - Fransson EI AU - Westerlund H AU - Westerholm PJM AU - Virtanen M AU - Vahtera J AU - Väänänen A AU - Theorell T AU - Suominen SB AU - Shipley MJ AU - Salo P AU - Rugulies R AU - Pentti J AU - Pejtersen JH AU - Oksanen T AU - Nordin M AU - Nielsen ML AU - Kouvonen A AU - Koskinen A AU - Koskenvuo M AU - Knutsson A AU - Ferrie JE AU - Dragano N AU - Burr H AU - Borritz M AU - Bjorner JB AU - Alfredsson L AU - Batty GD AU - Singh-Manoux A AU - Kivimäki M for the IPD-Work Consortium LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 370 IP - DP - 2014 Jan 01 TI - Pulmonary Fibrosis Associated with Aluminum Trihydrate (Corian) Dust PG - 2154-2157 AB - A 64-year-old man who was an exercise physiologist was noted to have clinical and physiological features of idiopathic pulmonary fibrosis.1 On detailed questioning, he stated that he had ground, machined, drilled, and sanded Corian (a solid-surface material composed of acrylic polymer and aluminum trihydrate2) in his garage for about 16 years. He had typical clinical features of idiopathic pulmonary fibrosis and radiographic features of usual interstitial pneumonia, and a surgical lung biopsy showed histologic features of usual interstitial pneumonia a hallmark of idiopathic pulmonary fibrosis. Prompted by an elicited history of exposure and findings on polarized light microscopy, we conducted further tissue analyses that showed aluminum trihydroxide in the fibrotic lung; this finding provided support for a potential causal relationship between the Corian dust and pulmonary fibrosis. Although the patient avoided further exposure to Corian dust, his respiratory status slowly deteriorated over the next 7 years and he died from respiratory failure secondary to pulmonary fibrosis. High-resolution computed tomographic images of the chest showed an overall pattern that was consistent with end-stage usual interstitial pneumonia. At autopsy, the lungs were small; aluminum trihydroxide was detected in the fibrotic lungs. Although the evidence from this single case is circumstantial, the history of exposure, analyses of the lung tissue, and the sample of dust obtained from the patient's environment are consistent with a causal association. Pulmonary fibrosis has been associated with metal dusts and aluminum.3,4 A meta-analysis of six case–control studies of idiopathic pulmonary fibrosis showed a significant association between metal exposures and this condition.5 Without the elicited history of exposure to Corian dust and the finding of birefringent particles in the tissue, we would not have considered Corian dust as a potential cause of pulmonary fibrosis and the patient would have been considered to have idiopathic pulmonary fibrosis.1 Although the findings from this case do not confirm causality, until further data to support or refute the association are available, inquiry into each patient's occupational and environmental exposures should be made when considering a diagnosis of idiopathic pulmonary fibrosis. AU - Raghu G AU - Collins BF LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 69 IP - DP - 2014 Jan 01 TI - Subacute bronchial toxicity induced by an electronic cigarette: take home message PG - 596-597 AB - The case-based discussion of an adult smoker with respiratory symptoms and worsened pulmonary function shortly after switching to an electronic cigarette (e-cig can be interpreted differently. Ironically, some people experience transient (days/weeks) worsening of respiratory symptoms (cough, wheezing, chest tightness) after quitting.2 Cough and breathlessness have been reported when switching to e-cigs, but progressive improvement in respiratory symptoms is usually observed with regular use of these products AU - Polosa R AU - Campagna D AU - Tashkin D LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 64 IP - DP - 2014 Jan 01 TI - Respiratory protective equipment reduces occurrence of sensitization to laboratory animals PG - 104-108 AB - Background Respiratory protective equipment (RPE) has been shown to reduce exposure to laboratory animal allergens, but there are no studies that have examined its effect on the development of sensitization. Aims To examine the effect of RPE on the risk of sensitization to laboratory animals. Methods Survey of UK laboratory animal workers conducted between 1999 and 2001. Information was recorded on the type of RPE used when first exposed to animals and at the time of the survey. Sensitization to rat urinary proteins was assessed using skin-prick tests and assays of specific serum IgE antibodies. Results There were 776 workers surveyed of whom 228 had been exposed for fewer than 5 years. Those more recently employed were more likely to have used RPE. In employees with <5 years of exposure the use of face masks at first employment was associated with a lower prevalence of sensitization, irrespective of the intensity of exposure to laboratory animals. This reduction was significant only in those who entered the animal house daily. Conclusions The use of simple RPE at first exposure to laboratory animals may help to reduce the incidence of specific sensitization. AU - Jones AU - M. AU - Schofield AU - S. AU - Jeal AU - H. AU - Cullinan AU - P. LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 43 IP - DP - 2014 Jan 01 TI - Specific inhalation challenge in the diagnosis of occupational asthma: consensus statement PG - 1573-1587 AB - This consensus statement provides practical recommendations for specific inhalation challenge (SIC) in the diagnosis of occupational asthma. They are derived from a systematic literature search, a census of active European centres, a Delphi conference and expert consensus. This article details each step of a SIC, including safety requirements, techniques for delivering agents, and methods for assessing and interpreting bronchial responses. The limitations of the procedure are also discussed. Testing should only be carried out in hospitals where physicians and healthcare professionals have appropriate expertise. Tests should always include a control challenge, a gradual increase of exposure to the suspected agent, and close monitoring of the patient during the challenge and for at least 6 h afterwards. In expert centres, excessive reactions provoked by SIC are rare. A positive response is defined by a fall in forced expiratory volume in 1s >=15% from baseline. Equivocal reactions can sometimes be clarified by finding changes in nonspecific bronchial responsiveness, sputum eosinophils or exhaled nitric oxide. The sensitivity and specificity of SIC are high but not easily quantified, as the method is usually used as the reference standard for the diagnosis of occupational asthma. AU - Vandenplas O AU - Suojalehto H AU - Aasen T AU - Baur X AU - Burge PS AU - de Blay F AU - Fishwick D AU - Hoyle J AU - Maestrelli P AU - Muñoz X AU - Moscato G AU - Sastre J AU - Sigsgaard T AU - Suuronen K AU - Walusiak-Skorupa J AU - Cullinan P AU - the ERS Task Force on Specific Inhalation Challenges with Occupational Agents LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 44 IP - DP - 2014 Jan 01 TI - Cleaning agents and disinfectants: moving from recognition to action and prevention PG - 472-474 AB - none in journal AU - Heederik D LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 71 IP - DP - 2014 Jan 01 TI - Pesticides and respiratory health: where do we go from here? PG - 80 AB - For centuries, researchers have focused on exposures to hays, grains and animals as primary contributors to poor respiratory outcomes in farmers and agricultural workers.However, growing evidence suggests that other agricultural exposures, namely pesticides, may also adversely impact respiratory health. Recent studies from around the world have suggested that pesticides may be associated with respiratory symptoms and disease, particularly asthma.However, these studies have been based on self-reported outcomes and there have been few studies using objective measures of pulmonary function. De Jong et a report that occupational pesticide exposure is associated with poorer pulmonary function consistent with airway obstruction as measured by spirometry in two Dutch general population cohorts. These associations with pesticides were seen in both men and women and smokers and non-smokers; some associations were stronger in smokers, but not consistently so. AU - Hoppin AU - Jane A LA - PT - DEP - TA - Occupational and Environmental Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 71 IP - DP - 2014 Jan 01 TI - Pesticides and other occupational exposures are associated with airway obstruction: the LifeLines cohort study PG - 88-96 AB - Objectives Occupational exposures are important and possibly modifiable contributors to the global burden of chronic obstructive pulmonary disease (COPD). Exposure to vapours, gases, dusts and fumes (VGDF) has been associated with a two- to threefold higher COPD risk. Less is known about effects of occupational exposure to pesticides and solvents. In the current study, we assessed if VGDF, pesticides and solvents are associated with the level of lung function and the prevalence of airway obstruction in the general population.Methods We included 11 851 subjects aged 18–89 years from the LifeLines cohort study. Regression models assessing associations between occupational exposures (no/low/high), level of lung function (prebronchodilator FEV1, FEV1/FVC) and mild and moderate/severe airway obstruction were adjusted for sex, age, height, weight, current/ex-smoking and packyears. Additionally, we stratified by smoking status and gender and tested for interaction. A second general population cohort (n=2364) was used to verify our initial findings.Results Occupational exposure to VGDF and pesticides was associated with a lower level of FEV1 and FEV1/FVC and with a higher prevalence of mild and moderate/severe airway obstruction in the two general populations investigated. There were no associations with exposure to solvents.Conclusions Occupational exposure to both VGDF and pesticides is associated with airway obstruction in the general population. AU - de Jong K AU - Boezen H M AU - Kromhout H AU - Vermeulen R AU - Postma AU - D S AU - Vonk J M AU - The LifeLines Cohort study LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 69 IP - DP - 2014 Jan 01 TI - Occupational upper airway disease: how work affects the nose PG - 282-291 AB - Chronic inflammation of the upper airways is common and can arbitrarily be divided into rhinitis and rhinosinusitis. Infection and allergy represent two well-characterized and most frequently diagnosed etiologies of upper airway inflammation. Persistent upper airway inflammation caused by agents inhaled in the work environment represents a diagnostic challenge in clinical practice, and its pathophysiology has been little studied. Occupational rhinitis is a recognized medical condition with diagnostic and therapeutic guidelines. In contrast, only limited evidence is available about the relationship between work exposures and rhinosinusitis. This review aims at providing a comprehensive overview of the available literature on occupational upper airway disease with a focus on pathophysiological mechanisms and with an emphasis on the current unmet needs in work-related upper airway disease. AU - Hox V AU - Steelant B AU - Fokkens W AU - Nemery B AU - Hellings PW LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 69 IP - DP - 2014 Jan 01 TI - EAACI Position Paper on assessment of cough in the workplace PG - 292-304 AB - Cough is a nonspecific and relatively common symptom that can present difficulties in diagnosis and management, particularly when it is reported to be associated with the workplace. The present consensus document, prepared by a taskforce of the Interest Group on Occupational Allergy of the European Academy of Allergy and Clinical Immunology by means of a nonsystematic review of the current literature, is intended to provide a definition and classification of work-related chronic cough (WRCC) to assist the daily practice of physicians facing with this symptom. The review demonstrates that several upper and lower airway work-related diseases may present with chronic cough; hence, the possible link with the workplace should always be considered. Due to the broad spectrum of underlying diseases, a multidisciplinary approach is necessary to achieve a definite diagnosis. Nevertheless, more epidemiological studies are necessary to estimate the real prevalence and risk factors for WRCC, the role of exposure to environmental and occupational sensitizers and irritants in its pathogenesis and the interaction with both upper and lower airways. Finally, the best management option should be evaluated in order to achieve the best outcome without adverse social and financial consequences for the worker. AU - Moscato G AU - Pala G AU - Cullinan P AU - Folletti I AU - van Wijk G AU - Pignatti P AU - Quirce S LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 64 IP - DP - 2014 Jan 01 TI - Work-exacerbated asthma in a workers’ compensation population PG - 206-210 AB - Background Asthma is becoming more prevalent with large numbers of individuals suffering from work-exacerbated asthma.Aims To examine the characteristics of workplace exposures and working days lost in relation to work-exacerbated asthma (WEA) in a workers’ compensation population.Methods An analysis of accepted workers’ compensation asthma claims in Ontario over a 5-year period. Claims among the top three industry groups were categorized based on working time lost of 1 day or less, 2–5 days and 6 days or more. Attributable agents were subdivided into dusts, smoke, chemicals and sensitizers.Results Among the asthma claims, 72% (645) fulfilled criteria for WEA from their history. The commonest industry groups were services, education and health care, with 270 claims that met our analysis requirements. Within these industry groups, education had a lower proportion of workers with short exacerbations (missing 1 day or less: 27%) while the health care industry had a higher than expected proportion of short exacerbations (55%). The agents to which WEA was attributed differed across the groups, with dusts having the highest proportion in the education group (65%), smoke in the service industry (34%) and sensitizers in health care (41%). Those agents more commonly attributed to exacerbations tended to have lower rates of prolonged exacerbation compared with less commonly involved agents.Conclusions The morbidity of WEA and the type of agents to which it was attributed varied between industry groups. AU - Lim T AU - Liss G M AU - Vernich L AU - Buyantseva L AU - Tarlo SM LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 43 IP - DP - 2014 Jan 01 TI - Occupational irritants and asthma: an Estonian cross-sectional study of 34 000 adults. PG - 647-656 AB - Occupational exposures make important contributions to asthma morbidity. The role of low/moderate level irritant exposures remains unclear. We aimed to determine which occupational exposures are associated with asthma in an eastern European country with low asthma prevalence.The Estonian Genome Center of University of Tartu collected data from 50 077 adults in 2002-2011. Asthma was assessed through a questionnaire regarding diagnosed diseases, current health status and medication. Exposures to 22 agents during the current and longest held jobs were estimated using an asthma-specific job-exposure matrix.Analyses included 34 015 subjects (aged 18-65 years, 67.0% females), of which 1209 (3.6%) reported asthma (608 with physician-confirmed diagnosis). After adjusting for age, sex and smoking habits, lifetime occupational exposure to known asthmagens (20.4%) was significantly associated with physician-diagnosed asthma (OR 1.28, 95% CI 1.03-1.59), especially high molecular weight agents (flour: OR 2.36, 95% CI 1.31-4.27; animals: OR 1.62, 95% CI 1.00-2.60). Exposure to low/moderate levels of irritants (17.4%) was associated with physician-diagnosed asthma (OR 1.88, 95% CI 1.48-2.37). More pronounced associations were observed in subjects reporting current treated asthma.Beyond confirming the effect of known asthmagens (which are well-known, mostly from observations in western countries), the results provide evidence for a role of low/moderate exposure to irritants. This finding, observed in a country with a low prevalence of asthma and atopy, provides new insight into the understanding of asthma heterogeneity. AU - Dumas O AU - Laurent E AU - Bousquet J AU - Metspalu A AU - Milani L AU - Kauffmann F AU - Le Moual N. LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 69 IP - DP - 2014 Jan 01 TI - Humidifiers: the use of biocides and lung disease PG - 692-693 AB - Over the last two decades several publications have reported outbreaks of interstitial lung disease caused by inhalational exposure to a chemical, usually at work, but occasionally in a domestic situation. These outbreaks frequently follow a change in formulation, which may be minor,(1) of a chemical already being used in the workplace, or a change in process leading to its aerosolisation. In 2006, paediatricians in South Korea became aware of a severe, rapid-onset interstitial pneumonitis in young children and infants; the disease responded very poorly to treatment, and mortality rates were close to 50%.(2) Its seasonal presentation, with most cases presenting in the spring, raised the possibility of an infective aetiology; hypersensitivity pneumonitis was also considered. The failure to find any microbiological evidence for the former, and the distinct clinical and pathological features that distinguished it from the latter led to the consideration of other hypotheses. As a result, the Korean Centre for Disease Control set up a series of case-control studies designed to examine a wide variety of alternative environmental explanations. In early 2013, the findings of a small (n=16) study of affected children were published (3); intriguingly, they indicated that all the cases, but just a third of the matched controls, had exposure to disinfectant used in domestic humidifiers, producing an OR of 2.73. The epidemic in adults from the same country is described (4) alongside the corresponding epidemiological investigation.5 As with the children, there was a very strong seasonal pattern to disease incidence and a clear clustering within families with an apparent predilection for pregnant or recently delivered women; 11 of the 15 female admissions were either pregnant or in the postpartum period. The tissue response was one of progressive, non-granulomatous, inflammation and, again, the disease appeared to have a rapid onset, was resistant to treatment and had a high mortality with five deaths; four patients survived following transplantation, and just two following conventional treatment. The epidemiological study (5) established to examine a range of indoor environmental factors, recruited 18 cases carefully matched to 121 hospital controls. The results again identified humidifier detergent as the likely cause of the outbreak, but in this case with an extraordinarily high, adjusted OR of 53.01 (95% CI 6.33 to 444.17); it is not clear whether the apparent susceptibility of young women was related to the state of pregnancy or, perhaps more likely, to an increased exposure to biocide in the home. As a consequence of these findings, biocide detergents were withdrawn from the market in 2011; subsequently, there have been no further new cases reported. South Korean winters and spring tend to be cold and dry with an average relative humidity of 60–65%. The use of home humidifiers is common there, particularly to relieve respiratory symptoms and dry skin. In a questionnaire survey of pregnant women in three areas of the country, 45% reported using humidifiers in December or January, in most cases for long periods of the day.(6) The first biocide for domestic humidifiers was introduced in South Korea in 1994, CMIT/MIT (chloromethylisothiazol/methylisothiazol), and was followed in 2000 by PHMG-phosphate (polyhexamethylene guanidine phosphate), most commonly used by the patients described here, and in 2009 by PGH (oligoethoxyethyl guanidine chloride). The timing of the introduction of PHMG is consistent with the development of this epidemic. Subsequent animal experiments have revealed inflammatory changes, similar to those seen in human cases, in PHMG-exposed and PGH-exposed animals, but not in controls or those exposed to the CMIT/MIT. The guanides are good general-purpose bacteriocides, fungicides and algeocides having a high surface activity which disrupts the cell wall and cytoplasm of a wide range of micro-organisms; their major use is controlling microbiological growth in cooling systems. The clinical picture described in these papers is unique. The exposure is to a ‘nonirritant’ chemical delivered in a particulate size capable of penetrating to bronchiolar and alveolar level in the lungs. The domestic humidifiers mainly used by the patients in these papers were warm mist, ultrasonic, and warm mist and ultrasonic; a study from the Korean Center for Disease Control and Prevention(7) reported that when humidifier disinfectants are added to distilled water and used in an ultrasonic nebuliser, nanoparticles of 30–80 nm are generated, consisting of PHMG and PGH. Humidification systems are used mainly in occupational settings where a stable relative humidity is required. They are used widely in a variety of industries including textiles, printing, timber, tobacco, cold stores, data centres, offices and automobile production. In the past, methods of cold water humidification included spraying water into incoming air, dripping water through a fibre mesh through which incoming air is forced, a spinning disc method in which a stream of water is trained against a rotating blade which atomises and blows it out of the humidifier, or the ultrasonic nebulisation of water into incoming air. The three former methods have largely now been discontinued, microbiological growth in static water proving difficult to control even with the use of a biocide.8 Microbial growth in workplace humidification systems has been reported to have caused cases of occupational asthma9 extrinsic allergic alveolitis (10) and humidifier fever.(11) The water supply to an ultrasonic nebuliser used in the workplace is directly from the mains, avoiding the presence of static water and, thus, the necessity of biocides. In the domestic setting, an ultrasonic nebuliser will have had a water supply coming from a small tank which, if not cleaned regularly, will develop microbial growth. In this outbreak, nebulisers were run with biocide in the water rather than it being used to clean the tank, a practise that was long ago deemed likely to be hazardous.(12) Bronchial asthma (13) as well as extrinsic allergic alveolitis (14) have been described as a result of microbiological contamination of home humidifiers. In Western Europe, the use of home humidifiers is rare; rather, with the introduction of ‘tight’ buildings, the chief problem is in preventing high levels of humidity occurring in the home. It is clearly necessary to keep home humidifiers clean, but running them with biocide detergents in the water is contraindicated. The tragedy of the Korean epidemic is a reminder of the importance of a full evaluation of the toxicity of chemical inhalants in the home. In this instance, the intended use of the biocides involved only dermal contact and possible ingestion and, therefore, was exempt from the submission of inhalation toxicology data. The use of these chemicals was then extended to humidifiers without recognition that this change in exposure route might cause significant health effects. 1. Moya C, Anto JM,Newman Taylor AJ; and the Collaborative Group for the Study of Toxicity in Textile Aerographic Factories. Outbreak of organising pneumonia in textile printing sprayers. Lancet 1994;344:498–502. 2. Cho YA, Kim SA, Jang SJ, et al Toxic inhalational injury-associated interstitial lung disease in children. J Korean Med Sci 2013;28:915–23. 3. Yang HJ, Kim HJ, Yu J, et al. Inhalation toxicity of humidifier disinfectants as a risk factor of children's interstitial lung disease in Korea: a case-control study. 4. Hong S-B, Kim HJ,Huh JW, et al. A cluster of lung injury associated with home humidifier use: clinical, radiological and pathological description of a new syndrome. Thorax 2014;69:694–702. 5. Kim HJ, Lee M-S,Hong S-B, et al. A cluster of lung injury cases associated with home humidifier use: an epidemiological investigation. Thorax 2014;69:703–8. 6. Chang MH, Park H, Ha M, et al. Characteristics of Humidifier Use in Korean Pregnant Women: The Mothers and Children's Environmental Health (MOCEH) Study. Environ Health Toxicol 2012;27:e2012003. 7.Korea Center for Disease Control and Prevention. Interim report of epidemiological investigation on lung injury with unknown cause in Korea. Public Health Wkly Rep 2011;4:831–2. 8. Pickering CAC,Moore WKS,Lacey J, et al. Investigation of a respiratory disease associated with an air conditioning system. Clin Allergy 1976;6:109–18. 9. Burge PS, Finnegan MJ, Horsfield N, et al. Occupational asthma in a factory with a contaminated humidifier. Thorax 1985;40:248–54. 10.Bansazak EF, Thiede WH, Fink JN. Hypersensitivity pneumonitis due to contamination of an air conditioner. N Engl J Med 1970;283:271–76. 11. Pestalozzi C. Febrile gruppenerkrangungen in einer modellschreinerei durch inhalation von mit schimmelpilzen kontaminiertem befeuchterwasser. (‘Befeuchterfieber’). Schweiz Med Wochenschr 1959;89:710–13. 12. Pickering CAC, Newman Taylor A. Extrinsic allergic bronchioloalveolitis (hypersensitivity pneumonitis). In: ParkesWR , ed. Occupational lung disorder. 3rd edn. Oxford: Butterworth Heinemann, 1994. 13. Solomon WR. Fungus aerosols arising from cold mist vaporizers. J Allergy Clin Immunol 1970;54:222–8. 14. Kane GC, Marx JJ, Prince DS . Hypersensitivity pneumonitis secondary to Klebsiella oxytoca. A new case of humidifier lung. Chest 1993;104:627–29. AU - Pickering CAC LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 145 IP - DP - 2014 Jan 01 TI - A Comparison of Health-Related Quality of Life in Idiopathic Pulmonary Fibrosis and Chronic Hypersensitivity Pneumonitis PG - 1333-1338 AB - Background: Patients with interstitial lung disease (ILD) have poor health-related quality of life (HRQL). However, whether HRQL differs among different subtypes of ILD is unclear. The aim of this study was to determine whether HRQL was different among patients with idiopathic pulmonary fibrosis (IPF) and chronic hypersensitivity pneumonitis (CHP). Methods: We identified patients from an ongoing longitudinal cohort of patients with ILD. HRQL was assessed using the Short Form (SF)-36 medical outcomes form (version 2.0). Regression analysis was used to determine the association between clinical covariates and HRQL, primarily the physical component summary (PCS) and mental component summary (MCS) score. A multivariate regression model was created to identify potential covariates that could help explain the association between the ILD subtype and HRQL. Results: Patients with IPF (n = 102) were older, more likely to be men, and more likely to have smoked. Pulmonary function was similar between the groups. The patients with CHP (n = 69) had worse HRQL across all eight domains of the SF-36, as well as the PCS and MCS, compared with patients with IPF (P < .01-.09). This pattern remained after controlling for age and pulmonary function (P < .01-.02). Covariates explaining part of the relationship between disease subtype and PCS score included severity of dyspnea (P < .01) and fatigue (P < .01). Covariates explaining part of the relationship between disease subtype and MCS score included severity of dyspnea (P < .01), female sex (P = .02), and fatigue (P = .02). Conclusions: HRQL is worse in CHP compared with IPF. HRQL differences between ILD subtypes are explained in part by differences in sex, dyspnea, and fatigue. AU - Lubin M AU - Chen H AU - Elicker B AU - Jones KD AU - Collard HR AU - Lee JS LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 69 IP - DP - 2014 Jan 01 TI - A cluster of lung injury cases associated with home humidifier use: an epidemiological investigation PG - 703-708 AB - Background In April 2011 a tertiary hospital in Seoul, Korea reported several cases of severe respiratory distress of unknown origin in young adults. Methods To find the route of transmission, causative agent and patient risk factors of the outbreak, an investigation of the epidemic was initiated. Clinicopathological conferences led to the suspicion that the cases related to an inhalation injury. An age- and sex-matched case–control study was therefore performed to examine the inhalation exposure of the patients to various agents. Results Of the 28 confirmed cases, 18 agreed to participate. A total of 121 age- and sex-matched controls with pulmonary, allergic or obstetric disease were selected. All patients and controls completed questionnaires with questions about exposure to various inhalants. The crude ORs for patient exposure to indoor mould, humidifier use, humidifier detergent use and insecticide use were 4.4 (95% CI 1.5 to 13.1), 13.7 (95% CI 1.8 to 106.3), 47.3 (95% CI 6.1 to 369.7) and 3.9 (95% CI 1.3 to 11.7), respectively. However, when considered concurrently, indoor mould and insecticide use lost statistical significance. Moreover, humidifier use was ruled out as the cause because of a lack of biological plausibility and the weak strength of the association. This suggested that humidifier disinfectant was the cause of the outbreak. This information led the Korean government to order the removal of humidifier detergents from the market. In the years following the ban, no additional cases were detected. Conclusions Epidemiological evidence strongly suggests that the lung injury outbreak was caused by humidifier detergent use at home. AU - Kim HJ AU - Lee M AU - Hong S AU - Huh JW AU - Do K AU - Jang SJ AU - Lim C AU - Chae EJ AU - Lee H AU - Jung M AU - Park Y AU - Park J AU - Kwon G AU - Gwack J AU - Youn S AU - Kwon J AU - Yang B AU - Jun B AU - Kim Y AU - Cheong H AU - Chun BC AU - Kim H AU - Lee K AU - Koh Y LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 71 IP - DP - 2014 Jan 01 TI - Respiratory disease in United States farmers PG - 484-491 AB - Objectives Farmers may be at increased risk for adverse respiratory outcomes compared with the general population due to their regular exposures to dusts, animals and chemicals. However, early life farm exposures to microbial agents may result in reduced risk. Understanding respiratory disease risk among farmers and identifying differences between farmers and other populations may lead to better understanding of the contribution of environmental exposures to respiratory disease risk in the general population. Methods We compared the prevalence of self-reported respiratory outcomes in 43548 participants from the Agricultural Health Study (AHS), a prospective cohort of farmers and their spouses from Iowa and North Carolina, with data from adult participants in the National Health and Nutrition Examination Survey (NHANES) over the same period (2005–2010). Results AHS participants had lower prevalences of respiratory diseases (asthma, adult-onset asthma, chronic bronchitis and emphysema), but higher prevalences of current respiratory symptoms (wheeze, cough and phlegm) even after controlling for smoking, body mass index and population characteristics. The overall prevalence of asthma in the AHS (7.2%, 95% CI 6.9 to 7.4) was 52% of that in NHANES (13.8%, 95% CI 13.3 to 14.3), although the prevalence of adult-onset asthma among men did not differ (3.6% for AHS, 3.7% for NHANES). Conversely, many respiratory symptoms were more common in the AHS than NHANES, particularly among men. Conclusions These findings suggest that farmers and their spouses have lower risk for adult-onset respiratory diseases compared with the general population, and potentially higher respiratory irritation as evidenced by increased respiratory symptoms. AU - Hoppin JA AU - Umbach DM AU - Long S AU - Rinsky JL AU - Henneberger PK AU - Salo PM AU - Zeldin DC AU - London SJ AU - Alavanja MCR AU - Blair A AU - Freeman LEB AU - Sandler DP LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 71 IP - DP - 2014 Jan 01 TI - Respiratory symptoms and lung function abnormalities related to work at a flavouring manufacturing facility PG - 549-554 AB - Objectives To better understand respiratory symptoms and lung function in flavouring manufacturing workers. Methods We offered a questionnaire and lung function testing to the current workforce of a flavouring manufacturing facility that had transitioned away from diacetyl and towards substitutes in recent years. We examined symptoms, spirometric parameters and diffusing capacity measurements by exposure variables, including facility tenure and time spent daily in production areas. We used linear and logistic regression to develop final models adjusted for age and smoking status. Results A total of 367 (93%) current workers participated. Shortness of breath was twice as common in those with tenure >=7 years (OR 2.0, 95% CI 1.1 to 3.6). Other chest symptoms were associated with time spent daily in production. Participants who spent =1 h daily in production areas had twice the odds of any spirometric abnormality (OR 2.3; 95% CI 1.1 to 5.3) and three times the odds of low diffusing capacity (OR 2.8; 95% CI 0.9 to 9.4) than other participants. Mean spirometric parameters were significantly lower in those with tenure >= 7years and those who spent >= 1 h daily in production. Mean diffusing capacity parameters were significantly lower in those with tenure =7 years. Differences in symptoms and lung function could not be explained by age, smoking status or employment at another flavouring plant. Conclusions Symptoms and lung function findings were consistent with undiagnosed or subclinical obliterative bronchiolitis and associated with workplace exposures. Further efforts to lower exposures to flavouring chemicals, including diacetyl substitutessubstitutes, are warranted. AU - Cummings KJ AU - Boylstein RJ AU - Stanton ML AU - Piacitelli CA AU - Edwards NT AU - LeBouf RF AU - Kreiss K LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 69 IP - DP - 2014 Jan 01 TI - EAACI position paper: irritant-induced asthma PG - 1141-1153 AB - The term irritant-induced (occupational) asthma (IIA) has been used to denote various clinical forms of asthma related to irritant exposure at work. The causal relationship between irritant exposure(s) and the development of asthma can be substantiated by the temporal association between the onset of asthma symptoms and a single or multiple high-level exposure(s) to irritants, whereas this relationship can only be inferred from epidemiological data for workers chronically exposed to moderate levels of irritants. Accordingly, the following clinical phenotypes should be distinguished within the wide spectrum of irritant-related asthma: (i) definite IIA, that is acute-onset IIA characterized by the rapid onset of asthma within a few hours after a single exposure to very high levels of irritant substances; (ii) probable IIA, that is asthma that develops in workers with multiple symptomatic high-level exposures to irritants; and (iii) possible IIA, that is asthma occurring with a delayed-onset after chronic exposure to moderate levels of irritants. This document prepared by a panel of experts summarizes our current knowledge on the diagnostic approach, epidemiology, pathophysiology, and management of the various phenotypes of IIA. AU - Vandenplas O AU - Wiszniewska M AU - Raulf M AU - de Blay F AU - Gerth van Wijk R AU - Moscato G AU - Nemery B AU - Pala G AU - Quirce S AU - Sastre J AU - Schlünssen V AU - Sigsgaard T AU - Siracusa A AU - Tarlo SM AU - van Kampen V AU - Zock J-P AU - Walusiak-Skorupa J. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 44 IP - DP - 2014 Jan 01 TI - Predictors of work-related sensitisation, allergic rhinitis and asthma in early work life PG - 657-665 AB - investigation of occupational exposures in early work life using an unexposed reference group is rare. Thus, the present analyses aimed to assess the potential impact of occupational exposure and other risk factors on the prevalence of work-related sensitisation and incidence of allergic rhinitis/asthma using a population-based approach and taking into account an unexposed reference group. In SOLAR (Study on Occupational Allergy Risks) II, German participants of ISAAC (International Study of Asthma and Allergies in Childhood) phase II were followed from childhood (9–11 years) until early adulthood (19–24 years). Data on 1570 participants were available to fit predictive models. Occupational exposure was not statistically significantly associated with disease prevalence/incidence. Sensitisation in childhood, parental asthma, environmental tobacco smoke exposure during puberty, sex and study location were statistically significant predictors of outcome. Our results indicate that occupational exposure is of little relevance for work-related sensitisation prevalence and allergic rhinitis/asthma incidence in early work life, while other risk factors can be used to improve career guidance for adolescents. Further research on the role of a potential healthy hire effect and the impact of longer exposure duration is needed. AU - Kellberger J AU - Peters-Weist AS AU - Heinrich S AU - Pfeiffer S AU - Vogelberg C AU - Roller D AU - Genuneit J AU - Weinmayr G AU - von Mutius E AU - Heumann C AU - Nowak D AU - Radon K LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 71 IP - DP - 2014 Jan 01 TI - Rat-specific IgG and IgG4 antibodies associated with inhibition of IgE–allergen complex binding in laboratory animal workers PG - 619-623 AB - Objectives The relationship between exposure to rodent allergens and laboratory animal allergy is complex; at highest allergen exposures there is an attenuation of sensitisation and symptoms which are associated with increased levels of rat-specific immunoglobulin (Ig)G and IgG4 antibodies. We set out to examine whether the increased levels of rat-specific IgG and IgG4 antibodies that we have previously observed at high allergen exposure in our cohort of laboratory animal workers play a functional role through blockage of the binding of IgE–allergen complex binding to CD23 receptors on B cells. Methods Cross-sectional survey of laboratory animal workers (n=776) in six UK pharmaceutical companies were surveyed. IgE–allergen complex binding to B cells was measured in 703 (97.9%) eligible employees; their exposure was categorised by either job group or number of rats handled daily. Results We observed a significant decrease in IgE–allergen complex binding to B cells with increasing quartiles of both rat-specific IgG and IgG4 antibodies (p<0.001). IgE–allergen complex binding to B cells was lower in workers with high allergen exposure, and significantly so (p=0.033) in the subgroup with highest exposures but no work-related chest symptoms. Conclusions These findings demonstrate a functional role for rat-specific IgG/G4 antibodies in laboratory animal workers, similar to that observed in patients treated with high dose immunotherapy who become clinically tolerant, suggesting a potential explanation for the attenuation of risk at highest allergen exposures AU - Jones M AU - Jeal H AU - Schofield S AU - Harris JM AU - Shamji MH AU - Francis JN AU - Durham SR AU - Cullinan P LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - IP - DP - 2014 Jan 01 TI - Respiratory disease associated with occupational inhalation to hop (Humulus lupulus) during harvest and processing PG - AB - BACKGROUND: There is little published evidence for occupational respiratory disease caused by hop dust inhalation. In the United States, hops are commercially produced in the Pacific Northwest region. OBJECTIVE: To describe occupational respiratory disease in hop workers. METHODS: Washington State workers' compensation claims filed by hop workers for respiratory disease were systematically identified and reviewed. Incidence rates of respiratory disease in hop workers were compared with rates in field vegetable crop farm workers. RESULTS: Fifty-seven cases of respiratory disease associated with hop dust inhalation were reported from 1995 to 2011. Most cases (61%) were diagnosed by the attending health care practitioner as having work-related asthma. Seven percent of cases were diagnosed as chronic obstructive pulmonary disease, and the remaining cases were diagnosed as allergic respiratory disorders (eg, allergic rhinitis) or asthma-associated symptoms (eg, dyspnea). Cases were associated with hop harvesting, secondary hop processing, and indirect exposure. The incidence rate of respiratory disease in hop workers was 15 cases per 10,000 full-time workers, which was 30 times greater than the incidence rate for field vegetable crop workers. A strong temporal association between hop dust exposure and respiratory symptoms and a clear association between an increase in hop dust concentrations and the clinical onset of symptoms were apparent in 3 cases. CONCLUSION: Occupational exposure to hop dust is associated with respiratory disease. Respiratory disease rates were higher in hop workers than in a comparison group of agricultural workers. Additional research is needed before hop dust can be confirmed as a causative agent for occupational asthma. AU - Reeb-Whitaker CK AU - Bonauto DK LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 71 IP - DP - 2014 Jan 01 TI - Occupational asthma to fish PG - 804 AB - Allergic responses to a variety of seafood have been described, including fish. We report the evaluation of a 31-year-old worker who developed occupational asthma following exposure to sole fish (Yellowfin sole). She had been working in a restaurant’s kitchen, cooking different types of products including fish, most often sole. In the last 3 years, this worker had developed erythema and pruritus of the hands and forearms while she was manipulating fishes such as sole, she had increasing symptoms of dyspnoea, chest tightness and wheezing when she was exposed to cooking fumes from sole fish. She also reported symptoms suggestive of localised angioedema developing when she was eating fish. She had no nocturnal respiratory symptoms. She had smoked about 10 cigarettes per day since the age of 18. Allergen skin prick tests were positive to animals, house dust mites and pollens, in addition to sole fish extract. She had mild-to-moderate airway obstruction, with a FEV1/FVC of 1.89 L/3.33 L (67 and 95% of predicted value). PC20 methacholine was 0.67 mg/mL. She had a specific bronchoprovocation test with sole fish extract.The control day showed no changes in her baseline expiratory flows but when she was exposed to fish extract at a 1/126 dilution for 30 s, she developed a cough, chest tightness and dyspnoea, associated with a 30% fall in FEV1 compared to baseline, with a slow recovery over a period of 2 h. No late response was observed. The day after challenge, FEV1 was 1.95 L (68%) and PC20 methacholine was 0.38 mg/mL. Induced sputum eosinophil count was 3% of 10.8×106 cells/g. No increase in induced sputum eosinophils was noted after the challenge. AU - Boulet L-P AU - Laberge F LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 64 IP - DP - 2014 Jan 01 TI - Animal allergen sensitization in veterinarians and laboratory animal workers PG - 516-520 AB - Background Animals secrete allergens into the environment and exposure to these in the workplace may cause sensitization. Aims To identify the frequency of animal allergen sensitization and symptoms in animal workers. Methods Using skin prick tests (SPT), we assessed sensitization to 15 mammal and bird allergens in animal workers and controls. We also recorded symptoms and pulmonary function tests. Results There were 100 animal workers and 50 controls included in the study. Thirty-six per cent of animal workers and 10% of controls had positive SPT (P < 0.001, odds ratio [OR] = 5.1, 95% CI 1.7–16.0). The most common sensitizations were to horse (16% in animal workers versus 0% in controls, P < 0.01), canary (16% in animal workers versus 2% in controls, P < 0.05, OR = 9.3, 95% CI 1.2–194), cattle (13% in animal workers versus 0% in controls, P < 0.05), cat (12% in animal workers versus 6% in controls, not significant), rabbit and hamster (10% each in animal workers versus 0% in controls, P < 0.05). Allergy symptoms were reported by 52 animal workers, but only 36 of them had positive SPT. Twelve animal workers had abnormal pulmonary function tests and six had positive SPT. Conclusions Animal workers are at high risk of occupational sensitization to animal allergens. Exposure should be minimized through control measures and worker education about the risks of exposure and sensitization. AU - Moghtaderi M AU - Farjadian S AU - Abbaszadeh Hasiri M LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 64 IP - DP - 2014 Jan 01 TI - The prevalence of respiratory symptoms among mushroom workers in Ireland Jand PG - 533-538 AB - Background Respiratory conditions such as asthma, bronchitis, hypersensitivity pneumonitis and upper airways symptoms have been ascribed to fungal exposures. Mushroom workers may be at risk of these as a consequence. Aims To assess the prevalence of respiratory symptoms in mushroom workers. Methods A cross-sectional study assessed 4 weeks of respiratory symptoms among mushroom workers divided into four categories of exposure, using a self-administered respiratory questionnaire and spirometry. Results The population of 191 subjects was predominantly (66%) from Eastern Europe; 61% were women and 39% were under 30. It included 73 growers, 38 composters, 26 administrators and 52 packers. Among all workers, there was a high prevalence (67%) of one or more respiratory symptoms which did not appear to vary by age, gender, pack-years of smoking or duration of employment. There was a significant improvement in respiratory symptoms in workers during absence from the workplace (P < 0.001). Spirometry readings across all groups were within normal values. Symptom profiles suggest that as many as 22 workers had symptoms of airways disease; 18 (82%) of these were mushroom growers. Growers were significantly more likely to have symptoms consistent with airways disease than all other workers, odds ratio 9.2 (95% CI 3.0–28.4). Conclusions There was a high prevalence of respiratory symptoms among mushroom workers. Mushroom growers may be at high risk of airways disease, possibly from fungal antigens or related exposures. AU - Hayes JP AU - Rooney J LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 69 IP - DP - 2014 Jan 01 TI - Lesson of the month: extrinsic allergic (bronchiolo)alveolitis and metal working fluids PG - 1059-1060 AB - Introduction One of us was asked to consider a diagnosis of occupational asthma for a man who had worked for 20 years as a metal turner in a large, modern factory producing specialised machine parts. He described a 2 year history of severe breathlessness that improved when he was not at work. His spirometry was restrictive with a FEV1 of 1.35 L (40% predicted) and FVC of 1.8 L (45% predicted), a ratio of 75%. Other lung function measurements indicated gas trapping; his TLC was 5.01 L (79% predicted) and RV/TLC 170% predicted. A high resolution CT scan of his lungs revealed a widespread ‘mosaic’ pattern of attenuation indicative of small airflow obstruction. We made a diagnosis of occupational extrinsic allergic bronchioloalveolitis and recommended that he change his work. After 12 months working elsewhere in the same company, away from the machine shop, his dyspnoea was greatly improved but had not disappeared; his FVC had increased to 2.41 L, his FEV1 to 1.45 L and his TLC to 5.36 L. Four months later we were referred a man who was also a metal turner in the same factory. For 2 years he had been a patient in a specialist interstitial lung disease clinic with a diagnosis of chronic hypersensitivity pneumonitis. A marked lymphocytosis in his bronchoalveolar lavage suggested ongoing exposure to an external cause. The nature of this had not been established although the positive findings of an autoimmune screen had led to conjecture of an ‘autoimmune’ aetiology, and of a high level of serum-specific IgG antibodies to Aspergillus species, that exposure to ‘mould at home or work’ might be relevant; an occupational history noted only that he worked for a machine parts manufacturer. AU - Cullinan P AU - DSouza E AU - Tennant R AU - Barber C LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 134 IP - DP - 2014 Jan 01 TI - Occupational asthma phenotypes identified by increased fractional exhaled nitric oxide after exposure to causal agents PG - 1063 AB - Background The added value of fractional exhaled nitric oxide (Feno) remains controversial in the investigation of occupational asthma (OA). Objective We sought to assess whether or not the increase of Feno levels following positive specific inhalation challenge (SIC) was restricted to phenotypes of subjects sharing common clinical characteristics by using a statistical cluster analysis. Methods Subjects were investigated for possible OA in a tertiary center using SICs from 2006 to 2012. Feno levels and sputum eosinophil counts were assessed at baseline and 24 hours after SIC. We performed a 2-step cluster analysis of the subgroup of subjects with OA. A multivariate logistic regression was performed in order to identify the variables associated with an increase in Feno in subjects with OA. Results One hundred and seventy-eight subjects underwent SIC; 98 had a positive test. The cluster analysis performed in the OA subgroup identified 3 clusters. Despite a positive SIC, there was no increase in the Feno levels after exposure to occupational agents in Cluster 3, in which subjects were only exposed to low-molecular-weight (LMW) agents. The molecular weight of the agent (high molecular weight vs LMW) was the only factor associated with an increase in Feno (OR: 4.2 [1.1-16.8]) in subjects with a positive SIC. Conclusion An increase in Feno after exposure to agents causing OA seems to occur more consistently in subjects with OA caused by high molecular weight than in those with OA due to LMW. AU - Lemiere C AU - Nguyen S AU - Sava F AU - DAlpaos V AU - Huaux F AU - Vandenplas O LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 71 IP - DP - 2014 Jan 01 TI - Effectiveness of interventions to reduce flour dust exposures in supermarket bakeries in South Africa PG - AB - Rationale A recent study of supermarket bakery workers in South Africa demonstrated that 25% of workers were sensitised to flour allergens and 13% had baker's asthma. Evidence on exposure reduction strategies using specifically designed interventions aimed at reducing the risk of baker's asthma is scarce. Objectives The aim of this study was to evaluate the effectiveness of different control measures to reduce airborne flour dust exposure using a randomised design. Methods A group-randomised study design was used to assign 30 bakeries of a large supermarket chain store to two intervention groups and a control group, of which 15 bakeries were studied. Full-shift environmental personal samples were used to characterise exposure to flour dust and wheat and rye allergens levels pre-intervention (n=176) and post-intervention (n=208). Results The overall intervention effect revealed a 50% decrease in mean flour dust, wheat and rye allergen exposure. The reduction in exposure was highest for managers (67%) and bakers (47%), and lowest for counterhands (23%). For bakers, the greatest reduction in flour dust was associated with control measures such as the use of the mixer lid (67%), divider oil (63%) or focused training (54%). However, the greatest reduction (80%) was observed when using a combination of all control measures. Conclusions A specially designed intervention strategy reduced both flour dust and allergen levels. Best results were observed when combining both engineering controls and training. Further studies will investigate the long-term health impact of these interventions on reducing the disease burden among this group of bakers. AU - Baatjies R AU - Meijster T AU - Heederik D AU - Sander I AU - Jeebhay MF LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 160 IP - DP - 2014 Jan 01 TI - Lessons learned from the Syrian sarin attack: evaluation of a clinical syndrome through social media. PG - 644-8 AB - On the night of 21 August 2013, sarin was dispersed in the eastern outskirts of Damascus, killing 1400 civilians and severely affecting thousands more. This article aims to delineate the clinical presentation and management of a mass casualty event caused by a nerve agent as shown in the social media. Authors searched YouTube for videos uploaded of this attack and identified 210 videos. Of these, 67 met inclusion criteria and were evaluated in the final analysis.These videos displayed 130 casualties; 119 (91.5%) of which were defined as moderately injured or worse. The most common clinical signs were dyspnea (53.0%), diaphoresis (48.5%), and loss of consciousness (40.7%). Important findings included a severe shortage of supporting measures and lack of antidotal autoinjectors. Decontamination, documented in 25% of the videos, was done in an inefficient manner. Protective gear was not noticed, except for sporadic use of latex gloves and surgical masks.This is believed to be the first time that social media was used to evaluate clinical data and management protocols to better prepare against future possible events. AU - Rosman Y AU - Eisenkraft A AU - Milk N AU - Shiyovich A AU - Ophir N AU - Shrot S AU - Kreiss Y AU - Kassirer M LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 64 IP - DP - 2014 Jan 01 TI - Respiratory function in power plant workers exposed to nitrogen dioxide PG - 644-646 AB - Background Power plant workers are potentially exposed to nitrogen dioxide (NO2) and may therefore be at higher risk of pulmonary diseases than the general population. Aims To assess the association of NO2 exposure with spirometric abnormalities in power plant workers. Methods Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and forced expiratory ratio (FER = FEV1/FVC) were correlated with demographic characteristics, smoking history and environmental exposure to NO2 in power plant workers exposed to environmental NO2 at work and in a control group of administrative employees. Twenty-four hour environmental NO2 concentrations were measured at each workplace. Results The concentrations of environmental NO2 ranged from 1.21 to 7.82mg m-3 with a mean value of 3.91 + 1.51mg m-3. The results showed that FEV1 and FVC were significantly lower in 347 power plant workers than in the 349 controls (P < 0.001). The FER was significantly correlated with age, environmental NO2 concentration, smoking and height. Conclusions Occupational exposure to NO2 emissions in power plants is significantly associated with lung function abnormalities as assessed by spirometry. Spirometric measurements in power plant workers exposed to NO2 emissions may be an effective means of detecting early signs of impaired respiratory health in this group of workers. AU - Carbone U AU - Montuori P AU - Novi C AU - Triassi M LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 5 IP - DP - 2014 Jan 01 TI - Incense and joss stick making in small household factories, Thailand PG - 137-145 AB - Background: Incense and joss stick are generally used in the world. Most products were made in small household factories. There are many environmental and occupational hazards in these factories. Objective: To evaluate the workplace environmental and occupational hazards in small household incense and joss stick factories in Roi-Et, Thailand. Methods: Nine small household factories in rural areas of Roi-Et, Thailand, were studied. Dust concentration and small aerosol particles were counted through real time exposure monitoring. The inductively coupled plasma optical emission spectrometry (ICP-OES) was used for quantitative measurement of heavy metal residue in incense products. Results: Several heavy metals were found in dissolved dye and joss sticks. Those included barium, manganese, and lead. Rolling and shaking processes produced the highest concentration of dust and aerosols. Only 3.9 % of female workers used personal protection equipment. Conclusion: Dust and chemicals were major threats in small household incense and joss stick factories in Thailand. Increasing awareness towards using personal protection equipment and emphasis on elimination of environmental workplace hazards should be considered to help the workers of this industry. AU - Siripanich S AU - Siriwong W AU - Keawrueang P AU - Borjan M AU - Robson M. LA - PT - DEP - TA - Int J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20140101 IS - IS - VI - 44 IP - DP - 2014 Jan 01 TI - Asthma among workers in healthcare settings: role of disinfection with quaternary ammonium compounds. PG - 393-406 AB - INTRODUCTION: An increased incidence of asthma has been reported among healthcare workers. The role of quaternary ammonium compounds (QACs), commonly used in cleaning/disinfection products, has not been clearly defined. The aim of this study was to analyze associations between asthma and occupational exposure to disinfectants, especially QACs. METHODS: The study was performed on a stratified random sample of the various healthcare departments of 7 healthcare settings. The study included: questionnaire, physical examination and specific IgE assays. Occupational exposure assessment was performed by means of a work questionnaire, workplace studies and a review of products ingredients. Data were analyzed by logistic regression. RESULTS: response rate was 77%; 543 workers (89% female) participated; 37.1% were registered nurses (RNs), 16.4% auxiliary nurses (ANs), 17.3% cleaners; 32.8% were atopic. 335 participants were exposed to QACs. Nursing professionals reported a significantly higher risk of reported physician-diagnosed asthma and, for RNs, of nasal symptoms at work than administrative staff working in healthcare sector. This risk was particularly marked during disinfection tasks and when exposure to QACs. Exposure to QACs increased significantly the risk of reported physician diagnosed asthma and nasal symptoms at work (adjusted OR = 7.5 and 3.2 respectively). No significant association was found with other exposures such as latex glove use, chlorinated products / bleach or glutaraldehyde. CONCLUSION: RNs and ANs presented a higher risk of reported asthma than administrative staff. The highest risk was associated with tasks involving dilution of disinfection products by manual mixing, suggesting possible exposure to repeated peaks of concentrated products known to be strong respiratory irritants. Workplace interventions should be conducted in order to more clearly determine QAC exposure and improve disinfection procedures. AU - Gonzalez M AU - Jégu J AU - Kopferschmitt MC AU - Donnay C AU - Hedelin G AU - Matzinger F AU - Velten M AU - Guilloux L AU - Cantineau A AU - de Blay F. LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 42 IP - DP - 2013 Jan 01 TI - Welding, longitudinal lung function decline and chronic respiratory symptoms: a systematic review of cohort studies PG - 1186-1193 AB - While the acute respiratory risks of welding are well characterised, more chronic effects, including those on lung function, are less clear. We carried out a systematic review of published longitudinal studies of lung function decline in welders. Original cohort studies documenting two or more sequential measurements of lung function were reviewed. Meta-analysis was carried out on studies with suitable data on forced expiratory volume in 1 s (FEV1). Seven studies were included; their quality (measured on the Newcastle–Ottawa scale) was good, although exposure assessment was limited and the studies showed significant heterogeneity. Five had data suitable for meta-analysis; the pooled estimate of the difference in FEV1 decline between welders and nonwelders was -9.0 mL·year-1 (95% CI -22.5–4.5; p=0.193). The pooled estimates of difference in annual FEV1 decline between welders and referents who smoked was -13.7 mL·year-1 (95% CI -33.6–6.3; p=0.179). For welders and referents who did not smoke the estimated difference was -3.8 mL·year-1 (95% CI -20.2–12.6; p=0.650). Symptom prevalence data were mainly narrative; smoking appeared to have the greatest effect on symptom evolution. Collectively, available longitudinal data on decline of lung function in welders and respiratory symptoms suggest a greater effect in those who smoke, supporting a focus on smoking cessation as well as control of fume exposure in this trade. Further prospective studies are required to confirm these findings. AU - Szram J AU - Schofield SJ AU - Cosgrove MP AU - Cullinan P LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 68 IP - DP - 2013 Jan 01 TI - Airway dysfunction in elite athletes – an occupational lung disease? PG - 1343-1352 AB - Airway dysfunction is prevalent in elite endurance athletes and when left untreated may impact upon both health and performance. There is now concern that the intensity of hyperpnoea necessitated by exercise at an elite level may be detrimental for an athlete’s respiratory health. This article addresses the evidence of causality in this context with the aim of specifically addressing whether airway dysfunction in elite athletes should be classified as an occupational lung disease. The approach used highlights a number of concerns and facilitates recommendations to ensure airway health is maintained and optimized in this population. We conclude that elite athletes should receive the same considerations for their airway health as others with potential and relevant occupational exposures. AU - Price OJ AU - Ansley L AU - Menzies-Gow A AU - Cullinan P AU - Hull JH LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Cat and dog sensitization in pet shop workers PG - 563-567 AB - Background Sensitivity and symptoms related to animal proteins have been investigated in various occupational groups. However, data from pet shops are limited. Aims To investigate rates of sensitivity to cats and dogs among pet shop workers, to assess the relationship between sensitivity, allergen levels and symptoms and to investigate whether passive transport from pet shops to homes is possible. Methods Pet shop workers underwent interviews with a questionnaire adapted from the European Community Respiratory Health Survey. Dust samples for allergen detection were collected from pet shops using a vacuum cleaner. Skin tests were performed with common allergens. Dust samples were also obtained from the houses of 7 workers and 12 control subjects. Results Fifty-one workers from 20 pet shops were included in the study. Thirteen (25%) workers reported work-related symptoms. Four workers had sensitivity to animal allergens. The mean cat/dog allergen levels from pet shops were 15.7 and 3.2 µg/g, respectively. There was no significant relationship between cat/dog allergen levels and work-related symptoms and sensitivity to pets. None of the dust samples collected from the homes of pet shop workers contained cat allergens. Dog allergen was detected in only one house (0.58 µg/g). Neither cat nor dog allergens were found in the homes of the 12 control subjects. Conclusions Although a quarter of pet shop workers reported work-related symptoms, sensitivity to cat and dog was low. These findings suggest that work-related symptoms may be due to other factors than cat and dog sensitivity AU - Yilmaz I AU - Oner Erkekol F AU - Secil D AU - Misirligil Z AU - Mungan D LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 68 IP - DP - 2013 Jan 01 TI - Asthma and exposure to cleaning products – a European Academy of Allergy and Clinical Immunology task force consensus statement PG - 1532-1545 AB - Professional and domestic cleaning is associated with work-related asthma (WRA). This position paper reviews the literature linking exposure to cleaning products and the risk of asthma and focuses on prevention. Increased risk of asthma has been shown in many epidemiological and surveillance studies, and several case reports describe the relationship between exposure to one or more cleaning agents and WRA. Cleaning sprays, bleach, ammonia, disinfectants, mixing products, and specific job tasks have been identified as specific causes and/or triggers of asthma. Because research conclusions and policy suggestions have remained unheeded by manufactures, vendors, and commercial cleaning companies, it is time for a multifaceted intervention. Possible preventive measures encompass the following: substitution of cleaning sprays, bleach, and ammonia; minimizing the use of disinfectants; avoidance of mixing products; use of respiratory protective devices; and worker education. Moreover, we suggest the education of unions, consumer, and public interest groups to encourage safer products. In addition, information activities for the general population with the purpose of improving the knowledge of professional and domestic cleaners regarding risks and available preventive measures and to promote strict collaboration between scientific communities and safety and health agencies are urgently needed AU - Siracusa A AU - De Blay F AU - Folletti I AU - Moscato G AU - Olivieri M AU - Quirce S AU - Raulf-Heimsoth M AU - Sastre J AU - Tarlo SM AU - Walusiak-Skorupa J AU - Zock J-P LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 70 IP - DP - 2013 Jan 01 TI - Work related asthma. A causal analysis controlling the healthy worker effect PG - 603-610 AB - Objectives The healthy worker effect usually leads to underestimation of the association between occupational exposure and asthma. The role of irritants in work-related asthma is disputed. We estimated the effect of occupational exposure on asthma expression in a longitudinal study, using marginal structural modelling to control for the healthy worker effect. Methods Analyses included 1284 participants (17–79 years, 48% men) from the follow-up (2003–2007) of the French Epidemiological study on the Genetics and Environment of Asthma (case-control study). Age at asthma onset, periods with/without attacks over lifetime and occupational history were recorded retrospectively. Exposures to known asthmagens, irritants or low level of chemicals/allergens were evaluated through a job-exposure matrix. The job history was reconstructed into 5-year intervals. Results Thirty-one per cent of subjects had ever been exposed to occupational asthmagens. Among the 38% of subjects who had asthma (ever), presence of attacks was reported in 52% of all time periods. Using standard analyses, no association was observed between exposure to known asthmagens (OR (95% CI): 0.99 (0.72 to 1.36)) or to irritants/low level of chemicals/allergens (0.82 (0.56 to 1.20)) and asthma attacks. Using a marginal structural model, all associations increased with suggestive evidence for known asthmagens (1.26 (0.90 to 1.76)), and reaching statistical significance for irritants/low level of chemicals/allergens (1.56 (1.02 to 2.40)). Conclusions The healthy worker effect has an important impact in risk assessment in work-related asthma studies. Marginal structural models are useful to eliminate imbalances in exposure due to disease-driven selection. Results support the role of irritants in work-related asthma. AU - Dumas O AU - Moual NL AU - Siroux V AU - Heederik D AU - Garcia-Aymerich J AU - Kauffmann F AU - Basagaña X LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 42 IP - DP - 2013 Jan 01 TI - Occupational exposures and uncontrolled adult-onset asthma in the ECRHS II PG - on line AB - Eur Respir J. 2013 Aug 15. [Epub ahead of print] Occupational exposure is a well-recognized modifiable risk factor for asthma but the relationship between occupational exposure and asthma control has not been studied. We aimed to study this association among working-age adults from the European Community Respiratory Health Survey (ECRHS).Data were available for 7077 participants (in average 43 years, 45% never smokers; 5867 without asthma, 1210 with current asthma). Associations between occupational exposure to specific asthmagens and asthma control status (33% with uncontrolled asthma, based on the GINA guidelines) were evaluated using logistic and multinomial regressions, adjusted for age, gender and smoking status, with study areas included as a random effect.Statistically significant positive associations were observed between uncontrolled adult-onset asthma and both past 12-month and 10-year exposure to any occupational asthmagens (odds ratio (OR) [95% confidence interval]: 1.6[1.0-2.4], 1.7[1.2-2.5], respectively), high (1.7[1.0-2.8], 1.9[1.3-2.9]) and low (1.6[1.0-2.7], 1.8[1.2-2.7]) molecular weight agents, and cleaning agents (2.0[1.1-3.6], 2.3[1.4-3.6]), with stronger associations for long-term exposures. These associations were mainly explained by the exacerbation domain of asthma control and no associations were observed between asthmagens and partly-controlled asthma.These findings suggest that occupational exposure to asthmagens is associated with uncontrolled adult-onset asthma. Occupational risk factors should be quickly identified to prevent uncontrolled asthma. AU - Le Moual N AU - Carsin A AU - Siroux V AU - Radon K AU - Norback D AU - Toren K AU - Olivieri M AU - Urrutia I AU - Cazzoletti L AU - Jacquemin B AU - Benke G AU - Kromhout H AU - Mirabelli M AU - Mehta A AU - Schlünssen V AU - Sigsgaard T AU - Blanc PD AU - Kogevinas M AU - Anto J AU - Zock J LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 68 IP - DP - 2013 Jan 01 TI - Novel use of rituximab in hypersensitivity pneumonitis refractory to conventional treatment PG - 780-781 AB - Hypersensitivity pneumonitis (HP) is treated by removal of the inciting antigen, if identified, and with corticosteroids and immunosuppressive agents in extensive or progressive disease. A minority of patients continue to decline and suffer outcomes comparable to idiopathic pulmonary fibrosis. Rituximab, a B cell depleting anti-CD20 antibody, has shown benefit in interstitial lung diseases (ILDs) associated with connective tissue diseases (CTDs).1–3 We report a novel use of rituximab in a case of HP refractory to conventional treatment. A 57-year-old female never-smoker, with no previous medical history, presented with a 6-month history of progressive breathlessness and dry cough. Pulmonary function tests (PFTs) were impaired, with 26% of diffusing capacity for carbon monoxide (DLco) and 44% of forced vital capacity (FVC). A high-resolution CT (HRCT) showed changes suggestive … AU - Lota HK AU - Keir GJ AU - Hansell DM AU - Nicholson AG AU - Maher TM AU - Wells AU AU - Renzoni EA LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 42 IP - DP - 2013 Jan 01 TI - Rituximab in severe, treatment-refractory interstitial lung disease PG - e1 AB - Background In a subgroup of patients with severe interstitial lung disease (ILD) progressing despite conventional immunosuppression, rituximab, a B cell-depleting monoclonal antibody, may offer an effective rescue therapy. Methods Retrospective assessment of 50 patients with severe, progressive ILD (34 with connective tissue disease-associated ILD, 7 with fibrotic hypersensitivity pneumonitis, 3 with likely drug-induced ILD, the rest with miscellaneous ILD patterns, excluding idiopathic pulmonary fibrosis) treated with rituximab between 2010 and 2012. At the time of rituximab treatment, mean DLco was 25.5 % (±9.9%), and FVC was 49.1% (±17.6%). Change in pulmonary function tests compared to pre-rituximab levels, was assessed at six to twelve months post-treatment. Changes in lung function before and after treatment were analysed by Wilcoxon signed rank test. Results In contrast with a median decline in forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLco) of 14.6% and 18.8% respectively in the six to twelve months prior to rituximab, analysis of paired pulmonary function data revealed a median improvement in FVC of 5.7% (p<0.01) and stability of DLco (p<0.01) in the six to twelve months following rituximab treatment. Two patients developed serious infections (pneumonia) requiring hospitalisation following rituximab, and ten patients died, all from progression of underlying ILD, a median of 5.1 months after treatment. Conclusions In a subgroup of patients with severe, progressive ILD unresponsive to conventional immunosuppression, rituximab may offer a safe and effective therapeutic intervention. Future prospective, controlled trials are warranted to validate these findings. AU - Abdullah R AU - Ming D AU - Keir G AU - Maher T AU - Wells A AU - Renzoni E LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 42 IP - DP - 2013 Jan 01 TI - Occupational asthma from sensitization to 4, 4-methlyene bismorpholine in clean metalworking fluid PG - 1137-1139 AB - European Respiratory Society guidelines on the management of work-related asthma recommend that occupational asthma (OA) with an allergic mechanism should be diagnosed by both identifying the workplace as the cause, and confirming sensitization to the asthmagen by specific inhalational challenge (SIC), in the absence of any available specific IgE tests [1, 2]. Used (contaminated) metal working fluid is the usual cause of occupational asthma in exposed workers. We present the first case of OA due to the biocide additive 4,4-methylene-bismorpholine present in clean MWF. A 54-year old Kenyan man presented with a 2-year history of rhinitis, wheeze, dry cough and chest tightness, which were worse at night and whilst at work and improved away from work on holiday. He had had rhinitis from grass pollen, perfumes and cleaning agents intermittently for 15 years,and acne due to MWF 5 years previously. There was no childhood or family history of asthma and he had never smoked cigarettes. He had been employed as a machine tool setter-operator for 22 years manufacturing car axles. For the last 6 years he had worked on an enclosed computer numerical controlled (CNC) milling, drilling and boring machine, with its own oil sump, using carbide-tipped tools. It was loaded by a robot but there was no delay between the end of machining and door opening, which produced a visible mist about 3 meters from his work station. The machines used Fuchs Ecocool Ultralife A, a semi-synthetic MWF for aluminium alloys. Clinical examination and chest radiograph were unremarkable. Skin-prick allergy testing (SPT) revealed a 0mm reaction to 0.9% saline and a 7mm reaction to histamine hydrochloride 10mg/ml. There were positive reactions to grass pollen (8mm), dog dander (5mm), cladosporium (4mm) and 4, 4-methylenebis-morpholine (3mm),with borderline reactions to 5mg/ml cobalt chloride (2.5mm) and clean MWF (2.5mm). Total IgE was 2048kU/L, white blood cell count 7.81x109/L and eosinophil count was raised at 0.75x109/L. 2-hourly peak flow measurements made at home and work over 4 weeks were analysed using OASYS [1, 2]. The OASYS score was 3.4 and ABC score 23.4 litres/min/hour confirming a significant work effect (Figure 1). Spirometry revealed a borderline obstructive ventilatory defect (FEV1/FVC=70%) with normal indices (FEV1=2.75L (86% predicted); FVC=3.95L (100% predicted). While work-exposed, his fractional exhaled nitric oxide (FENO) was raised at 71ppb [3, 3] and non-specific bronchial responsiveness (NSBR) to methacholine was normal (>4800mcg by the Yan method [4]). He underwent specific inhalational challenge (SIC) after 3 weeks away from work. He was challenged with 7% clean Ecocool Ultralife A MWF in water for a total of 50 minutes via aTurboneb II and Maxineb 90 nebulizer. Initial FEV1 was 2.63L, which fell immediately by 20%, recovering after 15 minutes, and fell again at 3-11 hours by 29.7%, accompanied by asthmatic symptoms. Subsequent SIC to 0.7% 4, 4-methylene-bismorpholine in water (Chemical Abstract Service (CAS) registry number 5625-90-1; OA Hazard Index=0.98) for a total of 50 minutes resulted in immediate sustained rhinitis symptoms, then a late fall in FEV1 of 16.5% from 2.36L, at 9-11 hours after challenge (Figure 2). He had a >4-fold increase in NSBR to methacholine (pre-SIC PD20>4800mcg; 24-hour post-SIC PD20=587mcg), but no clinically significant change in FENO (FENO pre-SIC=77ppb; post-SIC=70ppb). He had negative SICs to the solvent 2, 2-aminoethoxyethanol (CAS registry number 929-06-6; OA Hazard Index=0.41), pH stabilizer 2-di-butylaminoethanol (CAS registry number 102-81-8; OA Hazard Index=0.95) and cobalt chloride 5mg/ml. A suitable unexposed workplace could not be found; nine months later he remained unemployed withongoing asthma symptoms that required treatment with 200micrograms of inhaled beclometasone b.d., with an FEV1 of 2.59L (82% predicted) and FVC of 4.45L (113% predicted) and FeNO 56ppb. The positive SIC and greater than 4-fold increase in NSBR to methacholine supports the diagnosis of OA from sensitization due to 4, 4-methylene-bismorpholine. Geier et al. have previously demonstrated dermatological sensitization to a number of structurally related biocide additives, including 1% 4,4-methylene bismorpholine by skin patch testing [4]. However, a number of features need to be accounted for. The baseline FENO was measured during work-exposure and was high, as was the pre-SIC FENO after 3 weeks away from work but was lower after 9 months without exposure. These values may have been confounded by atopy and rhinitis [Dweik, 5]. Some have found a significant increase in FENOfollowing a late asthmatic reaction; however asignificant proportion of low molecular weight (LMW) occupational asthmagensproduce a non-eosinophilic asthma variant [6] and although we did not obtain sputum cell counts, this may explain the lack of FENO change.. All measurements were carried out according to ERS/ATS guidelines [7] using the NioxMino handheld machine (Aerocrine AB, Solna, Sweden). A 3mm SPT to 4,4-methylene bismorpholine does not provide conclusive evidence of an IgE-mediated mechanism; indeed the absence of demonstrable specific IgE antibodies in subjects with OA caused by LMW agents has made many suspect non-IgE medicated mechanisms [8]. MWFs are used to reduce heat and friction in industrial metalworking operations, and are complex mixtures of oils, emulsifiers, alkaline pH buffers, biocides and other additives. Once used, MWFs may be contaminated with bacterial and fungal microbes, hydraulic fluid, added biocides,dissolved metals and other manufacturing by-products, all of which are potential sensitizers for OA, as well as causing extrinsic allergic alveolitis, humidifier fever and occupational bronchitis [5, 6]. SIC testing to MWF has been undertaken safely, though positive tests are much more common to used- than clean MWF [7, 8]. 4,4-methylene-bismorpholine has a high asthma hazard index (maximum 1.0) using the Manchester Occupational Asthma Hazard Programme, which has a high sensitivity in identifying novel asthmagens[9]. References [1] Baur X, Sigsgaard T. The new guidelines for management of work-related asthma.EurRespir J 2012;39:518-9. [2] Baur X, Sigsgaard T, Aasen TB et al. on behalf of the ERS Task Force on the management of work-related asthma. Guidelines for the management of work-related asthma.EurRespir J 2012;39:529-45. Erratum in: EurRespir J 2012;39:1553. [1] Gannon PF, Newton DT, Belcher J, Pantin CF, Burge PS.Development of OASYS-2: a system for the analysis of serial measurement of peak expiratory flow in workers with suspected occupational asthma. Thorax 1996;51:484-9. [2] Moore VC, Jaakkola MS, Burge CBSG et al.A New Diagnostic Score for Occupational Asthma.Chest 2009;135:307-14. [3] Dweik RA, Boggs PB, Erzurum SC et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J RespirCrit Care Med 2011;184:602-15. [3] See KC and Christiano DC. Normal values and thresholds for the clinical interpretation of exhaled nitric oxide levels in the general U.S. population: results from the National Health and Nutrition Examination Survey 2007-2010. Chest2013;143:107-16. [4] Yan K, Salome C, Woolcock AJ.Rapid method for measurement of bronchial responsiveness.Thorax 1983;38:760-5. [4] Geier J, Lessmann H, Becker D et al. Patch testing with components of water-based metalworking fluids: results of a multicentre study with a second series. Contact Dermatitis 2006;55(6):322-9. [5] Scott M, Razal A, Karmaus W et al. Influence of atopy and asthma on exhaled nitric oxide in an unselected birth cohort study. Thorax 2010;65:258-62. [6] Anees W, Huggins V, Pavord ID, Robertson AS, Burge PS. Occupational asthma due to low molecular weight agents: eosinophilic and non-eosinophilic variants. Thorax 2002;57:231-6. [7] Task force of the European Respiratory Society (ERS) and American Thoracic Society (ATS). ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide. Am J RespirCrit Care Med. 2005;171:912–30. [8] Sastre J, Vandenplas O, Park HS. Pathogenesis of occupational asthma.EurRespir J 2003;22:364-73. [5] Robertson W, Robertson A, Burge CBSG et al. Clinical investigation of an outbreak of alveolitis and asthma in a car engine manufacturing plant.Thorax 2007;62:981-90. [6] Zacharisen MC, Kadambi AR, Schlueter DP et al. The spectrum of respiratory disease associated with exposure to metal working fluids.J Occup Environ Med 1998;40:640-7. [7] Hendy MS, Beattie BE, Burge PS. Occupational asthma due to an emulsified oil mist. Br J Industr Med 1985;42:51-54. [8] Vellore AD, Moore VC, Robertson AS, Robertson W, Jaakkola MS, Burge PS.Specific bronchial challenge testing to metal working fluid.EurRespir J Suppl 2006;28:245s. [9] Jarvis J, Seed MJ, Elton R, Sawyer L, Agius R.Relationship between chemical structure and the occupational asthma hazard of low molecular weight organic compounds.Occup Environ Med 2005;62:243-50. AU - Walters GI AU - Moore VC AU - Robertson AS AU - McGrath EE AU - Parkes E AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Allergic bronchopulmonary aspergillosis in garden waste (compost) collectors—occupational implications PG - 517-519 AB - The separation of rotting garden material from general domestic waste and its collection for processing in industrial composting sites is a relatively new industry in the UK. Two cases of allergic bronchopulmonary aspergillosis and the results of health surveillance are described in a team of 28 garden waste (compost) collectors. A few cases of extrinsic allergic alveolitis due to Aspergillus fumigatus have previously been reported in compost workers. In the absence of any guidance from research and to prevent similar cases of a potentially serious illness, we advise that new starters to the job of collecting or processing compost are screened for asthma and aspergillus sensitivity, cystic fibrosis, bronchiectasis and immunodeficiency if their exposure to high levels of Aspergillus sp cannot be controlled. Annual health surveillance for these workers is also recommended. AU - Poole CJM AU - Wong M LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 55 IP - DP - 2013 Jan 01 TI - Are operating room nurses at higher risk of severe persistent asthma? The Nurses' Health Study. PG - 973-977 AB - OBJECTIVE: To assess the associations between operating room (OR) nursing, a category of health care workers at high risk of exposure to various inhaled agents, and asthma severity/control among women with asthma. METHODS: The level of severity/control in nurses with prevalent doctor-diagnosed asthma in 1998/2000 was compared, using nominal logistic regression, in OR nursing (n = 69) and administrative nursing (n = 546) from the US Nurses' Health Study for whom detailed information on asthma and nursing employment status was available. RESULTS: We observed a significant association between OR nursing, compared with administrative nursing, and severe persistent asthma (adjusted odds ratio, 2.48; 95% confidence interval, 1.06 to 5.77). CONCLUSIONS: Our findings suggest that nurses working in the OR are at a higher risk of severe persistent asthma. Further studies with detailed estimates of occupational exposures, especially to disinfectant/cleaning agents, are warranted. AU - Le Moual N AU - Varraso R AU - Zock JP AU - Henneberger P AU - Speizer FE AU - Kauffmann F AU - Camargo CA Jr. LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 107 IP - DP - 2013 Jan 01 TI - Functional and biological characteristics of asthma in cleaning workers PG - 673-683 AB - Objectives Cleaning workers have an increased risk of asthma but the underlying mechanisms are largely unknown. We studied functional and biological characteristics in asthmatic cleaners and compared these to healthy cleaners. Methods Forty-two cleaners with a history of asthma and/or recent respiratory symptoms and 53 symptom-free controls were identified. Fractional exhaled nitric oxide (FeNO) was measured and forced spirometry with reversibility testing was performed. Total IgE, pulmonary surfactant protein D and the 16 kDa Clara Cell secretory protein were measured in blood serum. Interleukins and other cytokines, growth factors, cys-leukotrienes and 8-isoprostane were measured in exhaled breath condensate. Information on occupational and domestic use of cleaning products was obtained in an interview. Associations between asthma status, specific characteristics and the use of cleaning products were evaluated using multivariable linear and logistic regression analyses. Results Asthma was associated with an 8% (95% confidence interval (CI) 1–15%) lower postbronchodilator FEV1, a higher prevalence of atopy (42% vs. 10%) and a 2.9 (CI 1.5–5.6) times higher level of total IgE. Asthma status was not associated with the other respiratory biomarkers. Most irritant products and sprays were more often used by asthmatic cleaners. The use of multiuse products, glass cleaners and polishes at work was associated with higher FeNO, particularly in controls. Conclusions Asthma in cleaning workers is characterised by non-reversible lung function decrement and increased total IgE. Oxidative stress, altered lung permeability and eosinophilic inflammation are unlikely to play an important underlying role, although the latter may be affected by certain irritant cleaning exposures. AU - Vizcaya D AU - Mirabelli MC AU - Orriols R AU - Antó JM AU - Barreiro E AU - Burgos F AU - Arjona L AU - Gomez F AU - Zock J LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 8 IP - DP - 2013 Jan 01 TI - Exposure of health workers in primary health care to glutaraldehyde PG - 31 AB - Background In order to avoid proliferation of microorganisms, cleaning, disinfection and sterilisation in health centres is of utmost importance hence reducing exposure of workers to biological agents and of clients that attend these health centres to potential infections. One of the most commonly-used chemical is glutaraldehyde. The effects of its exposure are well known in the hospital setting; however there is very little information available with regards to the primary health care domain. Objective To determine and measure the exposure of health workers in Primary Health Care Centres. Environmental to glutaraldehyde and staff concentration will be measured and compared with regulated Occupational Exposure Limits. Methods Observational, cross-sectional and multi-centre study. The study population will be composed of any health professionals in contact with the chemical substance that work in the Primary Health Care Centres in the areas of Barcelones Nord, Maresme, and Barcelona city belonging to the Catalan Institute of Health. Data will be collected from 1) Glutaraldhyde consumption from the previous 4 years in the health centres under study. 2) Semi-structured interviews and key informants to gather information related to glutaraldehyde exposure. 3) Sampling of the substance in the processes considered to be high exposure. Discussion Although glutaraldehyde is extensively used in health centres, scientific literature only deals with certain occupational hazards in the hospital setting. This study attempts to take an in-depth look into the risk factors and environmental conditions that exist in the primary care workplace with exposure to glutaraldehyde. AU - Jara MA AU - Hidalgo AM AU - Gulin JC AU - Albiach ML AU - Ortiz LM AU - Monserrat PT AU - Ollé XE LA - PT - DEP - TA - Journal of Occupational Medicine and Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 43 IP - DP - 2013 Jan 01 TI - Prevalence of IgE against neuromuscular blocking agents in hairdressers and bakers PG - 1256-1262 AB - Background Allergic IgE-mediated reactions to neuromuscular blocking agents (NMBAs) are the main cause of immediate hypersensitivity reactions in anaesthesia; their predominant occurrence in the absence of previous exposure to NMBAs suggests a risk related to environmental exposure. Objective To investigate the prevalence of specific IgE to quaternary ammonium ions in two populations professionally exposed to quaternary ammonium compounds, in the north-eastern France. Methods The study had a retrospective follow-up design whereby apprentices were assessed after their 2-year training period as apprentices. The professionally exposed hairdresser populations (n = 128) were compared with baker/pastry makers (n = 108) and ‘non-exposed’ matched control subjects (n = 379). Results We observed a 4.6-fold higher frequency of positive IgE against quaternary ammonium ions in hairdressers (HD), compared with baker/pastry makers (BP) and control (C) groups. The competitive inhibition of quaternary ammonium Sepharose radioimmunoassay (QAS-IgE RIA) with succinylcholine was significantly higher in HD, compared with BP and C groups, with inhibition percentage of 66.2 ± 7.4, 39.7 ± 6.0 and 43.8 ± 9.9, respectively (P < 0.001). The specific IgE against quaternary ammonium ions recognized also two compounds widely used by hairdressers, benzalkonium chloride and polyquaternium-10, in competitive inhibition of IgE RIA. When considering the whole study population, hairdresser professional exposure and total IgE > 100 kU/L were the two significant predictors of IgE-sensitization against quaternary ammonium ions in the multivariate analysis of a model that included age, sex, professional exposure, increased concentration of total IgE (IgE > 100 kU/L) and positive IgE against prevalent allergens (Phadiatop®; P = 0.019 and P = 0.001, respectively). Conclusion and Clinical Relevance The exposure to hairdressing professional occupational factors increases IgE-sensitization to NMBAs and quaternary ammonium ion compounds used in hairdressing. Besides the pholcodine hypothesis, our study suggests that repetitive exposure to quaternary ammonium compounds used in hairdressing is a risk factor for NMBAs sensitization. AU - Dong S AU - Acouetey DS AU - Guéant-Rodriguez R-M AU - Zmirou-Navier D AU - Rémen T AU - Blanca M AU - Mertes PM AU - Guéant J-L LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Work-related peak flow and asthma symptoms in a damp building PG - 287-290 AB - Working in damp conditions is associated with asthma, but few studies have used objective testing to document work-related patterns. Aims To describe the relationship of peak flow measurements to work-related asthma (WRA) symptoms and WRA among occupants in a damp office building. Methods At the beginning of the study, all workers were offered a questionnaire and methacholine challenge testing. Participants were then instructed to perform serial spirometry using handheld spirometers five times per day over a 3 week period. Peak flow data were analysed using OASYS-2 software. We calculated the area between the curves (ABC score) using hours from waking. We considered a score >5.6 L/min/h to be indicative of a work-related pattern. Results All 24 employees participated in the questionnaire. Seven participants (29%) reported physician-diagnosed asthma with onset after starting work in the building. Almost two-thirds (63%) of participants reported at least one lower respiratory symptom (LRS) occurring one or more times per week in the last 4 weeks. Twenty-two (92%) consented to participate in serial spirometry. Fourteen participants had adequate quality of serial spirometry, five of whom had ABC scores >5.6, ranging from 5.9–23.0. Of these five, two had airways responsiveness, three had current post-hire onset physician-diagnosed asthma and four reported work-related LRS. Conclusions We found evidence of work-related changes in serial peak flows among some occupants of an office building with a history of dampness. Serial peak flows may be a useful measure to determine WRA in office settings. AU - White SK AU - Cox-Ganser JM AU - Benaise LG AU - Kreiss K LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Occupational asthma and rhinitis caused by cyanoacrylate-based eyelash extension glues PG - 294-297 AB - Background Eyelash extensions are applied on top of customers’ lashes using instant glue containing cyano acrylate, known to cause occupational rhinitis (OR) and occupational asthma (OA). The number of beauty professionals applying these extensions is increasing due to their popularity. Aims To report on a case of OA with OR and a case of OR attributable to lash extension glue and to evaluate respiratory exposure in lash extension work. Methods Two beauty professionals with suspected OA and/or OR underwent inhalation challenge, including both control challenge and work-mimicking challenges using the lash extension glue, each with a 24-h follow-up. Volatile organic compounds (VOCs) present were assessed during the lash extension glue challenge. The glues were analysed for their (meth)acrylate content. Results Both beauty professionals (case 1 and case 2) applied lash extensions regularly for several hours per day as part of their work and had work-related rhinitis. Case 1 had a longer history of lash extension work and also had asthmatic symptoms. The first lash extension glue challenge was negative in both cases, but positive OR reactions were detected in the second test. Case 1 also had a late asthmatic reaction. During the lash extension glue challenge, VOC were present in total concentrations below the irritant threshold and ethylcyanoacrylate (ECA) was detected in a concentration of 0.4mg/m3. Chemical analysis of the glues revealed ECA was the major component. Conclusions Application of eyelash extensions using small amounts of cyanoacrylate-based glues can cause OA and OR. AU - Lindström I AU - Suojalehto H AU - Henriks-Eckerman M-L AU - Suuronen K LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Occupational allergy to squid (Loligo vulgaris) PG - 298-300 AB - Occupational allergy from exposure to squid has been rarely described, mainly as contact dermatitis or urticaria. Our report presents the first case of occupational asthma, rhinitis, conjunctivitis and contact urticaria to squid in a 33-year-old seafood production worker, with documented increased eosinophilia in the nasal and tear fluids after specific inhalation challenge test (SICT) with squid. IgE-mediated sensitization to squid was confirmed by positive skin prick test and opened skin test with squid extract. SICT demonstrated a direct and significant link between the exposure to squid and the allergic response from the respiratory system and conjunctiva. AU - Wiszniewska M AU - Tymoszuk D AU - Pas-Wyroslak A AU - Nowakowska-Swirta E AU - Chomiczewska-Skóra D AU - Palczynski C AU - Walusiak-Skorupa J LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Chlorhexidine—still an underestimated allergic hazard for health care professionals PG - 301-305 AB - Chlorhexidine is a low molecular weight occupational sensitizer that can cause different delayed and immediate-type allergic reactions including anaphylaxis. It is widely used as an antiseptic and disinfectant and not only in the occupational environment as it is present in toothpaste, mouthwash, nose and eye drops and ointments. We present three cases of occupationally exposed workers with airway allergy to chlorhexidine. The role of chlorhexidine as an occupational allergen was confirmed by placebo-controlled specific inhalative challenge tests monitored by spirometry and analysis of induced sputum (influx of eosinophils after provocation has been observed). One of these patients presented with a systemic reaction with ordinary environment exposure. These findings are a reminder to clinicians of chlorhexidine’s ability to cause various hypersensitivity reactions and the potential risk of this widely used antiseptic. AU - Wittczak T AU - Dudek W AU - Walusiak-Skorupa J AU - Swierczynska-Machura D AU - Palczynski C LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 68 IP - DP - 2013 Jan 01 TI - Usefulness of omalizumab in ten patients with severe occupational asthma PG - 813-815 AB - Background The management of severe occupational asthma (OA) remains problematic and new alternative treatments providing better disease control are required, ideally enabling affected individuals to remain in their job. Methods Ten patients with severe uncontrolled OA were treated with the monoclonal anti-IgE antibody omalizumab. In six cases the causative agent was a high molecular weight (HMW) compound and in four cases it was a low molecular weight (LMW) chemical. All of the patients had well documented OA despite workplace adjustments. Results During treatment, nine patients exhibited a lower rate of asthma exacerbations and used less oral or inhaled corticosteroids. Seven patients were able to continue working at the same workplace as before treatment. Conclusion We have demonstrated that omalizumab is a potential treatment for severe uncontrolled OA and enabled seven of the ten patients in the study to remain in their job. AU - Lavaud F AU - Bonniaud P AU - Dalphin JC AU - Leroyer C AU - Muller D AU - Tannous R AU - Mangiapan G AU - De Blay F LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 22 IP - DP - 2013 Jan 01 TI - The Impact of Air-conditioning Usage on Sick Building Syndrome during Summer in China PG - 490-497 AB - The air-conditioned thermal environments can have an important impact on human health. People stay in air-conditioned environments for a long period of time would tend to present weakened thermal adaptation and have weaker ability to endure hot environment, hence increasing the risk burden caused by heat stress on their physiological regulations to cause discomfort. In this study the relationship between human health – a prevalence of Sick Building Syndrome (SBS) – and air-conditioned indoor environment in summer was analysed using field studies. The results show that the discomfort could include physiological effects affecting the nervous system, the digestive system, the respiratory system, as well as irritation to skin and mucous membranes due to exposure to conditioned air. The frequency of such feelings of discomfort was higher for subjects who are acclimatised to air-conditioned spaces than for people who are not accustomed to air-conditioning. Thus, air-conditioning can be a cause of discomfort and could affect people’s health. AU - Caoa B AU - Shangb Q AU - Daib Z AU - Zhua Y LA - PT - DEP - TA - Indoor Built Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 70 IP - DP - 2013 Jan 01 TI - Work-related allergic respiratory disease and asthma in spice mill workers is associated with inhalant chili pepper and garlic exposures PG - 446-452 AB - Objective The aim of the study was to determine the prevalence and risk factors for allergic respiratory disease in spice mill workers. Methods A cross-sectional study of 150 workers used European Community Respiratory Health Survey questionnaires, Phadiatop, serum specific IgE (garlic, chili pepper), spirometry and fractional exhaled nitric oxide (FeNO). Personal air samples (n=62) collected from eight-hour shifts were analysed for inhalable particulate mass. Novel immunological assays quantified airborne garlic and chili pepper allergen concentrations. Results Mean dust particulate mass (geometric mean (GM)=2.06 mg/m3), chili pepper (GM=0.44 µg/m3) and garlic allergen (GM=0.24 µg/m3) were highest in blending and were highly correlated. Workers’ mean age was 33 years, 71% were men, 46% current smokers and 45% atopic. Spice-dust-related asthma-like symptoms (17%) were common, as was garlic sensitisation (19%), with 13% being monosensitised and 6% cosensitised to chili pepper. Airflow reversibility and FeNO>50 ppb was present in 4% and 8% of workers respectively. Spice-dust-related ocular-nasal (OR 2.40, CI 1.09 to 5.27) and asthma-like (OR 4.15, CI 1.09 to 15.72) symptoms were strongly associated with airborne garlic in the highly exposed (>0.235 µg/m3) workers. Workers monosensitised to garlic were more likely to be exposed to higher airborne chili pepper (>0.92 µg/m3) (OR 11.52, CI 1.17 to 113.11) than garlic allergens (OR 5.08, CI 1.17 to 22.08) in this mill. Probable asthma was also more strongly associated with chili pepper than with garlic sensitisation. Conclusions Exposure to inhalable spice dust (GM >2.06 mg/m3) containing garlic (GM>0.24 µg/m³) and chili pepper (GM >0.44 µg/m3) allergens increase the risk of allergic respiratory disease and asthma. AU - van der Walt A AU - Singh T AU - Baatjies R AU - Lopata AL AU - Jeebhay MF LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 70 IP - DP - 2013 Jan 01 TI - Assessing the impact of national level interventions on workplace respiratory disease in the UK: part 2—regulatory activity by the Health and Safety Executive PG - 483-490 AB - Objective To investigate whether interventions implemented by the UK Health and Safety Executive addressing exposure to isocyanate-based spray paints in motor vehicle repair (MVR), flour dust in craft bakeries, rosin-based solder flux fume in the electronics industry, metalworking fluids and wood dust coincided with a decline in incidence of work-related short latency respiratory disease or asthma in the target groups. Method Changes in the incidence of work-related short latency respiratory disease reported to a UK-based surveillance scheme were compared using a longitudinal, negative binomial regression model with ß distributed random effects. An interrupted time series design was used and comparisons according to inclusion or exclusion in the target group were made by including a statistical interactions expressed as a ratio of incidence rate ratios (RIRRs) in the model. Results The incidence of work-related short latency respiratory disease attributed to flour dust significantly increased relative to all other agents (RIRR: 1.10; 95% CI 1.06 to 1.16) whereas work-related short latency respiratory disease attributed to rosin-based solder flux fume significantly declined relative to all other agents (0.94; 0.90 to 0.99). No significant changes in the incidence of SLRD attributed to wood dust (1.03; 0.91 to 1.16) or spray paints (1.03; 0.95 to 1.11) relative to all other agents were observed. A higher proportion of reports originated from the industries targeted by the intervention for rosin-based solder flux fume (65/107; 61%) than spray painting (27/93; 27%) or wood dust (16/42; 38%). Conclusions These data support a beneficial effect of interventions to reduce exposure to rosin-based solder flux fume but an increase in work-related short latency respiratory disease attributed to flour dust may indicate increased exposure or increased awareness of the problem AU - Stocks SJ AU - McNamee R AU - Turner S AU - Carder M AU - Agius RM LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 70 IP - DP - 2013 Jan 01 TI - Assessing the impact of national level interventions on workplace respiratory disease in the UK: part 1—changes in workplace exposure legislation and market forces PG - 476-482 AB - Objective The 2004 amendment to the Control of Substances Hazardous to Health 2002 regulations (COSHH 2004) introducing workplace exposure limits (WELs) was enacted in the UK in 2005. This study aimed to determine whether introducing this legislation coincided with a reduction in the incidence of work-related short latency respiratory disease (SLRD) attributed to the agents with a WEL. The second objective was to determine whether changes in legislation, WELs and market forces coincided with a reduction in the incidence of SLRD attributed to glutaraldehyde and latex. Method Reports of SLRD made to the Surveillance of Work-related and Occupational Respiratory Disease scheme were used to estimate the change in incidence within reporters between two time periods (interrupted time series design) using a longitudinal, negative binomial regression model with ß distributed random effects. A statistical interaction term was included in the model to make comparisons between the groups defined by suspected causal agent and/or occupation, essentially comparing two interrupted time series. Time periods were defined prospectively representing the changes in legislation or market forces. Results The introduction of the COSHH 2004 legislation in the UK coincided with a significant reduction in reports of SLRD attributed to agents with a WEL relative to those without a WEL (ratio of incidence rate ratios: 0.70; 95% CI 0.52 to 0.93) and a significant reduction in SLRD attributed to glutaraldehyde in healthcare workers (0.20; 0.07 to 0.57) and latex in all workers (0.37; 0.16 to 0.85). Conclusions These data are consistent with a beneficial effect of legislation aiming to reduce workplace exposures. AU - Stocks SJ AU - McNamee R AU - Turner S AU - Carder M AU - Agius RM LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 70 IP - DP - 2013 Jan 01 TI - Occupational asthma and occupational rhinitis: the united airways disease model revisited PG - 41-475 AB - Objectives Whereas accumulating evidence indicates close associations between rhinitis and asthma, little is known about the relationships between occupational rhinitis (OR) and occupational asthma (OA). This study analyses the prevalence of OR associated with OA, globally and according to the various causal agents, and investigates the temporal relationships between these two conditions. Methods Data on incident cases of OA (2008–2010) were collected through the French national occupational disease surveillance and prevention network, using a standardised form including information on occupation, causal agents, presence of OR, and respective dates of occurrence of rhinitis and asthma. Results Among the 596 reported OA cases with latency period, 555 could be attributed to identified agents: high molecular weight (HMW) agents (n=174); low molecular weight (LMW) agents (n=381). Overall, OR was associated with OA in 324 (58.4%) cases. The frequency of association was significantly higher for HMW agents than for LMW agents (72.2% vs 51.5%, p<0.001). OR occurred before OA significantly more frequently for HMW agents than for LMW agents (p<0.01). Conclusions These results show that OR is frequently associated with OA, especially when HMW agents are involved. They are consistent with the hypothesis that OR, in conjunction with OA, is more likely to be caused by sensitisers that cause disease via IgE-mediated mechanisms and suggest that symptoms of OR should be taken into account in the medical surveillance of workers exposed to HMW agents. AU - Ameille J AU - Hamelin K AU - Andujar P AU - Bensefa-Colas L AU - Bonneterre V AU - Dupas D AU - Garnier R AU - Loddé BA AU - Rinaldo M AU - Descatha A AU - Lasfargues G AU - Pairon J AU - the members of the rnv3p LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - ISSN:1541- IP - DP - 2013 Jan 01 TI - COPD in the Working Age Population: The Economic Impact on Both Patients and Government PG - 1-11 AB - Objectives: To explore the full economic impact, on both patients and government, as a result of COPD in the working age population. Methods: The economic impact of COPD due to medical treatment, impaired productivity and early retirement was assessed in a cross sectional cost analysis of the Dutch COPD population aged 45–64 years. The costing year was 2009 and input parameters were derived from both national data sources and the international COPD uncovered survey. Results: While direct medical costs for COPD patients of working age were relatively low (€91 million), the amount of lost productivity (income) due to early retirement (€223 mill on) exceeded over two times their medical costs. In addition, costs for the government were considerable because of lost tax revenues (€77 million) and COPD related disability pensions paid (€180 million). Apart from lost productivity due to early retirement, costs due to impaired productivity for working COPD patients were €63 million. Conclusions: The costs of COPD for both patients of working age as for the government were considerable, making this population a priority for prevention and intervention programs of healthcare providers, employers and government. AU - van Boven JFM AU - Vegter S AU - der van Molen T AU - Postma MJ LA - PT - DEP - TA - COPD JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 8 IP - DP - 2013 Jan 01 TI - Diagnostic approach in cases with suspected work-related asthma PG - 17 AB - Background: Work-related asthma (WRA) is a major cause of respiratory disease in modern societies. The diagnosis and consequently an opportunity for prevention are often missed in practice. Methods: Based on recent studies and systematic reviews of the literature methods for detection of WRA and identification of specific causes of allergic WRA are discussed. Results and Conclusions: All workers should be asked whether symptoms improve on days away from work or on holidays. Positive answers should lead to further investigation. Spirometry and non-specific bronchial responsiveness should be measured, but carefully performed and validly analysed serial peak expiratory flow or forced expiratory volume in one second (FEV1) measurements are more specific and confirm occupational asthma in about 82% of those still exposed to the causative agent. Skin prick testing or specific immunoglobulin E assays are useful to document allergy to high molecular weight allergens. Specific inhalational challenge tests come closest to a gold standard test, but lack standardisation, availability and sensitivity. Supervised workplace challenges can be used when specific challenges are unavailable or the results non-diagnostic, but methodology lacks standardisation. Finally, if the diagnosis remains unclear a follow-up with serial measurements of FEV1 and non-specific bronchial hyperresponsiveness should detect those likely to develop permanent impairment from their occupational exposures. AU - Aasen TB AU - Burge PS AU - Henneberger PK AU - Schlünssen V AU - Baur X on behalf of the ERS Task Force LA - PT - DEP - TA - Journal of Occupational Medicine and Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Health surveillance for occupational respiratory disease PG - 322-340 AB - Background Occupational lung diseases remain common, and health surveillance is one approach used to assist identification of early cases. Aims To identify areas of good practice within respiratory health surveillance and to formulate recommendations for practice. Methods Published literature was searched since 1990 using a semi-systematic methodology. Results A total of 561 documents were identified on Medline and Embase combined. Other search engines did not identify relevant documents that had not already been identified by these two main searches. Seventy-nine of these were assessed further and 36 documents were included for the full analysis. Conclusions Respiratory health surveillance remains a disparate process, even within disease type. A standard validated questionnaire and associated guidance should be developed. Lung function testing was common and generally supported by the evidence. Cross-sectional interpretation of lung function in younger workers needs careful assessment in order to best identify early cases of disease. More informed interpretation of the forced expiratory volume in 1 s/forced vital capacity ratio, for example by using a lower limit of normal for each worker, and of longitudinal lung function information is advised. Immunological tests appear useful in small groups of workers exposed to common occupational allergens. Education, training and improved occupational health policies are likely to improve uptake of health surveillance, to ensure that those who fail health surveillance at any point are handled appropriately. AU - Lewis L AU - Fishwick D LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Occupational egg allergy in an embryological research facility PG - 348-353 AB - Background Hen and quail eggs are commonly used in embryological research. While immunoglobin E (IgE)-associated allergy to hens’ egg proteins is recognized in employees in the food industry, there are no previous reports from workers in embryological research. Two newly identified cases prompted us to examine the extent of this problem in a university laboratory. Aims To determine the prevalence and determinants of sensitization to egg among a group of workers in an embryological research laboratory. Methods Following the identification of egg sensitization in two research workers, we surveyed 116 employees from a single embryology research laboratory in 2005. Sensitization to egg was assessed by skin prick tests and/or specific IgE measurement and examined in relation to a number of potential determinants, including the extent of appropriate control measures. Results Four employees were sensitized to egg, each with digestive symptoms of egg allergy. All had worked directly with eggs, giving a prevalence of specific sensitization in that group of 6.1% (95% confidence interval (CI) [1.7%, 14.8%]). There was a statistically significant trend for those sensitized to report a shorter duration of exposure to eggs and less frequent use of hygiene control measures to reduce exposure. Conclusions Sensitization to eggs among those occupationally exposed to egg protein in research work occurs more commonly than in the general population. The presence of digestive symptoms after eating eggs may be indicative of sensitization to egg and should be incorporated into health evaluation of exposed workers. AU - Jones M AU - Skidmore A AU - Glozier N AU - Welch J AU - Hunter AS AU - Cullinan P LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Lung function in fragrance industry employees PG - 377-379 AB - Background Production employees in the UK fragrance industry are exposed to large numbers of chemical substances and mixtures. There is a lack of published literature describing the effects of occupational respiratory exposure in this industry. Aims To investigate whether occupational respiratory exposure to chemicals in the UK fragrance industry is linked to a statistically significant change in lung function as measured using spirometry. Methods A multi-site cross-sectional study in which five UK companies took part, comprising an exposed group (fragrance production and associated functions) and a control group (non-exposed industry employees, e.g. office staff). Spirometric measurements (forced expiratory volume in 1 second, forced vital capacity and peak expiratory flow) were taken pre- and post-shift. Participants provided information on potential confounding factors (smoking, history of respiratory problems and body mass index). Post-shift measurements were compared between groups, using analysis of covariance to adjust for the baseline pre-shift measurements. Results A total of 112 subjects participated: 60 in the exposed group and 52 in control group (response rate 33 and 24%, respectively). Adjusted mean differences in post-shift spirometric measurements between exposed and control groups were not statistically significant. Conclusions No significant effects were observed on the spirometric performance of the study population. This work is the first step in a novel area of research, and the industry would benefit from further such research. AU - Dix GR LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 86 IP - DP - 2013 Jan 01 TI - Is specific IgE antibody analysis feasible for the diagnosis of methylenediphenyl diisocyanate-induced occupational asthma? PG - 417-430 AB - Purpose Early recognition improves the prognosis of isocyanate asthma. A major unanswered question is whether IgE-dependent mechanisms are of diagnostic value? Our objective was to appraise serological methods using various methylenediphenyl diisocyanate (MDI)-albumin conjugates and weigh up the data versus the outcome of standardized comprehensive clinical diagnostics to evaluate the viability of immunological analysis in supportive MDI-asthma diagnosis (OAI). Methods Specific IgE (sIgE) and IgG (sIgG) binding was measured with fluorescence enzyme immunoassay in 43 study subjects (using conjugates prepared in-vapor, in-solution and commercial preparations). The differential clinical diagnosis included standardized measurement of pulmonary function, non-specific bronchial hyper-responsiveness, specific MDI-prick test (MDI-SPT) and specific inhalation challenge (MDI-SIC). Results Detailed diagnostic scheme allows the differential OAI and MDI-induced hypersensitivity pneumonitis (PI). The presumed OAI diagnoses were confirmed in 84 % (45 % cases having demonstrable sIgE antibodies) with RR 5.7, P > 0.001, when OAI diagnosis is correlated with MDI-SIC/MDI-SPT (RR 1.28 for MDI-SIC alone); sIgG antibodies were clinically relevant for PI and not for the OA diagnosis. MDI-specific IgE data generated with commercial ImmunoCAP preparations show high correlation with our in-vapor generated MDI conjugates. Conclusions Isocyanate-specific IgE antibodies are not always detectable but their presence is strongly predictive of OAI and supportive for the diagnosis. MDI-SPT can be a valuable parameter differentiating OAI and PI. We have confirmed and extended published data showing that isocyanate-albumin conjugates perform better in specific antibody assays when prepared with volatile phase formulations and would like to stress additionally the necessity for further refinements and standardization in clinical diagnostics procedures. AU - Budnik LT AU - Preisser AM AU - Permentier H AU - Baur X LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Agents and trends in health care workers’ occupational asthma PG - 513-516 AB - Background There is a disproportionately high number of cases of work-related asthma occurring in health care occupations due to agents such as glutaraldehyde, latex and cleaning products. Aims To understand the causes and measure trends over time of occupational asthma (OA) in health care workers (HCWs). Methods We reviewed OA notifications from the Midland Thoracic Society’s Surveillance Scheme of Occupational Asthma (SHIELD) database in the West Midlands, UK, from 1991 to 2011 and gathered data on occupation, causative agent and annual number of notifications. Results There were 182 cases of OA in HCWs (median annual notifications = 7; interquartile range [IQR] = 5–11), representing 5–19% of annual SHIELD notifications. The modal annual notification was 20 (in 1996); notifications have declined since then, in line with total SHIELD notifications. The majority of cases (136; 75%) occurred in nursing, operating theatre, endoscopy and radiology staff. The most frequently implicated agents were glutaraldehyde (n = 69), latex (n = 47) and cleaning products (n = 27), accounting for 79% of the 182 cases. Cleaning product-related OA was an emerging cause with 22 cases after 2001 and only 5 cases between 1991 and 2000. Conclusions Control measures within the UK National Health Service have seen a decline in OA in HCWs due to latex and glutaraldehyde, though OA remains a problem amongst HCWs exposed to cleaning products. Continuing efforts are required to limit the number of cases in this employment sector. AU - Walters GI AU - Moore VC AU - McGrath EE AU - Burge PS AU - Henneberger PK LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Prediction of obeche wood-induced asthma by specific skin prick testing PG - 429-431 AB - Background It has previously been shown that a positive skin prick test (SPT) result is a good predictor of a positive specific inhalation challenge (SIC) in patients with occupational asthma (OA) related to wheat or rye flours. This association has not been previously studied in OA attributable to obeche wood. Aims To describe a clinical series of patients with OA induced by obeche wood. To investigate if the SPT result can be used as a predictor for the outcome of SIC tests. Methods OA was diagnosed according to patient history, lung function examinations and SIC tests, as well as the determination of obeche SPTs. We analysed sensitivity, specificity and positive (PPV) and negative predictive values (NPV) at different wheal sizes of the SPTs and drew receiver-operating characteristic plots using the SIC test result as the gold standard. Results Obeche wood SIC tests were performed on 34 symptomatic workers. Of these, 27 workers had a positive test result and were diagnosed as having OA. The minimal cut-off value with a PPV of 100% was an SPT wheal of 3.5 mm from obeche wood. This means that all workers with a wheal size of =3.5 mm from obeche wood had a positive SIC. Conclusions Positive SPT results in symptomatic workers were good predictors of a positive SIC. SIC with obeche wood may be unnecessary in strongly sensitized workers. AU - Hannu T AU - Lindström I AU - Palmroos P AU - Kuuliala O AU - Sauni R LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Occupational management of type I latex allergy PG - 395-404 AB - Background Although the incidence of type 1 latex allergy has decreased in recent years with the introduction of powder-free low-protein (PFLP) latex gloves, type 1 latex allergy is still commonly found among workers who use natural rubber latex (NRL) gloves at work. Aims To elucidate the optimal management of workers with type 1 latex allergy whose work necessitates the use of NRL gloves in the workplace. Methods A sensitive electronic search of relevant bibliographic databases was performed with related search terms for articles from 1 January 1990 to 1 September 2010. Relevant abstracts were reviewed, and studies that furnished data on the management of type 1 latex allergy in the workplace were extracted. Articles for inclusion in the review were appraised using the Scottish Intercollegiate Guideline Network methodology. Results A total of 7041 abstracts were retrieved; 12 articles met the inclusion criteria for the review. We found moderately strong and consistent evidence that avoidance of NRL in the workplace reduces both symptoms and markers of sensitization in latex-allergic individuals. There is limited evidence that latex-allergic workers can continue to use PFLP gloves with no worsening of symptoms, provided that their co-workers also use PFLP latex or non-latex gloves. Conclusions Individuals with type 1 latex allergy whose work necessitates them wearing latex gloves may continue in their job provided that adjustments are made to ensure that they are not exposed to powdered latex gloves. AU - Madan I AU - Cullinan P AU - Ahmed SM LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Respiratory and dermal symptoms in Thai nurses using latex products PG - 425-428 AB - Background Despite known health risks related to the use of powdered latex gloves (PLGs), they are still widely used in hospitals in developing countries due to the high cost of alternatives. Aims To determine the prevalence of dermal and respiratory symptoms associated with latex glove use in nurses in Thailand and evaluate the influence of previously reported occupational risk factors in this population. Methods A cross-sectional study in female nurses working in three Thai hospitals. Participants completed a questionnaire on demographics, occupational and personal history, use of latex products at work and dermal and respiratory symptoms attributed to occupational use of latex gloves. Results Of 899 nurses, 18% reported health effects attributed to the use of latex products. After adjustment for confounding, occupational risk factors associated with increased reporting of dermal symptoms included wearing more than 15 pairs of PLG per day (odds ratio (OR): 2.10, 95% confidence interval (CI): [1.32–3.34]), using chlorhexidine (OR: 2.07, 95% CI: [1.22–3.52]) and being an operating theatre nurse (OR: 2.46, 95% CI: [1.47–4.12]). Being a labour ward nurse (OR: 3.52, 95% CI: [1.26–9.85]) was the only factor associated with increased reporting of respiratory symptoms. Conclusions Continuing use of PLGs in Thai nurses is associated with increased prevalence of dermal symptoms compared with data from developed countries. Measures to reduce such health effects are well established and should be considered. Additionally, replacement of chlorhexidine with an alternative detergent seems advisable. AU - Supapvanich C AU - Povey AC AU - de Vocht F LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Interstitial lung disease due to fumes from heat-cutting polymer rope PG - 451-453 AB - Interstitial lung disease (ILD) due to inhalation of fume/smoke from heating or burning of synthetic polymers has not been reported previously. A fish farm worker developed ILD after cutting rope (polypropylene and nylon) for about 2 hours per day over an extended period using an electrically heated ‘knife’. This process produced fume/smoke that entered the workers breathing zone. No other likely cause was identified. This case suggests that exposure to airborne contaminants generated by the heating or burning of synthetic polymers has the potential to cause serious lung disease. AU - Sharman P AU - Wood-Baker R LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 70 IP - DP - 2013 Jan 01 TI - Chronic obstructive pulmonary disease and longitudinal changes in pulmonary function due to occupational exposure to respirable quartz PG - 9-14 AB - Objectives The present study sought to examine the long-term effects of exposure to respirable quartz on pulmonary function with particular focus on chronic obstructive pulmonary disease (COPD). Methods The study is based on the Wismut cohort of former uranium miners. Spirometric data were ascertained together with quantitative estimates of cumulative exposure to respirable quartz for each of 1421 study subjects born between 1954 and 1956. The case definition for COPD is based on the criteria of the Global Initiative for Chronic Obstructive Lung Disease. Linear mixed regression models were fitted to identify significant determinants of longitudinal changes in lung function parameters. Results An average of five spirometries were available for each miner. It was shown that cumulative exposure to 1 mg/m3-year respirable quartz leads, on average, to a relative reduction in forced expiratory volume in 1 s/ orced vital capacity (FEV1/FVC) of 2.75% (p<0.001). A nested case–control approach demonstrated that the risk for COPD stage I increases with increasing cumulative exposure to respirable quartz (OR 1.81 per 1 mg/m3-year). Conclusions This paper adds further evidence on the long-term effects of exposure to respirable quartz, which include a decline in pulmonary function parameters and an increase in the incidence of COPD. AU - Möhner M AU - Kersten N AU - Gellissen J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 63 IP - DP - 2013 Jan 01 TI - Respiratory function and chemical exposures among female hairdressers in Palestine PG - 73-76 AB - Background Hairdressers are exposed to chemicals and work tasks that may cause respiratory symptoms. There is little awareness of occupational health among hairdressing salons in Palestine. Aims To characterize respiratory symptoms, lung function, and knowledge of exposure to hazards among female Palestinian hairdressers. Methods Cross-sectional study of female hairdressers and controls of female university students and staff. Working history and respiratory symptoms were collected using questionnaire. Lung function was measured. Working conditions were characterized in salons. Results A total of 170 hairdressers from 56 salons and 170 controls participated. Nineteen per cent of the hairdressers reported wheezing versus 11% in the control group. The mean forced vital capacity was 3.31 l compared with 3.42 l for controls. Adjusting for age and height, there was a forced expiratory volume in 1 s reduction of 0.093 l (95% confidence interval (CI) = 0.06–0.15) comparing hairdressers with controls. A small number of hairdressers used respiratory protective equipment, and satisfactory ventilation in salons were lacking. Conclusions Female hairdressers had higher prevalence of reported asthma and respiratory symptoms than the controls, but these differences reduced markedly when adjusted for age, height, weight and years of education. They had lower lung function measurements than the control group. Increasing the awareness of occupational health hazards and improving the work conditions for the hairdressers in Palestine is needed. Possible bias could be present as hairdressers might have over reported symptoms or lung function measurements might be affected by differences in socioeconomic status between the two groups. AU - Nemer M AU - Kristensen P AU - Nijem K AU - Bjertness E AU - Skogstad M LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 70 IP - DP - 2013 Jan 01 TI - Mortality in a cohort of Staffordshire pottery workers: follow-up to December 2008 PG - 149-155 AB - Objectives To examine mortality from lung cancer, chronic obstructive pulmonary disease (COPD) and chronic non-malignant renal disease (cNMRD) in pottery workers exposed to silica. Methods A cohort of Stoke-on-Trent pottery workers (N=5115), previously followed to 1992, was traced for vital status and cause of death to December 2008. Standardised mortality ratio (SMR) analyses, comparing deaths to England and Wales and Stoke-on-Trent, examined underlying cause in 1985–1992 and 1993–2008 and mentioned cause for 1993–2008. Survival analysis considered exposure duration and concentration of respirable silica for lung cancer, COPD and cNMRD, using Cox regression. Results Excess risks of lung cancer, COPD and cNMRD were seen against both England and Wales and Stoke-on-Trent for 1985–2008. SMRs for lung cancer and COPD were lower in 1993–2008 and non-significant for lung cancer against Stoke-on-Trent in that period (SMR 1.07 95% CI 0.92 to 1.25). Exposure concentration, estimated for 1943 subjects, was related to lung cancer in smokers for early but not later deaths with mean silica concentration >200 µg/m3 among deaths to June 1992 (HR 2.80 95% CI 1.21 to 6.50). For COPD an increasing trend with duration and (non-significantly) with mean concentration was seen for early but not later deaths in smokers. No relation was observed between estimated exposures and cNMRD. Conclusions Excess rates of death from COPD and lung cancer were more marked in the period of the first follow-up (1985–1992) than in the second, with any relation to estimated exposure being limited to the earlier period. Conclusions about COPD and exposure were limited by an early selective destruction of files. AU - Cherry N AU - Harris J AU - McDonald C AU - Turner S AU - NewmanTaylor A AU - Cullinan P LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 70 IP - DP - 2013 Jan 01 TI - Pattern and predictors for respiratory illnesses and symptoms and lung function among textile workers in Karachi, Pakistan PG - 99-107 AB - Objectives To determine pattern and predictors for respiratory illnesses and symptoms and lung function among textile workers in Karachi, Pakistan. Methods This was a cross-sectional survey of 372 adult male textile workers from the spinning and weaving sections of 15 textile mills from Karachi. Data were collected from November to December 2009 through a structured, pretested questionnaire and spirometry. Results Prevalence of byssinosis was 10.5%, chronic cough 7.5%, chronic phlegm 12.9%, wheeze with shortness of breath 22.3%, shortness of breath (grade 2) 21%, chest tightness ever 33.3%; whereas, a low prevalence of asthma (4%) was identified in this population. Eight per cent had obstructive, 8% restrictive and 2% mixed pattern of lung function abnormality. After controlling for potential confounders, work in the spinning section predicts frequent wheeze (AOR=2.0; 95% CI 1.1 to 3.5), wheeze with shortness of breath (AOR=1.8; 95% CI 1.0 to 3.4), and obstructive pattern on spirometry (AOR=2.5; 95% CI 1.0 to 6.2). Prolonged duration of work predicts breathlessness grade 1 (AOR=1.8; 95% CI 1.0 to 3.1) and grade 2 (AOR=2.7; 95% CI 1.3 to 5.4), as well as decrements in Forced Expiratory Volume in the first second (FEV1) and FEV1/Forced Vital Capacity ratio. Lack of education predicts frequent wheeze (AOR=2.0; 95% CI 1.2 to 3.3), and Sindhi ethnicity predicts chest tightness apart from during cold (AOR=2.7; 95% CI 1.1 to 6.6). Conclusions This study highlights the burden of respiratory illnesses and symptoms, and a low prevalence of asthma among textile workers in Karachi. Work in the spinning section, lack of education, prolonged duration of work and Sindhi ethnicity, were identified as important risk factors. AU - Nafees AA AU - Fatmi Z AU - Kadir MM AU - Sathiakumar N LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 70 IP - DP - 2013 Jan 01 TI - Cross-shift and longitudinal changes in FEV1 among wood dust exposed workers PG - 22-28 AB - Objectives Acute lung function (LF) changes might predict an accelerated decline in LF. In this study, we investigated the association between cross-shift and longitudinal changes in forced expiratory volume in 1 s (FEV1) among woodworkers in a 6-year follow-up study. Methods 817 woodworkers and 136 controls participated with cross-shift changes of FEV1 at baseline and FEV1 and forced vital capacity at follow-up. Height and weight were measured and questionnaire information on respiratory symptoms, employment and smoking habits was collected. Wood dust exposure was assessed from 3572 personal dust measurements at baseline and follow-up. Cumulative wood dust exposure was assessed by a study-specific job exposure matrix and exposure time. Results The median (range) of inhalable dust at baseline and cumulative wood dust exposure was 1.0 (0.2–9.8) mg/m3 and 3.8 (0–7.1) mg year/m3, respectively. Mean (SD) for %?FEV1/workday and ?FEV1/year was 0.2 (6.0)%, and -29.1 (41.8) ml. Linear regression models adjusting for smoking, age, height and weight change showed no association between cross-shift and annual change in FEV1 among woodworkers or controls. Including different exposure estimates, atopy or cross-shift change dichotomised or as quartiles did not change the results. Conclusions This study among workers exposed to low levels of wood dust does not support an association between acute LF changes and accelerated LF decline. AU - Jacobsen GH AU - Schlünssen V AU - Schaumburg I AU - Sigsgaard T LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 131 IP - DP - 2013 Jan 01 TI - Work-exacerbated asthma and occupational asthma: Do they really differ? PG - 704-710 AB - Background Although work-exacerbated asthma (WEA) is a prevalent condition likely to have an important societal burden, there are limited data on this condition. Objectives The aims of this study were (1) to compare the clinical, functional, and inflammatory characteristics of workers with WEA and occupational asthma (OA) and (2) compare health care use and related costs between workers with WEA and OA, as well as between workers with work-related asthma (WRA; ie, WEA plus OA) and those with non–work-related asthma (NWRA) in a prospective study. Methods We performed a prospective observational study of workers with and without WRA with a 2-year follow-up. The diagnosis of OA and WEA was based on the positivity and negativity of results on specific inhalation challenges, respectively. Results One hundred fifty-four subjects were enrolled: 53 with WEA, 68 with OA, and 33 control asthmatic subjects (NWRA). WEA was associated with more frequent prescriptions of inhaled corticosteroids (odds ratio [OR], 4.4; 95% CI, 1.4-13.6; P = .009), a noneosinophilic phenotype (OR, 0.3; 95% CI, 0.1-0.9; P = .04), a trend toward a lower FEV1 (OR, 0.9; 95% CI, 0.9-1.0; P = .06), and a higher proportion of smokers (OR, 2.5; 95% CI, 0.96-9.7; P = .06) than the diagnosis of OA. The health care use of WRA and related costs were 10-fold higher than those of NWRA. Conclusion Workers with WEA appeared to have features of greater asthma severity than workers with OA. In contrast with OA, WEA was associated with a noneosinophilic phenotype. Both OA and WEA were associated with greater health care use and 10-fold higher direct costs than NWRA. AU - Lemière C AU - Boulet L AU - Chaboillez S AU - Forget A AU - Chiry S AU - Villeneuve H AU - Prince P AU - Maghni K AU - Kennedy WA AU - Blais L LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 68 IP - DP - 2013 Jan 01 TI - Asthma and occupation in the 1958 birth cohort PG - 365-371 AB - Objective To examine the association of adult onset asthma with lifetime exposure to occupations and occupational exposures. Methods We generated lifetime occupational histories for 9488 members of the British 1958 birth cohort up to age 42 years. Blind to asthma status, jobs were coded to the International Standard Classification of Occupations 1988 and an Asthma Specific Job Exposure Matrix (ASJEM) with an expert re-evaluation step. Associations of jobs and ASJEM exposures with adult onset asthma were assessed in logistic regression models adjusting for sex, smoking, social class at birth and childhood hay fever. Results Of the 7406 cohort members with no asthma or wheezy bronchitis in childhood, 639 (9%) reported asthma by age 42 years. Adult onset asthma was associated with 18 occupations, many previously identified as risks for asthma (eg, farmers: OR 4.26, 95% CI 2.06 to 8.80; hairdressers: OR 1.88, 95% CI 1.24 to 2.85; printing workers: OR 3.04, 95% CI 1.49 to 6.18). Four were cleaning occupations and a further three occupations were likely to use cleaning agents. Adult onset asthma was associated with five of the 18 high-risk specific ASJEM exposures (flour exposure: OR 2.12, 95% CI 1.17 to 3.85; enzyme exposure: OR 2.32, 95% CI 1.22 to 4.42; cleaning/disinfecting products: OR 1.67, 95% CI 1.26 to 2.22; metal and metal fumes: OR 1.45, 95% CI 1.02 to 2.07; textile production: OR 1.71, 95% CI 1.12 to 2.61). Approximately 16% (95% CI 3.8% to 27.1%) of adult onset asthma was associated with known asthmagenic occupational exposures. Conclusions This study suggests that about 16% of adult onset asthma in British adults born in the late 1950s could be due to occupational exposures, mainly recognised high-risk exposures. WA AU - Ghosh RE AU - Cullinan P AU - Fishwick D AU - Hoyle J AU - Warburton CJ AU - Strachan DP AU - Butland BK AU - Jarvis D LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 70 IP - DP - 2013 Jan 01 TI - Obliterative bronchiolitis in fibreglass workers: a new occupational disease? PG - 357-359 AB - Rationale and objectives Obliterative bronchiolitis (OB) is a rare disease with a small number of established occupational aetiologies. We describe a case series of severe OB in workers making glass-reinforced plastics. Methods Workplace exposures were the likely cause after the independent diagnosis of OB in two workers laying up the fibreglass hulls of yachts; the second worker took over the job of the first after he left following a lung transplant. Presentation of these two cases at international meetings led to others identifying similar workers. Main results We identified six workers with good evidence of OB. All were involved in preparing fibreglass with styrene resins, five as boat builders laying up fibreglass hulls and one during cooling-tower fabrication. The disease came on rapidly without unusual acute exposures. Two patients had lung transplants, while another died while waiting for one. Histology confirmed OB in the four with biopsies/post-mortem examinations or explanted lungs. Conclusions A rare, potentially fatal disease occurring in six workers laying up fibreglass with styrene resins from five different worksites suggests that work exposures were the cause of their OB. The precise agent responsible awaits identification. AU - Cullinan P AU - McGavin CR AU - Kreiss K AU - Nicholson AG AU - Maher TM AU - Howell T AU - Banks J AU - Newman Taylor AJ AU - Chen C-H AU - Tsai P-J AU - Shih T-S AU - Burge PS LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 70 IP - DP - 2013 Jan 01 TI - Sensitisation to cereal flour allergens is a major determinant of elevated exhaled nitric oxide in bakers PG - 310-316 AB - Objective Various studies of the usefulness of fractional exhaled nitric oxide (FeNO) in occupational settings remain inconclusive. The objective was to investigate the determinants of increased FeNO in bakery workers. Methods A cross-sectional study of 424 supermarket bakery workers used a questionnaire and serum specific IgE to wheat, rye and a-amylase. FeNO during the work shift were assessed using a hand-held portable sampling device (NIOX MINO). Results The median FeNO was 15 ppb, in atopics 21 ppb and current smokers 12 ppb. Increased FeNO was strongly associated with IgE to wheat independent of smoking and atopy status. In the multivariate model, IgE to wheat, current smoking, atopy and age were significantly associated with FeNO. Stratified analysis in a subgroup of atopic non-smokers demonstrated the strongest relationship between FeNO and various clinical endpoint such as wheat (OR=9.43) or rye (OR=11.76) sensitisation, work-related allergic rhinitis (OR=8.13) or asthma (OR=5.44), and probable baker's asthma (OR=6.72). Conclusions Sensitisation to cereal flour allergens rather than asthma symptoms is a major determinant of elevated FeNO among bakers. This relationship is modified by atopy and current smoking status. AU - Baatjies R AU - Jeebhay MF LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 68 IP - DP - 2013 Jan 01 TI - Evaluation of commercial skin prick test solutions for selected occupational allergens PG - 651-658 AB - Background Skin prick testing (SPT) is an important step in the diagnosis of IgE-mediated occupational allergic diseases. The outcome of SPT is related to the quality of allergen extracts. Thus, the aim of the study was to assess different commercially available SPT solutions for selected occupational allergens. Methods SPT was performed in 116 bakers, 47 farmers and 33 subjects exposed to natural rubber latex (NRL), all with work-related allergic symptoms. The SPT solutions from different manufacturers (n = 3–5) for wheat flour, rye flour, soy, cow hair/dander, storage mites (Tyrophagus putrescentiae, Lepidoglyphus destructor, Acarus siro) and NRL were analysed with respect to their protein and antigen contents. SPT was carried out in 16 allergy centres in six European countries using standardized procedures. Specific IgE values were used as the gold standard to calculate the sensitivity and specificity of SPT solutions. The optimal cut-point for each SPT solution was determined by Youden Index. Results Protein and antigen contents and patterns of the SPT solutions varied remarkably depending on the manufacturer. While SPT solutions for wheat flour and soy reached overall low sensitivities, sensitivities of other tested SPT solutions depended on the manufacturer. As a rule, solutions with higher protein and antigen content showed higher sensitivities and test efficiencies. Conclusions There is a wide variability of SPT solutions for occupational allergens, and the sensitivity of several solutions is low. Thus, improvement and standardization of SPT solutions for occupational allergens is essential. AU - van Kampen V AU - de Blay F AU - Folletti I AU - Kobierski P AU - Moscato G AU - Olivieri M AU - Quirce S AU - Sastre J AU - Walusiak-Skorupa J AU - Kotschy-Lang N AU - Müsken H AU - Mahler V AU - Schliemann S AU - Ochmann U AU - Sültz J AU - Worm M AU - Sander I AU - Zahradnik E AU - Brüning T AU - Merget R AU - Raulf-Heimsoth M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 143 IP - DP - 2013 Jan 01 TI - Incidence of Severe Asthmatic Reactions After Challenge Exposure to Occupational Agents PG - 1261-1268 AB - Background: Specific inhalation challenges (SICs) with occupational agents are used to establish the diagnosis and etiology of occupational asthma. The aim of this study was to assess the frequency and determinants of severe asthmatic reactions induced by various occupational agents during SICs performed using realistic methods of exposure. Methods: The SIC records of 335 consecutive subjects with a positive SIC (ie, = 20% fall in FEV1) due to various occupational agents were reviewed. Asthmatic reactions were graded as moderate when requiring repeated administration of an inhaled short-acting ß2-agonist (SABA) and severe when requiring repeated SABA and systemic corticosteroids. Results: Overall, 68 of the 335 subjects (20%) required an inhaled SABA during the SICs. The multivariate logistic regression analysis showed that the need for an inhaled SABA increased when the SIC involved a low-molecular-weight agent (LMW) (OR, 2.47; 95% CI, 1.43-4.28) and marginally so when the subjects required regular treatment with an inhaled corticosteroid (OR, 1.62; 95% CI, 0.93-2.80). The severity of asthmatic reactions was graded as moderate in 12% and severe in 3% of the subjects. Of the 10 severe reactions, five developed after exposures = 5 min. Multivariate logistic regression analysis showed that challenging subjects with a LMW agent was the only significant determinant for the development of moderate/severe reactions (OR, 3.05; 95% CI, 1.62-5.73). Conclusions: Challenges with LMW agents are associated with a higher risk of an asthmatic reaction requiring pharmacologic treatment. This study may provide useful guidelines for further improving the safety of SICs. AU - Vandenplas O AU - D'Alpaos V AU - Evrard G AU - Jamart J LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 68 IP - DP - 2013 Jan 01 TI - GOLD classifications and mortality in chronic obstructive pulmonary disease: the HUNT Study, Norway PG - 914-921 AB - Background How different Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifications of chronic obstructive pulmonary disease (COPD) predict mortality is unclear. Objective To examine the association of spirometric GOLD grades and the new ABCD groups with mortality, and to compare their informativeness in relation to mortality. Methods We studied 1540 people with post-bronchodilator COPD who participated in the Norwegian Nord-Trøndelag Health Study 1995–1997 and were followed up on all-cause mortality until May 2012. The associations of spirometric GOLD grades and ABCD groups with mortality were estimated by sex specific adjusted HRs from Cox regression and standardised mortality ratios. To assess the informativeness of spirometric GOLD grades and ABCD groups at predicting mortality we used the difference in twice the log-likelihood of a Cox regression model with and without each COPD classification. Results The distribution of participants was 28% in GOLD 1, 57% in GOLD 2, 13% in GOLD 3 and 2% in GOLD 4, in contrast to 61% in group A, 18% in group B, 12% in group C and 10% in group D. During a median of 14.6 years of follow-up, 837 people (54%) died. Mortality increased gradually from GOLD 1 to 4, while it was generally similar in groups A and B, and in groups C and D. Spirometric GOLD grades were substantially more informative than ABCD groups at predicting mortality. Conclusions Spirometric GOLD grades predicted mortality better than the new ABCD groups among people with COPD from a Norwegian general population. AU - Leivseth L AU - Brumpton BM AU - Nilsen TIL AU - Mai X AU - Johnsen R AU - Langhamme A LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 17 IP - DP - 2013 Jan 01 TI - The role of surgical lung biopsy in the management of interstitial lung disease: experience from a single institution in the UK PG - 253-257 AB - OBJECTIVES: Interstitial lung disease (ILD) includes a wide spectrum of pulmonary pathologies. The role of surgical lung biopsy (SLB) in the diagnosis of ILD is still controversial. The purpose of this study was to ascertain whether SLB is worthwhile in the management of ILD. METHODS: One hundred and three patients underwent SLB for ILD from April 2008 to March 2010 at a single institution. Outcomes included patient demographics, preoperative investigations, preoperative diagnosis and treatment, surgical approach, number and site of biopsies, complications, length of postoperative stay and postoperative pathological diagnosis and treatment. RESULTS: Fifty-one (49.6%) patients were male and 52 (50.4%) were female. The median age was 58 (range 26–78). Major complications were seen in 7 patients (6.8%). Five patients (4.9%) died within 30 days following surgery. Definitive pathological diagnosis (DPD) was reached in 72 (69.9%) patients, whereas no DPD was achieved in 31 (30.1%). Within the group of patients who received DPD, this differed from the clinical diagnosis in 53 patients (51.5%), and was concordant in 19 (18.4%). The DPD was helpful in guiding the management of 47 patients (45.6%), who had a change in their treatment following the procedure. The median hospital stay was 4 days (range 2–42 days). CONCLUSIONS: SLB is a well-recognized procedure. Although it provides a diagnosis for the majority of patients, in our series SLB was inconclusive in a considerable number of cases and did not lead to a therapeutic change for more than half of all patients. Furthermore, SLB is not without risk and can be associated with a prolonged hospital stay. We believe that SLB should be performed in a select group of patients with ILD after discussion by a multidisciplinary panel. AU - Blackhalla V AU - Asifa M AU - Renierib A AU - Civitellib S AU - Kirka A AU - Jilaihawia A AU - Granatoa F LA - PT - DEP - TA - Interactive CardioVascular and Thoracic Surgery JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - CG163 IP - DP - 2013 Jan 01 TI - Idiopathic pulmonary fibrosis: The diagnosis and management of suspected idiopathic pulmonary fibrosis PG - - AB - Diagnosis Diagnose idiopathic pulmonary fibrosis only with the consensus of the multidisciplinary team (listed in table 1), based on: the clinical features, lung function and radiological findings (see recommendation 1.2.1); pathology when indicated (see recommendation 1.2.4); Table 1 Minimum composition of multidisciplinary team involved in diagnosing idiopathic pulmonary fibrosis Stage of diagnostic care pathway Multidisciplinary team composition (all healthcare professionals should have expertise in interstitial lung disease) After clinical evaluation, baseline lung function and CT Consultant respiratory physician Consultant radiologist Interstitial lung disease specialist nurse Multidisciplinary team coordinator When considering performing bronchoalveolar lavage, and/or transbronchial biopsy or surgical lung biopsy Only some patients will have bronchoalveolar lavage or transbronchial biopsy but they may be being considered for surgical lung biopsy Consultant respiratory physician Consultant radiologist Consultant histopathologist Thoracic surgeon as appropriate Interstitial lung disease specialist nurse Multidisciplinary team coordinator When considering results of bronchoalveolar lavage, transbronchial biopsy or surgical lung biopsy Consultant respiratory physician Consultant radiologist Consultant histopathologist Interstitial lung disease specialist nurse Multidisciplinary team coordinator AU - NICE guidelines LA - PT - DEP - TA - NICE guidance JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 25 IP - DP - 2013 Jan 01 TI - A Case of Occupational Asthma in a Plastic Injection Process Worker PG - 25 AB - Objectives We report a case of death due to asthma attack in a plastic injection process worker with a history of asthma. Methods To assess task relevance, personal history including occupational history and medical records were reviewed. Samples of the substances utilized in the injection process were collected by visiting the patient’s workplace. The work environment with the actual process was reproduced in the laboratory, and the released substances were evaluated. Results The medical records confirmed that the patient’s conventional asthma was in remission. The analysis of the resins discharged from the injection process simulation revealed styrene, which causes occupational asthma, and benzenepropanoic acid, 3,5-bis(1,1-dimethylethyl)-4-hydroxy-, and octadecyl ester. Even though it was not the case in the present study, various harmful substances capable of inducing asthma such as formaldehyde, acrolein, and acetic acid are released during resin processing. Conclusion A worker was likely to occur occupational asthma as a result of the exposure to the harmful substances generated during the plastic injection process. AU - Lee JS AU - Kwak HS AU - Choi BS AU - Park SY LA - PT - DEP - TA - Annals of Occupational and Environmental Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 0 IP - DP - 2013 Jan 01 TI - Riot control agents: the tear gases CN, CS and OC—a medical review PG - 1-6 AB - Introduction 2-Chloroacetophenone (CN), o-chlorobenzylidene malonitrile (CS) and oleoresin capsicum (OC) are common riot control agents. While serious systemic effects are uncommon, exposure to high concentrations may lead to severe complications and even death. The aim of this narrative review is to summarise all main aspects of the riot control agents CN, CS and OC toxicology, including mechanisms of toxicity, clinical features and management. Methods OVID MEDLINE and ISI Web of Science were searched for terms associated with CN, CS and OC toxicity in humans and those describing the mechanism of action, clinical features and treatment protocols. Results CN, CS and OC are effective lacrimating agents; evidence for toxicity, as measured by the threshold for irritation, is greatest for CN, followed by CS and OC. Typically, ocular and respiratory tract irritation occurs within 20–60 s of exposure. Ocular effects involve blepharospasm, photophobia, conjunctivitis and periorbital oedema. Following inhalation, effects may include a stinging or burning sensation in the nose, tight chest, sore throat, coughing, dyspnoea and difficulty breathing. Dermal outcomes are variable, more severe for CN and include dermal irritation, bulla formation and subcutaneous oedema. Removal from the contaminated area and fresh air is a priority. There is no antidote; treatment consists of thorough decontamination and symptom-directed supportive care. Ocular exposure requires thorough eye decontamination, an eye exam and appropriate pain management. Monitoring and support of respiratory function is important in patients with significant respiratory symptoms. Standard treatment protocols may be required with patients with pre-existing respiratory conditions. Dermal exposures may require systemic steroids for patients who develop delayed contact dermatitis. Conclusions CN, CS and OC are effective riot control agents. In the majority of exposures, significant clinical effects are not anticipated. The irritant effects can be minimised both by rapid evacuation from sites of exposure, decontamination and appropriate supportive care. AU - Schep LJ AU - Slaughter RJ AU - McBride DI LA - PT - DEP - TA - J R Army Med Corps JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 2 IP - DP - 2013 Jan 01 TI - Thiocyanate Blood Levels in Chlorobenzylidenemalononitrile (CS) Riot Control Gas Patients; the Egyptian Experience PG - 1-5 AB - This study aims to clarify the systemic toxic effects of chlorobenzylidenemalononitrile (CS) and to confirm or reject the possibility of cyanide intoxication on the exposed patients. The study was conducted in PCC Ain Shams University, on exposed rioters during the November 2011 demonstrations to CS gas in Cairo. Control groups included light and moderate to heavy smokers as well as non-smokers. Plasma thiocyanate, the metabolite of cyanide was assayed in all groups. Plasma thiocyanate of victims of CS exposed gas showed no significant differences from light smoker volunteers and was not significantly different when followed up after 2 weeks. Clinical and laboratory workup did not detect any of the evidence pertaining to cyanide poisoning. No fatality was recorded in the studied series. It is concluded that transient exposure of street rioters to CS gas (2.8 minutes average) in open air, hence with limited J Forensic Toxicol Pharmacol 2:1. doi:10.4172/2325-9841.1000104 AU - El-Masry MK AU - Azim SA LA - PT - DEP - TA - J Forensic Toxicol Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 22 IP - DP - 2013 Jan 01 TI - Hot tub lung: an occupational hazard PG - 88-90 AB - Hot tub baths have become increasingly common in residences as well as hotels and spa facilities. Recently, such baths have been associated with an emerging disorder known as hot tub lung (HTL). HTL is a diffuse granulomatous lung disease caused by inhalation of water aerosol containing non-tuberculous mycobacteria (NTM), in most cases belonging to the Mycobacterium avium complex [1]. Here, we report a cluster of confirmed, probable and possible HTL with occupational associations. To our knowledge, case 1 is the first confirmed case of occupational HTL in the literature AU - Fjällbrant H AU - Akerstrom M AU - Svensson E AU - Andersson E LA - PT - DEP - TA - Eur Respir Rev JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 13 IP - DP - 2013 Jan 01 TI - The use of specific inhalation challenge in hypersensitivity pneumonitis PG - 151-158 AB - Purpose of review: The diagnosis of hypersensitivity pneumonitis remains a dilemma because of the absence of any characteristic features able to distinguish it from other interstitial lung diseases. We analyze the current role of the specific inhalation challenge (SIC) in the diagnosis of this entity. Recent findings: Few descriptions of the use of SIC for the diagnosis of hypersensitivity pneumonitis have been published in recent years. In fact, hypersensitivity pneumonitis is still diagnosed on the basis of clinical criteria, as there is no agreement on the diagnostic utility of SIC. Two major reviews carried out in the past year have concluded that this test is not standardized and is usually unnecessary; however, a third study found that the test can indeed recreate the symptoms and functional abnormalities in the laboratory, and may therefore be of considerable use in the diagnosis of hypersensitivity pneumonitis. Hypersensitivity pneumonitis remains a diagnostic challenge. Given that the main cause of the disease is sensitization and hyper-responsiveness to specific antigens in susceptible individuals, SIC is an obvious candidate as the gold standard for diagnosis of this entity. The present review analyzes the reasons for the test's limited use, assesses its diagnostic utility, and proposes a basis for its standardization. AU - Munoz X AU - Morell F AU - Cruz MJ LA - PT - DEP - TA - Current Opinion in Allergy & Clinical Immunology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 56 IP - DP - 2013 Jan 01 TI - Investigation of Respiratory and Dermal Symptoms Associated with Metal Working Fluids at an Aircraft Engine Manufacturing Facility PG - 1394-1401 AB - Background Each year, 1.2 million metalworkers are exposed to metalworking fluids (MWFs), which can cause dermal and respiratory disease. The National Institute for Occupational Safety and Health (NIOSH) conducted a health hazard evaluation of MWF exposures at an aircraft engine manufacturing facility. The objectives were to determine employee exposures to endotoxin and MWFs in the air, characterize symptoms experienced by employees working with MWFs, compare them to symptoms of employees unexposed to MWFs, and make recommendations for reducing exposures based on results. Methods 407 workers were categorized as MWF exposed or MWF unexposed and completed questionnaires. Estimated prevalence ratios (PR) of dermatitis, asthma, and work-related asthma (WRA) symptoms were calculated. Airborne concentrations of MWF and endotoxin were measured, and work practices observed. Results MWF exposed workers had a significantly higher prevalence of dermatitis on wrists/forearms (PR 2.59; 95% CI 1.22, 5.46), asthma symptoms (PR 1.49; 95% CI 1.05, 2.13) and WRA symptoms (PR 2.10; 95% CI 1.22, 3.30) than unexposed workers. Airborne concentrations of MWF were below the NIOSH recommended exposure limit (REL) for MWF aerosols (thoracic particulate mass). Conclusions Despite MWF exposures below the NIOSH REL, exposed workers had a higher prevalence of asthma, WRA, and dermatitis symptoms than unexposed workers. Recommendations to reduce exposure included configuring mist collectors to automatically turn on when the machine is in use, and enforcing enclosure use. AU - Meza F AU - Chen C AU - Hudson N LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 8 IP - DP - 2013 Jan 01 TI - Airway Symptoms and Biological Markers in Nasal Lavage Fluid in Subjects Exposed to Metalworking Fluids PG - e83089. AB - Background Occurrence of airway irritation among industrial metal workers was investigated. The aims were to study the association between exposures from water-based metal working fluids (MWF) and the health outcome among the personnel, to assess potential effects on the proteome in nasal mucous membranes, and evaluate preventive actions. Methods The prevalence of airway symptoms related to work were examined among 271 metalworkers exposed to MWF and 24 metal workers not exposed to MWF at the same factory. At the same time, air levels of potentially harmful substances (oil mist, morpholine, monoethanolamine, formaldehyde) generated from MWF was measured. Nasal lavage fluid was collected from 13 workers and 15 controls and protein profiles were determined by a proteomic approach. Results Airway symptoms were reported in 39% of the workers exposed to MWF although the measured levels of MWF substances in the work place air were low. Highest prevalence was found among workers handling the MWF machines but also those working in the same hall were affected. Improvement of the ventilation to reduce MWF exposure lowered the prevalence of airway problems. Protein profiling showed significantly higher levels of S100-A9 and lower levels of SPLUNC1, cystatin SN, Ig J and ß2-microglobulin among workers with airway symptoms. Conclusions This study confirms that upper airway symptoms among metal workers are a common problem and despite low levels of MWF-generated substances, effects on airway immune proteins are found. Further studies to clarify the role of specific MWF components in connection to airway inflammation and the identified biological markers are warranted. AU - Fornander L AU - Graff P AU - Wåhlén K AU - Wåhlén K AU - Flodin U AU - Leanderson P AU - Lindahl M AU - Ghafouri B LA - PT - DEP - TA - Plos One JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 788 IP - DP - 2013 Jan 01 TI - Hypersensitivity Pneumonitis due to Metalworking Fluids: How to Find the Antigens PG - 335-340 AB - Most surveys of outbreaks of hypersensitivity pneumonitis (HP) in subjects with occupational exposure to water-based metalworking fluids (MWFs) were unable to detect a clear link between symptoms and the precise causative agents. We studied the case of a male 41-year-old industrial knife grinder with exposure to water-based MWFs since 12 years. The diagnosis of HP was made by typical work-related symptoms, the demonstration of high lymphocyte numbers in bronchoalveolar lavage and elevated IgG antibody concentrations to various molds in the patient’s serum, and complete recovery after early exposure cessation. Whereas an environmental survey showed only low numbers of mold contamination in one sump sample, high antigenic activity was demonstrated in the same sample by antigen-specific IgG inhibition tests. We conclude that the detection of antigenic molds in water-based MWFs by culture methods may be limited. The link between occupational exposure to specific molds in MWFs and hypersensitivity pneumonitis can be established by the demonstration of antigenic activity by antigen-specific IgG inhibition tests. AU - Merget R AU - Sander I AU - van Kampen V AU - Raulf-Heimsoth M AU - Rabente T AU - Kolk A AU - Brüning T LA - PT - DEP - TA - Neurobiology of respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 187 IP - DP - 2013 Jan 01 TI - An Official American Thoracic Society Clinical Practice Guideline: Exercise-induced Bronchoconstriction PG - 1016-1027 AB - Diagnosis The diagnosis of EIB is established by changes in lung function provoked by exercise, not on the basis of symptoms. Serial lung function measurements after a specific exercise or hyperpnea challenge are used to determine if EIB is present and to quantify the severity of the disorder. It is preferable to assess FEV1, because this measurement has better repeatability and is more discriminating than peak expiratory flow rate. The airway response is expressed as the percent fall in FEV1 from the baseline value. The difference between the pre-exercise FEV1 value and the lowest FEV1 value recorded within 30 minutes after exercise is expressed as a percentage of the pre-exercise value. The criterion for the percent fall in FEV1 used to diagnose EIB is >10%. The severity of EIB can be graded as mild, moderate, or severe if the percent fall in FEV1 from the pre-exercise level is >10% but <25%, >25% but <50%, and >50%, respectively. A number of surrogates for exercise testing have been developed that may be easier to implement than exercise challenge. These surrogates include eucapnic voluntary hyperpnea or hyperventilation, hyperosmolar aerosols, including 4.5% saline, and dry powder mannitol. AU - Parsons JP AU - Hallstrand TS AU - Mastronarde JG AU - Kaminsky DA AU - Rundell KW AU - Hull JH AU - Storms WW AU - Weiler JM AU - Cheek FM AU - Wilson KC AU - and Anderson SD LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 9 IP - DP - 2013 Jan 01 TI - The Global Lung Function Initiative: dispelling some myths of lung function test interpretation PG - 463-474 AB - Lung function results can help with establishing a diagnosis, with assessment of treatment effects and with making a prognosis. However, arbitrary differences in the way lung function is expressed and interpreted may result in mismanagement of patients as well as hindering our understanding of the global burden of lung disease. In this article, we summarise the Global Lung Function Initiative spirometry reference equations and dispel some common myths related to the use and interpretation of spirometry results. AU - Stanojevic S AU - Quanjer P AU - Miller MR AU - Stocks J LA - PT - DEP - TA - Breathe JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20130101 IS - IS - VI - 175 IP - DP - 2013 Jan 01 TI - Delayed asthma bronchiale due to epoxy resin PG - 2643-2644 AB - Epoxy resin is a low molecular weight agent, which can cause both acute and delayed allergic reactions. However, it is known causing skin reactions with direct or airborne contact. Rarely it can cause airway reactions like asthma bronchiale. We describe a case of a windmill worker who developed delayed asthma bronchiale due to airborne contact with epoxy resin. AU - Authried G1 AU - Al-Asadi H AU - Møller U AU - Sherson DL LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 7 IP - DP - 2012 Jan 01 TI - Residential Dampness and Molds and the Risk of Developing Asthma: A Systematic Review and Meta-Analysis PG - e47526 AB - Context Studies from different geographical regions have assessed the relations between indoor dampness and mold problems and the risk of asthma, but the evidence has been inconclusive. Objective To assess the relations between indicators of indoor dampness and mold problems and the risk of developing new asthma, and to investigate whether such relations differ according to the type of exposure. Data sources A systematic literature search of PubMed database from 1990 through March 2012 and the reference lists of recent reviews and of relevant articles identified in our search. Study selection Cohort/longitudinal and incident case-control studies assessing the relation between mold/dampness and new asthma were included. Data extraction Three authors independently evaluated eligible articles and extracted relevant information using a structured form. Synthesis Sixteen studies were included: 11 cohort and 5 incident case-control studies. The summary effect estimates (EE) based on the highest and lowest estimates for the relation between any exposure and onset of asthma were 1.50 (95% confidence interval [CI] 1.25–1.80, random-effects model, Q-statistic 38.74 (16), P?=?0.001) and 1.31 (95% CI 1.09–1.58, random-effects model, Q-statistic 40.08 (16), P?=?0.000), respectively. The summary effect estimates were significantly elevated for dampness (fixed-effects model: EE 1.33, 95% CI 1.12–1.56, Q-statistic 8.22 (9), P?=?0.413), visible mold (random-effects model; EE 1.29, 95% CI 1.04–1.60, 30.30 (12), P?=?0.001), and mold odor (random-effects model; EE 1.73, 95% CI 1.19–2.50, Q-statistics 14.85 (8), P?=?0.038), but not for water damage (fixed-effects model; EE 1.12, 95% CI 0.98–1.27). Heterogeneity was observed in the study-specific effect estimates. Conclusion The evidence indicates that dampness and molds in the home are determinants of developing asthma. The association of the presence of visible mold and especially mold odor to the risk of asthma points towards mold-related causal agents. AU - Quansah R AU - Jaakkola MS AU - Hugg TT AU - Heikkinen SAM AU - Jaakkola JJK LA - PT - DEP - TA - PLOS ONE JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 12 IP - DP - 2012 Jan 01 TI - Lung function decline in relation to diagnostic criteria for airflow obstruction in respiratory symptomatic subjects PG - 12 AB - Background Current COPD guidelines advocate a fixed < 0.70 FEV1/FVC cutpoint to define airflow obstruction. We compared rate of lung function decline in respiratory symptomatic 40+ subjects who were 'obstructive' or 'non-obstructive' according to the fixed and/or age and gender specific lower limit of normal (LLN) FEV1/FVC cutpoints. Methods We studied 3,324 respiratory symptomatic subjects referred to primary care diagnostic centres for spirometry. The cohort was subdivided into four categories based on presence or absence of obstruction according to the fixed and LLN FEV1/FVC cutpoints. Postbronchodilator FEV1 decline served as primary outcome to compare subjects between the respective categories. Results 918 subjects were obstructive according to the fixed FEV1/FVC cutpoint; 389 (42%) of them were non-obstructive according to the LLN cutpoint. In smokers, postbronchodilator FEV1 decline was 21 (SE 3) ml/year in those non-obstructive according to both cutpoints, 21 (7) ml/year in those obstructive according to the fixed but not according to the LLN cutpoint, and 50 (5) ml/year in those obstructive according to both cutpoints (p = 0.004). Conclusion This study showed that respiratory symptomatic 40+ smokers and non-smokers who show FEV1/FVC values below the fixed 0.70 cutpoint but above their age/gender specific LLN value did not show accelerated FEV1 decline, in contrast with those showing FEV1/FVC values below their LLN cutpoint. AU - Akkermans RP AU - Berrevoets MA AU - Smeele IJ AU - Lucas AE AU - Thoonen BP AU - Grootens-Stekelenburg JG AU - Heijdra YF AU - van Weel C AU - Schermer TR LA - PT - DEP - TA - BMC Pulmonary Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 58 IP - DP - 2012 Jan 01 TI - Modest and variable efficacy of pre-exposure hydroxocobalamin and dicobalt edetate in a porcine model of acute cyanide salt poisoning PG - 190-200 AB - Introduction. On theoretical grounds, hydroxocobalamin is an attractive antidote for cyanide poisoning as cobalt compounds have the ability to bind and detoxify cyanide. This paper reviews the pharmacokinetic and pharmacodynamic aspects of hydroxocobalamin, its efficacy in human cyanide poisoning and its adverse effects. Methods. PubMed was searched for the period 1952 to April 2012. A total of 71 papers were identified in this way; and none was excluded. Pharmacokinetics and pharmacodynamics. Pharmacokinetic studies in dogs and humans suggest a two-compartment model, with first order elimination kinetics. Pharmacodynamic studies in animals suggest that hydroxocobalamin would be a satisfactory antidote for human cyanide poisoning. Efficacy in human poisoning. There is limited evidence that hydroxocobalamin alone is effective in severe poisoning by cyanide salts. The evidence for the efficacy of hydroxocobalamin in smoke inhalation is complicated by lack of evidence for the importance of cyanide exposure in fires and the effects of other chemicals as well as confounding effects of other therapeutic measures, including hyperbaric oxygen. Evidence that hydroxocobalamin is effective in poisoning due to hydrogen cyanide alone is lacking; extrapolation of efficacy from poisoning by ingested cyanide salts may not be valid. The rate of absorption may be greater with inhaled hydrogen cyanide and the recommended slow intravenous administration of hydroxocobalamin may severely limit its clinical effectiveness in these circumstances. Adverse effects. Both animal and human data suggest that hydroxocobalamin is lacking in clinically significant adverse effects. However, in one human volunteer study, delayed but prolonged rashes were observed in one-sixth of subjects, appearing 7 to 25 days after administration of 5 g or more of hydroxocobalamin. Rare adverse effects have included dyspnoea, facial oedema, and urticaria. Conclusions. Limited data on human poisonings with cyanide salts suggest that hydroxocobalamin is an effective antidote; data from smoke inhalation are less clear-cut. Although clinically important reactions to hydroxocobalamin have not been seen, some, non-life threatening, adverse reactions can occur. AU - Thompson A AU - Dunn M AU - Jefferson RD AU - Dissanayake K AU - Reed F AU - Gregson R AU - Greenhalgh S AU - Clutton RE AU - Blain PG AU - Thomas SH AU - Eddleston M LA - PT - DEP - TA - Clin Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 141 IP - DP - 2012 Jan 01 TI - Indium Lung Disease PG - 1512-1521 AB - Background Reports of pulmonary fibrosis, emphysema, and, more recently, pulmonary alveolar proteinosis (PAP) in indium workers suggested that workplace exposure to indium compounds caused several different lung diseases. Methods To better understand the pathogenesis and natural history of indium lung disease, a detailed, systematic, multidisciplinary analysis of clinical, histopathologic, radiologic, and epidemiologic data for all reported cases and workplaces was undertaken. Results Ten men (median age, 35 years) who produced, used, or reclaimed indium compounds were diagnosed with interstitial lung disease 4-13 years after first exposure (n = 7) or PAP 1-2 years after first exposure (n = 3). Common pulmonary histopathologic features in these patients included intraalveolar exudate typical of alveolar proteinosis (n = 9), cholesterol clefts and granulomas (n = 10), and fibrosis (n = 9). Two patients with interstitial lung disease had pneumothoraces. Lung disease progressed following cessation of exposure in most patients and was fatal in two. Radiographic data revealed that two patients with PAP subsequently developed fibrosis and one also developed emphysematous changes. Epidemiologic investigations demonstrated the potential for exposure to respirable particles and an excess of lung abnormalities among coworkers. Conclusions Occupational exposure to indium compounds was associated with PAP, cholesterol ester crystals and granulomas, pulmonary fibrosis, emphysema, and pneumothoraces. The available evidence suggests exposure to indium compounds causes a novel lung disease that may begin with PAP and progress to include fibrosis and emphysema, and, in some cases, premature death. Prospective studies are needed to better define the natural history and prognosis of this emerging lung disease and identify effective prevention strategies. AU - Cummings KJ AU - Nakano M AU - Omae K AU - Takeuchi K AU - Chonan T AU - Xiao Y AU - Harley RA AU - Roggli VL AU - Hebisawa A AU - Tallakseni RJ AU - Trapnell BC AU - Day GA AU - Saito R AU - Stanton ML AU - Suarthana E AU - Kreiss K LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 12 IP - DP - 2012 Jan 01 TI - Lung injury following hydrocarbon inhalation in aircrew PG - 98-102 AB - This paper is outlines current knowledge and personal experience gained in managing a significant number of aircraft cabin and flight deck crew and some passengers and aircraft engineers, both nationally and internationally, who have presented with respiratory and other complaints, which have occurred after exposure to toxic fumes on board an aircraft cabin over a twelve year period. SPECIAL INVESTIGATIONS In general, experience shows that respiratory and other investigations are rarely undertaken at initial presentation. Unfortunately it is commonplace that appropriate tests are not considered until a later date, when symptoms continue. Delay may result in missing the opportunity to physically or chemically detect abnormality. For example, if volatile hydrocarbons are to be detected in the blood stream, serum samples need to be taken promptly before the substance is completely eliminated from the circulation. As in many cases the symptoms remit with time, special tests undertaken remotely may no longer show abnormality and, hence, the real incidence of abnormalities remains unknown. From the respiratory view point, standard tests of spirometry and diffusing capacity are commonly found to be within the normal range. Chest X-rays and high resolution CT chest scans almost never get taken at the time of injury or within a short period, so it is difficult to know whether there are any acute radiological changes. Some of those who complain of breathlessness upon exertion and who have normal standard lung function tests (spirometry, diffusing capacity) have been shown to have an elevated alveolar-arterial oxygen gradient, implying that there has been an injury to the lung at the alveolar-capillary membrane level. Thus tests of greater sensitivity, in this case arterial blood gas analysis, may reveal more subtle lung injury. Finally, there are no specific diagnostic tests for the aerotoxic syndrome, which contributes to its lack of general acceptance as a real entity AU - Burdon J LA - PT - DEP - TA - Journal of Biological Physics and Chemistry JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 78 IP - DP - 2012 Jan 01 TI - Factors influencing the microbial composition of metalworking fluids and potential implications for machine operator's lung PG - 34-41 AB - Hypersensitivity pneumonitis, also known as “machine operator's lung” (MOL), has been related to microorganisms growing in metalworking fluids (MWFs), especially Mycobacterium immunogenum. We aimed to (i) describe the microbiological contamination of MWFs and (ii) look for chemical, physical, and environmental parameters associated with variations in microbiological profiles. We microbiologically analyzed 180 MWF samples from nonautomotive plants (e.g., screw-machining or metal-cutting plants) in the Franche-Comté region in eastern France and 165 samples from three French automotive plants in which cases of MOL had been proven. Our results revealed two types of microbial biomes: the first was from the nonautomotive industry, showed predominantly Gram-negative rods (GNR), and was associated with a low risk of MOL, and the second came from the automotive industry that was affected by cases of MOL and showed predominantly Gram-positive rods (GPR). Traces of M. immunogenum were sporadically detected in the first type, while it was highly prevalent in the automotive sector, with up to 38% of samples testing positive. The use of chromium, nickel, or iron was associated with growth of Gram-negative rods; conversely, growth of Gram-positive rods was associated with the absence of these metals. Synthetic MWFs were more frequently sterile than emulsions. Vegetable oil-based emulsions were associated with GNR, while mineral ones were associated with GPR. Our results suggest that metal types and the nature of MWF play a part in MWF contamination, and this work shall be followed by further in vitro simulation experiments on the kinetics of microbial populations, focusing on the phenomena of inhibition and synergy. AU - Murat JB AU - Grenouillet F AU - Reboux G AU - Penven E AU - Batchili A AU - Dalphin JC AU - Thaon I AU - Millona L LA - PT - DEP - TA - Appl Environ Microbiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 142 IP - DP - 2012 Jan 01 TI - Recent advances in hypersensitivity pneumonitis PG - 208-217 AB - Hypersensitivity pneumonitis (HP) is a pulmonary disease with symptoms of dyspnea and cough resulting from the inhalation of an allergen to which the subject has been previously sensitized. The diagnosis of HP most often relies on an array of nonspecifi c clinical symptoms and signs developed in an appropriate setting, with the demonstration of interstitial markings on chest radiographs, serum precipitating antibodies against offending antigens, a lymphocytic alveolitis on BAL, and/or a granulomatous reaction on lung biopsies. The current classification of HP in acute, subacute, and chronic phases is now challenged, and a set of clinical predictors has been proposed. Nonspecific interstitial pneumonitis, usual interstitial pneumonia, and bronchiolitis obliterans organizing pneumonia may be the sole histologic expression of the disease. Presumably,like in idiopathic interstitial pneumonia, acute exacerbations of chronic HP may occur without further exposure to the offending antigen. New offending antigens, such as mycobacteria causing hot tub lung and metalworking fluid HP, have recently been identified and have stimulated further research in HP. AU - Lacasse Y AU - Girard M AU - Cormier Y LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 54 IP - DP - 2012 Jan 01 TI - Lung Function and Respiratory Symptoms in Hard Metal Workers Exposed to Cobalt PG - 409-413 AB - Objective: To follow-up lung function and airway symptoms in workers exposed to cobalt dust at a hardmetal plant. Methods: A total of 582 employees underwent spirometry and completed a questionnaire. A historical exposure matrix was created, assigning figures for historical and recent work-related exposure. Results: At the time of employment, 5% reported symptoms from respiratory tract. At follow-up, 5% suffered from persistent coughing and 7% reported asthma; 20% were daily smokers. Among nonsmokers without asthma, an evident, statistically nonsignificant, dose–response effectwas seen between increasing cobalt exposure and decline in FEV1 (forced expiratory volume in the first second). In all exposure categories, the FEV1 in smokers declined 10 mL more per year than for nonsmokers. Conclusions: Even low levels of cobalt exposure seem to hamper lung function both in smokers and nonsmokers. This impact is considered low in relation to the effect of aging. AU - Rehfisch P AU - Anderson M AU - Berg P AU - Lampa E AU - Nordling Y LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 40 IP - DP - 2012 Jan 01 TI - Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations PG - 1324-1343 AB - The aim of the Task Force was to derive continuous prediction equations and their lower limits of normal for spirometric indices, which are applicable globally. Over 160,000 data points from 72 centres in 33 countries were shared with the European Respiratory Society Global Lung Function Initiative. Eliminating data that could not be used (mostly missing ethnic group, some outliers) left 97,759 records of healthy nonsmokers (55.3% females) aged 2.5–95 yrs. Lung function data were collated and prediction equations derived using the LMS method, which allows simultaneous modelling of the mean (mu), the coefficient of variation (sigma) and skewness (lambda) of a distribution family. After discarding 23,572 records, mostly because they could not be combined with other ethnic or geographic groups, reference equations were derived for healthy individuals aged 3–95 yrs for Caucasians (n=57,395), African–Americans (n=3,545), and North (n=4,992) and South East Asians (n=8,255). Forced expiratory value in 1 s (FEV1) and forced vital capacity (FVC) between ethnic groups differed proportionally from that in Caucasians, such that FEV1/FVC remained virtually independent of ethnic group. For individuals not represented by these four groups, or of mixed ethnic origins, a composite equation taken as the average of the above equations is provided to facilitate interpretation until a more appropriate solution is developed. Spirometric prediction equations for the 3–95-age range are now available that include appropriate age-dependent lower limits of normal. They can be applied globally to different ethnic groups. Additional data from the Indian subcontinent and Arabic, Polynesian and Latin American countries, as well as Africa will further improve these equations in the future. AU - Quanjer PH AU - Stanojevic S AU - Cole TJ AU - Baur X AU - Hall GL AU - Culver BH AU - Enright PL AU - Hankinson JL AU - Ip MSM AU - Zheng J AU - Stocks J LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 5 Suppl 3 IP - DP - 2012 Jan 01 TI - REVIEW ON REACTIVE AIRWAYS DYSFUNCTION SYNDROME (RADS) PG - 10-15 AB - Over the past twenty years, work-related asthma has been increasingly recognized to focus on reactive airways disease syndrome (RADS), but little is known about its impact on health. RADS is a controversial and poorly understood condition produced by inhalational injury from gas, vapors, or fumes. There was a general lack of adequate information on exposure, investigation and, in particular, outcome of reported cases or case series of RADS. In this review, it is our intent to summarize clinical presentation, diagnosis, pathology, management and case series of RADS. AU - PATEL PD AU - PATEL RK AU - PATEL NJ LA - PT - DEP - TA - Asian Journal of Pharmaceutical and Clinical Research JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 3 IP - DP - 2012 Jan 01 TI - Occupational and Environmental Risk Factors for Idiopathic Pulmonary Fibrosis in Egypt: A Multicenter Case-Control Study PG - 107-116 AB - Background: Despite the advances in medical therapy and technology, the prognosis of idiopathic pulmonary fibrosis (IPF) remains poor and the need for disease prevention based on identifying the risk factors becomes mandatory. Occupational and environmental exposures were studied in several countries and found to play important role in the disease development. However, in Egypt, a little attention has been paid to study the effect of these factors in the disease development. Objective: To identify the occupational and environmental risk factors associated with the development of IPF in Egypt. Methods: A multicenter hospital-based case-control study was carried out in chest hospitals affiliated to three Egyptian cities—Cairo, Tanta and Mansoura. Subjects were 201 patients with confirmed IPF (cases) and 205 age-, sex- and residence-matched controls. Data on occupational and environmental factors were obtained from a questionnaire. Multiple logistic regression analysis was used to determine the independent risk factors of IPF in both sexes for single factors with adjustment for age, residence and smoking status. Results: Compared with the controls, the risk of IPF in male workers was observed to increase significantly in chemical and petrochemical industries and carpentry and wood working (OR=2.56, 95% CI: 1.02–7.01), and with occupational exposures to wood dust and wood preservatives. Among female workers, a significant increase was observed in farming (OR=3.34, 95% CI: 1.17–10.12), raising birds and occupational exposures to animal feeds, products and dusts and pesticides. Risk of IPF decreased significantly in male workers and insignificantly among female workers in sales and clerical related activities. The environmental exposures to birds and cats were significantly associated with elevated risk of IPF development in both sexes. Conclusion: In Egypt, farming, raising birds and wood working are important risk factors for the development of IPF. AU - Awadalla NJ AU - Hegazy A AU - Elmetwally RA AU - Wahby I LA - PT - DEP - TA - International Journal of Occupational and Environmental Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 186 IP - DP - 2012 Jan 01 TI - Examination of the Carbon Monoxide Diffusing Capacity (DLCO) in Relation to Its KCO and VA Components PG - 132-139 AB - The single-breath carbon monoxide diffusing capacity (DLCO) is the product of twomeasurements during breath holding at full inflation: (1) the rate constant for carbon monoxide uptake from alveolar gas (kCO [minute21]) and (2) the “accessible” alveolar volume (VA). kCO expressed permmHg alveolar dry gas pressure (Pb*) as kCO/Pb*, and thenmultiplied byVA, equalsDLCO; thus,DLCO divided byVA (DLCO/VA, also called KCO) is only kCO/Pb* in different units, remaining, essentially, a rate constant. The notion that DLCO/VA “corrects” DLCO for reduced VA is physiologically incorrect, because DLCO/VA is not constant as VA changes; thus, the term KCO reflects the physiology more appropriately. Crucially, the same DLCO may occur with various combinations of KCO and VA, each suggesting different pathologies. Decreased KCO occurs in alveolar–capillary damage, microvascular pathology, or anemia. Increased KCO occurswith (1) failure to expand normal lungs to predicted full inflation (extrapulmonary restriction); or (2) increased capillary volume and flow, either globally (left-toright intracardiac shunting) or from flow and volume diversion from lost or damaged units to surviving normal units (e.g., pneumonectomy). Decreased VA occurs in (1) reduced alveolar expansion, (2) alveolar damage or loss, or (3)maldistribution of inspired gases with airflow obstruction. KCO will be greater than 120% predicted in case 1, 100–120%in case 2, and 40–120%in case 3, depending on pathology. KCO and VA values should be available to clinicians, as fundamental to understanding the clinical implications of DLCO. The diffusing capacity for nitric oxide (DLNO), and the DLNO/DLCO ratio, provide additional insights. AU - Hughes JMB AU - Pride NB LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 32 IP - DP - 2012 Jan 01 TI - A Case of Occupational Asthma Induced by Cleaning Agent PG - 272-275 AB - BACKGROUND: Cleaning agents have an airway irritant effect. There have been few reports of occupational asthma induced by cleaning agents at workplace or at home. Chlorine, the most common chemical used in cleaning products, has a strong irritative effect on the airways. We experienced a case of occupational asthma caused by chlorine that developed in a health care worker. CASE HISTORY: Eleven years later, she developed dyspnea and cough, which was aggravated after exposure to cleaning agent spray that released chlorine at workplace. RESULTS: The patient was positive to 2 house dust mites on skin prick tests but negative to the cleaning agent. Methacholine bronchoprovocation tests showed a negative result; however, a specific bronchoprovocation test with exposure to the cleaning agent showed a positive response of more than 15% fall of forced expiratory volume in 1 second. There were no significant changes in sputum cell counts and exhaled nitric oxide levels after the specific bronchoprovocation test. CONCLUSION: To the best of our knowledge, this is the first case of occupational asthma caused by, chlorine, a cleaning agent that developed in a health care worker in Korea, which was confirmed by the specific bronchoprovocation test. AU - Nam YH AU - Jin HJ AU - Yoo HS AU - Shin YS AU - Ye YM AU - Park HS. LA - PT - DEP - TA - Korean J Asthma Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 56 IP - DP - 2012 Jan 01 TI - Systematic review of respiratory outbreaks associated with exposure to water-based metalworking fluids PG - 374-388 AB - Introduction: Potential demographic risk factors for outbreaks of respiratory disease due to water-based metalworking fluids (MWFs) were investigated through systematic review of published outbreak investigations. Methods: Search terms were selected by a multidisciplinary team, assisted by an experienced library information service. Several computerized literature databases were searched for articles published between January 1990 and October 2011, relating to ill health outbreaks due to MWFs. Papers meeting the search criteria were reviewed in detail, and their references checked for additional articles. Study design and demographic details of the outbreak were extracted from the selected articles and entered into standardized evidence tables. Results: Thirty-five articles relating to investigations of 27 outbreaks of respiratory ill health attributed to MWF exposure were identified. The majority of reports were case series of disease or observational cross-sectional studies of symptoms and hygiene measurements. Eight of the outbreak investigations included an element of case–control analysis. Most outbreaks were from the USA, had occurred in large car- or aeronautical-manufacturing plants, and were associated with the use of central shared sumps. Hygiene studies have not demonstrated consistent risk factors for respiratory outbreaks, in terms of the type of MWF utilized, degree of microbial contamination, or levels of personal exposure. Six studies were identified that found workers with MWF exposure during outbreaks were more likely to report respiratory or systemic symptoms than unexposed control workers. Six case–control analyses were also identified that found workers with extrinsic allergic alveolitis (EAA) were more likely to demonstrate certain immune responses to microbial contaminants and/or used MWFs than workers without EAA. Conclusion: Despite a number of detailed workplace and immunological studies of asthma and alveolitis outbreaks in MWF-exposed workforces, our understanding of their aetiology remains limited. AU - Burton CM AU - Crook B AU - Scaife H AU - Evans GS LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 8 IP - DP - 2012 Jan 01 TI - Health-related quality of life among patients with bronchial asthma in Ile-Ife, Nigeria PG - 9-11 AB - This study showed that asthma results in significant impairment of HRQoL which correlates poorly with the spirometric measurement. Although this is not a novel finding, it has been demonstrated in our study population. Gender appears to affect the HRQoL of the asthmatic, with the female sex appearing to predict a poorer quality of life. The HRQoL assessment is an important aspect of evaluating the impact of asthma on the patients. Its use should be encouraged and locally validated and adapted instruments developed to augment the already existing ones. Routine use of mini HRQoL instruments should be incorporated into the clinic assessment of patients with asthma and other chronic respiratory diseases. Greater attention should be paid to good asthma control, since increased frequency of attacks may indicate a worsening HRQoL. AU - Adeniyi BO AU - Erhabor GE AU - Awopeju FO AU - Obaseki DO AU - Adewole OO AU - Burney P LA - PT - DEP - TA - African Journal of Respiratory Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 75 IP - DP - 2012 Jan 01 TI - Symptoms, Spirometry, and Serum Antibody Concentrations Among Compost Workers Exposed to Organic Dust PG - 492-500 AB - Work-related symptoms and diseases of 190 currently exposed compost workers, 59 former compost workers, and 38 nonexposed control subjects were investigated in a cross-sectional study. Using a standardized questionnaire, participants were asked for work-related symptoms, exposures to bioaerosols, atopic diseases, and smoking habits. The subjects underwent a physical examination and a lung function test. In addition, total immunoglobulin (Ig) E, IgE specific to environmental allergens and moulds, and IgG specific to molds and actinomycetes were quantified. Compared to controls, compost workers suffered more often from cough and irritation of the eyes in terms of mucosal membrane irritation (MMI). Former compost workers reported similar work-related complaints, but most MMI symptoms had improved after termination of bioaerosol exposure. In contrast, cough and dyspnea persisted, indicating a chronic process. Lung function parameters of compost workers were within the reference ranges. Nevertheless, forced vital capacity (FVC) was significantly lower than for controls. Specific IgE to environmental allergens and molds was positive in 25.3% and 7.4%, respectively, of currently exposed compost workers. There were no marked differences in IgE and IgG concentrations among the three groups. Compost workers suffered with a higher frequency from cough and MMI symptoms. The findings that MMI symptoms improved in former compost workers after leaving the job confirmed the association with bioaerosol exposure. Further, the reduced FVC may be produced by this exposure. There was no higher frequency of mold sensitization in the group of compost workers compared to controls, which may be an indication of a healthy worker survivor effect. AU - van Kampen V AU - Deckert A AU - Hoffmeyer F AU - Taeger D AU - Brinkmann E AU - Brüning T AU - Raulf-Heimsoth M AU - Bünger J LA - PT - DEP - TA - Journal of Toxicology and Environmental Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 129 IP - DP - 2012 Jan 01 TI - Genetic Variants in Antioxidant Genes Are Associated With Diisocyanate-Induced Asthma PG - 166-173 AB - Diisocyanates are a common cause of occupational asthma, but risk factors are not well defined. A case-control study was conducted to investigate whether genetic variants of antioxidant defense genes, glutathione S-transferases (GSTM1, GSTT1, GSTM3, GSTP1), manganese superoxide dismutase (SOD2), and microsomal epoxide hydrolase (EPHX1) are associated with increased susceptibility to diisocyanate-induced asthma (DA). The main study population consisted of 353 Caucasian French-Canadians from among a larger sample of 410 diisocyanate-exposed workers in three groups: workers with specific inhalation challenge (SIC) confirmed DA (DA+, n = 95); symptomatic diisocyanate workers with a negative SIC (DA-, n = 116); and asymptomatic exposed workers (AW, n = 142). Genotyping was performed on genomic DNA, using a 5'-nuclease PCR assay. The SOD2 rs4880, GSTP1 rs1695, and EPHX1 rs2740171 variants were significantly associated with DA in both univariate and multivariate analyses. In the first logistic regression model comparing DA+ and DA- groups, SOD2 rs4880, GSTM1 (null), GSTP1 rs762803, and EPHX1 rs2854450 variants were associated with DA (p = 0.004, p = 0.047, p = 0.021, p <0.001, respectively). Genotype combinations GSTT1*GSTP1 rs762803, GSTM1*EPHX1 rs2854450, EPHX1 rs2740168*EPHX1 rs1051741, and GSTP1 rs762803*EPHX1 rs2740168 were also associated with DA in this model (p = 0.027, p = 0.002, p = 0.045, p = 0.044, respectively). The GSTP1 rs1695 and EPHX1 rs1051741 and rs2740171 variants showed an association with DA in the second model comparing DA+ and AW groups (p = 0.040, p = 0.019, p = 0.002, respectively). The GSTM3 rs110913*EPHX1 rs1051741 genotype combination was also associated with DA under this model (p = 0.042). The results suggest that variations in SOD2, GST, and EPHX1 genes and their interactions contribute to DA susceptibility. AU - Yucesoy B AU - Johnson VJ AU - Lummus ZL AU - Kissling GE AU - Fluharty K AU - Gautrin D AU - Malo J AU - Cartier A AU - Boulet L AU - Sastre J AU - Quirce S AU - Germolec DR AU - Tarlo SM AU - Cruz M AU - Munoz X AU - Luster MI AU - Bernstein DI LA - PT - DEP - TA - Toxicology Science JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 69 IP - DP - 2012 Jan 01 TI - Occupational risk factors associated with work-exacerbated asthma in Quebec PG - 901-907 AB - Background There is limited information regarding the occupational exposures of subjects with a diagnosis of work-exacerbated asthma (WEA). Objectives To: (1) identify potential specific occupational, chemical, biological and physical agents associated with incident cases of WEA and (2) compare these agents with occupational exposures of occupational asthma (OA) and non-work-related asthma (NWRA) cases. Methods Subjects were workers with work-related asthma (WRA) or NWRA referred between 2005 and 2008 to two Quebec clinics specialised in the field of WRA. Specific inhalation challenges were performed to differentiate OA from WEA. Work exposures were assessed using a detailed occupational questionnaire. Exposures to 41 chemical and biological agents were coded in a semiquantitative way according to a combination of indices for concentration in workplace air, frequency and confidence of exposure by an occupational hygienist expert in occupational exposure coding. This expert was blind to the medical status of WEA, OA or NWRA. Five physical agents were coded on a yes/no scale. Results 153 subjects were enrolled (53 WEA, 67 OA and 33 NWRA). WEA cases were significantly more exposed to ammonia, engine exhaust fumes, silica, mineral fibres, aerosol propellants and solvents, and significantly less exposed to animal derived dust and enzymes than were OA cases. Exposure to physical conditions did not differ between WEA and OA. Conclusions Exposures associated with WEA differ from those associated with OA in this study. A proportion of subjects with WEA may suffer from low-dose irritant asthma, which remains a hypothesis to be tested. AU - Lemiere C AU - Bégin D AU - Camus M AU - ForgetA AU - Boulet L-P AU - Gérin M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 6 IP - DP - 2012 Jan 01 TI - Current topics in occupational asthma PG - 615-627 AB - The study of occupational asthma (OA) provides insights into asthma in general, as the cause is known. The relationships between the cause and response can be measured and modifying factors can be identified and their influence quantified. Developing OA has much more serious consequences for the patient than new onset asthma unrelated to work exposures, as the patient’s livelihood is nearly always affected. Many healthcare professionals are more ready to accept and act on asthmatic symptoms when they are unrelated to work than when work may be the cause; antagonism can also occur in the workplace. This article reviews some of the areas where development and controversy enrich the study of OA. It makes no attempt to be comprehensive. AU - Burge PS AU - Hoyle J LA - PT - DEP - TA - Expert Review of Respiratory Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 22 IP - DP - 2012 Jan 01 TI - Microbiological evaluation of ten French archives and link to occupational symptoms PG - 514-522 AB - Fungi that damage documents in archives may harm workers’ health, depending on which mold species are inhaled, the concentrations of fungal species inhaled, and individual factors. Our aim was to identify and quantify fungi in archives and to investigate possible links with the symptoms experienced by workers. Ten French archives were sampled using an air impactor and electrostatic dust collectors. Allergies and general symptoms felt by 144 workers were reported using a self-report questionnaire. Utilizing culture-based analysis methods along with qPCR, Penicillium chrysogenum, Cladosporium sphaerospermum, and Aspergillus versicolor were the three main fungi in air and dust in terms of quantity and frequency. Median fungal concentrations in storage areas, ranged from 30 to 465 CFU/m3. People working in the most contaminated archives did not report more symptoms of allergy than others. However, workers in contact with moldy documents reported more headaches (odds ratio, 2.4; 95% confidence interval, 1.1–5.3), fatigue (OR, 2.9; 95% CI, 1.2–6.7), eye irritation (OR, 5.4; 95% CI, 1.9–14.9), throat irritation (OR, 2.4; 95% CI, 1.0–5.7), coughing (OR, 3.2; 95% CI, 1.2–8.4), and rhinorrhea (OR, 2.6; 95% CI, 1.0–6.4) than others. Other parameters such as dust levels and concentrations of metabolites and chemical substances should be considered as confounding factors in further investigations to isolate the role of molds. AU - Roussel S AU - Reboux G AU - Millon L AU - Parchas M-D AU - Boudih S AU - Skana F AU - Delaforge M AU - Rakotonirainy MS LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 69 IP - DP - 2012 Jan 01 TI - Occupational exposure to cleaning products and asthma in hospital workers PG - 883-889 AB - Objective Cleaning products may cause work-related asthma, but information regarding the specific exposures involved is scarce. We aimed to determine the associations between asthma and occupational exposure to cleaning agents in hospital workers. Methods Analyses were conducted in 179 (136 women) hospital workers and a reference population of 545 subjects (18–79 years) from the French case-control and familial Epidemiological study on the Genetics and Environment of Asthma (2003–2007). Exposures to cleaning agents were estimated using three methods: self-report, expert assessment and an asthma-specific job-exposure matrix (JEM). Associations between cleaning products and current asthma were evaluated by logistic regressions, stratified by sex and adjusted for age and smoking status. Results According to expert assessment, 55% of male and 81% of female hospital workers were exposed to cleaning/disinfecting tasks weekly (p<0.001). No association was observed between cleaning/disinfecting tasks and current asthma in men or in women whatever the assessment method used. In women, exposure to decalcifiers (expert assessment) was associated with current asthma (OR (95% CI):2.38 (1.06 to 5.33)). In hospital workers classified as exposed according to both the expert assessment and the JEM, additional associations were observed for exposure to ammonia (3.05 (1.19 to 7.82)) and to sprays with moderate/high intensity (2.87 (1.02 to 8.11)). Conclusions Female hospital workers are often exposed to numerous cleaning products, some of which were markedly associated with current asthma. Low numbers prevented a meaningful analysis in men. Objective and more accurate estimates of occupational exposure to cleaning products are needed to better understand the adverse effects of cleaning products. AU - Dumas O AU - Donnay C AU - Heederik DJJ AU - Héry M AU - Choudat D AU - Kauffmann F AU - Moual NL LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 69 IP - DP - 2012 Jan 01 TI - Evaluating interventions aimed at reducing occupational exposure to latex and rubber glove allergens PG - 925-931 AB - Objective Concerns over occupational exposures to blood-borne viruses resulted in increased protective glove use; consequentially latex allergy became a hazard for some occupational groups. Interventions aimed at managing this problem included substitution measures (eg, non-powdered/non-latex gloves), but such changes may not occur simultaneously across occupational sectors. This study evaluated whether the incidence of occupational dermatoses fell after interventions aiming to reduce exposure to ‘latex and rubber glove allergens’ (‘latex’) were introduced, and whether these interventions were more effective for healthcare workers (HCWs), compared with non-HCWs. Methods Incidence rate ratios (IRRs) comparing cases reported to EPIDERM (a UK-wide surveillance scheme) during post versus pre-intervention periods were calculated, both where ‘latex’ was cited and for cases associated with other exposures (‘controls’). Results Among HCWs, cases of contact urticaria and allergic contact dermatitis (ACD) where ‘latex’ was cited showed significant downward trends post-intervention, with IRRs of 0.72, 95% CI; 0.52 to 1.00 and 0.47, 95% CI; 0.35 to 0.64 respectively. For HCWs, this fall in ‘latex’ associated ACD was significantly greater (p=0.02) than for other exposures (‘controls’) IRR=0.85, 95% CI; 0.57 to 1.28, and greater than that among non-HCWs (IRR 0.75, 95% CI; 0.61 to 0.93). Increases over time were seen for irritant contact dermatitis (ICD) reporting for HCWs, both for cases associated with ‘latex’ (IRR 1.47, 95% CI: 1.02 to 2.13) and for other exposures (‘controls’) IRR 1.36, 95% CI 1.06 to 1.76, but not for non-HCWs. Conclusions A reduction in overall ACD, particularly in HCWs, coincided with interventions aimed at managing workplace contact dermatoses associated with ‘latex’ exposure. A coincidental rise in ICD reporting is also important, both for hand care and for infection control strategies. AU - Turner S AU - McNamee R AU - Agius R AU - Wilkinson SM AU - Carder M AU - Stocks SJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 67 IP - DP - 2012 Jan 01 TI - Perceived stress and risk of adult-onset asthma and other atopic disorders: a longitudinal cohort study PG - 1408-1414 AB - Background Psychological stress can affect airway inflammatory response to irritants and allergens, but the importance of stress in the etiology of adult-onset respiratory and dermatologic allergic disorders remains unclear. We aim to address the relationship between perceived stress and the risk of adult-onset asthma, allergic rhinitis, atopic dermatitis, and asthma/bronchitis medication. Methods Participants (n = 9785) from the Copenhagen City Heart Study, Denmark, free of atopic disorders at baseline in 1981–1983 were asked questions on stress intensity and frequency. They were followed for first-time asthma hospitalization in nationwide registers until 2010, with < 0.1% loss to follow-up. Objective measures of lung function allowed for thorough adjustment for confounding and prevented ambiguity between diagnosis of asthma and chronic obstructive lung disease. Daily intake of asthma/bronchitis medication and incidence of asthma, allergic rhinitis, and atopic dermatitis were assessed by self-report after 10 years of follow-up in 5648 persons. Results Perceived stress was associated with atopic disorders in a dose-dependent manner (Ptrend < 0.001). High vs low stress was associated with higher risk of self-reported asthma incidence (OR = 2.32; 95% CI: 1.47–3.65), daily intake of asthma/bronchitis medication (OR = 2.26; 95% CI: 1.42–3.58), first-time asthma hospitalization (HR = 2.01; 95% CI: 1.41–2.86), allergic rhinitis (OR = 1.64; 95% CI: 0.99–2.72), and atopic dermatitis (OR = 1.75; 95% CI: 1.11–2.77). The associations were similar for smokers and nonsmokers. Conclusions Stress is strongly associated with asthma incidence and hospitalization, use of asthma medication as well as with allergic rhinitis and atopic dermatitis in adults. AU - Rod NH AU - Kristensen TS AU - Lange P AU - Prescott E AU - Diderichsen F. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 55 IP - DP - 2012 Jan 01 TI - Occupational rhinitis and asthma due to EDTA-containing detergents or disinfectants. PG - 677-82 AB - BACKGROUND: Detergents and disinfectants are an emerging cause of work-related rhinitis and asthma. These products may contain ethylenediamine tetraacetic acid (EDTA). The authors report 10 cases of EDTA-related asthma and/or rhinitis. METHODS: Review of the medical charts of patients who presented with work-related rhinitis (alone or with asthma), with a history of exposure to aerosols of EDTA-containing products and who underwent a nasal provocation test (NPT) with tetrasodium EDTA (1-4%) in our occupational health unit. RESULTS: Twenty-eight patients underwent a NPT with EDTA, which was positive in 10 cases. These patients, mostly cleaners or healthcare workers, used spray formulations of cleaning products. CONCLUSIONS: This case series is the first report of EDTA-related respiratory disease, documented by a specific test. An irritant mechanism is unlikely. Further studies are required to distinguish between an immunoallergic response and a pharmacological mechanism possibly resulting from calcium chelation, as suggested by animal experiments. A ban of spray preparations would be sufficient to prevent respiratory disease induced by EDTA inhalation, regardless of its mechanism. AU - Laborde-Casterot H AU - Villa AF AU - Rosenberg N AU - Dupont P AU - Lee HM AU - Garnier R LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 69 IP - DP - 2012 Jan 01 TI - Work-related asthma in France: recent trends for the period 2001–2009 PG - 391-397 AB - Objective Knowledge on the time-course (trends) of work-related asthma (WRA) remains sparse. The aim of this study was to describe WRA trends in terms of industrial activities and the main causal agents in France over the period 2001–2009. Method Data were collected from the French national network of occupational health surveillance and prevention (Réseau National de Vigilance et de Prévention des Pathologies Professionnelles (RNV3P)). Several statistical models (non-parametric test, zero-inflated negative binomial, logistic regression and time-series models) were used and compared with assess trends. Results Over the study period, 2914 WRA cases were included in the network. A significant decrease was observed overall and for some agents such as isocyanates (p=0.007), aldehydes (p=0.01) and latex (p=0.01). Conversely, a significant increase was observed for cases related to exposure to quaternary ammonium compounds (p=0.003). The health and social sector demonstrated both a growing number of cases related to the use of quaternary ammonium compounds and a decrease of cases related to aldehyde and latex exposure. Conclusions WRA declined in France over the study period. The only significant increase concerned WRA related to exposure to quaternary ammonium compounds. Zero-inflated negative binomial and logistic regression models appear to describe adequately these data. AU - Paris C AU - Ngatchou-Wandji J AU - Luc A AU - McNamee R AU - Bensefa-Colas L AU - Larabi L AU - Telle-Lamberton M AU - Herin F AU - Bergeret A AU - Bonneterre V AU - Brochard P AU - Choudat D AU - Dupas D AU - Garnier R AU - Pairon J AU - Agius RM AU - Ameille J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 67 IP - DP - 2012 Jan 01 TI - A role for sensory nerves in the late asthmatic response PG - 19-25 AB - Background In allergic asthma, exposure to relevant antigens leads to an early asthmatic response (EAR) followed, in certain subjects, by a late asthmatic response (LAR). Although many subjects with asthma consider LAR to be one of the defining symptoms of their disease, and despite its widespread use in the clinical assessment of new therapeutic entities, the mechanism underlying the LAR remains unclear. Method A study was undertaken using ovalbumin-sensitised and challenged Brown Norway rat and C57BL/6J mouse models which recapitulate phenotypic features of allergic asthma including the LAR and its susceptibility to clinically effective agents. Results In conscious animals an EAR was followed by a LAR. The LAR was subjectively evidenced by audible (wheeze) and visual signs of respiratory distress associated with quantifiable changes in non-invasive lung function assessment. Treatments that attenuated the EAR failed to impact on the LAR and, while anaesthesia did not impact on EAR, it abolished LAR. A key role for airway sensory neuronal reflexes in the LAR was therefore hypothesised, which was confirmed by the blockade observed after administration of ruthenium red (non-selective cation channel blocker), HC-030031 (TRPA1 inhibitor) and tiotropium bromide (anticholinergic) but not JNJ-17203212 (TRPV1 inhibitor). Conclusion These results suggest that LAR involves the following processes: allergen challenge triggering airway sensory nerves via the activation of TRPA1 channels which initiates a central reflex event leading to a parasympathetic cholinergic constrictor response. These data are supported by recent clinical trials suggesting that an anticholinergic agent improved symptoms and lung function in patients with asthma. AU - Raemdonck K AU - de Alba J AU - Birrell MA AU - Grace M AU - Maher SA AU - Irvin CG AU - Fozard JR AU - O'Byrne PM AU - Belvisi MG LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 42 IP - DP - 2012 Jan 01 TI - Distinct temporal patterns of immediate asthmatic reactions due to high- and low-molecular-weight agents PG - 1021-1027 AB - Background Exposure to occupational agents can cause immediate asthmatic reactions. Objective It can be hypothesized that the pattern of immediate reactions is different for high (HMW)- and low-molecular-weight (LMW) agents. To test this, we studied the temporal features of reactions in workers who underwent specific inhalation challenges for possible occupational asthma. Methods We examined 467 immediate reactions due to HMW (n = 248, 53%) and LWW (n = 219, 47%) agents in regards to timing of the maximum reaction and recovery. Results The median duration of exposure to elicit significant immediate reactions was comparable for HMW and LMW agents (15 min). The median maximum fall in FEV1 occurred after 20 min for LMW by comparison with 10 min for HMW agents (P < 0.001). The median timing of recovery of FEV1 to 10% baseline was shorter for HMW (60 min) than for LMW (90 min) agents (P < 0.01), and significantly more subjects recovered to 10% baseline (89.5%) for HMW than for LMW agents (72.6%) (P < 0.001). Confounding variables such as age, atopy, baseline airway calibre and the maximum fall in FEV1 at the time of the immediate reaction did not alter the significant effect of the nature of the agent per se. Immediate reactions were followed by a late asthmatic reaction more often in the case of LMW (37.3%) than HMW (26.2%) agents (P < 0.05). Significant changes in non-specific bronchial responsiveness were significantly (P = 0.02) more frequent after reactions to LMW (31.9%) than to HMW (21.4%) agents. We found similar trends by comparing reactions to flour (n = 113), the principal cause of reactions to HMW agents, and diisocyanates (n = 111), the principal LMW agent. Conclusions and Clinical Relevance This study shows distinct patterns for immediate reactions due to occupational agents. These results can provide useful guidelines for performing specific inhalation challenges and improve the safety of the procedure. AU - Malo J-L AU - Ghezzo H AU - LArchevêque J LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 62 IP - DP - 2012 Jan 01 TI - Systematic review of respiratory case definitions in metalworking fluid outbreaks PG - 337-342 AB - Background Since the mid-1990s, outbreaks of asthma and extrinsic allergic alveolitis (EAA) have been identified in workers exposed to metalworking fluids (MWFs). The cause of these outbreaks remains to be determined. Aims To identify and review all previously published occupational lung disease case definitions and diagnostic criteria that have been utilized during MWF outbreak investigations. Methods Respiratory outbreaks due to MWFs were identified by a systematic literature search for articles published between 1990 and October 2011. Investigations reporting the usage of disease case definitions or diagnostic criteria for respiratory disease were reviewed and summarized. Results The literature search identified 35 papers relating to 27 outbreaks of respiratory disease in MWF-exposed workers. Fourteen case definitions for MWF-related respiratory disease were identified: seven for EAA, five for occupational asthma and one each for humidifier fever and industrial bronchitis. A single paper was identified where any comparison of different disease case definitions (for EAA) had been performed. Conclusions A range of case definitions and diagnostic criteria for MWF respiratory disease have been utilized in outbreak investigations, but the majority have been produced for individual outbreak investigations without previous validation. It may be difficult to compare the findings of future workplace studies without a more standardized approach to case identification and diagnosis. AU - Barber CM AU - Burton CM AU - Scaife H AU - Crook B AU - Evans GS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 130 IP - DP - 2012 Jan 01 TI - Farming environments and childhood atopy, wheeze, lung function, and exhaled nitric oxide PG - 382-388 AB - Background Previous studies have demonstrated that children raised on farms are protected from asthma and allergies. It is unknown whether the farming effect is solely mediated by atopy or also affects nonatopic wheeze phenotypes. Objective We sought to study the farm effect on wheeze phenotypes and objective markers, such as lung function and exhaled nitric oxide, and their interrelation with atopy in children. Methods The GABRIEL Advanced Studies are cross-sectional, multiphase, population-based surveys of the farm effect on asthma and allergic disease in children aged 6 to 12 years. Detailed data on wheeze, farming exposure, and IgE levels were collected from a random sample of 8023 children stratified for farm exposure. Of those, another random subsample of 858 children was invited for spirometry, including bronchodilator tests and exhaled nitric oxide measurements. Results We found effects of exposure to farming environments on the prevalence and degree of atopy, on the prevalence of transient wheeze (adjusted odds ratio, 0.78; 95% CI, 0.64-0.96), and on the prevalence of current wheeze among nonatopic subjects (adjusted odds ratio, 0.45; 95% CI, 0.32-0.63). There was no farm effect on lung function and exhaled nitric oxide levels in the general study population. Conclusions Children living on farms are protected against wheeze independently of atopy. This farm effect is not attributable to improved airway size and lung mechanics. These findings imply as yet unknown protective mechanisms. They might include alterations of immune response and susceptibility to triggers of wheeze, such as viral infections. AU - Fuchs O AU - Genuneit J AU - Latzin P AU - Büchele G AU - Horak E AU - Loss G AU - Sozanska B AU - Weber J AU - Heederik D AU - Braun-Fahrländer C AU - Frey U AU - von Mutius E AU - GABRIELA Study Group LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 8 IP - DP - 2012 Jan 01 TI - Spirometry: step by step PG - 233-240 AB - Spirometry is easy to perform once trained and can be performed anywhere. It is useful for detecting early change and disease progression. Quality is important to ensure useful and reproducible results, otherwise results may be incorrectly interpreted. Training from a reputable centre should be undertaken to ensure the measures are understood as well as how to get the best results out of the patient. Please note - there is an error in this paper: Vital capacity (VC)should read as: the maximum amount of air that can be exhaled when blowing out at a steady rate Peak expiratory flow (PEF) should read as: the maximal flow that can be exhaled when blowing out as fast as possible AU - Moore VC LA - PT - DEP - TA - Breathe JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 185 IP - DP - 2012 Jan 01 TI - Statins and pulmonary fibrosis: the potential role of NLRP3 inflammasome activation. PG - 547-556 AB - RATIONALE: The role of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) in the development or progression of interstitial lung disease (ILD) is controversial. OBJECTIVES: To evaluate the association between statin use and ILD. METHODS: We used regression analyses to evaluate the association between statin use and interstitial lung abnormalities (ILA) in a large cohort of smokers from COPDGene. Next, we evaluated the effect of statin pretreatment on bleomycin-induced fibrosis in mice and explored the mechanism behind these observations in vitro. MEASUREMENTS AND MAIN RESULTS: In COPDGene, 38% of subjects with ILA were taking statins compared with 27% of subjects without ILA. Statin use was positively associated in ILA (odds ratio, 1.60; 95% confidence interval, 1.03-2.50; P = 0.04) after adjustment for covariates including a history of high cholesterol or coronary artery disease. This association was modified by the hydrophilicity of statin and the age of the subject. Next, we demonstrate that statin administration aggravates lung injury and fibrosis in bleomycin-treated mice. Statin pretreatment enhances caspase-1-mediated immune responses in vivo and in vitro; the latter responses were abolished in bone marrow-derived macrophages isolated from Nlrp3(-/-) and Casp1(-/-) mice. Finally, we provide further insights by demonstrating that statins enhance NLRP3-inflammasome activation by increasing mitochondrial reactive oxygen species generation in macrophages. CONCLUSIONS: Statin use is associated with ILA among smokers in the COPDGene study and enhances bleomycin-induced lung inflammation and fibrosis in the mouse through a mechanism involving enhanced NLRP3-inflammasome activation. Our findings suggest that statins may influence the susceptibility to, or progression of, ILD. AU - Xu JF AU - Washko GR AU - Nakahira K AU - Hatabu H AU - Patel AS AU - Fernandez IE AU - Nishino M AU - Okajima Y AU - Yamashiro T AU - Ross JC AU - Estépar RS AU - Diaz AA AU - Li HP AU - Qu JM AU - Himes BE AU - Come CE AU - D'Aco K AU - Martinez FJ AU - Han MK AU - Lynch DA AU - Crapo JD AU - Morse D AU - Ryter SW AU - Silverman EK AU - Rosas IO AU - Choi AM AU - Hunninghake GM LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 157 IP - DP - 2012 Jan 01 TI - May the reduction of exposure to specific sensitizers be an alternative to work cessation in occupational asthma? Results from a follow-up study. PG - 186-193 AB - BACKGROUND: Few data are reported on the effects of a reduction of exposure to specific sensitizers in occupational asthma (OA). The objective of this study was to evaluate the clinical outcome of subjects with OA, comparing the effect of a reduction with that of the persistence or cessation of occupational exposure to the specific sensitizer. SUBJECTS AND METHODS: Forty-one subjects with OA due to different sensitizers were diagnosed via a specific inhalation challenge. After a follow-up interval of 3.5 years, subjects were reexamined by clinical assessment, bronchial hyperresponsiveness (BH) and induced sputum. RESULTS: At follow-up, subjects who had reduced occupational exposure (n=2) showed a significant improvement in BH and a nonsignificant improvement in sputum eosinophilia (from 5.3 to 1.1%, n.s.), while subjects still exposed (n=10) showed a significant decrease in FEV(1). Subjects who ceased work (n=9) showed a trend of improvement in BH and sputum eosinophilia.Logistic analysis showed that the major determinant of improvement in BH at follow-up was the severity of BH at diagnosis, with a minimal contribution from the duration of exposure and treatment with inhaled corticosteroids during follow-up; reduction of work exposure did not enter into any model. CONCLUSION: The reduction of occupational exposure could not be considered to be as effective as work cessation, which remained the best treatment for OA. However, it was not associated with a deterioration of FEV(1) as observed in subjects with persistent exposure. AU - Talini D AU - Novelli F AU - Melosini L AU - Bacci E AU - Bartoli ML AU - Cianchetti S AU - Dente FL AU - Di Franco A AU - Vagaggini B AU - Paggiaro PL LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 2 IP - DP - 2012 Jan 01 TI - Occupational asthma in Japan PG - 173-180 AB - Research into occupational asthma (OA) in Japan has been led by the Japanese Society of Occupational and Environmental Allergy. The first report about allergic OA identified konjac asthma. After that, many kinds of OA have been reported. Cases of some types of OA, such as konjac asthma and sea squirt asthma, have been dramatically reduced by the efforts of medical personnel. Recently, with the development of new technologies, chemical antigen-induced asthma has increased in Japan. Due to advances in anti-asthma medication, control by medical treatment tends to be emphasized and the search for causative antigens seems to be neglected. Furthermore, we do not have a Japanese guideline for diagnosis and management of OA. This article discusses the current state of OA in Japan AU - Dobashi K LA - PT - DEP - TA - Asia Pac Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 62 IP - DP - 2012 Jan 01 TI - How physicians allocate causation: a scenario study with factorial design PG - 407-412 AB - Background Causation is a complex concept but important in suspected work-related disease. Physicians routinely make initial assessments of causation as part of their work, but the factors contributing to these assessments are not well understood. Aims To determine which factors influence a family physician’s assessment of causation when seeing patients with suspected work-related injury or illness. Methods Four groups of family physicians with differing levels of prior reporting (zero, low, medium, high) to the Workers Compensation Board received a questionnaire including four randomly allocated case scenarios. For each scenario there were four versions with either strong or weak causal features suggesting work or non-work factors were important causes or contributors. Responses to questions were made on a series of visual analogue scales. Results The nature of the condition and scenario type (i.e. strength of the causal information about workplace and non-workplace factors) were associated with the physicians’ opinion on work-relatedness. Understanding the nature of the patient’s work, the timing of symptoms and the patients’ opinion about work-relatedness were viewed by the physicians as important. A decision that a condition was not work related was influenced primarily by the strength of potential causes outside work. Prior reporting history of the physician was not associated with opinions on work-relatedness, nor the factors considered in reaching this decision. Conclusions The characteristics of the case scenario were more important in determining a physician’s opinion about work-relatedness than the characteristics of the physician. AU - Beach J AU - Chen Y AU - Cherry N LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 62 IP - DP - 2012 Jan 01 TI - Skin and respiratory symptoms among workers with suspected work-related disease PG - 420-426 AB - Background Many workers are exposed to chemicals that can cause both respiratory and skin responses. Although there has been much work on respiratory and skin outcomes individually, there are few published studies examining lung and skin outcomes together. Aims To identify predictors of reporting concurrent skin and respiratory symptoms in a clinical population. Methods Patients with possible work-related skin or respiratory disease were recruited. An interviewer- administered questionnaire collected data on skin and respiratory symptoms, health history, smoking habits, workplace characteristics and occupational exposures. Predictors of concurrent skin and respiratory symptoms were identified using multiple logistic regression models adjusted for age, sex and atopy. Results In total, 204 subjects participated; 46% of the subjects were female and the mean age was 45.4 years (SD = 10.5). Most subjects (n = 167, 82%) had possible work-related skin disease, compared with 37 (18%) subjects with possible work-related respiratory disease. Subjects with a history of eczema (OR 3.68, 95% CI 1.7–7.8), those from larger workplaces (OR 2.82, 95% CI 1.8–7.4) and those reporting respirator use at work (OR 2.44, 95% CI 1.2–4.8) had significantly greater odds of reporting both work-related skin and respiratory symptoms. Current smoking was also associated with reporting concurrent skin and respiratory symptoms (OR 2.57, 95% CI 1.2–5.8). Conclusions Workers reported symptoms in both systems, and this may be under-recognised both in the workplace and the clinic. The association between history of eczema and concurrent skin and respiratory symptoms suggests a role for impaired barrier function but needs further investigation. AU - Arrandale VH AU - Kudla I AU - Kraut AG AU - Scott JA AU - Tarlo SM AU - Redlich CA AU - Holness DL LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 62 IP - DP - 2012 Jan 01 TI - Upper airway symptoms among workers with work-related respiratory complaints PG - 427-434 AB - Background Work-related rhinitis and asthma symptoms frequently co-exist. Aims To determine the prevalence and nature of nasal, pharyngeal, laryngeal and sinus symptoms among individuals with work-related respiratory symptoms. Methods Individuals referred to a tertiary occupational asthma clinic for investigations with specific inhalation challenges were evaluated using the RHINASTHMA quality of life questionnaire and a questionnaire that assessed the nature and frequency of upper airway symptoms, their relationship to the workplace and their temporal relationship with the onset of asthma symptoms. Results There were 83 study participants. At least one upper airway symptom was reported by all of these individuals: nasal in 92%; pharyngeal in 82%; laryngeal in 65% and sinus in 53% of participants. Overall, there were no significant differences in the frequencies of nasal, pharyngeal, laryngeal and sinus symptoms when comparing these with occupational asthma (OA), work-exacerbated asthma (WEA) and work-related respiratory symptoms (WRS), except that nasal bleeding was most frequent among those with WRS. The presence of laryngeal symptoms was significantly associated with rhinitis-specific quality of life impairment. Individuals with workplace exposures to high molecular weight agents had greater impaired quality of life than those who were exposed to low molecular weight agents (RHINASTMA Upper Airway sub-scores: 24.0±10.4 versus 19.8±6.8; P < 0.05). Conclusions Individuals who were referred for work-related respiratory symptoms experienced high rates of work-related nasal, pharyngeal, laryngeal and sinus symptoms, regardless of having OA, WEA or WRS. AU - Miedinger D AU - Gautrin D AU - Castano R LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 62 IP - DP - 2012 Jan 01 TI - Occupational rhinitis caused by concurrent sensitization to two different allergens Occupational rhinitis caused by concurrent sensitization to two different allergens PG - 466-468 AB - Background Exposure to wheat flour and guar gum is a well-known cause of occupational respiratory allergies among workers in the food processing industry. To date, there have been no reports of occupational rhinitis (OR) caused concurrently by two different allergens present in the workplace. Aims To report a case of OR likely to be induced concurrently by exposure to wheat flour and guar gum in a mid-40s male employed in the food processing industry. Methods Allergy tests and nasal challenge tests were performed to investigate and confirm the diagnosis of OR. We discuss potential mechanisms involved in the observed dual sensitization. Results The patient showed positive responses to wheat and guar gum extracts on skin prick testing. The total IgE was 1680 kU/l (0–100 kU/l). The diagnosis of OR was confirmed by nasal challenge tests with wheat flour and guar gum on different days. In contrast to the control day, the challenge with flour and guar gum induced an immediate clinical reaction associated with a decrease in nasal volume measured by acoustic rhinometry. The patient was advised to avoid exposure to wheat and guar gum, which resulted in a gradual resolution of nasal symptoms. Conclusions Co-sensitization and cross-reactivity are possible mechanisms involved in cases of concurrent sensitization to related and unrelated allergens in patients complaining of work-related rhinitis symptoms. AU - Castano R LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 62 IP - DP - 2012 Jan 01 TI - Vaccinating welders against pneumonia PG - 325-330 AB - Background In 2011, the Department of Health in England recommended that welders should each receive a single dose of the 23-valent pneumococcal polysaccharide vaccine (PPV23). Aims To assess the evidence behind the advice and its practical implications. Methods The review was informed by a systematic search in Medline, which related pneumonia to welding and/or exposure to metal fume, and was supplemented using the personal libraries of the authors. Results There is consistent evidence that welders die more often of pneumonia, especially lobar pneumonia, are hospitalized more often for lobar and pneumococcal pneumonia, and more often develop invasive pneumococcal disease (IPD). It is estimated that one case of IPD may be prevented over a 10-year period by vaccinating 588 welders against pneumococcal infection. Conclusions A good case exists that employers should offer PPV23 vaccination to welders and other employees exposed to metal fume. Additionally, reasonable measures must be taken to minimize exposure to welding fume, and welders should be encouraged not to smoke. AU - Palmer KT AU - Cosgrove MP LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 62 IP - DP - 2012 Jan 01 TI - Probable occupational pneumonitis caused by inhalation of crushed clozapine PG - 385-387 AB - We present a case of non-specific interstitial pneumonia (NSIP) probably caused by exposure to inhaled clozapine powder. The patient worked in a pharmacy and crushed clozapine tablets over several years. She presented with insidious onset of breathlessness and had mild hypoxia. High-resolution computed tomography demonstrated centrilobular nodules with peribronchial consolidation. Lung biopsy revealed a mixed cellular and fibrotic NSIP. Her symptoms and radiological findings resolved once exposure to clozapine powder ceased. The clear temporal relationship between increased exposure to inhaled clozapine and the development of NSIP, followed by the subsequent resolution on cessation of exposure, strongly suggest an occupational cause. Both the active ingredients and the excipients of powdered medicine may be responsible for causing pneumonitis in chronic exposure. AU - Lewis A AU - Gibbs A AU - Hope-Gill B LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 12 IP - DP - 2012 Jan 01 TI - Diagnosis of Occupational Asthma: An Update PG - 221-231 AB - Work-related asthma (WRA) includes patients with sensitizer- and/or irritant-induced asthma in the workplace, as well as patients with preexisting asthma that is worsened by work factors. WRA is underdiagnosed; thus, the diagnosis is critical to prevent disease progression and its potential for morbidity and mortality. The interview is the first diagnostic tool to be used by physicians, and the question,"Does asthma improve away from work?” is of the highest sensitivity. However, history can show numerous false positives, and the relationships between asthma worsening and work should be confirmed by objective methods such as peak expiratory flow (PEF) at and away from work. PEF sensitivity and specificity can be enhanced in combination with nonspecific bronchial hyperresponsiveness to histamine/methacholine (NSBP) before and after 2 weeks at work and a similar period off work. Immunologic testing,especially skin prick test (SPT) or specific IgE, is useful for high molecular weight allergens and some low molecular weight agents. Other immunologic tests, as well as induced sputum, measurement of exhaled nitric oxide, exhaled breath condensate, and specific inhalation challenge (SIC)are methods that contribute to the diagnosis and are typically performed at specialized facilities. A diagnosis of occupational asthma (OA) should no longer be based on a compatible history only but should be confirmed by means of objective testing. SIC is the diagnostic gold standard. When SIC is not available, the combination of PEF measurement, NSBP test, a specific SPT, or specific IgE may be an appropriate alternative in diagnosing OA. AU - Jares Edgardo AU - Baena-Cagnani Carlos AU - Gomez Maximiliano LA - PT - DEP - TA - Curr Allergy Asthma Rep JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 69 IP - DP - 2012 Jan 01 TI - Recovery from workplace-induced airway inflammation 1 year after cessation of exposure PG - 721-726 AB - Background Bacterial single-cell protein (BSCP) constitutes of dried bacterial mass which is used as protein enrichment in animal and fish feed. In the production of BSCP, workers are exposed to organic dust containing high levels of endotoxins (arithmetic mean 390 EU/m3 in the moderate exposure and 5800–11?000 EU/m3 in the high exposure groups) and have elevated levels of sputum neutrophils and cytokines associated with exposure. Objective The aim of the present study was to investigate if airway inflammation among the workers had declined 1 year after cessation of exposure. Methods Twenty-four non-smoking production workers (age 28–52) with a work history of 2–7 years were included in the study. Markers of airways inflammation and innate immune function (using flow cytometry) were assessed in an exposure period and 1 year after cessation of exposure. Results Sputum neutrophil proportion and numbers were significantly decreased 1 year after cessation of exposure to BSCP (43% vs 71%, 186 vs 598 neutrophils/mg sputum; p<0.001) as were eNO (17 ppb vs 21 ppb (p=0.01) and interleukin-1ß (p<0.05) and interleukin-8 (p<0.05). Neutrophils had enhanced expression of CD11b/CR3 (p<0.01) and CD16/Fc?RIII (p<0.001) and macrophages had lower expression of CD86 (p<0.01) 1 year after cessation of exposure. Conclusions One year after closure of the plant airway neutrophils and exhaled NO levels resolved to lower levels and cell surface phenotypes associated with innate immune function recovered to higher levels, indicating that these changes were partly reversible among workers who were no longer exposed to endotoxins in a BSCP plant. AU - Sikkeland LIB AU - Eduard W AU - Skogstad M AU - Alexis NE AU - Kongerud J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 69 IP - DP - 2012 Jan 01 TI - overy from workplace-induced airway inflammation 1 year after cessation of exposure PG - 721-726 AB - Background Bacterial single-cell protein (BSCP) constitutes of dried bacterial mass which is used as protein enrichment in animal and fish feed. In the production of BSCP, workers are exposed to organic dust containing high levels of endotoxins (arithmetic mean 390 EU/m3 in the moderate exposure and 5800–11?000 EU/m3 in the high exposure groups) and have elevated levels of sputum neutrophils and cytokines associated with exposure. Objective The aim of the present study was to investigate if airway inflammation among the workers had declined 1 year after cessation of exposure. Methods Twenty-four non-smoking production workers (age 28–52) with a work history of 2–7 years were included in the study. Measurements Markers of airways inflammation and innate immune function (using flow cytometry) were assessed in an exposure period and 1 year after cessation of exposure. Results Sputum neutrophil proportion and numbers were significantly decreased 1 year after cessation of exposure to BSCP (43% vs 71%, 186 vs 598 neutrophils/mg sputum; p<0.001) as were eNO (17 ppb vs 21 ppb (p=0.01) and interleukin-1ß (p<0.05) and interleukin-8 (p<0.05). Neutrophils had enhanced expression of CD11b/CR3 (p<0.01) and CD16/Fc?RIII (p<0.001) and macrophages had lower expression of CD86 (p<0.01) 1 year after cessation of exposure. Conclusions One year after closure of the plant airway neutrophils and exhaled NO levels resolved to lower levels and cell surface phenotypes associated with innate immune function recovered to higher levels, indicating that these changes were partly reversible among workers who were no longer exposed to endotoxins in a BSCP plant. AU - Sikkeland LIB AU - Eduard W AU - Skogstad M AU - Alexis NE AU - Kongerud J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 67 IP - DP - 2012 Jan 01 TI - Chronic obstructive pulmonary disease among residents of an historically industrialised area PG - 901-907 AB - Objective To assess the contribution of workplace exposures to chronic obstructive pulmonary disease (COPD) risk in a community with a heavy burden of past industrial employment. Methods A random population sample of Sheffield, UK residents aged over 55 years (n=4000), enriched with a hospital-based supplemental sample (n=209), was approached for study. A comprehensive self-completed questionnaire elicited physician-made diagnoses, current symptoms, and past workplace exposures. The latter were defined in three ways: self-reported exposure to vapours, gases, dusts and fumes (VGDF); response to a specific exposure checklist; and through a job exposure matrix (JEM) assigning exposure risk likelihood based on job history independent of respondent-reported exposure. A subset of the study group underwent lung function testing. Population attributable risk fractions (PAR%), adjusted for age, sex and smoking, were calculated for association between workplace exposure and COPD. Results 2001 (50%) questionnaires were returned from the general population sample and 60 (29%) by the hospital supplement. Among 1754 with complete occupational data, any past occupational exposure to VGDF carried an adjusted excess risk for report of a physician's diagnosis of COPD, emphysema, or chronic bronchitis (ORs 3.9; 95% CI 2.7 to 5.8), with a corresponding PAR% value of 58.7% (95% CI 45.6% to 68.7%). The PAR% estimate based on JEM exposure was 31%. From within the subgroup of 571 that underwent lung function testing, VGDF exposure was associated with a PAR% of 20.0% (95% CI -7.2 to 40.3%) for Global initiative for chronic Obstructive Lung Disease (GOLD) 1 (or greater) level of COPD. Conclusion This heavy industrial community-based population study has confirmed significant associations between reported COPD and both generic VGDF and JEM-defined exposures. This study supports the predominantly international evidence-based notion that workplace conditions are important when considering the current and future respiratory health of the workforce. AU - Darby AC AU - Waterhouse JC AU - Stevens V AU - Billings CG AU - Billings CG AU - Burton CM AU - Young C AU - Wight J AU - Blanc PD AU - Fishwick D LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 62 IP - DP - 2012 Jan 01 TI - Shift work effects on serial PEF measurements for occupational asthma PG - 525-532 AB - Background Diurnal variation (DV) affects lung function but the changes are thought to be related to sleep patterns rather than time of day. When diagnosing occupational asthma (OA), serial peak expiratory flow (PEF) measurements are the recommended first line investigation, but could be confounded by shift work. Aims The aim of the study was to investigate the effects of shift work on PEF measurements used for diagnosing OA. Methods PEF records containing more than one shift pattern with =4 days per shift were identified. OA diagnosis was based on an Oasys-2 score =2.51 and non-OA on having an alternative clinical diagnosis and Oasys-2 score <2.51. The mean area between curves (ABC) score, mean PEF DV and cross-shift PEF changes were calculated for each shift. Results Records from 123 workers with OA and 69 without OA satisfied inclusion criteria. In the OA group, PEF declined more on afternoon and night shifts than days (P < 0.001). The ABC score was lower in the OA group on night (P < 0.05) and afternoon shifts (P < 0.05) as compared with days, without significant differences in DV. Among those without OA, cross-shift PEF increased more on day shifts (mean + 25 l/min) than afternoon or night shifts (+1 l/min) (P < 0.001). The sensitivity for the ABC score and DV were good and similar across shifts, but specificity was reduced using DV (DV mean 39%; ABC 98%). Conclusions PEF responses between work and rest show small differences according to shift type. The ABC score has a high sensitivity and specificity for all shifts; differences in DV have lower specificity. AU - Moore VC AU - Jaakkola MS AU - Burge CBSG AU - Pantin CFA AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 62 IP - DP - 2012 Jan 01 TI - An outbreak of occupational asthma due to chromium and cobalt PG - 533-540 AB - Background Five metal turners employed by an aerospace manufacturer presented to the Birmingham Chest Clinic occupational lung disease unit. Four cases of occupational asthma (OA) due to chromium salt (3) and cobalt (1) were diagnosed by serial peak-expiratory flow measurements and specific inhalation challenge testing. Aims To measure the extent of the outbreak and to provide epidemiological data to ascertain the aetiology. Methods Participants answered a detailed, self-administered questionnaire, designed to detect occupational lung disease. Urine chromium and cobalt excretion, spirometry and exhaled nitric oxide measurements were taken. Those with possible, probable or definite non-OA or OA, after questionnaire, were invited to undertake two-hourly peak flow measurements and received specialist follow-up. Results A total of 62 workers (95% of workforce) participated. Sixty-one per cent of employees were working in higher metalworking fluid (MWF) exposure areas. Ninety per cent of workers had urinary chromium excretion indicating occupational exposure. Sixty-six per cent of workers reported active respiratory symptoms, although there were no significant differences between exposure groups. Two further workers with probable OA were identified and had significantly higher urinary chromium and cobalt concentration than asymptomatic controls. Eighteen cases of occupational rhinitis (OR) were identified, with significantly raised urinary chromium concentration compared with asymptomatic controls. Conclusions Chromium salt and cobalt can be responsible for OA and OR in workers exposed to MWF aerosols. Onset of symptoms in those with positive specific challenges followed change in MWF brand. Workers with OA had increased urinary concentrations of chromium and cobalt, and those with OR had increased urinary concentrations of chromium. AU - Walters GI AU - Moore VC AU - Robertson AS AU - Burge CBSG AU - Vellore A-D AU - Burge PS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 62 IP - DP - 2012 Jan 01 TI - Audit of the recording of occupational asthma in primary care PG - 570-573 AB - Background Occupational asthma (OA) remains common; 1 in 10 cases of adult-onset asthma is due to work. Health outcomes are better with early diagnosis, but there is considerable delay, largely due to lack of enquiry about work effect in primary care. National guidelines (2008) recommend asking two screening questions, which together have a high sensitivity in identifying OA. Aims To audit how working-age asthmatics are currently screened for OA in a local primary care population. Methods An audit of the electronic patient records of working-age asthmatics, from four Birmingham primary care practices was undertaken. Practice-level data (list size, gender, prevalence of asthma and OA and socio-economic status) and patient-level data (gender, age, onset, occupation and work-effect enquiry and lung function) were collected. Results The total practice population was 27 295 of which 17 564 (64%) were of working age. The audit sample was 396 of whom 49% were male. The prevalence of asthma in working-age adults was 12% (8–15%) and the prevalence of OA in working-age asthmatics was 0.3% (0–0.8%). Occupation was recorded in only 55/396 (14%) cases with very few (2) documented within the asthma-review template. Occupation was only recorded in 13/55 adult-onset asthmatics in high-risk occupations. Of 396, 9 (2%) had any work-effect enquiry and 4 patients had work-effect enquiry at diagnosis in those with traceable notes (n = 117). Conclusions The prevalence of OA was low, suggesting under-diagnosis plus under-reporting in primary care. Occupation and work-effect enquiry is lacking despite guidelines for identifying OA. Existing electronic templates for recording asthma review could be modified to include these elements. AU - Walters GI AU - McGrath EE AU - Ayres JG LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 55 IP - DP - 2012 Jan 01 TI - Occupational contact allergens: Are they also associated with occupational asthma? PG - 353-360 AB - Background Workplace exposures that can potentially cause both allergic occupational contact dermatitis (AOCD) and occupational asthma (OA) are not clearly identified. Methods Occupational contact allergens (OCAs) were identified using North American Contact Dermatitis Group (NACDG) data. Reference documents and systematic reviews were used to determine whether each OCA had been reported to potentially cause OA. The presence or absence of a sensitizer notation in occupational hygiene reference documents was also examined. Results The 10 most common OCAs were: epoxy resin*, thiuram, carba mix, nickel sulfate*, cobalt chloride*, potassium dichromate*, glyceryl thioglycolate, p-phenylenediamine*, formaldehyde* and glutaraldehyde*. Seven (indicated by *) were determined to be possible causes of OA. Information on sensitizing potential from OH reference materials contained conflicting information. Conclusions Several common OCAs can also potentially cause OA. Inhalation and dermal exposures to these agents should be controlled and both OA and AOCD should be considered as possible AU - Arrandale VH AU - Liss GM AU - Tarlo SM AU - Pratt MD AU - Sasseville D AU - Kudla I AU - Holness DL LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 85 IP - DP - 2012 Jan 01 TI - The persistence of allergen exposure favors pulmonary function decline in workers with allergic occupational asthma PG - 181-188 AB - Background In asthmatics, a rapid decline in pulmonary function is observed, likely as a consequence of airways remodeling. Persistence of allergen exposure in patients with occupational asthma (OA) maintains chronic bronchial inflammation, resulting in a more severe lung function decline. Few studies were performed on the efects of allergen exposure cessation. Objective This study aims at evaluating the infuence of allergen exposure cessation on respiratory decline in allergic asthmatic workers. Methods Two groups of workers with allergic OA were selected. The first group (30 workers) changed job after the diagnosis and was no more exposed to sensitizing allergens, and the second group (28 subjects) did not and, as a consequence of preventive measures in the work place, was exposed to a lower level of allergens. All were treated with conventional therapy, according to GINA protocols. FEV1 changes during a 12-year period were evaluated. Results Despite pharmacological therapy, the pulmonary function decay slope was steeper in workers continuously exposed to the sensitizing agent (even at reduced level) than in those with a complete cessation of exposure: Final FEV1 loss was 512.5 +/- 180 ml versus 332.5 +/- 108 ml, respectively. The diference became significant after 4 years from the cessation of the exposure. Conclusions The study shows that the cessation of the exposure to allergen in the work place appears the most eVective measure in limiting pulmonary function decline in asthmatic workers and underlines the importance of allergic risk assessment and control in the management of occupational asthma. AU - Di Giampaolo L AU - Cavallucci E AU - Braga M AU - Renzetti A AU - Schiavone C AU - Quecchia C AU - Petrarca C AU - Di Gioacchino M LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 44 IP - DP - 2012 Jan 01 TI - Role of vitamin D-binding protein in isocyanate-induced occupational asthma PG - 319-329 AB - The development of a serological marker for early diagnosis of isocyanate-induced occupational asthma (isocyanate-OA) may improve clinical outcome. Our previous proteomic study found that expression of vitamin D-binding protein (VDBP) was upregulated in the patients with isocyanate-OA. In the present study, we evaluated the clinical relevance of VDBP as a serological marker in screening for isocyanate-OA among exposed workers and its role in the pathogenesis of isocyanate-OA. Three study groups including 61 patients with isocyanate-OA (group I), 180 asymptomatic exposed controls (AECs, group II), 58 unexposed healthy controls (NCs, group III) were enrolled in this study. The baseline serum VDBP level was significantly higher in group I compared with groups II and III. The sensitivity and specificity for predicting the phenotype of isocyanate-OA with VDBP were 69% and 81%, respectively. The group I subjects with high VDBP (= 311 µg/ml) had significantly lower PC20 methacholine levels than did subjects with low VDBP. The in vitro studies showed that TDI suppressed the uptake of VDBP into RLE-6TN cells, which was mediated by the downregulation of megalin, an endocytic receptor of the 25-hydroxycholecalciferol-VDBP complex. Furthermore, toluene diisocyanate (TDI) increased VEGF production and secretion from this epithelial cells by suppression of 1,25-dihydroxycholecalciferol [1,25(OH)2D3] production. The findings of this study suggest that the serum VDBP level may be used as a serological marker for the detection of isocyanate-OA among workers exposed to isocyanate. The TDI-induced VEGF production/secretion was reversed by 1,25(OH)2D3 treatment, which may provide a potential therapeutic strategy for patients with isocyanate-OA. AU - Kim S AU - Choi G AU - Nam Y AU - Kim J AU - Hur G AU - Kim S AU - Park SM AU - Park H LA - PT - DEP - TA - Experimental and Molecular Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 136 IP - DP - 2012 Jan 01 TI - Effect of current depression on the association of work-related asthma with adverse asthma outcomes: a cross-sectional study using the Behavioral Risk Factor Surveillance System PG - 1135-1142 AB - BACKGROUND: Depression has been associated with a decreased level of asthma control. The aim of our study was to examine associations between health-professional diagnosed work-related asthma (WRA) and current depression and the effect of current depression on the associations of WRA with adverse asthma outcomes. METHOD: We analyzed data from the 2006 and 2008 Behavioral Risk Factor Surveillance System Asthma Call-Back Survey and the Anxiety and Depression Module conducted in 25 states and District of Columbia for ever-employed adults with current asthma. We computed weighted proportions and prevalence ratios adjusted for age, sex, race/ethnicity, education, current employment status, and smoking status. Survey participants who were ever told by a doctor or other health professional that their asthma was related to any job they ever had were determined to have WRA. Participants with current depression were identified using self-report of depressive symptoms. RESULTS: Of ever-employed adults with current asthma, an estimated 9.1% had WRA and 17.0% had current depression. Persons with WRA were significantly more likely than those with non-WRA to have current depression. Persons with either WRA, current depression, or both WRA and current depression were significantly more likely to have adverse asthma outcomes than persons with asthma and neither condition. The associations with adverse asthma outcomes were stronger when both current depression and WRA were present. LIMITATIONS: This is a cross-sectional and hypothesis-generating study. CONCLUSIONS: Depression may play an important role in asthma management and should be considered when assessing patients with asthma and, in particular, those with WRA. AU - Mazurek JM AU - Knoeller GE AU - Moorman JE LA - PT - DEP - TA - J Affect Disord JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 103 IP - DP - 2012 Jan 01 TI - Description of a specific bronchial provocation test for the diagnosis of occupational asthma due to platinum salts PG - 123-129 AB - BACKGROUND: Occupational exposure to platinum salts may cause the onset of skin and respiratory disorders with an IgE-mediated allergic mechanism. The diagnosis of occupational asthma due to platinum salts was, in a small number of cases, achieved also via occupational specific bronchial provocation tests (sBPT), which until now were conducted by pouring platinum salt dusts from one tray to another or by direct aerosoling of hexachloroplatinate solutions into the patient's airways. METHODS: Here we describe an original occupational sBPT based on atomization of solutions of ammonium hexachloroplatinate, at increasing concentrations, in a 5 m3 challenge room: the starting solution is a 1:100 dilution of the preset threshold of the patient's skin reactivity to the substance. In the absence of a bronchoconstrictive response, the following concentration is atomized (each time 10 times higher than the previous one), until the maximum concentration, 10(-2) M, is reached. The patient is not in the challenge room during atomization of the solutions, but enters when this operation has been completed and remains there for 15 minutes, unless he/she shows signs of respiratory trouble before that time. After each exposure, the patient is clinically monitored, with respiratory function tests at preset times, until at least 8 hours after the end of the exposure. RESULTS AND CONCLUSIONS: The test allowed identifying a respiratory hypersensitivity specifically to platinum as cause of asthma in two precious metal workers, with the onset of immediate bronchospasm in one patient and biphasic bronchospasm in the other. Compared to the sBPT by pouring a mixture of platinum salt dusts from one tray to another, the method we designed offers a better standardization of bronchial stimulation and, compared to direct aerosoling of hexachloroplatinate into the patient's airways, it has the advantage of reproducing the respiratory risk conditions occurring in the workplace and offers better safety guarantees for the patient, since it reduces the risk of onset of serious asthmatic or even systemic responses in subjects highly hypersensitive to this metal. AU - Porro S AU - Cerri S AU - Bernabeo F AU - Pisati G. LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 108 IP - DP - 2012 Jan 01 TI - Diagnostic utility of exhaledbreath condensate analysis in conjunction with specific inhalation challenge in individuals with suspected work-related asthma PG - 151-156 AB - Background Establishing the role of exhaledbreath condensate (EBC) analysis in work-related asthma (WRA), and more specifically, in conjunction with specific inhalation challenge (SIC), is difficult. Objective To measure EBC pH, and nitrite/nitrate concentrations before and after SIC in individuals with suspected WRA exposed to either high-molecular-weight (HMW) or low-molecular-weight (LMW) agents and evaluate whether these changes are useful to distinguish between occupational asthma (OA) and work-exacerbated asthma (WEA). Methods One hundred twenty-five consecutive workers undergoing SIC were enrolled. Exhaledbreath condensate was collected at the end of the baseline day and 24 hours after exposure to the offending agent. In all EBC samples, pH was measured, and nitrite and nitrate concentrations were determined. Results Specific inhalation challenge was positive in 66 individuals, who were then diagnosed with OA. Work-exacerbated asthma was diagnosed in 14, and in 45 patients establishing a direct relationship between the symptoms and work exposure was not possible. In patients with WEA, EBC pH values after SIC were significantly lower than those before SIC (P = .0047). Using the receiver operating characteristic (ROC) curve, we found that an EBC pH decrease of greater than 0.4 units after SIC achieved the most satisfactory sensitivity 79% (confidence interval [CI]: 49–94) and specificity of 100% (CI: 68–100), considering only patients with asthma and without OA. A decrease in EBC pH of 0.4 or more common in those exposed to HMW agents (8/19, 42%) than in those exposed to LMW agents (7/47, 15%). Conclusions Exhaled breath condensate pH in conjunction with SIC may be useful for diagnosing WEA. AU - Sánchez-Vidaurre S AU - Cruz M AU - Gómez-Ollés S AU - Morell F AU - Muñoz X LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 25 IP - DP - 2012 Jan 01 TI - Metal-induced asthma and chest X-ray changes in welders PG - 242-250 AB - Objectives The aim of this study was to evaluate the coexisting factors and usefulness of diagnostic methods in metal-induced asthma in Polish welders. Materials and Methods Examination of 50 welders occupationally exposed to metals and with suspicion of metal-induced asthma (group A), 100 welders occupationally exposed to metals but without suspicion of metal-induced asthma (group B), and two control groups (10 patients with atopic asthma and 10 healthy subjects) was carried out. Questionnaire survey, clinical examination, skin prick tests to common aeroallergens and metal salts, rest spirometry tests, X-ray, metacholine challenge and a single-blind, placebo controlled specific inhalation challenge tests with metals (or work-like conditions challenge tests) were performed. Results In group A — in 9 cases we obtained positive results of specific inhalation challenge tests with metals (in 3 cases with nickel, in 4 cases with chromium, in 1 case with cobalt and in 1 case with manganese). Nine cases of metal-induced occupational asthma were recognized. In group B — only in one case we obtained positive results of work-like conditions challenge test (clinical and spirometry changes, eosinophil influx in induced sputum), which confirmed the diagnosis of occupational asthma. In most of examined welders (62%), pulmonary changes in chest X-ray images were noted. The statistical analysis revealed that working as a welder for more than 10 years is the coexisting factor of presence of chest X-ray changes (p- or q-type nodular changes or interstitial changes). Positive results of skin prick tests with metal salts were the coexisting factors of occupational asthma due to metals among examined group of welders. Conclusions Specific inhalation challenge plays the key role in diagnostics of metal-induced asthma in welders. Pulmonary changes in chest X-ray were found in a significant percentage of examined welders. AU - Wittczak T AU - Dudek W AU - Walusiak-Skorupa J AU - Swierczynska-Machura D AU - Cader W AU - Kowalczyk M AU - Palczynski C LA - PT - DEP - TA - Int J Occup Med Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 62 IP - DP - 2012 Jan 01 TI - Sensitization and irritant-induced occupational asthma with latency are clinically indistinguishable PG - 129-133 AB - Sensitization and irritant-induced occupational asthma with latency are clinically indistinguishable P. S. Burge, V. C. Moore and A. S. Robertson Correspondence to: P. S. Burge, Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK. Tel: +44 (0)1214240734; fax +44 (0)1217720292; e-mail: sherwood.burge@heartofengland.nhs.uk Abstract Background Acute irritant exposures at work are well-recognized causes of asthma. In the occupational setting, low-dose exposure to the same agent does not provoke asthma. Occupational asthma (OA) with latency due to irritants is not widely accepted. Aims To compare workers with OA with latency likely to be due to irritant exposures with workers with the more usual sensitization-induced OA. Methods Following identification of a worker who fulfils all the criteria for irritant-induced OA with latency whose investigation documented lime dust as a cause for his OA, we searched the Shield reporting scheme database between 1989 and 2010 for entries where the OA was more likely to be due to irritant than allergic mechanisms and compared these with the remainder where allergic mechanisms were likely. Outcome measures were latent interval from first exposure to first work-related symptom, non-specific bronchial reactivity, smoking, atopy and the presence of pre-existing asthma. Results A previously fit lecturer teaching bricklaying had irritant-induced OA with latency without unusual exposures with an immediate asthmatic reaction following exposure to a sand/lime mixture (pH 8). The Shield database identified 127 workers with likely irritant-induced asthma with latency and 1646 with hypersensitivity-induced OA. The two groups were indistinguishable in terms of pre-existing asthma, atopy, age, latent interval, non-specific reactivity and smoking. Conclusions Irritant exposure is a cause of OA with latency currently clinically indistinguishable from OA due to sensitization. AU - Burge PS AU - Moore VC AU - Robertson AS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 129 IP - DP - 2012 Jan 01 TI - Occupational asthma caused by IgE-mediated sensitization to multiple woods PG - 254-256 AB - We report a case of a multiple sensitization to different woods demonstrated by in vivo and in vitro tests. Cross-reactivity among different woods was assessed by using ELISA cross-inhibition assays. Surprisingly, pine extract was a strong inhibitor of 2 tropical woods such as obeche (genus Sterculia, family Sterculiaceae) and iroko (genus Milicia, family Moreaceae), which are unrelated to pine (genus Pinus, family Pineaceae). Information about wood allergens is scarce with few exceptions,1, 2 and so the nature of the allergen(s) responsible for the multiple sensitizations in this patient is still unknown; although the presence of low-molecular-weight compounds such as abietic acid and dehydroabietic acid was demonstrated in the extract by using gas chromatography combined with mass spectrometry, no IgE-binding activity was detected. Further studies are necessary to characterize wood antigens and develop standardized extracts to improve the diagnosis of occupational asthma caused by wood dust. AU - Campo P AU - Aranda A AU - Palacin A AU - Montañez MI AU - Díaz-Perales A AU - Blanca M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 69 IP - DP - 2012 Jan 01 TI - Air exposure assessment of TDI and biological monitoring of TDA in urine in workers in polyurethane foam industry PG - 93-98 AB - Objectives Toluene diisocyanate (TDI) is used in the manufacturing process of polyurethane (PU) foams and is a potent inducer of occupational asthma. The objective of this study was to evaluate the correlation between the exposure to total TDI (2,4- and 2,6-TDI) in air and the corresponding biomarker concentration of total TDA (2,4- and 2,6-TDA) in hydrolysed urine. The aim was also to propose an appropriate biological exposure limit for total TDA in urine. Methods 9 workers from two production lines in a PU foam producing plant were studied. Personal exposure to TDI during four representative production shifts was monitored by an active air sampling method (filter impregnated with 1-(2-methoxyphenyl)piperazine) and quantified by high-performance liquid chromatography and diode array detection (NIOSH n° 2535, 5521). In parallel, pre-shift and post-shift urinary samples were collected from the exposed workers, and TDA concentrations were determined by gas chromatography–mass spectrometry after alkaline hydrolysis. All samples were collected on four measuring days: two Fridays (end of workweek) and two Mondays (start of workweek) separated by a weekend without exposure. Results Strong correlations between the personal air concentrations of total TDI and the corresponding biomarker levels of total TDA in urine (r=0.816) were observed. An increase of 18.12 µg TDA/l (post-shift minus pre-shift concentration) corresponds to an exposure of 5 ppb (37 µg/m3, the current American Conference of Governmental Industrial Hygienists threshold limit value) during the shift. Conclusions The increase in TDA during the shift is a suitable biomarker for exposure to TDI during the same shift. Further research is needed to evaluate the use of start of week or end of week post-shift TDA in urine as biomarker since TDA was found to accumulate during the working week and thus the moment of sampling will clearly influence the result. AU - Geens T AU - Dugardin S AU - Schockaert A AU - Cooman GD AU - van Sprundel M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 69 IP - DP - 2012 Jan 01 TI - Sensitisation to common allergens and respiratory symptoms in endotoxin exposed workers: a pooled analysis PG - 99-106 AB - Objective To test the hypotheses that current endotoxin exposure is inversely associated with allergic sensitisation and positively associated with non-allergic respiratory diseases in four occupationally exposed populations using a standardised analytical approach. Methods Data were pooled from four epidemiological studies including 3883 Dutch and Danish employees in veterinary medicine, agriculture and power plants using biofuel. Endotoxin exposure was estimated by quantitative job-exposure matrices specific for the study populations. Dose–response relationships between exposure, IgE-mediated sensitisation to common allergens and self-reported health symptoms were assessed using logistic regression and generalised additive modelling. Adjustments were made for study, age, sex, atopic predisposition, smoking habit and farm childhood. Heterogeneity was assessed by analysis stratified by study. Results Current endotoxin exposure was dose-dependently associated with a reduced prevalence of allergic sensitisation (ORs of 0.92, 0.81 and 0.66 for low mediate, high mediate and high exposure) and hay fever (ORs of 1.16, 0.81 and 0.58). Endotoxin exposure was a risk factor for organic dust toxic syndrome, and levels above 100 EU/m3 significantly increased the risk of chronic bronchitis (p<0.0001). Stratification by farm childhood showed no effect modification except for allergic sensitisation. Only among workers without a farm childhood, endotoxin exposure was inversely associated with allergic sensitisation. Heterogeneity was primarily present for biofuel workers. Conclusions Occupational endotoxin exposure has a protective effect on allergic sensitisation and hay fever but increases the risk for organic dust toxic syndrome and chronic bronchitis. Endotoxin's protective effects are most clearly observed among agricultural workers. AU - Basinas I AU - Schlünssen V AU - Heederik D AU - Sigsgaard T AU - Smit LAM AU - Samadi S AU - Omland Ø AU - Hjort C AU - Madsen AM AU - Skov S AU - Wouters IM LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 69 IP - DP - 2012 Jan 01 TI - Long-term occupational outcomes of endotoxin exposure and the effect of exposure cessation PG - 107-112 AB - Objective To study the possible respiratory and haematological effects of endotoxin exposure to bacterial single-cell protein (BSCP) in workers during a follow-up period of 5 years including 4 years of exposure and 1 year without exposure. Methods The study included 28 workers examined in 2002–2005 and 1 year after exposure termination in 2007. The arithmetic mean endotoxin exposure was 5800–11?000 EU/m3 among the high exposure group and 390 EU/m3 in the low exposure group. Assessment of lung function included spirometry and gas diffusion in 2003, 2004 and 2007. Rhinometry was performed in 2004 and 2007. Blood analysis included leukocyte cell count and measurement of the acute phase proteins: C-reactive protein, interleukin-6, eosinophilic cationic protein, macrophage inflammatory protein-1a, monocyte chemoattractant protein-1, chemoattractant protein RANTES, platelet-derived growth factor BB, fibrinogen and D-dimer. Results In the low exposure group, but not in the high exposure group, there were significant improvements in both forced vital capacity (FVC) (290 ml) and forced expiratory volume in 1 s (FEV1) (180–210 ml) (p=0.004–0.03) 1 year after the end of exposure. The number of leukocytes and eosinophilic cationic protein and D-dimer levels increased significantly with increasing endotoxin exposures and decreased significantly 1 year after exposure termination. Changes in acute phase proteins suggested exposure-related tolerance. Conclusions An inflammatory tendency during an exposure period of 4 years seems to reverse 1 year after cessation of exposure to endotoxins from a single species. Lung function improved significantly among workers exposed to low levels of endotoxin but not among the highly exposed workers. AU - Skogstad M AU - Sikkeland LIB AU - Øvstebø R AU - Haug KBF AU - Heldal KK AU - Skare Ø AU - Kongerud J AU - Kierulf P AU - Eduard W LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 69 IP - DP - 2012 Jan 01 TI - Association between cleaning-related chemicals and work-related asthma and asthma symptoms among healthcare professionals PG - 35-40 AB - Objectives Work-related asthma (WRA) is an important public health problem affecting one quarter of adults with asthma. Although cleaning substances are routinely used in hospitals, few studies have addressed their potential adverse respiratory health effects on healthcare professionals (HCPs). This study attempts to identify relationship between work-related exposure to cleaning-related chemicals and development of WRA among HCPs. Methods Of 5600 HCPs surveyed, 3650 responded to a validated questionnaire about their occupation, asthma diagnosis, variability of asthma symptoms at and away from work, and exposure to individual cleaning substances. Workplace asthma was defined as a categorical variable with four mutually exclusive categories: work-related asthma symptoms (WRAS), work-exacerbated asthma (WEA), occupational asthma (OA) and none. Multivariable logistic regression analysis was used to evaluate the association between self-reported use of cleaning substances and asthma outcomes among HCPs. Results Prevalences of WRAS, WEA and OA were 3.3%, 1.1% and 0.8%, respectively. The prevalence estimates were generally higher among female than male HCPs. The odds of WRAS and WEA increased in a dose-dependent manner for exposure in the longest job to cleaning agents and disinfectants/sterilants, respectively. For exposure in any job, the odds of WRAS were significantly elevated for both factor 1 (bleach, cleaners/abrasives, toilet cleaners, detergents and ammonia) and factor 2 (glutaraldehyde/ortho-phtaldehyde, chloramines and ethylene oxide). Significantly elevated odds of WEA were observed for exposure to bleach, factor 2 and formalin/formaldehyde. Exposure to chloramines was significantly associated with an almost fivefold elevated odds of OA. Conclusions HCPs are at risk of developing WRA from exposure to cleaning substances. AU - Arif AA AU - Delclos GL LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 69 IP - DP - 2012 Jan 01 TI - Allergy among veterinary medicine students in The Netherlands PG - 48-55 AB - Background Veterinary medicine students who practice with animals are potentially exposed to many occupational agents, yet sensitisation and allergic symptoms among this group have not been studied extensively. Objective The objective of this study was to estimate the prevalence of sensitisation and allergic symptoms in veterinary medicine students in association with study specialisation over time. Methods A questionnaire-based cross-sectional study was conducted. Blood was collected and tested for total and specific serum IgE for 16 different common and study-specific allergens using enzyme immunoassay. Results New development of self-reported allergic symptoms to various allergens occurred in 8.7%, of which 44% was deducted against animals. Handling farm animals was strongly associated with self-reported allergies to various allergens (OR=6.9, 95% CI 1.9 to 25) and animal allergens (OR=12, 95% CI 1.4 to 103). Sensitisation to at least one allergen occurred in 33.1%. Sensitisation prevalence tended to be elevated in later years of the equine study program. In contrast to self-reported allergies, the prevalence of sensitisation to any allergen decreased with prolonged study duration for those specialising in farm animal health (years 3–5: OR=0.5, 95% CI 0.3 to 1.1; year 6: OR=0.2, 95% CI 0.1 to 0.5). This was independent of whether people were raised on a farm, which is in itself a protective factor for allergy and sensitisation. Conclusion This study provides evidence of an elevated prevalence of allergic symptoms with increasing years of veterinary study, suggesting that contact with animals, more specifically contact to farm animals, is a risk factor for the development of symptoms. AU - Samadi S AU - Spithoven J AU - Jamshidifard A-R AU - Berends BR AU - Lipman L AU - Heederik DJJ AU - Wouters IM LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 129 IP - DP - 2012 Jan 01 TI - Airway remodeling and inflammation in competitive swimmers training in indoor chlorinated swimming pools PG - 351-358 AB - Background Airway disorders are common in regular chlorinated swimming pool attendees, particularly competitive athletes, but the impact of intense swimming training on airway function and structure remains unclear. Objective This study aimed to evaluate airway inflammation and remodeling in elite swimmers. Methods Twenty-three elite swimmers were tested during off-training season. All had exhaled nitric oxide measurement, methacholine test, eucapnic voluntary hyperpnea challenge, allergy skin prick tests, and bronchoscopy with bronchial biopsies. Clinical data and tissues from 10 age-matched mild-asthmatic and 10 healthy nonallergic subjects were used for comparison. Results Swimmers had increased airway mucosa eosinophil and mast cell counts than did controls (P < .05). They had more goblet cell hyperplasia and higher mucin expression than did healthy or asthmatic subjects (P < .05). A greater submucosal type I and III collagen expression and tenascin deposition was also observed in swimmers than in controls (P < .05). Neither exhaled nitric oxide nor airway responsiveness to methacholine or eucapnic voluntary hyperpnea challenge correlated with these inflammatory and remodeling changes. Conclusion Intense, long-term swimming training in indoor chlorinated swimming pools is associated with airway changes similar to those seen in mild asthma, but with higher mucin expression. These changes were independent from airway hyperresponsiveness. The long-term physiological and clinical consequences of these changes remain to be clarified. AU - Bougault V AU - Loubaki L AU - Joubert P AU - Turmel J AU - Couture C AU - Laviolette M AU - Chakir J AU - Boulet L-P LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 129 IP - DP - 2012 Jan 01 TI - Comparison of methacholine and mannitol bronchial provocation tests in workers with occupational asthma PG - 555-556 AB - This study showed that although mannitol BPT results were positive in the minority of subjects (30%), those with a positive mannitol BPT result had more active disease in terms of greater airflow limitation and more eosinophilic inflammation and higher exhaled nitric oxide levels compared with values seen in subjects with a negative mannitol BPT result. Therefore the mannitol BPT might be more relevant than the methacholine BPT for assessing the impairment/disability of subjects with a previous diagnosis of OA. However, the mannitol BPT was not sensitive for identification of AHR to methacholine in this population. The mannitol BPT was able to successfully induce sputum for obtaining valid sputum cell counts. The quality of sputum samples was better with hypertonic saline than with mannitol but still of good quality after using mannitol. There was a significant discrepancy between the cell counts obtained with hypertonic saline and mannitol for sputum induction. Furthermore, there was a substantial difference between the classifications in the different inflammatory phenotypes between the 2 methods, as shown by the low agreement of the eosinophil (? = 0.1) and paucigranulocytic (? = 0.1) phenotypes between the methacholine and mannitol BPTs (Table II). These results differ somewhat, with previous results showing similar eosinophil and neutrophil cell counts after hypertonic saline and mannitol.9 The protocols used to administer hypertonic saline differed significantly between the 2 studies, which might explain these differences. AU - Lemiere C AU - Miedinger D AU - Jacob V AU - Chaboillez S AU - Tremblay C AU - Brannan JD LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 106 IP - DP - 2012 Jan 01 TI - Characterisation of asthma that develops during adolescence; findings from the Isle of Wight Birth Cohort PG - 329-337 AB - Background Understanding of adolescent-onset asthma remains limited. We sought to characterise this state and identify associated factors within a longitudinal birth cohort study Methods The Isle of Wight Whole Population Birth Cohort was recruited in 1989 (N=1456) and characterised at 1, 2, 4, 10 and 18-years. “Adolescent-onset asthma” was defined as asthma at age 18 without prior history of asthma, “persistent-adolescent asthma” as asthma at both 10 and 18 and “never-asthma” as those without asthma at any assessment. Results Adolescent-onset asthma accounted for 28.3% of asthma at 18-years and was of similar severity to persistent-adolescent asthma. Adolescent-onset asthmatics showed elevated bronchial hyper-responsiveness (BHR) and atopy at 10 and 18 years. BHR in this group at 10 was intermediate to that of never-asthmatics and persistent-adolescent asthma. By 18 their BHR, bronchodilator reversibility and sputum eosinophilia was greater than never-asthmatics and comparable to persistent-adolescent asthma. At 10, males who later developed adolescent-onset asthma had reduced FEV1 and FEF25–75, while females had normal lung function but then developed impaired FEV1 and FEF25–75 in parallel with adolescent asthma. Factors independently associated with adolescent-onset asthma included atopy at 10 (OR=2.35; 95% CI=1.08–5.09), BHR at 10 (3.42; 1.55–7.59), rhinitis at 10 (2.35; 1.11–5.01) and paracetamol use at 18-years (1.10; 1.01–1.19). Conclusions Adolescent-onset asthma is associated with significant morbidity. Predisposing factors are atopy, rhinitis and BHR at age 10 while adolescent paracetamol use is also associated with this state. Awareness of potentially modifiable influences may offer avenues for mitigating this disease state. AU - Kurukulaaratchy RJ AU - Raza A AU - Scott M AU - Williams P AU - Ewart S AU - Matthews S AU - Roberts G AU - Arshad SH LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 39 IP - DP - 2012 Jan 01 TI - Guidelines for the management of work-related asthma PG - 529-545 AB - Work-related asthma, which includes occupational asthma and work-aggravated asthma, has become one of the most prevalent occupational lung diseases. These guidelines aim to upgrade occupational health standards, contribute importantly to transnational legal harmonisation and reduce the high socio-economic burden caused by this disorder. A systematic literature search related to five key questions was performed: diagnostics; risk factors; outcome of management options; medical screening and surveillance; controlling exposure for primary prevention. Each of the 1,329 retrieved papers was reviewed by two experts,followed by Scottish Intercollegiate Guidelines Network grading, and formulation of statements graded according to the Royal College of General Practitioners’ three-star system. Recommendations were made on the basis of the evidence-based statements, which comprise the following major evidence-based strategic points. 1) A comprehensive diagnostic approach considering the individual specific aspects is recommended. 2) Early recognition and diagnosis is necessary for timely and appropriate preventative measures. 3) A stratified medical screening strategy and surveillance programme should be applied to at-risk workers. 4) Whenever possible,removing exposure to the causative agent should be achieved, as it leads to the best health outcome. If this is not possible, reduction is the second best option, whereas respirators are of limited value. 5) Exposure elimination should be the preferred primary prevention approach. AU - Baur X AU - Sigsgaard T AU - Aasen TB AU - Burge PS AU - Heederik D AU - Henneberger P AU - Maestrelli P AU - Rooyackers J AU - Schlunssen V AU - Vandenplas O AU - Wilken D on behalf of the ERS Task Force on the Management of Work-related Asthma LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 67 IP - DP - 2012 Jan 01 TI - Standards of care for occupational asthma: an update PG - 278-280 AB - Background The British Thoracic Society (BTS) Standards of Care (SoC) Committee produced a standard of care for occupational asthma (OA) in 2008, based on a systematic evidence review performed in 2004 by the British Occupational Health Research Foundation (BOHRF). Methods BOHRF updated the evidence base from 2004–2009 in 2010. Results This article summarises the changes in evidence and is aimed at physicians, nurses and other healthcare professionals in primary and secondary care, occupational health and public health and at employers, workers and their health, safety and other representatives. Conclusions Various recommendations and evidence ratings have changed in the management of asthma that may have an occupational cause. AU - Fishwick D AU - Barber CM AU - Bradshaw LM AU - Ayres JG AU - Barraclough R AU - Burge S AU - Corne JM AU - Cullinan P AU - Frank TL AU - Hendrick D AU - Hoyle J AU - Curran AD AU - Niven R AU - Pickering T AU - Reid P AU - Robertson A AU - Stenton C AU - Warburton CJ AU - Nicholson PJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 42 IP - DP - 2012 Jan 01 TI - Molecular characterization of wheat allergens specifically recognized by patients suffering from wheat-induced respiratory allergy PG - 597-609 AB - Background Wheat (Triticum aestivum) is an important allergen source responsible for various clinical manifestations of allergy (i.e. food allergy, pollen allergy, respiratory allergy to flour-Baker's asthma. Objective The objective of this study was the molecular and immunological characterization of new recombinant wheat allergens and to evaluate their usefulness for the diagnosis of allergy to wheat. Methods A T. aestivum cDNA library was constructed and screened with serum IgE from patients suffering from wheat allergy to identify cDNAs coding for new wheat allergens. The allergen-encoding cDNAs were expressed in Escherichia coli and purified to homogeneity. IgE reactivity of recombinant proteins was analysed in RAST-based, non-denaturing dot blot experiments and by ELISA with sera from wheat allergic patients and their allergenic activity was assessed in basophil degranulation experiments. Results We report the molecular characterization, recombinant expression and purification of five wheat allergens, a thioredoxin h isoform, glutathione transferase, 1-Cys-peroxiredoxin, profilin and dehydrin. Homologous proteins were identified by sequence comparisons in various plants. 1-Cys-peroxiredoxin appeared to be the most relevant of the newly identified wheat allergens according to prevalence of IgE recognition and results from basophil degranulation experiments. It showed IgE cross-reactivity with seed proteins from barley, rye, rice, maize, soy, oat and spelt. 1-Cys-peroxiredoxin, glutathione transferase and dehydrin were mainly recognized by patients with baker's asthma but not wheat-induced food allergy. Conclusion and Clinical Relevance The characterized recombinant wheat allergens may be useful for the development of serological tests which allow the discrimination of different clinical manifestations of wheat allergy AU - Pahr S AU - Constantin C AU - Mari A AU - Scheiblhofer S AU - Thalhamer J AU - Ebner C AU - Vrtala S AU - Mittermann I AU - Valenta R LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 12 IP - DP - 2012 Jan 01 TI - Concise guidance: diagnosis, management and prevention of occupational asthma PG - 156-159 AB - This concise guidance, prepared for physicians, summarises the British Occupational Health Research Foundation guideline for the prevention, identification and management of occupational asthma. Approximately one in six people of working age who develop asthma have work-related asthma, where work has either caused or aggravated their disease. Physicians who assess working adults with asthma need to ask the patient about their job and the materials they work with, and be aware of those that carry particular risks; they should also ask whether symptoms improve regularly on days away from work. A diagnosis of occupational asthma (ie asthma caused by work) should not be made on the basis of history alone, but be supported by immunological and physiological investigations of proven diagnostic benefit. Following a validated diagnosis of occupational asthma, physicians should recommend early avoidance of further exposure, because this offers the best chance of complete recovery. If appropriate and timely interventions are not taken, the prognosis of occupational asthma is poor, with only approximately one-third of workers achieving full symptomatic recovery. Full text also available at http://www.rcplondon.ac.uk/resources/diagnosis-management-and-prevention-occupati onal-asthma-concise-guideline AU - Nicholson PJ AU - Cullinan P AU - Burge PS LA - PT - DEP - TA - Clinical Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 67 IP - DP - 2012 Jan 01 TI - Negative impact of occupational exposure on surgical outcome in patients with rhinosinusitis PG - 560-565 AB - Background Chronic rhinosinusitis (CRS) is a frequent condition that is treated by functional endoscopic sinus surgery (FESS) when medical treatment fails. Endogenous as well as exogenous factors may be responsible for persisting symptoms after FESS. The role of occupational exposures on success of FESS has never been investigated. Methods In this case–control study, we tested the hypothesis that the outcome of FESS procedures is related to exposures at work. Questionnaires were sent to 890 patients who had undergone one or more FESS procedures and to 182 controls. Three independent experts assessed blindly the reported work exposures to inhaled agents. The relationship between exposure and the number of FESS procedures was analyzed. Results Relevant occupational exposure was reported by 25% of all responding patients undergoing FESS (n = 467) and 12% of controls (n = 69). The prevalence of occupational exposures increased linearly with the number of FESS procedures from 21% in those who had one FESS to 44% in those who had four or more FESS (?2 = 12.74, P < 0.001). Logistic regression analysis with adjustments for potential confounders, including smoking, atopy, and asthma, confirmed that the odds ratio (OR) for reporting occupational exposures was significantly higher in those needing more than one FESS (OR = 1.64) or more than two FESS (OR = 1.97). These results were mainly driven by exposure to low molecular weight agents. Conclusion Exposure at work appears to be a risk factor for the occurrence of CRS and for its recurrence or persistence, as evidenced by the need for revision surgery. AU - Hox V AU - Delrue S AU - Scheers H AU - Adams E AU - Keirsbilck S AU - Jorissen M AU - Hoet PH AU - Vanoirbeek JA AU - Nemery B AU - Hellings PW LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 67 IP - DP - 2012 Jan 01 TI - EAACI consensus statement for investigation of work-related asthma in non-specialized centres PG - 491-501 AB - Work-related asthma (WRA) is a relevant problem in several countries, is cause of disability and socioeconomic consequences for both the patient and the society and is probably still underdiagnosed. A correct diagnosis is extremely important to reduce or limit the consequences of the disease. This consensus document was prepared by a EAACI Task Force consisting of an expert panel of allergologists, pneumologists and occupational physicians from different European countries. This document is not intended to address in detail the full diagnostic work-up of WRA, nor to be a formal evidence-based guideline. It is written to provide an operative protocol to allergologists and physicians dealing with asthma useful for identifying the subjects suspected of having WRA to address them to in-depth investigations in a specialized centre. No evidence-based system could be used because of the low grade of evidence of published studies in this area, and instead, ‘key messages’ or ‘suggestions’ are provided based on consensus of the expert panel members AU - Moscato G AU - Pala G AU - Barnig C AU - De Blay F AU - Del Giacco SR AU - Folletti I AU - Heffler E AU - Maestrelli P AU - Pauli G AU - Perfetti L AU - Quirce S AU - Sastre J AU - Siracusa A AU - Walusiak-Skorupa J AU - van Gerth Wjik R LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 39 IP - DP - 2012 Jan 01 TI - Domestic use of cleaning sprays and asthma activity in females PG - doi:10.1183/09031936 AB - We aimed to study the associations between the household use of cleaning sprays and asthma symptoms and control of asthma, in females from the Epidemiological study on the Genetics and Environment of Asthma (EGEA). Data were available for 683 females (44 years, 55% never smokers, 439 without asthma and 244 with current asthma). Both domestic exposures and asthma phenotypes (asthma symptom score, current asthma, poorly-controlled asthma (56%)) were evaluated as previously described in the European Community Respiratory Health Survey. Associations between the use of sprays and asthma phenotypes were evaluated using logistic and nominal regressions, adjusted for age, smoking, body mass index and occupational exposures. Significant associations were observed between the weekly use of at least 2 types of sprays and a high asthma symptom score (odds ratio (OR) [95% confidence interval] 2.50[1.54–4.03]) compared to a null score. Consistent results were observed for current asthma (1.67[1.08–2.56]) and poorly-controlled asthma (2.05[1.25–3.35]) compared to females without asthma. The association for current asthma was higher in females without avoidance of polluted places (2.12[1.27–3.54]) than in those reporting avoidance (0.99[0.53–1.85]). The common use of household cleaning sprays is positively associated with a high asthma symptom score, current asthma and poorly-controlled asthma in females AU - Le Moual N AU - Varraso R AU - Siroux V AU - Dumas O AU - Nadif R AU - Pin I AU - Zock JP AU - Kauffmann F AU - and on behalf of the Epidemiological Study on the Genetics and Environment of Asthma LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 185 IP - DP - 2012 Jan 01 TI - A Large Subgroup of Mild-to-Moderate Asthma Is Persistently Noneosinophilic PG - 612-619 AB - Rationale: Airway eosinophilia is typical of asthma, and many controller treatments target eosinophilic disease. Asthma is clinically heterogeneous, however, and a subgroup of people with asthma do not have airway eosinophilia. The size of this subgroup is uncertain because prior studies have not examined repeated measures of sputum cytology to determine when people with asthma have intermittent versus persistent sputum eosinophila and when they are persistently noneosinophilic. Objectives: To determine the prevalence and clinical characteristics of the noneosinophilic asthma phenotype. Methods: We analyzed sputum cytology data from 995 subjects with asthma enrolled in clinical trials in the Asthma Clinical Research Network where they had undergone sputum induction and measures of sputum cytology, often repeatedly, and assessment of responses to standardized asthma treatments. Measurements and Main Results: In cross-sectional analyses, sputum eosinophilia (=2% eosinophils) was found in only 36% of subjects with asthma not taking an inhaled corticosteroid (ICS) and 17% of ICS-treated subjects with asthma; an absence of eosinophilia was noted frequently, even in subjects with asthma whose disease was suboptimally controlled. In repeated measures analyses of people with asthma not taking an ICS, 22% of subjects had sputum eosinophilia on every occasion (persistent eosinophilia); 31% had eosinophilia on at least one occasion (intermittent eosinophilia); and 47% had no eosinophilia on every occasion (persistently noneosinophilic). Two weeks of combined antiinflammatory therapy caused significant improvements in airflow obstruction in eosinophilic asthma, but not in persistently noneosinophilic asthma. In contrast, bronchodilator responses to albuterol were similar in eosinophilic and noneosinophilic asthma. Conclusions: Approximately half of patients with mild-to-moderate asthma have persistently noneosinophilic disease, a disease phenotype that responds poorly to currently available antiinflammatory therapy. AU - McGrath KW AU - Icitovic N AU - Boushey HA AU - Lazarus SC AU - Sutherland ER AU - Chinchilli VM AU - for the Asthma Clinical Research Network of the National Heart AU - Lung AU - and Blood Institute LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - doi:10.115 IP - DP - 2012 Jan 01 TI - Occupational Asthma: New Low-Molecular-Weight Causal Agents, 2000–2010 PG - 597 AB - Background. More than 400 agents have been documented as causing occupational asthma (OA). The list of low-molecular-weight (LMW) agents that have been identified as potential causes of OA is constantly expanding, emphasizing the need to continually update our knowledge by reviewing the literature. Objective. The objective of this paper was to identify all new LMW agents causing occupational asthma reported during the period 2000–2010. Methods. A Medline search was performed using the keywords occupational asthma, new allergens, new causes, and low-molecular-weight agents. Results. We found 39 publications describing 41 new LMW causal agents, which belonged to the following categories: drugs (n = 12), wood dust (n = 11), chemicals (n = 8), metals (n = 4), biocides (n = 3), and miscellaneous (n = 3). The diagnosis of OA was confirmed through SIC for 35 of 41 agents, peak expiratory flow monitoring for three (3) agents, and the clinical history alone for three (3) agents. Immunological tests provided evidence supporting an IgE-mediated mechanism for eight (8) (20%) of the newly described agents. Conclusion. This paper highlights the importance of being alert to the occurrence of new LMWsensitizers, which can elicit OA. The immunological mechanism is explained by a type I hypersensitivity reaction in 20% of all newly described LMW agents. AU - Pralong JA AU - Cartier A AU - Vandenplas O AU - Labrecque M LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 21 IP - DP - 2012 Jan 01 TI - Contribution of host factors and workplace exposure to the outcome of occupational asthma PG - 88-96 AB - The outcome of occupational asthma after diagnosis is often poor. The identification of factors associated with a worse outcome may help in the management of the disease, determining its prognosis and assessing the permanent impairment attributable to occupational exposure. The aim of this systematic review was to provide the available evidence from the medical literature to answer the question: ‘‘What is the contribution of host factors and workplace exposure to the risk of a bad outcome of occupational asthma?’’ A systematic literature search was conducted in March 2010. We retrieved 177 abstracts. Of these, 67 were assessed as potentially relevant. After full text evaluation, 35 articles that were actually relevant for the question were included in the analysis. The information obtained was sufficient to establish that older age, high-molecular-weight agents, impaired lung function and longer duration of exposure to the offending agent at the time of diagnosis had a negative role on the outcome of occupational asthma. Atopy and smoking at diagnosis did not seem to influence the outcome of occupational asthma. A limited number of studies considered sex and the pattern of asthmatic reaction on specific inhalation challenge and their findings were contradictory AU - Maestrelli P AU - Schlünssen V AU - Mason P AU - Sigsgaard T AU - on behalf of the ERS Task Force on the Management of Work-related Asthma LA - PT - DEP - TA - Eur Respir Rev JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 21 IP - DP - 2012 Jan 01 TI - What is the optimal management option for occupational asthma? PG - 125-139 AB - The optimal management of occupational asthma remains uncertain in clinical practice. The aim of this review was to analyse the published information pertaining to the management of occupational asthma in order to produce evidence-based statements and recommendations. A systematic literature search was conducted up to March 2010 to identify original studies addressing the following different treatment options: 1) persistence of exposure; 2) pharmacological treatment; 3) complete avoidance of exposure; 4) reduction of exposure; and 5) the use of personal protective equipment. After full text evaluation of 83 potentially relevant articles, 52 studies were retained for analysis. The conclusions from this systematic review are limited by the methodological weaknesses of most published studies. Critical analysis of available evidence indicates that: 1) persistent exposure to the causal agent is more likely to result in asthma worsening than complete avoidance; 2) there is insufficient evidence to determine whether pharmacological treatment can alter the course of asthma in subjects who remain exposed; 3) avoidance of exposure leads to recovery of asthma in less than one-third of affected workers; 4) reduction of exposure seems to be less beneficial than complete avoidance of exposure; 5) personal respiratory equipment does not provide complete protection. AU - Vandenplas O AU - Dressel H AU - Nowak D AU - Jamart J on behalf of the ERS Task Force on the Management of Work-related Asthma LA - PT - DEP - TA - Eur Respir Rev JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 21 IP - DP - 2012 Jan 01 TI - What are the benefits of medical screening and surveillance? PG - 105-111 AB - Pre-employment examination is considered to be an important practice and is commonly performed in several countries within the European Union. The benefits of medical surveillance programmes are not generally accepted and their structure is often inconsistent. The aim of this review was to evaluate, on the basis of the available literature, the usefulness of medical screening and surveillance. MEDLINE was searched from its inception up to March 2010. Retrieved literature was evaluated in a peer-review process and relevant data was collected following a systematic extraction schema. Pre-placement screening identifies subjects who are at an increased risk for developing workrelated allergic disease, but pre-employment screening is too low to be used as exclusion criteria. Medical surveillance programmes can identify workers who have, or who are developing, workrelated asthma. These programmes can also be used to avoid worsening of symptoms by implementing preventive measures. A combination of different tools within the surveillance programme, adjusted for the risk of the individual worker, improves the predictive value. Medical surveillance programmes provide medical as well as socioeconomic benefits.However, pre-employment screening cannot be used to exclude workers. They may act as a starting point for surveillance strategies. A stratified approach can increase the effectiveness and reduce the costs for such programmes AU - Wilken D AU - Baur X AU - Barbinova L AU - Preisser A AU - Meijer E AU - Rooyackers J AU - Heederik D on behalf of the ERS Task Force LA - PT - DEP - TA - Eur Respir Rev JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 21 IP - DP - 2012 Jan 01 TI - Primary prevention: exposure reduction, skin exposure and respiratory protection PG - 112-124 AB - Interventions for the primary prevention of occupational asthma have been reported in the medical literature, understanding the effectiveness of these efforts could help future interventions. The aim of our study was to evaluate the existing knowledge regarding the impact of controlling work exposure on the prevention of occupational asthma. We conducted systematic literature searches through April 2010 to examine if control of workplace exposures is effective for primary prevention of sensitisation and occupational asthma. The literature search for primary prevention of occupational asthma yielded 29 studies. Assessment of the available information led to the following conclusions and recommendations concerning primary prevention of occupational asthma. Exposure elimination is the strongest and preferred primary preventive approach to reduce the burden of occupational asthma. If elimination is not possible, exposure reduction is the second best option for primary prevention of occupational asthma. The evidence for the effectiveness of respirators in preventing occupational asthma is limited, and other options higher in the list of controls for occupational exposures, notably eliminating or minimising exposures at the source or in the environment, should be used preferentially. There is strong evidence to recommend not using powdered allergen-rich natural rubber latex gloves. There is weak evidence that suggests workers should minimise skin exposure to asthma-inducing agents. AU - Heederik D AU - Henneberger PK AU - Redlich CA on behalf of the ERS Task Force on the Management of Work-related Asthma LA - PT - DEP - TA - Eur Respir Rev JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 21 IP - DP - 2012 Jan 01 TI - The management of work-related asthma guidelines: a broader perspective PG - 125-139 AB - The aim of the European Respiratory Society work-related asthma guidelines is to present the management and prevention options of work-related asthma and their effectiveness. Work-related asthma accounts for 5–25% of all adult asthma cases and is responsible for a significant socioeconomic burden. Several hundred occupational agents, mainly allergens but also irritants and substances with unknown pathological mechanisms, have been identified as causing work-related asthma. The essential message of these guidelines is that the management of work-related asthma can be considerably optimised based on the present knowledge of causes, risk factors, pathomechanisms, and realistic and effective interventions. To reach this goal we urgently require greatly intensified primary preventive measures and improved case management. There is now a substantial body of evidence supporting the implementation of comprehensive medical surveillance programmes for workers at risk. Those workers who fail surveillance programmes need to be referred to a clinician who can confirm or exclude an occupational cause. Once work-related asthma is confirmed, a revised risk assessment in the workplace is needed to prevent further cases. These new guidelines confirm and extend already existing statements and recommendations. We hope that these guidelines will initiate the much-needed research that is required to fill the gaps in our knowledge and to initiate substantial improvements in preventative measures. AU - Baur X AU - Aasen TB AU - Burge PS AU - Heederik D AU - Henneberger PK AU - Maestrelli P AU - Schlunssen V AU - Vandenplas O AU - Wilken D on behalf of the ERS Task Force on the Management of Work-related Asthma LA - PT - DEP - TA - Eur Respir Rev JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 62 IP - DP - 2012 Jan 01 TI - CT findings related to exposure to polyvinyl chloride PG - 261-265 AB - Background Although some adverse health effects of exposure to polyvinyl chloride (PVC) are well known, there is limited evidence of its effects on the respiratory system. Aims To assess the pulmonary effects of exposure to PVC with high-resolution computed tomography (HRCT). Methods Workers and administrative staff of two PVC production plants completed questionnaires and went through pulmonary function testing and HRCT. Analysis of PVC dust in the work environment was performed by the Directorate of Occupational Health and Safety. Results In total, 104 PVC-exposed workers and 43 administrative controls participated. HRCT revealed pleural and/or parenchymal changes in 55% of the exposed subjects. Pleural thickening was detected in 14 subjects, 13 of whom were in the exposed group (P < 0.05). Isolated pleural thickening without parenchymal involvement was present in seven workers, who were all in the exposed group (P < 0.05). Pleural thickening was frequently bilateral and localized to the parietal and visceral pleura. Round opacities, heterogeneous attenuation and ground-glass opacities were only detected in the exposed group (P < 0.05). Exposure to dust increased the risk of findings on HRCT (odds ratio (OR) 4.2, P < 0.05). There were no correlations between pulmonary function tests or respiratory symptoms and HRCT findings. HRCT changes were more common in subjects with forced mid-expiratory flow (FEF25–75) < 50% (P < 0.001). Conclusions This study found that exposure to PVC dust, at levels below the legal limit for respirable particulate matter, was associated with parenchymal changes and pleural thickening on HRCT. AU - Süyür H AU - Elbek O AU - Bayram N AU - Aydin N AU - Özkur A AU - Gündoggdu N AU - Akkurt I LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 62 IP - DP - 2012 Jan 01 TI - Occupational asthma due to spruce wood PG - 301-304 AB - Workers exposed to a variety of wood dusts are known to experience work-related respiratory symptoms, including occupational asthma. There are, however, few reports of occupational asthma due to spruce wood. We present the case of a 31-year-old sawmill owner with severe asthma caused by exposure to spruce wood dust, who developed asthmatic symptoms after 2 years of working. Investigations included clinical examination, routine laboratory tests, spirometry, chest X-ray, total serum immunoglobulin E (IgE) and specific serum IgEs against various woods and other occupational allergens. Additionally, we monitored the peak expiratory flow rate (PEFR) and symptom score both at work and when off work. Specific serum IgE for spruce wood was detected (7.8 IU/ml). The results of PEFR and workplace symptom-score monitoring, coupled with an elevated eosinophil count in induced sputum, supported the diagnosis of occupational asthma. To our knowledge, this is the first well-documented case of occupational asthma induced by spruce wood dust. A type I immunological mechanism seems to be responsible. AU - Wittczak T AU - Dudek W AU - Walusiak-Skorupa J AU - Bochenska-Marciniak M AU - Nowakowska-Swirta E AU - Kuna P AU - Palczynski C LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 185 IP - DP - 2012 Jan 01 TI - The Incidence of Work-related Asthma-like Symptoms and Dust Exposure in Norwegian Smelters PG - 1280-1285 AB - Rationale: The prevalence of respiratory symptoms among employees in smelters is positively associated with dust exposure. Objectives: To investigate the association between the incidence of work-related asthma-like symptoms (WASTH) and dust exposure. Methods: All the employees were invited to participate in a 5-year longitudinal study. The outcome of WASTH was defined as the combination of dyspnea and wheezing improving on rest days or vacation in an individual who had no asthma previously. Information about smoking and occupational status was obtained from a questionnaire. A job exposure matrix of total dust was developed. Multivariate data analyses were performed using Cox regression. Measurements and Main Results: The total follow-up time of the employees (n = 2,476) was 8,469 years, and the median follow-up time for participants was 4.0 years. During the follow-up, 91 employees developed WASTH, and the corresponding incidence rate for WASTH per 1,000 person-years was 8.9 (7.3–10.9) (95% confidence interval in parentheses). The risk ratio of WASTH increased significantly (P = 0.0001) with dust exposure in the middle and high categories (1.0–2.9 and =3.0 mg/m3). Stratified analyses showed that the effect of current dust exposure varied with both previous exposure (PE) to dust and fumes (P = 0.006) and airflow limitation (AFL) (P = 0.033). The final analyses showed that the risk ratios for WASTH per 1 mg/m3 increase in current dust exposure were 1.1 (0.93–1.2), 1.4 (1.1–1.8), 1.6 (1.1–2.3), and 1.9 (1.2–3.0) for the categories (PE+/AFL-), (PE-/AFL-), (PE+/AFL+, and (PE-/AFL+). Conclusions: In conclusion, dust exposure was associated with an increased incidence of WASTH. AU - Søyseth V AU - Johnsen HL AU - Henneberger PK AU - Kongerud J LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 185 IP - DP - 2012 Jan 01 TI - Occupational Exposure to Dusts, Gases, and Fumes and Incidence of Chronic Obstructive Pulmonary Disease in the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults PG - 1292-1300 AB - Rationale: There is limited evidence from population-based studies demonstrating incidence of spirometric-defined chronic obstructive pulmonary disease (COPD) in association with occupational exposures. Objectives: We evaluated the association between occupational exposures and incidence of COPD in the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). Measurements and Main Results: Prebronchodilator ratio of forced expiratory volume in 1 second over forced vital capacity (FEV1/FVC) was measured in 4,267 nonasthmatic SAPALDIA participants ages 18–62 at baseline in 1991 and at follow-up in 2001–2003. COPD was defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criterion (FEV1/FVC < 0.70) and Quanjer reference equation (FEV1/FVC < lower limit of normal [LLN]), and categorized by severity (=80% and <80% predicted FEV1 for stage I and stage II+, respectively). Using a job-exposure matrix, self-reported occupations at baseline were assigned exposures to biological dusts, mineral dusts, gases/fumes, and vapors, gases, dusts, or fumes (VGDF) (high, low, or unexposed as reference). Adjusted incident rate ratios (IRRs) of stage I and stage II+ COPD were estimated in mixed Poisson regression models. Statistically significant (P < 0.05) IRRs of stage II+ GOLD and LLN-COPD, indicating risks between two- and fivefold, were observed for all occupational exposures at high levels. Occupational exposure-associated risk of stage II+ COPD was observed mainly in males and ages =40 years, and remained elevated when restricted to nonsmokers. Conclusions: In a Swiss working adult population, occupational exposures to biological dusts, mineral dusts, gases/fumes, and VGDF were associated with incidence of COPD of at least moderate severity. AU - Mehta AJ AU - Miedinger D AU - Keidel D AU - Bettschart R AU - Bircher A AU - Bridevaux P AU - Curjuric I AU - Kromhout H AU - Rochat T AU - Rothe T AU - Russi EW AU - Schikowski T AU - Schindler C AU - Schwartz J AU - Turk A AU - Vermeulen R AU - Probst-Hensch N AU - Künzli N and the SAPALDIA Team1 LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 69 IP - DP - 2012 Jan 01 TI - Respiratory, allergy and eye problems in bagasse-exposed sugar cane workers in Costa Rica, FEV1, questionnaire PG - 331-338 AB - Aims To evaluate bagasse (sugar cane fibres) and microbiological exposure among sugar cane refinery workers in Costa Rica and its relationships with respiratory, allergy and eye problems. Methods Ventilatory lung function and total serum IgE were measured in 104 sugar cane workers in five departments at one refinery before the harvesting season, and repeated for 77 of the workers at the end of the season. Information on the prevalence of respiratory and other symptoms was collected with a standardised questionnaire. During the harvesting season, inhalable dust, endotoxin and mould levels were measured among 74 randomly selected sugar cane workers across departments. Results During the harvesting season, dust levels were relatively high in some departments, while endotoxin and mould levels were around background levels. Workers' ventilatory lung function differed between departments before, but not during the harvesting season or between seasons. During the harvesting season, the prevalence of wheeze and eye problems almost doubled in workers exposed to bagasse and other types of dust, whereas shortness of breath and rhinitis increased only in bagasse-exposed workers. Reporting wheeze and shortness of breath was positively associated with the number of years working at the refinery, suggesting a long-term health effect. Conclusion In this refinery, the differences in workers' ventilatory lung function before the harvesting season are unlikely to be explained by bagasse exposure. However, the increase in reported symptoms (wheeze, shortness of breath, eye problems and rhinitis) over the season is likely due to irritation by dust, in particular bagasse, rather than microbiological agents. AU - Gascon M AU - Kromhout H AU - Heederik D AU - Eduard W AU - de van Joode BW LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20120101 IS - IS - VI - 69 IP - DP - 2012 Jan 01 TI - Workplace interventions for treatment of occupational asthma: a Cochrane systematic review PG - 373-374 AB - Background The impact of workplace interventions on the outcome of occupational asthma is not well-understood. Objectives To evaluate the effectiveness of workplace interventions on the outcome of occupational asthma. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; NIOSHTIC-2; CISDOC and HSELINE up to February 2011. Selection criteria Randomised controlled trials, controlled before and after studies and interrupted time series of workplace interventions for occupational asthma. Data collection and analysis Two authors independently assessed study eligibility and trial quality, and extracted data. Main results We included 21 controlled before and after studies with 1447 participants that reported on 29 comparisons. In 15 studies, removal from exposure was compared with continued exposure. Removal increased the likelihood of reporting absence of symptoms (risk ratio (RR) 21.42, 95% confidence interval (CI) 7.20 to 63.77), improved forced expiratory volume (FEV1 %) (mean difference (MD) 5.52 percentage points, 95% CI 2.99 to 8.06) and decreased non-specific bronchial hyper-reactivity (standardised mean difference (SMD) 0.67, 95% CI 0.13 to 1.21). In six studies, reduction of exposure was compared with continued exposure. Reduction increased the likelihood of reporting absence of symptoms (RR 5.35, 95% CI 1.40 to 20.48) but did not affect FEV1 % (MD 1.18 percentage points, 95% CI -2.96 to 5.32). In eight studies, removal from exposure was compared with reduction of exposure. Removal increased the likelihood of reporting absence of symptoms (RR 39.16, 95% CI 7.21 to 212.83) but did not affect FEV1 % (MD 1.16 percentage points, 95% CI -7.51 to 9.84). Two studies reported that the risk of unemployment after removal from exposure was increased compared with reduction of exposure (RR 14.3, 95% CI 2.06 to 99.16). Three studies reported loss of income of about 25% after removal from exposure. Overall the quality of the evidence was very low. Authors' conclusions There is very low-quality evidence that removal from exposure improves asthma symptoms and lung function compared with continued exposure. Reducing exposure also improves symptoms, but seems not as effective as complete removal. However, removal from exposure is associated with an increased risk of unemployment, whereas reduction of exposure is not. The clinical benefit of removal from exposure or exposure reduction should be balanced against the increased risk of unemployment. We need better studies to identify which interventions intended to reduce exposure give most benefit. AU - de Groene GJ AU - Pal TM AU - Beach J AU - Tarlo SM AU - Spreeuwers D AU - Frings-Dresen MHW AU - Mattioli S AU - Verbeek JH LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 184 IP - DP - 2011 Jan 01 TI - Interpretation of Exhaled Nitric Oxide Levels (FENO)for Clinical Applications PG - 602-615 AB - We suggest using the following values to determine a significant increase in FENO: greater than 20% for values over 50 ppb or more than 10 ppb for values lower than 50 ppb from one visit to the next (weak recommendation, low quality of evidence). We suggest using a reduction of at least 20% in FENO for values over 50 ppb or more than 10 ppb for values lower than 50 ppb as the cut point to indicate a significant response to antiinflammatory therapy (weak recommendation, low quality of evidence). Minimally Important Differences, and Prognostic Significance of FENO The within-subject coefficient of variation for FENO in healthy subjects is approximately 10%, or up to 4 ppb. The variation increases to approximately 20%in patients with asthma. Since a change of 20% could be due to the variation in the FENO measurement, the Committee recommends a change of at least 20% to indicate a significant rise or fall in FENO over time or following an intervention. AU - Dweik RA AU - Boggs PB AU - Erzurum SC AU - Irvin CG AU - Leigh MW AU - Lundberg JO AU - Olin A AU - Plummer AL AU - Taylor DR LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 85 Suppl 1 IP - DP - 2011 Jan 01 TI - The Human Bitumen Study: executive summary PG - 3-9 AB - Bitumen has attracted attention from the scientific community and regulating agencies. The debate on health effects of exposure to vapours and aerosols of bitumen during the hot application of bitumen ranges from respiratory and neurological effects to carcinogenicity. In 2000, the German Hazardous Substances Committee (AGS), in collaboration with the German Bitumen Forum, initiated the examination of a group of mastic asphalt workers and a same number of construction workers without exposure bitumen using a cross-shift design. The study was then extended to the Human Bitumen Study, and the recruitment was finished in 2008 after examination of 500 workers on 80 construction sites. Three hundred and twenty workers exposed to vapours and aerosols of bitumen at high processing temperatures and 118 workers at outdoor construction sites were included. In the Human Bitumen Study external exposure to vapours and aerosols of bitumen, internal exposure to PAH by analysing urinary 1-hydroxypyrene, the sum of hydroxyphenanthrenes and the sum of 1- and 2-hydroxynaphthalenes, irritative effects in the upper and lower airways and genotoxic effects in blood cells were investigated. The study turned out to be one of the largest investigations of workers exposed to vapours and aerosols of bitumen under current exposure conditions. The present paper summarizes its background and main topics. AU - Raulf-Heimsoth M AU - Pesch B AU - Rühl R AU - Brüning T LA - PT - DEP - TA - Archives of Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 18 IP - DP - 2011 Jan 01 TI - Direct costs of occupational asthma due to sensitization in Quebec (1988 to 2002): Revisited PG - e1-e5 AB - BACKGROUND: In a previous study, the authors assessed direct costs for occupational asthma (OA) in a random sample of eight to 10 accepted claims per year for OA between 1988 and 2002. Compensation for loss of income (CLI) was found to be significantly higher for men and for OA caused by low-molecular-weight agents. OBJECTIVES AND METHODS: To identify sociodemographic factors that modulate CLI, the dossier of each claimant in the previous study was re-examined. RESULTS: Higher CLI costs were directly related to the duration of CLI (over which loss of income was reimbursed) (r=0.65). Costs of CLI were higher in patients 30 years of age or older at diagnosis, married subjects and individuals who were offered early retirement or were enrolled in an active interventional rehabilitation program. Higher CLI costs in men, but not in women, were associated with the following sociodemographic factors: older age, different rehabilitation program (early retirement and active program versus no specific program) and married status. Older age was found to be significant in the multivariate analysis performed for men. The cost of CLI was higher in workers with OA caused by low-molecular-weight agents. Although proportionally fewer men and younger workers were affected with OA caused by low-molecular-weight agents, the longer duration of CLI for this category of agent could explain the higher costs. CONCLUSION: Higher costs for CLI were associated in men (but not women) with older age, married status and type of rehabilitation program (early retirement and active rehabilitation). Higher costs of CLI for OA caused by low-molecular-weight agents were associated with a longer duration of CLI per se, and not with sociodemographic factors. AU - J-L Malo AU - M-V Zunzunegui AU - J L'Archevêque AU - S Cardinal AU - H Ghezzo LA - PT - DEP - TA - Can Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - supplement IP - DP - 2011 Jan 01 TI - Is diurnal PEF variation sensitive and specific for the diagnosis of occupational asthma? PG - 1 AB - Serial peak expiratory flow (PEF) measurements on days at and away from work are recommended as the first step in the objective confirmation of occupational asthma. This study aims to identify the best cut off for the difference between diurnal variation (DV) at work and DV at rest (days off work) that is both sensitive and specific for diagnosing occupational asthma. Methods: Mean 2-hourly PEFs were plotted separately for work days and rest days for 109 workers with occupational asthma and 117 control asthmatics. DV at work and rest was calculated by the Oasys program from records containing = 4 day shifts, = 4 rest days and = 6 readings per day. DV at work minus DV at rest was calculated by% predicted and% mean. Patients were randomly divided into 2 datasets (analysis and test sets). Receiver operator characteristic curve analysis determined a cut off point from Set 1 that best identified those with occupational asthma, which was then tested in Set 2. Results: ROC curve analysis gave an area under the curve of 0.68 (set 1) and 0.69 (set 2) analysed as% mean and 0.70 (set 1 and set 2) analysed as% predicted. Table 1 shows the sensitivity and specificity of DV at different cut offs in set 2. Table 1 Set 2: DV at work - DV at rest (% predicted) Set 2: DV at work - DV at rest (% mean) Cut off (%) Sensitivity (%) Specificity (%) Sensitivity (%) Specificity (%) 7.6 20 100 28 95 3.4 44 95 54 90 1.4 63 83 65 71 0.6 67 57 69 57 Conclusion: A 1.4% higher DV at work compared to rest has the best combined sensitivity and specificity for the diagnosis of occupational asthma. Although the sensitivity and specificity are acceptable, they are somewhat lower than other scores calculated by the Oasys program. AU - Moore V AU - Jaakkola M AU - Burge CBSG AU - Robertson A AU - Pantin C AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 41 IP - DP - 2011 Jan 01 TI - A novel case of bakers asthma PG - 1839 AU - Sara LD AU - Croom AJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 5 IP - DP - 2011 Jan 01 TI - Workplace interventions for treatment of occupational asthma PG - 1-93 AB - Background The impact of workplace interventions on the outcome of occupational asthma is not well-understood. Objectives To evaluate the effectiveness of workplace interventions on the outcome of occupational asthma. Search strategy We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; NIOSHTIC-2; CISDOC and HSELINE up to February 2011. Selection criteria Randomised controlled trials, controlled before and after studies and interrupted time series of workplace interventions for occupational asthma. Data collection and analysis Two authors independently assessed study eligibility and trial quality, and extracted data. Main results We included 21 controlled before and after studies with 1447 participants that reported on 29 comparisons. In 15 studies, removal from exposure was compared with continued exposure. Removal increased the likelihood of reporting absence of symptoms (risk ratio (RR) 21.42, 95% confidence interval (CI) 7.20 to 63.77), improved forced expiratory volume (FEV1 %) (mean difference (MD) 5.52 percentage points, 95% CI 2.99 to 8.06) and decreased non-specific bronchial hyper-reactivity (standardised mean difference (SMD) 0.67, 95% CI 0.13 to 1.21). In six studies, reduction of exposure was compared with continued exposure. Reduction increased the likelihood of reporting absence of symptoms (RR 5.35, 95% CI 1.40 to 20.48) but did not affect FEV1 % (MD 1.18 percentage points, 95% CI -2.96 to 5.32). In eight studies, removal from exposure was compared with reduction of exposure. Removal increased the likelihood of reporting absence of symptoms (RR 39.16, 95% CI 7.21 to 212.83) but did not affect FEV1 % (MD 1.16 percentage points, 95% CI -7.51 to 9.84). Two studies reported that the risk of unemployment after removal from exposure was increased compared with reduction of exposure (RR 14.3, 95% CI 2.06 to 99.16). Three studies reported loss of income of about 25% after removal from exposure. Overall the quality of the evidence was very low. Authors' conclusions There is very low-quality evidence that removal from exposure improves asthma symptoms and lung function compared with continued exposure. Reducing exposure also improves symptoms, but seems not as effective as complete removal. However, removal from exposure is associated with an increased risk of unemployment, whereas reduction of exposure is not. The clinical benefit of removal from exposure or exposure reduction should be balanced against the increased risk of unemployment. We need better studies to identify which interventions intended to reduce exposure give most benefit. Cochrane Database of Systematic Reviews 2011, Issue 5. Art. No.: CD006308. DOI: 10.1002/14651858.CD006308.pub3 AU - de Groene GJ AU - Pal TM AU - Beach J AU - Tarlo SM AU - Spreeuwers D AU - Frings-Dresen MH AU - Mattioli S AU - Verbeek JH LA - PT - DEP - TA - Cochrane Database of Systematic Reviews JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Factors influencing respirator use at work in respiratory patients PG - 576-582 AB - Background When engineering controls such as ventilation are not sufficient to prevent hazardous exposures in workplaces, respiratory protective devices (RPDs) may be provided to decrease workers’ exposures. Often, workers do not use RPDs consistently when required. Aims Our goal was to determine important factors associated with RPD usage in workers with respiratory disease exposed to airborne hazards at work. Methods One hundred and twenty-nine respiratory clinic patients in jobs with self-identified hazardous airborne substances completed a questionnaire and their clinic files were reviewed. Statistical analysis using chi-squared test and binary logistical regression was done to identify associations with RPD usage. Results Forty-one per cent reported always wearing RPDs whenever a hazard was present; 33% never wore RPD. Compliance was highest among healthcare workers (72%) and lowest among workers in food and service industries (13 and 22%, respectively), P < 0.01. The compliance of co-workers, conveniently located RPDs, safety training discussing the use of RPDs, fit testing available at the workplace and age were positively associated with compliance (P < 0.05). Experiencing symptoms of shortness of breath and nasal stuffiness were negatively associated with compliance (P < 0.05). Conclusions Addressing company factors and workers’ symptoms apparently influencing compliance may optimize RPD usage. AU - Fukakusa J AU - Jang B AU - Ribeiro M AU - Kudla I AU - Tarlo SM LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Review of preventative behavioural interventions for dermal and respiratory hazards PG - 311-320 AB - Background No previous systematic review of the evidence base has been undertaken to help occupational health professionals understand how to reliably lower the instance of occupational ill-health through reducing risk-taking behaviour. Aims To evaluate the effectiveness and processes of occupational-based behavioural interventions for workers exposed to dermal and respiratory hazards. Methods A systematic review was conducted. Sixteen electronic databases were searched using key words. Bibliography, health and safety websites and hand searches of key journals were also undertaken. Articles were included if they evaluated an intervention targeting workers’ behavioural compliance, addressed dermal or respiratory hazards, used before and after measures with a control group comparison and used behaviour-related exposure indicators such as airborne exposure, health effects, behaviour observations and self-reported work practices. Data were extracted according to potential sources of bias, impact and behavioural change processes used. Results Ten of 550 articles identified as potentially relevant were included. A predominance of small effect sizes, particularly for larger samples, demonstrated limited but positive impact upon exposure. Studies contained too much heterogeneity for reliable meta-analysis. None of the studies covered the full range of behaviour change components necessary for reducing exposure risk. Conclusions We conclude that future interventions could enhance their effectiveness through improving design quality, reporting and basing their content upon evidence-based behavioural change approaches. Using a comprehensive range of evidence-informed behaviour change ingredients should improve occupational health professional's ability to reliably reduce occupational ill-health where exposure cannot totally be designed out of the workplace. AU - Lunt JA AU - Sheffield D AU - Bell N AU - Bennett V AU - Morris LA LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 128 IP - DP - 2011 Jan 01 TI - New-onset asthma and the effect of environment and occupation among farming and nonfarming rural subjects PG - 761-765 AB - Background Many factors, including environmental exposures, have been related to the increase in the prevalence of asthma, but only few have been tested for in longitudinal studies. Objective We studied farming students to determine whether their environment during childhood and as adults was a factor determining subsequent onset of asthma. Methods From 1994 to 1998, new cases of asthma were identified by means of an annual posted questionnaire followed by a telephone interview in a prospective cohort consisting of 1964 farming-school students and 407 nonfarming subjects aged 16 to 26 years. For each case, we selected a control subject from the cohort with no asthma in a case-based design, and all underwent an interview and a clinical examination. Results We found 122 new cases of asthma. In a multiple regression model the odds ratio for new asthma was 3.3 (95% CI, 1.7-6.3) for smoking; 3.4 (95% CI, 1.6-7.0), 2.5 (95% CI, 1.1-5.3), and 7.0 (95% CI, 1.2-41.6) for exposure to swine, dairy production, and welding, respectively; and 11.7 (95% CI, 2.4-56.4) for bronchial hyperresponsiveness at baseline. Being born and raised on a farm significantly reduced the risk odds ratio (0.5 [95% CI, 0.3-0.98]), whereas atopy had no influence. Conclusion Exposure to swine and dairy confinements, welding, smoking, and bronchial hyperresponsiveness are risk factors for nonallergic asthma, and being born and raised on a farm reduces the subsequent risk. These findings support the theory that immune and inflammatory responses can be influenced by environmental exposure to early childhood, reducing the risk of asthma later in life. AU - Omland Ø AU - Hjort C AU - Pedersen OF AU - Miller MR AU - Sigsgaard T LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Acute life-threatening extrinsic allergic alveolitis in a paint controller PG - 440-442 AB - Background Occupational diisocyanate-induced extrinsic allergic alveolitis (EAA) is a rare and probably underestimated diagnosis. Two acute occupational EAA cases have been described in this context, but neither of them concerned hexamethylene diisocyanate (HDI) exposure. Aims To investigate the cause of a life-threatening EAA arising at work in a healthy 30-year-old female paint quality controller. Methods Occupational medical assessment, workplace evaluation, airborne and biological monitoring and immunodermatological tests. Results Diagnosis of EAA relied on congruent clinical and radiological information, confirmed occupational HDI exposure and positive IgG antibodies and patch tests. The patient worked in a small laboratory for 7 years, only occasionally using HDI-containing hardeners. While working with HDI for 6 h, she developed breathlessness, rapidly progressing to severe respiratory failure. Workplace HDI airborne exposure values ranged from undetectable levels to 4.25 p.p.b. Biological monitoring of urinary hexamethylene diamine in co-workers ranged from <1.0 to 15.4 µg/g creatinine. Patch tests 8 months later showed delayed skin reaction to HDI at 48 h. Subsequent skin biopsy showed spongiotic dermatitis with infiltration of CD4+ and CD8+ T cells. Conclusions We believe this is the first reported case of acute life-threatening EAA following exposure to HDI. Low concentrations of airborne HDI and relatively high urinary hexamethylene diamine suggest significant skin absorption of HDI could have significantly contributed to the development of this acute occupational EAA. AU - Bieler G AU - Thorn D AU - Huynh CK AU - Tomicic C AU - Steiner U-C AU - Yawalkar N AU - Danuser B LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Occupation and work-related ill-health in UK construction workers PG - 407-415 AB - Background Construction workers are at increased risk of work-related ill-health (WRI) worldwide. Aims To compare the incidence of medically reported WRI in occupations within the UK construction industry according to job title. Methods We calculated standardized incidence rate ratios (SRRs) using WRI cases for individual job titles returned to The Health and Occupation Reporting network by clinical specialists and UK population denominators. We counted frequencies of reported causal exposures or tasks reported by clinical specialists, occupational physicians and general practitioners. Results We found significantly increased incidence of WRI compared with other workers in the same major Standard Occupational Classification, i.e. workers with similar levels of qualifications, training, skills and experience, for skin neoplasia in roofers (SRR 6.3; 95% CI: 3.1–13.1), painters and decorators (2.1; 95% CI: 1.2–3.6) and labourers in building and woodworking trades (labourers, 6.6; 95% CI: 3.2–13.2); contact dermatitis in metal workers (1.4; 95% CI: 1.1–1.7) and labourers (1.6; 95% CI: 1.1–2.3); asthma in welders (3.8; 95% CI: 2.8–5.0); musculoskeletal disorders in welders (1.7; 95% CI: 1.1–2.8), road construction operatives (6.1; 95% CI: 3.8–9.6) and labourers (2.5; 95% CI: 1.7–3.7); long latency respiratory disease (mesothelioma, pneumoconiosis, lung cancer, non-malignant pleural disease) in pipe fitters (4.5; 95% CI: 3.2–6.2), electrical workers (2.7; 95% CI: 2.4–3.2), plumbing and heating engineers (2.3; 95% CI: 1.9–2.7), carpenters and joiners (2.7; 95% CI: 2.3–3.1), scaffolders (12; 95% CI: 8–18) and labourers (3.3; 95% CI: 2.6–4.1). Conclusions UK construction industry workers have significantly increased risk of WRI. These data in individual construction occupations can be used to inform appropriate targeting of occupational health resources. AU - Stocks SJ AU - Turner S AU - McNamee R AU - Carder M AU - Hussey L AU - Agius RM LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 38 IP - DP - 2011 Jan 01 TI - Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence PG - 804-811 AB - Reduction of exposure to sensitising agents causing occupational asthma has been proposed as an alternative to total avoidance in order to minimise the adverse socio-economic impact of the condition. The aim of this systematic review was to compare the effects of these two management options on asthma and socio-economic outcomes. A bibliographic search was conducted to identify studies examining the outcome of workers with occupational asthma after reduction or cessation of exposure to the causal agent. The changes in asthma symptoms and nonspecific bronchial hyperresponsiveness after reduction or cessation of exposure were described in nine and five studies, respectively. The meta-analysis of pooled data showed that a reduction of exposure was associated with a lower likelihood of improvement (OR 0.16, 95% CI 0.03–0.91) and recovery (OR 0.30, 95% CI 0.11–0.84) of asthma symptoms and a higher risk of worsening of the symptoms (OR 10.23, 95% CI 2.97–35.28) and nonspecific bronchial hyperresponsiveness (OR 5.65, 95% CI 1.11–28.82), compared with complete avoidance of exposure. This systematic review indicates that reduction of exposure cannot be routinely recommended as an alternative to cessation of exposure in the management of occupational asthma. However, further investigations are required before drawing evidence-based conclusions on the cost-effectiveness of this approach. AU - Vandenplas O AU - Dressel H AU - Wilken D AU - Jamart J AU - Heederik D AU - Maestrelli P AU - Sigsgaard T AU - Henneberger P AU - Baur X LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 68 IP - DP - 2011 Jan 01 TI - A cross-shift study of lung function, exhaled nitric oxide and inflammatory markers in blood in Norwegian cement production workers PG - 799-805 AB - Objectives To study possible effects of aerosol exposure on lung function, fractional exhaled nitric oxide (FeNO) and inflammatory markers in blood from Norwegian cement production workers across one work shift (0 to 8 h) and again 32 h after the non-exposed baseline registration. Methods 95 workers from two cement plants in Norway were included. Assessment of lung function included spirometry and gas diffusion pre- and post-shift (0 and 8 h). FeNO concentrations were measured and blood samples collected at 0, 8 and 32 h. Blood analysis included cell counts of leucocytes and mediators of inflammation. Results The median respirable aerosol level was 0.3 mg/m3 (range 0.02–6.2 mg/m3). FEV1, FEF25–75% and DLCO decreased by 37 ml (p=0.04), 170 ml/s (p<0.001) and 0.17 mmol/min/kPa (p=0.02), respectively, across the shift. A 2 ppm reduction in FeNO between 0 and 32 h was detected (p=0.01). The number of leucocytes increased by 0.6×109 cells/l (p<0.001) across the shift, while fibrinogen levels increased by 0.02 g/l (p<0.001) from 0 to 32 h. TNF-a level increased and IL-10 decreased across the shift. Baseline levels of fibrinogen were associated with the highest level of respirable dust, and increased by 0.39 g/l (95% CI 0.06 to 0.72). Conclusions We observed small cross-shift changes in lung function and inflammatory markers among cement production workers, indicating that inflammatory effects may occur at exposure levels well below 1 mg/m3. However, because the associations between these acute changes and personal exposure measurements were weak and as the long-term consequences are unknown, these findings should be tested in a follow-up study. AU - Fell AKM AU - Notø H AU - Skogstad M AU - Nordby K AU - Eduard W AU - Svendsen MV AU - Øvstebø R AU - Trøseid AMS AU - Kongerud J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 68 IP - DP - 2011 Jan 01 TI - Endotoxin exposure, CD14 and wheeze among farmers: a gene–environment interaction PG - 826-831 AB - Objectives Endotoxin-exposed workers are at an increased risk of non-atopic asthma and lung-function decline. Genetic variants may influence susceptibility to these effects. The objective of the present study was to assess whether the association between occupational endotoxin exposure and wheeze is modified by innate immunity gene variants. Methods Twenty-four single nucleotide polymorphisms (SNPs) in CD14, Toll-like receptor 4 (TLR4), TLR2, MD2 and MyD88 were genotyped in 408 agricultural workers with spirometry and questionnaire data on asthma symptoms available. Personal airborne endotoxin exposure levels were estimated in 249 exposure measurements. Results The association between endotoxin exposure and wheeze was modified by three CD14 SNPs: -260 C/T (rs2569190), -1247 T/C (rs2569191) and -1721 A/G (rs2915863), and one MD2 SNP (rs10808798 T/C). In individuals carrying the CD14 and MD2 major allele variants, the prevalence of wheeze increased with increasing endotoxin concentration, whereas this was the opposite in minor allele homozygotes. Interaction between endotoxin exposure and genotype was statistically significant under the best-fitting recessive model (p=0.05 to 0.006). Correction for multiple comparisons resulted in marginally significant p values for interaction (p<0.06) for CD14 -260 C/T and -1247 T/C, and for MD2 rs10808798 T/C. The CD14 SNPs appeared to modify associations between endotoxin exposure and forced expiratory volume in 1 s in a similar direction (p interaction=0.07 to 0.15). Conclusions The association between occupational endotoxin exposure and wheeze in agricultural workers was significantly modified by genetic variants in CD14 and MD2. Our study suggests that carriers of the functional CD14/-260 C allele are more responsive to endotoxin exposure than T allele homozygotes. AU - Smit LAM AU - Heederik D AU - Doekes G AU - Koppelman GH AU - Bottema RWB AU - Postma DS AU - Wouters IM LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 68 IP - DP - 2011 Jan 01 TI - Exposure and genetics increase risk of beryllium sensitisation and chronic beryllium disease in the nuclear weapons industry PG - 842-848 AB - Objectives Beryllium sensitisation (BeS) and chronic beryllium disease (CBD) are caused by exposure to beryllium with susceptibility affected by at least one well-studied genetic host factor, a glutamic acid residue at position 69 (E69) of the HLA-DPß chain (DPßE69). However, the nature of the relationship between exposure and carriage of the DPßE69 genotype has not been well studied. The goal of this study was to determine the relationship between DPßE69 and exposure in BeS and CBD. Methods Current and former workers (n=181) from a US nuclear weapons production facility, the Y-12 National Security Complex (Oak Ridge, Tennessee, USA), were enrolled in a case–control study including 35 individuals with BeS and 19 with CBD. HLA-DPB1 genotypes were determined by PCR-SSP. Beryllium exposures were assessed through worker interviews and industrial hygiene assessment of work tasks. Results After removing the confounding effect of potential beryllium exposure at another facility, multivariate models showed a sixfold (OR 6.06, 95% CI 1.96 to 18.7) increased odds for BeS and CBD combined among DPßE69 carriers and a fourfold (OR 3.98, 95% CI 1.43 to 11.0) increased odds for those exposed over an assigned lifetime-weighted average exposure of 0.1 µg/m3. Those with both risk factors had higher increased odds (OR 24.1, 95% CI 4.77 to 122). Conclusion DPßE69 carriage and high exposure to beryllium appear to contribute individually to the development of BeS and CBD. Among workers at a beryllium-using facility, the magnitude of risk associated with either elevated beryllium exposure or carriage of DPßE69 alone appears to be similar. AU - Dyke MVV AU - Martyny JW AU - Mroz MM AU - Silveira LJ AU - Strand M AU - Cragle DL AU - Tankersley WG AU - Wells SM AU - Newman LS AU - Maier LA LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 68 IP - DP - 2011 Jan 01 TI - Exposure to bioaerosols, respiratory health and lung-specific proteins: a prospective study in garbage and wastewater workers PG - 856-859 AB - Objectives To prospectively assess respiratory health in wastewater workers and garbage collectors over 5 years. Methods Exposure, respiratory symptoms and conditions, spirometry and lung-specific proteins were assessed yearly in a cohort of 304 controls, 247 wastewater workers and 52 garbage collectors. Results were analysed with random coefficient models and linear regression taking into account several potential confounders. Results Symptoms, spirometry and lung-specific proteins were not affected by occupational exposure. Conclusions In this population no effects of occupational exposure to bioaerosols were found, probably because of good working conditions. AU - Tschopp A AU - Bernard A AU - Thommen AM AU - Jeggli S AU - Dumont X AU - Oppliger A AU - Hotz P LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 21 IP - DP - 2011 Jan 01 TI - Dynamics of gas-phase trichloramine (NCl3) in chlorinated, indoor swimming pool facilities PG - 391-399 AB - Trichloramine (NCl3) is recognized as an irritant of the human respiratory system and other tissues. Processes that lead to volatilization from the liquid phase allow for human exposure to gas-phase NCl3 in swimming pool settings. The dynamics of these processes are not well defined. A N,N-diethyl-p-phenylenediamine/potassium iodide (DPD/KI)-based wet-chemistry method for measuring gas-phase NCl3 concentration was verified and applied in chlorinated, indoor swimming pool facilities. Other gas-phase oxidants in the air of indoor pools provided interference of 15% or less. The DPD/KI method was applied for the measurement of gas-phase NCl3 in four chlorinated, indoor swimming pool facilities. All results showed a correlation between bather loading and gas-phase NCl3 concentration. The nature of swimmer activities also influenced air quality, presumably because of the effects of these activities on mixing near the gas–liquid interface. Practical Implications The activities of swimmers promote transfer of volatile compounds from water to the surrounding air. For chlorinated, indoor pool facilities, this can lead to exposure to gas-phase chemicals that can cause irritation of the respiratory system and other tissues. The focus of this study was on NCl3, a common disinfection by-product (DBP) in chlorinated pools. However, the conditions that promote NCl3 transfer are likely to promote transfer of other volatile chemicals from water to air. As such, it is possible that other DBPs formed in pools may also contribute to diminished air quality. AU - Weng S-C AU - Weaver WA AU - Zare Afifi M AU - Blatchley TN AU - Cramer JS AU - Chen J AU - Blatchley III ER LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 66 IP - DP - 2011 Jan 01 TI - Multiple wheat flour allergens and cross-reactive carbohydrate determinants bind IgE in baker’s asthma. PG - 1208-1215 AB - Background: Several wheat flour allergens relevant to baker’s asthma have been identified in the last 25 years. The aim of this study was to determine the frequency of sensitization to these allergens in German bakers. Methods: Using recombinant DNA technology, the following wheat flour allergens were cloned, expressed in Escherichia coli and purified: five subunits of the wheat a-amylase inhibitors (WTAI-CM1, WTAI-CM2, WTAI-CM3, WDAI-0.19 and WMAI-0.28), thioredoxin, thiol reductase or 1-cys-peroxiredoxin homologues, triosephosphate-isomerase, aß-gliadin, serpin, glyceraldehyde-3-phosphate-dehydrogenase, a nonspecific lipid transfer protein (nsLTP), dehydrin, profilin and peroxidase. In addition, ImmunoCAPs with the recombinant allergen ?-5-gliadin and two cross-reactive carbohydrate determinants (CCDs), horse radish peroxidase (HRP) and the N-glycan of bromelain (MUXF), were used. Specific IgE was measured in wheat flour-positive sera from 40 German bakers with work-related asthma/rhinitis and 10 controls with pollinosis. Results: Thirty bakers (75%) had IgE to at least one of the 19 single allergens. Most frequent was IgE to WDAI-0.19, HRP and MUXF (25% each), followed by WTAI-CM1 (20%), thiol reductase (16%), WTAI-CM3 (15%), WTAI-CM2 and thioredoxin (12.5%), WMAI-28, triosephosphate-isomerase, aß-gliadin (10%), 1-cys-peroxiredoxin (7.5%), dehydrin, serpin, glyceraldehyde-3-phosphate-dehydrogenase (5%), ?-5-gliadin, nsLTP and profilin (2.5%). Fifteen bakers (38%) had IgE to any a-amylase inhibitor and 12 (30%) to at least one CCD. The controls reacted exclusively to CCDs (80%), profilin (60%), thioredoxin (30%), triosephosphate isomerase and nsLTP (10%). Conclusions: The single allergen sensitization profiles obtained with 17 recombinant wheat flour allergens and two CCDs revealed no major allergen for German bakers. The highest frequencies were found for a-amylase inhibitors and CCDs. AU - Sander I AU - Rozynek P AU - Rihs H-P AU - van Kampen V AU - Chew FT AU - Lee WS AU - Kotschy-Lang N AU - Merget R AU - Brüning T AU - Raulf-Heimsoth M. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 68 IP - DP - 2011 Jan 01 TI - A workforce-based study of occupational exposures and asthma symptoms in cleaning workers PG - 914-919 AB - Objectives To study associations between use of cleaning products and asthma symptoms in cleaning workers. Methods Information on respiratory symptoms, history of asthma, workplaces, use of cleaning products and acute inhalation incidents were obtained through a self-administered questionnaire. 917 employees of 37 cleaning companies in Barcelona were studied. 761 (83%) were current cleaners, 86 (9%) former cleaners and 70 (8%) had never worked as cleaners. Multivariable logistic regression analyses were used to evaluate the associations between specific exposures among current cleaners and wheeze without having a cold, chronic cough and current asthma. Associations with an asthma symptom score were also studied using negative binomial regression analyses to report mean ratios. Results After adjusting for sex, age, nationality and smoking status, the prevalence of current asthma was non-significantly higher among current (OR 1.9; 95% CI 0.5 to 7.8) and former cleaners (OR 1.9; CI 0.6 to 5.5) than in never cleaners. Cleaners working in hospitals during the last year had a significantly increased prevalence of wheeze, current asthma and a 1.8 (95% CI 1.2 to 2.8) times higher mean asthma score. Use of hydrochloric acid was strongly associated with asthma score (mean ratio 1.7; 95% CI 1.1 to 2.6). Use of ammonia, degreasers, multiple purpose products and waxes was also associated with asthma score. Conclusions Cleaning work in places with high demand for disinfection, high cleaning standards and use of cleaning products containing respiratory irritants is associated with higher risk of asthma symptoms. This suggests irritants have an important role in cleaning-related asthma. AU - Vizcaya D AU - Mirabelli MC AU - Antó J-M AU - Orriols R AU - Burgos F AU - Arjona L AU - Zock J-P LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 68 IP - DP - 2011 Jan 01 TI - A cross-sectional study of exposures, lung function and respiratory symptoms among aluminium cast-house workers PG - 876-882 AB - Objectives To investigate exposures, respiratory symptoms, lung function and exposure–response relationships among aluminium cast-house workers. Methods A cross-sectional study was conducted among 182 workers. Exposure data were used to model exposure to irritants. Lung function and questionnaire data on respiratory symptoms were compared to a general population sample and an internal reference group. Blood samples were taken from 156 workers to examine total IgE, eosinophils and sensitisation to common allergens. Results Average daily mean exposure to inhalable dust, metals, hydrogen fluoride, fluoride salts and sulphur dioxide was relatively low compared to reference values. Airflow patterns in the hall were disturbed regularly and resulted in pot emissions with high concentrations of fluorides. Peak exposures to chlorine gas occurred intermittently due to production process disturbances. Workers reported significantly more respiratory symptoms (continuous trouble with breathing (prevalence ratio (PR) 2.5; 95% CI 1.2 to 5.3), repeated trouble with breathing (PR 1.8; 95% CI 1.1 to 3.0), wheezing (PR 1.4; 95% CI 1.1 to 1.8), asthma attack (ever) (PR 2.8; 95% CI 1.7 to 4.6) and doctor diagnosed asthma (PR 2.6; 95% CI 1.5 to 4.4). Regression analysis showed significantly lower FEV1 values (-195 ml) and FVC values (-142 ml) compared to a general population sample. Lung function did not differ between groups. Conclusion This epidemiological study suggests cast-house workers in the aluminium industry are exposed to respiratory hazards. Exposure–response relationships could not be demonstrated but this study supports preventive measures in the work environment with a focus on (peak) exposures to irritants. AU - van Rooy FGBGJ AU - Houba R AU - Stigter H AU - Zaat VAC AU - Zengeni MM AU - Rooyackers JM AU - Boers HE AU - Heederik DJJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Improving estimates of specialist-diagnosed, work-related respiratory and skin disease PG - 33-39 AB - Background Work-related skin and respiratory disease still constitute an important part of the work-related ill-health (WRIH) burden of Great Britain (GB). It is therefore important to be able to accurately quantify the true incidence of these two groups of disease. Aims To improve the accuracy of the methodology to estimate clinical specialist incidence rates, with a focus on skin and respiratory disease. Specifically, we sought to estimate the number of additional cases not captured by voluntary surveillance through The Health and Occupation Reporting (THOR) network and provide a better estimation of the true incidence of work-related skin and respiratory disease in GB. Methods Cases not captured by THOR in 2005–2007 due to non-participation of eligible clinical specialists and due to <100% response rates by THOR participants were estimated, and the numerator adjusted accordingly. Adjusted incidence rates were calculated using Labour Force Survey data as the denominator. Results During 2005–2007, 62% of skin cases and 60% of GB respiratory cases were likely to have been captured by THOR. After adjustment, dermatologist-derived incidence rates for skin disease were raised from 9 to 14 per 100?000 employed, while those for respiratory disease were raised from 10 to 17 per 100?000 employed. Conclusions We have provided a significant improvement in the surveillance-based methodology used to estimate the number of cases of WRIH captured by THOR and hence enabled more accurate estimations of GB incidence rates for clinical specialist-reported WRIH. AU - Carder M AU - McNamee R AU - Turner S AU - Hussey L AU - Money A AU - Agius R LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 66 IP - DP - 2011 Jan 01 TI - Costs of occupational asthma in the UK PG - 128-133 AB - Objectives To estimate the social costs of occupational asthma in the UK. Methods A desk-top approach using cost-of-illness methodology was employed, defining direct and indirect lifetime costs for six scenarios: a male and a female worker each exposed to isocyanates, latex and biocides (eg, glutaraldehyde) or flour. The numbers of new cases annually in each industry were estimated from Survey of Work-related and Occupational Respiratory Disease (SWORD) data. The main outcome measure was the current value total working lifetime costs of new cases annually for each scenario. Results Assuming 209 new cases of occupational asthma in the six scenarios in the year 2003, the present value total lifetime costs were estimated to be £25.3–27.3 million (2004 prices). Grossing up for all estimated cases of occupational asthma in the UK in 2003, this came to £70–100 million. About 49% of these costs were borne by the individual, 48% by the state and 3% by the employer. Conclusions The cost to society of occupational asthma in the UK is high. Given that the number of newly diagnosed cases is likely to be underestimated by at least one-third, these costs may be as large as £95–135 million. Each year a new stream of lifetime costs will be added as a newly diagnosed cohort is identified. Approaches to reduce the burden of occupational asthma have a strong economic justification. However, the economic burden falls on the state and the individual, not on the employer. The incentive for employers to act is thus weak. AU - Ayres JG AU - Boyd R AU - Cowie H AU - Hurley JF LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 66 IP - DP - 2011 Jan 01 TI - Who bears the costs of occupational asthma? PG - 92-93 AB - Most workers with occupational asthma who remain exposed to the causative agent have accelerated loss of FEV1(1) and recover less when eventually removed from exposure than those removed within the first year of occupational asthma symptoms.(2) The reasons for this are not obvious, as most childhood onset asthmatics remain exposed to the causative allergens and infrequently develop severe airflow obstruction later in life. It is possible that the timing of exposure related to the maturity of the immune system is critical, and the development of a degree of tolerance is more common in childhood than later in life. Whatever the reasons, the recommendation for removal from exposure within a year of first occupational asthma symptoms is based on good evidence.(2) There is an established societal view that those disabled by their work through no fault of theirs are entitled to some form of compensation. How this is achieved varies widely between countries. Most countries rely on an insurance-based system, sometimes with support from the government.(3) In the UK there is a dual system with a no-fault compensation system without employer contribution funded by the central government and a common law system which requires the establishment of negligence on the part of the employer. Neither work well in the context of occupational asthma. Central to compensation is the assessment of disability. Most disability systems work better when the disability is fixed (such as loss of a limb or irreversible airflow obstruction) than when the disability is very variable, as in asthma. Many occupational asthmatics are not really disabled in daily life, but are completely disabled from doing the job which caused their disease. There is therefore a strong case for directing compensation to re-entry into the job market. For a young person early in their career retraining with different exposures is often the best option, and some compensation schemes, such as in Finland and Quebec, facilitate this. Surveillance schemes mostly based on specialist clinic reports show the occupational asthma peaks later in life.(4) Retraining in a different trade/profession then places the worker at the bottom of another career pathway with loss of income and promotion prospects. Many such workers would be better moved sideways/upwards where their exposures can be removed and their skills and knowledge retained. This should be more easily managed in large organisations (such as healthcare) but difficult for small employers, such as bakeries where occupational asthma developing later in life is fairly common. There are therefore costs generated by the development of occupational asthma. The employer loses a worker and perhaps production, has costs involved in replacement and retraining, and may have an increase in insurance contributions. The worker loses income, particularly in the third of workers in whom relocation fails and unemployment results.(2) Finding a new job often results in a lower income. Finally, the state usually provides financial assistance for those without work and income. Costs may be direct (such as healthcare, retraining and drugs) and indirect (such as loss of income and loss of productivity). These costs have been modelled in a paper by Ayres et al for typical UK male and female workers with occupational asthma due to isocyanates, flour or grain and latex or glutaraldehyde (see page 128).(5) The methodology used the number of new notifications of occupational asthma to the SWORD surveillance scheme in 2003,(6) a voluntary reporting scheme for respiratory physicians incorporating data from the occupational physicians reporting scheme OPRA, and estimated costs incurred over the lifetime of the disease from the point of first diagnosis (an incidence-based approach). The total lifetime costs for Great Britain in 2003 were then distributed between those incurred by the individual, the employers and the government. The costs were based on estimates from the literature rather than directly measured data, and included data from several European countries including the UK as well as USA and Canada. The average worker with occupational asthma was estimated to take about 4 days extra sick leave per year, with a quarter staying in the same job, a quarter being relocated with the same employer, 15% finding a job with a new employer and 35% remaining unemployed or retiring. Total lifetime costs were estimated between £94?000 and £198?000, being more for men than women, and more for workers sensitised to latex or glutaraldehyde than flour or grain. These estimates were extrapolated to the estimated 631 new workers with occupational asthma in 2003, giving lifetime costs for the 2003 cohort of £71.7 to £100.1 million. These figures are clearly estimates and may be some way from the true costs; however, the most interesting conclusion was the distribution of the costs between worker, employer and government, with the employer bearing only 3–4% of the total cost and the remainder being borne fairly equally between worker and government. Occupational asthma is clearly a bad disease for the worker and the government, the employer having little financial incentive to control the cause. There are two main approaches to reduce the impact and costs of occupational asthma, either reducing the incidence or limiting its consequences. Occupational asthma is a preventable disease. Glutaraldehyde asthma in the UK has vanished at little extra cost, initially following limitation of glutaraldehyde use and then its replacement for cold sterilisation. The replacement of latex with nitrile and other materials for gloves was delayed while the costs of replacements decreased, latex asthma now being uncommon in UK medical practice.(7) Both these examples have taken many years from the identification of the problem to its control. Flour in bakers and isocyanates in moulders and painters have been more difficult to control; both still remain common causes of occupational asthma. The medical consequences of occupational asthma are reduced by early removal from exposure, which can be enhanced by medical surveillance detecting early disease.(2) In the UK, occupational health is not part of the National Health Service, is not compulsory and when provided is managed by individual contracts between employer and provider. Many of these do not include management of surveillance failures(8) contributing to the delay in diagnosis even when surveillance is in place.(9) Reducing the impact of occupational asthma, and therefore reducing the lifetime costs, requires the return of the worker to employment without loss of productivity or income for the worker. For those who wish to work again, proper assessment of the workers' abilities and preservation of income while retraining is surely the way forward. This requires a change in many compensations schemes away from providing a regular pension for many years to compensation focused on support during retraining and return to work. References 1.Anees W, Moore VC, Burge PS. FEV1 decline in occupational asthma. Thorax 2006;61:751–5. 2.Nicholson PJ, Cullinan P, Burge PS, et al. Occupational asthma: prevention, identification and management. Systematic review and recommendations. London: British Occupational Health Foundation, 2010. 3.Dewitte JD, ChanYeung M, Malo JL. Medicolegal and compensation aspects of occupational asthma. Eur Respir J 1994;7:969–80. 4.Gannon PFG, Burge PS. The SHIELD scheme in the West Midlands Region, United Kingdom. Br J Ind Med 1993;50:791–6. 5.Ayres JG, Boyd R, Hurley JF. The costs of occupational asthma in the UK. Thorax 2011;66:128–33. 6.Ross DJ. Ten years of the SWORD project. Surveillance of work-related and occupational respiratory disease. Clin Exp Allergy 1999;29:750–3. 7.Bakerly ND, Moore VC, Vellore AD, et al. Fifteen-year trends in occupational asthma: data from the Shield surveillance scheme. Occup Med (London) 2008;58:169–74. 8.Mackie J. Effective health surveillance for occupational asthma in motor vehicle repair. Occup Med (London) 2008;58:551–5. 9.Fishwick D, Bradshaw L, Davies J, et al. Are we failing workers with symptoms suggestive of occupational asthma? Primary Care Respir J 2007;16:304–10. AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 68 IP - DP - 2011 Jan 01 TI - A prospective evaluation of air quality and workers' health in broiler and layer operations PG - 102-107 AB - Objectives In developed countries, poultry are raised in totally confined buildings in which workers are exposed to indoor airborne contaminants. A prospective study was conducted to investigate the relationship between workers' respiratory health and airborne contaminants during the life cycle of broiler and layer flocks. Methods Seventeen layer and 16 broiler operations were chosen within a 200 km radius of Edmonton. An attempt was made to visit each broiler operation twice during the winter and summer seasons in the early and later periods of the 6-week production cycle and visit each layer operation three times during the early, middle and later periods of the 40-week production cycle. Results In broiler operations, respirable particle counts, total dust and endotoxin concentrations, and ammonia levels increased with flock age, while mean endotoxin load (EU/mg) decreased in the winter and summer seasons. Increases in dust and endotoxin concentrations in the winter season were not statistically significance. Mean endotoxin concentration increased and mean dust concentration and ammonia level decreased with flock age in layer operations, although not all these changes were statistically significant. Mean across-shift decrements in FEV1 and FVC increased with flock age among workers from layer operations. Endotoxin concentration was significantly associated with across-shift changes in FEV1 among workers in layer operations. Conclusion In our study, changes in lung function appear more closely associated with changes in endotoxin than other contaminants. Changes in indoor environmental conditions occurring in poultry barns which are dependent on the flock age may affect workers' health in poultry operations. AU - Senthilselvan A AU - Beach J AU - Feddes J AU - Cherry N AU - Wenger I LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 279 IP - DP - 2011 Jan 01 TI - The respiratory allergen glutaraldehyde in the local lymph node assay: Sensitization by skin exposure, but not by inhalation PG - 115-122 AB - Previously, a selection of low molecular weight contact and respiratory allergens had tested positive in both a skin and a respiratory local lymph node assay (LLNA), but formaldehyde was negative for sensitization by inhalation. To investigate whether this was due to intrinsic properties of aldehyde sensitizers, the structurally related allergen glutaraldehyde (GA) was tested. BALB/c mice were exposed by inhalation to 6 or 18 ppm GA (respiratory LLNA), both generated as a vapor and as an aerosol. Other groups received 0.25% or 2.5% GA on the skin of the ears (skin LLNA). Lymphocyte proliferation and cytokine production were measured in the draining lymph nodes. GA was positive in the skin LLNA and its cytokine profile (IL-4/IFN-?) skewed towards a Th2-type immune response with increasing dose. Inhalation exposure did not result in increased lymphocyte proliferation or increased cytokine levels, despite comparable tissue damage (irritation) in the skin and respiratory tract. We hypothesize that the highly reactive and hydrophilic GA oligomerizes in the protein-rich mucous layer of the respiratory tract, which impedes sensitization but still facilitates local irritation. Within the context of risk assessment in respiratory allergy, our results stress the importance of prevention of skin – besides inhalation – exposure to aldehydes like GA. Keywords: AU - van Triela JJ AU - van Breea BWJ AU - Robertsb DW AU - Muijsera H AU - Duistermaata E AU - Woutersenc RA AU - Kupera CF LA - PT - DEP - TA - Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Occupational asthma in professional cleaning work: a clinical study PG - 121-126 AB - Background Several epidemiological studies have reported an increased risk of asthma among professional cleaners. To date, however, no analysis of large patient series from clinic of occupational medicine has been published. Aims To describe the cases of occupational asthma (OA) diagnosed at the Finnish Institute of Occupational Health (FIOH) during the period 1994–2004 in workers employed in professional cleaning work. Methods OA was diagnosed according to patient history, lung function examinations and specific challenge tests with measurements of the forced expiratory volume in 1 second and peak expiratory flow values. Results Our series comprised 20 patients, all female, with a mean age of 48.8 years (range 27–60 years). The mean duration of cleaning work before the onset of the respiratory symptoms was 14.3 years (range 1–36 years), and the mean duration of cleaning work before the FIOH examinations was 18.6 years (range 3–38 years). OA was triggered by chemicals in 9 cases (45%) and by moulds in 11 cases (55%). The chemicals were cleaning chemicals (wax-removing substances containing ethanolamines in five cases and a cleaning agent containing chloramine-T in one case) and chemicals used in the industrial processes at workplaces (three cases). Of the moulds, the most frequently associated with OA was Aspergillus fumigatus (nine cases). Conclusions OA was attributed not only to cleaning chemicals but also to other chemicals used in work environments. Moulds are presented as a new cause of OA in cleaners. AU - Mäkelä R AU - Kauppi P AU - Suuronen K AU - Tuppurainen M AU - Hannu T LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Exhaled nitric oxide and spirometry in respiratory health surveillance PG - 108-114 AB - Background Exposure to pollutants in bakeries and hairdressing salons can cause airway syndromes varying from bronchial irritation to asthma. Workplace respiratory health surveillance aims to identify possible cases requiring further investigation. Aims To compare the performance of fractional exhaled nitric oxide (FENO) and spirometry for health surveillance of apprentice bakers (ABs) and apprentice hairdressers (AHDs). Determinants of FENO were also identified. Methods Symptoms and physician-diagnosed asthma were evaluated by questionnaire. FENO was measured and spirometry was carried out. Subjects with elevated FENO (FENO > upper limit normal), airway obstruction [forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) < 95th percentile] and atopy (history of allergies) were identified. Results A total of 126 apprentices (59 ABs and 67 AHDs) participated. Twenty-nine (23%) apprentices had abnormal tests: 4 had associated high FENO and airway obstruction, while 25 had either high FENO (n = 15) or airway obstruction (n = 10) alone. Compared with ABs (n = 16), AHDs (n = 13) had more asthma (38 versus 0%; P < 0.05) and atopy (62 versus 6%; P < 0.05). There was no difference in symptoms, smoking FENO or airways obstruction. Among 97 subjects with normal tests, no differences existed between ABs (n = 53) and AHDs (n = 44). Average FENO was increased in atopic non-smokers compared with atopic smokers and non-atopic subjects (P < 0.05). Smoking, a history of allergies, FEV1/FVC % observed and respiratory symptoms were the main determinants of FENO. Conclusions FENO and spirometry were not overlapping dimensions in ABs and hairdressers, each test contributing unique information on the physiological status of the respiratory system. FENO may provide added information on airway inflammation not provided by spirometry AU - Bohadana AB AU - Hannhart B AU - Ghezzo H AU - Teculescu D AU - Zmirou-Navier D LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 183 IP - DP - 2011 Jan 01 TI - Swimming Pool Attendance, Asthma, Allergies and Lung Function in the ALSPAC Child Cohort PG - 582-588 AB - RATIONALE: Cross-sectional studies have reported inconsistent findings for the association between recreational swimming pool attendance and asthma and allergic diseases in childhood. OBJECTIVES: To examine whether swimming in infancy and childhood was associated with asthma and allergic symptoms at age 7 and 10 years in a UK longitudinal population-based birth cohort (ALSPAC). METHODS: Data on swimming were collected by questionnaire at 6, 18, 38, 42, 57, 65 and 81 months. Data on rhinitis, wheezing, asthma, eczema, hay fever, asthma medication and potential confounders were collected through questionnaire at 7 and 10y. Spirometry and skin prick testing were performed at 7-8y. Data for analysis were available for 5,738 children. MEASUREMENTS AND MAIN RESULTS: At age 7y, >50% of the children swam once/week. Swimming frequency did not increase the risk of any evaluated symptom, either overall or in atopic children. Children with a high versus low cumulative swimming pool attendance from birth to 7y had an odds ratio (OR) of 0.88 (95% confidence interval 0.56-1.38) and 0.50 (0.28-0.87), respectively, for ever and current asthma at 7y, and a 0.20 (0.02-0.39) standard deviation increase in the mid forced expiratory flow. Asthmatic children with a high versus low cumulative swimming had an OR for current asthma at 10y of 0.34 (0.14-0.80). CONCLUSIONS: This first prospective longitudinal study suggests that swimming did not increase the risk of asthma or allergic symptoms in British children. Swimming was associated with increased lung function and lower risk of asthma symptoms, especially among children with pre-existing respiratory conditions. AU - Font-Ribera L AU - Villanueva CM AU - Nieuwenhuijsen MJ AU - Zock J AU - Kogevinas M AU - Henderson J LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 68 IP - DP - 2011 Jan 01 TI - What is the best strategy to reduce the burden of occupational asthma and allergy in bakers? PG - 176-182 AB - Rationale Insight into the effectiveness of intervention strategies will help realise a decrease in the occupational disease burden from (allergic) respiratory diseases in the bakery population. Objectives To use a simulation model to assess the impact of different intervention strategies on the disease burden of the bakery population over time. Methods A recently developed dynamic population based model was used to prospectively evaluate the impact on disease burden resulting from different intervention strategies. We distinguished interventions based on exposure reductions for flour dust and fungal a-amylase, health surveillance combined with reduction in exposure, and pre-employment screening. Main Results The impact of most interventions on disease burden was limited, generally less than 50% for lower respiratory symptoms and disabling occupational asthma. Only the rigorous health surveillance strategy, identifying workers who are sensitised or report upper respiratory symptoms and decreasing their individual exposures by 90% shortly after diagnosis, resulted in a decrease of almost 60% in disease burden after 20 years. Conclusions This study demonstrates that different intervention strategies have substantially different impacts on the burden of disease. The time window during which changes occur differs considerably between strategies. This information can assist policy makers in their choice of intervention and gives guidance for achievable reductions in disease burden. AU - Meijster T AU - Warren N AU - Heederik D AU - Tielemans E LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 66 IP - DP - 2011 Jan 01 TI - IgG4 antibodies against rodents in laboratory animal workers do not protect against allergic sensitization PG - 517-522 AB - Background: The modified Th2 response, defined as an IgG4 response in the absence of IgE, is suggested to protect against the development of allergic sensitization. However, studies suggesting this protective effect all had a cross-sectional design, making it impossible to study the development of both responses. Aim of the study: We aimed to study the dynamics in IgG4 antibodies in relation to allergic sensitization in an occupational cohort of starting laboratory animal workers. Moreover, we studied the relation between exposure, antibody responses, atopy and self reported allergic symptoms. Methods: A total of 110 starting animal workers were followed for 2 years. IgG4 antibodies against rats and mice were assessed. Workers were tested for allergic sensitization and exposure to animal allergens was estimated. Symptom status was assessed using questionnaires. Results: Rat and mouse specific IgG4 antibodies were present before the development of allergy and did not significantly change over time. Allergic sensitization was related to exposure and atopic status but high levels of IgG4 showed no protective effect. In contrary, workers that developed mouse specific sensitization during follow up had higher levels of mouse specific IgG4. Symptoms were related to allergic sensitization and IgG4 levels did not influence that relationship. Conclusions: IgG4 antibodies are present before IgE antibodies develop and IgG4 levels are stable over time. In our occupational cohort, the modified Th2 response had no protective effect on development of sensitization or allergic symptoms. AU - Krop EJM AU - Doekes G AU - Heederik DJJ AU - Aalberse RC AU - van der Zee JS LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 41 IP - DP - 2011 Jan 01 TI - Association of bronchial reactivity to occupational agents with methacholine reactivity, sputum cells and immunoglobulin E-mediated reactivity PG - 497-504 AB - Background Bronchial responsiveness and IgE-mediated reactivity are associated with specific bronchial reactivity to allergens. Objective Our aim was to examine whether airway inflammation also plays a role. Methods Retrospective analysis of all subjects who underwent specific inhalation challenges in the investigation of occupational asthma (OA) since 2000. Responsiveness to methacholine (PC20) and levels of eosinophils and neutrophils in induced sputum on the control day were associated with the presence of OA (positive-specific inhalation challenge). In a sample of subjects exposed to wheat flour, we also examined the role of specific IgE-mediated reactivity (skin reactivity, specific IgE). Results PC20 level was significantly more often normal in subjects with OA (35 of 129, 27% instances) by comparison with non-OA (15 of 189, 8% instances), but the positive predictive value of responsiveness to methacholine for OA was low (35%). Coupling information on the level of eosinophils to responsiveness to methacholine increased positive predictive values for OA from 39% to 69% depending on the thresholds used. The best balance of positive (69%) and negative (60%) predictive values was obtained in the case of normal PC20 and eosinophils 3%. In a multivariate analysis carried out in 34 subjects exposed to wheat flour, responsiveness to methacholine, sputum eosinophils, skin weal size and levels of specific IgE were all significantly associated with OA to wheat flour. Conclusion and Clinical Relevance Information on the level of sputum eosinophils in addition to PC20 provides a better association with OA vs. non-OA when PC20 is normal. Levels of sputum eosinophils in addition to PC20 and IgE-mediated reactivity increase the likelihood of OA due to wheat flour AU - Malo J-L AU - Cardinal S AU - Ghezzo H AU - LArchevêque J AU - Castellanos L AU - Maghni K LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 127 IP - DP - 2011 Jan 01 TI - Airway hyperresponsiveness in elite swimmers: Is it a transient phenomenon? PG - 892-898 AB - Background Airway hyperresponsiveness is highly prevalent in competitive swimmers, but it is unknown whether this is transient or persistent. Objectives To document changes in airway responsiveness and airway inflammation in elite swimmers during intense training and rest. Methods Nineteen swimmers and 16 healthy controls completed a standardized questionnaire, allergy skin prick tests, exhaled nitric oxide measurement, eucapnic voluntary hyperpnea testing, methacholine challenge, and induced sputum analysis. Testing was performed during intense swimming and after at least 2 weeks of rest. Results Sixteen swimmers and 13 controls were atopic. Airway responsiveness to methacholine and eucapnic voluntary hyperpnea was significantly higher in swimmers than in controls (P < .0001). A significant decrease in airway responsiveness was observed from training to rest in swimmers only (P < .005). This occurred with both methacholine challenge—with PC20 values of 6.0 mg/mL and 12.8 mg/mL, respectively—and eucapnic voluntary hyperpnea testing—with a maximum fall in FEV1 after voluntary testing of 14.1 L and 10.1 L, respectively. Eight of 12 swimmers with airway hyperresponsiveness during intense training had normal airway responsiveness during rest. No airway inflammation occurred, and no significant change in this parameter was observed from training to rest. Conclusion Training may contribute to the development of airway hyperresponsiveness in elite swimmers, but this seems reversible in many athletes after training cessation for at least 2 weeks AU - Bougault V AU - Turmel J AU - Boulet L-P LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 68 IP - DP - 2011 Jan 01 TI - Medical surveillance programme for diisocyanate exposure PG - 302-307 AB - Objectives Surveillance programmes for occupational asthma should reduce the severity of asthma both at the time of diagnosis and after removal from exposure as well as costs related to functional impairment. The aim of this study was to compare the severity and cost of diisocyanate-induced occupational asthma in workers participating in a surveillance programme and in twice the number of workers diagnosed after being referred by their physician. Methods Answers to a self-administered questionnaire led to possible referral for further assessment that included methacholine testing and specific inhalation challenges as the gold standard for confirming occupational asthma. Results Of the 2897 workers who participated, 182 (6.3%) had a positive questionnaire. 79/182 (43%) were referred for further medical assessment and 20 had confirmed occupational asthma by specific inhalation testing. At the time of diagnosis, the 20 screened subjects had a mean PC20 of 3.35 mg/ml as compared to 1.50 mg/ml (p=0.05) in the 66 controls. Two years after diagnosis and removal from exposure, the 20 subjects screened had a mean PC20 of 4.81 mg/ml compared to 1.67 mg/ml (p=0.03) in controls. Clinical remission occurred in 34% of the screened group compared to 16% of the control group (p=0.02). The median costs for functional impairment were $C11?900 in screened subjects and $C19?600 in controls (p=0.04). Conclusions Subjects with occupational asthma screened by a medical surveillance programme have a better outcome both at the time of diagnosis and 2 years after removal from exposure, with lower compensation costs compared to controls. AU - Labrecque M AU - Malo J-L AU - Alaoui KM AU - Rabhi K LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 37 IP - DP - 2011 Jan 01 TI - Influence of hay and animal feed exposure on respiratory status: a longitudinal study PG - 767-774 AB - Our aim was to study respiratory symptoms and lung function decline in farmers, with particular attention to the influence of handling hay, straw and animal feed. From a cohort recruited in 1993–1994, 219 (82.6%) dairy farmers, 130 (62.5%) nondairy agricultural workers and 99 (66.4%) controls were re-evaluated in 2006. They answered medical and occupational questionnaires, underwent spirometric tests at both evaluations and pulse oximetry in 2006. Dairy and nondairy agricultural workers showed an increased risk for usual morning phlegm (adjusted OR 4.27 (95% CI 1.41–12.95) and 3.59 (95% CI 1.16–11.10), respectively). Animal feed handling was associated with increased risks of wheezing (p = 0.01) and usual morning phlegm (p = 0.04); hay or straw handling was associated with increased risk of wheezing (p = 0.008). Adjusting for smoking, age, height, sex and altitude, dairy farmers had greater declines in forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio (p = 0.01) than controls. An increased decline in FEV1 for all agricultural workers was associated with animal feed handling, both measured as a categorical (currently versus never handling; p = 0.05) or quantitative value (years of exposure during the survey period; p = 0.03). Hay, straw or animal feed handling represents a risk factor of bronchial symptoms and, for animal feed only, of accelerated decline in expiratory flows. AU - Thaon I AU - Thiebaut A AU - Jochault L AU - Lefebvre A AU - Laplante JJ AU - Dalphin JC LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 41 IP - DP - 2011 Jan 01 TI - High-altitude treatment: a therapeutic option for patients with severe, refractory asthma? PG - 775-782 AB - High-altitude treatment has been applied for more than a century in the treatment of pulmonary diseases including asthma. Many uncontrolled and controlled studies have shown its beneficial effects in children and adolescents with house dust mite allergic asthma. A recent study also showed an improvement in markers of airway inflammation in adult patients with severe intrinsic asthma, suggesting that factors other than HDM avoidance may contribute to the beneficial influence of the high-altitude climate therapy on asthma. The dry mountain climate not only has decreased levels of mite allergens but also decreased levels of pollens, fungal spores and air pollution, as well as high exposure to UV light with immunomodulatory and anti-inflammatory effects. Treatments targeting environmental control have never been investigated systematically in severe asthma, which is surprising, as environmental factors have been recognized as important contributors to asthma severity for many years and more evidence has been accumulating ever since. Preliminary evidence shows the beneficial effects of high-altitude treatment in patients with severe refractory asthma on symptoms, lung function and oral corticosteroid requirement, irrespective of atopic status. In this narrative review, we will discuss why high-altitude treatment might be a promising therapeutic option for patients who suffer from this disabling disease. AU - Rijssenbeek-Nouwens LH AU - Bel EH LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 41 IP - DP - 2011 Jan 01 TI - Evaluation of two new recombinant guinea-pig lipocalins, Cav p 2 and Cav p 3, in the diagnosis of guinea-pig allergy PG - 899-908 AB - Background Guinea-pigs, classical laboratory animals now often kept as pets, regularly elicit important allergic reactions. Two guinea-pig allergens have been described previously to some extent; however, biomolecular and immunological data are lacking. Objective To identify major guinea-pig allergens, produce them as recombinant proteins and define their allergenic potential and clinical importance in allergic patients. Methods Protein extracts were prepared from various guinea-pig tissues and allergens were purified by ion exchange chromatography. The N-termini of two immunoglobulin E (IgE)-reactive proteins were determined and degenerate primers were designed for cDNA amplification by RT-PCR. Allergenic properties of recombinant proteins were assayed by immunoblotting, ELISA and mediator release assays. Specific IgE were quantified in the sera of 26 guinea-pig-allergic patients. Results Major IgE-reactive proteins were detected in submaxillary and harderian gland extracts. Two proteins were identified and the cDNAs were cloned. The 17 kDa protein expressed in the harderian gland corresponds to the previously described Cav p 2. The 19 kDa protein, Cav p 3, is a new allergen expressed in the submaxillary gland. Recombinant Cav p 2 and Cav p 3 were recognized by IgE antibodies from 65% and 54% of guinea-pig-allergic patients, respectively. Both proteins demonstrated equivalent allergenic activity in the mediator release assays. Conclusion and Clinical Relevance Two major guinea-pig allergens, Cav p 2 and Cav p 3, have been characterized and produced as recombinant proteins. Combined to guinea-pig serum albumin, the new allergens proved to be valuable in the component-resolved diagnosis of guinea-pig allergy. AU - Hilger C AU - Swiontek K AU - Kler S AU - Diederich C AU - Lehners C AU - Vogel L AU - Vieths S AU - Hentges F LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 37 IP - DP - 2011 Jan 01 TI - Stressful life events and the onset of asthma PG - 1360-1365 AB - The status of stressful life events as a risk factor for asthma is unclear and may be dependent on pre-existing allergic rhinitis. This study examined whether exposure to stressful life events predicted the onset of asthma in adults. This is a prospective, population-based cohort study of 16,881 males and females, aged 20–54 yrs and free of diagnosed asthma at the beginning of the follow-up (January 1, 2004). Data about stressful life events were gathered with a postal survey. The onset of asthma was ascertained through national registers until December 31, 2005. During the follow-up period, 192 incident cases of asthma were identified. High total exposure to stressful life events, as indicated by a cumulative severity score, predicted the onset of asthma (hazard ratio 1.96, 95% CI 1.22–3.13). This association was robust to adjustment for demographics, smoking and having a cat/dog at home and it was observed both among those with and without allergic rhinitis at baseline. Of the 10 most stressful life events, the illness of a family member, marital problems, divorce or separation and conflicts with a supervisor were associated with the onset of asthma. Our study suggests that stressful life events may increase the onset of asthma. AU - Lietzén R AU - Virtanen P AU - Kivimäki M AU - Sillanmäkif L AU - Vahtera J AU - Koskenvuof M LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 66 IP - DP - 2011 Jan 01 TI - Occupational rhinitis in bell pepper greenhouse workers: determinants of leaving work and the effects of subsequent allergen avoidance on health-related quality of life PG - 903-908 AB - Background: Avoidance of occupational allergens or reduction in exposure has been advocated as the mainstay of the management of occupational rhinitis. Sparse data to the effect of allergen avoidance are available. Objective: To identify factors that may lead to leaving work and to address the effect of subsequent allergen avoidance on quality of life. Methods: A survey to the prevalence of occupational allergy to bell pepper performed in 1999 comprised 472 employees, of which 254 had work-related rhinitis and 228 completed the Rhinitis-related Quality of Life Questionnaire. After 8-year follow-up in 2007, 91 workers with rhinitis in 1999 were available to fill out the questionnaire again and were used to evaluate the course of nasal disease in terms of perceived severity and impact on daily life. Results: Workers with rhinitis at baseline were more likely to leave their job in bell pepper cultivation for another job (OR = 1.62, 95% CI 0.95–2.75). Among the 91 workers, 58 subjects were still at work, whereas 33 subjects had left work. The subjects who left jobs reported substantial improvement in quality of life. The magnitude of the changes ranged from -0.31 to -1. The effect of quitting work on the mean quality of life score amounted -0.76 ± 0.15. Conclusions The current study is the first large longitudinal studies showing that leaving work and subsequent occupational allergen avoidance have a beneficial effect on rhinitis-related quality of life. The study suggests that occupational rhinitis can be a reason to leave work. AU - van Wijk GR AU - Patiwael JA AU - de Jong NW AU - de Groot H AU - Burdorf A. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 68 IP - DP - 2011 Jan 01 TI - Job choice and the influence of prior asthma and hay fever PG - 494-501 AB - Objectives To investigate whether prior symptoms of allergic disease influence first job undertaken on leaving school. Methods The study included 5020 members of the 1958 British birth cohort who provided a job history (including start dates) at age 33 and for whom information on allergic disease in childhood and adolescence was reported by parents at ages 7, 11 and 16. Occupational group (high risk, low risk, reference) was based on first job and its probable asthma risk. Results With occupational group defined using only job title, the RR of taking a high risk over a reference level job was an estimated 30% (RR ratio (RRR) 0.70; 95% CI 0.56 to 0.88) lower among those with than without prior reported symptoms of hay fever/allergic rhinitis but an estimated 60% (RRR 1.60; 1.17 to 2.19) higher among those with symptoms of asthma/wheezy bronchitis in adolescence compared to those with no history of asthma/wheezy bronchitis. With occupational group defined using an asthma specific job exposure matrix, a similar association was observed for prior hay fever/allergic rhinitis (RRR 0.77; 0.62 to 0.96) but not for asthma/wheezy bronchitis (RRR 1.18; 0.85 to 1.64). There was no evidence of an association between prior eczema and occupational group of first job. Conclusion Whether our findings indicate avoidance or residual confounding, it would be prudent for future studies of occupation and the incidence or recurrence of asthma in adult life to adjust for any previous history of hay fever/allergic rhinitis. AU - Butland BK AU - Ghosh R AU - Strachan DP AU - Cullinan P AU - Jarvis D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 41 IP - DP - 2011 Jan 01 TI - Farming environment and prevalence of atopy at age 31: prospective birth cohort study in Finland PG - 987-993 AB - Background Cross-sectional studies have shown an association between the farming environment and a decreased risk of atopic sensitization, mainly related to contact with farm animals in the childhood. Objective Investigate the association of a farming environment, especially farm animal contact, during infancy, with atopic sensitization and allergic diseases at the age of 31. Methods In a prospective birth cohort study, 5509 subjects born in northern Finland in 1966 were followed up at the age of 31. Prenatal exposure to the farming environment was documented before or at birth. At age 31, information on health status and childhood exposure to pets was collected by a questionnaire and skin prick tests were performed. Results Being born to a family having farm animals decreased the risk of atopic sensitization [odds ratio (OR) 0.67; 95% confidence interval (CI) 0.56–0.80], atopic eczema ever (OR 0.77; 95% CI 0.66–0.91), doctor-diagnosed asthma ever (OR 0.74; 95% CI 0.55–1.00), allergic rhinitis at age 31 (OR 0.87; 95% CI 0.73–1.03) and allergic conjunctivitis (OR 0.86; 95% CI 0.72–1.02) at age 31. There was a suggestion that the reduced risk of allergic sensitization was particularly evident among the subjects whose mothers worked with farm animals during pregnancy, and that the reduced risk of the above diseases by farm animal exposure was largely explained by the reduced risk of atopy. Having cats and dogs in childhood revealed similar associations as farm animals with atopic sensitization. Conclusion and Clinical Relevance Contact with farm animals in early childhood reduces the risk of atopic sensitization, doctor-diagnosed asthma and allergic diseases at age 31. AU - Lampi J AU - Canoy D AU - Jarvis D AU - Hartikainen A-L AU - Keski-Nisula L AU - Järvelin M-R AU - Pekkanen J LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 41 IP - DP - 2011 Jan 01 TI - Occupational sensitization to soy allergens in workers at a processing facility PG - 1022-1030 AB - Background Exposure to soy antigens has been associated with asthma in community outbreaks and in some workplaces. Recently, 135 soy flake processing workers (SPWs) in a Tennessee facility were evaluated for immune reactivity to soy. Allergic sensitization to soy was common and was five times more prevalent than in health care worker controls (HCWs) with no known soy exposure. Objective To characterize sensitization to soy allergens in SPWs. Methods Sera that were positive to soy ImmunoCAP (n=27) were tested in IgE immunoblots. Wild-type (WT) and transgenic (TG) antigens were sequenced using nanoscale Ultra-Performance Liquid Chromatography Tandem Mass Spectrometry (nanoUPLC MS/MS). IgE reactivity towards 5-enolpyruvylshikimate-3-phosphate synthase (CP4-EPSP), a protein found in TG soy, was additionally investigated. De-identified sera from 50 HCWs were used as a control. Results Immunoblotting of WT and TG soy flake extracts revealed IgE against multiple soy antigens with reactivity towards 48, 54, and 62 kDa bands being the most common. The prominent proteins that bound SPW IgE were identified by nanoUPLC MS/MS analysis to be the high molecular weight soybean storage proteins, ß-conglycinin (Gly m 5), and Glycinin (Gly m 6). No specific IgE reactivity could be detected to lower molecular weight soy allergens, Gly m 1 and Gly m 2, in soybean hull (SH) extracts. IgE reactivity was comparable between WT and TG extracts; however, IgE antibodies to CP4-EPSP could not be detected. Conclusions and Clinical Relevance SPWs with specific IgE to soy reacted most commonly with higher molecular weight soybean storage proteins compared with the lower molecular weight SH allergens identified in community asthma studies. IgE reactivity was comparable between WT and TG soy extracts, while no IgE reactivity to CP4-EPSP was observed. High molecular weight soybean storage allergens, Gly m 5 and Gly m 6, may be respiratory sensitizers in occupational exposed SPWs. AU - Green BJ AU - Cummings KJ AU - Rittenour WR AU - Hettick JM AU - Bledsoe TA AU - Blachere FM AU - Siegel PD AU - Gaughan DM AU - Kullman GJ AU - Kreiss K AU - Cox-Ganser J AU - Beezhold DH LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Differentiating occupational asthmatics from non-occupational asthmatics and irritant-exposed workers PG - 191-195 AB - Background Serial peak expiratory flow(PEF) records have been recommended as a first-line investigation in workers suspected as having occupational asthma (OA). Aims To determine which PEF variability index best differentiates workers with OA from non-occupational asthmatics and unaffected irritant-exposed workers. Methods PEF was measured at least four times daily for at least 3 weeks in three groups of subjects: (i) forty healthy grain-exposed farmers and dockers, (ii) forty-two consecutive workers with independently confirmed OA and (iii) forty-eight non-occupational asthmatics. Indices of PEF variability were compared between groups. Results The difference in mean PEF between rest and work periods best separated the occupational asthmatic workers from the others. The upper 95% confidence limit of this index for grain-exposed workers was 2.8% of predicted PEF (16 l/min) and 3.3% (15 l/min) for non-occupational asthmatics. Sensitivity for diagnosing OA using this index was 70%. An increase in diurnal variation on workdays of >7% had a sensitivity of only 27% for the diagnosis of OA. The difference between maximum PEF on workdays and minimum PEF on rest days had a sensitivity of <10% against non-occupational asthmatic controls. Conclusions Difference in mean PEF between workdays and rest days is the best simple index for differentiating subjects with OA from those with non-OA or irritant-exposed healthy subjects. Differences >16 l/min are unlikely to be due to significant irritant exposure in healthy workers. AU - Anees W AU - Blainey D AU - Moore VC AU - Robertson K AU - Burge PS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 37 IP - DP - 2011 Jan 01 TI - Do young adults with childhood asthma avoid occupational exposures at first hire? PG - 1043-1049 AB - Information on the healthy worker hire effect in relation to asthma is scant. We aimed to assess whether and how childhood asthma-related characteristics (before hire) relate to occupational exposures at first hire. Analyses were conducted in 298 children examined at the first survey of the Epidemiological Study on the Genetics and Environment of Asthma (1991–1995), who reported a training period or a job at follow-up in 2003–2007 (aged 17–29 yrs; 53% males). Exposure likelihood to dust, gases and/or fumes in their first occupation was estimated by the ALOHA job exposure matrix. Asthma before the first occupation and two asthma classifications for severity (Global Initiative for Asthma 2002 guidelines) and symptoms were defined by questionnaire. In their first job, 47% of subjects were exposed. After adjustment (age, sex and education), pre-hire onset asthmatics (59%) were nonsignificantly less likely to be exposed (OR 0.67, 95% CI 0.41–1.11). Associations were stronger when considering those with severe asthma or high symptom score in childhood (OR 0.27 (95% CI 0.11–0.63) and OR 0.49 (95% CI 0.25–0.99), respectively). The association was observed in those who completed a university degree (OR 0.55, 95% CI 0.29–1.04) but not in the others (OR 0.98, 95% CI 0.44–2.22), with consistent results for all asthma characteristics. Results suggest a healthy worker hire effect in subjects with more severe or more symptomatic asthma in childhood. Education may modulate self-selection. AU - Dumas O AU - Smit LAM AU - Pin I AU - Kromhout H AU - Siroux V AU - Nadif R AU - Vermeulen R AU - Heederik D AU - Hery M AU - Choudat D AU - Kauffmann F AU - Le Moual N AU - on behalf of the Epidemiological Study on the Genetics and Environment of Asthma (EGEA) LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 183 IP - DP - 2011 Jan 01 TI - Occupational Exposure And Respiratory Health Problems Among Nutmeg Production Workers In Grenada, The Caribbean PG - A1182 AB - Rationale: The nutmeg industry is a major contributor to the Grenadian economy. The goal of this study was to investigate respiratory health problems and possible related occupational exposures among production workers at the largest nutmeg receiving and processing station. Methods: In this cross-sectional study, we offered a standardized questionnaire (including sections on demographics, occupational history, airways symptoms, physician-diagnosed diseases, and smoking status), spirometry and allergen skin-prick testing for nutmeg to all 92 workers. Eighty-six workers completed the questionnaire, and 85 took part in spirometry and skin-prick testing. We collected samples for measurement of airborne dust (9 area, 6 personal) and mold (3 bulk dusts, 17 spore traps). Additionally, we collected 4 short-duration samples for semi-quantitative measurement of phosphine (a pesticide). The Institutional Review Board of St. George’s University approved study procedures. Results: Area geometric mean (GM) inhalable dust concentrations were 0.43 (cracking), 0.64 (final sorting), 0.72 (drying and mace), and 1.8 mg/m3 (first-stage sorting). GM personal concentrations were 2.3 (cracking), 7.0 (drying and mace), and 7.3 mg/m3 (first-stage sorting). A short-duration dust sample collected during turning of nutmegs (drying area) had a concentration of 2.3 mg/m3. Analysis of mold in bulk dust showed 8.4x104, 2.0x106, and 4.4x107 CFU/g from the mace, first-stage sorting, and drying areas, respectively. Total mold spores during work activities ranged from 3.3x103 (mace area) to 9.8x105 spores/m3 (drying area). Penicillium and Aspergillus were the predominant mold genera in these samples. Phosphine levels at the beginning and end of fumigation were =0.1 ppm. Workers were mostly female (74.0%) and nonsmokers (79.1%) with a mean age of 48.3±8.1 years. The most common lower respiratory symptoms were dry cough (49.4%) and shortness of breath (42.9%). Approximately half of workers with these common symptoms reported a work-related pattern. The most common upper respiratory symptoms were sneezing (66.3%) and stuffy nose (47.1%). Prevalences of physician-diagnosed asthma and sinusitis were 9.5% and 26.5%, respectively. Skin prick test results indicated that 16.5% of workers had nutmeg allergy, and spirometric results showed that 18.8% workers had obstruction. Smokers and non-smokers had similar prevalences of symptoms. Preliminary questionnaire analyses showed similar symptom prevalences across work areas. Conclusions: Our findings are among the first to describe occupational health issues in this industry. High prevelances of respiratory symptoms among workers in this facility are consistent with measured levels of dust and mold, and were widespread over all work areas. Future work will attempt to evaluate exposure-response relationships. AU - Akpinar-Elci M AU - Day G AU - Bidaisee S AU - Cox-Ganser J AU - Peters S AU - Elci O LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 66 IP - DP - 2011 Jan 01 TI - Pet shop workers: exposure, sensitization, and work-related symptoms PG - 1081-1087 AB - Background: Allergy to laboratory animals is a well-known occupational hazard. The aim was to investigate the frequency of allergic sensitization and respiratory symptoms among pet shop staff and to document their work environment. Methods: Subjects (n = 59) from 24 pet shops were investigated with a questionnaire and lung function tests and skin prick tests against a panel of common inhalant and pet shop allergens. Blood samples were taken for immunoglobulin E (IgE) and IgE antibodies against Phadiatop and specific pet shop allergens. Personal airborne rodent allergen (n = 40) and endotoxin exposure (n = 40) was measured during work. Airborne rodent allergens were also collected using petri dishes at work (n = 40) and at home (n = 45). Results: Fifty-three percent reported nasal symptoms, 34% eye symptoms, and 22% had experienced symptoms indicating asthma. However, only four workers (7%) were previously diagnosed with asthma. One-third reported respiratory symptoms at work, mostly against rodents, birds, insects, and hay, and 29% were sensitized to work-related allergens, mainly rodents and fodder insects, e.g., Zophobas. Atopy and total IgE > 100 kU/l increased prevalence of pet shop sensitization [prevalence ratio (PR) 17 and 5.5, respectively], and atopy increased work-related symptoms (PR 3.2). Endotoxin levels were similar between shops with and without rodents. Exposure to animals outside of work was extensive. Conclusions: A third of the pet shop workers reported airway symptoms at work or were sensitized, sometimes to unusual pet shop allergens, especially among atopics. The findings stress the importance of improving the knowledge of health risks and allergen avoidance measures among pet shop staff. AU - Renström A AU - Olsson M AU - Hedrén M AU - Johansson SGO AU - van Hage M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 66 IP - DP - 2011 Jan 01 TI - Occupational exposures and chronic obstructive pulmonary disease: a hospital based case–control study PG - 597-601 AB - Background Occupational exposures are associated with chronic obstructive pulmonary disease (COPD). This study investigated this association among a population with a high prevalence of tuberculosis and smoking. Methods Cases (n=110) diagnosed by pulmonologists were selected from specialist respiratory clinics. Frequency sex- and age-matched controls (n=102) were selected from other clinics at the same institutions. Lifetime occupational exposure histories were obtained through interviews. Exposure variables derived from the ALOHA Job Exposure Matrix (JEM) were used to complement the self-reporting variables. ORs were calculated from logistic regression models, adjusting for smoking and past history of tuberculosis. Percentage population attributable risk (PAR%) was also calculated. Results The adjusted ORs for COPD from the JEM-derived high cumulative biological dust exposure, high cumulative mineral dust exposure and high cumulative gas and fumes exposure were 2.1 (95% CI 1.1 to 4.2), 1.1 (95% CI 0.6 to 2.4) and 1.8 (95% CI 0.8 to 3.9), respectively. Self-reported occupational exposures were associated with higher risks, with adjusted ORs for high dust exposure-years and high chemical, gas and fumes exposure-years of 5.9 (95% CI 2.6 to 13.2) and 3.6 (95% CI 1.6 to 7.9), respectively. Among ever smokers, there was an increased risk for COPD, with ORs ranging from 5.0 to 5.5. Tuberculosis was a strong risk factor, with an OR ranging from 7.7 to 8.1. The PAR% was 25% for self-reported high exposures, but lower when the JEM variables were used. Conclusions Lifetime occupational exposures contribute to the risk of COPD, adjusted for smoking. These risks are present in populations with a high burden of tuberculosis, which is considered an important causative factor. AU - Govender N AU - Lalloo UG AU - Naidoo RN LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 41 IP - DP - 2011 Jan 01 TI - Allergen inhalation challenge in smoking compared with non-smoking asthmatic subjects PG - 1084-1090 AB - Background Smoking asthmatics experience more severe symptoms, require more rescue medication and have more asthma-related hospitalizations than non-smoking asthmatics. However, studies in mice suggest that mainstream cigarette smoke may reduce airway inflammation and may attenuate airway hyperresponsiveness. A comparison of allergen-induced airway inflammatory responses of smoking and non-smoking atopic asthmatics has not been examined previously. Objectives To determine whether allergen-induced airway responses and inflammatory profiles are attenuated in smoking when compared with non-smoking mild allergic asthmatic subjects. Methods Allergen inhalation challenges were performed in 13 smoking and 19 non-smoking mild allergic asthmatic subjects. The forced expired volume in 1 s (FEV1) was measured up to 7 h after allergen inhalation. Methacholine airway responsiveness was measured before and at 24 h after allergen and sputum was induced before and at 7 and 24 h after allergen. Results Both the smoking and non-smoking groups developed similar allergen-induced falls in FEV1 during the early and late asthmatic responses and similar increases in allergen-induced airway eosinophils. The mean maximum fall in FEV1 during the late response was 16.3±4.3% in non-smokers and 12.9±7.2% in smokers. The smoking asthmatics, however, did not develop allergen-induced methacholine airway hyperresponsiveness, whereas the non-smoking controls developed a 1.18 doubling dose shift in methacholine PC20 (P<0.05). Conclusions and Clinical Relevance Mild allergic asthmatic subjects, who were current smokers with a mean 6-year pack history, develop allergen-induced eosinophilic airway inflammation and late responses, similar in magnitude to non-smoking asthmatics, but do not develop methacholine airway hyperresponsiveness associated with the allergen-induced airway eosinophilia. AU - Meghji Z AU - Dua B AU - Watson RM AU - Gauvreau GM AU - OByrne PM LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 128 IP - DP - 2011 Jan 01 TI - Profilin: A relevant aeroallergen? PG - 416-418 AB - In this study we provide further evidence supporting the concept that profilin can elicit nasal and bronchial responses in patients with pollen allergy who are also sensitized to profilin and therefore should be considered as a respiratory allergen. Nasal responses were lower than bronchial responses, likely because of low concentrations of allergen reaching the nasal mucosa. Nasal and bronchial challenge tests with natural and recombinant Bet v 1 were previously described by Godnic-Cvar et al.9 To our knowledge, ours is the first study to demonstrate that profilin can induce allergic respiratory symptoms. In the other part of the study, we demonstrated that the amount of profilin present in different pollen extracts is low compared with the quantity of the main allergens within each pollen studied. The profilin content in grasses is significantly higher than that present in trees or weeds. This higher prevalence in grasses supports and could explain the correlation between profilin sensitization and grass allergy.5,10 However, these finding do not indicate that a standardization strategy for grass vaccines based on the quantification of potential relevant minor allergens, such as profilin, could increase its efficacy in patients sensitized to grass pollen. In conclusion, profilin can elicit respiratory symptoms in sensitized patients with rhinitis, asthma, or both. Therefore it should be considered a potentially relevant respiratory allergen when patients are exposed to high levels of grass pollen. AU - Ruiz-Garcia M AU - del Potro MG AU - Fernandez-Nieto M AU - Barber D AU - Jimeno-Nogales L AU - Sastre J LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 128 IP - DP - 2011 Jan 01 TI - Hexamethylene diisocyanate asthma is associated with genetic polymorphisms of CD14, IL-13, and IL-4 receptor a PG - 418-420 AB - we have confirmed a previous observation in expanded groups of workers: a reported association between genotype combinations associated with Th2 and innate immunity and diisocyanate-induced asthma caused by HDI. Replication of these results in other background populations will be necessary to define the possible value of these genetic markers for risk assessment. AU - Bernstein DI AU - Kissling GE AU - Hershey GK AU - Yucesoy B AU - Johnson VJ AU - Cartier A AU - Gautrin D AU - Sastre J AU - Boulet L AU - Malo J AU - Quirce S AU - Tarlo SM AU - Langmeyer S AU - Luster MI AU - Lummus ZL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 184 IP - DP - 2011 Jan 01 TI - An Official American Thoracic Society Statement: Work-Exacerbated Asthma PG - 368-378 AB - Rationale: Occupational exposures can contribute to the exacerbation as well as the onset of asthma. However, work-exacerbated asthma (WEA) has received less attention than occupational asthma (OA) that is caused by work. Objectives: The purpose of this Statement is to summarize current knowledge about the descriptive epidemiology, clinical characteristics, and management and treatment of WEA; propose a case definition for WEA; and discuss needs for prevention and research. Methods: Information about WEA was identified primarily by systematic searches of the medical literature. Statements about prevention and research needs were reached by consensus. Measurements and Main Results: WEA is defined as the worsening of asthma due to conditions at work. WEA is common, with a median prevalence of 21.5% among adults with asthma. Different types of agents or conditions at work may exacerbate asthma. WEA cases with persistent work-related symptoms can have clinical characteristics (level of severity, medication needs) and adverse socioeconomic outcomes (unemployment, reduction in income) similar to those of OA cases. Compared with adults with asthma unrelated to work, WEA cases report more days with symptoms, seek more medical care, and have a lower quality of life. WEA should be considered in any patient with asthma that is getting worse or who has work-related symptoms. Management of WEA should focus on reducing work exposures and optimizing standard medical management, with a change in jobs only if these measures are not successful. Conclusions: WEA is a common and underrecognized adverse outcome resulting from conditions at work. Additional research is needed to improve the understanding of the risk factors for, and mechanisms and outcomes of, WEA, and to inform and evaluate preventive interventions. AU - Henneberger PK AU - Redlich CA AU - Callahan DB AU - Harber P AU - Lemière C AU - Martin J AU - Tarlo SM AU - Vandenplas O LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Impact of worker education on respiratory symptoms and sensitization in bakeries PG - 321-327 AB - Background Flour exposure is known to cause significant respiratory problems. Aims To investigate the development of work-related sensitization, the period between first exposure and the development of symptoms (latent period) and the impact of workplace training programmes on respiratory health in plant bakers. Methods Two hundred and sixty-four bakers were investigated by assessing work-related respiratory symptoms and latent period before symptoms/sensitization, spirometry and testing for an array of workplace-specific IgE. Results There was a significant relationship between the presence of work-related respiratory symptoms and flour dust allergen-specific IgE. Latent periods varied widely: median for work-related nasal symptoms 36 months, cough 42 months and chest tightness 120 months. Latent periods were shorter for workers with evidence of flour sensitization (work-related wheeze: mean 13 months with sensitization, 97 months without, P < 0.05, work-related nasal symptoms, respectively; mean 19 months, 71 months, P < 0.01). Those warned of the health implications of flour dust had less work-related wheeze (warned; 1%, not warned 11%, P < 0.05). There was an excess of work-related symptoms and work-related-specific IgE combined in those who had not been warned of these health implications (12 versus 1%, P <0.01). Conclusions Reporting of ‘being warned’ of potential health implications from breathing flour dust protected strongly against the reporting of important health end points. Latent periods for the development of work-related symptoms varied widely. Simple health messages, which may be overlooked in worker training programmes, can have significant benefits for worker health in the bakery population. AU - Fishwick D AU - Harris-Roberts J AU - Robinson E AU - Evans G AU - Barraclough R AU - Sen D AU - Curran AD LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Work-related symptoms in nail salon technicians PG - 335-340 AB - Background Nail salons are a rapidly expanding small business sector. Environmental health practitioners have raised concerns about potential health and safety issues. Aims To establish the extent of work-related health issues reported by nail salon technicians, their knowledge of health and safety regulations and of the products used. Methods Nail technicians completed a researcher-administered questionnaire, and responses were compared to those of non-exposed office-based control subjects. Results In all, 39 of 588 nail salons approached agreed to participate (7%), with all 71 (100%) of the available nail technicians within these salons completing study questionnaires. The majority of the nail technicians (99%) had received training that had included aspects of health and safety and most reported being aware of the Control of Substances Hazardous to Health regulations (59/70, 84%) and risk assessments (65/70, 93%). Compared to the control group, the nail technicians reported statistically significant increased levels of work-related neck (OR 5.0, 95% CI 1.6–15.6), shoulder (15.0, 3.1–71.8), wrist/hand (3.6, 1.2–10.7) and lower back problems (3.5, 1.0–12.5). Work-related nasal symptoms were also significantly more common in nail technicians (6.2, 1.3–30.7). Conclusions This study demonstrated a higher prevalence of a range of musculoskeletal problems and respiratory symptoms reported by nail technicians compared to office-based controls. An ergonomic and exposure assessment of work practices in this industry is warranted to identify the working practices associated with these symptoms, in order to inform best practice, supplement industry and regulatory guidance and develop appropriate practical work-based training. AU - Harris-Roberts J AU - Bowen J AU - Sumner J AU - Stocks-Greaves M AU - Bradshaw L AU - Fishwick D AU - Barber CM LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Self-reported work-related symptoms in hairdressers PG - 328-334 AB - Background Detailed studies of current symptoms reported by hairdressers and of the training received to reduce the health risks associated with this work are uncommon. Aims To document current levels of self-reported health problems in hairdressers, compared to non-hairdressing controls. Methods An interviewer-led questionnaire recording demographic information, work history, health training levels and the presence of self-reported respiratory, skin, musculoskeletal and non-specific symptoms was administered. Results In total, 147 hairdressers, 86% of whom were female (median age 27 years) and 67 non-hairdressing controls, all female (median age 38 years) were recruited. Following adjustment for age, smoking and years worked, hairdressers reported significantly higher levels of musculoskeletal problems, including work-related shoulder pain (OR 11.6, 95% CI 2.4–55.4), work-related wrist and hand pain (2.8, 1.1–7.6), work-related upper back pain (3.8, 1.0–14.9), work-related lower back pain (4.9, 1.5–15.9) and work-related leg/foot pain (31.0, 3.8–267.4). The frequency of self-reported asthma was similar in both groups (hairdressers 16%, controls 17%) as was chest tightness and wheeze. Work-related cough was significantly more frequently reported in hairdressers than in controls (13.2, 1.3–131.5). While hairdresser training was commonplace, such training did not always appear to have resulted in awareness of potential workplace health risks. Conclusions This study identified frequently reported musculoskeletal, skin and respiratory symptoms in hairdressers. This points to a need to develop training that not only deals with risk assessment but also informs hairdressers about the health risks of their work. AU - Bradshaw L AU - Harris-Roberts J AU - Bowen J AU - Rahman S AU - Fishwick D LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Medium-density fibreboard and occupational asthma. A case series PG - 357-363 AB - Background Medium-density fibreboard (MDF) is a wood composite material, composed primarily of softwood, bonded with a synthetic formaldehyde-based resin. It is increasingly used, as it has various advantages over natural woods. Methods Enquiry of the national reporting scheme data and three case reports were used to further the evidence base linking this exposure to occupational asthma (OA). Results From 1991 to 2007, 21 cases of occupational sensitization to MDF were reported to the UK voluntary reporting scheme, Surveillance of Work Related Occupational Respiratory Disease (SWORD): 18 reported as occupational asthma (OA) and 3 as occupational rhinitis. All workers were male, with a mean age of 48 years, working in education, furniture manufacturing or joinery among other employments. Conclusions Whilst reporting scheme data identified relatively small numbers of cases of OA likely to be due to MDF, the evidence base supporting this link is generally lacking. The three cases presented, where OA was attributed to MDF exposure, add to this evidence AU - Burton C AU - Bradshaw L AU - Agius R AU - Burge S AU - Huggins V AU - Fishwick D LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Occupational asthma and rhinitis due to detergent enzymes in healthcare PG - 364-369 AB - Background The use of proteolytic enzymes to improve the cleaning efficacy of washing powders was introduced in the mid 1960s. Many microbial enzymes are known to be potent respiratory sensitizers but previously there has been only one case of occupational asthma associated with workplace exposure in a healthcare worker. Aims To report two cases of occupational asthma associated with exposure to biological enzymes in health-care workers and related occupational cases. Methods Reporting of clinical case reports from three different work places. Results One case of occupational asthma and three other cases with work-related asthma or rhinitis occurred in one workplace. A single case of probable occupational asthma presented at a second workplace with another case of work-related asthma at a third workplace. Exposures occurred in areas used for cleaning medical instruments and endoscopy suites. Hygiene measurements confirmed the potential for exposure. Control measures were not in place and recognition of the hazard was missing in these workplaces. Conclusions Detergent enzymes when used in healthcare settings should be recognized as potential respiratory sensitizers. Healthcare institutions and professional bodies that recommend the use of detergent enzymes should review their risk assessments to ensure that the most appropriate methods for preventing or reducing exposure are in place. AU - Adisesh A AU - Murphy E AU - Barber CM AU - Ayres JG LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Respiratory symptoms in insect breeders PG - 370-373 AB - Background A number of specialist food suppliers in the UK breed and distribute insects and insect larvae as food for exotic pets, such as reptiles, amphibians and invertebrates. Aims To investigate the extent of work-related (WR) symptoms and workplace-specific serum IgE in workers potentially exposed to a variety of biological contaminants, including insect and insect larvae allergens, endotoxin and cereal allergens at a UK specialist insect breeding facility. Methods We undertook a study of respiratory symptoms and exposures at the facility, with subsequent detailed clinical assessment of one worker. All 32 workers were assessed clinically using a respiratory questionnaire and lung function. Eighteen workers consented to provide serum for determination of specific IgE to workplace allergens. Results Thirty-four per cent (11/32) of insect workers reported WR respiratory symptoms. Sensitization, as judged by specific IgE, was found in 29% (4/14) of currently exposed workers. Total inhalable dust levels ranged from 1.2 to 17.9 mg/m3 [mean 4.3 mg/m3 (SD 4.4 mg/m3), median 2.0 mg/m3] and endotoxin levels of up to 29435 EU/m3 were recorded. Conclusions Exposure to organic dusts below the levels for which there are UK workplace exposure limits can result in respiratory symptoms and sensitization. The results should alert those responsible for the health of similarly exposed workers to the potential for respiratory ill-health and the need to provide a suitable health surveillance programme. AU - Harris-Roberts J AU - Fishwick D AU - Tate P AU - Rawbone R AU - Stagg S AU - Barber CM AU - Adisesh A LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 66 IP - DP - 2011 Jan 01 TI - Prevention of work-related respiratory allergies among pre-apprentices or apprentices and young workers PG - 1164-1173 AB - Apprenticeship is a period of increased risk of developing work-related respiratory allergic diseases. There is a need for documents to provide appropriate professional advice to young adults aiming to reduce unsuitable job choices and prevent impairment from their careers. The present document is the result of a consensus reached by a panel of experts from European and non-European countries addressed to allergologists, pneumologists, occupational physicians, primary care physicians, and other specialists interested in this field, which aims to reduce work-related respiratory allergies (rhinoconjunctivitis and asthma) among allergic or nonallergic apprentices and other young adults entering the workforce. The main objective of the document is to issue consensus suggestions for good clinical practice based on existing scientific evidence and the expertise of a panel of physicians. AU - Moscato G AU - Pala G AU - Boillat MA AU - Folletti I AU - van Gerth Wijk R AU - Olgiati-Des Gouttes D AU - Perfetti L AU - Quirce S AU - Siracusa A AU - Walusiak-Skorupa J AU - Tarlo SM LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 68 IP - DP - 2011 Jan 01 TI - Reduced lung function among sisal processors PG - 682-685 AB - Objectives The objective of this study was to examine lung function and chronic respiratory symptoms among sisal workers in Tanzania and compare the results with a control group. Methods A cross-sectional study on chronic respiratory symptoms and lung function was conducted in 2006 among male Tanzanian sisal processing workers from six sisal estates. Participants included 86 workers in decortication departments, 68 workers in brushing departments and 30 low exposed security guards. The response rate was 97%. Chronic respiratory symptoms and background information were obtained by structured interview. Forced ventilatory capacity (FVC) and forced expiratory volume in 1 s (FEV1) were estimated before and after a work shift, and FEV1/FVC ratio calculated. Results Workers were aged 19–85, with the oldest in the brushing and security departments. Chronic cough and chest tightness were experienced by 38% and 68% of workers in brushing departments, 20% and 6% of workers in decortication and 7% and 0% of security workers, respectively. A reduced FEV1/FVC ratio related to years of work was found among workers in brushing departments when adjusting for age, smoking, previous respiratory illnesses and body mass index, using regression analyses. Work in decortication departments was not related to reduced lung function parameters. The prevalence of FEV1/FVC<70 was above 50 for all three groups. Lung function parameters were similar before and after work shifts, except that peak expiratory flow increased among workers in brushing departments after work shifts. Conclusions The results indicate a relationship between work in sisal brushing departments and the development of obstructive lung disorders. AU - Kayumba A AU - Moen BE AU - Bråtveit M AU - Eduard W AU - Mashalla Y LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 20 IP - DP - 2011 Jan 01 TI - A Survey of Fungal Contamination on Books in Public Libraries with Mechanical and Natural Ventilation PG - 393-399 AB - Libraries are very propitious environments for the growth of fungi. The great concentration of organic material available for these microorganisms, and often with the lack of adequate ventilation or climate control, would favour this situation. This study was conducted in 2003 to determine the predominant genera of fungi in public libraries by a survey of fungi contaminating the upper surface of books, with and without air conditioning in the city of São Paulo, Brazil, in the winter and summer, during the respective periods with high and low levels of airborne fungi in that city. Six libraries were chosen, located on the campus of the University of São Paulo, three of them with air conditioning and the other three with natural ventilation. In these six libraries, 31 genera of fungi were identified in total. The genera and frequency of contaminant fungi recovered differed significantly between the libraries with and without air conditioning and in the samples collected in the summer as opposed to the winter. Cladosporium was the most frequent in the libraries with and without air conditioning, and in the winter. Aspergillus was isolated more often in the summer. AU - Reis-Menezes AA AU - Gambale W AU - Giudice MC LA - PT - DEP - TA - Indoor Built Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 184 IP - DP - 2011 Jan 01 TI - Case–Control Study of Lung Function in World Trade Center Health Registry Area Residents and Workers PG - 582-589 AB - Rationale: Residents and area workers who inhaled dust and fumes from the World Trade Center disaster reported lower respiratory symptoms in two World Trade Center Health Registry surveys (2003–2004 and 2006–2007), but lung function data were lacking. Objectives: To examine the relationship between persistent respiratory symptoms and pulmonary function in a nested case–control study of exposed adult residents and area workers 7–8 years after September 11, 2001. Methods: Registrants reporting post September 11th onset of a lower respiratory symptom in the first survey and the same symptom in the second survey were solicited as potential cases. Registrants without lower respiratory symptoms in either Registry survey were solicited as potential control subjects. Final case–control status was determined by lower respiratory symptoms at a third interview (the study), when spirometry and impulse oscillometry were also performed. Measurements and Main Results: We identified 180 cases and 473 control subjects. Cases were more likely than control subjects to have abnormal spirometry (19% vs. 11%; P < 0.05), and impulse oscillometry measurements of elevated airway resistance (R5; 68% vs. 27%; P < 0.0001) and frequency dependence of resistance (R5–20; 36% vs. 7%; P < 0.0001). When spirometry was normal, cases were more likely than control subjects to have elevated R5 and R5–20 (62% vs. 25% and 27% vs. 6%, respectively; both P < 0.0001). Associations between symptoms and oscillometry held when factors significant in bivariate comparisons (body mass index, spirometry, and exposures) were analyzed using logistic regression. Conclusions: This study links persistent respiratory symptoms and oscillometric abnormalities in World Trade Center–exposed residents and area workers. Elevated R5 and R5–20 in cases despite normal spirometry suggested distal airway dysfunction as a mechanism for symptoms. AU - Friedman SM AU - Maslow CB AU - Reibman J AU - Pillai PS AU - Goldring RM AU - Farfel MR AU - Stellman SD AU - and Berger KI LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 184 IP - DP - 2011 Jan 01 TI - An Official ATS Clinical Practice Guideline: Interpretation of Exhaled Nitric Oxide Levels (FENO)for Clinical Applications PG - 602-615 AB - We recommend the use of FENO in the diagnosis of eosinophilic airway inflammation (strong recommendation,moderate quality of evidence. We recommend the use of FENO in determining the likelihood of steroid responsiveness in individuals with chronic respiratory symptoms possibly due to airway inflammation (strong recommendation, low quality of evidence. We suggest that FENO may be used to support the diagnosis of asthma in situations in which objective evidence is needed (weak recommendation, moderate quality of evidence. We suggest the use of cut points rather than reference values when interpreting FENO levels (weak recommendation,low quality of evidence. We recommend accounting for age as a factor affecting FENO in children younger than 12 years of age (strong recommendation, high quality of evidence. We recommend that low FENO less than 25 ppb (<20 ppb in children) be used to indicate that eosinophilic inflammation and responsiveness to corticosteroids are less likely (strong recommendation, moderate quality of evidence. We recommend that FENO greater than 50 ppb (>35 ppb in children) be used to indicate that eosinophilic inflammation and, in symptomatic patients, responsiveness to corticosteroids are likely (strong recommendation, moderate quality of evidence. We recommend that FENO values between 25 ppb and 50 ppb (20–35 ppb in children) should be interpreted cautiously and with reference to the clinical context. (strong recommendation, low quality of evidence). We recommend accounting for persistent and/or high allergen exposure as a factor associated with higher levels of FENO (strong recommendation, moderate quality of evidence. We recommend the use of FENO in monitoring airway inflammation in patients with asthma (strong recommendation, low quality of evidence. We suggest using the following values to determine a significant increase in FENO: greater than 20% for values over 50 ppb or more than 10 ppb for values lower than 50 ppb from one visit to the next (weak recommendation, low quality of evidence. We suggest using a reduction of at least 20% in FENO for values over 50 ppb or more than 10 ppb for values lower than 50 ppb as the cut point to indicate a significant response to antiinflammatory therapy (weak recommendation,low quality of evidence). AU - Dweik RA AU - Boggs PB AU - Erzurum SC AU - Irvin CG AU - Leigh MW AU - Lundberg JO LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 68 IP - DP - 2011 Jan 01 TI - Cost-benefit analysis in occupational health: a comparison of intervention scenarios for occupational asthma and rhinitis among bakery workers PG - 739-745 AB - Objectives Use of cost-benefit analysis in occupational health increases insight into the intervention strategy that maximises the cost-benefit ratio. This study presents a methodological framework identifying the most important elements of a cost-benefit analysis for occupational health settings. One of the main aims of the methodology is to evaluate cost-benefit ratios for different stakeholders (employers, employees and society). The developed methodology was applied to two intervention strategies focused on reducing respiratory diseases. Methods A cost-benefit framework was developed and used to set up a calculation spreadsheet containing the inputs and algorithms required to calculate the costs and benefits for all cost elements. Inputs from a large variety of sources were used to calculate total costs, total benefits, net costs and the benefit-to-costs ratio for both intervention scenarios. Results Implementation of a covenant intervention program resulted in a net benefit of €16?848?546 over 20 years for a population of 10?000 workers. Implementation was cost-effective for all stakeholders. For a health surveillance scenario, total benefits resulting from a decreased disease burden were estimated to be €44?659?352. The costs of the interventions could not be calculated. Overall, there was an estimated benefit of Euro 44,659,352 for the full 20-year period for a population of 10,000 workers. A total of 4,200 individual interventions was estimated. Based on these figures the average cost of an individual intervention needs to remain below Euro 10,000 per intervention for there to be a net benefit. If the interventions are fully paid for by the employers, the average cost must remain below Euro 4,650 per individual intervention so as not to exceed the employer’s benefits. However, it should be acknowledged that in many cases workplace changes are likely to affect more than one worker and changes will also impact on future workers, which further complicates the assessment of intervention costs at an individual level. Conclusion This study provides important insights for developing effective intervention strategies in the field of occupational medicine. Use of a model based approach enables investigation of those parameters most likely to impact on the effectiveness and costs of interventions for work related diseases. Our case study highlights the importance of considering different perspectives (of employers, society and employees) in assessing and sharing the costs and benefits of interventions. AU - Meijster T AU - van Duuren-Stuurman B AU - Heederik D AU - Houba R AU - Koningsveld E AU - Warren N AU - Tielemans E LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 68 IP - DP - 2011 Jan 01 TI - Respiratory health and lung function in Chinese restaurant kitchen workers PG - 746-752 AB - Objectives To measure air pollutant concentrations in Chinese restaurant kitchens using different stove types and assess their influence on workers' respiratory health. Methods 393 kitchen workers from 53 Chinese restaurants were surveyed over 16 months: 115 workers from 21 restaurants using only electric stoves and 278 workers from 32 restaurants using only gas stoves. Workers were interviewed about their respiratory symptoms and had their lung function tested. Concentrations of nitric oxide (NO), nitrogen dioxide (NO2), carbon monoxide (CO), carbon dioxide (CO2), methane (CH4), non-methane hydrocarbons (NMHC), total volatile organic compounds (TVOC) and fine particulate matter (PM2.5) were measured using portable monitors and air-bag sampling. Temperature and noise levels were assessed. Results Median concentrations of NO, NO2 and CO were 7.4, 1.5 and 1.6 times higher in gas-fuelled kitchens than in electric ones and average concentrations of PM2.5 and TVOC were 81% and 78% higher, respectively. Differences were smaller for CH4 and NMHC. Electricity-run kitchens were 4.5°C cooler and 9 dBA less noisy than gas-fuelled ones. Workers using electric cookers had significantly better lung function than their gas-using counterparts and their mean FEV1 and FVC values were 5.4% and 3.8% higher, respectively, after adjustment for confounders. Wheeze, phlegm, cough and sore throat were more prevalent in workers using gas. The adjusted OR for having phlegm regularly was significantly higher. Conclusions The poorer lung function and higher prevalence of respiratory symptoms among workers in gas-fuelled kitchens compared to those in electricity-powered kitchens may be associated with exposure to higher concentrations of toxic air pollutants generated during gas cooking. AU - Wong TW AU - Wong AHS AU - Lee FSC AU - Qiu H LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 9 IP - DP - 2011 Jan 01 TI - Identification of clinically significant psychological distress and psychiatric morbidity by examining quality of life in subjects with occupational asthma PG - 76-86 AB - Background: The Juniper Asthma Specific Quality of Life Questionnaire (AQLQ(S)) is a questionnaire that allows measurement of disease specific quality of life. We wanted to examine correlations between the (AQLQ(S)) general and different subscale scores and both psychiatric morbidity and levels of psychological distress in individuals with occupational asthma (OA) and to determine if results in the emotional function subscale allow identification of individuals with clinically significant psychological distress or current psychiatric disorders. Methods: This was a cross-sectional study of individuals with OA who were assessed during a re-evaluation for permanent disability, after they were no longer exposed to the sensitizing agent. Patients underwent a general sociodemographic and medical history evaluation, a brief psychiatric interview (Primary Care Evaluation of Mental Disorders, PRIME-MD) and completed a battery of questionnaires including the AQLQ(S), the St-Georges Respiratory Questionnaire (SGRQ), and the Psychiatric Symptom Index (PSI). Results: There was good internal consistency (Cronbach alpha = 0.936 for the AQLQ(S) total score) and construct validity for the AQLQ(S) (Spearman rho = -0.693 for the SGRQ symptom score and rho = -0.650 for the asthma severity score). There were medium to large correlations between the total score of the AQLQ(S) and the SGRQ symptom score (r = -.693), and PSI total (r = -.619) and subscale scores (including depression, r = -.419; anxiety, r = -.664; anger, r = -.367; cognitive disturbances, r = -.419). A cut-off of 5.1 on the AQLQ(S) emotional function subscale (where 0 = high impairment and 7 = no impairment) had the best discriminative value to distinguish individuals with or without clinically significant psychiatric distress according to the PSI, and a cut-off of 4.7 best distinguished individuals with or without a current psychiatric disorder according to the PRIME-MD. Conclusions: Impaired quality of life is associated with psychological distress and psychiatric disorders in individuals with OA. Findings suggest that the AQLQ(S) questionnaire may be used to identify patients with potentially clinically significant levels of psychological distress. AU - Miedinger D AU - Lavoie KL AU - L'Archeveque J AU - Ghezzo H AU - Malo J LA - PT - DEP - TA - Health and Quality of Life Outcomes JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 126 IP - DP - 2011 Jan 01 TI - Work-Related Asthma Among Adults with Current Asthma in 33 States and DC: Evidence from the Asthma Call-Back Survey, 2006–2007 PG - 603-611 AB - Asthma is associated with a variety of physical, chemical, and biological stimuli including those found in the workplace.The term “work-related asthma” (WRA), representing a subset of all asthma, encompasses both occupational asthma (OA), which is asthma that is caused by workplace exposure to a sensitizing or irritant substance, and work-exacerbated asthma (WEA), which is asthma that is worsened by work-related factors. WRA is a preventable and underdiagnosed occupational lung disease associated with adverse social and economic outcomes, disability, and mortality.Workers who leave their jobs due to WRA often experience loss in income and/or unemployment.A French study followed workers with WRA for an average of 3.1 years after diagnosis. At follow-up, 44% had left their jobs, 25% were unemployed, and 46% had experienced loss in income.Among adults with asthma, those with WRA have a lower quality of life and more frequent emergency department and doctors' visits for worsening asthma. WRA caused by a number of workplace agents may also lead to death. An estimated 6.7% of adults aged =18 years in the United States have current asthma. The American Thoracic Society has cited estimates that 4%–58% (median = 15%) of adults with asthma have WRA. Estimates of the proportion of adults with OA range from 10% to 15%, and estimates of WEA range from 14% to 58% (median = 21%). However, few such estimates have been published at the state level. The Adult Asthma Call-Back Survey (ACBS), part of the Behavioral Risk Factor Surveillance System (BRFSS), offers a unique opportunity to provide this information for a large number of states. To determine the proportion of asthma that is work-related, we analyzed data from the 2006 and 2007 ACBS for each participating state. AU - Knoeller GE AU - Mazurek JM AU - Moorman JE LA - PT - DEP - TA - Pub Health Reports JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 5 IP - DP - 2011 Jan 01 TI - Short-term prognosis of occupational asthma in a Finnish population PG - 143-149 AB - Background: Causative agents of occupational asthma (OA) are well described in literature but far less is known about factors affecting the outcome of OA. Short duration of exposure, early diagnosis when symptoms appear and further avoidance of exposure have been suggested as good prognostic factors. This study was designed to investigate a short-term outcome of OA. Methods: The medical records of 47 Caucasian patients from a Finnish population diagnosed with OA in year 2003 were reviewed retrospectively. Employment status at 6-month follow-up of all patients was determined. We assessed the following potential predictors of unemployment at follow-up: the causative agents of OA, asthma medication, spirometry results, smoking status, gender, age, occupation, atopy status, bronchial hyperresponsiveness and time to diagnosis. We calculated odd ratios (ORs) to predict employment status at follow-up. Results: At the follow-up examination, 23 persons (49%) were not working. At the time of follow-up there were no significant differences in pulmonary function between those employed and those who discontinued to work. Atopy at baseline predicted diminished lung function at the 6-month follow-up. In addition, atopy was the only prognostic factor and was inversely related to the work discontinuation at the follow-up [OR 0.18, 95% confidence interval (CI) 0.04–0.79]. Work continuation as an OA outcome at 6 months could not be predicted by gender, age, occupational status, exposure antigen, smoking habits or duration of symptoms before diagnosis. Conclusions: The socio-economic short-term prognosis of OA was relatively poor since half of the patients were not at work at the 6 months follow-up. AU - Kauppi P AU - Hannu T AU - Helaskoski E AU - Toivio P AU - Sauni R LA - PT - DEP - TA - clinical respiratory journal JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 105 IP - DP - 2011 Jan 01 TI - Serum cytokines markers in toluene diisocyanate-induced asthma PG - 1091-1094 AB - BACKGROUND: Toluene diisocyante-induced occupational asthma (TDI-OA) is an inflammatory disease of airway, composing inflammatory cells and cytokines associated with airway remodeling. Majority of the patients with TDI-OA presented persistent asthma. Therefore, early diagnosis is essential for the favorable prognosis. We investigated to identify serologic markers for early diagnosis of TDI-OA. METHODS: We enrolled 69 patients with TDI-OA and 95 asymptomatic exposed controls (AECs). Neutrophil-related cytokines, including myeloperoxidase (MPO) and interleukin-8 (IL-8), as well as airway remodeling-related cytokines, including transforming growth factor-ß1 (TGF-ß1), metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), and vascular endothelial growth factor (VEGF), were measured by ELISA in the sera of each subject. To evaluate the validity of the each cytokine and combined cytokines for discriminating between TDI-OA and AEC, Receiver operating characteristic (ROC) curve was used. RESULTS: There were significant differences in the serum levels of MMP-9 and VEGF between two groups (p < 0.05). Using the optimal cutoff value of MMP-9 (182.96 ng/mL), the sensitivity and specificity were 79.7% and 80.0%, respectively, with the area under the curve (AUC) of 0.815. When the cytokines were combined to improve sensitivity, the combined values of MMP-9, VEGF, and IL-8 comprised the best set, for which the AUC increased to 0.822 and the sensitivity increased to 82.6% but specificity decreased to 75.8%. CONCLUSIONS: The single serum cytokine MMP-9 level or the combined cytokines MMP-9, VEGF, and IL-8 can be used as meaningful serologic markers for identifying patients with TDI-OA among exposed workers. AU - Kim JH AU - Kim JE AU - Choi GS AU - Kim HY AU - Ye YM AU - Park HS. LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 18 IP - DP - 2011 Jan 01 TI - Course of occupational asthma depending on the duration of workplace exposure to allergens – a retrospective cohort study in bakers and farmers PG - 35-40 AB - The management of occupational asthma requires valid information about prognostic factors. The present study therefore investigates the importance of exposure duration, work cessation, and confounding factors on allergic obstructive airway disease in bakers and farmers. Patients with confirmed allergic occupational airway disease registered in a German Occupational Health Inspectorate received a mailed questionnaire on their respiratory health and employment status. Relations between duration of exposure and course of disease were analysed by multifactorial logistic regression under consideration of confounding variables. 178 patients (65 [36.5%] farmers and 113 [63.5%] bakers) aged between 24 and 74 (mean 42.0 ± standard deviation 12.7) years of age were included in the analysis. Farmers had much more severe respiratory complaints than bakers, and a significantly larger proportion of them (77.5%) had been employed for over 10 years (bakers: 36.6%). Unlike in bakers (Odds-Ratio for a sum score of more than 4 points 6.48 [95%CI 2.04–20.56]), among farmers (OR 1.47 [95%CI 0.30–.29]) the duration of work under exposure did not independently explain the severity of respiratory complaints. The multivariate statistical analysis confirms the prognostic value of the cessation of work in occupational asthma; this remedy, however, is often not available for farmers. . AU - Broding HC AU - Frank P AU - Hoffmeyer F AU - Bünger J LA - PT - DEP - TA - Ann Agric Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 184 IP - DP - 2011 Jan 01 TI - Test Properties and Minimal Clinically Important Difference PG - 1382-1389 AB - Rationale: Forced vital capacity (FVC) is an established measure of pulmonary function in idiopathic pulmonary fibrosis (IPF). Evidence regarding its measurement properties and minimal clinically important difference (MCID) in this population is limited. Objectives: To assess the reliability, validity, and responsiveness of FVC and estimate the MCID in patients with IPF. Methods: The study population included all 1,156 randomized patients in two clinical trials of IFN-?1b. FVC and other measures of functional status were measured at screening or baseline and 24-week intervals thereafter. Reliability was assessed based on two proximal measures of FVC, validity was assessed based on correlations between FVC and other measures of functional status, and responsiveness was assessed based on the relationship between 24-week changes in FVC and other measures of functional status. Distribution-based and anchor-based methods were used to estimate the MCID. Measurements and Main Results: Correlation of percent-predicted FVC between measurements (mean interval, 18 d) was high (r = 0.93; P < 0.001). Correlations between FVC and other parameters were generally weak, with the strongest observed correlation between FVC and carbon monoxide diffusing capacity (r = 0.38; P < 0.001). Correlations between change in FVC and changes in other parameters were slightly stronger (range, r = 0.16–0.37; P < 0.001). Importantly, 1-year risk of death was more than twofold higher (P < 0.001) in patients with a 24-week decline in FVC between 5% and 10%. The estimated MCID was 2–6%. Conclusions: FVC is a reliable, valid, and responsive measure of clinical status in patients with IPF, and a decline of 2–6%, although small, represents a clinically important difference. AU - du Bois RM AU - Weycker D AU - Albera C AU - Bradford WZ AU - Costabel U AU - Kartashov A AU - King TE AU - Lancaster L AU - Noble PW AU - Sahn SA AU - Thomeer M AU - Valeyre D AU - Wells AU LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - ID 365683 IP - DP - 2011 Jan 01 TI - Occupational Asthma in Antibiotic Manufacturing Workers: Case Reports and Systematic Review PG - 9 pages AB - Background. The risks of occupational asthma (OA) from antibiotics are uncertain. We report 4 new cases and a systematic review of the literature. Methods. Cases were identified through a specialist clinic, each underwent specific provocation testing (SPT). We subsequently reviewed the published literature. Results. The patients were employed in the manufacture of antibiotics; penicillins were implicated in three cases, in the fourth erythromycin, not previously reported to cause OA. In two, there was evidence of specific IgE sensitisation. At SPT each developed a late asthmatic reaction and increased bronchial hyperresponsiveness. 36 case reports have been previously published, 26 (citing penicillins or cephalosporins). Seven cross-sectional workplace-based surveys found prevalences of 5–8%. Conclusions. OA in antibiotic manufacturers may be more common than is generally recognised. Its pathogenesis remains unclear; immunological tests are of uncertain value and potential cases require confirmation with SPT. Further study of its frequency, mechanisms, and diagnosis is required. AU - Angulo SD AU - Szram J AU - Welch J AU - Cannon J AU - and Cullinan P LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 1 IP - DP - 2011 Jan 01 TI - Evidence-­-based guidance for the assessment of new employees with asthma A report to the British Occupational Health Research Foundation PG - 1-33 AU - Cullinan P LA - PT - DEP - TA - BOHRF JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 66 IP - DP - 2011 Jan 01 TI - occupational asthma; is this the cause of excess respiratory symptoms and COPD described in bitumen exposed workers? PG - A5-A6 AB - Introduction Epidemiological studies suggest increased risk of asthma and COPD in asphalt exposed workers.1 Bitumen is used in this industry. In this case we describe occupational asthma caused by bitumen exposure in a lab environment. This is the first such report to our knowledge. Case History A 49-year old male with no history of asthma or atopy and <5 pack years smoking history presented with airflow obstruction on surveillance spirometry, cough and wheeze. He analysed hot bitumen samples (1900 C) in a lab environment without using respiratory protective equipment. Spirometry FEV1 57%, FVC 85% ratio 55%. Respiratory symptoms improved after 3 weeks off work, returning soon after he rejoined the lab. Peak flow rates were variable and lower at work. Analysis with OASYS scored 3.08 (Abstract S4 figure 1). Histamine challenge test was positive (PC20 2.216 mg/ml). Skin prick test to paraldehyde was positive. After 8 weeks away from the exposed environment the subject was asymptomatic, continued to have obstructive spirometry but improved bronchial reactivity (PC20 7.489 mg/ml) without medication and improved peak flows with little diurnal variation. One week after restarting work the respiratory symptoms returned. Repeat OASYS charts scored 3.14 with histamine reactivity similar to baseline (PC20 2.81 mg/ml) after 4 weeks. A specific challenge test was not possible due to the problems with heating bitumen to 1900°C in the hospital lab. Conclusion The progression of symptoms and lung function in relation to work history supports the diagnosis of occupational asthma induced by bitumen fume exposure. This has not been reported previously. The possible mechanisms include sensitisation to short chain aldehydes, produced by partial combustion of bitumen which oxidises at these temperatures. Other potential sensitisers contained in bitumen are nickel and vanadium. Further studies are needed to investigate the by-products of heated bitumen and whether the previously described excess of COPD and respiratory disease in these workers is due to unidentified occupational asthma from bitumen fume exposure. AU - Surange N AU - Hoyle J LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 53 IP - DP - 2011 Jan 01 TI - Quality-of-Life, Psychological, and Cost Outcomes 2 Years After Diagnosis of Occupational Asthma PG - 231-238 AB - Objective: To examine the association between clinical and socioeconomic variables and their influence on psychological and cost outcomes in patients with occupational asthma (OA). Methods: Longitudinal study of 60 subjects who claimed compensation for OA in Quebec. Besides clinical markers of asthma, quality of life (QOL), psychological distress (PD) measures, and an instrument to diagnose mental disorders were used. Results: The QOL and PD parameters had moderate correlations with clinical markers of OA. Asthma severity, employment, marital status, income, and the length of employment with the employer showed the strongest associations with QOL and PD. More-impaired QOL was associated with higher direct costs for compensation. Conclusions: Impaired QOL and PD are frequent among subjects with OA receiving compensation and are associated with clinical markers of OA and socioeconomic factors. AU - Miedinger D AU - Lavoie KL AU - L'Archevˆeque J AU - Ghezzo H AU - Zunzunuegui MV AU - Malo J-L LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 54 IP - DP - 2011 Jan 01 TI - Occupational asthma related to low levels of airborne methylene diphenyl diisocyanate (MDI) in orthopedic casting work PG - 906-910 AB - Orthopedic plaster casts contain methylene diphenyl diisocyanate (MDI). A few case reports have suggested occupational asthma to MDI in casting work. However, the knowledge of the exposure levels related to the occupational asthma cases is lacking. We report on two occupational asthma cases due to MDI in nurses irregularly applying orthopedic plaster casts, verified with placebo controlled specific inhalation challenge. The levels of MDI in the air were measured in the exposure chamber during the specific inhalation challenges with a quantitative method including filter collection and subsequent liquid chromatography-mass spectrometry (LC-MS) analysis of the isocyanate groups. In order to estimate the level of airborne MDI in casting work, measurements were conducted also in two hospitals during the application and removal of synthetic plaster casts using the same method. The concentrations were well below the occupational exposure limit in both specific inhalation challenge and hospital measurements. Based on our findings, even minor exposure to airborne MDI in casting work can cause an asthmatic reaction in some patients. AU - Suojalehto H AU - Linström I AU - Henriks-Eckerman M AU - Jungewelter S AU - Suuronen K LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 105 IP - DP - 2011 Jan 01 TI - Reduced work ability in middle-aged men with asthma from youth- a 20-year follow-up PG - 950-955 AB - We studied, whether asthma diagnosed in childhood or early adulthood affects work ability 20 years later. We used Finnish Defence Force registers, 1986–1990, to select: (1) conscripts with asthma to represent a mild/moderate asthma group (n = 485), (2) asthmatics who were exempted from military service to represent a relatively severe asthma group (n = 393) and (3) a control group (n = 1500) without asthma. A questionnaire consisting of validated questions on asthma and work ability was sent out in 2009. A total of 54% of the men in the first study group, 44% of those in the second study group and 44% of the controls answered. The mean age of the participants was 41 (range 37–51). Self-assessed current work ability compared with lifetime best had decreased in 28.9% of the first asthma group, in 31.1% of the second asthma group, and in 19.7% of the controls (p = 0.0007). Current smoking (OR 2.5), only basic education (OR 2.6), being a manual worker (OR 2.7) and current severe asthma (OR 3.8) associated most strongly with decreased work ability among the asthmatics. Both mild and more severe asthma at the age of around 20 seems to be associated with reduced work ability in 40-year-old males. AU - Lindström I AU - Pallasaho P AU - Luukkonen R AU - Suojalehto H AU - Karjalainen J AU - Lauerma A AU - Karjalainen A LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 62 IP - DP - 2011 Jan 01 TI - The real value of diagnostic methods in case of long time of cessation of occupational exposure to diisocyanates among patients diagnosed in the nofer institute of occupational medicine in Lodz PG - 567-577 AB - BACKGROUND: The aim of the study was to analyze the data obtained during the diagnostic process and their real values in the final diagnosis of patients exposed to diisocyanates amd suspected of occupational allergic disease of the respiratory system The patients have been hospitalized in the Nofer Institute of Occupational Medicine over recent 11 years. MATERIAL AND METHODS: In 1999-2009 we hospitalized 37 patients exposed to diisocyanates and suspected of occupational asthma. RESULTS: Test results of 37 patients were analyzed. The patients were divided into three groups of those with diagnosed occupational asthma, with diagnosed non-occupational asthma and those without any allergic airway disease. 40.0% of patients with occupational asthma, 64.3% of patients with non-occupational asthma and 15.4% of patients without any allergic disease were sensitized to at least one of common allergens. We did not find any specific IgE to diisocyanates. Specific challenge tests were performed in all the 37 subjects. We observed positive results of SIT with diisocyanates in 10 patients. CONCLUSIONS: Only specific challenge test with diisocyanates showed the real diagnostic value in case of a 7.5-year cessation of exposure. Determination of serum specific IgE to diisocyanates does not seem to be of clinical value in the diagnosis of diisocyanate-induced asthma in case of a 7.5 year cessation of exposure. Atopy is not the risk factor in diisocyanate-induced asthma. AU - Swierczynska-Machura D AU - Walusiak-Skorupa J AU - Wiszniewska M AU - Lipinska-Ojrzanowska A AU - Wittczak T AU - Dudek W AU - Palczynski C LA - PT - DEP - TA - Med Pracy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 32 IP - DP - 2011 Jan 01 TI - Diagnosing of bakers' respiratory allergy: Is specific inhalation challenge test essential? PG - 111-118 AB - The diagnosis of occupational asthma (OA) and/or rhinitis needs to be confirmed by means of objective methods, because it is followed by important social and financial consequences. The aim of the study was to evaluate sensitivity and specificity of diagnostic methods as skin-prick tests (SPTs) to occupational allergens, evaluation of allergen-specific serum IgE, and nonspecific bronchial hyperreactivity with reference to a specific inhalation challenge test in diagnosing bakers' respiratory allergy due to wheat flour. The study group included 358 bakers suspected of having OA due to wheat flour. They underwent physical examination, SPTs to common and occupational allergens, allergen-specific IgE determination, spirometry, nonspecific bronchial challenge, and specific inhalation test. The sensitivity of SPTs to occupational allergens in recognition of baker's rhinitis was low (47.9%) unlike the estimation of allergen-specific IgE (76.4%), with relatively high specificity (77.4 and 68.3%, respectively). Bronchial hyperreactivity (PC20 < 8 mg/mL) was the most sensitive method, whereas high degree of bronchial hyperreactivity (PC20 < 1 mg/m3) alone or bronchial hyperreactivity (PC20 < 8 mg/m3) combined with the skin reactivity to wheat flour was the most specific method of recognizing OA. Neither SPTs to occupational allergens nor evaluation of serum allergen-specific IgE alone or combined with nonspecific bronchial hyperreactivity are characterized by sufficient diagnostic accuracy to replace the specific inhalation challenge test. For the establishment of a definite diagnosis of baker's asthma, specific challenge testing with occupational allergens should be performed. AU - Wiszniewska M AU - Nowakowska-Swirta E AU - Palczynski C AU - Walusiak-Skorupa J LA - PT - DEP - TA - Allergy and Asthma Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 6 IP - DP - 2011 Jan 01 TI - Chronic Airflow Limitation in a rural Indian population: Aetiology and relationship to Body Mass Index PG - 543-549 AB - PURPOSE: Respiratory conditions remain a source of morbidity globally. As such, this study aimed to explore factors associated with the development of airflow obstruction (AFO) in a rural Indian setting and, using spirometry, study whether underweight is linked to AFO. METHODS: Patients > 35 years old attending a rural clinic in West Bengal, India, took a structured questionnaire, had their body mass index (BMI) measured, and had spirometry performed by an ancillary health care worker. RESULTS: In total, 416 patients completed the study; spirometry was acceptable for analysis of forced expiratory volume in 1 second in 286 cases (69%); 16% were noted to exhibit AFO. Factors associated with AFO were: increasing age (95% confidence interval (CI) 0.004-0.011; P = 0.005), smoking history (95% CI 0.07-0.174; P = 0.006), male gender (95% CI 0.19-0.47; P = 0.012), reduced BMI (95% CI 0.19-0.65; P = 0.02), and occupation (95% CI 0.12-0.84; P = 0.08). The mean BMI in males who currently smoked (n = 60; 19.29 kg/m(2); standard deviation [SD] 3.46) was significantly lower than in male never smokers (n = 33; 21.15 kg/m(2) SD 3.38; P < 0.001). AFO was observed in 27% of subjects with a BMI <18.5 kg/m(2), falling to 13% with a BMI =18.5 kg/m(2) (P = 0.013). AFO was observed in 11% of housewives, 22% of farm laborers, and 31% of cotton/jute workers (P = 0.035). CONCLUSION: In a rural Indian setting, AFO was related to advancing age, current or previous smoking, male gender, reduced BMI, and occupation. The data also suggest that being under-weight is linked with AFO and that a mechanistic relationship exists between low body weight, smoking tobacco, and development of AFO. AU - Chakrabarti B AU - Purkait S AU - Gun P AU - Moore VC AU - Choudhuri S AU - Zaman MJ AU - Warburton C AU - Calverley PMA AU - Mukherjee R LA - PT - DEP - TA - International Journal of Chronic Obstructive Pulmo JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 54 IP - DP - 2011 Jan 01 TI - Airway response to chlorine inhalation (bleach) among cleaning workers with and without bronchial hyperresponsiveness PG - 293-299 AB - Background Symptoms of obstructive lung disease in domestic cleaning staff have been related to the use of bleach and other irritant cleaning products. Material and Methods Included in the study were thirteen cleaning employees with work-related asthma-like symptoms, three asthmatic controls and three atopic subjects without bronchial hyperresponsiveness (BHR) who had no exposure to cleaning products. The study protocol consisted of a methacholine test, sputum induction and fraction of exhaled nitric oxide measurement (FENO) both at baseline and 24?hr after a 1-hr inhalation challenge with either placebo or bleach at a concentration of 0.4?ppm of chlorine. Results The inhalation of the placebo caused no bronchial reactions. Mean maximum fall in FEV1 during challenge testing with bleach was significantly higher than the values obtained during the placebo challenge. Inhalation challenge with bleach elicited two isolated late asthmatic reactions and one dual asthmatic reaction. Of all the patients who underwent challenge testing with bleach, only one had a =2-fold decrease in methacholine PC20 24?hr after the challenge. No significant correlation was found between maximum fall in FEV1 and PC20 methacholine. Following challenge testing with bleach, no clinically significant changes in sputum cell counts or FENO were detected. Conclusions These results suggest that bleach inhalation at a concentration of 0.4?ppm—a concentration below 8-hr permissible occupational exposure level—brings about a substantial decrease in FEV1 in subjects with and without BHR. Some subjects have a positive challenge response to bleach inhalation. AU - Sastre J AU - Madero MF AU - Fernández-Nieto M AU - Sastre B AU - del Pozo V AU - Potro MG AU - Quirce S LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 66 IP - DP - 2011 Jan 01 TI - Lung function decline in relation to mould and dampness in the home: the longitudinal European Community Respiratory Health Survey ECRHS II. PG - 396-401 AB - BACKGROUND: There are few longitudinal studies that have examined the association of lung function decline with indoor mould and dampness. Lung function decline in relation to dampness and mould in the home has studied in adults over a 9 year period. METHODS: Spirometry was performed twice in participants in the European Respiratory Health Survey (ECRHS I and II) who were initially examined aged 20-45 years, in 1990-1995 and 9 years later (n=6443). Information on their current home was collected twice by interview. Dampness (water damage or damp spots) and indoor mould, ever and in the last 12 months, were assessed. A dampness score and a mould score were calculated. In addition, 3118 homes at 22 centres were inspected directly at follow-up for the presence of dampness and mould. RESULTS: Dampness and mould were common. Overall, 50.1% reported any dampness and 41.3% any indoor mould in either ECRHS I or ECRHS II. Women with dampness at home had an additional decline in forced expiratory volume in 1 s (FEV(1)) of -2.25 ml/year (95% CI -4.25 to -0.25), with a significant trend in increased lung function decline in relation to the dampness score (p=0.03). The association in women was significant when excluding those with asthma at baseline. Observed damp spots in the bedroom was associated with a significant additional decline in FEV(1) of -7.43 ml/year (95% CI -13.11 to 1.74) in women. CONCLUSION: Dampness and indoor mould growth is common in dwellings, and the presence of damp is a risk factor for lung function decline, especially in women. AU - Norbäck D AU - Zock JP AU - Plana E AU - Heinrich J AU - Svanes C AU - Sunyer J AU - Künzli N AU - Villani S AU - Olivieri M AU - Soon A AU - Jarvis D. LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 61 IP - DP - 2011 Jan 01 TI - Occupational asthma caused by heated triglycidyl isocyanurate PG - 65-67 AB - Six workers exposed as bystanders to heated triglycidyl isocyanurate (TGIC) developed occupational asthma confirmed by serial peak expiratory flow measurement and Oasys analysis. Specific inhalation challenge testing resulted in late or dual asthmatic reactions to heated TGIC in four of four tested and was negative in three control asthmatics. One worker tested only with unheated TGIC had a negative specific challenge test. Heated TGIC can cause occupational asthma from bystander exposure. AU - Anees W AU - Moore VC AU - Croft JS AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 63 IP - DP - 2011 Jan 01 TI - Randomized Comparison of a Multidisciplinary Team Care Program With Usual Care in Patients With Systemic Sclerosis PG - 909-917 AB - Objective. To compare the effectiveness of a multidisciplinary team care program with usual outpatient care in patients with systemic sclerosis (SSc; scleroderma). Methods. We performed a randomized controlled trial comparing a 12-week multidisciplinary team care program (1 day per week; individual treatments, group exercises, and group education) with outpatient clinic care. Outcome measures included the Hand Mobility in Scleroderma (HAMIS) test, grip strength, maximal mouth opening (MMO), 6-minute walk distance (6MWD), maximum aerobic capacity (VO2max), Checklist Individual Strength 20 (CIS-20), SSc Health Assessment Questionnaire (HAQ), and Short Form 36 (SF-36), assessed at 0, 12, and 24 weeks. Statistical comparisons of change scores were done by analysis of covariance. Results. Twenty-eight patients were assigned to the intervention group (mean age 53.9 years, 15 of 28 with diffuse SSc) and 25 were assigned to the control group (mean age 51.7 years, 15 of 25 with diffuse SSc). Twenty-five patients (89%) in the intervention group completed the treatment program. At 12 weeks, there was a significantly greater improvement in grip strength (2.2 versus 1.8 kg; P  0.001), MMO (1.4 versus 0.9 mm; P  0.011), 6MWD (42.8 versus 3.9 meters; P  0.021), and HAQ score (0.18 versus 0.13; P  0.025) in the intervention group, whereas differences for the other outcome measures did not reach significance. At 24 weeks, the effect on grip strength persisted. Conclusion. In patients with SSc, a 12-week multidisciplinary day patient treatment program was more effective than regular outpatient care with respect to 6MWD, grip strength, MMO, and HAQ score, but not for VO2max, HAMIS test, CIS-20, SF-36, and visual analog scale for pain. This study provides a first step in quantifying the effect of a multidisciplinary team care program and warrants the conduct of further intervention studies. AU - Schouffoer AA AU - Ninaber MK AU - de Beaart-van Voorde LJJ AU - der Van Giesen FJ AU - De Jong Z AU - Stolk J AU - Voskuyl AE AU - Scherptong RWC AU - Van Laar JM AU - Schuerwegh AJM AU - Huizinga TWJ AU - Vliet Vlieland PM LA - PT - DEP - TA - Arthritis Care & Research JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 24 IP - DP - 2011 Jan 01 TI - Occupational allergy to birds within the population of Polish bird keepers employed in zoo gardens PG - 292-303 AB - Objectives To evaluate the risk factors for the development of occupational allergy to birds among Polish zoo garden keepers. Methods A total of 200 bird zookeepers employed in the Polish zoo gardens in KLódz, Warsaw, Gdansk, Chorzów and Plock and exposed occupationally to bird allergens were examined using a questionnaire, skin prick tests (SPTs) to common allergens and bird allergens, spirometry and cytograms of nasal swab. The level of total IgE in serum and serum-specific IgE to parrot, canary, pigeon feathers and serum were also evaluated. Results Eight percent of bird zookeepers were sensitized to at least one of the bird allergens. The most frequent allergens yielding positive SPT results were D. farinae — 32 cases (16%), D. pteronyssinus — 30 cases (15%) and grass pollens (16.5%). In the studied group, allergen-specific IgE against bird allergens occurred with the following frequency: 87 (43.5%) against canary feathers and/or serum, 80 (40%) against parrot feathers and/or serum and 82 (41%) against pigeon feathers and/or serum. Occupational allergy was diagnosed in 39 (26.5%) cases, occupational rhinitis was present in 22 (15%) cases, occupational asthma in 20 (13.6%) subjects, occupational conjunctivitis in 18 (12.2%) cases, whereas occupational skin diseases in 11 (7.5%) cases. More eosinophils were found in nose swab cytograms among bird zookeepers with occupational airway allergy. Conclusions The findings indicate that occupational allergy to birds is an important health problem among zoo bird keepers in Poland. AU - Swiderska-Kielbik S AU - Krakowiak A AU - Wiszniewska M AU - Nowakowska-Swirta E AU - Walusiak-Skorupa J AU - Sliwkiewicz K AU - Palczynski C LA - PT - DEP - TA - International Journal of Occupational Medicine and JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 140 IP - DP - 2011 Jan 01 TI - Hot Tub Lung From Mycobacterium asiaticum PG - 156A AB - INTRODUCTION: Nontuberculous mycobacteria (NTM) are ubiquitous in our environment and can cause multiple pulmonary diseases, including nodulocavitary disease, interstitial disease, and hypersensitivity pneumonitis-like granulomatous lung disease. The latter disease is often referred to as ‘hot tub lung’ in the literature due to its association with exposure to NTM present in hot water aerosols primarily during indoor hot tub use by immunocompetent hosts. Diagnostic criteria include history of hot water aerosol exposure, recurrent symptoms coinciding with exposure, radiological evidence of bilateral ground glass or poorly defined centrilobular nodular opacities, bronchoalveolar lavage lymphocytosis and histological evidence of diffuse inflammatory infiltrates along interstitium and nonnecrotizing granulomas 1. Additionally, the same NTM species are isolated from respiratory samples and hot tub water. The disease usually resolves with abstinence from hot tub. Currently, there is still debate whether the disease represents infection by NTM or a hypersensitivity reaction to mycobacterial antigens or a combination of the two processes. While M. avium complex is the most common NTM causing ‘hot tub lung’; M. fortuitum has also been rarely implicated 3. CASE PRESENTATION: We report the first-described case in the literature of M. asiaticum causing ‘hot tub lung’. Our patient is a 63 year old immunocompetent mechanical engineer who presented with a five month history of worsening dyspnea, nonproductive cough, fevers, and weight loss. Physical exam was notable for bilateral crackles in lung fields. His HRCT of the chest showed bilateral diffuse ground glass opacities and centrilobular nodules without significant mediastinal lymphadenopathy. Pulmonary function tests showed a restrictive pattern with decreased diffusing capacity. Prior to his evaluation, he was treated as an inpatient for atypical pneumonia with a macrolide antibiotic. Symptoms of dyspnea and cough improved during his hospitalization but recurred within a week of returning home. He was a lifelong nonsmoker, and had a cat and a dog as pets at home. He denied history of travel outside of New Mexico or of unusual occupational or environmental exposures. On further questioning, he stated he had daily use of an indoor hot tub that he had self-built a few years prior and patient often used the hot tub in place of his daily shower. In fact, he had increased his use of the hot tub since feeling poorly, as he thought it may help his symptoms. He underwent an outpatient bronchoscopy with transbronchial biopsies. Histological examination showed cellular interstitial pneumonitis and well-formed non-necrotizing granulomas. Bronchoalveolar lavage was smear negative but culture grew M. asiaticum. The patient abstained completely from his hot tub and was not given any pharmacological therapy. A month later, his symptoms resolved; he resumed his daily exercise routine of walking two miles. His Chest X-ray normalized though his pulmonary function abnormality improved but did not completely resolve two months out. DISCUSSION:M. asiaticum was first reported as causing human disease in the early 1980s; since then only a few cases have been reported in the literature 2. The largest case series described 24 patients from Australia. All patients had either pre-existing bronchiectasis or underlying lung disease such as COPD and hot tub exposure was not described. Most patients were treated with anti-tuberculous drugs. In addition, there have been rare case reports of M asiaticum causing soft tissue infections or lymphadenitis. We present the first reported case in the literature of hypersensitivity pneumonitis-like granulomatous lung disease caused by M. asiaticum. We hypothesize that there is likely a common antigenic component among various NTM species that can trigger hypersensitivity pneumonitis. CONCLUSIONS: Physicians need to be thus alerted to the possibility of ‘hot tub lung’ being caused by various NTM species other than M. avium complex. Reference #1 Sood, Akshay et al. 2007. Hypersensitivity Pneumonitis-like Granulomatous Lung Disease with Nontuberculous Mycobacteria from Exposure to Hot Water Aerosols. Environmental Health Perspectives 115(2)262-266 Reference #2 Grech, Miriam et al. 2010. Clinical Significance of Mycobacterium asiaticum Isolates in Queensland, Australia. Journal of Clinical Microbiology 48(1) 162-167 Reference #3 Falkinham, Joseph O. 2003. Mycobacterial Aerosol and Respiratory Disease. Emerging Infectious Diseases 9(7) 763-767. AU - Heynekamp T AU - Sood A AU - Busby H LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 38 Suppl 5 IP - DP - 2011 Jan 01 TI - Diagnosis of occupational asthma from serial plots of PEF; first year results of open access to the Oasys internet database PG - 4939 AB - Occupational asthma requires validation. The most accessible first stage is diagnostic confirmation from serial measurements of PEF or FEV1, supported by all evidence-based reviews. Reliance on these diagnostic methods is limited by interpreter disagreement and record quality. The Oasys diagnostic aid overcomes both of these problems by applying evidence-based data quality and interpreter-independent diagnoses. In April 2010 we made Oasys freely available via the internet. Uploaded records are anonymous but their country of origin can often be identified from the email address. We compare the results of uploaded records for the first 9 months of open access, with records entered in 2010 from our centre, where Oasys has been in use for many years. 349 records have been entered from our centre and 321 records uploaded from centres outside our own; sources including Denmark (32), other UK (165), Korea (5), Italy (5), Taiwan (5) and Unknown (99). PEF data quality and interpretation Number Quality optimal Occupational asthma Birmingham 349 174 (50%) 111 (32%) Rest of the world 321 167 (52%) 80 (25%) The table shows that other centres using Oasys are able to achieve similar quality and diagnostic confirmation to our own and is suitable for more widespread use. It is freely available via www.occupationalasthma.com AU - Burge CBSG AU - Burge PS AU - Harvey J AU - Barraclough R AU - Hoyle J AU - Thilsing T AU - Paris C LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 38 IP - DP - 2011 Jan 01 TI - Hypersensitivity pneumonitis and metalworking fluids contaminated by mycobacteria PG - 486-487 AB - Whilst Tillie-Leblond et al. [1] are correct in stating that the majority of MWF-HP outbreaks have occurred in the USA, the UK Powertrain and French outbreaks are not the only ones to have occurred in Europe. We have provided scientific support to three other similar outbreaks in the UK, all with confirmed cases of MWF-HP [4, 5]. In addition, we have diagnosed single cases of MWF-HP or asthma in workers from at least five other workplaces close to our occupational lung disease clinic. We are also aware of a published respiratory outbreak from Croatia [6], and have recently had separate personal communications with groups in Germany and Sweden relating to investigations of possible MWF outbreaks. Supportive evidence for a more widespread European problem come from cross-sectional studies that have demonstrated an excess of respiratory symptoms and asthma in machine shop workers in southern Finland [7], and an excess of wheeze, chronic bronchitis, chronic rhinitis and eye irritation in Swedish metalworkers [8]. It is clear, therefore, that this remains an important area of research relevant to European MWF-exposed workers, as the exact aetiology of MWF-HP has remained elusive [9] since Bernstein et al. [10] described the first cases in 1995. Although Mycobacterium immunogenum have been implicated as the cause in the French outbreak and a number of outbreaks in the USA, there is strong evidence against this being the cause of the UK outbreaks [3, 5]. In the UK Powertrain investigation, it was not possible to culture any opportunuistic mycobacteria or find any evidence of mycobacterial DNA by PCR in 125 MWF samples. Analysis of MWF samples from two other workplaces associated with UK MWF-HP outbreaks also found no detectable mycobacterial DNA. In addition to this, no demonstrable precipitin responses to extracts of M. immunogenum, Mycobacterium chelonae or Mycobacterium fortuitum were seen in 129 Powertrain UK workers, a group that included 17 cases of MWF-HP, 70 cases of occupational asthma, and 42 asymptomatic exposed controls. Further evidence against a mycobacterial cause came from specific challenges performed in two workers, where positive responses were seen after controlled exposure to used MWFs that did not contain mycobacteria [3]. Although referenced by Tillie-Leblond et al. [1], the detailed immunological investigation performed on workers from a MWF-HP outbreak in the USA, where mycobacterial contamination was identified [11], is not discussed in any detail. In this key study [11], in vitro secretion of interleukin-8, tumour necrosis factor-a and interferon-? were measured in whole blood and from peripheral blood mononuclear cells in response to incubation with M. immunogenum antigen. These measures of immunity to M. immunogenum were able to distinguish between MWF-exposed and -unexposed workers, but not between workers with and without MWF-HP. This study serves to highlight the difficulties of interpreting immunological findings in HP, as many workers with demonstrable immune responses are asymptomatic, and never go on to develop disease [12]. Tillie-Leblond et al. [1] state in their article that the presence of five arcs to M. immunogenum by electrosyneresis differentiates MWF-HP from healthy exposed workers. Whilst this may have been true in most cases, it was not true for all, and may therefore be of limited clinical value in isolation. It should be noted that the two groups in this study had also been differentiated in other ways, based on the presence of symptoms, lung crackles and normal gas transfer prior to any immunological comparison. Whilst we agree with the authors that this test threshold needs further validation, there seems little point in aiming to differentiate those with MWF-HP from healthy workers without symptoms, as this can be done more easily by questionnaire. Whether the five-arc threshold has any diagnostic value is dependant on whether it can assist in differentiating workers experiencing work-related symptoms due to allergic occupational lung disease (HP and asthma) from those with similar symptoms due to chronic bronchitis, exacerbations of existing respiratory conditions, nonspecific irritant responses or humidifier fever. Alternatively, the utility of the test in preventing disease, as part of a prospective study of health surveillance linked to exposure modification in MWF apprentices, would also be of great interest. It is these areas that we believe merit further study by the authors to continue to improve the knowledge base in the complex area of MWF-HP outbreaks. ?Tillie-Leblond I, Grenouillet F, Reboux G, et al. Hypersensitivity pneumonitis and metalworking fluids contaminated by mycobacteria. Eur Respir J 2011; 37: 640–647.Abstract/FREE Full TextGoogle Scholar ?Dawkins P, Robertson A, Robertson W, et al. An outbreak of extrinsic alveolitis at a car engine plant. Occup Med (Lond) 2006; 56: 559–565.Abstract/FREE Full TextGoogle Scholar ?Robertson W, Robertson AS, Burge CB, et al. Clinical investigation of an outbreak of alveolitis and asthma in a car engine manufacturing plant. Thorax 2007; 62: 981–990.Abstract/FREE Full TextGoogle Scholar ?Fishwick D, Tate P, Elms J, et al. Respiratory symptoms, immunology and organism identification in contaminated metalworking fluid workers. What you see is not what you get. Occup Med (Lond) 2005; 55: 238–241.AbstractGoogle Scholar ?Health and Safety Executive. Barnsley company fined after staff exposed to hazardous mist. http://www.hse.gov.uk/press/2009/coiyh44109.htm Date last accessed: May 17, 2011. Date last updated: November 30, 2009. ?Jaksic S, Uhitil S, Zivkovic J. Bacterial pollution of cutting fluids: a risk factor for occupational diseases. Arh Hig Rada Toksikol 1998; 49: 239–244.MedlineGoogle Scholar ?Jaakkola MS, Suuronen K, Luukkonen R, et al. Respiratory symptoms and conditions related to occupational exposures in machine shops. Scand J Work Environ Health 2009; 35: 64–73.MedlineWeb of ScienceGoogle Scholar ?Lillienberg L, Andersson EM, Järvholm B, et al. Respiratory symptoms and exposure-response relations in workers exposed to metalworking fluid aerosols. Ann Occup Hyg 2010; 54: 403–411.Abstract/FREE Full TextGoogle Scholar ?Rosenman KD. Asthma, hypersensitivity pneumonitis and other respiratory diseases caused by metalworking fluids. Curr Opin Allergy Clin Immunol 2009; 9: 97–102.CrossRefMedlineWeb of ScienceGoogle Scholar ?Bernstein DI, Lummus ZL, Santilli G, et al. Machine operators’ lung – a hypersensitivity pneumonitis disorder associated with exposure to metalworking fluid aerosols. Chest 1995; 108: 636–641.CrossRefMedlineWeb of ScienceGoogle Scholar ?Trout D, Weissman DN, Lewis D, et al. Evaluation of hypersensitivity pneumonitis among workers exposed to metal removal fluids. Appl Occup Environ Hyg 2003; 18: 953–960.MedlineGoogle Scholar ?Girard M, Lacasse Y, Cormier Y. Hypersensitivity pneumonitis. Allergy 2009; 64: 322–334.CrossRefMedlineWeb of ScienceGoogle Scholar AU - Barber CM AU - Burton C AU - Robinson E AU - Crook B AU - Evans G AU - Fishwick D LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 37 IP - DP - 2011 Jan 01 TI - Hypersensitivity pneumonitis and metalworking fluids contaminated by mycobacteria PG - 640-647 AB - Metalworking fluids (MWF) are responsible for hypersensitivity pneumonitis (HP). The aim of the present study was to identify the antigen (Ag) responsible for MWF-associated HP, and to optimise serological diagnosis by definition of a threshold allowing discrimination between HP patients and asymptomatic exposed workers. 13 patients, who were workers at a car engine manufacturing plant, were suspected of MWF-associated HP. Microbial analysis of 83 used MWFs was carried out. Sera from 13 MWF-associated HP patients, 12 asymptomatic exposed workers and 18 healthy unexposed controls were tested to determine their immunological responses to three Ags, including Mycobacterium immunogenum. M. immunogenum was identified in 40% of used fluids by culture and confirmed by DNA sequencing. The threshold for differentiating MWF-associated HP patients from asymptomatic exposed workers was five arcs of precipitation (sensitivity 77% and specificity 92%), as determined by electrosyneresis (ES). Using ELISA methods with protein extract from M. immunogenum, a threshold leading to 92% sensitivity and 100% specificity was established. The detection of specific antibodies against M. immunogenum Ag at high levels in case sera suggests that M. immunogenum-contaminated MWF is responsible for MWF-associated HP. To discriminate MWF-associated HP patients from asymptomatic exposed workers, we suggest a five-arc threshold for ES and a 1.6-AU threshold for ELISA methods. AU - Tillie-Leblond I AU - Grenouillet F AU - Reboux G AU - Roussel S AU - Chouraki B AU - Lorthois C AU - Dalphin J-C AU - Wallaert B AU - Millon L LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 156 IP - DP - 2011 Jan 01 TI - IgE-mediated hypersensitivity reactions to cannabis in laboratory personnel. PG - 423-426 AB - BACKGROUND: There have been sporadic reports of hypersensitivity reactions to plants of the Cannabinaceae family (hemp and hops), but it has remained unclear whether these reactions are immunologic or nonimmunologic in nature. OBJECTIVE: We examined the IgE-binding and histamine-releasing properties of hashish and marijuana extracts by CAP-FEIA and a basophil histamine release test. METHODS: Two workers at a forensic laboratory suffered from nasal congestion, rhinitis, sneezing and asthmatic symptoms upon occupational contact with hashish or marijuana, which they had handled frequently for 25 and 16 years, respectively. Neither patient had a history of atopic disease. Serum was analyzed for specific IgE antibodies to hashish or marijuana extract by research prototype ImmunoCAP, and histamine release from basophils upon exposure to hashish or marijuana extracts was assessed. Results were matched to those of 4 nonatopic and 10 atopic control subjects with no known history of recreational or occupational exposure to marijuana or hashish. RESULTS: Patient 1 had specific IgE to both hashish and marijuana (CAP class 2), and patient 2 to marijuana only (CAP class 2). Controls proved negative for specific IgE except for 2 atopic individuals with CAP class 1 to marijuana and 1 other atopic individual with CAP class 1 to hashish. Stimulation of basophils with hashish or marijuana extracts elicited histamine release from basophils of both patients and 4 atopic control subjects. CONCLUSIONS: Our results suggest an IgE-related pathomechanism for hypersensitivity reactions to marijuana or hashish. AU - Herzinger T1 AU - Schöpf P AU - Przybilla B AU - Ruëff F. LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 53 IP - DP - 2011 Jan 01 TI - Results From the US Industry-Wide Phosgene Surveillance: The Diller Registry PG - 239-244 AB - Objective: In 2004, The American Chemistry Council Phosgene Panel established a phosgene exposure registry among US phosgene producers with the primary purpose of monitoring health outcome information for workers with acute exposure. Methods: We examine symptoms among 338 workers with phosgene exposure. The phosgene exposures averaged 8.3 ppm-minutes ranging up to 159 ppm-minutes with most exposures below 10 ppm-minutes. Results: We found that the level of phosgene exposure in ppm-minutes was related to workers reporting mostly irritation symptoms of the nose, throat and eyes within 48 hours of exposure. However, we found no relationship between phosgene exposure and the presence of symptoms 30 days after exposure. Conclusions: These findings lend credence to the theory that prolonged respiratory effects do not occur with doses less than 150 ppm-minutes. AU - Collins JJ AU - Molenaar DM AU - Bowler LO AU - Harbourt TJ AU - Carson M AU - Avashia B AU - Calhoun T AU - Vitrano C AU - Chalfont R AU - Howard P LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 49 IP - DP - 2011 Jan 01 TI - A mass cyanide poisoning from pickling bamboo shoots PG - 834-839 AB - Context. Bamboo shoots contain cyanogenic glycosides named taxiphyllin. Cyanide poisoning from cyanogenic glycosides commonly occurs following ingestion. However, toxicity caused by inhalation of hydrogen cyanide gas (HCN) produced from pickled shoots has never been reported. Objective. To describe cyanide poisoning in eight victims who were exposed to HCN produced in a well containing pickling bamboo shoots. Materials and methods. Due to a series of botched rescue attempts, a total of eight patients entered into a 27 m3 well containing pickled bamboo shoots and immediately lost consciousness. After rescue, two patients developed cardiac arrest, metabolic acidosis and died. Four other patients suffered metabolic acidosis, but recovered after supportive care. The remaining two regained consciousness and recovered soon after the event. Ambient air study and cyanide content of bamboo shoots helped confirm the diagnosis. Results. All patients had high anion gap metabolic acidosis with normal oxygenation. Blood cyanide levels ranged from 2.66 to 3.30 mcg/ml (taken after about 18 h of incident). Ambient air study (21 h after incident) revealed oxygen 20.9%, and sulfur dioxide 19.4 ppm. The instrument was unfortunately not equipped to detect HCN. A simulation study revealed HCN and sulfur dioxide in the ambient air at 10 ppm and 7.5 ppm, respectively. Cyanide content in the bamboo shoots ranged from 39 to 434 mg/kg in the wet shoots. Discussion. This series of patients developed sudden onset of alteration of consciousness and metabolic acidosis upon exposure, and cyanide was confirmed in all victims. The simulation study confirmed the presence of HCN in the ambient air of the well containing bamboo shoots. Conclusion. We have reported mass acute cyanide poisoning with two fatalities. The source of HCN was unusual as it was produced from pickling bamboo shoot. AU - Sang-A-Gad P AU - Guharat S AU - Wananukul W LA - PT - DEP - TA - Clin Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 53 IP - DP - 2011 Jan 01 TI - Trends in respiratory diagnoses and symptoms of firefighters exposed to the World Trade Center disaster: 2005–2010 PG - 364-369 AB - Objectives To compare the prevalence of self-reported respiratory diagnoses in World Trade Center-exposed Fire Department of New York City firefighters to the prevalence in demographically similar National Health Interview Survey participants by year; and, 2) to describe the prevalence of World Trade Center-related symptoms up to 9years post-9/11. Methods We analyzed 45,988 questionnaires completed by 10,999 firefighters from 10/2/2001 to 9/11/2010. For comparison of diagnosis rates, we calculated 95% confidence intervals around yearly firefighter prevalence estimates and generated odds ratios and confidence intervals to compare the odds of diagnoses in firefighters to the National Health Interview Survey prevalence, by smoking status. Results Overall, World Trade Center-exposed firefighters had higher respiratory diagnosis rates than the National Health Interview Survey; Fire Department of New York City rates also varied less by smoking status. In 2009, bronchitis rates in firefighters aged 45–65 were 13.3 in smokers versus 13.1 in never-smokers while in the National Health Interview Survey, bronchitis rates were doubled for smokers: 4.3 vs. 2.1. In serial cross-sectional analyses, the prevalence of most symptoms stabilized by 2005, at ~10% for cough to ~48% for sinus. Conclusions We found generally higher rates of respiratory diagnoses in World Trade Center-exposed firefighters compared to US males, regardless of smoking status. This underscores the impact of World Trade Center exposure and the need for continued monitoring and treatment of this population. AU - Weakley J AU - Webber MP AU - Gustave J AU - Kelly K AU - Cohen HW AU - Hall CB AU - Prezant DJ LA - PT - DEP - TA - Preventive medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 54 IP - DP - 2011 Jan 01 TI - Work-Related Asthma in Health Care in Ontario PG - 278-284 AB - Background The health of workers in health care has been neglected in the past. There are few reports regarding occupational asthma (OA) in this group, and work-exacerbated asthma (WEA) has rarely been considered. Methods We examined the frequency of claims for OA and WEA allowed by the compensation board in Ontario, Canada for which industry was coded as ‘‘health care’’ between 1998 and 2002, to determine the frequency of OA and WEA, causative agents, and occupations. Results During this period, five claims were allowed for sensitizer OA, two for natural rubber latex (NRL), and three for glutaraldehyde/photographic chemicals. The two NRL cases occurred in nurses who had worked for >10 years prior to ‘‘date of accident.’’ There were 115 allowed claims for WEA; health care was the most frequent industry for WEA. Compared to the rest of the province, claims in health care made up a significantly greater proportion of WEA claims (17.8%) than OA (5.1%) (odds ratio, 4.1, 95% CI 1.6–11.6; P ¼ 0.002). The rate of WEA claims was 2.1 times greater than that in the rest of the workforce (P < 0.0001). WEA claims occurred in many jobs (e.g., clerk), other than ‘‘classic’’ health care jobs such as nurses, and were attributed to a variety of agents such as construction dust, secondhand smoke, and paint fumes. Conclusions WEA occurs frequently in this industrial sector. Those affected and attributed agents include many not typically expected in health care. The incidence of OA claims in this sector in general was low; the continued low number of OA claims due to NRL is consistent with the successful interventions for prevention. AU - Liss GM AU - Buyantseva L AU - Luce CE AU - Ribeiro M AU - Manno M AU - Tarlo SM LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 84 IP - DP - 2011 Jan 01 TI - Occupational asthma caused by triglycidyl isocyanurate PG - 547-549 AB - Background Several cases of allergic contact dermatitis, two cases of occupational asthma from over one decade ago and one case of hypersensitivity pneumonitis have been documented in painters who use polyester powder paint containing triglycidyl isocyanurate (TGIC). Methods We report a 28-year-old female who, 4 months after beginning work in a powder-coating factory, developed asthma-like symptoms. In her workplace, aluminium frames were treated with an electrostatic powder paint containing 2.5–10% TGIC. Results Serial peak-flow measurements performed during both working and non-working periods demonstrated peak-flow variability of up to 46% on work days. Bronchial methacholine test results also varied between times at work and away from work. PC20 methacholine was 0.32 mg/ml and fraction of exhaled nitric oxide (FENO) was 18 ppb. A controlled exposure challenge was performed with a placebo yielding no changes in FEV1 over a 24-hour period. On visit 2, the patient was placed in the chamber and exposed to TGIC (4% in lactose) at a mean concentration of 3.61 mg/m3 for a total of 15 min. A 20% fall in FEV1 from baseline was elicited at 10 min, together with cough and wheezing. No late response was demonstrated. Twenty-four hours after the challenge, neither methacholine PC20 nor FENO levels varied from baseline values. No IgE was detected by ELISA testing and no IgE-binding bands were found by immunoblot analysis of patient and control serum. Conclusions The aforementioned results demonstrate that TGIC inhalation induced immunologic occupational asthma, although no IgE mechanism was evidenced. AU - Sastre J AU - Carnes J AU - del Potro MG AU - Manso L AU - Aguado E AU - Fernández-Nieto M LA - PT - DEP - TA - Int J Occup Med Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20110101 IS - IS - VI - 84 IP - DP - 2011 Jan 01 TI - Prolonged exposure to damp and moldy workplaces and new-onset asthma PG - 713 AB - Purpose Epidemiological evidence shows that indoor dampness is associated with respiratory symptoms, the aggravation of preexisting asthma, and the development of new-onset asthma. Follow-up studies indicate that symptoms compatible with asthma constitute risk factors for the future development of asthma. The aims of the study were (1) to assess whether asthma-like symptoms (cough, dyspnea, and wheeze) that occur in relation to exposure to damp and moldy work environments lead to the later development of asthma and (2) to assess the importance of continued exposure to indoor dampness and molds at work in the development of asthma. Methods We followed 483 patients with asthma-like symptoms related to damp workplaces but without objective evidence of asthma in baseline examinations. The development of asthma and present work conditions were established with the use of a questionnaire 3–12 years later. Results A total of 62 patients (13%) reported having developed asthma during the study period. Continued exposure to a damp or moldy environment was associated with a more than fourfold increase in the risk of asthma (odds ratio 4.6, 95% confidence interval 1.8–11.6). Working in a non-remediated environment at follow-up was the strongest risk factor for developing asthma. The remediation of damp buildings seemed to be associated with a decrease in the risk of asthma. Conclusions The results indicate that exposure at work to dampness and molds is associated with the occurrence of new-onset asthma. Exposed workers suffering from asthma-like symptoms represent a risk group for the development of asthma. The risk appears especially high if the exposure continues. Due to inherent weaknesses of patient series, the findings need corroborative studies. AU - Karvala K AU - Toskala E AU - Luukkonen R AU - Uitti J AU - Lappalainen S AU - Nordman H LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 83 IP - DP - 2010 Jan 01 TI - New-onset adult asthma in relation to damp and moldy workplaces PG - 855-865 AB - Objective Damp and moldy indoor environments aggravate pre-existing asthma. Recent meta-analyses suggest that exposure to such environments may also induce new-onset asthma. We assessed the probability of molds being the cause of asthma in a patient series examined because of respiratory symptoms in relation to workplace dampness and molds. Methods Altogether 694 such patients had been clinically assessed between 1995 and 2004. According to their histories, they had all been exposed to molds at work and had suffered from work-related lower respiratory symptoms. The investigations had included specific inhalation challenge (SIC) tests with mold extracts and serial peak expiratory flow (PEF) recordings. Using internationally recommended diagnostic criteria for occupational asthma (OA), we categorized the patients into three groups: probable, possible, and unlikely OA (156, 45, and 475 patients, respectively). The clinical details of 258 patients were analyzed, and their levels of microbial exposure were evaluated. Results The agreement between the serial PEF recordings and SIC tests (both being either positive or negative) was 56%. In the group of probable OA, mold sensitization was found in 20%. The level of exposure and sensitization to molds was associated with probable OA. At 6 months, the follow-up examinations of 136 patients with probable OA showed that the symptoms were persistent, and no improvement in spirometry was noted despite adequate treatment. Only 58% of the patients had returned to work. Conclusions Exposure to damp and moldy workplaces can induce new-onset adult asthma. IgE mediation is a rare mechanism, whereas other mechanisms are unknown. AU - Karvala K AU - Toskala E AU - Luukkonen R AU - Lappalainen S AU - Uitti J AU - Nordman H LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 54 IP - DP - 2010 Jan 01 TI - The New Zealand Workforce Survey II: Occupational Risk Factors for Asthma PG - 154-164 AB - Introduction: We conducted a cross-sectional population-based survey in New Zealand that collected information on work history, current workplace exposures, and selected health outcomes. We report here the findings on occupational risk factors for asthma symptoms. Methods: A random sample of men and women aged 20–64 years were selected from the New Zealand Electoral Roll and invited to take part in a telephone survey. Current asthma was defined as: (i) woken up by shortness of breath in the past 12 months; or (ii) an attack of asthma in the past 12 months; or (iii) currently taking asthma medication. Adult-onset asthma was defined as first attack of asthma at age 18 or over. Prevalence odds ratios (ORs) for all occupations were calculated using logistic regression adjusting for sex, age, smoking, and deprivation. Results: Totally, 2903 participants were included in the analyses. The prevalence of current asthma was 17% and the prevalence of adult-onset asthma was 9%. Prevalence ORs for current asthma were elevated for ever working as a printer [OR = 2.26; 95% confidence interval (CI) = 1.09–4.66], baker (OR = 1.98; 95% CI = 1.02–3.85), sawmill labourer (OR = 3.26; 95% CI = 1.05–10.16), metal processing plant operator (OR = 2.48; 95% CI = 1.22–5.05), and cleaner (OR = 1.60; 95% CI = 1.09–2.35). Excess risks of adult-onset asthma were also found for ever working as a printer, baker, and sawmill labourer as well as ever-working as a market-oriented animal producer (OR = 1.66; 95% CI = 1.14–2.41), and other agricultural worker (OR = 2.08; 95% CI = 1.03–4.20). A number of occupations not previously considered at high risk for asthma were also identified, including teachers and certain sales professionals. Conclusion: This population-based study has confirmed findings of previous international studies showing elevated risks in a number of high-risk occupations. The strongest risks were consistently observed for printers, bakers, and sawmill labourers. Several occupations were also identified that have not been previously associated with asthma, suggesting that the risk of occupational asthma may be more widely spread across the workforce than previously assumed. AU - Eng A AU - Mannetje AT AU - Douwes J AU - Cheng S AU - McLean D AU - Ellison-Loschmann L AU - Pearce N LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 104 IP - DP - 2010 Jan 01 TI - Chronic obstructive pulmonary disease in older persons: A comparison of two spirometric definitions PG - 1189-1196 AB - Background Among older persons, we previously endorsed a two-step spirometric definition of chronic obstructive pulmonary disease (COPD) that requires a ratio of forced expiratory volume in 1 sec to forced vital capacity (FEV1/FVC) below .70, and an FEV1 below the 5th or 10th standardized residual percentile (“SR-tile strategy”). Objective To evaluate the clinical validity of an SR-tile strategy, compared to a current definition of COPD, as published by the Global Initiative for Obstructive Lung Disease (GOLD-COPD), in older persons. Methods We assessed national data from 2480 persons aged 65–80 years. In separate analyses, we evaluated the association of an SR-tile strategy with mortality and respiratory symptoms, relative to GOLD-COPD. As per convention, GOLD-COPD was defined solely by an FEV1/FVC < .70, with severity staged according to FEV1 cut-points at 80 and 50 percent predicted (%Pred). Results Among 831 participants with GOLD-COPD, the risk of death was elevated only in 179 (21.5%) of those who also had an FEV1 < 5th SR-tile; and the odds of having respiratory symptoms were elevated only in 310 (37.4%) of those who also had an FEV1 < 10th SR-tile. In contrast, GOLD-COPD staged at an FEV1 50–79%Pred led to misclassification (overestimation) in terms of 209 (66.4%) and 77 (24.6%) participants, respectively, not having an increased risk of death or likelihood of respiratory symptoms. Conclusion Relative to an SR-tile strategy, the majority of older persons with GOLD-COPD had neither an increased risk of death nor an increased likelihood of respiratory symptoms. These results raise concerns about the clinical validity of GOLD guidelines in older persons. AU - Fragoso CAV AU - Concato J AU - McAvay G AU - Ness PHV AU - Rochester CL AU - Yaggi HK AU - Gill TM LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 31 IP - DP - 2010 Jan 01 TI - Acute and chronic cadmium poisoning PG - 107-115 AB - Cadmium is a metallic impurity in various minerals. The two main cadmium exposure sources in general population are food and tobacco smoking. Its industrial exploitation has grown in the early twentieth century. Cadmium is used in accumulators or alkaline batteries (80%) and in pigments for paints or plastics (10%), in electrolytic process by deposit or by cadmium plating on metals or to reduce melting points (welding rods…). Cadmium is a cumulative toxic substance whose half-time for elimination is about 20 to 40 years and it is mainly stored in the liver and kidneys. Inhalation of cadmium oxide fumes may cause inhalation fevers or chemical pneumonitis. Cadmium chronic poisoning causes mainly renal tubulopathy and could be the cause of osteomalacia and diffuse osteoporosis. Cadmium is classified as certain carcinogen agent for humans by IARC (International Agency for Research on Cancer). The most relevant biological index exposure is the urinary cadmium. According to literature, no chelating agent can be still used in human cadmium poisonings. In France, some diseases caused by occupational exposure to cadmium may be compensated. AU - Andujar P AU - Bensefa-Colas L AU - Descatha A LA - PT - DEP - TA - La Revue De Médecine Interne JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 11 IP - DP - 2010 Jan 01 TI - Reproducibility of the airway response to an exercise protocol standardized for intensity, duration, and inspired air conditions, in subjects with symptoms suggestive of asthma PG - 120 AB - Background Exercise testing to aid diagnosis of exercise-induced bronchoconstriction (EIB) is commonly performed. Reproducibility of the airway response to a standardized exercise protocol has not been reported in subjects being evaluated with mild symptoms suggestive of asthma but without a definite diagnosis. This study examined reproducibility of % fall in FEV1 and area under the FEV1 time curve for 30 minutes in response to two exercise tests performed with the same intensity and duration of exercise, and inspired air conditions. Methods Subjects with mild symptoms of asthma exercised twice within approximately 4 days by running for 8 minutes on a motorized treadmill breathing dry air at an intensity to induce a heart rate between 80-90% predicted maximum; reproducibility of the airway response was expressed as the 95% probability interval. Results Of 373 subjects challenged twice 161 were positive (=10% fall FEV1 on at least one challenge). The EIB was mild and 77% of subjects had <15% fall on both challenges. Agreement between results was 76.1% with 56.8% (212) negative (< 10% fall FEV1) and 19.3% (72) positive on both challenges. The remaining 23.9% of subjects had only one positive test. The 95% probability interval for reproducibility of the % fall in FEV1 and AUC0-30 min was ± 9.7% and ± 251% for all 278 adults and ± 13.4% and ± 279% for all 95 children. The 95% probability interval for reproducibility of % fall in FEV1 and AUC0-30 min for the 72 subjects with two tests =10% fall FEV1 was ± 14.6% and ± 373% and for the 34 subjects with two tests =15% fall FEV1 it was ± 12.2% and ± 411%. Heart rate and estimated ventilation achieved were not significantly different either on the two test days or when one test result was positive and one was negative. Conclusions Under standardized, well controlled conditions for exercise challenge, the majority of subjects with mild symptoms of asthma demonstrated agreement in test results. Performing two tests may need to be considered when using exercise to exclude or diagnose EIB, when prescribing prophylactic treatment to prevent EIB and when designing protocols for clinical trials AU - Anderson SD AU - Pearlman DS AU - Rundell KW AU - Perry CP AU - Boushey H AU - Sorkness CA AU - Nichols S AU - Weiler JM LA - PT - DEP - TA - Respiratory Research JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 66 IP - DP - 2010 Jan 01 TI - An update on contraindications for lung function testing PG - 714-723 AB - Guidelines on contraindications for lung function tests have been based on expert opinion from >30 years ago. High-risk contraindications to lung function testing are associated with cardiovascular complications such as myocardial infarct, pulmonary embolism or ascending aortic aneurysm. Slightly less risky but still serious contraindications are predominantly centred on recovery from major thoracic, abdominal or head surgery. Less serious surgical procedures will present a possible risk, but the RR depends upon whether the lung function is essential or can wait until the patient’s condition improves. In recent decades there have been moves towards less invasive surgical techniques, keyhole surgery and new technology such as laser surgery which minimise the amount of collateral damage to surrounding tissues. In thoracic surgery there is a shift in emphasis to quicker postsurgical mobility. Furthermore there has been little analysis of the scientific facts behind the current recommendations and contraindications. The principle absolute and relative contraindications are in need of revision, and recommended times of abstaining from lung function tests needs to be reviewed. This review aims to outline the key issues and suggests newer recommendations for contraindications for performing lung function using a risk matrix, as well as offering alternative approaches to testing patients who may be at risk of complication from testing. In general, the previous recommendation of waiting for 6 weeks after surgical procedures or medical complications before performing lung function can often now be reduced to <3 weeks with modern less invasive surgical techniques. Cooper BG. Thorax (2010). Thorax 2011;66:714e723. doi:10.1136/thx.2010.139881 AU - Cooper BG LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 73 IP - DP - 2010 Jan 01 TI - Acute health effects associated with exposure to volcanic air pollution (vog) from increased activity at Kilauea Volcano in 2008. PG - 1370-1381 AB - In 2008, the Kilauea Volcano on the island of Hawai'i increased eruption activity and emissions of sulfurous volcanic air pollution called vog. The purpose of this study was to promptly assess for a relative increase in cases of medically diagnosed acute illnesses in an exposed Hawaiian community. Using a within-clinic retrospective cohort design, comparisons were made for visits of acute illnesses during the 14 wk prior to the increased volcanic emissions (low exposure) to 14 wk of high vog exposure when ambient sulfur dioxide was threefold higher and averaged 75 parts per billion volume per day. Logistic regression analysis estimated effect measures between the low- and high-exposure cohorts for age, gender, race, and smoking status. There were statistically significant positive associations between high vog exposure and visits for medically diagnosed cough, headache, acute pharyngitis, and acute airway problems. More than a sixfold increase in odds was estimated for visits with acute airway problems, primarily experienced by young Pacific Islanders. These findings suggest that the elevated volcanic emissions in 2008 were associated with increased morbidity of acute illnesses in age and racial subgroups of the general Hawaiian population. Continued investigation is crucial to fully assess the health impact of this natural source of sulfurous air pollution. Culturally appropriate primary- and secondary-level health prevention initiatives are recommended for populations in Hawai'i and volcanically active areas worldwide. PMID: 20818536 DOI: 10.1080/15287394.2010.497440 AU - Longo BM1 AU - Yang W AU - Green JB AU - Crosby FL AU - Crosby VL LA - PT - DEP - TA - J Toxicology Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 7 IP - DP - 2010 Jan 01 TI - Hypersensitivity Pneumonitis Caused by Fungi PG - 229-236 AB - Hypersensitivity pneumonitis (HP) is a complex syndrome caused by an exaggerated immune response to the inhalation of a large variety of organic particles. The most frequent antigens that cause HP pigeon breeders’ disease) and bacteria (Saccharopolyspora rectivirgula). However, fungi are also implicated in many cases, including occupational and nonoccupational outbreaks. The clinical course of the disease is highly variable and its diagnosis clinically challenging since no specific test or biomarker allows a consistent diagnosis. Therefore, a combination of symptoms, bronchoalveolar lavage findings, chest imaging, lab tests, and often biopsies are needed for an accurate diagnosis. Regardless of the cause or the responsible environment, the histopathology is similar and usually consists of a granulomatous interstitial bronchiolocentric pneumonitis characterized by the presence of poorly formed granulomas and a prominent interstitial infiltrate composed of lymphocytes, plasma cells, and macrophages. However, some patients may show a ‘‘nonspecific interstitial pneumonia’’ pattern, or even a usual interstitial pneumonia–like pattern. Importantly, patients with chronic HP may evolve to interstitial fibrosis or develop emphysematous changes, although the reason(s) for these different pathological responses are presently unclear. This review provides a general overview of HP, emphasizing its fungal etiologies, and also examines the currently used clinical criteria for diagnosis and proposes an alternative classification. Challenges for future research include identification of biomarkers that may predict outcome and progression (primarily of chronic HP), and the need for a better understanding of the underlyingmolecular and geneticmechanisms of the disease. Keywords: hypersensitivity pneumonitis; extrinsic allergic alveolitis; fungi; lung inflammation AU - Selman M AU - Lacasse Y AU - Pardo A AU - Cormier Y LA - PT - DEP - TA - Proc Am Thorac Soc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 108 IP - DP - 2010 Jan 01 TI - Metalworking fluids biodiversity characterization PG - 437-449 AB - Aims: Hypersensitivity pneumonitis of machinists associated with metalworking fluids (MWF) was recently linked to Mycobacterium immunogenum. In addition to Mycobacterium, impacts of continuous and massive contact to other micro-organisms, such as Pseudomonas, were little studied. This report intended to quantify and characterize the microbial load of 44 in-use MWF. Methods and Results: The main biodiversity of MWF was assessed using cultural methods, quantitative PCR (qPCR) and denaturing gradient gel electrophoresis (DGGE). Total bacteria concentrations ranged from undetectable to 109 16S rRNA gene copies per millilitre. Concentrations obtained by qPCR were up to five orders of magnitude higher than by culture, suggesting that MWF contamination is generally underestimated. Two samples showed high concentrations of Myco. immunogenum (1·55 × 107 and 3·49 × 105 16S rRNA gene copies per millilitre). The overall biodiversity was low, as observed by culture and DGGE, and was comparable to data found in the literature. Pseudomonas pseudoalcaligenes was by far the main bacteria found in MWF samples (33 out of 44), followed by Ochrobactrum anthropi (32 out of 44). There was no significant relationship between the biodiversity profiles and the kind of MWF or equipment used, making it difficult to predict which micro-organisms will colonize each particular MWF. Conclusions: Very high concentrations of bacteria were found in most MWF studied and limited biodiversities were observed. Many species of micro-organisms were retrieved from MWF samples, but they were mostly colonized by Pseudomonas pseudoalcaligenes and Ochrobactrum anthropi. Significance and Impact of the Study: The major micro-organisms observed or recovered in this study from in-use MWF were present in very high concentrations, and thus further studies are needed to confirm their role in workers’ respiratory disorders or health-related problems. AU - Gilbert Y AU - Veillette M AU - Duchaine C LA - PT - DEP - TA - J Applied Microbiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 138 IP - DP - 2010 Jan 01 TI - Hypersensitivity Pneumonitis Due to Molds in a Saxophone Player PG - 724-726 AB - This 48-year-old patient was evaluated for an interstitial pneumonia. An open-lung biopsy showed a pattern of nonspecific interstitial pneumonia. The CT scan appearance, showing mosaic ground-glass opacities in the ventilated parts of the lung, the centrolobular predominance of inflammation on the lung sections, and the presence of a lymphocytic alveolitis at BAL suggested a hypersensitivity pneumonitis. The patient was a white-collar worker and had no contact with pets, birds, drugs, or molds at home. He used to play the saxophone as a hobby. Two molds, Ulocladium botrytis and Phoma sp, were detected in the saxophone. Precipitating antibodies to these molds were present in his serum. An additional study confirmed the frequent colonization of saxophones with potentially pathogenic molds, such as Fusarium sp, Penicillium sp, and Cladosporium sp. Respiratory physicians should be aware of the risk of hypersensitivity pneumonitis in saxophone or perhaps other wind instrument players. AU - Metzger F AU - Haccuria A AU - Reboux G AU - Nolard N AU - Dalphin J AU - Vuyst PD LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 138 IP - DP - 2010 Jan 01 TI - Trombone Player’s Lung: A Probable New Cause of Hypersensitivity Pneumonitis, PG - 754-756 AB - hat had not remitted for approximately 15 years. He denied symptoms suggesting rhinitis or esophageal reflux and had not responded to gastric acid suppression, bronchodilators, corticosteroids, and treatment of rhinitis. There had been periods when the cough was more severe and associated with dyspnea and low-grade fever. Allergy testing was negative. There was no relevant past history, medication use, substance use, or exposure. The physical examination and a chest radiograph were normal, and pulmonary function tests, including a methacholine challenge test were normal. A high-resolution CT (HRCT) scan of the chest demonstrated a mosaic pattern on the expiratory views. Bronchoscopic examination revealed no endobronchial abnormalities. Subsequently, the patient noted that his symptoms improved significantly when he did not play his trombone for 2 weeks and that the periods of more severe symptoms had been when he was playing more than usual. A diagnosis of hypersensitivity pneumonitis (HP) due to a contaminated trombone was entertained (brass players inhale with the instrument at their mouth between measures). The inside of the instrument showed innumerable whitish plaques suggesting bacterial colonies. A smear of the biofilm revealed fungal elements, and the Ziehl-Neelsen smear revealed >?100 acid-fast bacilli per oil immersion field (×1,000). Cultures revealed large numbers of Mycobacterium chelonae/abscessus group, Fusarium sp (a mold), and scant Stenotrophomonas maltophilia and Escherichia coli. After the patient began immersing his instrument regularly in 91% isopropyl alcohol, his cough resolved completely over several weeks. He has been symptom free for approximately 20 months, except when he neglected to clean his instrument for more than a month. AU - Metersky ML AU - Bean SB AU - Meyer JD AU - Mutambudzi M AU - Brown-Elliott BA AU - Wechsler ME AU - Wallace RJ LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 10 IP - DP - 2010 Jan 01 TI - Update on asthma and cleaners PG - 114-120 AB - Purpose of review This paper summarises the recent literature on the relation between cleaning exposures and respiratory health, in particular asthma, including reviews, epidemiological surveys, surveillance programmes and exposure studies. The authors also aimed to identify gaps in the current knowledge and to recommend future research on the topic. Recent findings A large international general population study showed an increased risk of new-onset asthma associated with cleaning work, with professional use of cleaning products, and with domestic use of cleaning sprays. Three surveillance studies confirm the recognition of occupational asthma cases among cleaners and among others who use cleaning products at work. Six workforce-based studies show that respiratory symptoms are partly work-related, and are associated with certain specific exposures including sprays, chlorine bleach and other disinfectants. Summary Recent studies have strengthened the evidence of asthma and other adverse respiratory effects in cleaning workers. Similar effects were seen in other settings where cleaning products are used such as healthcare professionals and homemakers. Both new-onset asthma and work-exacerbated asthma due to cleaning exposures may play a role. Exposure to cleaning sprays, chlorine bleach and other disinfectants may be particularly relevant. The predominant effect mechanisms remain largely unclear and may include both specific sensitisation and irritant-related features. AU - Zock J-P AU - Vizcaya D AU - Moual NL LA - PT - DEP - TA - Curr Opin Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 Suppl 4 IP - DP - 2010 Jan 01 TI - The evaluation of an improved method of occupational asthma diagnosis from timepoint analysis of serial pef records PG - A80-81 AB - Background The diagnosis of occupational asthma requires objective confirmation. Analysis of serial measurements of Peak Expiratory Flow (PEF) is usually the most convenient first step in the confirmatory process. We previously described a statistical method of analysis comparing mean 2-h values on work and rest days which required the worker to wake at similar times on rest and work days. This was achieved in only 43% of records. We describe a new method of timepoint analysis without this restriction and overcoming a theoretical problem with the original analysis (the assumption that the variance of the waking reading was the same as the variance at other times of the day). Methods Workers were asked to measure PEF approximately 2-h from waking to sleeping for 3–4?weeks. 236 PEF records from workers with independently diagnosed occupational asthma, and 320 from asthmatic controls were available. Readings were grouped by the time since waking, in an attempt to correct for changes in diurnal variation induced by changes in shift and waking time. Daily PEF measurements were meaned into matching 2-h time segments. The pooled SD for rest day measurements (excluding waking readings) was obtained from a one-way ANOVA. Timepoints with mean workday PEF statistically lower (at the Bonferroni adjusted 5% level) than the restdays were counted, after adjusting for the number of contributing measurements at each point. Results A minimum of four analysable timepoint comparisons per day was needed. 78% of records were suitable for analysis. Records with one or more timepoints statistically worse on workdays gave a sensitivity of 71% against independently diagnosed occupational asthma and a specificity of 93% in non-occupational asthmatics. Conclusion The removal the requirement to wake at similar times on work and rest days increased the utility of timepoint analysis for the diagnosis of occupational asthma from 43–78% without compromising sensitivity or specificity. Statistical validity was also improved. AU - Burge CBSG AU - Moore VC AU - Robertson AS AU - Pantin CFA AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 17 IP - DP - 2010 Jan 01 TI - Mass casualty incident involving pepper spray exposure: impact on the emergency department and management of casualties PG - 352-359 AB - Hong Kong Journal of Emergency Medicine Mass casualty incident involving pepper spray exposure: impact on the emergency department and management of casualties JJ Oh , R Yong , R Ponampalam, V Anantharman, SH Lim Introduction: Exposure to pepper spray in an urban shopping complex resulted in 13 casualties being treated at a tertiary public hospital emergency department (ED). This report describes the ED's organisation in response to the disaster, and clinical management of those affected. Results: Thirteen casualties - 11 acute, 2 delayed - presented with symptoms ranging from ocular, respiratory and skin irritation to nausea, vomiting and giddiness. The culprit agent was determined basing on the index patient's history and physical findings. All cases were decontaminated at the ED's on-site Hospital Decontamination Station. Nine adults were monitored overnight in the Emergency Observation Ward under the Toxic Inhalation Protocol and discharged well. The index case was treated symptomatically with improvement, but discharged against medical advice three hours later. No ED re-attendances were recorded. Conclusions: The effects of pepper spray exposure are brief and self-limiting, but ED management can pose challenges in a mass casualty situation. AU - Oh JJ AU - Yong R AU - Ponampalam R AU - Anantharman V AU - Lim SH LA - PT - DEP - TA - Hong Kong J.Emerg.Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 340 IP - DP - 2010 Jan 01 TI - Multidisciplinary team working in cancer: what is the evidence? PG - c951 AB - Multidisciplinary team working in cancer: what is the evidence? BMJ2010; 340 doi: http://dx.doi.org/10.1136/bmj.c951(Published 23 March 2010) Cite this as: BMJ 2010;340:c951 Clinical decision making A multidisciplinary approach to clinical decision making aims to ensure that tumours are accurately staged and treatment recommendations are evidence based, patient centred, and reached by consensus. Two observational studies in breast cancer found that multidisciplinary teams resulted in more evidence based recommendations and more timely treatment.18 19 The treatment recommendations made by multidisciplinary teams do not always take into account the patients’ preferences and their wider psychological and social issues. Analysis of decision making within upper gastrointestinal and colorectal cancer teams in the UK showed that 10-15% of treatment recommendations were not implemented.20 21 Typically, patients received more conservative treatment than originally planned because the teams had not considered patient based information such as comorbidity and patient preferences. Clinical outcomes In the UK, multidisciplinary working is associated with improved five year survival in colorectal22 and oesophageal cancer23 and improved two year survival in head and neck cancer.24 A recent systematic review also reports limited evidence of improved survival in lung cancer.25 In Sweden, introduction of multidisciplinary care was associated with improved seven year relative survival from breast cancer.26 Differences in survival rates within one healthcare region were eliminated once they established multidisciplinary teams and adhered to regional treatment guidelines. 25. Coory M, Gkolia P, Yang I, Bowman R, Fong K. Systematic review of multidisciplinary teams in the management of lung cancer. Lung Cancer2008;60:14-21 Cath Taylor, research fellow1, Alastair J Munro, professor of radiation oncology2, Rob Glynne-Jones, consultant clinical oncologist3, Clive Griffith, consultant breast surgeon4, Paul Trevatt, Macmillan network nurse director5, Michael Richards, national cancer director6, Amanda J Ramirez, professor of liaison psychiatry7 AU - Taylor C AU - Munro AJ AU - Glynne-Jones R AU - Griffith C AU - Trevatt P AU - Richards M AU - Ramirez AJ LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 60 IP - DP - 2010 Jan 01 TI - Health surveillance of workers exposed to laboratory animal allergens PG - 591-597 AB - Background Laboratory animal allergy (LAA) remains prevalent among workers exposed to laboratory animals. Pre-placement and health surveillance procedures vary between different employers. Aims To determine evidence-based strategies for pre-placement and periodic health assessments for workers exposed to laboratory animals. Methods Literature was searched systematically using Medline and EMBASE for articles published in all languages up to the end of May 2010. Evidence-based statements and recommendations were graded according to a modified Royal College of General Practitioner's star system. Results Hundred and nine studies were identified from the literature search; 59 of these were accessed for critical appraisal and 50 contributed to the evidence statements. Conclusions We recommend that laboratory animal workers should have a baseline health assessment that includes a health questionnaire, face-to-face assessment and spirometry. Identification of specific immunoglobulin E to common aero-allergens and to domestic and laboratory animal allergens may be used to identify workers who would benefit from further advice about managing their exposure, where risk assessment indicates that this might be prudent. Thereafter health surveillance should be performed by administering an appropriate health questionnaire, covering upper and lower respiratory, eye and skin symptoms on exposure, and wheals with animal scratches. The questionnaire should be administered at increased frequency for the first few years, the frequency being determined by a risk assessment. Where a worker develops new symptoms suggestive of LAA or where an asthmatic employee experiences deterioration either in symptoms or in control, they should be assessed further and a multicause multidisciplinary investigation performed AU - Nicholson PJ AU - Mayho GV AU - Roomes D AU - Swann AB AU - Blackburn BS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 60 IP - DP - 2010 Jan 01 TI - Comparison of various airflow measurements in symptomatic textile workers PG - 631-634 AB - Aims To investigate the poorly understood relationship between work-related respiratory symptoms, airway reactivity, across working shift change in forced expiratory volume in 1 s (FEV1) and work-related changes in serial peak expiratory flow (sPEF) measures in a group of textile workers. Methods Fifty-three workers, 34 exposed to cotton dust and 19 to man-made fibre (MMF), were investigated using a standard respiratory questionnaire, sPEF, across-shift FEV1 measurement and airway responsiveness. Results Thirty-four workers (64%) were male, and 9 workers (17%) had a >5% across-shift fall in FEV1, and these falls were associated with the presence of work-related symptoms. Seven workers had a positive sPEF chart as judged by the software analysis (OASYS), although there was no relationship between work-related symptoms and sPEF. Six cotton workers (18%) and one MMF worker (5%) had airway hyperreactivity, which was associated strongly with work-related symptoms. Five of the 7 subjects with a positive sPEF had airway hyperreactivity compared with 12 of 46 with a negative sPEF. Conclusions In this worker group, the presence of work-related respiratory symptoms was best associated with airway hyperresponsiveness and across-shift changes in FEV1. While a positive sPEF chart was associated with increased airway responsiveness, it was not associated with work-related symptoms. sPEF measurements may not be the initial investigation of choice for such workers. As these findings also have relevance to developing evidence-based approaches to health surveillance, further work is needed to better define these relationships in other workers complaining of work-related respiratory symptoms. AU - Fishwick D AU - Barraclough R AU - Pickering T AU - Fletcher A AU - Lewis R AU - Niven R AU - Warburton CJ LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - Effects of latex avoidance on latex sensitization, atopy and allergic diseases in patients with spina bifida PG - 1585-1593 AB - Background: Ten years ago, avoidance measures such as the performance of latex-free operations were implemented in children with spina bifida. Since then, latex sensitization and latex allergy have decreased in this high-risk group. Objective: To study the effect of primary latex-free prophylaxis on the prevalence of allergic diseases and atopy as a marker for sensitization spreading in children with spina bifida. Methods: One hundred and twenty children with spina bifida born after the introduction of latex-free prophylaxis and operated on under latex-free conditions (‘current group’) were examined for latex sensitization, latex allergy, sensitization to aero- and food allergens and allergic diseases. Results were compared to a ‘historic’ (not latex-free operated) group of children with spina bifida and comparable age (n = 87) and to a recent sample of children from the general population (n = 12 403). Results: In comparison with the ‘historic group’, latex sensitization (55%vs 5%, P < 0.001) and latex allergy (37%vs 0.8%, P < 0.001) were significantly reduced in the ‘current group’. Furthermore, a significant reduction could be demonstrated for sensitization to aeroallergens (41.4%vs 20.8%, P = 0.001) and for allergic diseases (35%vs 15%, P = 0.001). The prevalence for atopy, sensitization to aero-/foodallergens and for allergic diseases in children of the ‘current group’ was similar to those in children of the weighted population sample. Conclusions: Latex avoidance in children with spina bifida prevents latex sensitization and latex allergy. Additionally, it also seems to prevent sensitization to other allergens and allergic diseases which might be explained by the prevention of sensitization spreading AU - Blumchen K AU - Bayer P AU - Buck D AU - Michael T AU - Cremer R AU - Fricke C AU - Henne T AU - Peters H AU - Hofmann U AU - Keil T AU - Schlaud M AU - Wahn U AU - Niggemann B. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - Airborne allergy to tomato proteins PG - 1626-1627 AB - case report, IgE, supermarket worker, rhinoconjuctivitis, rhinitis, reacted to handling bunch tomatos on stems, IgE to stems but not tomato fruit, no pfts etc, no outcome data AU - R Asero AU - G Mistrello AU - S Amato LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 60 IP - DP - 2010 Jan 01 TI - Work-associated irritable larynx syndrome PG - 546-551 AB - Background Work-associated respiratory symptoms may be caused by disorders of both the lower and upper respiratory tract. We propose that occupational exposures may initiate and/or trigger recurrent hyperkinetic laryngeal symptoms, predominantly episodic dyspnoea, dysphonia, cough and sensation of tension in the throat—work-associated irritable larynx syndrome (WILS). Aims To examine characteristics of individual and work-related factors that are associated with WILS, occupational asthma (OA) and work-exacerbated asthma (WEA). Methods Subjects with WILS, OA and WEA were identified from an occupational lung disease clinic. A review of 448 charts of patients attending the clinic between 2002 and 2006 was undertaken, with information entered onto a standardized abstraction form. Results Fifty subjects were identified with OA, 40 with WEA and 30 with WILS. Subjects with the diagnosis of WILS were more likely to be female and more frequently reported symptoms of gastro-oesophageal reflux. The most common triggers of workplace symptoms in the WILS group were odours, fumes, perfumes and cleaning agents. Fourteen patients with WILS identified a specific precipitating event at the workplace at the time of the onset of their symptoms and five of these subjects presented to an emergency department within 24 h of the event. Conclusions Dysfunction of the upper airway is an important cause of work-associated respiratory symptoms. The identification and management of WILS requires a multidisciplinary approach with a focus on modifying work-related and intrinsic factors that may perpetuate symptoms. AU - Hoy RF AU - Ribeiro M AU - Anderson J AU - Tarlo SM LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - Occupational allergy to bell pepper pollen in greenhouses in the Netherlands, an 8-year follow-up study PG - 1423-1429 AB - Background: Pollen from bell pepper plants cultivated in greenhouses are known to cause occupational allergic disease. A cross-sectional study among 472 bell pepper employees in 1999 estimated prevalences for sensitization to bell pepper pollen of 28% and for work-related allergic symptoms of 54%. There is scarce information on the incidence of work-related allergy and its risk factors. Aims of the present study were to estimate the cumulative incidence of work-related symptoms and sensitization to bell pepper pollen, and to determine risk factors for the onset of these symptoms and sensitization. Methods: Bell pepper employees who participated in a cross-sectional survey in 1999 were asked to take part in a follow-up study in 2007. Information on demographic characteristics, job characteristics and allergic symptoms was gathered by means of a questionnaire. Furthermore, skin tests were performed with a.o. bell pepper pollen. Results: In total, 280 of 472 employees were available for questionnaires and in 250 employees allergy tests were performed. During the 8-year follow-up, the cumulative incidence of sensitization to bell pepper pollen was 9% and of work-related rhinitis 19%. Atopy [odds ratio (OR) 5.60] and smoking (OR 3.53) were significantly associated with development of rhinitis. The cumulative incidence of work-related asthma symptoms was 8%. Again atopy (OR 5.03) and smoking (OR 11.85) were significant risk factors. Conclusion: Cumulative incidences for sensitization to bell pepper pollen, work-related rhinitis and asthma symptoms were 9%, 19% and 8%, respectively. Atopy and smoking are risk factors for developing work-related symptoms among workers in bell pepper horticulture AU - Patiwael JA AU - Jong NW AU - Burdorf A AU - Groot H AU - van Wijk RG LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 40 IP - DP - 2010 Jan 01 TI - Allergy to rodents: an update PG - 1593-1601 AB - Allergy to rodents in the workplace is an important occupational health problem affecting research, pharmaceutical and toxicological sectors and can have a serious impact on employees working in this area. Despite measures to reduce aeroallergen exposures to rodents in the workplace, there are few signs that this occupational health problem is declining. Rodent allergens are well characterized and exposure–response relationships have been demonstrated to be complex. More recently, the importance of rodent allergens outside of the workplace has been demonstrated in several studies of individuals with asthma. This review focuses on rodent allergy both in the workplace and in the home and examines the complex exposure–response relationships between allergen exposure and sensitization and asthma. Risk factors for rodent allergy and mechanisms of tolerance to rodent allergens are discussed. AU - Jeal H AU - Jones M LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - - IP - DP - 2010 Jan 01 TI - Occupational asthma: prervention, identification and management. Systematic review and recommendations PG - - AU - Nicholson PJ AU - Cullinan P AU - Burge PS AU - Boyle C LA - PT - DEP - TA - British Occupational Health Foundation, London JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 36 IP - DP - 2010 Jan 01 TI - Occupational asthma to solder wire containing an adipic acid flux PG - 962-963 AB - We present the first case of occupational asthma to colophony-free solder wire containing an adipic acid flux, previously only reported in a pharmaceutical factory worker who was in contact with spiramycin powder 1. The 43-yr-old female presented with rhinitic symptoms in 1992. She had worked as a solderer and desolderer of alternator parts since June 1989. The process used a colophony-free solder wire containing an adipic acid flux from 1996, but, when desoldering, colophony fluxes may still have been present. From 1998, she experienced a gradual onset of breathlessness and chest tightness, which she noticed was affecting her keep fit. She had had no asthma, hay fever or eczema in childhood and there was no family history of these conditions. She was a lifelong nonsmoker and gave negative skin prick rest results to common environmental allergens. She started to show nocturnal waking and shortness of breath in the morning, feeling better on days away from work, particularly on holiday. She also noticed that she felt better when not soldering at work. She carried out serial peak expiratory flow measurements four times daily for a total of 4 weeks. When plotted using the Oasys program, they showed work related changes, with an Oasys score of 3.1 (probable occupational asthma; a score of > 2.5 has a sensitivity of 75% and specificity of 94% for occupational asthma diagnosis) and an area between the curves (ABC) score of 15 L/min/h (an ABC score of >= 15 L/min/h has a sensitivity of 69% and specificity of 100%). She was admitted for specific inhalation challenge testing to colophony and adipic acid fluxed solder wires. She melted roughly 1m of solder wire (using an iron heated to 170 C over three challenges, totalling 30 min for the colophony containing wire and 12 min for the adipic acid wire. She exhibited a late asthmatic reaction after the adipic acid exposure, with her forced expiratory volume in 1s falling by a maximum of 28% from baseline, She showed no reaction to the colophony fluxed solder wire. Her methacholine reactivity before challenge was 5,450 ug methacholine (normal) using the Yan method, halving following adipic acid wire challenge to 1,729 ug (mildly hyperreactive). Adipic acid exhibits an asthma hazard index of 0.75 using the chemical hazard assessment program. Substances with indices of >0.5 have a high probability of being an asthmagen. Other non colophony based fluxes, such as palmitic acid and dodecanedioic acid, also have high hazard indices (0.92 and 0.94, respectively). On follow up, the worker had joined a different company as a toilet cistern assembler. She still showed significant asthma, with occasional nocturnal wakening and a St George's Respiratory Questionnaire score of 50.8. Her methacholine reactivity was normal at >4800 ug. Thus adipic acid fluxed solder wire is a new cause of occupational asthma. AU - Moore VC AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 36 Suppl 5 IP - DP - 2010 Jan 01 TI - Is data quality more important than data quantity in the diagnosis of occupational asthma from serial PEF records? PG - 864s-865s AB - Serial peak expiratory flows (PEF) are a cheap and effective way to confirm the diagnosis of occupational asthma. Records are susceptible to fabrication and poor quality. There is a trade off between accepting only blows fulfilling quality standards with reduced data quantity and accepting all blows irrespective of quality. We have investigated the effect of systematically reducing quality on the diagnostic sensitivity and specificity using the Oasys system. Methods PEF measurements from 36 specific inhalation challenge positive workers and 44 non-occupational asthmatics were used. Every PEF measurement was randomly changed to be up to +50L/minor-50L/min from the original value in increments of 10L/min. Records were randomised 3 times and compared at each randomisation to the original using the Oasy sscore ,area between curves (ABC) score and timepoint analysis. Results The table shows how the sensitivity and specificity changed at each randomisation after data corruption. Sensitivity and (Specificity) of Oasys score at randomisations 0, 1, 2 and 3 respectively was 75(84), 67(73), 72(68), 86(86) Sensitivity and (Specificity) of ABC score was 69(93), 61(89), 55(86), 69(93) Sensitivity and (Specificity) of Timepoint analysis was 64(84), 58(84), 44(86), 55(86) Conclusion The sensitivity and specificity for diagnosing occupational asthma was little affected by reducing data quality using Oasys analyses. This suggests that data quality is less important than quantity in this situation. AU - Moore V AU - Burge C AU - Burge S LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 126 IP - DP - 2010 Jan 01 TI - Gene-environment interactions influence airways function in laboratory animal workers PG - 232-240 AB - Background Most diseases, including asthma, result from the interaction between environmental exposures and genetic variants. Functional variants of CD14 negatively affect lung function in farm workers and children exposed to animal allergens and endotoxin. Objective We hypothesized that CD14 polymorphisms interact with inhaled endotoxin, mouse allergen, or both to decrease airways function in laboratory animal workers. Methods Three hundred sixty-nine Caucasian workers completed a symptom and work exposure questionnaire, skin prick testing, and spirometry. Individual exposure estimates for endotoxin and murine allergen were calculated by weighting task-based breathing zone concentrations by time reported for each task and length of time in the current job. Real-time PCR was used to assess CD14/-1619, -550, and -159 alleles. Multiple linear regression predicting airways function included an interaction term between genotype and exposure. Results Workers at the highest quartile of the natural log-transformed cumulative endotoxin exposure and with the endotoxin-responsive CD14/-1619 G allele had significantly lower FEV1 and forced expiratory flow, midexpiratory phase (FEF25-75) percent predicted compared with workers with an AA genotype, with no significant differences noted at lower endotoxin levels for either genotype. The gene-environment effect was marked for atopic workers. Laboratory animal allergy, murine allergen exposure, CD14/-159 or -550 genotype, and a gene-exposure interaction term for these genotypes and exposures did not predict changes in lung function. Conclusions A significant gene-environment interaction affects airways function in laboratory animal workers. More highly endotoxin-exposed workers with CD14/-1619G alleles have significantly lower FEV1 and FEF25-75 percent predicted than those with CD14/-1619AA alleles. Atopic workers are particularly affected by cumulative endotoxin exposures. AU - Pacheco KA AU - Rose CS AU - Silveira LJ AU - Van Dyke MV AU - Goelz K AU - MacPhail K AU - Maier LA LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 67 IP - DP - 2010 Jan 01 TI - Do long periods off work in peak expiratory flow monitoring improve the sensitivity of occupational asthma diagnosis? PG - 562-567 AB - Introduction Serial peak expiratory flow (PEF) monitoring is a useful confirmatory test for occupational asthma diagnosis. As weekends off work may not be long enough for PEF records to recover, this study investigated whether including longer periods off work in PEF monitoring improves the sensitivity of occupational asthma diagnosis. Methods Serial PEF measurements from workers with occupational asthma and from workers not at work during their PEF record, containing minimum data amounts and at least one rest period with =7 consecutive days off work, were analysed. Diagnostic sensitivity and specificity of the area between the curves (ABC) score from waking time and Oasys score for occupational asthma were calculated for each record by including only consecutive rest days 1–3 in any rest period, including only consecutive rest days from day 4 onwards in any rest period or including all available data. Results Analysing all available off work data (including periods away from work of =7 days) increased the mean ABC score by 17% from 35.1 to 41.0 l/min/h (meaning a larger difference between rest and work day PEF values) (p=0.331) and the Oasys score from 3.2 to 3.3 (p=0.588). It improved the sensitivity of the ABC score for an occupational asthma diagnosis from 73% to 80% while maintaining specificity at 96%. The effect on the Oasys score using discriminant analysis was small (sensitivity changed from 85% to 88%). Conclusions Sensitivity of PEF monitoring using the ABC score for the diagnosis of occupational asthma can be improved by having a longer period off work. AU - Moore VC AU - Jaakkola MS AU - Burge CBSG AU - Pantin CFA AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 21 IP - DP - 2010 Jan 01 TI - Asthma in late adolescence – farm childhood is protective and the prevalence increase has levelled off PG - 806-813 AB - While the prevalence of and risk factors for asthma in childhood have been studied extensively, the data for late adolescence are more sparse. The aim of this study was to provide up-to-date information on the prevalence of and risk factors for asthma in the transitional period between childhood and adulthood. A secondary aim was to analyze whether the increase in asthma prevalence has levelled off. A large-scale, detailed postal questionnaire focusing on asthma and respiratory symptoms, as well as possible risk factors, was mailed to 30 000 randomly selected subjects aged 16–75 in Gothenburg and the surrounding western Sweden region. The present analyses are based on the responses from 1261 subjects aged 16–20 (560 men and 701 women). The prevalence of physician-diagnosed asthma was 9.5%, while 9.6% reported the use of asthma medicine. In the multivariate analysis, the strongest risk factors for physician-diagnosed asthma and other asthma variables were heredity for asthma and heredity for allergy, particularly if they occurred together. Growing up on a farm significantly reduced the prevalence of physician-diagnosed asthma and the likelihood of using asthma medication, OR 0.1 (95% CI 0.02–0.95). Smoking increased the risk of recurrent wheeze, long-standing cough, and sputum production. In conclusion, the prevalence of physician-diagnosed asthma and the use of asthma medication in the 16- to 20-yr age group support the notion that the increase in asthma prevalence seen between the 1950s and the 1990s has now levelled off. In line with the hygiene hypothesis, a farm childhood significantly reduced the likelihood of asthma. The adverse effects of smoking could already be seen at this young age. The question "have you been exposed on a large scale to dust, gasses or fumes at work" incresased the risk of wheeze in the last 12 months; OR 1.7 (1.1-2.6); Recurrent wheeze OR 2.1 (1.1-4.1) but not physician diagnosed asthma OR 1.0 (0.5-1.8) AU - Wennergren G AU - Ekerljung L AU - Alm B AU - Eriksson J AU - Lötvall J AU - Lundbck B LA - PT - DEP - TA - Pediatric Allergy and Immunology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 67 IP - DP - 2010 Jan 01 TI - Search strings for the study of putative occupational determinants of disease PG - 436-443 AB - Objective To identify efficient PubMed search strategies to retrieve articles regarding putative occupational determinants of conditions not generally considered to be work related. Methods Based on MeSH definitions and expert knowledge, we selected as candidate search terms the four MeSH terms describing ‘occupational disease’, ‘occupational exposure’, ‘occupational health’ and ‘occupational medicine’ (DEHM) alongside 22 other promising terms. We first explored overlaps between the candidate terms in PubMed. Using random samples of abstracts retrieved by each term, we estimated the proportions of articles containing potentially pertinent information regarding occupational aetiology in order to formulate two search strategies (one more ‘specific’, one more ‘sensitive’). We applied these strategies to retrieve information on the possible occupational aetiology of meningioma, pancreatitis and atrial fibrillation. Results Only 20.3% of abstracts were retrieved by more than one DEHM term. The more ‘specific’ search string was based on the combination of terms that yielded the highest proportion (40%) of potentially pertinent abstracts. The more ‘sensitive’ string was based on the use of broader search fields and additional coverage provided by other search terms under study. Using the specific string, the numbers of abstracts needed to read to find one potentially pertinent article were 1.2 for meningioma, 1.9 for pancreatitis and 1.8 for atrial fibrillation. Using the sensitive strategy, the numbers needed to read were 4.4 for meningioma, 8.9 for pancreatitis and 10.5 for atrial fibrillation. Conclusions The proposed strings could help health care professionals explore putative occupational aetiology for diseases that are not generally thought to be work related. AU - Mattioli S AU - Zanardi F AU - Baldasseroni A AU - Schaafsma F AU - Cooke RM AU - Mancini G AU - Fierro M AU - Santangelo C AU - Farioli A AU - Fucksia S AU - Curti S AU - Violante FS AU - Verbeek J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 67 IP - DP - 2010 Jan 01 TI - Allergen and endotoxin exposure in a companion animal hospital PG - 486-492 AB - Background Exposure to allergens, both in general and occupational environments, is known to result in sensitisation and exacerbation of allergic diseases, while endotoxin exposure might protect against allergic diseases. This may be important for veterinarians and co-workers. However, exposure levels are mostly unknown. Objective We investigated the allergen and endotoxin exposure levels of veterinary medicine students and workers in a companion animal hospital. Methods Airborne and surface dust was collected using various sampling methods at different locations. Allergen levels in extracts were measured with sandwich ELISAs and/or the multiplex array for indoor allergens (MARIA). Endotoxin was determined by limulus amebocyte lysate (LAL) assay. Results Fel d 1 (Felis domesticus), Can f 1 (Canus familiaris) and endotoxin were detected in all except stationary samples. The geometric mean (GM) level of personal inhalable dust samples for Fel d 1 was 0.3 ng/m3 (range: below lower limit of detection (< LOD) to 9.4), for Can f 1 3.6 ng/m3 (< LOD to 73.3) and for endotoxin 4.4 EU/m3 (< LOD to 75). Exposure levels differed significantly between job titles, with highest allergen exposure for student assistants in the intensive care unit (Fel d 1, GM 1.5 ng/m3; Can f 1, GM 18.5 ng/m3), and highest endotoxin exposure for students (GM 10.1 EU/m3). Exposure levels in dust captured by diverse sampling methods correlated with each other (p< 0.05). Conclusion Allergen exposure likely occurs during veterinary practice, with relatively low endotoxin levels. Future research should investigate dose–response relationship between airborne allergen exposure and health effects. AU - Samadi S AU - Heederik DJJ AU - Krop EJM AU - Jamshidifard A-R AU - Willemse T AU - Wouters IM LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 19 IP - DP - 2010 Jan 01 TI - Health Effects of Residents Exposed to Stachybotrys in Water-damaged Houses in Finland PG - 476-485 AB - This paper describes the medical examination of 26 residents living in Finnish houses with indoor air problems and Stachybotrys contamination. Environmental samples were obtained from patients at the Clinic for Indoor Air Health Problems where special attention was paid to the presence of possible health effects caused by moulds, especially by Stachybotrys chartarum. S. chartarum was isolated and identified in samples collected from the homes or work places of 26 patients admitted for respiratory illness. Most of the isolated S. chartarum strains showed slight toxicity when tested in a cell culture but only two were found to produce satratoxins G and H. Diverse spectra of non-specific symptoms were reported by the 26 patients and irritation of the upper airways and eyes were the most common. Lymphocytosis was found in the bronchoalveolar lavage fluid in 6 of the 10 patients who underwent bronchofibreoscopy. IgG antibodies against S. chartarum were determined in the serum of 20 patients and increased levels were found in 10 of them. The symptoms or the severity of the illnesses were not associated with the IgG level. Patients were followed-up for 1—5 years, with a few patients experiencing persistent health effects such as severe eye irritation. We conclude that some of the symptoms may be caused by Stachybotrys exposure but a causal relationship could not be shown. Lymphocytosis was found in bronchial lavage in half of the patients examined by bronchoscopy suggesting that immunoactivation in lungs may quite often occur from exposure to water-damaged microbes. AU - Mussalo-Rauhamaa H AU - Nikulin M AU - Koukila-Kähkölä P AU - Hintikka E AU - Malmberg M AU - and Haahtela T LA - PT - DEP - TA - Indoor Built Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 60 IP - DP - 2010 Jan 01 TI - Assessment of respiratory health surveillance for laboratory animal workers PG - 458-463 AB - Background Occupational asthma is the most common work-related respiratory disease in the UK. Individuals whose work potentially puts them at risk include those exposed to laboratory animals. Workplace health surveillance programmes aim to minimize these health risks but are recognized to be challenging to implement effectively. Aims To evaluate the efficacy of the respiratory health surveillance programme provided by a National Health Service occupational health service (OHS) to individuals potentially exposed to respiratory sensitizers at work with laboratory animals. Methods Case notes from the OHS respiratory health surveillance programme over a 2 year period were examined. Symptom detection by the OHS surveillance questionnaire was compared to a cross-sectional survey using items from the validated International Union Against Tuberculosis and Lung Disease (IUATLD) questionnaire. The surveillance spirometry records were audited against good standards of practice. Results The response rate for the anonymized survey using IUATLD questions was 60% and detected similar numbers of potential work-related symptoms to the OHS surveillance questionnaire. Over 80% of spirometry records met accepted standards for technique, effort and recording. In this study of 85 individuals over 2 years, three cases of occupational asthma were identified. Conclusions The current surveillance appears to be effective in identifying potential cases of occupational asthma. Modification of the questionnaire content and layout might improve response rates. This study suggests that spirometry does not detect new cases other than those already identified by questionnaire. AU - Allan KM AU - Murphy E AU - Ayres JG LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 60 IP - DP - 2010 Jan 01 TI - Surveillance of Australian workplace Based Respiratory Events (SABRE) in New South Wales PG - 376-382 AB - Background The Surveillance of Australian workplace Based Respiratory Events (SABRE) New South Wales (NSW) scheme is a voluntary notification scheme established to determine the incidence of occupational lung diseases in NSW Australia. Aims Data presented in this paper summarize the last 7 years of reporting to SABRE (June 2001 to December 2008). Methods Every 2 months, participating occupational physicians, respiratory physicians and general practitioners (accredited by the NSW WorkCover Authority) reported new cases of occupational lung disease seen in their practices. Data collected include gender, age, causal agent and the occupations and industries believed responsible. Estimated incidence was calculated for each disease. Results Three thousand six hundred and fifty-four cases were notified to the scheme, consisting of 3856 diagnoses. Most of the cases were males (76%). Pleural plaques [1218 (28%)] were the most frequently reported condition, followed by mesothelioma [919 (24%)]. Silicosis [90 (2%)] and occupational asthma [OA; 89 (2%)] were the most frequently reported non-asbestos-related diseases. Estimated rates for mesothelioma, diffuse pleural thickening (DPT) and OA were 83, 83 and 5 cases per million employed males per year, respectively. Trades such as carpenters and electricians associated with the building industry, electricity supply and asbestos product manufacture were the most common occupations and industries reported. Conclusions Asbestos-related diseases are the most frequently reported conditions to SABRE NSW. The very low incidence of OA for NSW most likely reflects under-diagnosis as well as under-reporting. Occupational lung disease is still occurring in NSW despite current preventative strategies. The SABRE scheme currently provides the only available information in this area. AU - Hannaford-Turner K AU - Elder D AU - Sim MR AU - Abramson MJ AU - Johnson AR AU - Yates DH LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - Dynamics in cytokine responses during the development of occupational sensitization to rats PG - 1227-1233 AB - Background: Occupational allergy forms an attractive model to study the development of allergic responses, as in some occupations it has a high incidence and develops quickly. In a cohort of starting laboratory animal workers, we previously found 20% sensitization to animal allergens within 2 years. Methods: We compared cellular responses of incident laboratory animal workers who developed rat-specific sensitization (cases, n = 18) during 2 years of follow-up to control animal workers matched for atopic status but without sensitization after follow-up (controls, n = 18). Practically, this is a case–control study, nested within the cohort. Rat-specific IgE antibodies were measured in sera, and allergen-specific and nonspecific cytokine responses were measured in whole blood and in isolated peripheral blood mononuclear cells. Results: Self-reported allergic symptoms were related to the presence of rat-specific IgE (P = 0.01). Cases developed a rat allergen–specific interleukin (IL)-4 response during sensitization, while controls did not show an increased IL-4 response (at visit D: 33 vs 5 IL-4 producing cells/106 cells, P < 0.001). The IL-4 response was related to the levels of rat-specific IgE in cases (visit D: rho = 0.706, P < 0.001). By contrast, allergen-specific IL-10 and interferon (IFN) responses as well as nonspecific cytokine responses were comparable between cases and controls. Conclusion: This study is the first to show the development of an allergen-specific IL-4 response in adult human subjects during allergen-specific sensitization. This IL-4 response was quantitatively associated with the development of the specific IgE antibodies. Allergen-specific or nonspecific IL-10 and IFN responses showed no protective effect on the development of allergic sensitization AU - Krop EJM AU - van de Pol MA AU - Lutter R AU - Heederik DJJ AU - Aalberse RC AU - van der Zee JS LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 40 IP - DP - 2010 Jan 01 TI - Lupin allergy: a hidden killer at home, a menace at work; occupational disease due to lupin allergy PG - 1467-1472 AB - The products of the flowering plant, lupin, are increasingly used as a human food product, particularly in baking. Occupational sensitization to lupin with occupational rhinitis, conjunctivitis and asthma was first described in 2001, and confirmed in a larger cross-sectional study in a food processing company in 2006. Sensitization by inhalation may result in occupational asthma, work-exacerbated asthma, occupational rhinitis and conjunctivitis. The incidence of occupational sensitization may be as high as 29%. The relationship with exposure intensity is as yet unclear, and requires further clarification. Although there is little information from long-term studies, these diseases are likely to improve after cessation of exposure. Cross-sensitization to other legumes, particularly peanuts, has been shown by skin prick testing, with potential for serious anaphylactic reactions. This review summarizes the available literature on occupational sensitization to lupin products. It is one of two reviews, one covering the problem of lupin allergy in the home, while the present article deals with lupin sensitization in the workplace. Increased awareness is needed of this occupational hazard to avoid future cases of occupational disease and their accompanying morbidity and potential mortality. AU - Campbell CP AU - Yates DH LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 40 IP - DP - 2010 Jan 01 TI - Sensitization to lupine flour: is it clinically relevant? PG - 1571-1577 AB - Background Lupinus angustifolius (blue lupine) is used for human and animal consumption. Currently, the lupine content in bread varies from 0% to 10% and from 0.5% to 3% in pastry. Although lupine flour is present in many products, anaphylaxis on lupine flour is rarely seen. Objective The aim of our study was to determine the clinical relevance of sensitization to lupine flour. Methods From October 2004 until October 2005, we performed skin prick tests (SPT) with lupine flour, peanut and soy extracts in consecutive patients attending our allergy clinic with a suspected food allergy. In patients sensitized to lupine flour, double-blind placebo-controlled food challenges (DBPCFC) were performed and specific IgE was measured. Results We tested 372 patients. SPTs with peanut, soy and lupine flour were positive in 135, 58 and 22 patients, respectively. Nine patients with sensitization to lupine flour underwent DBPCFC, which was negative in eight cases. In contrast, one patient experienced significant symptoms. Four of these nine patients suspected lupine by history. Two other patients with a positive history to lupine declined from challenges. In these patients, a 3-day dietary record showed that they could consume lupine without symptoms. Specific IgE in the serum was positive for L. angustifolius, peanut and soy in all nine patients. Conclusion These results demonstrate that clinical lupine allergy is very uncommon, even in the presence of sensitization to lupine flour. The estimated prevalence of lupine allergy, among patients with a suspected food allergy, referred to a tertiary allergy centre in the Netherlands is 0.27–0.81%. In most, although not all cases, sensitization is not clinically relevant and is most likely caused by cross-sensitization to peanut. In selected cases, eliciting doses are low, making significant reactions possible. Cite this as: N. W. de Jong, M. S. van Maaren, B. J. Vlieg-Boersta, A. E. J. Dubois, H. de Groot and R. Gerth van Wijk, Clinical & Experimental Allergy, 2010 (40) 1571–1577. AU - de Jong NW AU - van Maaren MS AU - Vlieg-Boersta BJ AU - Dubois AEJ AU - de Groot H AU - van Wijk RG LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 36 IP - DP - 2010 Jan 01 TI - Factors influencing duration of exposure with symptoms and costs of occupational asthma PG - 728-734 AB - The most important factor for the prognosis of occupational asthma is the length of exposure with symptoms prior to removal from exposure. We wanted to identify factors, including socioeconomic status, that can influence the delay in submitting a claim to a medicolegal agency after the onset of asthmatic symptoms, and to confirm that this delay is associated with worse respiratory prognosis and higher direct costs. This is a cross-sectional study of subjects who claimed compensation for occupational asthma at the Workers' Compensation Board of Quebec, Canada. Data were collected at re-evaluation ~2.5 yrs after diagnosis. Information on the number of years with symptoms and removal from exposure was obtained from the medicolegal file. 60 subjects were included in the study. Being older, having a revenue of >30,000 Canadian dollars and having occupational asthma due to high molecular weight agents were all positively associated with the number of years of exposure with symptoms before removal from exposure. Subjects with persistent airway hyperresponsiveness at follow-up had a higher number of years with symptoms. Experiencing symptoms in the workplace for <1 yr generated lower direct costs. These findings might help in surveillance programmes that could be preferentially targeted for these subgroups of workers. AU - Miedinger D AU - Malo J-L AU - Ghezzo H AU - LArchevêque J AU - Zunzunegui M-V LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 36 IP - DP - 2010 Jan 01 TI - Application of a prediction model for work-related sensitisation in bakery workers PG - 735-742 AB - Identification of work-related allergy, particularly work-related asthma, in a (nationwide) medical surveillance programme among bakery workers requires an effective and efficient strategy. Bakers at high risk of having work-related allergy were indentified by use of a questionnaire-based prediction model for work-related sensitisation. The questionnaire was applied among 5,325 participating bakers. Sequential diagnostic investigations were performed only in those with an elevated risk. Performance of the model was evaluated in 674 randomly selected bakers who participated in the medical surveillance programme and the validation study. Clinical investigations were evaluated in the first 73 bakers referred at high risk. Overall 90% of bakers at risk of having asthma could be identified. Individuals at low risk showed 0.3–3.8% work-related respiratory symptoms, medication use or absenteeism. Predicting flour sensitisation by a simple questionnaire and score chart seems more effective at detecting work-related allergy than serology testing followed by clinical investigation in all immunoglobulin E class II-positive individuals. This prediction based stratification procedure appeared effective in detecting work-related allergy among bakers and can accurately be used for periodic examination, especially in small enterprises where delivery of adequate care is difficult. This approach may contribute to cost reduction. AU - Meijer E AU - Suarthana E AU - Rooijackers J AU - Grobbee DE AU - Jacobs JH AU - Meijster T AU - de Monchy JGR AU - van Otterloo E AU - van Rooy FGBGJ AU - Spithoven JJG AU - Zaat VAC AU - Heederik DJJ LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 36 IP - DP - 2010 Jan 01 TI - The occupational contribution to severe exacerbation of asthma PG - 743-750 AB - The goal of this study was to identify occupational risk factors for severe exacerbation of asthma and estimate the extent to which occupation contributes to these events. The 966 participants were working adults with current asthma who participated in the follow-up phase of the European Community Respiratory Health Survey. Severe exacerbation of asthma was defined as self-reported unplanned care for asthma in the past 12 months. Occupations held in the same period were combined with a general population job-exposure matrix to assess occupational exposures. 74 participants reported having had at least one severe exacerbation event, for a 1-yr cumulative incidence of 7.7%. From regression models that controlled for confounders, the relative risk (RR) was statistically significant for low (RR 1.7, 95% CI 1.1–2.6) and high (RR 3.6, 95% CI 2.2–5.8) biological dust exposure, high mineral dust exposure (RR 1.8, 95% CI 1.02–3.2), and high gas and fumes exposure (RR 2.5, 95% CI 1.2–5.5). The summary category of high dust, gas, or fumes exposure had RR 3.1 (95% CI 1.9–5.1). Based on this RR, the population attributable risk was 14.7% among workers with current asthma. These results suggest occupation contributes to approximately one in seven cases of severe exacerbation of asthma in a working population, and various agents play a role. AU - Henneberger PK AU - Mirabelli MC AU - Kogevinas M AU - Antó JM AU - Plana E AU - Dahlman-Höglund A AU - Jarvis DL AU - Kromhout H AU - Lillienberg L AU - Norbäck D AU - Olivieri M AU - Radon K AU - Torén K AU - Urrutia I AU - Villani S AU - Zock JP LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 67 IP - DP - 2010 Jan 01 TI - Occupational asthma and allergy in snow crab processing in Newfoundland and Labrador PG - 17-23 AB - Background: Risk factors and prevalence of occupational asthma (OA) and occupational allergy (OAl) in the snow crab-processing industry have been poorly studied. Objective: To estimate the prevalence of OA and OAl in snow crab-processing workers and determine their relationship with exposure to snow crab allergens and other potential risk factors. Methods: A total of 215 workers (120 female/95 male) were recruited from four plants in Newfoundland and Labrador, Canada in 2001–2002. Results from questionnaires, skin-prick tests to snow crab meat and cooking water, specific IgEs against the latter, spirometry and peak flow monitoring were used to develop a diagnostic algorithm. An index based on work history and exposure measurements of snow crab aeroallergens was developed to estimate the cumulative exposure for each worker. Results: The prevalences of almost certain or highly probable OA and OAl were 15.8% and 14.9%, respectively. A high cumulative exposure to crab allergens, in jobs mostly held by women, was associated with OA (odds ratio (OR)?=?14.0, 95% CI 3.0 to 65.8) (highest vs lowest Cumulative Exposure Index) and with OAl (OR?=?7.1, 95% CI 1.9 to 29.0); job held when symptoms started (cleaning, packing, freezing) also predicted OA (OR?=?3.9, 95% CI 1.6 to 8.7) and OAl (OR?=?3.2, 95% CI 1.4 to 7.5). Atopy (OR?=?2.8, 95% CI 1.2 to 6.8), female gender (OR?=?10.7, 95% CI 3.6 to 32.1) and smoking were significant determinants for OA (OR?=?3.1, 95% CI 1.3 to 7.4). Conclusions: The prevalences of OA and OAl are high in snow crab-processing workers of Canada’s East Coast. Cumulative exposure to snow crab allergens was related to the prevalences of OA and OAl in a dose–response manner taking into account atopy, gender and smoking. AU - Gautrin D AU - Cartier A AU - Howse D AU - Horth-Susin L AU - Jong M AU - Swanson M AU - Lehrer S AU - Fox G AU - Neis B LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 35 IP - DP - 2010 Jan 01 TI - ERS position paper: work-related respiratory diseases in the EU PG - 234-238 AB - According to a 2000 estimate based on workforce data and the CAREX (Carcinogen Exposure) database there were 386,000 deaths worldwide due to non-cancer respiratory diseases (asthma: 38,000; chronic obstructive pulmonary disease (COPD): 318,000; pneumoconioses: 30,000) and nearly 6.6 million disability-adjusted life years (DALYs) (asthma: 1,621,000; COPD: 3,733,000; pneumoconioses: 1,288,000) attributable to occupational exposure to airborne particulates. The same figures for Europe were 52,700 deaths (asthma: 6,200; COPD: 39,300; pneumoconioses: 7,200) and 868,000 DALYs (asthma: 139,000; COPD: 468,000; pneumoconioses: 261,000). Respiratory diseases rank as the third most prevalent occupational disease category (after ergonomic and stress-related diseases) according to a survey of occupational diseases in the European Union (EU). The prevalence of respiratory diseases was 296 per 100,000 population, with the highest proportion found in the mining industry. This amounts to almost 600,000 persons in the former 15 member states. Many of these diseases, though induced while working, are chronic, thus explaining the highest prevalence among older workers (0.5% aged 55–64 yrs). Traditional high-risk occupations, such as mining, farming, manufacturing and service work (e.g. hairdressers), are among the professions with a high prevalence of occupational lung diseases. However, high rates of occupational lung disease are also seen in newer professions, such as public administration, education and occupational cleaning; the latter could be a reflection of problems related to new cleaning procedures, as found by the European Community Respiratory Health Survey (ECRHS), or to problems with indoor air in public spaces. The pneumoconioses induced by exposure to mineral and other dusts at high concentrations were the dominating occupational lung diseases in the early industrialisation era. Their prevalence has been decreasing during the past decades. At the same time the obstructive lung diseases have gained increased importance, first because these diseases are widespread in the population, hence even small occupational contributions are important for society, and secondly because smoking has become less common during the same period, thereby revealing the "true" burden of occupational exposures, especially on COPD. Although mining and quarrying are decreasing in industrially advanced countries, new technologies have introduced known exposures to new groups of workers. One example of this is the recurrence of silicotic lesions in construction workers, shown to coincide with the new technique of hand-held high-speed tools now in common use on construction sites. These new tools are a challenge to us all, since they introduce a potential dangerous exposure to groups of workers unaware of the associated risk. For malignant diseases we are facing an epidemic of malignant mesothelioma caused by the intensive use of asbestos up to the late 1980s. The number of annual cases is predicted to increase steadily until 2020 in the old member states, and perhaps even later in the new member states 5. AU - Sigsgaard T AU - Nowak D AU - Annesi-Maesano I AU - Nemery B AU - Torén K AU - Viegi G AU - Radon K AU - Burge S AU - Heederik D LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 60 IP - DP - 2010 Jan 01 TI - Further validation of computer-based prediction of chemical asthma hazard PG - 115-120 AB - Background There is no agreed protocol for the prediction of low molecular weight (LMW) respiratory sensitizers. This creates challenges for occupational physicians responsible for the health of workforces using novel chemicals and respiratory physicians investigating cases of occupational asthma caused by novel asthmagens. Aims To iterate the external validation of a previously published quantitative structure–activity relationship (QSAR) model for the prediction of novel chemical respiratory sensitizers and to better characterize its predictive accuracy. Methods An external validation set of control chemicals was identified from the Australian Hazardous Substances Information System. An external validation set of asthmagenic chemicals was identified by a thorough search of the peer-reviewed literature from January 1995 onwards using the Medline database. The QSAR model was used to determine an ‘asthma hazard index’ (between 0 and 1) for each chemical. Results A total of 28 external validation asthmagens and 129 control chemicals were identified. The area under the receiver operating characteristic (ROC) curve for the model's ability to distinguish asthmagens from controls was 0.87 (95% CI 0.76–0.97). Using a cut-off hazard index of 0.5 resulted in sensitivity of 79% and specificity of 93%. For prior probability ranging from 1:300 to 1:100, the negative predictive value (NPV) was 1 and positive predictive value (PPV) 0.04–0.1 while for prior probability ranging from 1:20 to 1:3, the NPV was 0.91–0.99 and PPV 0.39–0.85. Conclusions The ROC curve for this QSAR demonstrates good global predictive power for distinguishing asthmagenic from non-asthmagenic LMW organic compounds. Potential for utilization by occupational and respiratory physicians is evident from its predictive values. AU - Seed M AU - Agius R LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 60 IP - DP - 2010 Jan 01 TI - Long-term respiratory symptoms in World Trade Center responders PG - 145-151 AB - Background New York State (NYS) employees who responded to the World Trade Center (WTC) disaster on or after 11 September 2001 potentially experienced exposures that might have caused persistent respiratory effects. NYS responders represent a more moderately exposed population than typical first responders. Aims To assess whether NYS employees who were WTC responders were more likely than controls to report lower respiratory symptoms (LRS) or a diagnosis of asthma 5 years post-9/11. Persistence and severity of symptoms were also evaluated. Methods Participants were initially mailed self-administered questionnaires (initial, Year 1, Year 2) and then completed a telephone interview in Year 3. Data were analysed using Poisson's regression models. Results WTC exposure was associated with LRS, including cough symptoms suggestive of chronic bronchitis, 5 years post-9/11. When exposure was characterized using an exposure assessment method, the magnitude of effect was greater in those with exposure scores above the mean. WTC exposure was associated with persistence of LRS over the 3 year study period. Results also suggest that participants with the highest exposures were more likely to experience increased severity of their asthma condition and/or LRS. Conclusions Our findings suggest that even in a moderately exposed responder population, lower respiratory effects were a persistent problem 5 years post-9/11, indicating that some WTC responders require ongoing monitoring. AU - Mauer MP AU - Cummings KR AU - Hoen R LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 140 IP - DP - 2010 Jan 01 TI - Recent developments in occupational asthma PG - 128-132 AB - Occupational exposures now account for 20% of adult onset asthma. Overall incidence has not declined, but recognition of the problem and substitutions have resulted in dramatic reductions in some causes of occupational asthma, particularly latex and glutaraldehyde in healthcare workers. Newer at risk workers include cleaners and those exposed to metal-working fluid. Standards of care have now been published, supported by evidence-based reviews of the literature, which are likely to require referral to centres specialising in occupational asthma for compliance. The spectrum of occupational asthma is expanding, with low-dose irritant mechanisms likely to account for some occupational asthma with latency. Eosinophilic and non-eosinophilic phenotypes are also seen, the non-eosinophilic variant having more normal non-specific responsiveness than the eosinophilic subgroup. Physiological confirmation of occupational asthma is required but remains challenging. Specific challenges may be negative in workers confirmed as having occupational asthma from workplace challenges. Serial measurements of peak expiratory flow or FEV1 are feasible in the occupational health and general respiratory clinic settings and provide a method of validation of occupational asthma in those without ready access to specific challenge testing, while minimum data quantity standards are now established which need to be achieved for optimal sensitivity/specificity. New developments in the analysis of serial measurements of peak expiratory flow comparing the mean hourly values on work and rest days have shown good specificity and sensitivity from shorter records (but more frequent readings) than needed for the standard Oasys score. AU - Burge PS LA - PT - DEP - TA - Swiss Medical Weekly JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - Noninvasive methods for assessment of airway inflammation in occupational settings PG - 445-458 AB - The present document is a consensus statement reached by a panel of experts on noninvasive methods for assessment of airway inflammation in the investigation of occupational respiratory diseases, such as occupational rhinitis, occupational asthma, and nonasthmatic eosinophilic bronchitis. Both the upper and the lower airway inflammation have been reviewed and appraised reinforcing the concept of 'united airway disease' in the occupational settings. The most widely used noninvasive methods to assess bronchial inflammation are covered: induced sputum, fractional exhaled nitric oxide (FeNO) concentration, and exhaled breath condensate. Nasal inflammation may be assessed by noninvasive approaches such as nasal cytology and nasal lavage, which provide information on different aspects of inflammatory processes (cellular vs mediators). Key messages and suggestions on the use of noninvasive methods for assessment of airway inflammation in the investigation and diagnosis of occupational airway diseases are issued. AU - Quirce S AU - Lemière C AU - de Blay F AU - del Pozo V AU - Gerth Van Wijk R AU - Maestrelli P AU - Pauli G AU - Pignatti P AU - Raulf-Heimsoth M AU - Sastre J AU - Storaas T AU - Moscato G. G LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - A meta-analysis on wood dust exposure and risk of asthma PG - 467-473 AB - Work-related asthma is the most common occupational respiratory disorder in the industrialized countries. It has been postulated that wood dust exposure may increase the risk of work-related asthma. The objective of this study was to assess, through a meta-analysis, the risk of developing work-related asthma associated with wood dust exposure. A systematic search of the literature was performed. Inclusion and exclusion criteria were applied and a quality scale used to measure the quality of the included studies was developed. Using standard meta-analysis techniques, studies were pooled using both random and fixed effects models. Nineteen studies were included which consisted of three cohort studies, twelve case–control studies and four mortality studies. The pooled relative risk (RR) of asthma among workers exposed to wood dust was 1.53 (95% CI 1.25–1.87). When the analysis was restricted to studies carried out on Caucasian populations, the pooled RR was 1.59 (95% CI 1.26–2.00) while the pooled RR of studies on Asian populations was 1.15 (95% CI 0.92–1.44). Wood workers present a higher risk of asthma. Future research should include careful evaluation of ethnicity and nativity as risk modifiers. AU - Pérez-Ríos M AU - Ruano-Ravina A AU - Etminan M AU - Takkouche B. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 1 IP - DP - 2010 Jan 01 TI - A Systematic Review of Serial Peak Expiratory Flow Measurements in the Diagnosis of Occupational Asthma PG - 31-44 AB - This paper systematically reviews literature on the application of serial peak expiratory flow (PEF) measurements in the diagnosis of occupational asthma and calculates summary estimates of the sensitivity, specificity and feasibility of serial PEFs. Methods Papers were searched for on the Medline database via the PubMed website (http://www.ncbi.nlm.nih.gov/sites/entrez) and on the Birmingham Chest Clinic departmental website (www.occupationalasthma.com) from 2004 until April 2009 using the search terms “Peak flow AND occupational asthma” and “Peak flow AND work related asthma”. Abstracts were screened to select those justifying a full paper review. Papers used in the British Occupational Health Research Foundation (BOHRF) guidelines (current until June 2004) were also reviewed. Case studies and narrative reviews were excluded. Type of analysis, quality of paper, sensitivity and specificity of serial PEFs compared to reference tests and return rates were documented. Results were pooled from all studies to produce overall estimates. Results A total of 80 abstracts were reviewed, leading to 23 full papers for further review plus 15 papers from the 2004 BOHRF review. 7 papers were excluded (mostly for duplicate data) leaving 31 papers for inclusion. The pooled sensitivity of serial PEF fulfilling minimum data quantity requirements for a diagnosis of occupational asthma was 82% (95% CI 76-90) and the pooled specificity 88% (95% CI 80-95). Return rates were similar between PEFs requested through workplace studies (85%) and those requested in a clinical setting (78%) with 61% being interpretable for a diagnosis of occupational asthma from either setting. Conclusion Based on a systematic literature search, serial PEF measurement is a feasible, sensitive and specific test for the diagnosis of occupational asthma, when potential sources of error are understood. AU - Moore VC AU - Jaakkola MS AU - Burge PS LA - PT - DEP - TA - Annals of Respiratory Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - Cross-reactive carbohydrate determinants in diagnostics of occupational allergy – preliminary results PG - 664-665 AB - Detection of CCDs is not helpful in differentiation diagnostics of occupational and not occupational allergy. Study of bakers, farmers, carpenters and health-care workers. AU - Wiszniewska M AU - Zgorzelska-Kowalik J AU - Nowakowska-wirta E AU - Palczynski C AU - Walusiak-Skorupa J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - Symptoms after mould exposure including Stachybotrys chartarum, and comparison with darkroom disease PG - 245-255 AB - Background: Mould-attributed symptoms have included features which overlap with unexplained syndromes such as sick building syndrome. Objectives: We describe questionnaire and chart review findings in patients following exposure to moulds which include Stachybotrys and compare responses with two control groups. Methods: Thirty-two patients presented with symptoms attributed to mould exposures. Exposure identification for 25 patients had reported S tachybotrys chartarum as well as other mould (Aspergillus, Penicillium), 88% at work. The remaining seven had professionally visualized or self-reported/photographic exposure evidence only. A chart review was performed and a follow-up with a questionnaire, including questions on current health status, and nonspecific symptoms. Results: Cough, shortness of breath and chest tightness (at presentation) were reported in 79%, 70% and 64%, respectively, and persisted >6 weeks in 91%. Skin test(s) were positive to fungal extract(s) in 30%. Seventeen returned questionnaires were obtained 3.1 (SD 0.5) years after the initial clinic assessment. Among this subgroup, persisting asthma-like symptoms and symptoms suggestive of sick building syndrome were frequent, and similar to a group previously assessed for darkroom disease among medical radiation technologists. The mould-exposed group more commonly reported they were bothered when walking in a room with carpets, complained of a chemical or metallic taste in their mouth, and had problems in concentration when compared with a control physiotherapist group (P < 0.005). Conclusions: Although only a minority with health concerns from indoor mould exposure had demonstrable mould-allergy, a significant proportion had asthma-like symptoms. Other symptoms were also common and persistent after the initial implicated exposure. AU - Al-Ahmad M AU - Manno M AU - Ng V AU - Ribeiro M AU - Liss GM AU - Tarlo SM LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - Effects of chlorine and exercise on the unified airway in adolescent elite Scottish swimmers PG - 269-273 AB - Background: Chlorine metabolites and high training load may produce exercise-induced bronchospasm (EIB) in elite swimmers. The aim of this study was to assess the combined effects of chlorine and exercise on the unified airway of adolescent elite swimmers. Methods: The Scottish Midlands District squad were assessed during an indoor pool session at the National Swimming Academy. Athletes trained at least 8 h per week. Subjects underwent tidal (TNO) and nasal (NNO) exhaled NO and peak nasal inspiratory flow (PNIF) pre and post a 2 h session. A physiological exercise challenge assessed EIB in n = 36 swimmers (>10% fall in forced expiratory volume in 1 s (FEV1)). Results: Combined and free chlorine levels (mg/l) were 1.66 and 0.3 respectively. n = 36 swimmers (mean age 13.3 years) were assessed: n = 8 (22%) had known asthma; n = 13 (36%) had a positive physiological challenge; 18 (50%) complained of symptoms suggestive of EIB. n = 10/28 (36%) who did not have asthma were found to have a positive exercise challenge. There was no significant association between reported exercise symptoms and positive exercise test. There was no significant change in TNO or NNO for pre vs postexposure, irrespective of asthma diagnosis or AHR. n = 15 (42%) swimmers complained of worsening nasal symptoms postexposure, but only n = 7 (14%) had a demonstrable fall in PNIF (mean 33 l/min). No significant association was found between PNIF and symptoms. Conclusions: Combined exposure to chlorine and exercise did not affect surrogate markers of inflammation in the unified airway. There was a high prevalence of undiagnosed EIB. AU - Clearie KL AU - Vaidyanathan S AU - Williamson PA AU - Goudie A AU - Short P AU - Schembri Lipworth SBJ LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 60 IP - DP - 2010 Jan 01 TI - Quality of life in health care workers with latex allergy PG - 62-65 AB - Background Exposure to latex gloves and glove powder makes health care workers (HCWs) particularly susceptible to developing an allergy to latex. Aims To assess the impact on the quality of life (QOL) of HCWs who are allergic to latex products before removal from latex exposure and after removal from exposure. Methods We studied 39 latex allergic HCWs from the Health & Safety Executive south area. Twenty-nine attended for an assessment with the occupational physician and were asked to fill out a questionnaire. Spirometry, immunoglobulin E levels and latex radioallergosorbent test levels were measured. Results In total, 29/39 (74%) of patients responded. All of the participants had a type 1 allergy to latex. All individuals reported a significant improvement of symptoms once latex was removed from their working environment. Of those that reported skin complaints, 83% reported that their skin no longer had an impact on their QOL once latex was removed. Over 90% (n = 26) of all participants stated that their eye/nose symptoms had no longer an impact on their QOL and 86% (n = 25) of all participants stated that their respiratory symptoms had no impact on their QOL following the removal of latex from their working environment. Overall, 45% of the respondents had changed jobs: 61% of this group changed to a completely nonclinical post. Conclusions On average, 86% of latex allergic HCWs reported that their QOL had improved significantly since their removal from latex. In employees who are latex allergic/sensitized, taking latex avoidance measures results in cessation or diminution of symptoms. AU - Power S AU - Gallagher J AU - Meaney S LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 67 IP - DP - 2010 Jan 01 TI - Early changes in respiratory health in trades' apprentices and physician visits for respiratory illnesses later in life PG - 237-243 AB - Objectives An inception cohort of trades' apprentices had rapid declines in lung function (forced expiratory volume in 1 s (FEV1)) and rapid increases in bronchial responsiveness (?BR) over the first 2 years of employment. We used physician visit data to assess respiratory health over the following 13 years. Methods Construction painter, electrician, insulator and machinist apprentices beginning at a British Columbia trade school in 1988 were invited to participate and were followed up 2 years later. Subjects were linked to provincial medical databases to examine physician visits for asthma and other respiratory illnesses for the 13 years following. Multivariable models with rapid decline in FEV1 and rapid increase in BR from years 1 to 3 were constructed. Respiratory symptoms were also examined as predictors of visit rates and meeting a case definition (for asthma or other respiratory illness). Results The cohort included 281 apprentices (97% are men). Sixteen subjects met the asthma case definition (=2 visits coded as asthma in 1 year) and 20 met the other respiratory illness case definition (=3 visits for bronchitis, emphysema, respiratory symptoms in 1 year). In models controlling for demographic factors and smoking, subjects with bronchitis symptoms at baseline were more likely to develop other respiratory illness during follow-up (RR 4.4, 95% CI 1.6 to 11.9). Apprentices who developed asthma symptoms over the first 2 years were approximately six times more likely to become asthma cases (95% CI 1.9 to 18.8). Those with a rapid increase in BR were at increased risk of becoming asthma cases (RR 5.5, 95% CI 1.9 to 16.1), as well as having higher asthma visit rates (RR 6.5). Subjects with rapid decline in FEV1 were 3.2 times more likely to become asthma cases (95% CI 0.8 to 12.1). Conclusions Changes in respiratory health early in adulthood, especially increased BR, are associated with respiratory physician visits. These findings are important for workplace screening and prevention and also suggest that physician visit databases are promising research tools in respiratory epidemiology. AU - Peters CE AU - Demers PA AU - Sehmer J AU - Karlen B AU - Kennedy SM LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 104 IP - DP - 2010 Jan 01 TI - Two variants of occupational asthma separable by exhaled breath nitric oxide level PG - 873-879 AB - Exhaled nitric oxide (FE(NO)) has been used as a marker of asthmatic inflammation in non-occupational asthma, but some asthmatics have a normal FE(NO). In this study we investigated whether, normal FE(NO) variants have less reactivity in methacholine challenge and smaller peak expiratory flow (PEF) responses than high FE(NO) variants in a group of occupational asthmatics. METHODS: We measured FE(NO) and PD(20) in methacholine challenge in 60 workers currently exposed to occupational agents, who were referred consecutively to a specialist occupational lung disease clinic and whose serial PEF records confirmed occupational asthma. Bronchial responsiveness (PD(20) in methacholine challenge) and the degree of PEF change to occupational exposures, (measured by calculating diurnal variation and the area between curves score of the serial PEF record in Oasys), were compared between those with normal and raised FE(NO). Potential confounding factors such as smoking, atopy and inhaled corticosteroid use were adjusted for. RESULTS: There was a significant correlation between FE(NO) and bronchial hyper-responsiveness in methacholine challenge (p = 0.011), after controlling for confounders. Reactivity to methacholine was significantly lower in the normal FE(NO) group compared to the raised FE(NO) group (p = 0.035). The two FE(NO) variants did not differ significantly according to the causal agent, the magnitude of the response in PEF to the asthmagen at work, or diurnal variation. CONCLUSIONS: Occupational asthma patients present as two different variants based on FE(NO). The group with normal FE(NO) have less reactivity in methacholine challenge, while the PEF changes in relation to work are similar. AU - Moore VC AU - Anees W AU - Jaakkola MS AU - Burge CB AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 60 IP - DP - 2010 Jan 01 TI - Cobalt asthma — a case series from a cobalt plant PG - 301-306 AB - Background Cobalt has been shown to induce mainly asthma, allergic contact dermatitis and hard metal disease. The data on cobalt asthma are mainly based on case reports. Aims To characterize all the cases of occupational cobalt asthma encountered in a cobalt plant at the time of diagnosis and 6 months later. We also evaluated the incidence of cobalt asthma in different departments on the basis of data on occupational exposures. Methods We identified cases of cobalt asthma confirmed with specific bronchial challenge tests in the Kokkola cobalt plant in Finland where exposure levels have been regularly monitored. Results Between 1967 and 2003, a total of 22 cases of cobalt asthma were diagnosed in the cobalt plant. On challenge tests, mostly late or dual asthmatic reactions were observed. The incidence of cobalt asthma was the highest in the departments with the highest cobalt exposure levels. All cases of cobalt asthma were encountered in departments where irritant gases were present in the ambient air in addition to cobalt. At the time of the follow-up examination 6 months later, non-specific hyperreactivity had mostly remained at the same level or increased. Conclusions The incidence of cobalt asthma correlated with the exposure levels of cobalt in corresponding departments. An irritating effect of gaseous compounds may enhance the risk of cobalt asthma and even the smallest amounts of cobalt may be harmful to susceptible workers. Symptoms of asthma may continue despite the fact that occupational exposure to cobalt has ceased. AU - Sauni R AU - Linna A AU - Oksa P AU - Nordman H AU - Tuppurainen M AU - Uitti J LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - Maize starch should be considered as a potential occupational allergen in tablet manufacturing. PG - 630-631 AB - Case report of 19 year old pharmaceutical apprentice making asprin, nifedipine, ciprofloxacin and moxifloxicin using maize starch as binder. Negative prick test to standard maize antigens, positive to asprin tablet mixture but negative to ASA and positive to maize bran extract. methacholine 4mg/ml. Nasal provocation with maize bran (method unspecified), gave immediate reaction. Western blot with maize flour showed 50 kda band, possibly matching maize endosperm AU - Maniu C-M AU - Faupel U AU - Siebenhaar G AU - Hunzelmann N LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - Usefulness of basophil activation test in diagnosis of occupational nonasthmatic eosinophilic bronchitis PG - 627-629 AB - eosinophilic bronchitis, baker, case report, workplace challenge, bronchial provocation test negative, skin prick tests negative, Storage mite basophil activation test positive AU - Pala G AU - Pignatti P AU - Perfetti L AU - Caminati M AU - Gentile E AU - Moscato G LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 67 IP - DP - 2010 Jan 01 TI - Agreement in diagnosing occupational asthma by occupational and respiratory physicians who report to surveillance schemes for work-related ill-health PG - 471-478 AB - Objectives To assess diagnostic agreement for occupational asthma, and to identify case and rater characteristics associated with this diagnosis. Methods Summaries of possible occupational asthma cases were sent to 104 occupational and respiratory physicians. Raters assigned likelihood scores (0–100%) of occupational asthma based on case histories (phase 1), and on histories plus investigative procedures (phase 2). Interclass correlation coefficients were calculated as statistical measures of reliability for occupational asthma scores. Comparisons between mean scores were assessed for statistical significance using tests based on multilevel models. RRs were calculated to summarise effects of raters' demographics, and of supplying investigative procedures information. Results Occupational asthma scores showed limited agreement within each group of (occupational or respiratory) physicians, but scores were not systematically different. The difference between mean overall scores was 2.1% (52.1% occupational physicians; 50.0% respiratory physicians) in phase 1 (95% CI -2.6 to 6.8, p=0.37). In phase 2, mean overall scores were 46.1% (occupational physicians) and 41.5% (respiratory physicians); the difference in mean overall scores was 4.6% (95% CI -3.5 to 12.5, p=0.27). Raters with General Medical Council registration =1986 were more likely to give a positive occupational asthma diagnosis. In phase 2, male raters were more likely to label cases as occupational asthma than female raters (RR 4.5, 95% CI 3.3 to 6.0). Conclusions The RR of a positive occupational asthma diagnosis was unaffected by clinical speciality. Further work on why physicians consider cases to be occupational asthma will assist better diagnosis and prevention of this disease. AU - Turner S AU - McNamee R AU - Roberts C AU - Bradshaw L AU - Curran A AU - Francis M AU - Fishwick D AU - Agius R LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 36 IP - DP - 2010 Jan 01 TI - Infant swimming in chlorinated pools and the risks of bronchiolitis, asthma and allergy PG - 41-47 AB - Recent studies suggest that swimming in chlorinated pools during infancy may increase the risks of lower respiratory tract infection. The aim of the present study was to assess the influence of swimming in chlorinated pools on the risks of bronchiolitis and its late consequences. A total of 430 children (47% female; mean age 5.7 yrs) in 30 kindergartens were examined. Parents completed a questionnaire regarding the child’s health history, swimming practice and potential confounders. Attendance at indoor or outdoor chlorinated pools ever before the age of 2 yrs was associated with an increased risk of bronchiolitis (OR 1.68; 95% CI 1.08–2.68; p = 0.03), which was exposure-dependent for both types of pool (p-value for trend <0.01). Associations persisted, and were even strengthened, by the exclusion of other risk factors. Among children with no parental antecedents of atopic disease or no day-care attendance, odds ratios for bronchiolitis amounted to 4.45 (1.82–10.9; p = 0.001) and 4.44 (1.88–10.5; p = 0.007) after >20 h spent in chlorinated pools during infancy. Infant swimmers who developed bronchiolitis also showed higher risks of asthma and respiratory allergies later in childhood. Swimming pool attendance during infancy is associated with a higher risk of bronchiolitis, with ensuing increased risks of asthma and allergic sensitisation. AU - Voisin C AU - Sardella A AU - Marcucci F AU - Bernard A LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 101 IP - DP - 2010 Jan 01 TI - Asthma induced by chloramine T in nurses: case report,skin prick test positive,challenge,case report, PG - 134-138 AB - BACKGROUND: Chloramine T is used in hospitals as a disinfectant and for sterilization of endoscopy instruments. OBJECTIVES: A case of a nurse suffering from asthma due to Chloramine T is presented in order to focus attention on this occupational disease. METHODS AND RESULTS: The patient (male, 43 years) had been a nurse since 1993, working in various departments and operating rooms where he was exposed to glutaraldehyde and Chloramine T to disinfect surgical and endoscopy instruments. In 2007 he noticed the beginning of asthmatic reactions after exposure to the disinfectant. Skin tests with common allergens gave positive reactions and a skin test with Chloramine T gave a positive result. An inhalation test with glutaraldehyde gave negative results for both asthma and rhinitis. During the inhalation test with Chloramine T 0.5%, a significant biphasic decrease in FEVI was observed. The score of subjective symptoms for rhinitis was negative, CONCLUSIONS: The case confirms the current difficulty in diagnosing occupational asthma due to Chloramine T in health care workers, which is due to the frequent presence of late reactions and to exposure to several respiratory allergens and irritants in the workplace. The specific inhalation challenge is thus confirmed as the gold standard for the diagnosis of asthma induced by Chloramine T and in occupational asthma in general. It may very well be that the frequency of occupational asthma due to sensitization to Chloramine T in nurses is underestimated. AU - Sartorelli P AU - Paolucci V AU - Rendo S AU - Romeo R AU - Murdaca F AU - Mariano A LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 67 IP - DP - 2010 Jan 01 TI - Occupational asthma caused by the predatory beneficial mites Amblyseius californicus and Amblyseius cucumeris,gardener,case report. PG - 287 AB - The increasing awareness of problems with chemical pesticides used in greenhouses has led to a widespread use of biological control measures such as beneficial arthropods and microbiological pesticides. However, exposure to microbiological pesticides may confer a risk of immunoglobulin E-mediated sensitization.1 In a study by Baelum et al including 456 greenhouse workers, skin rash, nose and eye symptoms were seen in persons developing sensitization towards beneficial predatory mites during the 3-year study period and Groenewoud et al found a prevalence of 23% of sensitization to Amblyseius cucumeris in a cross-sectional study of 472 Dutch greenhouse workers.2 3 The predatory beneficial mites A cucumeris and Amblyseius californicus is known to cause sensitization and allergic symptoms from the skin, nose and eyes, but so far no case of occupational asthma caused by these predatory mites has been reported. A 34-year-old male gardener, a non-smoker, was referred to our Department of Occupational and Environmental Health. The previous 10 years, he had been working in a tomato and green pepper nursery. During October to December each year, he was removing plants and cleaning up in all the greenhouses, including the sweet bell pepper greenhouses, and from January to September, he worked in the tomato nursery. A californicus was used as a biological control measure in the tomato nursery in 2003 and 2004 and A cucumeris in 2003 to 2007 in the neighboring sweet bell pepper greenhouses. During the past few years before referral, he had recurrent episodes of rash on the hands, wrists and face and symptoms of rhinitis and conjunctivitis with relief of symptoms on days off work. At the beginning of a new tomato season, he developed respiratory symptoms with wheezing and coughing. He was reported sick by his general practitioner and treated with antihistamines and a short-acting ß2-agonist, which relieved his symptoms completely. After his sick leave he returned to work but had to leave the tomato greenhouse after 1.5 h of work because of severe respiratory distress. He was seen by his general practitioner who found him severely asthmatic with a pronounced drop in lung function and with a flushing of the face and neck. The patient also complained of itchy and runny eyes. The patient was reported sick again and referred to our Department of Occupational and Environmental Medicine. On admission he was free of symptoms and free of medication because his symptoms had resolved completely during his sick leave. At the allergy centre, the following tests were performed: (1) Skin prick test (birch, timothy, Artimisia, horse, dog, cat, Alternaria, Cladosporium, Dermatophagoides farinae, tomato plants (Sendrico and Aromata), latex and material from the tomato nursery (fresh tomato plants stem and leaf), withered tomato plant (plum tomato), red and green plum tomato and cocktail tomato); (2) histamine release test (HRT) for fresh tomato plant and flower, cultivation material, withered tomato plant, tomato stem and leaf, plum tomato, cocktail tomato and dust from tomato nursery. (3) immune-specific immunoglobulin E (birch, timothy, Artemisia, Alternaria, Cladosporium, Dermatophagoides pteronyssinus and D farinae, tomato, Aspergillus niger and Cephalosporium acremonium); (4) patch test (European Standard Series, tomato, tomato leaf and stem, tomatoleoresin, latex and vinyl gloves). All tests were negative. A slight positive skin prick test reaction to D pteronyssinus was seen, but this reaction was not reproducible when the test was repeated. A challenge test was then performed where the patient was handling plant material from the tomato nursery in a plastic bowl. After 5 min of handling the plant material, the patient developed respiratory symptoms with a drop in forced expiratory volume in 1 s (FEV1) equivalent to 72% of the expected (FEV1=2.95). To test for sensitization to predatory beneficial mites, allergen preparation was made by extraction of the following species: Tetranychus urticae, Hypoaspis miles, A cucumeris and A californicus (for details on allergen preparation, see Baelum et al3). HRT (RefLab, Copenhagen, Denmark) revealed clear positive reaction (class V and VI) to A cucumeris and A californicus, respectively, and no reaction to T urticae or H miles. Skin prick testing revealed a positive reaction to A cucumeris but not to A californicus, T urticae or H miles. A nasal challenge with a mix of A cucumeris, A californicus, T urticae and H miles was performed resulting in a forceful clinical reaction including nasal blockage and respiratory distress. Lung auscultation revealed prolonged expiration, and lung function test showed a marked drop in FEV1 from 4.2 to 3.6 litres. The patient was treated with terbutaline inhaler, which restored lung function and resolved symptoms completely. HRT was repeated again with a marked positive reaction to A cucumeris and A californicus class V and VI respectively. Conclusion and policy implications This is the first report documenting occupational asthma caused by A cucumeris and A californicus and emphasizes the need for regulation, guidelines and preventive measures when handling these mites and mite-treated plants. Further studies are needed to evaluate antigen exposure and identification of workers at risk. AU - Skousgaard SG AU - Thisling T AU - Bindslev-Jensen C AU - Baelum J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 137 IP - DP - 2010 Jan 01 TI - Occupational asthma due to colistin in a pharmaceutical worker PG - 1200-1201 AB - To our knowledge, this is the first case report of a 24-year-old man working in a pharmaceutical company transporting and storing raw materials who developed occupational asthma (OA) to colistin. The specific inhalation challenge confirmed the diagnosis of OA to colistin. Specific IgE was not detected, because dot-blot analysis was negative at all colistin concentrations tested. To our knowledge, OA due to a peptide antibiotic has not previously been described. This antibiotic should be listed as a trigger of OA AU - Gomez-Olles S AU - Madrid-San MF AU - Cruz MJ AU - Munoz X LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 101 IP - DP - 2010 Jan 01 TI - Sequential sensitization to different occupational compounds in a young woman. PG - 49-54 AB - BACKGROUND: Very few authors have reported sensitization to two or more different occupational sensitizers in a single patient. OBJECTIVE: To describe a subject with occupational asthma caused by sensitization to two different agents, exposure to which occurred in dierent time periods. METHODS: We studied a young woman with asthma-like symptoms predominantly in relationship to a sequential occupational exposure, first to methylene diisocyanate (MDI) and later to flour dust. In the first and second periods of occupational exposure, the patient was subjected to metbacholine challenge test (MCT), sputum analysis, and specific challenge test (SCT). RESULTS: At the first observation, MCT (PD20FEV1: 0.109 mg) and SCT with MDI were positive and induced sputum analysis showed a high percentage of eosinophils (32%). The patient reduced exposure to MDI but symptoms worsened with continuing occupational exposure. After one year, she started another job exposed to flour dust. After four years, asthma symptoms persisted despite treatment with inhaled corticosteroids and bronchodilators, and bronchial byperreactivity and sputum eosinophbilia were still present (PD2OFEV1: 0.067 mg; sputum eosinophils: 5.3%). The patient also developed rhinitis symptoms associated with dermatitis. A SCT with flour dust showed an immediate response (deltaFEV1: 33%). The subject left work and a year later was still symptomatic:pulmonary function was within normal limits under regular therapy and induced sputum showed absence of eosinophilia. CONCLUSIONS: This was an unusual case of double sensitization to different occupational compounds to which the patient was exposed in different time periodsj suggesting the role of a pre-existing occupational aSthma in the development and/or worsening of sensitization to other occupational agents. AU - Talini D AU - Novelli F AU - Bacci E AU - de Santis M AU - Paggiaro PL LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 137 IP - DP - 2010 Jan 01 TI - Investigation of occupational asthma: sputum cell counts or exhaled nitric oxide?. PG - 617-622 AB - BACKGROUND The measure of sputum eosinophil counts is a useful tool in the investigation of occupational asthma (OA), but processing sputum is time consuming. Measuring the fractional concentration of exhaled nitric oxide (FENO) may be an alternative in clinical practice. The aim of this study was to assess the respective changes of sputum eosinophil counts and FENO following exposure to occupational agents in the routine practice of two tertiary centers in North America and Europe. METHODS Workers undergoing specific inhalation challenges (SICs) for possible OA in tertiary clinics in both Canada and Belgium were enrolled. Sputum cell counts and FENO were collected at the end of the control day and at 7 and 24 h after exposure to the offending agent. RESULTS Forty-one subjects had a negative SIC; 26 subjects had OA proven by a positive SIC. In subjects with positive SIC, there was a significant increase in sputum eosinophils at 7 h (9.0 [9.9]%) and 24 h (11.9 [14.9]%) after exposure compared with the baseline (2.8 [4.2]%), whereas there was a significant increase in FENO only 24 h after exposure (26.0 [30.5] ppb) compared with the baseline (16.6 [18.5] ppb). A 2.2% change in sputum eosinophil counts achieved a much higher sensitivity and positive predictive value than a 10-ppb change in FENO with similar specificity and negative predictive value for predicting a 20% decrease in FEV(1) during SICs. CONCLUSIONS Sputum eosinophil counts constitute a more reliable tool than FENO to discriminate positive and negative SICs. AU - Lemiere C AU - D'Alpaos V AU - Chaboillez S AU - Cesar M AU - Wattiez M AU - Chiry S AU - Vandenplas O LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - Matrix metalloproteinases, IL-8 and glutathione in the prognosis of workers exposed to chlorine PG - 722-730 AB - Background: Workers exposed to chlorine may be at risk of deterioration in FEV1. Methods: A prospective study of 72 workers examined over a 5.8 ± 1.9 year period. A sample of induced sputum for cells and mediators was obtained in 69 subjects at baseline (Vb) and in 36 both at Vb and at follow-up (Vf). Results: Sixty-four workers (89%) experienced at least one accidental inhalation of chlorine in the interval. The mean decrease in FEV1 was 30 ml/year and thus was within normal limits. Among the analysed remodelling markers, the level of the MMP-9-TIMP-1 complex, but not of free MMP-9 and TIMP-1, significantly diminished from Vb to Vf. We found significant correlations between neutrophils, IL-8, MMP-9 and MMP9-TIMP-1 complex at Vb and Vf. While levels of total glutathione, IL-8, MMP9, TIMP-1 and MMP9-TIMP-1 complex were highly correlated with each other at Vb, this was inconstant at Vf. Levels of MMP9-TIMP1 complex and of TIMP1 at Vf were significantly lower in workers reporting chlorine puffs with mild acute respiratory symptoms between visits compared to those who had no, or asymptomatic inhalations (P = 0.03 and 0.02, respectively). The fall in FEV1 from Vb to Vf was significantly correlated with levels of glutathione at Vb. Cough between visits was associated with a decrease in FEV1 (P = 0.06). Conclusion: Although no accelerated loss in FEV1 was documented in these workers exposed to chlorine, subjects with a greater fall in FEV1 were more likely to report cough and have higher levels of total glutathione at Vb. AU - Maghni K AU - Malo J-L AU - L'Archevêque J AU - Castellanos L AU - Gautrin D. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - Clinical and inflammatory features of occupational asthma caused by persulphate salts in comparison with asthma associated with occupational rhinitis PG - 784-790 AB - Background: The relationships between asthma and rhinitis are still a crucial point in respiratory allergy and have scarcely been analysed in occupational setting. We aimed to compare the clinical and inflammatory features of subjects with occupational asthma only (OA) to subjects with OA associated to occupational rhinitis (OAR) caused by persulphate salts. Methods: The clinical charts of 26 subjects diagnosed in our Unit as respiratory allergy caused by ammonium persulphate (AP), confirmed by specific inhalation challenge (SIC), were reviewed. Twenty-two out of twenty-six patients underwent pre-SIC-induced sputum challenge test (IS) and 24/26 underwent nasal secretion collection and processing. Results: Twelve out of twenty-six patients received a diagnosis of OA-only and 14/26 of OAR. Duration of exposure before diagnosis, latency period between the beginning of exposure and asthma symptom onset, basal FEV1, airway reactivity to methacholine and asthma severity did not differ in the two groups. Eosinophilic inflammation of upper and lower airways characterized both groups. Eosinophil percentage in IS tended to be higher in OAR [11.9 (5.575–13.925)%] than in OA-only [2.95 (0.225–12.5)%] (P = 0.31). Eosinophilia in nasal secretions was present both in subjects with OAR [55 (46–71)%] and in subjects with OA-only [38 (15–73.5)%], without any significant difference. Discussion: Our results indicate that OA because of ammonium persulphate coexists with occupational rhinitis in half of the patients. Unexpectedly, rhinitis did not seem to have an impact on the natural history of asthma. The finding of nasal inflammation in subjects with OA-only without clinical manifestations of rhinitis supports the united airway disease concept in occupational respiratory allergy as a result of persulphates AU - Moscato G AU - Pala G AU - Perfetti L AU - Frascaroli M AU - Pignatti P. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 40 IP - DP - 2010 Jan 01 TI - Pro/Con debate: is occupational asthma induced by isocyanates an immunoglobulin E-mediated disease? PG - 1155-1162 AB - Isocyanates, low-molecular weight chemicals essential to polyurethane production, are one of the most common causes of occupational asthma, yet the mechanisms by which exposure leads to disease remain unclear. While isocyanate asthma closely mirrors other Type I Immune Hypersensitivity (Allergic) disorders, one important characteristic of hypersensitivity ('allergen'-specific IgE) is reportedly absent in a large portion of affected individuals. This variation from common environmental asthma (which typically is induced by high-molecular weight allergens) is important for two reasons. (1) Allergen-specific IgE is an important mediator of many of the symptoms of bronchial hyper-reactivity in 'allergic asthma'. Lack of allergen-specific IgE in isocyanate hypersensitive individuals suggests differences in pathogenic mechanisms, with potentially unique targets for prevention and therapy. (2) Allergen-specific IgE forms the basis of the most commonly used diagnostic tests for hypersensitivity (skin prick and RAST). Without allergen-specific IgE, isocyanates may go unrecognized as the cause of asthma. In hypersensitive individuals, chronic exposure can lead to bronchial hyperreactivity that persists years after exposure ceases. Thus, the question of whether or not isocyanate asthma is an IgE-mediated disease, has important implications for disease screening/surveillance, diagnosis, treatment and prevention. The present Pro/Con Debate, addresses contemporary, controversial issues regarding IgE in isocyanate asthma. AU - Wisnewski AV AU - Jones M LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - Matrix metalloproteinases-7, -8, -9 and TIMP-1 in the follow-up of diisocyanate-induced asthma PG - 61-68 AB - Background: Diisocyanate-induced asthma (DIA) is known to be associated with poor prognosis. We wished to clarify if matrix metalloproteinases (MMP)-7, -8 or -9 or tissue inhibitor of matrix metalloproteinases (TIMP-1) are associated with the functional or inflammatory outcome in DIA patients. Methods: This is a longitudinal study where 17 patients with DIA diagnosed by a specific challenge test to diisocyanates were monitored. Exposure to diisocyanates was terminated seven (mean) months before the challenge test. The studies included spirometry, histamine challenge test and bronchoscopy. MMP-7, MMP-8, TIMP-1 [Enzyme-linked immunosorbent assay (ELISA)- and immunofluorometric assay-methods], MMP-9 (ELISA and zymography), interferon-gamma, tumour necrosis factor-alpha, interleukin-6, -8, -15, -17, CXCL-5/ENA-78, monocyte chemoattractant protein-1 and macrophage inhibitory factor (MIF) (ELISA) were assayed from bronchoalveolar lavage (BAL) fluid. Inhaled steroid therapy was initiated after the examinations, which were repeated at 6 months and at 3 years during the treatment. The results were compared with those of 15 healthy controls. Results: Inhaled steroid medication increased BAL levels of MMP-9 and MMP-9/TIMP-1 and decreased MMP-7 and MMP-7/TIMP-1. The increase in MMP-9 levels was associated with a decline in the TH-2 type inflammation. Conclusions: Our data suggest that reduced TH-2 type inflammation in DIA after inhaled steroid medication is reflected as elevated MMP-9 and MMP-9/TIMP-1 levels in BAL. MIF may be the inducer of MMP-9. This might point to some protective role for MMP-9 in DIA. AU - Piirilä P AU - Lauhio A AU - Majuri M-L AU - Meuronen A AU - Myllärniemi M AU - Tervahartiala T AU - Vuorinen K AU - Laitinen A AU - Alenius H AU - Kinnula VL AU - Sorsa T LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 40 IP - DP - 2010 Jan 01 TI - BSACI guidelines for the investigation of suspected anaphylaxis during general anaesthesia PG - 15-31 AB - Investigation of anaphylaxis during general anaesthesia requires an accurate record of events including information on timing of drug administration provided by the anaesthetist, as well as timed acute tryptase measurements. Referrals should be made to a centre with the experience and ability to investigate reactions to a range of drug classes/substances including neuromuscular blocking agents (NMBAs) intravenous (i.v.) anaesthetics, antibiotics, opioid analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), local anaesthetics, colloids, latex and other agents. About a third of cases are due to allergy to NMBAs. Therefore, investigation should be carried out in a dedicated drug allergy clinic to allow seamless investigation of all suspected drug classes as a single day-case. This will often require skin prick tests, intra-dermal testing and/or drug challenge. Investigation must cover the agents administered, but should also include most other commonly used NMBAs and i.v. anaesthetics. The outcome should be to identify the cause and a range of drugs/agents likely to be safe for future use. The allergist is responsible for a detailed report to the referring anaesthetist and to the patient's GP as well as the surgeon/obstetrician. A shorter report should be provided to the patient, adding an allergy alert to the case notes and providing an application form for an alert-bracelet indicating the wording to be inscribed. The MHRA should be notified. Investigation of anaphylaxis during general anaesthesia should be focussed in major allergy centres with a high throughput of cases and with experience and ability as described above. We suggest this focus since there is a distinct lack of validated data for testing, thus requiring experience in interpreting tests and because of the serious consequences of diagnostic error. AU - Ewan PW AU - Dugué P AU - Mirakian R AU - Dixon TA AU - Harper JN AU - Nasser SM LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 67 IP - DP - 2010 Jan 01 TI - Increased risk of oesophageal adenocarcinoma among upstream petroleum workers. PG - 335-340 AB - OBJECTIVES: To investigate cancer risk, particularly oesophageal cancer, among male upstream petroleum workers offshore potentially exposed to various carcinogenic agents. METHODS: Using the Norwegian Registry of Employers and Employees, 24 765 male offshore workers registered from 1981 to 2003 was compared with 283 002 male referents from the general working population matched by age and community of residence. The historical cohort was linked to the Cancer Registry of Norway and the Norwegian Cause of Death Registry. RESULTS: Male offshore workers had excess risk of oesophageal cancer (RR 2.6, 95% CI 1.4 to 4.8) compared with the reference population. Only the adenocarcinoma type had a significantly increased risk (RR 2.7, 95% CI 1.0 to 7.0), mainly because of an increased risk among upstream operators (RR 4.3, 95% CI 1.3 to 14.5). Upstream operators did not have significant excess of respiratory system or colon cancer or mortality from any other lifestyle-related diseases investigated. CONCLUSION: We found a fourfold excess risk of oesophageal adenocarcinoma among male workers assumed to have had the most extensive contact with crude oil. Due to the small number of cases, and a lack of detailed data on occupational exposure and lifestyle factors associated with oesophageal adenocarcinoma, the results must be interpreted with caution. Nevertheless, given the low risk of lifestyle-related cancers and causes of death in this working group, the results add to the observations in other low-powered studies on oesophageal cancer, further suggesting that factors related to the petroleum stream or carcinogenic agents used in the production process might be associated with risk of oesophageal adenocarcinoma AU - Kirkeleit J AU - Riise T AU - Bjørge T AU - Moen BE AU - Bråtveit M AU - Christiani DC. LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 IP - DP - 2010 Jan 01 TI - Risk factors of new-onset asthma in adults: a population-based international cohort study. PG - 1021-1030 AB - BACKGROUND: The occurrence of new-onset asthma during adulthood is common, but there is insufficient understanding of its determinants including the role of atopy. OBJECTIVE: To assess the risk factors for the development of new-onset asthma in middle-aged adults and to compare them according to atopy. METHODS: A longitudinal analysis of 9175 young adults who participated in two surveys of the European Community Respiratory Health Survey (ECRHS) conducted 9 years apart. FINDINGS: We observed 179 cases of new-onset asthma among 4588 participants who were free of asthma and reported at the beginning of the follow-up that they had never had asthma (4.5 per 1000 person-years). In a logistic regression, the following risk factors were found to increase the risk of new-onset asthma: female gender (OR: 1.97; 95% confidence interval (CI): 1.38, 2.81), bronchial hyperresponsiveness (3.25; 2.19, 4.83), atopy (1.55; 1.08, 2.21), FEV(1) < 100 % predicted (1.87; 1.34, 2.62), nasal allergy (1.98;1.39,2.84) and maternal asthma (1.91; 1.13; 3.21). Obesity, respiratory infections in early life and high-risk occupations increased the risk of new-onset asthma although we had limited power to confirm their role. Among the atopics, total IgE and sensitization to cat were independently related to the risk of new-onset asthma. The proportion of new-onset asthma attributable to atopy varied from 12% to 21%. CONCLUSION: Adults reporting that they had never had asthma were at a substantial risk of new-onset asthma as a result of multiple independent risk factors including lung function. Atopy explains a small proportion of new-onset adult asthma. AU - Antó JM AU - Sunyer J AU - Basagaña X AU - Garcia-Esteban R AU - Cerveri I AU - de Marco R AU - Heinrich J AU - Janson C AU - Jarvis D AU - Kogevinas M AU - Kuenzli N AU - Leynaert B AU - Svanes C AU - Wjst M AU - Gislason T AU - Burney P. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 363 IP - DP - 2010 Jan 01 TI - Tiotropium Bromide Step-up Therapy for Adults with Uncontrolled Asthma. PG - 1715-1726 AB - Background Long-acting beta-agonist (LABA) therapy improves symptoms in patients whose asthma is poorly controlled by an inhaled glucocorticoid alone. Alternative treatments for adults with uncontrolled asthma are needed. Methods In a three-way, double-blind, triple-dummy crossover trial involving 210 patients with asthma, we evaluated the addition of tiotropium bromide (a long-acting anticholinergic agent approved for the treatment of chronic obstructive pulmonary disease but not asthma) to an inhaled glucocorticoid, as compared with a doubling of the dose of the inhaled glucocorticoid (primary superiority comparison) or the addition of the LABA salmeterol (secondary noninferiority comparison). Results The use of tiotropium resulted in a superior primary outcome, as compared with a doubling of the dose of an inhaled glucocorticoid, as assessed by measuring the morning peak expiratory flow (PEF), with a mean difference of 25.8 liters per minute (P<0.001) and superiority in most secondary outcomes, including evening PEF, with a difference of 35.3 liters per minute (P<0.001); the proportion of asthma control days, with a difference of 0.079 (P = 0.01); the forced expiratory volume in 1 second (FEV1) before bronchodilation, with a difference of 0.10 liters (P = 0.004); and daily symptom scores, with a difference of -0.11 points (P<0.001). The addition of tiotropium was also noninferior to the addition of salmeterol for all assessed outcomes and increased the prebronchodilator FEV1 more than did salmeterol, with a difference of 0.11 liters (P = 0.003). Conclusions When added to an inhaled glucocorticoid, tiotropium improved symptoms and lung function in patients with inadequately controlled asthma. Its effects appeared to be equivalent to those with the addition of salmeterol AU - Peters SP AU - Kunselman SJ AU - Icitovic N AU - Mooore WC et al. LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 67 IP - DP - 2010 Jan 01 TI - Programmed health surveillance and detection of emerging diseases in occupational health: contribution of the French national occupational disease surveillance and prevention network (RNV3P) PG - 178-186 AB - Objective The French national occupational disease surveillance and prevention network (RNV3P) includes the 30 occupational disease consultation centres in university hospitals to which patients are referred for potentially work-related diseases, and an occupational health service. The aim of this work is to demonstrate the contribution of RNV3P to national health surveillance. Methods Data from consultations are recorded in standardised occupational health reports and coded using international or national classifications. Programmed health surveillance is carried out through annual follow-up of annual referrals to experts for pre-selected disease–exposure associations, as well as incidence estimations for the well characterised working population followed by the occupational health service. Hypotheses on new emerging diseases are generated using statistical methods employed in pharmacosurveillance and by modelling as an exposome to analyse multiple exposures. Results 58?777 occupational health reports were collected and analysed from 2001 to 2007. Referrals to the 30 university hospital centres increased significantly for asbestos-related diseases, mood disorders and adjustment disorders related to psychological and organisational demands, and for elbow and shoulder disorders related to manual handling. Referrals significantly decreased for asthma and for rhinitis related to exposure to organic dusts (vegetable or animal) or chemicals, except for cosmetics and cleaning products. Estimation of incidences by the occupational health services showed different patterns in different sectors of activity. The methods for detecting emerging diseases are presented and illustrated using the example of systemic sclerosis, identifying new exposures and new sectors of activity to be investigated. Conclusion The RNV3P collects data from two complementary samples: 30 university hospital centres (workers or former workers) and an occupational health service (current workers). This dual approach is useful for surveillance and for hypothesis generation on new emerging disease–exposure associations AU - Bonneterre V AU - Faisandier L AU - Bicout D AU - Bernardet C AU - Piollat J AU - Ameille J AU - de Clavière C AU - Aptel M AU - Lasfargues G AU - de Gaudemaris R LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 1 IP - DP - 2010 Jan 01 TI - SPIROMETRY AND ELECTRONIC HANDHELD METERS FOR HOME MONITORING PG - 17-35 AU - Moore VC and Burge PS LA - PT - DEP - TA - The Buyers Guide JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 14 IP - DP - 2010 Jan 01 TI - Workplace spirometry monitoring for respiratory disease prevention: a methods review. PG - 796-805 AB - This report reviews methods applicable in workplace spirometry monitoring for the identification of individuals with excessive lung function decline. Specific issues addressed include 1) maintaining longitudinal spirometry data precision at an acceptable level so that declines due to adverse physiological processes in the lung can be readily detected in an individual; 2) applying interpretative strategies that have a high likelihood of identifying workers at risk of developing lung function impairment; and 3) enhancing effectiveness of spirometry monitoring for intervention and disease prevention. Applications in ongoing computerized spirometry monitoring programs are described that demonstrate approaches to improving spirometry data precision and quality, and facilitating informed decision-making on disease prevention. AU - Hnizdo E AU - Glindmeyer HW AU - Petsonk EL. LA - PT - DEP - TA - Int J Tuberc Lung Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 12 IP - DP - 2010 Jan 01 TI - Pre-employment examinations for preventing occupational injury and disease in workers PG - CD008881. AB - Background Many employers and other stakeholders believe that health examinations of job applicants prevent occupational diseases and sickness absence. Objectives To evaluate the effectiveness of pre-employment examinations of job applicants in preventing occupational injury, disease and sickness absence compared to no intervention or alternative interventions. Search methods We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE,CINAHL,PsycINFO and PEDro (to December 2009) not restricted by date, language or publication type. Selection criteria We included randomised controlled trials (RCTs), controlled before-after studies (CBA), and interrupted time-series (ITS) of health examinations to prevent occupational diseases and injuries in job applicants. Data collection and analysis Four review authors (NM, ML, JV, ES) independently selected studies, extracted data, and determined study quality. The studies were too heterogeneous for statistical pooling of results. Main results We included two RCTs, five CBA studies and two ITS. Seven studies with 5872 participants evaluated the screening process of preemployment examinations and two studies with 2164 participants evaluated the measures to mitigate the risks found following the screening process. Of those studies that evaluated the screening process, one study found that a general examination did not reduce sick leave (Mean Difference -0.1 95% CI -0.5 to 0.3) but another study found that a more task focused examination did (MD -36 95% CI -68.3 to - 3.8). One study found that incorporation of a bronchial challenge test decreased occupational asthma (trend change -2.6 95% CI -3.6 to -1.5). Three studies that included functional capacity evaluation found contradictory effects on injury rates and number of medical visits. The rates of rejecting job applicants varied from 2% to 35%. Neither of the two studies that evaluated risk mitigation found an increased injury rate after training or work accommodations had been implemented. We rated the evidence for all outcomes as very low quality. Conclusions There is very low quality evidence that pre-employment examinations that are specific to certain jobs or health problems could reduce occupational disease, injury, or sickness absence. This supports the current policy to restrict pre-employment examinations to jobspecific examinations. More studies are needed that take into account the harms of rejecting job applicants. AU - Mahmud N AU - Schonstein E AU - Schaafsma F AU - Lehtola MM AU - Fassier JB AU - Reneman MF AU - Verbeek JH LA - PT - DEP - TA - Cochrane Database of Systematic Reviews JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 52 IP - DP - 2010 Jan 01 TI - Ortho-phthaldehyde exposure levels among endoscope disinfection workers PG - 74 AU - Miyajima AU - K LA - PT - DEP - TA - Sangyo Eiseigaku Zasshie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 52 IP - DP - 2010 Jan 01 TI - Ortho-phthaldehyde exposure levels among endoscope disinfection workers PG - 74 AU - Miyajima K LA - PT - DEP - TA - Sangyo Eiseigaku Zasshie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 17 IP - DP - 2010 Jan 01 TI - Outcome of occupational asthma after removal from exposure: A follow-up study PG - 61-66 AB - BACKGROUND: Despite being removed from their workplace, the majority of workers with occupational asthma (OA) remain afflicted with asthma. OBJECTIVES: To assess the time course of clinical, functional and inflammatory parameters in subjects with OA over a four-year period, and whether the airway inflammation observed at the time of the diagnosis predicts the outcome of OA. METHODS: The present study was a four-year, prospective, longitudinal investigation of workers with OA. Spirometry, methacholine challenge and sputum induction were performed at two weeks, and followed up at six months, and one, two, three and four years after the performance of specific inhalation challenges. RESULTS: A total of 24 subjects were enrolled. Overall, clinical and functional characteristics remained stable during the four-year follow-up period. Sputum eosinophil (Eos) counts decreased within two weeks after exposure. Two groups of subjects were identified according to low (less than 2%, Eos-) or high (2% or greater, Eos+) Eos counts after exposure to the offending agent. The Eos+ group decreased their dose of inhaled corticosteroids, had a trend toward an improvement of airway responsiveness as well as a stable forced expiratory volume in 1 s (FEV1), whereas the Eos- group showed a decrease in FEV1, without any improvement in their functional parameters. The Eos- group also had an increase in sputum neutrophils after exposure to the occupational agents as well as during the follow-up period. CONCLUSION: There was a rapid decrease in eosinophilic inflammation after removal from exposure. Subjects with a noneosinophilic asthmatic reaction during specific inhalation challenge seemed to have a poorer prognosis than subjects with eosinophilic airway inflammation. AU - Lemiere C AU - Chaboillez S AU - Welman M AU - Maghni K LA - PT - DEP - TA - Can Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 1 IP - DP - 2010 Jan 01 TI - A Comparison between Venables Standardized Respiratory Questionnaire and Pre-Shift Spirometry in Screening of Occupational Asthma in a Steel Industry PG - 191-197 AB - Background: Occupational asthma (OA) is the most common occupational lung disease in developed countries. One of the causative agents is metal fume that may be encountered in steel industries. Screening for the OA is mainly performed by questionnaire but in our country spirometry is used more commonly. Objective: To compare the diagnostic value of the Venables standardized respiratory questionnaire and pre-shift spirometry as screening tools for OA. Method: In a cross-sectional study, we investigated 450 workers of a steel industry by the Venables standardized questionnaire. We also performed a pre-shift spirometry as the screening spirometry and a post-shift spirometry. A person with 10% drop in post-shift FEV1 compared with the pre-shift value was considered as asthmatic (our gold-standard). The results of the questionnaire and the pre-shift spirometry were then examined against the gold-standard test results. For each test, sensitivity, specificity, positive and negative predictive values were calculated. Results: The overall prevalence of OA among our studied workers was 3.9% (95% CI: 1.9%–5.9%). The highest rate was seen in those working in catering (25%) and welding (10%) units. Pre-shift spirometry and the questionnaire had low sensitivity (42.9% and 28.6%, respectively) and positive predictive values (16.7% and 3.6%, respectively); moderate specificity (92.4% and 71.6%, respectively) and high negative predictive values (97.9% and 96.5%, respectively). Conclusion: Taking into account the ease of use of the questionnaire, it seems that it is more feasible to use questionnaire as the primary screening tool for the diagnosis of OA. AU - Mirmohammadi SJ AU - Mehrparvar AH AU - Gharavi M AU - Fathi F LA - PT - DEP - TA - International journal of occupational and environmental medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 24 IP - DP - 2010 Jan 01 TI - Trihalomethanes in swimming pool water in four areas of Spain participating in the INMA project PG - 483-486 AB - OBJECTIVE: Swimming is one of the most widely practiced sports in Spain among people of all ages and physical conditions. This activity is also a source of exposure to disinfection by-products (DBP), which are potentially toxic. The DBP concentration in swimming pool water is not regulated and is poorly known. The aim of this study was to describe trihalomethane concentrations in swimming pool water in the municipalities of four cohorts of the INMA project. METHODS: In July 2009, trihalomethanes were analyzed in water from 27 swimming pools in Asturias, Granada, Valencia and Sabadell. RESULTS: The mean total trihalomethane concentration was 42.7 g/L (standard deviation [SD]=19.1) in indoor pools and 151.2 g/L (SD=80.7) in outdoor pools. In all pools, the most abundant trihalomethane was always chloroform. The lowest levels were found in Granada. CONCLUSION: Trihalomethane concentrations in swimming pool water were highly variable. Outdoor swimming pools showed the highest levels, which were usually above the legal limit for drinking water. Copyright Copyright 2010 SESPAS. Published by Elsevier Espana. All rights reserved. AU - Font-Ribera L AU - Esplugues A AU - Ballester F AU - Martinez-Arguelles B AU - Tardon A AU - Freire C AU - Fernandez MF AU - Carrasco G AU - Cases A AU - Sunyer J AU - Villanueva CM LA - PT - DEP - TA - Gaceta Sanitaria JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 36 IP - DP - 2010 Jan 01 TI - Adverse respiratory outcomes associated with occupational exposures at a soy processing plant PG - 1007-1015 AB - This study aimed to characterise the relationship between adverse health outcomes and occupational risk factors among workers at a soy processing plant. A questionnaire, spirometry, methacholine challenge, immune testing and air sampling for dust and soy were offered. Prevalence ratios (PRs) of respiratory problems from comparisons with the US adult population were calculated. Soy-specific immunoglobulin (Ig)G and IgE among participants and healthcare worker controls were compared. Associations between health outcomes and potential explanatory variables were examined using logistic regression. 147 (52%) out of 281 employees, including 66 (70%) out of 94 production workers, participated. PRs were significantly elevated for wheeze, sinusitis, ever-asthma and current asthma. Participants had significantly higher mean concentrations of soy-specific IgG (97.9 mg·L-1 versus 1.5 mg·L-1) and prevalence of soy-specific IgE (21% versus 4%) than controls. Participants with soy-specific IgE had three-fold greater odds of current asthma or asthma-like symptoms, and six-fold greater odds of work-related asthma-like symptoms; the latter additionally was associated with production work and higher peak dust exposures. Airways obstruction was associated with higher peak dust. Work-related sinusitis, nasal allergies and rash were associated with reported workplace mould exposure. Asthma and symptoms of asthma, but not other respiratory problems, were associated with immune reactivity to soy. AU - Cummings KJ AU - Gaughan DM AU - Kullman GJ AU - Beezhold DH AU - Green BJ AU - Blachere FM AU - Bledsoe T AU - Kreiss K AU - Cox-Ganser J LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 138 suppl IP - DP - 2010 Jan 01 TI - Bronchial Challenges and Respiratory Symptoms in Elite Swimmers and Winter Sport Athletes Airway Hyperresponsiveness in Asthma: Its Measurement and Clinical Significance PG - 31S-37S AB - This study was aimed at the following: (1) the prevalence of airway hyperresponsiveness (AHR) and exercise-induced bronchoconstriction (EIB) in swimmers and winter sport athletes according to the previously recommended regulatory sport agencies criteria, (2) the relationship between respiratory symptoms and AHR/EIB, (3) the impact of the chosen cutoff value for AHR on its prevalence, and (4) the effect on the prevalence of the positive eucapnic voluntary hyperpnea (EVH) test of using the highest vs the lowest spirometric post-EVH values to calculate the magnitude of the airway response. We compared the prevalence of respiratory symptoms with responses to methacholine challenge and EVH in 45 swimmers, 45 winter sport athletes, and 30 controls. Two methacholine challenge cutoffs for AHR were analyzed: = 4 mg/mL (the sport agencies’ criteria for AHR) and = 16 mg/mL. Sixty percent of swimmers, 29% of winter sport athletes, and 17% of controls had evidence of EIB or AHR (with the = 4 mg/mL criteria). Among athletes with a methacholine provocative concentration inducing a 20% decrease in the FEV1 between 4 and 16 mg/mL, 43% of swimmers and 100% of winter sport athletes were symptomatic (P < .05). Prevalence of positive EVH tests were 39% in swimmers, 24% in winter sport athletes, and 13% in controls when the highest FEV1 value measured at each time point post-EVH was used to identify maximal response for calculation of airway response, although these prevalences were higher if we used the lowest value. This study suggests that AHR/EIB is frequent in swimmers, whereas the frequently reported respiratory symptoms in winter sport athletes are often not related to AHR/EIB. Furthermore, the choice of methods for assessing methacholine challenge and EVH responses influences the prevalences of AHR and EIB AU - Bougault V AU - Turmel J AU - Boulet L LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 60 IP - DP - 2010 Jan 01 TI - Respiratory health of municipal solid waste workers PG - 631-634 AB - Background There is an increasing evidence that the incidence of work-related pulmonary problems is greater in waste collectors than in the general workforce. Aims To evaluate the respiratory health of municipal solid waste workers (MSWWs). Methods One hundred and eighty-four municipal employees of Keratsini (104 MSWWs and 80 controls) participated in a cross-sectional study. All participants were asked to fill in a slightly modified version of the Medical Research Council questionnaire. Lung function was evaluated by spirometry. Results Spirometry revealed reduced mean forced vital capacity (FVC) and forced expiratory volume in 1 s (as a percentage of predicted values) in MSWWs compared with controls. After adjustment for smoking status, only the decline in FVC was statistically significant (P < 0.05). Prevalence of all respiratory symptoms was higher in MSWWs than in controls. After adjustment for confounding factors, the difference reached statistical significance (P < 0.05) for morning cough, cough on exertion and sore throat. Conclusions The results of this cross-sectional study indicate a higher prevalence of respiratory symptoms and a greater decrease in lung function in MSWWs. A number of limitations such as the relatively small size of population and the ‘healthy worker’ effect should be taken into account. AU - Athanasiou M AU - Makrynos G AU - Dounias G LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 185 IP - DP - 2010 Jan 01 TI - Diesel Exhaust Exposure and Nasal Response to Attenuated Influenza in Normal and Allergic Volunteers PG - 179-185 AB - Rationale: Diesel exhaust enhances allergic inflammation, and pollutants are associated with heightened susceptibility to viral respiratory infections. The effects of combined diesel and virus exposure in humans are unknown. Objectives: Test whether acute exposure to diesel modifies inflammatory responses to influenza virus in normal humans and those with allergies. Methods: We conducted a double-blind, randomized, placebo-controlled study of nasal responses to live attenuated influenza virus in normal volunteers and those with allergic rhinitis exposed to diesel (100 µg/m3) or clean air for 2 hours, followed by standard dose of virus and serial nasal lavages. Endpoints were inflammatory mediators (ELISA) and virus quantity (quantitative reverse-transcriptase polymerase chain reaction). To test for exposure effect, we used multiple regression with exposure group (diesel vs. air) as the main explanatory variable and allergic status as an additional factor. Measurements and Main Results: Baseline levels of mediators did not differ among groups. For most postvirus nasal cytokine responses, there was no significant diesel effect, and no significant interaction with allergy. However, diesel was associated with significantly increased IFN-? responses (P = 0.02), with no interaction with allergy in the regression model. Eotaxin-1 (P = 0.01), eosinophil cationic protein (P < 0.01), and influenza RNA sequences in nasal cells (P = 0.03) were significantly increased with diesel exposure, linked to allergy. Conclusions: Short-term exposure to diesel exhaust leads to increased eosinophil activation and increased virus quantity after virus inoculation in those with allergic rhinitis. This is consistent with previous literature suggesting a diesel “adjuvant” effect promoting allergic inflammation, and our data further suggest this change may be associated with reduced virus clearance. AU - Noah TL AU - Zhou H AU - Zhang H AU - Horvath K AU - Robinette C AU - Kesic M AU - Meyer M AU - Diaz-Sanchez D AU - Jaspers I LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 65 Suppl 4 IP - DP - 2010 Jan 01 TI - Work-related respiratory symptoms in the UK; Do primary care physicians miss diagnostic opportunities in occupational asthma? PG - A79 AB - Introduction and objectives Occupational lung disease is prevalent and costly. Population-based studies show that up to 20 cases of occupational lung disease per 100?000 workers per year should be identified.1 The Health and Safety Executive estimates the cost of occupational asthma to our society to be over £1.1 billion for each 10 year period.2 The prognosis of these individuals is better if they are removed from exposure quickly; however, this policy leads to unnecessary job loss in cases where the diagnosis is wrong.3 Little is known about the number of workers who present to primary care with work-related symptoms, or what proportion of these are referred for hospital specialist advice once a work-related element has been identified. Methods The Health & Occupation Reporting network in General Practice (THOR-GP) at the University of Manchester, collects work-related ill-health data from between 250 and 300 GPs trained to diploma level in occupational medicine. Cases of undiagnosed respiratory disease, reported as unspecified work-related respiratory symptoms between 2006 and 2009 were retrospectively identified. The cases were subdivided into exposure (if known) and categorised as referred if sent to a hospital specialist for further investigation. Results In 2006–2009 GPs reported 4902 cases of work-related ill-health, of which 115 (2%) were reports of respiratory disease. 27 cases of non-specified work-related respiratory illness were identified. Only 26% (7/27) were referred for a specialist opinion despite uncertainty of diagnosis. Of those not referred, the majority (17/20) were exposed to known asthmagens as illustrated in Abstract P6 Figure 1 (consensus view after exposure review from three occupational/respiratory physicians). Agents attributed to cases reported with respiratory symptoms referred to hospital specialists. Conclusions More than three quarters of the cases with undiagnosed work-related symptoms identified in primary care were not referred to secondary care for diagnostic clarification. 85% of these cases were exposed to known asthmagens. The lack of diagnosis and/or specialist assessment in these cases may have significant impact on disease prognosis, disability and socio-economic cost to society. AU - Hoyle J AU - Hussey L AU - Barraclough R AU - Agius R LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 67 IP - DP - 2010 Jan 01 TI - Occupational asthma due to 5-aminosalicylic acid PG - 798-799 AB - Occupational asthma due to 5-aminosalicylic acid 5-Aminosalicylic acid (5-ASA) is an antiinflammatory drug with a structural resemblance to phenacetin and is widely used to treat inflammatory bowel diseases. 5-ASA is the active constituent of sulphasalazine and sulphapyridine is its transport molecule. Some studies suggest that the serious adverse effects of the drug are in many cases due to sulphapyridine; however, at least in some patients, the adverse effects of sulphasalazine are attributable to 5-ASA itself.1 2 Pharmaceutical development has concentrated on delivering 5-ASA to the mucosa of the small intestine and colon using other inert carriers such as mesalazine. Blood dyscrasias, hepatitis, pancreatitis, pericarditis, pneumonitis and serious skin reactions have been reported in patients treated with sulphasalazine. Allergy to ASA and other salicylates, such as aspirin, has been reported.3 We report a case of occupational asthma due to 5-ASA. A 56-year-old man complained of cough, dyspnea and wheezing 1 month after beginning work manufacturing a drug containing 5-ASA, in spite of taking measures to protect his skin and respiratory system. Symptoms typically appeared 6 h after the start of shifts. Symptoms worsened with the passing of time. The patient was treated with salbutamol as needed. For the last 30 years he has worked for a pharmaceutical company manufacturing various drugs. The man was diagnosed with occupational asthma caused by amoxicillin 29 years ago and with nasal polyposis 7 years ago. He currently works in the manufacture of levofloxacin and tolerates oral amoxicillin and ibuprofen. The patient was evaluated 6 months after he had discontinued his contact with 5-ASA. Physical examination, blood tests and spirometry results were normal. Skin prick tests with common inhalants showed positive results to grass pollen, with a negative reaction to 5-ASA (10 mg/ml). Methacholine PC20 was >16 mg/ml, fraction of exhaled nitric oxide (FENO) level was 32 ppb, and sputum induced by hypertonic saline inhalation and processed as previously described,4 showed no eosinophils. After signed informed consent was provided by the patient, an exposure challenge was carried out with a placebo (lactose as sham exposure) in a 7m3 chamber for 30 min. The results showed no changes in FEV1 over 24 h, as measured hourly with a computerised flow metre (Amos, Jaeger, Germany) while respecting sleep time. On visit 2, the patient was exposed to 5-ASA (5% in lactose) in the chamber at a mean concentration of 2.65 mg/m3 for a total of 30 min. A late response, with a maximum fall in FEV1 of 16%, was elicited 9 h after the challenge. At 24 h after the challenge, methacholine PC20 level was 10 mg/ml, FENO level was 53 ppb and induced sputum showed 65% eosinophils. The above results demonstrate that 5-ASA inhalation was able to induce an eosinophilic asthmatic reaction and, while the underlying mechanism causing this event is still unknown, it appears to be similar to that of other low-molecular-weight agents causing immunologic occupational asthma. To our knowledge, this is the first report of occupational asthma due to 5-aminosalicylic acid. Joaqui ´n Sastre,1,2 Manuela Garci ´a del Potro,1 Erika Aguado,1 Mar Ferna´ndez-Nieto1,2 AU - Sastre J AU - del Potro MG AU - Aguado E AU - Fernandez-Nieto M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 53 IP - DP - 2010 Jan 01 TI - Occupational immediate-type asthma and rhinitis due to rhodium salts PG - 42-46 AB - Background Whereas platinum salts are well known occupational allergens, rhodium salts have not been identified as inhalative sensitizing substances. Methods A 27-year-old atopic operator of an electroplating plant developed work-related shortness of breath and runny nose with sneezing after exposure to rhodium salts. Quantitative skin prick tests (SPT) and bronchial challenge tests with a dosimeter protocol were performed with quadrupling doses of the sodium chloride salts of rhodium (Na3RhCl6) and platinum (Na2PtCl6). Results The patient showed positive SPT reactions and positive bronchial immediate-type reactions with rhodium and platinum salts. Sensitivity to rhodium salt was much higher than to platinum salt; the molar concentrations differed by a factor of 256 in SPT and a factor of 16 in bronchial challenges. Conclusions Rhodium salts should be considered as occupational immediate-type allergens. AU - Merget R AU - Sander I AU - van Kampen V AU - Raulf-Heimsoth M AU - Ulmer H AU - Kulzer R AU - Bruening T LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20100101 IS - IS - VI - 78 IP - DP - 2010 Jan 01 TI - Occupational Asthma Caused by Metal Arc Welding of Iron PG - 455-459 AB - Epidemiological studies have shown that exposure to welding fumes can be a cause of occupational asthma (OA), although the mechanisms implicated are unknown. We describe 3 patients (all men, mean age 42 years) with OA secondary to exposure to welding fumes generated during metal arc welding on iron. The exposure time ranged from 7 to 43 years and the time of the onset of symptoms following the start of exposure was 2–12 years. Patients were diagnosed by specific inhalation challenge (SIC). Environmental levels of Fe, Cd, Cu, Cr, Ni, NO2, NO, CO, and O3 produced during the SIC did not exceed threshold limit values. Samples of induced sputum were obtained before and after the SIC and showed an increase in neutrophils and concentrations of IL-8, TNF-a and TNF-ß after the SIC. This study presents the first clinical findings reported in welders with OA, mainly working with iron. Neutrophilic inflammation seems to play a role in this disease. AU - Muñoz X AU - Cruz MJ AU - Freixa A AU - Guardino X AU - Morell F LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 10 IP - DP - 2009 Jan 01 TI - EAACI position paper on occupational rhinitis PG - 16 AB - The present document is the result of a consensus reached by a panel of experts from European nd non-European countries on Occupational Rhinitis (OR), a disease of emerging relevance which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored on that of occupational asthma, as well as a diagnostic algorithm based on steps allowing for different levels of diagnostic evidence are proposed. The needs for future research are pointed out. Key messages are issued for each item. AU - Moscato G AU - Vandenplas O AU - Wijk RGV AU - Malo J-L AU - Perfetti L AU - Quirce S AU - Walusiak J AU - Castano R AU - Pala G AU - Gautrin D AU - Groot HD AU - Folletti I AU - Yacoub MR AU - Siracusa A LA - PT - DEP - TA - Respiratory Research JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 124 IP - DP - 2009 Jan 01 TI - Impact of chlorinated swimming pool attendance on the respiratory health of adolescents. PG - 1110-1118 AB - OBJECTIVE: The goal was to estimate the burden of allergic diseases associated with chlorinated pool exposure among adolescents. METHODS: We examined 847 students, 13 to 18 years of age, who had attended outdoor or indoor chlorinated pools at various rates. Of them, 114 had attended mainly a copper-silver pool and served as a reference group. We measured total and aeroallergen-specific immunoglobulin E (IgE) levels in serum and screened for exercise-induced bronchoconstriction. Outcomes were respiratory symptoms, hay fever, allergic rhinitis, and asthma that had been diagnosed at any time (ever asthma) or was being treated with medication and/or was associated with exercise-induced bronchoconstriction (current asthma). RESULTS: Among adolescents with atopy with serum IgE levels of>30 kIU/L or aeroallergen-specific IgE, the odds ratios (ORs) for asthma symptoms and for ever or current asthma increased with the lifetime number of hours spent in chlorinated pools, reaching values of 7.1 to 14.9 when chlorinated pool attendance exceeded 1000 hours. Adolescents with atopy with chlorinated pool attendance of >100 hours had greater risk of hay fever (OR: 3.3-6.6), and those with attendance of >1000 hours had greater risk of allergic rhinitis (OR: 2.2-3.5). Such associations were not found among adolescents without atopy or with copper-silver pool attendance. The population attributable risks for chlorinated pool-related ever-diagnosed asthma, hay fever, and allergic rhinitis were 63.4%, 62.1%, and 35.0%, respectively. CONCLUSION: Chlorinated pool exposure exerts an adjuvant effect on atopy that seems to contribute significantly to the burden of asthma and respiratory allergies among adolescents. AU - Bernard A AU - Nickmilder M AU - Voisin C AU - Sardella A LA - PT - DEP - TA - Pediatrics JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 82 IP - DP - 2009 Jan 01 TI - Is there a need for special preventive medical check-ups in employees exposed to experimental animal dust? PG - 319-327 AB - Objective Due to new legal requirements in Germany, the employer must request preventive medical check-ups for activities involving exposure to dust from experimental animals in the rooms in which the animals are kept. The objective is to report our first experiences with these medical check-ups in the context of academic research. Methods The check-ups were carried out since November 2005 and comprised a questionnaire and a medical examination, including a pulmonary function test with whole-body plethysmography. Respiratory, nasal and ocular symptoms related to occupational exposure to animals were documented. Participation in skin prick tests (ubiquitous inhalation allergens and laboratory animal allergens), a bronchial provocation test with methacholine, and serological examinations for total IgE and specific IgE antibodies was voluntary. Results Data on 132 persons are presented. One hundred and six of these had already been exposed for at least 1 year. Main complaints at the workplace were sneezing and runny nose. Ocular symptoms and bronchial asthma were reported infrequently. The development of at least one of these symptoms occurred in 34% of employees with an exposure of at least 1 year. If the weekly exposure duration was at least 5 h, the proportion of employees with complaints rose to 44.9%. In employees occupationally exposed to mice and rats, work-related complaints occurred in 33.7 and 37.8%, respectively, and sensitisation rates were 12.7 and 16.3%, respectively. Employees with and without complaints differed in history of allergic symptoms, and workplace safety measures. Conclusions In employees with occupational contact with laboratory animal dust, the frequency of complaints was high. The results confirm the necessity of regular medical check-ups for employees with contact with laboratory animal dust. Nevertheless, the medical check-ups must be part of a prevention strategy including education, engineering controls, administrative controls, use of personal protective equipment and vocational integration. AU - Schmid K AU - Jüngert B AU - Hager M AU - Drexler H LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 35 IP - DP - 2009 Jan 01 TI - Occupational exposure and incidence of respiratory disorders in a general population PG - 454-461 AB - Objective Our aim was to study the effect of occupational exposure on the incidence of adult asthma and six respiratory symptoms using a job-exposure matrix (JEM). Methods From 1985, we conducted an 11-year community cohort study on the incidence of asthma and respiratory symptoms in Western Norway (N=2401, aged 15–70 years at baseline). The analyses in the current study were based on subjects =65 years at baseline, since those >65 years were unlikely to experience significant occupational exposures within the follow-up period. Results More women than men were exposed to biological dust (38% versus 29%), while more men than women were exposed to mineral dust (48% versus 19%), and gas or fumes (58% versus 53%). After adjusting for age, educational level, smoking, and previous occupational exposures, we found that high exposure to biological dust exposure was significantly related to a higher incidence of chronic and morning cough in men; for women, low exposure was related to attacks of dyspnea. Low exposure to workplace gas or fumes was significantly related to incident phlegm cough and attacks of dyspnea for women, while for men, high exposure was related to dyspnea grade 2. For the incidence of asthma and phlegm cough, after adjusting for all confounders, we found a significant interaction between workplace exposures and gender, where women had a higher risk of disease. Conclusions Assessed by a JEM, occupational airborne exposure was weakly related to the incidence of asthma and respiratory symptoms, significantly more so for women than for men. AU - Skorge TD AU - Eagan TML AU - Eide GE AU - Gulsvik A AU - Bakke PS LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 9 IP - DP - 2009 Jan 01 TI - Psychological distress and occupational asthma PG - 103-109 AB - Purpose of review: To summarize recent findings on the psychological impact of occupational asthma, on the basis of a review of medical and psychological literature published between 1998 and 2008. For the purposes of this review, 'psychological impacts' are defined as the experience of psychological stress or distress, which refers to the experience of negative emotions (e.g., anxiety and sadness/depression). When severe and chronic, psychological distress may reach clinical levels and is referred to as a 'psychiatric disorder', which is a clinical diagnosis based on established diagnostic criteria. Recent findings: Only one original article assessing psychological impacts has been published in the past 10 years (in 2007). Levels of psychological distress (i.e., depression, anxiety, and cognitive dysfunction) were all in the clinical range, and rates of anxiety disorders and dysthymia (a chronic form of depression) affected approximately 35 and 23% of patients, respectively. The paucity of available literature indicates that the study of psychological factors associated with occupational asthma is still in its infancy. Though preliminary and in need of replication, the only published study to date suggests that patients with occupational asthma may be highly anxious and many are chronically depressed, a finding that is consistent with previous studies with nonoccupational asthmatics. The established link between psychological factors (e.g., depression and anxiety) and nonoccupational asthma suggests that future studies are desperately needed to more comprehensively assess the scope and severity of the psychological burden of this disease. AU - Lavoie KL AU - Joseph M AU - Bacon SL LA - PT - DEP - TA - curr Opinion in Allergy and Clinical Immunology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 136 IP - DP - 2009 Jan 01 TI - Changes in Sputum Eicosanoids and Inflammatory Markers After Inhalation Challenges With Occupational Agents PG - 1308-1315 AB - Background: An increase in cysteinyl-leukotrienes (LTs) after specific inhalation challenge (SIC) with common allergens in patients with atopic asthma has been shown previously, but there are scarce data with occupational agents. We sought to determine whether there are differences in lower airway inflammatory markers and the production of cytokines and eicosanoids between patients with a positive or negative SIC response to occupational agents. Methods: Twenty-six patients with suspected occupational asthma and 13 healthy control subjects were studied. Spirometry, methacholine challenge, and sputum induction were performed at baseline and 24 h after SIC with occupational agents. Several cytokines and inflammatory mediators, including eicosanoids, were measured in sputum. Results: Twenty-six SICs were carried out with high-molecular-weight or low-molecular-weight agents, and the responses were positive in 18 patients. SIC elicited nine early asthmatic responses, two dual asthmatic responses, and seven isolated late asthmatic responses. Significant increments in sputum eosinophil counts were found only in patients with positive SIC responses compared with baseline values. Interleukin-10 levels were decreased in patients with positive and negative SIC responses compared to those in healthy control subjects. A significant increase (p < 0.05) in the LTC4/prostaglandin E2 (PGE2) ratio was observed in patients after positive SIC responses compared to those with negative SIC responses. Conclusions: Overexpression of LTC4, relative underproduction of PGE2, and greater airway eosinophilia were observed in patients with positive SIC responses. AU - Fernández-Nieto M AU - Sastre B AU - Sastre J AU - Lahoz C AU - Quirce S AU - Madero M AU - del Pozo V LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 52 IP - DP - 2009 Jan 01 TI - Frequency of work-related respiratory symptoms in workers without asthma. PG - 447-454 AB - Background Clinicians are faced with subjects complaining of work-related respiratory symptoms (WRS) without any evidence of asthma. We sought to assess the prevalence of subjects with WRS without asthma in a cohort of workers referred for possible work-related asthma (WRA) as well as compare the characteristics and the work environment of subjects with WRS to subjects with WRA. Methods A prospective observational study of workers referred for possible WRA over a 1-year period. Detailed medical and occupational questionnaires were administered. Pulmonary function tests as well as specific-inhalation challenges were performed. Results One hundred twenty workers were investigated. Fifty-one had WRA while 69 had WRS. The type and the severity of the respiratory symptoms were similar in both groups, except for wheezing which was more frequently reported in subjects with WRA (32 (62.7%)) than in subjects with WRS (16 (23.2%)) (P<0.01). Both the workers with WRS and WRA were mainly employed in the manufacturing sector (64.7% (WRA) and 71% (WRS)). At the time of the first assessment 64.7% of subjects with WRA and 56.5% with WRS had left their workplace because of their bothersome respiratory symptoms. Conclusions Subjects with WRS without asthma represent a large proportion of the subjects assessed in clinics specialized in the field of WRA. Like subjects with WRA, the population with WRS is likely to represent a significant medical burden. The similarity of the symptoms between the WRA and the WRS groups emphasizes the need to perform a thorough and objective investigation to diagnose WRA. AU - Chiry S AU - Boulet L-P AU - Lepage AU - Forget A AU - Bégin D AU - Chaboillez S AU - Malo J-L AU - Gérin M AU - Lemiere C LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 103 IP - DP - 2009 Jan 01 TI - Coexistent emphysema delays the decrease of vital capacity in idiopathic pulmonary fibrosis PG - 1209-1215 AB - Although previous authors have reported single data point, yearly changes in respiratory function have not been examined in combined pulmonary fibrosis and emphysema (CPFE). To quantify the annual changes in respiratory function of patients with CPFE and to examine the difference in survival between CPFE patients and patients with idiopathic pulmonary fibrosis without emphysema (IPF alone), 26 patients with CPFE and 33 IPF alone patients, whose respiratory function had been monitored for at least a year, were selected. The baseline of vital capacity percent predicted (VC% pred) in CPFE patients was greater than that in IPF-alone patients (86.6±24.0% vs. 72.8±19.4%, p=0.018). The annual decrease in VC% pred was significantly less in CPFE patients than in IPF-alone patients (-1.2±4.8% vs. -8.0±7.4%, p<0.001). Baseline ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC%) in CPFE patients was lower than that in IPF-alone patients (76.6±8.5% vs. 85.2±6.7%, p<0.001). In the CPFE group, FEV1/FVC% tended to decrease with time (-0.5±2.2% per year), but, in contrast, it increased in IPF-alone patients (+1.1±3.4% per year) (p=0.036). Baseline of diffusing capacity percent predicted (DLco% pred) was significantly lower in CPFE patients than in IPF-alone patients (45.3±15.0% vs. 60.7±19.8%, p=0.003). The annual decrease in DLco% pred was lower in CPFE patients than in IPF-alone patients (-3.7±7.9% vs. -10.7±8.8%, p=0.042). There was no significant difference in the survival duration between 26 CPFE and 33 IPF-alone patients according to Kaplan–Meier analysis. AU - Akagi T AU - Matsumoto T AU - Harada T AU - Tanaka M AU - Kuraki T AU - Fujita M AU - Watanabe K LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 43 IP - DP - 2009 Jan 01 TI - Yields of Carbonyl Products from Gas-Phase Reactions of Fragrance Compounds with OH Radical and Ozone PG - 3561-3568 AB - Chamber studies to quantify formation yields of oxygenated organic reaction products were performed for gas-phasereactions of the hydroxyl radical (OH · ) and ozone (O3) with the common cleaning product terpene compounds limonene, R-terpineol,and geraniol. The reaction products observed were identified and quantified using derivatization by O-(2,3,4,5,6-pentafluorobenzyl)hydroxylamine (PFBHA) and gas chromatography/mass spectrometry.Limonenerate constantsandproductmechanisms havebeenexamined previously. Several of these investigations have measured product yields from limonene reactions and those results are compared with the results presented here. Although rate constants and product mechanisms have previously been investigated for R-terpineol and geraniol, yields of oxygenated organic reaction products have not been measured. Reactions from the fragrance compounds in this study produced several dicarbonyl reaction products such as glyoxal, methylglyoxal, and 4-oxopentanal which were observed from all three terpenes. Total carbonyl yields ranged from 5.1% for the limonene + O3 reaction to 92% for the geraniol + O3 reaction. AU - Frorester CD AU - Wells IR LA - PT - DEP - TA - Environ Sci Technol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - An international prospective general population based study of respiratory work disability PG - 339-344 AB - Background: Previous cross-sectional studies have shown that job change due to breathing problems at the workplace (respiratory work disability) is common among adults of working age. That research indicated that occupational exposure to gases, dust and fumes was associated with job change due to breathing problems, although causal inferences have been tempered by the cross-sectional nature of previously available data. There is a need for general population-based prospective studies to assess the incidence of respiratory work disability and to delineate better the roles of potential predictors of respiratory work disability. Methods: A prospective general population cohort study was performed in 25 centres in 11 European countries and one centre in the USA. A longitudinal analysis was undertaken of the European Community Respiratory Health Survey including all participants employed at any point since the baseline survey, 6659 subjects randomly sampled and 779 subjects comprising all subjects reporting physician-diagnosed asthma. The main outcome measure was new-onset respiratory work disability, defined as a reported job change during follow-up attributed to breathing problems. Exposure to dusts (biological or mineral), gases or fumes during follow-up was recorded using a job-exposure matrix. Cox proportional hazard regression modelling was used to analyse such exposure as a predictor of time until job change due to breathing problems. Results: The incidence rate of respiratory work disability was 1.2/1000 person-years of observation in the random sample (95% CI 1.0 to 1.5) and 5.7/1000 person-years in the asthma cohort (95% CI 4.1 to 7.8). In the random population sample, as well as in the asthma cohort, high occupational exposure to biological dust, mineral dust or gases or fumes predicted increased risk of respiratory work disability. In the random sample, sex was not associated with increased risk of work disability while, in the asthma cohort, female sex was associated with an increased disability risk (hazard ratio 2.8, 95% CI 1.3 to 5.9). Conclusions: Respiratory work disability is common overall. It is associated with workplace exposures that could be controlled through preventive measures. AU - K Torén AU - J-P Zock AU - M Kogevinas AU - E Plana AU - J Sunyer AU - K Radon AU - D Jarvis AU - H Kromhout AU - A d’Errico AU - F Payo AU - J M Antó and P D Blanc LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - An international prospective general population based study of respiratory work disability PG - 339-344 AB - Background: Previous cross-sectional studies have shown that job change due to breathing problems at the workplace (respiratory work disability) is common among adults of working age. That research indicated that occupational exposure to gases, dust and fumes was associated with job change due to breathing problems, although causal inferences have been tempered by the cross-sectional nature of previously available data. There is a need for general population-based prospective studies to assess the incidence of respiratory work disability and to delineate better the roles of potential predictors of respiratory work disability. Methods: A prospective general population cohort study was performed in 25 centres in 11 European countries and one centre in the USA. A longitudinal analysis was undertaken of the European Community Respiratory Health Survey including all participants employed at any point since the baseline survey, 6659 subjects randomly sampled and 779 subjects comprising all subjects reporting physician-diagnosed asthma. The main outcome measure was new-onset respiratory work disability, defined as a reported job change during follow-up attributed to breathing problems. Exposure to dusts (biological or mineral), gases or fumes during follow-up was recorded using a job-exposure matrix. Cox proportional hazard regression modelling was used to analyse such exposure as a predictor of time until job change due to breathing problems. Results: The incidence rate of respiratory work disability was 1.2/1000 person-years of observation in the random sample (95% CI 1.0 to 1.5) and 5.7/1000 person-years in the asthma cohort (95% CI 4.1 to 7.8). In the random population sample, as well as in the asthma cohort, high occupational exposure to biological dust, mineral dust or gases or fumes predicted increased risk of respiratory work disability. In the random sample, sex was not associated with increased risk of work disability while, in the asthma cohort, female sex was associated with an increased disability risk (hazard ratio 2.8, 95% CI 1.3 to 5.9). Conclusions: Respiratory work disability is common overall. It is associated with workplace exposures that could be controlled through preventive measures. AU - Torén K AU - Zock J-P AU - Kogevinas M AU - Plana E AU - Sunyer J AU - Radon K AU - Jarvis D AU - Kromhout H AU - dErrico A AU - Payo F AU - Antó JM AU - Blanc PD LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - Hypersensitivity Pneumonitis PG - 322-334 AB - The first few cases of hypersensitivity pneumonitis (HP) were described in the early 20th century in farmers exposed to moldy hay or straw. As then, HP has been ascribed to multiple inhaled antigens found in a large variety of environmental settings. Hypersensitivity pneumonitis results from an exaggerated immune response, which gives rise to acute infection-like symptoms or to progressive, sometimes irreversible lung damage. The diagnosis is based on a combination of clinical characteristics of the disease. Clinical diagnostic criteria have recently been published. The immune mechanisms leading to HP are still incompletely understood. Initially, believed to be a classes III and IV immune response, we now have a clearer understanding of the complex inflammatory events involved. These include the release of pro inflammatory cytokines and a decrease in the immune control mechanisms via surfactant, dendritic and T-regulatory cells. Despite the improved understanding, the treatment and outcome of HP have not changed. Oral corticosteroids remain the only effective drugs and contact withdrawal constitutes the ideal solution. If unchecked, HP can lead to irreversible lung damage in the form of fibrosis or emphysema, respiratory insufficiency and even death. AU - Girard M AU - Lacasse Y AU - Cormier Y LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 46 IP - DP - 2009 Jan 01 TI - Serial lung function variability using four portable logging meters PG - 961-966 AB - Objective. Portable lung function logging meters that allow measurement of peak expiratory flow (PEF) and forced expiratory volume in 1 second (FEV1) are useful for the diagnosis and exclusion of asthma. The aim of this study was to investigate the within and between-session variability of PEF and FEV1 for four logging meters and to determine the sensitivity of meters to detect FEV1 and PEF diurnal changes. Methods. Thirteen assessors (all hospital staff members) were asked to record 1 week of 2-hour PEF and FEV1 measurements using four portable lung function meters. Within-session variability of PEF and FEV1 were compared for each meter using a coefficient of variation (COV). Between-session variability was quantified using parameter estimates from a cosinor analysis which modeled diurnal change for both lung function measures and also allowed for variation between days for individual sessions. Results. The mean within-session COV for FEV1 was consistently lower than that for PEF (p < 0.001). PEF showed a higher but not significantly different (p = 0.068) sensitivity for detecting diurnal variation than FEV1. PEF was also slightly more variable between days, but not significantly different than FEV1 (p = 0.409). PEF and FEV1 diurnal variability did not differ between the 4 meters (p = 0.154 and 0.882 respectively), but within-session FEV1 COV differed between meters (p = 0.009). Conclusion. PEF was marginally more sensitive to within-day variability than FEV1 but was less repeatable. Overall, differences between the 4 meters were small, suggesting that all meters are clinically useful. AU - Moore VC AU - Parsons NR AU - Jaakkola MS AU - Burge CBSG AU - Pantin CF AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - J Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - Diagnosis of occupational asthma from time point differences in serial PEF measurements PG - 1032-1036 AB - Background The diagnosis of occupational asthma requires objective confirmation. Analysis of serial measurements of peak expiratory flow (PEF) is usually the most convenient first step in the diagnostic process. A new method of analysis originally developed to detect late asthmatic reactions following specific inhalation testing is described. This was applied to serial PEF measurements made over many days in the workplace to supplement existing methods of PEF analysis. Methods 236 records from workers with independently diagnosed occupational asthma and 320 records from controls with asthma were available. The pooled standard deviation for rest day measurements was obtained from an analysis of variance by time. Work day PEF measurements were meaned into matching 2-hourly time segments. Time points with mean work day PEF statistically lower (at the Bonferroni adjusted 5% level) than the rest days were counted after adjusting for the number of contributing measurements. Results A minimum of four time point comparisons were needed. Records with >=2 time points significantly lower on work days had a sensitivity of 67% and a specificity of 99% for the diagnosis of occupational asthma against independent diagnoses. Reducing the requirements to >=1 non-waking time point difference increased sensitivity to 77% and reduced specificity to 93%. The analysis was only applicable to 43% of available records, mainly due to differences in waking times on work and rest days. Conclusion Time point analysis complements other validated methods of PEF analysis for the diagnosis of occupational asthma. It requires shorter records than are required for the Oasys score and can identify smaller changes than other methods, but is dependent on low rest day PEF variance. AU - Burge CBSG AU - Moore VC AU - Pantin CFA AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - A case of occupational asthma caused by inhalation of vancomycin powder PG - 1391-1392 AB - A pharmacetical worker who developed occupational asthma and rhinitis 5 months after starting purification of vancomycin powder. Positive peak flow and history, refused specific challenge. IgE and skin prick testing to vancomycin negative, but strong basophil histamine release using HSA conjugate (negative in controls). Authors suggest that the mechanism is direct histamine release AU - Choi G-S AU - Sung J-M AU - Lee J-W AU - Ye Y-M AU - Park H-S LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - Malt can cause both occupational asthma and allergic alveolitis PG - 1228-1229 AB - Specific inhalation challenge can help differentiate occupational asthma from allergic alveolitis caused by malt. AU - Miedinger D AU - Malo J-L AU - Cartier A AU - Labrecque M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 66 IP - DP - 2009 Jan 01 TI - A dynamic population-based model for the development of work-related respiratory health effects among bakery workers PG - 810-817 AB - Objectives: This paper presents a dynamic population-based model for the development of sensitisation and respiratory symptoms in bakery workers. The model simulates a population of individual workers longitudinally and tracks the development of work-related sensitisation and respiratory symptoms in each worker. Methods: The model has three components: a multi-stage disease model describing the development of sensitisation and respiratory symptoms in each worker over time; an exposure model describing occupational exposure to flour dust and allergens; and a basic population model describing the length of a worker’s career in the bakery sector and the influx of new workers. Each worker’s disease state is modelled independently using a discrete time Markov Chain, updated yearly using each individual’s simulated exposure. A Bayesian analysis of data from a recent epidemiological study provided estimates of the yearly transition probabilities between disease states. Results: For non-atopic/non-sensitised workers the estimated probabilities of developing moderate (upper respiratory) symptoms and progression to severe (lower respiratory) symptoms are 0.4% (95% CI 0.3 to 0.5%) and 1.1% (95% CI 0.6 to 1.9%) per mg/m3/year of flour dust, respectively, and approximately twice these for atopic workers. The model predicts that 36% (95% CI 26 to 46%) of workers with severe symptoms are sensitised to wheat and 22% (95% CI 12 to 37%) to a-amylase. The predicted mean latency period for respiratory symptoms was 10.3 years (95% CI 8.3 to 12.3). Conclusions: While the model provides a valuable population-level representation of the mechanisms contributing to respiratory diseases in bakers, it was primarily developed for use in quantitative health impact assessment. Future research will use the model to evaluate a range of workplace interventions, including achievable reductions in exposure and health surveillance. The general methodology is applicable to other diseases such as chronic obstructive pulmonary disease, silicosis and musculoskeletal disorders and could be particularly valuable for forecasting changes in long latency diseases. AU - Warren N AU - Meijster T AU - Heederik D AU - Tielemans E LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - epub IP - DP - 2009 Jan 01 TI - Further validation of computer-based prediction of chemical asthma hazard. PG - - AB - BACKGROUND: There is no agreed protocol for the prediction of low molecular weight (LMW) respiratory sensitizers. This creates challenges for occupational physicians responsible for the health of workforces using novel chemicals and respiratory physicians investigating cases of occupational asthma caused by novel asthmagens. AIMS: To iterate the external validation of a previously published quantitative structure-activity relationship (QSAR) model for the prediction of novel chemical respiratory sensitizers and to better characterize its predictive accuracy. METHODS: An external validation set of control chemicals was identified from the Australian Hazardous Substances Information System. An external validation set of asthmagenic chemicals was identified by a thorough search of the peer-reviewed literature from January 1995 onwards using the Medline database. The QSAR model was used to determine an 'asthma hazard index' (between 0 and 1) for each chemical. RESULTS: A total of 28 external validation asthmagens and 129 control chemicals were identified. The area under the receiver operating characteristic (ROC) curve for the model's ability to distinguish asthmagens from controls was 0.87 (95% CI 0.76-0.97). Using a cut-off hazard index of 0.5 resulted in sensitivity of 79% and specificity of 93%. For prior probability ranging from 1:300 to 1:100, the negative predictive value (NPV) was 1 and positive predictive value (PPV) 0.04-0.1 while for prior probability ranging from 1:20 to 1:3, the NPV was 0.91-0.99 and PPV 0.39-0.85. CONCLUSIONS: The ROC curve for this QSAR demonstrates good global predictive power for distinguishing asthmagenic from non-asthmagenic LMW organic compounds. Potential for utilization by occupational and respiratory physicians is evident from its predictive values. AU - Seed M AU - Agius R. LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - Occupational allergy caused by marigold (Tagetes erecta) flour inhalation PG - 1100-1101 AB - Marigold flour has been extensively used by the food additive industry as a poultry feed colourant to give more attractive colour to eggs and chicken meat. AU - Lluch-Pérez M AU - García-Rodríguez RM AU - Malet A AU - Amat P AU - Bartolomé B LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - Occupational asthma caused by octopus particles PG - 1101-1102 AB - A seafood processing worker suffered asthma after handling octopus. AU - Rosado A AU - Tejedor MA AU - Benito C AU - Cárdenas R AU - González-Mancebo E LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - Dual sensitization to rat and mouse urinary allergens reflects cross-reactive molecules rather than atopy PG - 855-861 AB - ABSTRACT Background: Sensitization to rats and mice can develop in laboratory animal workers exposed to only one species. Reasons for this dual sensitization are unclear but may reflect a genetic predisposition to developing allergy (atopy) or alternatively cross-reactivity between rat and mouse urinary allergens. We examined cross-reactivity between rat and mouse urine and the effect atopy has on dual sensitization in laboratory animal workers. Methods: In a cross-sectional study the frequency of sensitization to rat and/or mouse was analysed in 498 employees exposed to both rat and mouse at work and 220 to rat only. RAST inhibitions, western blots and blot inhibitions were carried out on a subset of five individuals to assess cross-reactivity. Results: Fourteen per cent of workers were sensitized to rats and 9% to mouse. Over half (62%) of rat sensitized individuals were also mouse sensitized and the majority (91%) of mouse sensitized individuals were also rat sensitized. IgE cross-reactivity was demonstrated between rat and mouse urine using RAST inhibitions. Rates of atopy did not differ between rat only sensitized individuals compared with those sensitized to both species. Sensitization to cats and rabbits was more common amongst those with dual sensitization. Conclusions: Dual sensitization to rat and mouse reflects IgE cross-reactivity rather than atopy. Individuals with dual sensitization are more likely to be sensitized to other animal allergens. These findings will have implications for individuals working with only one rodent species who develop sensitization and symptoms to be aware of the potential for allergy to other species. AU - Jeal H AU - Harris J AU - Draper A AU - Newman Taylor A AU - Cullinan P AU - Jones M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - The importance of nasal provocation test in the diagnosis of natural rubber latex allergy PG - 862-867 AB - ABSTRACT Background: Most studies regarding natural rubber latex (NRL) allergy have concentrated on the prevalance using skin prick test (SPT) and specific IgE assay. The objective of this study is to examine the target organ (skin, nasal mucosa) responses in patients with positive SPT to NRL using the nasal provacation test (NPT) and glove use test (GUT). Methods: Four thousand four hundred and twenty patients presented to our polyclinic between July 2003 and January 2007 were evaluated. One thousand six hundred and ninety-nine patients had positive SPT to one or more allergens (NRL and other inhaler allergens). Twenty-nine patients with positive SPT to NRL comprised the NRL sensitive group (group 1). Thirty-five randomized patients with positive SPT to an inhaler allergen other than NRL and negative NRL-specific IgE comprised atopic control group (group 2). Thirty healthy individuals who had no allergic diseases and had negative SPT and NRL-specific IgE comprised the healthy control group (group 3). Results: The lowest NRL allergen concentration leading to NPT positiveness was 0.05 µg/mL. NPT was negative in groups 2 and 3. NPT was found to have a sensitivity of 96%, specificity of 100%, negative predictive value of 98% and positive predictive value of 100%. GUT was found to have a sensitivity of 81%, specificity of 90%, negative predictive value of 75% and positive predictive value of 93%. Conclusions: Nasal provocation test was successfully used for the first time in the diagnosis of NRL allergy. NPT is a more sensitive method as compared to GUT. AU - Ünsel M AU - Mete N AU - Ardeniz Ö AU - Göksel S AU - Ersoy R AU - Sin A AU - Gulbahar O AU - Kokuludag A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - Sputum eosinophilia: an early marker of bronchial response to occupational agents PG - 754-761 AB - ABSTRACT Background: False-negative responses to specific inhalation challenge (SIC) with occupational agents may occur. We explored whether assessing changes in sputum cell counts would help improve the identification of bronchial reactivity to occupational agents during SICs. Methods: The predictive value of the changes in sputum cell counts after a negative FEV1 response to a first challenge exposure to an occupational agent was determined using the changes in airway calibre observed during repeated challenges as the 'gold standard'. The study included 68 subjects investigated for work-related asthma in a tertiary centre. After a control day, the subjects were challenged with the suspected occupational agent(s) for up to 2 h. All subjects who did not show an asthmatic reaction were re-challenged on the following day. Additional challenges were proposed to those who demonstrated a = 2% increase in sputum eosinophils or an increase in nonspecific bronchial hyperresponsiveness to histamine after the second challenge day. Results: Six of the 35 subjects without changes in FEV1 on the first challenge developed an asthmatic reaction on subsequent challenges. ROC analysis revealed that a >3% increase in sputum eosinophils at the end of the first challenge day was the most accurate parameter for predicting the development of an asthmatic response on subsequent challenges with a sensitivity of 67% and a specificity of 97%. Conclusions: An increase in sputum eosinophils is an early marker of specific bronchial reactivity to occupational agents, which may help to identify subjects who will develop an asthmatic reaction only after repeated exposure. AU - Vandenplas O AU - D'Alpaos V AU - Heymans J AU - Jamart J AU - Thimpont J AU - Huaux F AU - Lison D AU - Renauld J-C LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - Latex-induced occupational asthma: time trend in incidence and relationship with hospital glove policies PG - 415-420 AB - ABSTRACT Background: Natural rubber latex (NRL) has become as a major cause of occupational asthma (OA) in workers using NRL gloves. Few population-based studies have assessed the impact of changes in the patterns of glove usage on the incidence of NRL-induced OA. Objective: To characterize the time trends in incident cases of NRL-induced OA in Belgium and examine whether incidence rates were related to the types of gloves used in hospitals. Methods: Incident cases of NRL-induced OA were identified through a retrospective review of all claims submitted to the Workers' Compensation Board up to December 2004. Based on the results of diagnostic procedures, the diagnosis of NRL-induced OA was categorized as definite, probable, unlikely, or indeterminate. The patterns of glove usage were characterized through a questionnaire survey of Belgian hospitals. Results: A total of 298 claims for NRL-induced OA were identified, including 127 subjects with definite OA and 68 with probable OA. Categorized by the year of asthma onset, the incident cases of definite and probable NRL-induced OA markedly decreased from 1999 onwards. The use of powdered NRL gloves fell from 80.9% in 1989 to 17.9% in 2004. Powdered NRL gloves were predominantly substituted with NRL-free gloves, especially in the case of non-sterile procedures. Conclusion: These national compensation-based data confirm that a persistent decline in the incidence of NRL-induced OA has occurred since late 1990s. This downward trend has temporally been associated with a decreasing usage of powdered NRL, further supporting a beneficial role of changes in glove policies. AU - Vandenplas O AU - Larbanois A AU - Vanassche F AU - François S AU - Jamart J AU - Vandeweerdt M AU - Thimpont J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - Occupational asthma IgE mediated due to Chrysonilia sitophila in coffee industry PG - 1686-1687 AB - Crysonilia sitophila as an allergen to be considered for occupational asthma. This is the first case report with specific challenge, previous cases have occured in wood processing and coffee. It grew on used coffee from coffee machines, which the worker was replenishing. AU - Monzón S AU - Gil J AU - Ledesma A AU - Ferrer L AU - San Juan S AU - Abós T LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 102 IP - DP - 2009 Jan 01 TI - OCCUPATIONAL ASTHMA CAUSED BY NEUROSPORA SITOPHILA SENSITIZATION IN A COFFEE DISPENSER SERVICE OPERATOR PG - 168-169 AU - Heffler E AU - Nebiolo F AU - Pizzimenti S AU - Ferlini M AU - Marchese C AU - Rolla G LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - Occupational asthma and rhinitis induced by a cephalosporin intermediate product: description of a case PG - 1390-1391 AB - 7-TACA as a new causal agent of occupational asthma and rhinitis. AU - Pala G AU - Pignatti P AU - Perfetti L AU - Cosentino R AU - Moscato G LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 34 IP - DP - 2009 Jan 01 TI - Determinants of asthma phenotypes in supermarket bakery workers PG - 825-833 AB - While baker's asthma has been well described, various asthma phenotypes in bakery workers have yet to be characterised. Our study aims to describe the asthma phenotypes in supermarket bakery workers in relation to host risk factors and self-reported exposure to flour dust. A cross-sectional study of 517 supermarket bakery workers in 31 bakeries used a questionnaire, skin prick tests, and specific immunoglobulin E to wheat, rye and fungal -amylase and methacholine challenge testing. The prevalence of probable occupational asthma (OA, 13%) was higher than atopic (6%), nonatopic (6%) and work-aggravated asthma (WAA, 3%) phenotypes. Previous episodes of high exposure to dusts, fumes and vapours causing asthma symptoms were more strongly associated with WAA (OR 5.8, 95% CI 1.7–19.2) than OA (2.8, 1.4–5.5). Work-related ocular–nasal symptoms were significantly associated with WAA (4.3, 1.3–13.8) and OA (3.1, 1.8–5.5). Bakers with OA had an increased odds ratio of reporting adverse reactions to ingested grain products (6.4, 2.0–19.8). OA is the most common phenotype among supermarket bakery workers. Analysis of risk factors contributes to defining clinical phenotypes, which will guide ongoing medical surveillance and clinical management of bakery workers. AU - Baatjies R AU - Lopata AL AU - Sander I AU - Raulf-Heimsoth M AU - Bateman ED AU - Meijster T AU - Heederik D AU - Robins TG AU - Jeebhay MF LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 66 IP - DP - 2009 Jan 01 TI - Detergent protease exposure and respiratory disease: case-referent analysis of a retrospective cohort PG - 754-758 AB - Objectives: To examine the relationship between protease exposure and respiratory disease in a cohort of detergent enzyme manufacturers. Methods: Case–referent analysis of a cohort of employees working in a European detergent factory between 1989 and 2002. Cases with new lower or upper respiratory disease were ascertained by examination of occupational health records and matched to referents on date of first employment. Personal exposures to airborne detergent protease were estimated, using a job exposure matrix, from >12 000 measurements taken in the factory during the period of study. Results: We found clear, monotonic relationships between estimated protease exposure and both lower and upper respiratory disease. After control for age, sex and smoking, the odds ratio of lower respiratory disease was significantly elevated (1.98, 95% CI 1.04 to 3.79) in those employees working in jobs in the highest quartile of protease exposure (geometric mean 7.9 ng.m–3). For employees with upper respiratory disease, the risk was significantly elevated at a lower level of estimated protease exposure (geometric mean 2.3 ng.m–3). Conclusions: These findings provide strong evidence of an association between detergent enzyme exposure and the development of respiratory disease in an occupational setting. Using the routinely collected information on specific sensitisation and the close attention to workplace exposures that are characteristic of this industry, it should be possible to derive meaningful occupational exposure standards for most detergent enzymes. AU - Brant A AU - Upchurch S AU - van Tongeren M AU - Zekveld C AU - Helm J AU - Barnes F AU - Newman Taylor AJ AU - Cullinan P LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 66 IP - DP - 2009 Jan 01 TI - A cross-sectional study among detergent workers exposed to liquid detergent enzymes PG - 759-765 AB - Objectives: To investigate sensitisation and respiratory health among workers who produce liquid detergent products and handle liquid detergent enzymes. Methods: We performed a cross-sectional study among 109 eligible workers of a detergent products plant. 108 were interviewed for respiratory and allergic symptoms and 106 blood samples were taken from them to examine sensitisation to enzymes. Those sensitised to 1 enzymes were referred for clinical evaluation. Workers and representatives were interviewed to characterise exposure qualitatively and estimate exposure semi-quantitatively. Workers were classified into three exposure groups with varying exposure profiles to enzymes, based on frequency, duration, and level of exposure. Results: Workers were exposed to proteases, -amylase, lipase and cellulase. The highest exposures occurred in the mixing area. Liquid spills with concentrated enzyme preparations and leakage of enzymes during weighing, transportation and filling were causing workplace contaminations and subsequently leading to both dermal and inhalation exposure for workers. Workers with the highest exposures reported significantly more work-related symptoms of itching nose (prevalence ratio (PR) = 4.2, 95% CI 1.5 to 12.0) and sneezing (PR = 4.0, 95% CI 1.5 to 10.8) and marginally significant more symptoms of wheezing (PR = 2.9, 95% CI 0.9 to 8.7) compared with the least exposed group. Fifteen workers (14.2%) were sensitised to 1 enzymes. A marginally statistically significant gradient in sensitisation across the exposure categories was found (p = 0.09). There was a clinical case of occupational asthma and two others with probable occupational rhinitis. Conclusions: Workers exposed to liquid detergent enzymes are at risk of developing sensitisation (14%) and respiratory allergy. AU - van Rooy FGBGJ AU - Houba R AU - Palmen N AU - Zengeni MM AU - Sander I AU - Spithoven J AU - Rooyackers JM AU - Heederik DJJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - Audit of quality of diagnostic procedures for occupational asthma PG - 230-236 AB - Background Previous studies have reported deficiencies in the quality of the diagnosis of occupational asthma. A low quality of diagnostic procedures means that the occupational cause of asthma is less likely to be revealed. Aims To assess the current quality of the diagnosis of occupational asthma before referral to a specialist occupational medicine centre. Methods The quality of diagnostic procedures was assessed by reviewing the files of 150 patients who were referred to the Finnish Institute of Occupational Health in 2003 with a suspicion of an occupational cause of their asthma. The quality indicators used were assessment of workplace exposures, spirometric studies, bronchodilator response, serial workplace measurements of peak expiratory flow (PEF) and the time since first symptoms to the final diagnosis. For each indicator, criteria to differentiate between sufficient and insufficient care were developed. Results Exposure assessments, spirometric studies and bronchodilator responses were performed in 92, 87 and 79% of cases in the total study group, respectively. Workplace measurements of PEF had been performed in 51% of the cases, and the quality of measurements was sufficient in 52%. Workplace exposures had been assessed significantly more often in occupational health care than in other health care units. The median time from the beginning of symptoms to the final diagnosis was 3.2 years. Conclusions Although the diagnostic procedures were mostly of sufficient quality, the performance of serial measurements of PEF at the workplace and the time to diagnosis should be substantially improved. AU - Sauni R AU - Kauppi P AU - Helaskoski E AU - Virtema P AU - Verbeek J LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - Occupational exposure and sensitization to fungi among museum workers PG - 237-242 AB - Background Museum employees are exposed to fungi and storage mites in the workplace. Aims To evaluate the prevalence and risk factors of sensitization to moulds, as well as clinical symptoms associated with allergy in museum workers. Methods A total of 103 employees of the Polish National Museum (NM) in Warsaw, potentially exposed to fungi during their work, were assessed using a questionnaire and skin prick tests to common allergens and fungal extracts. The level of total and serum-specific IgE to moulds was evaluated, and spirometry was performed in all subjects. Mycological analysis of the workplace was also performed. Results Penicillium, Aspergillus, Cladosporium, Alternaria, Trichoderma, Acremonium and Paecilomyces were the most frequent species isolated from investigated exhibits of NM. Thirty per cent of museum employees were sensitized to at least one of the fungal allergens. Logistic regression analysis revealed that duration of occupational exposure lasting >5 years, family history of atopy, presence of a cat at home, sinusitis, allergic rhinitis and a history of frequent respiratory infections were risk factors for the development of sensitization to fungi in this working group. Conclusions This study suggests an important role of fungi as occupational allergens for museum workers. The prevalence of allergic symptoms among employees of NM was relatively high. Further studies are necessary to elucidate the importance of particular fungal species in the development of occupational allergy. AU - Wiszniewska M AU - Walusiak-Skorupa J AU - Pannenko I AU - Draniak M AU - Palczynski C LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - Occupational allergy to Artemia fish fry feed in aquaculture PG - 243-248 AB - Background Artemia (brine shrimp) is used as feed for fish fry and shrimp in aquaculture. Two employees in a Norwegian aquaculture research farm reported having chest symptoms when working in an Artemia hatch room. Aims To determine the presence and prevalence of Artemia sensitization at the farm and the extent of any Artemia-related respiratory and hand skin symptoms and to identify the allergens involved. Methods Participants completed a questionnaire and structured interview. Skin prick tests (SPTs) were performed, and immunoglobulin E (IgE) antibodies to Artemia, shrimp and recombinant tropomyosin were determined. Gel electrophoresis and immunoblots of Artemia extracts were also carried out. Results Thirty of 42 employees (71%) participated. Among the 24 subjects exposed to Artemia, four (17%) reported chest and/or hand skin symptoms during exposure and three of them were IgE sensitized to Artemia. Five (21%) of those exposed demonstrated IgE antibodies to Artemia and four (17%) had immediate-positive SPTs. A serum pool from these subjects exhibited IgE binding to a protein of 97 kDa in the Artemia extract. Conclusions Occupational exposure to the Artemia fish fry feed can cause IgE sensitization and allergic symptoms affecting airways and skin. AU - Granslo J-T AU - Van Do T AU - Aasen TB AU - Irgens Å AU - Florvaag E LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - Cutaneous and respiratory symptoms among professional cleaners PG - 249-254 AB - Background Occupational dermatitis is very common and has a large economic impact. Cleaners are at an increased risk for both work-related cutaneous and respiratory symptoms. Aims To compare the prevalence of occupational cutaneous symptoms among professional indoor cleaners to other building workers (OBW) and to determine associations with exposures and with respiratory symptoms among cleaners. Methods A questionnaire completed by indoor professional cleaners and OBW to compare rash and respiratory symptoms between these groups examined workplace factors such as training, protective equipment and work tasks. Results In total, 549 of the 1396 professional cleaners (39%) and 593 of the 1271 OBW (47%) completed questionnaires. The prevalence of rash was significantly higher in the cleaners compared to the OBW. For male cleaners, 21% (86/413) had a rash in the past 12 months compared to only 11% (13/115) of OBW (P < 0.05). The rashes experienced by the cleaners were more likely to be on their hands and worse at work. Cleaners washed their hands significantly more often than OBW. Cleaners with a rash were less likely to have received workplace training regarding their skin and were more likely to find the safety training hard to understand. Cleaners with a rash within the past year were significantly more likely to have work-related asthma symptoms than cleaners without a rash (P < 0.001). Conclusions This study demonstrates a strong link between work-related symptoms of asthma and dermatitis among cleaners. Effective preventive measures, such as the use of protective skin and respiratory equipment, should be emphasized. AU - Lynde CB AU - Obadia M AU - Liss GM AU - Ribeiro M AU - Holness DL AU - Tarlo SM LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - Pulmonary effects of spot welding in automobile assembly PG - 267-269 AB - Background Spot welding is a type of resistance welding in which pieces of metals are pressed together and an electric current is passed through them. Spot welders are at risk of contact with some potentially hazardous agents but there are few studies about the respiratory effects of spot welding. Aims Our objective was to study lung function and respiratory symptoms among spot welders and office workers at an automobile assembly factory in Iran. Methods This was a cross-sectional study of 137 male spot welders and 129 office workers. We used a questionnaire to record demographic data, smoking habits, work history and respiratory symptoms. Spirometry was performed to assess lung function status. Metal fume samples from the respiratory zone of spot welders were analysed. Results The concentrations of metal fume were less than the American Conference of Industrial Hygienists (ACGIH) threshold limit values. There were significantly lower values for average forced expiratory volume in 1st second (FEV1), FEV1/forced vital capacity and 25–75% forced expiratory flow in spot welders compared to controls. There was also a significantly raised prevalence of respiratory symptoms (sputum and dyspnoea) in spot welders. Fifteen per cent of spot welders and 1% of controls had an obstructive pattern in spirometry. Conclusions Our survey suggests that spot welders are at risk of developing respiratory symptoms and decreasing pulmonary function values despite their exposure to components of welding fume being within ACGIH guidelines. AU - Loukzadeh Z AU - Sharifian SA AU - Aminian O AU - Shojaoddiny-Ardekani A LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - IgE-mediated chlorhexidine allergy: a new occupational hazard? PG - 270-272 AB - Background Chlorhexidine is an effective antimicrobial agent commonly used in UK hospitals, primarily for skin decontamination. Recent UK infection control guidelines recommend the use of 2% chlorhexidine solution in specific clinical settings, thus increasing chlorhexidine use by health care workers (HCWs). Chlorhexidine has been widely reported to cause IgE-mediated allergic reactions (from urticaria and angioedema to anaphylaxis) among patients undergoing surgery/invasive procedures. Despite its widespread use in health care settings, there are no reports of clinically confirmed occupational IgE-mediated chlorhexidine allergy. Aims To identify cases of chlorhexidine allergy among health care workers. Methods A questionnaire was distributed among HCWs in wards and operating theatres at a UK district general hospital to raise awareness of potential chlorhexidine allergy and to invite those with possible clinical allergy to come forward for further testing. Diagnosis was based on an appropriate clinical history with positive serum-specific IgE to chlorhexidine and/or positive skin prick testing. Results Four cases of occupational IgE-mediated allergy to chlorhexidine were identified. Conclusions Despite its excellent antimicrobial properties, chlorhexidine is an occupational allergen. We suggest that chlorhexidine allergy be included in the differential diagnosis of HCWs presenting with work-related allergic symptoms. Increased awareness and easier access to chlorhexidine-specific IgE serological testing should facilitate early diagnosis of affected HCWs, allowing appropriate avoidance measures to be instigated—thus reducing the risk of potentially severe allergic reactions in the future. AU - Nagendran V AU - Wicking J AU - Ekbote A AU - Onyekwe T AU - Garvey LH LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - Occupational asthma and the paper recycling industry PG - 277-279 AB - Background Occupational disease linked to the paper recycling industry has not been well documented. No previously confirmed formal diagnosis of occupational asthma (OA) caused by hydroxylamine has been made. Methods We have assessed and performed occupational assessment of eight workers involved in this industry. Two of these were later diagnosed with OA and are reported here. Results Both workers developed their respiratory symptoms within 2 years of the first use of the chemical hydroxylamine as part of the ‘de-inking’ process. Hydroxylamine was used as a substitute for glutaraldehyde on risk grounds, although no prior cases of OA had been found. The two workers had worked at the same plant for 11 and 20 years, respectively. Both gave histories of work-related wheeze, shortness of breath and cough. Both cases performed OASYS peak flow records over a 3-week period and had OASYS II index of 2.85 and 2.67, respectively. Both were redeployed on site to non-exposed areas and subsequently demonstrated improvement in bronchial reactivity. Case 2 subsequently consented to and underwent a blinded, placebo-controlled occupational challenge using hydroxylamine demonstrating a significant isolated late asthmatic response. Conclusions We believe that these are the first two confirmed cases of OA caused by hydroxylamine in the paper recycling industry. AU - Tran S AU - Francis H AU - Hoyle J AU - Niven R LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 39 IP - DP - 2009 Jan 01 TI - Soluble human leucocyte antigen-G and interleukin-10 levels in isocyanate-induced asthma PG - 812-819 AB - Background We previously reported that in moderate-to-severe asthma there is a deficit of IL-10 secretion that could prevent the production of soluble HLA-G (sHLA-G), a non-classical human leucocyte antigen class I molecule with tissue-protective properties in inflammatory responses. Objective Our objective was to investigate the production of sHLA-G and the secretion of IL-10 by peripheral blood mononuclear cells (PBMCs) in asthma induced by isocyanates and to compare the results with those obtained in non-occupational allergic asthma. Method sHLA-G and IL-10 were measured by ELISA in the culture supernatants of unstimulated or lipopolysaccharide (LPS)-stimulated PBMCs obtained from 20 subjects with isocyanate asthma, 16 asymptomatic subjects exposed to isocyanates, 18 subjects with non-occupational allergic asthma, and 26 healthy control subjects. Results Occupational exposure to isocyanates was associated with high baseline levels of secretion of IL-10 by PBMCs, whether or not the exposed subjects had asthmatic symptoms. However, spontaneous production of sHLA-G by PBMC was significantly higher in subjects with isocyanate asthma compared with asymptomatic-exposed controls. In contrast, PBMCs from subjects with non-occupational allergic asthma produced sHLA-G only after LPS stimulation. Conclusions sHLA-G production and IL-10 secretion are influenced by workplace exposure to isocyanates and by development of asthma. The different behaviour of both sHLA-G and IL-10 in asthma induced by isocyanates compared with non-occupational allergic asthma suggests a heterogeneous biological role for HLA-G molecules and for IL-10, a key cytokine of immune and inflammatory responses. AU - Mapp CE AU - Ferrazzoni S AU - Rizzo R AU - Miotto D AU - Stignani M AU - Boschetto P AU - Maestrelli P AU - Baricordi OR LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - PEF analysis requiring shorter records for occupational asthma diagnosis PG - 413-417 AB - Background The Oasys programme plots serial peak expiratory flow (PEF) measurements and produces scores of the likelihood that the recordings demonstrate occupational asthma. We have previously shown that the area between the mean workday and rest day PEF curves [the area between the curves (ABC) score] has a sensitivity of 69% and specificity of 100% when plotted from waking time using a cut-off score of 15 l/min/h. Aims To investigate the minimum data requirements to maintain the sensitivity and specificity of the ABC score. Methods A total of 196 sets of measurements from workers with occupational asthma confirmed by methods other than serial PEFs and 206 records from occupational and non-occupational asthmatics who were not at work at the time of PEF monitoring were analysed according to their mean number of readings per day. Measurements from work and rest days were sequentially removed separately and the ABC score calculated at each reduction. The sensitivity and specificity of the ABC score (using a cut-off of 15 l/min/h) was calculated for each duration. Results Two-hourly measurements (8 readings per day) with eight workdays and three rest days had 68% sensitivity and 91% specificity for occupational asthma diagnosis. As readings decreased to 4 readings per day, 15 workdays were required to provide a specificity above 90%. Conclusions To be sensitive and specific in the diagnosis of occupational asthma, the ABC score requires 2-hourly PEF measurements on eight workdays and three rest days. This is a short assessment period that should improve patient compliance. AU - Moore VC AU - Jaakkola MS AU - Burge CBSG AU - Pantin CF AU - Robertson AS AU - Vellore AD AU - Burge PS LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - Consensus on work-related asthma PG - 213-217 AB - The recently published consensus statement on work-related asthma from the American College of Chest Physicians (ACCP) [1] [endorsed by the Occupational and Environmental Medical Association of Canada, the Canadian Thoracic Society (CTS) and the Canadian Society of Asthma, Allergy and Immunology and freely available on the website http://chestjournal.org/cgi/content/abstract/134/3_suppl/1S] is the latest in a number of recent statements addressing aspects of this topic. Given the previous statements, some readers may question the merits of yet another relating to this topic, and further ask why it is a consensus statement rather than an evidence-based guideline. As some of the authors of these guidelines, we feel it is important for clinicians to understand how this statement differs from others as it may help in deciding where the advice suggested can be of most help in clinical practice. Work-related asthma contributes to a significant proportion of adult-onset asthma-occupational asthma (OA) has been estimated to be the most common chronic occupational disease in many countries [2] and work exacerbated asthma (WEA) reportedly occurs in up to 25% of working asthmatics in primary care [3]. Nevertheless, the diagnosis is complicated and controversial; it will not be reached without a high index of suspicion and without asking questions about the temporal relationship of symptoms with work. Not surprisingly, work-related asthma is likely to be under-recognized: workers may be unaware that work exposures can contribute or cause asthma; they may not wish to admit to a work–asthma relationship (because of concern about losing their job). Finally, physicians may not question occupational exposures and differences in severity of asthma symptoms during working days versus weekends or holidays off-work [4]. The ACCP statement was developed by generating a specific series of questions, having methodological and content contributors, providing clear methods, seeking widespread feedback and providing easily translatable advice. Unlike previous statements, this document emphasizes both WEA (asthma that is not caused by the workplace but is worsened by workplace exposures) and OA (asthma caused by work, either secondary to a specific sensitizer or a high-level irritant exposure), detailing the advised approach to diagnosis and management. Another difference is the significant focus on prevention. The current statement expands the scope of previous North American OA statements, including a 1995 ACCP document [5] and 1998 CTS Guidelines [6], and provides an updated approach based on both evidence from literature review (where available) and consensus expert opinion (where evidence was limited). The ACCP Work-Related Asthma group was initially charged with the responsibility of developing an evidence based guideline (using the GRADE system), based on a systematic review of OA [7,8]. This report suggested high-quality evidence existed in only limited topics, e.g. conclusions on OA diagnosis were restricted to few areas for which sufficient evidence existed in the form of a comparison to a reference standard, specific occupational challenge tests (SICs). The panel recognized that SICs are performed in only a few centres and that patients who undergo these tests are not necessarily representative of all patients with suspected OA. The clinical indication for SIC when available (which can take 4 days to perform) is likely to be in cases where other tests were not performed or were inconclusive. Patients in whom the index of suspicion is high (e.g. painter, baker, red cedar lumber worker), who have a positive skin test response to a relevant work allergen and/or increased peak flow variability and/or increased methacholine responsiveness while working compared with off-work have a strong case for the diagnosis of work-related asthma and are unlikely to undergo SIC. This is especially the case in jurisdictions where SICs are not mandatory for diagnosis. Conversely, when SIC is performed only after having other preceding inconclusive tests, there can be questions as to the validity of comparing SIC results with these other tests. Due to the time, expense and limited availability of SIC, relatively few studies have been specifically designed to compare other diagnostic tests with SICs. Thus, the systematic review [7] could only draw evidence-based conclusions on the value of specific immunologic responses to a work allergen and of a single measure of airway responsiveness, such as a methacholine challenge (which reflects asthma, but not necessarily OA) in comparison with SIC. The report could not draw conclusions on the value of tests such as serial peak expiratory flow recordings, changes in measures of airway responsiveness and changes in induced sputum eosinophilia during periods at and off-work (tests which reflect asthma changes in relation to work). Further limitations of comparisons with this reference standard are that SICs can be falsely positive or negative [9] and are not of value in diagnosing irritant-induced OA or irritant-related exacerbations at work (except by excluding OA). Similarly, the systematic review [7] considered that formal analyses of management options could not be performed. Randomized studies of removal, reduced exposure, or continued exposure to a work sensitizer in those with OA, are unlikely to be performed. Moreover, published cohort studies demonstrate heterogeneity among reports regarding causative agents, asthma severity and duration of follow-up, precluding statistical comparisons. However, qualitative evidence synthesis did provide support for removal from exposure [7]-similar to recent British conclusions [10]. The ACCP panel thus developed a consensus statement based on the considered best available information from a broader medical literature including cohort studies and case series. A recent British Thoracic Society document similarly addressed Standards of Care for Occupational Asthma [11], following a Delphi document [12] and evidence-based review [13]; a Spanish Society of Pulmonology and Thoracic Surgery [14] document is also a clinical guide. Not surprisingly, there are differences in the emphasis taken by the British, Spanish and North American documents. The ACCP document emphasizes need for consideration and management of WEA both initially in asthmatics and in those in whom the diagnosis of OA has been excluded-rather than only continuing with usual asthma management. Each recognizes the limitations of the reference standard SIC and the possibility of false-positive and false-negative responses. Differences in emphasis on uses of various diagnostic tests for OA among different statements from Europe and North America may reflect the lack of sufficient studies to determine diagnostic test characteristics compared with a reference standard. For example, the British Standards of Care document [11] supported use of a computerized interpretation system for records of serial peak expiratory flow readings. This has the potential advantage of providing an objective grade to the results and may be helpful for those physicians who do not frequently assess such patients. However, it has not been shown to be more reliable than 'eye-balling' plotted results by a physician with experience in interpreting such results (and the systematic review [7] did not express preference for one method of interpretation over the other). The British document put less emphasis than the ACCP document on serial methacholine challenges-comparing results during a working period to those during an off-work period. This test has support from numerous case reports and highly influenced estimates of OA probability from expert opinion among those reviewing a set of cases with serial investigations [15] but also has not been sufficiently quantified in relation to specific challenges. Finally, as an example perhaps reflecting availability in most North American versus British centres, skin testing for those occupational allergens for which a reliable extract is available was given more emphasis in the ACCP Statement than the comparable in vitro specific IgE assays. Differences in the investigation of OA may also be influenced by requirements of the different compensation systems. In Canada, the requirements of provincial Workers' Compensation Board certainly influence the investigation performed in each province, e.g. only the Quebec compensation system requires SIC for OA diagnosis in the majority of cases. The essential message of this document is that work related asthma is common yet under-recognized, should be suspected in all adult asthmatics and carefully evaluated to allow accurate diagnosis, early management, and prevention of future cases among co-workers. Work related asthma and the associated significant disability from this are potentially preventable in many cases with workplace measures and early intervention to reduce or eliminate the inciting agent. We hope that this latest consensus statement is a useful resource for clinicians. AU - Tarlo SM AU - Rowe B AU - Liss GM AU - Lemiere C AU - Beach J LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - Questionnaire assessment of airway disease symptoms in equine barn personnel PG - 220-225 AB - Background People working in cattle, swine and poultry barns have a higher prevalence of respiratory symptoms and decreased lung function. There is scant evidence regarding the respiratory health of humans working in horse barns, although it is well documented that stabled horses have a high prevalence of airway disease. Aims To determine whether people spending time in horse barns have a higher prevalence of self-reported respiratory symptoms than non-exposed controls. Methods A cross-sectional questionnaire study was conducted from May 2005 to January 2006 to investigate the prevalence of self-reported respiratory symptoms in 82 barn-exposed subjects and 74 control subjects. Logistic regression and the chi-square test were used to analyse the data. Results There was a significantly higher prevalence of self-reported respiratory symptoms in the barn-exposed group (50%) versus the control group (15%). Exposure to horse barns, smoking and family history of asthma or allergies was independent risk factors for respiratory symptoms. High exposure to the horse barn yielded a higher odds ratio for self-reported respiratory symptoms (8.9). Conclusions Exposure to the equine barn is a risk factor for respiratory symptoms. Investigation of organic dust exposures, lung function and horse dander allergies in the barn-exposed group will be necessary to determine how best to protect the health of this group. AU - Mazan MR AU - Svatek J AU - Maranda L AU - Christiani D AU - Ghio A AU - Nadeau J AU - Hoffman AM LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - Peak expiratory flow analysis in workers exposed to detergent enzymes PG - 418-423 AB - Aims To study serial peak expiratory flow (PEF) responses in a group of symptomatic detergent enzyme-exposed workers. Methods Workers were recruited from a biological detergent formulating and packaging company. Those with occupational asthma symptoms and/or specific IgE to a detergent enzyme were asked to complete 2 hourly PEF measurements for 4 weeks. Outputs from the Oasys program (Oasys score, rest-work score and rest-work difference in diurnal variation) assessed PEF response. These were then related to the levels of sensitization and current occupational exposure to detergent enzymes. Results In all, 67/72 workers returned PEF records; 97% were able to return a record with at least four readings per day and 87% at least 3 weeks in length. Of total, 79% (n = 27) of those with a final diagnosis of occupational asthma had peak flow records confirming the disease using Oasys. PEF response was similar in those with high, medium and low levels of exposures and those with negative, low-moderate and high specific IgE levels. Conclusions The Oasys program is a sensitive tool for the diagnosis of detergent enzyme occupational asthma, but the levels of exposure and specific IgE sensitization to enzymes do not affect the magnitude of PEF response in symptomatic workers. AU - Moore VC AU - Cullinan P AU - Sadhra S AU - Burge PS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - Occupational asthma to gel flux containing dodecanedioic acid PG - 1099-1100 AB - We report the first case of occupational asthma to colophony free gel flux predominantly containing dodecanedioic acid. The patient worked as an electronics instructor from 1999 where he initially used solder wire and a separate flux (both colophony). In 2002 he changed to a colophony-free solder wire (predominantly palmitic acid) and a separate gel flux. In 2004 he developed work-related stuffy nose and dyspnoea. This became worse in 2005 when he woke twice a night and had a blocked nose, wheeze and sputum for the first 2 hours after waking. Serial peak expiratory flow records confirmed occupational asthma (Oasys score 3). His exhaled nitric oxide while exposed was 14.3ppb (Aerocrine Niox). He was admitted for specific bronchial challenge testing to both solder wires and fluxes. He melted approximately 5 metres of solder wire (using an iron heated to 370°C) spread over 3 challenges totalling 70 minutes. For the fluxes, he dipped the soldering iron into the flux approximately every 10 seconds, letting it fume into the challenge chamber after each insertion. For the colophony flux, he did this over 3 challenges totalling 17 minutes, and for only 8 minutes when using the colophony-free gel flux. He was negative to colophony wire/flux and wire containing predominantly palmitic acid, but positive to gel flux containing predominantly dodecanedioic acid, falling by a maximum of 23% from baseline. His methacholine reactivity was >4800 Dg methacholine (Yan method) pre challenge, becoming measurable post challenge at 3490 ug AU - Moore VC AU - Manney S AU - Vellore AU - Burge PS LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - A review of www.occupationalasthma.com PG - 284 AB - This website contains information and many references on occupational asthma. It also has information on a computer program (OASYS) to help diagnosis asthma from serial peak flow records. It is very easily found if you Google occupational asthma and appears high up on the resulting list. The web page loads on to the screen quickly and directly to the home page with no annoying front pages or moving parts which reduce load speed. The website has a very pleasing design with an industrial scene at the top and a light blue background colour scheme that is easy on the eye, and evocative of health, care, air, blue sky thinking etc. All were very apt with a clear and easily readable font. The structure is well laid out into nine main tables for Workers, Employers, Medics, Specialists, References, British Occupational Health Research Foundation (BHORF), OASYS, Shield and Forums. The order of the tabs has been organised from a researcher’s view of the world though. The website is very easy to use and simple to navigate around. No site map is required. The links all work well, so that behind the simple uncluttered structure, there is a massive amount of information accessed by the links. It is written in plain English, clear, to the point, with no gobbledegook. The pictures help to clarify the information and also act as hyperlinks, rather than just to look good on the screen. Just looking around the pages to write this article, I relearned a lot of information that I had forgotten from AFOM days and learned new information. There is straightforward information for workers on how to find out if they have occupational asthma. There are very useful downloads such as a date entry sheet for recording peak flow; how to carry out a detailed respiratory survey and an occupational asthma clinic proforma. The search facility for references is superb with a quirky photo-hyperlink to the author information page. The access to all the BOHRF information on occupational asthma and the Shield Surveillance scheme means that all the occupational asthma information is available at one very easily accessible point. There is also a Forum for discussion and seems to be in frequent use, particular on questions about published papers. The list of possible jobs was perhaps too simplistic though, and there did not appear to be information on RIDDOR which one might expect to find on the employer page. In summary, this is an excellent site on all aspects of occupational asthma. I would recommend a visit and saving it to your favourites for future reference. AU - Bell L LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - DIESEL EXHAUST CAUSING LOW-DOSE IRRITANT ASTHMA WITH LATENCY? PG - 424-427 AB - Background: Diesel exhaust exposure may cause acute irritant induced asthma, and potentiate allergen induced asthma. There are no previous reports of occupational asthma due to diesel exhaust. Aim: To describe occupational asthma with latency in workers exposed to diesel exhaust in bus garages Methods: The Shield database of occupational asthma notifications in the West Midlands, UK was searched between 1990 and 2006 for workers where diesel exhaust exposure was thought to be the cause of the occupational asthma. Those without other confounding exposures whose occupational asthma was validated by serial peak expiratory flow analysis using Oasys software were included. Results: 15 workers were identified with occupational asthma attributed to diesel exhaust. Three had validated new-onset asthma with latency. All worked in bus garages where diesel exhaust exposure was the only likely cause of their occupational asthma. Occupational asthma was confirmed by measures of non-specific reactivity and serial measurements of peak expiratory flow with Oasys scores of 2.9, 3.73 and 4 (positive score >2.5). AU - Adewole F AU - Moore VC AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 66 IP - DP - 2009 Jan 01 TI - Respiratory and skin effects of exposure to wood dust from the rubber tree Hevea brasiliensis PG - 442-447 AB - Objectives: Potential health effects related to wood dust from the rubber tree, which produces natural rubber latex, have not been previously investigated. The main aim of this study was to investigate the relations of rubber tree dust exposure to respiratory and skin symptoms, asthma and lung function. Methods: A cross-sectional study was conducted among 103 workers (response rate 89%) in a rubber tree furniture factory and 76 office workers (73%) in four factories in Thailand. All participants answered a questionnaire and performed spirometry. Inhalable dust levels were measured in different work areas. Results: Factory workers showed increased risk of wheezing, nasal symptoms and asthma compared to office workers. There was a dose-dependent increase in wheeze and skin symptoms in relation to dust level. Significantly increased risks of nasal symptoms (adj OR 3.67, 95% CI 1.45 to 9.28) and asthma (8.41, 1.06 to 66.60) were detected in the low exposure category. Workers exposed to ethyl cyanoacrylate glue had significantly increased risk of cough, breathlessness and nasal symptoms. There was dose-dependent reduction in spirometric lung function with wood dust level. Conclusions: This study provides new evidence that workers exposed to wood dust from the rubber tree experience increased risk of nasal symptoms, wheeze, asthma and skin symptoms and have reduced spirometric lung function. Exposure to cyanoacrylate is related to significantly increased respiratory symptoms. Results suggest that the furniture industry using rubber tree wood should implement appropriate exposure control measures to reduce wood dust exposure and cyanoacrylate glue exposure to protect their employees. AU - Sripaiboonkij P AU - Phanprasit W AU - Jaakkola MS LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 179 IP - DP - 2009 Jan 01 TI - Irritant-induced Asthma from Work Irritant induced asthma from work; What Happens Next? PG - 857-858 AB - ‘‘Inhalation accidents’’ at work are common, particularly in the chemical, plastics, and engineering sectors. In almost all cases, fortunately, the outcome is good, a testament to the remarkable resilience of the human respiratory tract. Factory physicians who registered 383 such accidents in a surveillance program in the United Kingdom, for example, later reported that in just 10% of cases did respiratory symptoms persist for a month or more and in only 3% was there a persistent asthmatic outcome (1). This experience is probably more representative than that of respiratory specialists to whom, of course, difficult cases are referred. They commonly see patients with persistent respiratory symptomsthat have been attributed to an irritant exposure at work and, in many instances, the prognosis seems poor. Stuart Brooks and his coauthors were the first to codify this specialist experience with, in 1985, a description of 10 cases of a persistent asthma-like condition that followed a single irritant exposure, of which 8 cases encountered the irritant at work (2); the average duration of symptoms was 3 years. There are at least two critical features of this important paper. First, the initiating exposures were of very high intensity: one patient, for example, was trapped beneath a 55-gallon drum of 35% hydrazine while another was in a bookshop into which an airplane crashed and caught fire. Second, the diagnostic criteria applied by the authors were peculiarly stringent and included measurable bronchial hyperreactivity and a ‘‘documented’’ absence of any preceding respiratory disease. Strict criteria such as these are valuable in assigning causality, but do not eliminate the possibility that high-dose irritant exposures can cause disease in individuals with a preexisting respiratory condition. Moreover, it is very rarely the case that there are pre-morbid measurements of airway function and thus, in general, it is supposition that an inhalational accident followed by bronchial hyperreactivity is a matter of cause and effect. Brooks and his colleagues coined the term ‘‘reactive airways dysfunction syndrome’’ to describe the experience of their patients. While this was useful as an acronym (RADS), it was not particularly descriptive, and the term has been largely superseded by the near-simile ‘‘irritant-induced asthma.’’ The fate of patients with irritant-induced asthma is often considered to be poor, but this is largely on the basis of anecdote and case experience, since there are very few surveys of prognosis in patient cohorts. Where such information is available, it suggests that many patients find that their symptoms respond poorly to standard asthma medications (3). Malo and coauthors describe the experience of 29 men and 6 women in Quebec who since 1988 have been compensated for irritant-induced asthma acquired after an inhalation accident at work (4). The diagnosis required an onset of symptoms within 24 hours of the accident, a history absent of any previous asthma or other chronic obstructive lung diseases, and either bronchial hyperresponsiveness (n=30) or ‘‘significant’’ airway obstruction (FEV1 <1.5 L, n=5). After a minimum interval of 4 years and an average of around 13 years, almost all 35 patients continued to have symptoms consistent with asthma, a third were using inhaled corticosteroids, and a third were still smoking. There was little evidence of any improvement—or deterioration—in spirometry, the mean percent predicted FEV1 and FVC values being approximately 70% at diagnosis and follow up. Twenty-three patients had repeat measurements of their metacholine responsiveness, 17 (74%) with persistently abnormal results. The remainder underwent spirometry before and after a bronchodilator. From the whole cohort, there was no physiologic evidence of continuing airway hyperreactivity in nine cases (25%); and in a further three, methacholine responsiveness had improved by at least two doubling doses. In this small study there was no evidence that either the severity or chemical nature of the initial event had any bearing on the outcome. Those with evidence of functional improvement tended to be younger (although few were very young) and to have a higher PC20 at presentation. What can we learn from these findings? The experience reported is very unlikely to be characteristic of workplace inhalational accidents in general and, in any case, the participation rate (52% of those eligible) raises concerns that a particularly poor prognosis is being presented. Nonetheless it would seem, at least among those who seek compensation for irritant-induced asthma and taking account of the response rate, that more than half will continue to report asthmatic symptoms for many years after what was probably quite a severe inhalational accident, and that more than one third will have persistent airway hyperreactivity. These are useful data. The levels of anxiety and depression in this cohort were quite high, again a feature that will be familiar to experienced physicians and one that raises the question of whether, how, and when psychological treatment might be helpful in improving symptomatic recovery. What is less clear is why some patients fare less well than others. If failure to recover is a consequence of inadequate remodeling after toxic airways damage, then one might expect it to be related to the severity of the initiating injury, or perhaps to its chemical nature. Neither appeared important in this cohort, although its small size will have limited its power to address these issues and retrospective measurements of severity (hospital attendance in this case) are difficult in individual cases. Nonetheless these findings, except in the instance of a very severe exposure, are in accord with the experience of most physicians. On the other hand, youth may be an advantage as is probably the case in other forms of occupational asthma (5). We do not know, and it will be difficult ever to know, whether workers’ compensation schemes affect, favorably or otherwise, prognosis, even when they are as generous as that in Quebec. Finding answers to these questions is going to need much larger cohorts of well-characterized patients followed, preferably prospectively, for 5 years or more, which will be a challenge AU - Cullinan P LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 179 IP - DP - 2009 Jan 01 TI - Long-Term Outcomes of Acute Irritant-induced Asthma PG - 923-928 AB - Rationale: The long-term outcomes of acute irritant-induced asthma (IIA) are mostly unknown. Objectives: To study the long-term outcomes of IIA. Methods: We reassessed 35 subjects who experienced IIA at a mean interval of 13.6 ± 5.2 years. Measurements and Main Results: The causal agent was chlorine in 20 cases (57%). At diagnosis, the mean ± SD FEV1 was 74.5 ± 19.5% predicted, and all subjects showed bronchial hyperresponsiveness. At reassessment, all subjects reported respiratory symptoms, and 24 (68%) were on inhaled steroids. There were no significant improvements in FEV1 and FEV1/FVC values. Twenty-three subjects had a methacholine test, and only six subjects had normal levels of responsiveness. Of the remaining 12 subjects, six had improvement in FEV1 after bronchodilator 10%. In samples of induced sputum obtained from 27 subjects, six had eosinophils 2%. Levels of inflammatory and remodeling mediators were higher than in control subjects but were no different from subjects with occupational asthma due to sensitization. Quality of life score was 4.4 ± 1.5 on a 0 (worst) to 7 (best) scale. Twelve subjects had an abnormal depression score. Conclusions: This study provides the first evidence of significant long-term impact of acute IIA on various outcomes. AU - Malo J AU - LArchevêque J AU - Castellanos L AU - Lavoie K AU - Ghezzo H AU - Maghni K LA - PT - DEP - TA - Am Rev Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 34 IP - DP - 2009 Jan 01 TI - Airway obstruction related to diacetyl exposure at microwave popcorn production facilities, bronchiolitis, microwave popcorn PG - 63-71 AB - Obstructive lung diseases including bronchiolitis obliterans have been reported among microwave popcorn production employees. Butter flavourings including diacetyl have been associated with these findings. The present study was initiated at four microwave popcorn production plants to determine if exposure to diacetyl was associated with decrements in pulmonary function. Comprehensive diacetyl exposure assessment was undertaken for all job tasks. Spirometry was conducted for 765 full-time employees between 2005 and 2006. Outcomes included decrement in forced expiratory volume in one second (FEV1) % predicted, airway obstruction and persistent decline in FEV1. Inclusion in the high-exposure group (mixers) prior to respirator use was associated with a significantly decreased FEV1 % pred in non-Asian and Asian males at -6.1 and -11.8% pred, respectively, and an eight-fold increased risk for airway obstruction. Cumulative diacetyl exposure 0.8 ppm-yr caused similar results. No significant impact was seen in nonmixers or between current diacetyl exposure and persistent decline in FEV1. Unprotected exposure as a mixer to butter flavouring including diacetyl resulted in decrements in FEV1 (% pred) and increased airway obstruction. Control of employee exposure to butter flavouring additives is warranted in regard to both short-term peak and 8-h workday exposure. AU - Lockey E AU - Hilbert TJ AU - Levin LP AU - Ryan PH AU - White KL AU - Borton EK AU - Rice CH AU - McKay RT AU - LeMasters GK LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 66 IP - DP - 2009 Jan 01 TI - Effect of an intervention aimed at reducing the risk of allergic respiratory disease in bakers: change in flour dust and fungal alpha-amylase levels PG - 543-549 AB - Introduction: We evaluated the effect on exposure of an intervention programme, which focused on risk education and providing information on good work practices. This intervention programme was enrolled as part of a Dutch covenant in the flour processing industry (industrial bakeries, flour mills, ingredient producers). Methods: Data from several measurement surveys collected pre- and post-intervention were used to evaluate changes in exposure over time. All datasets contained personal measurements analysed for flour dust and fungal -amylase contents, and contextual information was available on process characteristics, work practice, and use of control measures. Results: Changes in exposure over time varied substantially between sectors and jobs. For bakeries a modest downward annual trend of –2% was found for flour dust and –8% for amylase. For flour mills the annual trend for flour dust was –12%; no significant trend was observed for amylase. For ingredient producers results were generally non-significant but indicated a reduction in flour dust exposure and increase in fungal -amylase exposure. Modest increase in use of control measures and proper work practices were reported in most sectors, especially the use of local exhaust ventilation and decreased use of compressed air. Conclusions: The magnitude of the observed reductions in exposure levels indicates that the sector-wide intervention strategy implemented during the covenant period had a limited overall effect. This indicates that a more rigorous approach is needed to substantially decrease the exposure levels to flour dust and related allergens and, respectively, the prevalence of associated occupational diseases. AU - Meijster T AU - Tielemans E AU - Heederik D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 34 IP - DP - 2009 Jan 01 TI - Serial PEF measurement is superior to cross-shift change in diagnosing occupational asthma PG - 574-578 AB - ABSTRACT: Cross-shift measurements of peak expiratory flow (PEF) are commonly employed in the diagnosis of occupational asthma, although evidence for this approach is lacking. The current paper presents an evaluation of the technique. Methods Mean changes in PEF across morning/day shifts were compared between workers with occupational asthma, confirmed using specific challenge testing, and non-working asthmatics. Individuals were divided into a development set, used to identify the optimum cross-shift change for diagnosing occupational asthma, and an evaluation set, used to test the sensitivity and specificity of this value. Comparative analysis of serial PEF records was performed using the Oasys-2 computerised system. Results A cross-shift decrease in PEF of 5 L/min achieved acceptable specificity in the development set. Applied to the evaluation set, this cut-off had a specificity of 90.9% and a sensitivity of 50%. Sensitivity could not be improved without unacceptable compromise to specificity. Analysis of serial PEF records using linear discriminant analysis identified occupational asthma with a sensitivity of 83.3% and a specificity of 90.9%. Serial analysis using mean work/rest day PEF comparison had a sensitivity of 66.7% and a specificity of 100%. Conclusion Cross-shift changes in PEF in morning/day-shift workers have poor sensitivity in diagnosing occupational asthma, and are inferior to serial techniques. AU - Park D AU - Moore VC AU - Burge CBSG AU - Jaakkola MS AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 19 IP - DP - 2009 Jan 01 TI - Asthma and respiratory symptoms in hospital workers related to dampness and biological contaminants PG - 280-290 AB - The National Institute for Occupational Safety and Health investigated respiratory symptoms and asthma in relation to damp indoor environments in employees of two hospitals. A cluster of six work-related asthma cases from one hospital department, whose symptoms arose during a time of significant water incursions, led us to conduct a survey of respiratory health in 1171/1834 employees working in the sentinel cases hospital and a nearby hospital without known indoor environmental concerns. We carried out observational assessment of dampness, air, chair, and floor dust sampling for biological contaminants, and investigation of exposure-response associations for about 500 participants. Many participants with post-hire onset asthma reported diagnosis dates in a period of water incursions and renovations. Post-hire asthma and work-related lower respiratory symptoms were positively associated with the dampness score. Work-related lower respiratory symptoms showed monotonically increasing odds ratios with ergosterol, a marker of fungal biomass. Other fungal and bacterial indices, particle counts, cat allergen and latex allergen were associated with respiratory symptoms. Our data imply new-onset of asthma in relation to water damage, and indicate that work-related respiratory symptoms in hospital workers may be associated with diverse biological contaminants. AU - Cox-Ganser JM AU - Rao CY AU - Park J- AU - Schumpert JC AU - and Kreiss K LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - Occupational asthma due to exposure to chengal wood dust PG - 357-359 AB - Background Chengal is a resistant rainforest hardwood that is commonly used in South-East Asia for the construction of boats, bridges, house structures and furniture. It contains oligostilbenoids, phenolics, quinones and resins. Aims To describe a case of occupational asthma (OA) related to chengal wood dust. Methods The patient was evaluated clinically for asthma in relation to occupational history, serial peak flow monitoring and specific inhalation challenge (SIC) test. Results Peak flow monitoring showed significant deterioration during exposure to chengal wood dust at work. SIC test resulted in an isolated immediate asthmatic reaction. Conclusions Exposure to chengal wood dust can lead to OA and possibly rhinitis. The underlying mechanism should be investigated. AU - Lee LT AU - Tan KL LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 59 IP - DP - 2009 Jan 01 TI - Management of occupational health risks in small-animal veterinary practices PG - 316-322 AB - Background Small-animal work is a major element of veterinary practice in the UK and may be hazardous, with high levels of work-related injuries and ill-health reported in Australia and USA. There are no studies addressing the management of occupational health risks arising from small-animal work in the UK. Aims To investigate the sources of health and safety information used and how health and safety and 12 specific occupational health risks are managed by practices. Methods A cross-sectional postal survey of all small-animal veterinary practices in Hampshire. A response was mandatory as this was a Health & Safety Executive (HSE) inspection activity. Results A total of 118 (100%) practices responded of which 93 were eligible for inclusion. Of these, 99 and 86%, respectively, were aware of the Royal College of Veterinary Surgeons (RCVS) practice standards and had British Small Animal Veterinary Association (BSAVA) staff members, while only 51% had previous contact with HSE (publications, advice and visit). Ninety per cent had health and safety policies, but only 31% had trained responsible staff in health and safety. Specific health hazards such as occupational allergens and computer use were relatively overlooked both by practices and the RCVS/BSAVA guidance available in 2002. Conclusions Failings in active health risk management systems could be due to a lack of training to ensure competence in those with responsibilities. Practices rely on guidance produced by their professional bodies. Current RCVS guidance, available since 2005, has remedied some previous omissions, but further improvements are recommended. AU - D'Souza E AU - Barraclough R AU - Fishwick D AU - Curran A LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 6 IP - DP - 2009 Jan 01 TI - An Official ATS Proceedings: Asthma in the Workplace The Third Jack Pepys Workshop on Asthma in the Workplace: Answered and Unanswered Questions PG - 339-349 AB - WORKSHOP EXECUTIVE SUMMARY AND BOTTOM-LINE ISSUES The strengths of this Workshop include representatives from multiple disciplines, from basic science, environmental science, epidemiology, occupational hygiene, and clinician researchers. The international participation reflects WRA as a worldwide concern, although still understudied in many developing countries. It is a potentially preventable and curable problem, important for public and occupational health, and the outcome of research has potential for policy changes. WEA and OA represent important clinical problems, and patients need as accurate a diagnosis as feasible with support for best management and future occupation; misdiagnosis can be as harmful as missing the diagnosis, leading to inappropriate advice to change a job with potentially adverse financial and social consequences. WEA is common, but further consensus is needed as to clinical and research definitions and diagnostic criteria. OA is a valuable model for non-OA, having a clearly defined single specific causative agent. definitions need to be clearer to allow valid comparisons between studies. The concept of work-reactivated asthma seems useful. For the phenotype of eosinophilic bronchitis, it remains unclear whether this is a different disease or a different stage of asthma. None of the current diagnostic tests for OA is perfect in isolation. If new tests are added, such as induced sputum eosinophils, it is important to have studies to determine the diagnostic gain from these before adding or substituting them for other tests. Patients studied from tertiary centers may not represent the full spectrum of disease, and can have more psychiatric/psychological co-morbidity than in primary care settings. There is a need to balance the medical and socio-economic impacts of job changes for workers with OA. The potential of markedly reduced exposure, as has been successful for OA from natural rubber latex in allowing sensitized healthcare workers to continue to work, should be investigated. Physicians need to consider, and influence, compensation systems to provide appropriate support and retraining for workers with OA. A major advance in recent years has been the understanding that the OA incidence due to sensitizers largely relates to the exposure levels. Workplace controls should focus on reduction of exposure rather than worker susceptibility in the prevention of OA. In that light, we now need well performed intervention studies to demonstrate effects of preventive measures and means to implement them widely and to enable change. There is a need also to increase employer and government commitments to prevention and appropriate compensation, and a need to be able to ensure preventive measures. Genetic studies may provide helpful data, insofar as gene–environmental interactions may be relevant to mechanisms of disease. Relative to idiopathic disease, the population with OA due to high-molecular-weight antigens has a well defined phenotype, set of exposures, and sensitizer-based mechanism of disease. The disadvantage of relatively small sample size could be overcome by collaborative studies using hypothesis-generating and hypothesis-testing analytic strategies. Mechanisms of sensitization remain less clear for many low molecular weight sensitizers, such as diisocyanates. Further understanding may lead to better immunologic testing that could be relevant to exposure assessment, diagnosis, and disease management. The role of irritants in asthma causation and exacerbation, acting alone or as adjuvants or co-factors, also requires more research. Large knowledge gaps exist in work-related rhinitis and in global aspects of WRA and related disability. Finally, the need for research addressing work-related asthma was particularly glaring, not only to advance knowledge in this area but also to attract the best young researchers for the future. AU - Tarlo SM AU - Malo J-L AU - on behalf of the Third Jack Pepys Workshop on Asthma in the Workplace LA - PT - DEP - TA - Proc American Thoracic Soc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 39 IP - DP - 2009 Jan 01 TI - Toluene diisocyanate enhances human bronchial epithelial cells' permeability partly through the vascular endothelial growth factor pathway PG - 1532-1539 AB - ABSTRACT Background Toluene diisocyanate (TDI) is a recognized chemical asthmogen; yet, the mechanisms of its toxicity have not been elucidated. Objective To investigate the influence of TDI on the permeability of human bronchial epithelial cell (HBE; HBE135-E6E7) monolayers in vitro, and the expression of vascular endothelial growth factor (VEGF) in these cells. Methods TDI–human serum albumin (HSA) conjugates were prepared by a modification of Son's method. Fluorescein isothiocyanate-labelled dextran and transmission electron microscopy were used to evaluate the effects of TDI–HSA on HBE135-E6E7 permeability. RT-PCR and ELISA were used to evaluate VEGF gene expression and protein release from HBE135-E6E7 cells stimulated by TDI–HSA. A VEGF-neutralizing antibody was used in monolayer permeability experiments to determine the role of the VEGF pathway in this process. Results TDI–HSA significantly increased the permeability coefficients of HBE135-E6E7 monolayers (P<0.01). TDI–HSA treatment significantly increased the expression of VEGF165 and VEGF189 genes (P<0.01). ELISA showed that TDI significantly induces VEGF release from HBE135-E6E7 cells. Cells treated with TDI–HSA and VEGF-neutralizing antibody had significantly lower permeability coefficients than cells treated with TDI–HSA only (P<0.01), but still significantly higher than control cells (P<0.01). Cells treated with TDI–HSA had fewer tight junctions (TJs) than control and HSA-treated cells, and addition of the anti-VEGF antibody did not restore the original number of TJs. Conclusion TDI increases the permeability of HBE cell monolayers, partly through a VEGF-mediated pathway. This suggests the importance of VEGF in TDI-induced pulmonary diseases, but shows that other pathways may be involved in the pathogenic process. AU - Zhao H AU - Peng H AU - Cai S-X AU - Li W AU - Zou F AU - Tong W LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 52 IP - DP - 2009 Jan 01 TI - Data linkage to estimate the extent and distribution of occupational disease: new onset adult asthma in Alberta, Canada. PG - 831-840 AB - BACKGROUND: Although occupational asthma is a well recognized and preventable disease, the numbers of cases presenting for compensation may be far lower than the true incidence. METHODS: Workers' Compensation Board (WCB) claims for any reason 1995-2004 were linked to physician billing data. New onset adult asthma (NOAA) was defined as a billing for asthma (ICD-9 code of 493) in the 12 months prior to a WCB claim without asthma in the previous 3 years. Incidence was calculated by occupation, industry and, in a case-referent analysis, exposures estimated from an asthma specific job exposure matrix. RESULTS: There were 782,908 WCB eligible claims, with an incidence rate for NOAA of 1.6%: 23 occupations and 21 industries had a significantly increased risk. Isocyanates (OR 1.54: 95% CI 1.01-2.36) and exposure to mixed agricultural allergens (OR = 1.59: 95% CI 1.17-2.18) were related to NOAA overall, as were exposures to cleaning chemicals in men (OR = 1.91:95% CI 1.34-2.73). Estimates of the number of cases of occupational asthma suggested a range of 4% to about half for the proportion compensated. CONCLUSIONS: Data linkage of administrative records can demonstrate under-reporting of occupational asthma and indicate areas for prevention. AU - Cherry N AU - Beach J AU - Burstyn I AU - Fan X AU - Guo N AU - Kapur N LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 149 IP - DP - 2009 Jan 01 TI - Classification of Hypersensitivity Pneumonitis A Hypothesis PG - 161-166 AB - Background: Regardless of the causative antigen, hypersensitivity pneumonitis (HP) is usually classified as 'acute', 'subacute' or 'chronic'. Considerable confusion still surrounds this classification because there are no widely accepted criteria to distinguish the various stages. The objective of this study was to determine whether the current classification of HP truly reflects categories of patients with distinct clinical features. Methods: Data obtained from a large prospective multicenter cohort study (the HP Study) were used to divide a cohort of patients with HP into a limited number of categories (clusters) with maximally differing clinical patterns, without prejudgment. The results of this cluster analysis were compared with the current classification of HP (acute, subacute or chronic). Results: 168 patients were included in the analysis. A 2-cluster solution best fitted the data. Patients in cluster 1 (41 patients) had more recurrent systemic symptoms (chills and body aches) and normal chest radiographs than those in cluster 2 (127 patients) who showed significantly more clubbing, hypoxemia, restrictive patterns on pulmonary function tests and fibrosis on high-resolution computed tomography (HRCT). All p values were <0.0001, using Fisher's exact test. Nodular opacities were seen on HRCT as often in cluster 1 as in cluster 2. There was considerable disagreement between the current classification of HP and the results of our analysis. Conclusion: The current classification of acute, subacute and chronic HP is not supported by our analysis. Subacute HP is particularly difficult to define. AU - Lacasse Y AU - Selman M AU - Costabel U AU - Dalphin J AU - Morell F AU - Erkinjuntti-Pekkanen R AU - Mueller NL AU - Colby TV AU - Schuyleri M AU - Jomphe V AU - Cormier Y AU - for the HP Study Group LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - Mortality from infectious pneumonia in metal workers: a comparison with deaths from asthma in occupations exposed to respiratory sensitisers PG - 983-986 AB - Background: National analyses of mortality in England and Wales have repeatedly shown excess deaths from pneumonia in welders. During 1979–90 the excess was attributable largely to deaths from lobar pneumonia and pneumonias other than bronchopneumonia, limited to men of working age and apparent in other occupations with exposure to metal fumes. The findings for 1991–2000 were assessed and compared with the mortality pattern from asthma in occupations exposed to known respiratory sensitisers. Methods: The Office of National Statistics supplied data on deaths by underlying cause among men aged 16–74 years in England and Wales during 1991–2000, including age and last held occupation. Data were abstracted on pneumonia for occupations with exposure to metal fumes and on asthma for occupations commonly reported to surveillance schemes as at risk of occupational asthma. The expected numbers of deaths were estimated by applying age-specific proportions of deaths by cause in the population to the total deaths by age in each occupational group. Observed and expected numbers were compared for each cause of death. Results: Among men of working age in occupations with exposure to metal fumes there was excess mortality from pneumococcal and lobar pneumonia (54 deaths vs 27.3 expected) and from pneumonias other than bronchopneumonia (71 vs 52.4), but no excess from these causes at older ages or from bronchopneumonia at any age. The attributable mortality from metal fume exposure was 45.3 excess deaths compared with an estimated 62.6 deaths from occupational asthma. Conclusion: Exposure to metal fumes is a material cause of occupational mortality. The hazard deserves far more attention than it presently receives. AU - Palmer KT AU - Cullinan P AU - Rice S AU - Brown T AU - Coggon D LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 1 IP - DP - 2009 Jan 01 TI - British Guideline on the Management of Asthma PG - 1-125 AU - BTS/SIGN LA - PT - DEP - TA - BTS JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 103 IP - DP - 2009 Jan 01 TI - Long-term prognosis of immediate hypersensitivity type of occupational laryngitis PG - 130-135 AB - The present study investigated, for the first time, the long-term prognosis of hypersensitivity type of occupational laryngitis (OL). Thirteen patients with OL diagnosed in 1990-1993 at the Finnish Institute of Occupational Health participated in a questionnaire follow-up study. The records of the primary diagnostic investigations were also reviewed. The mean follow-up time was 12.5 (range 11-15) years. The mean age of the study subjects was 51.5 (range 32-64) years; nine (69%) were women. In addition to OL during the primary examinations, two patients were diagnosed to have occupational asthma, and nine patients occupational rhinitis. During the follow-up, six additional patients had developed asthma. Asthma had thus been diagnosed in 8 of the 13 (61%) patients. At present, nine patients (69%) were non-employed. Of these, seven were on work disability pension, of whom six had occupational or non-occupational asthma in addition to OL. The remaining four patients (31%) were still working: three had training for some other type of work, and one had been transferred to another job. None of them had developed asthma during the follow-up. The current study, based on a small series, suggests that many of the patients with previously diagnosed OL developed asthma and were not employed. AU - Hannu T AU - Sala E AU - Toskala E LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 135 IP - DP - 2009 Jan 01 TI - A New Diagnostic Score for Occupational Asthma PG - 307-314 AB - Evidence-based guidelines recommend serial peak expiratory flow (PEF) measurements on days at and away from work as the first step in the objective confirmation of occupational asthma. The aim of this study was to improve the diagnostic value of computer-based PEF analysis by calculating a score from the area between the curves (ABC) of PEF on days at and away from work in Oasys. Mean 2-hourly PEFs were plotted separately for work days and rest days for 109 workers with occupational asthma and 117 control asthmatics. A score based on the ABC was computed from records containing >= 4 day shifts, >= 4 rest days and >= 6 readings per day. Patients were randomly divided into 2 datasets (analysis and test sets). Receiver operator characteristic (ROC) curve analysis determined a cut off point from Set 1 that best identified those with occupational asthma, which was then tested in Set 2. Logistic regression analysis showed that all ABC PEF scores were significant predictors of occupational asthma, with the best being ABC per hour from waking (odds ratio= 11.9 per 10L/hour/min; 95% CI 10.8-13.1). ROC curve analysis showed that a difference of 15 l/min/hour provided a high specificity without compromising sensitivity for occupational asthma diagnosis. Analysis of dataset 2 confirmed a specificity of 100% and sensitivity of 72%. The ABC PEF score is sensitive and specific for the diagnosis of occupational asthma and can be calculated from a shorter PEF surveillance than is needed for the current Oasys-2 work effect index. AU - Moore VC AU - Jaakkola MS AU - Burge CBSG AU - Robertson AS AU - Pantin CF AU - Vellore AD AU - Burge PS LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - Occupational exposures and the risk of COPD: dusty trades revisited PG - 6-12 AB - Background: The contribution of occupational exposures to chronic obstructive pulmonary disease (COPD) and, in particular, their potential interaction with cigarette smoking remains underappreciated. Methods: Data from the FLOW study of 1202 subjects with COPD (of which 742 had disease classified as stage II or above by Global Obstructive Lung Disease (GOLD) criteria) and 302 referent subjects matched by age, sex and race recruited from a large managed care organisation were analysed. Occupational exposures were assessed using two methods: self-reported exposure to vapours, gas, dust or fumes on the longest held job (VGDF) and a job exposure matrix (JEM) for probability of exposure based on occupation. Multivariate analysis was used to control for age, sex, race and smoking history. The odds ratio (OR) and adjusted population attributable fraction (PAF) associated with occupational exposure were calculated. Results: VGDF exposure was associated with an increased risk of COPD (OR 2.11; 95% CI 1.59 to 2.82) and a PAF of 31% (95% CI 22% to 39%). The risk associated with high probability of workplace exposure by JEM was similar (OR 2.27; 95% CI 1.46 to 3.52), although the PAF was lower (13%; 95% CI 8% to 18%). These estimates were not substantively different when the analysis was limited to COPD GOLD stage II or above. Joint exposure to both smoking and occupational factors markedly increased the risk of COPD (OR 14.1; 95% CI 9.33 to 21.2). Conclusions: Workplace exposures are strongly associated with an increased risk of COPD. On a population level, prevention of both smoking and occupational exposure, and especially both together, is needed to prevent the global burden of disease. AU - Blanc PD AU - Iribarren C AU - Trupin L AU - Earnest G AU - Katz PP AU - Balmes J AU - Sidney S AU - Eisner MD LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 64 IP - DP - 2009 Jan 01 TI - Occupational rhinitis in workers investigated for occupational asthma PG - 50-54 AB - Background: The links between asthma and rhinitis are now referred to as united airways disease (UAD). Current evidence shows that the UAD model seems to be applicable to occupational rhinitis (OR) and occupational asthma (OA). A study was undertaken to objectively assess, in the context of specific inhalation challenge (SIC) testing, the concomitance of bronchial and nasal reaction in the investigation of OR and OA. Methods: 43 subjects with a history of work-related asthma symptoms underwent SIC for confirmation of OA and investigation of OR. Changes in bronchial calibre were measured by spirometry and nasal patency and airway inflammation were assessed by acoustic rhinometry and nasal lavage. Results: A positive nasal challenge was observed in 25 SIC tests and a positive bronchial challenge was observed in 17 SIC tests. A concomitant positive nasal and bronchial challenge was observed in 13 instances. This association was significant (risk ratio = 1.7; 95% CI 1.0 to 2.4; p = 0.04) and more frequent in subjects challenged with high molecular weight agents (n = 11/22) than with low molecular weight agents (n = 2/21). In subjects with a positive nasal challenge, nasal lavage showed a significant increase in eosinophils 30 min after exposure which correlated with changes in nasal patency. Conclusion: The results of this study provide objective evidence to support the concept of UAD using OR and OA as a model to demonstrate a significant concomitant physiological reaction of the nose and lungs after challenge. This study shows that OR can be assessed by objective means; it often coexists with OA but can be present without OA. AU - Castano R AU - Gautrin D AU - Thériault G AU - Trudeau C AU - Ghezzo H AU - Malo J-L LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 66 IP - DP - 2009 Jan 01 TI - A cross-sectional study of lung function and respiratory symptoms among chemical workers producing diacetyl for food flavourings PG - 105-110 AB - Objectives: Four diacetyl workers were found to have bronchiolitis obliterans syndrome. Exposures, respiratory symptoms, lung function and exposure–response relationships were investigated. Methods: 175 workers from a plant producing diacetyl between 1960 and 2003 were investigated. Exposure data were used to model diacetyl exposure. Lung function and questionnaire data on respiratory symptoms were compared to a general population sample and respiratory symptoms to an internal reference group. Results: Workers were potentially exposed to acetoin, diacetyl, acetaldehyde and acetic acid. Historic diacetyl exposure ranged from 1.8 to 351 mg/m3, and from 3 to 396 mg/m3 for specific tasks. Diacetyl workers reported significantly more respiratory symptoms compared to the general population sample (continuous trouble with breathing (prevalence ratio (PR) = 2.6; 95% CI 1.3 to 5.1), daily cough (PR = 1.5; 95% CI 1.1 to 2.1), asthma attack (ever) (PR = 2.0; 95% CI 1.2 to 3.4), doctor diagnosed asthma (PR = 2.2; 95% CI 1.3 to 3.8) and asthma attack in the last year (PR = 4.7; 95% CI 1.9 to 11.4)) and to a minimally exposed internal reference group (ever trouble with breathing (PR = 2.8; 95% CI 1.1 to 7.0) and work-related shortness of breath in the last year (PR = 7.5; 95% CI 1.1 to 52.9)). Lung function did not differ between groups. A positive relationship between exposure and FEV1 was found. Conclusion: The excess of respiratory symptoms in this retrospective cohort suggests that diacetyl production poses an occupational hazard. Limited historical exposure data did not support a quantitative individual diacetyl exposure–response relationship, but our findings suggest that preventive measures are prudent. AU - van Rooy FGBGJ AU - Smit LAM AU - Houba R AU - Zaat VAC AU - Rooyackers JM AU - Heederik DJJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 66 IP - DP - 2009 Jan 01 TI - Which tools best predict the incidence of work-related sensitisation and symptoms PG - 111-117 AB - Background/aim: This study used information from the questionnaire alone or in conjunction with clinical tests, such as skin-prick testing (SPT) and bronchial responsiveness (BR) testing at entry, to develop models for estimating the probability of the occurrence of specific IgE-sensitisation to and respiratory symptoms in contact with laboratory animal (LA) allergens after 32 months’ training in an animal health technology programme. Methods: Four multivariable logistic regression models were developed for each endpoint, consisting of: (1) questionnaire; (2) questionnaire and SPT; (3) questionnaire and BR testing; and (4) questionnaire, SPT and BR testing. The prognostic models were derived from a cohort of Canadian animal health technology apprentices. The models’ internal validity and diagnostic accuracy were evaluated and compared. Results: Symptoms indicative of asthma and allergic symptoms at baseline composed the final questionnaire model for the occurrence of occupational sensitisation and symptoms. Both questionnaire models showed a good discrimination (area under the receiver operating characteristics curve were 0.73 and 0.78, respectively) and calibration (Hosmer-Lemeshow test p value >0.10). Addition of SPT and/or BR testing increased the specificity of the questionnaire model for LA sensitisation, but not for symptoms at work. To facilitate their application in practice, the final questionnaire models were converted to easy-to-use scoring system. Conclusions: Questionnaire is an easy tool that can give accurate prediction of the incidence of occupational sensitisation and symptoms. AU - Suarthana E AU - Malo J-L AU - Heederik D AU - Ghezzo H AU - LArchevêque J AU - Gautrin D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 9 IP - DP - 2009 Jan 01 TI - Asthma caused by occupational exposures is common - a systematic analysis of estimates of the population-attributable fraction PG - 7 AB - BACKGROUND: The aim of this paper is to highlight emerging data on occupational attributable risk in asthma. Despite well documented outbreaks of disease and the recognition of numerous specific causal agents, occupational exposures previously had been relegated a fairly minor role relative to other causes of adult onset asthma. In recent years there has been a growing recognition of the potential importance of asthma induced by work-related exposures METHODS: We searched Pub Med from June 1999 through December 2007. We identified six longitudinal general population-based studies; three case-control studies and eight cross-sectional analyses from seven general population-based samples. For an integrated analysis we added ten estimates prior to 1999 included in a previous review. RESULTS: The longitudinal studies indicate that 16.3% of all adult-onset asthma is caused by occupational exposures. In an overall synthesis of all included studies the overall median PAR value was 17.6%. CONCLUSION: Clinicians should consider the occupational history when evaluating patients in working age who have asthma. At a societal level, these findings underscore the need for further preventive action to reduce the occupational exposures to asthma-causing agents AU - Torén K AU - Blanc PD LA - PT - DEP - TA - BMC Pulm Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 33 IP - DP - 2009 Jan 01 TI - Asthma, airway inflammation and epithelial damage in swimmers and cold-air athletes PG - 740-746 AB - Endurance athletes show an increased prevalence of airway hyperresponsiveness. The aim of the present study was to evaluate the long-term effects of training on airway responsiveness, inflammation and epithelial damage in swimmers and cold-air athletes. In total, 64 elite athletes (32 swimmers and 32 cold-air athletes), 32 mild asthmatic subjects and 32 healthy controls underwent allergy skin prick testing, methacholine challenge and induced sputum analysis. Overall, 69% of swimmers and 28% of cold-air athletes had airway hyperresponsiveness. Sputum neutrophil count correlated with the number of training hours per week in both swimmers and cold-air athletes. Eosinophil counts were higher in swimmers than in healthy subjects, although they were lower than in asthmatic subjects, and correlated with airway hyperresponsiveness in swimmers only. The eosinophil count in cold-air athletes was similar to that in healthy subjects. Bronchial epithelial cell count was not correlated with airway hyperresponsiveness but was significantly increased in swimmers, compared with healthy and asthmatic controls. In conclusion, the present authors observed significant airway inflammation only in competitive athletes with airway hyperresponsiveness. However, the majority of elite athletes showed evidence of bronchial epithelial damage that could possibly contribute to the development of airway hyperresponsiveness. AU - Bougault V AU - Turmel J AU - St-Laurent J AU - Bertrand M AU - Boulet L-P LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 33 IP - DP - 2009 Jan 01 TI - Comparative airway response to high- versus low-molecular weight agents in occupational asthma PG - 734-739 AB - Airway responses to occupational agents in sensitised workers may vary clinically and physiologically. The patterns of change in airway responsiveness, type of response and fall in expiratory flows following laboratory exposure to high- or low-molecular weight agents (HMW and LMW agents, respectively) were compared in sensitised workers. Data on workers who underwent specific inhalation challenges with occupational sensitisers (117 exposed to HMW agents and 130 to LMW agents) were collected from their medical charts. Maximum falls in forced expiratory volume in one second (FEV1) were of similar magnitude for both types of agents. Compared with HMW agents, LMW agents induced more frequently late or dual responses and higher increases in airway responsiveness. After exposure to HMW agents, there was a mean±SD reduction in doubling concentrations of methacholine of 0.5±1.7 for early responses, compared with 2.8±1.2 and 1.4±2.0 for late and dual responses, respectively. Isolated early responses were more frequently found in females, smokers, workers with a higher % predicted FEV1 and higher provocation concentration causing a 20% fall in FEV1, and in those with longer asthma duration. Workers’ characteristics, as well as the type of agent they are sensitised to, may help to predict the type of response after specific inhalation challenge AU - Dufour M-H AU - Lemière C AU - Prince P AU - Boulet L-P LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 33 IP - DP - 2009 Jan 01 TI - Hypersensitivity pneumonitis associated with the use of temozolomide PG - 931-934 AB - The aim of the present study was to investigate a case of hypersensitivity pneumonitis associated with the use of temozolomide in the treatment of gliosarcoma. A 54-yr-old female developed dyspnoea, cough and hypoxia after surgical resection for gliosarcoma and adjuvant radio- and chemotherapy with temozolomide. A high-resolution computed tomography scan of the thorax showed a bilateral ground-glass pattern. Bronchoscopy with bronchoalveolar lavage and lung biopsies was performed. Bronchoalveolar lavage demonstrated significant lymphocytic alveolitis and transbronchial lung biopsies revealed lymphocytic infiltration with foamy macrophages, consistent with hypersensitivity pneumonitis. There was no evidence of other causes, including infections. After withdrawing temozolomide and initiating prednisolone therapy, the patient had no further pulmonary symptoms. To the present authors’ knowledge, this is the first definitively described case of temozolomide-associated hypersensitivity pneumonitis. AU - Koschel D AU - Handzhiev S AU - Leucht V AU - Holotiuk O AU - Fisseler-Eckhoff A AU - Höffken G LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 33 IP - DP - 2009 Jan 01 TI - Different respiratory phenotypes are associated with isocyanate exposure in spray painters PG - 494-501 AB - Associations have been observed between exposure to isocyanates, consisting mainly of oligomers, and respiratory symptoms and isocyanate specific sensitisation in spray painters. The aim of the present study was to assess associations between isocyanate exposure and more objective respiratory effect measures such as bronchial hyperresponsiveness (BHR), baseline spirometry and exhaled nitric oxide (eNO) in a subset of spray painters. Methacholine challenge and eNO measurements were performed in 229 workers. Questionnaires and blood samples were obtained. Specific immunoglobulin (Ig)E and IgG to hexamethylene di-isocyanate were assessed in serum using various assays. Personal exposure was estimated by combining personal task-based inhalatory exposure measurements and time-activity information. Workers with higher isocyanate exposure were more often hyperresponsive (prevalence ratio comparing the 75th versus 25th percentile of exposure 1.8). In addition, significant exposure-related decreased forced expiratory volume in one second (FEV1), FEV1/forced vital capacity ratio and flow–volume parameters independent of BHR were found. BHR was more prevalent among sensitised workers. This was statistically significant for only IgG-ImmunoCAP (Phadia, Uppsala, Sweden) positive workers. eNO was not associated with exposure although slightly elevated eNO levels in specific IgG positive subjects were found. The current study provides evidence that exposure to isocyanate oligomers is related to asthma with bronchial hyperresponsiveness as a hallmark, but also shows independent chronic obstructive respiratory effects resulting from isocyanate exposure. AU - Pronk A AU - Preller L AU - Doekes G AU - Wouters IM AU - Rooijackers J AU - Lammers J-W AU - Heederik D LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 33 IP - DP - 2009 Jan 01 TI - Occupational exposures and COPD: an ecological analysis of international data PG - 298-304 AB - The occupational contribution to chronic obstructive pulmonary disease (COPD) has yet to be put in a global perspective. In the present study, an ecological approach to this question was used, analysing group-level data from 90 sex-specific strata from 45 sites of the Burden of Obstructive Lung Disease study, the Latin American Project for the Investigation of Obstructive Lung Disease and the European Community Respiratory Health Survey follow-up. These data were used to study the association between occupational exposures and COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II or above. Regression analysis of the sex-specific group-level prevalence rates of COPD at each site against the prevalence of occupational exposure and ever-smoking was performed, taking into account mean smoking pack-yrs and mean age by site, sex, study cohort and sample size. For the entire data set, the prevalence of exposures predicted COPD prevalence (0.8% increase in COPD prevalence per 10% increase in exposure prevalence). By comparison, for every 10% increase in the proportion of the ever-smoking population, the prevalence of COPD GOLD stage II or above increased by 1.3%. Given the observed median population COPD prevalence of 3.4%, the model predicted that a 20% relative reduction in the disease burden (i.e. to a COPD prevalence of 2.7%) could be achieved by a 5.4% reduction in overall smoking rates or an 8.8% reduction in the prevalence of occupational exposures. When the data set was analysed by sex-specific site data, among males, the occupational effect was a 0.8% COPD prevalence increase per 10% change in exposure prevalence; among females, a 1.0% increase in COPD per 10% change in exposure prevalence was observed. AU - Blanc PD AU - Menezes AMB AU - Plana E AU - Mannino DM AU - Hallal PC AU - Toren K AU - Eisner MD AU - Zock J-P LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 66 IP - DP - 2009 Jan 01 TI - Chronic obstructive pulmonary disease mortality in railroad workers PG - 221-226 AB - Background: There is little information describing the risk of non-malignant respiratory disease and occupational exposure to diesel exhaust. Methods: US railroad workers have been exposed to diesel exhaust since diesel locomotives were introduced after World War II. In a retrospective cohort study we examined the association of chronic obstructive pulmonary disease (COPD) mortality with years of work in diesel-exposed jobs. To examine the possible confounding effects of smoking, multiple imputation was used to model smoking history. A Cox proportional hazards model was used to estimate an incidence rate ratio, adjusted for age, calendar year, and length of follow-up after leaving work (to reduce bias due to a healthy worker survivor effect). Results: Workers in jobs with diesel exhaust exposure had an increased risk of COPD mortality relative to those in unexposed jobs. Workers hired after the introduction of diesel locomotives had a 2.5% increase in COPD mortality risk for each additional year of work in a diesel-exposed job. This risk was only slightly attenuated after adjustment for imputed smoking history. Conclusions: These results support an association between occupational exposure to diesel exhaust and COPD mortality. AU - Hart JE AU - Laden F AU - Eisen EA AU - Smith TJ AU - Garshick E LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 66 IP - DP - 2009 Jan 01 TI - Specific antibodies to diisocyanate and work-related respiratory symptoms in apprentice car-painters PG - 227-234 AB - Background: Isocyanates are the main cause of occupational asthma in most countries. Study of immunological markers of diisocyanate asthma may identify individuals at risk. Objectives: (1) To study changes in specific antibodies to hexamethylene diisocyanates (HDI); (2) to describe the incidence of work-related respiratory symptoms in relation to changes in specific antibody levels. Methods: Prospective study in 385 apprentice car-painters during their 18 months of training. Participants were assessed on entering and completing their training using questionnaires, methacholine challenges and measurements of HDI-specific immunoglobulin E (IgE), immunoglobulin G (IgG) and subclass 4 of IgG (IgG4) antibodies. Results: Complete data are available for 298 subjects. 13 subjects (4.4%) reported 1 new work-related lower respiratory symptoms and 19 (6.4%), 1 new work-related nasal symptoms. Increases in levels of specific IgE and IgG above the 97th and 95th percentiles were significantly associated with duration of exposure. Increase in specific IgG was inversely related to incidence of work-related lower respiratory symptoms (OR = 0.001, 95% CI 0.000 to 0.09) after adjusting for relevant covariates. The rise in specific IgG4 was significantly greater in those who did not develop work-related nasal symptoms (OR = 0.09, 95% CI 0.01 to 0.7). Conclusion: In this cohort of apprentice car-painters, a small proportion show increases in HDI-specific IgG and IgE after few months of exposure. Increases in specific IgG and IgG4 appear to have a protective effect on the incidence of work-related lower and upper respiratory symptoms, respectively. Assessment of specific antibodies to isocyanates may help identify subjects at risk of developing symptoms. AU - Dragos M AU - Jones M AU - Malo J-L AU - Ghezzo H AU - Gautrin D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 66 IP - DP - 2009 Jan 01 TI - Exhaled nitric oxide in endotoxin-exposed adults: effect modification by smoking and atopy PG - 251-255 AB - Objectives: Occupational exposure to endotoxin is associated with non-allergic asthma and other airway inflammatory reactions. Little is known about the role of mucosal nitric oxide (NO) production in endotoxin-induced airway inflammation. The objective was to explore exposure–response relationships between occupational endotoxin exposure and fractional concentrations of exhaled NO (FENO) and study the role of FENO as an intermediate factor in the relationship between endotoxin exposure and asthma-like symptoms. Methods: FENO was measured online in 425 farmers and agricultural processing workers. For each participant (cumulative) endotoxin level was modelled on the basis of 249 personal measurements and job history. Atopy was assessed as specific serum IgE to common inhalant allergens, and other health data and personal characteristics by standardised questionnaires. Results: A significant positive exposure–response relationship was found between endotoxin and FENO, but only in non-atopic, non-smoking subjects (p = 0.001). FENO was significantly associated with current wheeze and other asthma-like symptoms irrespective of atopy and current smoking. Associations between endotoxin exposure and symptoms changed slightly after adjusting for FENO. Conclusions: A positive association was found between occupational endotoxin exposure and exhaled nitric oxide in non-smoking, non-atopic adults. Increased FENO was associated with asthma-like symptoms, but the role of FENO as an intermediate factor between endotoxin exposure and airway symptoms appears to be limited. AU - Smit LAM AU - Heederik D AU - Doekes G AU - Wouters IM LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 66 IP - DP - 2009 Jan 01 TI - Risks for the development of outcomes related to occupational allergies: an application of the asthma-specific job exposure matrix compared with self-reports and investigator scores on job-training-related exposure PG - 256-263 AB - Background and aim: Risks for development of occupational sensitisation, bronchial hyper-responsiveness, rhinoconjunctival and chest symptoms at work associated with continued exposure to high molecular weight (HMW) allergens were estimated with three exposure assessment methods. Methods: A Cox regression analysis with adjustment for atopy and smoking habit was carried out in 408 apprentices in animal health technology, pastry making, and dental hygiene technology with an 8-year follow-up after training. The risk of continued exposure after training, estimated by the asthma-specific job exposure matrix (JEM), was compared with self-reports and investigator scores on job-training-related exposure. Associations between outcomes and work duration in job(s) related to training were also evaluated. Results: Exposure to animal-derived HMW allergens, subsequent to the apprenticeship period, as estimated by the JEM, was associated with a significantly increased risk for occupational sensitisation (hazard ratio (HR) 6.4; 95% CI 2.3 to 18.2) and rhinoconjunctival symptoms at work (HR 2.6; 95% CI 1.1 to 6.2). Exposure to low molecular weight (LMW) agents significantly increased the risk of developing bronchial hyper-responsiveness (HR 2.3; 95% CI 1.1 to 5.4). Exposure verification appeared to be important to optimise the sensitivity and the specificity, as well as HRs produced by the JEM. Self-reports and investigator scores also indicated that further exposure to HMW allergens increased the risk of developing occupational allergies. The agreement between self-reports, investigator scores, and the JEM were moderate to good. There was no significant association between respiratory outcomes and work duration in jobs related to training. Conclusion: The asthma-specific JEM could estimate the risk of various outcomes of occupational allergies associated with exposure to HMW and LMW allergens, but it is relatively labour intensive. Exposure verification is an important integrated step in the JEM that optimised the performance of the matrix. AU - Suarthana E AU - Heederik D AU - Ghezzo H AU - Malo J-L AU - Kennedy SM AU - Gautrin D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 66 IP - DP - 2009 Jan 01 TI - Occupational exposures and asthma among nursing professionals PG - 274-278 AB - Objectives: To identify occupational exposure risk factors associated with the development of new-onset asthma in nurses. Methods: A cross-sectional survey was administered to a sample of licensed Texas nurses (response rate 70%) and compared to three other healthcare professional groups. Nursing professionals were defined based on self-reported longest held job. Outcome variables were physician-diagnosed new-onset asthma after entry into the healthcare profession and symptoms associated with bronchial hyper-responsiveness (BHR). Occupational exposures were ascertained through a job-exposure matrix, grouped into four categories: cleaning-related tasks, use of powdered latex gloves, administration of aerosolised medications, and tasks involving adhesive compounds, glues and/or solvents. Results: After adjustment for age, sex, ethnicity, atopy, smoking, body mass index and seniority, reported asthma was significantly greater among nursing professionals involved in medical instrument cleaning (OR = 1.67, 95% CI 1.06 to 2.62) and exposure to general cleaning products and disinfectants (OR = 1.72, 95% CI 1.00 to 2.94). Use of powdered latex gloves during 1992–2000 was associated with 1.6 times (95% CI 1.01 to 2.50) the odds of reported asthma. In univariate analysis, exposure to adhesives, glues and/or solvents was associated with a twofold increase in the odds of reported asthma, but not after adjustment for covariates. Similarly, the odds of BHR-related symptoms were significantly greater among nursing professionals exposed to general cleaning products and disinfectants (OR = 1.57, 95% CI 1.11 to 2.21) and adhesives, glues and/or solvents used in patient care (OR = 1.51, 95% CI 1.08 to 2.12). Conclusion: Among nursing professionals, workplace exposures to cleaning products and disinfectants increase the risk of new-onset asthma AU - Arif AA AU - Delclos GL AU - Serra C LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 123 IP - DP - 2009 Jan 01 TI - Occupational asthma: current concepts in pathogenesis, diagnosis, and management. PG - 519-528 AB - Occupational asthma (OA) may account for 25% or more of de novo adult asthma. The nomenclature has now better defined categories of OA caused by sensitizing agents and irritants, the latter best typified by the reactive airways dysfunction syndrome. Selecting the most appropriate diagnostic testing and management is driven by assessing whether a sensitizer is involved, and if so, identifying whether the sensitizing agent is a high-molecular-weight agent such as a protein or a low-molecular-weight reactive chemical such as an isocyanate. Increased understanding of the pathogenesis of OA from reactive chemical sensitizers is leading to development of better diagnostic testing and also an understanding of why testing for sensitization to such agents can be problematic. Risk factors for OA including possible genetic factors are being delineated better. Recently published guidelines for the diagnosis and management of occupational asthma are summarized; these reflect an increasingly robust evidence basis for recommendations. The utility of diagnostic tests for OA is being better defined by evidence, including sputum analysis performed in relation to work exposure with suspected sensitizers. Preventive and management approaches are reviewed. Longitudinal studies of patients with OA continue to show that timely removal from exposure leads to the best prognosis. AU - Dykewicz AU - MS. LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 4 IP - DP - 2009 Jan 01 TI - Influence of horse stable environment on human airways PG - 10 AB - Background: Many people spend considerable amount of time each day in equine stable environments either as employees in the care and training of horses or in leisure activity. However, there are few studies available on how the stable environment affects human airways. This study examined in one horse stable qualitative differences in indoor air during winter and late summer conditions and assessed whether air quality was associated with clinically detectable respiratory signs or alterations to selected biomarkers of inflammation and lung function in stable personnel. Methods: The horse stable environment and stable-workers (n = 13) in one stable were investigated three times; first in the winter, second in the interjacent late summer and the third time in the following winter stabling period. The stable measurements included levels of ammonia,hydrogen sulphide, total and respirable dust, airborne orse allergen, microorganisms, endotoxin and glucan. The stable-workers completed a questionnaire on respiratory symptoms, underwent nasal lavage with subsequent analysis of inflammation markers, and performed repeated measurements of pulmonary function. Results: Measurements in the horse stable showed low organic dust levels and high horse allergen levels. Increased viable level of fungi in the air indicated a growing source in the stable. Air particle load as well as 1,3-ß-glucan was higher at the two winter time-points, whereas endotoxin levels were higher at the summer time-point. Two stable-workers showed signs of bronchial obstruction with increased PEF-variability, increased inflammation biomarkers relating to reported allergy, cold or smoking and reported partly work-related symptoms. Furthermore, two other stable-workers reported work-related airway symptoms, of which one had doctor's diagnosed asthma which was well treated. Conclusion: Biomarkers involved in the development of airway diseases have been studied in relation to environmental exposure levels in equine stables. Respirable dust and 1,3-ß-glucan levels were increased at winter stabling conditions. Some employees (3/13) had signs of bronchial obstruction, which may be aggravated by working in the stable environment. This study contributes to the identification of suitable biomarkers to monitor the indoor horse stable environment and the personnel. An improved management of the stable climate will be beneficial for the health of both stable workers and horses. AU - Elfman L AU - Riihimäki M AU - Pringle J AU - Wålinder R LA - PT - DEP - TA - Journal of Occupational Medicine and Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 53 IP - DP - 2009 Jan 01 TI - Determinants of Exposure to Metalworking Fluid Aerosols: A Literature Review and Analysis of Reported Measurements PG - 271-288 AB - An extensive literature review of published metalworking fluid (MWF) aerosol measurement data was conducted to identify the major determinants that may affect exposure to aerosol fractions (total or inhalable, thoracic and respirable) and mass median diameters (MMDs). The identification of determinants was conducted through published studies and analysis of published measurement levels. For the latter, weighted arithmetic means (WAMs) by number of measurements were calculated and compared using analysis of variance and t-tests. The literature review found that the major factors affecting aerosol exposure levels were, primarily, decade, type of industry, operation and fluid and engineering control measures. Our analysis of total aerosol levels found a significant decline in measured levels from an average of 5.36 mg m2 prior to the 1970s and 2.52 mg m2 in the 1970s to 1.21 mg m2 in the 1980s, 0.50 mg m2 in the 1990s and 0.55 mg m2 in the 2000s. Significant declines from the 1990s to the 2000s also were found in thoracic fraction levels (0.48 versus 0.40 mg m2), but not for the respirable fraction. The WAMs for the auto (1.47 mg m2) and auto parts manufacturing industry (1.83 mg m2) were significantly higher than that for small-job machine shops (0.68 mg m2). In addition, a significant difference in the thoracic WAM was found between the automotive industry (0.46 mg m2) and small-job machine shops (0.32 mg m2). Operation type, in particular, grinding, was a significant factor affecting the total aerosol fraction [grinding operations (1.75 mg m23) versus other machining (0.95 mg m2)], but the levels associated with these operations were not statistically different for either the thoracic or the respirable fractions. Across all decades, the total aerosol fraction for straight oils (1.49 mgm2) was higher than for other fluid types (soluble 5 1.08 mgm2, synthetic 5 0.52 mg m2 and semisynthetic 5 0.50 mg m2). Fluid type was also found to be partly associated with differences in the respirable fraction level. We found that the total aerosols were measured by a variety of sampling media, devices and analytical methods. This diversity of approaches makes interpretation of the study results difficult. In conclusion, both the literature review and the measurement data analyzed found that decade and type of industry, operation and fluid were important determinants of total aerosol exposure. Industry type and fluid type were associated with differences in exposure to the thoracic and respirable fraction levels, respectively. AU - Park D AU - Stewart PA AU - Coble JB LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 79 IP - DP - 2009 Jan 01 TI - Determination of thiosulfate in human urine by high performance liquid chromatography PG - 229-234 AB - Thiosulfate is a sulfate analogue with a thiosulfur substituent and is found in human samples. Its concentration in urine is increased in some diseases and after exposure to hydrogen sulfide gas. We have developed a sensitive, simple and cheap method for thiosulfate determination in urine. The method is based on precolumn derivatization with 2-chloro-1-methylquinolinium tetrafluoroborate followed by reversed-phase liquid chromatography separation and ultraviolet detection of 1-methyl-2-thioquinolone at 375nm. The calibration curve for thiosulfate was linear in the tested range 0.5–50µmolL-1 with correlation coefficient better than 0.999. The analytical recovery and relative standard deviation values for precision within the calibration range were from 90.1% to 104.2% and from 2.39% to 5.59%, respectively. The lower limit of detection and quantitation were 0.3 and 0.5µmolL-1, respectively. The mean (range) concentration of thiosulfate normalized against creatinine for apparently healthy seven women and six men was 2.21 (1.45–2.77) and 2.51 (1.36–4.89)mmolmol-1 creatinine, respectively. We monitored thiosulfate in urine samples from one volunteer for 24h. The urinary excretion of thiosulfate was 21.4µmol per 24h. This method can be used for routine clinical monitoring thiosulfate in urine. Cysteine and cysteinylglycine can be measured concurrently, if needed. AU - Chwatko G AU - Bald E LA - PT - DEP - TA - Talenta JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 103 IP - DP - 2009 Jan 01 TI - Methacholine challenge e Comparison of an ATS protocol to a new rapid single concentration technique PG - 1898e1903 AB - Bronchial methacholine challenge is well established in asthma diagnostics and research. ATS guidelines propose a five step standard dosimeter (SDM) protocol with incremental concentrations of methacholine to calculate the concentration causing a 20% drop in FEV1 in an individual (PC20FEV1). In contrast, the aerosol provocation system (APS) by Viasys automatically determines the administered dose of methacholine by measuring the effective nebulisation time and referring it to drug concentration and nebuliser power. Therefore, it offers a feasible and less time-consuming provocation procedure by applying incremental doses (PD20) of methacholine using a single concentration (16 mg/mL methacholine, APS-SC). In this study we compared these two methods in 52 young adults (25+/- 5.8 years). Following a screening visit, subjects were randomly assigned to undergo either SDM or APS-SC followed by the other method within 1 week. A close correlation between concentration and dosage causing a 20% fall of FEV1 was found (r=0.69, p<0.001). Using the ATS categorisation of bronchial responsiveness we interpreted the results of the APSSC method as follows: PD20 methacholine <0.3 mg as ‘‘moderate to severe BHR’’, 0.3-0.6 mg as ‘‘mild BHR’’, 0.6-1.0 mg as ‘‘borderline BHR’’, and >1.0 mg as ‘‘normal bronchial response’’. We conclude that the five-step APS-SC is a suitable method, providing reliable results. In clinical practice the APS-SC is a timesaving procedure and less prone to errors since only one dilution of methacholine is necessary compared to the SDM. AU - Schulze J AU - Rosewich M AU - Riemer C AU - Dressler M LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 42 IP - DP - 2009 Jan 01 TI - Acute Bronchodilator Response Has Limited Value in Differentiating Bronchial Asthma from COPD PG - 367-372 AB - Background. Acute responsiveness to inhaled bronchodilators is often used to differentiate between bronchial asthma and chronic obstructive pulmonary disease (COPD). The response can be expressed in terms of a change in FEV1 and FVC in several ways—as absolute change, change as percent of baseline value, or as percent of predicted value with different thresholds for a positive test. A comprehensive evaluation of the diagnostic value of these different methods of expressing the acute bronchodilator response has not been carried out. Methodology. Response to inhaled salbutamol was measured by spirometry in 200 asthmatics and 154 patients with COPD. The sensitivity, specificity, and positive and negative predictive values of different methods of expressing responsiveness were calculated. Receiver operative characteristic curves were obtained. Results. None of the expressions of response gave a clear-cut separation between the two diseases. A ?FEV1= 0.2 L gave the most satisfactory combination of sensitivity (73%) and specificity (80%) and the highest positive (82%) and negative predictive values (69%) for diagnosing asthma. These values were superior to those obtained for the ERS or the ATS criteria for reversibility (?FEV1%predicted = 9% and ?FEV1 of = than 12% and 0.2 L over the baseline, respectively), which had almost similar diagnostic characteristics. This was confirmed by the area under curve of the ROC plots. Expressions of response in terms of changes in FVC were unsatisfactory in separating the two diseases. Conclusions. It was concluded that the test of acute bronchodilator responsiveness has limited diagnostic value in separating asthma and COPD. AU - Chhabra SK LA - PT - DEP - TA - J Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - 100 IP - DP - 2009 Jan 01 TI - Occupational, domestic and environmental mesothelioma risks in the British population: a case–control study PG - 1175-1183 AB - We obtained lifetime occupational and residential histories by telephone interview with 622 mesothelioma patients (512 men, 110 women) and 1420 population controls. Odds ratios (ORs) were converted to lifetime risk (LR) estimates for Britons born in the 1940s. Male ORs (95% confidence interval (CI)) relative to low-risk occupations for >10 years of exposure before the age of 30 years were 50.0 (25.8–96.8) for carpenters (LR 1 in 17), 17.1 (10.3–28.3) for plumbers, electricians and painters, 7.0 (3.2–15.2) for other construction workers, 15.3 (9.0–26.2) for other recognised high-risk occupations and 5.2 (3.1–8.5) in other industries where asbestos may be encountered. The LR was similar in apparently unexposed men and women (~1 in 1000), and this was approximately doubled in exposed workers’ relatives (OR 2.0, 95% CI 1.3–3.2). No other environmental hazards were identified. In all, 14% of male and 62% of female cases were not attributable to occupational or domestic asbestos exposure. Approximately half of the male cases were construction workers, and only four had worked for more than 5 years in asbestos product manufacture. AU - Rake C AU - Gilham C AU - Hatch J AU - Darnton A AU - Hodgson J AU - Peto J LA - PT - DEP - TA - Br J Cancer JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20090101 IS - IS - VI - IP - DP - 2009 Jan 01 TI - Occupational, Domestic and Environmental Mesothelioma Risks in Britain, a Case Control Study PG - AB - BACKGROUND By 1970 Britain led the world in asbestos regulation, yet the British mesothelioma death-rate is now the highest in the world, with 1740 deaths in men (1 in 40 of all male cancer deaths below age 80) and 316 in women in 2006. According to the latest HSE projection about 1 in 170 of all British men born in the 1940s will die of mesothelioma. The increase in mesothelioma mortality in Britain over the last 40 years is the legacy of widespread use of asbestos. Substantial exposures continued until about 1970 in parts of the asbestos industry, and until the early 1980s in the much larger workforce in construction and other occupations where asbestos lagging was applied or AIB (asbestos insulation board) was sawn. Most mesotheliomas now occurring are due to exposures prior to 1980, and analyses of British mesothelioma deaths based on last recorded occupation suggest that former construction workers, particularly plumbers, electricians and carpenters, constitute the main high risk group, together with insulation workers, shipbuilders and locomotive engineers. However, until now, no representative study to quantify the relationship between mesothelioma risk and lifetime occupational and residential history has been carried out in Britain. A separate scientific publication of the results set out in this report is also available(Rake et al., 2009). METHODS Lifetime occupational and residential histories were obtained by telephone interview with 622 mesothelioma patients (512 men, 110 women) and 1420 population controls. Lifetime risks (LR) were estimated for British men and women born in the 1940s. Occupations other than construction were classified as high, medium or low risk, and proportions of mesotheliomas attributable to these groups, including construction, and to domestic exposures (living with an exposed worker) were also estimated. RESULTS Men: Relative to low-risk occupations, risks (odds ratios) for men with more than 10 years of exposure before age 30 were 50.0(95%CI 25.8-96.8; LR = 1 in 17) for carpenters, 17.1(95%CI 10.3-28.3; LR = 1 in 50) for plumbers, electricians and painters, 7.0(95%CI 3.2-15.2; LR = 1 in 125) for other construction workers, 15.3(95%CI 9.0-26.2; LR = 1 in 55) for other recognised high-risk occupations, and 5.2(95%CI 3.1-8.5; LR = 1 in 170) in other ‘medium risk’ industries where asbestos may be encountered. The risk in men who had worked only in industrial occupations that we classified as low-risk was no higher than in white-collar workers; only 8% (13/153) of male mesothelioma cases who had worked in ‘low-risk’ industrial occupations had never worked in a higher risk occupation. Among men, 46% of mesotheliomas were attributable to construction, 39% to other occupations and 1.3% to domestic exposures, with 14% of cases not attributable to any known occupational or domestic asbestos exposure. Over a fifth (21%) of male cases had worked as carpenters. Only 4 cases (<1%) had worked for 5 or more years in asbestos product manufacturing. Women: Only 5 of the 110 women with mesothelioma had worked in high-risk occupations (odds ratio (OR) 4.8, 95%CI 1.3-17.7), and a further 32 had worked in industrial jobs classified as medium risk, often as assemblers (OR 2.4, 95%CI 1.3-4.3). Among women 22% of mesotheliomas were attributable to occupational exposures and 16% to domestic exposures, with 62% not attributable to occupational or domestic asbestos exposure. Unexposed cases: The LR was similar in apparently unexposed men and women (less than 1 in 1000). This ‘background’ risk was approximately doubled in exposed workers’ relatives (OR 2.0, CI 1.3-3.2). No other specific environmental hazards were identified. CONCLUSIONS 1. Mesothelioma risk is determined largely by asbestos exposure before age 30, and ranges from a lifetime risk of 1 in 17 for ten or more years of carpentry before age 30 to less than 1 in 1,000 in apparently unexposed men and women. Our results suggest that the predicted total of 90,000 mesotheliomas in Britain between 1970 and 2050 will include approximately 15,000 carpenters. 2. The risk of lung cancer caused by asbestos is likely to be of the same order as the mesothelioma risk. This would imply that more than 1 in 10 of British carpenters born in the 1940s with more than 10 years of employment in carpentry before age 30 will die of a cancer caused by asbestos. 3. Asbestos exposure was widespread, with 65% of male and 23% of female controls having worked in occupations that were classified as medium or higher risk. 4. Britain was the largest importer of amosite (brown asbestos), and there is strong although indirect evidence that this was a major cause of the uniquely high mesothelioma rate. The US imported far less amosite than Britain but used similar amounts of chrysotile (white asbestos) and more crocidolite (blue asbestos), and US mesothelioma death-rates in middle age are now 3 to 5 times less than British rates. British carpenters frequently worked with asbestos insulation board containing amosite. 5. We found no evidence of increased risk associated with non-industrial workplaces or those that were classified as ‘low risk’, including motor mechanics and workers handling gaskets and mats that may have contained asbestos. 6. The only potential non-occupational exposure associated with increased risk was living with an exposed worker. 7. The increasing trend in female rates in Britain and a comparison between British and US female rates both suggest that a substantial proportion of mesotheliomas with no known occupational or domestic exposure were probably caused by environmental asbestos exposure. The sources of this presumably included construction, building maintenance and industrial activities but may also include release of asbestos from buildings due to normal occupation and weathering. AU - Peto J AU - Rake C AU - Gilham C AU - Hatch J LA - PT - DEP - TA - HSE Books 2009 [Research Report RR696]. JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Long-term decline in lung function, utilisation of care and quality of life in modified GOLD stage 1 COPD PG - 768-774 AB - Background: Little is known about the long-term outcomes of individuals with mild chronic obstructive pulmonary disease (COPD) as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Methods: A population cohort of 6671 randomly selected adults without asthma was stratified into categories of modified GOLD-defined COPD (prebronchodilator spirometry). Further stratification was based on the presence or absence of respiratory symptoms. After 11 years, associations between baseline categories of COPD and decline in forced expiratory volume in 1 s (FEV1), respiratory care utilisation and quality of life as measured by the SF-36 questionnaire were examined after controlling for age, sex, smoking and educational status. Results: At baseline, modified GOLD criteria were met by 610 (9.1%) participants, 519 (85.1%) of whom had stage 1 COPD. At follow-up, individuals with symptomatic stage 1 COPD (n = 224) had a faster decline in FEV1 (29 ml/ year (95% CI 213 to 25)), increased respiratory care utilisation (OR 1.6 (95% CI 1.0 to 2.6)) and a lower quality of life than asymptomatic subjects with normal lung function (n = 3627, reference group). In contrast, individuals with asymptomatic stage 1 COPD (n = 295) had no significant differences in FEV1 decline (23 ml/year (95% CI 27 to +1)), respiratory care utilisation (OR 1.05 (95% CI 0.63 to 1.73)) or quality of life scores compared with the reference group. Conclusions: In population-based studies, respiratory symptoms are of major importance for predicting longterm clinical outcomes in subjects with COPD with mild obstruction. Population studies based on spirometry only may misestimate the prevalence of clinically relevant COPD. AU - Bridevaux P-O AU - Gerbase MW AU - Probst-Hensch NM AU - Schindler C AU - Gaspoz J-M AU - Rochat T LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 51 IP - DP - 2008 Jan 01 TI - Work-related asthma in the Educational Services industry: California, Massachusetts, Michigan, and New Jersey, 1993–2000 PG - 47-59 AB - Objectives To characterize work-related asthma (WRA) cases working in the educational services industry identified by state-based occupational disease surveillance systems. Methods We examined 2,995 WRA cases reported from 1993 to 2000 to four states: California, Massachusetts, Michigan, and New Jersey. Results A total of 265 (9%) WRA cases were employed in the educational services industry; 69% of cases were classified as new-onset asthma and 31% as work-aggravated asthma. New-onset asthma cases were further classified as occupational asthma (61%) or as reactive airways dysfunction syndrome (8%). The most frequently reported occupation was teachers and teachers' aides (54%). The most frequently reported agents were indoor air pollutants (28%), unspecified mold (16%), dusts (14%), and cleaning products (7%). Conclusions Asthma within the educational services industry is an occupational health problem. The health of school employees should also be considered when initiatives addressing asthma among schoolchildren are instituted. The identification, elimination, and/or control of respiratory hazards are important factors for the protection of staff and students alike. AU - Mazurek JM AU - Filios M AU - Willis R AU - Rosenman KD AU - Reilly MJ AU - McGreevy K AU - Schill DP AU - Valiante D AU - Pechter E AU - Davis L AU - Flattery J AU - Harrison R LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 45 IP - DP - 2008 Jan 01 TI - Acute hydrogen sulfide poisoning in a dairy farmer PG - 420-423 AB - Introduction. Hydrogen sulfide is a lipid-soluble gas produced in occupational settings and from decaying organic matter. We present a 36-year-old man who developed acute respiratory arrest from hydrogen sulfide poisoning while performing work as a dairy farmer. Case report. The subject entered a poorly ventilated tank containing degrading eggs and, within seconds, collapsed. Coworkers were able to extract him within minutes but he was apneic. He was intubated by emergency medical services and subsequently managed with supportive care in the intensive care unit. Upon admission, a powerful rotten egg scent was noted and a hydrogen sulfide poisoning was suspected. Serum analysis for the presence of thiosulfate confirmed the diagnosis. Nitrite therapy was not administered as the subject arrived outside of the therapeutic window of effectiveness and showed evidence of excellent oxygenation. His examinations following arrival were consistent with an anoxic brain injury which slowly improved several months after the incident with intensive neuro-rehabilitation. Discussion. Hydrogen sulfide is a mitochondrial toxin and inhibits cytochrome-aa3 and prevents cellular aerobic metabolism. Therapies for toxic exposures include removal from the contaminated environment, ventilation with 100% oxygen, and nitrite therapy if administered immediately after exposure. Hyperbaric oxygen (HBO) therapy has anecdotal support and remains controversial. Conclusion. Hydrogen sulfide is a significant occupational health hazard. Education, personal protective equipment, and early treatment are important in improving outcomes. AU - Gerasimon G AU - Bennett S AU - Musser J AU - Rinard J LA - PT - DEP - TA - Clin Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 36 IP - DP - 2008 Jan 01 TI - Primary blast injury: Update on diagnosis and treatment PG - s311-s317 AB - Background: Injuries from combat and terrorist explosions are increasing worldwide. As such, physicians can expect to treat more patients with complex and unique patterns of injury produced not only by fragments and blunt trauma, but also by high-pressure air expanding from the detonation center. Discussion: Tissue damage from the blast wave or primary blast injury can be an important cause of occult trauma to the ocular, aural, pulmonary, cardiovascular, musculoskeletal, and neurologic systems. Awareness of the extensive corporal effects of the blast wave is an essential prerequisite to diagnosis. Summary: This article focuses on the incidence, risk factors, diagnosis, management, and screening for primary blast injury. AU - Ritenour AE AU - Baskin TW LA - PT - DEP - TA - Critical Care Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 31 IP - DP - 2008 Jan 01 TI - Multidisciplinary interobserver agreement in the diagnosis of idiopathic pulmonary fibrosis PG - 585-591 AB - The purpose of the present study was to evaluate the accuracy of the diagnosis of idiopathic pulmonary fibrosis (IPF) by respiratory physicians in six European countries, and to calculate the interobserver agreement between high-resolution computed tomography reviewers and histology reviewers in IPF diagnosis. The diagnosis of usual interstitial pneumonia (UIP) was assessed by a local investigator, following the American Thoracic Society/European Respiratory Society consensus statement, and confirmed when a minimum of two out of three expert reviewers from each expert panel agreed with the diagnosis. The level of agreement between readers within each expert panel was calculated by weighted kappa. The diagnosis of UIP was confirmed by the expert panels in 87.2% of cases. A total of 179 thoracic high-resolution computed tomography scans were independently reviewed, and an interobserver agreement of 0.40 was found. Open or thoracoscopic lung biopsy was performed in 97 patients, 82 of whom could be reviewed by the expert committee. The weighted kappa between histology readers was 0.30. It is concluded that, although the level of agreement between the readers within each panel was only fair to moderate, the overall accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis in expert centres is good (87.2%). AU - Thomeer M AU - Demedts M AU - Behr J AU - Buhl R AU - Costabel U AU - Flower CDR AU - Verschakelen J AU - Laurent F AU - Nicholson AG AU - Verbeken EK AU - Capron F AU - Sardina M AU - Corvasce G AU - Lankhorst I LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 102 IP - DP - 2008 Jan 01 TI - Long-term mortality follow-up of the ISOLDE participants: causes of death during 13 years after trial completion PG - 1468-1472 AB - The Inhaled Steroids in Obstructive Lung Disease (ISOLDE) study was a trial that randomised 752 patients with moderate to severe COPD to fluticasone propionate 1000 mcg/day or placebo for three years. We aimed to examine the causes of death of the ISOLDE participants after the original three up to 13 years post-randomisation. Death certificates were obtained either from the NHS Strategic Tracing Service or from the Office of National statistics. Deaths were classified according to the trial protocol. In the subsample of 375 participants from the seven ISOLDE original centers where complete extended follow-up was conducted, the factors associated with observed higher mortality (p<0.05) were male gender, older age and more severe COPD. Causes of death were; 107 (52%) respiratory, 38 (18%) cardiac, 29 (14%) lung cancer, 16 (8%) other cancer and 16 (8%) other causes. The percentage of respiratory-related deaths increased during the follow-up period; from 46% within the three-year trial, to 48% after 3–6 years, 57% after 6–9 years, and 60% after 9–13 years of follow-up (p for trend<0.05). We conclude that participants' survival is poor (only 44% in the 13 years after the ISOLDE trial), and that respiratory-related illnesses were the most frequent causes of death in patients with moderate to severe COPD. AU - Bale GA AU - Martinez-Camblor P AU - Burge PS AU - Soriano JB LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 60 IP - DP - 2008 Jan 01 TI - Systematic review of multidisciplinary teams in the management of lung cancer PG - 14-21 AB - Background In several countries, clinical practice guidelines for lung cancer recommend that multidisciplinary (MD) teams should be used to plan the management of all lung cancer patients. We conducted a systematic review to evaluate and critically appraise the effectiveness of multidisciplinary teams for lung cancer. Materials and methods Medline searches were carried out for the period 1984 to July 2007. We included any study that mentioned team working among specialists with diagnostic and curative therapeutic intent, where members of the team met at a specified time, either in person or by video or teleconferencing, to discuss the diagnosis and management of patients with suspected lung cancer. All study designs were included. We were particularly interested in whether multidisciplinary working improved survival but also considered other outcomes such as practice patterns and waiting times. Results Sixteen studies met the criteria for inclusion. Statistical pooling was not possible due to clinical heterogeneity. Only two of the primary studies reported an improvement in survival. Both were before-and-after designs, providing weak evidence of a causal association. Evidence of the effect of MD teams was stronger for changing patient management than for affecting survival. Six of the studies reported an increase in the percentage of patients undergoing surgical resection or an increase in the percentage of patients undergoing chemotherapy or radiotherapy with curative intent. Conclusion This systematic review shows limited evidence linking MD teams with improved lung cancer survival. This does not mean that MD teams do not improve survival, merely that currently available evidence of this is limited. It seems intuitively obvious that MD teams should improve outcomes for lung cancer patients, but there are difficulties in conducting randomised trials to show this. The best way forward would be prospective evaluation of the effectiveness of MD teams as they are implemented, paying particular attention to collecting data on potential confounders. AU - Coory M AU - Gkolia P AU - Yang I AU - Bowman R AU - Fong K. LA - PT - DEP - TA - Lung cancer JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 38 IP - DP - 2008 Jan 01 TI - Paraquat Poisonings: Mechanisms of Lung Toxicity, Clinical Features, and Treatment PG - 13-71 AB - Paraquat dichloride (methyl viologen; PQ) is an effective and widely used herbicide that has a proven safety record when appropriately applied to eliminate weeds. However, over the last decades, there have been numerous fatalities, mainly caused by accidental or voluntary ingestion. PQ poisoning is an extremely frustrating condition to manage clinically, due to the elevated morbidity and mortality observed so far and due to the lack of effective treatments to be used in humans. PQ mainly accumulates in the lung (pulmonary concentrations can be 6 to 10 times higher than those in the plasma), where it is retained even when blood levels start to decrease. The pulmonary effects can be explained by the participation of the polyamine transport system abundantly expressed in the membrane of alveolar cells type I, II, and Clara cells. Further downstream at the toxicodynamic level, the main molecular mechanism of PQ toxicity is based on redox cycling and intracellular oxidative stress generation. With this review we aimed to collect and describe the most pertinent and significant findings published in established scientific publications since the discovery of PQ, focusing on the most recent developments related to PQ lung toxicity and their relevance to the treatment of human poisonings. Considerable space is also dedicated to techniques for prognosis prediction, since these could allow development of rigorous clinical protocols that may produce comparable data for the evaluation of proposed therapies. AU - Dinis-Oliveira RJ AU - Duarte JA AU - Sánchez-Navarro A AU - Remião F AU - Bastos ML AU - Carvalho F LA - PT - DEP - TA - Clinical Reviews in toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 23 IP - DP - 2008 Jan 01 TI - Korean ginseng-induced occupational asthma and determination of IgE binding components PG - 232-235 AB - A number of case reports on occupational asthma caused by herbal medicines have been issued, for example, on Sanyak, Chunkung, Banha, and Brazilian ginseng. Recently, cases of occupational asthma induced by Sanyak and Korean ginseng have been reported, but the pathogenic mechanisms involved are unknown. This study was carried out to evaluate the immunologic mechanism underlying Korean ginseng-induced occupational asthma. A patient engaged in Korean ginseng wholesale was referred for recurrent dyspnea, wheezing, and nasal symptoms, which were aggravated at work. Allergen bronchial provocation testing to Korean ginseng extract showed a typical immediate response, and skin prick testing to Korean ginseng extract also showed a strong positive response. Moreover, serum-specific IgE levels to Korean ginseng extract were significantly higher than in controls. Enzyme-linked immunosorbent assay (ELISA) inhibition tests showed a dose-dependent inhibition by Korean ginseng, but not by Dermatophagoides farinae, wheat flour, or Chinese balloon flower. Sodium dodecylsulfate-poly-acrylamide gel electrophoresis (SDS-PAGE) and immunoblotting revealed four specific Immunoglobulin E (IgE) binding components at 26, 30, 47, and 60 kDa, which were not bound by control sera. These results strongly suggest that occupation asthma induced by Korean ginseng is induced via an IgE-mediated mechanism. AU - Kim KM AU - Kwon HS AU - Jeon SG AU - Park CH AU - Sohn SW AU - Kim DI AU - Kim SS AU - Chang YS AU - Kim YK LA - PT - DEP - TA - Journal of Korean medical science JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 3 IP - DP - 2008 Jan 01 TI - A prospective study of decline in lung function in relation to welding emissions. PG - 6 AB - Background Numerous cross-sectional studies have reported reduced lung function among welders but limitations of exposure assessment and design preclude causal inference. The aim of this study was to investigate if long-term exposure to welding fume particulates accelerates the age-related decline in lung function. Methods Lung function was measured by spirometry in 1987 and 2004 among 68 steel welders and 32 non-welding production workers. The decline in forced expiratory volume (FEV1) was analysed in relation to cumulated exposure to fume particulates among welders during the follow-up period. Results Among smokers the decline in FEV1 through follow-up period was in average 150 ml larger among welders than non-welders while the difference was negligible among non-smokers. The results did not reach statistical significance and within welders the decline in lung function was not related to the cumulated welding particulate exposure during follow-up period Conclusion Long-term exposure to welding emissions may accelerate the age-related decline of lung function but at exposure levels in the range of 1.5 to 6.5 mg/m3 the average annual excess loss of FEV1 is unlikely to exceed 25 ml in smokers and 10 ml in non-smokers. AU - Christensen AU - S.W. AU - Bonde AU - J.P. & Omland AU - Ø. LA - PT - DEP - TA - https://doi.org/10.1186/1745-6673-3-6 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 19 IP - DP - 2008 Jan 01 TI - Sixty-four Michigan patients hospitalised or treated in emergency department with lung disease from waterproofing sprays PG - 1-3 AB - This issue of the newsletter will discuss chemical pneumonitis that has occurred from exposure to waterproofing sprayed on boot/shoes, tents, tile or grout. There have been 64 individuals hospitalized or treated in the emergency department in Michigan reported to the state from 2003 to 2007. The case report that follows describes the onset of chemical pneumonitis with marked hypoxia and bilateral radiographic evidence of diffuse airspace disease. AU - Anon LA - PT - DEP - TA - Project Sensor JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 177 IP - DP - 2008 Jan 01 TI - Obliterative Bronchiolitis in Boatbuilders Exposed to Styrene and Isocyanates PG - a157 AB - The identification of bronchiolitis in workers exposed to diacetyl prompted us to look for connections between workers previously identified by us with obliterative bronchiolitis, the cause for which had not been identified. Three non-smoking workers were identified who all had the same job laying up fibreglass hulls of motor yachts. Two worked in the same boat builders and the other was making similar boats elsewhere. The disease came on rapidly in all workers, and was confirmed in one by histology after lung transplant. A further worker from the first boat builder was also affected but had also been a heavy smoker. The lung function (as percent predicted) is shown in the table. The cause of the bronchiolitis has not been established. Their major exposure was to styrene used to bond the fibreglass. Other materials included an unsaturated polyester gelcoat, sections of rigid MDI foam which heated after styrene application, methylethylketone peroxide used as a catalyst and solvents used to clean brushes. We have no information relating to the possibility of methyl isocyanate exposure. Epidemiological studies of similarly exposed workers are needed. Lung function percent predicted Index case Workmate New workplace Age 31 43 54 Latent interval to first symptom 6 months 1 year 4 years FEV1 18 36 66 FVC 56 97 118 FEF50 8 10 22 DLCO 73 96 102 Smoking pack years 0 0 <1 AU - Burge PS AU - Robertson AS AU - Cullinan P AU - Howell TJ LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 45 IP - DP - 2008 Jan 01 TI - Serial exhaled nitric oxide measurements in the assessment of laboratory animal allergy. PG - 101-107 AB - BACKGROUND: Laboratory animal allergy (LAA) may cause eosinophilic airway inflammation, for which exhaled nitric oxide (FE(NO)) measurements are sensitive and specific. Our objective was to assess whether serial FE(NO) measurements might detect exposure-related inflammation in laboratory animal workers. METHODS. Fifty laboratory animal workers participated. Measurements of FE(NO) and spirometry were obtained at baseline (Friday) and twice-daily following a weekend with no animal contact. RESULTS: Eleven of 50 subjects had work-related symptoms, and 2 of 11 had positive serology for LAA. Baseline FE(NO) was high (> 150 ppb) in the two seropositive subjects and increased progressively during the working week in one subject, confirming exposure-driven airway inflammation. In seronegative subjects, mean FE(NO) levels were 19.8 (standard deviation [SD], 20.1) and 21.7 (SD, 20.8) in the symptomatic and nonsymptomatic groups, respectively, with no significant changes in FE(NO) over time. CONCLUSION: Serial FE(NO) measurements may provide complementary information in the assessment of possible occupational sensitisation. The sensitivity and specificity of this approach to diagnosing occupational asthma requires further evaluation. AU - Hewitt RS AU - Smith AD AU - Cowan JO AU - Schofield JC AU - Herbison GP AU - Taylor DR LA - PT - DEP - TA - J Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 177 IP - DP - 2008 Jan 01 TI - The healthy worker effect in asthma: work may cause asthma, but asthma may also influence work. PG - 4-10 AB - Despite the increasing attention to the relationship between asthma and work exposures, occupational asthma remains underrecognized and its population burden underestimated. This may be due, in part, to the fact that traditional approaches to studying asthma in populations cannot adequately take into account the healthy worker effect (HWE). The HWE is the potential bias caused by the phenomenon that sicker individuals may choose work environments in which exposures are low; they may be excluded from being hired; or once hired, they may seek transfer to less exposed jobs or leave work. This article demonstrates that population- and workplace-based asthma studies are particularly subject to HWE bias, which leads to underestimates of relative risks. Our objective is to describe the HWE as it relates to asthma research, and to discuss the significance of taking HWE bias into account in designing and interpreting asthma studies. We also discuss the importance of understanding HWE bias for public health practitioners and for clinicians. Finally, we emphasize the timeliness of this review in light of the many longitudinal "child to young adult" asthma cohort studies currently underway. These prospective studies will soon provide an ideal opportunity to examine the impact of early workplace environments on asthma in young adults. We urge occupational and childhood asthma epidemiologists collaborate to ensure that this opportunity is not lost. AU - Le Moual N AU - Kauffmann F AU - Eisen EA AU - Kennedy SM LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 58 IP - DP - 2008 Jan 01 TI - Effective health surveillance for occupational asthma in motor vehicle repair PG - 551-555 AB - Background Diisocyanates are the commonest reported cause of occupational asthma (OA) in the UK. Health surveillance should play an important part in the early detection of disease and the prevention of long-term morbidity. Aim To assess the efficacy of a UK-wide health surveillance programme provided to the motor vehicle repair industry. Methods Analysis of respiratory questionnaire and spirometry results during the period 1995–2000 and more detailed assessment of the outcome of cases suggestive of OA between 1998 and 2000. Results Approximately 3700 employees underwent health surveillance each year. As a result, a number (27%) required further assessment; information on 92 employees who were referred to their general practitioner (GP) for further assessment was examined. Half of these employees subsequently failed to see their GP and of those referred to a specialist only 63% attended that appointment. Of the 20 employees who did see a specialist, nine (45%) were subsequently diagnosed as having OA due to isocyanates, indicating a mean annual incidence rate of 0.79 per 1000 workers identified by surveillance. A year after identification, five of the diagnosed employees were still working in the same job. Conclusions Health surveillance is only one part of a process for identifying OA. In this programme, the high drop out rate of employees in the medical investigation process initiated by surveillance was a significant problem. Recommendations are suggested for the future operation of respiratory health surveillance programmes. AU - Mackie J LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 58 IP - DP - 2008 Jan 01 TI - Sodium metabisulphite induced airways disease in the fishing and fish-processing industry PG - 545-550 AB - Background Sodium metabisulphite is recognized as a potential cause of airway irritation and possibly occupational asthma, but awareness of its use in the fishing and fish-processing industry is low. Aims and methods To describe three cases of occupational airways disease due to SMBS exposure and to review the literature. Results Three patients, one trawlerman and two prawn processors, developed work-related airways disease due to exposure to sodium metabisulphite, one with irritant-induced asthma with a positive-specific bronchial challenge associated with very high sulphur dioxide exposures, one with occupational asthma and one with vocal cord dysfunction and underlying asthma. Of the nine cases recorded in the literature, most were non-atopic and responses to specific bronchial challenge when undertaken showed an immediate response. Exposures to sulphur dioxide in these settings are very high, in excess of 30 ppm. Conclusion Sodium metabisulphite should be regarded as a cause of occupational airways disease and its use in the fish and prawn-processing industry investigated further to better identify risks from exposure and handling of the agent in the workplace. AU - Steiner M AU - Scaife A AU - Semple S AU - Hulks G AU - Ayres JG LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 22 IP - DP - 2008 Jan 01 TI - Occupational rhinitis in damp and moldy workplaces PG - 457-462 AB - BACKGROUND Numerous studies confirm the association between exposure to indoor air dampness and molds and different health outcomes. Of these, upper respiratory tract problems are the most commonly reported work-related symptoms in damp indoor environments. The aim of this study was to describe a clinically investigated patient series with occupational rhinitis induced by molds. METHODS Nasal provocation test (NPT) with commercial fungal allergens was performed in 369 patients during 1995-2004 at the Finnish Institute of Occupational Health. Of these, 60 (16%) were positive. In addition to positive NPT, the diagnosis of occupational rhinitis was based on verified exposure to molds, work-related nasal symptoms, and clinical investigations. We wanted to review the patient files of these 60 patients retrospectively, and 56 patients gave their informed consent. RESULTS The mean age of the patients was 43.7 years (SD +/- 9.5). Fifty (89.3%) patients were women. In 23% of the patients, IgE-mediated allergy to molds could be established. Atopy significantly increased IgE sensitization to molds (OR, 10.3 [95% CI, 2.0-52.5]). The most common mold to induce occupational rhinitis was Aspergillus fumigatus. Exposure time was over 5 years in 63% of the patients. Association between the IgE sensitization to molds and exposure level was statistically significant (Fisher's exact test, p = 0.046). CONCLUSION This is the first clinically investigated series on occupational rhinitis in relation to a moldy environment. Based on our findings, we conclude that molds growing in conjunction with moisture damages can induce occupational rhinitis. IgE-mediated allergy to molds was not common. Atopy and significant exposure level increased IgE sensitization to molds. AU - Karvala K AU - Nordman H AU - Luukkonen R AU - Nykyri E AU - Lappalainen S AU - Hannu T AU - Toskala E LA - PT - DEP - TA - Am J Rhinol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 65 IP - DP - 2008 Jan 01 TI - Respiratory and skin hypersensitivity reactions caused by a peptide coupling reagent PG - 715-716 AB - TBTU (2-[1H-benzotriazol-1-yl]-1,1,3,3-tetramethyluronium tetrafluoroborate; CAS No: 125700-67-6) and HBTU (2-[1H-benzotriazol-1-yl]-1,1,3,3-tetramethyluronium hexafluorophosphate; CAS No: 94790-7-1) are increasingly used as coupling reagents for the stepwise synthesis of peptides. There have been isolated reports describing the development of rhinitis, urticaria and contact dermatitis 1–4 caused by these uronium compounds. We evaluated six workers exposed to TBTU in a laboratory producing a wide variety of biologically active peptides. Three times a week, they weighed 30–50 g of TBTU powder into separate aliquots which were dissolved in dimethylformamide in closed vials and connected to an automated synthesiser. The survey included a detailed questionnaire and skin-prick tests with five common inhalant allergens, natural rubber latex, and reshly prepared dilutions of TBTU, HBTU and hydroxybenzotriazole (HOBt) (1 and 10 mg/ml) in sterile saline. One employee reported work-related asthma and rhinitis, while three others experienced both rhinitis and skin symptoms (transient urticarial rash of the hands and face and persistent eczematous-like skin lesions on the hands). The nasal and skin symptoms markedly decreased after improvement in the plant ventilation system, isolation of the weighing procedure, and implementation of stringent work practices (systematic cleaning procedures, use of respiratory rotectivemasks for weighing operations, protective clothes changed daily, use of long-sleeved gloves). These four symptomatic workers showed an immediate skin-prick test response to TBTU but not to saline solution. Three of them also demonstrated a positive skin reaction to HBTU, while skin testing with HOBt gave negative results. Skin-prick tests with TBTU, HBTU and HOBt were negative in nine unexposed control subjects. Specific IgE antibodies against TBTU and HBTU conjugated to human serum albumin could not be detected in symptomatic workers using the ImmunoCAP technique (personal communication from L Strombeck, Phadia Diagnostics, Uppsala, Sweden). In the employee reporting work-related asthma, bronchial provocation challenge by tipping TBTU powder elicited an immediate asthmatic reaction and a significant increase in non-specific bronchial responsiveness to histamine. Analysis of induced sputum showed an increase in the percentage of sputum eosinophils (6.3% of 5.326106 cells/ml) at 24 h post-challenge vs 0.3% of 1.896106 cells/ml in the control day sample).the 1.0 mg/ml solution of TBTU induced complete blockage of nasal cavities and an increase in nasal lavage fluid eosinophils (from 0% post-saline to 20.5% in the sample collected 4 h after TBTU instillation). The results of bronchial challenge with TBTU were consistent with those reported in asthmatic reactions induced by lowmolecular weight agents, although the underlying mechanisms remain largely uncertain. Thus, the bronchial response to TBTU was associated with a significant increase in non-specific bronchial hyperresponsiveness and in sputum eosinophils. Immediate skin-prick test response to TBTU and HBTU supported a type I allergic response directed against these agents. Specific IgE antibodies could not be detected, which is often the case in workers with occupational asthma caused by low-molecular-weight agents.5 The nature of skin symptoms was consistent both with urticaria resulting from type I allergy and with allergic contact dermatitis due to delayed type IV hypersensitivity. The potentiating effects of other chemicals present in the workplace, such as dimethylformamide, should be further explored. These findings indicate that uronium salts have a high potential for inducing respiratory and skin hypersensitivity reactions. Stringent work hygiene programs should be implemented to minimise airborne and skin exposure to peptide coupling reagents. Exposed workers should be carefully observed for the development of respiratory and skin symptoms. AU - Vandenplas O AU - Hereng M-P AU - Heymans J AU - Huaux F AU - Lilet-Leclercq C AU - Dezfoulian B AU - Grand J-L AU - Thimpont J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 148(1) IP - DP - 2008 Jan 01 TI - IgE-Mediated Occupational Asthma from Epoxy Resin PG - 41-44 AB - Background Epoxy resins (ERs) are used in paints and other protective coatings, including flooring materials. Bisphenol A diglycidyl ether (BADGE) ERs (BADGE ERs) account for about 75% of the ERs used world-wide. ERs can cause both immediate and delayed allergic reactions, but immediate reactions are rare. Methods Occupational asthma (OA) was diagnosed on the basis of a specific challenge test combined with the patient's history of occupational exposure and respiratory symptoms. Results A 39-year-old nonsmoking construction worker experienced dyspnea when laying ER-containing floors, but not in other situations. He also presented skin symptoms. IgE-mediated allergy to BADGE ER could be verified with both serum IgE antibodies and skin prick tests. The specific bronchial challenge test with BADGE ER caused an immediate asthmatic reaction. On patch testing, a positive reaction was provoked by BADGE ER. Conclusions This is the first study on a patient exposed to BADGE ER with IgE-mediated immediate OA, based on a positive inhalation challenge test. If work-related respiratory symptoms develop when handling ERs, the possibility of OA should be recognized. AU - Hannu T AU - Frilander H AU - Kauppi P AU - Kuuliala O AU - Alanko K LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 51 IP - DP - 2008 Jan 01 TI - Occupational asthma caused by sculptured nails containing methacrylates PG - 968-974 AB - BACKGROUND In recent decades, the use of artificial nails including methacrylates (MAs) has increased. This study presents the first two clinical cases of occupational asthma (OA) caused by sculptured nails containing MAs. METHODS In both cases, OA was diagnosed on the basis of a work simulation test combined with the patient's history of occupational exposure and respiratory symptoms. RESULTS Both patients developed work-related respiratory symptoms 4-5 years before the current examinations. Previously, the first patient (a 30-year-old female) was diagnosed as having allergic contact dermatitis (ACD) to MAs; the second patient (a 27-year-old female) had no skin symptoms. In both cases, a dual asthmatic reaction was observed in the bronchial provocation test, in which the patients simulated their work using their own products including MAs. CONCLUSIONS Sculptured nails containing MAs can induce OA in nail technicians. Products not containing MAs should be used to prevent OA and ACD. If MAs are used, they should be handled with appropriate safety measures. AU - Sauni R AU - Kauppi P AU - Alanko K AU - Henriks-Eckerman ML AU - Tuppurainen M AU - Hannu T LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 44 IP - DP - 2008 Jan 01 TI - Course of bronchial hyperresponsiveness in patients with occupational asthma caused by exposure to persulfate salts PG - 140-145 AB - OBJECTIVE: Persulfate salts are among the most frequently implicated causes of occupational asthma. The aim of this study was to describe the course of bronchial hyperresponsiveness and immunologic test results in patients with occupational asthma due to persulfate salts. PATIENTS AND METHODS: Ten patients with occupational asthma due to persulfate salts were studied. Diagnosis was based on specific bronchial challenge tests performed at least 3 years before enrollment. An exhaustive medical and work history was taken during interviews with all patients, and all underwent spirometry and nonspecific bronchial challenge testing. Total immunoglobulin E levels were determined and skin prick tests to several persulfate salts were performed. RESULTS: At the time of evaluation, 7 patients had avoided workplace exposure to persulfate salts. The bronchial hyperresponsiveness of 3 of those 7 patients had improved significantly. No improvement was observed in patients who continued to be exposed. Specific skin prick tests became negative in 3 patients who were no longer exposed at the time of the follow-up evaluation. Most of the patients continued to report symptoms, although improvements were noted. One patient, however, reported worsening of symptoms in spite of avoidance of exposure. CONCLUSIONS: Although asthma symptoms and bronchial hyperresponsiveness may persist for patients with occupational asthma due to persulfate salts, their condition seems to improve if they avoid exposure. This course does not seem to differ from that reported for other cases of occupational asthma. AU - Munoz X AU - Gomez-Olles S AU - Cruz MJ AU - Untoria MD AU - Orriols R AU - Morell F LA - PT - DEP - TA - Archivos de Bronconeumologia JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 32 IP - DP - 2008 Jan 01 TI - Workplace-specific challenges as a contribution to the diagnosis of occupational asthma PG - 997-1003 AB - The diagnosis of occupational asthma can be made by exposing workers to the relevant agent either in a hospital laboratory through specific inhalation challenges (SICs) or in the workplace. As suggested by several authors, workers with negative laboratory SIC can be monitored at the workplace under supervision. The present study aims to assess the frequency of, and identify factors associated with, a positive workplace reaction in workers with negative SIC in the laboratory. Methods The results of workplace challenges were examined in 99 workers who underwent negative SIC between 1994 and 2004. A positive reaction either in the SIC or in the workplace was defined as a sustained fall in forced expiratory volume in one second of >20%. Results In total, 22 (22.2%) workers showed positive responses at the workplace. These subjects more often had increased baseline methacholine responsiveness (90.5 versus 67.6%). They also underwent more days of SIC testing (4.9 versus 3.3 days) and were exposed more often to two or more agents (56 versus 28.4%) and for a longer period of time (363.3 versus 220.4 min) in the laboratory. Cnclusion The present study illustrates the usefulness of workplace monitoring of airway function in the investigation of occupational asthma and identifies factors that are more often associated with a positive reaction. AU - Rioux J-P AU - Malo J-L AU - LArcheveque J AU - Rabhi K AU - Labrecque M LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 32 IP - DP - 2008 Jan 01 TI - Outdoor swimming pools and the risks of asthma and allergies during adolescence PG - 979-988 AB - Exposure to indoor chlorinated swimming pools can be detrimental to the airways of swimmers and increase asthma risks but it is unknown whether these effects concern outdoor pools. The present study examined 847 secondary school adolescents who had attended residential or nonresidential outdoor chlorinated pools at a variable rate. The main outcomes were: ever asthma (physician-diagnosed at any time); current asthma (ever asthma under medication and/or with exercise-induced bronchoconstriction); elevated exhaled nitric oxide; and aeroallergen-specific immunoglobulin (Ig)E in serum. The prevalence of ever and current asthma significantly increased with the lifetime number of hours spent in outdoor pools by up to four and eight times, respectively, among adolescents with the highest attendance (>500 h) and a low exposure to indoor pools (<250 h). Odds for asthma were significantly increased among adolescents with total serum IgE >25 kIU·L–1, on average by 1–2 units for each 100-h increase in pool attendance. Use of residential outdoor pools was also associated with higher risks of elevated exhaled nitric oxide and sensitisation to cat or house dust mite allergens. Outdoor chlorinated swimming pool attendance is associated with higher risks of asthma, airways inflammation and some respiratory allergies. AU - Bernard A AU - Nickmilder M AU - Voisin C LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 58 IP - DP - 2008 Jan 01 TI - Does exercise cause asthma? PG - 480-484 AB - Background The Israel Defence Forces needed to define the correlation between physical activity and asthma. Aim To determine whether combat unit (CU) soldiers are more susceptible to exercise-induced asthma (EIA) than other military units. Methods A follow-up study of recruits with normal clinical and pulmonary function tests over a period of 30 months after having been assigned to CU, maintenance units (MU) or clerical tasks (CT). The participants chosen had already been subjected to additional tests 6 weeks after induction to eliminate any cases of active asthma. Results Out of 799 subjects, 125 developed asthma during the follow-up. Twenty-one per cent of those in the CU developed asthma against 15% in the MU and 5% in the CT. The relative risks for newly diagnosed asthma were 3.7 for CU/CT (P < 0.001), 2.7 for MU/CT (P < 0.001) and 1.4 for CU/MU (P < 0.05). EIA was observed as the only manifestation of asthma in 32% of the soldiers posted in CU compared to 13 and 11% in MU and CT, respectively. Conclusion The increased risk of EIA in CU compared to MU and CT may indicate that any one or all the factors associated with CU service conditions could contribute to this increased risk of uncovering the mild cases of asthma, especially EIA, that had been overlooked up to the time of induction into the army. AU - Katz I AU - Moshe S AU - Levin M AU - Slodownik D AU - Yagev Y LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 58 IP - DP - 2008 Jan 01 TI - Occupational exposures among domestic and industrial professional cleaners PG - 458-463 AB - Background Despite being a large part of the workforce, cleaners remain a relatively understudied occupational group in the USA. Aims The aims of this focus group study were to identify and characterize occupational exposures, symptoms and job tasks among domestic and industrial professional cleaners. Methods Twelve focus group sessions were conducted in Lubbock, TX, and Houston, TX. Participants were asked about their job tasks, type of products they use to clean, bodily symptoms, job training and work environment. Results Out of 99 attendees, 79 domestic and industrial cleaners participated actively in the focus group sessions. Three general themes emerged regarding cleaning professionals' work experiences: (i) job training, (ii) chemical exposure and use and (iii) competence. Domestic cleaners demonstrated significant skills deficit across each of these three themes as compared to industrial cleaners. Domestic cleaners reported more frequent exposure to respiratory irritants and sensitizers and also reported adverse respiratory symptoms as compared to industrial cleaners. Conclusions The results from this qualitative study are consistent with earlier findings from quantitative studies placing domestic cleaners at risk of exposure to chemicals that are respiratory irritants and/or sensitizers. AU - Arif AA AU - Hughes PC AU - Delclos GL LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 134 IP - DP - 2008 Jan 01 TI - Work-Related Asthma American College of Chest Physicians Consensus Statement PG - 1S-41S AB - Background: A previous American College of Chest Physicians Consensus Statement on asthma in the workplace was published in 1995. The current Consensus Statement updates the previous one based on additional research that has been published since then, including findings relevant to preventive measures and work-exacerbated asthma (WEA). Methods: A panel of experts, including allergists, pulmonologists, and occupational medicine physicians, was convened to develop this Consensus Document on the diagnosis and management of work-related asthma (WRA), based in part on a systematic review, that was performed by the University of Alberta/Capital Health Evidence-Based Practice and was supplemented by additional published studies to 2007. Results: The Consensus Document defined WRA to include occupational asthma (ie, asthma induced by sensitizer or irritant work exposures) and WEA (ie, preexisting or concurrent asthma worsened by work factors). The Consensus Document focuses on the diagnosis and management of WRA (including diagnostic tests, and work and compensation issues), as well as preventive measures. WRA should be considered in all individuals with new-onset or worsening asthma, and a careful occupational history should be obtained. Diagnostic tests such as serial peak flow recordings, methacholine challenge tests, immunologic tests, and specific inhalation challenge tests (if available), can increase diagnostic certainty. Since the prognosis is better with early diagnosis and appropriate intervention, effective preventive measures for other workers with exposure should be addressed. Conclusions: The substantial prevalence of WRA supports consideration of the diagnosis in all who present with new-onset or worsening asthma, followed by appropriate investigations and intervention including consideration of other exposed workers. AU - Tarlo SM AU - Balmes J AU - Balkissoon R AU - Beach J AU - Beckett W AU - Bernstein D AU - Blanc PD AU - Brooks SM AU - Cowl CT AU - Daroowalla F AU - Harber P AU - Lemiere C AU - Liss GM AU - Pacheco KA AU - Redlich CA AU - Rowe B AU - Heitzer J LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 65 IP - DP - 2008 Jan 01 TI - Measurement of trends in incidence of work-related skin and respiratory diseases, UK 1996–2005 PG - 808-814 AB - Objectives: The ability to measure temporal trends in disease incidence is important, but valid methods are needed. This study investigates UK trends during 1996–2005 in work-related skin and respiratory diseases including non-malignant pleural disease, asthma, mesothelioma and pneumoconiosis and the potential for bias when using surveillance systems for this purpose. Methods: The volunteer reporters in three surveillance schemes were specialist physicians for skin diseases, specialist physicians for respiratory diseases and occupational physicians, respectively, who provided monthly reports of new cases of disease which they considered work related. Poisson regression models were used to investigate variation by calendar year (trend), season and reporter characteristics. Separately, temporal patterns in the probabilities of non-response and zero reports were investigated. Annual changes in disease incidences were compared between reporter groups. Results: There was little evidence of change in incidences of non-malignant pleural disease, mesothelioma, skin neoplasia and urticaria, but falls were seen for contact dermatitis and pneumoconiosis. Although the directions of change were similar across reporter groups, the magnitude of annual change in incidence was often inconsistent: for occupational asthma, it was –1.9% (95% CI –5.2 to 1.4) and –12.1% (95% CI–19.5 to –4.1) using respiratory and occupational physician reports, respectively. Response rates were high (85%), but non-response increased slightly with membership time, as did the probability of a zero return in some groups. Adjustment of results for presumed reporting fatigue led to an upward correction in some calendar trends. Conclusions: As some estimated changes in incidence based on volunteer reporting may be biased by reporting fatigue, apparent downward trends need to be interpreted cautiously. Differences in the population bases of the surveillance schemes and UK health service capacity constraints may also explain the differences in trends found here. AU - McNamee R AU - Carder M AU - Chen Y AU - Agius R LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Prevention of work-related airway allergies; summary of the advice from the Health Council of the Netherlands PG - 1593-1596 AB - The Health Council of the Netherlands published a report in which the best procedure and method for recommending health-based occupational exposure limits (OELs) for inhaled allergens were identified by evaluating the scientific state of the art. Many respiratory disorders in the workplace arise from inhalation of substances which can cause allergy. To protect workers against respiratory allergy, various preventive measures are taken, one of them being reduction of exposure by setting legally binding standards. These are based on health-based OELs that specify a level of exposure to an airborne substance, a threshold level, below which it may reasonably be expected that there is no risk of adverse health effects. The Council is of the opinion that an OEL should prevent against allergic sensitization, as sensitization plays a crucial biological role and is a prerequisite for the development of allergy. Furthermore, the Council considers it most likely that the exposure level below which no allergic sensitization develops for most allergens is so low, that OELs are difficult to set with the current knowledge and technical feasibilities. An alternative approach is to accept exposure, which carries a small predefined risk in developing allergic sensitization. In addition, it is worth considering periodic screening of exposed workers on allergic sensitization, because timely intervention can prevent worse. The feasibility of periodic screening and what else is needed to comply with the most important criteria, should however be judged case-by-case. AU - Rijnkels JM AU - Smid T AU - Van den Aker EC AU - Burdorf A AU - van Wijk RG AU - Heederik DJJ AU - Houben GF AU - Van Loveren H AU - Pal TM AU - Van Rooy FGBGJ AU - Van der Zee JS LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Wheat allergen exposure and the prevalence of work-related sensitization and allergy in bakery workers PG - 1597-1604 AB - Background: Occupational airway diseases are common among bakers. The present study describes the association between exposure to wheat allergen levels and sensitization to wheat allergens, work-related upper and lower respiratory symptoms and asthma in bakery workers. Methods: As part of a Health Surveillance System for early detection of (allergic) occupational airway diseases a so-called 'validation study' was performed among Dutch bakers for validation of a diagnostic model that predict the likelihood of sensitization to specific workplace allergens. The present study used serology and questionnaire results of a subgroup of 860 bakers participating in the validation study. An earlier developed job-exposure matrix was used to predict average and cumulative personal exposure to wheat allergens. Results: The prevalence of wheat sensitization, work-related respiratory symptoms and asthma increased till average wheat exposure levels of approximately 25–30 µg/m3, leveled off and decreased at higher exposure concentrations. Exposure–response curves showed a stronger pronounced bell-shape with cumulative exposure. Associations were strongest for asthma and work-related lower respiratory symptoms (PR~2 and PR~3.5–4.5 for average and cumulative exposure, respectively). Associations were only found in atopics. Wheat sensitization was an important factor in the prevalence of respiratory symptoms. Conclusion: In accordance with earlier studies, the present study showed a bell-shaped exposure–response relationship especially for cumulative wheat allergen exposure with sensitization, allergic respiratory symptoms and asthma. The healthy worker effect may be the possible explanation for the bell-shaped relationship. AU - Jacobs JH AU - Meijster T AU - Meijer E AU - Suarthana E AU - Heederik D LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - book IP - DP - 2008 Jan 01 TI - Latex allergy, Occupational aspects of management, A national guideline PG - 1-55 AB - About a quarter of the world’s demand for elastic products is supplied by natural rubber derived from the Hevea brasiliensis tree. Natural rubber latex (NRL) from this tree is used in the production of numerous rubber products found at home and at work including gloves, balloons, adhesive tape and bandages, condoms and catheters, rubber bands, dental dams, tourniquets and resuscitation equipment. Allergy to certain latex proteins emerged as an occupational disease in the 1980s and continues to be an important occupational health problem as natural rubber products are used increasingly worldwide, particularly in healthcare. Symptoms of the immediate type of allergy produced range from rash, itchy or runny eyes or nose, sneezing, and coughing to chest tightness, shortness of breath and anaphylactic shock. The symptoms experienced depend in part on the route of exposure, which can be by direct contact with skin or mucosa, or by inhalation. Although there is a large body of research on latex allergy, few studies have examined occupational health interventions. This systematic review summarises current evidence and is intended to assist occupational health professionals, managers and other interested parties in providing advice on occupational health interventions to address the problem of latex allergy from both individual and institutional perspectives. The review is concerned particularly with issues relating to gloves, as these represent by far the main occupational use of latex. Latex allergy of the immediate type is distinguished in this review from contact dermatitis caused by delayed hypersensitivity (type IV allergy) to chemicals that are added to latex during processing. The main focus of this review is on type I or immediate-type allergy to latex proteins, which has a reported prevalence of up to 17% in certain occupational groups. Key findings and recommendations • The use of powder-free, low protein latex gloves as an alternative to powdered latex gloves significantly reduces the incidence of latex allergy and latex-induced asthma, as well as the prevalence of latex-related symptoms. Powdered latex gloves should therefore not be used in the workplace. • At a national and local level, a policy that encourages switching from powdered latex gloves to powder-free low protein latex gloves is a proven effective method of reducing the incidence of latex allergy. • Employees with latex allergy, latex sensitivity or latex-induced asthma should use nonlatex gloves. • In employees who are latex allergic/sensitised, taking latex avoidance measures results in cessation or diminution of symptoms. Markers of sensitisation decrease regardless of whether co-workers continue to use powder-free low protein latex gloves or latex-free gloves. • In employees with latex-induced asthma or rhinitis, the use of powder-free low protein gloves by their colleagues reduces symptoms and indices of severity in the affected employee to a similar degree as the use of non-latex gloves by colleagues. Latex allergy: occupational aspects of management • All but the most severe cases of latex allergy and latex-induced asthma can be managed without the need for redeployment, ill health retirement or termination of employment. Adjustments include careful personal avoidance of latex at work and minor changes in the workplace. • There is a lack of published primary research comparing occupational interventions for those who are sensitised to latex (without symptoms), with those with clinical latex allergy. • No reports of new cases of latex allergy arising from non-powdered low protein latex glove use were found. The evidence does not therefore support a complete ban on the use of latex gloves. Institutions should judge whether their needs would be met better by the use of latex-free or powder-free latex gloves, or use of both in different settings, while taking into account the desirable and undesirable properties of both materials. AU - Ahmed SM for NHS Plus AU - Royal College of Physicians and Faculty of Occupational Medicine. LA - PT - DEP - TA - Royal College of Physicians, London JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 58 IP - DP - 2008 Jan 01 TI - Allergic contact dermatitis and asthma caused by limonene in a labourer handling citrus fruits. PG - 315-316 AB - AU - Guarneri F AU - Barbuzza O AU - Vaccaro M AU - Galtieri G. LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 51 IP - DP - 2008 Jan 01 TI - Quality control chart method for analyzing PEF variability in occupational asthma. PG - 223-228 AB - BACKGROUND: Asthma is the most common occupational respiratory disorder in the industrialized world. In this research we investigated the effectiveness of quality control chart as a method to explore the work-relatedness of asthma using peak expiratory flow (PEF) as the variable of interest. METHOD: PEF measurements were recorded from several workers suspected of having occupational asthma. The measurements were recorded for a period of 2 weeks at work and two away from work. For each subject, average [symbol: see text] quality control chart was developed and analyzed using Shewhart methods. RESULTS: Using the ratio of average daily PEF diurnal variation at work to the baseline average diurnal variation, quality control chart detected and characterized increased variation in PEF between the periods at workplace and away from workplace. This ratio was evaluated at 15% and 20% and compared to the results of the gold standard. A ratio of greater than 15% produced a sensitivity of 94% and specificity of 61%. These results are as good as and in some cases better than the previously published work. CONCLUSIONS: Quality control chart is an effective and inexpensive method for early intervention to detect workers suspected for occupational asthma. Also, the findings in this article are an invitation for further research in occupational asthma using quality control chart methods for other indices of airways obstruction (FEV-1, RAW) or inflammation (NO). AU - Hayati F AU - Maghsoodloo S AU - DeVivo MJ AU - Thomas RE AU - Lemiere C LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 21 IP - DP - 2008 Jan 01 TI - Occupational asthma due to manganese exposure: a case report PG - 81-83 AB - Manganese belongs to a group of agents called transitional metals that are known to induce occupational asthma. However, well-documented cases of manganese-induced asthma have been lacking thus far. We have discussed a case of a 42-year-old non-smoking welder with work-related dyspnea. A number of clinical procedures were performed including clinical examination, routine laboratory tests, total serum IgE, skin prick tests to common aeroallergens and manganese nitrate, resting spirometry test, histamine challenge, and a single-blind, placebo-controlled specific inhalation challenge with 0.1% manganese chloride solution. Clinical findings and laboratory test results remained normal but a significant bronchial hyperreactivity was found. During the specific inhalation challenge, dyspnea and a significant decrease in forced expiratory volume (FEV1)were observed. An increased proportion of eosinophils and basophils in induced sputum could also be noted at 4 and 24 h after the challenge. The argument for recognizing the condition as occupational asthma was a positive clinical response to the specific challenge test as well as the morphological changes found in induced sputum. To our knowledge, this is the first well-documented case of manganese-induced occupational asthma. AU - Wittczak T AU - Dudek W AU - Krakowiak A AU - Walusiak J LA - PT - DEP - TA - Int J Occup Med Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 52 IP - DP - 2008 Jan 01 TI - Evaluation of Peak Exposures in the Dutch Flour Processing Industry: Implications for Intervention Strategies PG - 587-596 AB - Objectives: To effectively decrease occupational exposure to flour dust and related allergens, detailed information on exposure determinants and effectiveness of control measures is essential. In this paper, we use personal real-time exposure measurements to get more insight into the relationship between specific work characteristics, including the use of control measures, and (peak) exposure to flour dust. The study has three objectives: (i) identify tasks and activities related to peak exposure, (ii) identify control measures and other important exposure determinants and (iii) assess the potential impact of these control measures on the (peak) exposure to flour dust. Methods: A data set containing 82 real-time exposure measurements in combination with information from detailed observations was used to study the association between peak exposures and different tasks, activities and other determinants such as control measures. Descriptive statistics of peak exposure on job level were generated as well as information on contribution of task-specific peak exposures to time-weighted average (TWA) exposure levels. Finally, we evaluated the efficacy of a variety of control measures on task exposure by comparing exposure levels of groups of workers with and without controls. Results: In workers included in this study, >75% of TWA exposure is directly associated with peak exposures during a limited set of well-defined tasks/activities. The impact of a single task on population TWA exposure is generally limited (<40%). Worker behavior seems an important determinant in effective exposure control for many tasks. Conclusions: Data from real-time measurements provide important detailed information with respect to exposure determinants and control measures, not obtainable from conventional measurement studies focusing at TWA exposure. This information is essential to perform prospective impact assessments of intervention strategies on the populations’ exposure distribution. AU - Meijster T AU - Tielemans E AU - Schinkel J AU - Heederik D LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 22 IP - DP - 2008 Jan 01 TI - Cell types involved in allergic asthma and their use in in vitro models to assess respiratory sensitization PG - 1419-1431 AB - This review first describes the mechanism and cell types involved in allergic asthma, which is a complex clinical disease characterized by airway obstruction, airway inflammation and airway hyperresponsiveness to a variety of stimuli. The development of allergic asthma exists of three phases, namely the induction phase, the early-phase asthmatic reaction (EAR) and the late-phase asthmatic reaction (LAR). In the induction phase, antigen-presenting cells play a major role. Most important cells in the EAR are mast cells, and during the LAR, various cell types, such as eosinophils, neutrophils, T cells, macrophages, dendritic cells (DCs), and cells that endow structure are involved. In occupational asthma, this immunological mechanism is involved in 90% of the cases. The second part of this review gives an overview of in vitro models to assess the hazardous potential of high- and low-molecular weight chemicals on the respiratory system. In order to develop a good in vitro model for respiratory allergy, the choice of appropriate celltypes is important. Epithelial cells, macrophages and DCs are currently the most used models in this field of research. AU - Verstraelen S AU - Bloemen K AU - Nelissen I AU - Witters H AU - Schoeters G AU - Van Den Heuvel R LA - PT - DEP - TA - Toxicology in Vitro JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 372 IP - DP - 2008 Jan 01 TI - Endotyping asthma: new insights into key pathogenic mechanisms in a complex, heterogeneous disease. PG - 1107-1119 AB - Clinical asthma is very widely assumed to be the net result of excessive inflammation driven by aberrant T-helper-2 (Th2) immunity that leads to inflamed, remodelled airways and then functional derangement that, in turn, causes symptoms. This notion of disease is actually poorly supported by data, and there are substantial discrepancies and very poor correlation between inflammation, damage, functional impairment, and degree of symptoms. Furthermore, this problem is compounded by the poor understanding of the heterogeneity of clinical disease. Failure to recognise and discover the underlying mechanisms of these major variants or endotypes of asthma is, arguably, the major intellectual limitation to progress at present. Fortunately, both clinical research and animal models are very well suited to dissecting the cellular and molecular basis of disease endotypes. This approach is already suggesting entirely novel pathways to disease-eg, alternative macrophage specification, steroid refractory innate immunity, the interleukin-17-regulatory T-cell axis, epidermal growth factor receptor co-amplification, and Th2-mimicking but non-T-cell, interleukins 18 and 33 dependent processes that can offer unexpected therapeutic opportunities for specific patient endotypes. AU - Anderson GP LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 22 IP - DP - 2008 Jan 01 TI - Anaphylaxis Following Cystoscopy With Equipment Sterilized With Cidex® OPA (Ortho-Phthalaldehyde): A Review of Two Cases PG - 2181-2184 AB - Purpose: Ortho-phthalaldehyde (Cidex® OPA) is a commonly used solution for rapid sterilization of flexible endoscopic equipment. We report two cases of anaphylaxis following cystoscopy with endoscopes sterilized with this agent. Only a handful of such reactions have been reported in the published literature, the majority of which are in the bladder cancer population undergoing surveillance cystoscopy. Patients and Methods: We reviewed the clinical presentation of two cases of anaphylaxis following flexible cystoscopy with instruments sterilized with ortho-pthalaldehyde. We further describe their subsequent evaluation by an allergy and immunology specialist who performed skin testing to confirm a suspected ortho-pthalaldehyde allergy. Results: Both patients were skin test positive to ortho-phthalaldehyde antigen. As a result, sterilization techniques for our flexible endoscopes has been altered. To date, no further anaphylactic reactions have occurred in our bladder cancer patients, including the two cases presented herein following subsequent cystoscopic evaluations. Conclusions: Ortho-phthalaldehyde-sterilized cystoscopes have been associated with anaphylactic reactions in a small number of patients who have undergone repeated cystoscopy. The manufacturer has already made recommendations to avoid this agent in bladder cancer patients. It may be prudent to extend this practice to other populations undergoing repeat cystoscopy. AU - Cooper DE AU - White AA AU - Werkema AN AU - Auge BK LA - PT - DEP - TA - Journal of Endourology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 18 IP - DP - 2008 Jan 01 TI - Occupational Asthma and Rhinoconjunctivitis Caused by Cricket Allergy PG - 136-142 AB - Allergic occupational asthma can be caused by a number of substances, mostly proteins, derived from animals, plants,foods, and enzymes. Insect exposure is not very common in Western countries. However, laboratory workers or other professional groups may have direct contact with these animals. Nowadays, many insect species belonging to different orders have been implicated in allergic processes. It has been estimated that 50% of animal-sensitized individuals will develop rhinoconjunctivitis, 25% skin reactions, and 25% asthma, and most allergic processes in these individuals affect multiple target organs. We present a patient with occupational asthma and rhinoconjunctivitis caused by inhaling cricket (Acheta campestris) particles and contact urticaria after handling of crickets. A 28-year-old man with no previous personal history of asthma or other respiratory disorders and who had never smoked came to our allergy unit with a 4-year history of frequent episodes of cough, dyspnea, and wheezing accompanied by rhinoconjunctivitis and occasionally chemosis and urticaria. He had worked for 7 years as an assistant in a reptile shop, where he fed reptiles with live crickets, which themselves were fed with cornmeal. He developed the symptoms after a latent period of 3 years. The patient reported improvement of the respiratory symptoms and disappearance of cutaneous symptoms at the weekend and during holidays. Skin prick tests with a battery of common inhalant allergens, including dust mites, pollens, moulds, cat and dog dander, and insect (German cockroach, oriental cockroach, and American cockroach), were negative. Skin prick test with a manufactured cricket extract at a concentration of 1 mg of freeze-dried material per milliliter was positive (7 mm wheal diameter) and negative in 5 control individuals. Skin prick test (prick by prick) with a cornmeal extract was negative. Spirometric values were in the normal range (forced vital capacity [FVC], 5.18 L [89% of predicted]; forced expiratory volume in 1 second, 4.11 L [89% of predicted]; forced expiratory fl ow at 25%-75% of FVC, 3.68 L/s [80% of predicted]) and the results of a bronchodilator test were negative. Serial determinations of peak expiratory flow were seen to drop by more than 20% during work periods and returned to normal values at the weekend. A specific nasal challenge test, measured with acoustic rhinometry, was performed with a cricket extract and showed an immediate response at 1:1000 dilution of the extract used in the prick test, with a reduction in nasal volume of more than 30% between the 2nd and 5th centimeter into the nostrils measured at 10 minutes. A nasal challenge with phosphate buffered saline was negative. Specific nasal challenge test with cricket extract was performed in a control patient with a negative result. The protein profile of the cricket extract showed several bands with a molecular weight range of 10 to 100 kDa. Immunoblot experiments showed several bands with immunoglobulin (Ig) E binding capacity. The most prominent bands corresponded to proteins with a molecular weight of 17, 32, 47, and 62 kDa. No bands were recognized with a pool of sera from healthy control individuals. Patients with IgE sensitization to crickets, without evidence of clinical relevance, have been reported in previous studies and most of them showed cross reactivity with other insects.Bagenstose et al reported 2 patients whose clinical history strongly suggested an asthma-related allergy linked to their occupation, but the diagnosis was not confirmed by respiratory function tests. Crickets appeared to be involved. The suspected cricket allergy was confirmed by a skin test and bronchial inhalation challenge. However, both patients were sensitized to several common aeroallergens and also other allergens they were exposed to in their jobs, including crickets. In conclusion, this is the first reported case of unequivocal occupational asthma and rhinoconjunctivitis with contact urticaria in a patient monosensitized to cricket. The clinical relevance was demonstrated by specific nasal challenge test measured by acoustic rhinometry. More studies are necessary to determine the immunochemical characteristics of the allergens and cross-reactivity with other insect groups. AU - Bartra J AU - Carnés J AU - Muñoz-Cano R AU - Bissinger I AU - Picado C LA - PT - DEP - TA - J Inv Allergod Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 18 IP - DP - 2008 Jan 01 TI - Occupational Asthma and Rhinoconjunctivitis Caused by Cricket Allergy PG - 136-142 AB - Allergic occupational asthma can be caused by a number of substances, mostly proteins, derived from animals, plants,foods, and enzymes. Insect exposure is not very common in Western countries. However, laboratory workers or other professional groups may have direct contact with these animals. Nowadays, many insect species belonging to different orders have been implicated in allergic processes. It has been estimated that 50% of animal-sensitized individuals will develop rhinoconjunctivitis, 25% skin reactions, and 25% asthma, and most allergic processes in these individuals affect multiple target organs. We present a patient with occupational asthma and rhinoconjunctivitis caused by inhaling cricket (Acheta campestris) particles and contact urticaria after handling of crickets. A 28-year-old man with no previous personal history of asthma or other respiratory disorders and who had never smoked came to our allergy unit with a 4-year history of frequent episodes of cough, dyspnea, and wheezing accompanied by rhinoconjunctivitis and occasionally chemosis and urticaria. He had worked for 7 years as an assistant in a reptile shop, where he fed reptiles with live crickets, which themselves were fed with cornmeal. He developed the symptoms after a latent period of 3 years. The patient reported improvement of the respiratory symptoms and disappearance of cutaneous symptoms at the weekend and during holidays. Skin prick tests with a battery of common inhalant allergens, including dust mites, pollens, moulds, cat and dog dander, and insect (German cockroach, oriental cockroach, and American cockroach), were negative. Skin prick test with a manufactured cricket extract at a concentration of 1 mg of freeze-dried material per milliliter was positive (7 mm wheal diameter) and negative in 5 control individuals. Skin prick test (prick by prick) with a cornmeal extract was negative. Spirometric values were in the normal range (forced vital capacity [FVC], 5.18 L [89% of predicted]; forced expiratory volume in 1 second, 4.11 L [89% of predicted]; forced expiratory fl ow at 25%-75% of FVC, 3.68 L/s [80% of predicted]) and the results of a bronchodilator test were negative. Serial determinations of peak expiratory flow were seen to drop by more than 20% during work periods and returned to normal values at the weekend. A specific nasal challenge test, measured with acoustic rhinometry, was performed with a cricket extract and showed an immediate response at 1:1000 dilution of the extract used in the prick test, with a reduction in nasal volume of more than 30% between the 2nd and 5th centimeter into the nostrils measured at 10 minutes. A nasal challenge with phosphate buffered saline was negative. Specific nasal challenge test with cricket extract was performed in a control patient with a negative result. The protein profile of the cricket extract showed several bands with a molecular weight range of 10 to 100 kDa. Immunoblot experiments showed several bands with immunoglobulin (Ig) E binding capacity. The most prominent bands corresponded to proteins with a molecular weight of 17, 32, 47, and 62 kDa. No bands were recognized with a pool of sera from healthy control individuals. Patients with IgE sensitization to crickets, without evidence of clinical relevance, have been reported in previous studies and most of them showed cross reactivity with other insects.Bagenstose et al reported 2 patients whose clinical history strongly suggested an asthma-related allergy linked to their occupation, but the diagnosis was not confirmed by respiratory function tests. Crickets appeared to be involved. The suspected cricket allergy was confirmed by a skin test and bronchial inhalation challenge. However, both patients were sensitized to several common aeroallergens and also other allergens they were exposed to in their jobs, including crickets. In conclusion, this is the first reported case of unequivocal occupational asthma and rhinoconjunctivitis with contact urticaria in a patient monosensitized to cricket. The clinical relevance was demonstrated by specific nasal challenge test measured by acoustic rhinometry. More studies are necessary to determine the immunochemical characteristics of the allergens and cross-reactivity with other insect groups. AU - Bartra J AU - Carnés J AU - Muñoz-Cano R AU - Bissinger I AU - Picado C LA - PT - DEP - TA - J Inv Allergod Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 45 IP - DP - 2008 Jan 01 TI - Asthma and swimming: a meta-analysis. PG - 639-647 AB - In this meta-analysis, studies on swimming and asthma were divided into four groups: Group I compared frequency of asthma among elite swimmers to that of other athletes; Group II examined the association between asthma and swimming during childhood; Group III evaluated effects of swimming programs on asthma severity and pulmonary function; and Group IV compared immediate respiratory effects of swimming to those of other types of exercise. The summary results were expressed as meta-odds ratios (ORs) for binary endpoints such as presence of asthma, and meta-differences for continuous endpoints such as changes in post-exercise pulmonary function tests (PFTs). All summary measures of effect were calculated using random effects models accompanied by a corresponding 95% confidence interval (CI) and a test for heterogeneity. In the analysis comparing frequency of asthma among elite swimmers to that among other athletes (Group I), meta-ORs ranged from 2.3 to 2.6 with all 95% CIs excluding 1.0. The corresponding meta-ORs reflecting the association between asthma and swimming pool use during childhood (Group II) were in the 0.63-0.82 range and were not statistically significant. In comparison to swimming, running and/or cycling was associated with a statistically significant four-to six-fold increase in exercise induced bronchospasm. Although asthma is more commonly found among elite swimmers than among other high-level athletes, it is premature to draw conclusions about the causal link between swimming and asthma because most studies available to date used cross-sectional design, because the association is not confirmed among non-competitive swimmers, and because asthmatics may be more likely to select swimming as the activity of choice because of their condition. AU - Goodman M AU - Hays S LA - PT - DEP - TA - J Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 15 IP - DP - 2008 Jan 01 TI - Direct costs of occupational asthma in Quebec between 1988 and 2002 PG - 413-416 AU - Malo J-L AU - LArchevêque J AU - Ghezzo H LA - PT - DEP - TA - Can Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 15 IP - DP - 2008 Jan 01 TI - Direct costs of occupational asthma in Quebec between 1988 and 2002 PG - 413-416 AB - BACKGROUND: Forty to 70 cases of occupational asthma due to sensitization to an agent present in the workplace are accepted each year by the Commission de la santé et de la sécurité du travail, the Quebec medicolegal agency. OBJECTIVES AND METHODS: In a random sample of eight to 10 accepted claims per year from 1988 to 2002, the direct costs of compensation for loss of income (CLI) and compensation for functional impairment (CFI), as well as the associations of these costs with selected variables, were assessed. RESULTS: Mean costs (presented as Canadian dollars ×103) of CLI, CFI and total were 72.5, 11.7 and 92.8, respectively, while the median costs were 40.7, 7.6 and 61.3 for CLI, CFI and total, respectively. Median CLI costs were significantly higher in men than women (69.9 versus 13.1), workers aged 40 years or older versus those younger than 40 years (90.1 versus 27.4), workers with occupational asthma due to workplace exposure to low versus high molecular weight agents (51.2 versus 38.6), and workers taking inhaled steroids at diagnosis (92 versus 52) and reassessment (81 versus 35). Median CFI costs were also higher in those requiring retraining (10.4) and taking early retirement (61.8) than workers who stayed with the same employer but in a different job (5.4). Median CFI costs were significantly higher for individuals being treated with inhaled steroids at the time of diagnosis (14.0 versus 5.2) and reassessment (13 versus 6), and for those left with bronchial hyperresponsiveness (9.5 versus 0.8) related to forced expiratory volume in 1 s and forced expiratory volume in 1 s/forced vital capacity. CONCLUSION: Age, sex, nature of occupational agent, treatment with inhaled steroids and type of rehabilitation all affect CLI, whereas lung function status at baseline and reassessment is related to CFI. AU - Malo J-L AU - L'Archevêque J AU - Ghezzo H LA - PT - DEP - TA - Can Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 21 IP - DP - 2008 Jan 01 TI - Asthma arising in flavoring-exposed food production workers PG - 173-177 AB - OBJECTIVES: While working for a small family-owned popcorn popping company, all of the three non-smoking workers developed a respiratory disease. Because of the newly identified associations between the flavoring chemicals and bronchiolitis obliterans, the specifics of these cases and their exposures were investigated to add to the body of knowledge of flavoring-related lung disease. MATERIALS AND METHODS: We obtained data on work processes as well as full-shift personal and area air samples for diacetyl, acetoin, 2-nonanone, acetaldehyde, and total volatile organic compounds. Air samples were collected on thermal desorption tubes for analysis by gas chromatography mass spectrometry. We also reviewed medical records and conducted interview with the workers. RESULTS: Air samples representative of the exposures that exacerbated asthma symptoms in two workers contained many different aldehydes. The data from interview and medical records and the high resolution computed tomograms of the chest indicated the presence of occupational asthma in all the three workers and possible bronchiolitis obliterans in two of them. This case series emphasizes a need for exposure reduction and medical surveillance among workers exposed to flavoring chemicals, and provides evidence for an increased risk of occupational asthma, as well as bronchiolitis obliterans, in flavoring-exposed workers. AU - Sahakian N AU - Kullman G AU - Lynch D AU - Kreiss K LA - PT - DEP - TA - Int J Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 58 IP - DP - 2008 Jan 01 TI - Facilities for investigating occupational asthma in UK non-specialist respiratory departments PG - 71-73 AB - Background The facilities which should be available to physicians offering specialist occupational asthma services have recently been agreed upon by a UK panel of experts. Aims This study aimed to investigate whether these facilities are available in UK non-specialist secondary care respiratory departments and to document tertiary care referral patterns. Methods A random sample of 100 UK respiratory units was selected, and the lead consultant invited to participate. Face-to-face interviews were conducted to document information on departmental facilities available for investigating cases of occupational asthma and utilization of tertiary referral centres. Results In total, 66% of consultants interviewed had seen a case of occupational asthma in the previous month, and 76% reported having ever referred a patient with suspected occupational asthma to a specialist centre for further investigation (referral distance range 1–111 miles). All the departments were able to perform the investigations previously deemed an absolute necessity in all patients. The availability of in-house facilities that were deemed as must be available varied between 3–100%. Conclusions The results of this study demonstrate that while the majority of basic facilities are widely available, many respiratory departments do not have direct access to investigations routinely required to investigate occupational asthma. Access to specialist occupational respiratory centres varies within the UK, and in some parts of the country involves long travelling distances for patients. AU - Barber CM AU - Naylor S AU - Bradshaw L AU - Francis M AU - Harris-Roberts J AU - Rawbone R AU - Curran A AU - Fishwick D LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Occupational asthma and rhinitis caused by eugenol in a hairdresser PG - 137-138 AB - A hairdresser developed rhinitis and asthma following occupational exposure to eugenol-containing perfumes, confirmed by specific inhalation challenge. AU - Quirce S AU - Fernandez-Nieto M AU - del Pozo V AU - Sastre B AU - Sastre J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 65 IP - DP - 2008 Jan 01 TI - Mortality, morbidity and occupational exposure to airway-irritating agents among men with a respiratory diagnosis in adolescence PG - 120-125 AB - Objectives: To examine the influence of an airway diagnosis in adolescence on future health and occupation in Swedish men. Methods: Data were collected from the linkage of four Swedish national registers: the Military Service Conscription Register, the Population and Housing Censuses, the Inpatient Care Register and the National Cause of Death Register. A job-exposure matrix for airway-irritating substances was developed for application on the conscription cohort. The cohort included 49 321 Swedish men born 1949-51. Three groups-(1) healthy, (2) asthmatics (mild and severe asthma) and (3) subjects with allergic rhinitis without concurrent asthma-were identified at conscription and analysed for mortality, in-patient care and strategies for choice of occupation with emphasis on airway-irritating job exposure. Analyses were adjusted for smoking and childhood socioeconomic position. Results: The prevalence of total asthma was 1.8%, severe asthma 0.45% and allergic rhinitis 2.7%. Mortality for all causes was significantly higher in total asthma, hazard ratio (HR) 1.49 (95% CI 1.00 to 2.23), and lower in allergic rhinitis, HR 0.52 (95% CI 0.30 to 0.91). Asthma was a risk factor for inpatient care while allergic rhinitis was associated with less in-patient care (odds ratio (OR) for total asthma 1.16 (95% CI 1.00 to 1.34), severe asthma 1.38 (95% CI 1.04 to 1.85), allergic rhinitis 0.92 (95% CI 0.82 to 1.03)). Those with asthma tended to avoid jobs with a high probability for airway-irritating exposure (OR 0.88, 95% CI 0.71 to 1.09), but not to the same extent as subjects with allergic rhinitis (OR 0.58, 95% CI 0.47 to 0.70) (ORs from 1990). Conclusion: Subjects with asthma did not change their exposure situation to the same extent as subjects with allergic rhinitis. Further, asthmatics had an increased risk for morbidity and mortality compared to healthy subjects and subjects with allergic rhinitis. AU - Wiebert P AU - Svartengren M AU - Lindberg M AU - Hemmingsson T AU - Lundberg I AU - Nise G LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 31 IP - DP - 2008 Jan 01 TI - Longitudinal lung function decline and wood dust exposure in the furniture industry PG - 343-348 AB - The aim of the present study was to investigate the relationship between change in lung function and cumulative exposure to wood dust. In total, 1,112 woodworkers (927 males, 185 females) and 235 reference workers (104 males, 185 females) participated in a 6-yr longitudinal study. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), height and weight were measured, and questionnaire data on respiratory symptoms, wood dust exposure and smoking habits were collected. Cumulative inhalable wood dust exposure was assessed using a study-specific job exposure matrix and exposure time. The median (range) for cumulative wood dust exposure was 3.75 (0–7.55) mg·year·m–3. A dose–response relationship between cumulative wood dust exposure and percent annual decrease in FEV1 was suggested for female workers. This was confirmed in a linear regression model adjusted for confounders, including smoking, height and age. An additional difference of -14.50 mL·yr–1 and –27.97 mL·yr–1 was revealed for females exposed to 3.75–4.71 mg·yr·m–3 or to >4.71 mg·yr·m–3, respectively, compared with non-/low-exposed females. For females, a positive trend between wood dust exposure and the cumulative incidence proportion of FEV1/FVC <70% was suggested. In conclusion, in the present low-exposed cohort, female woodworkers had an accelerated decline in lung function, which may be clinically relevant. AU - Jacobsen G AU - Schlunssen V AU - Schaumburg I AU - Taudorf E AU - Sigsgaard T LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 65 IP - DP - 2008 Jan 01 TI - Exposure assessment should be integrated in studies on the prevention and management of occupational asthma PG - 149-150 AB - Evidence-based medicine (EBM) approaches have recently been applied to occupational asthma.1 2 The EBM document by Newman Taylor et al1 for occupational asthma evaluates, among other issues, the existence of exposure-response relations for sensitisation and asthma. The cited references indeed provide evidence that exposure-response curves exist for certain high molecular weight allergens. The risk for allergen-specific sensitisation and asthma increases steeply with increasing allergen exposure, especially in atopics.3 More sensitised individuals express respiratory symptoms at higher exposure than at low exposure.4 The time to development of allergy is shorter at higher exposures than at lower exposure.5 The question arises of what the implications of all these findings are with regard to primary prevention of allergic respiratory disease? Exposure-response relations suggest that lowering the exposure will reduce the burden of disease. Some direct evidence exists which illustrates that reduction of exposure leads to reduction of disease burden. Reduction of the exposure, by introducing powder-free gloves, led to a reduction in the number of sensitised and asthmatic workers.6 This conclusion is based on ecological evidence as well as longitudinal intervention studies. The effect of exposure reductions on sensitisation in more complex situations, with multiple determinants of exposure, is not as clearly established. Uncertainty exists as to whether the risk for developing enzyme-related sensitisation and asthma in the detergent industry has reduced, because incidence data for the appropriate population at risk have not been collected.7 A reduction in the incidence of sensitisation has been suggested in laboratory animal workers with exposure to urinary allergens, on the basis of a pre-post intervention comparison within a retrospective cohort. The intervention consisted of the introduction of a code of practice, engineering controls and educational lectures. However, because the population at risk was defined inappropriately in the calculation of annual incidence and migration out of the workforce seemed high, especially in more recent years, the presented incidence figures might underestimate the true incidence. In addition, changes in allergen level were not monitored which also limits the interpretation.8 Second, with regard to progression of disease, different opinions seem to exist. Continuation of exposure is associated with progression of symptoms.9 Specific work-related sensitised workers with high exposure have more symptoms than those with low exposure.5 10 This suggests also that even in sensitised workers the presence and severity of symptoms is exposure-related. Similarly, exposure reduction may influence the presence and severity of symptoms in sensitised workers. Vandenplas et al compared results from studies involving complete elimination (174 individuals) or exposure reduction (102 individuals) from six studies and concluded that the likelihood of improvement or resolution of symptoms or of preventing deterioration is greater in workers who have no further exposure to the causative agent.11 In contrast, Beach et al conclude, on the basis of a detailed and structured EBM evaluation involving the same evidence, that "the evidence regarding outcomes for workers who reduce, rather than cease, their exposure is insufficient to draw firm conclusions".2 Why is the available evidence considered insufficient and what are some of the problems with most available intervention studies? A closer inspection of the literature on exposure cessation versus reduction, shows that among other methodological shortcomings, objective information on the intervention variable (exposure) is either not documented or in most cases based on subjective judgment only. Quantitative information is usually not collected. We know from the literature that exposure reductions are difficult to evaluate using subjective approaches and bias is a major complicating factor.12 Thus if and to what extent the exposure was truly reduced is not known and this potentially affects the internal validity; changes in outcome may not be related to changes in exposure only. Thus we cannot be certain if a reduction actually took place, and if it was relevant and sufficient enough to reduce symptoms or signs such as bronchial hyper-responsiveness or inflammation. Even if we conclude that some of these interventions were effective, external validity is still an issue. We cannot compare results across studies because we cannot compare exposure levels and exposure changes across studies. Thus, at best there is uncertainty whether exposure cessation is the only reasonable option to manage sensitiser-induced occupational asthma. The scientific basis on the effect of exposure reduction strategies is limited and the quality of the exposure assessment component does not allow firm conclusions. Most intervention studies involving respiratory allergy can best be characterised as "complex intervention studies".13 Complex interventions consist of several intervention components. Evaluation is known to be difficult because of problems with developing, identifying, documenting and reproducing the intervention. Such interventions closely resemble occupational healthcare practice, where several components can be identified to control exposure because several determinants of exposure exist (tasks, technologies, personal protective equipment, etc). These circumstances make it even more necessary to monitor the effect of interventions by following changes in exposure. These observations have several implications: There is a need for well-designed intervention studies among individuals with occupational asthma aimed at establishing the effect of gradual exposure reductions. Exposure reduction is worthy of discussion because it is an alternative to abrupt unemployment and loss of quality of life and income. However, such studies also involve ethical issues, which need to be explored further and balanced against the potential advantages. When undertaken, sound quantitative exposure assessment methodology needs application in intervention studies in order to assess intervention effects objectively. The past decade has seen the emergence of core concepts, usually described as "evidence-based medicine". These are used to evaluate the available scientific literature to obtain general conclusions and generate recommendations to be used in professional standards and future research agendas. It has been recognised that different study topics in EBM require different evaluation tools that go beyond the evaluation of quality of the classical randomised controlled trial or other epidemiological designs.14 Thus specific "evidence-based" tools need to be developed for the evaluation of the exposure assessment components of occupational studies, possibly even specific for exposure assessment for asthma. The tools should give an assessment of the quality of the exposure assessment component of a study with focus on potential biases which affect the exposure proxy or the resulting exposure response relation. If we do not succeed in developing such tools we will make incorrect inferences based on clinical, epidemiological and hygiene literature. It is probably needless to say that asthma research benefited considerably from recent developments in the field of exposure assessment. Good exposure assessment practices will also in the future contribute to our understanding of the prevention and management of occupational allergy and asthma. AU - Heederik D AU - van Rooy FGBGJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 65 IP - DP - 2008 Jan 01 TI - Occupational asthma PG - 151-151 AB - There is a long and sometimes ignoble history of occupational diseases being normalised and/or wrongly attributed to factors outside the workplace. In 1919, for example, a local physician blamed the "black lung" of Appalachian coal miners on "housing conditions and hurtful forms of recreation".1 Sixteen years later the disease was still considered "an ordinary condition that need cause no worry".2 When occupational diseases are considered "natural", or are ascribed to characteristics of the worker or his domestic environment, then there is little incentive to improve working conditions. The last decade or so has seen a paradigm shift in our understanding of occupational asthma. It is no longer considered a disease that solely reflects individual susceptibility; there is now a consistent body of evidence relating its incidence—at least at a population level—to the intensity of allergen exposure in the workplace. Thus, even if the details of exposure-response relations and their thresholds (if any) remain hazy, it has become an imperative to ensure control of such exposures. Success in doing so and in reducing disease incidence has been claimed for, among others, enzyme asthma in the detergent industry,3 latex asthma in healthcare workers4 and diisocyanate asthma in a variety of settings.5 Such published examples of primary preventive interventions share three characteristics: first, they are remarkably casual over even the most basic of epidemiological principles; second, they tend to describe multifaceted programmes and the role of exposure control rather than, say, employee education in reducing disease is unclear; and third, they employ at best crude and always ecological measures of allergen exposure. Heederik and van Rooy, expert in such matters, call for better measurement to improve the interpretation of such interventions and develop appropriate inferences from them. Even if they are not explicit in what they mean by "sound" exposure assessment, there must be few who would disagree with them. More will find difficulties with their second call which concerns the management (the "tertiary prevention") of workers who have already developed occupational asthma. Current practice incorporates complete exposure avoidance which all too often implies a change of occupation and consequent hardship. In this issue Heederik and van Rooy argue for studies of exposure reduction (rather than complete avoidance) in case management essentially incorporating careful exposure assessment, presumably at a personal level (see page 10.1136/oem.2005.024711).6 Individual case management by continued but reduced allergen exposure is contentious not least because for many years experts in occupational asthma have been claiming that only the cessation of all further exposure can be effective in recovery. This "expert" argument is based on the hypersensitive immunology of occupational allergy, the observation that affected employees frequently have symptoms at extremely low levels of exposure and the claim that the prognosis of the disease is related adversely to the duration of symptomatic employment. It is also, perhaps, an argument of prudence. In fact the efficacy of complete exposure avoidance is far from certain and nor is it clear that further exposure of any degree after the onset of symptoms is detrimental to prognosis in all types of disease. Moreover there are some settings in which continued exposure is countenanced with the connivance if not the blessing of employers and their occupational health advisors; laboratory animal asthma is one such example, reflecting perhaps the capital value of labour in that sector. It seems timely to open debate in this area but it would be naive to ignore the very real difficulties posed by any "well-designed intervention study" on workers with occupational asthma. Ironically the issues of exposure measurement may be the least of these problems. Any such study would need to be based within a workplace—more probably an occupational sector—with a sufficient and continuing experience of the disease, and would of course require the cooperation not only of employers but also of their insurers and lawyers. It is likely that there will be considerable resistance. Measuring exposure reduction implies detailed knowledge of exposures prior to any intervention—not easy to incorporate within a study design. Nor will it be straightforward to be sure that the reduction has been sufficient to prevent the persistence of disease and will continue to be so. Subjective reports of symptomatic resolution would need to be verified by objective and sustained evidence of reduced airway inflammation. Some of the newer non-invasive methods of assessment (sputum induction or measurement of exhaled NO) might be valuable additions to the serial assessment of peak flow of bronchial responsiveness. Therefore the difficulties will be more than just ethical. Nonetheless I welcome the debate. If nothing more, it is time we learned properly how to enrich the currency with which we measure the effects of occupational asthma. Experts tend to worry about asthma; patients are at least as worried about their jobs. AU - Cullinan P LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 65 IP - DP - 2008 Jan 01 TI - Circulating lipopolysaccharides in the blood from "bioprotein" production workers PG - 211-214 AB - Background: Workers producing bacterial single-cell protein (BSCP), "bioprotein," are exposed to organic dust containing high levels of endoxins (lipopolysaccharides, LPS). Workers in this industry have complained of episodes of fever, fatigue, chest tightness, skin dryness and rubor. The aim of the present study was to quantify LPS and inflammatory mediators in plasma among the workers and non-exposed control subjects. Methods: We included eight non-smoking production workers, aged 32–51 (median 38), and eight non-smoking, non-exposed controls, aged 30–51 (median 39). Airborne and plasma endotoxin concentrations were measured, as well as plasma hsCRP and different cytokines, chemokines and metalloproteinases. Results: The workers who did not use personal respiratory protection were exposed to varying airborne levels of endotoxin, 430 (75–15 000) EU/m3 (median, range). The level of plasma LPS was significantly elevated (p = 0.01) among the workers compared to the non-exposed controls. The workers also had elevated levels of MCP-1 (p = 0.02), MIP-1 (p = 0.05) and MMP-3 (p = 0.04). IL-6 and hsCRP were also elevated among the exposed group, but not significantly (p = 0.10 and p = 0.07, respectively). Conclusions: In this study, we detected LPS in plasma of individuals exposed to high levels of LPS at their workplace. This finding is supported by elevated levels of several inflammatory cytokines among the workers, significantly exceeding that of the non-exposed control group. To the best of our knowledge, this is the first time that plasma LPS, together with increased inflammatory markers in plasma, has been detected in an occupational setting. AU - Sikkeland LIB AU - Skogstad M AU - Ovstebo R AU - Brusletto B AU - Haug KBF AU - Kongerud J AU - Eduard W AU - Kierulf P LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 58 IP - DP - 2008 Jan 01 TI - Fifteen-year trends in occupational asthma: data from the Shield surveillance scheme PG - 169-174 AB - Background Trends of occupational asthma (OA) differ between regions depending on local industries, provisions for health and safety at the workplace and the availability of a reporting scheme to help in data collection and interpretation. Aim To assess trends in OA in an industrialized part of the UK over a 15-year period. Methods Occupational and chest physicians in the West Midlands were invited to submit details of newly diagnosed cases with OA. Data were then transferred to the regional centre for occupational lung diseases for analysis. Results A total of 1461 cases were reported to the scheme. Sixty-eight per cent were males with mean (standard deviation) age of 44 (12) years. The annual incidence of OA was 42 per million of working population (95% CI 5 37–45). OA was most frequently reported in welders (9%) and health carerelated professions (9%) while ,1% of cases were reported in farmers. Isocyanates were the commonest offending agents responsible for 21% of reports followed by metal working fluids (MWFs) (11%), adhesives (7%), chrome (7%), latex (6%) and glutaraldehyde (6%). Flour was suspected in 5% of cases while laboratory animals only in 1%. Conclusions Our data confirm a high annual incidence of OA in this part of the UK. MWFs are an emerging problem, while isocyanates remain the commonest cause. Incidence remained at a fairly stable background level with many small and a few large epidemics superimposed. Schemes like Midland Thoracic Society’s Rare Respiratory Disease Registry Surveillance Scheme of Occupational Asthma could help in identifying outbreaks by linking cases at the workplace. AU - Bakerly ND AU - Moore VC AU - Vellore AD AU - Jaakkola MS AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Standards of care for occupational asthma PG - 240-250 AB - Occupational asthma remains a common disease in the UK with up to 3000 new cases diagnosed each year. The Health and Safety Executive (HSE) estimates the cost to our society to be over £1.1 billion for each 10-year period. In October 2001 the Health and Safety Commission agreed a package of measures aimed at reducing the incidence of asthma caused by exposure to substances in the workplace by 30% by 2010. Key to this aim are primary prevention by proper risk assessment and exposure control, together with secondary prevention to ensure reduction in the delay between the development of allergic symptoms at work (normally nasal or respiratory) and appropriate advice to the affected worker and workplace. Conservative estimates suggest that one in 10 cases of adult onset asthma relate directly to sensitisation in the workplace, with a smaller subset of workers with acute irritant induced asthma. The latter-formerly termed reactive airway dysfunction syndrome (RADS)-relates to asthma caused by exposure to high levels of airborne irritants. The prognosis of individuals with occupational asthma is better if they are removed from exposure quickly, particularly within a year of first symptoms. However, removing individuals often leads to unemployment. If the diagnosis of occupational asthma is incorrect, advising individuals whose asthma is not caused by work to be removed from exposure may have unnecessary financial and social consequences. The reported incidence of occupational asthma may be underestimated by as much as 50% (ES3* SIGN 3). (ES, Evidence Statement with original BOHRF reference number as suffix.) AU - Fishwick D AU - Barber CM AU - Bradshaw LM AU - Harris-Roberts J AU - Francis M AU - Naylor S AU - Ayres J AU - Burge PS AU - Corne JM AU - Cullinan P AU - Frank TL AU - Hendrick D AU - Hoyle J AU - Jaakkola M AU - Newman Taylor AJ AU - Nicholson P AU - Niven R LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 65 IP - DP - 2008 Jan 01 TI - Occupation and adult onset of rhinitis in the general population PG - 38-43 AB - Objectives: Occupational exposures have been associated with an increased risk of new-onset rhinitis in apprentices. However, population-based prospective data are scarce and do not cover new onset of rhinitis later in life. The authors studied the association between occupational exposure and adult onset of rhinitis prospectively. Methods: The data of 4994 participants (age at follow-up 28–57 years) from 27 centres of the European Community Respiratory Health Survey II who were symptom-free at baseline were analysed. As outcome at follow-up self-reported (a) nasal allergies ("allergic rhinitis") and (b) runny, blocked nose for 12 months a year ("perennial rhinitis") were used. Occupational exposures at any time during follow-up were defined by job title. Results: The cumulative incidence of allergic rhinitis, perennial rhinitis and both conditions was 12%, 11% and 3%, respectively. Compared to office workers, male medical professionals were at increased risk of new onset of allergic rhinitis (OR 3.0; 95% CI 1.4 to 6.4). Odds ratios were reduced in metal workers not involved in metal making or treating (0.3; 95% CI 0.1 to 0.7). For perennial rhinitis ORs were significantly increased in cleaners (1.4; 95% CI 1.0 to 2.1). Conclusions: Cleaners and medical professionals may be at increased risk for adult-onset rhinitis. AU - Radon K AU - Gerhardinger U AU - Schulze A AU - Zock J-P AU - Norback D AU - Toren K AU - Jarvis D AU - Held L AU - Heinrich J AU - Leynaert B AU - Nowak D AU - Kogevinas M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Occupational asthma to ivy (Hedera helix) PG - 482-483 AB - Agent Ivy (Hedera helix Job Florist Specific IgE not tested Lynphocyte proliferation not tested Skin prick test negative Patch test positive Non-specific reactivity 0.08 at work, 0.43 after budesonide Serial Peak Flow positive, not plotted Specific Challenge (1/1000) immediate reaction to cutting and tearing ivy AU - Hannu T AU - Kauppi P AU - Tuppurainen M AU - Piirila P LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Exercise-induced asthma, respiratory and allergic disorders in elite athletes: epidemiology, mechanisms and diagnosis: Part I of the report from the Joint Task Force of the European Respiratory Society (ERS) and the European Academy of Allergy and Clinical Immunology (EAACI) in cooperation with GA2LEN PG - 387-403 AB - Aims: To analyze the changes in the prevalence of asthma, bronchial hyperresponsiveness (BHR) and allergies in elite athletes over the past years, to review the specific pathogenetic features of these conditions and to make recommendations for their diagnosis. Methods: The Task Force reviewed present literature by searching Medline up to November 2006 for relevant papers by the search words: asthma, bronchial responsiveness, EIB, athletes and sports. Sign criteria were used to assess level of evidence and grades of recommendation. Results: The problems of sports-related asthma and allergy are outlined. Epidemiological evidence for an increased prevalence of asthma and BHR among competitive athletes, especially in endurance sports, is provided. The mechanisms for development of asthma and bronchial hyperresponsiveness in athletes are outlined. Criteria are given for the diagnosis of asthma and exercise induced asthma in the athlete. Conclusions: The prevalence of asthma and bronchial hyperresponsiveness is markedly increased in athletes, especially within endurance sports. Environmental factors often contribute. Recommendations for the diagnosis of asthma in athletes are outlined. AU - Carlsen KH AU - Anderson SD AU - Bjermer L AU - Bonini S AU - Brusasco V AU - Canonica W AU - Cummiskey J AU - Delgado L AU - Del Giacco SR AU - Drobnic F AU - Haahtela T AU - Larsson K AU - Palange P AU - Popov T AU - van Cauwenberge P LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 38 IP - DP - 2008 Jan 01 TI - Clinical and immunologic findings of methylene diphenyl diisocyanate-induced occupational asthma in a car upholstery factory PG - 586-593 AB - Background Although methylene diphenyl diisocyanate (MDI) is widely used in many industries, there have been few immunological studies of MDI-induced occupational asthma. Objectives We investigated the effects of MDI exposure on the clinical and immunologic condition of workers in a single car upholstery factory. Methods Fifty-eight MDI-exposed workers were studied. Work-related lower-respiratory symptoms (WRRS) were identified using a questionnaire. Serum-specific IgE and IgG antibodies to MDI-human serum albumin conjugate were detected by ELISA. Atopy was evaluated using a skin prick test. MDI-induced occupational asthma was confirmed in the symptomatic workers with a positive result on an MDI-specific inhalation test. Results Thirteen (22.4%) of the subjects complained of WRRS. MDI-induced occupational asthma was confirmed in five (8.6%) of the workers, and occupational eosinophilic bronchitis was confirmed in two (3.5%). The prevalence of specific IgG antibodies (20.7%) was higher than that of specific IgE antibodies (8.6%). The prevalence of MDI-induced occupational asthma/eosinophilic bronchitis was strongly associated with the presence of both WRRS and serum-specific IgG antibodies to an MDI-human serum albumin conjugate (P<0.01, <0.05, respectively). Conclusion These findings suggest that MDI could be a causative agent of occupational asthma among MDI-exposed workers. The prevalence of MDI-induced occupational asthma was 8.6%, and MDI-induced eosinophilic bronchitis was confirmed in two workers. The presence of work-related lower-respiratory symptoms and serum-specific IgG antibodies to an MDI-human serum albumin conjugate may be used to predict MDI-induced occupational asthma/eosinophilic bronchitis in MDI-exposed workers. AU - Hur G-Y AU - Koh D-H AU - Choi G-S AU - Park H-J AU - Choi S-J AU - Ye Y-M AU - Kim K-S AU - Park H-S LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 31 IP - DP - 2008 Jan 01 TI - Respiratory effects of occupational exposures in a milk powder factory PG - 807-814 AB - Ingestion of milk powder is a known cause of allergies in children, but the risks to respiratory health from exposure to inhaled milk powder have not been studied previously. The aim of the present study was to assess the effects of occupational exposures in a milk powder factory on respiratory symptoms and lung function. A cross-sectional study was conducted on 167 milk powder factory workers (response rate 77%) and 76 office workers (73%) from four factories in Thailand. All participants answered a questionnaire and performed spirometry. Measurements of concentrations of dust were used to give additional information on exposures. Mean respirable dust concentrations in the factory were 0.02–2.18 mg·m–3. The risk of breathlessness and nasal symptoms were significantly increased in production and packing staff. The risk of skin symptoms was significantly increased in those adding vitamin mixture to milk powder. Factory workers showed significantly lower forced expiratory volume in one second measured as percentage of predicted value. The present study provides new evidence that workers exposed to milk powder by inhalation are at an increased risk of nasal symptoms, wheezing and breathlessness, and exhibit reduced spirometric lung function, even at relatively low air concentrations of milk dust. AU - Sripaiboonkij P AU - Phanprasit W AU - Jaakkola MS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Inflammation and functional outcome in diisocyanate-induced asthma after cessation of exposure PG - 583-591 AB - Background: The clinical outcome of diisocyanate-induced asthma has been found to be poor despite cessation of exposure. Our aim was to study the outcome of diisocyanate-induced asthma after initiation of inhaled steroid treatment at a mean period of 7 months (range 2–60 months) after cessation of exposure by following up lung function and bronchial inflammation. Methods: Bronchoscopy was performed on 17 patients 2 days after a positive inhalation challenge test, after which budesonide 1600 µg a day was started. Bronchoscopy, spirometry, and histamine challenge tests were repeated at 6 months and on average 3 years. The results were also compared with those obtained from 15 healthy control subjects. Results: Nonspecific bronchial hyperreactivity diminished significantly (P = 0.006); however, forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) values decreased, with a median yearly reduction of FEV1 of 79 ml. The count of mast cells in bronchial mucosa decreased (P = 0.012) and that of macrophages increased (P = 0.001). Interleukin-4 level in mucosa was during the first year significantly higher than in controls but its level decreased in the follow-up. Interleukin-6, interleukin-15, and tumour necrosis factor alpha messenger-RNA levels were significantly higher in hyperreactive patients than in nonhyperreactive patients at the end of the follow-up. Conclusion: Our results indicate that inflammation may persist in diisocyanate-induced asthma despite inhaled steroid medication. However, TH2-type inflammation diminished. Persistent nonspecific bronchial hyperreactivity was associated with proinflammatory acting cytokines produced mainly by macrophages. Considering the poor prognosis of the disease the findings could be utilized to develop the follow-up and treatment of diisocyanate-induced asthma. AU - Piirilä PL AU - Meuronen A AU - Majuri M-L AU - Luukkonen R AU - Mäntylä T AU - Wolff HJ AU - Nordman H AU - Alenius H AU - Laitinen A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Improving latex-allergy diagnosis: the clinical role of Hev b8-specific IgE PG - 620-621 AB - Negative challeng to latex gloves in patients with HevB8 (prolifin) antibodies alone AU - Antonicelli L AU - Micucci C AU - Mistrello G AU - Roncarolo D AU - Zanotta S AU - Cinti B AU - Garritani MS AU - Bonifazi F LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 177 IP - DP - 2008 Jan 01 TI - Prevalence of Tuberculosis in Health Care Workers in Delhi PG - A437 AB - Background The risk of Tuberculosis (TB) in Health Care Workers (HCWs) is not well established. While some believe it to be similar to that of the general population, some studies found a 2- to 6-fold increased risk. Two-thirds of the world’s population infected with TB reside in Asia but the data on risk of TB among HCWs in Asia is disproportionately scarce. Methods All 62 TB HCWs working in a large Indian urban teaching hospital (all employed for >1 year; 32 health visitors (TBHV) and 30 lab technicians (LT) preparing over 400 sputum smears a month) answered a questionnaire and were assessed clinically. Pre-employment TB vaccination status and Mantoux test results were recorded and point prevalence of pulmonary TB (June 2005) was estimated. Results One TBHV and 4 LTs were clinicoradiologically diagnosed with pulmonary TB. None of the cases had prior vaccination; all had a positive Mantoux test suggesting intact cell-mediated immunity; all were employed >6 years as a TB HCW; none were known domestic TB contacts. A higher occurrence of TB was found in LTs compared to TBHVs, in keeping with a previous Scottish study (Capewell S, Leaker AR, Leitch AG. Pulmonary tuberculosis in health service staff: is it still a problem? Tubercle 1988; 69:113–8.) but the z - test was not significant at 5% level of significance for the two proportions. Discussion TB HCWs working in countries with high TB prevalence appear to be at a high risk for TB disease. Routine annual chest radiographs have been shown to fail to identify 60% of new cases. We recommend tuberculin skin tests at periodic intervals for high risk HCWs in similar settings (an annual tuberculin skin test conversion rate of 3.96% and a significant linear relationship between acquisition of TB infection and HCW training duration has been previously demonstrated in the same institution in India). Further studies to determine screening frequency are necessary and interferon gamma based assays are likely to have a significant role, particularly in those prior vaccination. AU - Bhattacharya M AU - Gupta N AU - Vellore AD AU - Mukherjee R AU - Joshi TK AU - Burge PS LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Mechanisms of asthma in Olympic athletes - practical implications PG - 685-694 AB - Athletes’ symptoms may only occur in extreme conditions, which are far from normal. Exercise may increase ventilation up to 200 l/min for short periods in speed and power athletes, and for longer periods in endurance athletes such as swimmers and cross-country skiers. Increasing proportions of young athletes are atopic, i.e. they show signs of IgE-mediated allergy which is, along with the sport event (endurance sport), a major risk factor for asthma and respiratory symptoms. Mechanisms in the etiology and clinical phenotypes vary between disciplines and individuals, and it may be an oversimplification to discuss athlete’s asthma as a distinct and unambiguous disease. Nevertheless, the experience on Finnish Olympic athletes suggests at least two different clinical phenotypes, which may reflect different underlying mechanisms. The pattern of ‘classical asthma’ is characterized by early onset childhood asthma, methacholine responsiveness, atopy and signs of eosinophilic airway inflammation, reflected by increased exhaled nitric oxide levels. Another distinct phenotype includes late onset symptoms (during sports career), bronchial responsiveness to eucapnic hyperventilation test, but not necessarily to inhaled methacholine, and a variable association with atopic markers and nitric oxide. A mixed type of eosinophilic and neutrophilic airway inflammation seems to affect especially swimmers, ice-hockey players, and cross-country skiers. The inflammation may represent a multifactorial trauma, in which both allergic and irritant mechanisms play a role. There is a significant problem of both under- and overdiagnosing asthma in athletes and the need for objective testing is emphasized. Follow-up studies are needed to assess the temporal relationship between asthma and competitive sporting, taking better into account individual disposition, environmental factors (exposure), intensity of training and potential confounders. AU - Haahtela T AU - Malmberg P AU - Moreira A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Omalizumab in persistent severe bakers' asthma PG - 790-791 AB - Omalizumab resulted in staying at work with flour exposure and much better control of asthma over 6 months AU - Olivieri M AU - Biscardo CA AU - Turri S AU - Perbellini L LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Occupational allergy in a researcher due to Ole e 9, an allergenic 1,3-ß-glucanase from olive pollen PG - 784-785 AU - Palomares O AU - Fernández-Nieto M AU - Villalba M AU - Rodríguez R AU - Cuesta-Herranz J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 177 IP - DP - 2008 Jan 01 TI - Long-Term Outcomes in a Prospective Cohort of Apprentices Exposed to High-Molecular-Weight Agents PG - 871-879 AB - Rationale We conducted a long-term (8-yr) follow-up of 408 apprentices entering programs involving exposure to high-molecular weight allergens. Objectives: The objectives were to assess the frequency of new and persisting sensitization, symptoms, and bronchial hyperresponsiveness in relation with job history after ending apprenticeship and to examine characteristics significantly associated with the incidence and remission of these occupational outcomes. Methods A respiratory symptom questionnaire, skin prick tests with work-related allergens (laboratory animals, flour, and latex), spirometry, and methacholine challenge were administered. The association between incidence or remission of these outcomes and individual characteristics at baseline and end of apprenticeship was examined. Measurements and Main Results In subjects who at any time during follow-up held a job related to their training (78%), the incidence of sensitization, rhinoconjunctival and chest symptoms, and bronchial hyperresponsiveness at follow-up was 1.3, 1.7, 0.7, and 2.0 per 100 person-years, respectively. The remission of these outcomes acquired during apprenticeship was 18.5, 9.6, 9.6, and 12.4 per 100 person years, respectively, in subjects no longer in a job related to training. Several clinical, immunological, and functional characteristics at baseline and acquired during apprenticeship were found to be significantly associated with the incidence and remission of the outcomes. Conclusions The incidence of sensitization, symptoms, and bronchial hyperresponsiveness was lower while at work than during the apprenticeship period. A high proportion of subjects in a job not related to training experienced remission of symptoms acquired during apprenticeship. AU - Gautrin D AU - Ghezzo H AU - Infante-Rivard C AU - Magnan M AU - L'Archeveque J AU - Suarthana E AU - Malo J-L LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 58 IP - DP - 2008 Jan 01 TI - Socioeconomic and occupational groups and risk of asthma in Sweden PG - 161-168 AB - Aim To investigate possible associations between hospitalization for asthma and socioeconomic status and occupation. Methods A nationwide database was constructed by linking Swedish Census data to the Hospital Discharge Register (1987–2004). The hospital diagnoses of asthma were based on the International Classification of Diseases. Standardized incidence ratios were calculated for different socioeconomic and occupational groups. Ninety-five per cent confidence intervals were calculated assuming a Poisson distribution. Results A total of 13 202 male and 11 876 female hospitalizations for asthma were retrieved at ages >30 years. The socioeconomic groups with <9 years of education were associated with a significantly increased risk of hospitalization for asthma. Among male occupations, increased risks were noted for farmers, mechanics and iron and metal workers, welders, bricklayers, workers in food manufacture, packers, loaders and warehouse workers, waiters and chimney sweeps with prolonged exposures in two censuses. For female occupations, increased risks were observed among assistant nurses, religious, juridical and other social science-related workers, drivers, mechanics and iron and metalware workers and wood workers. Conclusions The present study suggests that socioeconomic status (low educational level) and occupation have an effect on the population's risk of hospitalization for asthma. AU - Li X AU - Sundquist J AU - Sundquist K LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 58 IP - DP - 2008 Jan 01 TI - Which agents cause reactive airways dysfunction syndrome (RADS)? A systematic review PG - 205-211 AB - Aim To identify those agents reported as being associated with reactive airways dysfunction syndrome (RADS). Methods A systematic review was undertaken. Abstracts were screened and those selected reviewed against pre-determined diagnostic criteria for RADS. Results Significant information gaps were identified for all measures of interest. In some articles, even the causative agent was not reported. The most commonly reported agents were chlorine (nine subjects), toluene di-isocyanate (TDI) (n = 6) and oxides of nitrogen (n = 5). Most exposures occurred in the workplace (n = 51) and affected men (60%). Dyspnoea (71%) and cough (65%) were the commonest symptoms. Median symptom duration was 13 months (interquartile range = 6.5–43.5) for RADS. Conclusions Although the most commonly reported agent associated with RADS was chlorine, the main finding of a general lack of adequate information on exposure, investigation and outcome suggests that to better explore RADS a more structured approach to gathering information is required. A minimum data set for reporting RADS cases is proposed. AU - Shakeri MS AU - Dick FD AU - Ayres JG LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 31 IP - DP - 2008 Jan 01 TI - Exposure–response analysis of allergy and respiratory symptoms in endotoxin-exposed adults PG - 1241-1248 AB - The objective of the present study was to investigate exposure–response relationships between current endotoxin exposure and allergic and respiratory symptoms in adults, taking into account farming exposures during childhood. A cross-sectional study was conducted among 877 Dutch farmers and agricultural industry workers in 2006. Based on 249 full-shift personal airborne endotoxin samples, a job-exposure matrix was constructed to assign endotoxin exposure levels to all participants. Associations between endotoxin exposure and questionnaire data on symptoms were studied by multiple logistic regression. Adjusted odds ratios (OR) for an interquartile range increase in endotoxin level were elevated for respiratory symptoms such as wheezing (OR 1.41 (95% confidence interval 1.16–1.72)), wheezing with shortness of breath (1.50 (1.18–1.90)) and daily cough (1.29 (1.03–1.62)). In contrast, endotoxin was strongly associated with a decreased prevalence of hay fever (0.62 (0.49–0.78)). Workers who had grown up on a farm had a lower prevalence of hay fever, but no evidence was found of effect modification by farm childhood. In conclusion, occupational endotoxin exposure in adulthood is associated with an increased risk of asthma-like symptoms but a reduced prevalence of hay fever. AU - Smit LAM AU - Heederik D AU - Doekes G AU - Blom C AU - van Zweden I AU - Wouters IM LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 38 IP - DP - 2008 Jan 01 TI - Human innate immune responses to hexamethylene diisocyanate (HDI) and HDI–albumin conjugates PG - 957-967 AB - Background Isocyanates, a leading cause of occupational asthma, are known to induce adaptive immune responses; however, innate immune responses, which generally precede and regulate adaptive immunity, remain largely uncharacterized. Objective The aim of the study was to identify and characterize the cellular, molecular and systemic innate immune responses induced by hexamethylene diisocyanate (HDI). Methods Human peripheral blood mononuclear cells (PBMCs) were stimulated in vitro with HDI–albumin conjugates or control antigen, and changes in phenotype, gene and protein expression were characterized by flow cytometry, microarray, Western blot and ELISA. Cell uptake of isocyanate was visualized microscopically using HDI–albumin conjugates prepared with fluorescently labelled albumin. In vivo, human HDI exposure was performed via a specific inhalation challenge, and subsequent changes in PBMCs and serum proteins were measured by flow cytometry and ELISA. Genotypes were determined by PCR. Results Human monocytes take up HDI–albumin conjugates and undergo marked changes in morphology and gene/protein expression in vitro. The most significant (P-values 0.007–0.05) changes in mircoarray gene expression were noted in lysosomal genes, especially peptidases and proton pumps involved in antigen processing. Chemokines that regulate monocyte/macrophage trafficking (MIF, MCP-1) and pattern-recognition receptors that bind chitin (chitinases) and oxidized low-density lipoprotein (CD68) were also increased following isocyanate–albumin exposure. In vivo, HDI-exposed subjects exhibited a drastic increase in the percentage of PBMCs with the same HDI–albumin responsive phenotype characterized in vitro (HLA-DR+/CD11c+ with altered light scatter properties). An exposure-dependent decrease (46±11%; P<0.015) in serum concentrations of chitinase 3-like-1 was also observed in individuals who lack the major (type 1) human chitinase (due to genetic polymorphism), but not in individuals possessing at least one functional chitinase-1 allele. Conclusions Previously unrecognized innate immune responses to HDI and HDI–albumin conjugates could influence the clinical spectrum of exposure reactions. AU - Wisnewski AV AU - Liu Q AU - Liu J AU - Redlich CA LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Have the prevalence and incidence of occupational asthma and rhinitis because of laboratory animals declined in the last 25 years? PG - 834-841 AB - I. Folletti11Occupational Allergology, Department of Clinical and Experimental Medicine, A. Forcina22Department of Economics, Finance and Statistics, A. Marabini33Occupational Medicine and Toxicology, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy, A. Bussetti33Occupational Medicine and Toxicology, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy, A. Siracusa11Occupational Allergology, Department of Clinical and Experimental Medicine1Occupational Allergology, Department of Clinical and Experimental Medicine, 2Department of Economics, Finance and Statistics, 3Occupational Medicine and Toxicology, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy Prof. Andrea Siracusa Medicina del Lavoro Azienda Ospedaliera S. Maria Via T. di Joannuccio 05100 Terni Italy : LA, laboratory animals; LAA, laboratory animal allergy; OA, occupational asthma; OR, occupational rhinitis; SPT, skin prick test; WRCS, work-related chest symptoms; WRNS, work-related nasal symptoms.Abstract Background: Data for time trends in the prevalence of occupational asthma (OA) and rhinitis (OR) are not known. Objective: To investigate the prevalence and incidence of OA and OR over time. Methods: We chose to review studies on the prevalence and incidence of OA and OR due to laboratory animals (LA) as a marker of changing OA and OR patterns over time and analysed 15 cross-sectional and 4 longitudinal studies published from 1980 to 2006. Results: The estimated prevalence of OA, defined as work-related chest symptoms (WRCS), declined from 8.2% in 1976 to 4.2% in 2001 (P < 0.005). When defined by WRCS and positive skin prick test (SPT) to LA, the estimated prevalence of OA was 6.7% in 1977 and 2.9% in 1999 (P < 0.02). The prevalence of OR, defined by WRNS or WRNS and SPT to LA, was not related to study date but was inversely associated with mean exposure duration. In four longitudinal studies no clear trend emerged over time. Conclusions: This review suggests a trend toward a progressive decline in the prevalence of occupational asthma due to laboratory animals, which may be due to the reduction of exposure since the early 1980s. A further reduction of exposure is needed to prevent the onset of occupational rhinitis. AU - Folletti I AU - Forcina A AU - Marabini A AU - Bussetti A AU - Siracusa A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Prediction of challenge test results by flour-specific IgE and skin prick test in symptomatic bakers PG - 897-902 AB - Background: Wheat and rye flours are among the most important allergens causing occupational asthma. Usually, the diagnosis of baker’s asthma is based on inhalation challenge tests with flours. Aims of the study: To evaluate the relevance of flour-specific serum immunoglobulin E (IgE) and skin prick test (SPT) in the diagnosis of baker’s asthma and to define flour-specific IgE concentrations and wheal sizes that allow a prediction of the outcome of challenge testing. Methods: Bronchial and nasal challenge tests with wheat (rye) flour were performed in 71 (95) symptomatic bakers. Determinations of flour-specific IgE as well as SPTs were performed in all subjects. Analyses included the calculation of sensitivity, specificity, positive (PPV) and negative predictive values (NPV) at different IgE concentrations and different wheal sizes, and receiver-operating characteristics (ROC) plots with the challenge result as gold standard. Results: Thirty-seven bakers were positive in the challenge with wheat flour, while 63 were positive with rye flour. Depending on the flour-specific IgE concentrations (wheal size), PPV was 74–100% (74–100%) for wheat and 82–100% (91–100%) for rye flour, respectively. The minimal cut-off values with a PPV of 100% were 2.32 kU/l (5.0 mm) for wheat flour and 9.64 kU/l (4.5 mm) for rye flour. The shapes of the ROC plots were similar for wheat and rye flour. Conclusion: High concentrations of flour-specific IgE and clear SPT results in symptomatic bakers are good predictors for a positive challenge test. Challenge tests with flours may be avoided in strongly sensitized bakers. AU - van Kampen V AU - Rabstein S AU - Sander I AU - Merget R AU - Brüning T AU - Broding HC AU - Keller C AU - Müsken H AU - Overlack A AU - Schultze-Werninghaus G AU - Walusiak J AU - Raulf-Heimsoth M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Occupational asthma due to tampico fiber from agave leaves PG - 943-945 AB - Tampico fiber is extracted from the leaves of Agave lechugilla which grows mainly in Mexico. The material is used extensively for making yard brooms, deck brushes and bath brushes. Agave-induced irritant contact dermatitis has been previously reported among workers with Agave tequilana for tequila making (1, 2). Allergic reactions caused by tampico fibers have not been previously reported. We surveyed the five employees (two supervisors and three machine operators) at a brush making-plant. The two supervisors (patients 1 and 2), who were brothers and had been exposed to tampico for 13 and 10 years, respectively, reported work-related rhinitis and asthma symptoms. Patient 1 also experienced localized contact urticaria with tampico fiber. Patient 1 had experienced rhinitis and asthma symptoms for 10 and 2 years, and patient 2 for 8 and 5 years, respectively. The remaining workers did not report symptoms at work. Exhaled nitric oxide (eNO) measurements (Nioxmino; Aerocrine, Solna, Sweden) performed at the end of the work shift were elevated only in the two symptomatic employees (44 and 83 ppb), whereas they were normal in the remaining workers (<23 ppb). The mean concentration of total dust particles in the brush-making plant during an ordinary work shift using a laser-based aerosol monitor (DustTrack model 8520; TSI, St. Paul, MN, USA) was 0.42 mg/m3 (range: 0.28–0.68). After obtaining written informed consent, single blind specific inhalation challenges (SIC) were carried out. On visit 1, methacholine inhalation test and sputum induction was performed. On visit 2, the patients underwent a SIC with nebulized aqueous tampico extract (3). Twenty-four hours later, on visit 3, sputum induction was performed again. On visit 4, a week apart from the tampico SIC, the patients underwent a SIC with horsehair extract. Spirometry results were normal. Sputum was processed as previously described (4) and analyzed using FC scan cytometry (FACSCalibur flow cytometer; Becton Dickinson, San José, CA, USA). Monoclonal antibodies (Pharmingen, San Diego, CA, USA) used to identify sputum cells are described elsewhere (4). Skin prick testing with tampico extract 10% w/v was positive in patient 1 (5 mm) and patient 2 (3 mm), whereas it was negative with horsehair extract. Both patients also had positive skin prick tests to grass pollen, and patient 2 to house dust mites and cat and dog dander. The remaining workers had negative skin tests to tampico and horsehair extracts. PC20methacholine was 0.9 mg/ml (patient 1) and 8 mg/ml (patient 2). SIC with tampico at 10% w/v elicited an isolated early asthmatic response in both patients. An increase in sputum total cell count and neutrophils count (about threefold) as well as in eosinophil counts (fourfold) in induced sputum were observed 24 h after SIC. Two subjects with asthma underwent the same challenge protocol with tampico and no relevant changes in forced expiratory volume in 1 s or sputum were observed. The increase in eosinophil counts in sputum after tampico SIC in the patients, as well as the negative results obtained with exposure to horsehair support the specificity of the airway reaction to tampico. There is still conflicting evidence regarding the usefulness of eNO in the investigation of occupational asthma (5). A study reported an increase of eNO in individuals with symptoms of asthma when exposed to laboratory animals (6). Sodium dodecylsulphate-polyacrylamide gel electrophoresis revealed several protein bands ranging from 14 to 97 kDa (Fig 1A). Immunonoblotting was performed using the patient’s serum diluted at 1/10, incubated overnight, and revealed with a second antibody (antihuman IgE) diluted at 1/5000. Three IgE-binding bands were recognized in the tampico extract of about 31, 39 and 43 kDa (Fig. 1B). These results point out that tampico fibers may give rise to upper and lower airway symptoms as well as to airway inflammation through an IgE-dependent mechanism. AU - Quirce S AU - Fernández-Nieto M AU - Pastor C AU - Sastre B AU - Sastre J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Occupational asthma caused by chamomile PG - 1090-1092 AB - 43 year old man developed rhinitis and asthma 11 years after starting work as a maintenance worker in a tea packing plant processing black tea (Camellia sinensis) and herbal teas including chamomile, lime (Tilia cordata) and dog rose. Symptoms related to chammile packing. Histamine Pc20 20mg/ml after 8 months off work pre-challenge. Immediate reaction to tipping chomile 300g for 1 hour, negatibe reaction tipping black tea. Induced sputum 6 hours after black tea showed no eosinophils, 6 hours after chamomile Pc20 8mg/ml and sputum eosinophils (7.5%). Lime tea also negative. SPT to chamomile extract 10mg/ml 6mm wheal, black and lime negative. IfE to chamomile positive (Immunocap) AU - Vandenplas O AU - Pirson F AU - D'Alpaos V AU - Vander Borght T AU - Thimpont J AU - Pilette C LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Occupational rhinitis to sodium alendronate PG - 1092-1093 AB - Agent Sodium alendronate Job Tablet packer in pharmaceutical plant Specific IgE not done Lymphocyte proliferation not tested Skin prick test positive 1:10 w/v Patch test positive 1:10 w/v Non-specific reactivity Methacholine Pc20 1636 u/ml pre challenge and 704 ug/ml post challenge Serial Peak Flow not done Induced sputum Eosinophils 1.2% pre and 7.9% post alendronate challenge Specific Challenge 10mg alendronate in lactose for 60 minutes positive immediate nasal reaction but no chande in FEV1 Follow-up symptom free after removal from exposure AU - Pala G AU - Perfetti L AU - Cappelli I AU - Caminati M AU - Moscato G LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Occupational rhinitis PG - 969-980 AB - The present document is the result of a consensus reached by a panel of experts from European and nonEuropean countries on Occupational Rhinitis (OR), a disease of emerging relevance, which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored to that of occupational asthma, as well as a diagnostic algorithm based on steps allowing different levels of diagnostic evidence, are proposed. The needs for future research are pointed out. Key messages are issued for each item. AU - Moscato G AU - Vandenplas O AU - Van Gerth Wijk R AU - Malo JL AU - Quirce S AU - Walusiak J AU - Castano R AU - De Groot H AU - Folletti I AU - Gautrin D AU - Yacoub MR AU - Perfetti L AU - Siracusa A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Exercise-induced asthma, respiratory and allergic disorders in elite athletes PG - 1084-1084 AU - Burge PS AU - Robertson AS LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 63 IP - DP - 2008 Jan 01 TI - Occupational asthma caused by linseed oilcake PG - 1250-1251 AB - Linum usitatissimum Case report of chemist in research lab producing new vegetable oil bases biopolymers; latency 30 months for rhinitis, asthma 2 years later AU - Vandenplas O AU - D'Alpaos V AU - César M AU - Collet S AU - Tafforeau M AU - Thimpont J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 38 IP - DP - 2008 Jan 01 TI - Asthma induced by inhalation of flour in adults with food allergy to wheat PG - 1349-1356 AB - Background Wheat is one of the major food allergens and it is also an inhalant allergen in workers exposed to flour dusts. Food allergy to wheat in adulthood seems to be rare and has never been reported to be associated with asthma induced by flour inhalation. Objective The study aimed at detecting adults with food allergy to wheat and screening them for the presence of specific bronchial reactivity to inhaled wheat proteins. Methods Adults with a history of adverse reactions to ingestion of wheat underwent skin prick test with commercial wheat extract and were assessed for the presence of specific wheat IgE in the sera. Food sensitivity to wheat was confirmed by double-blind, placebo-controlled food challenge (DBPCFC). Specific bronchial reactivity was investigated through a specific bronchial challenge with wheat proteins. Results In nine patients with evidence of specific IgE response to wheat, a diagnosis of food allergy was made by DBPCFC. Only two subjects had asthma as disease induced by ingestion of wheat. Seven subjects reported a history of respiratory symptoms when exposed to flour dusts. A significant reduction of forced expiratory volume in 1 s (FEV1) was detected in these seven patients when a specific bronchial challenge with flour proteins was performed. Only three out of seven subjects with asthma induced by flour could be considered occupationally exposed to flour dusts. Conclusion For the first time, it has been shown that specific bronchial reactivity to wheat proteins can be detected in patients with different disorders associated with food allergy to wheat. The presence of asthma induced by inhaled flour is not strictly related to occupational exposure and it may also occur in subjects not displaying asthma among symptoms induced by wheat ingestion. AU - Salvatori N AU - Reccardini F AU - Convento M AU - Purinan A AU - Colle R AU - De Carli S AU - Garzoni M AU - Lafiandra D AU - De Carli M LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 32 IP - DP - 2008 Jan 01 TI - The incidence of respiratory symptoms and sensitisation in baker apprentices PG - 452-459 AB - The aim of the current study was to describe the incidence of respiratory symptoms and allergic sensitisation and the sequence of events leading to respiratory symptoms among Danish baker apprentices (BA). A total of 114 BA were surveyed over a 20-month period. Questionnaires were completed along with spirometric analysis and skin-prick tests to common and work-related allergens. Bronchial hyperresponsiveness (BHR) was determined at baseline and at the end of the follow-up period. The incidences of work-related rhinitis and asthma-like symptoms were 22.1 and 10.0 cases 100 person-years, respectively. At 20 months the cumulative incidence proportion was 40.2 and 20.5% for rhinitis and asthma-like symptoms, respectively. The cumulative incidence of occupational sensitisation was 6.1%. An increased risk of asthma-like symptoms was found in both atopic subjects and in females. In the BA with new onset respiratory symptoms, an increase in BHR from baseline was observed. Forced expiratory volume in one second and forced vital capacity did not change during the follow-up period. No relationship was observed between new sensitisation and new symptoms. Conclusion rhinitis- and asthma-like symptoms were found to develop commonly in Danish baker apprentices. The mechanism by which symptoms arose was perceived to reflect the development of an inflammation rather than the production of a specific immunoglobulin E pathway, as sensitisation to occupational allergens was rarely observed. Hence, respiratory symptoms and allergy may develop through separate pathways. AU - Skjold T AU - Dahl R AU - Juhl B AU - Sigsgaard T LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 32 IP - DP - 2008 Jan 01 TI - Vitamins as asthmagens in the workplace PG - 819-820 AB - Vitamins are chemically unrelated organic compounds that the body cannot synthesise in sufficient quantities on its own (with the exception of vitamin D), but are essential in small amounts to maintain a normal metabolism and good health. Occupational asthma caused by thiamine (vitamin B1) has been previously reported, and confirmed with specific bronchial provocation tests. Using a quantitative structure–activity relationship (QSAR) model linking chemical structure and their occupational asthma hazard developed by Jarvis, Agius and Seed, the thiamine molecule has been shown to have a high risk of being a chemical respiratory sensitiser. The chemical asthma hazard assessment programme based on the above model was used to study common vitamin compounds. The asthma hazard index of a chemical is expressed as a value 0–1, with 1 indicating definite asthmagenic potential. Vitamins A, D, B1, B2, B3, B5, biotin and folic acid molecules carry a high probability of causing respiratory sensitisation. Both water-soluble and fat-soluble vitamins are used as additives in the food industry and their asthmagenic potential in the workplace needs to be recognised. AU - Vellore AD AU - Madathil S AU - Heinink RA AU - Moore VC AU - Manney S AU - Burge CBSG AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20080101 IS - IS - VI - 32 IP - DP - 2008 Jan 01 TI - Sub-acute occupational hypersensitivity pneumonitis due to low-level exposure to diisocyanates in a secretary PG - 807-811 AB - There is virtually no information in the literature about the exposure levels needed to induce hypersensitivity pneumonitis (HP) by diisocyanates. The present study reports a case of occupational HP due to diisocyanates after low-level exposure. A 53-yr-old female never-smoker developed progressive shortness of breath on exertion, cough, fatigue and flu-like symptoms shortly after she began work as a secretary of a car body repair shop. A diagnosis of HP was made 2 yrs later, based on a restrictive ventilatory defect, a reticulonodular and discrete ground-glass pattern on high-resolution computed tomography, lymphocytosis in bronchoalveolar lavage and specific immunoglobulin G antibodies to diisocyanate human serum albumin conjugates in the patient's serum. The diagnosis was confirmed by recovery after exposure cessation and deterioration after re-exposure. Ambient monitoring revealed air concentrations of different diisocyanate monomers below the detection limit in both the patient's work station and in front of the paint spray booths, with the exception of one measurement that showed 4,4-methylenediphenyl diisocyanate concentrations of 3 µg.m-3 in front of one booth (corresponding to a total reactive isocyanate group concentration of 1 µg.m-3). The present authors conclude that concentrations of diisocyanates far below current exposure limits may induce hypersensitivity pneumonitis in susceptible subjects. AU - Schreiber J AU - Knolle J AU - Sennekamp J AU - Schulz KT AU - Hahn JU AU - Hering KG AU - Raulf-Heimsoth M AU - Merget R LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 27 IP - DP - 2007 Jan 01 TI - Bronchial responsiveness in bakery workers: relation to airway symptoms, IgE sensitization, nasal indices of inflammation, flour dust exposure and smoking PG - 327-34 AB - BACKGROUND Bronchial hyperresponsiveness (BHR) is common in bakery workers. The relation between bronchial responsiveness measured with a tidal breathing method and smoking, airway symptoms, IgE-sensitization, nasal indices of inflammation and flour dust exposure have been studied with bronchial responsiveness expressed as a continuous outcome. MATERIAL AND METHODS Bakery workers (n = 197) were subjected to interviews, questionnaires, allergy tests, workplace dust measurements and bronchial methacholine provocation. Eosinophil cationic protein (ECP) and alpha(2)-macroglobulin were measured in nasal lavage. Bronchial responsiveness was expressed as slope(conc), a measurement based on regressing the per cent reduction in FEV(1) at each provocation step. RESULTS BHR expressed as slope(conc) was associated with smoking (P = 0.009), asthma symptoms at work (P = 0.001), and occupational IgE sensitization (P = 0.048). After adjusting for baseline lung function the association between BHR and IgE sensitization was no longer present. We demonstrated an association between nasal ECP and BHR (slope(conc) < 3: P = 0.012), but not to alpha(2)-macroglobulin in nasal lavage. No association was seen between BHR and current exposure level of flour dust, number of working years in a bakery or a history of dough-making. CONCLUSION BHR is related to baseline lung function, work-related asthma symptoms, smoking and nasal eosinophil activity, but not to occupational IgE sensitization and current flour dust exposure when measured with metacholine provocation. The slope(conc) expression seems to be a useful continuous outcome in bronchial responsiveness testing. AU - Storaas T AU - Irgens A AU - Florvaag E AU - Steinsvåg SK AU - Ardal L AU - Do TV AU - Greiff L AU - Aasen TB LA - PT - DEP - TA - Clin Respir Physiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 27 IP - DP - 2007 Jan 01 TI - Nasal indices of eosinophilic and exudative inflammation in bakery-workers. PG - 23-9 AB - AIMS Rhinitis symptoms frequently occur in bakery-workers. Yet, little is known about the pathophysiology of this condition. The objective of the present study was to examine nasal indices of inflammation in relation to occupational dust exposure, occupational rhinitis according to defined criteria, rhinitis symptoms associated to the workplace, and occupational sensitization in bakery-workers. METHODS Bakery-workers (n = 197) were subjected to interviews, questionnaires, workplace dust measurements, allergy tests, and nasal lavages with and without histamine. alpha(2)-Macroglobulin and eosinophil cationic protein (ECP) were measured in saline lavages as indices of plasma exudation and eosinophilic activity, respectively. Histamine lavages were employed to explore the nasal exudative responsiveness. RESULTS alpha(2)-Macroglobulin and ECP increased significantly by increased workplace dust exposure (P< or =0.035). Furthermore, the exudative responsiveness to histamine increased significantly by such exposure (P< or =0.016). Similar patterns were seen in workers with occupational rhinitis and in subjects with rhinitis symptoms associated to the workplace, but not in workers with occupational sensitization. CONCLUSIONS We conclude that occupational dust exposure in bakery-workers is associated with nasal eosinophilic exudative inflammation. In contrast, occupational sensitization is not a discriminating factor with regard to indices of eosinophilic, exudative inflammation in the present material. AU - Storaas T AU - Ardal L AU - Van Do T AU - Florvaag E AU - Steinsvåg SK AU - Irgens A AU - Aasen TB AU - Greiff L LA - PT - DEP - TA - IARC Scientific Publications JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 41 IP - DP - 2007 Jan 01 TI - Respiratory symptoms and lung function impairment in underground gold miners in Ghana PG - 38-47 AB - BACKGROUND: This is the first study in Ghana in the Obuasi gold mines where the silica content of the respirable dust is 10%, less than in previously studied gold mines, with only 23% of the miners having ever smoked. OBJECTIVES: The study was to assess the prevalence of respiratory impairment in the Ghanaian gold miner and to quantify the effects of the respirable dust on pulmonary function DESIGN: A cross sectional epidemiological study METHOD: The study was carried out using MRC respiratory symptoms questionnaire, spirometry, and personal respirable dust measurements. RESULTS: A total of 1236 miners were studied. The mean age was 39.7 +/-5.8 (SD) years with a mean of 12.6 +/- 6.7 (SD) years underground service and a mean total cumulative exposure to dust of 10.34 +/-5.61 (SD) mg.m(-3).years. The prevalence of chronic bronchitis was 21.2% and not clearly related to cumulative exposure. MRC breathlessness grade>/=2 was 31.3%, significantly related to cumulative respirable dust exposure after adjustment of age and smoking. There was however significant reduction in FEF(25-75%) with increasing dust exposure and an interaction with ever smoking. There was no correlation between cumulative exposure to respirable dust and FEV(1) % predicted in any group, suggesting that exposure to respirable silica at a mean level of 0.06 mg/m(3) had no deleterious effect on FEV(1) in a population with little tuberculosis, good housing and a low level of cigarette smoking. CONCLUSION: The prevalence of chronic bronchitis in the Ghanaian gold mine is related more to smoking than any occupational factors. AU - Bio F AU - Sadhra S AU - Jackson C AU - Burge PS LA - PT - DEP - TA - Ghana Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 41 IP - DP - 2007 Jan 01 TI - Low back pain in underground gold miners in Ghana PG - 21-25 AB - BACKGROUND: Biomechanical lumbo-spinal strain and intense physical work are the characteristic hallmarks of mining work. OBJECTIVES: To determine the prevalence and predisposing factors for Low Back Pain (LBP) among male underground gold miners at the Obuasi gold mine in Ghana. METHODS: This is a cross sectional study on 280 male underground gold miners from June to October 2001 with a structured questionnaire administered through interviews. RESULTS: The twelve months prevalence of low back pain among miners was 67%. The mean age of the workers was 40 years (+/- 5.6, ranging from 27 to 53 years). Increasing age was significantly associated with low back pain, (P=0.05) OR 2.07 (95% CI 0.99 to 4.34) after adjustment for smoking and occupation. Prevalence of LBP was highest among workers performing engineering (82%) duties. Heavy physical work (77%), was identified as a major cause of LBP, which could be prevented by the use of lifting aids (16%). CONCLUSION: The prevalence of low back pain in this group is comparable with that obtained from other studies in Africa and Europe. Training and education as a means of reducing LBP was suggested by just a few of the respondents. AU - Bio F AU - Sadhra S AU - Jackson C AU - Burge PS LA - PT - DEP - TA - Ghana Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 176 IP - DP - 2007 Jan 01 TI - Respiratory Symptoms, Sensitization, and Exposure–Response Relationships in Spray Painters Exposed to Isocyanates PG - 1090-1097 AB - Rationale: Associations between oligomeric isocyanate exposure, sensitization, and respiratory disease have received little attention, despite the extensive use of isocyanate oligomers. Objectives: To investigate exposure–response relationships of respiratory symptoms and sensitization in a large population occupationally exposed to isocyanate oligomers during spray painting. Methods: The prevalence of respiratory symptoms and sensitization was assessed in 581 workers in the spray-painting industry. Personal exposure was estimated by combining personal task-based inhalatory exposure measurements and time activity information. Specific IgE and IgG to hexamethylene diisocyanate (HDI) were assessed in serum by ImmunoCAP assay and enzyme immunoassays using vapor and liquid phase HDI–human serum albumin (HDI–HSA) and HSA conjugates prepared with oligomeric HDI. Measurements and Main Results: Respiratory symptoms were more prevalent in exposed workers than among comparison office workers. Log–linear exposure–response associations were found for asthmalike symptoms, chronic obstructive pulmonary disease–like symptoms, and work-related chest tightness (prevalence ratios for an interquartile range increase in exposure of 1.2, 1.3 and 2.0, respectively; P 0.05). The prevalence of specific IgE sensitization was low (up to 4.2% in spray painters). Nevertheless, IgE to N100 (oligomeric HDI)–HSA was associated with exposure and work-related chest tightness. The prevalence of specific IgG was higher (2–50.4%) and strongly associated with exposure. Conclusions: The results provide evidence of exposure–response relationships for both work-related and non–work-related respiratory symptoms and specific sensitization in a population exposed to oligomers of HDI. Specific IgE was found in only a minority of symptomatic individuals. Specific IgG seems to be merely an indicator of exposure. AU - Pronk A AU - Preller L AU - Raulf-Heimsoth M AU - Jonkers ICL AU - Lammers J-W AU - Wouters IM AU - Doekes G AU - Wisnewski AV AU - Heederik D LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 30 (Suppl IP - DP - 2007 Jan 01 TI - Rate of FEV1 decline in workers with eosinophilic and non eosinophilic occupational asthma PG - 155s AB - Background: We have previously shown that workers with occupational asthma caused by low molecular weight agents can be divided into those with raised and normal levels of sputum eosinophils, (>2.2%) measured during symptomatic exposure to the causative agent. Workers with continuing exposure to the causative agent have accelerated FEV1 decline. Aims: To investigate the relationship between FEV1 decline (dFEV1) and sputum eosinophilia in workers with occupational asthma and continuing exposure to causative agents (both low molecular and high molecular agents) from two centres: Occupational Lung Disease Unit, Birmingham and Dipartimento Cardio Toracico, Università di Pisa, Pisa. Methods: 63 consecutive workers with occupational asthma from 2 centres were investigated during symptomatic exposure to the causative agents at work with: (1) Sputum induction studies (2) bronchial hyper reactivity measurement and (3) serial FEV1 measurements for a minimum period of 12 months (mean period 4.69 years; SD 2.96). dFEV1 during exposure was calculated by linear regression utilising all individual measurements in the eosinophilic and non-eosinophilic groups. Results: 42.5% of the studied workers were atopic; 33.3% were current smokers and, 84.6% exhibited bronchial hyper reactivity (methacholine). The majority of the patients were on treatment with inhaled corticosteroids (87.6%). Low molecular weight agents were the cause in 52.6% of workers; isocyanates were the single largest group. The mean annual dFEV1 in the studied workers was -14.8 mL/year. Conclusions: The eosinophilic group as a whole had greater FEV1 decline compared to the non-eosinophilic group; this group also had a higher number of individuals with a mean annual FEV1 decline of >60 mL/year. The variance was large however and the mean differences between the groups statistically non-significant. This may suggest that an additional variable, perhaps interacting with eosinophil phenotype, could be affecting the dFEV1. Longitudinal FEV1 studies in workers with occupational asthma who tolerate continuing exposure to the causative agent are likely to be biased as a survivor population; those with rapid FEV1 decline are often unable to continue work due to disability. Larger studies are required to further define the phenotypes. AU - Vellore AD AU - Talini D AU - Anees W AU - Moore V AU - Novelli F AU - Paggiaro P AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 14(2) IP - DP - 2007 Jan 01 TI - Health effects of exposure to organic dust in workers of a modern hatchery PG - 341-5 AU - Skórska C AU - Mackiewicz B AU - Golec M AU - Cholewa G AU - Chmielowiec-Korzeniowska A AU - Dutkiewicz J LA - PT - DEP - TA - Ann Agric Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 62 IP - DP - 2007 Jan 01 TI - The paper recycling industry, hydroxylamine and occupational asthma: two case reports PG - A130 AB - Introduction: Occupational disease linked to the paper recycling industry has not as of yet been well documented. No previously confirmed formal diagnosis of occupational asthma caused by hydroxylamine has been made. Methods and results: We have assessed and performed occupational assessment of 8 workers involved in this industry. Two of these original 8 assessed workers were later diagnosed with occupational asthma (OA). Both workers developed their respiratory symptoms within 2 years of the first use of the chemical hydroxylamine as part of the "de-inking" process (it was used as a substitute for glutaraldehyde on risk grounds although no prior cases of OA had been found, while glutaraldehyde was used for this process). The 2 positive cases had worked at the same plant for 11 and 20 years, respectively. Both gave histories of work related wheeze, shortness of breath and cough. Both cases performed OASYS peak flow records over a three week period and had OASYS II index of 2.85 and 2.67 respectively. Both cases were redeployed on site to non-exposed areas and subsequently demonstrated improvement in bronchial reactivity. Case 1: diagnosis PC20 = 1.25 mg/ml; 12 months post cessation of exposure 4.5 mg/ml; Case 2: diagnosis PC20 6 mg/ml; 6 months post cessation of exposure >8.0 mg/ml). Case 2 subsequently consented to and underwent blinded, placebo controlled occupational challenge using hydroxylamine by first painting on to a board, then by aerosol exposure within the challenge room demonstrates the late asthmatic reaction occurring on the high exposure hydroxylamine challenge (aerosolised). Since the first 2 cases were found 1 of 2 further referrals from the same industry site has also been provisionally diagnosed with OA. Conclusion: We believe these are the first 2 confirmed cases of OA caused by hydroxylamine in the paper recycling industry. AU - Tran S AU - Hoyle J AU - Niven RM AU - Francis HC LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 176 IP - DP - 2007 Jan 01 TI - Effect of Occupational Exposures on Decline of Lung Function in Early Chronic Obstructive Pulmonary Disease PG - 994-1000 AB - Rationale: Several occupational exposures adversely affect lung function. Objectives: This study reports the influence of continued occupational dust and fume exposures on the rate of decline of lung function in participants with early chronic obstructive pulmonary disease (COPD) studied in a population-based study. Methods: Subjects consisted of 5,724 participants in the Lung Health Study, a multicenter study of smoking cessation and anticholinergic bronchodilator administration in smokers with early COPD (3,592 men; 2,132 women). Average post-bronchodilator FEV1 at entry was 78.4% predicted for men and 78.2% predicted for women; all participants had an FEV1/FVC ratio less than 0.70. Measurements and Main Results: Participants underwent a baseline evaluation and five annual follow-up assessments, including questionnaires and spirometry. The effect of ongoing dust or fume exposure on FEV1 in each follow-up year was statistically evaluated with a mixed-effects regression model, which was adjusted for FEV1 at entry, age, airway responsiveness to methacholine, baseline smoking intensity, and time-varying (yearly) smoking status during each follow-up year. In men with early COPD, each year of continued fume exposure was associated with a 0.25% predicted reduction in post-bronchodilator FEV1% predicted. Continued smoking and airway hyperresponsiveness were also associated with reduction in FEV1 during each year of follow-up in both men and women. Statistically significant effects of dust exposure on the rate of decline were not found, nor were effects of fume exposure noted in women. Conclusions: These results suggest a need for secondary prevention by controlling occupational fume exposures. AU - Harber P AU - Tashkin DP AU - Simmons M AU - Crawford L AU - Hnizdo E AU - Connett J and for the Lung Health Study Group LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - - IP - DP - 2007 Jan 01 TI - FEV1 Decline in workers with occupational asthma and normal exhaled NO levels PG - - AB - Background Continuing workplace exposure to causative agent is associated with a poor prognosis in occupational asthma. Two separate phenotypes have been previously described based on the presence of sputum eosinophilia (>2.2%). Eosinophilic subjects have significantly increased fractional exhaled nitric oxide levels (FENO) and show higher non-specific bronchial reactivity and bronchodilator reversibility, lower pre-bronchodilator FEV1, FEV1/FVC and worse St George Respiratory Questionnaire (SGRQ) scores. Aims To determine whether the rate of FEV1 decline (aFEV1) is different in a group of workers with occupational asthma who have normal FENO compared to those with raised FENO measurements . (Logan® 2000; +/- 9.6 ppb at flow of 200 L/min). We postulated that the rate of FEV1 decline during continued exposure would be less in those with normal FENO measurements at presentation compared to those with raised FENO. Methods 51 consecutive workers with occupational asthma who had FENO measurements and sputum induction studies whilst exposed to the causative agent were followed up with regular FEV1 measurements until complete removal from exposure (Minimum follow up period of = 1 year; mean 5.4 yrs, SD 2.92). All workers were advised to avoid continuing exposure at diagnosis. The aFEV1 in the normal and raised FENO groups was calculated by linear regression analysis using all measurements made over the follow-up period. Results In the normal FENO group (n=38) which was predominant, only 5/32 (15.6%) had DFEV1 > -60 mL/year compared to the high FENO group (5/7, 71.4% had D FEV1 > -60 mL/year). Mean DFEV1 in the normal FENO group was -6.86 mL/year (95% CI, -0.041 to 0.028); only 7 out of 13 workers with raised FENO at presentation remained exposed for >1yr before complete removal from exposure, making DFEV1 assessment and statistical analysis unreliable in this group. Conclusions Our previous work has showed DFEV1 of 100.9 mL/yr (SEM 17.7) in 90 workers with OA (not phenotyped by FENO) caused by low molecular weight agents with continuing exposure who were then followed up over a mean of 2.9 yrs. In this study, workers with normal FENO at presentation (with ongoing exposure) shows a FEV1 decline of 6.9 mL/year over a longer period, suggesting a better prognosis for this group despite continuing exposure to the causative agent. However, higher dropout rates in workers with rapid FEV1 decline in general needs to be considered. AU - Vellore AD AU - Moore VC AU - Burge CBSG AU - Robertson AS AU - Anees W AU - Burge PS LA - PT - DEP - TA - MTS Congress JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 37 IP - DP - 2007 Jan 01 TI - Assessment of soy aeroallergen levels in different work environments PG - 1863-1872 AB - Background Airborne soybean hull proteins are known causes of asthma epidemics around harbours and soy processing plants. Soy flour dust proteins may cause occupational allergy in food and feed industries. Objective To compare enzyme immunoassays (EIAs) for soy hull and soy flour aeroallergens, exposure assessment in various work environments. Methods Airborne dust samples (n=324) from soy unloading and/or processing plants, the animal feed industry and pig stables were analysed by two soy flour assays: one assay for measuring complete soy hull proteins and two assays for measuring the purified low-molecular-weight (LMW) soy hull allergens. Results Immunoblotting confirmed strong differences between antibody specificities and soy preparations. The results of the two soy flour assays and the assay for measuring complete soy hull proteins were highly correlated (r>0.85). The two LMW soy hull assays also showed a strong mutual correlation (r=0.91), but much less correlation with assays for measuring soy flour and complete soy hull. The levels of LMW soy hull proteins were the highest at sites of soybean unloading or processing, while soy flour levels were particularly high in the soy and animal feed industry. Conclusions The optimal EIA procedure for soy aeroallergen exposure assessment depends on the type of work environment and the local soy dust composition. Thus, the type of work environment should always be taken into account in future soy allergy studies in order to prevent a possible underestimation of the workers' actual risk of developing soy allergy AU - Gomez-Olles S AU - Cruz MJ AU - Bogdanovic J AU - Wouters IM AU - Doekes G AU - Sander I AU - Morell F AU - Rodrigo MJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 29 IP - DP - 2007 Jan 01 TI - Interstitial pulmonary disorders in indium-processing workers PG - 317-324 AB - The production of indium-tin oxide has increased, owing to the increased manufacture of liquid-crystal panels. It has been reported that interstitial pneumonia occurred in two indium-processing workers; therefore, the present study aimed to evaluate whether interstitial pulmonary disorders were prevalent among indium workers. The study was carried out in 108 male workers in the indium plant where the two interstitial pneumonia patients mentioned above were employed, and included high-resolution computed tomography (HRCT) of the lungs, pulmonary function tests and analysis of serum sialylated carbohydrate antigen KL-6 and the serum indium concentration. Significant interstitial changes were observed in 23 indium workers on HRCT and serum KL-6 was abnormally high (>500 U·mL-1) in 40 workers. Workers with serum indium concentrations in the highest quartile had significantly longer exposure periods, greater HRCT changes, lower diffusing capacity of the lung for carbon monoxide and higher KL-6 levels compared with those in the lowest quartile. The serum indium concentration was positively correlated with the KL-6 level and with the degree of HRCT changes. In conclusion, the results of the present study indicated that serum KL-6 and high-resolution computed tomography abnormalities were prevalent among indium workers and that these abnormalities increased with the indium burden, suggesting that inhaled indium could be a potential cause of occupational lung disease. AU - Chonan T AU - Taguchi O AU - Omae K LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 29 IP - DP - 2007 Jan 01 TI - Occupational asthma caused by stainless steel welding fumes: a clinical study PG - 85-90 AB - The aim of the present study was to describe the cases of occupational asthma (OA) due to stainless steel welding fumes diagnosed at the Finnish Institute of Occupational Health during the period 1994–2003. OA was diagnosed according to patient history, lung function examinations and welding challenge tests with measurements of the forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) values. The present series comprised 34 patients, all male, with a mean age of 44.7 yrs (range 22–57), mainly working as welders. The mean duration of exposure was 22.4 yrs, and the mean duration of exposure before the onset of respiratory symptoms was 18 yrs. Dyspnoea was the most frequently reported work-related respiratory symptom. During the inhalation challenge tests, the mode of the asthmatic FEV1/PEF reaction was delayed in 16 (47%) patients, immediate in nine (26%) patients and dual (both immediate and delayed) in nine (26%) patients. In the follow-up assessment 6 months later, only six patients were considered able to continue performing welding tasks, whereas occupational injury pension was recommended for seven, and measures of vocational rehabilitation for 14 patients. In most cases, after the diagnosis of occupational asthma, the continuation of welding work was not possible. AU - Hannu T AU - Piipari R AU - Tuppurainen M AU - Nordman H AU - Tuomi T LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 64 IP - DP - 2007 Jan 01 TI - Ecological association between childhood asthma and availability of indoor chlorinated swimming pools in Europe PG - 37-46 AB - Background: It has been hypothesised that the rise in childhood asthma in the developed world could result at least in part from the increasing exposure of children to toxic chlorination products in the air of indoor swimming pools. Objectives: Ecological study to evaluate whether this hypothesis can explain the geographical variation in the prevalence of asthma and other atopic diseases in Europe. Methods: The relationships between the prevalences of wheezing by written or video questionnaire, of ever asthma, hay fever, rhinitis, and atopic eczema as reported by the International Study of Asthma and Allergies in Childhood (ISAAC), and the number of indoor chlorinated swimming pools per inhabitant in the studied centres were examined. Associations with geoclimatic variables, the gross domestic product (GDP) per capita, and several other lifestyle indicators were also evaluated. Results: Among children aged 13–14 years, the prevalence of wheezing by written questionnaire, of wheezing by video questionnaire, and of ever asthma across Europe increased respectively by 3.39% (95% CI 1.96 to 4.81), 0.96% (95% CI 0.28 to 1.64), and 2.73% (95% CI 1.94 to 3.52), with an increase of one indoor chlorinated pool per 100 000 inhabitants. Similar increases were found when analysing separately centres in Western or Northern Europe and for ever asthma in Southern Europe. In children aged 6–7 years (33 centres), the prevalence of ever asthma also increased with swimming pool availability (1.47%; 95% CI 0.21 to 2.74). These consistent associations were not found with other atopic diseases and were independent of the influence of altitude, climate, and GDP per capita. Conclusions: The prevalence of childhood asthma and availability of indoor swimming pools in Europe are linked through associations that are consistent with the hypothesis implicating pool chlorine in the rise of childhood asthma in industrialised countries. AU - Nickmilder M AU - Bernard A LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 57 IP - DP - 2007 Jan 01 TI - Work-related asthma symptoms and attitudes to the workplace PG - 30-35 AB - Background The Health & Safety Executive estimate that between 1500–3000 UK workers develop asthma through potentially avoidable workplace exposures each year. Aims To assess the perception of health, safety and the work environment by workers with symptoms suggestive of occupational asthma. Methods A total of 97 workers referred to hospital specialists with symptoms suggestive of occupational asthma were studied in order to investigate their attitudes to the workplace, safety and health. A qualitative study design using semi-structured telephone interviews at 2 months and 12 months following enrolment was used at 6 national UK centres with a special interest in occupational asthma. Results Many workers in the study felt let down by the workplace and management and perceived that a lack of health and safety measures had contributed to the development of their asthma symptoms. Many workers felt that their employers were ‘uncaring’ and were pursuing or considering medico-legal cases against them. Conclusions Workers' perception of risk influences their behaviour in the workplace, and their own health beliefs potentially create barriers to changing this. It is essential to consider workers' perceptions when developing strategies to effect change within the workplace. AU - Bradshaw LM AU - Barber CM AU - Davies J AU - Curran AD AU - Fishwick D LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 37 IP - DP - 2007 Jan 01 TI - Outcomes in occupational asthma caused by reactive dye after long-term avoidance PG - 225-230 AB - Background Reactive dye (RD) is known to be a causative agent of occupational asthma (OA). However, to date, no report has been issued concerning the long-term outcomes of RD-induced OA. Objectives We sought to evaluate the long-term outcomes in cases of OA caused by RD. Methods A total of 11 OA patients confirmed by RD bronchial challenge were enrolled in this study. First and second follow-up examinations were conducted at 4.3±2.3 and 13.7±2.3 years (means±SD) after the initial examinations, respectively. Skin prick test with RD and 11 common inhalant allergens, pulmonary function test, methacholine bronchial provocation testing, symptom and medication scores were determined at each visit. In addition, inflammatory cells in induced sputum were measured at the second follow-up examinations. Results Reduced lung function at initial examinations did not recover at the first and second examinations despite cessation of exposure and proper pharmacological treatment. In addition, asthma severity (as determined by symptom and medication scores) and non-specific airway hyper-responsiveness to methacholine also did not improve. However, skin reactivity to RD almost disappeared at the second examinations. Interestingly, four of the six patients who showed negative skin responses to all 11 common inhalant allergens at initial examinations were found to be atopic at the second examinations. Moreover, in terms of airway inflammation, seven of the 11 patients showed eosinophilia in induced sputum (3%) at the second examinations despite having been on high-dose inhaled corticosteroid medication. Conclusion The present study demonstrates that reduced lung function and asthmatic symptoms persist in RD-induced OA even after long-term exposure avoidance. AU - Park H-W AU - Kim D-I AU - Sohn S-W AU - Park C-H AU - Kim S-S AU - Chang Y-S AU - Min K-U AU - Kim Y-Y AU - Cho S-H LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 64 IP - DP - 2007 Jan 01 TI - Respiratory symptoms and bronchial responsiveness among cleaning and disinfecting workers in the food industry PG - 75-81 AB - Objectives: To measure the levels of exposure to nitrogen trichloride (NCl3) and aldehydes among cleaning and disinfecting workers in the atmosphere of food industry plants during cleaning and disinfecting operations, and to examine how they relate to irritant and chronic respiratory symptoms—which are indices of pulmonary function—and bronchial hyperresponsiveness (BHR) to methacholine. Methods: 175 exposed workers (M = 149; F = 26) recruited from 17 enterprises of the food industry (8 cattle, pig, and ovine slaughterhouses, 8 fowl slaughterhouses, and 1 catering firm) and 70 non-exposed workers (M = 52; F = 18) were examined. Concentration levels of NCl3 and aldhehydes were measured by personal sampling. Symptoms were assessed by means of a questionnaire and the methacholine bronchial challenge (MBC) test using an abbreviated method. Subjects were labelled MBC+ if forced expiratory volume in one second (FEV1) fell by 20% or more. The linear dose-response slope (DRS) was calculated as the percentage fall in FEV1 at last dose divided by the total dose administered. Results: 277 air samples were taken in the 17 food industry plants. For a given plant and in a given workshop, the actual concentrations of chloramines, aldehydes, and quaternary ammonium compounds were measured with personal samplers during the different steps of the procedures. For each cleaner, a total exposure index was calculated. A statistically significant concentration-response relationship was found between eye, nasal, and throat symptoms of irritation—but not chronic respiratory symptoms—and exposure levels or exposure duration. No relation was found between BHR and exposure. Conclusions: These data show that cleaning and disinfecting workers in the food industry are at risk of developing eye, nasal, and throat irritation symptoms. Although NCl3 exposure does not seem to carry a risk of developing permanent BHR, the possibility of transient BHR cannot be ruled out entirely. AU - Massin N AU - Hecht G AU - Ambroise D AU - Héry M AU - Toamain JP AU - Hubert G AU - Dorotte M AU - Bianchi B LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 62 IP - DP - 2007 Jan 01 TI - Outcome of occupational asthma after cessation of exposure: a systematic review PG - 147-152 AB - Background: Patients with occupational asthma, and their medical advisers, need valid information about the prognosis of their disease. Methods: A systematic review of the published literature on the symptomatic and functional outcomes of occupational asthma was carried out after avoidance of exposure to the causative agent. Through a full search of electronic and bibliographic sources, original studies documenting complete recovery from asthma (n = 39,1681 patients) or improvement in non-specific bronchial hyper-responsiveness (NSBHR; n = 28,695 patients) were identified. The median duration of follow-up was 31 (range 6–240) months for studies of symptomatic recovery and 37 (6–240) months for studies of NSBHR. Most studies were of patients recruited from special clinics. Results: Reported rates of symptomatic recovery varied from 0% to 100%, with a pooled estimate of 32% (95% CI 26% to 38%). These rates were lower with increasing age (p = 0.019) and among clinic based populations (p = 0.053). Patients with the shortest durations of exposure (76 months) had the highest rate of recovery (36%; 95% CI 25% to 50%), but the effect was not linear. The pooled prevalence of persistent NSBHR at follow-up was 73% (95% CI 66% to 79%). This figure was higher among patients whose disease was due to high-molecular-weight agents (p = 0.006) and, less clearly, those from clinic-based populations (p = 0.561). In between-study comparisons, no clear patterns of improvement relating to total duration of exposure or follow-up were found. From within-study comparisons there was some evidence that a shorter duration of symptoms was associated with a higher rate of symptomatic recovery. Conclusion: The available data on the prognosis of occupational asthma are insufficiently consistent to allow confident advice to be given to patients with the disease. Clinicians and epidemiologists with an interest in this disease should consider a collaborative and carefully standardised study of the prognosis of occupational asthma. AU - Rachiotis G AU - Savani R AU - Brant A AU - MacNeill SJ AU - Newman Taylor AJ AU - Cullinan P. LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 64 IP - DP - 2007 Jan 01 TI - Spreading of occupational allergens: laboratory animal allergens on hair-covering caps and in mattress dust of laboratory animal workers PG - 267-272 AB - Background: Family members of laboratory animal workers are at risk of developing allergy to laboratory animals. Little is known about the spreading of laboratory animal allergens outside the animal facilities. Objective: To assess the presence of laboratory animal allergens in dust collected from mattresses of laboratory animal workers and unexposed controls. Methods: Mouse and rat urinary proteins were measured in samples of mattress dust collected by laboratory animal workers and unexposed controls. In addition, rat and mouse allergens were determined in extracts of hair-covering caps, used during laboratory animal work, to estimate spreading of allergen through dust captured on hair. Allergen concentrations on hair caps were compared with exposure measured by personal airborne dust sampling. Results: Levels of rat urinary allergens (RUA) and mouse urinary allergens (MUA) and mouse urinary protein (MUP) 8, a specific pheromone-binding mouse allergen, were significantly higher in mattress samples of laboratory animal workers than in those of controls. Hair-covering caps used in animal facilities harboured large amounts of RUA and MUA, which correlated significantly with exposure measured by the personal sampling technique in the animal facility. Conclusions: Occupational laboratory animal allergens are detectable in mattress dust of laboratory animal workers. Transfer of allergens via uncovered hair of animal workers is likely contributing to this phenomenon. This study stresses the importance of using hair caps to prevent spreading of occupational allergens. AU - Krop EJM AU - Doekes G AU - Stone MJ AU - Aalberse RC AU - van der Zee JS LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 64 IP - DP - 2007 Jan 01 TI - The validation of work-related self-reported asthma exacerbation PG - 343-348 AB - Objective: To determine the validity of work-related self-reported exacerbation of asthma using the findings from serial peak expiratory flow (PEF) measurements as the standard. Methods: Adults with asthma treated in a health maintenance organisation were asked to conduct serial spirometry testing at home and at work for 3 weeks. Self-reported respiratory symptoms and medication use were recorded in two ways: a daily log completed concurrently with the serial PEF testing and a telephone questionnaire administered after the PEF testing. Three researchers evaluated the serial PEF records and judged whether a work relationship was evident. Results: 95 of 382 (25%) working adults with asthma provided adequate serial PEF data, and 13 of 95 (14%) were judged to have workplace exacerbation of asthma (WEA) based on these data. Self-reported concurrent medication use was the most valid single operational definition, with a sensitivity of 62% and a specificity of 65%. Conclusions: A work-related pattern of self-reported asthma symptoms or medication use was usually not corroborated by serial PEF testing and failed to identify many people who had evidence of WEA based on the serial PEF measurements. AU - Bolen AR AU - Henneberger PK AU - Liang X AU - Sama SR AU - Preusse PA AU - Rosiello RA AU - Milton DK LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 29 IP - DP - 2007 Jan 01 TI - Assessment of impairment/disability due to occupational asthma through a multidimensional approach PG - 889-896 AB - Subjects with occupational asthma (OA) are often left with permanent sequelae after removal from exposure, and assessing their impairment/disability should utilise various tools. The aim of the present study was to examine whether: 1) assessment of inflammation in induced sputum is relevant to impairment; and 2) use of questionnaires on quality of life and psychological factors can be useful for the evaluation of disability. In total, 40 subjects were prospectively assessed for permanent impairment/disability due to OA 2 yrs after cessation of exposure. Impairment was assessed as follows: 1) need for asthma medication; 2) asthma severity; 3) airway calibre and responsiveness; and 4) degree of inflammation in induced sputum. Disability was assessed according to quality of life and psychological distress. There was a significant improvement in airway responsiveness and inflammation from diagnosis to the present assessment. Sputum eosinophils 2% and neutrophils >60% were present in eight (20%) and 12 (30%) out of all subjects, respectively, one or the other feature being the only abnormalities in 15% of subjects. Quality of life was moderately affected and there was a prevalence of depression and anxiety close to 50%. In the assessment of subjects with occupational asthma, information on airway inflammation and psychological impacts are relevant to the assessment of impairment/disability, although these findings need further investigation. AU - Yacoub M-R AU - Lavoie K AU - Lacoste G AU - Daigle S AU - L’Archevêque J AU - Ghezzo H AU - Lemière C AU - Malo J-L LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 62 IP - DP - 2007 Jan 01 TI - Clinical investigation of an outbreak of alveolitis and asthma in a car engine manufacturing plant PG - 981-990 AB - Background Exposure to metal working fluid (MWF) has been associated with outbreaks of extrinsic allergic alveolitis (EAA) in the USA, with bacterial contamination of MWF being a possible cause, but is uncommon in the UK. Twelve workers developed EAA in a car engine manufacturing plant in the UK, presenting clinically between December 2003 and May 2004. This paper reports the subsequent epidemiological investigation of the whole workforce. The study had three aims: (1) to measure the extent of the outbreak by identifying other workers who may have developed EAA or other work-related respiratory diseases; (2) to provide case detection so that those affected could be treated; and (3) to provide epidemiological data to identify the cause of the outbreak. Methods The outbreak was investigated in a three-phase cross-sectional survey of the workforce. In phase I a respiratory screening questionnaire was completed by 808/836 workers (96.7%) in May 2004. In phase II 481 employees with at least one respiratory symptom on screening and 50 asymptomatic controls were invited for investigation at the factory in June 2004. This included a questionnaire, spirometry and clinical opinion. 454/481 (94.4%) responded and 48/50 (96%) controls. Workers were identified who needed further investigation and serial measurements of peak expiratory flow (PEF). In phase III 162 employees were seen at the Birmingham Occupational Lung Disease clinic. 198 employees returned PEF records, including 141 of the 162 who attended for clinical investigation. Case definitions for diagnoses were agreed. Results 87 workers (10.4% of the workforce) met case definitions for occupational lung disease, comprising EAA (n = 19), occupational asthma (n = 74) and humidifier fever (n = 7). 12 workers had more than one diagnosis. The peak onset of work-related breathlessness was Spring 2003. The proportion of workers affected was higher for those using MWF from a large sump (27.3%) than for those working all over the manufacturing area (7.9%) (OR = 4.39, p<0.001). Two workers had positive specific provocation tests to the used but not the unused MWF solution. Conclusions Extensive investigation of the outbreak of EAA detected a large number of affected workers, not only with EAA but also occupational asthma. This is the largest reported outbreak in Europe. Mist from used MWF is the likely cause. In workplaces using MWF there is a need to carry out risk assessments, to monitor and maintain fluid quality, to control mist and to carry out respiratory health surveillance. Abbreviations EAA, extrinsic allergic alveolitis; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; HF, humidifier fever; MWF, metal working fluid; OA, occupational asthma; PEF, peak expiratory flow AU - Robertson W AU - Robertson A AU - Burge CB AU - Moore V AU - Jaakkola MS AU - Dawkins PA AU - Burd M AU - Rawbone R AU - Gardner I AU - Kinoulty M AU - Crook B AU - Evans GS AU - Harris-Roberts J AU - Rice SB AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 11 IP - DP - 2007 Jan 01 TI - Occupational asthma in the developing and industrialised world: a review PG - 122-133 AB - Occupational asthma is the most common occupational lung disease in industrialised countries, and the second most common occupational lung disease reported after pneumoconioses in developing countries. The median proportion of adult cases of asthma attributable to occupational exposure is between 10% and 15%. The population attributable fraction appears to be similar in industrialised and developing countries characterised by rapid industrialisation (13-15%), but lower in less industrialised developing countries (6%). The high-risk occupations and industries associated with the development of occupational asthma vary depending on the dominant industrial sectors in a particular country. High-risk exposure to cleaning agents and pesticide exposure in developing countries appear to be as important as exposure to isocyanates, cereal flour/grain dust, welding fumes, wood dust and, more recently, hairdressing chemicals, commonly reported in industrialised countries. The reported mean annual incidence of occupational asthma in developing countries is less than 2 per 100 000 population, compared to very high rates of up to 18/100 000 in Scandinavian countries. While occupational asthma remains under-recognised, especially in developing countries, it remains poorly diagnosed and managed and inadequately compensated worldwide. Primary and secondary preventive strategies should be directed at controlling workplace exposures, accompanied by intense educational and managerial improvements. Appropriate treatment remains early removal from exposure to ensure that the worker has no further exposure to the causal agent, with preservation of income. However, up to one third of workers with occupational asthma continue to remain exposed to the causative agent or suffer prolonged work disruption, discrimination and risk of unemployment. AU - Jeebhay MF AU - Quirce S LA - PT - DEP - TA - Int J Tuberc Lung Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 64 IP - DP - 2007 Jan 01 TI - Defining and investigating occupational asthma: a consensus approach PG - 361-365 AB - Background: At present there is no internationally agreed definition of occupational asthma and there is a lack of guidance regarding the resources that should be readily available to physicians running specialist occupational asthma services. Aims: To agree a working definition of occupational asthma and to develop a framework of resources necessary to run a specialist occupational asthma clinic. Method: A modified RAND appropriateness method was used to gain a consensus of opinion from an expert panel of clinicians running specialist occupational asthma clinics in the UK. Results: Consensus was reached over 10 terms defining occupational asthma including: occupational asthma is defined as asthma induced by exposure in the working environment to airborne dusts vapours or fumes, with or without pre-existing asthma; occupational asthma encompasses the terms "sensitiser-induced asthma" and "acute irritant-induced asthma" (reactive airways dysfunction syndrome (RADS)); acute irritant-induced asthma is a type of occupational asthma where there is no latency and no immunological sensitisation and should only be used when a single high exposure has occurred; and the term "work-related asthma" can be used to include occupational asthma, acute irritant-induced asthma (RADS) and aggravation of pre-existing asthma. Disagreement arose on whether low dose irritant-induced asthma existed, but the panel agreed that if it did exist they would include it in the definition of "work-related asthma". The panel agreed on a set of 18 resources which should be available to a specialist occupational asthma service. These included pre-bronchodilator FEV1 and FVC (% predicted); peak flow monitoring (and plotting of results, OASYS II analysis); non-specific provocation challenge in the laboratory and specific IgE to a wide variety of occupational agents. Conclusion: It is hoped that the outcome of this process will improve uniformity of definition and investigation of occupational asthma across the UK. AU - Francis HC AU - Prys-Picard CO AU - Fishwick D AU - Stenton C AU - Burge PS AU - Bradshaw LM AU - Ayres JG AU - Campbell SM AU - Niven RM LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 57 IP - DP - 2007 Jan 01 TI - Occupational dermatitis and allergic respiratory diseases in Finnish metalworking machinists PG - 277-283 AB - Aim To investigate the incidences and trends of occupational skin diseases (OSDs) and allergic respiratory diseases (ARDs) in machinists working in the fabrication of metal products. Methods Data from the Finnish Register of Occupational Diseases during 1992–2001 were analysed. Incidence rates for skin and respiratory diseases of machinists were calculated and compared to the total working population. The patients investigated at the Finnish Institute of Occupational Health in the same period were described in detail. Results A total of 279 dermatoses and 34 ARDs were reported. Skin diseases accounted for 27% of all occupational diseases. The incidences of the skin and respiratory diseases were 1.6 and 0.2 cases per 1000 person-years, respectively. This represents a 3-fold risk for getting an OSD compared to the total working population. The number of allergic contact dermatitis (ACD) increased 3-fold during the study period. The most common causes of ACD were metalworking fluids (MWFs) and their ingredients such as formaldehyde, ethanolamines and colophony. Eighty-five per cent of ARDs were asthmas. The commonest causes of asthma were metal dusts and fumes, epoxy resins and hardeners and MWFs and their components. Conclusions Contact dermatitis is a common occupational health problem in metalworking machinists, whereas occupational respiratory disease is rare. Only a few specific chemicals in the metalworking have thus far been identified as respiratory allergens. Specific skin tests and inhalation challenge tests with MWFs and their ingredients are recommended if an OSD or a respiratory disease is suspected. AU - Suuronen K AU - Aalto-Korte K AU - Piipari R AU - Tuomi T AU - Jolanki R LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 37 IP - DP - 2007 Jan 01 TI - Diisocyanate conjugate and immunoassay characteristics influence detection of specific antibodies in HDI-exposed workers PG - 1095-1102 AB - Background The structural characteristics of diisocyanate chemical protein antigens vary depending upon the methods of production, and may influence diisocyanate antigen immunoassays. The impact of different antigen preparation methods on immunoassay sensitivity, specificity, and predictive value for identifying workers with diisocyanate asthma (DA) has not been systematically evaluated. Objective Evaluate the influence of preparation methodology of hexamethylene diisocyanate human serum albumin (HDI–HSA) conjugates on the performance of specific antibody assays for identifying workers with confirmed HDI asthma. Methods Asthmatic reactions to HDI exposure were assessed in 80 autobody shop workers by specific inhalation challenge (SIC). HDI-specific IgE and IgG in serum were measured by RAST and ELISA with seven different HDI–HSA conjugates prepared in liquid phase with monomeric or polymeric HDI, or vapour-phase monomeric HDI. The HDI : HSA substitution ratios were determined by mass spectrometry. Results DA was confirmed by SIC in 23 subjects. The maximal sensitivity for detecting specific IgE among workers with positive SIC results was higher with RAST and with polymeric vs. monomeric HDI–albumin conjugates (21.7% vs. 8.7%) with a generally high specificity (95%). HDI–HSA specific IgG antibody was also detected in 22–43% of HDI asthmatics depending upon the conjugate used. The specificity of specific IgG varied from 88% to 96%, and it was higher for monomeric (vs. polymeric) HDI–albumin conjugates with low (vs. high) substitution ratios. Conclusion The test performance of specific IgE and IgG immunoassays for identifying a positive SIC response varied with different HDI–HSA conjugates. Standard test antigens and common immunoassays must be used to minimize inter-laboratory variability. AU - Campo P AU - Wisnewski AV AU - Lummus Z AU - Cartier A AU - Malo J-L AU - Boulet LP AU - Bernstein DI LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 64 IP - DP - 2007 Jan 01 TI - Rhinitis and asthma symptoms in non-domestic cleaners from the São Paulo metropolitan area, Brazil PG - 446-453 AB - Background: Exposure to cleaning products has frequently been reported as a symptom trigger by workers with work-related asthma diagnosed in workers’ health clinics in the city of São Paulo, Brazil. Objectives: To estimate rhinitis and asthma symptoms prevalence and to analyse associated risk factors. Method: A respiratory symptoms questionnaire (Medical Research Council 1976) and the International Study of Asthma and Allergies in Childhood questionnaire were applied to 341 cleaners working in the city of São Paulo, along with obtaining full occupational histories, skin prick tests and spirometry. Timing their symptoms onset in relation to occupational history allowed estimation of work-related asthma and/or rhinitis. Risk factors related to selected outcomes were analysed by logistic regression. Results: 11% and 35% of the cleaners had asthma and rhinitis, respectively. The risk of work-related asthma/rhinitis increased with years of employment in non-domestic cleaning (OR 1.09, 95% CI 1.00 to 1.18, >0.92–3 years; OR 1.28, 95% CI 1.01 to 1.63, >3–6.5 years; OR 1.71, 95% CI 1.02 to 2.89, >6.5 years). Atopy was associated with asthma and rhinitis (OR 2.91, 95% CI 1.36 to 6.71; OR 2.06, 95% CI 1.28 to 3.35, respectively). There was a higher risk of rhinitis in women (OR 2.07, 95% CI 1.20 to 3.70). Conclusions: Cleaning workers are at risk of contracting work-related asthma and/or rhinitis, and the risk increases with years of employment in non-domestic cleaning. Women present higher risk of rhinitis than men. AU - Maçãira EdeF AU - Algranti E AU - Mendonça EMC AU - Bussacos MA LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 64 IP - DP - 2007 Jan 01 TI - Occupational risk factors for asthma among nurses and related healthcare professionals in an international study PG - 474-479 AB - Objective: The authors examined the relations between self-reported work tasks, use of cleaning products and latex glove use with new-onset asthma among nurses and other healthcare workers in the European Community Respiratory Health Survey (ECRHS II). Methods: In a random population sample of adults from 22 European sites, 332 participants reported working in nursing and other related healthcare jobs during the nine-year ECRHS II follow-up period and responded to a supplemental questionnaire about their principal work settings, occupational tasks, products used at work and respiratory symptoms. Poisson regression models with robust error variances were used to compare the risk of new-onset asthma among healthcare workers with each exposure to that of respondents who reported professional or administrative occupations during the entire follow-up period (n = 2481). Results: Twenty (6%) healthcare workers and 131 (5%) members of the referent population reported new-onset asthma. Compared to the referent group, the authors observed increased risks among hospital technicians (RR 4.63; 95% CI 1.87 to 11.5) and among those using ammonia and/or bleach at work (RR 2.16; 95% CI 1.03 to 4.53). Conclusions: In the ECRHS II cohort, hospital technicians and other healthcare workers experience increased risks of new-onset current asthma, possibly due to specific products used at work. AU - Mirabelli MC AU - Zock J-P AU - Plana E AU - Antó JM AU - Benke G AU - Blanc PD AU - Dahlman-Höglund A AU - Jarvis DL AU - Kromhout H AU - Lillienberg L AU - Norbäck D AU - Olivieri M AU - Radon K AU - Sunyer J AU - Torén K AU - van Sprunde LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 64 IP - DP - 2007 Jan 01 TI - Decline in lung function and mortality: implications for medical monitoring PG - 461-466 AB - Aim: To investigate the risk of death associated with selected cut-off points for rate of decline of forced expiratory volume in one second (FEV1). Methods: Mortality rates of a cohort of 1730 coal miners who had performed two pulmonary function tests 12.8 years apart were followed up for an additional 12 years. Based on previous studies, cut-off points for FEV1 rate of decline (ml/year) were selected as 30, 60 and 90 ml/year. Cox proportional hazard regression was used to estimate multivariate risk ratio of death in each category. Results: The risk ratios (compared to "below 30 ml/year") were 1.39 (95% CI 0.99 to 1.97) in the "60 to less than 90 ml/year" category and 1.90 (95% CI 1.32 to 2.76) in the "90 ml/year and above" category. Rates of decline above 90 ml/year were consistently related to excess mortality. In non-smokers and those with neither restrictive nor obstructive patterns at the first survey, rates of decline above 60 ml/year were significantly associated with increased mortality. Conclusions: Risk of death increases in individuals with rates of decline above about 60 ml/year and is statistically significant with declines of 90 ml/year or more. These results should be useful to healthcare providers in assessing lung function declines observed in individuals. AU - Sircar K AU - Hnizdo E AU - Petsonk E AU - Attfield M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 62 IP - DP - 2007 Jan 01 TI - Occupational eosinophilic bronchitis in a foundry worker exposed to isocyanate and a baker exposed to flour PG - 368-370 AB - Eosinophilic bronchitis without asthma may occur as a consequence of occupational exposure. The cases of a foundry worker and a baker who developed symptoms, respectively, due to exposure to isocyanate and flour, are reported. Cough was not associated with variable airflow obstruction or with airway hyper-responsiveness and was responsive to inhaled corticosteroids. The eosinophilia detectable in their sputum was causally related to the occupational exposure in the workplace. The examination of induced sputum should be used in addition to the objective monitoring of lung function for workers who have asthma-like symptoms in an occupational setting. AU - Di Stefano F AU - Di Giampaolo AU - Nicola Verna L AU - Di Gioacchino M LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 131 IP - DP - 2007 Jan 01 TI - A Systematic Review of the Diagnosis of Occupational Asthma PG - 569-578 AB - Background: This study systematically reviews literature regarding the diagnosis of occupational asthma (OA) and compares specific inhalation challenge (SIC) testing with alternative tests. Methods: Electronic databases and trials registries were searched; additional references were identified from bibliographic searches of included studies, hand searches of conferences, and author contacts. Various study designs (clinical trials, cohorts, cross-sectional, or case series) were included involving workers with suspected OA. All diagnostic tests were compared to a "reference standard," and two researchers independently extracted 2 x 2 data. Pooled sensitivities and specificities (95% confidence intervals [CIs]) were derived. Results: Seventy-seven studies were included. For high molecular weight (HMW) agents, the nonspecific bronchial provocation (NSBP) test, skin-prick test (SPT), and serum-specific IgE had sensitivities > 73% when compared to SIC. Specificity was highest for specific IgE vs SIC (79.0%; 95% CI, 50.5 to 93.3%). The highest sensitivity among low molecular weight asthmagens occurred between combined NSBP and SPT vs SIC (100%; 95% CI, 74.1 to 100%). When compared to SIC, specific IgE and SPT had similar specificities (88.9%; 95% CI, 84.7 to 92.1%; and 86.2%; 95% CI, 77.4 to 91.9%, respectively). For HMW agents, high specificity was demonstrated for positive NSBP tests and SPTs alone (82.5%; 95% CI, 54.0 to 95.0%) or when combined with specific IgE (74.3%; 95% CI, 45.0 to 91.0%) vs SIC. Sensitivity was somewhat lower (60.6% and 65.2%, respectively). Conclusions: In appropriate clinical situations when SIC is not available, the combination of a NSBP test with a specific SPT or specific IgE may be an appropriate alternative to SIC in diagnosing OA. While positive results of single NSBP test, specific SPT, or serum-specific IgE testing would increase the likelihood of OA, a negative result could not exclude OA. AU - Beach J AU - Russell K AU - Blitz S AU - Hooton N AU - Spooner C AU - Lemiere C AU - Tarlo SM AU - Rowe BH LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 29 IP - DP - 2007 Jan 01 TI - Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers PG - 690-698 AB - The association between swimming pool characteristics and activities of employees and respiratory symptoms in employees was studied. Trichloramine levels were measured to evaluate relationships with pool characteristics and to estimate long-term exposure levels. Questionnaires were available from 624 pool workers and 38 swimming facilities. Chloramine levels were measured by area sampling over 2-h periods and analysed using ion chromatography. Work-related and general respiratory symptoms, and symptoms indicative of atopy and bronchial hyperresponsiveness were considered. Respiratory symptom prevalence among pool workers was compared with symptoms in a Dutch population sample. Chloramine levels were modelled with regression analysis. This model was used to estimate long-term average chloramine levels for each pool studied. Employees with higher exposure reported upper respiratory symptoms with greater frequency. Upper respiratory symptoms were statistically significantly associated with cumulative chloramine levels (odds ratio (OR) >1.4 for hoarseness, lost voice, sinusitis). General respiratory symptoms were significantly elevated compared with a Dutch population sample (OR ranged 1.4–7.2). An excess risk for respiratory symptoms indicative of asthma was observed in swimming pool employees. Aggravation of existing respiratory disease or interactions between irritants and allergen exposures are the most likely explanations for the observed associations. AU - Jacobs JH AU - Paan S AU - van Rooy FGBGJ AU - Meliefste C AU - Zaat VAC AU - Rooyackers JM AU - Heederik D LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 64 IP - DP - 2007 Jan 01 TI - Employment status and use of respiratory protection among metalworkers, solderers and welders PG - 548-552 AB - Objectives: Reported associations of self-employment with occupational injury and cerebrovascular disease suggest that worker safety and health precautions may vary by occupational status. The authors assessed the extent to which use of respiratory protection and ventilation equipment is associated with self-employed versus employee status among adults in an international study. Methods: The European Community Respiratory Health Survey II (ECRHS II) is a follow-up study conducted in a population-based random sample of adult ECRHS I participants. Men and women enrolled in the ECRHS II completed interviewer-administered questionnaires to provide information about their occupational status and job history during the 9-year ECRHS follow-up period. Respondents in selected occupational groups completed supplemental questionnaires about their jobs and use of respiratory protection and ventilation equipment on-the-job. The authors assessed self-reported use of respiratory and ventilation equipment among 72 self-employed and 371 employed adults in metalworking, soldering and welding occupations. Results: Local exhaust ventilation (fixed extraction: OR 0.37, 95% CI 0.17 to 0.80; mobile extraction: OR 0.23, 95% CI 0.09 to 0.60; on-tool extraction: OR 0.39, 95% CI 0.18 to 0.88) was reported less frequently among self-employed respondents than among employed respondents. The magnitude of the negative association between self-employment status and any of the three types of local exhaust ventilation was not attenuated by adjustment for duration of work per day or week or asthma and/or wheezing symptoms. Respiratory protection was not associated with employment status in these data. Conclusions: More limited use of local exhaust ventilation among self-employed workers compared to employees suggests the need to promote occupational safety among self-employed workers. AU - Mirabelli MC AU - Zock J-P AU - Plana E AU - Benke G AU - Kromhout H AU - Norbäck D AU - Olivieri M AU - Radon K AU - Villani S AU - Kogevinas M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 30 IP - DP - 2007 Jan 01 TI - Twelve-year longitudinal study of respiratory status in dairy farmers PG - 97-103 AB - To evaluate respiratory risk in dairy farmers, the present authors conducted a longitudinal study in the Doubs region of France. From a cohort constituted in 1986 (T1), 157 (62.8%) dairy farmers and 159 (63.6%) controls were re-evaluated in 1998 (T3). The study protocol comprised a medical and occupational questionnaire, spirometric tests at both evaluations, and noninvasive measure of blood oxygen saturation with pulse oximetry (Sp,O2) at T3. In 1998, the prevalence of chronic bronchitis was higher in dairy farmers. In cross-sectional analyses, all respiratory function parameters and Sp,O2 were significantly lower in dairy farmers. In a multiple linear regression model, farming, age, male sex and smoking were significantly and negatively correlated with Sp,O2. However, the mean annual decline in respiratory function parameters did not differ significantly between groups. After adjustment of covariables, accelerated decline in vital capacity and forced expiratory volume in one second was associated with age, smoking and male sex. Decline in vital capacity was accelerated in dairy farmers working in traditional farms and those currently foddering. The current study demonstrates that dairy farming is associated with an increased risk of lung disorders and a decrease in blood oxygen saturation and suggests that respiratory function impairment is correlated with cumulated exposure to organic dusts AU - Gainet M AU - Thaon I AU - Westeel V AU - Chaudemanche H AU - Venier AG AU - Dubiez A AU - Laplante JJ AU - Dalphin J-C LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 37 IP - DP - 2007 Jan 01 TI - Optimized methods for fungal a-amylase airborne exposure assessment in bakeries and mills PG - 1229-1238 AB - Background In order to enable reproducible and comparable exposure measurements of fungal alpha-amylase (a-amylase) in different laboratories and countries, the entire procedure from sampling of airborne dust to measuring extracted samples (including standards and the used enzyme) immunoassays must be standardized. The aim of this study was to establish optimal elution and assay conditions. Methods A parallel sampler was used for simultaneous collection of 10 samples of inhalable dust in bakeries and mills in Germany, England, the Netherlands and Spain. Three enzyme-immunoassays (EIAs) for detection of fungal a-amylase based on monoclonal antibodies or polyclonal antibodies were used for the measurement of the parallel-sampled filters (n=432) extracted using several methods. The results were analysed by regression analysis of variance. Additional filters (n=54) were extracted and analysed using two EIAs to investigate the storage stability of the extracts. Results Although a-amylase concentrations correlated well (r0.88), differences were found between the EIAs in the sensitivity and nominal values (up to a mean factor 5.8). The best elution medium for airborne filters (phosphate-buffered saline ‘PBS’ with 0.05% Tween-20) led to 1.2 to two times higher a-amylase allergen yields than extraction in PBS only, while higher Tween-20 concentrations decreased the extracted a-amylase yield. During storage of frozen dust/filter extracts for 3–4 months at -20°C, a loss of approximately 40% of measurable a-amylase was observed, which could be partially prevented by addition of 0.1% casein to the medium directly after extraction. Conclusion Although the effects of only a few of many possible causes of variation were investigated, for these factors a clear choice could be made with regard to optimal elution conditions and the use of validated EIAs with calibrated standards, thus making significant progress towards a completely standardized procedure for airborne a-amylase measurements. AU - Sander I AU - Zahradnik E AU - Raulf-Heimsoth M AU - Wouters IM AU - Renström A AU - Harris-Roberts J AU - Robinson E AU - Rodrigo MJ AU - Goldscheid N AU - Brüning T AU - Doekes G LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 57 IP - DP - 2007 Jan 01 TI - Dehydroabietic acid as a biomarker for exposure to colophony PG - 362-366 AB - Background Colophony (rosin) is a natural product derived from the resin of coniferous trees with many industrial applications including soldering fluxes. Exposure to colophony fume through soldering is one of the leading causes of occupational asthma in the UK. Aims To assess occupational exposure to colophony from solder fume at selected workplaces in the UK and to investigate the use of dehydroabietic acid (DHA) as a biomarker of exposure. Methods Six companies in the UK electronics industry were visited and occupational hygiene assessments of extent and control of exposure to rosin-based solder flux fume were undertaken. Urine samples were analysed for one of the main constituents of rosin, DHA. Results There was a positive linear relationship between airborne exposure to solder fume and urinary DHA level. The levels of urinary DHA measured in UK workers were significantly lower than those previously measured in African workers because of the use of appropriate exposure control measures, for example, local exhaust ventilation with fixed ducting and flexible hose, tip extraction, etc. It is suggested that good occupational hygiene practice would result in urinary DHA levels of <3 µmol/mol creatinine in a post-shift urine sample. Conclusions Urinary DHA is a valid biomarker of exposure to colophony in solder fume. Further work on the excretion kinetics of urinary DHA, the possibility of skin absorption and further occupational hygiene surveys would be beneficial. Keywords Biological monitoring; colophony; exposure; rosin; solder fume; urine AU - Baldwin PEJ AU - Cain JR AU - Fletcher R AU - Jones K AU - Warren N LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 37 IP - DP - 2007 Jan 01 TI - Percutaneous reactivity to natural rubber latex proteins persists in health-care workers following avoidance of natural rubber latex PG - 1349-1356 AB - Background Long-term avoidance of natural rubber latex [Hevea brasiliensis (Hev b)] is currently recommended for health-care workers (HCWs) with established natural rubber latex (NRL) allergy. Percutaneous sensitivity to eight Hev b NRL allergens was evaluated in HCWs in 2000. To date, no studies have evaluated the longitudinal effects of NRL avoidance on percutaneous sensitivity to NRL allergens. Objective The aims of this study were to evaluate changes in percutaneous reactivity to non-ammoniated latex (NAL) and NRL allergens in HCWs 5 years after a recommendation to avoid NRL and to evaluate factors that predict the persistence of in vivo sensitivity to NAL and NRL allergens. Methods Skin prick testing was performed with NAL, seven NRL allergens (Hev b 1, 2, 3, 4, 6.01, 7.01, and 13), and recombinant Hev b 5 (rHev b 5) in 34 HCWs who were initially evaluated in 2000 for occupationally related NRL allergy. Serial 10-fold dilutions of NAL and NRL allergens were employed in skin testing. Sera from the HCWs were assayed for latex and enhanced latex (rHev b 5-enriched allergosorbent)-specific IgE antibodies using the ImmunoCAP® assay. Results The prevalence of work-related symptoms significantly decreased between 2000 and 2005 with avoidance of NRL (P<0.05). A 100-fold reduction in percutaneous sensitivity to Hev b 2 and Hev b 7 was less likely in those with prior history of systemic reactions to NRL (P=0.0053), reported history of reaction to cross-reactive foods (P=0.014), continued local reactions to NRL gloves (P<0.0001), or high NRL glove exposure since the initial study (P=0.0075). The diagnostic sensitivity and specificity of the latex-specific IgE serology was 54% and 87.5%, respectively, in comparison with NAL skin tests. The addition of rHev b 5 to the ImmunoCAP® (enhanced latex) allergosorbent altered the diagnostic sensitivity and specificity of the ImmunoCAP® to 77% and 75%, respectively. Conclusion While symptoms may resolve quickly with NRL avoidance therapy, detectable IgE indicating continued sensitization remains beyond 5 years, and thus continued avoidance of NRL should be recommended. AU - Smith AM AU - Amin HS AU - Biagini RE AU - Hamilton RG AU - Arif SAM AU - Yeang HY AU - Bernstein DI LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 30 IP - DP - 2007 Jan 01 TI - Respiratory symptoms, atopy and bronchial hyperreactivity in professional firefighters PG - 538-544 AB - The aim of the present study was to assess respiratory health in professional firefighters. A total of 101 male professional firefighters from Basel, Switzerland, were included in the study. A control group consisting of 735 male subjects of the general population was composed of the Basel sample of the Swiss Study on Air Pollution and Lung Diseases in Adults. All subjects were administered a standardised questionnaire, spirometry, skin-prick tests and bronchial challenge testing to methacholine. Respiratory symptoms at work were more frequent in firefighters compared with the control group, including burning eyes (21 versus 3%), running nose (19 versus 2%), itchy throat (26 versus 3%), cough (28 versus 3%), dyspnoea (7 versus 2%) and headache (25 versus 3%), respectively. Atopy was present in 51% of firefighters compared with 32% in the control group. The odds ratio for hyperreactivity to methacholine was 2.24 (95% confidence interval 1.12–4.48) for firefighters compared with the control group. Firefighters reported more respiratory symptoms at work and suffered more often from atopy compared with the control group. Bronchial hyperreactivity was more pronounced in firefighters, but it was not related to acute exposure or duration of employment. It remains unclear whether these findings were present at recruitment or developed after joining the workforce. AU - Miedinger D AU - Chhajed PN AU - Stolz D AU - Gysin C AU - Wanzenried A-B AU - Schindler C AU - Surber C AU - Bucher HC AU - Tamm M AU - Leuppi JD LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 30 IP - DP - 2007 Jan 01 TI - Educational intervention decreases exhaled nitric oxide in farmers with occupational asthma PG - 545-548 AB - Allergic occupational asthma is frequent in farming populations. As educational interventions can improve disease management, the short-term effect of an educational intervention in asthmatic farmers was evaluated on the basis of spirometric indices and exhaled nitric oxide fraction (FeNO). Farmers with occupational asthma (n = 81), mostly sensitised against cow dander and storage mites, participated in a 1-day educational programme. Outcome measures were assessed at baseline and after 4–6 weeks, using FeNO, lung function and a questionnaire. Results were compared with those of a control group without intervention (n = 24). In the educational group, the proportion of subjects reporting work-related symptoms was reduced after the intervention. The FeNO decreased from a geometric mean of 28.2 to 25.7 ppb, and, in subjects with an elevated (>35 ppb) baseline FeNO (n = 32), from 59.7 to 49.2 ppb. The corresponding changes in the control group were 25.6 versus 27.7 ppb and 49.5 versus 48.1 ppb. Spirometric results were unaltered in the two groups. Thus exhaled nitric oxide fraction, a marker of allergic airway inflammation, indicated a beneficial effect of a short-term educational intervention in farmers with occupational asthma. This suggests a potential for exhaled nitric oxide fraction in assessing the efficacy of preventive measures within a short time with higher sensitivity than spirometry. AU - Dressel H AU - Gross C AU - de la Motte D AU - Sültz J AU - Jörres RA AU - Nowak D LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 30 IP - DP - 2007 Jan 01 TI - First months of employment and new onset of rhinitis in adolescents PG - 349-355 AB - To investigate the incidence of rhinitis in adolescents taking into account duration and kind of employment in holiday and vocational jobs, and to study latency until development of symptoms.Participants of the ISAAC-II study in Munich and Dresden enrolled in 1995 were re-contacted by a postal questionnaire in 2002 (age 16 to 18 years). This focused on allergic rhinitis (AR), kind and duration of all jobs, and potential confounders. All jobs hold for at least 8 hours.week(-1) and at least 1 month were coded and occupational exposure was assigned by a job-exposure matrix.Of the 3785 participants, 964 reported an employment history. The median duration of employment was 10 months (25(th); 75(th) percentile: 1; 16 months). After adjusting for potential confounders, those working in high-risk occupations (OR 1.4; CI 1.0-2.1) had an increased risk for new onset of rhinitis, especially those exposed to low molecular weight agents (OR 1.78; 95% CI 1.1, 2.8). The incidence of rhinitis was the highest among those currently employed in a high-risk job for less than 10 months.Teenagers who start working in high-risk occupations have a higher incidence of rhinitis as compared to those not working. This increased risk might occur early on during employment. AU - Riu E AU - Dressel H AU - Windstetter D AU - Weinmayr G AU - Weiland S AU - Vogelberg C AU - Leupold W AU - von Mutius E AU - Nowak D AU - Radon K LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 57 IP - DP - 2007 Jan 01 TI - Acute respiratory symptoms among sisal workers in Tanzania PG - 290-293 AB - Background Few studies have focused on respiratory health effects among sisal workers. Aim To report on the prevalence of acute respiratory symptoms among sisal processors. Methods We interviewed 163 dust-exposed brushing and decortication workers and 31 low-exposed security workers from six sisal estates in Tanzania using a modified symptom score questionnaire to determine the prevalence of acute respiratory symptoms during work. Groups were compared using chi-square tests, Fisher's exact tests, t-tests and logistic regression, adjusting for confounding factors. Results After the first working day of the week, 73% of the brushing workers reported dry cough, 66% sneezing, 65% productive cough, 63% running nose and 34% stuffy nose. Brushing workers had a significantly higher prevalence of these symptoms than decortication workers. Brushing and decortication workers had significantly more dry cough and sneezing than the control group of security workers, when adjusting for age, smoking, past respiratory diseases and residence. Conclusion Processors of sisal fibre have a high prevalence of acute respiratory symptoms. More detailed studies on work and health in sisal estates are needed, including exposure studies. AU - Kayumba AV AU - Bråtveit M AU - Mashalla Y AU - Moen BE LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 64 IP - DP - 2007 Jan 01 TI - Occupational asthma: an assessment of diagnostic agreement between physicians PG - 185-190 AB - Objectives: To investigate the levels of agreement between expert respiratory physicians when making a diagnosis of occupational asthma. Methods: 19 cases of possible occupational asthma were identified as part of a larger national observational cohort. A case summary for each case was then circulated to 12 physicians, asking for a percentage likelihood, from the supplied information, that this case represented occupational asthma. The resulting probabilities were then compared between physicians using Spearman’s rank correlation and Cohen’s coefficients. Results: Agreement between the 12 physicians for all 19 cases was generally good as assessed by Spearman’s rank correlation. For all 66 physician–physician interactions, 45 were found to correlate significantly at the 5% level. The agreement assessed by analysis was more variable, with a median value of 0.26, (range –0.2 to +0.76), although 7 of the physicians agreed significantly (p<0.05) with 5 of their colleagues. Only in one case did the responses for probability of occupational asthma all exceed the "on balance" 50% threshold, although 12 of the 19 cases had an interquartile range of probabilities not including 50%, implying "on balance" agreement. The median probability values for each physician (all assessing the identical 19 cases) varied from 20% to 70%. Factors associated with a high probability rating were the presence of a positive serial peak expiratory flow Occupation Asthma SYStem (OASYS)-2 chart, and both the presence of bronchial hyper-reactivity and significant change in reactivity between periods of work and rest. Conclusions: Despite the importance of the diagnosis of occupational asthma and reasonable physician agreement, certain variations in diagnostic assessment were seen between UK expert centres when assessing paper cases of possible occupational asthma. Although this may in part reflect the absence of a normal clinical consultation, a more unified national approach to these patients is required. AU - Fishwick D AU - Bradshaw L AU - Henson M AU - Stenton C AU - Hendrick D AU - Burge PS AU - Niven R AU - Warburton C AU - Rogers T AU - Rawbone R AU - Cullinan P AU - Barber C AU - Pickering CAC AU - Williams N AU - Ayres JA AU - Curran AD LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 57 IP - DP - 2007 Jan 01 TI - Biological monitoring of TDI-derived amines in polyurethane foam production PG - 444-448 AB - Background Toluene diisocyanate (TDI) is used in industry in the production of flexible polyurethane foam, commonly a mixture of the 2,4- and 2,6- isomers. The production process may lead to exposure to diisocyanates which are associated with respiratory disease. A method has been available for the determination of TDI biomarkers in urine for some years. Aims To explore the usefulness of urinary toluenediamine (uTDA) in assessing whether dermal absorption of diisocyanates makes a significant contribution to a worker's total exposure. Methods Twenty-six workers took part in the study. Thirteen workers whose duties brought them into physical contact with uncured polyurethane foam during their shift (handlers) were compared to a control group of 13 workers in the same block plant environment had no physical contact with uncured foam on the day that sampling took place (non-handlers). Creatinine-adjusted uTDA levels in the two groups were compared across a work shift. Results Both groups of workers were exposed to similar levels of airborne TDI. Ten handlers were found to have TDA in post-shift urine samples above detection limits compared with two non-handlers (P < 0.05). No clear relationship was found between the level of airborne TDI exposure and post-shift uTDA. Conclusions uTDA provides a useful indication of the contribution which skin absorption makes to total TDI exposure. The results suggest that skin protection when handling uncured polyurethane foam may not receive sufficient consideration AU - Austin S LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 176 IP - DP - 2007 Jan 01 TI - Bronchiolitis Obliterans Syndrome in Chemical Workers Producing Diacetyl for Food Flavorings PG - 498-504 AB - Rationale: Workers in microwave popcorn plants are at risk of developing bronchiolitis obliterans associated with exposure to butter flavoring volatiles, including diacetyl. Objectives: To investigate the risk of bronchiolitis obliterans for chemical workers producing diacetyl, with exposure to less complex mixtures of chemicals. Methods: We interviewed and conducted spirometry on 175 of 196 workers from a chemical production plant that produced diacetyl between 1960 and 2003. We used all available historical exposure data to classify all workers into three exposure groups with varying exposure profiles to diacetyl, based on frequency and level of exposure. Measurements and Main Results: Workers with fixed airway obstruction underwent further pulmonary function testing (including diffusing capacity and lung volumes) and paired inspiratory and expiratory high-resolution computed tomography studies. We identified three cases consistent with bronchiolitis obliterans syndrome with air trapping on high-resolution computed tomography of the lungs, in the highest exposure group of 102 process operators. Two of these cases were lifelong nonsmokers. Potential exposures included acetoin, diacetyl, acetaldehyde, and acetic acid, with diacetyl exposures in the range previously reported to be associated with fixed airway obstruction in the microwave popcorn industry. Conclusions: Exposure to an agent during diacetyl production appears to be responsible for causing bronchiolitis obliterans syndrome in chemical process operators, consistent with the suspected role of diacetyl in downstream food production AU - van Rooy FGBGJ AU - Rooyackers JM AU - Prokop M AU - Houba AU - R Smit LAM AU - Heederik DJJ LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 37 IP - DP - 2007 Jan 01 TI - Latex allergy: low prevalence of immunoglobulin E to highly purified proteins Hev b 2 and Hev b 13 PG - 1502-1511 AB - Background Hevea brasiliensis (Hev b) 2 and Hev b 13 have recently been identified as major latex allergens by detecting specific IgE antibodies in >50% of sera from Hev b latex-allergic individuals. Objective We assessed the prevalence rates for sensitization to extensively purified latex allergens in patients from three diverse geographical areas. Methods Native Hev b 2, Hev b 5, Hev b 6.01 and Hev b 13 were purified by non-denaturating chromatography and were used in ELISAs to assess sera from 215 latex-allergic patients and 172 atopic non-sensitized controls from Finland, Spain and the United States to detect allergen-specific IgE antibodies. Results Unexpectedly, even highly purified Hev b 13 contained epitope(s) to which Hev b 6-specific human IgE antibodies bound effectively. Further purification, however, reduced the prevalence of IgE antibody reactivity to low levels: 15%, 5% and 11% for Hev b 2, and 18%, 30% and 27% for Hev b 13 among latex-allergic Finnish, Spanish and American patients, respectively. Interestingly, Finnish patients had a lower prevalence of Hev b 5-specific IgE antibody (28%) as compared with Spanish (49%) and American (71%) patients. The prevalence of Hev b 6.01-specific IgE reactivity was uniformly >50% in all three populations. Conclusion Neither Hev b 2 nor Hev b 13 appear to be major latex allergens when evaluated in serological assays using highly purified allergens. The reason(s) for the observed differences in published sensitization rates in various geographic regions requires further study. The purity of the allergen preparations has a marked impact on the accuracy of latex-specific IgE antibody detection in epidemiological studies and in the serological diagnosis of latex allergy. AU - Palosuo T AU - Lehto M AU - Kotovuori A AU - Kalkkinen N AU - Blanco C AU - Poza P AU - Carrillo T AU - Hamilton RG AU - Alenius H AU - Reunala T AU - Turjanmaa K LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - - IP - DP - 2007 Jan 01 TI - A new diagnostic test for occupational asthma utilising the difference in hourly peak expiratory flow between work and rest days PG - - AB - Oasys-2 (1) curr AU - Moore VC AU - Jaakkola MS AU - Burge CBSG AU - Pantin CF AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - ERS Congress JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 16 IP - DP - 2007 Jan 01 TI - Are we failing workers with symptoms suggestive of occupational asthma? PG - 304-310 AB - AIMS To assess the route to secondary care for patients with possible occupational asthma, and to document the duration of workrelated symptoms and referral times. METHODS Consecutive patients with suspected occupational asthma were recruited to a case series from six secondary care clinics with an interest in occupational asthma. Semi-structured interviews were performed and hospital case notes were reviewed to summarise relevant investigations and diagnosis. RESULTS 97 patients were recruited, with a mean age of 44.2 years (range 24-64), 51 of whom (53%) had occupational asthma confirmed as a diagnosis. Most (96%) had consulted their general practitioner (GP) at least once with work-related respiratory symptoms, although these had been present for a mean of 44.6 months (range 0-320 months) on presentation to secondary care. Patients experienced a mean delay for assessment in secondary care of 4 years (range 1-27 years) following presentation in primary care. CONCLUSIONS Significant diagnostic delay currently occurs for patients with occupational asthma in the UK. AU - Fishwick D AU - Bradshaw L AU - Davies J AU - Henson M AU - Stenton C AU - Burge PS AU - Niven R AU - Warburton C AU - Hendrick D AU - Rogers T AU - Rawbone R AU - Curran AD LA - PT - DEP - TA - Primary Care Respiratory Journal JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 37 IP - DP - 2007 Jan 01 TI - Quantitative analysis of immunoglobulin E reactivity profiles in patients allergic or sensitized to natural rubber latex (Hevea brasiliensis) PG - 1657-1667 AB - Background Characterized native and recombinant Hevea brasiliensis (rHev b) natural rubber latex (NRL) allergens are available to assess patient allergen sensitization profiles. Objective Quantification of individual IgE responses to the spectrum of documented NRL allergens and evaluation of cross-reactive carbohydrate determinants (CCDs) for more definitive diagnosis. Methods Sera of 104 healthcare workers (HCW; 51 German, 21 Portuguese, 32 American), 31 spina bifida patients (SB; 11 German, 20 Portuguese) and 10 Portuguese with multiple surgeries (MS) were analysed for allergen-specific IgE antibody (sIgE) to NRL, single Hev b allergens and CCDs with ImmunoCAP™ technology. Results In all patient groups rHev b 5-sIgE concentrations were the most pronounced. Hev b 2, 5, 6.01 and 13 were identified as the major allergens in HCW and combined with Hev b 1 and Hev b 3 in SB. In MS Hev b 1 displayed an intermediate relevance. Different sIgE antibody levels to native Hevea brasiliensis (nHev b) 2 and rHev b 6.01 allowed discrimination of SB with clinical relevant latex allergy vs. those with latex sensitization. Sensitization profiles of German, Portuguese and American patients were equivalent. rHev b 5, 6.01 and nHev b 13 combined detected 100% of the latex-allergic HCW and 80.1% of the SB. Only 8.3% of the sera showed sIgE response to CCDs. Conclusions Hev b 1, 2, 5, 6.01 and 13 were identified as the major Hev b allergens and they should be present in standardized latex extracts and in vitro allergosorbents. CCDs are only of minor relevance in patients with clinical relevant latex allergy. Component-resolved diagnostic analyses for latex allergy set the stage for an allergen-directed immunotherapy strategy. AU - Raulf-Heimsoth M AU - Rihs H-P AU - Rozynek P AU - Cremer R AU - Gaspar AU - Pires G AU - Yeang HY AU - Arif SAM AU - Hamilton RG AU - Sander I AU - Lundberg M AU - Bruning T LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 37 IP - DP - 2007 Jan 01 TI - Increased release of histamine in patients with respiratory symptoms related to perfume PG - 1676-1680 AB - Background Environmental perfume exposure may cause respiratory symptoms. Individuals with asthma and perfume contact allergy report such symptoms more frequently than others. However, immunologic mechanisms have not been demonstrated and the symptoms are not associated with IgE-mediated allergy. The study aimed to investigate whether basophils from patients with respiratory symptoms related to perfume released more histamine in the presence of perfume as compared with healthy volunteers. Methods Histamine release was measured by the glass fibre method. Blood was obtained from healthy volunteers (n=20) and patients with respiratory symptoms related to perfume (n=17) attending a dermatological outpatient clinic for patch testing. The effect of an international brand perfume was investigated using the basophil histamine release test with perfume. Furthermore, basophils from a healthy non-atopic donor were incubated with participant's sera and histamine release induced by perfume was measured. Results In both groups incremental perfume concentrations showed a positive and significant (P<0.001) dose-response effect on the release of histamine. At the highest perfume concentration, the basophils released significantly (P<0.05) more histamine in patients as compared with healthy volunteers. No difference was found between the groups when sera were incubated with basophils from a healthy non-atopic donor. Conclusion Perfume induces a dose-dependent non-IgE-mediated release of histamine from human peripheral blood basophils. Increased basophil reactivity to perfume was found in patients with respiratory symptoms related to perfume. AU - Elberling J AU - Skov PS AU - Mosbech H AU - Holst H AU - Dirksen A AU - Johansen JD LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 1 IP - DP - 2007 Jan 01 TI - Occupational and work-exacerbated asthma: similarities and differences PG - 43-49 AB - Over the years, there have been tremendous efforts to improve the understanding of occupational asthma (OA), whereas work-exacerbated asthma (WEA) has been somewhat overlooked. The aim of this work is to review the literature, comparing the prevalence of OA and WEA, their clinical and inflammatory characteristics, as well as the work environment of those suffering from OA and WEA. We performed a PubMed search up to September 2006 using the keywords: work-related asthma, WEA, work-aggravated asthma and OA. Only studies in English were included for consideration. We found that OA and WEA are prevalent conditions. The characteristics of subjects with OA and WEA vary according to the type of studies undertaken to describe these conditions. Many sensitizing agents have been reported to cause OA, whereas exposures to irritant agents seem to be associated with the occurrence of WEA. The inflammatory profile may differ between these two conditions, but the data are too limited and sometimes too contradictory to allow a firm conclusion to be drawn. The socioeconomic outcome of these conditions seems similar. Therefore, further studies investigating the prevalence of WEA, as well as its clinical, functional and inflammatory characteristics, are needed to improve the management of the workers with WEA. AU - Lemiere C LA - PT - DEP - TA - Expert Review of Respiratory Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 132 IP - DP - 2007 Jan 01 TI - Comparison of Peak Expiratory Flow Variability Between Workers With Work-Exacerbated Asthma and Occupational Asthma PG - 483-488 AB - Background: Peak expiratory flow (PEF) monitoring is frequently used to diagnose occupational asthma (OA). The variability of PEF between periods at work and away from work has not been described in workers with work-exacerbated asthma (WEA). We sought to assess and compare the diurnal variability of PEF during periods at and away from work between subjects with OA and WEA. Methods: Workers referred for work-related asthma underwent PEF monitoring for 2 weeks at and away from work. The diagnostic of OA or WEA was subsequently made according to the respective positivity or negativity of the specific inhalation challenges. PEF mean diurnal variability was calculated during periods at and away from work. PEF graphs were also interpreted using direct visual analysis by five observers and using a computer program (Oasys-2, Expert System ) [available at: http://www.occupationalasthma.com]. Results: Thirty-four subjects were investigated (WEA, n = 15; OA, n = 19). There was a greater variability of PEF at work than away from work in both OA (19.8 ± 8.7% vs 10.7 ± 6.3%, p < 0.001) and WEA (14.2 ± 4.8% vs 10.6 ± 5.6%, p = 0.02). However, the magnitude of the variability was higher in OA than in WEA (p = 0.02). The visual interpretation of PEF or the Oasys-2 program failed to distinguish WEA from OA. Conclusion: Although workers with OA showed a higher PEF variability than workers with WEA when at work, clinicians were unable to reliably differentiate OA from WEA using the visual interpretation of PEF graphs or the computerized analysis. AU - Chiry S AU - Cartier A AU - Malo J-L AU - Tarlo SM AU - Lemière C LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 64 IP - DP - 2007 Jan 01 TI - Incidence of respiratory sensitisation and allergy to enzymes among employees in an enzyme producing plant and the relation to exposure and host factors PG - 763-768 AB - Objectives: Belonging to the group of high molecular weight respiratory sensitisers, microbial enzymes have been reported as a well known cause of occupational allergy, typically manifesting itself as rhinitis and/or asthma. High exposure to such high molecular weight sensitisers, and possibly also peak exposures, implies a higher risk than low exposure, but the exact relation between exposure, sensitisation and clinical allergy remains to be clarified. The authors sought to estimate the risk of respiratory enzyme allergy in an enzyme producing plant and to assess the relation between exposure indices and allergy. Methods: Retrospective follow-up study based upon data gathered from health surveillance since 1970. 1207 employees from production and laboratories were included. The level of enzyme exposure in the relevant departments was estimated retrospectively into five exposure levels based on 10-fold increments/decrements of the threshold limit value and other exposure information. The risk was estimated in an exponential regression survival model fitted with constant intensity for subperiods of time using maximum likelihood estimation. Results: During the first three years of a person's employment, the enzyme sensitisation and allergy incidence rates were 0.13 and 0.03 per person-year at risk, respectively. In the fitted models, exposure class did not correlate with the outcome variables. The risk of sensitisation decreased along the three decades, whereas the risk of allergy remained unchanged. The risk of sensitisation and allergy was doubled among smokers. Pre-employment atopy was only associated with sensitisation risk. Conclusion: Sensitisation to enzymes decreased during the study period, possibly reflecting improvements in the working environment. A similar decrease could not be demonstrated for allergy to enzymes. Neither of the two outcomes correlated with exposure estimates, possibly because of the low precision of the estimates. AU - Larsen AI AU - Johnsen CR AU - Frickmann J AU - Mikkelsen S LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 62 IP - DP - 2007 Jan 01 TI - Latex allergy: the sum quantity of four major allergens shows the allergenic potential of medical gloves PG - 781-786 AB - Background: Assessment of allergenic potential of medical devices made of natural rubber latex (NRL) requires the measurement of concentrations of specific allergenic proteins or polypeptides eluting from rubber. Methods: Four NRL allergens (Hev b 1, 3, 5, and 6.02) were quantified in all medical glove brands marketed in Finland in 1999, 2001, and 2003 (n = 208) by a capture enzyme immunoassay. The results were compared with those obtained from previous nationwide market surveys, using a skin prick test-validated human IgE-based ELISA-inhibition method. Results: A high overall correlation (r = 0.87, 95% CI 0.83–0.90) emerged between the sum values of the four allergens(µg/g glove) and IgE-ELISA inhibition (allergen units, AU/ml, 1 : 5 diluted glove extract). The sum of four allergens when set at 0.15 µg/g discriminated ‘low allergenic’ (<10 AU/ml) from ‘moderate- to high-allergenic’ (=10 AU/ml) gloves at a sensitivity of 0.93 (95% CI 0.85–0.98) and specificity of 0.90 (95% CI 0.83–0.94). When the sum was below the detection limit (0.03 µg/g) all gloves belonged to the previously defined low-allergen category. Conclusions: By comparing the sum concentration of four selected NRL allergens with results obtained in human IgE-ELISA inhibition, it was possible set a cut-off level (0.15 µg/g) below which virtually all gloves contain low or insignificant amounts of allergens, and can be considered as low allergenic. At different cut-off-points, one could calculate the likelihood of a given glove to belong to the previously defined low, moderate or high allergen categories. AU - Palosuo T AU - Reinikka-Railo H AU - Kautiainen H AU - Alenius H AU - Kalkkinen N AU - Kulomaa M AU - Reunala T AU - Turjanmaa K LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 62 IP - DP - 2007 Jan 01 TI - Asthma and methacrylates – gluing together the evidence PG - 575-576 AB - Acrylates are a group of reactive compounds frequently handled in many different occupations. They cure rapidly without separate addition of hardener; polymerization is catalyzed by light, heat, or oxygen. There are two important groups of acrylates, methacrylates, and cyanoacrylates; both are used as glues. Exposure to cyanoacrylates has been linked to asthma in several case reports and one epidemiological study (1-4). Methacrylates are also used as plastic filling material leading to exposure among dental and surgical personnel and workers in different biotechnical and pharmaceutical industries. In Scandinavia, work with methacrylates has been common among dental personnel for some decades now. The use of composite resin materials for dental restoration has increased because of the replacement of mercury based materials, such as amalgam. Although these newer plastic fillings (composite resins) are made from different varieties of less volatile methacrylates, the bondings consist of more volatile acrylates, such as 2-hydroxyethyl-metahcrylate (HEMA) and triethylene glycol dimethacrylate (TEGDMA). Studies conducted in Finland and Sweden to measure exposure to HEMA among dental nurses have shown rather low median levels, around 3 lg/m3 (5, 6). However, higher levels were found when working around the patient's mouth, during mixing of the components and when removing old fillings. The highest short-term concentrations of HEMA were 68 lg/m3 in the Finnish study (5) and 20 lg/m3 in the Swedish study (6). The only European Union country which has an occupational exposure limit for HEMA is the Netherlands, where the limit is 270 lg/m3, for 8 h work. AU - Torén K LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 62 IP - DP - 2007 Jan 01 TI - Respiratory effects of exposure to methacrylates among dental assistants PG - 648-654 AB - Background: Case reports of occupational asthma in dental personnel have been published, but there is little data on the risk of respiratory disorders related to occupational exposure to methacrylates in dental assistants. The objective of this study was to investigate the relation of exposure to methacrylates to occurrence of respiratory symptoms and diseases among dental assistants. Methods: A cross-sectional study of female dental assistants from the membership register of the Finnish Association of Dental Hygienists and Assistants was conducted in the Helsinki metropolitan area. A CATI was carried out to collect information on health and exposures. A total of 799 dental assistants participated (response rate 87%). Results: Daily use of methacrylates was related to a significantly increased risk of adult-onset asthma (adjusted OR 2.65, 95% CI 1.14–7.24), nasal symptoms (1.37, 1.02–1.84), and work-related cough or phlegm (1.69, 1.08–2.71). Nasal symptoms showed a dose–response relation with increasing years of exposure to methacrylates, and those with >10 years of exposure had also increased risk of hoarseness, dyspnoea, and wheezing with dyspnoea. Dental assistants with a history of atopic diseases were particularly susceptible to exposure to methacrylates, the adjusted OR for adult asthma being in this group 4.18 (95% CI 1.02–28.55) and for nasal symptoms 2.11 (1.08–4.19). Conclusions: This study provides new evidence that the risk of adult-onset asthma, nasal symptoms and other respiratory symptoms increase significantly with daily use of methacrylates in dental assistants’ work. The results suggest that exposure to methacrylates poses an important occupational hazard for dental assistants. AU - Jaakkola MS AU - Leino T AU - Tammilehto L AU - Ylostalo P AU - Kuosma E AU - Alanko K LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 62 IP - DP - 2007 Jan 01 TI - An occupational respiratory allergy caused by Sinapis alba pollen in olive farmers PG - 447-450 AB - Background: Sinapis alba (white mustard) is a entomophilic species included in the Brassicaceae family. To date it has not been related to allergic sensitization or clinical respiratory disease. Methods: Twelve olive orchard workers had a history of rhinitis and/or bronchial asthma that occurred during control weed management and/or harvest, from January to March. They underwent skin prick tests (SPT) with S. alba pollen extract and a standard battery of aeroallergens. Sinapis alba pollen extract was prepared for performing quantitative skin tests, enzyme allergosorbent test and nasal challenge test (NCT). A portable monitoring station and an urban volumetric Hirst-type spore trap were used for the aerobiological study. Results: Eleven patients suffered from rhinitis and bronchial asthma and one had only from rhinitis. All patients were sensitized to S. alba pollen extract, and they showed a positive NCT response. In the urban aerobiologic monitoring station the amount of S. alba pollen only exceptionally reached peaks of 21 grains/m3, whereas in the work environment peaks of 1801 grains/m3 were detected between 15 February and 7 April. Conclusions: We demonstrate the existence of a new occupational allergen for olive farmers: S. alba pollen. We point out the importance of perform aerobiological sampling within the occupational environment for the detection and quantification of the allergenic source. AU - Anguita JL AU - Palacios L AU - Ruiz-Valenzuela L AU - Bartolome B AU - Saenz de San Pedro B AU - Cano E AU - Quiralte J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 62 IP - DP - 2007 Jan 01 TI - Turnip and zucchini: new foods in the latex-fruit syndrome PG - 452-453 AB - Turnip and zucchini: new vegetables responsible for cross-reactivity between latex and plant-derived foods AU - Pereira C AU - Tavares B AU - Loureiro G AU - Lundberg M AU - Chieira C LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 62 IP - DP - 2007 Jan 01 TI - Occupational asthma due to spores of Pleurotus ostreatus PG - 211-212 AB - A case of occupational asthma due to Pleurotus ostreatus’ spores inhalation, and the environmental study is reported AU - Vereda A AU - Quirce S AU - Fernandez-Nieto M AU - Bartolome B AU - Sastre J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 49 IP - DP - 2007 Jan 01 TI - Asthma Caused by Peracetic Acid-Hydrogen Peroxide Mixture PG - 155-158 AB - J Occup Health year 2007 volume 49 number 2 page 155 - 158 AU - CRISTOFARI-MARQUAND E AU - KACEL M AU - MILHE F AU - MAGNAN A AU - LEHUCHER-MICHEL M LA - PT - DEP - TA - J Occup Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 81 IP - DP - 2007 Jan 01 TI - Irritative effects of fumes and aerosols of bitumen on the airways: results of a cross-shift study PG - 35-44 AB - Possible health hazards of fumes and aerosols of bitumen are in discussion, and data on their adverse effects on human airways under current exposure conditions are limited. To assess the irritative effects of exposure to fumes and aerosols of bitumen on the airways, a cross-sectional cross-shift study was conducted including external and internal exposure measurements, spirometry and especially non-invasive methods like nasal lavage collection and induction of sputum in order to identify and evaluate more precisely inflammatory process in the upper and lower airways. The cross-shift study comprised 74 mastic asphalt workers who were exposed to fumes and aerosols of bitumen and 49 construction workers without this exposure as reference group. Questionnaire, spirometry, ambient monitoring and urinary analysis were performed. Humoral and cellular parameters were measured in nasal lavage fluid (NALF) and induced sputum. For data analysis, a mixed linear model was performed on the different outcomes with exposure group, time of measurement (pre-, post-shift), current smoking, German nationality and age as fixed factors and subjects as random factor. Based on personal exposure measurements during shift, mastic asphalt workers were classified into a low (=10 mg/m3; n = 46) and a high (>10 mg/m3; n = 28) exposure group. High exposure was accompanied by significant higher urinary post-shift concentrations of 1-hydroxypyrene and the sum of hydroxyphenanthrenes. Acute respiratory symptoms were reported more frequently in the high exposure group after shift. Significant cross-shift declines in lung function parameters (forced expiratory volume in 1 s [FEV1 (% predicted)] and forced vital capacity [FVC (% predicted)]) were measured in mastic asphalt workers. Pre-shift FEV1 (% predicted) and FVC (% predicted) were higher in the low exposure group. In pre- and post-shift NALF samples, interleukin (IL)-1ß-, IL-8- and total protein concentrations were lower in the low exposure group compared to the reference and the high exposure group. Pre- and post-shift neutrophil percentages in both nasal and sputum samples were also lower in the low exposure group. Significantly higher pre- and post-shift sputum concentrations of IL-8, IL-6, nitrogen oxide (NO) derivatives and total protein were detected especially in highly exposed workers. Irritative effects of exposure to fumes and aerosols of bitumen on the upper and lower airways were apparent, especially in mastic asphalt workers with exposure above 10 mg/m3. AU - Raulf-Heimsoth M AU - Pesch B AU - Schott K AU - Kappler M AU - Preuss R AU - Marczynski B AU - Angerer J AU - Rihs HP AU - Hahn JU AU - Merget R LA - PT - DEP - TA - Archives of Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 176 IP - DP - 2007 Jan 01 TI - The Use of Household Cleaning Sprays and Adult Asthma PG - 735-741 AB - Rationale: Cleaning work and professional use of certain cleaning products have been associated with asthma, but respiratory effects of nonprofessional home cleaning have rarely been studied. Objectives: To investigate the risk of new-onset asthma in relation to the use of common household cleaners. Methods: Within the follow-up of the European Community Respiratory Health Survey in 10 countries, we identified 3,503 persons doing the cleaning in their homes and who were free of asthma at baseline. Frequency of use of 15 types of cleaning products was obtained in a face-to-face interview at follow-up. We studied the incidence of asthma defined as physician diagnosis and as symptoms or medication usage at follow-up. Associations between asthma and the use of cleaning products were evaluated using multivariable Cox proportional hazards or log-binomial regression analysis. Measurements and Main Results: The use of cleaning sprays at least weekly (42% of participants) was associated with the incidence of asthma symptoms or medication (relative risk [RR], 1.49; 95% confidence interval [CI], 1.12–1.99) and wheeze (RR, 1.39; 95% CI, 1.06–1.80). The incidence of physician-diagnosed asthma was higher among those using sprays at least 4 days per week (RR, 2.11; 95% CI, 1.15–3.89). These associations were consistent for subgroups and not modified by atopy. Dose–response relationships (P < 0.05) were apparent for the frequency of use and the number of different sprays. Risks were predominantly found for the commonly used glass-cleaning, furniture, and air-refreshing sprays. Cleaning products not applied in spray form were not associated with asthma. Conclusions: Frequent use of common household cleaning sprays may be an important risk factor for adult asthma. AU - Zock JP AU - Plana E AU - Jarvis D AU - Antó JM AU - Kromhout H AU - Kennedy SM AU - Künzli N AU - Villani S AU - Olivieri M AU - Torén K AU - Radon K AU - Sunyer J AU - Dahlman-Hoglund A AU - Norbäck D AU - Kogevinas M LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 80 IP - DP - 2007 Jan 01 TI - Risk factors associated with airway allergic diseases from exposure to laboratory animal allergens among veterinarians PG - 465-475 AB - Objectives Investigate the risk factors for the development of occupational airway allergy (OAA) from exposure to laboratory animal allergens (LAA) among Polish veterinarians. Methods Two hundred veterinarians responded to the questionnaire and were subjected to skin prick test (SPT) to common allergens and LAA (rat, mouse, hamster, guinea pig, rabbit). Evaluation of total serum IgE level and specific IgE against occupational allergens was performed. In addition, bronchial hyperreactivity (BHR) and peak expiratory flow rate (PEFR) were measured before and after specific challenge testing (SCT) only in the subjects with work-related symptoms suggestive of occupational asthma (OA). Results The prevalence of asthmatic and ocular symptoms was statistically more prevalent in the group of veterinarians sensitised to LAA versus non-sensitised subjects. The most frequent occupational allergens of skin and serum reactivity were LAA (44.5 and 31.5%, respectively). In 41 (20.5%) and in 22 (11%) subjects out of 200 veterinarians, serum specific IgE to natural rubber latex (NRL) allergens and disinfectants was also found. Serum sensitisation to cat allergens and daily contact with laboratory animals (LA) increased the risk for developing isolated occupational rhinitis. Furthermore, working time of more than 10 years and daily contact with LA were also significant risk factors for the development of OAA. Measuring PEFR and BHR before and after SCT is a useful method to confirm the presence of OA. Conclusions Allergy to LAA is an important health problem among veterinary medicine practitioners in Poland. AU - Krakowiak A AU - Wiszniewska M AU - Krawczyk P AU - Szulc B AU - Wittczak T AU - Walusiak J AU - Palczynski C LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 56 IP - DP - 2007 Jan 01 TI - Three Cases of Ortho-phthalaldehydeinduced Anaphylaxis after Laryngoscopy: Detection of Specific IgE in Serum PG - 313-316 AB - Background: Ortho-phthalaldehyde (OPA) has recently been used as a disinfectant for various medical apparatuses. OPA is not generally recognized as a potential allergen. Case Summary: Subsequent to our recent report describing a patient presenting with OPA-induced anaphylaxis following laryngoscopy, we experienced two more such cases. In all three cases, the basophil histamine release test was useful for identifying the allergen as OPA. OPA-specific IgE was successfully detected in the serum of the patients by ELISA. Discussion: Physicians and co-medical workers need to be aware of potential allergens to which patients may be exposed during routine medical procedures. AU - Suzukawa M AU - Komiya A AU - Koketsu R AU - Kawakami A AU - Kimura M LA - PT - DEP - TA - Allergology International JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 49 IP - DP - 2007 Jan 01 TI - Health hazards from exposure to ortho-phthalaldehyde, a disinfectant for endoscopes, and preventive measures for health care workers PG - 1-8 AB - Recently, the use of ortho-phthalaldehyde(OPA)has been increasing as an alternative to glutaraldehyde(GA)for endoscope disinfection. We detected development of bronchial asthma and contact dermatitis in health care workers(HCW)employed in an endoscopy unit. After performing health examinations and work environment measurements, we took preventative measures against development of these diseases. Seventeen of 70 HCW had experienced skin, respiratory, or eye symptoms. Contact dermatitis occurred in 4 workers, one of whom also developed asthma. OPA concentration in the air of the endoscopy unit ranged from 0.06 to 2.01 ppb. The highest OPA concentration was obtained while the cover of a bucket for dipping endoscopy instruments was opened. Dipping of instruments was then discontinued, a personal protector was provided to each HCW and local ventilation devices for auto-washers, and health education was performed for HCW. At the periodic health examination the next year, two of 83 HCW described mild eye irritation, but no contact dermatitis or bronchitis had newly developed. This study clearly revealed that despite a very low level of OPA in air, symptoms of skin and the respiratory tract can occur. Spreading use of OPA as a substitute for GA may result in serious health risks for HCW. To prevent health hazards from OPA exposure, wearing of a personal protector and use of a fully automated washing machine with a local air exhauster are required. AU - Fujita H AU - Sawada Y AU - Ogawa M AU - Endo Y. LA - PT - DEP - TA - Sangyo Eiseigaku Zasshie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 57 IP - DP - 2007 Jan 01 TI - Why I became an occupational physician PG - 226 AB - Pulmonary tuberculosis, as a student, turned me to lung diseases as a specialty, so after house jobs at Guy's Hospital and the Brompton Hospital, and some locum work in the tuberculosis service which was then in decline, I went to Newcastle upon Tyne to a new department of Industrial Health to study pneumoconiosis of coal workers. The Department, which was funded by the Nuffield Foundation and welcomed by local physicians, was innovative. Under the late Richard Browne teaching of undergraduates occupational health, medical statistics, pulmonary physiology; social workers instead of the older lady almoners, and record keeping were introduced so that it has become a major school of medicine. My post involved research and teaching in occupational medicine to undergraduate medical students, and over the next 25 years, I worked on pneumoconiosis (in conjunction with the Unit at Cardiff), lead poisoning, antimony toxicology, compressed air disease (when the Tyne Tunnels were built) and eventually the long-term effects of diving (especially bone necrosis). Although to my regret, I never took a DIH, I was so involved in the area that I was awarded an MRC Rockefeller Fellowship which took me to Pittsburgh, USA, and was editor of the British Journal of Industrial Medicine for 7 years; president of the SOM, the BOHS and the Section of Occupational Medicine of the RSM; Dean of the Faculty of Occupational Medicine 1984–6; Professor of Occupational Medicine and Hygiene at Newcastle University and civilian adviser to the army from 1980–6 among other tasks. Thus, I came into the specialty by default and out of interest in what I was doing. At the time occupational disease was not uncommon and the field was a largely clinical one so that an MRCP was an advantage. I sense that the field has changed a good deal during the last few years and occupational disease may not be so important as it was. Since retirement, I have become involved in medical historical studies, particularly in the Scottish alchemists of the 17th century, but I still gave a paper in Heidelberg on antimony toxicity last year AU - McCallum RI LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 1 IP - DP - 2007 Jan 01 TI - Constrictive bronchiolitis obliterans: the fibrotic airway disorder PG - 139-147 AU - Epler GR LA - PT - DEP - TA - Expert review of respiratory medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 186 IP - DP - 2007 Jan 01 TI - Mushroom worker's lung: organic dust exposure in the spawning shed PG - 472-474 AU - Hoy RF AU - Pretto JJ AU - van GelderenD AU - McDonald CF LA - PT - DEP - TA - Med J Aust JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 101 IP - DP - 2007 Jan 01 TI - Approaches to the diagnosis and management of occupational asthma amongst UK respiratory physicians PG - 1903-1908 AB - This study aimed to assess the approach to the diagnosis and management of occupational asthma amongst general (non-specialist) respiratory consultants in the UK. A random sample of 100 UK general respiratory physicians were invited to participate, and asked to provide information on their diagnostic approach to a case scenario of a patient with possible occupational asthma relating to flour exposure. Participation rates were 42% for the main part of the study. Less than half of consultants specifically reported they would ask whether symptoms improved away from work, and just over a third mentioned examining the patient. All of those interviewed recommended a chest X-ray, and 98% simple spirometry. Eighty-six per cent suggested measurement of serial peak flows, recorded for between 2 and 8 weeks, with measurements taken half-twelve hourly. Less than half advocated a specific flour allergy test, and almost one-quarter (23%) would not perform any immunological test at all. Once a diagnosis of occupational asthma was confirmed, less than two-thirds of those interviewed commented they would recommend some form of exposure reduction, and only 28% specifically stated they would offer compensation advice. The diagnosis of occupational asthma by general respiratory physicians within the UK lacks standardisation, and in some cases falls short of evidence-based best practise. AU - Barber CM AU - Naylor S AU - Bradshaw LM AU - Francis M AU - Harris-Roberts J AU - Rawbone R AU - Curran AD AU - Fishwick D LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 370 IP - DP - 2007 Jan 01 TI - Exposure to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II) PG - 336-341 AB - BACKGROUND: The role of exposure to substances in the workplace in new-onset asthma is not well characterised in population-based studies. We therefore aimed to estimate the relative and attributable risks of new-onset asthma in relation to occupations, work-related exposures, and inhalation accidents. METHODS: We studied prospectively 6837 participants from 13 countries who previously took part in the European Community Respiratory Health Survey (1990-95) and did not report respiratory symptoms or a history of asthma at the time of the first study. Asthma was assessed by methacholine challenge test and by questionnaire data on asthma symptoms. Exposures were defined by high-risk occupations, an asthma-specific job exposure matrix with additional expert judgment, and through self-report of acute inhalation events. Relative risks for new onset asthma were calculated with log-binomial models adjusted for age, sex, smoking, and study centre. FINDINGS: A significant excess asthma risk was seen after exposure to substances known to cause occupational asthma (Relative risk=1.6, 95% CI 1.1-2.3, p=0.017). Risks were highest for asthma defined by bronchial hyper-reactivity in addition to symptoms (2.4, 1.3-4.6, p=0.008). Of common occupations, a significant excess risk of asthma was seen for nursing (2.2, 1.3-4.0, p=0.007). Asthma risk was also increased in participants who reported an acute symptomatic inhalation event such as fire, mixing cleaning products, or chemical spills (RR=3.3, 95% CI 1.0-11.1, p=0.051). The population-attributable risk for adult asthma due to occupational exposures ranged from 10% to 25%, equivalent to an incidence of new-onset occupational asthma of 250-300 cases per million people per year. INTERPRETATION: Occupational exposures account for a substantial proportion of adult asthma incidence. The increased risk of asthma after inhalation accidents suggests that workers who have such accidents should be monitored closely. AU - Kogevinas M AU - Zock JP AU - Jarvis D AU - Kromhout H AU - Lillienberg L AU - Plana E AU - Radon K AU - Toren K AU - Alliksoo A AU - Benke G AU - Blanc PD AU - Dahlman-Hoglund A AU - D'Errico A AU - Hery M AU - Kennedy S AU - Kunzli N AU - Leynaert B AU - Mirabelli MC AU - Muniozguren N AU - Norback D AU - Olivieri M AU - Payo F AU - Villani S AU - van Sprundel M AU - Urrutia I AU - Wieslander G AU - Sunyer J AU - Anto JM LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 74 IP - DP - 2007 Jan 01 TI - Occupational asthma related to mouse allergen exposure and rhinoconjunctivitis due to collagenase inhalation in a laboratory technician PG - 467-470 AB - We describe the case of a 27-year-old patient working in a research laboratory, who developed occupational asthma to mouse proteins and presented symptoms of rhinoconjunctivitis caused by manipulation of collagenase. Specific inhalation challenge confirmed the diagnosis of occupational asthma to mouse proteins, whereas specific challenge with collagenase only evoked symptoms of rhinitis and conjunctivitis. SDS-PAGE and Western blot analysis for collagenase showed that the patient's IgE antibodies bound specifically to a protein with a molecular weight of 92 kDa. Hence, this was an unusual case of double sensitization. The sensitization to collagenase presented in this report may represent a new occupational disease in technicians working in medical or research laboratories. AU - Munoz X AU - Gomez-Olles S AU - Cruz MJ AU - Morell F LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 33 IP - DP - 2007 Jan 01 TI - Occupational vocal cord dysfunction due to exposure to wood dust and xerographic toner PG - 153-158 AB - OBJECTIVES: Vocal cord dysfunction is a poorly understood entity that is often misdiagnosed as asthma. Both irritant and non-irritant vocal cord dysfunction have been described. This report presents two cases of irritant vocal cord dysfunction secondary to specific environmental exposure, the first to iroko and western red cedar wood (a carpenter) and the second to xerographic printing toner (a secretary). METHODS: Several tests were performed, including chest radiographs, measurements of total serum immunoglobulin E, skin prick tests with common pneumoallergens (as well as iroko and western red cedar in the first case), pulmonary function studies, methacholine challenge testing, specific inhalation challenge performed with suspected agents in a single-blinded fashion, and peak expiratory flow testing and fiberoptic rhinolaryngoscopy (in case 1). RESULTS: During the specific inhalation challenge, the patients showed dysphonia, chest tightness, inspiratory stridor, and flattening of the inspiratory limb of the maximum flow-volume loop in spirometry, with no significant decreases in the level of forced expiratory volume in 1 second; fiberoptic rhinolaryngoscopy confirmed the diagnosis of vocal cord dysfunction in case 1. CONCLUSIONS: It is important to know that agents that can cause occupational asthma can also cause vocal cord dysfunction. The mechanisms by which these agents produce vocal cord dysfunction are unknown. The differences in the clinical presentation of the patients described relative to the reported cases suggest that more than one pathophysiological mechanism may be implicated in the genesis of this entity. AU - Munoz X AU - Roger A AU - De la Rosa D AU - Morell F AU - Cruz MJ LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 49(5) IP - DP - 2007 Jan 01 TI - Occupational asthma due to welding fumes from stellite PG - 473-4 AB - Welding is associated with respiratory effects such as metal fume fever, chronic bronchitis, lung function abnormalities, and occupational asthma (OA).1 Previous studies have described OA in workers exposed to welding fumes from stainless steel2,3 and aluminum.4 Stellite is a metal alloy with both cobalt and chromium.5 The amount of cobalt is usually about 60% and of chromium about 30%. It also contains tungsten and a small amount of carbon. Stellite alloys are resistant to corrosion and also retain their hardness at elevated temperatures. They are used in wear-related applications such as in the manufacture of components of gas turbine and jet engines, and in cutting tools. Previously, respiratory symptoms including cough, dyspnea, and wheezing have been described in saw filers exposed to stellite,6 and in workers maintaining hard metal and stellite blades.7 However, to the best of our knowledge, OA associated with exposure to welding fumes from stellite has not been described. We report here on such a worker. A 42-year-old man, working since age 18 for the same employer manufacturing machines for the pulp and paper industry, had tasks including cutting mild or stainless steel for his first 6 years. Thereafter, he worked as a machinist; the material used was mild or stainless steel, and he also used metal working fluids. Very near his workplace, welding on stellite took place, but he himself did not take part. The patient had a history of perennial rhinitis, and had smoked for 4 years in his youth. He had been examined in a local central hospital for dyspnea 15 years before the examinations at the Finnish Institute of Occupational Health (FIOH), where bronchial asthma was diagnosed and asthma medication started. During one year prior to examinations at the FIOH, the patient had started to experience worsening of his asthma symptoms. This worsening was clearly related to exposure to stellite welding fumes, and his use of short-acting inhaled bronchodilating medication was therefore increased. Before this, his asthma has been in good balance with moderate use of regular inhaled budenoside combined with sodium chromoglycate. Because of asthma exacerbation, the patient contacted his occupational health physician, and workplace peak expiratory flow (PEF) monitoring was scheduled. The results were suggestive of OA: PEF values were 540–620 L/min when he was not in his workplace or when he was not exposed to welding fumes from stellite; on one working day with stellite welding, his PEF value fell to 480 L/min, but rose after short-acting bronchodilatating medication to 590 L/min. The patient was referred to FIOH for further examination. At the FIOH, auscultation of his chest was normal. Total serum immunoglobulin (Ig)E was 281 kU/L. Spirometry was normal, but the histamine challenge test revealed mild bronchial hyperresponsiveness (PD15 1.20 mg). His diurnal PEF and forced expiratory volume in 1 second (FEV1) values were within normal limits. Skin prick tests for common allergens showed allergy to pollens of grass, mugwort, alder, and dandelion, to epithelia of cow, and to Pityrosporum ovale, but for metals they were negative.8 The concentrations of the tested metals in water solutions were nickel sulfate 10 mg NiSO4/mL, potassium dichromate 1 mg Cr6+/mL, chromium chloride 1 mg Cr3+/mL, and cobalt chloride 1 mg Co2+/mL.3 Diagnosis of OA was made according to the European guidelines.9 Bronchial challenge tests were performed in a special welding exposure chamber. The referent test was by a diluent (ALK-Abello A/S, Copenhagen, Denmark). Cobalt and chromium challenge tests comprised solutions of cobalt chloride (0.1–10 mg Co2+/mL) and potassium dichromate (0.01—1 mg Cr6+/mL). Stellite welding was done by welding (30 minutes) on mild steel with a special stellite electrode (Soudostel HR21, Soudometal SA, Belgium), which consisted of about 65% cobalt, 28% chromium, 4.5% molybdenum, 2.5% nickel, and 0.25% carbon. After challenge tests, the patient was followed up for 24 hours. Lung function measurements (FEV1 and PEF) were done with a portable, pocket-size spirometer (One Flow, STI MEDICAL, Saint-Romans, France). A drop of 20% in PEF or FEV1 was regarded as significant compared with both starting level and control test. Clinical symptoms and lung auscultation findings were also recorded. In our patient, the referent inhalation challenge test did not indicate any adverse reactions, nor did the tests with both cobalt and chromium solutions. Welding mild steel with the specific electrode for stellite, however, caused an immediate asthmatic reaction, with a 21% drop in PEF measurements, and a suggestive delayed reaction, with a 15% drop. FEV1 values did not show a significant drop (maximal drop was –10% immediately). In association with the significant PEF drop, lung auscultation revealed wheezing in forced expirium. To confirm the diagnosis of OA, a workplace challenge test with PEF monitoring was performed. This showed a variation in PEF values of 560–630 L/min without exposure to stellite welding fumes, but after a 3-hour work exposure to stellite welding, PEF values dropped to 480 L/min and returned to the starting level in 19 hours. Based on work-related respiratory symptoms, occupational exposure, suggestive workplace PEF monitoring, positive findings in the specific welding challenge test, and the positive workplace challenge test, the diagnosis was OA. Avoidance of working near stellite welding was recommended, and regular inhaled budesonide medication was continued, with salbutamol on demand. Our patient's asthmatic reaction was specifically related to stellite welding, since specific challenge tests with either cobalt or chromium solutions did not indicate any adverse reactions. The rationale for first performing challenge tests to chromium and cobalt solutions was that these metals might have been responsible, because stellite contains them and because these agents have earlier been associated with OA.10,11 In line with this, we used a diluent as a referent challenge. Because these active challenge tests did not indicate any adverse reactions and the patient's OA was clearly associated with stellite welding fumes, we performed this challenge test, as well, using welding on mild steel with a special stellite electrode. This was reasonable, because most of the welding fumes are generated from the electrode, with the welded material playing a minor role. In our patient, the pathophysiological mechanism responsible for the induction of OA remains unknown. Although some studies concerning OA related to metals have proposed an IgE-mediated mechanism, skin reactivity to metal salts has not been consistently demonstrated in subjects with OA caused by these agents.12 Our patient showed no immediate skin reactivity to chromium or cobalt in skin-prick tests, and the specific challenge tests with these metal solutions did not indicate any adverse reactions. Tungsten was not skin prick tested. The literature has one case study reporting tungsten- induced OA with positive scratch test to this metal; in that case, however, the diagnosis of OA was based only on symptoms, with no lung function examinations or specific challenge tests.13 Unfortunately, we could not determine the concentrations of the welding aerosols during specific challenge tests to possibly further elucidate the pathophysiological mechanism. In conclusion, exposure to welding fumes from stellite should be included among etiological factors capable of inducing OA. Where there is doubt about the diagnosis, specific challenge tests remain the only method to confirm OA caused by welding fumes at an individual level. AU - Hannu T AU - Piipari R AU - Tuppurainen M AU - Tuomi T LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 9 IP - DP - 2007 Jan 01 TI - The prevalence of occupational asthma and rhinitis among woodworkers in south-eastern Nigeria PG - 52-55 AB - Wood dusts are known to cause respiratory disorders like rhinitis and asthma. This study was therefore done to determine the magnitude of the problem among woodworkers in south-eastern Nigeria exposed to high level of wood dust. Five hundred and ninety one woodworkers were selected using a stratified random sampling. The prevalence of woodwork-related rhinitis and asthma were then observed in the study population. Also the peak expiratory flow rate (PEFR) of each woodworker was obtained. The prevalence of occupational rhinitis was 78%, while that of asthma was 6.5%. As period of woodwork increased the prevalence of rhinitis and asthma increased (rhinitis: chi2 trend = 53.015, df = 1, P = 0.000). For asthma, chi2 trend = 19.721, df = 1, P = 0.000). Also the PEFR significantly became low with increasing years of exposure to woodwork (chi2 trend = 75.965, df = 1, P = 0.000). In conclusion the prevalence of rhinitis and asthma in woodworkers was high and significantly increased with years of working as a woodworker. AU - Aguwa EN AU - Okeke TA AU - Asuzu MC LA - PT - DEP - TA - Tanzan Health Res Bull JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 119 IP - DP - 2007 Jan 01 TI - Occupational sensitization to lupin in the workplace: occupational asthma, rhinitis, and work-aggravated asthma PG - 1133-1139 AB - Lupin is a legume. Its seed can be ground into flour and incorporated into food as a protein source. Cases of rhinitis, urticaria, and anaphylaxis from ingestion of lupin have been reported as well as asthma. OBJECTIVE: To present a cross-sectional study of workers in a food processing company who were exposed to lupin and developed occupational allergy secondary to inhaling lupin products. METHODS: Subjects were interviewed using a standardized questionnaire, including demographics and current and past symptoms. They underwent skin prick tests (SPTs) to common aeroallergens and lupin products, spirometry, and off-line exhaled nitric oxide measurement. Symptomatic subjects, sensitized to lupin on SPT, underwent methacholine bronchial provocation challenge. Those with bronchial hyperresponsiveness had specific bronchial provocation challenge to lupin. RESULTS: A total of 53/54 subjects completed testing (98%). Overall, 21% (11/53) had positive SPT results to lupin. The lupin-sensitive group had a trend toward atopy (P = .06). Seven of 11 (64%) subjects in this group were symptomatic; all had rhinitis, and 2 had wheeze. Two subjects had positive methacholine challenges, and 1 had a positive specific bronchial provocation challenge to lupin with both an early-phase and a late-phase response. CONCLUSION: Allergy to inhaled lupin occurs in the workplace. A high sensitization rate on SPT was found, which correlated with symptoms. The clinical significance of cross-reactivity between legumes on SPT is unclear. CLINICAL IMPLICATIONS: Sensitization to the legume, lupin, can occur from exposure at work and carries a high prevalence of clinical symptoms, which in some cases leads to occupational rhinitis and asthma. AU - Campbell CP AU - Jackson AS AU - Johnson AR AU - Thomas PS AU - Yates DH LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 119 IP - DP - 2007 Jan 01 TI - Is occupational asthma to diisocyanates a non-IgE-mediated disease? PG - 757-758 AB - BACKGROUND: Exposure to diisocyanates in the workplace is an important cause of occupational asthma. The majority of patients with diisocyanate-induced asthma have no detectable diisocyanate-specific IgE antibodies in serum. There has been much debate as to whether this is due to diisocyanate-induced asthma being mediated by non-IgE mechanisms or whether it is the result of using inappropriate conjugates. OBJECTIVE: We sought to determine whether RNA message for Cepsilon, IL-4, and other associated inflammatory markers could be detected locally within the bronchial mucosa after diisocyanate challenge. METHODS: Fiberoptic bronchoscopic bronchial biopsy specimens were obtained at 24 hours after both a control and an active challenge in 5 patients with positive and 7 patients with negative inhalation test responses to diisocyanates. Using both immunohistochemistry and in situ hybridization, we determined mRNA for Cepsilon, IL-4, IL-5, and other associated inflammatory markers. RESULTS: There was a striking absence of Cepsilon and IL-4 mRNA-positive cells in bronchial biopsy specimens from patients challenged with diisocyanate (Cepsilon median of 0 and interquartile range of 0-1.85; IL-4 median of 0 and interquartile range of 0-0.85). In contrast, there were increased numbers of IL-5-, CD25-, and CD4-positive cells and a trend toward an increase in eosinophils after active challenge with diisocyanate. CONCLUSION: We found a striking absence of both bronchial Cepsilon and IL-4 RNA message after inhalation challenge with diisocyanates, irrespective of whether the challenge test response was positive or negative. We propose that diisocyanate-induced asthma is a non-IgE-mediated disease, at least in patients in whom specific IgE antibodies to diisocyanates are undetectable. AU - Jones MG AU - Floyd A AU - Nouri-Aria KT AU - Jacobson MR AU - Durham SR AU - Taylor AN AU - Cullinan P LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 14 IP - DP - 2007 Jan 01 TI - Cost-effectiveness of various diagnostic approaches for occupational asthma. PG - 276-280 AB - BACKGROUND: Diagnosis of occupational asthma (OA) by specific inhalation challenge (SIC) can be costly and is not always available. The use of sputum testing to avoid this in some patients may be a more cost-effective alternative. OBJECTIVES: To compare the cost-effectiveness of SIC with serial measurements of sputum cell counts (sputum testing) and peak expiratory flow (PEF) monitoring. METHODS: Clinical data and testing costs for OA in 49 patients were collected during a previously published trial, modelled and compared using TreeAge Pro. Clinical outcome was the percentage of accurately diagnosed patients, using SIC as the gold standard. The PEF approach used the most accurate assessment of five experts who were blinded to SIC results. Differences in the proportion of eosinophils during periods on and off work were used for the sputum testing approach and in PEF/sputum for the combined approach. Unit costs were estimated from charges in Canadian hospitals. Data were analyzed by one-way and two-way analyses, and by probabilistic sensitivity analysis using a Monte Carlo simulation technique. RESULTS: The PEF approach had an estimated accuracy of 52% and cost $365 per patient tested. Compared with PEF monitoring, sputum testing was more accurate and cost an estimated $255 for each additional OA patient correctly diagnosed. SIC costs per additional correct diagnosis were $11,032 compared with sputum testing and $6,458 compared with PEF monitoring. The combined PEF/sputum testing approach was not cost-effective in the base case analysis, but cannot be excluded according to probabilistic sensitivity analyses. CONCLUSIONS: Although SIC remains the reference test to diagnose OA, when this test is not available, sputum testing is a cost-effective alternative to PEF for diagnosis of OA. Comment in: Can Respir J. 2007 Jul-Aug;14(5):264-6. AU - Kennedy WA AU - Girard F AU - Chaboillez S AU - Cartier A AU - Côté J AU - Hargreave F AU - Labrecque M AU - Malo JL AU - Tarlo SM AU - Redlich CA AU - Lemière C LA - PT - DEP - TA - Can Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 58 IP - DP - 2007 Jan 01 TI - Occupational asthma in subjects occupationally exposed to herbal and fruit tea dust. PG - 211-221 AB - We performed a cross-sectional study to detect occupational asthma (OA) in 63 subjects occupationally exposed to herbal and fruit tea dust and in 63 corresponding controls. The evaluation included a questionnaire, skin prick tests to workplace and common inhalant allergens, spirometry, and histamine challenge test. The evaluation of the work-relatedness of asthma in the exposed workers was based on serial peak expiratory flow rate (PEFR) measurements and bronchoprovocation tests. We found a higher prevalence of respiratory symptoms in the exposed workers, whereas spirometric parameters were significantly lower. The prevalence of sensitisation to allergens and of bronchial hyperresponsivenss (BHR) did not differ significantly between the groups. The prevalence of asthma was also similar in both groups (8.0 % vs. 6.4 %; P=0.540). Work-relatedness of symptoms was reported by all asthmatic tea workers and by no control with asthma. Significant work-related changes in PEFR diurnal variations and in non-specific BHR, suggesting allergic OA, were found in one tea worker with asthma (1.6 %). No specific workplace agent causing OA in the affected subject was identified. None of the tea workers with asthma met the criteria for medical case definition of the reactive airway dysfunction syndrome (RADS). Our data confirm workplace exposure to herbal and fruit tea dust as a risk factor for OA. AU - Minov J AU - Karadzinska-Bislimovska J AU - Vasilevska K AU - Risteska-Kuc S AU - Stoleski S LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 20 IP - DP - 2007 Jan 01 TI - Work-related respiratory symptoms among cotton-fabric sewing workers PG - 17-24 AB - OBJECTIVES: An inspection of the sewing unit in a 700-bed hospital revealed that workers employed in this unit complained of cough, shortness of breath, and tightness in the chest. The aim of this cross-sectional study was to assess the prevalence of respiratory symptoms in the sewing workers and dust concentration in the workplace. The obtained results were compared with the control group. MATERIALS AND METHODS: The sewing workers (n = 22, including 19 current and 3 former employees) and 22 housekeepers as controls were included in the study. All the participants responded to the respiratory questionnaire and underwent spirometric measurements, skin prick test, chest X-ray, and methacholine inhalation test. Environmental dust was measured using both an air pump and a vertical elutriator. RESULTS: The sewing workers reported more symptoms of phlegm, chest tightness and eye irritation than persons of the control group. Neither clinical investigations nor respiratory disorders under study provided evidence for a significant difference between the sewing workers and the control group. Of the 22 subjects, 2 (9.1%) showed occupational asthma and 4 (18.2%) mucous membrane irritation and organic dust toxic symptoms. The total and respiratory dust was within normal limits, but the dust concentration measured by the elutriator was above the limit value of 0.34 +/- 0.09 mg/m. After ventilation improvements, the dust level decreased to 0.19 +/- 0.06 mg/m. CONCLUSIONS: This study indicated that respiratory and ocular disorders were related to organic dust produced during the sewing process of cotton fabric. AU - Phakthongsuk P AU - Sangsupawanich P AU - Musigsan A AU - Thammakumpee G LA - PT - DEP - TA - Int J Occup Med Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 80 IP - DP - 2007 Jan 01 TI - Rechallenging subjects with occupational asthma due to toluene diisocyanate (TDI), after long-term removal from exposure. PG - 298-305 AB - OBJECTIVES: Aims of this study were to define (1) whether toluene diisocyanate (TDI) bronchial hyper-responsiveness persists in subjects with occupational asthma after long-term cessation of exposure; (2) whether evolution of specific bronchial TDI sensitization and symptoms and functional abnormalities of asthma were coincident, and (3) the determinants at the time of diagnosis of patients' outcome. METHODS: Twenty-five nonatopic spray painters with occupational asthma due to TDI were re-examined 58 +/- 7 (46-73) months after removal from exposure. On both examinations, the severity of asthmatic symptoms and the need for antiasthma treatment over the past 12 months were graded and lung function tests, measurement of airway responsiveness to methacholine (PD(20)), circulating total IgE and TDI-HSA specific IgE, skin tests with common inhalant allergens and specific bronchial challenge with TDI were carried out. RESULTS: Seven subjects were still TDI-reactors and 18 lost reactivity to it. All persistent reactors had still asthma and their symptom score, medication score, FEV(1), PD(20) and serum IgE were unchanged between assessments. In the 18 subjects no longer responsive to TDI, 8 had still features of asthma: their symptom and medication score had improved significantly, but FEV(1), PD(20) and serum IgE had not significantly changed; the other ten patients no longer reactors to TDI were also asymptomatic and their PD(20) had become normal. The duration of symptomatic exposure to TDI was the only feature at diagnosis that differentiated patients with persistent TDI airway hyper-responsiveness and asthma from those who were no longer responsive to TDI but still asthmatic and those who were no longer responsive to TDI and no longer asthmatic (4 +/- 1.6; 2.1 +/- 0.8; 0.6 +/- 0.3 years, respectively; p < 0.001). CONCLUSION: our study demonstrates that airway sensitization to TDI and symptoms and functional airway abnormalities of asthma can persist for years after cessation of exposure and may have different outcome. If avoidance of the offending agent takes place within few months after the development of symptoms, remission of asthma and of TDI bronchial hyper-responsiveness can occur, whereas waiting for years makes it too late to cure asthma and, in the end, to reverse specific sensitization. AU - Pisati G AU - Baruffini A AU - Bernabeo F AU - Cerri S AU - Mangili A LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 33 IP - DP - 2007 Jan 01 TI - Occupational asthma and rhinitis in workers from a lasamide production line. PG - 74-78 AB - OBJECTIVES: A wide range of low-molecular-weight agents can cause occupational asthma. The chemical industry is an environment in which numerous hazardous substances are used. Lasamide (2,4-dichloro-5-sulfamoylbenzoic acid) is one of them (along with its precursors). METHODS: Five patients from a lasamide production line with suspected occupational asthma and rhinitis were examined. During the first visit, skin prick tests, total immunoglobulin E (IgE), a nonspecific bronchoprovocation test, and specific bronchoprovocation tests using occupational agents were performed to confirm the diagnosis of allergic diseases. During the follow-up visit (1-3 years after removal from exposure), all of the tests (except the specific bronchoprovocation test) were performed again. RESULTS: At the first hospitalization, the total IgE levels were increased in three patients. In addition, skin prick tests and the nonspecific bronchoprovocation test were positive for three patients. After the specific bronchoprovocation test, serious bronchoconstriction occurred in three patients; symptoms of rhinitis were present in all five patients. Several years after removal from exposure to the occupational agents, normalization (with respect to the parameters followed) was not yet complete for all of the patients. CONCLUSIONS: The process of lasamide production seems to be hazardous and is likely to cause allergic respiratory disease. The prognosis of allergic diseases caused by these products is not very favorable. Allergic symptoms (despite the removal from occupational allergen exposure) persisted even after several years. AU - Klusácková P AU - Lebedová J AU - Pelclová D AU - Salandová J AU - Senholdová Z AU - Navrátil T LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 50 IP - DP - 2007 Jan 01 TI - Blood eosinophils in workers with aluminum potroom asthma are increased to higher levels in non-smokers than in smokers. PG - 443-448 AB - BACKGROUND: Aluminum potroom asthma (PA) has been described in several reports. This study aimed to investigate the association between blood eosinophils and PA. METHODS: In a cross-sectional study, 338 workers were examined as follows: spirometry, blood eosinophils, skin prick test, and work exposure measurements. They also completed a questionnaire on respiratory symptoms, smoking, allergy, and duration of work exposure. RESULTS: The odds ratio for PA was 4.2 (95% confidence interval 1.5-9.7) for workers with eosinophils > or =400 x 10(6) cells/L compared with workers with eosinophils <200 x 10(6) cells/L. In non-smokers, the number of eosinophils was 177 x 10(6) cells/L (P < 0.001) higher among workers with PA than asymptomatic workers, whereas the corresponding difference among current smokers was only 63 x 10(6) cells/L (P = 0.03). CONCLUSIONS: The prevalence of PA was positively associated with blood eosinophils. An attenuation of the blood eosinophil increase was observed in smoking asthmatics, suggesting an immune-modulating effect of smoking. AU - Sjåheim T AU - Kongerud J AU - Søyseth V LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 167 IP - DP - 2007 Jan 01 TI - Secondhand smoke and health-related quality of life in never smokers: results from the SAPALDIA cohort study 2 PG - 2516-2523 AB - BACKGROUND: Although secondhand smoke (SHS) has been linked with various respiratory conditions and symptoms, its association with health-related quality of life (HRQOL) is unknown. METHODS: A cross-sectional study was performed of 2500 never smokers in Switzerland who participated in the Swiss Cohort Study on Air Pollution and Lung Diseases in Adults and completed a 36-Item Short Form Health Survey (SF-36) in 2002. Using linear regression models adjusting for confounders, we measured the association between HRQOL and moderate or high SHS exposure (< or =3 h/d or >3 h/d) compared with no SHS exposure. Data from men and women were analyzed separately and further stratified by source of SHS (home, workplace, and public spaces). RESULTS: After adjustments, SHS was associated with reduced scores in all SF-36 domains. High SHS exposure predicted a greater reduction in HRQOL. Compared with nonexposed women, those with high SHS exposure at home had significantly lower scores on the physical functioning (-7.8, P < .001), role physical (-10.5, P = .02), bodily pain (-9.2, P = .01), and social functioning (-8.1, P = .007) domains. Exposed men had lower scores for the role physical domain (-20.0, P < .001) and a trend toward lower scores in other domains. In women, exposure to SHS at home was associated with a stronger negative effect on HRQOL than at work and in public spaces. CONCLUSIONS: Secondhand smoke is associated with reduced HRQOL, more significantly so in women. Exposure to SHS at home and high levels of exposure are associated with lower SF-36 scores, suggesting a dose-response relationship AU - Bridevaux PO AU - Cornuz J AU - Gaspoz JM AU - Burnand B AU - Ackermann-Liebrich U AU - Schindler C AU - Leuenberger P AU - Rochat T AU - Gerbase MW AU - SAPALDIA Team LA - PT - DEP - TA - Arch Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 80 IP - DP - 2007 Jan 01 TI - A 5-year follow-up study on respiratory disorders and lung function in workers exposed to organic dust from composting plants PG - 306-312 AB - Objectives To evaluate acute and chronic eVects of long-term exposure to organic dust on respiratory disorders and lung function among employees at 41 composting facilities in Germany. Methods A total of 218 compost workers and 66 control subjects were enrolled in the cohort. They were evaluated using a standardized questionnaire, a clinical examination, and spirometric measurements. Changes of symptoms, respiratory disorders, and lung function were determined in a first survey after 5 years of exposure in 123 compost workers and 48 controls. Exposure measurements were performed at six composting facilities for respirable dust, cultivable microorganisms, and endotoxins. Results Exposure measurements revealed high concentrations of thermo-tolerant thermophilic actinomycetes and filamentous fungi in the bioaerosols at the composting sites. A signifcantly higher job fluctuation was observed among the compost workers compared to control subjects (95 vs. 18; p < 0.05). Compost workers reported a signiWcantly higher prevalence of mucosal membrane irritation (MMI) of the eyes and upper airways than control subjects. Conjunctivitis was diagnosed signiWcantly more often in compost workers. Forced vital capacity in percent of predicted (FVC%) of the non-smoking compost workers declined significantly (-5.4%) during the observation period compared to control subjects. The decline of FVC% in 16 compost workers exceeded 10% of initial values. A significant increase was observed in the number of compost workers suffering from chronic bronchitis (RR = 1.41; 95% CI = 1.28–1.55). Allergic alveolitis was diagnosed clinically in two compost workers. Conclusions The exposure to organic dust at workplaces of composting facilities is associated with adverse acute and chronic respiratory health effects, including MMI, chronic bronchitis, and an accelerated decline of FVC%. The pattern of health effects differs from those at other workplaces with exposures to organic dust possibly due to high concentrations of thermo-tolerant/thermophilic actinomyces and filamentous fungi at composting plants. AU - Bünger J AU - Schappler-Scheele B AU - Hilgers R AU - Hallier E LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 49 IP - DP - 2007 Jan 01 TI - Natural History and Risk Factors of Early Respiratory Responses to Exposure to Cotton Dust in Newly Exposed Workers. PG - 853-861 AB - Objective: A prospective study of newly exposed cotton workers was performed to investigate the natural history of respiratory symptoms and lung function changes. Methods: A total of 157 workers naive to cotton dust exposure were investigated by questionnaire, spirometry, and skin tests. They were examined before employment (baseline) and at the end of the first week, and the first, third, sixth, and 12th month after starting work. Acute airway response was defined as either a cross–first-shift or a cross-week fall in forced expiratory volume in one second (FEV1). The longitudinal change of lung function over the year was also calculated. Five hundred seventy-two personal dust sampling and 191 endotoxin measurements were performed to assess the exposure. Results: Forty percent of workers reported work-related symptoms in the first week of the study. Smoking, endotoxin, and dust concentrations were risk factors for all work-related symptoms. Acute airway responses were witnessed after immediate exposure. Female status was the only factor found to be predictive of acute airway response. The mean longitudinal fall in FEV1 at 1 year was 65.5 mL (standard error  37.2). Age, early respiratory symptoms, and early fall in cross-week FEV1 were found to predict the 12-month fall in FEV1. Cross–first-shift and cross-week falls in FEV1 reduced in magnitude during the course of the study. Conclusions: This study of workers naive to cotton dust exposure has demonstrated that respiratory symptoms and acute airway responses develop early following first exposure, and a tolerance effect develops in those workers with the continued exposure. Current smoking and increasing exposure predicts the development of work-related lower respiratory tract symptoms, while early symptoms and acute airway changes across the working week predict the longitudinal loss of lung function at 1 year. AU - Nadi B AU - Kalaca S AU - Francis H AU - Fletcher AM AU - Pickering CAC AU - Tumerdem N AU - Cali S AU - Oldham L LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 11 IP - DP - 2007 Jan 01 TI - Occupation in chronic obstructive pulmonary disease and chronic bronchitis: an update PG - 251-257 AB - This review critically evaluates the recent scientific literature relevant to occupational risk factors for chronic obstructive pulmonary disease (COPD) and chronic bronchitis. The 2003 American Thoracic Society statement on the occupational contribution to the burden of airway disease synthesized relevant data on this topic through 1999. Since 2000, 14 separate studies have published values or provide data that allow estimation of the population attributable risk per cent (PAR%) for the proportion of chronic bronchitis or COPD due to work-related factors. Based on data since 2000, the median PAR% value for both chronic bronchitis and COPD is 15%. A number of additional studies have been published that underscore the association between specific occupational exposures and airflow obstruction. In addition, data are emerging that indicate the extent to which COPD is a cause of work disability; limited data raise the possibility that among those with occupational COPD, disability may be even more prominent. This review supports previous analyses concluding that there is a causal association between work-related exposures and COPD. AU - Blanc PD AU - Torén K LA - PT - DEP - TA - Int J Tuberc Lung Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 49 IP - DP - 2007 Jan 01 TI - Prospective Study of Hydroxocobalamin for Acute Cyanide Poisoning in Smoke Inhalation PG - 794-801 AB - Study objective: To assess outcomes in patients treated with hydroxocobalamin at the fire scene or in the ICU for suspected smoke inhalation-associated cyanide poisoning. Methods: Adult smoke inhalation victims with suspected cyanide poisoning as determined by soot in the face, mouth, or nose or expectorations and neurologic impairment received an intravenous infusion of hydroxocobalamin 5 g (maximum 15 g) at the fire scene or in the ICU in this observational case series conducted from 1987 to 1994. Blood cyanide specimens were collected before administration of hydroxocobalamin. The threshold for cyanide toxicity was predefined as greater than or equal to 39 mol/L. Results: The sample included 69 patients (mean age 49.6 years; 33 men), of whom 39 were comatose. Out-of-hospital deaths were excluded. Fifty of the 69 patients (72%) admitted to the ICU survived after administration of hydroxocobalamin. In the group in which cyanide poisoning was confirmed a posteriori (n42), 67% (28/42) survived after administration of hydroxocobalamin. The most common adverse events were chromaturia (n6), pink or red skin discoloration (n4), hypertension (n3), erythema (n2), and increased blood pressure (n2). No serious adverse events were attributed to hydroxocobalamin. Laboratory tests revealed transient alterations in renal and hepatic function consistent with the critical condition of the patients and mild anemia consistent with progressive hemodilution. Conclusion: Empiric administration of hydroxocobalamin was associated with survival among 67% of patients confirmed a posteriori to have had cyanide poisoning. Hydroxocobalamin was well tolerated irrespective of the presence of cyanide poisoning. Hydroxocobalamin appears to be safe for the outof-hospital treatment of presumptive cyanide poisoning from smoke inhalation. AU - Borron SW AU - Baud FJ AU - Barriot P AU - Imbert M AU - Bismuth C LA - PT - DEP - TA - Ann Emerg Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 27 IP - DP - 2007 Jan 01 TI - Occupational Asthma due to Styrene and Toluene Diisocyanate PG - 70-73 AB - Styrene, a common solvent and volatile organic compound (VOC), is widely used in the factories of plastics, resins, insulators, coatings, and paints. While toluene diisocyanate (TDI) is a well-known causative agent of asthma, styrene has been rarely reported to cause occupational asthma (OA). We report a 50-year-old repairman with OA due to both styrene and TDI in whose job was filling cracks and flattening the surface of vehicles with styrene-containing plaster's putty, followed by spray painting. He suffered from cough, dyspnea durings the work with putty. Hepresented with a 2-year history of asthma and allergic rhinitis. The level of serum total IgE and sputum eosinophils were 2,878 IU/L and 63%, respectively. The methacholine challenge test was positive (PC20 0.59 mg/mL). The bronchoprovacation tests with TDI and styrene showed early and dual responses, respectively. Currently, he is in well- controlled state with the use of a combination of inhaled corticosteroid and long acting beta2-agonist after the avoidance of the causative agents. AU - Ye YM AU - Choi GS AU - Park HJ AU - Kim HA AU - Hur GY AU - Park HS LA - PT - DEP - TA - Korean J Asthma Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 25 IP - DP - 2007 Jan 01 TI - Prevalence of asthma, rhinitis, and eczema in the university population of Phitsanulok, Thailand PG - 127-132 AB - Allergic diseases have been increasing around the world. Many studies in Thai children by ISAAC protocol found an increase in the prevalences of asthma, allergic rhinitis and eczema. Nevertheless very few stud-ies in Thai adults have been done. The objective of this study was to evaluate the prevalence of asthma, allergic rhinitis and eczema among Naresuan University students. Two thousand six hundred and ninety-three students (835 males and 1,858 females) completed ISAAC standardized written and video questionnaires. The age range was 17-53 years (mean 20.0 ± 3.2 years) of which 97.2% were less than 30 years old. The prevalences of allergic rhinitis within the past 12 months and allergic rhinitis with concomitant conjunctivitis were 57.4% and 25.6%. The prevalences of wheeze within the past 12 months and of diagnosed asthma were 12.1% and 9.8%. The eczema prevalence within the past 12 months was 15.0%. Subjects with rhinoconjunctivitis had significantly more wheeze within the past 12 months and more asthma than those without rhinoconjunctivitis (25.8% and 20.1% vs. 7.6% and 6.3%; p < 0.0001, p < 0.0001). The prevalences of wheeze within the past 12 months and asthma in males (14.1%, 11.9%) were significantly higher than in females (11.2%, 8.9%) (p = 0.044 and 0.018, respectively). Simi-lar to a recent study in Bangkok University students, our results showed an increasing trend in allergic diseases in the adult population of Phitsanulok, Northern Thailand, as compared to a study 2 decades ago. ASIAN PACIFIC JOURNAL OF ALLERGY AND IMMUNOLOGY (2007) 25:127-132 AU - Uthaisangsook S LA - PT - DEP - TA - ASIAN PACIFIC JOURNAL OF ALLERGY AND IMMUNOLOGY JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 39 IP - DP - 2007 Jan 01 TI - Suitability of biocompost as a bedding material for stabled horses: respiratory hygiene and management practicalities PG - 129-135 AB - Reasons for performing study: Bedding material in stables has an important influence on air hygiene and information on the suitability of biocompost and wood shavings is incomplete. Objectives: To compare the suitability and benefit of biocompost and wood shavings as bedding in horse stables and to determine key air factors for the evaluation of the potential impact of these materials on respiratory health. Methods: The study was conducted in a naturally ventilated stable with 4 horses. Air hygiene parameters were measured 24 h/day for 7 days with each bedding type: ammonia (NH3), inhalable and respirable dust, endotoxins, colony forming units (CFU) of total mesophilic bacteria, fungi, actinomycetes and thermophilic actinomycetes. Both bedding materials were analysed for general chemical composition, particle size distribution and natural microbial content. The animals' behaviour was monitored by video cameras, and their health and cleanliness status determined by clinical and visual examination. Results: Concentrations of NH3, dust, endoxins and fungi were significantly higher during the monitoring period with wood shavings than with biocompost. In contrast concentrations of mesophilic bacteria, mesophilic actinomycetes and thermophilic actinomycetes microbial pollutants were highest with biocompost. The water content of bulk biocompost was considerably higher than that of wood shavings. Particles =0.4 mm were not detectable in bulk wood shavings. The concentration of thermophilic actinomycetes by weight in raw biocompost was 639 times higher than in raw wood shavings. No significant differences were observed in the time spent by the horses lying down. The biocompost material tended to adhere more intensively to the animals' hair coat. Horses showed no clinical signs indicating any adverse effects of the biocompost material during the trials. Conclusions: Biocompost cannot be recommended as bedding material for horses in stables, because the concentration of thermophilic actinomycetes and other agents that elicit and maintain recurrent airway obstructions was significantly higher with biocompost than with wood shavings. To ensure the well-being of horses, any new bedding material must be tested very carefully before it is introduced to the market. AU - SEEDORFJ AU - SCHRÖDER M AU - KÖHLER L AU - HARTUNG J LA - PT - DEP - TA - Equine Veterinary Journal JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 14 IP - DP - 2007 Jan 01 TI - Hot tub lung mimicking classic acute and chronic hypersensitivity pneumonitis: Two case reports PG - 354-356 AB - Pulmonary disease in otherwise healthy patients can occur by secondary exposure to nontuberculous mycobacteria from hot tubs. The pathology of hot tub lung may be related to an infection, a hypersensitivity reaction or both. Previous reports of hot tub lung have highlighted distinct pathological features that have distinguished this entity from classic hypersensitivity pneumonitis. Two cases of hot tub lung in Ontario, which presented at very different time points in their disease course, are reported; one patient presented more fulminantly with a clinical picture resembling subacute hypersensitivity pneumonitis, and the other presented with chronic disease. Both cases exhibited clinical, radiological and pathological findings closely mimicking classic subacute and chronic hypersensitivity pneumonitis. AU - Verma G AU - Jamieson F AU - Chedore P AU - Hwang D AU - Boerner S AU - Geddie WR AU - Chapman KR AU - Marras TK LA - PT - DEP - TA - Can Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 101 IP - DP - 2007 Jan 01 TI - Occupational exposure and severe pulmonary fibrosis PG - 2207-2212 AB - Background External agents, especially metal and wood dust, are believed to be risk factors for development of idiopathic pulmonary fibrosis (IPF). The aim of this case–control study was to investigate which occupational exposure types are associated with development of severe pulmonary fibrosis (PF), and especially IPF. Methods An extensive postal questionnaire including 30 specific items regarding occupational exposure was completed by 181 patients with severe PF and respiratory failure reported to the Swedish Oxygen Register, among whom 140 were judged as having IPF. The questionnaire was also completed by 757 control subjects. We stratified data for age, sex and smoking and calculated odds ratios (ORs). Results We found increased risk for IPF in men with exposure to birch dust (OR 2.7, 95% confidence interval (95% CI) 1.30–5.65) and hardwood dust (OR 2.7, 95% CI 1.14–6.52). Men also had slightly increased ORs associated with birds. We did not find any increased risk in association with metal dust exposure. Conclusion Exposure for birch and hardwood dust may contribute to the risk for IPF in men. AU - Gustafson T AU - Dahlman-Höglund A AU - Nilsson K AU - Ström K AU - Tornling G AU - Torén K LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 176 IP - DP - 2007 Jan 01 TI - Carbon monoxide poisoning: risk factors for cognitive sequelae and the role of hyperbaric oxygen PG - 491-497 AB - Rationale: Carbon monoxide poisoning is common and causes cognitive sequelae. Hyperbaric oxygen (HBO2) reduces cognitive sequelae incidence, but which patients may benefit from HBO2 is unclear. Objectives: Risk factor determination for 6-wk cognitive sequelae from CO poisoning and risk modification with HBO2. Methods: Patients were from a randomized controlled trial, enrolling acutely CO-poisoned patients more than 15 years of age. Patients eligible but not enrolled in the randomized trial, and not receiving HBO2, were followed during the study interval. In patients not receiving HBO2, we performed univariate analyses including risk factors identified by randomized trial subgroup analyses. A multivariable analysis was performed using univariate results with and without HBO2. Measurements and Main Results: In 163 patients not receiving HBO2, 68 (42%) manifested sequelae. Risk factors for sequelae from subgroup analyses were loss of consciousness, age of 36 years or more, and carboxyhemoglobin levels greater than or equal to 25%. By univariate analyses, risks for sequelae were age of 36 years or more (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.3–4.9; P = 0.005), and exposure intervals greater than or equal to 24 hours (OR, 2.4; 95% CI, 1.2–4.8; P = 0.019). Including 75 patients receiving HBO2, cognitive sequelae was reduced in patients age of 36 years or more (OR, 0.3; 95% CI, 0.2–0.6; P < 0.001). Exposure intervals greater than or equal to 24 hours are an independent risk factor for sequelae (OR, 2.0; 95% CI, 1.0–3.8; P = 0.046). Conclusions: HBO2 oxygen is indicated for patients with acute CO poisoning who are 36 years or older or have exposure intervals greater than or equal to 24 hours. In addition, subgroup analyses support that patients with loss of consciousness or higher carboxyhemoglobin levels warrant HBO2. Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.200701-026OC AU - Weaver LK AU - Valentine KJ AU - Hopkins RO LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 357 IP - DP - 2007 Jan 01 TI - Respiratory Effects of Exposure to Diesel Traffic in Persons with Asthma PG - 2348--2358 AB - BACKGROUND Air pollution from road traffic is a serious health hazard, and people with preexisting respiratory disease may be at increased risk. We investigated the effects of short-term exposure to diesel traffic in people with asthma in an urban, roadside environment. METHODS We recruited 60 adults with either mild or moderate asthma to participate in a randomized, crossover study. Each participant walked for 2 hours along a London street (Oxford Street) and, on a separate occasion, through a nearby park (Hyde Park). We performed detailed real-time exposure, physiological, and immunologic measurements. RESULTS Participants had significantly higher exposures to fine particles (<2.5 µm in aerodynamic diameter), ultrafine particles, elemental carbon, and nitrogen dioxide on Oxford Street than in Hyde Park. Walking for 2 hours on Oxford Street induced asymptomatic but consistent reductions in the forced expiratory volume in 1 second (FEV1) (up to 6.1%) and forced vital capacity (FVC) (up to 5.4%) that were significantly larger than the reductions in FEV1 and FVC after exposure in Hyde Park (P=0.04 and P=0.01, respectively, for the overall effect of exposure, and P<0.005 at some time points). The effects were greater in subjects with moderate asthma than in those with mild asthma. These changes were accompanied by increases in biomarkers of neutrophilic inflammation (sputum myeloperoxidase, 4.24 ng per milliliter after exposure in Hyde Park vs. 24.5 ng per milliliter after exposure on Oxford Street; P=0.05) and airway acidification (maximum decrease in pH, 0.04% after exposure in Hyde Park and 1.9% after exposure on Oxford Street; P=0.003). The changes were associated most consistently with exposures to ultrafine particles and elemental carbon. CONCLUSIONS Our observations serve as a demonstration and explanation of the epidemiologic evidence that associates the degree of traffic exposure with lung function in asthma. AU - McCreanor J AU - Cullinan P AU - Nieuwenhuijsen MJ AU - Stewart-Evans J AU - Malliarou E AU - Jarup L AU - Harrington R AU - Svartengren M AU - Han I-K AU - Ohman-Strickland P AU - Kian Fan Chung KF AU - Zhang J LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 188 IP - DP - 2007 Jan 01 TI - CT Findings of Granulomatous Pneumonitis Secondary to Mycobacterium avium-intracellulare Inhalation: “Hot Tub Lung” PG - 1050-1053 AB - OBJECTIVE. The objective of our study was to describe the CT features of “hot tub lung” caused by exposure to Mycobacterium avium complex (MAC) organisms in contaminated water. MATERIALS AND METHODS. Chart review was performed to identify all patients with a histologic diagnosis of granulomatous pneumonitis and positive cultures for MAC between January 1, 1995, and July 1, 2004. Individuals identified who also had a hot tub were included in the study. Twelve patients, seven females and five males with an average age of 50 years (range, 13-66 years), who had a CT scan were identified. The CT images were reviewed by two thoracic radiologists who assessed the images for the presence of any parenchymal abnormalities, including nodules, areas of ground-glass attenuation, reticular opacities, and air trapping, on expiratory images. When nodules, reticular opacities, areas of ground-glass attenuation, or a combination of these findings was present, the reviewers visually determined the extent of involvement of the lungs using a scale of < 10%, 10-40%, or > 40%. They also recorded the distribution of the involvement both cephalocaudal and transaxial. Decisions were reached by consensus of the reviewers. RESULTS. Nodules were present in 10 (83%) of 12 patients. In eight (80%) of 10 patients, the nodules were diffuse with a centrilobular distribution. In the other two, the nodules were randomly distributed with an upper lung predominance. In five patients the nodules showed areas of ground-glass attenuation, whereas in the other five the nodules were solid. Areas of ground-glass attenuation were present in eight (75%) of 12 patients and were bilateral in all cases. The areas of ground-glass attenuation were diffuse in the cephalocaudal plane with a random distribution in the transaxial plane in seven (88%) of eight cases. In the remaining case, the areas of groundglass attenuation had a lower lung predominance with a random distribution in the transaxial plane. Expiratory images showed evidence of air trapping in all seven cases for which these images were available. In one patient, air trapping was the only abnormality identified. CONCLUSION. The CT findings in patients with hot tub lung include areas of groundglass attenuation, centrilobular nodules, and air trapping on expiratory images. These findings are similar to previously published findings of subacute hypersensitivity pneumonitis. Therefore, in cases in which CT findings suggest hypersensitivity pneumonitis, hot tub lung should also be a diagnostic consideration. AU - Hartman TE AU - Jensen E AU - Tazelaar HD AU - Hanak V AU - Ryu JH LA - PT - DEP - TA - Am J Roent JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 7 IP - DP - 2007 Jan 01 TI - The global distribution of fatal pesticide self-poisoning: systematic review PG - 357 AB - Background Evidence is accumulating that pesticide self-poisoning is one of the most commonly used methods of suicide worldwide, but the magnitude of the problem and the global distribution of these deaths is unknown. Methods We have systematically reviewed the worldwide literature to estimate the number of pesticide suicides in each of the World Health Organisation's six regions and the global burden of fatal self-poisoning with pesticides. We used the following data sources: Medline, EMBASE and psycINFO (1990–2007), papers cited in publications retrieved, the worldwide web (using Google) and our personal collections of papers and books. Our aim was to identify papers enabling us to estimate the proportion of a country's suicides due to pesticide self-poisoning. Results We conservatively estimate that there are 258,234 (plausible range 233,997 to 325,907) deaths from pesticide self-poisoning worldwide each year, accounting for 30% (range 27% to 37%) of suicides globally. Official data from India probably underestimate the incidence of suicides; applying evidence-based corrections to India's official data, our estimate for world suicides using pesticides increases to 371,594 (range 347,357 to 439,267). The proportion of all suicides using pesticides varies from 4% in the European Region to over 50% in the Western Pacific Region but this proportion is not concordant with the volume of pesticides sold in each region; it is the pattern of pesticide use and the toxicity of the products, not the quantity used, that influences the likelihood they will be used in acts of fatal self-harm. Conclusion Pesticide self-poisoning accounts for about one-third of the world's suicides. Epidemiological and toxicological data suggest that many of these deaths might be prevented if (a) the use of pesticides most toxic to humans was restricted, (b) pesticides could be safely stored in rural communities, and (c) the accessibility and quality of care for poisoning could be improved. AU - Gunnell D AU - Eddleston M AU - Phillips MR AU - Konradsen F LA - PT - DEP - TA - BMC Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 47 IP - DP - 2007 Jan 01 TI - Asthme et rhinite d'origine professionnelle causés par le séné [Occupational asthma and rhinithis caused by senna] PG - 371-372 AB - The authors report a case of occupational allergy by senna: a 28-year-old female developped an IgE-mediated asthma and rhinitis caused by senna in a phytopharmaceutical factory: the skin prick test gave a 12-mm wheal reaction, the CAP-RAST Phadia with senna was positive (2.9 kU/L) and in the bronchial challenge test, she exhibited a strong reduction of FEV1 (48 %). AU - Mairesse CL. LA - PT - DEP - TA - Rev Fr Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 29 IP - DP - 2007 Jan 01 TI - Diagnostic value of serum precipitins to mould antigens in active hypersensitivity pneumonitis PG - 706-712 AB - Serum precipitins have a controversial diagnostic value in hypersensitivity pneumonitis (HP). The present authors’ objective was to assess their diagnostic value by developing scores from a panel of specific antigens tested by two techniques (electrosyneresis and double diffusion) to discriminate active HP from other interstitial lung diseases. Consecutive patients presenting with a condition for which HP was considered in the differential diagnosis were included in the study. All patients underwent the same standardised diagnostic procedure, including precipitin tests performed in routine conditions. Clinical manifestations, bronchoalveolar lavage and high-resolution computed tomography defined the presence or absence of HP. Receiver-operating characteristic curves and logistic regression were used to develop the serological scores. A total of 122 patients (including 31 cases of HP) were included in the study. Five antigens from the panel were selected for the serological scores (Absidia corymbifera, Eurotium amstelodami, Wallemia sebi, Saccharopolyspora rectivirgula and mesophilic Streptomyces sp.). Electrosyneresis was more discriminative than the double-diffusion technique. Predictive negative values varied 81–88% and predictive positive values varied 71–75% for prevalence of HP 20–35%. In conclusion, serological scores using a panel of relevant antigens may guide both biological and clinical practice in areas of high prevalence of hypersensitivity pneumonitis. AU - Fenoglio C-M AU - Reboux G AU - Sudre B AU - Mercier M AU - Roussel S AU - Cordier J-F AU - Piarroux R AU - Dalphin J-C LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - IP - DP - 2007 Jan 01 TI - Allergy to Cassava: A New Allergenic Food With Cross-Reactivity to Latex PG - 409-412 AB - Patients who are allergic to latex (Hevea brasiliensis) may exhibit cross-hypersensitivity with foods. We present a case of anaphylaxis due to cassava in a patient suffering from pollinosis, latex allergy, and latex-fruit syndrome. We performed sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting with cassava, avocado, chestnut, banana, kiwi, and latex extracts in order to analyze the protein bands and their molecular weights, and identify immunoglobulin (Ig) E-binding bands. Immunoblot inhibition and enzyme-linked immunosorbent assay (ELISA) inhibition were performed with latex in order to assess cross-reactivity. Cassava exhibited numerous protein bands, 5 of which were IgE-binding (89.75, 46.28, 26.68, 21.38, and 19.49 kd). These cassava IgE-binding bands were 100% inhibited by preincubation of the patient’s serum with latex extract. The ELISA inhibition between latex and cassava was 23%. Our results con? rm cassava as another food with clinical cross-reactivity in patients suffering from latex allergy. AU - Ibero M AU - Castillo MJ AU - Pineda F LA - PT - DEP - TA - J Inv Allergod Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20070101 IS - IS - VI - 11 IP - DP - 2007 Jan 01 TI - Silica, silicosis and tuberculosis PG - 474-484 AB - Exposure to crystalline silica dust causes multiple diseases, but silicosis and silica dust-associated tuberculosis (TB), in particular, are the two diseases that remain high on the list of occupational health priorities in low-income countries and that still occur in some high-income countries. The prevalence of silica-related TB is exacerbated by the human immunodeficiency virus (HIV) epidemic in low-income countries. This review describes the morphology of silica and the variable potency of the different forms. Sources of crystalline silica are discussed, with emphasis on less commonly recognised sources, such as small-scale mining operations and agriculture. Trends in the prevalence of asilicosis are also presented. Although efforts have been made for many years in most countries to reduce silica dust levels, silicosis continues to occur even in young people. The clinical and pathological features and diagnosis of silicosis, with emphasis on chest radiography, are described. The high risk of mycobacterial infection in silica-exposed individuals is given particular attention, with emphasis on control. Treatment for latent TB is recommended. The management of silicosis and silica-associated TB, including monitoring for early detection of disease and surveillance to identify diseasecausing workplaces, are discussed in detail. Prevention of disease, in the form of dust control, remains the focus of the World Health Organization and International Labour Office Global Elimination of Silicosis Campaign. However, clinicians must be aware that silica-associated diseases will be around for many years to come. AU - Rees D AU - Murray J LA - PT - DEP - TA - Int J Tuberc Lung Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 63 IP - DP - 2006 Jan 01 TI - A cross sectional study of the respiratory health of workers handling printing toner dust PG - 244-249 AB - Background Although recent case reports have suggested possible respiratory effects of solid toner dust inhalation, this hypothesis has not been verified by epidemiological studies. Objectives To conduct a cross sectional study to evaluate the association between the biological indices of lung fibrosis and toner dust exposure in an occupational cohort handling solid toner dust in their work life. Methods A total of 600 male toner workers and 212 control subjects were surveyed in terms of their subjective respiratory symptoms, pulmonary functions, and chest radiographic findings. In addition to the exposure history, the current working conditions and personal exposure levels to toner dust were also examined. Results Although subjects handling toner for more than 20 years tended to show a higher prevalence of respiratory symptoms and minimal chest x ray abnormalities, there was no consistent relation between the exposure to toner dust and the biological responses of the respiratory system. Conclusion Deterioration of respiratory health related to toner dust exposure is less likely to occur in current well controlled work environments, especially if the powdered toner is handled carefully. Nonetheless, it is important to collect further epidemiological evidence on the biological effects of toner dust inhalation, preferably using a longitudinal study design. AU - Nakadate T AU - Yamano Y AU - Adachi C AU - Kikuchi Y AU - Nishiwaki Y AU - Nohara M AU - Satoh T AU - Omae K LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 57 IP - DP - 2006 Jan 01 TI - HEALTH RISKS BY BROMOMETHANE AND OTHER TOXIC GASES IN IMPORT CARGO SHIP CONTAINERS PG - 1-4 AB - Containers are increasingly used for the worldwide transport of all kinds of goods. Consistent with national and international regulations on pest controls, a growing proportion of these containers undergoes fumigation. Frequently, the prescribed labelling is missing. According to literature, this situation may lead to accidents and represents a significant health risk to dock workers, inspectors and custom workers. Furthermore, warehouse workers and even consumers may come in contact with these toxic fumigants. Presented measurement data underline this health risks due to bromomethane but also due to other fumigants and, surprisingly, due to further noxious gases. So far, no routine method for sensitive and specific measurements on the spot has been available. The consequences of container fumigation should always be carefully weighed up, and alternatives to pesticides, e.g. heat treatment or atmospheres with reduced oxygen and for high CO2 concentrations should be considered. In addition, stringent international controls as well as sanctions if IMO’s “Recommendations on the safe use of pesticides in ships” are disregarded are required. AU - BAUR X AU - YU F AU - POSCHADEL B AU - VELDMAN W AU - VOS TK LA - PT - DEP - TA - Internat. Marit. Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 100 IP - DP - 2006 Jan 01 TI - Hot tub lung: Presenting features and clinical course of 21 patients PG - 610-615 AB - Background Hot tub lung is an emerging lung disorder associated with exposure to Mycobacterium avium complex organisms contaminating hot tub water. Objectives To define the clinical characteristics and outcome of patients with hot tub lung. Methods Retrospective review of 21 patients diagnosed with hot tub lung at a tertiary medical center over a 7-year period. Results The mean (±sd) age at presentation was 46 (± 15) years; 9 patients were men (43%). All patients described ongoing exposure to hot tubs. The most common referral diagnoses were sarcoidosis, bronchitis, and asthma. Dyspnea and cough were present in all patients, hypoxemia was noted in 10 patients (48%). High-resolution computed tomography of the chest had been performed in 20 patients and demonstrated diffuse centrilobular nodules and/or ground-glass opacities in all patients. M. avium complex was isolated from the hot tub water, respiratory secretions and/or lung tissue in all patients. Bronchoscopic or surgical lung biopsy was obtained in 18 patients and demonstrated bronchiolocentric granulomatous inflammation. With avoidance of exposure, clinical and radiologic improvement was observed in all patients. Additionally, 13 patients (62%) received corticosteroid therapy, 1 (5%) antimycobacterial therapy, 2 (10%) received both, and 5 patients (24%) received no pharmacologic therapy. Conclusions Hot tub lung likely represents hypersensitivity pneumonitis due to inhalational exposure to M. avium complex. Antimycobacterial therapy does not appear to be required in the management of this disease. Although corticosteroids may be helpful in the treatment of severely affected patients, others can be managed by avoidance of additional exposure alone. AU - Hanak V AU - Kalra S AU - Aksamit TR AU - Hartman TE AU - Tazelaar HD AU - Ryu JH LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 44 IP - DP - 2006 Jan 01 TI - Prehospital Administration of hydroxocobalamin for Smoke Inhalation-Associated Cyanide Poisoning: 8 Years of Experience in the Paris Fire Brigade PG - 37-44 AB - Introduction. This article reports the results of a retrospective study of 8 years of experience of the Paris Fire Brigade with the prehospital use of hydroxocobalamin. Methods. The head physician at the Paris Fire Brigade extracted and summarized data from standardized forms completed at the fire scene and, when available, hospital reports to assess survival status and clinical parameters associated with the use of hydroxocobalamin for each patient who received it for smoke inhalation-associated cyanide poisoning from 1995 to 2003. Results. Of the 101 patients administered hydroxocobalamin, 30 survived, 42 died (17 at the fire scene and 25 at the intensive-care unit), and survival status was not known in the remaining 29 patients. Among the 72 patients for whom survival status was known, survival rate was 41.7% after the administration of hydroxocobalamin. Of the 38 patients found in cardiac arrest, 21 had a return of spontaneous circulation during prehospital care. Of the 12 patients who were initially hemodynamically unstable (systolic blood pressure 0 to =90 mmHg), 9 recovered systolic blood pressure an average of 30.6 minutes after the start of hydroxocobalamin infusion. Among nonsedated patients in the sample as a whole (n = 52), mean (SD) Glasgow coma scale score improved from 7.9 (5.4) initially to 8.5 (5.7) after administration of hydroxocobalamin. Among nonsedated patients who were initially neurologically impaired (n = 18), Glasgow coma scale score improved in 9 patients, did not change in 8 patients, and worsened in 1 patient. Two adverse events—red or pink coloration of urine or skin (n = 5) and cutaneous rash (n = 1)—were assessed as being possibly related to hydroxocobalamin. Conclusion. Hydroxocobalamin has a risk:benefit ratio rendering it suitable for prehospital use in the management of acute cyanide poisoning caused by smoke inhalation. AU - Fortin J AU - Giocanti J AU - Ruttimann M AU - and Kowalski J LA - PT - DEP - TA - Clin Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 69 IP - DP - 2006 Jan 01 TI - The respiratory health hazards of volcanic ash: a review for volcanic risk mitigation PG - 1-24 AB - Studies of the respiratory health effects of different types of volcanic ash have been undertaken only in the last 40 years, and mostly since the eruption of Mt. St. Helens in 1980. This review of all published clinical, epidemiological and toxicological studies, and other work known to the authors up to and including 2005, highlights the sparseness of studies on acute health effects after eruptions and the complexity of evaluating the long-term health risk (silicosis, non-specific pneumoconiosis and chronic obstructive pulmonary disease) in populations from prolonged exposure to ash due to persistent eruptive activity. The acute and chronic health effects of volcanic ash depend upon particle size (particularly the proportion of respirable-sized material), mineralogical composition (including the crystalline silica content) and the physico-chemical properties of the surfaces of the ash particles, all of which vary between volcanoes and even eruptions of the same volcano, but adequate information on these key characteristics is not reported for most eruptions. The incidence of acute respiratory symptoms (e.g. asthma, bronchitis) varies greatly after ashfalls, from very few, if any, reported cases to population outbreaks of asthma. The studies are inadequate for excluding increases in acute respiratory mortality after eruptions. Individuals with pre-existing lung disease, including asthma, can be at increased risk of their symptoms being exacerbated after falls of fine ash. A comprehensive risk assessment, including toxicological studies, to determine the long-term risk of silicosis from chronic exposure to volcanic ash, has been undertaken only in the eruptions of Mt. St. Helens (1980), USA, and Soufrière Hills, Montserrat (1995 onwards). In the Soufrière Hills eruption, a long-term silicosis hazard has been identified and sufficient exposure and toxicological information obtained to make a probabilistic risk assessment for the development of silicosis in outdoor workers and the general population. A more systematic approach to multi-disciplinary studies in future eruptions is recommended, including establishing an archive of ash samples and a website containing health advice for the public, together with scientific and medical study guidelines for volcanologists and health-care workers. AU - Horwell CJ AU - Baxter PJ LA - PT - DEP - TA - Bulletin of Volcanology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 99 IP - DP - 2006 Jan 01 TI - Comparison of Early and Late Toxic Effects of Sulfur Mustard in Iranian Veterans PG - 273-282 AB - Sulfur mustard is an alkylating agent that reacts with ocular, respiratory, cutaneous, and bone marrow tissues, resulting in early and late toxic effects. We compare these effects based on the experience in Iranian veterans exposed to the agent during the Iran-Iraq conflict (1983–88). The first clinical manifestations of sulfur mustard poisoning occurred in the eyes with a sensation of grittiness, lacrimation, photophobia, blepharospasm, and corneal ulceration. Respiratory effects appeared as rhinorhea, laryngitis, tracheobronchitis, and dyspnoea. Skin lesions varied from erythema to bullous necrotization. Initial leukocytosis and lymphopenia returned to normal within four weeks in recovered patients, but marked cytopenia with bone marrow failure occurred in fatal cases. Late toxic effects of sulfur mustard were most commonly found in lungs, skin and eyes. Main respiratory complications were chronic obstructive pulmonary disease, bronchiectasis, asthma, large airway narrowing, and pulmonary fibrosis. Late skin lesions were hyperpigmentation, dry skin, atrophy, and hypopigmentation. Fifteen of the severely intoxicated patients were diagnosed with delayed keratitis, having corneal vascularization, thinning, and epithelial defect. Respiratory complications exacerbated over time, while cutaneous and ocular lesions decreased or remained constant. Both the severity and frequency of bronchiectatic lesions increased during long-term follow-up. The only deteriorating cutaneous complication was dry skin. The maximum incidence of delayed kaeratitis was observed 15 to 20 years after initial exposure. Being suggested as the main cause ofassociated with malignancies and recurrent infections, natural killer cells were significantly lower 16 to 20 years after intoxication. You have free access to this content Mahdi Balali-Mood* and Mehrdad Hefazi AU - Balali-Mood M AU - Hefazi M LA - PT - DEP - TA - Basic & Clinical Pharmacology & Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 117 IP - DP - 2006 Jan 01 TI - Exposure to the fish parasite Anisakis causes allergic airway hyperreactivity and dermatitis PG - 1098-1105 AB - Background: Several case reports show allergy and anaphylactic reactions to the fish parasite Anisakis in the domestic and occupational setting. Further research is needed on the prevalence and mechanisms of disease. Objective: To determine the prevalence of Anisakis sensitization and related symptoms among workers in 2 fish processing factories, and to use gene-deficient mice to determine the working mechanisms of Anisakis allergy. Methods: A modified version of the European Community Respiratory Health Survey was used to interview 578 South African fish-processing workers. Sensitization to Anisakis, seafood, and common aeroallergens was determined by skin prick test. Lung function was measured by spirometry and methacholine challenge. Serum eicosapentaenoic acid levels were used as an index of seafood consumption. Sensitized wildtype, IL-4, or IL-4 receptor a–deficient mice were challenged orally with Anisakis extract. Allergic reactions, lung pathology, antibodies, cytokines, mast cell proteases, and histamine were evaluated. Results: The prevalence of sensitization to Anisakis was higher than the prevalence of sensitization to fish (8% vs 6%). Anisakis-specific IgE reactivity was associated with bronchial hyperreactivity and dermatitis, and significantly increased with fish consumption. In mice, Anisakis infective larvae (L3) induced a striking TH2/type 2 response. Food-allergic–type reactions induced by oral challenge with Anisakis extract were absent in IL-4 receptor a knockout mice. Conclusion: Anisakis sensitization in fish-processing workers is associated with allergic symptoms and correlates with high levels of fish consumption. Anisakis proteins induce allergic reactions in sensitized mice by IL-4/IL-13–mediated mechanisms. Clinical implications: Anisakis allergy should be considered in fish-processing workers with allergic symptoms. AU - Nieuwenhuizen N AU - Lopata AL AU - Jeebhay MF AU - De'Broski RH AU - Robins TG AU - Brombacher F LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 174 IP - DP - 2006 Jan 01 TI - Respiratory effects of environmental tobacco exposure are enhanced by bronchial hyperreactivity PG - 1125-1131 AB - RATIONALE: Exposure to environmental tobacco smoke (ETS) is associated with increased reports of respiratory symptoms and reduced lung function, but the long-term effects of ETS are unclear, notably in healthy individuals with bronchial hyperresponsiveness (BHR). OBJECTIVE: To assess the longitudinal effects of ETS exposure on the development of respiratory symptoms and spirometry in subjects with BHR. METHODS: The study population included 1,661 never-smokers from the SAPALDIA (Swiss Study on Air Pollution and Lung Diseases in Adults) cohort, assessed in 1991 (baseline) and 11 yr later, who were symptom-free at baseline. Incident reports of respiratory symptoms and results of spirometry were assessed at the follow-up survey. MAIN RESULTS: Exposure to ETS reported in the two surveys was strongly associated with the development of cough (odds ratio, 2.1; 95% confidence interval, 1.2-3.7; p = 0.01). In subjects with BHR exposed to ETS at both surveys, a trend for strong associations were observed for wheeze, cough, dyspnea, and chronic bronchitis; however, the association reached statistical significance only for the symptom of dyspnea (p < 0.01). Lower FEV1/FVC (mean +/- SD, 72.9 +/- 7.7 vs. 76.8 +/- 6.1%; p < 0.01) and FEF(25-75) (forced expiratory flow, midexpiratory phase)/FVC (mean +/- SD, 56.1 +/- 22.5 vs. 68.1 +/- 21.6%; p < 0.01) were observed in subjects with BHR exposed to ETS compared with nonexposed subjects without BHR. Lower values were found in subjects continuing exposure by the follow-up survey. CONCLUSION: Exposure to ETS was strongly associated with the development of respiratory symptoms in previously asymptomatic subjects with BHR within 11 yr. Furthermore, subjects with underlying BHR had reduced lung function at follow-up, thus suggesting a higher risk for the development of chronic respiratory disease in this subset of the population. AU - Gerbase MW AU - Schindler C AU - Zellweger JP AU - Kunzli N AU - Downs SH AU - Brandli O AU - Schwartz J AU - Frey M AU - Burdet L AU - Rochat T AU - Ackermann-Liebrich U AU - Leuenberger P AU - SAPALDIA Team LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 63 IP - DP - 2006 Jan 01 TI - Primary prevention of latex related sensitisation and occupational asthma: a systematic review PG - 359-364 AB - Methods: Eight primary prevention intervention studies on natural rubber latex (NRL) published since 1990 were identified and reviewed. This is the largest evidence base of primary prevention studies for any occupational asthmagen. Results: Review of this small and largely observational evidence base supports the following evidence statement: Substitution of powdered latex gloves with low protein powder-free NRL gloves or latex-free gloves greatly reduces NRL aeroallergens, NRL sensitisation, and NRL-asthma in healthcare workers. Evidence in support of this statement is ranked SIGN level 2+, referring to well conducted case-control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal. Conclusion: Substitution of powdered latex gloves with low protein powder-free NRL gloves or latex-free gloves promises benefits to both workers’ health and cost and human resource savings for employers. This message should be broadly disseminated beyond the hospital sector to include other healthcare settings (such as aged care facilities) as well as food service and other industries where latex gloves might be used. AU - LaMontagne AD AU - Radi S AU - Elder DS AU - Abramson MJ AU - Sim M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 73 IP - DP - 2006 Jan 01 TI - Hill Walkers’ Lung PG - 836-839 AB - A previously healthy female presented with a 7-week history of dyspnoea on exertion following inhalation of a fluorochemical-based water repellent spray, which was applied to footwear, in the living area that she shared with 8 members of her family while on a hill walking holiday. Clinical examination,serial lung function studies, bronchoalveolar lavage,transbronchial biopsies and high-resolution CT thorax confirmed a sub-acute interstitial pneumonitis, which did not resolve until 15 weeks following exposure. None of her family members were affected despite similar exposure. Interstitial pneumonitis due to inhalation of fluorochemical-based water repellent, though rarely described, usually presents in an acute severe form necessitating immediate therapy and resolves in 1–4 weeks. Pulmonary fibrosis can also occur.Sub-acute interstitial pneumonitis following inhalation of fluorochemical-based water repellent spray should always be considered as a cause of unexplained persistent respiratory symptoms in otherwise healthy individuals involved in outdoor pursuits. AU - Cormican LJ AU - Rees PJ LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 168 IP - DP - 2006 Jan 01 TI - Work-related asthma caused by IgE-verified allergy to methylene di-isocynate PG - 1345-1346 AB - A 44-year-old blacksmith periodically exposed to methylene di-isocynate (MDI) from foaming processes over the course of eight years developed an acute episode of asthma shortly after high exposure to MDI. The respiratory symptoms declined gradually over some months. A year later the specific IgE to MDI was still high (23.92 KU/l), but lung function (FEV1, PEF and FVC) was normal and no bronchial hyperreactivity was observed. He is still working at the same factory under respiratory health surveillance. AU - Rudbeck MG AU - Omland O LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 141 IP - DP - 2006 Jan 01 TI - Sensitization due to gum arabic (Acacia senegal): the cause of occupational allergic asthma or crossreaction to carbohydrates? PG - 51-56 AB - BACKGROUND: A pharmaceutical industry worker was exposed to dust of gum arabic in the tablet coating plant and complained of work-related shortness of breath, chest tightness, runny nose, itching and redness of the eyes. This case was investigated for allergy to gum arabic and compared with a control group. The aim of the study was to identify the IgE-binding components responsible for the work-related symptoms. METHODS: Skin prick tests (SPTs)and specific IgE (sIgE) measurements with environmental and occupational allergens, spirometry and a specific bronchial challenge with gum arabic were performed. One hundred and nineteen control subjects underwent SPT with gum arabic and 43 controls were tested for sIgE. Crossreactivity between gum arabic and horse radish peroxidase was investigated by IgE CAP inhibition. A combined procedure of immunoblotting and periodate treatment was applied to identify the epitope nature of gum arabic. RESULTS: Allergy to gum arabic was shown by SPT, presence of sIgE and a positive bronchial challenge with gum arabic. Sensitization to gum arabic was demonstrated by SPT or sIgE in 7 and 5 controls, respectively. The results of inhibition with horse radish peroxidase, immunoblotting and periodate treatment suggest that gum arabic sIgE of the patient and 1 SPT-positive control subject were directed to the polypeptide chains of gum arabic. In contrast, gum arabic sIgE of the other controls reacted to carbohydrate components. CONCLUSIONS: Sensitization to gum arabic carbohydrate structures occurs casually in atopic patients with pollen sensitization without obvious exposure to gum arabic. This study suggests that allergy to gum arabic is mediated preferentially by IgE antibodies directed to polypeptide chains of gum arabic. AU - Sander I AU - Raulf-Heimsoth M AU - Wiemer K AU - Kespohl S AU - Brüning T AU - Merget R LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 130 IP - DP - 2006 Jan 01 TI - Quality of occupational history assessments in working age adults with newly diagnosed asthma. PG - 455-462 AB - BACKGROUND: Approximately 10 to 15% of new-onset asthma in adults is attributable to occupational exposure. The occupational history is the most important instrument in the diagnosis of occupational asthma (OA). STUDY OBJECTIVES: To assess the quality of occupational histories obtained by health-care providers and to measure the prevalence of clinician-diagnosed OA in a population at elevated risk for OA. SETTING: An academic US Department of Veteran Affairs medical center. STUDY POPULATION: One hundred ninety-seven adults (age range, 18 to 55 years) with newly diagnosed asthma who had completed pulmonary function testing (PFT) and a structured respiratory health questionnaire. MEASUREMENTS: We conducted a structured retrospective comparison of occupational respiratory health history documented by clinicians with data documented by patients on a structured questionnaire. We analyzed PFT results to assess physiologic impairment. We also conducted a structured examination of the actions taken by health-care providers based on their occupational history assessments. RESULTS: Patient self-reports of respiratory exposures and symptoms were common. A job title was documented by one or more clinicians in 75% of patient medical records. Additional occupational history data were charted much less frequently. A diagnosis of OA was made in only 2% of patients. Clinical action to address OA was documented for only one patient. CONCLUSIONS: Clinicians who manage adults with newly diagnosed asthma take incomplete occupational histories. We detected discordance between the occupational exposure histories documented by patients and those charted by clinicians. OA may go unrecognized and possibly undermanaged by clinicians. AU - Shofer S AU - Haus BM AU - Kuschner WG LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 36 IP - DP - 2006 Jan 01 TI - Relationship between neurokinin 2 receptor gene polymorphisms and serum vascular endothelial growth factor levels in patients with toluene diisocyanate-induced asthma. PG - 1153-1160 AB - Among the various pathogenic mechanisms of toluene diisocyanate (TDI)-induced asthma, a contribution from neurogenic inflammation has been suggested. OBJECTIVE: To evaluate neurokinin 2 receptor (NK2R) gene polymorphisms in association with the clinical phenotype of TDI-induced asthma, 70 TDI-induced occupational asthma (TDI-OA)patients, 59 asymptomatic exposed controls (AEC), and 93 unexposed healthy controls (NC) were enrolled in the study. METHODS: Two single-nucleotide polymorphisms (SNPs) of NK2R, 7853G>A (Gly231Glu) and 11 424G>A (Arg375His), were genotyped using a single base extension method. The levels of PC20 methacholine, specific IgE and IgG to TDI-human serum albumin conjugate, and serum vascular endothelial growth factor (VEGF), matrix metalloproteinase-9, and TGF-beta1 were compared according to the NK2R genotypes of the subjects with TDI-OA and AEC. RESULTS: No significant differences in allele, genotype, or haplotype frequencies of these two SNPs were noted among the three groups (P>0.05, respectively). Moreover, subjects with the NK2R 7853GG genotype had higher serum VEGF levels than those with GA or AA among the TDI-exposed workers (P=0.040). CONCLUSION: The NK2R 7853GG genotype may contribute to increased serum VEGF levels, which result in airway inflammation after TDI exposure. AU - Ye YM AU - Kang YM AU - Kim SH AU - Kim CW AU - Kim HR AU - Hong CS AU - Park CS AU - Kim HM AU - Nahm DH AU - Park HS LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 96 IP - DP - 2006 Jan 01 TI - Occupational rhinoconjunctivitis and bronchial asthma due to Acalypha wilkesiana allergy. PG - 719-722 AB - BACKGROUND: Acalypha wilkesiana, or copperleaf, is a plant of the Euphorbiaceae family. Although it is widely known as an outdoor ornamental plant, no cases of A. wilkesiana allergy have been reported to date. OBJECTIVE: To describe a patient with occupational respiratory allergy to A. wilkesiana. METHODS: Extracts from A. wilkesiana leaves and flowers were used for skin prick testing, specific conjunctival and bronchial challenge tests, and in vitro studies. These studies range from A. wilkesiana specific IgE determination to sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunodetection of A. wilkesiana protein bands in patient serum samples and immunoblot inhibition by preincubation with Salsola kali and Chenopodium album pollen extracts. RESULTS: Our patient had positive skin prick test reactions to A. wilkesiana leaf and flower extracts; negative reactions were found in a control group of 20 atopic patients. On immunodetection of A. wilkesiana extracts in patient serum samples, as many as 9 different IgE-binding proteins, with apparent molecular weights of 16 to 86 kDa, were revealed. Preincubation with S. kali and C. album pollen extracts completely inhibited IgE binding to the A. wilkesiana extract. Specific bronchial challenge resulted in a spirometric 30% decline in forced expiratory volume in 1 second with respect to baseline 1 minute after 1:100 (vol/vol) A. wilkesiana extract solution inhalation; 2 atopic controls had negative bronchial challenge test results. CONCLUSION: Acalypha wilkesiana is a new etiologic agent for IgE-mediated occupational respiratory allergy. AU - Pérez E AU - Blanco C AU - Bartolomé B AU - Ortega N AU - Castillo R AU - Dumpiérrez AG AU - Almeida L AU - Carrillo T LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 16 IP - DP - 2006 Jan 01 TI - Occupational asthma due to piperazine citrate. PG - 138-139 AB - BACKGROUND: Piperazine is a secondary heterocyclic amine that may give rise to occupational asthma of uncertain mechanism. METHODS: We report on a 42-year-old woman, a process operator in a chemical factory, who developed work-related symptoms of rhinitis and asthma upon exposure to piperazine citrate. She remained symptom free during holidays and days off work. RESULTS: Skin prick test with piperazine citrate was positive. Specific inhalation challenge with piperazine citrate at a concentration of 5 mg/m3 for 30 minutes elicited an isolated late asthmatic response. Airway hyperresponsiveness to methacholine significantly increased 3 hours after the piperazine challenge, preceding the late asthmatic response. CONCLUSION: This patient had developed occupational asthma caused by piperazine, as confirmed by the specific inhalation challenge test, possibly due to an immunological mechanism. AU - Quirce S AU - Pelta R AU - Sastre J LA - PT - DEP - TA - J Inv Allergod Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 57 IP - DP - 2006 Jan 01 TI - Exercise-induced bronchoconstriction in textile and agricultural workers and in bakers. PG - 379-386 AB - To assess the prevalence and the characteristics of exercise-induced bronchoconstriction (EIB) in subjects occupationally exposed to organic dusts we performed a cross-sectional study including 152 exposed subjects (67 textile workers, 42 agricultural workers, and 43 bakers) and 72 unexposed controls. Evaluation of exposed and unexposed subjects included a questionnaire, skin prick tests to common inhalant allergens, spirometry, and exercise challenge tests (ECT). The EIB prevalence found in textile workers was 8.9 %, in agricultural workers 7.1 %, in bakers 6.9 %, and in office workers 5.5 %. The highest bronchial reaction to exercise was found in ECT-positive agricultural workers (26.1+/-6.9), followed by textile workers (25.2+/-7.4), bakers (23.0+/-5.8), and office workers (21.8+/-4.4). EIB was significantly associated with atopy and positive family history of asthma in all exposed groups. EIB was significantly associated with smoking duration in textile workers (P=0.039) and agricultural workers (P=0.027). Bronchial reaction to exercise was significantly greater in smoking than in non-smoking textile (P=0.045) and agricultural workers (P=0.032). Our data suggest that the combination of daily smoking and workplace exposure to certain types of organic dusts could contribute to EIB development and severity. AU - Minov J AU - Karadzinska-Bislimovska J AU - Vasilevska K AU - Risteska-Kuc S AU - Stoleski S LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 61 IP - DP - 2006 Jan 01 TI - HLA DRB1*15-DPB1*05 haplotype: a susceptible gene marker for isocyanate-induced occupational asthma? PG - 891-894 AB - BACKGROUND: There has been no study for evaluating the associations of human leukocyte antigen (HLA) class I and II alleles with toluene diisocyanate (TDI)-induced asthma in an Asian population. OBJECTIVE: The aim of this study was to investigate a susceptible or protective marker of HLA class I and II alleles in TDI-induced asthma. METHODS: Fifty-five patients with TDI-induced asthma patients (group I) showing positive responses on TDI bronchoprovocation test, 47 asymptomatic exposed subjects (group II) and 95 unexposed healthy nonatopic controls (group III) were enrolled in our study. HLA class I and II genotyping was done by the direct DNA sequencing method. RESULTS: The allelic frequency of C*09 (15.5%) was significantly higher in group I than in group III (6.8%, P = 0.019), but this statistical significance disappeared after correction was made for multiple comparisons. On two-locus and three-locus haplotype analysis, the allelic frequency of HLA DRB1*15-DPB1*05 in group I (10.6%) was significantly higher than that of group II (0%, P = 0.001) and group III (2.5%, P = 0.003). The allelic frequencies of HLA A*02-DRB1*15, A*02-DQB1*06, B*62-C*09 and A*02-DRB1*15-DQB1*06 were significantly higher in group I (8.5%, 10.3%, 8.2% and 6.8%, respectively) than those allelic frequencies of group III (1.3%, P = 0.002; 1.6%, P = 0.001; 0.6%, P < 0.0001; 0%, P < 0.0001, respectively). The allelic frequencies of HLA DQB1*06-DPB1*05 and DRB1*15-DQB1*06-DPB1*05 were significantly higher in group I (16.0% and 10.5%) than those in group II (2.5%, P = 0.001; 0%, P = 0.001), while the frequencies of DRB1*09-DPB1*05 and DRB1*09-DQB1*0303-DPB1*05 were significantly lower in group I (0% and 0%) than those of group II (7.4%, P = 0.004; 7.5%, P = 0.004). These differences remained statistically significant even after the correction for multiple comparisons. CONCLUSIONS: The HLA haplotype DRB1*15-DPB1*05 can be a susceptibility gene marker for the development of TDI-induced asthma among the exposed workers in the Korean population. AU - Kim SH AU - Oh HB AU - Lee KW AU - Shin ES AU - Kim CW AU - Hong CS AU - Nahm DH AU - Park HS LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 61 IP - DP - 2006 Jan 01 TI - A case of occupational asthma and rhinitis caused by Sanyak and Korean ginseng dust PG - 392-393 AB - Sanyak has been used as a food and herbal material for various symptoms in oriental medicine. There have been few reports of occupational asthma induced by herb materials. Until now there has been no account of occupational asthma caused by Korean ginseng. We describe a case of occupational asthma and rhinitis caused by Sanyak (Dioscorea batatas) and Korean ginseng (Panax ginseng), as confirmed by specific inhalation challenge tests. A 29-year-old female patient was presented to the emergency department (ED) of Eulji University Hospital in Daejeon, Korea, for the treatment of dyspnea, wheezing, and cough. The patient had been incidentally exposed to airborne Sanyak dust, during the process of grinding dried Sanyak into powder, 5 min before the onset of symptoms. She had been a merchant of herbal materials for the previous 26 months. Twelve months before her visit, she had been admitted to another hospital and diagnosed with bronchial asthma after the sudden onset of dyspnea following an exposure to airborne ginseng dust. The patient had been suffering from nasal itching, sneezing, rhinorrhea, and nasal obstruction during the spring season for 6 years and had also experienced itching and swelling of the lips, tongue, and throat after ingesting fresh chestnut, sweet potato, and ginseng. The patient was a non-smoker and had no family history of allergic diseases. The patient appeared acutely ill and had tachypnea. Diffuse expiratory wheezes were noted over both lung fields. Arterial blood gas measurements at the ED indicated a pH of 7.414, PaCO2 of 30.8 mmHg, PaO2 of 70.4 mmHg and SaO2 94.6%. The total IgE level was 663.0 IU/ml. After pharmacological treatment, her symptoms resolved in a day. Proteins were extracted from Ginseng and Sanyak, and used for skin-prick tests, inhalation challenge tests, and laboratory studies. The skin-prick testing was expressed as mean wheal diameter/mean erythema diameter (in millimeters): Dermatophagoides pteronyssinus 6.5/23.5 (Allergopharma, Reinbek, Germany); alder tree pollen 5.5/33.5 (Allergopharma); birch tree pollen 3.5/17 (Allergopharma); ginseng (1 : 100 w/v) 3/12; Sanyak (1 : 100 w/v) 3.75/19; histamine 4/17.5; and saline 0/0. Nonspecific and specific challenge tests were performed during her stable state. The methacholine bronchial challenge test revealed a 20% decline of forced expiratory volume in 1 s[FEV1] at the concentration of 0.75 mg/ml. The bronchoprovocation tests showed early asthmatic responses to both Sanyak and ginseng extracts (1 : 1000 and 1 : 100 w/v, respectively). Serum-specific IgE and IgG4 antibodies to Sanyak were detected by enzyme linked immunosorbent assay[ELISA], but there was no specific antibody binding to ginseng. The sodium dodecyl sulphate-polyacrylamide gel electrophoresis[SDS-PAGE] and an IgE-immunoblot, a 35-kDa IgE-binding component was detected in the Sanyak extracts, but no IgE-binding component was noted in the ginseng extract. The ELISA inhibition test, specific IgE binding, and IgG4 binding to Sanyak demonstrated specific, dose-dependent inhibition by Sanyak extracts but not by other control agents. The patient in this study showed the occurrence of occupational asthma induced by Sanyak and Korean ginseng. Although there is a report of occupational asthma being induced by Brazilian ginseng no cases of bronchial asthma caused by Korean ginseng have been previously reported. Brazilian ginseng and Korean ginseng are different plants in terms of taxonomic classification. Brazilian ginseng (Pfaffia paniculata) belongs to the Amaranthaceae family; in contrast, the Korean ginseng (Panax ginseng) belongs to the Araliaceae family. This study, it is suggested that Sanyak-derived allergen can induce IgE-mediated allergic reactions. We were unable to demonstrate specific IgE and IgG4 antibodies to Korean ginseng extract despite the fact that the patient showed a positive bronchial provocation and positive responses to a skin-prick test. Further studies are needed to investigate the pathogenic mechanism of occupational asthma caused by Korean ginseng AU - J.-Y. Lee AU - Y.-D. Lee AU - J.-W. Bahn AU - H.-S. Park LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 96 IP - DP - 2006 Jan 01 TI - Occupational allergic IgE-mediated disease from Boletus edulis: case report PG - 507-51 AB - BACKGROUND: Fungal components can cause allergic symptoms either through inhalation, ingestion or contact. Allergic disease from occupational exposure to Boletus edulis (BE) has only seldom been reported. OBJECTIVES: Report on a female worker who developed respiratory and skin symptoms from occupational exposure to BE in selecting and packing dried mushrooms. She never had symptoms after eating mushrooms. METHODS: An environmental study was performed by personal air samplings and settled dust collection. The RAST-inhibition procedure was used to detect BE allergen potency in collected dust. The subject underwent clinical evaluation, spirometry, skin prick-tests, RAST methacoline and specific inhalation challenge with BE extract. A follow-up study was made 2, 4 and 8 months after the first evaluation and after cessation of exposure. RESULTS: BE allergens were found in the settled dust. Clinical examination showed eczema on the face and hands. The worker had hyper-eosinophilia, bronchial hyper-responsiveness to methacoline, no allergy to common inhalants and foods, positive prick-test and RAST for BE. The specific inhalation challenge induced broncho-constriction. At follow-up we observed a progressive clinical and functional improvement. CONCLUSIONS: Our data show that BE can induce cutaneous and respiratory symptoms from occupational exposure to dried mushroom dusts. The pathogenesis is an IgE-allergy. Our patient had no symptoms from ingestion, which supports the hypothesis that respiratory allergy is due to mushroom antigens that differ from those involved in food-related allergic reactions. Erratum in: Med Lav. 2006 Jan-Feb;97(1):87 _______________________________________ AU - Baruffini A AU - Pisati G AU - Russello M AU - Falagiani P LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 79 IP - DP - 2006 Jan 01 TI - Occupational asthma due to chromium and nickel salts. PG - 483-486 AB - BACKGROUND: Exposure to chromium and nickel salts is a poorly characterized cause of occupational asthma. METHODS: We describe four patients with work-related asthma due to metallic salts. Skin-prick tests to potassium dichromate and nickel sulfate were performed. The patients underwent methacholine inhalation tests and specific inhalation challenges (SIC) with both chromium and nickel salts. RESULTS: Two patients showed positive skin-prick tests to potassium dichromate and nickel sulfate. All patients had bronchial hyperresponsiveness to methacholine, which increased 24 h after SIC with metallic salts. SIC with potassium dichromate elicited late asthmatic reactions (LAR) in two workers, one subject had an early asthmatic reaction (EAR), and another subject showed a dual asthmatic reaction (DAR). SIC with nickel sulfate induced a DAR in one subject and a late asthmatic reaction in another. CONCLUSIONS: Chromium and nickel salts can give rise to occupational asthma in exposed workers. The underlying mechanism may be IgE-mediated in some cases. AU - Fernández-Nieto M AU - Quirce S AU - Carnés J AU - Sastre J LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 117 IP - DP - 2006 Jan 01 TI - Airway inflammation in occupational asthma caused by styrene PG - 248-250 AB - Styrene or phenylethylene has rarely been reported as a causative agent of occupational asthma. This volatile monomer is widely used in the production of polymers, copolymers, and reinforced plastics and is a reactive solvent in the manufacture of unsaturated polyester resins. Styrene is known as an irritant to the skin and mucous membranes and has been associated with dysfunction of the central nervous system. Workers in auto body shops may be exposed to styrene, because they use polyester resins in paints and car putty. A 31-year-old man, a nonatopic and nonsmoker with persistent asthma, was referred for evaluation to the outpatient allergy clinic of our hospital. He had worked as a painter in an auto body shop for 4 years on a regular 8-hour shift during the day. He did not wear any protective equipment. During the last year, he had experienced sneezing, nasal discharge, ocular itching, and nasal stuffiness as well as dyspnea, dry cough, and wheezing when working. Asthma symptoms were more intense at the end of the work shift and at night, and he remained symptom-free during holidays and days off work. He handled paints containing hexamethylene diisocyanate (HDI) and polyester resins and hardeners that included in their composition styrene at a concentration of 10% to 25%, as disclosed by product labels and material data safety sheets. He was evaluated 4 months after he had left his job because of asthma symptoms. After obtaining written informed consent, 3 single-blind specific inhalation challenges (SICs) were performed in a 7-m3 challenge chamber on separate days. This chamber is made of lacquered stainless steel (Telstar Projects SA, Madrid, Spain) and equipped with vacuum exhaust and high-efficiency particle arrest filtration. On visit 1, PC20 was measured, and sputum induction was performed. On visit 2, the patient painted placebo solution (polyol) with a brush onto a cardboard for 5 minutes. Spirometry was performed at 5, 10, 20, 30, 40, and 60 minutes after the inhalation challenge. From that moment, peak expiratory flow and FEV1 were measured hourly with a computerized flowmeter (Amos, Jaeger, Germany) for 24 hours after challenge, respecting sleeping time. On visit 3, the patient underwent a SIC with HDI. Twenty-four hours later, on visit 4, methacholine inhalation test and sputum induction were performed again. Three days later, on visit 5, the patient painted the styrene solution (20 mL) on a cardboard for 4 minutes, and the following day, on visit 6, a methacholine inhalation test and sputum induction were performed. Physical examination, blood tests, and spirometry results were normal. Specific IgE against diisocyanates measured in the patient's serum was negative. Specific IgE against styrene was assayed in duplicate by ELISA, using a concentration of 20 µg/mL and serum dilution series starting from 1:2 as described elsewhere,5 and was also negative. Sputum was induced by hypertonic saline inhalation and processed as previously described (both with and without dithiothreitol).6 Sputum samples were analyzed using flow cytometer scan cytometry (FACSCalibur flow cytometer; Becton Dickinson, San José, Calif). mAbs (Pharmingen, San Diego, Calif) used to identify cells were CD19, CD3, CD4, CD8, CD16, CD45, CCR3 (B and T lymphocytes, neutrophils, and eosinophils), CD63, and CDw125 (activated basophils). At baseline (visit 1), PC20 methacholine was 1 mg/mL. On visit 2 (sham exposure), no significant changes in FEV1 were observed over the next 24 hours. On visit 3, SIC with HDI at a concentration of 15 ppb for 120 minutes elicited no reaction. No significant changes in FEV1, PC20 methacholine, or cell counts in induced sputum were observed 24 hours after the HDI challenge. On visit 5, the styrene challenge elicited an isolated late asthmatic response, with a maximum fall in FEV1 of 22% 11 hours after the provocation test. An increase in sputum eosinophils from 0.02 × 106 to 0.43 × 106 cells/mL and a striking increment of activated basophil counts in induced sputum were observed 24 hours after styrene SIC, but no significant changes were observed in PC20 methacholine. The results of induced sputum analysis by flow cytometry did not vary with or without dithiothreitol. Three subjects with suspected occupational asthma underwent the same challenge protocol with styrene, and no relevant changes in FEV1 or PC20 methacholine were observed. The increase in eosinophil and basophil counts in sputum after styrene SIC in the patient, as well as the negative results obtained with exposure to placebo and HDI, support the specificity of the airway reaction to styrene. A rise in eosinophil counts in sputum greater than 0.26 × 106 cells/mL after SIC or greater than 2% after exposure at work are considered to be clinically significant. An increase in basophil counts in induced sputum has been found in atopic subjects with asthma9 and subjects with occupational asthma10 after SIC. Interestingly, the number of sputum basophils correlated with airway hyperresponsiveness to methacholine.9 AU - Fernández-Nieto M AU - Quirce S AU - Fraj J AU - del Pozo V AU - Seoane C AU - Sastre B AU - Lahoz C AU - Sastre J LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 96 IP - DP - 2006 Jan 01 TI - Occupational allergic rhinoconjunctivitis and asthma to goat and cross-reactivity with cow epithelium. PG - 579-585 AB - BACKGROUND: The development of sensitization and symptoms after the inhalation of epithelial allergens is common. OBJECTIVES: To investigate the allergic response (in vivo and in vitro) of 3 individuals clinically sensitive and occupationally exposed to cow and goat and to evaluate the allergenic cross-reactivity between cow and goat epithelium extracts. METHODS: Three patients--a butcher and 2 doctors in veterinary medicine--were evaluated. These patients reported allergic respiratory symptoms after occupational exposure to goats and cows. Extracts were prepared from epithelia of both animals. All the patients underwent organ-specific allergen challenges with cow and goat extracts. Four nasal and 2 bronchial challenges were conducted following standardized procedures. RESULTS: All 3 patients had positive challenge results with the offending allergen extract. Specific IgE to goat allergens was detected in all patients. Several IgE-binding bands were detected. Inhibition assays (enzyme allergosorbent test and immunoblots) confirmed moderate-to-high cross-reactivity between goat and cow extracts. CONCLUSIONS: We confirm clinical sensitivity and specific IgE binding to goat and cow allergens in occupationally exposed individuals. There was good correlation among the clinical history, exposure, and the laboratory findings. AU - Ferrer A AU - Carnés J AU - Marco FM AU - Andréu C AU - Fernández-Caldas E LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 28 IP - DP - 2006 Jan 01 TI - Three new cases of apparent occupational asthma in swine confinement facility employees. PG - 1281-1282 AB - In a previous issue of the European Respiratory Journal, Dosman et al. 1 reported on four cases of occupational asthma in newly employed workers in the large, recently developed, swine production facilities in Saskatchewan (Canada). All were full-time employees and all developed symptoms suggestive of asthma within a short time of commencing employment. None of the cases had a history of asthma, allergy symptoms or previous exposure to indoor air contaminants of swine confinement facilities. Work in swine buildings has been associated with respiratory symptoms, reductions in mean and across-shift lung function values 2, and increased bronchial responsiveness 3, 4. Asthma has been reported in swine workers, but this has typically occurred in workers with lengthy employment 5, 6. Cases 1–3 in our initial report showed some reaction to skin-prick allergy tests. While forced expiratory volume in one second (FEV1) for case 1 was relatively stable over time, provocation challenge causing a 20% fall in FEV1 (PC20) was reduced for several months following resignation from the swine barn. Case 1 also experienced symptoms requiring removal from the barn during a re-entry challenge. It was speculated that these cases might exhibit a type of occupational asthma, described by Brooks et al. 7, as "not-so-sudden onset" nonallergic asthma resulting from irritant exposure over a number of months. Since the initial study 1, we have encountered three additional cases that have been labelled as cases 5, 6 and 7 (table 1). In contrast to the previous four cases, the cases reported herein are all male. Again, none of the cases had a history of asthma or wheeze and none had reported previous regular occupational exposures in a swine confinement facility. Each of the cases developed symptoms within weeks to months of commencing employment and each has had continued sensitivity to exposures in a swine barn. Case 5 was a 48-yr-old ex-smoker who began working in the swine industry in late 2002. Within 6 months of employment, he began to have respiratory symptoms, which eventually led to a severe episode several months after commencement of work. Pulmonary function showed evidence of mild airways obstruction, but a post-bronchodilator test was not conclusive. He underwent methacholine challenge testing where FEV1 decreased by 18% at 4 mg·mL-1, compatible with a mild increase in airways responsiveness. However, overall PC20 was not calculable because, at 8 mg·mL-1, the decrease in FEV1 was 12%. He exhibited mild skin-prick test reactivity to shellfish and house dust, along with strong reactivity to grain dust. He improved while away from work but continues to work part time at the swine facility. Case 6 was a 47-yr-old ex-smoker. He began working in the swine barns in early 2003. Shortly after commencing work, he developed respiratory symptoms, which improved away from work. After 1 yr, he resigned from work. FEV1 at the clinic was 3.36 L while PC20 was 1.95 mg·mL-1. He had a mild skin-prick test reaction to house dust mite. Since resigning, he continues to be bothered by cough and wheeze, as well as continuing to use fluticasone propionate b.i.d. (GlaxoWellcome Inc., Mississauga, ON, Canada). We have less information for case 7, a 30-yr old who had spent 1 yr working in a swine barn 10 yrs ago. He developed cough and wheeze shortly after commencing, which continued after quitting the barn. Allergy skin-prick testing and pulmonary function testing was not completed. The addition of these new cases to the previous case series 1 leads us to believe that the extent of this condition may be more common than originally suspected, and that some newly employed workers in swine confinement facilities are at risk of developing a form of asthma identified as "not-so-sudden onset asthma" 7. Pre-employment assessments and frequent early employment monitoring of workers may be important tools in addressing early respiratory effects in workers in this industry. Finally, we believe that studying this population would provide further insight into the mechanisms by which occupational asthma occurs among workers in these facili AU - Dosman JA AU - Lawson JA AU - Kirychuk SP AU - Cormier Y AU - Biem J AU - Koehncke N LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 54 IP - DP - 2006 Jan 01 TI - Isolated late asthmatic reaction after exposure to ammonium persulfate in a hairdresser PG - 62-63 AU - Harth V AU - Raulf-Heimsoth M AU - Brüning T AU - Merget R LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 49(5) IP - DP - 2006 Jan 01 TI - Immediate hypersensitivity type of occupational laryngitis in a welder exposed to welding fumes of stainless steel PG - 402-405 AB - BACKGROUND Although upper respiratory symptoms have been reported to occur in welders, occupational laryngitis of immediate hypersensitivity type due to welding fumes of stainless steel has not been previously reported. METHODS Occupational laryngitis was diagnosed based on the specific challenge test combined with the patient's history of occupational exposure and laryngeal symptoms. RESULTS During the past few years, a 50-year-old man had started to experience laryngeal symptoms while welding stainless steel. The welding challenge test with stainless steel caused significant changes in the laryngeal status 30 min after challenge: increased erythema, edema, and hoarseness of the voice. The referent inhalation challenge test by welding mild steel was negative. CONCLUSION The welding of stainless steel should be included in the etiological factors of occupational laryngitis of immediate hypersensitivity type. AU - Hannu T AU - Piipari R AU - Toskala E LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 56(6) IP - DP - 2006 Jan 01 TI - Anaphylaxis and allergic contact urticaria from occupational airborne exposure to HBTU PG - 430-433 AB - We describe a case of anaphylaxis and allergic contact urticaria from occupational airborne exposure to HBTU (o-(benzotriazol-1-yl)-N,N,N',N'-tetramethyluronium hexafluorophosphate), which is a chemical used widely for solid and solution-phase peptide synthesis. Previously, the use of this chemical has been associated with occupational asthma, allergic contact urticaria and allergic contact dermatitis in individual cases, but not with anaphylaxis. Our diagnoses were based on the clinical symptoms, positive skin prick test (SPT) and positive skin provocation test to HBTU. The positive SPT indicates that the anaphylaxis reaction was IgE-mediated. We recommend that in the handling of HBTU, appropriate safety measures should be compulsory, and if work-related symptoms develop, the possibility of anaphylaxis should be considered in advising on appropriate work tasks. AU - Hannu T AU - Alanko K AU - Keskinen H LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 42 IP - DP - 2006 Jan 01 TI - Occupational asthma caused by chromium and nickel PG - 302-306 AB - We report the case of a 40-year-old woman who developed occupational asthma following exposure to chromium and nickel in the nickel-plating section of a metalworks company. Skin prick tests for specific antibodies proved positive for nickel chloride at a concentration of 1 mg/mL and negative for potassium dichromate. The specific bronchial provocation test confirmed the diagnosis of occupational asthma due to exposure to chromium and nickel. The patient presented a late positive reaction to nickel chloride (0.1 mg/mL) and an immediate positive reaction to a 10 mg/mL solution of potassium dichromate. These results indicate a dual response to nickel and chromium in this patient AU - Cruz MJ AU - Costa R AU - Marquilles E AU - Morell F AU - Munoz X LA - PT - DEP - TA - Archivos de Bronconeumologia JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 96 IP - DP - 2006 Jan 01 TI - Occupational asthma related to aescin inhalation PG - 494-496 AB - BACKGROUND: More than 400 agents are recognized as causes of occupational asthma, a work-related disease that can be induced by an immunologic or a nonimmunologic mechanism. OBJECTIVE: To describe a 57-year-old man employed in the pharmaceutical industry who developed bronchial asthma while working with products such as Plantago ovata and aescin, an active ingredient with anti-inflammatory and venotonic properties. METHODS: Various tests were performed, including radiography, total serum IgE titer measurements, skin tests against common pneumoallergens and Plantago species, pulmonary function studies, a methacholine test, and specific inhalation challenge with P. ovata and aescin. RESULTS: The results of these tests, including specific inhalation challenge, confirmed the diagnosis of occupational asthma due to aescin exposure, whereas the results of specific challenge with P. ovata, a known cause of occupational asthma, were negative. CONCLUSIONS: Aescin may represent a new causative agent of occupational asthma in personnel working in the pharmaceutical industry. The mechanism by which aescin can produce asthma is unknown, but analysis of the characteristics of our patient suggests a non-IgE immunologic mechanism, although an irritative mechanism secondary to long-term low-level exposure to aescin, a possible irritant, cannot be ruled out. AU - Munoz X AU - Culebras M AU - Cruz MJ AU - Morell F LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 28 IP - DP - 2006 Jan 01 TI - Healthcare workers with tuberculosis infected during work PG - 1216-1221 AB - The risk for healthcare workers (HCWs) of tuberculosis (TB) attributable to occupational exposure is difficult to determine, as are the conditions contributing to this risk. The objective of the present study was to determine which TB cases among HCWs in the Netherlands were infected during work and to analyse factors which contributed to infection and subsequent disease. The total study population consisted of 101 cases over a 5-yr period. In 67 (66%) subjects the route of infection could be determined by epidemiological and microbiological information. Of these cases, 28 out of 67 (42%) were due to infection at work, 19 (28%) were community acquired, and 20 (30%) were infected abroad. The 28 cases infected at work were subject to an in-depth analysis. Delayed diagnosis of the index case, especially in the elderly patient, was the main cause of patient-to-HCW transmission. In some circumstances, inadequate infection-control measures also contributed to transmission. In conclusion, a high suspicion of tuberculosis by the clinician, adequate infection control measures by hospital authorities, and early identification of latent tuberculosis infection by occupational and public-health specialists are necessary to prevent tuberculosis among healthcare workers. AU - de Vries G AU - Sebek AU - MMGG AU - Lambregts-van Weezenbeek CSB LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 88 IP - DP - 2006 Jan 01 TI - Formaldehyde, 2-Butoxyethanol and 1-tert-Butoxypropan-2-ol PG - 1-439 AB - This is a book published by the world health organisation. Contains some very good information about formaldehyde. Has an extensive section on the uses of formaldehyde and typical exposure levels (pages 50 - 72) and a review of irritant and allergic effects (pages 196 - 205). AU - World Health Organisation IARC Working group on the evaluation of carcinogenic risks to humans LA - PT - DEP - TA - IARC Monographs on the evaluation of carcinogenic JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 34 IP - DP - 2006 Jan 01 TI - Occupational asthma due to acrylates in a graphic arts worker. PG - 32-36 AB - BACKGROUND: Acrylates are used in a wide variety of products such as solvents, adhesives, paints, printing ink, soft contact lenses, porcelain nails, and methacrylates (used by dentists and orthopedists). Currently there are various types of acrylic compounds: acrylates, cyanoacrylates (such as tissue adhesives and home glues), and methacrylates (prostheses and dental and orthopaedic fillings). The sensitization mechanism is unknown, but the allergy is believed to be due to a non-IgE mediated phenomenon, since a late asthmatic response occurs. Various cases of acrylate-induced asthma have been reported, specially in dentists and persons using glues or paints containing this substance. MATERIAL AND METHODS: We present the case of a 52-year-old man who had been working in graphic arts for the previous 7 years. For the previous 2 years he had experienced persistent cough with a sensation of drowning, dyspnea that increased with moderate exertion, and nasal obstruction despite continuous treatment. The symptoms first appeared after an episode of acute respiratory difficulty associated with weight loss, pulmonary infiltrates, and eosinophilia. Peak expiratory flow (PEF) was measured during work and sick leave, and specific bronchial challenge with acrylates was performed in a bronchial chamber. RESULTS: The PEF improved on weekends and sick leave. The challenge test provoked a late asthmatic response and the non-specific bronchial hyperreactivity increased after the test. As well in the sputum samples there was a increase of eosinophil amount AU - Reig RAI AU - Cimarra ALM AU - Robledo ET AU - Fernandez NM AU - Quirce GS AU - Seaone PC LA - PT - DEP - TA - Allergol Immunopathol (Madr) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 114 IP - DP - 2006 Jan 01 TI - Experimental PVC material challenge in subjects with occupational PVC exposure. PG - 1409-1413 AB - Background: Polyvinyl Chloride (PVC) Materials have been linked to asthma in several epidemiologic studies, but the possible causal factors remain unknown. Participants: We challenged 10 subjects experimentally to degraded PVC products under controlled conditions. All of the subjects had previously experienced respiratory symptoms suspected to be caused by this kind of exposure in their work place. Five subjects had doctor-diagnosed asthma. Methods: The subjects were exposed to degraded PVC material in an exposure chamber, a challenge with ceramic tile was used as the control test. We followed exhaled nitric oxide, nasal NO, lung functions, cytokines (tumor necrosis factor-alpha (TNF-alpha),interleukin-4 (IL-4), IL-6, and IL-12) and NO in nasal lavage fluid (NAL) during and after the exposures. We also measured 2-ethylhexanol in exhaled breath samples and NAL. Results: On the morning after the PVC exposure, subjects reported respiratory tract symptoms significantly more often than they did after the control test (50% vs. 0%, respectively; p = 0.029; n = 10). We did not detect any changes in lung functions or levels of exhaled NO, nasal NO, or NO in NAL after PVC challenge compared with the control test. Cytokine levels increased after both exposures, with no statistically significant difference between situations. All of the exhaled breath samples collected during the PVC exposure contained 2- ethylhexanol. Conclusions: PVC flooring challenge can evoke respiratory tract symptoms in exposed subjects. Our results do not support the hypothesis that PVC materials themselves evoke immediate asthmatic reactions. The chamber test used is well suited to this type of exposure study. AU - Tuomainen A AU - Stark H AU - Seuri M AU - Hirvonen MR AU - Linnainmaa M AU - Sieppi A AU - Tukiainen H LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 37 IP - DP - 2006 Jan 01 TI - Control chart for monitoring occupational asthma PG - 17-26 AB - INTRODUCTION: Work-related asthma has become the most prevalent occupational respiratory disease in the developed world. Occupational asthma is thought to affect 5%-10% of people worldwide. The first step in the diagnosis of occupational asthma is to establish work-relatedness. Although considerable research has been conducted in the area of occupational asthma, no simple, effective, and statistically sound method has been developed that can be used as an initial step to effectively identify the workers at risk for occupational asthma. The purpose of this research was to investigate whether Shewhart control chart method can be used as an effective method to detect occupational asthma. METHOD: Forty-five workers who completed the study and provided usable peak expiratory flow (a lung function marker) recordings while at work and away from work were included in this study. Control charts were developed using Shewhart's Method. The lower control limit of at work control chart (LCL(W)) was compared to each subject's Personal Best (PB) value. RESULTS: Reviewing the results of this comparison showed LCL(W)<60% PB to have a sensitivity of 85.71%, specificity of 87.50%, and an error rate of 13.33%. When the subjects suspected for false positive and false negative diagnoses were identified, the test produced a sensitivity of 95.24%, a specificity of 95.83% and an error rate of 4.44%. CONCLUSIONS: Our results were as good as, and in some cases better than, published clinical guidelines. IMPACT ON INDUSTRY: Our research showed that the control chart method is an effective, simple, and inexpensive tool for early intervention in workers suspected for occupational asthma. AU - Hayati F AU - Maghsoodloo S AU - Devivo MJ AU - Carnahan BJ. LA - PT - DEP - TA - Journal of Safety Research JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 117 IP - DP - 2006 Jan 01 TI - Ortho-phthalaldehyde-induced anaphylaxis after laryngoscopy. PG - 1500-1501 AB - AU - Suzukawa M AU - Yamaguchi M AU - Komiya A AU - Kimura M AU - Nito T AU - Yamamoto K. LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 48 IP - DP - 2006 Jan 01 TI - Longitudinal Limits of Normal Decline in Lung Function in an Individual PG - 625-634 AB - Objectives: The objectives of this study were to propose a method of calculating longitudinal limits of normal decline (LND) in forced expiratory volume in 1 second to identify individuals with an excessive decline in lung function and to compare the method with other published LND methods. Methods: We used longitudinal data from 11 workplace-based spirometric monitoring programs conducted from 1987 to 2001 on 12,729 workers to evaluate effectiveness of each LND method in identifying a true excessive decline in forced expiratory volume in 1 second defined using two criteria: slope >60 mL/year or >90 mL/year estimated over 5 or more years of follow up. Results: In comparison to the LND proposed by the American College of Occupational and Environmental Medicine, the proposed method had 5.0 to 2.7 times higher sensitivity over years 1 through 5 for the >60-mL/yr criterion. Conclusions: The proposed LND method was more effective than the other methods for identifying excessive declines. AU - Hnizdo E. Sircar K. Glindmeyer H AU - Petsonk E LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 11 IP - DP - 2006 Jan 01 TI - Inflammatory subtypes in asthma: Assessment and identification using induced sputum PG - 54-61 AB - Objective: The authors sought to investigate the detection of non-eosinophilic asthma using induced sputum. Although this is an important subtype of clinical asthma, its recognition is not standardized. Methods: Adult non-smokers with asthma and healthy controls underwent sputum induction and hypertonic saline challenge. Non-eosinophilic asthma was defined as symptomatic asthma with normal sputum eosinophil counts. The normal range for sputum eosinophil count was determined using the 95th percentile from the healthy control group as a cut-off point. Results: The recognition of non-eosinophilic asthma using eosinophil proportion was in agreement with a definition based on absolute eosinophil count (kappa 0.67). Non-eosinophilic asthma was a stable subtype over both the short term (4 weeks) and longer term (5 years, kappa 0.77). Airway inflammation in asthma could be categorized into four inflammatory subtypes based on sputum eosinophil and neutrophil proportions. These subtypes were neutrophilic asthma, eosinophilic asthma, mixed granulocytic asthma and paucigranulocytic asthma. Subjects with increased neutrophils (neutrophilic asthma and mixed granulocytic asthma) were older and had an increased total cell count and cell viability compared with other subtypes. Conclusion: Induced sputum eosinophil proportion is a good discriminator for eosinophilic asthma, providing a reproducible definition of a homogenous group. The remaining non-eosinophilic subjects are heterogeneous and can be further classified based on the presence of neutrophils. These inflammatory subtypes have important implications for the investigation and characterization of airway inflammation in asthma. AU - Simpson JL AU - Scott R AU - Boyle MJ AU - Gibson PG LA - PT - DEP - TA - Respirology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 368 IP - DP - 2006 Jan 01 TI - Asthma: defining of the persistent adult phenotypes PG - 804-813 AB - The common disease asthma is probably not a single disease, but rather a complex of multiple, separate syndromes that overlap. Although clinicians have recognised these different phenotypes for many years, they have remained poorly characterised, with little known about the underlying pathobiology contributing to them. Development of targeted therapies for asthma, and phenotype-specific clinical trials have raised interest in these phenotypes. Improved understanding of these phenotypes in complex diseases such as asthma will also improve our ability to link specific genotypes to their associated disease, which should help development of biomarkers. However, there is no standardised method to define asthma phenotypes. This Review analyses some of the methods that have been used to define asthma phenotypes and proposes an integrated method of classification to improve our understanding of these phenotypes. AU - Wenzel SE LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 124 IP - DP - 2006 Jan 01 TI - TRPA1 Mediates the Inflammatory Actions of Environmental Irritants and Proalgesic Agents PG - 1269-1282 AB - TRPA1 is an excitatory ion channel targeted by pungent irritants from mustard and garlic. TRPA1 has been proposed to function in diverse sensory processes, including thermal (cold) nociception, hearing, and inflammatory pain. Using TRPA1-deficient mice, we now show that this channel is the sole target through which mustard oil and garlic activate primary afferent nociceptors to produce inflammatory pain. TRPA1 is also targeted by environmental irritants, such as acrolein, that account for toxic and inflammatoryactions of tear gas, vehicle exhaust, and metabolic byproducts of chemotherapeutic agents. TRPA1-deficient mice display normal cold sensitivity and unimpaired auditory function, suggesting that this channel is not required for the initial detection of noxious cold or sound. However, TRPA1-deficient mice exhibit pronounced deficits in bradykinin-evoked nociceptor excitation and pain hypersensitivity. Thus, TRPA1 is an important component of the transduction machinery through which environmental irritants and endogenous proalgesic agents depolarize nociceptors to elicit inflammatory pain. AU - Bautista DM AU - Jordt S AU - Nikai T AU - Tsuruda PR AU - Read AJ AU - Poblete J AU - Yamoah EN AU - Basbaum AI AU - Julius D LA - PT - DEP - TA - Cell JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 118 IP - DP - 2006 Jan 01 TI - Do asthma and allergy influence subsequent pet keeping? An analysis of childhood and adulthood. PG - 691-698 AB - BACKGROUND: Asthma and allergy might influence the choice of keeping pets, leading to apparent protective effects of pets on allergic disease. OBJECTIVE: We investigated the effects of asthma and allergy on subsequent pet keeping in childhood and adulthood. METHODS: Information about asthma and pet keeping at ages 0 to 4, 5 to 15, 20 to 44, and 26 to 56 years was provided by 9812 subjects participating in the 9-year follow-up of the European Community Respiratory Health Survey. RESULTS: In childhood asthma debut at younger than 5 years was associated with less cat keeping at 5 to 15 years (odds ratio [OR], 0.60; 95% CI, 0.44-0.82), an effect only observed when the parents did not have asthma or allergy (P(interaction) = .045). Childhood asthma did not influence adult pet ownership, unless there were adult symptoms. Adults less often acquired cats at follow-up if they had 3 or more asthma symptoms (OR, 0.78; 95% CI, 0.64-0.95), were taking asthma medication (OR, 0.48; 95% CI, 0.31-0.74), had hay fever (OR, 0.75; 95% CI, 0.62-0.91), had atopy (OR, 0.75; 95% CI, 0.61-0.91), or had specific IgE to cat (OR, 0.57; 95% CI, 0.39-0.82) at baseline. Adults who already had pets usually continued keeping the same type of pet, except that the presence of 3 or more asthma symptoms was associated with less subsequent dog keeping (OR, 0.69; 95% CI, 0.53-0.89). Pet removal between surveys to reduce allergen was reported by 4.7%. CONCLUSION: Selective avoidance subsequent to asthma or allergy was observed for childhood cat keeping and adult cat acquisition. Avoidance would produce an apparent protective effect of cats on childhood asthma (large OR, 0.83). Avoidance was generally not observed for dogs or birds. CLINICAL IMPLICATIONS: A part of the protective effects of childhood cats on asthma and allergy can be attributed to selective avoidance AU - Svanes C AU - Zock JP AU - Antó J AU - Dharmage S AU - Norbäck D AU - Wjst M AU - Heinrich J AU - Jarvis D AU - de Marco R AU - Plana E AU - Raherison C AU - Sunyer J LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 48 IP - DP - 2006 Jan 01 TI - A Case of Occupational Bronchial Asthma and Contact Dermatitis Caused by ortho-Phthalaldehyde Exposure in a Medical Worker PG - 413-416 AB - endoscopy nurse, symptoms, no challenge or PEF year 2006 volume 48 number 6 page 413 - 416 AU - FUJITA H AU - OGAWA M AU - ENDO Y LA - PT - DEP - TA - J Occup Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 61 IP - DP - 2006 Jan 01 TI - Three cases of occupational asthma induced by thiamphenicol: detection of serum-specific IgE PG - 394-395 AB - Thiamphenicol, a derivative of chloramphenicol,has been widely prescribed in Korea. A few cases of contact dermatitis caused by thiamphenicol have been reported and cross-reactivity with chloramphenicol was suggested (1, 2). To date, there has been no report of rhinitis or asthma caused by thiamphenicol. Although exposure to antibiotics including b-lactams are known to cause asthma in workers in the pharmaceutical industry (3), the pathogenesis of occupational asthma induced by antibiotics still remains unclear. This is the first case of occupational asthma and rhinitis caused by thiamphenicol inhalation in which both immunoglobulin-E (IgE)-mediated and non-non-IgE-mediated responses were at work. AU - Ye Y-M AU - Kim H-M AU - Suh C-H AU - Nahm D-H AU - Park H-S LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 48 IP - DP - 2006 Jan 01 TI - A case of occupational asthma induced by falcata wood (Albizia falcataria). PG - 392-395 AU - Tomioka AU - K AU - Kumagai AU - S AU - Kameda AU - M AU - Kataoka Y LA - PT - DEP - TA - J Occupational Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 16 IP - DP - 2006 Jan 01 TI - Occupational Rhinitis and Asthma due to Cedroarana (Cedrelinga catenaeformis Ducke) Wood Dust Allergy PG - 385-387 AB - We describe a case of occupational rhinitis and asthma in a 46-year-old carpenter who presented nasal and bronchial symptoms after cedrorana (Cedrelinga catenaeformis Ducke) wood dust exposure. Skin prick tests with a battery of common allergens and different kinds of wood, were positive to cedrorana and grass pollen and negative to the other wood extracts. Nasal provocation and exposure challenge tests with Cedrorana wood dust also gave a positive reaction. IgE-immunoblotting showed two bands of 45 and 78 kDa respectively. This is the first reported case of occupational rhinitis and asthma due to Cedrorana wood dust where an IgE mediated mechanism has been found. Resumen. Describimos un caso de rinitis y asma ocupacional en un carpintero de 46 años de edad que presentaba síntomas nasales y bronquiales tras la exposición al polvo de madera de Cedrorana (Cedrelinga catenaeformis Ducke). Las pruebas cutáneas, mediante prick-test, con una batería de alérgenos comunes y distintos extractos de madera,fueron positivas frente al extracto de Cedrorana y al polen de gramíneas, siendo negativas para el resto de las maderas. La provocación nasal y el test de exposición con el polvo de madera de Cedrorana fueron positivos. El Inmunoblotting reveló dos bandas de 45 y 78 kDa respectivamente. Este es el primer caso descrito de rinitis y asma ocupacional debido al polvo de madera de Cedrorana, donde se ha encontrado un mecanismo mediado por IgE. AU - Eire MÁ AU - Pineda F AU - Losada SV AU - de la Cuesta CG AU - Villalva MM LA - PT - DEP - TA - J Inv Allergod Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 55 IP - DP - 2006 Jan 01 TI - A case of chrome asthma induced by exposure to the stone cutter dust PG - 1556-1561 AB - The case of a forty-six year old, male patient with asthma caused by exposure to dust containing chrome is presented. When the patient was nineteen years old, he started working as a stonemason in a factory. He cut and ground stone with a stone-cutter to make statues and tombstones. Three years after staring to work, contact dermatitis was observed on his arms and hands. Within six years of work, he suffered from chronic coughing. After eight years, he experienced bronchial asthma attacks with wheezing and dyspnea. He had been exposed to dust for eight years before developing asthma. The symptoms increased gradually. He fell into severe asthma attacks causing unconsciousness and dyspnea. Several common therapies were not effective. The characteristics of his clinical course and occupational history suggested that the asthma must be caused by exposure to dust containing metal generated in the factory. Skin Patch Tests (SPT) were performed for cobalt, copper, iron, chrome, tin, and manganese salt. The result of the SPT indicated a strong positive result for potassium dichromate and positive for chromium sulfate, but did not show any indications in the control or for other metallic salt. Fluorescent X-ray analysis detected that chrome was present in the powder dust under the stone-cutter machine. However, the fluorescent X-ray analysis did not detect chrome in the stone materials. It was suggested that chrome must be contained in the metal dust generated from the steel cutter used to cut off and grind the stone. The metal component in the used cutter edge and the unused cutter edge were analyzed with electro-probe microanalyzer (EPMA). The result revealed that chrome was contained in the used, dull cutter edge and not in the new sharp cutter edge. Thus, the patient had been exposed to the dust containing chrome generated from part of the stainless steel of cutter. He had sensitized to chrome and this had caused the occupational chrome-asthma. AU - Onizuka R AU - Tanabe K AU - Nakayama Y AU - Fukuchi T AU - Nakata K AU - Hiki T LA - PT - DEP - TA - Arerugi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 27 IP - DP - 2006 Jan 01 TI - Do respiratory symptoms predict job choices in teenagers? PG - 774-778 AB - Existing guidelines advise adolescents with asthma and allergies against high-risk occupations. The aim of the current authors' analyses was to investigate the resulting self-selection in a prospective cohort study. The participants of Phase II of the International Study of Asthma and Allergies in Childhood in Germany (aged 9-11 yrs at baseline) were re-contacted after 7 yrs (response rate was 77%) and were asked to complete a questionnaire, which included items on atopic diseases. The subjects were also asked about the type of job they would like to have in the future (preferred job choice). Exposure to agents with potential asthma risk was evaluated using a job exposure matrix. The analyses were restricted to those in school-based vocational training programmes without occupational exposures. A total of 33% of subjects chose jobs with high asthma risk, 23% selected low asthma risk jobs and the remaining adolescents indicated jobs without known asthma risk (reference category). There were no statistically significant associations between asthma, allergic rhinitis or atopic dermatitis and selecting jobs with asthma risk. Participants with allergic rhinitis tended to select high risk jobs less frequently. In conclusion, self-selection into low risk jobs seems to play a minor role in teenagers with asthma or allergies. AU - Radon K AU - Huemmer S AU - Dressel H AU - Windstetter D AU - Weinmayr G AU - Weiland S AU - Riu E AU - Vogelberg C AU - Leupold W AU - von Mutius E AU - Goldberg M AU - Nowak D. LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 102 IP - DP - 2006 Jan 01 TI - Geographical distribution of acute symptoms after a train collision involving epichlorohydrin exposure PG - 46-51 AB - In September 2002, two freight trains collided in a northern German town. The inhabitants were potentially exposed to the probable human carcinogen epichlorohydrin. As no objective data on the level of exposure were available, we aimed to assess the geographical distribution of acute symptoms among local residents and subjects occupationally involved in the accident (e.g., firemen). A random sample of 932 adult local residents and 342 occupationally involved subjects were invited to answer a mail-in questionnaire. The main outcome measures were self-reported acute symptoms potentially associated with combustion products (e.g., irritation of the eyes, nose, or throat) and stress-related nonspecific symptoms. The main location during the first 26 h after the accident served as exposure proxy. For occupationally involved subjects, the time spent at the accident site was also used. The overall prevalence of symptoms potentially associated with combustion products was 9.8% for residents and 25.4% for occupationally involved subjects. After adjustment, subjects whose main location was close to the accident site had an increased risk for such symptoms. Among occupationally involved subjects the risk increased with duration at the accident site. Neither main location nor time at the accident site was significantly associated with non-specific symptoms. We could provide an example for designing and carrying out an epidemiologic study shortly after a local accident with potential public health impact. We could define parts of the population at increased risk for symptoms potentially specific for the exposure under study. AU - Radon K AU - Rosenberger A AU - Ehrenstein V AU - Hoopmann M AU - Basting I AU - Tödt H AU - Reichert J AU - Dressel H AU - Schmid M AU - Suchenwirth R AU - Nowak D LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 117 IP - DP - 2006 Jan 01 TI - Infection with Syphacia obvelata (pinworm) induces protective Th2 immune responses and influences ovalbumin-induced allergic reactions PG - 1098-1105 AB - Infections with pinworms are common in rodent animal facilities. In this study, we show the consequence of an outbreak in a transgenic barrier facility of infection by Syphacia obvelata, a murine pinworm gastrointestinal nematode. Immune responses were defined in experimental infection studies with BALB/c mice. Infection with S. obvelata induced a transient Th2-type immune response with elevated interleukin 4 (IL-4), IL-5, and IL-13 cytokine production and parasite-specific immunoglobulin G1 (IgG1). In contrast, BALB/c mice deficient in IL-13, IL-4/13, or the IL-4 receptor alpha chain showed chronic disease, with a >100-fold higher parasite burden, increased gamma interferon production, parasite-specific IgG2b, and a default Th2 response. Interestingly, infected IL-4-/- BALB/c mice showed only slightly elevated parasite burdens compared to the control mice, suggesting that IL-13 plays the dominant role in the control of S. obvelata. The influence that pinworm infection has on the allergic response to a dietary antigen was found to be important. Helminth-infected mice immunized against ovalbumin (Ova) elicited more severe anaphylactic shock with reduced Ova-specific IL-4 and IL-5 than did noninfected controls, demonstrating that S. obvelata infection is able to influence nonrelated laboratory experiments. The latter outcome highlights the importance of maintaining mice for use as experimental models under pinworm-free conditions. AU - Nieuwenhuizen N AU - Lopata AL AU - Jeebhay MF AU - Herbert DR AU - Robins TG AU - Brombacher F LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 56 IP - DP - 2006 Jan 01 TI - An outbreak of extrinsic alveolitis at a car engine plant PG - 559-565 AB - Background Twelve workers from a car engine-manufacturing plant presented with extrinsic allergic alveolitis (EAA), with heterogeneous clinical, radiological and pathological findings. They were exposed to metalworking fluids (MWF) that cooled, lubricated and cleaned the machines. Methods They were characterized by history, examination, lung function testing, radiology, bronchoscopic lavage, lung biopsy and serology. Sera were tested for precipitins to a crude extract of used MWF and to reference cultures of bacteria suspected to be implicated. Results All were males and none were current smokers. All had dyspnoea, many had weight loss and cough, but only half had influenza-like symptoms. Only half had auscultatory crackles. Five had peak flow variability, four with an occupational component. There was overall restrictive spirometry, decreased lung volumes and reduced gas transfers. Ten had radiological evidence of interstitial lung disease. Seven (of eight) had lymphocytosis on bronchial lavage, including the two with inconclusive radiology. Seven (of 11) had lung biopsies showing inflammatory infiltrates, two with fibrosis and one with granulomas. Three (of 11) had strong positive precipitins to an extract of the used MWF from the plant. Molecular biological analysis of the MWF revealed Acinetobacter and Ochrobactrum. Precipitins to Acinetobacter were detected in seven of 11 workers tested (and four of 11 control workers). Precipitins to Ochrobactrum were detected in three of 11 workers tested (and three of 11 control workers). Conclusion This is the largest series reported in Europe of EAA due to an aerosol of microbiologically contaminated MWF in heavy manufacturing industry. AU - Dawkins P AU - Robertson AS AU - Robertson W AU - Moore V AU - Reynolds J AU - Langman G AU - Robinson E AU - Harris-Roberts J AU - Crook B AU - Burge PS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 0 IP - DP - 2006 Jan 01 TI - Occupational Risk Factors and Asthma Among Healthcare Professionals. PG - 0 AB - RATIONALE Recent U.S. data suggest an increased risk of work-related asthma among healthcare workers, yet only a few specific determinants have been elucidated. OBJECTIVES To evaluate associations of asthma prevalence with occupational exposures in a cross-sectional survey of healthcare professionals. METHODS A detailed questionnaire was mailed to a random sample (n=5600) of all Texas physicians, nurses, respiratory therapists and occupational therapists with active licenses in 2003. Information on asthma symptoms and nonoccupational asthma risk factors obtained from the questionnaire was linked to occupational exposures derived through an industry specific job-exposure matrix. MEASUREMENTS Two a priori defined outcomes: a) physician-diagnosed asthma with onset after entry into healthcare ('reported asthma'),and b) 'bronchial hyperresponsiveness-related symptoms',defined through an 8-item symptom-based predictor. MAIN RESULTS Overall response rate was 66%. The final study population consisted of 862 physicians, 941 nurses, 968 occupational therapists and 879 respiratory therapists (n=3650). Reported asthma was associated with medical instrument cleaning (OR,2.22;95%CI,1.34-3.67), general cleaning (OR,2.02;95%CI,1.20-3.40), use of powdered latex gloves between the years 1992 and 2000 (OR,2.17;95%CI,1.27-3.73) and administration of aerosolized medications (OR,1.72;95%CI,1.05-2.83). The risk associated with latex glove use was not apparent after the year 2000. Bronchial hyperresponsiveness-related symptoms were associated with general cleaning (OR,1.63;95%CI,1.21-2.19), aerosolized medication administration (OR,1.40;95%CI,1.06-1.84), use of adhesives on patients (OR,1.65;95%CI, 1.22-2.24) and exposure to a chemical spill (OR,2.02;95%CI,1.28-3.21). CONCLUSIONS The contribution of occupational exposures to asthma in healthcare professionals is not trivial, meriting both implementation of appropriate controls and further study. AU - Delclos GL AU - Gimeno D AU - Arif AA AU - Burau KD AU - Carson A AU - Lusk C AU - Stock T AU - Symanski E AU - Whitehead LW AU - Zock JP AU - Benavides FG AU - Anto JM. LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 61 IP - DP - 2006 Jan 01 TI - Inhaled formaldehyde exposure: effect on bronchial response to mite allergen in sensitized asthma patients PG - 1344-1350 AB - Background: Formaldehyde, an indoor air pollutant, is known to be an irritant and an etiologic factor in occupational asthma. An epidemiologic study suggests that it may also increase the risk of childhood asthma for concentrations above 60 µg/m3. Aim: To evaluate the influence of pre-exposure to low-dose formaldehyde (100 µg/m3 in 30 min according to the World Health Organization's recommended maximum value for indoor environments) on bronchial response to Dermatophagoides pteronyssinus. Method: Nineteen asthmatic subjects were included. Each subject underwent a mite allergen bronchial challenge test immediately after a standardized exposure in a chamber to formaldehyde or air (random order). Induced sputum were collected 24 h before and after mite challenge. Results: After formaldehyde inhalation, patients developed an immediate bronchial response at a significantly lower dose of mite allergen than after air exposure (the geometric mean PD20 for Der p 1 was 34.3 ng after formaldehyde and 45.4 ng after placebo, P = 0.05). The late-phase reaction, expressed as the maximum fall in forced expiratory volume in 1 s (FEV1) from baseline, was significantly higher after formaldehyde (15%vs 11%, P = 0.046). Conclusion: Our study demonstrated that exposure to low levels of formaldehyde significantly enhanced bronchial responsiveness to mite allergen in mite-sensitized subjects with asthma. AU - Casset A AU - Marchand C AU - Purohit A AU - le Calve S AU - Uring-Lambert B AU - Donnay C AU - Meyer P AU - de Blay F LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 36 IP - DP - 2006 Jan 01 TI - The prognosis of occupational asthma due to detergent enzymes: clinical, immunological and employment outcomes PG - 483-488 AB - Background Little is known about the prognosis of occupational asthma induced by high molecular weight proteins. Objective Our objective was to measure the clinical, immunological and employment outcomes of individuals with occupational asthma induced by detergent enzymes. Methods We undertook a workforce-based follow-up study in 35 (78%) of the 45 ex-employees from a single factory with occupational asthma. In each case the diagnosis was supported by evidence of specific sensitization and characteristic changes in peak flow or a positive response to specific bronchial provocation testing. Results This group had left the factory on average 37 months before study. On review 25 (71%) reported chest symptoms during the last month. Compared with when working at the factory, most (86%) reported that their symptoms had improved. Twenty continued to attend their general practitioner for respiratory symptoms and 19 still used asthma medications. Since leaving the factory 16 (46%) and four (11%) had found full-time or part-time employment, respectively; of these 16 found they were paid less than when they worked at the factory. The remaining 15 subjects had not had any paid employment. All but two had positive skin prick tests to one or more three detergent enzymes. The estimated half-life of serum-specific IgE antibodies was 20 months for protease, and 21 months for cellulase and amylase. Conclusions Population-based follow-up studies of the prognosis of occupational asthma are rare but probably avoid the bias in clinic-derived surveys. This study demonstrates that 3 years after the avoidance of exposure with detergent enzymes most patients continue to be troubled by, albeit improved, symptoms and experience difficulty in re-employment. AU - Brant A AU - Zekveld C AU - Welch J AU - Jones AU - M Newman Taylor AJ AU - Cullinan P LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 48 IP - DP - 2006 Jan 01 TI - Impairment in workers with isocyanate-induced occupational asthma and removed from exposure in the province of Quebec between 1985 and 2002 PG - 1093-1098 AB - OBJECTIVE: The objective of this project was to assess both the outcome for patients diagnosed with proven isocyanate-induced occupational asthma (IIOA) by specific inhalation challenge (SIC) and the functional impairment, 2 years after cessation of exposure to isocyanates, using the compensation insurance scale proposed in the province of Quebec. METHODS: We used a retrospective cohort of 233 patients diagnosed in the province of Quebec between 1985 and 2002 and randomly chose 105 of those patients. We kept 89 subjects with complete data at T0 (the time of diagnosis) and 79 were reevaluated at T2, approximately 2 years after their removal from exposure, for final impairment-disability assessment. At each evaluation (T0 and T2), a clinical examination and lung function tests, including spirometry and methacholine challenge, were performed. RESULTS: At T2, 79 of 89 patients were reassessed (89%). The remaining patients were lost to follow up (8) or too unstable to be reassessed for final impairment-disability settlement (2). No statistical difference was observed for spirometry data and antiasthmatic medication use between T0 and T2 (P = 0.11). At T2, 73% of patients were still using short-acting beta2 agonists and 39% inhaled glucocorticoids. A forced expiratory volume in 1 second variation of +/-10% from T0 to T2 occurred in 31 subjects (40%). Forced expiratory volume in 1 second worsened in 14 (18%), remained significantly unchanged in 51 (64%), and improved in 14 (18%). Nonspecific bronchial hyperresponsiveness (BHR) improved in significantly in 19 (24%); the others remained unchanged. Both were not associated with smoking status (P > 0.05). Nonspecific BHR was normalized in nine of 79 (11%) patients. Clinical remission occurred in only four (5%) subjects. The mean impairment-disability score was 21% +/- 13% at 2 years according to the scale used by the Workers' Compensation Board. CONCLUSIONS: These results show the generally poor medical outcome of IIOA and suggest the importance of early detection and withdrawal of the workers from exposure to isocyanates. They also emphasize the need for medical surveillance program and adequate treatment of patients with IIOA. AU - Labrecque M AU - Khemici E AU - Cartier A AU - Malo J-L AU - Turcot J LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 18 IP - DP - 2006 Jan 01 TI - Immediate Hypersensitivity to Common Inhalants. An Investigation of Nasobronchial Allergy Patients in Kolkata, India PG - 114-119 AB - Background Nasobronchial allergic manifestations are highly prevalent in the Kolkata population, resulting in urticaria, allergic rhinitis, and extreme cases of bronchial asthma. Identification of etiologic factor(s) is of primary importance to provide patients with the best possible diagnosis and treatment. Unfortunately, baseline information in this respect from developing countries with poor economies is still fragmentary. Methods/Data base Skin prick tests with 17 common aero-allergens were done on 682 patients with a history of different nasobronchial allergic complaints to evaluate the frequency of immediate hypersensitivity reactions. The influence of age and gender, if any, on allergen sensitivity was also investigated. Results/Conclusion The most common aeroallergens identified so far are house dust followed by cotton, kapok, pollen of Cocos nucifer and Brassica nigra, and two species of house dust mite - Dermatophagoides pteronyssinus and D. farinae. They account for about 74% of nasobronchial allergy in the Kolkata population. The frequency of positive skin reactions was found to be independent of age and gender. AU - Podder S AU - Chowdhury I AU - Das A AU - Gupta SK AU - Saha GK AU - Saha GK LA - PT - DEP - TA - Allergy Clin Immunol Int JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 79(2) IP - DP - 2006 Jan 01 TI - The effects of long-term occupational exposure to dust from herbs PG - 169-75 AU - Golec M LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 105 IP - DP - 2006 Jan 01 TI - Yacht-makers lung: a case of hypersensitivity pneumonitis in yacht manufacturing PG - 47-50 AB - We present a case of hypersensitivity pneumonitis in a 46 year old female working at a yacht manufacturing company. She reported a 2 month history of progressive dyspneoa, chest tightness, and daytime, nocturnal, and exertional cough in temporal relationship to work where she was exposed to chemicals involved in the manufacture of yachts. Treatment with systemic antibiotic therapy, inhaled bronchodilators, and inhaled corticosteroids provided minimal relief of symptoms. Spirometry revealed a restrictive defect and a chest x-ray demonstrated a diffuse interstitial pattern. She improved on oral corticosteroids and with avoidance of her work environment had resolution of her symptoms and normalization of her spirometry. Among the various chemicals the patient was exposed to, the most likely causative agents for her symptoms were dimethyl phthalate and styrene. Although the specific checmical or antigen could not be determined, the history and objections findings are consistent with occupational hypersensitivity pneumonitis. This represents a case of hypersensitivity pneumonitis related to the manufacture of yachts. AU - Volkman KK AU - Merrick JG AU - Zacharisen C LA - PT - DEP - TA - Wisconsin Medical Journal JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 17 IP - DP - 2006 Jan 01 TI - Diagnosing occupational asthma PG - 77-80 AU - Mukherjee R AU - Burge PS LA - PT - DEP - TA - Practice Nursing JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 474 IP - DP - 2006 Jan 01 TI - The true cost of occupational asthma in Great Britain PG - 1-117 AB - • The ‘average’ worker suffering from OA is estimated to lose between 3.5 and just over 4.5 work days per year. A worker with milder or more severe OA is estimated to lose close to 2 and 10 work days per year respectively. • The total number of newly reported cases of OA in Great Britain in 2003 was 631,of which 442 were male workers and 189 were female workers. • The total lifetime costs to society of these new cases of OA are estimated to range from £71.7 to £100.1 million; or about £3.4 to £4.8 million per year over the lifetime of the disease. If comparable numbers of new cases were diagnosed in 2004, 2005, 2006 and so on, this would give rise to additional streams of lifetime costs of similar magnitude. • For male workers the estimated total lifetime costs to society range from £53.6 to £78.0 million, which equates to about £121,000 to £176,000 per worker with OA. • For female workers, the estimated total lifetime costs to society range from £18.1 to £22.1 million, which equates to about £96,000 to £117,000 per worker with OA. • Allowing for the fact that the number of new cases of OA diagnosed in 2003 is under-reported by up to one-third, the total lifetime costs to society could be as high as £95.6 to £133.5 million. • The estimated total lifetime costs to society are made up of costs incurred by the individual, employers and the state (‘taxpayers’). The largest cost burden falls on the individual worker (who incurs about 49% of total costs), followed very closely by taxpayers (who incur about 47% of total costs). In contrast, employers of workers diagnosed with OA in 2003 only incur about 4% of total costs. • There appears, therefore, to be little incentive for employers to reduce the incidence of new cases of OA in Great Britain, despite the fact that significant benefits would accrue to the rest of society: benefits to the state and employees could be as high as £69.7 and £96.3 million over the lifetime of those workers diagnosed with the disease in 2003. • This pattern of cost burdens suggests that employers are imposing a significant ‘external’ cost on the rest of society. AU - Boyd R AU - Cowie H AU - Hurley F AU - Ayres JG LA - PT - DEP - TA - Health and safetty Executive Research Report JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 61 IP - DP - 2006 Jan 01 TI - FEV1 decline in occupational asthma PG - 751-755 AB - Background: In occupational asthma continued workplace exposure to the causative agent is associated with a poor prognosis. However, there is little information available on how rapidly lung function declines in those who continue to be exposed, nor how removal from exposure affects lung function. Methods: We studied FEV1 in 156 consecutive subjects with occupational asthma (87% due to low molecular weight agents) using simple regression analyses to provide estimates of FEV1 decline before and after removal from exposure. Results: In 90 subjects who had FEV1 measurements made over at least a year prior to removal (median 2.9 years), mean rate of FEV1 decline was 100.9 ml per year (standard error 17.7). One year after removal from exposure, FEV1 had improved by 12.3 ml (standard error 31.6). FEV1 declined at an average of 26.6 ml per year (standard error 18ml) in 86 subjects who had measurements over at least one year (median 2.6 years) following removal from exposure. FEV1 decline was not significantly worse in current versus never smokers, nor was it affected by use of inhaled corticosteroids. Conclusion: FEV1 declines rapidly in exposed workers with occupational asthma. Following removal from exposure FEV1 continued to decline but at a slower rate, similar to the rate of decline in healthy adults. AU - Anees W AU - Moore VC AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 27 IP - DP - 2006 Jan 01 TI - Short-term respiratory effects of cleaning exposures in female domestic cleaners PG - 1196-1203 AB - Symptoms of obstructive lung disease in domestic cleaners have been related to the use of bleach and other irritant cleaning products. The short-term effects of cleaning exposures on respiratory symptoms and peak expiratory flow (PEF) were investigated in domestic cleaners with respiratory disorders. In a panel study, 43 female domestic cleaners with a recent history of asthma and/or chronic bronchitis completed a 2-week diary, collecting information on respiratory symptoms, PEF and cleaning exposures. Mixed regression models were used to assess daily changes in symptoms and PEF associated with specific cleaning exposures. The probability of having work-related asthma was individually assessed by a computerised diagnostic system and an occupational asthma expert. Lower respiratory tract symptoms were more common on working days and were predominantly associated with exposure to diluted bleach, degreasing sprays/atomisers and air fresheners. Associations with upper respiratory tract symptoms and PEF were less apparent. Eleven (30%) subjects scored positively for work-related asthma. It is concluded that exposure to certain irritant cleaning products aggravates lower respiratory tract symptoms in female domestic cleaners with asthma or chronic bronchitis. AU - Medina-Ramón M AU - Zock JP AU - Kogevinas M AU - Sunyer J AU - Basagaña X AU - Schwartz J AU - Burge PS AU - Moore V AU - Antó JM LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 63 IP - DP - 2006 Jan 01 TI - Reported occupational respiratory diseases in Catalonia PG - 255-260 AB - Objectives: A voluntary surveillance system was implemented in Catalonia (Spain) to ascertain the feasibility, incidence, and characteristics of occupational respiratory diseases and compare them with those of the compulsory official system. Methods: In 2002, in collaboration with the Occupational and Thoracic Societies of Catalonia, occupational and chest physicians and other specialists were invited to report, on a bimonthly basis, newly diagnosed cases of occupational respiratory diseases. Information requested on each case included diagnosis, age, sex, place of residence, occupation, suspected agent, and physician’s opinion on the likelihood that the condition was work related. Compulsory official system data derived from statistics on work related diseases for possible disability benefits declared by insurance companies, which are responsible for declaring these diseases to the Autonomous Government of Catalonia. Results: Of 142 physicians seeing patients with occupational respiratory diseases approached, 102 (74%) participated. Three hundred and fifty nine cases were reported, of which asthma (48.5%), asbestos related diseases (14.5%), and acute inhalations (12.8%) were the most common. Physicians rated 63% of suspected cases as highly likely, 28% as likely, and 8% as low likelihood. The most frequent suspected agents reported for asthma were isocyanates (15.5%), persulphates (12.1%), and cleaning products (8.6%). Mesothelioma (5.9%) was the most frequent diagnosis among asbestos related diseases. The number of acute inhalations reported was high, with metal industries (26%), cleaning services (22%), and chemical industries (13%) being the most frequently involved. The frequency of occupational respiratory diseases recorded by this voluntary surveillance system was four times higher than that reported by the compulsory official system. Conclusions: The compulsory scheme for reporting occupational lung diseases is seriously underreporting in Catalonia. A surveillance programme based on voluntary reporting by physicians may provide better understanding of the incidence and characteristics of these diseases. Persulphates and cleaning products, besides isocyanates, were the most reported causes of occupational asthma. Metal industries and cleaning services were the occupations most frequently involved in acute inhalations with a remarkably high incidence in our register. AU - Orriols R AU - Costa R AU - Alberti C AU - Castejon J AU - Monso E AU - Panades R AU - Rubira N AU - Zock J-P AU - Members of the Malaltia Ocupacional Respiratoria (MOR) Group LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 61 IP - DP - 2006 Jan 01 TI - A 10 year asthma programme in Finland: major change for the better PG - 663-670 AB - Background A National Asthma Programme was undertaken in Finland from 1994 to 2004 to improve asthma care and prevent an increase in costs. The main goal was to lessen the burden of asthma to individuals and society. Methods The action programme focused on implementation of new knowledge, especially for primary care. The main premise underpinning the campaign was that asthma is an inflammatory disease and requires anti-inflammatory treatment from the outset. The key for implementation was an effective network of asthma-responsible professionals and development of a post hoc evaluation trategy. In 1997 Finnish pharmacies were included in the Pharmacy Programme and in 2002 a Childhood Asthma mini-Programme was launched. Results The incidence of asthma is still increasing, but the burden of asthma has ecreased considerably. The number of hospital days has fallen by 54% from 110 000 in 1993 to 51 000 in 2003, 69% in relation to the number of asthmatics (n = 135 363 and 207 757, respectively), with the trend still ownwards. In 1993, 7212 patients of working age (9% of 80 133 asthmatics) received a disability pension from the Social Insurance Institution compared with 1741 in 2003 (1.5% of 116 067 asthmatics). The absolute decrease was 76%, and 83% in relation to the number of asthmatics. The increase in the cost of asthma (compensation for disability, drugs, hospital care, and outpatient doctor visits) ended: in 1993 the costs were J218 million which had fallen to J213.5 million in 2003. Costs per patient per year have decreased 36% (from J1611 to J1031). Conclusion It is possible to reduce the morbidity of asthma and its impact on ndividuals as well as on society. Improvements would have taken place without the programme, but not of this magnitude. AU - Haahtela T AU - Tuomisto LE AU - Pietinalho A AU - Klaukka T AU - Erhola M AU - Kaila M AU - Nieminen MM AU - Kontula E AU - Laitinen LA LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 28 IP - DP - 2006 Jan 01 TI - 15 Years of SHIELD: a reporting scheme for occupational asthma PG - 245s AB - SHIELD is the Midland Thoracic Society’s Rare Surveillance Scheme for Occupational Asthma in the West Midlands, England, UK (working population 2.2 million). The database is a useful tool to locate outbreaks within a particular field of work and discover causative agents. There have been 1461 notifications of occupational asthma since January 1990. The number of overall referrals peaked in 1990, 1995 and 2004, the latter being mostly due to a large outbreak due to metal working fluid used in the manufacture of car engines; there have been two previous smaller outbreaks in other engineering works. Isocyanates have been the commonest cause of occupational asthma over the last 15 years accounting for an average of 18% of all cases until 2005 when notifications dropped. The number of glutaraldehyde and latex associated occupational asthma cases has now declined, due to better management or removal of the agents. The incidence of colophony has also decreased more recently with the introduction of colophony free solder fluxes. There have been outbreaks due to cobalt in valve manufacture and chrome in a stainless steel foundry. There has been little variation in reports of flour, woods, adhesives, welding fume and other biocides. In summary, although many agents have remained at a background level throughout the last 15 years, we should still be on the look out for new causes and old ones re-inventing themselves. AU - Moore V AU - Robertson A AU - Jaakkola M AU - Pantin C AU - Burge PS LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 28 IP - DP - 2006 Jan 01 TI - Occupational Asthma and allergy to sevoflurane and isoflurane in Anaesthetic staff PG - 245s AB - Isoflurane has caused contact dermatitis in an anaesthetist and dermatitis is common in anaesthetic workers. We report three cases (anaesthetic assistants or nurses) diagnosed with occupational asthma, work-related angioedema or dermatitis to isoflurane and sevoflurane who underwent specific bronchial provocation testing. AU - Vellore AD AU - Drought VJ AU - Tunnicliffe B AU - Moore VC AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 28 IP - DP - 2006 Jan 01 TI - Specific bronchial challenge testing to metal working fluid PG - 245s AB - Last year we reported an outbreak of 80 workers with occupational asthma and 22 with extrinsic allergic alveolitis from a car engine manufacturing plant. The cause was unclear, but aerosols from metal working fluids and washers were postulated, although endotoxin levels and microbial growth was very low. We now report specific bronchial provocation testing in two workers, one with evidence of alveolitis, and one with occupational asthma alone. AU - Vellore AD AU - Moore VC AU - Robertson AS AU - Robertson W AU - Jaakkola MS AU - Burge PS LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 25 IP - DP - 2006 Jan 01 TI - The relationship between perception of breathlessness and magnitude of PEF response in workers with occupational asthma PG - 245s AB - Some workers with occupational asthma appear to tolerate regular falls in lung function better than others. We hypothesise that this relates to their ability to perceive changes in airflow obstruction. Perception of breathlessness was assessed by measuring perceived breathlessness on a visual analogue scale (VAS) 4 times during a methacholine test. The slope of the regression line of percent fall in FEV1 vs. changes in VAS were used to divide 81 workers with objective evidence of occupational asthma (from serial PEF plots) into tertiles of high, intermediate and low perceivers. Changes in airflow obstruction at home and work were assessed using 2-hourly plots of PEF for at least 3 weeks. The Oasys plotter was used to calculate the differences in mean daily PEF and area under the curve for 2-hourly PEF between days at and away from work. Mean diurnal variation in PEF on workdays was also calculated. There was a significant correlation between VAS score and % fall in FEV1 (p=0.015) There was no relationship between the index of perception and baseline FEV1 % predicted, atopy or smoking. High, Intermediate and low perceivers had similar responses to occupational exposure; mean daily work-rest PEF (19;21;16 l/min), area under the 2-hourly PEF curve (268;316;203 l/min/day) and diurnal PEF variation on workdays (15;19;16 %mean). There was no significant correlation between the PEF variables and the perception index when all workers were considered together. Conclusion Perception of breathlessness as assessed during methacholine challenge was unrelated to the magnitude of PEF changes during tolerated work-exposure in a group with occupational asthma. AU - Moore VC AU - Burge CB AU - Shurvinton J AU - Burge PS LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 61 IP - DP - 2006 Jan 01 TI - Occupational asthma from dried flowers of Carthamus tinctorious (safflower) and Achillea millefolium (yarrow) PG - 1239-1240 AB - A 44-year-old woman, non-smoker, with a clinical history of spring seasonal rhinoconjunctivitis and asthma. She had no family history of atopy. For the last 6 years, she had een working temporarily as instructor of personnel making dried flower arrangements (centrepieces and baskets). Since 5 months after her first contact with dried flowers of safflower and yarrow she began to experience rhinitis, asthma and urticaria symptoms in the workplace when she handled these dried flowers. The physical examination was normal. Basal spirometry and chest X-ray was normal. Methacholine inhalation test was positive with a PC20 of 2.5 mg/ml. Total serum IgE was 7.94 kU/l. Skin prick test with common aeroallergens were positive to pollen from Cupressus sempervirens, Olea europaea, Lolium perenne, Salsola kali, Artemisia vulgaris and Parietaria judaica and to cat and dog epithelium. Skin prick test with aqueous extracts from dried flowers were positive to safflower (8 · 5 mm) and yarrow (10 · 7 mm). Specific Inhalation Bronchial Challenge with aqueous extract of safflower (0.625 mg/ml) and yarrow (1.25 mg/ml) elicited an asthmatic response with a fall in FEV1 of 27% and 31% respectively. Specific IgE (EAST) with safflower and yarrow flowers was 1.4 and 0, 9 kU/l respectively. Immunoblotting with safflower flowers revealed several IgE binding bands of 64,61, 47, 45, 41, 21, 18.6, and between 14–15 kDa and with yarrow flowers bands of 51, 21 and 18 kDa. Occupational respiratory symptoms caused by decorative flowers are seldom reported in the literature. Only two dried flowers (Limonium tataricum and Gypsophilia panniculata have been reported as a cause of allergic asthma. Carthamus tinctorius L. (safflower) and Achillea millefolium L. (yarrow) belong to the Compositae family. AU - Compes E AU - Bartolome B AU - Fernandez-Nieto M AU - Sastre J AU - Cuesta J. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 174 IP - DP - 2006 Jan 01 TI - Pulmonary Function after Exposure to the World Trade Center Collapse in the New York City Fire Department PG - 312-319 AB - Rationale: On September 11, 2001, the World Trade Center collapse created an enormous urban disaster site with high levels of airborne pollutants. First responders, rescue and recovery workers, and residents have since reported respiratory symptoms and developed pulmonary function abnormalities. Objectives: To quantify respiratory health effects of World Trade Center exposure in the New York City Fire Department. Measurements: Longitudinal study of pulmonary function in 12,079 New York City Fire Department rescue workers employed on or before 09/11/2001. Between 01/01/1997 and 09/11/2002, 31,994 spirometries were obtained and the FEV1 and FVC were analyzed for differences according to estimated World Trade Center exposure intensity. Adjusted average FEV1 during the first year after 09/11/2001 was compared with the 5 yr before 09/11/2001. Median time between 09/11/2001 and a worker's first spirometry afterwards was 3 mo; 90% were assessed within 5 mo. Main Results: World Trade Center–exposed workers experienced a substantial reduction in adjusted average FEV1 during the year after 09/11/2001 (372 ml; 95% confidence interval, 364–381 ml; p < 0.001) This exposure-related FEV1 decrement equaled 12 yr of aging-related FEV1 decline. Moreover, exposure intensity assessed by initial arrival time at the World Trade Center site correlated linearly with FEV1 reduction in an exposure intensity–response gradient (p = 0.048). Respiratory symptoms also predicted a further FEV1 decrease (p < 0.001). Similar findings were observed for adjusted average FVC. Conclusions: World Trade Center exposure produced a substantial reduction in pulmonary function in New York City Fire Department rescue workers during the first year after 09/11/2001. AU - Banauch GI AU - Hall C AU - Weiden M AU - Cohen HW AU - Aldrich TK AU - Christodoulou V AU - Arcentales N AU - Kelly KJ AU - Prezant DJ LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 63 IP - DP - 2006 Jan 01 TI - Prevalence and risk factors for work related asthma in young adults PG - 694-699 AB - Objectives: To investigate the prevalence and predictors of work related asthma in young adults from the general population. Methods: A total of 1922 subjects randomly selected from a birth cohort 1978/79 in Brazil, aged 23–25 years, completed a respiratory symptoms questionnaire based on the European Community Respiratory Health Survey, and underwent spirometry, bronchial challenge test with methacholine, and skin prick test. For subjects presenting with bronchial hyperresponsiveness, workplace exposure and its relationship with symptoms were assessed by a specific questionnaire and individualised job description to define cases of work related asthma. Main messages Atopy and low educational level are associated with work related asthma. Among young adults in Brazil, prevalence of work related asthma is high (4.2%). Pre-existing aggravated asthma represents one third of cases of work related asthma; occupational asthma, two thirds (or 2.7% prevalence). Young adults could be screened for early onset bronchial hyperresponsiveness as a powerful preventive tool. Results: The prevalence of work related asthma was 4.2% (81 cases): 1.5% (29 cases) were classified as aggravated asthma and 2.7% (52 cases) as occupational asthma. Work related asthma was associated with atopy and education. Lower educational level (1–8 years of schooling) was associated with work related asthma (odds ratio 7.06, 95% CI 3.25 to 15.33). There was no association between work related asthma and smoking, gender, or symptoms of rhinitis. Conclusion: The prevalence of work related asthma was high (4.2%), and was associated with low schooling, probably because of low socioeconomic level. The disease may therefore be a consequence of poverty. AU - Caldeira RD AU - Bettiol H AU - Barbieri MA AU - Terra-Filho J AU - Garcia CA AU - Vianna EO LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 28 IP - DP - 2006 Jan 01 TI - Pine dust, atopy and lung function: a cross-sectional study in sawmill workers PG - 791-798 AB - An increased risk of asthma symptoms has previously been shown in 772 pine sawmill workers. The aim of the current study was to assess the association between dust exposure, lung function and atopy. Subjects with (n = 59) and without (n = 167) asthma symptoms were randomly selected from the previous survey. Lung function and atopy were determined using spirometry and skin-prick tests, respectively. Inhalable dust levels were measured on the same day. The geometric mean dust concentration was 0.52 mg·m-3. Exposure to dry but not to green dust was associated with asthma symptoms. Green dust was associated with atopic sensitisation, particularly against outdoor allergens; no association was found for dry dust. Forced vital capacity, forced expiratory volume in one second and peak expiratory flow were significantly lower in workers exposed to high levels of green dust (-350 mL, -260 mL and -860 mL·s-1, respectively) and dry dust (-230 mL, -190 mL and -850 mL·s-1, respectively). These associations were observed both in subjects with and without asthma symptoms. No associations with cross-shift changes in lung function were found. Exposure to green pine sawdust may be a risk factor for atopy. Both green and dry dust were associated with obstructive as well as restrictive pulmonary effects. AU - Douwes J AU - McLean D AU - Slater T AU - Travier N AU - Cheng S AU - Pearce N LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 89 IP - DP - 2006 Jan 01 TI - Glove allergy and sensitization to natural rubber latex among nursing staff at Srinagarind Hospital, Khon Kaen, Thailand PG - 368-376 AB - BACKGROUND: According to studies from different countries, the prevalence of natural rubber latex (NRL) sensitization in healthcare workers ranges from 2.9 to 17%. The incidence and prevalence of sensitization and allergy to NRL in Thailand is limited to two studies. There is no study among the high risk healthcare workers. OBJECTIVES: 1) To estimate the prevalence of natural rubber latex (NRL) glove allergy and NRL sensitization among nurses; 2) To describe its clinical symptoms. MATERIAL AND METHOD: Included in the present study were 412 nursing and medical record staff. A self-administered questionnaire was used to collect personal biodata and individual allergy histories to NRL products. Skin prick tests (SPTs) with the commercial NRL allergens; Stallergenes, S.A, Fresnes, France, and common environmental allergens, were performed. RESULTS: The questionnaire response rate was 88% (412/470), 93% females. The response rate of SPT was 72% (295/412) (95%CI 67.2, 76.0). The prevalence of NRL glove allergic symptoms and NRL sensitization was 24% (95%CI 19.9, 28.1) and 2% (95%CI 0.4, 3.6), respectively. The mostfrequently reported symptoms among the positive SPT to NRL was angioedema. Five of the six NRL sensitised subjects had had high exposure to NRL. CONCLUSION: NRL sensitization among Thai nursing staff is less prevalent than in healthcare workers in Europe. AU - Chaiear N AU - Jindawong B AU - Boonsawas W AU - Kanchanarach T AU - Sakunkoo P LA - PT - DEP - TA - Journal of the Medical Association of Thailand JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20060101 IS - IS - VI - 61 IP - DP - 2006 Jan 01 TI - Occupational asthma and allergy to sevoflurane and isoflurane in anaesthetic staff PG - 1485-6 AB - Isoflurane has caused contact dermatitis in an anaesthetist (1), and dermatitis is common in anaesthetic workers (2). However, there are no prior reports of occupational asthma. We report three cases with occupational asthma, work-related angioedema or dermatitis to isoflurane (1-chloro-2,2,2- trifluoroethyl difluoromethyl ether) and sevoflurane [fluoromethyl 2,2,2-trifluoro- 1-(trifluoromethyl) ethyl ether] with positive specific bronchial provocation testing. All worked as anaesthetic assistants or nurses in the same hospital. AU - Vellore AD AU - Drought VJ AU - Sherwood-Jones D AU - Tunnicliffe B AU - Moore VC AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 62 IP - DP - 2005 Jan 01 TI - The precision of longitudinal lung function measurements: monitoring and interpretation PG - 695-701 AB - BACKGROUND The efficacy of decision making based on longitudinal spirometric measurements depends critically on the precision of the available data, which is determined by the magnitude of the within-person variation. AIMS Firstly, to describe and investigate two statistical methods-a pairwise estimate of within-person standard deviation s(p) and the reliability coefficient G-for use in the monitoring of precision of longitudinal measurements of forced expiratory volume in one second (FEV1). Secondly, to investigate the effect of longitudinal data precision on the detectable excess rate of decline in FEV1. METHODS The authors "monitored" retrospectively on a yearly basis the magnitude of the within-person variation s(p) and the coefficient G in 11 workplace based spirometric monitoring programmes conducted from 1987 to 2001 on 12 729 workers in various industrial plants. RESULTS The plant-specific mean values s(p) (range 122-166 ml) and G (range 0.88-0.95), averaged over all years of follow up, correlated well with the plant-specific within-person standard deviation s(r) (range 130-177 ml) estimated from all longitudinal data. The correlations were 0.90 for s(p) and 0.68 for G. The average precision of the longitudinal FEV1 measurements affected the duration of follow up needed to identify a "true" excess rate of decline in FEV1 in an individual. CONCLUSIONS The results show that monitoring of longitudinal spirometry data precision (1) allows that data precision can be improved or maintained at levels that allow individuals with a rapid decline to be identified at an earlier age; and (2) attaches a measure of precision to the data on which decision making is based. AU - Hnizdo E AU - Yu L AU - Freyder L AU - Attfield M AU - Lefante J AU - Glindmeyer HW LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 99 IP - DP - 2005 Jan 01 TI - Preventing influenza: an overview of systemic reviews PG - 1341-1349 AU - Van der Wouden JC AU - Bueving HJ AU - Poole P LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 51 IP - DP - 2005 Jan 01 TI - Pulmonary function prediction equations of male gold miners in Ghana PG - 67-71 AB - OBJECTIVES: To determine the reference values and prediction equations for the Ghanaian gold miner and to compare the lung function indices with those working in other parts of Africa. DESIGN: Descriptive study of the lung functions of life-long non smoking underground gold miners Prediction equations and reference values were then derives from best fitting equations and compared with previously published reference equations. SETTING: The study was conducted at the Obuasi gold mini in Ghana. SUBJECTS: Tests were conducted on 1 210 male miners. MAIN OUTCOME MEASURE: To assess the lung functions of the Ghanaian gold miner. RESULTS: The estimated prediction equations were as follows FVC (1) = -4.068 to 0.0210 x age (y) + 0496 x height (cm); FEV1(1) = -2.555 to 0.0210 age (y) +0.0360 x height (cm) and FET(25-75%) = -0.515 to 0.0157 x age (y)+ 0.0249 x height(cm). The closest fitting reference value was that of the European Community for Steel and Coal (ECCS) with a conversion factor (CF) of 0.87. CONCLUSION: The lung function indices of the Ghanaian gold miners are similar to those obtained from other west African countries, but lower than those from the southern and eastern Africa countries. The ECCS equation with a conversion factor of 0.87 fitted best for Ghanaian gold miners. Exposure to gold mine dust did not influence lung functions in this study. AU - Bio FY AU - Sadhra S AU - Jackson C AU - Burge PS. LA - PT - DEP - TA - Central African J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 125 IP - DP - 2005 Jan 01 TI - Occupational rhinitis: diagnostic criteria, relation to lower airway symptoms and IgE sensitization in bakery workers PG - 1211-7 AB - CONCLUSIONS The use of different diagnostic criteria has considerable consequences for the prevalence estimates of occupational rhinitis. There is a strong relationship between occupational rhinitis and lower airway symptoms. Storage mites appear to be important occupational allergens in Norwegian bakeries. OBJECTIVES To study the consequences of various diagnostic criteria on the prevalence of occupational rhinitis, assess the prevalence of IgE sensitization and explore the relationships between upper and lower airway symptoms and between symptoms and IgE sensitization. MATERIAL AND METHODS A total of 197 employees in 6 bakeries were interviewed and completed a questionnaire. A skin prick test was performed, total and specific IgE were determined and a histamine release test was performed for relevant allergens. The criteria for the diagnosis of occupational rhinitis were based on the 1994 International Consensus Report on Rhinitis. RESULTS The prevalence of occupational rhinitis varied between 23% and 50%, depending on the criteria used. The occurrence of nasal symptoms was found to precede the development of lower airway symptoms. Occupational rhinitis, both IgE- and non-IgE-mediated, was associated with asthma symptoms. The most frequent causes of sensitization (20%) were different species of storage mites. Storage mite sensitization was related to occupational rhinitis and work exposure. AU - Storaas T AU - Steinsvåg SK AU - Florvaag E AU - Irgens A AU - Aasen TB LA - PT - DEP - TA - Acta Otolaryngol (Stockh) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 12(1) IP - DP - 2005 Jan 01 TI - Respiratory effects of exposure to dust from herbs PG - 5-10 AU - Golec M AU - Skórska C AU - Mackiewicz B AU - Góra A AU - Dutkiewicz J LA - PT - DEP - TA - Ann Agric Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 12(2) IP - DP - 2005 Jan 01 TI - Health effects of exposure to herb dust in valerian growing farmers PG - 247-52 AU - Skórska C AU - Golec M AU - Mackiewicz B AU - Góra A AU - Dutkiewicz J LA - PT - DEP - TA - Ann Agric Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 60 IP - DP - 2005 Jan 01 TI - Chronic bird fancier's lung: histopathological and clinical correlation. An application of the 2002 ATS/ERS consensus classification of the idiopathic interstitial pneumonias PG - 665-671 AB - Background: Chronic bird fancier's lung (BFL) has often been misdiagnosed as one of the idiopathic interstitial pneumonias (IIPs). Methods: To define the clinical and pathological characteristics of chronic BFL, 26 patients with chronic BFL from whom a surgical lung biopsy specimen was taken between October 1992 and June 2001 were evaluated. The histopathological characteristics of the surgical lung biopsy specimens were examined and correlations between the histopathology and clinical characteristics were analysed. The quality of chronic inflammatory and fibrotic changes was expressed according to the 2002 ATS/ERS consensus classification of IIPs. Results: Two patients were diagnosed as having bronchiolitis obliterans organising pneumonia (BOOP)-like lesions, five as having cellular non-specific interstitial pneumonia (NSIP)-like lesions, and eight as having fibrotic NSIP-like lesions. The other 11 patients were considered to have usual interstitial pneumonia (UIP)-like lesions because of the temporal heterogeneous appearances of the fibrotic changes. However, fibrosis in these patients had developed in centrilobular as well as perilobular areas, suggestive of hypersensitivity pneumonitis. Nineteen patients (73.1%) had multinucleated giant cells, often with cholesterol clefts, while only five patients (19.2%) had granulomas. Patients with BOOP-like or cellular NSIP-like lesions tended to have recurrent acute episodes, whereas patients with UIP-like lesions had an insidious onset. Patients with BOOP-like or cellular NSIP-like lesions had a more favourable outcome than those with fibrotic NSIP-like and UIP-like lesions. Conclusions: The qualities of chronic inflammatory and fibrotic lesions vary significantly among patients with chronic BFL but correlate with clinical features and prognosis. Abbreviations: BFL, bird fancier's lung; BOOP, bronchiolitis obliterans organising pneumonia; HP, hypersensitivity pneumonitis; IIP, idiopathic interstitial pneumonia; NSIP, non-specific interstitial pneumonia; UIP, usual interstitial pneumonia AU - Ohtani Y AU - Saiki S AU - Kitaichi M AU - Usui Y AU - Inase N AU - Costabel U AU - Yoshizawa Y LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 138 IP - DP - 2005 Jan 01 TI - Detection of fish antigens aerosolized during fish processing using newly developed immunoassays PG - 21-28 AB - BACKGROUND: Aerosolization of fish proteins during seafood processing has been identified as a potential route for allergic sensitization and occupational asthma among workers involved in high-risk activities. The aim of this study was to develop immunological assays for the quantification of aerosolized fish antigens in a fish-processing factory. METHODS: Polyclonal antibodies to the main fish species processed in the factory (anchovy and pilchard) were generated in rabbits and compared by ELISA inhibition assay and immunoblotting. These antisera were utilized to develop ELISA assays for the detection of fish antigens. The ELISA inhibition assays were evaluated by analyzing environmental air samples collected from three areas in a fish-processing factory: pilchard canning, fish meal production and lobster processing. RESULTS: By immunoblotting, the rabbit polyclonal antibodies demonstrated IgG antibody binding patterns comparable with IgE antibodies of fish-sensitized patients, particularly in regard to the major fish allergens parvalbumins. The sensitivity of the fish-specific ELISA assays developed was 0.5 microg/ml. The ELISA inhibition assays were able to differentiate between the two different fish species of interest but did not recognize a crustacean species. Notable differences in exposure levels to canned pilchard and anchovy antigens were demonstrated in the three different working areas of the factory, with assays having a detection limit as low as 105 ng/m(3). CONCLUSION: These ELISA-based assays are sensitive and specific to quantify differential exposure levels to fish antigens produced during fish processing, making it possible to investigate exposure-disease response relationships among workers in this industry AU - Nieuwenhuizen N AU - Lopata AL AU - Jeebhay MF AU - Herbert DR AU - Robins TG AU - Brombacher F LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 49 IP - DP - 2005 Jan 01 TI - Environmental exposure characterization of fish processing workers PG - 423-437 AB - BACKGROUND: Aerosolization of seafood and subsequent inhalation, during processing is a potential high-risk activity for allergic respiratory disease. OBJECTIVES: To quantify total thoracic particulate, protein concentration and specific fish (pilchard, anchovy) antigen concentrations in fish processing plants; to determine the correlation between these exposure metrics; and to identify the major determinants of variability and the optimal grouping strategies for establishing dose-response relationships for fish antigen exposures. METHODS: Exposure assessments were conducted on randomly selected individuals within each of the identified 'exposure groups' (EGs) in two fish processing factories. Personal time-integrated sampling was conducted with a thoracic fraction sampler and analysed for particulate mass, total protein and specific fish antigens. Exposure metrics were developed on the basis of individually measured exposures and average levels of these personal samples within EGs. The main components of the exposure variability were determined using ANOVA techniques. RESULTS: A total of 198 full-shift personal aerosol samples were collected and analysed. Twenty-two percent of the samples were below the limit of detection (LOD) for pilchard and 23% for anchovy assays. Personal sampling revealed wide variations across EGs in arithmetic mean concentrations of thoracic particulate 0.61 mg m(-3) (range: LOD-11.3), total protein 0.89 microg m(-3) (LOD-11.5), pilchard antigen 150 ng m(-3) (LOD-15 973) and anchovy antigen 552 ng m(-3) (LOD-75 748) levels. The fishmeal loading and bagging sections of both plants showed consistently high thoracic particulate mass (0.811-2.714 mg m(-3)), total protein (0.185-1.855 microg m(-3)), pilchard antigen (538-3288 ng m(-3)) and anchovy antigen (1708-15 431 ng m(-3)). The a priori strategy that grouped workers according to EGs produced reasonably satisfactory summary exposure metric statistics. An alternative grouping strategy based on department revealed comparable elasticity (exposure contrast). While the correlation between the log-transformed thoracic particulate mass and fish antigen concentrations were generally modest (Pearson's r = 0.32-0.35, P < 0.001), a high correlation was found between pilchard and anchovy antigen concentrations (Pearson's r = 0.71, P < 0.001). Models using factory and department grouping strategies accounted for a significant portion of the variability (adjusted r(2) = 0.18, P = 0.043) in pilchard antigen levels. Grouping strategies using a combination of factory and department yielded the highest degree of elasticity for thoracic particulate (0.38) and pilchard antigen (0.42) levels. CONCLUSIONS: Workers involved in bony fish processing are at risk of inhaling aerosols containing pilchard and anchovy fish antigens. Antigen exposures are highest during fishmeal production and bagging. Grouping strategies based on department and factory may provide a more efficient approach than a priori classification of EGs for evaluating fish antigen exposures. AU - Jeebhay MF AU - Robins TG AU - Seixas N AU - Baatjies R AU - George DA AU - Rusford E AU - Lehrer SB AU - Lopata AL LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 60 IP - DP - 2005 Jan 01 TI - Occupational allergy in laboratory workers caused by the African migratory grasshopper Locusta migratoria PG - 200-205 AB - BACKGROUND: Recent reports of fatal asthma cases associated with swarms of locusts affecting African countries have highlighted the importance of this insect in causing asthma morbidity and mortality. However, only limited information is available about the allergic health outcomes such as asthma and its determinants in exposed individuals. In this study, workers exposed to the African migratory locust Locusta migratoria were evaluated for allergic health outcomes as well as the nature of the offending allergens. METHODS: Ten scientists and technicians exposed to locusts in a laboratory were investigated for locust-related allergy using questionnaires and immunological tests. The presence of allergy was determined by quantification of specific IgE and IgG to L. migratoria using the UniCAP system and via skin-prick testing (SPT). The allergens were characterized by Western blot and ImmunoCAP inhibition assays. RESULTS: Six of the 10 workers experienced symptoms ranging from urticaria and rhinoconjuctivitis to asthma. Seven individuals demonstrated sensitivity on SPT and five had specific IgE antibodies to L. migratoria. Significant cross-reactivity was demonstrated for allergens in the locust faeces, body and wings but not to cockroach allergens. Novel allergens with molecular weights of approximately 70 kDa were identified in locust wings, which are distinctly different from other known allergen sources from locusts. CONCLUSION: Exposure to L. migratoria allergens is a potential sensitizer in exposed individuals. Raised levels of locust-specific IgE can be readily quantified. The wings of this insect species have been identified as a novel allergen source. AU - Lopata AL AU - Fenemore B AU - Jeebhay MF AU - Gade G AU - Potter PC LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 37 IP - DP - 2005 Jan 01 TI - Atopy and new-onset asthma in young Danish farmers and CD14, TLR2, and TLR4 genetic polymorphisms: a nested case-control study PG - 1602-1608 AB - Background Evidence exists that exposure to high levels of microbial agents such as endotoxin in the farm environment decreases the risk of atopic sensitization. Genetic variation in innate immunity genes may modulate the response to microbial agents and thus influence susceptibility to asthma and atopy. Objective To study potential associations between single nucleotide polymorphisms (SNPs) in CD14, Toll-like receptor 2 (TLR2), and TLR4 genes, and atopy and new-onset asthma in young farmers. Methods A nested case-control study was conducted within a cohort of 1901 young Danish farmers. We genotyped 100 new-onset asthma cases and 88 control subjects for three CD14 SNPs, three TLR2 SNPs, and two TLR4 SNPs. Atopy at baseline (defined as a positive skin prick test to one or more common inhalant allergens) was found in 17 asthma cases (17.0%) and in 17 controls (19.3%). Results The CD14/-260T allele was significantly associated with less atopy [odds ratio (OR) 0.39; 95% confidence interval (CI) 0.21-0.72, additive genetic model], whereas the CD14/-651T allele was positively associated with atopy (OR 2.53; 95% CI 1.33-4.80). Similar results were obtained by haplotype analysis. Stratified analysis by farm childhood showed stronger effects of both CD14 SNPs on atopy among farmers who were born and raised on a farm, although no significant interaction was found. No associations between CD14, TLR2, or TLR4 genotypes and new-onset asthma were found. Conclusion The CD14/-260 and CD14/-651 promoter polymorphisms are associated with atopy prevalence among young adults exposed to farm environments. AU - Smit LAM AU - Bongers SIM AU - Ruven HJT AU - Rijkers GT AU - Wouters IM AU - Heederik D AU - Omland O AU - Sigsgaard T LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 25 IP - DP - 2005 Jan 01 TI - Pulmonary fibrosis in an individual occupationally exposed to inhaled indium-tin oxide PG - 200-204 AB - Despite the increasing industrial use of indium-tin oxide (ITO) to manufacture flat-panel displays, such as liquid-crystal displays or plasma display panels for televisions, little is known about the potential health hazard induced by occupational exposure to indium compounds. The current study describes a case of fibrotic lung disease that developed after a 4-yr exposure to ITO. The pathology of the lung demonstrated pulmonary fibrosis with the presence of cholesterol granulomas. In conclusion, more attention needs to be paid to the possible toxic effects of indium compounds, and maximum healthcare measures should be taken to protect industry workers from these toxicities. AU - Homma S AU - Miyamoto A AU - Sakamoto S AU - Kishi K AU - Motoi N AU - Yoshimura K LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 12 IP - DP - 2005 Jan 01 TI - Health effects of exposure to herb dust in valerian growing farmers PG - 247-252 AB - The aim of the present study was to determine the health status of farmers cultivating valerian (Valeriana officinalis L.) and occupationally exposed to dust from this plant. A group of 75 valerian growing farmers were examined. As a reference group, 50 urban dwellers, not exposed to any kind of organic dust were examined. All people were interviewed for the presence of work-related symptoms and subjected to physical and spirometric examinations. Skin prick tests were conducted with 4 microbial antigens associated with organic dust and 3 herbal extracts, precipitin tests with 12 microbial antigens and 4 herbal extracts and tests for specific inhibition of leukocyte migration with 4 microbial antigens. 30.7 % of the valerian farmers reported occurrence of work-related symptoms. No significant differences were found between the spirometric values in the group of valerian farmers and the reference group. Valerian farmers showed a low frequency of positive skin reactions to all tested antigens (0-4.0 %), not significantly greater compared to reference group. The frequency of positive precipitin reactions to the antigen of Gram-negative bacterium Pantoea agglomerans was very high in valerian farmers (45.5 %) with 3-fold concentrated sera and significantly greater compared to the reference group (p < 0.001). The positive precipitin response of valerian farmers to other microbial and herbal antigens was much lower or absent and did not show any difference compared to reference group. In the test for specific inhibition of leukocyte migration, the highest frequencies of positive reactions in valerian farmers were noted with Pantoea agglomerans and Saccharopolyspora rectivirgula (15.0 % each), in both cases significantly greater compared to reference group (p < 0.05). In conclusion, the farmers growing valerian showed a moderate frequency of work-related symptoms and low reactivity to most microbial and herbal allergens. They exhibited an increased immunologic response to Gram-negative bacterium Pantoea agglomerans which appears to be the most important risk factor associated with valerian dust. AU - Skórska C AU - Golec M AU - Mackiewicz B. Góra A AU - Dutkiewicz J LA - PT - DEP - TA - Annals of Agricultural & Environmental Medicin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 99 IP - DP - 2005 Jan 01 TI - Extrinsic allergic alveolitis caused by misting fountains PG - 943-947 AB - Recently, an increasing number of patients were presented to our clinics with febrile and respiratory symptoms associated with exposure to a new type of domestic ultrasonic humidifier. We report on 11 patients who developed recurrent episodes of fever, cough and dyspnea after repeated exposure to ultrasonic misting fountains at home. A diagnosis of extrinsic allergic alveolitis (EAA) or toxic alveolitis was made on the basis of the history and the clinical, radiological, laboratory and immunological findings. Eight patients were subjected to inhalative challenge tests with their own ultrasonic misting fountains, and all of them exhibited positive reactions. Nine patients were diagnosed with an EAA (humidifier lung) and two patients with a toxic alveolitis (humidifier fever). This study demonstrates the potential for ultrasonic misting fountains to cause illness in the home. In view of the increasing popularity of these devices, humidifier lung and humidifier fever should be considered in the differential diagnosis of patients with unexplained pulmonary or flu-like illnesses with fever. AU - Koschela D AU - Stark W AU - Karmann F AU - Sennekamp J AU - Müller-Wening D LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 62 IP - DP - 2005 Jan 01 TI - Relationship between chemical structure and the occupational asthma hazard of low molecular weight organic compounds PG - 243-250 AB - Aims To investigate quantitatively, relationships between chemical structure and reported occupational asthma hazard for low molecular weight (LMW) organic compounds; to develop and validate a model linking asthma hazard with chemical substructure; and to generate mechanistic hypotheses that might explain the relationships. Methods A learning dataset used 78 LMW chemical asthmagens reported in the literature before 1995, and 301 control compounds with recognised occupational exposures and hazards other than respiratory sensitisation. The chemical structures of the asthmagens and control compounds were characterised by the presence of chemical substructure fragments. Odds ratios were calculated for these fragments to determine which were associated with a likelihood of being reported as an occupational asthmagen. Logistic regression modelling was used to identify the independent contribution of these substructures. A post-1995 set of 21 asthmagens and 77 controls were selected to externally validate the model. Results Nitrogen or oxygen containing functional groups such as isocyanate, amine, acid anhydride, and carbonyl were associated with an occupational asthma hazard, particularly when the functional group was present twice or more in the same molecule. A logistic regression model using only statistically significant independent variables for occupational asthma hazard correctly assigned 90% of the model development set. The external validation showed a sensitivity of 86% and specificity of 99%. Conclusions Although a wide variety of chemical structures are associated with occupational asthma, bifunctional reactivity is strongly associated with occupational asthma hazard across a range of chemical substructures. This suggests that chemical cross-linking is an important molecular mechanism leading to the development of occupational asthma. The logistic regression model is freely available on the internet and may offer a useful but inexpensive adjunct to the prediction of occupational asthma hazard. AU - Jarvis J AU - Seed MJ AU - Elton R AU - Sawyer L AU - Agius R LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 115 IP - DP - 2005 Jan 01 TI - IgE-mediated asthma associated with a unique allergen from Angelim pedra (Hymenolobium petraeum) wood PG - 624-635 AB - Exposure to sawdust from a variety of woods has been shown to cause occupational asthma and contact urticaria, according to published scientific reports.2, 3 The following is a description of a case of occupational asthma caused by Angelim pedra in a 38-year-old male carpenter who was asymptomatic when harvesting Angelim pedra wood in Brazil for 20 years. He has lived in Spain since 1998. In 2000, he began to have cough, rhinorrhea, wheezing, dyspnea, and ocular itching within a few minutes of each new exposure on initating new work with this imported wood in Spain in 1999. He reported no symptoms with other woods. Skin prick tests were performed by using the extracts of a variety of wood sawdust (iroko, mansonia, oak, cedar, pine, teak, obeche), which were extracted (10% wt/vol) in PBS and shaken for 24 hours at room temperature. The suspension was centrifuged at 8000 rpm for 30 minutes, the pellet was discarded, and the remaining solution was filtered through a 0.22-µm pore size membrane. All skin tests with extracts of various kinds of woods were tested in 3 atopic and nonatopic unexposed carpenters. AU - Alday E AU - Gómez M AU - Ojeda P AU - Caballero ML AU - Moneo I LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 15 IP - DP - 2005 Jan 01 TI - Occupational asthma caused by Ipe (Tabebuia spp) dust PG - 81-83 AB - Background: Ipe is a resistant hardwood that contains naphtoquinones. It is easily found and frequently used in South and Central America. Naphtoquinones are skin sensitizers. Objective: To describe a case of occupational asthma related to Ipe wood dust. Methods: The patient was submitted to a clinical evaluation consisting of a respiratory symptom questionnaire,occupational history, serial measurements of lung function by spirometry, skin prick tests, patch tests, specific IgE and specific bronchial provocation tests to Ipe dust. Results: Serial lung function measurements showed sustained regression of obstruction following removal from exposure. Skin prick tests, but not patch tests, were positive to Ipe, and a specific bronchial challenge showed a late asthmatic reaction. Specific IgE search was negative. Conclusions: Exposure to Ipe wood dust can lead to occupational asthma. The underlying mechanism should be investigated. AU - Algranti E AU - Mendonça EMC AU - Ali SA AU - Kokron CM LA - PT - DEP - TA - J Inv Allergod Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 78 IP - DP - 2005 Jan 01 TI - Work-related accidents and occupational diseases in veterinarians and their staff PG - 230-238 AB - Objectives: We assessed the occupational hazards in veterinary practice by analysing accident insurance data in order to stimulate strategies to prevent occupational accidents and diseases in veterinarians and their staff. Methods: Approximately 10,000 veterinary practices comprising about 27,500 veterinarians and their staff are covered by the Institution of Statutory Accident Insurance of the Health and Welfare Service (BGW). Each year about 2,000 accident and occupational disease claims are filed by these veterinarians and their staff. The claims for the 5-year period from 1998 to 2002 are analysed in this paper. Results: For 2002, the incidence rate for accidents in the workplace was 105.4 per 1,000 full-time workers, a rate 2.9-times higher than for general practitioners of human medicine. When only severe accidents resulting in a loss of work time of more than 3 days were analysed, the relative risk increased to 9.2. Approximately 66% of the reported accidents are due to scratches, bites, or kicks from animals. Claims of occupational disease are filed 2.7-times more often by veterinarians and their staff than by general practitioners and their staff. The occupational diseases filed most often concern the skin (39%), followed by allergic respiratory diseases (30.5%), and infectious diseases (19.1%). Conclusions: Prevention strategies for veterinarians should focus on accidents caused by animals. The prevention of occupational diseases should focus on skin diseases, respiratory disease, and infections AU - Nienhaus A AU - Skudlik C AU - Seidler A LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 116 IP - DP - 2005 Jan 01 TI - Progression of self-reported symptoms in laboratory animal allergy PG - 127-132 AB - Background Laboratory animal allergy is a common illness among workers exposed to laboratory animals and can progress to symptoms of asthma. Objectives This study evaluates the continuum of disease from allergy symptoms to asthma symptoms in a dynamic cohort of workers exposed to animals in a pharmaceutical company. Methods Data arose from annual questionnaires administered to workers in a surveillance program established to monitor exposure to animals and the development of allergy. The life-table method was used to compare asthma-free survival between workers with and without symptoms of allergy. A Cox proportional hazards model was used to examine the effects of covariates on the development of asthma. Results A total of 603 workers contributed 2527.4 person-years to the study over the 12.3-year period. The probabilities of experiencing asthma symptoms by the 11th year of follow-up were 0.367 for workers with allergy symptoms and 0.052 for those without allergy symptoms. The hazard ratio for asthma symptoms when comparing workers with and without allergy symptoms was 7.39 (95% CI, 3.29-16.60) after adjustment for sex and family history of allergy. Female subjects developed asthma at a rate 3.4 times that of male subjects. Conclusions This study supports the hypothesis that laboratory animal allergy symptoms are a major risk factor for the development of asthma. It also suggests a heightened risk of asthma for women who work with laboratory animals, a finding that has not been previously reported. AU - Elliott L AU - Heederik D AU - Marshall S AU - Peden D AU - Loomis D LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 26 IP - DP - 2005 Jan 01 TI - Standardisation of spirometry PG - 319-338 AB - Spirometry is a physiological test that measures how an individual inhales or exhales volumes of air as a function of time. The primary signal measured in spirometry may be volume or flow. Spirometry is invaluable as a screening test of general respiratory health in the same way that blood pressure provides important information about general cardiovascular health. However, on its own, spirometry does not lead clinicians directly to an aetiological diagnosis. AU - Miller MR AU - Hankinson J AU - Brusasco V AU - Burgos F AU - Casaburi R AU - Coates A AU - Crapo R AU - Enright P AU - van der Grinten CPM AU - Gustafsson P AU - Jensen R AU - Johnson DC AU - MacIntyre N AU - McKay R AU - Navajas D AU - Pedersen OF AU - Pellegrino R AU - Viegi G and Wanger J. LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 172 IP - DP - 2005 Jan 01 TI - Asthma Severity and Exposure to Occupational Asthmogens PG - 440-445 AB - Rationale: Severe asthma is a public health problem with limited information regarding preventable causes. Although occupational exposures have been implicated as important risk factors for asthma and asthma exacerbations, associations between occupational exposures and asthma severity have not been reported. Objective: To examine associations between occupational exposures and asthma severity. Methods: The Epidemiological Study on the Genetics and Environment of Asthma combines a case-control study with a family study of relatives of patients with asthma. Adult patients (n = 148) were recruited in chest clinics and control subjects without asthma (n = 228) were population-based. Occupational exposures to nonasthmogenic irritants and asthmogens (classified as “any asthmogen” including three broad groups: high-molecular-weight agents, low-molecular-weight agents, and mixed environments) were assessed by an asthma-specific job exposure matrix. Asthma severity was defined from an 8-grade clinical score (frequency of attacks, persistent symptoms, and hospitalization). Patients with severe (score ? 2) and mild asthma were compared with control subjects using nominal logistic regression. Main Results: Significant associations were observed between severe adult-onset asthma and exposure to any occupational asthmogen (odds ratio [OR], 4.0; 95% confidence interval [CI], 2.0–8.1), high-molecular-weight agents (OR, 3.7; CI, 1.3–11.1), low-molecular-weight agents (OR, 4.4; CI, 1.9–10.1), including industrial cleaning agents (OR, 7.2; CI, 1.3–39.9), and mixed environments (OR, 7.5; CI, 2.4–23.5). No significant associations were found between nonasthmogenic irritants and asthma severity, nor between asthmogens and childhood-onset asthma or mild adult-onset asthma. Conclusions: Our results suggested a strong deleterious role of occupational asthmogens in severe asthma. Clinicians should consider occupational exposures in patients with moderate to severe asthma. AU - Moual NL AU - Siroux V AU - Pin I AU - Kauffmann F AU - Kennedy SM on behalf of the Epidemiological Study on the Genetics and Environment of Asthma (EGEA) LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 60 IP - DP - 2005 Jan 01 TI - Occupational asthma due to bethabara wood dust PG - 1544-1545 AU - Yacoub MR AU - Lemiere C AU - Labrecque M. LA - PT - DEP - TA - European Journal of Allergy and Clinical Imm JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 55 IP - DP - 2005 Jan 01 TI - Concerns for asthma at pre-placement assessment and health surveillance in platinum refining-a personal approach PG - 595-599 AB - Platinum, a noble metal, is inert in the body and has an important use in medical applications. It is used in autocatalysts to control harmful vehicular emissions and the catalytic effects improve efficiencies of pharmaceutical and petrochemical processes. The refining process involves exposure to halogeno complex salts of platinum which are potent allergens. They induce symptoms typical of a type I allergy, the most significant of which is asthma. Platinum refining not only exposes employees to the risk of sensitization to these salts but also to respiratory irritants. Inhalation of these aggravates pre-existing asthma. The increasing incidence of asthma in the community requires that prospective employees for platinum refining be assessed carefully to establish their respiratory health status in relation to the risk of sensitization or aggravation of pre-existing asthma. Routine medical surveillance has been shown to reduce persistence of asthma in sensitized workers who cease exposure to the platinum salts upon diagnosis. Skin prick test using dilute platinum salt solutions can detect sensitization at an early stage and this has become the mainstay of surveillance programmes as it is objective and reproducible as well as predictive for the development of symptoms when exposure is allowed to continue. Symptoms are not sensitive or specific. Smoking is a significant risk factor AU - Linnett PJ LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 59 IP - DP - 2005 Jan 01 TI - Respiratory health of welders in a container yard, Sri Lanka PG - 226-229 AB - Background The fumes and gases released during welding can lead to respiratory ill-health. Aims To assess prevalence of respiratory symptoms (RS) and respiratory function (RF) of welders in comparison to a control group (CG). Methods A cross-sectional study was conducted among welders and controls selected from office support staff of a medical faculty. RS were determined by administering a questionnaire and RF with the use of an electronic spirometer. Results Forty-one welders and 41 controls participated. Chronic bronchitis was significantly higher among welders (27%; n = 11) than in controls (7%; n = 3) with an odds ratio of 4.6 [95% confidence interval (CI): 1.1–23.3]. Forced vital capacity (FVC), forced expiratory volume in the first second of forced vital capacity (FEV1.0), forced mid-expiratory flow rate (FEF25–75%) and peak expiratory flow rate (PEFR) were slightly higher among welders (2.97 l, 2.6 l, 3.4 l/s and 339 l/min, respectively) than in the CG (2.79 l, 2.4 l, 3.38 l/s and 323 l/min, respectively), the differences of which were not statistically significant. On comparison of the observed values of welders with the predicted normal values, the observed FVC (2.97 versus 3.35 l, respectively) and PEFR (339 versus 538 l/min) had significantly lower values. Conclusions Welders are at a higher risk of developing chronic bronchitis with non-impairment of lung function in comparison to the CG. AU - Jayawardana P AU - Abeysena C LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 62 IP - DP - 2005 Jan 01 TI - World at work: Cleaners PG - 581-584 AB - Professional cleaning is a basic service occupation that is carried out worldwide in many different environments, both indoors and outdoors. Cleaning workers form an important proportion of the total working population; for instance 3% in the USA, 4% in Finland,1 and 10% of the female working population in Spain.2 Cleaners often have low occupational skills and belong to the less advantaged educational and socioeconomic groups.3,4 There are a number of important differences in the organisation of cleaning jobs between geographical areas and their prevailing cultures, which are related to differences in work conditions and hence occupational hazards. In many countries cleaning work is predominantly done by women, with a relatively high proportion of older women.4 Immigrants constitute another major group doing cleaning work in many industrialised areas. Cleaners may be employed by private cleaning companies and sent out to clean buildings of various contractors, which may result in dispersed workplaces. An important number of cleaners are employed in the informal sector, particularly those in cleaning private homes,2 but also in cleaning bars, schools, and other places. This is often characterised by precarious employment, often part-time. The related low social and legal protection results in payment on an hourly basis without proper contracts or insurance. Taking into account all these particular characteristics, cleaners are likely to escape from control such as regulations, health surveillance, and risk prevention. The purpose of this paper is to provide a concise overview of the most common occupational hazards in cleaning work, and to discuss possibilities to improve control and prevention. AU - Zock JP LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - - IP - DP - 2005 Jan 01 TI - Diagnosis and Management of Work-Related Asthma PG - 1-107 AB - Context Approximately 5 to 15 percent of adult onset asthma is thought to be occupational asthma (OA). Objectives To systematically review literature regarding the diagnosis and management of OA,and specifically, to compare specific inhalation challenge testing (SIC) with alternative tests, and to review management, including reduction or cessation of exposure. Search Strategy Electronic databases and trials registries were searched. Additional references were identified by bibliographic searches of included studies, hand searches of conference proceedings, and contact with authors. Selection Criteria: Population: De-novo OA or a previous diagnosis of asthma that was exacerbated at work. Study design: Controlled clinical trials, prospective or retrospective cohort, cross-sectional, case-series. Diagnosis: Intervention: At least two diagnostic tests, including one or more from a pre-determined hierarchy of ‘reference standard’ tests. Outcomes 2 x 2 or 2 x 1 table, sensitivity, specificity, likelihood ratios, time to diagnosis, cost of diagnosis, and adverse effects. Management: Intervention: Pharmacological treatment, removal, reduced, or continued exposure. Outcomes: Pulmonary function, medication use, quality of life, symptoms, economic consequences, and adverse events. Data Extraction Two researchers independently extracted data. Data Analysis Diagnosis: Pooled sensitivities and specificities for sensitizer-induced OA with 95% confidence intervals (CI) were derived using a random effects model. Management: Weighted pooling of means and standard deviations to combine results within studies. Quantitative analysis was not conducted due to heterogeneity. Main Results One-hundred and twenty-four unique diagnostic studies and 65 unique management studies were included. Much of the evidence relates to sensitizer induced OA. Diagnosis: Among the high molecular weight (HMW) asthmagens compared to SIC, nonspecific bronchial provocation (NSBP) test, skin prick test (SPT), and serum specific IgE had sensitivities above 73 percent. The specificity was highest between serum specific IgE versus SIC (79.0 percent [95% CI: 50.5 to 93.3 percent]). The highest sensitivity among low molecular weight (LMW) asthmagens occurred between SPT and SIC (72.9 percent [95% CI: 59.7 to 83.0 percent]), but this applied only to LMW sensitizers for which SPT could be performed. When compared to SIC, serum specific IgE and SPT had similar specificities (88.9 percent [95% CI: 84.7 to 92.1 percent] and 86.2 percent [95% CI: 77.4 to 91.9 percent], respectively). For HMW asthmagens, a combined positive test result to NSBP test and SPT versus SIC yielded modest sensitivity (60.6 percent [95% CI: 21.0 to 89.9 percent]) yet high specificity (82.5 percent [95% CI: 54.0 to 95.0 percent]). Management: Removed workers showed improved lung function and decreased non-specific broncial responsiveness at follow-up; exposed workers were either no better or worse. Lack of data prevented conclusions about the effectiveness of reducing exposure. Removed workers suffered from reduced income and/or unemployment. Fully or partially exposed workers also appeared to have reduced earnings over time. Conclusions Diagnosis: Single NSBP test, specific SPT, or serum specific IgE testing alone is insufficient to diagnose OA. While positive results would increase the likelihood of OA, a negative result would not exclude OA. The literature supports the concept of combined testing; however, additional research is required to determine which combination of tests would result in sufficient sensitivity and specificity that it could replace SIC. Management: OA appears to be slow to resolve, and may worsen irrespective of subsequent exposure status. Patients who are removed from the workplace rarely experience complete resolution, may require medications, and experience continued airflow limitation. Standard treatments for asthma appear to be effective in OA; however, there is limited research. AU - Beach J AU - Rowe BH AU - Blitz S AU - Crumley E AU - Hooton N AU - Russell K AU - Spooner C AU - Klassen T. LA - PT - DEP - TA - AHRQ Publication No. 06-E003-2. Rockville JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 26 IP - DP - 2005 Jan 01 TI - What are the questionnaire items most useful in identifying subjects with occupational asthma? PG - 1056-1063 AB - The present study assessed the usefulness of key items obtained from a clinical "open" questionnaire prospectively administered to 212 subjects, referred to four tertiary-care hospitals for predicting the diagnosis of occupational asthma (OA). Of these subjects, 72 (34%) were diagnosed as OA (53% with OA due to high-molecular-weight agents) according to results of specific inhalation challenges, and 90 (42%) as non-OA. Wheezing at work occurred in 88% of subjects with OA and was the most specific symptom (85%). Nasal and eye symptoms were commonly associated symptoms. Wheezing, nasal and ocular itching at work were positively, and loss of voice negatively associated with the presence of OA in the case of high-, but not low molecular-weight agents. A prediction model based on responses to nasal itching, daily symptoms over the week at work, nasal secretions, absence of loss of voice, wheezing, and sputum, correctly predicted 156 out of 212 (74%) subjects according to the presence or absence of OA by final diagnosis. In conclusion, key items, i.e. wheezing, nasal and ocular itching and loss of voice, are satisfactorily associated with the presence of occupational asthma in subjects exposed to high-molecular-weight agents. Therefore, these should be addressed with high priority by physicians. However, no questionnaire-derived item is helpful in subjects exposed to low-molecular-weight agents. AU - Vandenplas O AU - Ghezzo H AU - Munoz X AU - Moscato G AU - Perfetti L AU - Lemiere C AU - Labrecque M AU - L'Archeveque J AU - Malo JL LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 26(4) IP - DP - 2005 Jan 01 TI - Occupational asthma due to manual metal-arc welding of special stainless steels PG - 736-9 AB - Occupational asthma (OA) can be induced by fumes of manual metal-arc welding on stainless steel. In recent years, the use of special stainless steels (SSS) with high chromium content has increased. This study presents two cases of OA caused by manual metal-arc welding on SSS. In both cases, the diagnosis of OA was based on respiratory symptoms, occupational exposure and positive findings in the specific challenge tests. In the first case, a 46-yr-old welder had experienced severe dyspnoea while welding SSS (SMO steel), but not in other situations. Challenge tests with both mild steel and stainless steel using a common electrode were negative. Welding SSS with a special electrode caused a delayed 37% drop in forced expiratory volume in one second (FEV1). In the second case, a 34-yr-old male had started to experience dyspnoea during the past few years, while welding especially SSS (Duplex steel). The workplace peak expiratory flow monitoring was suggestive of OA. Challenge tests with both mild steel and stainless steel using a common electrode did not cause bronchial obstruction. Welding SSS with a special electrode caused a delayed 31% drop in FEV1. In conclusion, exposure to manual metal-arc welding fumes of special stainless steel should be considered as a new cause of occupational asthma. AU - Hannu T AU - Piipari R AU - Kasurinen H AU - Keskinen H AU - Tuppurainen M AU - Tuomi T LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 15 IP - DP - 2005 Jan 01 TI - Specific IgG to Thermoactynomices vulgaris, Micropolyspora faeni and Aspergillus fumigatus in building workers exposed to esparto grass (plasterers) and in patients with esparto-induced hypersensitivity pneumonitis. PG - 17-21 AB - BACKGROUND: Esparto is one the most frequent causes of hypersensitivity pneumonitis in Spain. OBJECTIVE: Determination of risk factors in the working environment that could explain the sensitisation process, and assessment of the differences in specific IgG levels to Aspergillus fumigatus, Saccharopolyspora rectivirgula and Thermoactynomices vulgaris in patients with hypersensitivity pneumonitis induced by esparto, exposed healthy plasterers and control population. METHODS: Determination of precipitins and specific IgG to Aspergillus fumigatus, Saccharopolyspora rectivirgula and Thermoactynomices vulgaris in the three previously mentioned groups. Questionnaire on possible risk occupational and extra-occupational factors. RESULTS: Both healthy and exposed plasterers have higher levels of specific IgG to Aspergillus fumigatus, Saccharopolyspora rectivirgula and Thermoactynomices vulgaris than the healthy controls. The patients had higher levels of IgG than exposed healthy plasterers only to Thermoactynomices vulgaris. Precipitins were detected in only two patients. There were no occupational factors influencing on the sensitisation process. CONCLUSIONS: Specific IgG is an occupational exposure marker among plasterers, but it has not been possible to establish a cut off point that differentiates exposed subjects from affected ones. This determination has a greater sensitivity than precipitins. We did not identify occupational or extra-occupational risk factors that facilitate the sensitisation process. AU - Gamboa PM AU - Urbaneja F AU - Olaizola I AU - Boyra JA AU - Gonzalez G AU - Antepara I AU - Urrutia I AU - Jauregui I AU - Sanz ML LA - PT - DEP - TA - J Inv Allergod Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 16 IP - DP - 2005 Jan 01 TI - Occupational asthma in apprentice adolescent car painters. PG - 662-668 AB - Occupational asthma (OA) is one of the leading causes of pulmonary diseases and has been extensively studied in adults. Childhood employment, a significant problem in many developing countries, should be studied to determine and evaluate its effects on psychosocial and lung health. In order to investigate the presence of work-related asthma-like symptoms and OA in apprentice adolescent car painters, 72 adolescents between the ages of 15-20 yr studying in Vocational Training Centres of Ankara were investigated using questionnaire, pulmonary function test (PFT), serial peak expiratory flow (PEF) measurements and methacholine inhalation tests. As a control group, 72 adolescents studying in Industrial and Commercial Training Centres located in the same environment were investigated with questionnaire and PFT. Almost 50% of the study group had work-related asthma-like symptoms for which occupational dermatitis history was predictive [odds ratio: 2.9 (1.026-8.13) (95% confidence interval)]. Seventeen of 22 with serial PEF measurements showed a variability of > or =20% and three (4.2%) of 12 tested with methacholine inhalation test had a PC20 < or = 8 mg/ml, which led to the diagnosis of OA. There was no statistically significant difference between study and control groups in terms of PFT. conclusion The high prevalence of work-related asthma-like symptoms among adolescent car painters clearly indicates the need for routine follow-up of adolescent workers for lung health. AU - Eifan AO AU - Derman O AU - Kanbur N AU - Sekerel BE AU - Kutluk T LA - PT - DEP - TA - Pediatr Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 55 IP - DP - 2005 Jan 01 TI - Evidence-based decision making in an endoscopy nurse with respiratory symptoms exposed to the new ortho-phthalaldehyde (OPA) disinfectant. PG - 575-578 AB - BACKGROUND: ortho-Phthalaldehyde (OPA) can cause mucous irritation, respiratory symptoms and IgE-mediated hypersensitivity reactions. Very little information is available about OPA-related effects in health personnel. AIM: To report the decision-making process for the case of an endoscopy nurse complaining of cough and burning of the nose and throat during OPA exposure at work. METHODS: The problem focused on the relationship between OPA exposure and the respiratory symptoms and was investigated using an evidence-based (EB) medicine paradigm. RESULTS: A literature search was performed using the database Medline and the search engine Google. Papers and guidelines were assessed for their suitability in the EB case identification of suspected occupational asthma (OA). A multistep approach suggested by a guideline was considered most appropriate for practical use. The nurse shared the decision-making process and underwent evaluation of the clinical suspicion index and interventions for diagnosis of OA. Despite the high clinical suspicion index, the diagnosis of OA was excluded and any work restriction was avoided. Health surveillance follow-up showed a good clinical outcome and prompt recovery from respiratory symptoms after improvement of environmental control measures. CONCLUSION: The case study shows that the implementation of EB guidelines provides the occupational physician with an appropriate decision-making process for the identification and management of workers with suspected OA. Screening out of OA is highly relevant because diagnosis of disease requires removal from exposure and frequently impacts negatively on worker employment. Comment in: Occup Med (Lond). 2006 Jun;56(4):284-5. AU - Franchi A AU - Franco G LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 25 IP - DP - 2005 Jan 01 TI - Latex allergen exposure increases exhaled nitric oxide in symptomatic healthcare workers PG - 309-316 AB - The objective of this study was to investigate the clinical and diagnostic impact of baseline exhaled nitric oxide (eNO) levels and latex allergen-induced eNO changes in different healthcare worker groups. Healthcare workers, 31 latex-sensitised and 14 nonsensitised, underwent occupational-type challenge tests with powdered allergenic latex gloves. Sensitised as well as nonsensitised healthcare workers developed a significant eNO increase 1 h after challenge. Conversely, only latex-sensitised employees showed a significant eNO increase 22 h after challenge, which showed a significant relationship with bronchial obstruction (specific airway resistance changes). However, there was no difference in either baseline eNO level or eNO increase after 22 h between asthmatic (n = 13) and rhinitic only (n = 20) responders. The specificity and sensitivity of a 50% eNO increase after 22 h in responders were 100 and 56%, respectively. These results support the assumption that the whole respiratory tract is involved in a combined allergic rhinitis and asthma syndrome. Smoking healthcare workers showed reduced baseline exhaled nitric oxide levels, but, as shown for the first time, an allergen-induced exhaled nitric oxide increase comparable to that of nonsmokers. Corticosteroid therapy inhibited the allergen-induced exhaled nitric oxide change but not the clinical response in the challenge test. These findings suggest that cigarette smoke and corticosteroids initiate distinct molecular mechanisms influencing nitric oxide concentrations in the airways. ________________________________________ AU - Baur X AU - Barbinova L LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 47 IP - DP - 2005 Jan 01 TI - Work-related asthma in the spray-on truck bed lining industry PG - 514-517 AB - OBJECTIVE: The objective of this study was to identify work-related asthma (WRA) workers' compensation claims associated with methylene diphenyl diisocyanate (MDI) exposure in the spray-on truck bed lining industry and estimate the asthma incidence rate in this industry. METHODS: The authors conducted a descriptive study of workers' compensation claims meeting an established surveillance case definition for WRA. RESULTS: Eight WRA workers' compensation claims were identified in the truck bed lining industry in Washington State for a claims incidence rate of 200 per 10,000 full-time equivalent. The medical evaluation of the cases was inadequate because none of the truck bed lining cases had medical testing to objectively link their asthma to the workplace. CONCLUSIONS: The rate of work-related asthma in the truck bed lining industry is excessive and suggests a need for significant intervention, including improvements in the clinical assessment provided to MDI-exposed workers. AU - Bonauto DK AU - Sumner AD AU - Curwick CC AU - Whittaker SG AU - Lofgren DJ LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 127 IP - DP - 2005 Jan 01 TI - Allergic rhinitis, asthma, and atopy among grape farmers in a rural population in Crete, Greece PG - 372-378 AB - STUDY OBJECTIVE: To measure the prevalence of allergic rhinitis, atopy, and asthma among grape farmers, and to compare the respiratory and atopic status in grape farmers with those of nonexposed control subjects. DESIGN: Cross-sectional study. SETTING: Malevisi region in northern Crete, Greece. SUBJECTS AND METHODS: One hundred twenty grape farmers and 100 control subjects living in the Malevisi region were examined. The protocol comprised a questionnaire, skin prick tests for 16 common allergens, measurement of specific IgE antibodies against 8 allergens, and spirometry before and after bronchodilation. RESULTS: Grape farmers were found to have an excess of respiratory symptoms. The comparison with the control group, after adjusting for age, sex, and smoking status, showed that the differences were statistically significant for rhinorrhea (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.5 to 5.1; p < 0.001), sneezing (OR, 2.2; 95% CI, 1.2 to 4.0; p < 0.01), and nasal itching (OR, 1.9; 95% CI, 1.0 to 3.6; p < 0.05), but were nonsignificant for asthma-related symptoms. In the multiple logistic regression model, grape farmers were found to have increased work-related symptoms, such as sneezing (OR, 2.9; 95% CI, 1.3 to 6.6; p < 01), rhinorrhea (OR, 2.9; 95% CI, 1.3 to 6.6; p < 0.01), cough (OR, 3.7; 95% CI, 1.2 to 11.4; p < 0.05), and dyspnea (OR, 3.8; 95% CI, 1.1 to 1.3; p < 0.05). The prevalence of allergic rhinitis was 40.8% in grape farmers and 26% in control subjects (OR, 2.0; 95% CI, 1.1 to 3.5; p < 0.02). Increased but statistically nonsignificant values of asthma prevalence were found in grape farmers (6.7%) compared with the control group (2.0%). The prevalence of atopy was 64.2% in grape farmers and 38.0% in the control group (OR, 2.2; 95% CI, 1.2 to 3.5; p < 0.01). Mean FEV1 was significantly lower in grape farmers than in control subjects (p < 0.05), after adjusting for age, sex, and smoking status. Bronchial obstruction was reversible in 23 grape farmers (19.2%) and in 6 control subjects (6%; p < 0.01). CONCLUSIONS: The study mainly demonstrated the high prevalence of allergic rhinitis and work-related respiratory symptoms in grape farmers compared to control subjects. It also suggested that grape farming is possibly associated with increased allergic sensitization to specific pollens, low baseline FEV1, and increased bronchial hyper-responsiveness. Further studies are needed to determine the potential risk factors for these disorders among the farming population. Comment in: Chest. 2005;127:1087-8. AU - Chatzi L AU - Prokopakis E AU - Tzanakis N AU - Alegakis A AU - Bizakis I AU - Siafakas N AU - Lionis C LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 53 IP - DP - 2005 Jan 01 TI - Respiratory symptoms and functions in tea workers PG - 28-33 AB - Respiratory symptoms and function tests were studied in tea workers and in a control group. The prevalance of acute and chronic respiratory symptoms were not different in two groups except for an acute burning sensation of eye-nose-throat and a chronic cough. Also the comparison of the respiratory function tests between tea workers (both smokers and nonsmokers) and the controls were not different at preshift and postshift 30th minute and 8th hour. When preshift and postshift results were compared in tea workers (both in smokers and nonsmokers); statistically significant reductions of FEV1, FEV1/FVC, FEF25-75 and FEF25 were seen at the postshift values. However statistically significant reductions were not observed in controls. Thus we conclude acute tea dust exposure may cause bronchial obstruction particularly in small airways. AU - Cöplü L AU - Selçuk ZT AU - Yilmaz AS AU - Arsava BE AU - Kalyoncu AF AU - Sahin AA AU - Baris YI LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 47 IP - DP - 2005 Jan 01 TI - Is forced oscillation technique useful in the diagnosis of occupational asthma? PG - 847-853 AB - OBJECTIVE: The aim of the study was to determine whether the forced oscillation technique (FOT), which does not require active cooperation, may be useful to assess bronchial responsiveness in patients with suspected occupational asthma (OA). METHODS: Changes in resistances evaluated by FOT, and DeltaFEV1 measured during methacholine challenge test were compared in 77 adults referred for suspected OA. Spearman correlations and ROC curves were used. RESULTS: R0 at the final dose of methacholine (R0hmd) and DeltaR0 were strongly correlated with Delta FEV1 (p < 0.001). The ROC curves showed that R0hmd >or= 240% predicted was the best cut-off value to discriminate subjects with OA from nonasthmatic subjects (sensitivity: 80%, specificity: 76%). CONCLUSION: FOT can be proposed as an alternative method for the assessment of bronchial responsiveness in subjects with suspected OA, unable to correctly perform forced expiratory maneuvers. AU - Descatha A AU - Fromageot C AU - Ameille J AU - Lejaille M AU - Falaize L AU - Louis A AU - Lofaso F LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 37 IP - DP - 2005 Jan 01 TI - Air pollution and atopy PG - 11-16 AB - Relationships between air pollutants and atopy can be studied within 3 different settings. In vitro, exposure of pollen to air pollutants induce morphological changes and seems to facilitate extrusion on allergenic material out of the pollen grain. In animal as well as in human experiments, air pollutants, especially diesel exhaust particulates, are able to trigger an IgE-response. Epidemiological surveys also show that air pollutants trigger symptoms in patients. In contrast, whether or not air pollutants can induce de novo allergic diseases is still a matter of debate. Some surveys suggest that, in humans also, air pollutants, especially diesel-exhaust particulates, could trigger allergic sensitization and development of atopic diseases. At home, other pollutants can be involved: volatile organic compounds have pro-inflammatory properties and favour T-cell sensitization. Relationship between exposure to secondhand tobacco smoke or occupational hazards and atopic sensitization have led to discordant results AU - Boutin-Forzano S AU - Hammou Y AU - Gouitaa M AU - Charpin D LA - PT - DEP - TA - European Annals of Allergy and Clinical Immunology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 56 IP - DP - 2005 Jan 01 TI - Exercise-induced bronchoconstriction and exercise-induced respiratory symptoms in workers exposed to tea dust. PG - 317-326 AB - Assuming that airborne particles and pollutants are important contributing factors in the development of exercise-induced bronchoconstriction (EIB), we performed a case-control study including 63 tea workers (36 men and 27 women, aged 36-55, duration of employment 3-30 years) and an equal number of office workers, matched by sex and age. Exercise-induced respiratory symptoms were recorded in a questionnaire. Skin prick tests, spirometry, as well as exercise and histamine challenge were carried out. Environmental measurements were performed on site during the work shifts. The prevalence of self-reported exercise-induced respiratory symptoms and EIB did not differ significantly between the exposed and control group (41.6% vs 36.8%, and 6.4% vs 4.8%, respectively). In both exposed and control workers, EIB was strongly linked to asthma (P < 0.01). In the exposed workers it was significantly associated with positive family history of asthma (P < 0.01) and positive family history of atopies (P < 0.05), whereas in the exposed smokers it was significantly related to smoking duration (P < 0.05). Bronchial reaction to exercise in the exposed smokers was significantly greater than in control smokers (P < 0.05). Self-reported exercise-induced respiratory symptoms were weakly associated with EIB, with a large proportion of false positive and a low proportion of false negative results in both groups. AU - Minov J AU - Karadzinska-Bislimovska J AU - Risteska-Kuc S AU - Stoleski S LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 128 IP - DP - 2005 Jan 01 TI - Occupational asthma and occupational rhinitis in hairdressers. PG - 3590-3598 AB - BACKGROUND: Hairdressers are at risk for occupational respiratory diseases, but the risk factors, causal agents, and underlying mechanisms are not completely defined. AIM: To describe the features of a large group of hairdressers consecutively referred to our center for suspected occupational asthma (OA) over an 8-year period, the type of occupational respiratory diseases, the etiologic agents, and the diagnostic tests. RESULTS: Forty-seven hairdressers (mean age, 25 years; range, 17 to 52 years) were studied. On the basis of the response to the specific inhalation challenge (SIC), 24 patients received a diagnosis of OA (51.1%), which was due to persulfate salts in 21 patients (87.5%), permanent hair dyes in 2 patients (8.3%), and latex in 1 patient (4.2%). Thirteen of these 24 patients (54.2%) also received a diagnosis of occupational rhinitis, which was due to persulfate salts in 11 patients (84.6%) and to paraphenylenediamine in two patients (15.4%). Patients with persulfate asthma had a long period of exposure to bleaching agents, a long latent period between the start of exposure and the onset of symptoms, and a prevalent eosinophilic airway inflammation in induced sputum. The skin-prick test with ammonium persulfate performed in a subset of patients gave negative results CONCLUSIONS: In the present study, we confirmed that persulfate salts are the major agents involved in OA and occupational rhinitis in hairdressers. The positive response to the SIC in only a part of the population of symptomatic exposed workers, the period between the starting of exposure and the onset of symptoms, the type of response to the SIC, and the high frequency of association of asthma with other diseases such as dermatitis and rhinitis suggest an immunologic mechanism that remains to be elucidated._______________________________________ AU - Moscato G AU - Pignatti P AU - Yacoub MR AU - Romano C AU - Spezia S AU - Perfetti L LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 47 IP - DP - 2005 Jan 01 TI - Physical and mental health symptoms among NYC transit workers seven and one-half months after the WTC attacks PG - 475-483 AB - BACKGROUND: On September 11, 2001, 600-800 New York City transit (NYCT) workers were working near the World Trade Center (WTC) Towers. After the disaster, employees reported physical and mental health symptoms related to the event. METHODS: Two hundred sixty-nine NYC transit employees were surveyed for mental and physical health symptoms 7(1/2) months after the WTC disaster. RESULTS: Workers in the dust cloud at the time of the WTC collapse had significantly higher risk of persistent lower respiratory (OR = 9.85; 95% CI: 2.24, 58.93) and mucous membrane (OR = 4.91; 95% CI: 1.53, 16.22) symptoms, depressive symptoms (OR = 2.48; 95% CI: 1.12, 5.51), and PTSD symptoms (OR = 2.91; 95% CI: 1.003, 8.16) compared to those not exposed to the dust cloud. Additional WTC exposures and potential confounders were also analyzed. CONCLUSIONS: Clinical follow up for physical and psychological health conditions should be provided for public transportation workers in the event of a catastrophic event. AU - Tapp LC. Baron S AU - Bernard B AU - Driscoll R AU - Mueller C AU - Wallingford K LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 60 IP - DP - 2005 Jan 01 TI - Occupational asthma induced by thiamine in a vitamin supplement for breakfast cereals PG - 1213-1214 AB - AU - Drought VJ AU - Francis HC AU - McL Niven R AU - Burge PS LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 18 IP - DP - 2005 Jan 01 TI - Occupational asthma caused by cobalt chloride in a diamond polisher after cessation of occupational exposure: a case report. PG - 151-158 AB - OBJECTIVES: The inspiration of cobalt containing dust leads to various respiratory symptoms, including asthma and interstitial lung disease. Occupational asthma caused by cobalt chloride has been diagnosed in a 35-year-old patient, who worked as a diamond polishing disc former. The patient presented a 2-year history of dyspnea, cough and symptoms of rhinitis. MATERIALS AND METHODS: The patient underwent a medical history interview, skin prick tests with common and occupational allergens (cobalt and nickel chloride), and pulmonary function testing both before and after the nasal provocation with 0.05% cobalt chloride. Additionally, the authors analyzed morphological and biochemical changes before and after the specific nasal challenge test. Cell proliferation analysis was also carried out. RESULTS: Skin prick tests (SPTs) with common environmental allergens were found to be negative, while SPTs with cobalt chloride were positive for all applied solutions. The provocation with cobalt chloride caused a significant increase in the proportion of eosinophils, basophils and albumin during the late allergic reaction. The positive lymphocyte transformation caused by cobalt was also observed. CONCLUSIONS: Cobalt salts may induce occupational asthma. The mechanism of this asthma may be IgE-mediated. The cobalt-sensitized lymphocytes may play an important role in this disease. AU - Krakowiak A AU - Dudek W AU - Tarkowski M AU - Swiderska-Kielbik S AU - Niescierenko E AU - Palczynski C LA - PT - DEP - TA - Int J Occup Med Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 18 IP - DP - 2005 Jan 01 TI - Changes in cellular and biochemical profiles of induced sputum after allergen-induced asthmatic response: method for studying occupational allergic airway inflammation. PG - 27-33 AB - OBJECTIVES: The purpose of the study was to analyze morphological and biochemical changes in induced sputum after the provocation with occupational allergens (mixture of flours and grains) in subjects with diagnosed occupational asthma. MATERIALS AND METHODS: Subjects with occupational asthma and healthy volunteers had physical examination, skin prick tests with common and occupational allergens, and spirometry. Specific IgE against common and occupational allergens was also measured. Bronchial inflammation was characterized by the percentage of cells, levels of eosinophil cationic protein (ECP), and changes in mucosal permeability index. RESULTS: There was a significant increase in the proportion of eosinophils, basophils, lymphocytes, and in the ECP level in induced sputum of occupational allergics after the specific provocation. CONCLUSION: Sputum induction is a reliable method for measuring allergen-induced airway inflammation. AU - Krakowiak A AU - Krawczyk-Adamus P AU - Dudek W AU - Walusiak J AU - Palczynski C LA - PT - DEP - TA - Int J Occup Med Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 53 IP - DP - 2005 Jan 01 TI - The prevalence of occupational asthma in auto and furniture dye workers in downtown Elazig PG - 371-378 AB - Occupational asthma (OA) is characterized by reversible airway obstruction and/or bronchial hyperresponsiveness occurred after exposition to dust, vapor, gas or smoke which are present in the workplace. We aimed to determine the frequency of OA in auto and furniture dye workers in our city center. One-hundred-forty-two workers in Elazig Central Industrial Centre (86 auto, 56 furniture dyes) were included in the study. The workers were questioned with "Turkish Thorax Association Occupational and Environmental Pulmonary Diseases Evaluation Form", and physical examination and pulmonary function tests (PFT) were performed. Follow of peak expiratory flow rate (PEFR) and reversibility tests were performed to patients who had complaints or abnormality in PFT. The workers who had reversibility and positive daily PEFR variability were taken away from work and PEFR variables were followed. The workers had no symptoms when they were taken away from work and daily PEFR were below than 20%, accepted as OA. Twenty-one workers of 22 workers who have abnormal questionnaire, symptoms and abnormality in PFT, accepted daily PEFR measurements. Daily PEFR variability and reversibility test were positive in 5 (3.52%) workers who were accepted as OA. We detected the prevalence of OA, an important worker health problem, was 3.52% in auto and furniture dyes in industrial centre of our city. We think that the prevalence of OA can be determined with detailed history, serial PEFR follow and using PFT, in the absence of specific bronchial provocative tests. Thus, it is important to be become conscious about OA the groups who are under risk. AU - Turgut T AU - Tasdemir C AU - Muz MH AU - Deveci F AU - Kirkil G LA - PT - DEP - TA - Tuberk Toraks JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 15 IP - DP - 2005 Jan 01 TI - Occupational asthma caused by white mushroom. PG - 219-221 AB - The commercial growing of white mushroom (Agaricus bisporus) is a frequent activity in certain Spain regions as La Rioja. We report two cases of white mushroom workers suffering from asthma caused by hypersensitivity to basidiocarp and spores of white mushroom. AU - Venturini M AU - Lobera T AU - Blasco A AU - Del Pozo MD AU - González I AU - Bartolomé B LA - PT - DEP - TA - J Inv Allergod Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 55 IP - DP - 2005 Jan 01 TI - Glutaraldehyde-induced occupational asthma: BALF components and BALF and serum Clara cell protein (CC16) changes due to specific inhalatory provocation test. PG - 572-574 AB - 65: Occup Med (Lond). 2005 Oct;55(7):572-4. OBJECTIVES: The purpose of this study was to evaluate bronchoalveolar lavage fluid (BALF) components and Clara cell protein (CC16) concentration in serum and BALF in patients with glutaraldehyde (GA)-induced asthma, before and after a specific inhalatory provocation test (SIPT) with GA, in comparison to atopic asthmatics and healthy individuals. METHODS: Spirometry and bronchoalveolar lavage were performed before and after SIPT. The serum and BALF concentrations of CC16 and cytogram content in BALF were evaluated. RESULTS: In GA-sensitized asthmatics, the level of CC16 in BALF and serum was significantly lower at 24 h after SIPT in comparison with the values recorded prior to the experiment. There was a significant increase in the proportion of eosinophils, basophils and lymphocytes in BALF of GA-sensitized asthmatics obtained after SIPT. CONCLUSIONS: The determination of CC16 either in serum or in BALF is a non-invasive test to detect Clara cell damage. AU - Palczynski C AU - Walusiak J AU - Krakowiak A AU - Halatek T AU - Ruta U AU - Krawczyk-Adamus P AU - Wittczak T AU - Swiercz R AU - Gorski P AU - Rydzynski K LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 62 IP - DP - 2005 Jan 01 TI - Horse rug lung: toxic pneumonitis due to fluorocarbon inhalation PG - 414-416 AB - Fluorocarbons are widely used in industry, and manifestations of inhalation toxicity include polymer fume fever, reactive airways dysfunction, and bronchospasm. Only seven cases of alveolitis occurring acutely after inhalation have been reported. This paper presents four cases of toxic pneumonitis due to direct inhalation of industrial fluorocarbon used as a waterproofing spray for horse rugs. These cases differ from previous reports and show that chronic as well as acute alveolitis can result from fluorocarbon inhalation. Corticosteroid treatment may be beneficial. The need for stricter control in the workplace is emphasised. AU - Wallace GMF AU - Brown PH LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 55 IP - DP - 2005 Jan 01 TI - Improving the quality of peak flow measurements for the diagnosis of occupational asthma PG - 385-388 AB - Introduction Serial measurements of peak expiratory flow (PEF) are recommended in the evidence-based review list as the first stage in objective confirmation of occupational asthma. Different centres have reported widely different success in obtaining records of sufficient data quantity for diagnosis. We investigated different methods of instruction and determined the return rate and quality of the resulting record for the diagnosis of occupational asthma. Methods Consecutive new referrals were recruited from a specialized occupational lung disease clinic and requested to carry out serial PEFs for the assessment of suspected occupational asthma. Requests to carry out the records were either from written postal instructions or personal instruction from a PEF specialist. Record quality received from other clinicians was also analysed separating those using dedicated occupational forms, and those submitting on graph type forms. Results The postal return rate was 56% and the personal rate 85%. The number of records fulfilling all the data quality criteria were similar in the postal and personal groups (55 and 59%, respectively). Pre-existing records from other clinics plotted from graph charts (fulfilling all criteria) were only adequate in 23%, compared with 61% adequate for pre-existing records plotted from occupational forms. Failure of the record to contain consecutive work periods of =3 workdays was the most common failure. Conclusion The return rate of PEFs for diagnosing occupational asthma is better when patients have been given specific instructions from a PEF specialist and the data quantity better when recorded on a dedicated form. AU - Huggins V AU - Anees W AU - Pantin C AU - Burge PS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 55 IP - DP - 2005 Jan 01 TI - Specific IgE to colophony? PG - 234-237 AB - Background Colophony (rosin) is a natural product obtained from coniferous trees. It is used in a diverse range of products such as adhesives, ink, paints and soldering fluxes. Some workers exposed to colophony during soldering can develop occupational asthma; at present, no specific IgE test is available to assess sensitization to colophony. Methods Serum samples were obtained from exposed symptomatic individuals (n=7), some with a likely diagnosis of occupational asthma, exposed asymptomatic individuals (n=10) and unexposed individuals (n=11). Serum was tested for specific IgE antibodies against a protein extract produced following in vitro challenge of mono-mac-6 cells with colophony extract. Results Serum from exposed symptomatic individuals showed increased binding of specific IgE antibodies to a range of colophony–cell protein conjugates [29% (2/7) of samples tested when cut-off >0.1 or 86% (6/7) of samples tested when cut-off >0%] compared with both the exposed asymptomatic [0% when cut-off >0.1, or 20% when cut-off >0% (2/10)] and the non-exposed control populations [0% when cut-off >0.1, or 27% when cut-off >0% (3/11)]. Conclusions This novel approach for the production of conjugates to assess sensitization to colophony was able to detect specific IgE in colophony-exposed workers with a likely diagnosis of occupational asthma. AU - Elms J AU - Fishwick D AU - Robinson E AU - Burge S AU - Huggins V AU - Barber C AU - Williams N AU - Curran A LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 62 IP - DP - 2005 Jan 01 TI - Evidence based guidelines for the prevention, identification, and management of occupational asthma PG - 290-299 AB - BACKGROUND Occupational asthma is the most frequently reported work related respiratory disease in many countries. This work was commissioned by the British Occupational Health Research Foundation to assist the Health and Safety Executive in achieving its target of reducing the incidence of occupational asthma in Great Britain by 30% by 2010. AIM The guidelines aim to improve the prevention, identification, and management of occupational asthma by providing evidence based recommendations on which future practice can be based. METHODS The literature was searched systematically using Medline and Embase for articles published in all languages up to the end of June 2004. Evidence based statements and recommendations were graded according to the Royal College of General Practitioner's star system and the revised Scottish Intercollegiate Guidelines Network grading system. RESULTS A total of 474 original studies were selected for appraisal from over 2500 abstracts. The systematic review produced 52 graded evidence statements and 22 recommendations based on 223 studies. DISCUSSION Evidence based guidelines have become benchmarks for practice in healthcare and the process used to prepare them is well established. This evidence review and its recommendations focus on interventions and outcomes to provide a robust approach to the prevention, identification, and management of occupational asthma, based on and using the best available medical evidence. The most important action to prevent cases of occupational asthma is to reduce exposure at source. Thereafter surveillance should be performed for the early identification of symptoms, including occupational rhinitis, with additional functional and immunological tests where appropriate. Effective management of workers suspected to have occupational asthma involves the identification and investigation of symptoms suggestive of asthma immediately they occur. Those workers who are confirmed to have occupational asthma should be advised to avoid further exposure completely and early in the course of their disease to offer the best chance of recovery. AU - Nicholson PJ AU - Cullinan P AU - Newman Taylor AJ AU - Burge PS AU - Boyle C LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 47 IP - DP - 2005 Jan 01 TI - Effects of Nitrogen Dioxide on Allergic Airway Responses in Subjects With Asthma PG - 1250-1259 AB - Objective: We sought to determine whether nitrogen dioxide (NO2) can enhance airway inflammation after allergen challenge in asthmatic subjects. Methods: Fifteen house-dust-mite (HDM)- sensitive asthmatic subjects were exposed for 3 hours to filtered air or 0.4 ppm NO2, followed by inhalational challenge with HDM allergen. Markers of inflammation were measured in sputum at 6 hours and 26 hours after allergen challenge. Results: After exposure to NO2, eosinophil concentration decreased significantly in the 6-hour postallergen sputum. No significant NO2-related difference was observed for other variables. Conclusions: Our results suggest that, in most asthmatic individuals, multihour exposure to a high ambient concentration of NO2 does not enhance the inflammatory response to subsequent inhaled allergen as assessed by cell distribution in induced sputum. Because the decrease in airway eosinophils has been reported in previous animal studies, future research should be directed toward the mechanism of this effect. AU - Witten A AU - Solomon C AU - Abbritti E AU - Arjomandi M AU - Zhai W AU - Kleinman M AU - Balmes J LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 93 IP - DP - 2005 Jan 01 TI - An evaluation of the impact of a multidisciplinary team, in a single centre, on treatment and survival in patients with inoperable non-small-cell lung cancer PG - 977-978 AB - Treatment and survival of patients with inoperable Non-small-cell lung cancer in 1997 (n=117) and 2001 (n=126), before and after the introduction of a multidisciplinary team, was examined in a single centre. There were no differences in age, sex and extent of deprivation between the two years. However, in 2001, 23% of patients received chemotherapy treatment compared with 7% in 1997 (P<0.001). Median survival in 2001 was 6.6 months compared with 3.2 months in 1997 (P<0.001). AU - Forrest LM AU - McMillan DC AU - McArdle CS AU - Dunlop DJ LA - PT - DEP - TA - British journal of cancer JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 49 IP - DP - 2005 Jan 01 TI - Inhaled and intravenous corticosteroids both attenuate chlorine gas-induced lung injury in pigs PG - 183-190 AB - Background: The accidental release of chlorine gas is a constant threat in urban areas. The purpose of this randomized, blinded, controlled experiment was to examine the effects of post-injury administration of inhaled or intravenous corticosteroid in chlorine gas-injured pigs followed for 23 h. Methods: Anaesthetized, ventilated pigs (n = 24) in the prone position were exposed to chlorine gas (400 parts per million in air) (1160 mg/m3) for 15 min, then randomly allocated to receive inhaled budesonide (BUD) and intravenous placebo, intravenous betamethasone (BETA) and inhaled placebo or inhaled and intravenous placebo. Haemodynamics, gas exchange and lung mechanics were evaluated for 23 h after exposure to chlorine gas. Results: Airway and pulmonary artery pressures increased and arterial oxygenation fell sharply (from 13.5 ± 0.8 to 6.7 ± 0.9 kPa, P < 0.001) after chlorine gas exposure. These immediate changes were followed by a gradual improvement over 5–7 h to a stable level of dysfunction for the rest of the experiment in placebo animals. Arterial oxygen tension, pulmonary vascular resistance and airway pressure recovered faster and more completely in the budesonide and betamethasone groups than in the placebo group (P < 0.01). Lung wet weight to dry weight ratios were greater in the placebo group than in the budesonide and betamethasone groups (6.34 ± 0.59 vs. 5.56 ± 0.38 and 5.53 ± 0.54, respectively, P < 0.05). There was a trend towards lower histological injury scores compared with placebo in animals that received budesonide (P = 0.05) or betamethasone (P = 0.07). Conclusion: Treatment of chlorine gas lung injury with nebulized budesonide or intravenous betamethasone had similar positive effects on recovery of lung function. AU - Wang J AU - Winskog C AU - Edston E AU - Walther AU - SM LA - PT - DEP - TA - Acta Anaesthesiologica Scandinavica JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 54 IP - DP - 2005 Jan 01 TI - Occurrence and characterization of multiple novel genotypes of Mycobacterium immunogenum and Mycobacterium chelonae in metalworking fluids PG - 329-338 AB - Rapidly growing mycobacteria colonize metalworking fluids, leading to contamination of occupational environments and exposure-related respiratory illnesses in machine workers. Lately, it has been emphasized that these fluids are colonizable by a single genotype of a rapidly growing mycobacterium species, Mycobacterium immunogenum. Here, we report on the genotypic diversity of mycobacteria in these fluids, including isolation and characterization of multiple novel genotypes of two distinct species, Mycobacterium chelonae and M. immunogenum. Using agar culturing and Mycobacterium-specific PCR, 13 mycobacterial isolates were recovered from 100 geographically diverse in-use metalworking fluid samples. Based on restriction fragment length polymorphism of PCR products, DNA sequencing (hsp 65 gene segment), and phylogenetic analysis of 16S–23S rDNA internal transcribed spacer (ITS) sequences, six isolates were identified as M. immunogenum and seven as M. chelonae; an additional isolate from metalworking fluid diluent water was identified as M. diernhoferi. Genomic DNA macro-restriction fragment pattern analysis, using pulsed-field gel electrophoresis with Xba I and Spe I restriction digestions, showed intraspecies variation among the isolates of M. immunogenum and M. chelonae. Visual and computer-assisted dendrogram analysis of the Xba I macro-restriction patterns revealed three novel genotypes of M. immunogenum and two of M. chelonae, whereas Spe I macro-restriction patterns revealed only two genotypes for each isolate. None of the identified genotypes matched the reportedly dominant one of M. immunogenum from metalworking fluids. Both mycobacterial species are prevalent in metalworking fluids and there is a considerable strain-level genetic diversity within them AU - Khan IU AU - Selvaraju SB AU - Yadav JS LA - PT - DEP - TA - FEMS microbiology ecology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 171 IP - DP - 2005 Jan 01 TI - Needs and Opportunities for Research in Hypersensitivity Pneumonitis PG - 792-798 AB - Hypersensitivity pneumonitis (HP) develops after inhalation of many different environmental antigens, causing variable clinical symptoms that often make diagnosis uncertain. The prevalence of HP is higher than recognized, especially its chronic form. Mechanisms of disease are still incompletely known. Strategies to improve detection and diagnosis are needed, and treatment options, principally avoidance, are limited. A workshop recommended: a population-based study to more accurately document the incidence and prevalence of HP; better classification of disease stages, including natural history; evaluation of diagnostic tests and biomarkers used to detect disease; better correlation of computerized tomography lung imaging and pathologic changes; more study of inflammatory and immune mechanisms; and improvement of animal models that are more relevant for human disease. AU - Fink JN AU - Ortega HG AU - Reynolds HY AU - Cormier YF AU - Fan LL AU - Franks TJ AU - Kreiss K AU - Kunkel S AU - Lynch D AU - Quirce S AU - Rose C AU - Schleimer RP AU - Schuyler MR AU - Selman M AU - Trout D AU - and Yoshizawa Y LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 26 Suppl 4 IP - DP - 2005 Jan 01 TI - Serial peak flow measurements in occupational asthma; methods for monitoring response to exposure control using Oasys PG - 150s AB - We aimed to assess changes in serial measurements of peak expiratory flow (PEF) in workers with occupational asthma (OA) due to metal-working fluid following control of microbiological contamination and use of respiratory protective equiptment. Two hourly measurements of PEF were measured for 4 weeks before and after microbiological control in 24 workers with occupational asthma from one engine manufacturing factory, which resolved in 10 and persisted in 14 workers. The Oasys plotter (www.occupationalasthma.com) was used to generate the following indices; mean workday and restday PEF and diurnal variation ("days"; first reading at work to last reading before work the next day); area between mean hourly workday and restday PEF (area), Oasys score and Expert opinion. [Table 1] shows that the area between the mean restday and workday hourly readings was the most discriminating, and the mean diurnal variation the least discriminating variable between resolved and persisting OA. At presentation those with persisting OA had larger reactions on workdays and less restday recovery than those who resolved. This together with the improvement following control in those with persisting OA suggests a single cause for the outbreak, rather than 2 causes, only one of which had been controlled. AU - Burge C AU - Robertson A AU - Burge S LA - PT - DEP - TA - Eur J Respir Dis Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 214 IP - DP - 2005 Jan 01 TI - Medical aspects of sulphur mustard poisoning PG - 198-209 AB - Sulphur mustard is one of the major chemical warfare agents developed and used during World War I. Large stockpiles are still present in several countries. It is relatively easy to produce and might be used as a terroristic weapon. Sulphur mustard is a vesicant agent and causes cutaneous blisters, respiratory tract damage, eye lesions and bone marrow depression. The clinical picture of poisoning is well known from the thousands of victims during World War I and the Iran–Iraq war. In the latter conflict, sulphur mustard was heavily used and until now about 30,000 victims still suffer from late effects of the agent like chronic obstructive lung disease, lung fibrosis, recurrent corneal ulcer disease, chronic conjunctivitis, abnormal pigmentation of the skin, and several forms of cancer. Despite enormous research efforts during the last 90 years, no specific sulphur mustard antidote has been found. The prospering knowledge and developments of modern medicine created nowadays new chances to minimize sulphur mustard-induced organ damage and late effec AU - Kehe K AU - Szinicz L LA - PT - DEP - TA - Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 60 IP - DP - 2005 Jan 01 TI - BOHRF guidelines for occupational asthma PG - 364-366 AB - New guidelines for the identification, management, and prevention of occupational asthma are published this month in Occupational and Environmental Medicine.1 The first evidence based guidelines for occupational asthma, they were prepared by a working group that included clinicians, patients, occupational hygienists, and representatives of the Health and Safety Executive. The work was supported by a grant from the British Occupational Health Research Foundation (BOHRF). The guidelines will be supplemented by an abbreviated version for primary care practitioners, occupational health practitioners, employers, employees, and workplace safety representatives. These guidelines are intended to increase awareness and improve the management of occupational asthma by all practitioners who encounter such patients, and to stimulate the means to reduce its incidence by those able to effect this. The important issues in occupational asthma concern its aetiology, diagnosis, outcome and prevention. Questions about these are not readily answered by randomised controlled trials (RCTs) and, arguably, conventional hierarchies with the RCT at the apex are not appropriate for assessing the strength of evidence used in the generation of guidelines.2 Although not having the high internal validity of the RCT, strong inferences can be drawn from observational studies (whose external validity can be greater than that of an RCT) when these are well designed and their findings consistent and plausible. The guidelines address several questions that are of key importance to respiratory physicians: What proportion of asthma in adult life is attributable to occupation? What are the most frequent causes of occupational asthma and in which occupations are they encountered? What methods are most useful in the diagnosis of occupational asthma? How is a case of occupational asthma best managed? What is the prognosis of occupational asthma and what factors influence this? AU - Newman Taylor AJ AU - Cullinan P AU - Burge PS AU - Nicholson P AU - Boyle C LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 69 IP - DP - 2005 Jan 01 TI - Work-related asthma in teachers in Connecticut: association with chronic water damage and fungal growth in schools. PG - 9-17 AB - Purpose To review a series of 55 teachers from schools in Connecticut who presented consecutively to our clinic, and to summarize our clinical experience with work-related disease in this population, which could lead to a more formal study. Methods Retrospective chart review; data were abstracted concerning clinical and environmental factors and entered into a statistical spreadsheet program (JMP for Windows). Results Of the 55 educators, 22 were diagnosed with upper respiratory syndromes (rhinitis or sinusitis), three with bronchitis, and 23 with asthma. Of the 23 with asthma, 20 presented with active or symptomatic asthma, and seven of these were incident cases of occupational asthma. In addition, four cases (7%) of granulomatous lung disease (two hypersensitivity pneumonitis and two sarcoidosis) were diagnosed. Finally, three patients (5%) received only nonrespiratory diagnoses (panic disorder, sicca syndrome, and vertigo). In 33 work-places, the exposures of concern were predominantly related to ongoing "dampness" or visible mold growth. The remaining 22 work-places were "dry." Symptoms varied according to the work-place environment, with more patients from water damaged (vs dry) work-places having upper respiratory symptoms (76% vs 45%) and asthma (45% vs 23%). All seven patients with incident asthma and all four patients with interstitial lung disease worked in schools with documented water incursion. Conclusions Work-place exposures in water damaged school buildings are risk factors for development of work-related lower respiratory disease in schoolteachers and staff. Identification of such high-risk environments can be done by a simple but thorough qualitative evaluation during a walk-through inspection, and it should not require air sampling or surface sampling protocols for microbial contaminants. AU - Dangman KH1 AU - Bracker AL AU - Storey E LA - PT - DEP - TA - Connecticut Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20050101 IS - IS - VI - 15 IP - DP - 2005 Jan 01 TI - Allergy to freshwater shrimp (Gammarus). PG - 150-152 AB - We report three new cases of allergy to Gammarus, two of them involving cutaneous symptoms, and the third one with occupational asthma. The results showed exposure to feed containing Gammarus shrimp to be the main cause of the allergic symptoms in the three patients. In all cases the intervention of IgE was demonstrated, with the absence of cross-reactions with other common allergenic arthropods. AU - Fontán M AU - Añibarro B AU - Postigo I AU - Martínez J. LA - PT - DEP - TA - J Investig Allergol Clin Immunol. 2005;15(2):150–2. JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 59 IP - DP - 2004 Jan 01 TI - Health Hazards from Volcanic Gases: A Systematic Literature Review PG - 628-639 AB - Millions of people are potentially exposed to volcanic gases worldwide, and exposures may differ from those in anthropogenic air pollution. A systematic literature review found few primary studies relating to health hazards of volcanic gases. SO2 and acid aerosols from eruptions and degassing events were associated with respiratory morbidity and mortality but not childhood asthma prevalence or lung function decrements. Accumulations of H2S and CO2 from volcanic and geothermal sources have caused fatalities from asphyxiation. Chronic exposure to H2S in geothermal areas was associated with increases in nervous system and respiratory diseases. Some impacts were on a large scale, affecting several countries (e.g., Laki fissure eruption in Iceland in 1783–4). No studies on health effects of volcanic releases of halogen gases or metal vapors were located. More high quality collaborative studies involving volcanologists and epidemiologists are recommended. AU - Hansell A AU - Oppenheimer C LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 6 IP - DP - 2004 Jan 01 TI - A Case Report of Suspected Ginseng Allergy PG - 9 AB - Ginseng is the dried root of one of several species of the Araliaceae family of herbs. The most commonly used type is Asian ginseng (Panax ginseng), often sold as Chinese or Korean ginseng. The main active components of ginseng are ginsenosides, which are purported to have a variety of beneficial effects, including anti-inflammatory, antioxidant, and anticancer effects.[1] In addition, results of clinical research studies suggest that ginseng may improve psychological function, immune function, and conditions associated with diabetes.[1] At present, ginseng is widely used in some populations as a tonic agent; several tonic products with ginseng as a remedy are currently on the market. We report here our experience on a case of possible anaphylactic reaction to ginseng. In 1999, a 20-year-old male medical student at Chulalongkorn Medical School, in Bangkok, Thailand, was sent to the physician at the emergency room with the symptoms of generalized urticarial rash and difficulty in breathing. During a class, he ingested a sip of ginseng syrup and noted that the sickness symptoms occurred suddenly, about 3 minutes after ingestion. The canned ginseng syrup was a local product; its label confirmed the contents: syrup and ginseng. The student was therefore sent to the emergency room of the hospital. He had no history of a syrup or other additive allergy. At the emergency room, about 5 minutes from the classroom, he was found to be fully conscious. He developed hypotension: the first reading blood pressure was 90/60 mmHg. His pulse rate was 96/min. Wheezing was found on examination of the lungs. His heart sounds were normal. Discrete erythematous papules and angioedema were seen on the extremities, trunk, neck, face, feet, and hands. He had puffy erythematous eyelids and conjunctiva swelling bilaterally. He was promptly treated by intravenous steroid (dexamethasone 5 mg) and admitted to the emergency room for observation. Twenty minutes after admission, his blood pressure returned to normal (120/80 mmHg), wheezing ceased, and his difficulty in breathing ceased. Then he was sent to the ward in the hospital. His skin lesions gradually diminished: the urticaria diminished after admission and the papules completely diminished within 1 day. Oral prednisolone 10 mg every 8 hours was prescribed for him on the ward for 1 day and continued as home medication. He fully recovered within 1 day and was discharged. He was diagnosed with a possible ginseng allergy. The sudden, severe, potentially fatal, systemic allergic reaction involving various areas of the body, including the skin and respiratory and cardiovascular systems, in this case suggests an actual diagnosis of anaphylactic reaction. It is interesting that ginseng is widely touted and used for its possible antiallergic effect.[2] Smolina and colleagues[3] reported that ginseng provided increased resistance to coli-sepsis in mice, increased neutrophil and macrophage phagocytosis, stimulated humoral and cell immune factors, and induced important regulating cytokine-interferon gamma and tumor necrosis factor. In contrast, we report the opposite: a possible case of anaphylactic reaction due to Asian ginseng. Using the standard search methodologies, we have found no other reports of this kind of allergic reaction to Asian ginseng. There have been some reports of allergic reactions to Brazilian ginseng (Pfaffia paniculata), mostly in the form of respiratory tract hypersensitivity.[4,5] Subiza and coworkers[4] reported a case of respiratory allergy and asthmatic attack after respiratory exposure to Brazilian ginseng root powder, proven by provocative sensitization test. In the case reported here, the patient was exposed to Asian ginseng syrup by ingestion, and developed much more than respiratory allergy, with skin and blood pressure effects. I believe that this was actual anaphylaxis which can, of course, be fatal. Unfortunately, the confirmation by sensitization was not performed and the patient refused further immunologic investigation. Because Asian ginseng is a widely used herb and seems to be growing in popularity, awareness of the potential for serious — although apparently rare — undesired side effects, such as allergy, merits this publication. Author information Copyright and License information Disclaimer This article has been cited by other articles in PMC. Ginseng is the dried root of one of several species of the Araliaceae family of herbs. The most commonly used type is Asian ginseng (Panax ginseng), often sold as Chinese or Korean ginseng. The main active components of ginseng are ginsenosides, which are purported to have a variety of beneficial effects, including anti-inflammatory, antioxidant, and anticancer effects.[1] In addition, results of clinical research studies suggest that ginseng may improve psychological function, immune function, and conditions associated with diabetes.[1] At present, ginseng is widely used in some populations as a tonic agent; several tonic products with ginseng as a remedy are currently on the market. We report here our experience on a case of possible anaphylactic reaction to ginseng. In 1999, a 20-year-old male medical student at Chulalongkorn Medical School, in Bangkok, Thailand, was sent to the physician at the emergency room with the symptoms of generalized urticarial rash and difficulty in breathing. During a class, he ingested a sip of ginseng syrup and noted that the sickness symptoms occurred suddenly, about 3 minutes after ingestion. The canned ginseng syrup was a local product; its label confirmed the contents: syrup and ginseng. The student was therefore sent to the emergency room of the hospital. He had no history of a syrup or other additive allergy. At the emergency room, about 5 minutes from the classroom, he was found to be fully conscious. He developed hypotension: the first reading blood pressure was 90/60 mmHg. His pulse rate was 96/min. Wheezing was found on examination of the lungs. His heart sounds were normal. Discrete erythematous papules and angioedema were seen on the extremities, trunk, neck, face, feet, and hands. He had puffy erythematous eyelids and conjunctiva swelling bilaterally. He was promptly treated by intravenous steroid (dexamethasone 5 mg) and admitted to the emergency room for observation. Twenty minutes after admission, his blood pressure returned to normal (120/80 mmHg), wheezing ceased, and his difficulty in breathing ceased. Then he was sent to the ward in the hospital. His skin lesions gradually diminished: the urticaria diminished after admission and the papules completely diminished within 1 day. Oral prednisolone 10 mg every 8 hours was prescribed for him on the ward for 1 day and continued as home medication. He fully recovered within 1 day and was discharged. He was diagnosed with a possible ginseng allergy. The sudden, severe, potentially fatal, systemic allergic reaction involving various areas of the body, including the skin and respiratory and cardiovascular systems, in this case suggests an actual diagnosis of anaphylactic reaction. It is interesting that ginseng is widely touted and used for its possible antiallergic effect.[2] Smolina and colleagues[3] reported that ginseng provided increased resistance to coli-sepsis in mice, increased neutrophil and macrophage phagocytosis, stimulated humoral and cell immune factors, and induced important regulating cytokine-interferon gamma and tumor necrosis factor. In contrast, we report the opposite: a possible case of anaphylactic reaction due to Asian ginseng. Using the standard search methodologies, we have found no other reports of this kind of allergic reaction to Asian ginseng. There have been some reports of allergic reactions to Brazilian ginseng (Pfaffia paniculata), mostly in the form of respiratory tract hypersensitivity.[4,5] Subiza and coworkers[4] reported a case of respiratory allergy and asthmatic attack after respiratory exposure to Brazilian ginseng root powder, proven by provocative sensitization test. In the case reported here, the patient was exposed to Asian ginseng syrup by ingestion, and developed much more than respiratory allergy, with skin and blood pressure effects. I believe that this was actual anaphylaxis which can, of course, be fatal. Unfortunately, the confirmation by sensitization was not performed and the patient refused further immunologic investigation. Because Asian ginseng is a widely used herb and seems to be growing in popularity, awareness of the potential for serious — although apparently rare — undesired side effects, such as allergy, merits this publication. AU - Wiwanitkit V AU - Taungjaruwinai W LA - PT - DEP - TA - MedGenMed JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 86 IP - DP - 2004 Jan 01 TI - The Bhopal gas tragedy: An environmental disaster PG - 905-920 AB - The multi-disciplinary study of histopathology and toxicology of Bhopal gas tragedy resolved several issues. First, the progression of severe pulmonary oedema to chronic fibrosis was confirmed experimentally, following a single exposure to MIC. Analysis of the residue in Tank 610 revealed over 21 chemicals. Apart from MIC and HCN, some of them were tracked down to the blood and viscera of dead and living ‘exposees’. The rationale of NaTS therapy was substantiated by elevated urinary NaSCN levels in Double Blind Clinical Trials as well as patients. Apart from cyanide, the ‘cherry red’ discolouration was also shown to result from binding of MIC to end-terminal valine residues of Hb, as shown by changes in 2–3DPG levels and blood gas profiles. The finding of Ncarbamoylation of several other end-terminal amino acids of tissue proteins confirmed the distribution of MIC within the body, although the underlying mechanism is not yet fully understood. Possibly, the much faster S-carbamoylated compounds of the blood like glutathione and other sulphydryl containing enzymes like rhodanese could be responsible for re-circulation of MIC and protracted cyanide toxicity. It is hoped that eventually the enigma of the ‘Bio-chemical Lesion’ of MIC toxicity will be unraveled. AU - Sriramachari S LA - PT - DEP - TA - Current Science JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 59 IP - DP - 2004 Jan 01 TI - Recurrence of acute respiratory failure following use of waterproofing sprays PG - 541-542 AB - Between January and March 2003 six patients were admitted to hospital in the Lausanne area of Switzerland with acute respiratory failure following use of a waterproofing spray for clothes and leather. Within hours of exposure all patients developed a dry cough and rapidly progressive dyspnoea. The clinical picture included severe hypoxaemia, increased white blood cell count, raised Creactive protein, and reduced carbon monoxide. All patients had diffuse bilateral ground glass opacities on a high resolution CT scan, most often sparing the subpleural areas. Every patient improved following treatment with oral prednisone (0.5–0.9 mg/kg) but residual dyspnoea and reduced TLCO (<80% of predicted value) could be seen for more than 2 weeks. Acute respiratory failure was attributed to inhalation of the waterproofing spray in view of the sudden occurrence of symptoms following exposure, the diffuse ground glass opacities without other abnormalities on the CT scan, and the absence of any other detected cause. In particular, BAL fluid was sterile for bacteria, mycobacteria, viruses and fungi. Serological tests for chlamydia and mycoplasma were performed on two patients and were negative. A nasal swab for influenza was performed on one patient and was negative. We were, however, surprised that the patients used three different spray brands. Waterproofing sprays contain three types of components—a propellant gas (propane butane), a waterproofing agent (fluorocarbon resin), and a solvent. It appeared that the manufacturer of the fluorinated resin changed during the summer of 2002 (the same for the three brands) and that the isopropanol solvent had to be replaced with a heptane solvent. Consumers started complaining of respiratory symptoms in October 2002 and the first severe case requiring admission was reported in January 2003. The three products were withdrawn from the market at the beginning of March. During this 6 month period 153 cases of respiratory symptoms related to waterproofing sprays were reported to the Swiss Toxicological Information Centre, whereas less than 10 cases per year had been reported in the previous 7 years. The same fluorinated resin was also distributed in Germany, the Netherlands, and the UK. In Germany the waterproofing sprays were withdrawn before they reached the consumers. During the same period five patients were admitted to hospital in the Netherlands with the same complaints.1 These sprays were also withdrawn from the Dutch market. Surprisingly, no case has yet been recorded in the UK. However, only sprays for public use were withdrawn, not the industrial liquids. In Switzerland two additional patients developed a chemical pneumonitis with similar symptoms and diffuse bilateral ground glass opacities after using industrial waterproofing liquid with a nebuliser. Workers in the above mentioned countries should therefore be warned not to use the liquid form with nebulisers. In the past, several outbreaks of acute respiratory symptoms have been recorded in different countries including 550 in Oregon in 1992,2 3 in Pennsylvania and Virginia in 1993,4 in Quebec in 1993,5 and in Japan between 1992 and 1993.6 Most of these epidemics followed a modification of the composition of the spray. One untreated patient developed a pulmonary fibrosis during a German outbreak in the 1980s7 and one death was reported in Japan in the 1990s.8 Following these outbreaks, various suggestions were proposed to explain these intoxications.9 In our opinion, the most likely explanation for the present outbreak is that the heptane solvent, which is more volatile than the previous one (isopropanol), allows the mist containing the new fluorinated resin to spread further in the tracheobronchial tree and to reach the alveoli where it might produce reactive metabolites inducing an alveolitis. However, the exact chemical reaction remains unknown. Because of the potentially lethal aspect of these intoxications and the po ssibility of new outbreaks, we consider that more research is needed on the effect of mist particle size and large analytical epidemiological studies are required to investigate this phenomenon further. References 1 Bonte F, Rudolphus A, Tan KY, et al. Severe respiratory symptoms following the use of waterproofing sprays. Ned Tijdschr Geneeskd 2003;147:1185–8. 2 From the Centers for Disease Control and Prevention. Acute respiratory illness linked to use of aerosol leather conditioner—Oregon, 1992. JAMA 1993;269:568–9. 3 Smilkstein MJ, Burton BT, Keene W, et al. Acute respiratory illness linked to use of aerosol leather conditioner—Oregon, December 1992. MMWR Morb Mortal Wkly Rep 1993;41:965–7. 4 Burkhart KK, Britt A, Petrini G, et al. Pulmonary toxicity following exposure to an aerosolised leather protector. J Toxicol Clin Toxicol 1996;34:21–4. 5 Laliberte´ M, Sanfacon G, Blais R. Acute toxicity linked to use of a leather protector. Ann Emerg Med 1995;25:841–4. 6 Shintani S, Ishizawa J, Endo Y, et al. A progress report of toxicovigilance activity for acute inhalation poisonings by waterproofing spray in Japan (abstract). Clin Toxicol 1996;34:589. 7 Schicht R, Hartjen A, Still V. Alveolitis after inhalation of leather impregnation spray. Dsch Med Wochenschr 1982;107:688. 8 Ota H, Koge K, Tanaka H, et al. Acute respiratory failure due to inhalation of aerosol water proof agent (Japanese). Nihon Kokyuki Gakkai Zasshi 2000 Jun;38:485–9. 9 Hubbs AF, Castranova V, Ma JY, et al. Acute lung injury induced by a commercial leather conditioner. Toxicol Appl Pharmacol 1997;143:37–46. AU - Heinzer R AU - Fitting JW AU - Ribordy V AU - Kuzoe B AU - Lazor R AU - Fitting JW LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 48 IP - DP - 2004 Jan 01 TI - Six month tracking of microbial growth in a metalworking fluid after system cleaning and recharging. PG - 541-546 AB - Large volumes of metalworking fluids (MWFs) are used in manufacturing industries for cooling and lubrication of metal pieces and tools during machining. MWFs accumulate microbial growth through continuous recirculation and reuse. We studied the progression of microbial contamination for 6 months after dumping, cleaning and recharging (DCR) of a large semi-synthetic MWF system managed with several biocides. Fresh, uncontaminated fluid was added to the system after extensive cleaning. The following samples were collected and analyzed: pre-DCR fluid (before system cleaning); neat fluid diluted to 6% with water; in use MWF 12 h and 1, 3 and 6 months post-DCR. Samples were analyzed for total microorganism concentrations by direct counting using fluorescence microscopy and by plate counting on various media (R2A, BHI, Middlebrooks and rose bengal under aerobic conditions). In addition, PCR was performed for the detection of mycobacteria. There was a rapid progression in the total bacterial counts as determined by fluorescence microscopy: 5.7 x 10(7) cells/ml in the pre-DCR used fluid, no measurable bacteria in the neat fluid, 6.9 x 10(6) cells/ml after 12 h and 2.2 x 10(6), 3.6 x 10(8) and 6.1 x 10(8) cells/ml after 1, 3 and 6 months, respectively. On average, only 0.2% of the direct count organisms were quantified on R2A cultures. PCR showed the presence of mycobacteria in the used MWF at 3 and 6 months. Mycobacteria were also identified from cultures on Middlebrooks and R2A. This study demonstrates that standard methods for cleaning MWF systems are inadequate since residual bacteria in the system can rapidly repopulate the newly charged MWF. AU - Veillette M1 AU - Thorne PS AU - Gordon T AU - Duchaine C. LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 170 IP - DP - 2004 Jan 01 TI - Idiopathic Interstitial Pneumonia What Is the Effect of a Multidisciplinary Approach to Diagnosis? PG - 904-910 AB - Current guidelines recommend that the clinician, radiologist, and pathologist work together to establish a diagnosis of idiopathic interstitial pneumonia. Three clinicians, two radiologists, and two pathologists reviewed 58 consecutive cases of suspected idiopathic interstitial pneumonia. Each participant was provided information in a sequential manner and was asked to record their diagnostic impression and level of confidence at each step. Interobserver agreement improved from the beginning to the end of the review. After the presentation of histopathologic information, radiologists changed their diagnostic impression more often than did clinicians. In general, as more information was provided the confidence level for a given diagnosis improved, and the diagnoses rendered with a high level of confidence were more likely congruent with the final pathologic consensus diagnosis. The final consensus pathologist diagnosis was idiopathic pulmonary fibrosis in 30 cases. Clinicians identified 75% and radiologists identified 48% of these cases before presentation of the histopathologic information. Histopathologic information has the greatest impact on the final diagnosis, especially when the initial clinical/radiographic diagnosis is not idiopathic pulmonary fibrosis. We conclude that dynamic interactions between clinicians, radiologists, and pathologists improve interobserver agreement and diagnostic confidence. AU - Flaherty KR AU - King TE AU - Jr AU - Raghu G AU - Lynch JP AU - Colby TV AU - Travis WD AU - Gross BH AU - Kazerooni EA AU - Toews GB AU - Long Q AU - Murray S AU - Lama VN AU - Gay SE AU - Martinez FJ LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 15 IP - DP - 2004 Jan 01 TI - Occupational Risk Factors for Lung Cancer in Men and Women: A Population-Based Case–Control Study in Italy PG - 285-294 AB - Population attributable risk men 9.5% AU - Richiardi L AU - Boffetta P AU - Simonato L AU - Forastiere F AU - Zambon P AU - Fortes C AU - Gaborieau V AU - Merletti F LA - PT - DEP - TA - cancer causes and control JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 93 IP - DP - 2004 Jan 01 TI - Eucalyptus as a specific irritant causing vocal cord dysfunction PG - 299-303 AB - Background Vocal cord dysfunction (VCD) is a well-recognized clinical entity that frequently mimics asthma and is characterized by inappropriate adduction of the vocal cords during inspiration. The pathogenesis of VCD has not yet been defined. The only previous report suggested that respiratory irritants may trigger paradoxical motion of the vocal cords. Objective To report the case of a 46-year-old woman with VCD precipitated by eucalyptus exposure. Methods A masked flexible fiberoptic nasolaryngoscopy was performed to confirm whether VCD occurred with eucalyptus and not with other known respiratory irritants. The patient underwent inhalation challenges consisting of water, ammonia, pine oil, and a combination of eucalyptus (dried leaves) and ammonia. Two independent observers before patient challenge could not identify eucalyptus. Results Vocal cord dysfunction occurred within minutes of exposure to eucalyptus. This is the first report to prospectively document that a specific irritant, eucalyptus, can precipitate VCD. Negative skin prick test results, total IgE level, and negative IgE eucalyptus-specific antibodies support a nonimmunologic mechanism. Conclusions A new pathogenic mechanism for this clinical entity is supported by our observations. Furthermore, a nonimmunologic mechanism in which respiratory irritants may induce VCD is suspected. Future studies to elucidate this mechanism need to be performed in individuals with irritant-specific VCD. AU - Huggins JT AU - Kaplan A AU - Martin-Harris B AU - Sahn SA LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 112 IP - DP - 2004 Jan 01 TI - The association between asthma and allergic symptoms in children and phthalates in house dust: a nested case-control study. PG - 1393-7 AB - Global phthalate ester production has increased from very low levels at the end of World War II to approximately 3.5 million metric tons/year. The aim of the present study was to investigate potential associations between persistent allergic symptoms in children, which have increased markedly in developed countries over the past three decades, and the concentration of phthalates in dust collected from their homes. This investigation is a case-control study nested within a cohort of 10,852 children. From the cohort, we selected 198 cases with persistent allergic symptoms and 202 controls without allergic symptoms. A clinical and a technical team investigated each child and her or his environment. We found higher median concentrations of butyl benzyl phthalate (BBzP) in dust among cases than among controls (0.15 vs. 0.12 mg/g dust). Analyzing the case group by symptoms showed that BBzP was associated with rhinitis (p = 0.001) and eczema (p = 0.001), whereas di(2-ethylhexyl) phthalate (DEHP) was associated with asthma (p = 0.022). Furthermore, dose-response relationships for these associations are supported by trend analyses. This study shows that phthalates, within the range of what is normally found in indoor environments, are associated with allergic symptoms in children. We believe that the different associations of symptoms for the three major phthalates-BBzP, DEHP, and di-n-butyl phthalate-can be explained by a combination of chemical physical properties and toxicologic potential. Given the phthalate exposures of children worldwide, the results from this study of Swedish children have global implications. AU - Bornehag CG AU - Sundell J AU - Weschler CJ AU - Sigsgaard T AU - Lundgren B AU - Hasselgren M AU - Hagerhed-Engman L LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 67 IP - DP - 2004 Jan 01 TI - Pulmonary responses to welding fumes: role of metal constituents. PG - 233-249 AB - The chemical properties of welding fumes can be quite complex. Most welding materials are alloy mixtures of metals characterized by different steels that may contain iron, manganese, chromium, and nickel. Animal studies have indicated that the presence and combination of different metal constituents is an important determinant in the potential pneumotoxic responses associated with welding fumes. Animal models have demonstrated that stainless steel (SS) welding fumes, which contain significant levels of nickel and chromium, induce more lung injury and inflammation, and are retained in the lungs longer than mild steel (MS) welding fumes, which contain mostly iron. In addition, SS fumes generated from welding processes using fluxes to protect the resulting weld contain elevated levels of soluble metals, which may affect respiratory health. Recent animal studies have indicated that the lung injury and inflammation induced by SS welding fumes that contain water-soluble metals are dependent on both the soluble and insoluble fractions of the fume AU - Antonini JM AU - Taylor MD AU - Zimmer AT AU - Roberts JR LA - PT - DEP - TA - J Toxicol Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 36 IP - DP - 2004 Jan 01 TI - Occupational asthma in a highly industrialized region of UK: report from a local surveillance scheme PG - 56-62 AB - Abstract Estimates of the incidence of occupational asthma may be derived from surveillance schemes established in several countries. SHIELD is a voluntary surveillance scheme for occupational asthma in the West Midlands, a highly industrialized region of UK. The aim of this study was to estimate the general and specific incidence of occupational asthma in the West Midlands in 1990-97. The annual incidence was 41.2/million. There was a two fold difference in the incidence by sex (male 59.6/million/yr; female 27.4/million/yr). The highest annual incidence (53.2/million) was observed in the age group 45-64 yr (male) and 45-59 yr (female). Spray painters were the occupation at the highest risk of developing occupational asthma, followed by electroplaters, rubber and plastic workers, bakery workers and moulders. Although the percentage of reported cases was low among healthcare workers, there was a raising trend. Isocyanates still remained the most common causative agents with 190 (17.3%) out of the total 1097 cases reported to the surveillance scheme in seven years. There was a decrease in the reported cases due to colophony (9.5% to 4.6%), flour & wheat (8.9% to 4.9%). There was an increase of reported cases due to latex (0.4% to 4.9%) and glutaraldehyde (1.3% to 5.6%). The serial mesurement of peak expiratory flow at and away from work was the most used method of diagnosis to confirm the occupational cause of asthma. Specific bronchial challenge test with the occupational agents were used when the serial measurement of peak expiratory flow was not able to confirm undoubtdely the diagnostic suspicion or when it was difficult to identify the possible causative agent due to multiple exposures in the workplace. Following diagnosis, 24% of the patients were moved away from exposure within the same workplace in 1997, compared to 15.8% in the previous years. Those remaining exposed to the causative agent in the same workplace decreased from 28.3% to 17.7% between 1990-97. The surveillance of occupational asthma through this voluntary scheme has allowed to monitor the incidence of the disease in the region and to identify clusters of cases, where control measures are a priority. AU - Di Stefano F AU - Siriruttanapruk S AU - McCoach J AU - Di Gioacchino M AU - Burge PS LA - PT - DEP - TA - Allerg Immunol (Paris) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 23 IP - DP - 2004 Jan 01 TI - Effect of peak expiratory flow data quantity on diagnostic sensitivity and specificity in occupational asthma PG - 730-734 AB - Serial peak expiratory flow records are recommended in the first-line investigation of suspected occupational asthma. The effects of sequentially reducing the numbers of-working weeks, consecutive days at work and readings taken per day on diagnostic sensitivity and specificity were investigated, using good quality peak expiratory flow records from 81 workers with independently confirmed occupational asthma and 60 asthmatics without occupational exposure. Sensitivity was 81.8% for records of 4 weeks' duration and 70% for those of 2 weeks' duration (specificity 93.8 and 82.4% respectively). The sensitivity fell to 56.7% if there were only 2 consecutive workdays in each work period. Although best at 8 readings per day, sensitivity and specificity were acceptable with four daily readings (82.4 and 87%). The effect of defining a record as being of adequate quality if it was of >=2.5 weeks' duration, with >=4 readings per day and >=3 consecutive workdays in each work period, was tested in records not used in the initial data reduction process. The sensitivity and specificity respectively of adequate records were 78.1 and 91.8 versus 63.6 and 83.3% for inadequate records. Peak expiratory flow records for the diagnosis of occupational asthma should be interpreted with caution if they do not satisfy the suggested minimum data quantity criteria. AU - Anees W AU - Gannon PF AU - Huggins V AU - Pantin CFA AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 59 IP - DP - 2004 Jan 01 TI - Lack of association of HLA class I genes and TNF alpha-308 polymorphism in toluene di-isocyanate-induced asthma PG - 61-64 AB - Background: Toluene diisocyanate (TDI)-induced asthma is a common cause of occupational asthma and it affects 5–15% of the exposed population suggesting an underlying genetic susceptibility. Methods: To investigate the role of genetic factors in the development of TDI-induced asthma, we analyzed the distribution of human leukocyte antigen (HLA) class I genes and of tumor necrosis factor (TNF)-a A-308G polymorphism in 142 patients with TDI-induced asthma and in 50 asymptomatic exposed subjects. Results: Neither the distribution of HLA class I antigens nor the distribution of TNF-a A-308G polymorphism was different between patients with TDI-induced asthma and asymptomatic exposed subjects. Conclusions: These results suggest that HLA class I antigens and TNF-a A-308G are not associated with susceptibility or resistance to the development of TDI-induced asthma AU - Beghe B AU - Padoan M AU - Moss CT et al LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 169 IP - DP - 2004 Jan 01 TI - Airway inflammation after cessation of exposure to agents causing occupational asthma PG - 367-372 AB - Subjects with occupational asthma (OA) generally present asthma symptoms and airway hyperresponsiveness after cessation of exposure. We hypothesized that they are also left with airway inflammation. We assessed 133 subjects with OA at a mean interval of 8.7 years (0.5–20.8 years) after cessation of exposure by questionnaire, airway caliber, and responsiveness to methacholine. Satisfactory samples of induced sputum were obtained from 98 subjects. We defined three groups of subjects: (1) cured: normalization of the concentration of methacholine provoking a 20% decrease in FEV1 (PC20), (2) improved: increase in PC20 by 3.2-fold or more but PC20 still abnormal, and (3) not improved: no significant change in PC20. In all, 9/28 subjects (32.1%) with no improvement versus 6/56 (10.7%) subjects with partial and complete improvements had sputum eosinophils equal to or greater than 2% and 11/28 (39.3%) subjects versus 11/56 (19.6%) subjects showed sputum neutrophils equal to or greater than 61%. Levels of interleukin-8 and of the neutrophil-derived myeloperoxidase were significantly more elevated in sputum of subjects with no improvement. Those in the cured or improved groups had a significantly longer time lapse since diagnosis and a higher PC20 at the time of diagnosis. We conclude that failure to improve after cessation of exposure to an agent causing OA is associated with airway inflammation at follow-up. AU - Maghni K AU - Lemiere C AU - Ghezzo H et al LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 61 IP - DP - 2004 Jan 01 TI - Indices of asthma among atopic and non-atopic woodworkers PG - 504-511 AU - Schlunssen V AU - Schaumburg I AU - Heederik D et al LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 77 IP - DP - 2004 Jan 01 TI - Cork workers' occupational asthma: lack of association with allergic sensitisation to fungi of the work environment PG - 296-300 AB - Suberosis is an occupational lung disease of cork workers associated with repeated exposure to mouldy cork dust in the cork industry, usually presenting as an interstitial lung disorder (Extrinsic Allergic Alveolitis). However, Occupational Asthma can also be associated with cork dust exposure and demonstrated by serial peak expiratory flow changes. AIM: To investigate broncho-alveolar inflammation in patients with cork work-related occupational asthma evaluated by Broncho-alveolar fluid cellular profiles and serial peak expiratory flow (PEF) rates monitoring. RESULTS: We studied 14 patients with respiratory symptoms associated with occupational exposure in the cork industry. Positive PEF monitoring occurred in 7 cases Occupational Asthma-OA), and in 7 (Non-occupational asthmatics-NOA) PEF records were negative. There were no differences in age, lung function (FEV1%, RV%), bronchial hyperresponsiveness, years of exposure, and atopy between the two patients groups. However, patients with work-related asthma had higher BAL eosinophil counts than NOA (1.9 +/- 2.6% versus 0.2 +/- 0.3%; p < 0.05, Wilcoxon test). CONCLUSIONS: Cork worker's asthma, demonstrated by work related changes in serial PEF recordings, is associated with eosinophilic lung inflammation as described in other forms of occupational asthma. AU - Winck JC AU - Delgado L AU - Murta R et al LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 54 IP - DP - 2004 Jan 01 TI - Preventing baker's asthma: An alternative strategy PG - 21-27 AB - Background Although baker’s asthma has attracted considerable research interest over the last 30 years, success in its prevention has been slow to achieve. This paper describes the results of an alternative preventive strategy, based on an observation that the excess of sensitization in bread bakers is largely due to IgE-mediated allergy to fungal amylase, contained in bread improvers. The practical application of the strategy has been to limit bread improver exposures to <1 mg/m3 [8 h time-weighted average (TWA)], whilst exposures to all other ingredients, including flour, have been limited to <10 mg/m3 (8 h TWA). Method The paper describes the findings of in-house respiratory health surveillance and dust sampling programmes, from a UK food company whose primary interests are milling and baking, over the period following the introduction of the strategy to target the reduction in bread improver exposure. Results Over the 10 year period of surveillance, the incidence of symptomatic sensitization in the bread baking sector (2240 per million employees per annum) was greater than for the other flour-using groups (330 per million employees per annum), despite broadly similar total inhalable dust exposures. There was an overall reduction in the incidence of new cases of symptomatic sensitization, from 2085 per million employees per year in the first 5 years of the surveillance programme, to 405 per million employees per year in the subsequent 5 years. Conclusion The strategy of targeting bread improver exposure is an effective approach for the prevention of new cases of symptomatic sensitization in bread bakeries. AU - Smith TA LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 46 IP - DP - 2004 Jan 01 TI - Chronic obstructive pulmonary disease in never-smoking animal farmers working inside confinement buildings PG - 357-362 AB - BACKGROUND: In animal farming, respiratory disease has been associated with indoor air contaminants and an excess in FEV1 decline. Our aim was to determine the characteristics and risk factors for chronic obstructive pulmonary disease (COPD) in never-smoking European farmers working inside animal confinement buildings. METHODS: A sample of participants in the European Farmers' Study was selected for a cross-sectional study assessing lung function and air contaminants. Dose-response relationships were assessed using logistic regression models. RESULTS: COPD was found in 18 of 105 farmers (45.1 SD 11.7 years) (17.1%); 8 cases (7.6%) with moderate and 3 cases (2.9%) with severe disease. Dust and endotoxin showed a dose-response relationship with COPD, with the highest prevalence of COPD in subjects with high dust (low = 7.9%/high = 31.6%) and endotoxin exposure (low=10.5%/high=20.0%). This association was statistically significant for dust in the multivariate analysis (OR 6.60, 95% CI 1.10-39.54). CONCLUSION: COPD in never-smoking animal farmers working inside confinement buildings is related to indoor dust exposure and may become severe. AU - Monso E AU - Riu E AU - Radon K AU - Magarolas R AU - Danuser B AU - Iversen M AU - Morera J AU - Nowak D LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 46 IP - DP - 2004 Jan 01 TI - Occupational asthma and rhinitis caused by milk proteins. PG - 1100-1101 AB - letter AU - Toskala E AU - Piipari R AU - Aalto-Korte K AU - Tuppurainen M AU - Kuuliala O AU - Keskinen H LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 23 IP - DP - 2004 Jan 01 TI - Prevalence of asthma and exhaled nitric oxide are increased in bleachery workers exposed to ozone. PG - 87-92 AB - The aims of the present study were to determine whether exposure to high peaks of ozone resulted in an increased prevalence of asthma or respiratory symptoms among bleachery workers and whether nitric oxide (NO) was elevated in the exhaled air of these workers. Bleachery workers (n=228) from three Swedish pulp mills who had been exposed to ozone, together with 63 unexposed control subjects, were investigated by means of spirometry, Phadiatop, exhaled and nasal NO and answers to a questionnaire concerning respiratory symptoms and exposure. Exposure to an ozone peak that gave rise to respiratory symptoms was defined as a "gassing". Bleachery workers reporting four or more gassings involving ozone had an increased prevalence of adult-onset asthma, wheeze, and current asthma symptoms. They also had a higher median concentration of exhaled NO in comparison with those who reported no such gassings (19.2 versus 15.7 parts per billion). No such associations were found in respect of nasal NO. The results from this study show that bleachery workers who have been repeatedly exposed to ozone gassings have an increased prevalence of adult-onset asthma. The results also indicate exhaled nitric oxide may be a marker of airway inflammation in bleachery workers who have been exposed to high peaks of ozone. AU - Olin AC AU - Andersson E AU - Andersson M AU - Granung G AU - Hagberg S AU - Torén K LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 33 IP - DP - 2004 Jan 01 TI - A case report of occupational asthma due to gluteraldehyde exposure. PG - 275-278 AB - INTRODUCTION: We report the first case of occupational asthma due to gluteraldehyde exposure in Singapore and also describe the use of a specific inhalational challenge (SIC) test in confirming the diagnosis. CLINICAL PICTURE: A 32-year-old laboratory technician presented with adult-onset asthma 2 years after daily exposure to gluteraldehyde which was used to sterilise the mouthpieces used for lung function testing. SIC testing showed a 25% drop in FEV1 after exposure to gluteraldehyde but not after exposure to a control, thus confirming the diagnosis. TREATMENT: Alternative arrangements were made for sterilisation of the mouthpieces so that gluteraldehyde could be removed from the workplace. There was a marked improvement in her asthmatic control thereafter. CONCLUSIONS: This case illustrates the use of a SIC test in the diagnosis of occupational asthma. Gluteraldehyde is a known cause of occupational asthma and should be kept in mind when evaluating asthmatic patients in at-risk occupations. Effective ventilation and proper storage should be ensured to minimise exposure to gluteraldehyde where its use is necessary. AU - Ong TH AU - Tan KL AU - Lee HS AU - Eng P LA - PT - DEP - TA - Ann Acad Med Singapore JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 52 IP - DP - 2004 Jan 01 TI - Processes of care for individuals with work related asthma: treatment characteristics and impact of asthma on work PG - 327-337 AB - The prevalence of asthma among working adults continues to rise each year. The California Department of Health Services conducts surveillance of work related asthma (WRA) to classify each work related exposure using Doctor's First Reports of Occupational Illness and Injury (DFRs). Using a cross-sectional, descriptive, comparative design, additional interviews were conducted and medical records were reviewed to explore workers' and providers' perceptions of follow up care. Two cohorts were compared: workers with WRA who belonged to a large, single HMO (n = 79) and workers with WRA who underwent follow up outside this HMO (n = 76). The interview asked about providers seen, tests ordered, and the impact of asthma on work. The HMO clients were significantly more likely than the non-HMO clients to see occupational medicine specialists (p = .004) and have pulmonary function testing (p = .049) during initial treatment. Twenty-four percent of clients currently working reported missed workdays caused by asthma in the past 6 months. The findings indicate management of WRA varies by health care system in California. AU - Roberts JL AU - Janson S AU - Gillen M AU - Flattery J AU - Harrison R LA - PT - DEP - TA - AAOHN J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 34 IP - DP - 2004 Jan 01 TI - Leukotrienes and isocyanate-induced asthma: a pilot study. PG - 1684-1689 AB - BACKGROUND: The role of leukotrienes (LTs) in the pathophysiology of isocyanate-induced asthma is not well known. OBJECTIVE: We sought to characterize the type of airway inflammation induced by exposure to isocyanates and to investigate whether exposure to isocyanates induced an increase in LT receptor cysteinyl leukotriene ((CysLT)(1), CysLT(2) and leukotriene B(4) receptor (BLT(1))) expression, as well as a release of LT (LTC(4) and leukotriene B(4) (LTB(4))) and IL-8 in both asthmatics with isocyanate-induced asthma and healthy subjects. METHODS: We investigated eight subjects with isocyanate-induced asthma and eight healthy subjects. Both groups underwent specific inhalation challenges to isocyanates in the laboratory. Induced sputum was collected before and after exposure to isocyanates. CysLT(1), CysLT(2) and BLT(1) expression was assessed by flow cytometry, whereas LTC(4), LTB(4) and IL-8 were measured in the sputum supernatants by enzyme immunoassay. RESULTS: Exposure to isocyanates induced an increase in sputum neutrophils only in subjects with occupational asthma. There was a significant increase in CysLT(1) and BLT(1) receptor expression, as well as a release of LTB(4) and IL-8 after exposure to isocyanates compared with the baseline, only in subjects with isocyanate-induced asthma, whereas there was no increase in LTC(4). Exposure to isocyanates did not induce any change in LT receptor expression nor in the levels of LTC(4), LTB(4) and IL-8, in healthy subjects. CONCLUSION: The neutrophilia observed after exposure to isocyanates is likely to be related to the release of LTB(4), probably enhanced by the increased expression of BLT(1) on neutrophils as well as by the release of IL-8. The significance of the increase of CysLT1 receptor expression on neutrophils is unknown and needs further investigation. AU - Lemiere C AU - Pelissier S AU - Tremblay C AU - Chaboillez S AU - Thivierge M AU - Stankova J AU - Rola-Pleszczynski M LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 169 IP - DP - 2004 Jan 01 TI - Recovery of methacholine responsiveness after end of exposure in occupational asthma. PG - 1304-1307 AB - Recent data suggest that responsiveness to methacholine continues to improve 2 and more years after cessation of exposure to agents causing occupational asthma (OA). The goal of this study was to characterize further the curve of improvement to methacholine responsiveness in subjects with OA. Eighty subjects with confirmed OA who had at least two assessments of a provocative concentration of histamine causing a 20% drop in FEV(1) (PC(20)) and were seen for at least 2 years after cessation of exposure. The shape of recovery of PC(20) was assessed by CARMA (James K. Lindsey, Liège, Belgium) analysis. Slopes of recovery were compared in the first 2.5 years in 55 subjects and from 2.5 years until the end of observation in 56 subjects. Recovery curves showed progressive improvements in PC(20) significantly influenced by time lapse since end of exposure, sex, baseline PC(20), and FEV(1). The slopes of recovery were significantly different from zero both for the first 2.5 years after cessation of exposure (0.27 +/- 0.05 SEM natural logarithm of PC(20) per year) and later (0.09 +/- 0.008 SEM natural logarithm of PC(20) per year), with the slope significantly steeper for the first 2.5 years. This study shows that improvement in responsiveness to methacholine continues for years after cessation of exposure but that the improvement is more rapid in the first 2.5 years. AU - Malo JL AU - Ghezzo H LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 59 IP - DP - 2004 Jan 01 TI - 'Daily pattern' of an asthmatic reaction due to isocyanates PG - 234-235 AB - We describe the case of a subject who developed changes in forced expiratory volume (FEV1) that were significant when examined from day to day ('daily pattern' of reaction) but were not significant when values up to 7 or 8 h after ending challenge were considered. A 44-year-old car painter developed work-related respiratory symptoms approximately 1 year before being examined. He underwent specific inhalation challenges 3 months after leaving work. Table 1 summarizes the results of specific challenges to hexamethylene diisocyanate (HDI); these were carried out in a small cubicle by using a closed-circuit apparatus and a realistic approach. On 23 April 2003, the day-to-day % change in FEV1 was significant (-23%) whereas at hourly changes it was not (-15.1%). On the same day, PC20 fell significantly to 19 mg/ml, although remaining within normal values (PC20 > 16 mg/ml). There was also a significant increase in sputum eosinophils. Six days after stopping the challenge, on day 30 April 2003, baseline FEV1 improved and sputum eosinophils were back to 0%. After exposure to HDI on 01/05/03, there was a significant (-21.1%) hourly change accompanied by a fall in PC20 to an abnormal range and an increase in sputum eosinophils to 24%. This case report illustrates that, while changes in FEV1 documented 7–8 h after challenge did not reach significance, the changes in FEV1 from one day to the next can do so. This illustrates a 'daily pattern' of reaction which has so far been described with serial monitoring of peak expiratory flow rates. Interestingly, PC20 fell significantly and sputum eosinophils increased before significant hourly changes could be demonstrated, pointing out that these tools are at times more sensitive than hourly changes in FEV1 for documenting a reaction. It is interesting to note that discontinuation of exposure to the causal agent for almost 1 week resulted in the documentation of an 'hourly pattern.' We therefore think that it is relevant to assess FEV1 24 h after stopping exposure in cases where borderline changes in FEV1 are obtained after 7–8 h. AU - Malo J-L LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 22 IP - DP - 2004 Jan 01 TI - Occupational asthma, eosinophil and skin prick tests and serum total IgE values of the workers in a plant manufacturing rose oil PG - 103-108 AB - This study was aimed to determine the rate of occupational asthma (OA) in workers at a rose extracting plant. Specific clinical tests of 52 workers, randomly chosen from four local rose extracting plants, were statistically compared with the test results of 30 local control subjects of similar age and sex as the plant workers, but who had never worked in such a plant. There were no significant differences in pulmonary function tests (FVC, FEV1, FEV1/FVC, PEFR) between the control and test groups. Significantly higher serum total IgE values (p < 0.0001) were observed for the test subjects (239.08+/-240 IU/ml) compared to the control subjects (81.33+/-61.45 IU/ml). There were also significant differences (p < 0.0001) in the number of eosinophils between the control and test groups, with corresponding mean values of 2.28+/-2.75% and 0.73+/-1.72%, respectively. A specifically prepared skin prick test using a rose allergen (Rosa domescena) was positive for 53.84% in the test subjects whereas only 5.33% positive test results were seen in the control group. We have demonstrated the involvement of Rosa domescena pollen in occupational allergy, through IgE-mediated hypersensitivity. It was concluded that the workers of a rose oil extracting plant are more susceptible to the rose pollens. AU - Akkaya A AU - Ornek Z AU - Kaleli S LA - PT - DEP - TA - Asian Pac J Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 41 IP - DP - 2004 Jan 01 TI - Occupational asthma due to grain pests Eurygaster and Ephestia PG - 99-107 AB - BACKGROUND: Workers occupationally exposed to grain dust have a high prevalence of asthma. The pathogenesis of their respiratory symptoms remains obscure when sensitization to cereal allergens has not been proved. Given the ubiquity of arthropods in stored vegetable products, we have studied the allergenic potential of two very prevalent grain pests, Eurygaster and Ephestia, as a cause of occupational asthma. We have also studied the allergenic relationship between Anisakis simplex (AS) and these pests. METHODS: We selected 15 asthmatic workers exposed to cereal dust, in whom sensitization to cereal allergens was not clear. As controls, we selected a patient who suffered from anaphylaxis after the ingestion of cereals, 6 patients sensitized to different arthropods, 1 patient who suffered from asthma after inhaling fish flour contaminated with AS, and a pool of 40 asthmatic patients with different ethiologies not due to arthropods or cereals. We performed prick tests with these pests, AS, and pure and parasitized flours, bronchial challenges, specific IgE determination, and RAST inhibition. RESULTS: All of the 15 cereal-exposed workers were sensitized to Eurygaster and Ephestia. Only 2 had detectable levels of serum IgE to these pests, but 13 presented a positive prick test result and IgE to AS without problems after eating fish. Bronchial challenges were positive to Eurygaster in 7 patients and to Ephestia in 2 patients. Twelve patients had positive prick tests to parasitized flour but not to pure flour. The patient with cereal anaplylaxis presented sensitization to both flours but not to AS. In the control group, the patient who suffered from asthma after the inhalation of AS-parasitized fish flour presented a positive prick test result and high levels of specific IgE to these pests. The RAST inhibition showed cross-reactivity between Eurygaster and AS in this patient, but the inhibition was not as evident with the sera of other workers. The same tests in the group of 40 asthmatic patients were negative. CONCLUSIONS: The clinical importance of pests as a cause of baker's asthma should not be underestimated. Sensitization to Eurygaster and Ephestia could be important in the asthma episodes suffered by our patients, and the parasitized wheat was found to have a higher allergenic potential than pure cereal flour. AU - Armentia A AU - Lombardero M AU - Martinez C AU - Barber D AU - Vega JM AU - Callejo A LA - PT - DEP - TA - J Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 61 IP - DP - 2004 Jan 01 TI - Assessing individual employee risk factors for occupational asthma in primary aluminium smelting PG - 604-608 AB - AIMS: To assess the significance of individual risk factors in the development of occupational asthma of aluminium smelting (OAAS). METHODS: A matched case-control study nested in a cohort of 545 workers employed in areas with moderate to high levels of smelting dust and fume. The cohort comprised those who had their first pre-employment medical examination between 1 July 1982 and 1 July 1995; follow up was until 31 December 2000. Forty five cases diagnosed with OAAS and four controls per case were matched for the same year of pre-employment and age within +/-5 years. The pre-employment medical questionnaires were examined, blinded as to case-control status, and information obtained on demographics and details of allergic symptoms, respiratory risk factors, respiratory symptoms, and spirometry. Data from the subsequent medical notes yielded subsequent history of hay fever, family history of asthma, full work history, date of termination or diagnosis, and tobacco smoking history at the end-point. RESULTS: There was a significant positive association between hay fever diagnosed either at or during employment and OAAS (adjusted OR 3.58, 95% CI 1.57 to 8.21). A higher forced expiratory ratio (FEV1/FVC%) at employment reduced the risk of developing OAAS (adjusted OR 0.93, 95% CI 0.88 to 0.99). The risk of OAAS was more than three times higher in individuals with an FER of 70.0-74.9% than in individuals with an FER > or =80.0% (adjusted OR 3.46, 95% CI 1.01 to 11.89). CONCLUSIONS: Individuals with hay fever may be more susceptible to occupational asthma when exposed to airborne irritants in aluminium smelting. The pathological basis may be reduced nasal filtration and increased bronchial hyperresponsiveness. AU - Barnard CG AU - McBride DI AU - Firth HM AU - Herbison GP LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 54 IP - DP - 2004 Jan 01 TI - Occupational asthma after exposure to plaster casts containing methylene diphenyl diisocyanate. PG - 432-434 AB - BACKGROUND: The case of a 34-year-old female nurse is presented. She worked in an accident and emergency department in a district general hospital, with methylene diphenyl diisocyanate (MDI)-containing synthetic plaster casts. She worked with MDI on a daily basis for 4 years. She was out of the department for 1 year and on her return developed cough, wheeze and dyspnoea within 5 min of exposure to MDI- containing synthetic casts. METHOD: A bronchial provocation test was performed and confirmed an early asthmatic response. RESULTS: There was a 39% decrease in the forced expiratory volume in 1 s 15 min after exposure, which required the administration of a bronchodilator on two occasions. The patient has subsequently avoided MDI-containing synthetic plaster casts and has experienced no further respiratory symptoms. CONCLUSION: This case illustrates that respiratory sensitization can occur as a result of exposure to MDI-containing synthetic casts and highlights the need for vigilance when health care workers are using isocyanate-containing synthetic casts. AU - Donnelly R AU - Buick JB AU - Macmahon J LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 61 IP - DP - 2004 Jan 01 TI - Occupational asthma caused by cellulase and lipase in the detergent industry PG - 793-795 AB - Three employees from two different detergent companies were investigated for occupational asthma, using skin prick tests, serum specific IgE, and specific bronchial challenge. Two were challenged with lipase and one with cellulase. All three cases had immunological evidence of sensitisation to the detergent enzymes with which they worked. Bronchial challenge in each provoked a reproducible dual asthmatic response, which reproduced their work related symptoms. These are the first reported cases of occupational asthma attributable to cellulase and lipase in the detergent industry. Four of the most common enzymes used in this industry have now been reported to cause occupational asthma; continued vigilance and caution are needed when working with these or other enzymes. AU - Brant A AU - Hole A AU - Cannon J AU - Helm J AU - Swales C AU - Welch J AU - Newman Taylor A AU - Cullinan P LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 170 IP - DP - 2004 Jan 01 TI - An effective strategy for diagnosing occupational asthma: use of induced sputum. PG - 845-850 AB - Monitoring airway inflammation by means of induced sputum cell counts seems to improve the management of asthma. We sought to assess whether such monitoring at the end of periods at and away from work combined with the monitoring of PEF could improve the diagnosis of occupational asthma. We enrolled subjects suspected of having occupational asthma. Serial monitoring of PEF was performed during 2 weeks at and away from work. At the end of each period, induced sputum was collected. Specific inhalation challenge was subsequently performed. PEF graphs were interpreted visually by five independent observers. Forty-nine subjects, including 23 with positive specific inhalation challenge, completed the study. The addition of sputum cell counts to the monitoring of PEF increased the specificity of this test, respectively, by 18 (range [r] 13.7-25.5) or 26.8% (r 24.8-30.4) depending if an increase of sputum eosinophils greater than 1 or 2% when at work was considered as significant. The sensitivity increased by 8.2% (r 4.1-13.4) or decreased by 12.3% (r 3.1-24.1) depending on the cutoff value in sputum eosinophils chosen (greater than 1 or 2%, respectively). The addition of sputum cell counts to PEF monitoring is useful to improve the diagnosis of occupational asthma. AU - Girard F AU - Chaboillez S AU - Cartier A AU - Côté J AU - Hargreave FE AU - Labrecque M AU - Malo JL AU - Tarlo SM AU - Lemière C LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 61 IP - DP - 2004 Jan 01 TI - Validation of specific inhalation challenge for the diagnosis of occupational asthma due to persulphate salts PG - 861-866 AB - BACKGROUND: The significant value of tests used to certify the diagnosis of occupational asthma due to persulphate salts remains uncertain. AIMS: To validate the specific inhalation challenge (SIC) test for the diagnosis of occupational asthma. METHODS: Eight patients with occupational asthma due to persulphate salts, eight patients with bronchial asthma who were never exposed to persulphate salts, and ten healthy subjects were studied. Clinical history taking, spirometry, bronchial challenge with methacholine, skin prick testing to common inhalant allergens and persulphate salts, total IgE levels, and SIC to potassium persulphate were carried out in all subjects. The SIC used increasing concentrations of potassium persulphate (5, 10, 15, and 30 g) mixed with 150 g of lactose. Patients tipped the mixture from one tray to another at a distance of 30 cm from the face for 10 minutes in a challenge booth. RESULTS: The SIC was positive in all subjects with persulphate induced asthma and in one patient with bronchial asthma who had never been exposed to persulphate salts. Sensitivity was 100% (95% CI 67.6 to 100) and specificity was 87.5% (95% CI 52.9-97.8) when patients with occupational asthma due to persulphate salts were compared with those with bronchial asthma never exposed to persulphate salts. CONCLUSIONS: SIC to persulphate salts performed according to the protocol described appears to be useful for the diagnosis of occupational asthma secondary to inhalation of this substance AU - Munoz X AU - Cruz MJ AU - Orriols R AU - Torres F AU - Espuga M AU - Morell F LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 38 IP - DP - 2004 Jan 01 TI - Cleaning products and air fresheners: exposure to primary and secondary air pollutants PG - 2841-2865 AB - Building occupants, including cleaning personnel, are exposed to a wide variety of airborne chemicals when cleaning agents and air fresheners are used in buildings. Certain of these chemicals are listed by the state of California as toxic air contaminants (TACs) and a subset of these are regulated by the US federal government as hazardous air pollutants (HAPs). California's Proposition 65 list of species recognized as carcinogens or reproductive toxicants also includes constituents of certain cleaning products and air fresheners. In addition, many cleaning agents and air fresheners contain chemicals that can react with other air contaminants to yield potentially harmful secondary products. For example, terpenes can react rapidly with ozone in indoor air generating many secondary pollutants, including TACs such as formaldehyde. Furthermore, ozone–terpene reactions produce the hydroxyl radical, which reacts rapidly with organics, leading to the formation of other potentially toxic air pollutants. Indoor reactive chemistry involving the nitrate radical and cleaning-product constituents is also of concern, since it produces organic nitrates as well as some of the same oxidation products generated by ozone and hydroxyl radicals. Few studies have directly addressed the indoor concentrations of TACs that might result from primary emissions or secondary pollutant formation following the use of cleaning agents and air fresheners. In this paper, we combine direct empirical evidence with the basic principles of indoor pollutant behavior and with information from relevant studies, to analyze and critically assess air pollutant exposures resulting from the use of cleaning products and air fresheners. Attention is focused on compounds that are listed as HAPs, TACs or Proposition 65 carcinogens/reproductive toxicants and compounds that can readily react to generate secondary pollutants. The toxicity of many of these secondary pollutants has yet to be evaluated. The inhalation intake of airborne organic compounds from cleaning product use is estimated to be of the order of 10 mg d-1 person-1 in California. More than two dozen research articles present evidence of adverse health effects from inhalation exposure associated with cleaning or cleaning products. Exposure to primary and secondary pollutants depends on the complex interplay of many sets of factors and processes, including cleaning product composition, usage, building occupancy, emission dynamics, transport and mixing, building ventilation, sorptive interactions with building surfaces, and reactive chemistry. Current understanding is sufficient to describe the influence of these variables qualitatively in most cases and quantitatively in a few. AU - Nazaroff WW AU - Weschler CJ LA - PT - DEP - TA - Atmos Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 41 IP - DP - 2004 Jan 01 TI - Residential exposure to volatile organic compounds and asthma. PG - 259-270 AB - We critically analysed the literature concerning exposure to volatile organic compounds and asthma. Observational studies have consistently found a relation between volatile organic compounds and indicators of asthma, such as symptoms, peak flows, and objectively measured bronchial reactivity. In contrast, interventional studies have generally failed to find a relation between exposure to residential levels of formaldehyde and other volatile organic compounds and asthma. One hypothesis to explain the discrepancy in findings between interventional and observational studies is that the effect size is small requiring relatively large numbers of study subjects, common in observational studies but often not feasible in interventional studies. Another hypothesis is that longer duration of exposure is important, a common circumstance in observational studies where the home environment is the exposure setting. In contrast, duration of exposure in interventional studies is usually of minutes-to-hours in a chamber. Finally, the observed association in observational studies could be confounded by a factor which is a determinant of asthma and is also associated with exposure to volatile organic compounds AU - Dales R AU - Raizenne M LA - PT - DEP - TA - J Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 54 IP - DP - 2004 Jan 01 TI - Pheasant rearer's lung. PG - 500-503 AB - A 47-year-old gamekeeper presented with an 8 month history of variable breathlessness, cough and clinical features of severe interstitial lung disease. Open lung biopsy showed an extrinsic allergic alveolitis, which we believe related to his work rearing pheasants. Initially he was resistant, despite advice, to changing his occupation but subsequently, although ceasing exposure to pheasants and beginning treatment with corticosteroids, his disease progressed to the point where he developed respiratory failure and was referred for lung transplantation. Sadly, he died of progressive respiratory failure and cor pulmonale complicated by bronchopneumonia before this could be achieved. AU - Partridge SJ AU - Pepperell JCT AU - Forrester-Wood C AU - Ibrahim NBN AU - Raynal A AU - Swinburn CR LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 11 IP - DP - 2004 Jan 01 TI - Respiratory symptoms and peak expiratory flow rates among furniture-decoration students PG - 13-17 AB - This study was designed to evaluate the effects of furniture production, mainly including fir tree (aberia mulleriana), on respiratory health of young workers and to compare the results with those obtained from previous studies. Sixty-four furniture-decoration students (57 males and 7 females) and 62 controls (54 male, 8 female) from different departments in the same school were included into the study. All participants were assessed with a questionnaire (concerning history of occupational exposure, work-related respiratory and other symptoms, smoking history, previous asthma history), full physical examination, spirometric evaluation and chest radiograph. Participants then performed serial monitoring of peak expiratory flow rates (PEFR) at work and away from work within a month. Mean age of students was 20.9 +/- 3.7 years, 20.5 +/- 2.6 years in controls. There was no difference between study and control groups with regard to age, gender, smoking status and previous asthma history. Reported cough (23.4 % vs. 8.1 %) and shortness of breath (18.8 % vs. 6.5 %) were significantly higher in furniture-decoration students than in controls (p = 0.016 and p = 0.034, respectively). Furniture-decoration students had higher conjunctivitis (34.4 % vs. 9.7 %, p = 0.001) and rhinitis (34.4 % vs. 19.4 %, p = 0.044) history when compared with controls. Both students and controls were normal in terms of respiratory examination. PEF recordings were performed for approximately one month. Diurnal variability greater than 20 % was seen in 12/64 (18.7 %) of students at work, whereas it was detected in 4/62 (6.4 %) of controls (p = 0.034). When comparing for the presence of diurnal variability greater than 20 % in weekends, no difference was found between groups (p = 0.457). In conclusion, early detection of work-related respiratory changes by serial monitoring of peak expiratory flows should save the workers from hazardous respiratory effects of the furniture production, especially in young population. AU - Arbak P AU - Bilgin C AU - Balbay O AU - Yesildal N AU - Annakkaya AN AU - Ulger F LA - PT - DEP - TA - Annals of Agricultural & Environmental Medicin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 113 IP - DP - 2004 Jan 01 TI - Occupational asthma and IgE sensitization to 7-aminocephalosporanic acid PG - 785-787 AB - Cephalosporins cause occupational asthma, and it has been suggested that the pathogenesis is mediated by IgE. 7-ACA (amimocephalosporanic acid) is a major intermediate metabolite in the synthesis of cephalosporin. There has been one published report of occupational asthma caused by 7-ACA, in which a nonimmunologic mechanism was suggested. Ours is the first investigation to detect serum IgE specific to 7-ACA–HSA (human serum albumin) conjugate in an exposed worker with occupational asthma. This report describes the clinical findings in two asthmatic workers in a pharmaceutical plant who were exposed to 7-ACA powder used to synthesize ceftriaxone. To evaluate the IgE response, skin prick tests (SPTs) were performed in 5 exposed workers. To confirm bronchial sensitization in the two symptomatic workers, a methacholine bronchial challenge and specific bronchial provocation tests (BPTs) with 7-ACA and ceftriaxone were done. 7-ACA–HSA and ceftriaxone-HSA conjugates were prepared in our laboratory according to a method described previously. For IgE-ELISA, sera was incubated in 7-ACA–HSA conjugate or sham HSA coated well, and anti-human IgE and second antibody were added. Twenty nonatopic, healthy subjects with no history of exposure, who had negative SPTs to ACA and ceftriaxone, were enrolled as control subjects. Final absorbance value was determined by subtraction from that of sham HSA coated well. The positive cutoff value for specific IgE was determined by using the mean±3 SD of the absorbance values (patient LB). For the ELISA inhibition test, serum with high levels of specific IgE was preincubated with the free forms of 7-ACA and ceftriaxone, as well as with 7-ACA–HSA and ceftriaxone-HSA conjugates, and then subjected to IgE ELISA. None of the asymptomatic workers had positive responses to 7-ACA or ceftriaxone on SPT. However, two asthmatic subjects with work-related respiratory symptoms with or without rhinitis were found. Both patients had airway hyperresponsiveness to methacholine. Patient LB had a strong positive response to 7-ACA on SPT and had immediate bronchoconstriction after inhaling 7-ACA–powder solution during the specific BPT. Furthermore, high serum-specific IgE binding to 7-ACA–HSA conjugate was noted on ELISA Patient NS had a negative response to 7-ACA on SPT but developed significant bronchoconstriction on 7-ACA BPT. Serum-specific IgE antibody was not detected. None of the workers had positive responses to ceftriaxone on specific BPT. When the IgE-ELISA inhibition test was performed by using the serum from patient LB, significant inhibition was noted in a dose-dependent manner with the serial addition of 7-ACA–HSA conjugate, whereas there was partial inhibition with free 7-ACA (Fig 1, B). Minimal inhibition was noted with free ceftriaxone, sham HSA, or ceftriaxone-HSA conjugate AU - Park H-S AU - Kim K-U AU - Lee Y-M AU - Choi J-H AU - Lee J-H AU - Park S-W AU - Jang A-S AU - Park C-S LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 63 pt2 IP - DP - 2004 Jan 01 TI - Prevalence of crab asthma in crab plant workers in newfoundland and labrador PG - 333-6 AB - OBJECTIVES: The aim of the study was to determine the prevalence of snow crab sensitisation and occupational asthma. STUDY DESIGN: Prevalence study of symptoms, pulmonary function testing and allergy testing to crab was conducted in four crab plants of different design in Newfoundland and Labrador, Canada. METHODS: Plants workers in four crab plants were interviewed and offered skin testing, RAST, pulmonary function testing and peak flow monitoring before and during crab processing. RESULTS: 38% (n=78) had atopy. 18% (n=39) had certain or highly probable crab asthma. The prevalence of sensitisation in different crab plants varied from 50% (n=19) to 15% (n=16) and the prevalence of certain or highly probable crab asthma varied from 50% (n=19) to 9% (n=3). CONCLUSION: Crab asthma and sensitisation to snow crab is a major health problem for snow crab plant workers in Newfoundland and Labrador. AU - Cartier A AU - Lehrer SB AU - Horth-Susin L AU - Swanson M AU - Neis B AU - Howse D AU - Jong M LA - PT - DEP - TA - Int J Circumpolar Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 70 IP - DP - 2004 Jan 01 TI - Investigation of Spa Pools Associated with Lung Disorders Caused by Mycobacterium avium Complex in Immunocompetent Adults PG - 4906-4910 AB - Three cases of Mycobacterium avium complex-related lung disorders were associated with two poorly maintained spa pools by genotypic investigations. Inadequate disinfection of the two spas had reduced the load of environmental bacteria to less than 1 CFU/ml but allowed levels of M. avium complex of 4.3 x 104 and 4.5 x 103 CFU/ml. Persistence of the disease-associated genotype was demonstrated in one spa pool for over 5 months until repeated treatments with greater than 10 mg of chlorine per liter for 1-h intervals eliminated M. avium complex from the spa pool. A fourth case of Mycobacterium avium complex-related lung disease was associated epidemiologically but not genotypically with another spa pool that had had no maintenance undertaken. This spa pool contained low numbers of mycobacteria by smear and was culture positive for M. avium complex, and the nonmycobacterial organism count was 5.2 x 106 CFU/ml. Public awareness about the proper maintenance of private (residential) spa pools must be promoted by health departments in partnership with spa pool retailers AU - Lumb R AU - Stapledon R AU - Scroop A AU - Bond P AU - Cunliffe D AU - Goodwin A AU - Doyle R AU - and Bastian I LA - PT - DEP - TA - Appl Environ Microbiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 113 IP - DP - 2004 Jan 01 TI - Airborne cat allergen reduction in classrooms that use special school clothing or ban pet ownership PG - 1172-1177 AB - Background Allergens from furred animals are brought to school mainly via clothing of pet owners. Asthmatic children allergic to cat have more symptoms when attending a class with many cat owners, and some schools allocate specific resources to allergen avoidance measures. Objective The aim of the current study was to evaluate the effect of school clothing or pet owner–free classes compared with control classes on airborne cat allergen levels and to investigate attitudes and allergic symptoms among the children. Methods Allergen measurements were performed prospectively in 2 classes with school clothing, 1 class of children who were not pet owners, and 3 control classes during a 6-week period in 2 consecutive years. Portable pumps and petri dishes were used for collection of airborne cat allergen, and a roller was used for sampling on children's clothes. Cat allergen (Fel d 1) was analyzed with enzyme-linked immunoassay and immunostaining. Both years, questionnaires were administered to the children. Results We found 4-fold to 6-fold lower airborne cat allergen levels in intervention classes compared with control classes. Levels of cat allergen were 3-fold higher on clothing of cat owners than of children without cats in control classes. Pet ownership ban seemed less accepted than school clothing as an intervention measure. Conclusion For the first time, it has been shown that levels of airborne cat allergen can be reduced by allergen avoidance measures at school by using school clothing or pet ownership ban, and that both measures are equally efficient. The clinical effect of these interventions remains to be evaluated. AU - Karlsson A-S AU - Andersson B AU - Renström A AU - Svedmyr J AU - Larsson K AU - Borres MP LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 114 IP - DP - 2004 Jan 01 TI - Nine episodes of anaphylaxis following cystoscopy caused by Cidex OPA (ortho-phthalaldehyde) high-level disinfectant in 4 patients after cytoscopy PG - 392-397 AB - Background Ortho-phthalaldehyde (OPA) is a high-level disinfectant commonly used for processing heat-sensitive medical devices. Objective We report 4 patients who experienced 9 episodes of anaphylaxis following cystoscopy after a urology practice switched from using Cidex (glutaraldehyde [GTA]) to OPA for disinfecting their cystoscopes. Methods Allergic evaluations consisted of: skin testing to saline, histamine, glycerin, lidocaine, latex, GTA, and OPA and blood tests for total immunoglobulin E (IgE) and latex specific IgE. Findings The 4 patients were evaluated after 3 of them had experienced 2 episodes of anaphylaxis and one of them 3 episodes following outpatient cystoscopy for ongoing evaluation of bladder cancer. Skin testing of subjects and controls to lidocaine, latex, latex specific IgE, and GTA was negative. Skin testing to OPA resulted in immediate wheal and flare reactions in all 4 patients within 20 minutes and late reactions at 24 hours but negative reactions in controls. Subsequent to the testing, 3 of the patients returned for repeat cystoscopy in which GTA but not OPA was used to disinfect the cystoscopes and tolerated the procedure. Conclusions OPA solution should be considered a cause of anaphylactic/allergic reactions following cystoscopy and possibly following instrumentation with other medical devices disinfected by this material. Keywords Anaphylaxis; GTA (glutaraldehyde); high-level disinfectant Abbreviations GTA, Glutaraldehyde (Cidex); OPA, Ortho-phthalaldehyde (Cidex-OPA) AU - Sokol WN LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 59 IP - DP - 2004 Jan 01 TI - Parental smoking in childhood and adult obstructive lung disease: results from the European Community Respiratory Health Survey. PG - 295-302 AB - BACKGROUND: Early exposure to parental smoking appears to influence the development of the airways and predispose to respiratory symptoms. A study was undertaken to determine whether the consequences of parental smoking could be traced in adulthood. METHODS: Information from interviewer-led questionnaires was available for 18 922 subjects aged 20-44 years from random population samples in 37 areas participating in the European Community Respiratory Health Survey. Lung function data were available for 15,901 subjects. RESULTS: In men, father's smoking in childhood was associated with more respiratory symptoms (ORwheeze 1.13 (95% CI 1.00 to 1.28); never smokers: ORwheeze 1.21 (95% CI 0.96 to 1.50)) and there was a dose-dependent association between number of parents smoking and wheeze (one: OR 1.08 (95% CI 0.94 to 1.24); both: OR 1.24 (95% CI 1.05 to 1.47); ptrend = 0.010). A reduced ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) was related to father's smoking (-0.3% (95% CI -0.6 to 0)) and number of parents smoking (ptrend <0.001) among men. In women, mother's smoking was associated with more respiratory symptoms and poorer lung function (ORwheeze 1.15 (95% CI 1.01 to 1.31), never smokers: ORwheeze 1.21 (95% CI 0.98-1.51); FEV1 -24 ml (95% CI -45 to -3); FEV1/FVC ratio -0.6% (95% CI -0.9 to -0.3)). These effects were possibly accounted for by maternal smoking in pregnancy (ORwheeze 1.39 (95% CI 1.17 to 1.65); FEV1 -23 ml (95% CI -52 to 7); FEV1/FVC ratio -0.9% (95% CI -1.3 to -0.4)) as there was no association with paternal smoking among women (interaction by sex, p<0.05). These results were homogeneous across centres. CONCLUSION: Both intrauterine and environmental exposure to parental tobacco smoking was related to more respiratory symptoms and poorer lung function in adulthood in this multicultural study. The age window of particular vulnerability appeared to differ by sex, postnatal exposure being important only in men and a role for prenatal exposure being more evident in women. AU - Svanes C AU - Omenaas E AU - Jarvis D AU - Chinn S AU - Gulsvik A AU - Burney P. LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 58 IP - DP - 2004 Jan 01 TI - Epidemic soybean asthma and public health: new control systems and initial evaluation in Barcelona, 1996–98 PG - 461-465 AB - Objective: To evaluate the new measures adopted to control the risks from soybean unloading operations in the Port of Barcelona, after an episode of epidemic asthma in June 1996. Methods: After an initial cautionary suspension of all soybean unloading operations, they were subsequently resumed under restrictive criteria for time, flux, simultaneity, and meteorological conditions. Emission filtration systems based on either micro pore size filters or polytetrafluoroethylene membranes on tetratex filters showed promising results. Results: Allergen emission underwent a very important decrease to levels 95% to 98% lower. Emissions from the two plants with unloading operations are in the same order of magnitude as the processing plant that does not unload soybean. Allergen concentration levels presented fluctuations initially, but the new filters decreased mean values; despite increased unloading, allergen levels did not increase—mean allergen levels on unloading days (67 U/m3) and on days without unloading operations (63 U/m3) are similar. A panel of patients detected a cluster of increased symptoms during unloading operations on a day with suboptimal meteorological conditions and comparatively low allergen levels (225–415 U/m3). Since the June 1996 episode, no further asthma outbreak has been detected. Conclusions: The evaluation shows the effectiveness of the new filters in the control of soybean dust emission. With a systematic control programme, industrial soybean operations may function near urban centres without public health risks. These data may be useful in the development of future standards for allergenic agents. AU - Villalbi JR AU - Plasencia A AU - Manzanera R AU - Armengol R AU - Anto JM LA - PT - DEP - TA - J Epidemiol Community Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 46 IP - DP - 2004 Jan 01 TI - New-Onset Asthma Associated With Exposure to 3-amino-5-mercapto-1,2,4-triazole PG - 1246-1252 AB - Objective: The authors conducted an investigation of a cluster of eight new-onset asthma cases identified in a chemical plant through the Sentinel Event Notification Systems for Occupational Risks (SENSOR) program. Methods: Workplace investigation involved interviews with the asthma cases, review of medical records, and medical and industrial hygiene surveys in the plant. Results: Altogether, 11 work-related asthma cases were identified among the plant workers-approximately 10% of the workers exposed to the potential causative agents: 3-amino-5-mercapto-1,2,4-triazole (AMT) or N-(2,6-difluorophenyl)-5-methyl-[1,2,4]triazolo[1,5-a]pyrimidine-2-sulfonamide (DE-498; trade name Flumetsulam). Of these cases, six had physician-diagnosed occupational asthma (OA) based on work-related respiratory symptoms and nonspecific bronchial hyperresponsiveness (NSBH), and of these, three had work-related expiratory peak flow changes. Conclusions: The findings of this investigation, together with findings from concurrent animal studies, suggest that this outbreak of new-onset asthma was associated with exposure to AMT. Clinical Significance: A cluster of eight new-onset asthma cases was identified in a chemical plant through the SENSOR program. Subsequent workplace investigation identified AMT, used in the production of a herbicide N-(2,6-difluorophenyl)-5-methyl- [1,2,4]triazolo[1,5-a]pyrimidine-2-sulfonamide, as the most likely causal agent. AU - Hnizdo E AU - Sylvain D. Lewis DM AU - Pechter E AU - Kreiss K LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 61 IP - DP - 2004 Jan 01 TI - Occupational asthma caused by sodium disulphite in Norwegian lobster fishing PG - 873-874 AB - Sulphite is added to various foods due to its antioxidative effect. Sulphite is known to provoke bronchoconstriction in some atopics and individuals with asthma. Some asthmatics develop symptoms after ingestion of sulphite preserved foods. Occupational asthma due to sulphite has been described in the potato, wine, and laundry industries. An asthma-like syndrome has been described in agricultural workers during apricot sulphurisation. To our knowledge this is the first reported case of sulphite related occupational asthma in the fishing industry AU - Madsen J AU - Sherson D AU - Kjøller H AU - Hansen I AU - Rasmussen K LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 113 IP - DP - 2004 Jan 01 TI - Occupational asthma caused by tali and jatoba wood dusts PG - 361-363 AB - AU - Quirce S AU - Parra A AU - Antón E AU - Fernández-Nieto M AU - Jerez J AU - Sastre J LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 51 IP - DP - 2004 Jan 01 TI - Occupational asthma and IgE-mediated contact dermatitis from sapele wood PG - 88-89 AU - Álvarez-Cuesta C AU - Ortiz GG AU - Díaz ER AU - Barrios SB AU - Osuna CG AU - Aguado CR AU - Pineda F LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 46 IP - DP - 2004 Jan 01 TI - Exposure to bioaerosols: allergic reactions and respiratory function in Polish hop growers PG - 371-374 AB - BACKGROUND: The aim of the study was to assess the prevalence of work-related symptoms in hop growers and their relation to bioaerosols exposure. The study group comprised 69 hop growers and 58 office workers as controls. The examination included: physician-administrated questionnaire, PEF measurements, skin prick test, agar-gel precipitation test, and migration inhibition test. Microbiological air sampling was performed on all farms. RESULTS: The concentrations of total airborne microflora ranged from 2.08 to 129.6 x 10(3) CFU/m3. Airborne endotoxin and dust concentrations ranged from 26 to 6250 ng/m3 and 0.2-31.7 mg/m3, respectively. Altogether 52.2% of farmers complained of work-related symptoms. Positive skin reactions to microbial allergens were significantly more frequent in a group of hop growers with work-related respiratory symptoms compared to the rest of the farmers (18% vs 2%, P <0.05). Positive reactions in agar-gel precipitation test and in the leukocyte migration inhibition test were not correlated with the occurrence of work-related symptoms. The mean daily PEF values in farmers were lower compared to controls (469.7 +/- 127.5 vs 562.9 +/- 123.8; P <0.001). PEF (amp%mean) was higher in farmers compared to controls (9.3% vs 8.1%; P <0.05). CONCLUSION: Despite relatively lower exposure to bioaerosols, compared to farmers in other branches of agriculture, over 50% of hop growers complained of work-related symptoms. This may be partly due to the effects of microbial allergens and toxins and partly to the irritant or allergic properties of hop plant itself. AU - Gora A AU - Skorska C AU - Prazmo Z AU - Krysiska-Traczyk E AU - Sitkowska J AU - Dutkiewicz J LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 55 IP - DP - 2004 Jan 01 TI - Occupational allergies in the seafood industry--a comparative study of Australian and South African workplaces PG - 61-73 AB - Although seafood allergy due to ingestion is commonly observed in clinical practice, the incidence of seafood allergies in general and more specifically in the occupational setting in Australia is largely unknown. The work practices, occupational health services and allergic health problems in 140 seafood processing workplaces in Australia were examined and compared to previous studies in South Africa. A cross-sectional employer-based survey design was used to conduct the study in both countries. In the South African study a response rate of 60% (n = 41) was obtained, compared to a response rate of 18% (n = 140) in Australia. The most common seafood processed by workplaces in South Africa was finfish (76%) and rock lobster (34%). Similarly in Australia, finfish (34%) was the most frequently handled seafood. However, processing of prawns (24%) and oysters (21%) was more common in Australia. Common work processes in South Africa involved freezing (71%), cutting/filleting (63%) and degutting (58%) procedures. Similar processes were followed in Australian industries with the exception of shucking of oysters, particularly common in the aquaculture industries. About half of the workplaces in both countries provided an occupational health service and medical surveillance of workers. However, none of the workplaces in South Africa and only 9% of the workplaces in Australia had industrial hygiene programs for seafood aerosols in place. In both countries positive trends were observed between the size of the workforce and the provision of occupational health services (p<0.005). Similarly, skin rash accounted for highest of all reported health problems (78-81%) followed by asthmatic symptoms (7-10%) and other non-specific allergic symptoms (9-15%) in both countries. Most workplaces reported the annual prevalence of work-related symptoms to be less than 5%. In Australia 7% of respondents in workplaces reported workers having left their workplace due to work-related allergic problems. Despite a low response rate of contacted companies in Australia, there were great similarities between the two countries suggesting that there is a significantly elevated prevalence of work related allergic symptoms in both countries. Unexpectedly, mollusc processing was more common in Australia although the occupational health related effects among exposed workers has previously not been investigated in detail and merits further study. It is recommended that further epidemiological studies focus on seafood exposure in Australia and identify specific risk factors for sensitisation. AU - Lopata AL AU - Baatjies R AU - Thrower SJ AU - Jeebhay MF LA - PT - DEP - TA - International Maritime Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 61 IP - DP - 2004 Jan 01 TI - World at work: fish processing workers PG - 471-474 AB - The fishing and fish processing industry has experienced tremendous growth in recent years. In 1990 the Food and Agriculture Organisation (FAO) estimated that the number of people engaged in fishing, aquaculture, and related activities worldwide doubled to 28.5 million from 1970.1 Among these workers 52% worked aboard fishing trawlers, 32% were involved in aquaculture production (marine and freshwater), and 16% worked inland as capture fishers or in other land based activities such as processing. Ninety five per cent of these workers were from developing countries, producing 58% of the 98 million tons of world fish. Increased levels of production and processing of seafood have led and continue to lead to more frequent reporting of occupational health problems such as asthma among fish processing workers.2 These occupational health problems result in increased incapacity and absenteeism among affected workers, with women more affected as a result of differences AU - Jeebhay MF AU - Robins TG AU - Lopata AL LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 34 IP - DP - 2004 Jan 01 TI - Farming exposure in childhood, exposure to markers of infections and the development of atopy in rural subjects PG - 1178-1183 AB - BACKGROUND: Within the context of the hygiene hypothesis, we aimed to study the potential association between farming-related risk factors and Toxoplasma gondii (T. gondii) as well as Helicobacter pylori (H. pylori) seropositivity. METHODS: The study included questionnaire data and serum samples of 321 young adults living in a rural environment. Serum samples were analysed for specific IgE to a common panel of aeroallergens (SX1) as well as IgG against T. gondii and H. pylori. RESULTS: Regular contact with animal stables before the age of 3 years (odds ratio (OR) (95% confidence interval): 2.0 [1.0; 4.0]) and unpasteurized milk consumption at age 6 years (1.8 [1.0; 3.3]) were the strongest risk factors for T. gondii infection. None of the farming-related factors were significantly associated with H. pylori infection. Current consumption of raw farm milk was not significantly associated with H. pylori infection (2.1 [0.8; 5.3]). Regular contact with animal houses before the age of 7 years was the strongest predictor for atopy (0.49 [0.26-0.96]). The reduction in risk could not be further decreased by any other factor under consideration. After adjustment for animal house contact, the OR for atopy was decreased by raw milk consumption and H. pylori infection in an additive manner. CONCLUSION: Exposure to farming environments in childhood might predict T. gondii seropositivity in rural subjects. Nevertheless, the strongest predictor for atopy in rural subjects seems to be regular contact with farm animals. Whether T. gondii infection is an intermediate factor in the association between farm contact and atopy needs to be confirmed in larger studies. AU - Radon K AU - Windstetter D AU - Eckart J AU - Dressel H AU - Leitritz L AU - Reichert J AU - Schmid M AU - Praml G AU - Schosser M AU - von Mutius E AU - Nowak D. LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 59 IP - DP - 2004 Jan 01 TI - Rye flour induces a stronger bronchial response than wheat flour in occupational asthma PG - 833-838 AB - Background: Our aims were to compare the doses of wheat and rye flour that induce early bronchial responses in occupationally exposed asthmatic subjects and to assess the effects of the dose of inhaled flour, the duration of exposure and the dose rate. Methods: Ten patients underwent tests with lactose, wheat flour and rye flour. We compared the decrease in forced expiratory volume in 1 s (FEV1) observed during the challenge with flour and with lactose. We also calculated the amount of flour that was instantaneously active. Results: Seven subjects had significantly decreased FEV1 values following exposure to wheat and rye flour and two subjects only did so for rye flour. The provocative dose (PD, dose required to reduce FEV1 by 15%) of rye was lower than that of wheat flour (geometric mean; PD15 rye: 95 µg; wheat: 368 µg). The calculated doses of rye and wheat flour were better correlated with the change in FEV1 than were the cumulative doses. Conclusion: The bronchial response was greater with rye than with wheat flour. The response was related to the dose of allergen inhaled and to the dose rate. AU - Bernsefa L AU - Villette C AU - Tabka F AU - Causse-Sounillac E AU - Fabries JF AU - Choudat D. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 59 IP - DP - 2004 Jan 01 TI - Exposure to methyl methacrylate and hypersensitivity pneumonitis in dental technicians PG - 890-891 AB - We report two cases of dental technicians with a diagnosis of hypersensitivity pneumonitis because of inhalation of methyl methacrylate (MMA), occurring within the first weeks of exposure to MMA. When polishing and grinding prosthesis, dental technicians are exposed to mineral dusts and chemicals. Pneumoconiosis, asthma and hypersensitivity pneumonitis (HP) have been described, linked to silica, silicon carbide, asbestos or metals (1). Methyl methacrylate (MMA) is a monomer, commonly used in dental clinics. Previously, MMA has been shown responsible for occupational asthma, rhinoconjunctivitis, contact dermatitis or stomatitis (2, 3). We report two cases of HP induced by an exposure to MMA in students working in a dental laboratory. AU - Scherpereel A AU - Tillie-Leblond I AU - Pommier de Santi P AU - Tonnel AB. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 59 IP - DP - 2004 Jan 01 TI - Occupational asthma due to pork antigens PG - 893-893 AB - We describe two cases of occupational asthma (OA) in workers processing pork meat confirmed by specific inhalation challenges. Animal proteins are a part of the high-molecular weight agents that frequently causes OA (1). In the pork animal, swine confinement facility workers often develop respiratory problems (2, 3) these complaints are less frequent in meat pork-processing plants where the environmental conditions are different. The following report describes two cases of (OA) pork antigen in a meat pork industry. Both cases were male (33 and 49 years.), atopic and employed in a meat pork-processing plant for 1 and 11 years (subjects A and B) with no previous history of atopy. They were working on the production line, cutting up quarters of pork. After 6 months (subject A) and 11 years (subject B), both developed cough and attacks of wheezing and dyspnea, after starting work on the production line and getting worse at the end of the day. When seen in the clinic, both had been off work for several weeks and almost asymptomatics. Both subjects had a positive skin-prick test (10 and 5 mm) to an extract of pork meat antigen (Hollister-Stier Laboratories, Spokane, WA, USA). Subject A had normal forced expiratory volume (FEV1, 4.85 l) and borderline bronchial responsiveness with PC20 methacholine of 8.65 mg/ml. A bronchial challenge with nebulized pork meat antigen elicited an early response with 30% fall in FEV1 and no change in PC20 (Fig. 1). Subject B had also a normal FEV1 (3.14 l) and mild bronchial hyperresponsiveness (PC20 5 mg/ml). Monitoring of FEV1 at work confirmed the diagnosis of OA with an early response (FEV1 fell by 24% after 45 min of exposition with recovery over 2 h) . Patients were removed from their workplace with improvement in their symptomatology. AU - Labrecque M AU - Coté J AU - Cartier A AU - Lemière C AU - Malo J-L. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 54 IP - DP - 2004 Jan 01 TI - Occupational asthma case finding: a role for primary care PG - 731-733 AU - Levy ML AU - Nicholson PJ LA - PT - DEP - TA - Br J Gen Pract JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 61 IP - DP - 2004 Jan 01 TI - World at work: the electronics industry PG - 180-183 AB - The article review the processes in electronics manufacture. Simiconductor wafer manufacture where circuits are itched onto silicon wafers. Processes include crystal purification and growth, wafer preparation, epitaxy and oxidation, photolithography, doping and type conversion, metallisation, interconnections and packaging. This is followed by the assembly of the semiconductors including die separation and bonding, wire bonding, encapsulation, marking and testing. The encapsulation process may involve isocyanates, acrylates or epoxy resins, possible causes of occupational asthma. Printed circuit board manufacture includes resin bonding, impregnation, laminating, photomasking and etching, cutting and drilling, marking and testing. The printed circuit boards are then assembled with components which need to be soldered into the printed circuits. This process may be close to automatic flow solder machines, or may involve hand soldering, particularly when rectifying faulty connections. The solder flux fumes are the major hazard, but rectification may involve using a soldering iron to burn through a surface coating, which may liberate isocyanates. The board is then ready for assembly into the final product. AU - Koh D AU - Chan G AU - Yap E LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 11(1) IP - DP - 2004 Jan 01 TI - Immunologic reactivity to work-related airborne allergens in people occupationally exposed to dust from herbs PG - 121-7 AU - Golec M AU - Skórska C AU - Mackiewicz B AU - Dutkiewicz J LA - PT - DEP - TA - Ann Agric Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 113 IP - DP - 2004 Jan 01 TI - Effect of omalizumab in health care workers with occupational latex allergy PG - 360-361 AB - Latex allergy is common among health care workers who are frequently exposed to latex gloves and other latex-containing medical supplies. Product avoidance is difficult to achieve for many health care workers, and other management options are limited. Type I hypersensitivity reactions, such as latex allergy, are known to be mediated by IgE, and targeting IgE has already been investigated in the treatment of other allergic disorders. Omalizumab, a recombinant and humanized mAb, has been shown to be clinically efficacious in the treatment of patients with allergic asthma and rhinitis. On the basis of such findings, we have conducted a doubleblind, randomized, placebo-controlled study to determine whether the benefits of anti-IgE therapy extend to those with latex allergy. The study population was 18 health care workers (15 female and 3 male patients; mean age, 40 years) who had clinical symptoms of occupational latex allergy for at least 1 year (rhinitis, conjunctivitis, and/or mild-to-moderate asthma) and who had positive skin prick test responses to 2 preparations of latex allergens and relevant serum specific IgE levels (RAST class =2). Further inclusion criteria included a positive conjunctival challenge test total score (range, 0-13; positive if =7) 4 and increased total IgE levels (30-700 IU/mL). Subjects were randomly treated with either omalizumab (n = 9) or placebo (n = 9) administered by means of subcutaneous injection every 2 or 4 weeks for 16 weeks, during which time no change in the occupational environment was permitted. The dose of omalizumab was 150 to 750 mg/mo, depending on body weight and total serum IgE level at baseline. Efficacy was primarily evaluated in terms of the conjunctival challenge test total score after 8 and 16 weeks' treatment, along with skin reactivity to 3 dilutions of latex allergens and to latex glove exposure at study end (responders only). The conjunctival allergen challenge is a validated model developed by Abelson et al, and it has already been used in a previous study on latex allergy. The total conjunctival score was the sum of 5 subscores: redness, eyelid swelling, chemosis, and tearing, which were graded by the investigator from 0 to 3 (0, absent; 1, mild; 2, moderate; and 3, severe), and itching, which was graded by the patient from 0 to 4 (0, absent; 1, mild; 2, moderate; 3, severe; and 4, incapacitating). A clinically relevant change in the conjunctival score was defined as a decrease from an abnormal score (>7) to a normal score (<7). The use of rescue medication (oral or ocular antihistamines; oral, nasal or inhaled corticosteroids; and inhaled salbutamol) was permitted on an as-needed basis to control symptoms. Among the 16 evaluable subjects (2 patients of the omalizumab group discontinued: one for administrative problems and one for an adverse event), the mean conjunctival challenge test total score decreased from 10.0 to 5.0 during omalizumab therapy, whereas scores remained unchanged (from 9.67 to 9.0) for placebo recipients (P =0.003, Wilcoxon rank sum test. This difference remained significant when the analysis accounts for the 2 premature discontinuations with the last total score carried forward (omalizumab, –4.33; placebo, –0.67; P = .006). After 16 weeks, scores were negative in 4 (57.1%) of 7 subjects treated with omalizumab compared with none of the 9 placebo-treated subjects (P =0.019, Fisher exact test). Improvements in conjunctival challenge test scores with omalizumab were apparent for all subscores, including redness, chemosis, tears, and itching, whereas no relevant changes were apparent for placebo recipients. All subjects were subsequently treated with open-label omalizumab for a further 16 weeks. Some 8 (88.9%) of 9 subjects previously treated with placebo subsequently achieved negative total scores on the conjunctival challenge test along with the 3 remaining omalizumab-treated subjects who had positive scores after the first 16 weeks of treatment. The overall ocular response rate was therefore 93.8% (15/16), with 11 of 15 subjects also having a negative response on study completion to a latex glove challenge test (mild response in 4/15 subjects). At study end, the patients treated with omalizumab for 32 weeks exhibited mean relative decreases in skin reaction to the dilutions 11, 33, and 100 IR of latex allergens of 61%, 49%, and 64%, respectively. The 2 treatment groups had similar exposure to latex allergens during the study. Tolerability of omalizumab was good, with only 2 reports of related injection-site reactions during double-blind treatment (1 patient with 3 episodes of injection-site pain of increasing severity leading to the withdrawal of the subject and 1 patient with 2 short episodes of injection-site pruritus) and no clinically relevant changes in laboratory parameters. In summary, the findings of this study show that omalizumab has clinically relevant ocular and skin antiallergic activity in health care workers with occupational latex allergy. Further long-term studies are clearly warranted in patients with latex allergy. AU - Leynadier F AU - Doudou O AU - Gaouar H AU - Le Gros V AU - Bourdeix I AU - Guyomarch-Cocco L AU - Trunet P LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 46 IP - DP - 2004 Jan 01 TI - Polyisocyanates in occupational environments: a critical review of exposure limits and metrics PG - 480-491 AB - BACKGROUND: Determination of polyisocyanates is important because they are a major contributor of exposure to the isocyanate functional group in many workplace environments and are capable of inducing sensitization and asthma. However, with multiple different measurement metrics in use, comparison of isocyanate exposure data between studies and development of occupational exposure limits (OELs) for polyisocyanates is difficult. METHODS: An analysis of existing problems in the measurement and regulation of isocyanates is presented based on the published analytical, toxicological, and regulatory literature, and the authors' own analytical data and experience with isocyanates. RESULTS: This analysis supports a need for standardization of isocyanate measurement metrics and provides a framework for the development of an OEL for polyisocyanates. CONCLUSIONS: The total isocyanate group (microg NCO/m(3)) is recommended as the most feasible and practical metric (unit) by which to express polyisocyanate exposures for research, control, and regulatory purposes. The establishment of a comprehensive isocyanate OEL that simplifies the current agent-by-agent approach and expands coverage to polyisocyanates is also recommended AU - Bello D AU - Woskie SR AU - Streicher RP AU - Liu Y AU - Stowe MH AU - Eisen EA AU - Ellenbecker MJ AU - Sparer J AU - Youngs F AU - Cullen MR AU - Redlich CA LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 92 IP - DP - 2004 Jan 01 TI - Impact of long-term inhaled corticosteroid therapy on bone mineral density; results of a meta-analysis PG - 201-207 AU - Halpern MT AU - Schmier JK AU - Van Kerkhove MD AU - Watkins M AU - Kalberg CJ LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 59 IP - DP - 2004 Jan 01 TI - Type 1 latex allergy in healthcare workers with latex-induced contact urticaria syndrome: a follow-up study PG - 718-732 AU - Nettis E AU - Colanardi MC AU - Ferrannini A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 169 IP - DP - 2004 Jan 01 TI - Inhaled and nasal corticosteroid use and the risk of fracture PG - 83-88 AU - Suissa S AU - Baltzan M AU - Kremer R AU - Ernst P LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20040101 IS - IS - VI - 62 IP - DP - 2004 Jan 01 TI - Guidelines for the prevention, identification and management of occupational asthma: Evidence review and recommendations PG - - AB - Nicholson PJ, Cullinan P, Gosmore C, Newman Taylor AJ, Burge PS AU - Nicholson PJ AU - Cullinan P AU - Gosmore C AU - Newman Taylor AJ AU - Burge PS LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 6 IP - DP - 2003 Jan 01 TI - Inhaled formaldehyde: exposure estimation, hazard characterization, and exposure-response analysis PG - 85-114 AU - Liteplo RG AU - Meek ME LA - PT - DEP - TA - J Toxicology Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 33 IP - DP - 2003 Jan 01 TI - Prevalence of occupational allergy due to live fish bait PG - 507-510 AU - Siracusa A AU - Marcucci F AU - Spinozzi F AU - Marabini A AU - Pettinari L AU - Pace ML AU - Tacconi C LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - IP - DP - 2003 Jan 01 TI - Vaccines for preventing pneumococcal infections in adults PG - - AU - Dear KBG AU - Andrews RR AU - Holden J AU - Tatham DP LA - PT - DEP - TA - The Cochrane Database of Systematic Reviews JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 58 IP - DP - 2003 Jan 01 TI - The prevalence of IgE sensitization in asthmatic children PG - 668-671 AU - Doi S AU - Suzuki S AU - Morishita M AU - Yamada M AU - Kanda Y AU - Torii S AU - Sakamoto T LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 60 IP - DP - 2003 Jan 01 TI - Prevalence of sensitisation to cellulase and xylanase in bakery workers PG - 802-804 AB - Aims: To assess the prevalence of sensitisation to a range of exogenous fungal enzymes used in bakeries, and determine the relation between sensitisation and work related symptoms. Methods: Serum samples (n = 135) from a previous cross sectional study investigating the prevalence of respiratory symptoms and sensitisation to dust components, were reanalysed for specific IgE to the mixed enzymes cellulase, hemicellulase, and xylanase. Results: Eight (6%) of sera tested had detectable specific IgE to mixed enzymes (excluding fungal a-amylase) and 16 (12%) to fungal a-amylase. A significant increase (p = 0.03) in nasal symptoms was found in those workers sensitised to enzymes (including a-amylase and the mixed enzymes, but with or without sensitisation to wheat flour) when compared to those sensitised to wheat flour alone. Both groups had significantly greater levels of nasal symptoms in comparison to those with no evidence of sensitisation. Conclusions: The association between specific IgE to mixed enzymes, and an increased prevalence of nasal symptoms in individuals sensitised to enzymes, highlights the importance of measuring sensitisation to the full range of exogenous enzymes used in the baking industry, as well as to wheat flour. AU - Elms J AU - Fishwick D AU - Walker J AU - Rawbone R AU - Jeffrey P AU - Griffin P AU - Gibson M and Curran AD LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 157 IP - DP - 2003 Jan 01 TI - Exposure to metal fume and infectious pneumonia. PG - 227-233 AB - To test the hypothesis that inhalation of metal fume reversibly increases susceptibility to pneumonia, the authors conducted a case-control study. Men aged 20-64 years, admitted to 11 hospitals in West Midlands, England, with community-acquired pneumonia during 1996-1999 were interviewed about their lifetime occupational history, exposure to metal fume, and potential confounding factors. Similar information was collected from controls admitted to the same hospitals with nonrespiratory illness. For cases, exposures were timed relative to the onset of their illness (on average, 6 months before interview). Exposure histories for controls were censored 6 months before interview. Interviews were completed by 525 cases and 1,122 controls (response rates of 74% and 99%). Pneumonia was associated with reported occupational exposure to metal fume in the previous year (adjusted odds ratio (OR) = 1.6, 95% confidence interval (CI): 1.1, 2.4) but not in earlier periods (OR = 1.1). The risk was highest for lobar pneumonia and recent exposure to ferrous fume (OR = 2.3, 95% CI: 1.2, 4.3). The association was not specific to any one microorganism. These findings support the hypothesis that ferrous and possibly other metal fumes reversibly predispose to infectious pneumonia. Research should now focus on the underlying mechanisms and prevention. AU - Ayres JG AU - Mann J AU - Burge PS AU - Coggon D AU - Palmer KT AU - Poole J LA - PT - DEP - TA - Am J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 58(1) IP - DP - 2003 Jan 01 TI - Health effects of exposure to thyme dust in a group of thyme growing farmers PG - 195-203 AU - Golec M AU - Skórska C AU - Mackiewicz B AU - Dutkiewicz J LA - PT - DEP - TA - Ann Univ Mariae Curie Sklodowska [Med] JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 58(1) IP - DP - 2003 Jan 01 TI - Health effects of inhalation exposure to organic dust in hops farmers PG - 459-65 AU - Skórska C AU - Mackiewicz B AU - Góra A AU - Golec M AU - Dutkiewicz J LA - PT - DEP - TA - Ann Univ Mariae Curie Sklodowska [Med] JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 54 IP - DP - 2003 Jan 01 TI - Occupational asthma and interstitial cobalt-induced changes in a dental technician: a case report PG - 159-164 AB - It is a case report on a 55-year-old non-smoking female, dental technician, with a 36-year history of cobalt exposure. The patient suffered from dyspnea, coughing and decrease in physical load tolerance about 20 years after the first occupational contact with cobalt-containing metal dentures. Skin tests performed with a battery of common allergens (metals: nickel, chrome, cobalt; acrylates; disinfectants; and natural rubber latex) were negative. In the patient, interstitial radiological changes, respiratory insufficiency and decrease in diffusion capacity were observed. While performing a provocation test with 0.05% cobaltous chloride, the patient developed dyspnea with concomitant decrease in 1 second forced expiratory volume (FEV1) and peak respiratory flow (PEF) from the beginning of the 3rd hour after provocation and maximum intensity at the 8th hour. These symptoms persisted until the 24th hour. The authors conclude that occupational exposure of the dental technician to cobalt dust derived from metal dentures may cause chronic airway disease with interstitial inflammation, fibrosis and occupational asthma. AU - Wittczak T AU - Walusiak J AU - Krakowiak A AU - Palczyski C LA - PT - DEP - TA - Medycyna Pracy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 112 IP - DP - 2003 Jan 01 TI - Heterogeneity of IgE response to cefteram pivoxil was noted in 2 patients with cefteram-induced occupational asthma PG - 209-210 AB - AU - Suh Y AU - Lee Y AU - Choi J AU - Suh C AU - Nahm D AU - Park H LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 60 IP - DP - 2003 Jan 01 TI - Occupational asthma from fungicides fluazinam and chlorothalonil PG - 76-77 AB - We report two cases of occupational asthma caused by sensitisation to powdered fungicides fluazinam and chlorothalonil, from the same fungicide formulation plant. Both developed work related lower respiratory symptoms after a latent interval of asymptomatic exposure. The diagnosis in each case was confirmed with a serial peak flow record in the workplace followed by specific inhalation tests. These fungicides are known to cause dermatitis; this report indicates that these compounds can induce specific immunological reactions in the airways as well as skin. AU - Draper A AU - Cullinan P AU - Campbell C AU - Jones M AU - Newman Taylor A LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 21 IP - DP - 2003 Jan 01 TI - Diagnosing occupational asthma: how, how much, how far? PG - 879-885 AB - Diagnosing occupational asthma is still a challenge because it is based on a stepwise approach in which the depth of investigative means may vary depending on resources. The authors herewith review the existing investigative means from the approach of outlining controversies and queries. There is no validated clinical questionnaire for diagnosing occupational asthma. Immunological investigation is limited by the lack of standardised extracts for skinprick testing and specific immunoglobulin E assessments. Criteria for interpretation of changes in peak expiratory flow rates and bronchial responsiveness to pharmacological agents are still open to discussion. It is worth improving the methodology of specific inhalation challenges, either in the laboratory or in the workplace, to facilitate more extensive use of these tests. Validation of new means that assess airway inflammation, such as exhaled nitric oxide and induced sputum, needs to be performed. There is a need to increase the use of these diagnostic tests because the diagnosis is still too often based on "clinical impression". AU - Moscato G AU - Malo J-L AU - Bernstein D LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 60 IP - DP - 2003 Jan 01 TI - Lung hyperpermeability and asthma prevalence in schoolchildren: unexpected associations with the attendance at indoor chlorinated swimming pools PG - 385-394 AB - Aims: To study whether exposure to nitrogen trichloride in indoor chlorinated pools may affect the respiratory epithelium of children and increase the risk of some lung diseases such as asthma. Methods: In 226 healthy children, serum surfactant associated proteins A and B (SP-A and SP-B), 16 kDa Clara cell protein (CC16), and IgE were measured. Lung specific proteins were measured in the serum of 16 children and 13 adults before and after exposure to NCl3 in an indoor chlorinated pool. Relations between pool attendance and asthma prevalence were studied in 1881 children. Asthma was screened with the exercise induced bronchoconstriction test (EIB). Results: Pool attendance was the most consistent predictor of lung epithelium permeability. A positive dose-effect relation was found with cumulated pool attendance and serum SP-A and SP-B. Serum IgE was unrelated to pool attendance, but correlated positively with lung hyperpermeability as assessed by serum SP-B. Changes in serum levels of lung proteins were reproduced in children and adults attending an indoor pool. Serum SP-A and SP-B were already significantly increased after one hour on the pool side without swimming. Positive EIB and total asthma prevalence were significantly correlated with cumulated pool attendance indices. Conclusions: Regular attendance at chlorinated pools by young children is associated with an exposure dependent increase in lung epithelium permeability and increase in the risk of developing asthma, especially in association with other risk factors. We therefore postulate that the increasing exposure of children to chlorination products in indoor pools might be an important cause of the rising incidence of childhood asthma and allergic diseases in industrialised countries. Further epidemiological studies should be undertaken to test this hypothesis. AU - Bernard A AU - Carbonnelle S AU - Michel O AU - Higuet S AU - de Burbure C AU - Buchet J-P AU - Hermans C AU - Dumont X AU - Doyle I LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 44 IP - DP - 2003 Jan 01 TI - Atopic symptoms among California veterinarians PG - 166-171 AB - BACKGROUND: The prevalence of allergic symptoms among veterinarians has not been studied adequately. METHODS: A questionnaire was sent to 2,000 California veterinarians; the return rate was 73% (N=1416). RESULTS: A history of either asthma, allergic rhinitis (AR), or atopic dermatitis (AD) was reported by 66% of respondents. AR was reported by 62%, asthma by 16%, and AD by 11%. Forty percent of the veterinarians reported animal related respiratory and/or skin symptoms. The most commonly reported causes of symptoms were cats and dogs. In multivariate logistic analysis, the significant risk factors for having adult asthma were the history of AR with the history of AD (OR 13.9), AR alone (OR 6.3), and asthma in childhood (OR 6.4). CONCLUSIONS: The prevalence of asthma and other atopic symptoms was high in the studied population. Most veterinarians with respiratory or skin symptoms reported the symptoms as being related to specific animal contact. AU - Susitaival P AU - Kirk JH AU - Schenker MB. LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 68 IP - DP - 2003 Jan 01 TI - EAACI position paper: skin prick testing in the diagnosis of occupational type I allergies PG - 580-584 AB - Skin prick testing (SPT) in combination with the clinical history of the patient is one important step in the diagnosis of IgE-mediated occupational allergies. However, skin test performance is related to the quality of allergen extracts. The present consensus document was prepared by an EAACI Task Force consisting of an expert panel of allergologists and occupational physicians from Germany, Italy, Spain, France, Austria, and Poland. All members of the panel were also involved in the data collection within the European multicentre study STADOCA (Standard diagnosis for occupational allergy). The aim of this Task Force was the assessment of the quality of commercially available SPT solutions for selected occupational allergens under standardized procedure conditions in different European centres and institutes of Occupational Medicine. The data evaluation shows a wide variability among SPT solutions and also indicates that the sensitivity of several SPT solutions is low. Therefore, improvement and standardization of SPT solutions for occupational allergens is highly recommended. Clinical practitioners should also not presume that their SPT solutions are fully reliable. The main objective of the document is to issue consensus suggestions for the use of SPT with occupational allergens based on the European multicentre study STADOCA, on existing scientific evidence and the expertise of a panel of allergologists. AU - van Kampen V AU - de Blay F AU - Folletti I AU - Kobierski P AU - Moscato G AU - Olivieri M AU - Quirce S AU - Sastre J AU - Walusiak-Skorupa J AU - Raulf-Heimsoth M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 60 IP - DP - 2003 Jan 01 TI - Chronic obstructive pulmonary disease due to occupational exposure to silica dust: a review of epidemiological and pathological evidence PG - 267-243 AB - Occupational exposure is an important risk factor for chronic obstructive pulmonary disease (COPD), and silica dust is one of the most important occupational respiratory toxins. Epidemiological and pathological studies suggest that silica dust exposure can lead to COPD, even in the absence of radiological signs of silicosis, and that the association between cumulative silica dust exposure and airflow obstruction is independent of silicosis. Recent clinicopathological and experimental studies have contributed further towards explaining the potential mechanism through which silica can cause pathological changes that may lead to the development of COPD. In this paper we review the epidemiological and pathological evidence relevant to the development of COPD in silica dust exposed workers within the context of recent findings. The evidence surveyed suggests that chronic levels of silica dust that do not cause disabling silicosis may cause the development of chronic bronchitis, emphysema, and/or small airways disease that can lead to airflow obstruction, even in the absence of radiological silicosis. AU - Hnizdo E AU - Vallyathan V LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 25 IP - DP - 2003 Jan 01 TI - The role of household exposures in lung disease among women PG - 118-130 AB - Household exposures can pose a risk for adverse respiratory effects whose burden is borne disproportionately among women, much of it preventable. Relevant exposure risks fall into three categories. Exposures may arise out of the routine household activities including cooking, cleaning and laundering. Cooking can lead to exposure to particulate material and gases, each with potential adverse respiratory effects. Worldwide, cooking with biomass fuels and coal may carry the greatest health risk for women among domestic exposures. Food preparation can also lead to allergic disease, including asthma associated with handling common foodstuffs. Cleaning-chemical exposures can lead to irritant inhalation, most commonly from mixing misadventures involving hypochlorite bleach. Laundering also carries risks, either from dust-contaminated work clothes or from detergents and related products. A second group of exposures with a potential gender differential derives from domestic indoor-air quality. Exposures can include bioaerosols, environmental tobacco smoke and chemical off-gassing. To the extent that women spend more time indoors in these environments, they are at greater risk of adverse effects. Finally, sporadic yet important domestic exposures can occur through hobby or vocational activities, such as home maintenance or crafts work. AU - Blanc PD LA - PT - DEP - TA - Eur Respir Monogr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 53 IP - DP - 2003 Jan 01 TI - Increased risk of asthma among Finnish construction workers PG - 527-531 AB - Aim To determine the risk of asthma among 7891 Finnish construction workers in the Pirkanmaa Region of southern Finland. Method Retrospective cohort study of hospital records of the Tampere University Hospital. A population of Pirkanmaa paper mill workers (n = 2686) and the Pirkanmaa working age population (n = 252 500) served as reference populations. Results There were 147 new cases of asthma among the construction workers in 1991-1995. The annual rate was 37 per 10 000 workers and the odds ratio was 2.1 [95% confidence interval (CI) = 1.2-3.6] for the women and 1.8 (95% CI = 1.5-2.2) for the men when compared with the general working age population. In general, the risk of asthma among the paper mill workers did not differ from the risk of asthma among the general working age population. The construction workers had an increased risk for asthma, although the number of reported cases of occupational asthma was lower for the construction workers than for the paper mill workers or for the working population. Conclusion Construction work, especially dusty tasks, was associated with an elevated risk of asthma. Thus the effect of exposure to irritant agents may have a role in the development of asthma among construction workers. For the most part, these cases of asthma do not meet the criteria for occupational asthma because the specified causal agent can not be defined.The etiologic agents and mechanisms of asthma in construction work should be clarified for preventive measures. AU - Sauni R AU - Oksa P AU - Huikko S AU - Roto P AU - Uitti J LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 39 IP - DP - 2003 Jan 01 TI - Occupational asthma in food packers PG - 324-326 AB - This report describes the case of a 26-year-old woman working in a fish-processing factory who developed bronchial asthma when transferred to the packing department. Various tests, including a specific bronchial challenge test, confirmed a diagnosis of occupational asthma. While polyvinyl chloride (PVC) appeared to be the causal agent in this case, the possible role of other etiological agents is also discussed. Although occupational asthma in food packers is rare, we nonetheless consider it important to recognize this type of asthma given the widespread use of PVC. AU - Munoz X AU - Cruz MJ AU - Albanell M AU - Morell F LA - PT - DEP - TA - Archivos de Bronconeumologia JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 120 IP - DP - 2003 Jan 01 TI - Hypersensitivity pneumonitis in construction plasterers (espartosis): study of 20 patients PG - 578-583 AB - BACKGROUND AND OBJECTIVE: Espartosis is a type of hypersensitivity pneumonitis which frequently affects construction workers handling esparto fibres used as support material inside gypsum plaster. Exactly which agents produce this disease remains under discussion. The aims of this study were: a) to assess the possible etiologic role of the fungi colonizing esparto grass fibres and esparto itself in the genesis of this disease, and b) to describe the clinical characteristics of this disease in a large series of patients. PATIENTS AND METHOD: Twenty patients diagnosed of hypersensitivity pneumonitis due to esparto grass exposure were studied. Mycologic cultures of the esparto grass fibre samples provided by each patient were performed. Fungi and/or esparto were used for determination of specific IgG antibodies, specific skin tests and specific bronchial challenge tests. RESULTS: Most frequently isolated fungi in causal esparto samples were Aspergillus sp. (60%) and Mucor sp. (47%). Specific IgG antibody determinations and/or specific bronchial challenge tests showed antigenicity not only for Aspergillus sp. but also for non-fungi-contaminated esparto grass and other fungi such as Penicillium sp. or Mucor sp. These results were helpful for establishing a new etiologic approach to the diagnosis of this disease. CONCLUSIONS: Aspergillus fumigatus is recognized as a causal agent in hypersensitivity pneumonitis due to esparto grass exposure; however, other antigenic sources such as Penicillium frequentans and other fungi, as well as esparto grass fibres, also appear to play a role in the genesis of this disease. AU - Cruz MJ AU - Morell F AU - Roger A AU - Munoz X AU - Rodrigo MJ LA - PT - DEP - TA - Medicina Clinica JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 90 IP - DP - 2003 Jan 01 TI - Clinical and occupational outcomes in health care workers with natural rubber latex allergy PG - 209-213 AB - Background: There is limited information pertaining to clinical outcomes and economic consequences of natural rubber latex (NRL) allergy in health care workers (HCWs). Objective: To evaluate retrospectively health and economic outcomes in HCWs identified with NRL allergy and percutaneous reactivity to NRL. Methods: Sixty-seven HCWs with NRL allergy, confirmed by percutaneous reactivity to non-ammoniated latex (NAL) extract, were administered a detailed questionnaire to evaluate clinical and economic outcomes of active work and environmental interventions subsequent to recognition of work-related symptoms associated with NRL gloves. Results: Diagnoses based on predetermined case definitions associated with direct or indirect exposure to NRL gloves included contact urticaria in 67 (100%); work-related rhinitis in 23; work-related asthma symptoms in 25; and work-related anaphylaxis in 4 workers. Work related symptoms reportedly resolved in 44 of 49 (90%) of NAL skin test-positive workers who had reported skin, respiratory, and/or systematic symptoms and remained in their current work area and who switched to non-NRL gloves. Four of 24 (17%) workers with work-related asthma symptoms were compelled to change employment to NRL-safe workplaces, resulting in a mean 24% reduction in annual income. Conclusions: Clinical outcomes in this group of HCWs with NRL allergy were favorable after institution of interventions but incurred deleterious consequences in a minority of workers. AU - Bernstein DI AU - Karnani R AU - Biagini RE AU - Bernstein CK AU - Murphy K AU - Berendts B AU - Bernstein JA AU - I L. Bernstein IL LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 57 IP - DP - 2003 Jan 01 TI - Respiratory diseases in European farmers-II. Part of the European farmers' project PG - 510-517 AB - BACKGROUND: The aim of the European Farmers' Project was to estimate the prevalence of respiratory diseases in farmers across Europe. Furthermore, risk factors for respiratory symptoms in different parts of agricultural production should be assessed. METHODS: In the first part of the study, 7496 farmers from four European countries answered a written questionaire. Of these, 229 were visited at their farms in the second part of the survey. On site, spirometry, allergy tests, as well exposure measurements were performed. RESULTS: Farmers with animal production had a significantly lower prevalence of allergic diseases than the general population. In contrast, the prevalence of chronic phlegm was higher in animal farmers. Organic dust toxic syndrome (ODTS) was a major predictor of chronic bronchitis. It was indicated that allergens found in the working environment could be transfered to the living environment of the farmer. Poor ventilation as well as high temperatures inside the animal buildings were shown to have a negative impact on respiratory symptoms and lung function parameters. CONCLUSION: Animal farmers are at high risk of chronic bronchitis. Intervention studies on the efficacy of different types of ventilation are now warranted. Furthermore, prospective studies on the associaton between ODTS and COPD should be done. AU - Radon K AU - Garz S AU - Riess A AU - Koops F AU - Monso E AU - Weber C AU - Danuser B AU - Iversen M AU - Opravil U AU - Donham K AU - Hartung J AU - Pedersen S AU - Nowak D LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 21 IP - DP - 2003 Jan 01 TI - Region-related risk factors for respiratory symptoms in European and Californian farmers PG - 323-331 AB - Authors Monso E. Schenker M. Radon K. Riu E. Magarolas R. McCurdy S. Danuser B. Iversen M. Saiki C. Nowak D. Authors Full Name Institution Dept of Pneumology, Hospital Germans Trias i Pujol, Badalona, Catalonia, Spain. emonso@ns.hugtip.scs.es Title . Source European Respiratory Journal. 21(2):323-31, 2003 Feb. The aim of this study was to determine the prevalences and regional risk factors for respiratory symptoms in European and Californian farmers. Farmers participating in the 1993-1997 surveys performed in Europe (n = 7,188) and California (n = 1,839) were included in this cross-sectional study. Respiratory symptoms and farming characteristics were assessed by questionnaire and risk factors associated with symptoms using logistic regression. The prevalences of rhinitis and asthma were lower in European (12.7% and 2.8%) than in Californian farmers (23.9% and 4.7%), but chronic bronchitis and toxic pneumonitis were more prevalent in Europe (10.7% and 12.2%) than in California (4.41% and 2.7%). Respiratory symptoms were associated with poultry and rabbit farming, flower growing and the cultivation of grain and oil plants. Working in Europe was a statistically significant risk factor for chronic bronchitis and toxic pneumonitis. Chronic bronchitis was related to toxic pneumonitis, work inside confinement buildings and greenhouses. Chronic bronchitis and toxic pneumonitis are highly prevalent among European farmers and are mainly attributable to indoor work. AU - Monso E AU - Schenker M AU - Radon K AU - Riu E AU - Magarolas R AU - McCurdy S AU - Danuser B AU - Iversen M AU - Saiki C AU - Nowak D LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 41 IP - DP - 2003 Jan 01 TI - Acute Lung Injury Caused by Inhalation of Waterproofing Spray PG - 123-126 AB - A 55-year-old man was admitted to our hospital because of severe dyspnea 30 minutes after inhalation of waterproofing spray. He had used the spray outdoors and had then smoked a cigarette with spray-contaminated fingers. Chest radiography and computed tomography (CT) revealed diffuse ground glass opacities in both lungs. In pulmonary function tests, the lungs showed a moderately decreased diffusing capacity and there was slight hypoxemia. Transbronchial lung biopsy specimens demonstrated extensive alveolitis and marked eosinophil migration. Without any specific treatment, the patient recovered clinically in 4 days. We speculated that acute lung injury in this patient may have been induced by not only direct inhalation of the waterproofing spray itself, but also by inhalation of spray by-products resulting from decomposition due to heat. When waterproofing spray is used, precautions should be taken to avoid both inhalation and heating of the fumes AU - AKIHIRO T AU - KUNIHIKO I AU - TAKAHIRO T AU - HARUMI N AU - NAOKI M AU - TOMONORI H AU - MOTOYOSHI S AU - SHUNSUKE S AU - YOSHIAKI I LA - PT - DEP - TA - Journal of the Japanese Respiratory Society JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 112 IP - DP - 2003 Jan 01 TI - Incidence of occupational rhinoconjunctivitis and risk factors in animal-health apprentices PG - 1105-1111 AB - Background Exposure to laboratory animals often causes the appearance of immunologic sensitization and symptoms. Objective Our aim was to determine the incidence of occupational rhinoconjunctivitis and the timing of symptoms and their determinants in apprentices starting exposure to laboratory animals. Methods Data from 387 (92.8%) of 417 students entering career programs in animal health in 5 schools were kept for analysis. Questionnaires and skin prick tests with common and occupational inhalants were carried out on entry and at follow-up visits scheduled at 8, 20, 32, and 44 months, depending on the schools. Responsiveness to inhaled methacholine was assessed at entry. Results Ninety-three (24%) subjects showed incident occupational rhinoconjunctivitis symptoms, and 37 (9.6%) had symptoms combined with skin sensitization to an animal-derived allergen. Symptoms such as sneezing, rhinorrhea, and itchy eyes tended to develop early in the course of exposure. In two thirds of the subjects, symptoms persisted at subsequent visits. In a multivariate analysis the determinants of the appearance of rhinoconjunctivitis with or without allergic sensitization included sensitization to grass pollens (odds ratio [OR], 1.78; 95% CI, 0.99-3.19), as well as nasal (rhinorrhea in contact with dust: OR, 1.79; 95% CI, 1.05-3.05) and bronchial symptoms (chest tightness: OR, 3.31; 95% CI, 0.98-11.25; cough on exposure to strong odors: OR, 1.88; 95% CI, 0.98-3.59). Conclusion The incidence of occupational rhinoconjunctivitis symptoms with or without immunologic sensitization is high in apprentices starting exposure to laboratory animals. Symptoms related to histamine release are common in the early course of exposure. Determinants include immunologic and target-organ susceptibility. AU - Rodier F. Gautrin D. Ghezzo H. Malo JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 13 IP - DP - 2003 Jan 01 TI - Occupational rhinitis and bronchial asthma due to TBTU and HBTU sensitization PG - 133-134 AU - Miralles Lopez JC. Negro JM. Alonso JM. Garcia M. SanchezGascon F. Soriano J LA - PT - DEP - TA - J Inv Allergod Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 43 IP - DP - 2003 Jan 01 TI - Occupational asthma in the City of Sao Paulo, 1995-2000, with special reference to gender analysis PG - 611-617 AU - Coeli Mendonca EM. Algranti E. De Freitas JBP. Rosa EA. Dos Santos Freire JA. Santos UDP. Pinto J. Bussacos MA LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 111 IP - DP - 2003 Jan 01 TI - Time course of onset of sensitization to common and occupational inhalants in apprentices PG - 807-812 AU - Nguyen B. Ghezzo H. Malo JL. Gautrin D LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 90 IP - DP - 2003 Jan 01 TI - HLA phenotype and exposure in development of occupational asthma PG - 24-27 AU - Taylor AJ LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 21 IP - DP - 2003 Jan 01 TI - Definitions and types of work-related asthma: a nosological approach PG - 706-712 AB - The workplace can trigger or induce asthma and cause the onset of different types of work-related asthma. Analysis of previous definitions of occupational asthma (OA) led to the conclusion that evidence of a direct causal relationship between workplace exposure and the development of asthma remains the key element for defining OA. Based on clinical features and pathophysiological mechanisms, the following conditions should be distinguished in the spectrum of work-related asthma: 1) immunological OA characterised by a latency period necessary to acquire immunologically induced sensitisation; 2) nonimmunological OA characterised by the rapid onset of asthma following single or multiple exposures to high concentrations of irritant compounds; 3) work-related asthma defined by exacerbation of symptoms in workers with pre-existing or coincident asthma; and 4) variant syndromes including eosinophilic bronchitis, potroom asthma, and asthma-like disorders caused by organic dusts. The issues and controversies relating to this approach are critically reviewed in order to stimulate the consensus development of operational definitions of work-related asthma. AU - Vandenplas O AU - Malo JL LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 22 IP - DP - 2003 Jan 01 TI - The role of genetic factors in occupational asthma PG - 173-178 AU - Mapp CE LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 22 IP - DP - 2003 Jan 01 TI - Health and socioeconomic impact of work-related asthma PG - 689-697 AB - There is accumulating evidence that the workplace environment contributes significantly to the general burden of asthma. The purpose of this review is to explore the respiratory health and socioeconomic consequences of work-related asthma by addressing a series of controversial issues: 1) what is the natural history of occupational asthma and in what ways does ongoing exposure to the causal agent impact clinical outcomes?; 2) how does the natural history of irritant-induced asthma differ in its health outcomes from immunologically-mediated occupational asthma?; 3) do working conditions have a significant impact on asthma regardless of the aetiology of the disease?; 4) what is the scope of work disability from work-related-asthma in social and economic terms?; 5) what is the clinician's role in reducing the respiratory health consequences of work-related asthma? 6) to what extent do existing compensation and other social insurance schemes successfully address occupational asthma and work-aggravated asthma? AU - Vandenplas O AU - Toren K AU - Blanc PD LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 44 IP - DP - 2003 Jan 01 TI - Occupational exposures associated with work-related asthma and work-related wheezing amongst U.S workers PG - 368-376 AB - Background National estimates of occupational asthma (OA) in the United States are sparse. Methods Using data from the Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, we analyzed associations between occupation and work-related asthma and work-related wheezing among U.S. workers. Results This study identified several occupations that were at risk of developing work-related asthma and/or wheezing, with cleaners and equipment cleaners showing the highest risks. Other major occupations identified were farm and agriculture; entertainment; protective services; construction; mechanics and repairers; textile; fabricators and assemblers; other transportation and material moving occupations; freight, stock, and material movers; and motor vehicle operators. The population attributable risks for work-related asthma and work-related wheezing were 26% and 27%, respectively. Conclusions This study adds evidence to the literature that identifies work-related asthma as an important public health problem. Several occupations are targeted for additional evaluation and study. Of particular interest are cleaners, which are being increasingly reported as a risk group for asthma. Future intervention strategies need to be developed for effective control and prevention of asthma in the workplace. AU - Arif AA AU - Delclos GL AU - Whitehead LW AU - Tortolero SR AU - Lee ES LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 91 IP - DP - 2003 Jan 01 TI - Occupational asthma due to exposure to iroko wood dust PG - 393-397 AB - Background: Occupational asthma (OA) from iroko wood has been reported primarily in case reports. Objective: To improve understanding of the pathogenesis of OA induced by iroko wood dust. Methods: Three groups of woodworkers were included in this study: 9 workers who had clinically proven OA from iroko; 10 asymptomatic woodworkers; and 10 woodworkers with asthma. All patients underwent the following tests: a skin test with an iroko aqueous extract, specific IgE determination, and an iroko bronchial provocation test (IBPT). An eosinophil count was determined before and after the IBPT, and a methacholine inhalation test was performed after avoidance of exposure to iroko. Patients were asked to monitor their peak expiratory flow rates during a week at work followed by a week’s vacation. Results: In all patients with a personal history predictive of OA from iroko, a reduction of the peak expiratory flow rate and positivity to the IBPT while working with iroko were present. The latter test result showed a dual response, with a decrease in forced expiratory volume in 1 second from 25% to 32% at 10 minutes and a further decrease from 35% to 43% at 8 hours; at 24 hours, the eosinophil count was higher (P = .046). In 4 patients, the intradermal test results with iroko extract were positive, whereas the skin prick test result and the specific IgE determination were negative in all patients. The methacholine test result was also positive. In the control groups, all the test results with iroko extract were negative. Conclusions: Our data suggest that OA due to iroko wood may be induced by immunologic mechanisms other than IgE-mediated immediate hypersensitivity reactions. AU - Ricciardi L AU - Fedele R AU - Saitta S et al LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 123 IP - DP - 2003 Jan 01 TI - Occupational asthma due to persulfate salts: diagnosis and follow-up PG - 124-129 AB - Background Persulfate salts have been identified as a cause of occupational asthma (OA). The aim of the present study was to describe the clinical characteristics, diagnostic testing results, and follow-up of eight patients with OA that was triggered by these chemical compounds. Methods Eight patients with OA due to exposure to persulfate salts were studied. Immunologic, lung function, and specific bronchial challenge tests (SBCTs) were performed in all patients. Once their condition had been diagnosed, the patients were seen every 1, 3, and 6 months for a mean duration of 18 months. Results The mean time of exposure to persulfate salts up to diagnosis was 15 years (range, 3 to 27 years), and mean time that had elapsed between symptom onset and diagnosis was 38 months (range, 3 to 120 months). Three patients were smokers, six patients presented with rhinitis prior to asthma in relation to persulfate exposure, and three presented with dermatitis. The results of total IgE tests were positive in six patients, and the results of skin-prick tests for detection of persulfate salts were positive in five of these patients. The results of a SBCT was positive in the seven patients in whom it was performed. Symptoms persisted in all but one patient and required medical treatment. Conclusions The results suggest that the reliable diagnosis of OA due to persulfate salts must be based on the specific challenge test until further experience has been acquired. Despite avoiding exposure, patients continued with symptoms and required treatment for the control of symptoms. Finally, a dependent IgE mechanism appears to be implicated in the pathogenesis of OA due to exposure to persulfate salts. AU - Munoz X AU - Cruz MJ AU - Orriols R et al LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 21 IP - DP - 2003 Jan 01 TI - Long-term follow-up of toluene di-isocyanate-induced asthma PG - 637-640 AB - Eighty-seven cases of occupational asthma induced by toluene diisocyanate (TDI) were diagnosed by an inhalation challenge with TDI and methacholine. After an average follow-up interval of 11 yrs, all subjects were re-examined. Of the 87 subjects examined, 13 (15%) had remained in the same job, 44 (50.5%) had been removed from exposure for <10 yrs and 30 (34.5%) had been removed for >10 yrs. The proportion of subjects who experienced symptoms of asthma and those who were hyperresponsive to methacholine was significantly lower. Of the patients, 59% used short-acting bronchodilators, 8% long-acting bronchodilators and 18% were on regular inhaled glucocorticoids. Thus, multiple regression analysis showed a positive correlation between forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) at follow-up and FVC and FEV1 at diagnosis, and a negative correlation with smoking and with therapy with bronchodilators. Stepwise logistic regression showed that the follow-up provocative dose causing a 20% fall in the FEV1 (PD20) could be predicted from baseline PD20. These results indicate that respiratory symptoms and airway hyperresponsiveness to methacholine persist in subjects removed from exposure to TDI for >10 yrs. A more favourable prognosis was associated with a better lung function and a lower degree of airway hyperresponsiveness to methacholine at diagnosis. AU - Padoan M AU - Pozzato V AU - Simoni M et al LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 158 IP - DP - 2003 Jan 01 TI - Occupation and Asthma: A Population-based Incident Case-Control Study PG - 981-987 AB - The authors assessed the relations between occupation and risk of developing asthma in adulthood in a 1997–2000 population-based incident case-control study of 521 cases and 932 controls in south Finland. The occupations were classified according to potential exposure to asthma-causing inhalants. Asthma risk was increased consistently for both men and women in the chemical (adjusted odds ratio (OR) = 5.69, 95% confidence interval (CI): 1.08, 29.8), rubber and plastic (OR = 2.61, 95% CI: 0.92, 7.42), and wood and paper (OR = 1.72, 95% CI: 0.71, 4.17) industries. Risk in relation to occupation was increased only for men—for bakers and food processors (OR = 8.62, 95% CI: 0.86, 86.5), textile workers (OR = 4.70, 95% CI: 0.29, 77.1), electrical and electronic production workers (OR = 2.83, 95% CI: 0.82, 6.93), laboratory technicians (OR = 1.66, 95% CI: 0.17, 16.6), and storage workers (OR = 1.57, 95% CI: 0.40, 6.19). Of the predominantly men’s occupations, metal (OR = 4.52, 95% CI: 2.35, 8.70) and forestry (OR = 6.00, 95% CI: 0.96, 37.5) work were the strongest determinants of asthma. For women, asthma risk increased for waiters (OR = 3.03, 95% CI: 1.10, 8.31), cleaners (OR = 1.42, 95% CI: 0.81, 2.48), and dental workers (OR = 4.74, 95% CI: 0.48, 46.5). Results suggest an increased asthma risk both in traditional industries and forestry and in several nonindustrial occupations. AU - Jaakkola JJK AU - Piipari R AU - Jaakkola MS LA - PT - DEP - TA - Am J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 111 IP - DP - 2003 Jan 01 TI - HLA associations with occupational sensitisation to rat lipocalin allergens: a model for other animal allergies? PG - 795-799 AB - BACKGROUND Laboratory animal allergy is a common occupational health problem affecting between 11% and 44% of exposed researchers. Allergy to rats and mice is most common, probably because these are the animals most frequently used. OBJECTIVE We hypothesized that HLA class II molecules, involved in the presentation of allergen to the T cell and likely candidates for controlling the immune response, might be associated with sensitization to rat urinary proteins among laboratory animal handlers. METHODS We undertook a cross-sectional study of 741 employees at 6 pharmaceutical sites across the United Kingdom who had contact at work with laboratory rats. In all, 109 cases with specific sensitization to rat proteins and 397 referents were HLA-typed for DRB1 and DQB1 loci. Amino acid analyses of significantly associated HLA molecules were carried out. RESULTS HLA-DR7 was associated with sensitization (odds ratio [OR], 1.82; CI, 1.12-2.97), respiratory symptoms at work (OR, 2.96; CI, 1.64-5.37) and, most strongly, sensitization with symptoms (OR, 3.81; CI, 1.90-7.65). HLA-DR3 was protective against sensitization (OR, 0.55; CI, 0.31-0.97). Amino acid analyses of these 2 molecules indicated a biologically plausible explanation for the associations. CONCLUSION HLA phenotype is an important determinant of individual susceptibility to sensitization and asthma among laboratory animal workers. Similar mechanisms might apply in other animal allergies. AU - Jeal H AU - Draper A AU - Jones M AU - Harris J AU - Welsh K AU - Newman Taylor AJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 123 IP - DP - 2003 Jan 01 TI - Risk of asthma among Finnish patients with occupational rhinitis PG - 283-288 AB - Study objectives To determine the risk of asthma among patients with occupationally induced rhinitis. Design Patients with confirmed occupational rhinitis were followed for asthma incidence through register linkage. Patients with other occupational diseases were used as a reference population. Subjects Patients entered into the Finnish Register of Occupational Diseases in from 1988 to 1999 for occupational rhinitis (n = 3,637) or other occupational disease (n = 31,457) were observed until December 31, 2000, through two national registers of individuals who were eligible for the reimbursement of asthma medication and the Population Register Center. Methods Incidence rates of asthma were calculated, and a log-linear model, adjusted for age, gender, and occupation, was used to estimate the relative risks (RRs) of asthma among those with occupational rhinitis compared to those with other occupational diseases. Results There were 420 and 972 incident cases of asthma, respectively, among those with occupational rhinitis and the reference population. The crude RR of asthma was 4.8 (95% confidence interval [CI], 4.3 to 5.4) for all patients with occupational rhinitis, 5.4 (95% CI, 4.8 to 6.2) for those with occupational rhinitis accepted for compensation, and 3.7 (95% CI, 3.1 to 4.5) for patients with unaccepted occupational rhinitis. The RR varied according to occupation and was the highest among farmers and wood workers, both groups having a sevenfold risk. The risk was especially high during the year following notification, but a roughly threefold risk persisted several years thereafter. Conclusions Patients with occupationally induced rhinitis have a high risk of asthma, but further studies are needed to establish the effect of preventive interventions. AU - Karjalainen A AU - Martikainen R AU - Klaukka T et al LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 124 IP - DP - 2003 Jan 01 TI - Inhalation challenge with bovine dander allergens: who needs it? PG - 383-391 AB - Study objectives: To identify which tests would be useful in selecting patients for a specific inhalation challenge with bovine dander allergens (bSIC). Design: A prospective study. Setting: A university hospital. Patients: Thirty-seven dairy farmers with a clinical suspicion of occupational asthma due to bovine allergens. Interventions: Each patient (n = 27) underwent histamine challenge, mannitol challenge, exhaled nitric oxide (NO) measurement, bovine-specific serum IgE measurement, and skin-prick test (SPT) with bovine allergens prior to undergoing a bSIC. Results: Eleven patients responded to the inhalation challenge with bovine allergens. The sensitivity and specificity of the tests, based on this response, were 82% and 65%, respectively, for the histamine challenge; 20% and 94%, respectively, for the mannitol challenge; 27% and 77%, respectively, for the NO measurement; 82% and 100%, respectively, for the bovine-specific serum IgE measurement; and 100% and 50%, respectively, for the SPT. Multiple regression analysis revealed that only IgE-mediated sensitivity to bovine allergens, but neither bronchial hyperreactivity nor exhaled NO concentration, contributed significantly to the response. Conclusion: Only the SPT with bovine allergens and bovine-specific serum IgE measurements were useful in selecting patients for the bSIC. This challenge should not be performed in SPT-negative subjects. A diagnosis of occupational asthma due to bovine dander allergens could be made without an inhalation challenge test in asthmatic patients with high bovine-specific serum IgE levels. This practice would eliminate the need for the majority of bSICs. AU - Koskela H AU - Taivainen A AU - Tukiainen H et al LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 167 IP - DP - 2003 Jan 01 TI - American Thoracic Society Statement: Occupational Contribution to the Burden of Airway Disease PG - 787-797 AB - As the classic mineral dust-induced pneumoconioses decrease in frequency because of the control of exposure, obstructive airway diseases have emerged as the most prevalent category of occupational respiratory disorder (1). Unlike the pneumoconioses, recognition of work-relatedness for asthma and chronic obstructive pulmonary disease (COPD) is difficult. This is the case for two reasons. First, these are multifactorial diseases that are strongly associated with nonoccupational exposures. Second, the occupational dose–response and temporal relationships for obstructive airway diseases are complex. Nonetheless, because asthma and COPD are common diseases in the general population, even a small increase in the percentage of prevalence due to occupational exposures would have major public health impact and should be preventable. The purpose of this statement is to review the evidence implicating occupational factors in the pathogenesis of obstructive airway diseases and to quantify the contribution of work-related risk to the burden of these diseases in the general population. Assessing the occupational component of the total burden of asthma and COPD can better inform preventive strategies designed to reduce the morbidity and mortality associated with these conditions. AU - Balmes J AU - Becklake M AU - Blanc P et al LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 60 IP - DP - 2003 Jan 01 TI - Reported incidence of occupational asthma in France PG - 136-41 AB - Aims: To estimate the general and specific incidence of occupational asthma in France in 1996–99; and to describe the distribution of cases by age, sex, suspected causal agents, and occupation. Methods: New cases of occupational asthma were collected by a national surveillance programme, based on voluntary reporting, named Observatoire National des Asthmes Professionnels (ONAP), involving a network of occupational and chest physicians. For each case, the reporting form included information on age, sex, location of workplace, occupation, suspected causal agent, and methods of diagnosis. Estimates of the working population, used to calculate incidence rates by age, sex, region, and occupation, were obtained from the Institut National de la Statistique et des Etudes Economiques (INSEE) and from the French Securite Sociale statistics. Results: In 1996–99, 2178 cases of occupational asthma were reported to the ONAP, giving a mean annual rate of 24/million. Rates in men were higher than rates in women (27/million versus 19/million). The highest rate was observed in the 15–29 years age group (30/million). The most frequently incriminated agents were flour (20.3%), isocyanates (14.1%), latex (7.2%), aldehyde (5.9%), persulphate salts (5.8%), and wood dusts (3.7%). The highest risks of occupational asthma were found in bakers and pastry makers (683/million), car painters (326/million), hairdressers (308/million), and wood workers (218/million). Conclusion: Despite likely underreporting, the number of cases of occupational asthma reported to the ONAP was approximately twice the number of compensated cases over the same period. The relevance of the programme is confirmed by the reproducibility of the results year after year, and its consistency with other surveillance programmes. The ONAP programme is useful for the identification of targets for primary prevention. AU - Ameille J AU - Pauli G AU - CalastrengCrinquand A et al LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 76 IP - DP - 2003 Jan 01 TI - Sensitisation To Occupational Allergens In Bakers' Asthma And Rhinitis: A Case-Referent Study PG - 167-170 AB - Objectives. To study the importance of sensitisation to occupational allergens for the occurrence of asthma and rhinitis in bakers. Methods. This is a nested clinical case-referent study of bakers based on a cohort of Swedish former bakery students. Cases were asthmatic (n=25) or rhinitic bakers (n=20). Randomly selected bakers (n=44) were referents. All subjects underwent skin prick tests (SPTs) with common allergens, flours, fungal a-amylase and the storage mite L. destructor. Indices of airway inflammation were assessed in serum and the nose. Results. Seven of the asthmatics and eight of the rhinitics reported onset of disease during bakery work. Flour SPTs were positive in 43% of the asthmatics or rhinitics vs 16% of referents. The corresponding figures for a-amylase were 29%, 25%, and 7%. The odds ratio, adjusted for atopy, for an SPT positive to flour or a-amylase for asthmatics with onset during bakery work was 5.8 (95% confidence interval 1.1-32), and 2.6 (0.4-16) for the corresponding rhinitics. The positive predictive value of sensitisation to flour or a-amylase in relation to a clinical diagnosis of asthma or rhinitis was 71%. Sensitisation to L. destructor was rare. The indices of airway inflammation were similar in cases and in referents. Conclusions. Bakers' asthma is associated with sensitisation to flour and/or a-amylase, atopy taken into account. A similar association was suggested in bakers' rhinitis. Indices of airway inflammation were of low predictive value for detecting bakers' asthma or rhinitis in this study. AU - Brisman J AU - Lillienberg L AU - Belin L et al LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 41 IP - DP - 2003 Jan 01 TI - Occupational respiratory diseases in the Czech Republic PG - 121-123 AB - This paper presents the profile of occupational respiratory diseases in the Czech Republic. In a retrospective study the author analyzes structure, causes, occurrence, and trends of occupational diseases. Between 1996 and 2000, a total of 2,127 new cases were recorded, of which 62.0% were pneumoconioses caused by dust containing free silica, 21.0% were occupational asthma or allergic rhinitis and the rest were divided between lung cancer (10.0%), asbestos-related disorders (4.4%) and variety of other respiratory diseases (2.7%). During the period of the investigations, the decreasing trend of occupational respiratory diseases, which began in 1992, has continued. AU - Brhel P LA - PT - DEP - TA - Ind Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 45 IP - DP - 2003 Jan 01 TI - Allergic sensitisation, symptoms, and lung function among bakery workers as compared with a nonexposed work population PG - 648-655 AB - Only few studies have assessed relative risks on occupational asthma and allergy among bakery workers, and none of them have included respiratory and work-related symptoms as well as sensitization to occupational allergens and pulmonary function. A random sample of 246 workers from traditional and industrial bakeries in two regions of Belgium were compared with a reference population of 251 workers from a petrochemical plant in the same region. Data on skin test positivity, symptoms, and lung function were collected by standardized procedures. Differences between the two subpopulations were analyzed using multiple logistic and linear regression analyses. On average, bakery workers did not more often have skin test positivity than reference workers (39.4% and 42.6%, respectively). However, bakery workers had a strongly increased risk of sensitization to specific bakery allergens (OR 22.0, 95% CI = 6.3-77.1.), whereas their risks of positive skin tests to common allergens, including wheat pollen and storage mite, were significantly decreased (OR 0.6, 95% CI = 0.4-0.9). Bakery workers had significantly more often respiratory and work-related symptoms. Accordingly, they had lower lung function parameters. Atopy and sensitization to bakers' allergens were independent and additional risk factors for work-related symptoms. Bakery workers are at increased risk of respiratory and allergic symptoms and skin test reactivity to specific bakers' allergens wheat flour and alpha-amylase. Wheat pollen and storage mite should not be regarded as baker's allergens. Nevertheless, pulmonary function of bakery workers can be characterized as mild airway obstruction only. AU - Droste J AU - Myny K AU - Van Sprundel M et al LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 22 IP - DP - 2003 Jan 01 TI - Incidence of probable occupational asthma and changes in airway calibre and responsiveness in apprentice welders PG - 513-519 AB - The majority of cross-sectional studies have shown a higher prevalence of ventilatory impairment in welders while only few longitudinal studies were able to detect chronic effects on spirometry or bronchial responsiveness. The aim of the study was to determine the incidence of probable occupational asthma (OA), bronchial obstruction and hyperresponsiveness among 286 students entering an apprenticeship programme in the welding profession. This epidemiological prospective cohort study consisted of a baseline assessment survey and two follow-up assessments. A respiratory symptom questionnaire was administered at each visit. Spirometry and methacholine bronchial challenge test results, conducted once prior to onset of exposure and later after an average of 15 months of apprenticeship, were available for 194 subjects. The incidence of probable OA was ~3% (6 of 194). The incidence of bronchial hyperresponsiveness, defined as a =3.2-fold decrease in the provocative concentration causing a 20% fall in the forced expiratory volume in one second from baseline to the end of the study was 11.9%. A statistically significant difference was found between the baseline and end of study for the lung function values. In particular, the forced expiratory volume per cent predicted had significantly dropped by 8.4% on average. The significance of these early pulmonary function changes in relation to possible chronic effects of exposure to welding fumes and gases remains to be explored. AU - El-Zein M AU - Malo J-L AU - Infante-Rivard C AU - Gautrin D LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 58 IP - DP - 2003 Jan 01 TI - Occupational asthma evaluation PG - 461 AB - We read with interest the paper by Baldwin et al on the level of agreement between expert clinicians and OASYS software when making a diagnosis of occupational asthma. Our clinical unit uses OASYS plotting regularly, and finds it of great use as one element of the diagnostic toolkit available for the confirmation of a diagnosis of occupational asthma. We were interested to note that there was a low level of agreement between experts and OASYS when peak expiratory flow (PEF) records were interpreted, but agreement within experts was better. We would be interested to know whether the information provided to the experts on the nature of the work was used in determining their final outcome—that is, if an individual was working with a known sensitiser or was in a perceived high risk job, did this influence the outcome more than the graphical and mathematical data? In the clinical setting a decision is made to perform regular PEF monitoring in those patients who are thought to have a reasonable chance of having occupational asthma, as judged by the clinical information to date. Perhaps a further study option would be to give experts the clinical data first (more like the real life situation) and ask for a likelihood of occupational asthma based on this assessment, followed by a revision of that likelihood after PEF data are supplied. Would revealing the work effect score lead to further revision of the perceived estimate? Individual experts may be more or less swayed by the clinical data due to variation in their own practice, types of cases seen, geographical location, and so on. Experts were deemed to "under report" possible cases of occupational asthma. While this may indeed be the case, an alternative explanation is that the experts were more realistic, taking into account the clinical likelihood as well as the PEF pattern. OASYS systems clearly invoke complex comparisons between known cases of occupational asthma and the record being assessed. The authors suggest that PEF interpretation is best left to experts. While we agree that expert centres which consistently diagnose occupational asthma are needed, as many as one in 10 adult asthmatic patients is likely to have a substantial effect from work. It is therefore important for all such patients in the UK to have access to competent individuals trained to assess these patients. This is where OASYS (or similar) systems are likely to be very important as an initial screen, and could be carried out by primary care or occupational health nurses or other competent non-clinical people in the workplace. This would enable patients currently working to undergo PEF assessment, as opposed to the common situation of seeing patients in secondary care following a prolonged period of sickness absence, making diagnosis even more challenging. At present the consistency of diagnosis of occupational asthma throughout the UK is likely to be highly variable. We are currently involved in a multicentre UK based study assessing the application of the toolkit to diagnose occupational asthma, and it is evident that practice remains disparate between various expert centres. We are sure that the future of occupational asthma evaluation will and should rely on programs like OASYS, but that the diagnosis must be seen also in broader terms, taking into account clinical, immunological, and exposure data. AU - Fishwick D AU - Bradshaw LM AU - Tate PA AU - Curran AD LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 90 IP - DP - 2003 Jan 01 TI - Use of pulmonary function tests in the diagnosis of occupational asthma PG - 47-51 AB - OBJECTIVE To discuss the different methods of assessing lung function measurements for the diagnosis of occupational asthma, focusing in particular on serial peak expiratory flow rate (PEFR) monitoring, including details on how PEFR records should be kept, plotted, and analyzed and limitations of the method. DATA SOURCES Published studies on the use of diagnostic methods in occupational asthma, expert opinion, and recently obtained data from studies performed at a large occupational lung disease clinic. STUDY SOURCES The expert opinion of the author was used to select the relevant data for review. RESULTS Objective methods are necessary for the diagnosis of occupational asthma, since clinical history alone is not a satisfactory means of diagnosis. Serial PEFR monitoring has a high diagnostic sensitivity and specificity for occupational asthma and is more useful than evaluation of cross-shift change in forced expiratory volume in 1 second or change in nonspecific bronchial hyperresponsiveness. Interpretation is best performed by expert visual evaluation of plots of maximum, mean, and minimum daily PEFR readings. CONCLUSIONS Despite some limitations of the method, serial PEFR monitoring is usually the most appropriate first-line investigation in workers suspected of having occupational asthma. AU - Anees W LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 168 IP - DP - 2003 Jan 01 TI - Occupational asthma: an approach to diagnosis and management PG - 867-871 AU - Tarlo SM AU - Liss GM LA - PT - DEP - TA - CMAJ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 90 IP - DP - 2003 Jan 01 TI - Strategies For Distinguishing Asymptomatic Latex Sensitisation From True Occupational Allergy Or Asthma PG - 42-46 AU - Ownby DR LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 45 IP - DP - 2003 Jan 01 TI - Truncating the dose range for methacholine challenge tests: three occupational studies PG - 841-847 AU - Agalliu I AU - Eisen EA AU - Hauser R AU - Redlich CA AU - Stowe MH AU - Cullen MR AU - Wegman DH AU - Christiani DC AU - Kennedy SM LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 90 IP - DP - 2003 Jan 01 TI - PERSISTENCE OF BRONCHIAL REACTIVITY TO OCCUPATIONAL AGENTS AFTER REMOVAL FROM EXPOSURE AND IDENTIFICATION OF ASSOCIATED FACTORS PG - 52-55 AU - Lemière C LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 124 IP - DP - 2003 Jan 01 TI - Outcome of occupational asthma in patients with continuous exposure: a 3-year longitudinal study during pharmacologic treatment PG - 2372-2376 AB - Study objective: To evaluate the effect of treatment with beclomethasone dipropionate (500 µg bid) and salmeterol (50 µg bid) on lung function and respiratory symptoms in 20 subjects with occupational asthma (OA) still exposed to the work environment cause of their disease. Methods: At enrollment and every 6 months for 3 years, respiratory symptom score (from 0 [no symptoms] to 2 [moderate-to-severe symptoms]), spirometry, methacholine challenge, peak expiratory flow (PEF) variability, and the use of rescue salbutamol were evaluated. During the 3 years of follow-up, 10 subjects were excluded from the study because they retired or changed jobs. Measurements and results: Symptoms of work-related asthma started 12.6 ± 13.1 years (mean ± SD) before diagnosis. At baseline, mean FEV1 was 80.2% of predicted values and provocative dose of methacholine causing a 20% fall in FEV1 (PD20) was 1,001 ± 1,275 µg; the workers received 2.1 ± 2.4 puffs of salbutamol per day. After 3 years, no significant differences in any of the morbidity outcomes (FEV1, PD20, PEF variability, use of rescue salbutamol, respiratory symptom score) were found as compared with baseline or run-in values. Conclusions: Regular treatment with inhaled corticosteroids and long-acting bronchodilators seems to prevent respiratory deterioration over a 3-year period in workers with mild-to-moderate persistent OA who were still exposed at work to the environmental cause of their disease. AU - Marabini A AU - Siracusa A AU - Stopponi R AU - Tacconi C AU - Abbritti G LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 58 IP - DP - 2003 Jan 01 TI - Bronchodilator reversibility testing in chronic obstructive pulmonary disease PG - 659-664 AB - Background: A limited or absent bronchodilator response is used to classify chronic obstructive pulmonary disease (COPD) and can determine the treatment offered. The reliability of the recommended response criteria and their relationship to disease progression has not been established. Methods: 660 patients meeting European Respiratory Society (ERS) diagnostic criteria for irreversible COPD were studied. Spirometric parameters were measured on three occasions before and after salbutamol and ipratropium bromide sequentially or in combination over 2 months. Responses were classified using the American Thoracic Society/GOLD (ATS) and ERS criteria. Patients were followed for 3 years with post-bronchodilator FEV1 and exacerbation history recorded 3 monthly and health status 6 monthly. Results: FEV1 increased significantly with each bronchodilator, a response that was normally distributed. Mean post-bronchodilator FEV1 was reproducible between visits (intraclass correlation 0.93). The absolute change in FEV1 was independent of the pre-bronchodilator value but the percentage change correlated with pre-bronchodilator FEV1 (r=–0.44; p<0.0001). Using ATS criteria, 52.1% of patients changed responder status between visits compared with 38.2% using ERS criteria. Smoking status, atopy, and withdrawing inhaled corticosteroids were unrelated to bronchodilator response, as was the rate of decline in FEV1, decline in health status, and exacerbation rate. Conclusion: In moderate to severe COPD bronchodilator responsiveness is a continuous variable. Classifying patients as “responders” and “non-responders” can be misleading and does not predict disease progression. AU - Calverley PMA AU - Burge PS AU - Spencer S AU - Anderson JA AU - Jones PW AU - study Isolde the for investigators LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 44 IP - DP - 2003 Jan 01 TI - Asthma following household exposure to hydrofluoric acid. PG - 321-4 AB - BACKGROUND: Almost all reports of respiratory health effects of hydrofluoric acid are derived from industrial settings and usually involved massive and conspicuous exposures. In the present report we describe a case of adult-onset asthma immediately following use of a household rust stain remover that contained an 8-9% aqueous solution of hydrofluoric acid (HF). METHODS: This is a case-report. A literature search of hydrogen fluoride, and reactive airways dysfunction syndrome (RADS) was performed. RESULTS: A previously healthy 26-year-old woman developed asthma immediately following inhalation exposure to hydrofluoric acid from a household cleaner, consistent with reactive airways dysfunction syndrome. The circumstances of exposure and possible mechanism of disease are discussed. CONCLUSIONS: It is likely that this patient's use of the rust stain remover resulted in inhalation exposure to hydrofluoric acid well above any applicable standard, and hence constituted a "high level" irritant exposure capable of inducing reactive airways dysfunction syndrome. In our opinion, the presence of this concentration hydrofluoric acid in a consumer product may be unduly hazardous. AU - Franzblau A AU - Sahakian N LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 60 IP - DP - 2003 Jan 01 TI - Volcanic ash and Respiratory symptoms in children on the island of Montserrat, British West Indies PG - 207-211 AB - Background: In July 1995 the volcano on the West Indian island of Montserrat erupted after being inactive for several hundred years. Since then, clouds of ash have been released intermittently from the volcano. Some of this ash is <10 µm in diameter and therefore respirable. Concerns were raised that the particles might cause respiratory problems. Aims: To evaluate whether ashfalls had any effect on the respiratory health of children in Montserrat. Methods: A survey of asthma diagnoses, respiratory symptoms, exercise induced bronchoconstriction (EIB), and current and previous exposure to volcanic ash was carried out in schools in Montserrat during February 1998. Results: Questionnaire information was available for nearly 80% of the 443 children on the school rolls. The prevalence of wheeze symptoms in the previous 12 months was 18% in children aged 12 years and under and 16% in children aged 13 years and over. In children aged 12 and under, the prevalence of wheeze was greater in those who had ever been heavily or moderately exposed to volcanic ash compared with the group who had only ever been exposed to low levels (wheeze in last 12 months: odds ratio (OR) 4.30; wheeze ever: OR 3.45). The prevalence of EIB in 8–12 year olds was about four times higher in those who were currently heavily exposed to volcanic ash (OR 3.85) compared to those currently exposed to low levels. Conclusions: Volcanic ash emissions adversely affected the respiratory health of Montserrat children. The findings emphasise the need to limit exposures of children to volcanic ash and ensure the appropriate management of respiratory symptoms. AU - Forbes L AU - Jarvis D AU - Potts J AU - Baxter PJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 9 IP - DP - 2003 Jan 01 TI - Mycobacterial aerosols and respiratory disease PG - 763-767 AB - Environmental opportunistic mycobacteria, including Mycobacterium avium, M. terrae, and the new species M. immunogenum, have been implicated in outbreaks of hypersensitivity pneumonitis or respiratory problems in a wide variety of settings. One common feature of the outbreaks has been exposure to aerosols. Aerosols have been generated from metalworking fluid during machining and grinding operations as well as from indoor swimming pools, hot tubs, and water-damaged buildings. Environmental opportunistic mycobacteria are present in drinking water, resistant to disinfection, able to provoke inflammatory reactions, and readily aerosolized. In all outbreaks, the water sources of the aerosols were disinfected. Disinfection may select for the predominance and growth of mycobacteria. Therefore, mycobacteria may be responsible, in part, for many outbreaks of hypersensitivity pneumonitis and other respiratory problems in the workplace and home AU - Falkinham JO LA - PT - DEP - TA - Emerging infectious diseases JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 18 IP - DP - 2003 Jan 01 TI - Evaluation of hypersensitivity pneumonitis among workers exposed to metal removal fluids PG - 953-960 AB - Hypersensitivity pneumonitis (HP) was identified among employees in an automobile parts manufacturing facility. Mycobacteria immunogenum (MI) was identified as a metal removal fluid (MRF) contaminant at this facility and had been identified as a contaminant in other facilities where HP had occurred. We therefore questioned whether measurement of MI-specific cell-mediated immunity would be associated with HP in this facility. We also questioned whether measures of cell-mediated immunity would be more informative about the presence of HP than evaluation of serum anti-MI antibody levels. Workers were categorized for exposure and disease status by questionnaire and review of medical records. Cell-mediated immunity to MI was assessed by measuring in vitro secretion of cytokines (interleukin 8, tumor necrosis factor alpha, and interferon-?) from peripheral blood mononuclear cells or anticoagulated whole blood induced by culture with MI antigen. Serum antibodies against MI were also measured. Six study participants met our survey definition for HP and 48 did not. As has been reported for various agents causing HP, serum antibody levels against MI were increased in both exposed workers and workers with HP. Serum antibodies did not distinguish between the two. When expressed as a percentage of secretion induced by lipopolysaccharide, MI induced a significant increase in interleukin-8 secretion in exposed participants' whole blood cultures. There were trends for increased MI-induced secretion of interferon-? by peripheral blood mononuclear cells from both exposed workers and workers with HP. However, these trends did not attain statistical significance. Thus, several measures of immunity to MI distinguished between exposed and unexposed workers but not between workers with and without HP. These evaluations of cell-mediated immunity were not more informative than measurement of serum antibodies. As was done at this facility, institution of a comprehensive safety and health plan for MRF is necessary to eliminate (or minimize) health effects related to occupational exposures in the machining AU - Trout D AU - Weissman DN AU - Lewis D AU - Brundage RA AU - Franzblau A AU - Remick D LA - PT - DEP - TA - Appl Environ Microbiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 168 IP - DP - 2003 Jan 01 TI - Clinical Diagnosis of Hypersensitivity Pneumonitis PG - 952-958 AB - The diagnosis of hypersensitivity pneumonitis (HP) is difficult and often relies on histopathology. Our objective was to identify diagnostic criteria and to develop a clinical prediction rule for this disease. Consecutive patients presenting a condition for which HP was considered in the differential diagnosis underwent a program of simple standardized diagnostic procedures. High-resolution computed tomography scan and bronchoalveolar lavage (BAL) defined the presence or absence of HP. Patients underwent surgical lung biopsy when the computed tomography scan, BAL, and other diagnostic procedures failed to yield a diagnosis. A cohort of 400 patients (116 with HP, 284 control subjects) provided data for the rule derivation. Six significant predictors of HP were identified: (1) exposure to a known offending antigen, (2) positive precipitating antibodies to the offending antigen, (3) recurrent episodes of symptoms, (4) inspiratory crackles on physical examination, (5) symptoms occurring 4 to 8 hours after exposure, (6) and weight loss. The area under the receiver operating characteristic curve was 0.93 (95% confidence interval: 0.90–0.95). The rule retained its accuracy when validated in a separate cohort of 261 patients. The diagnosis of HP can often be made or rejected with confidence, especially in areas of high or low prevalence, respectively, without BAL or biopsy. AU - Lacasse Y AU - Selman M AU - Costabel U AU - Dalphin J AU - Ando M AU - Morell F AU - Erkinjuntti-Pekkanen R AU - Müller N AU - Colby TV AU - Schuyler M AU - Cormier Y LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 58 IP - DP - 2003 Jan 01 TI - Asthma symptoms in women employed in domestic cleaning: a community based study PG - 950-954 AB - Background: Epidemiological studies have shown an association between cleaning work and asthma, but the risk factors are uncertain. The aim of this study was to assess the risk of asthma in women employed in domestic cleaning. Methods: A cross sectional study was conducted in 4521 women aged 30 to 65 years. Information on respiratory symptoms and cleaning work history was obtained using a postal questionnaire with telephone follow up. Asthma was defined as reported symptoms in the last year or current use of drugs to treat asthma. Odds ratios (OR) with 95% confidence intervals (CI) for asthma in different cleaning groups were estimated using adjusted unconditional logistic regression models. Results: 593 women (13%) were currently employed in domestic cleaning work. Asthma was more prevalent in this group than in women who had never worked in cleaning (OR 1.46 (95% CI, 1.10 to 1.92)). Former domestic cleaning work was reported by 1170 women (26%), and was strongly associated with asthma (OR 2.09 (1.70 to 2.57)). Current and former non-domestic cleaning work was not significantly associated with asthma. Consistent results were obtained for other respiratory symptoms. Twenty five per cent of the asthma cases in the study population were attributable to domestic cleaning work. Conclusions: Employment in domestic cleaning may induce or aggravate asthma. This study suggests that domestic cleaning work has an important public health impact, probably involving not only professional cleaners but also people undertaking cleaning tasks at home. AU - Medina-Ramón M AU - Zock JP AU - Kogevinas M AU - Sunyer J AU - Antó JM LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20030101 IS - IS - VI - 45 IP - DP - 2003 Jan 01 TI - Work-related reactive airways dysfunction syndrome cases from surveillance in selected US states PG - 360-368 AB - The objective was to elaborate the descriptive epidemiology of work-related cases of reactive airways dysfunction syndrome (RADS). Cases of work-related asthma (WRA) were identified in four states in the United States during 1993-1995 as part of the Sentinel Event Notification Systems for Occupational Risks (SENSOR). Information gathered by follow-back interview was used to describe 123 work-related RADS cases and to compare them to 301 other WRA cases whose onset of disease was associated with a known asthma inducer. RADS represented 14% of all new-onset WRA cases identified by the state SENSOR surveillance systems. RADS cases had significant adverse medical and occupational outcomes identified by follow-back interview. In particular, 89% still had breathing problems, 78% had ever sought emergency care and 39% had ever been hospitalized for work-related breathing problems, 54% had applied for worker compensation benefits, and 41% had left the company where they experienced onset of asthma. These values equaled or exceeded the comparable figures for those WRA cases whose onset was attributed to a known inducer. Work-related RADS represents a minority of all WRA cases, but the adverse impact of this condition appears toequal that of other WRA cases. AU - Henneberger PK AU - Derk SJ AU - Davis L AU - Tumpowsky C AU - Reilly MJ AU - Rosenman KD AU - Schill DP AU - Valiante D AU - Flattery J AU - Harrison R AU - Reinisch F AU - Filios MS AU - Tift B LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - ISBN 0-743 IP - DP - 2002 Jan 01 TI - Five past midnight in Bhopal PG - AB - A book with a great account of the human side of the Bhopal tragedy AU - Lapierre D AU - Moro J LA - PT - DEP - TA - pub Simon and Schuster UK, London JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 347 IP - DP - 2002 Jan 01 TI - Hyperbaric Oxygen for Acute Carbon Monoxide Poisoning PG - 1057-1067 AU - Weaver AU - Lindell K. AU - Hopkins AU - Ramona O. AU - Chan AU - Karen J. AU - Churchill AU - Susan AU - Elliott AU - C. Gregory AU - Clemmer AU - Terry P. AU - Orme AU - James F. AU - Thomas AU - Frank O. AU - Morris AU - Alan H. LA - PT - DEP - TA - New England Journal of Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 58 IP - DP - 2002 Jan 01 TI - White matter hyperintensities and neuropsychological outcome following carbon monoxide poisoning PG - 1535-1532 AB - Background: Carbon monoxide (CO) poisoning may result in white matter hyperintensities (WMH) and neurocognitive impairments. Objective: To assess in a prospective study WMH in CO-poisoned patients and their relationship to cognitive functioning. Methods: Seventy-three consecutive CO-poisoned patients were studied. MR scans and neurocognitive tests were administered on day 1 (within 36 hours after CO poisoning), 2 weeks, and 6 months. Age- and sex-matched control subjects for white matter analyses only were obtained from the authors’ normative imaging database. MR scans were rated for WMH in the periventricular and centrum semiovale regions, using a 4-point rating scale. Two independent raters rated the scans, and a consensus was reached. Results: Thirty percent of CO-poisoned patients had cognitive sequelae. Twelve percent of the CO-poisoned patients had WMH, with significantly more periventricular, but not centrum semiovale, WMH than control subjects. The WMH in CO-poisoned patients did not change from day 1 to 6 months. Centrum semiovale hyperintensities were related to worse cognitive performance. Duration of loss of consciousness correlated with cognitive impairment at all three times. Initial carboxyhemoglobin levels correlated with loss of consciousness but not with WMH or cognitive sequelae. Conclusions: CO poisoning can result in brain injury manifested by WMH and cognitive sequelae. The WMH were not related to CO poisoning severity. The WMH occurred in both the periventricular and the centrum semiovale regions; however, only those in the centrum semiovale were significantly associated with cognitive impairments. AU - Parkinson RB AU - Hopkins RO AU - Cleavinger HB AU - Weaver LK AU - Victoroff J AU - Foley JF AU - Bigler ED LA - PT - DEP - TA - neurology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 347 IP - DP - 2002 Jan 01 TI - Cough and bronchial responsiveness in firefighters at the World Trade Center site PG - 806-815 AB - Background Workers from the Fire Department of New York City were exposed to a variety of inhaled materials during and after the collapse of the World Trade Center. We evaluated clinical features in a series of 332 firefighters in whom severe cough developed after exposure and the prevalence and severity of bronchial hyperreactivity in firefighters without severe cough classified according to the level of exposure. Methods “World Trade Center cough” was defined as a persistent cough that developed after exposure to the site and was accompanied by respiratory symptoms severe enough to require medical leave for at least four weeks. Evaluation of exposed firefighters included completion of a standard questionnaire, spirometry, airway-responsiveness testing, and chest imaging. Results In the first six months after September 11, 2001, World Trade Center cough occurred in 128 of 1636 firefighters with a high level of exposure (8 percent), 187 of 6958 with a moderate level of exposure (3 percent), and 17 of 1320 with a low level of exposure (1 percent). In addition, 95 percent had symptoms of dyspnea, 87 percent had gastroesophageal reflux disease, and 54 percent had nasal congestion. Of those tested before treatment of World Trade Center cough, 63 percent of firefighters (149 of 237) had a response to a bronchodilator and 24 percent (9 of 37) had bronchial hyperreactivity. Chest radiographs were unchanged from precollapse findings in 319 of the 332 with World Trade Center cough. Among the cohort without severe cough, bronchial hyperreactivity was present in 77 firefighters with a high level of exposure (23 percent) and 26 with a moderate level of exposure (8 percent). Conclusions Intense, short-term exposure to materials generated during the collapse of the World Trade Center was associated with bronchial responsiveness and the development of cough. Clinical and physiological severity was related to the intensity of exposure. Between October 1 and 14, 2001, 391 firefighters underwent medical screening examinations and 295 met the criteria for exposure, 102 of whom underwent methacholine or bronchodilator challenge. Clinical characteristics (sex, age, smoking status, and presence or absence of respiratory symptoms) did not differ significantly either between the subjects who were eligible for testing and the subjects who actually were tested or among the subjects in the two highest exposure groups (data not shown). In this cohort of 295 firefighters, the average age was 41±7 years, the mean tenure at the FDNY was 13±6 years, and 13 percent were exsmokers. All reported cough within 24 hours after exposure, and none were on medical leave. The mean FVC and FEV1 values were within normal limits in all groups. In the group of firefighters with a moderate level of exposure, the subjects who were eligible for testing had significantly higher FVC and FEV1 values than did subjects who were actually tested (FVC, 96 percent vs. 89 percent of the predicted value; P=0.04; and FEV1, 98 percent vs. 91 percent of the predicted value; P=0.003). Among tested subjects there were no significant differences between the mean spirometric values obtained before the collapse of the World Trade Center and those obtained afterward (FEV1, 103 percent and 95 percent of the predicted value, respectively; FVC, 98 percent and 92 percent of the predicted value). Among the four exposure groups, there were no significant differences in respirator use during the first week (fewer than 22 percent reported frequent use). AU - Prezant DJ AU - Weiden M AU - Banauch GI AU - McGuinness G AU - Rom WN AU - LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 17 IP - DP - 2002 Jan 01 TI - The fire in the Channel Tunne PG - 129-132 AB - The Channel Tunnel, which connects the United Kingdom with France, was designed and built between 1986 and 1993 with consideration of fire and life safety at the top of the agenda. Its design was constantly monitored by a bi-National Safety Authority appointed by an Inter Governmental Commission of the Governments of France and the UK. In November 1996 a shuttle train carrying heavy goods vehicles suffered a serious fire, which severely damaged the tunnel, though nobody was seriously hurt in the incident. This paper discusses the design for fire management, the fire itself, and lessons learned . Show more from the incident. AU - Kirkland CJ LA - PT - DEP - TA - Tunnelling and Underground Space Technology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 165 IP - DP - 2002 Jan 01 TI - Internet-based Home Monitoring of Pulmonary Function after Lung Transplantation PG - 694-697 AB - Home monitoring of spirometry has been advocated in lung transplant recipients for the early detection of acute infection and rejection of the allograft. We have developed a user-friendly, Internet-based telemonitoring system providing direct transmission of home spirometry to the hospital. In this prospective study, we assessed patient adherence with the monitoring, agreement between home and hospital spirometry, intrasubject coefficient of variation (CV) for FEV1 and FEF25–75, and sensitivity of these variables for the detection of acute complications. Twenty-two bilateral-lung and heart–lung transplant recipients were followed for a median of 473 d (range, 60–822), during which 13,833 measurements were obtained. Patient compliance was 55% for two measurements a day and 84% for one measurement a day. Agreement between home and hospital spirometry was within 4% for FEV1 and 6% for FEF25–75. Mean CV was 3.2% for FEV1 and 7.5% for FEF25–75. Using transbronchial lung biopsy and/or bronchoalveolar lavage as gold standards, the sensitivity of home spirometry was 63%, and 23% of true positives were detected by changes in FEF25–75 alone. We conclude that home monitoring of pulmonary function in lung transplant recipients via the Internet is feasible and provides very reproducible data; yet it has only a mild sensitivity for the detection of acute allograft dysfunction. AU - MORLION B AU - KNOOP C AU - PAIVA M AU - ESTENNE M LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 19 IP - DP - 2002 Jan 01 TI - Excess incidence of asthma among Finnish cleaners employed in different industries PG - 90-95 AB - The incidence and risk of asthma among female cleaners employed in different industries was explored. An increased risk of asthma has been associated with the cleaning profession, in some but not all studies. All Finnish females employed as cleaners and all those employed in administrative work were followed for asthma incidence through a record linkage in 1986–1998. An individual was defined as an “incident case of asthma” if they received rights for special reimbursement of asthma medication from the national health insurance or were recognized as having occupational asthma. Age-adjusted relative risks (RR) were estimated for cleaners in comparison with those employed in administrative work. There were 2,414 and 5,235 cases of asthma among the cleaners and administrative workers, respectively. The RR was 1.50 (95% confidence interval (CI) 1.43–1.57) in cleaners. The risk was increased in cleaners working in nearly all major sectors of economic activity, but cleaners employed by companies concerned with the manufacture of basic metals (RR 2.47; 95% CI 1.68–3.64) and food products (RR 2.19; 95% CI 1.69–2.85) had the highest risk. Only 25 of the “cases of asthma” among cleaners had been recognized as being occupational asthma. It could be concluded that cleaners have an increased risk of persistent adult-onset asthma. Factors inherent to the environment where cleaning is performed or differences in the cleaning agents used may explain the observed differences between industries. AU - Karjalainen A AU - Martikainen R AU - Karjalainen J AU - Klaukka T AU - Kurppa K LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - IP - DP - 2002 Jan 01 TI - Health Hazard Evaluation Report: HETA-2002-0155-2886 PG - HETA-2002-0155-2886 AB - Daimler Chrysler Transmission Plant, Kokomo, Indiana. US Department of Health and Human Services. Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. 2002. 43 MWF exposed 11 unexposed (same workplace) Exposed workers had significantly greater median antibody levels to Mycobacterium immunogenum and higher IL-8 secretion in response to M. immunogenum. AU - Trout D AU - Harney J LA - PT - DEP - TA - Health Hazard Evaluation Report: JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 51 IP - DP - 2002 Jan 01 TI - Respiratory illness in workers exposed to metalworking fluid contaminated with nontuberculous mycobacteria- Ohio 2001 PG - 349-352 AB - In January 2001, three machinists at an automobile brake manufacturing facility in Ohio (plant A) were hospitalized with respiratory illness characterized by dyspnea, cough, fatigue, weight loss, hypoxia, and pulmonary infiltrates. Hypersensitivity pneumonitis (HP) was diagnosed in all three workers. In March 2001, additional employees began seeking medical attention for respiratory and systemic symptoms. In May 2001, union and management representatives requested assistance from CDC's National Institute for Occupational Safety and Health (NIOSH) in determining the cause of the illnesses and preventing further illness in employees. This report describes two case reports and the preliminary results of the ongoing investigation, which found that exposure to aerosolized nontuberculous mycobacteria (NTM) might be contributing to the observed respiratory illnesses in this manufacturing facility. Clinicians and public health professionals should be alert to the variable presentation of occupational respiratory disease that might occur in workers in the machining industry AU - Weiss L AU - Pue C AU - Lewis R AU - Rossmoore H AU - Fink J AU - Harney MDJ AU - Trout D LA - PT - DEP - TA - MMWR Morb Mortal Wkly Rep JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 68 IP - DP - 2002 Jan 01 TI - Presence of a single genotype of the newly described species Mycobacterium immunogenum in industrial metalworking fluids associated with hypersensitivity pneumonitis. PG - 5580-5584 AB - Outbreaks of hypersensitivity pneumonitis (HP) among industrial metal-grinding machinists working with water-based metalworking fluids (MWF) have frequently been associated with high levels of mycobacteria in the MWF, but little is known about these organisms. We collected 107 MWF isolates of mycobacteria from multiple industrial sites where HP had been diagnosed and identified them to the species level by a molecular method (PCR restriction enzyme analysis [PRA]). Their genomic DNA restriction fragment length polymorphism (RFLP) patterns, as determined by pulsed-field gel electrophoresis (PFGE), were compared to those of 15 clinical (patient) isolates of the recently described rapidly growing mycobacterial species Mycobacterium immunogenum. A total of 102 of 107 (95%) MWF isolates (from 10 industrial sites within the United States and Canada) were identified as M. immunogenum and gave PRA patterns identical to those of the clinical isolates. Using genomic DNA, PFGE was performed on 80 of these isolates. According to RFLP analysis using the restriction enzymes DraI and XbaI, 78 of 80 (98%) of the MWF isolates represented a single clone. In contrast, none of the 15 clinical isolates had genetic patterns the same as or closely related to those of any of the others. Given the genomic heterogeneity of clinical isolates of M. immunogenum, the finding that a single genotype was present at all industrial sites is remarkable. This suggests that this genotype possesses unusual features that may relate to its virulence and its potential etiologic role in HP and/or to its resistance to biocides frequently used in MWF. AU - Wallace RJ AU - . AU - Zhang Y AU - Wilson RW AU - Mann L AU - Rossmoore H LA - PT - DEP - TA - Appl Environ Microbiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 96 IP - DP - 2002 Jan 01 TI - Prevalence of asthma, allergic rhinitis and eczema among university students in Bangkok PG - 34-38 AB - Prevalence of childhood asthma is increasing worldwide including in developing countries such as Thailand. Despite a wide availability of epidemiological data on childhood asthma in Thailand, prevalence of asthma in adults has not been well studied within this community. Objectives of this study were to study prevalence of asthma, allergic rhinitis and eczema in a random group of university students in Bangkok using the standardized written and video questionnaires from the ISAAC phase I protocol. The ISAAC phase I, written and video (International version, AVQ 3·0) questionnaires were administered to 3631 randomly selected university students from six universities in Bangkok. The age range of subjects were between 16–31 years (mean±=19·1±1·7 years). There were 1197 males and 2434 females (ratio=1:2·03). Data were entered into and analysed by the EpiInfo 4 program. Prevalence of wheeze within the past 12 months and of diagnosed asthma for this group of subjects was 10·1% and 8·8%. Prevalence of allergic rhinitis (nasal with eye symptoms within the past 12 months) was 26·3% and of eczema (rash at typical sites of atopic dermatitis, within the past 12 months) was 9·4%. Presence of rhinoconjunctivitis, gender and age were significant risk factors for asthma with male, younger subjects and those with rhinoconjunctivitis reported more frequent asthma-related symptoms (P<0·01). As in previous studies which found an increase in asthma among Thai children, this survey indicates that the prevalence of asthma among Thai university students has increased to the same level as in several European countries. A large number of adults residing in Bangkok are suffering from rhinitis-related symptoms, the majority of which probably represents allergic rhinitis. AU - Vichyanond P AU - Sunthornchart S AU - Singhirannusorn V AU - Ruangrat S AU - Kaewsomboon S AU - Visitsunthorn N LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 42 IP - DP - 2002 Jan 01 TI - Diisocyanate-exposed auto body shop workers: a one-year follow-up PG - 511-518 AU - Redlich CA AU - Stowe MH AU - Coren BA AU - Wisnewski AV AU - Holm CT AU - Cullen MR LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 121 IP - DP - 2002 Jan 01 TI - Use of specific inhalation challenge in the evaluation of workers at risk for occupational asthma: a survey of pulmonary, allergy, and occupational medicine residency training programs in the United States and Canada PG - 1323-1328 AU - Ortega HG AU - Weissman DN AU - Carter DL AU - BanksD LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 17 IP - DP - 2002 Jan 01 TI - Experience with early detection of toluene diisocyanate-associated occupational asthma PG - 856-862 AU - Conner PR LA - PT - DEP - TA - Appl Occup Environ Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 110 IP - DP - 2002 Jan 01 TI - - PG - S111-116 AU - Bernstein DI LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 32 IP - DP - 2002 Jan 01 TI - ISOCYANATE-INDUCED OCCUPATIONAL ASTHMA IN FAR-EAST ASIA: PATHOGENESIS TO PROGNOSIS PG - 198-204 AU - Park HS AU - Cho SH LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 165 IP - DP - 2002 Jan 01 TI - Bronchial responsiveness to adenosine 5'-monophosphate (amp) and methacholine differ in their relationship with airway allergy and baseline FEV1 PG - 327-331 AU - Meer G de AU - Heederik D LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 32 IP - DP - 2002 Jan 01 TI - Specific immunoglobulin E and immunoglobulin G antibodies to toluene diisocyanate - human serum albumin conjugate : useful markers for predicting long-term prognosis in toluene diisocyanate-induced asthma PG - 551-555 AU - Park HS AU - Lee SK LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 17 IP - DP - 2002 Jan 01 TI - Diisocyanate-induced asthma: diagnosis, prognosis, and effects of medical surveillance measures PG - 902-908 AU - Tarlo SM AU - Liss GM LA - PT - DEP - TA - Appl Occup Environ Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 57 IP - DP - 2002 Jan 01 TI - Features and severity of occupational asthma upon diagnosis: an Italian multicentric case review PG - 236-242 AU - Moscato G AU - Dellabianca A AU - Maestrelli P AU - Paggiaro P AU - Romano C AU - De Zotti R AU - Marabini A AU - Voltolini S AU - Crippa M AU - Previdi M AU - Bramé B AU - Benzon R AU - Siracusa A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 20 IP - DP - 2002 Jan 01 TI - Bronchial challenge with flour: early response is dependent on the dose of activated allergen inhaled PG - 409-416 AU - Choudat D AU - Fabriès JF AU - Martin JC AU - Villette C LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 57 IP - DP - 2002 Jan 01 TI - Occupational Asthma Due To Low Molecular Weight Agents : Eosinophilic And Non-Eosinophilic Variants PG - 231-236 AB - Background Despite having a work related deterioration in peak expiratory flow (PEF), many workers with occupational asthma show a low degree of within day diurnal variability atypical of non-occupational asthma. It was hypothesised that these workers would have a neutrophilic rather than an eosinophilic airway inflammatory response. Methods Thirty eight consecutive workers with occupational asthma induced by low molecular weight agents underwent sputum induction and assessment of airway physiology while still exposed at work. Results Only 14 (36.8%) of the 38 workers had sputum eosinophilia (>2.2%). Both eosinophilic and non-eosinophilic groups had sputum neutrophilia (mean (SD) 59.5 (19.6)% and 55.1 (18.8)%, respectively). The diurnal variation and magnitude of fall in PEF during work periods was not significantly different between workers with and without sputum eosinophilia. Those with eosinophilia had a lower forced expiratory volume in 1 second (FEV1; 61.4% v 83% predicted, mean difference 21.6, 95% confidence interval (CI) 9.2 to 34.1, p=0.001) and greater methacholine reactivity (geometric mean PD20 253 µg v 1401 µg, p=0.007). They also had greater bronchodilator reversibility (397 ml v 161 ml, mean difference 236, 95% CI of difference 84 to 389, p=0.003) which was unrelated to differences in baseline FEV1. The presence of sputum eosinophilia did not relate to the causative agent, duration of exposure, atopy, or lack of treatment. Conclusions Asthma caused by low molecular weight agents can be separated into eosinophilic and non-eosinophilic pathophysiological variants with the latter predominating. Both groups had evidence of sputum neutrophilia. Sputum eosinophilia was associated with more severe disease and greater bronchodilator reversibility but no difference in PEF response to work exposure. AU - Anees W AU - Huggins V AU - Pavord ID AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 110 IP - DP - 2002 Jan 01 TI - Primary prevention of natural rubber latex allergy in the German health care system through education and intervention PG - 318-23 AB - BACKGROUND The development of occupational asthma and allergic skin reactions caused by natural rubber latex (NRL) allergy are risks for health care workers. There are few published studies to suggest that intervention programs to reduce exposure will lead to primary prevention of sensitization. OBJECTIVE This study assesses the effects of intervention to reduce the incidence of NRL allergy in personnel working in health care facilities insured by the German statutory accident insurance company for health care workers, Berufsgenossenschaft fur Gesundheitsdienst und Wohlfahrtspflege, with approximately 3 million insured employees, by switching to powder-free NRL gloves. METHODS The timing of introduction of intervention strategies, such as education of both physicians and administrators, together with regulations demanding that health care facilities only purchase low-protein, powder-free NRL gloves are reported. We reviewed the annual numbers of reported suspected cases of NRL-caused occupational allergies and the amount and type of gloves used in German acute-care hospitals since 1986. RESULTS The purchase of powder-free NRL examination gloves exceeded that of powdered gloves for the first time in 1998. This only became true for powder-free NRL sterile gloves 2 years later in 2000. The incidence of suspected occupational NRL allergy cases rose until 1998 and has declined steadily since. There was a 2-year lag between the beginning of the decline in the purchase of powdered NRL examination gloves and the beginning of a decline in suspected NRL-caused occupational asthma cases. CONCLUSIONS Despite the effect of increased recognition of NRL allergies, education about NRL allergies in health care facilities combined with the introduction of powder-free gloves with reduced protein levels has been associated with a decline in the number of suspected cases of occupational allergies caused by NRL in Germany on a nationwide scale. These results clearly indicate that primary prevention of occupational NRL allergies can be achieved if these straightforward and practical interventions are properly carried out and maintained. AU - Allmers H AU - Schmengler J AU - Skudlik C LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 57 IP - DP - 2002 Jan 01 TI - Interpretation Of Occupational Peak Flow Records: Level Agreement Between Expert Clinicians And OASYS-2 PG - 860-864 AB - Background Oasys-2 is a validated diagnostic aid for occupational asthma that interprets peak expiratory flow (PEF) records as well as generating summary plots. The system removes inconsistency in interpretation, which is important if there is limited agreement between experts. A study was undertaken to assess the level of agreement between expert clinicians interpreting serial PEF measurements in relation to work exposure and to compare the responses given by Oasys-2. Method 35 PEF records from workers under investigation for suspected occupational asthma were available for review. Records included details of nature of work, intercurrent illness, drug therapy, predicted PEF, rest periods, and holidays. Simple plots of PEF and the Oasys-2 generated plots were available. Experts were advised that approximately 1 hour was available to review the records. They were asked to score each work-rest-work (WRW) period and each rest-work-rest (RWR) period for evidence of occupational effect. At the end of each record scores of 0-"100%" were given for evidence of "asthma" and "occupational effect" for the whole record. Kappa values were calculated for each scored period and for the opinions on the whole record. The scores were converted into four groups (0-25%, 26-50%, 51-75%, 76-"100%") and two groups (0-50% and 51-"100%") for analysis. This is relevant to scores produced by Oasys-2. Agreement between Oasys-2 scores and each expert was calculated. Results 24 of 35 records were analysed by seven experts in the allotted time. For whole record occupational effect, median kappa values were 0.83 (range 0.56-0.94) for two groups and 0.62 (0.11-0.83) for four groups. For asthma, median kappa values were 0.58 (0-0.67) and 0.42 (0.15-0.70) for two and four groups respectively. For all WRW and RWR periods kappa values were 0.84 (0.42-0.94) and 0.70 (0.46-0.87) respectively. Agreement between Oasys-2 and individual experts showed a median kappa value of 0.75 (0.50-0.92) for two groups and 0.50 (0.39-0.70) for four groups. Kappa values for the median expert score v Oasys-2 were 0.75 for two groups and 0.67 for four groups. Agreement was poor for records with intermediate probability, as defined by Oasys-2. Conclusion Considerable variation in agreement was seen in expert interpretation of occupational PEF records which may lead to inconsistencies in diagnosis of occupational asthma. There is a need for an objective scoring system which removes human variability, such as that provided by Oasys-2. AU - Baldwin DR AU - Gannon PFG AU - Bright P AU - Newton DT AU - Robertson AS AU - Venables KM AU - Graneek B AU - Barker RD AU - Cartier A AU - Malo JL AU - Wilsher M AU - Pantin CFA AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 28 IP - DP - 2002 Jan 01 TI - Exploration of asthma risk by occupation - extended analysis of an incidence study of the finnish population PG - 49-57 AB - OBJECTIVES: The objective of the study was to determine asthma risks at the most-detailed level of occupational classification in a previously described nationwide follow-up study that included the entire employed workforce of Finland. METHODS: In Finland, persons with clinically verified persistent asthma are registered for medication reimbursement within the national health insurance scheme. Data were combined from three national registers, and all 25- to 59-year-old employed Finns were followed for asthma incidence in 1986-1998. Altogether 49,575 cases were detected. A log-linear model was used to estimate the relative risks of asthma for 275 nonadministrative occupations in comparison with administrative work (33 occupations). RESULTS: A significantly increased risk was found for either men or women in 125 occupations. For the men, the risk was highest among bakers, laundry workers, shoemakers and repairers, tanners, fell mongers and pelt dressers, and metal plating and coating workers. For the women, the risk was highest among shoemakers and repairers, railway and station personnel, jewelry engravers, engineroom crew, molders, round-timber workers. and bakers. CONCLUSIONS: The results suggest that the work-related excess of asthma incidence is much more widely spread across the labor force than has been previously thought. A great number of occupations deserves to be targeted for in-depth studies focusing on the determinants of asthma excess and on possibilities for better asthma control among asthmatics working in these occupations. The large work-relatedness of asthma incidence should also raise public health interest because of the economic losses incurred and the potential for prevention. AU - Karjalainen A AU - Kurppa K AU - Martikainen R et al LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 75 IP - DP - 2002 Jan 01 TI - Allergy to animal fur and feathers among zoo workers PG - S113-116 AB - Objectives This study determined the prevalence of respiratory symptoms and immediate hypersensitivity to feather and fur allergens and pulmonary function among zoological garden workers. Methods Skin-prick test (SPT) reactivity to common and epithelium (hair) animal fur and feather allergens were examined in 68 zoological garden workers. All subjects responded to a questionnaire and underwent spirometry. Total and antigen-specific IgE were estimated among subjects claiming respiratory symptoms. Results Forty-five subjects revealed positive SPTs with any inhalant allergen. Twelve reacted to feather extracts and 18 reacted to animal fur extracts. IgE specific for occupational allergens was seen in the serum of five subjects with SPTs positive to feather allergens and in the serum of 12 subjects with SPTs positive to fur allergens. Nose or eye symptoms were reported most frequently. Rhinitis and asthma were reported by atopic subjects more often than by non-atopic subjects. Occupational asthma due to feathers was diagnosed in 2% of zoo workers, and to fur in 10% of subjects working in contact with birds and furred animals. Discussion The results suggest that occupational asthma caused by feathers is very rare in contrast to asthma caused by animal fur. Atopy predisposes to the development of allergic diseases caused by animal fur and feathers. AU - Krakowiak A AU - Palczynski C AU - Walusiak J et al LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 44 IP - DP - 2002 Jan 01 TI - Prevalence and onset of rhinitis and conjunctivitis in subjects with occupational asthma caused by trimellitic anhydride (TMA) PG - 1179-1181 AB - Individuals with occupational asthma may also report symptoms of rhinitis or conjunctivitis. The objective of this study was to investigate the prevalence of rhinitis and conjunctivitis in subjects with occupational asthma as a result of trimellitic anhydride (TMA). Additionally, we wanted to evaluate the onset of rhinitis and conjunctivitis symptoms as compared with the occupational asthma symptoms. In a case series design, we studied 25 consecutive employees with TMA-induced asthma; each of them had participated in an annual surveillance program in which they were queried about rhinitis, conjunctivitis, and other respiratory symptoms. Twenty-two of the 25 (88%) reported rhinitis symptoms whereas 17 of the 25 (68%) reported conjunctivitis symptoms. In 17 of the 22 (77%) individuals with rhinitis and asthma, the rhinitis symptoms preceded the asthma symptoms. In 14 of the 17 (82%) individuals with conjunctivitis, those symptoms preceded the asthma symptoms. In summary, symptoms of rhinitis and conjunctivitis are common in subjects with occupational asthma because of TMA and often precede the respiratory symptoms. AU - Grammer LC AU - Ditto AM AU - Tripathi A et al LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 121 IP - DP - 2002 Jan 01 TI - Effect of respiratory protective devices on development of antibody and occupational asthma to an acid anhydride PG - 1317-1322 AB - Study objectives: To determine whether the use of respiratory protective equipment would reduce the incidence of occupational asthma due to exposure to hexahydrophthalic anhydride (HHPA). Design: Prospective cohort study. Setting: A facility that makes an epoxy resin product requiring HHPA for its manufacture. Participants: Sixty-six individuals newly hired at a facility that makes an epoxy resin product requiring HHPA for its manufacture. Intervention: Employees who wished to use respiratory protective equipment could choose from three types of masks: dust mask, half-face organic vapor respirator, or full-face organic vapor respirator. Measurements: Workers were evaluated annually for development of positive antibody to HHPA and occupational, immunologic respiratory disease, including occupational asthma. Results: With use of respiratory protective equipment, the rate of developing an occupational immunologic respiratory disease was reduced from approximately 10 to 2% per year. Occupational asthma developed in only three individuals, and they were all in the higher exposure category. Statistically, one respirator was not superior to the others. Conclusion: Respiratory protective equipment can reduce the incidence of occupational immunologic respiratory disease, including occupational asthma, in employees exposed to HHPA. AU - Grammer LC AU - Harris KE AU - Yarnold PR LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 19 IP - DP - 2002 Jan 01 TI - Socioeconomic outcome of subjects experiencing asthma symptoms at work PG - 1107-1113 AB - The aim of this study was to investigate the socioeconomic outcomes of subjects who experienced work-related asthma symptoms in the absence of demonstrable occupational asthma (OA) and to compare these outcomes with those found in subjects with documented OA. Subjects (n=157) who were being investigated for work-related asthma, were surveyed. Of these 86 had OA, ascertained by a positive specific inhalation challenge (SIC), and 71 subjects had a negative SIC response. After a median interval of 43 months (range 12-85 months), the subjects were interviewed to collect information on employment status, income changes, and asthma-related work disability. Rates of work disruption and income loss at follow-up were similar in subjects with negative SIC (46% and 59%, respectively) and in those with OA (38% and 62%). The median loss as a percentage of initial income was 23% in subjects with negative SIC and 22% in subjects with OA. Asthma-related work disability, defined as any job change or work loss due to asthma, was slightly more common in subjects with OA (72%) than in those with negative SIC (54%). This study shows that, even in the absence of demonstrable occupational asthma, work-related asthma symptoms are associated with considerable socioeconomic consequences. AU - Larbanois A AU - Jamart J AU - Delwiche JP AU - et al LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 109 IP - DP - 2002 Jan 01 TI - Glutathione S-transferase GSTP1 is a susceptibility gene for occupational asthma induced by isocyanates PG - 867-872 AB - BACKGROUND Polymorphism at the pi class glutathione-S-transferase locus (GSTP1) is associated with allergen-induced asthma and related phenotypes. OBJECTIVE We sought to determine whether GSTP1 polymorphism influences susceptibility to asthma induced by toluene diisocyanate (TDI). METHODS The role of GSTP1 was assessed in 131 workers exposed to TDI, 92 with TDI-induced asthma and 39 asymptomatic subjects. The phenotype of the disease was characterized by using detailed clinical history, lung volumes, airway responsiveness to methacholine, and airway responsiveness to TDI. GST genotypes were determined by using PCR-based assays. RESULTS In patients exposed to TDI for 10 or more years, the frequency of the GSTP1 Val/Val genotype was lower in subjects who had asthma (odds ratio, 0.23; 95% confidence interval, 0.05-1.13; P =.074). Similarly, the frequency of this genotype was significantly lower in subjects with evidence of moderate-to-severe airway hyperresponsiveness to methacholine compared with the frequency in subjects with normal or mild hyperresponsiveness (P =.033). CONCLUSION These data suggest that homozygosity for the GSTP1*Val allele confers protection against TDI-induced asthma and airway hyperresponsiveness. This view is supported by the finding that the protective effect increases in proportion to the duration of exposure to TDI. AU - Mapp CE AU - Fryer AA AU - DeMarzo N et al LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 59 IP - DP - 2002 Jan 01 TI - Detection of workers sensitised to high molecular weight allergens: A diagnostic study in laboratory animal workers. PG - 189-195 AU - Meijer E AU - Grobbee DE AU - Heederik D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 96 IP - DP - 2002 Jan 01 TI - Diagnosis Of Flour-Induced Occupational Asthma In A Cross-Sectional Study PG - 236-243 AB - The diagnosis of occupational asthma is usually performed in epidemiology using a combination of symptoms and bronchial hyperresponsiveness, while in a clinical setting the 'gold standard' for the diagnosis of occupational asthma is the specific bronchial challenge test in the laboratory The aim of this study was to detect new cases of flour-induced occupational asthma (OA) in a group of workers exposed to grain and/or flour dust, by means of a step-by-step approach, as used in a clinical setting. In an epidemiological study, III millers and 186 bakers were examined by means of questionnaire, pulmonary function tests and skin-prick tests (SPT) to common allergens and to wheat flour dust extracts. From the whole sample, 82 subjects who showed asthma-like symptoms in the questionnaire and/or low forced expiratory volume in 1 sec (FEV1) were selected. Selected subjects underwent methacholine challenge test, and hyperreactive subjects underwent specific bronchial challenge with flour dust in the laboratory. Sixty-two of the selected subjects performed the methacholine challenge test, and 22 (33 8%) were hyperreactive (PD20 FEV1 <1 mg of methacholine). Fifteen of 22 hyperreactive subjects underwent specific bronchial challenge test (s BCT) with flour dust; a positive response was elicited in six subjects. These subjects can be diagnosed as having flour-induced occupational asthma. Atopy and skin sensitivity to flour was partially related to the response to flour bronchial challenge. Bronchial hyperreactivity can be observed in a small percentage of subjects with asthma-like symptoms and/or low FEV1, and a positive response to s BCTwas observed in a subgroup of hyperreactive subjects.Therefore, using these selection criteria, a diagnosis of flour-induced OA, as commonly performed in a clinical setting, can be performed in few previously undiagnosed subjects.This approach could be relevant for an early diagnosis ofoccupational asthma. AU - Talini D AU - Benvenuti A AU - Carrara M et al LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 59 IP - DP - 2002 Jan 01 TI - Changes in rates and severity of compensation claims for asthma due to diisocyanates: a possible effect of medical surveillance measures PG - 58-62 AB - Objectives: A medical surveillance programme was introduced into Ontario for workers exposed to diisocyanates in 1983, but no mandated surveillance programme is in effect in this province for other occupational respiratory sensitisers. This study assesses changes in incidence and severity of compensated claims for occupational asthma (OA) due to diisocyanates compared with other causes, which have occurred since the introduction of this surveillance programme. Methods: New claims for OA compensated by the Ontario Workers' Compensation Board (WCB) between 1980 and 1993 were retrospectively reviewed. Linkage was made between these data and an Ontario Ministry of Health database to assess hospital admissions for asthma from the date of onset of OA until the end of 1996. Results: Numbers of claims for OA induced by diisocyanates ranged from 9–15/year in 1980–83, increased up to 55–58 claims/year in 1988–90, then fell to 19–20 claims/year by 1992–93. By contrast yearly numbers of claims for OA due to other causes increased up to 1985–87 then remained relatively stable. Duration of symptoms for OA induced by diisocyanates was shorter than for other claims and there were fewer hospital admissions among those with OA induced by diisocyanates than among those with OA induced by other causes. Occupational asthma from all causes was diagnosed earlier in claims for 1987–93 compared with 1980–86, and indicators of severity of asthma were also milder in accepted claims during 1987–93 than in earlier claims. Conclusions: Although engineering and industrial hygiene measures may have contributed to these changes, our findings are also consistent with a beneficial contribution from the medical surveillance programme for workers exposed to diisocyanates. AU - Tarlo SM AU - Liss GM AU - Yeung KS LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 24 IP - DP - 2002 Jan 01 TI - Course of isocyanate-induced asthma in relation to exposure cessation: Longitudinal study of 50 subjects PG - 26-31 AB - Isocyanates, particularly Toluene Diisocyanate (TDI), have been the most common cause of occupational asthma for decades. Fifty workers with a diagnosis of isocyanate-induced asthma were followed up for a mean period of 8.4 years. Pulmonary function testing for FVC and FEV1, allergological tests, nonspecific bronchial challenge to methacholine and specific bronchial challenge to isocyanates were performed at the time of diagnosis and during follow-up. Data on symptoms and drug response were rated on a scale. Patients were subdivided into two groups based on persistence of (A; 13 patients) or removal from (B; 37 patients) isocyanate exposure. There were no significant differences in any characteristic between the two groups at the time of diagnosis. At follow-up, group B subjects showed significant improvement in symptoms, consequent reduction in use of medications and increase in PD20. None worsened, sixteen (43.3%) remained stable, twelve (32.4%) improved and nine (24.3%) became asymptomatic. The latter subjects were generally younger, they had shorter duration of symptoms and exposure to the agents, and longer removal from exposure, although none of these differences was significant. In 67% of cases they had an immediate reaction to TDI challenge. By contrast, the condition of group A patients deteriorated significantly during the follow-up period in terms of symptoms, pulmonary function parameters, PD20 and use of medications. Overall, seven subjects (53.8%) worsened during follow-up and none improved. Group B subjects were further divided into subgroups B1 and B2 based on duration of removal from exposure: B1 < 10 years, B2 > or = 10 years. There were no significant differences between the two subgroups, even though PD20 was higher in B2. The present study confirms that early diagnosis and immediate removal from exposure are crucial, though not always sufficient, for a favourable evolution of the disease. AU - Valentino M AU - Rapisarda V LA - PT - DEP - TA - G Ital Med Lav Ergon JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 109 IP - DP - 2002 Jan 01 TI - Occupational asthma caused by natural rubber latex: outcome according to cessation or reduction of exposure PG - 125-130 AB - BACKGROUND The long-term effects of reducing exposure to latex in subjects with latex-induced asthma remain unknown. OBJECTIVE The purpose of this study was to compare the health and socioeconomic outcomes of subjects with latex-induced asthma before and after reduction or cessation of exposure to latex. METHODS Thirty-six subjects with latex-induced asthma as ascertained by specific inhalation challenges were investigated after a median follow-up of 56 months (range, 12 to 92 months). Initial and follow-up visits included use of a detailed questionnaire and measurement of the concentration of histamine causing a 20% fall in FEV(1) (PC(20)). At follow-up, information on employment, financial status, and quality of life was collected. RESULTS At follow-up, 16 subjects were no longer exposed to latex, whereas 20 subjects had reduced exposure. In the subjects who avoided exposure, asthma severity decreased from a median score of 8.5 to 3.5 (P =.001) and the median histamine PC(20) value increased from 0.4 mg/mL to 2.3 mg/mL (P =.002). In the subjects who reduced their exposure, asthma-severity score improved from 6.5 to 2.5 (P <.001) and PC(20) values rose from 0.5 mg/mL to 2.4 mg/mL (P <.001). Cessation of exposure to latex was associated with asthma-related work disability (69%) and loss of income (62%) more frequently than was reduction of exposure (35% and 30%, respectively). CONCLUSION Reduction of exposure to latex should be considered a reasonably safe alternative that is associated with fewer socioeconomic consequences than removal from exposure. AU - Vandenplas O AU - Jamart J AU - Delwiche J-P AU - Evrard G AU - Larbanois A LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - - IP - DP - 2002 Jan 01 TI - Work Related Lung Disease Surveillance Report 2002 PG - - AU - - LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 165 IP - DP - 2002 Jan 01 TI - A Birth Cohort Study of Subjects at Risk of Atopy. Twenty-two-year Follow-up of Wheeze and Atopic Status PG - 176-180 AU - Rhodes HL AU - Thomas P AU - Sporik R AU - Holgate ST AU - Cogswell JJ LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 20 IP - DP - 2002 Jan 01 TI - Asthma characteristics in cleaning workers, workers in other risk jobs and office workers PG - 679-685 AB - Several studies have demonstrated an excess risk for asthma among cleaning workers. The aim of this analysis was to compare clinical, immunological and functional characteristics associated with asthma in cleaners and other occupational groups. Cleaners, workers exposed to high molecular weight (MW) agents, workers exposed to low MW agents, and office workers were identified from an international community-based epidemiological study. Influence of sex, smoking, age and atopy on the relationships with asthma was investigated. Rates of respiratory symptoms, bronchial hyperresponsiveness, atopic sensitisation and lung function were compared between asthmatics from the four groups (case-case analysis). The risk for asthma in workers exposed to low MW agents was higher among nonatopics than among atopics. Case-case analysis showed no major differences in asthma characteristics between cleaners and workers exposed to high or low MW agents. Asthmatic cleaners had less atopy, more chronic bronchitis and a lower lung function as compared to office workers. Asthma in cleaning workers showed many similarities with that in workers known to be at risk for occupational asthma. Atopic sensitisation did not seem to play an important role in cleaning-related asthma. AU - Zock JP AU - Kogevinas M AU - Sunyer J AU - Jarvis D AU - Toren K AU - Anto JM LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 166 IP - DP - 2002 Jan 01 TI - Occupational airborne exposure and the incidence of respiratory symptoms and asthma PG - 933-938 AU - Eagan TM AU - Gulsvik A AU - Eide GE AU - Bakke PS LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 63 IP - DP - 2002 Jan 01 TI - Crab allergen exposures aboard five crab-processing vessels PG - 605-609 AU - Beaudet N. Brodkin CA. Stover B. Daroowalla F. Flack J. Doherty D LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 9 IP - DP - 2002 Jan 01 TI - Prevalence and risk factors for airway diseases in farmers--summary of results of the European Farmers' Project PG - 207-213 AB - The aim of the European Farmers' Project was to determine prevalence and risk factors of respiratory diseases in farmers across Europe. A cross-sectional study in 7 centres was carried out. In the first stage of the study, nearly 8,000 farmers in Denmark, Germany, Switzerland, the UK, and Spain answered a standardised questionnaire on farming characteristics and respiratory symptoms. The second stage of the study included exposure assessment and lung function measurements in 4 of the centres. Within the group of farmers, pig farmers were at high risk of asthma-like syndrome as compared to farmers keeping other kinds of animals. Among plant farmers, greenhouse workers were at higher risk for symptoms of asthma. The prevalence of symptoms of allergies were significantly lower among animal farmers as compared to the population of the European Community Respiratory Health Survey. In contrast, animal farmers had a significantly higher prevalence of symptoms of chronic bronchitis. The major risk factor for respiratory symptoms was shown to be ventilation of the animal houses and greenhouses. Intervention studies are now warranted to test the effectiveness of improved ventilation on respiratory health. The reasons for the low prevalence of allergic diseases among farmers are currently under study. AU - Radon K AU - Monso E AU - Weber C AU - Danuser B AU - Iversen M AU - Opravil U AU - Donham K AU - Hartung J AU - Pedersen S AU - Garz S AU - Blainey D AU - Rabe U AU - Nowak D LA - PT - DEP - TA - Annals of Agricultural & Environmental Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 9 IP - DP - 2002 Jan 01 TI - Air contaminants in different European farming environments PG - 41-48 AB - Farmers are known to be at high risk from the development of occupational airway disease. The first stage of the European farmers' study has shown that pig farmers in Denmark and Germany, poultry farmers in Switzerland and greenhouse workers in Spain were at highest risk for work-related respiratory symptoms. Therefore, the aim of this study was to determine exposure levels at relevant farm workplaces. Dust and endotoxin levels as well as microbiological concentrations were determined in 213 crop and animal farming environments by personal sampling. The highest total dust concentrations were found in poultry houses in Switzerland with median concentrations of 7.01 mg/m(3). The median airborne endotoxin concentrations in total dust ranged between 0.36 ng/m(3) in Spanish greenhouses and 257.58 ng/m(3) in poultry houses in Switzerland. Likewise, the highest median concentrations of total (2.0 x (7) cells/m(3)) and active fungi (4.4 x (5) cfu/m(3)) have been found in Swiss poultry houses. The predominant fungus taxa discovered in poultry houses were Eurotium spp. and thermophilic fungi. Cladosporium and Botrytis were mainly detected in greenhouses. The exposure level found in this study might put the farmers at risk from respiratory diseases. AU - Radon K AU - Danuser B AU - Iversen M AU - Monso E AU - Weber C AU - Hartung J AU - Donham K AU - Palmgren U AU - Nowak D LA - PT - DEP - TA - Annals of Agricultural & Environmental Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - s38 IP - DP - 2002 Jan 01 TI - Respiratory failure in surgeons induced by natural rubber latex PG - 2438, S394 AU - Kazakova G AU - Vasilyeva O AU - Pashkova T AU - Chuchalin A LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 109 IP - DP - 2002 Jan 01 TI - Chemical constituents of diesel exhaust particles induce IL-4 production and histamine release by human basophils PG - 847-853 AB - Background: An epidemiologic relationship between airway allergic diseases and exposure to atmospheric pollutants has been demonstrated and suggested to be one factor in the increasing prevalence of asthma. Diesel exhaust particles (DEPs) have been shown to participate in the development of allergic airway inflammation, in which the targets include macrophages, B and T cells, epithelial cells, and mast cells. In addition to the adjuvant effect of DEPs on total and allergen-specific IgE production, DEPs also act to induce chemokines and cytokines and may play a key role in primary sensitization. Objective: DEPs have been shown to increase local IL-4-containing Kit+ cells soon after in vivo nasal challenge. The aim of this study was to examine the effects of DEPs on human basophils, a key source of IL-4. # Methods: Peripheral blood leukocytes from allergic and control subjects were cultured in the presence of organic extracts of DEP (DEPex) with or without allergen. The cultures were analyzed for IL-4-containing cells by using multiparameter flow cytometry, IL-4 secretion with ELISA, and histamine release. Results: Basophils, when exposed in vitro to DEPex, expressed IL-4 and released histamine significantly (P < .01) more than with antigen activation. DEPex did not synergize with allergen in cytokine production and histamine release. DEPex-induced basophil IL-4 expression peaked at 2 hours and persisted through 20 hours, in contrast to allergen-induced IL-4, which was transient. The effect of DEPex on basophil cytokine expression and histamine release was dose dependent and occurred with cells from both allergic and nonallergic subjects. DEPex induced IL-4 expression and histamine release in highly enriched basophil populations, suggesting it acts directly on basophils. Other peripheral blood leukocytes, including T cells, did not contribute to this cytokine expression. Preincubation with N-acetylcysteine completely abrogated DEPex-driven basophil IL-4 expression. Conclusions: Basophils are a direct target for DEPex, inducing IL-4 expression and histamine release in an IgE-allergen independent fashion. N-acetylcysteine inhibition of DEPex-driven IL-4 expression provides evidence that generation of reactive oxygen species is required for the effects observed. The capability of DEPex to activate basophils in both allergic and nonallergic subjects suggests a potential role of this pollutant in the increasing prevalence of allergic diseases. AU - Devouassoux G AU - Saxon A AU - Metcalfe DD AU - Prussin C AU - Colomb MG AU - Brambilla C AU - Diaz-Sanchez D AU - LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 57 IP - DP - 2002 Jan 01 TI - Prevalence of sensitization to the predatory mite Amblyseius cucumeris as a new occupational allergen in horticulture PG - 614-619 AB - Background Protection against thrips, a common pest in bell pepper horticulture is effectively possible without pesticides by using the commercially available predatory mite Amblyzeius cucumeris (Ac). The prevalence of sensitization to Ac among exposed greenhouse employees and its clinical relevance was studied. Methods 472 employees were asked to fill in a questionnaire and were tested on location. Next to RAST, skin prick tests (SPTs) were performed with common inhalant allergens, the storage mite Tyrophagus putrescentiae (Tp) which serves as a temporary food source during the cultivation process and Ac. Furthermore, nasal challenge tests with Ac were carried out in 23 sensitized employees. Results SPTs positive to Ac were found in 109 employees (23%). Work-related symptoms were reported by 76.1%. Sensitization to Tp was found in 62 employees of whom 48 were also sensitized to Ac. Immunoglobulin (Ig)E-mediated allergy to inhalant allergens appeared to be an important risk factor for sensitization to Ac. Employees with rhinitis symptoms showed a significantly higher response to all Ac doses during the nasal challenge test compared with employees without rhinitis symptoms. Conclusions The predatory mite Ac is a new occupational allergen in horticulture which can cause an IgE-mediated allergy in exposed employees. It is biologically active on the mucous membranes of the nose and therefore clinically relevant for the development of work-related symptoms. AU - Giséle CM AU - Groenewoud MD AU - de Graaf AU - van Oorschot–van NesAJO AU - de ong AJ AU - Vermeulen AM AU - van Toorenenbergen AW AU - Burdorf A AU - de Groot H AU - van Wijk RG LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 44 IP - DP - 2002 Jan 01 TI - Incidence of asthma among Finnish construction workers. PG - 752-757 AB - We wanted to explore the risk of asthma among male workers of the construction industry. All Finnish male construction industry workers and all those employed in administrative work were followed for asthma incidence through a register linkage in 1986 through 1998. Age-adjusted relative risks (RR) were estimated for 24 construction occupations. The risk was increased in nearly all construction occupations studied, but it was highest among welders and flame cutters (RR 2.34), asphalt roofing workers (RR 2.04), plumbers (RR 1.90), and brick layers and tile setters (RR 1.83). Only 45 (2%) of the cases of asthma among construction workers had been recognized as occupational asthma. Construction industry workers have an increased risk of adult-onset persistent asthma and cases of occupational asthma caused by well-established causative agents have only a minor contribution to this overall asthma excess. AU - Karjalainen A AU - Martikainen R AU - Oksa P AU - Saarinen K AU - Uitti J AU - Jukka AB LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 7 IP - DP - 2002 Jan 01 TI - Changes in serum pneumoproteins caused by short-term exposures to nitrogen trichloride in indoor chlorinated swimming pools. PG - 464-478 AB - Nitrogen trichloride (NCl(3)) is an irritant gas released in the air of indoor pools sanitized with chlorine-based disinfectants. In the present study we investigated the effects of NCl(3) on the pulmonary epithelium of pool attendees by measuring the leakage into serum of three lung-specific proteins (pneumoproteins): the alveolar surfactant-associated proteins A and B (SP-A and SP-B) and the bronchiolar 16 kDa Clara cell protein (CC16). Methods These pneumoproteins were measured in the serum of 29 recreational swimmers (16 children and 13 adults) before and after attending a chlorinated pool with a mean NCl(3) concentration of 490 microg m(-3). Pneumoprotein changes in serum were also studied in 14 trained swimmers performing an intensive 45 min standardized swimming session in a chlorinated pool (mean NCl(3) concentration of 355 microg m(-3)) and for the purposes of comparison in a non-chlorinated pool sanitized by the copper/silver method. Results Serum CC16 was not increased in recreational swimmers, but in trained swimmers serum levels of this protein peaked immediately after strenuous exercise, both in the copper/silver pool and in the chlorinated pool. This acute increase in airway permeability is probably the consequence of the mechanical stress on the epithelial barrier caused by overinflation and/or hyperventilation during intense exercise. Serum levels of SP-A and SP-B were unaffected by strenuous exercise in the copper/silver pool. The two proteins were, however, significantly increased in a time-dependent manner in recreational and trained swimmers attending the chlorinated pool. The intravascular leakage of SP-A and SP-B was already statistically significant after only 1 h of exposure to pool air without exercising and remained elevated for 12 h after. These changes were not associated with decrements in lung function. The ability of NCl(3) to acutely disrupt the lung epithelium barrier was confirmed in mice using serum CC16 and plasma proteins in bronchoalveolar lavage fluid as permeability markers. The significance of these permeability changes induced by NCl(3) in the deep lung is presently unknown. Conclusion In view of the increasing and widespread human exposure to this gas not only in indoor pools but also in a variety of other situations, these findings warrant further study. AU - Carbonnelle S AU - Francaux M AU - Doyle I AU - Dumont X AU - de Burbure C AU - Morel G AU - Michel O AU - Bernard A LA - PT - DEP - TA - Biomarkers JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 27 IP - DP - 2002 Jan 01 TI - Environmental risk factors and gender in nasal polyposis PG - 314-317 AB - The aetiology of nasal polyps remains obscure. Although clinically associated with asthma, notably in women, there is a marked male preponderance of polyposis. This study aimed to explore environmental pollutant triggers and gender differences in risk factors for nasal polyps. In total, 900 patients having surgery for polyposis and 120 new patients with nasal polyps completed a questionnaire with regard to occupational dust and chemical exposure. The male to female ratio was 2:1, and 52% were smokers, although only 37% of women smoked compared with 66% of men. Exposure to occupational dusts and chemicals was noted in 45% (retrospective) and 53% (prospective) of respondents. Women were 1.6 times more likely to be asthmatic and 2.7 times more likely to have allergic rhinitis than men. Men were 2.25 times more likely to be smokers and 2.48 times more likely to have been exposed to chemicals and dusts than women (all statistically significant differences). No significant gender associations were found for hayfever, eczema, aspirin intolerance, alcohol intake or hobby dust exposure AU - Collins MM AU - Pang Y-T AU - Loughran S AU - Wilson JA LA - PT - DEP - TA - Clin tolaryngol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 57 IP - DP - 2002 Jan 01 TI - Occupational asthma due to mitoxantrone PG - 461 AB - Occupational allergy due to cytostatics are scarce and mainly concern allergic contact dermatitis and allergic contact urticaria (1,2). To our knowledge, there is no published case report on mitoxantrone-induced allergic asthma. We present the case of a 41-year-old nurse who had worked for 13 years in an oncology ward with exposure to antineoplastic drugs. For three years she had suffered from rhinorrhea, dyspnea and cough attacks, occurring 1–2 h after beginning work. For the first two years the patient presented only work-related symptoms; in the third year she developed dyspnea also away from work. Clinical examinations, as well as routine laboratory parameters, remained normal. The total IgE (CAP System, Pharmacia, Sweden) level was low (4.89 km/l). No specific IgE antibodies against latex, disinfectants and b-lactams were detected. Also skin prick tests to common allergens, latex (Allergopharma, Germany) chloramine and chlorhexidine (0.001, 0.01 and 0.1% solutions) were negative. The histamine provocation test showed unremarkable bronchial hyperreactivity (PC20=0.093 mg/ml). The patient was subjected to a number of single-blind bronchial challenge tests with subsequent cytostatics monitored by spirometry and peak expiratory flow (PEFR) measurements. The provocation with mitoxantrone induced a 15% fall in forced expiratory volume (FEV1) at 1 h, with a 20% decrease 4 h later. One week later the challenge with mitoxantrone was repeated. Bronchoalveolar lavage fluid (BAL) was taken before and at 6 and 18 h after the provocation. Significant increase in lymphocytes and neutrophil proportion was observed, especially at 18 h after the challenge. We also noted eosinophil influx, up to 4%, and more than a two-fold increase (from 8.0% before to 18.2%) in the permeability index. The same provocation test was performed in an asthmatic volunteer not exposed to antineoplastic drugs. There were no significant changes in cell proportions apart from a slight increase in neutrophils (from 1% to 6% at 18 h). AU - Walusiak J AU - Wittczak T AU - Ruta U AU - Palczynsk C LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - - IP - DP - 2002 Jan 01 TI - The relationship between airway physiology, airway inflammation and prognosis in workers with occupational asthma PG - - AU - Anees W LA - PT - DEP - TA - Phd Thesis, University of Birmingham JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 19 IP - DP - 2002 Jan 01 TI - Indoor swimming pools, water chlorination and respiratory health PG - 790-793 AB - Swimming is generally considered to be a healthy leisure activity for both the young and old. Swimming is even often advised as the most appropriate sport for asthmatic children 1–3, mainly (but probably not solely) on the grounds that inhaling moist air is less conducive to triggering exercise-induced asthma 4. However, for obvious reasons of microbiological safety, the water of public and private swimming pools must be disinfected 5. The most common procedure for water disinfection consists of chlorination. As with all human and technological intervention, the use of chlorine-based products to disinfect swimming water may lead to a number of unwanted effects, in particular the presence of chlorine-containing compounds in the air. Consequently, chlorination may affect the respiratory health of either those who work as swimming attendants or instructors, or those who use the pools as customers, particularly children and the general public, but also competitive swimmers. Although the issue of the chlorination of public water supplies has received considerable attention, mainly with regard to the presence of potentially carcinogenic or teratogenic chlorinated by-products 6, 7, the respiratory hazards of chlorinated swimming water have been less well addressed. Thus, old 8, 9 and even more recent 10 reports on indoor pollution do not deal with the air of chlorinated swimming pools, despite the generally obvious and readily noticeable irritant character of this type of environment, even in well-maintained pools 11. AU - Nemery B AU - Hoet PHM AU - Nowak D LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 46 IP - DP - 2002 Jan 01 TI - Reduction of Exposure to Laboratory Animal Allergens in a Research Laboratory PG - 61-68 AB - Objectives: The purpose of this study was to determine exposure levels in the laboratory during different tasks and evaluate the effectiveness of safety equipment used to reduce personal exposure. Methods: Personal and stationary air samples were collected during different tasks in a laboratory animal facility in which several allergen reduction strategies had been implemented. Mouse urinary allergen concentrations were measured using a polyclonal sandwich enzyme-linked immunosorbent assay. Sera from the personnel (n = 29) were analysed every 6 months for the presence of specific antibodies against mouse and rat urinary allergens, and the staff answered questionnaires on work-related symptoms, exposure and use of respiratory protection. Results: The highest airborne mouse allergen levels were measured during manual emptying of cages, during changing of cages on an unventilated table and during handling of male animals on an unventilated table. Automatic emptying and cleaning of cages resulted in low airborne allergen levels in the working room. Using a ventilated cage-changing wagon reduced the allergen exposure level from 77 to 17 ng/m3. The housing of animals in ventilated cabinets, with air exhausted through the cabinet, effectively prevented the release of allergens into the ambient air. The handling of animals on ventilated benches and the use of a centralized vacuum cleaner resulted in a low exposure level. Only two subjects developed specific immunoglobulin E of >0.35 kU/l, of whom one was reduced to negative after increased use of respiratory protection. Conclusions: Effective reduction of exposure to allergens can be achieved by several strategies, which together appear to minimize sensitization to rodents. AU - THULIN H AU - BJÖRKDAHL M AU - KARLSSON A AU - RENSTRÖM A LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 75 IP - DP - 2002 Jan 01 TI - Occupational respiratory hypersensitivity in dental personnel PG - 209-216 AB - Objective: The aim was to study the causes of respiratory hypersensitivity in dental personnel based on the statistics of the Finnish Register of Occupational Diseases (FROD; 1975-1998) and the patient material of the Finnish Institute of Occupational Health (FIOH; 1990-1998). Methods: Details about the cases of respiratory hypersensitivity were compiled from the FROD. The occupational rhinitis diagnoses studied at the FIOH were based on work-related symptoms and a change in the status of the nasal mucosa during challenge testing; and the diagnosis of occupational asthma based on reactions in challenge testing, or on IgE positivity and peak flow monitoring at work and during days off. Results: A total of 64 cases of occupational respiratory diseases (ORDs) was diagnosed in dental personnel during 1975 to1998 according to the FROD; two cases in 1975 to 1989, and 62 in 1990 to 1998. Twenty-eight cases were of occupational asthma (18 caused by methacrylates), 28 occupational rhinitis (six caused by methacrylates), seven allergic alveolitis and one organic dust toxic syndrome (ODTS). The non-acrylate-material diagnosed in 1990-1998 at the FIOH comprised three cases of asthma and one of rhinitis caused by chloramine-T (sodium-N-chlorine-p-toluene sulphonamide); as well as one case of asthma, seven cases of rhinitis, and two cases of combined rhinitis and conjunctivitis caused by natural rubber latex (NRL). Furthermore, one case of occupational rhinitis caused by Nobetec containing colophony was diagnosed. The incidence rate (IR) of ORD increased from 0 in 1988 to a peak of 105.1 new cases per100,000 working years in 1995. During the last observation year, i.e. 1998, the IR was 55 new cases per 100,000 workers. The IR in dental personnel was lower than in the whole working population in Finland up until 1992, but since then has been greater than in the whole population, peaking in 1995 when the IR of dental personnel was 2.55 times greater than in the whole population. In addition, seven cases of allergic alveolitis and one organic dust toxic syndrome (ODTS) [7] case were reported inthe register, caused by mould inthe structures of the dental office building. Two of the alveolitis cases were diagnosed at the FIOH, based on exposure, symptoms and significant change in single-breath diffusing capacity. Moulds, yeasts and fungi caused one case of asthma and five cases of allergic rhinitis. Conclusion: The present study shows the increasing frequency of respiratory hypersensitivity among dental personnel. Besides methacrylates, important causes of respiratory hypersensitivity are NRL and chloramine-T. Volume 75, Number 4, 209-216 AU - Piirilä P AU - Hodgson U AU - Estlander T AU - Keskinen H AU - Saalo A AU - Voutilainen R AU - Kanerva L LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 450 IP - DP - 2002 Jan 01 TI - Evaluation of an expert system for the interpretation of serial peak expiratory flow measurements in the diagnosis of occupational asthma in a field trial PG - 1-14 AB - Oasys-2 is a computer based analytical tool for the evaluation of serial measurements of peak expiratory flow (PEF). This study aimed to evaluate Oasys-2 in an epidemiological setting. The study reviewed extant PEF records from 104 grain workers, and prospectively studied 228 further workers. Prospective PEF records were kept by 61%, 88% from both parts contained =4 readings/day. As the two independent experts lacked agreement on the minimal data quantity required to diagnose occupational asthma, a data reduction exercise was completed in non-grain workers with independently validated diagnoses to establish the relationship between data quantity and diagnostic sensitivity and specificity. Specificity >87% and sensitivity >70% was achieved with =3 complexes, =4 readings per day and =3 consecutive days at work. 67% of PEFs met these criteria, many failures lacked 3 consecutive grain exposed days. There was a poor correlation between PEF records, RAST's and questionnaire responses. 33 PEF records showed a work related effect, 39 had questionnaire responses suggesting occupational asthma, but only 7 were common to both groups. The PEF records identified a different group of affected workers from questionnaires and RAST's, the group with work-related PEF measurements showed more obstructive spirometry than those identified by the other methods. Oasys-2 is a computer based analytical tool for the evaluation of serial measurements of peak expiratory flow (PEF). This study aimed to evaluate Oasys-2 in an epidemiological setting. The study reviewed extant PEF records from 104 grain workers, and prospectively studied 228 further workers. Prospective PEF records were kept by 61%, 88% from both parts contained ?4 readings/day. As the two independent experts lacked agreement on the minimal data quantity required to diagnose occupational asthma, a data reduction exercise was completed in non-grain workers with independently validated diagnoses to establish the relationship between data quantity and diagnostic sensitivity and specificity. Specificity >87% and sensitivity >70% was achieved with =3 complexes, =4 readings per day and =3 consecutive days at work. 67% of PEFs met these criteria, many failures lacked 3 consecutive grain exposed days. There was a poor correlation between PEF records, RAST's and questionnaire responses. 33 PEF records showed a work related effect, 39 had questionnaire responses suggesting occupational asthma, but only 7 were common to both groups. The PEF records identified a different group of affected workers from questionnaires and RAST's, the group with work-related PEF measurements showed more obstructive spirometry than those identified by the other methods. AU - Anees W AU - Huggins V AU - Blainey D AU - Pantin CFA AU - Robertson K AU - Burge PS LA - PT - DEP - TA - HSE Books JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 9 IP - DP - 2002 Jan 01 TI - Work-related symptoms among furniture factory workers in Lublin region (eastern Poland) PG - 99-103 AB - 48 woodworkers employed in the furniture factory were examined. The control group consisted of 41 office workers with no exposure to organic dust. The examination included: interview on work-related symptoms, physical examination, and lung function test performed before and after the working-day. 38 out of 48 (79.2%) woodworkers reported work-related symptoms. The most common complaint was dry cough reported by 25 workers (52.1%), followed by general malaise -- reported by 17 (35.45%), conjunctivitis -- by 16 (33.3%), rhinitis - by 16 (33.3%), and skin symptoms by 16 (33.3%). Other symptoms such as headache, shortness of breath and chest pain occurred less frequently. Subjects working in initial processing and board processing departments had a higher prevalence of cough compared to workers employed in the varnishing department (p < 0.01).The prevalence of skin symptoms was significantly higher in board processing and varnishing departments compared to initial processing department (p < 0.05). Occupational asthma and allergic alveolitis were recorded in 3 out of 48 (6.2%) and 2 out of 48 (4.2%) workers, respectively. Baseline FVC and FEV(1) values were lower in woodworkers compared to controls (p < 0.01). The increased lung function parameters (FVC, FEV(1)) were observed in woodworkers who smoked compared to non-smokers. The difference was not statistically significant. There was a significant over-shift decrease of all measured spirometric values: FVC, FEV(1)), FEV(1)) /VC, PEF among woodworkers (p < 0.001). There was a significant pre-shift, post-shift decline in FVC, FEV(1)), FVC/FEV(1)), and PEF among workers under 30 years of age (p < 0.001). The same tendency was seen for FVC and FEV(1)) in subjects over 30. The percentage changes in FVC and FEV(1)) were greater in the group of younger workers (15.1% and 17.6%) respectively, than in the group of older subject (6.2%, 7.1%). The difference was not statistically significant. AU - Milanowski J AU - Gora A AU - Skorska C AU - Krysiska-Traczyk E AU - Mackiewicz B AU - Sitkowska J AU - Cholewa G AU - Dutkiewicz J LA - PT - DEP - TA - Annals of Agricultural & Environmental Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 109 IP - DP - 2002 Jan 01 TI - Effect of continuing or finishing high-level sports on airway inflammation, bronchial hyperresponsiveness, and asthma: A 5-year prospective follow-up study of 42 highly trained swimmers PG - 963-968 AB - Background: Mild eosinophilic airway inflammation and bronchial hyperresponsiveness—ie, mild asthma—have been shown to affect a high proportion of endurance athletes. The persistence of airway inflammation, bronchial hyperresponsiveness, and asthma in this population is not known, however, inasmuch as follow-up studies of athletes’ asthma have not been performed. Objective: The purpose of this study was to investigate effect of finishing high-level sports on airway inflammation, bronchial hyperresponsiveness, and asthma. Methods: Forty-two elite competitive swimmers, most of them from the Finnish national team (37/42; 88%), were followed for 5 years in a prospective manner. All of the swimmers completed questionnaires and underwent resting spirometry, histamine challenge testing, and skin prick tests at baseline and at followup. Twenty-nine swimmers (69%) also gave induced sputum samples on both occasions. Sixteen (38%) of the swimmers had continued their competitive careers during follow-up (active swimmers), but 26 (62%) had stopped competing more than 3 months before the follow-up examination (past swimmers). Results: Bronchial responsiveness was increased in 7 (44%) of the 16 active swimmers at baseline and in 8 (50%) of the 16 active swimmers at follow-up; it was increased in 8 (31%) of the 26 past swimmers at baseline and in 3 (12%) of the 26 past swimmers at follow-up (McNemar test, P = .025). The difference in the change in bronchial hyperresponsiveness between the study groups was significant (likelihood ratio test, P =.023). Current asthma (defined as bronchial hyperresponsiveness and exercise-induced bronchial symptoms monthly) was observed in 5 (31%) of the active swimmers at baseline and in 7 (44%) of the active swimmers at follow-up; of the past swimmers, it occurred in 6 (23%) at baseline and in 1 (4%) at follow-up (McNemar test, P = .025). The difference in the change in current asthma between the study groups was significant (likelihood ratio test, P = .0040). The sputum differential cell counts of eosinophils and lymphocytes increased significantly during the follow-up period in the active swimmers (Wilcoxon signed rank sum test; P = .033 and P = .0029, respectively); in the past swimmers, the sputum differential cell counts of eosinophils tended to decrease during the follow-up period (P= .17), whereas the differential cell counts of lymphocytes did not change significantly. The changes in the sputum differential cell counts of eosinophils between the study groups differed significantly (Mann-Whitney U test, P = .019). Conclusion: In swimmers who had stopped high-level training, bronchial hyperresponsiveness and asthma attenuated or even disappeared. Mild eosinophilic airway inflammation was aggravated among highly trained swimmers who remained active during the 5-year follow-up. Our results suggest that athletes’ asthma is partly reversible and that it may develop during and subside after an active sports career. AU - Helenius I AU - Rytilä P AU - Sarna S AU - Lumme A AU - Helenius M AU - Remes V AU - Haahtela T LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 6 IP - DP - 2002 Jan 01 TI - Awareness regarding occupational asthma amongst general practitioners-a critical evaluation PG - 16-20 AB - The original study presented herewith highlights some of the policies of general practitioners, who are considered to be the first point of contact of a patient with occupational asthma, with the health services, Besides bringing out the flaws existing in current treatment strategies, the article also discusses ideal management protocols for therapy of occupational asthma. AU - Hegde SC AU - Shah PB AU - Mahashur AA LA - PT - DEP - TA - Indian J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 1 IP - DP - 2002 Jan 01 TI - Hypersensitivity pneumonitis PG - 229-239 AU - Cormier Y LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 121 IP - DP - 2002 Jan 01 TI - A comparison of the validity of different diagnostic tests in adults with asthma PG - 1051-7 AB - STUDY OBJECTIVES: Diagnosing asthma is not always easy, and there are times when objective tests can be helpful. The extent to which these tests alter the probability of asthma depends on how much more commonly the test result is positive in subjects with asthma compared to healthy subjects and particularly subjects with conditions that are commonly confused with asthma. We set out to compare the sensitivity and specificity of different tests in this setting. DESIGN: Single-center, cross-sectional, observational study. SETTING: Teaching hospital. PATIENTS: Twenty-one healthy control subjects, 69 patients with asthma, and 20 subjects referred to the hospital with a diagnosis of asthma who were found to have alternative explanations for their symptoms (i.e., pseudoasthma). INTERVENTIONS: We measured methacholine airway responsiveness, the maximum within-day peak expiratory flow amplitude mean percentage (derived from twice-daily readings for > 2 weeks), the FEV(1)/FVC ratio, the percentage change in FEV(1) 10 min after the administration of 200 microg inhaled albuterol, and the differential eosinophil count in blood and induced sputum. We derived normal ranges (from the 95% upper or lower limit for healthy subjects), sensitivity, and specificity (ie, the percentage of subjects with pseudoasthma who had negative test results). RESULTS: Most tests were less specific when the reference population was composed of subjects with conditions that can be confused with asthma. Methacholine airway responsiveness and the sputum differential eosinophil count were the most sensitive (91% and 72%, respectively) and specific (90% and 80%, respectively) tests. CONCLUSION: We conclude that methacholine airway responsiveness and the sputum differential eosinophil count are the most useful objective tests in patients with mild asthma. AU - Hunter CJ AU - Brightling CE AU - Woltmann G AU - Wardlaw AJ AU - Pavord ID LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 35 IP - DP - 2002 Jan 01 TI - The use of noncancer endpoints as a basis for establishing a reference concentration for formaldehyde PG - 23-31 AU - Bender J LA - PT - DEP - TA - Regul Toxicol Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 60 IP - DP - 2002 Jan 01 TI - Exposure-response relationships among laboratory workers exposed to rats PG - 104-108 AB - Aim: To explore exposure-response relations in a cohort of laboratory animal workers. Methods: Exposure-response modelling was carried out in a cohort of 342 laboratory animal workers. Three exposure indices, divided into different exposure categories, were used in the analyses: intensity of exposure to rat urinary aeroallergen (RUA, the main allergen workers were exposed to), weekly duration of exposure to rats, and the product of the intensity and weekly duration of exposure. Outcomes studied were work related chest, eyes and nose, and skin symptoms that had started after employment at the sites, specific sensitisation, and a combination of symptoms and sensitisation. Cox proportional hazard modelling was used to explore exposure-response relations. Smoking, atopic status, age, and gender were taken into account. Results: We observed the clearest exposure-response relations for the intensity of exposure to RUA and the various endpoints. No clear exposure-response relations were observed for the weekly duration of exposure or the product of the intensity and weekly duration of exposure. The strongest and clearest exposure-response relations for symptoms were observed among rat sensitised workers, while the non-sensitised workers only showed small increased risks of developing symptoms without clear exposure-response relations. Sensitised workers were almost four times more likely to go on to develop chest symptoms compared to non-sensitised workers. AU - Nieuwenhuijsen MJ AU - Putcha V AU - Gordon S AU - Heederik D AU - Venables KM AU - Cullinan P AU - Newman Taylor AJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 57 IP - DP - 2002 Jan 01 TI - Occupational rhinoconjunctivitis and asthma in a wool worker caused by Dermesidae species PG - 1191-1194 AU - Brito FF AU - Mur P AU - Barber D AU - Lombardero M AU - Galindo PA AU - Gomez E AU - Borja J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 19 IP - DP - 2002 Jan 01 TI - Occupational asthma caused by chloramines in swimming-pool air PG - 827-832 AB - The first series of three workers who developed occupational asthma following exposure to airborne chloramines in indoor chlorinated swimming pools is reported. Health problems of swimmers in indoor pools have traditionally been attributed to the chlorine in the water. Chlorine reacts with bodily proteins to form chloramines; the most volatile and prevalent in the air above swimming pools is nitrogen trichloride. Two lifeguards and one swimming teacher with symptoms suggestive of occupational asthma kept 2-hourly measurements of peak expiratory flow at home and at work, analysed using the occupational asthma system (OASYS) plotter, and/or had specific bronchial challenge testing to nitrogen trichloride, or a workplace challenge. Air measurement in one of the pools showed the nitrogen trichloride levels to be 0.1–0.57 mg·m–3, which was similar to other studies. Two workers had peak expiratory flow measurements showing occupational asthma (OASYS-2 scores 2.88 and 3.8), both had a positive specific challenge to nitrogen trichloride at 0.5 mg·m–3 with negative challenges to chlorine released from sodium hypochlorite. The third worker had a positive workplace challenge. Swimming-pool asthma due to airborne nitrogen trichloride can occur in workers who do not enter the water because of this chloramine. The air above indoor swimming pools therefore needs to be assessed and managed as carefully as the water. AU - Thickett KM AU - McCoach JS AU - Gerber JM AU - Sadra S AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 7 IP - DP - 2002 Jan 01 TI - Reliability and validity of a sick building syndrome questionnaire PG - 83-125 AU - Berglund B AU - Gidlof Gunnarsson A AU - Soames J LA - PT - DEP - TA - Archives of the Centre for Sensory Research JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - IP - DP - 2002 Jan 01 TI - Asthma PG - 33-76 AU - Hendrick DJ AU - Burge PS LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 13 IP - DP - 2002 Jan 01 TI - Indoor particles and symptoms among office workers: results from a double-blind crossover study PG - 296-304 AU - Mendell MJ AU - Fisk WJ AU - Petersen MR AU - Hines CJ AU - Dong M AU - Faulkner D AU - Deddens JA AU - Ruder AM AU - Sullivan D AU - Boeniger MF LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20020101 IS - IS - VI - 305 IP - DP - 2002 Jan 01 TI - Prevalence of asthma and allergic disorders among children in united Germany: a descriptive comparison PG - 1395-1399 AU - von Mutius E AU - Fritzsch C AU - Weiland SK AU - Roll G AU - Magnussen H LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 163 IP - DP - 2001 Jan 01 TI - Rapid declines in FEV1 and subsequent respiratory symptoms, illnesses, and mortality in coal miners in the United States PG - 633-639 AB - Follow-up of cases and controls at start matched for FEV1. Cases subsequently had accelerated FEV1 decline. This paper compares them 6-18 years later. Those with previous accelerated FEV1 decline had more non-malignant respiratory (x3.2) and CVS mortality, more symptoms at follow-up. AU - Beeckman LF AU - Wang M AU - Petsonk EL AU - Wagner GR LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 163 IP - DP - 2001 Jan 01 TI - The majority of workers presenting with occupational asthma do not have sputum eosinophilia PG - A160-A160 AU - Anees W AU - Burge PS AU - Huggins V AU - Pavord I AU - Robertson AS LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 154 IP - DP - 2001 Jan 01 TI - Environmental tobacco smoke exposure and overtime work aas risk factors for sick building syndrome in japan PG - 803-808 AU - Mizoue T AU - Reijula K AU - Andersson K LA - PT - DEP - TA - Am J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 203 IP - DP - 2001 Jan 01 TI - Eye and skin symptoms in German office workers-subjective perception vs. objective medical screening PG - 311-316 AU - Brasche S AU - Bullinger M AU - Bronisch M AU - Bischof W LA - PT - DEP - TA - Int J Hyg Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 108 IP - DP - 2001 Jan 01 TI - Rhinoconjunctivitis and occupational asthma caused by Diplotaxis erucoides (wall rocket) PG - 125-127 AU - Brito FF AU - Mur P AU - Bartolome B AU - Galindo PA AU - Gomez E AU - Borja J AU - Martinez A LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 11 IP - DP - 2001 Jan 01 TI - Why do women suffer from sick building syndrome more than men? -subjective higher sensitivity versus objective causes. PG - 217-222 AU - Brasche S AU - Bullinger M AU - Morfeld M AU - Gebhardt HJ AU - Bischof W LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 4 IP - DP - 2001 Jan 01 TI - Occupational asthma due to formaldehyde PG - 440-445 AU - Kim C AU - Song J AU - Ahn Y AU - Park S AU - Park J AU - Noh J AU - Hong C LA - PT - DEP - TA - Yonsei Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - IP - DP - 2001 Jan 01 TI - Effectiveness of medical surveillance program for the prevention of occupational asthma caused by platinum salts: a nested case-control study PG - 707-712 AU - Merget R AU - Caspari C AU - DierkesGlobisch A AU - Kulzer R AU - Breitstadt R AU - Kniffka A AU - Degens PO AU - SchultzeWerninghaus G LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 58 IP - DP - 2001 Jan 01 TI - Sensitisation to natural rubber latex: an epidemiological study of workers exposed during tapping and glove manufacture in Thailand PG - 386-391 AB - OBJECTIVES To estimate the prevalence of sensitisation to natural rubber latex in latex tappers and latex glove factory workers, and to relate this to airborne exposure to latex. METHODS Five hundred workers employed in three latex glove factories, 314 tappers, and 144 college students (control group) were studied. The workers in the glove factories were classified into three exposure groups; high, moderate, and low. Personal exposures to natural rubber latex aeroallergens were measured by immunoassay. Symptom questionnaires and skin prick tests with latex allergens (Stallergènes 1:200 w/v) and other common environmental allergens were performed. The criterion for positivity was a wheal reaction at least 3 mm in diameter greater than that to a diluent control. RESULTS The geometric mean (GM) concentration of latex in air was 15.4 µg/m3 for those employed in glove stripping, glove inspections, and packing of powdered gloves. The moderate exposure glove manufacturing group and the tappers had GM concentrations of 2.3 and 2.4 µg/m3 respectively, compared with United Kingdom users of latex powdered gloves,who had GM concentrations of 0.5 µg/m3. The prevalence of sensitisation to latex in the tappers and latex glove factory workers was 1.3% and 1.7% respectively. No positive cases were found among the college students. Workers who showed a positive skin prick test to latex were more likely to be atopic. Work related respiratory and dermatological symptoms were found in about 20% of each population studied, but were not related to the presence of positive latex prick tests. CONCLUSIONS This study suggests that in the Thai latex industries, latex sensitisation is rare despite high concentrations of airborne exposure and is less prevalent than in the healthcare sector in Europe where skin exposure is greater. AU - Chaiear N AU - Sadra S AU - Jones M AU - Cullinan P AU - Foulds IS AU - Burge PS LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 51 IP - DP - 2001 Jan 01 TI - Respiratory disorders and allergies in tea packers PG - 259-265 AB - The aim of this study was to determine whether respiratory symptoms or cross-shift declines in lung function were related to occupational exposure to tea dust. A cross-sectional epidemiological study was conducted at a tea-packing plant. Subjects completed a questionnaire, spirometry before and after a full work shift, skin prick testing and venipuncture. Among the 83% of the workers at the site who participated, the prevalences of asthma, wheezing, hay fever and atopy were similar to the general population. Work-related nasal symptoms were more commonly reported by blenders and operators. There were six (3.2%) subjects with a cross-shift decline in the forced expiratory volume in 1 s of > 10%. Specific immunoglobulin E antibodies to black or chamomile tea were observed in 10 (5.6%) employees. As there was little evidence of specific allergic sensitization to the tea varieties tested, the excess of work-related respiratory and nasal symptoms probably represented non-specific irritation. AU - Abramson MJ AU - Sim MR AU - Fritschi L AU - Vincent T AU - Benke G AU - Rolland JM LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 8(2) IP - DP - 2001 Jan 01 TI - Response of herb processing workers to work-related airborne allergens PG - 275-83 AU - Dutkiewicz J AU - Skórska C AU - Milanowski J AU - Mackiewicz B AU - Krysinska-Traczyk E AU - Dutkiewicz E AU - Matuszyk A AU - Sitkowska J AU - Golec M LA - PT - DEP - TA - Ann Agric Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 8(2) IP - DP - 2001 Jan 01 TI - Exposure to airborne microorganisms and endotoxin in herb processing plants PG - 201-11 AU - Dutkiewicz J AU - Krysinska-Traczyk E AU - Skórska C AU - Sitkowska J AU - Prazmo Z AU - Golec M LA - PT - DEP - TA - Ann Agric Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 107 IP - DP - 2001 Jan 01 TI - Incidence of sensitization, symptoms, and probable occupational rhinoconjunctivitis and asthma in apprentices starting exposure to latex PG - 921-923 AB - Latex is a well-known sensitizer. Prospective studies in apprentices beginning to be exposed to latex have not been carried out. We wanted to determine the incidence of skin reactivity, cutaneous symptoms, rhinoconjunctivitis (RC) symptoms, respiratory symptoms, probable occupational RC, and asthma in apprentices in dental hygiene. A total of 122 students starting a program in dental hygiene technology were recruited between 1993 and 1995. A questionnaire, skin-prick tests with common aeroallergens and latex, and assessment of spirometry and responsiveness to methacholine were carried out on entry and at follow-up visits at 20 and 32 months after the start of exposure. Of the 110 subjects who participated for at least 1 follow-up visit, skin reactivity to latex developed in 7. Cutaneous symptoms developed in 6 of the 7, RC symptoms developed in 2, and respiratory symptoms developed in 1. Five of the 7 subjects had significant changes in methacholine responsiveness and fulfilled the definition of probable occupational asthma. Sensitized subjects were more likely to be atopic and to have a previous history of asthma and respiratory symptoms on exercise than were nonsensitized subjects. Three subjects at the 20-month assessment and 4 subjects at the 32-month visit showed skin reactivity. The cumulative incidences for skin sensitization, probable occupational RC, and occupational asthma to latex were 6.4%, 1.8%, and 4.5%, respectively. (J Allergy Clin Immunol 2001;107:921-3.) AU - Archambault S AU - Malo J-L AU - Infante-Rivard C AU - Ghezzo H AU - Gautrin D LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 58 IP - DP - 2001 Jan 01 TI - Occupational seafood allergy: a review PG - 553-562 AB - BACKGROUND: Recent years have seen increased levels of production and consumption of seafood, leading to more frequent reporting of allergic reactions in occupational and domestic settings. This review focuses on occupational allergy in the fishing and seafood processing industry. REVIEW: Workers involved in either manual or automated processing of crabs, prawns, mussels, fish, and fishmeal production are commonly exposed to various constituents of seafood. Aerosolisation of seafood and cooking fluid during processing are potential occupational situations that could result in sensitisation through inhalation. There is great variability of aerosol exposure within and among various jobs with reported allergen concentrations ranging from 0.001 to 5.061(microg/m(3)). Occupational dermal exposure occurs as a result of unprotected handling of seafood and its byproducts. Occupational allergies have been reported in workers exposed to arthropods (crustaceans), molluscs, pisces (bony fish) and other agents derived from seafood. The prevalence of occupational asthma ranges from 7% to 36%, and for occupational protein contact dermatitis, from 3% to 11%. These health outcomes are mainly due to high molecular weight proteins in seafood causing an IgE mediated response. Cross reactivity between various species within a major seafood grouping also occurs. Limited evidence from dose-response relations indicate that development of symptoms is related to duration or intensity of exposure. The evidence for atopy as a risk factor for occupational sensitisation and asthma is supportive, whereas evidence for cigarette smoking is limited. Disruption of the intact skin barrier seems to be an important added risk factor for occupational protein contact dermatitis. CONCLUSION: The range of allergic disease associated with occupational exposure to crab is well characterised, whereas for other seafood agents the evidence is somewhat limited. There is a need for further epidemiological studies to better characterise this risk. More detailed characterisation of specific protein antigens in aerosols and associated establishment of dose-response relations for acute and chronic exposure to seafood; the respective roles of skin contact and inhalational exposure in allergic sensitisation and cross reactivity; and the contribution of host associated factors in the development of occupational seafood allergies are important areas for future research AU - Jeebhay MF AU - Robins TG AU - Lehrer SB AU - Lopata AL LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 35 IP - DP - 2001 Jan 01 TI - Evaluation of individually ventilated cage systems for laboratory rodents: occupational health aspects PG - 42-50 AB - New ventilated caging systems for laboratory animals were compared with conventional caging regarding allergen distribution, ergonomic suitability, cage environment and animal welfare. This paper presents occupational health evaluations. Mice were placed in individually ventilated cage (IVC) systems, a ventilated cabinet, and in cages on open shelves (conventional husbandry). The IVC systems were studied at negative and positive airflow. Aeroallergens were sampled on filters (n = 204, including controls) in undisturbed rooms and during cage changing. Concentrations of mouse urinary allergen (Mus m 1) in filter eluates were measured using sandwich ELISA. An ergonomic evaluation was performed with measurement of traction forces. Staff exposure during cage changing was high in all systems, range 116-4430 ng Mus m 1/m3. In undisturbed animal rooms, allergen levels were orders of magnitude higher when using conventional caging compared with ventilated systems; P < 0.001. At positive pressure both IVCs leaked allergen (median Mus m 1 concentration was < 0.08 ng/m3 at negative, but 6.5 ng/m3 (IVC1) and 0.8 ng/m3 (IVC2S) at positive pressure). The IVC systems had ergonomic disadvantages compared with the conventional husbandry and the ventilated cabinet, for instance with cages in unsuitable working heights. Ventilated husbandry solutions reduce levels of airborne allergen substantially at negative pressure, but are ergonomically less suitable. To prevent allergen exposure during cage changing, we propose that this procedure should be performed under ventilated conditions. Producers and users must cooperate in optimizing animal caging systems for both animals and staff. AU - Renström A AU - Björing G AU - Höglund AU LA - PT - DEP - TA - Lab Animal JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 107 IP - DP - 2001 Jan 01 TI - Occupational asthma caused by IgE-mediated reactivity to Antiaris wood dust PG - 554-556 AB - AU - Higuero NC AU - Zabala BB AU - Villamuza YG AU - Gómez CM AU - de Gregorio AM AU - Sanchez CS LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 163 IP - DP - 2001 Jan 01 TI - Major histocompatibility complex and tumor necrosis factor-alpha polymorphisms in pigeon breeder's disease. PG - 1528-1533 AB - Pigeon breeders disease (PBD) is caused by the exposure of a susceptible host to avian antigens. However, genetic factors determining individual predisposition are unknown. In this work, polymorphisms of the major histocompatibility complex (MHC) class II alleles and tumor necrosis factor alpha (TNF- a ) promoter were evaluated in 44 patients with PBD, 99 healthy unrelated controls (HC), and 50 exposed but asymptomatic subjects (EAS). MHC typing was performed by PCR-specific sequence oligonucleotide analysis, and TNF- a polymorphism at - 238 and - 308 positions by amplification refractory mutation system-PCR. PBD patients showed a significant increase of the alleles HLA-DRB1*1305 (p < 0.001, OR = 15.4, 95% CI = 3.18–102.6 [HC], and OR = 17.05, 95% CI = 2.25–357.8 [EAS]) and HLA-DQB1*0501 (p < 0.05, OR = 2.93, 95% CI = 1.21–7.15 [HC], and OR = 2.96, 95% CI = 1.0–9.14 [EAS]). A decrease of HLA-DRB1*0802 was also noticed in patients when compared with both control groups (p < 0.05). Haplotype analysis revealed an increase of DRB1*1305–DQB1*0301 and a decrease of DRB1*0802–DQB1*0402. PBD patients had an increased frequency of TNF-2-308 compared with both control groups (p < 0.05). Patients exhibiting the TNF-2-308 allele were younger (33.9 ± 14.6 versus 44.2 ± 10.4 yr; p < 0.05), and displayed more lymphocytes in their bronchoalveolar lavages (88.0 ± 12.1 versus 68.9 ± 17.2; p < 0.05). These results suggest that genetic factors located within the MHC region contribute to the development of PBD. AU - Camarena A AU - Juárez A AU - Mejía M AU - Estrada A AU - Carrillo G AU - Falfán R AU - Zuñiga J AU - Navarro C AU - Granados J AU - Selman M. LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 42 IP - DP - 2001 Jan 01 TI - Controlling Exposure to Laboratory Animal Allergens PG - 17-36 AB - Laboratory animal allergy (LAA) is a significant occupational disease that may affect up to one third of personnel exposed to laboratory animals. Research has characterized the relative risks of exposure in terms of intensity, frequency, and duration associated with given tasks and work areas in the animal facility. Studies have shown that reduced exposure to animal allergens can reduce the incidence of LAA and relieve symptoms among affected workers. A combination of measures to eliminate or control allergen exposure, including engineering and administrative controls and personal protective equipment, have been integral components of effective LAA management programs. This article provides a comprehensive review of exposure control options, considerations, and “best practices” relative to laboratory animal allergen in the context of traditional industrial hygiene methods. AU - Harrison DJ LA - PT - DEP - TA - ILAR Journal JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 125 IP - DP - 2001 Jan 01 TI - Purification of the Major Allergen of Red Soft Coral (Dendronephthya nipponica) PG - 135-143 AB - Red soft coral (RSC; Dendronephthya nipponica, a marine coelenterate) causes spiny lobster fishermen living along the Pacific coast of Miyazaki Prefecture in Japan to develop occupational allergies, such as conjunctivitis, rhinitis, dermatitis and bronchial asthma. The aim of this study was to purify and to characterize RSC allergen, which causes occupational asthma in spiny lobster fishermen. The allergic responsiveness of spiny lobster fishermen to RSC was examined. The examinations included specific IgE production, skin test responses, lymphocyte stimulation tests and specific IgG production. We found that RSC has a strong sensitizing activity in humans at a molecular weight of 10 kD or more, while it has no IgE-producing activity at a molecular weight of less than 10 kD. Neither the nonatopic controls nor the atopic non-coral-allergic controls exhibited any RAST-binding activity to any fraction. For the purification and the identification of this new allergen component, repeated gel filtration of the RSC extract was performed on a Sephacryl S-200 column, followed by gel filtration on a Superose-6 column. The purified major allergen component Den n 1, which is separated on a Mono-Q column, showed intradermal responses, lymphocyte stimulating activity and specific IgG-producing activity in RSC-induced bronchial asthma patients. The 53-kD component was electroblotted on a polyvinylidene difluoride membrane. The N-terminal amino acid sequence of this new allergen component (Den n 1) was determined as Asp-Asp-Ile-Asn-Arg-Tyr-Ala-Phe-Asp-Asn-Lys-Ile-Asn- Asp-Lys-Leu-Phe-Asp-His-Trp-Gln-Ser. AU - Onizuka R AU - Kamiya H AU - Muramoto K AU - Goto R AU - Inoue K AU - Kumamoto K AU - Nakajima Y AU - Iida S AU - Ishigami F LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 120 IP - DP - 2001 Jan 01 TI - Bal Abnormalities and respiratory symptoms in molybdenum exposed hard-metal workers PG - nr 4 (suppl) AB - Introduction A group of hard-metal dust exposed workers suffer from cough and chest thightness without any signs of respiratory disease found in common occupational screening programs. The aim of the study was to detect an early adverse effect of chronic inhalative molybdenum and hard-metal dust exposure in those workers. Patients 43 employees of a hard metal plant, chronically exposed to hard-metal and molybdenum dusts and 23 healthy individuals without inhalative exposure were examined. Among the workers, 33 were suffering from cough and chest thightness whereas 10 were not symptomatic. Methods Chest X-rays were seen by two independent pulmologists. Spirometry was performed on a Jaeger spirometer. Bronchoalveolar Lavage cells were spun into slices and stained May-Gruenwald-Giemsa Inhalative exposure was confirmed by electron mycroscopy of BAL fluid. A higher percentage count of macrophages correlated with a decrease of carbon monoxyde transfer coefficient (KCO) (r=0.58, p<0.01). None of the investigated individuals showed firm radiological signs of interstitial lung disease Conclusion Chronic hard-metal and molybdenum dust exposure causes respiratory symptoms and a relative increase in inflammatory BAL cells in a subgroup of employees with no functional and radiological signs of respiratory disease. The cellular patterns we found in BAL in the group of symptomatic workers are similar to those found in patients suffering from interstitial lung disease, but of a more moderate extent. Respiratory symptoms in "healthy" workers are related to a change of BAL cellular patterns and therefore have to be considered as an indicator for an early adverse effect. AU - Ott HC AU - Prior C AU - Herold M AU - Riha M AU - Ott G LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 120 IP - DP - 2001 Jan 01 TI - Serum concentrations of ACE, Neopterin, TNF-a and SIL-2 R in healthy workers exposed to different metal dusts PG - nr 4 (suppl) AB - Introduction Chronic lead and hard-metal exposure can cause severe occupational lung disease. The aim of the study was to detect early adverse effects of chronic inhalative metal dust and fume exposure by measurement of different serum markers. Patients 155 healthy employees of a glass manufacturer company, a hard-metal plant, a tool manufacturer company and a biochemical plant were examined: 57 workers exposed to lead dust and fumes 38 workers exposed to hard-metal dust 14 workers exposed to molybdenum dust and fumes 17 workers exposed to hard-metal grinding-coolant aerosol 29 workers exposed to organic dust Methods Blood samples were collected during a routine medical check up, the serum was separated and the serum probes were kept frozen auntil further analysis. Serum concentrations were determined using commercially available enzyme assays Lead exposure triggers sIL-2R and TNF-a release. Hard-metal exposure induces TNF-a release. Grinding-coolant exposure induces TNF-a and neopterin release. Molybdenum exposure causes Neopterin release. Conclusion Each of the studied inhalative exposures seemes to induce a characteristic cytokine pattern and therefore a specific inflammatory answer. This can be considered as an early adverse effect. Increased levels of the serum markers measured in this study are a common finding in patients suffering from active interstitial lung disease. Wether our observations highlight an ongoing disease or indicate only a physiological reaction remains unclear. AU - Ott HC AU - Prior C AU - Herold M AU - Riha M AU - Ott G LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 56 IP - DP - 2001 Jan 01 TI - Oilseed rape flour: another allergen causing occupational asthma among farmers PG - 185-188 AB - Background: Farmers are exposed to a wide variety of sensitizers. Since occupational asthma (OA) can lead to permanent disability, exposure discontinuation is the preferred treatment. When this is not possible, the identification of the causative allergen may allow an alternative therapy. Methods: We present three farmers diagnosed with OA as a consequence of handling fodder. We carried out skin tests with common and occupational allergens and with oilseed rape (OSR) extract. Total and specific serum IgE levels were measured. The patients underwent the OSR-bronchial provocation test (OSR-BPT). The day before and 24 h after the OSR-BPT, the methacholine (M)-BPT and induced sputum were performed. Eosinophil percentages and ECP levels were measured in the sputum samples. Results: OSR sensitization (skin tests and specific serum IgE) was detected in all the patients. The OSR-BPT elicited early responses in two subjects. Methacholine sensitivity, sputum eosinophils, and sputum ECP levels increased 24 h after the OSR-BPT in all the patients. Conclusions: We have demonstrated that inhalation of OSR flour causes bronchoconstriction, induces an eosinophilic inflammatory bronchial response, and increases bronchial hyperresponsiveness in sensitized asthmatics. OSR flour contained in animal fodder should be considered another potential cause of OA among farmers. AU - Alvarez MJ AU - Estrada JL AU - Gozalo F AU - Fernandez-Rojo F AU - Barber D LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 164 IP - DP - 2001 Jan 01 TI - Work Is Related to a Substantial Portion of Adult-onset Asthma Incidence in the Finnish Population PG - 565-568 AB - There are no population-based follow-up studies to estimate the fraction of asthma incidence that is attributable to work. In Finland, individuals with clinically well-established persistent asthma are registered for reimbursement of medication from the national health insurance scheme. We combined, at an individual level, these data with the population census data of 1985, 1990, and 1995 to estimate the attributable fraction of work in adult-onset persistent asthma. Our follow-up study covered the entire 25- to 59-yr-old employed population of Finland in 1986–1998. Relative risks (RR) for occupational categories were estimated in comparison to those employed in administrative work. There were 49,575 incident cases of asthma. The attributable fraction of occupation was 29% (95% CI 25–33%) for men and 17% (95% CI 15–19%) for women. The risk was increased especially in agricultural work, manufacturing work, and service work. In addition to already established risk occupations of occupational asthma, such as food and beverage work, the analysis identified a large number of occupations with significant excess of asthma incidence. The results indicate that the impact of occupational factors in the inception of adult-onset persistent asthma, and consequently the potential for prevention, is much larger and more widely spread than generally assumed. AU - KARJALAINEN A AU - KURPPA K AU - MARTIKAINEN R AU - KLAUKKA T AU - KARJALAINEN J LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 17 IP - DP - 2001 Jan 01 TI - Diesel exhaust enhances airway responsiveness in asthmatic subjects PG - 909-915 AB - Particulate matter (PM) pollution has been associated with negative health effects, including exacerbations of asthma following exposure to PM peaks. The aim of the present study was to investigate the effects of short-term exposure to diesel exhaust (DE) in asthmatics, by specifically addressing the effects on airway hyperresponsiveness, lung function and airway inflammation. Fourteen nonsmoking, atopic asthmatics with stable disease, on continuous treatment with inhaled corticosteroids, were included. All were hyperresponsive to methacholine. Each subject was exposed to DE (particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10) 300 microg x m(-3)) and air during 1 h on two separate occasions. Lung function was measured before and immediately after the exposures. Sputum induction was performed 6 h, and methacholine inhalation test 24 h, after each exposure. Exposure to DE was associated with a significant increase in the degree of hyperresponsiveness, as compared to after air, of 0.97 doubling concentrations at 24 h after exposure (p < 0.001). DE also induced a significant increase in airway resistance (p=0.004) and in sputum levels of interleukin (IL)-6 (p=0.048). No changes were detected in sputum levels of methyl-histamine, eosinophil cationic protein, myeloperoxidase and IL-8. This study indicated that short-term exposure to diesel exhaust, equal to high ambient levels of particulate matter, is associated with adverse effects in asthmatic airways, even in the presence of inhaled corticosteroid therapy. The increase in airway responsiveness may provide an important link to epidemiological findings of exacerbations of asthma following exposure to particulate matter. AU - Nordenhäll C AU - Pourazar J AU - Ledin MC AU - Levin JO AU - Sandström T AU - Adelroth E LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 17 IP - DP - 2001 Jan 01 TI - Respiratory symptoms in European animal farmers PG - 747-754 AB - Farmers are known to be at high risk for the development of occupational airway disease. The aim of this European study was to determine which airway symptoms predominate in different types of animal farmers (cattle, pigs, poultry, sheep) and to compare the prevalence of symptoms to the general population. A total of 6,156 randomly selected animal farmers in Denmark, Germany (Schleswig-Holstein, Niedersachsen), Switzerland, and Spain completed a questionnaire on respiratory symptoms and farming characteristics in 1995-1997. The prevalence of general respiratory symptoms was compared to the results of the European Community Respiratory Health Survey (ECRHS) obtained in the same regions. Pig farmers were at highest risk for the development of work-related symptoms. A significant dose-response relationship between daily hours worked inside animal houses and symptoms was established for pig and poultry farmers. Additionally, self-reported nasal allergies (odds ratio (95% confidence interval): 3.92 (3.26-4.71)) and nasal irritation during work (3.98 (3.35-4.73)) were shown to be associated with the development of chronic phlegm. The prevalence of wheezing, shortness of breath, asthma and nasal allergies was signficantly lower among all farmers in the age group 20-44 yrs than among the general population. However, the prevalence of usually bringing up phlegm in winter among farmers was significantly higher than in the general population (9.4 (8.3-10.5%) versus 7.5 (6.5-8.5%)). Individual factors have been shown to be related to the prevalence of chronic phlegm among farmers. Additionally, this study could support the hypothesis that farming could be negatively related to allergic diseases. AU - Radon K AU - Danuser B AU - Iversen M AU - Jorres R AU - Monso E AU - Opravil U AU - Weber C AU - Donham KJ AU - Nowak D LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 405-410 IP - DP - 2001 Jan 01 TI - Exposure assessment and lung function in pig and poultry farmers PG - 405-410 AB - OBJECTIVES: To describe the relation between spirometric findings and farming characteristics and variables of exposure to organic dust measured during work in animal buildings. Farmers have traditionally been described as having one of the most dangerous occupations, so a large scale study on European farmers was carried out. This is the report of the second part of that study. METHODS: 40 pig farmers in Denmark and 36 poultry farmers in Switzerland were chosen randomly and were assessed over 1 working day. RESULTS: Mean (SD) baseline spirometric results in pig farmers were higher than in poultry farmers (forced expiratory volume in 1 second (FEV(1)) (% of reference value) 108.3 (16.7) v 100.2 (14.2); p=0.04). Baseline lung function results were significantly associated with ventilation of the animal houses. Furthermore, temperature was related to spirometric findings in pig farmers. CONCLUSIONS: Ventilation of the animal house and temperature might influence respiratory morbidity in farmers. AU - Radon K AU - Weber C AU - Iversen M AU - Danuser B AU - Pedersen S AU - Nowak D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 39 IP - DP - 2001 Jan 01 TI - Respiratory symptoms in Swiss farmers: an epidemiological study of risk factors PG - 410-418 AB - BACKGROUND: The study was undertaken to assess the prevalence and risk factors of self-reported asthma, symptoms of chronic bronchitis, hay fever, and work-related respiratory symptoms in Swiss farmers as well as to compare the prevalence rates of respiratory symptoms with the Swiss population (SAPALDIA-Study). METHODS: An epidemiological study was performed with a representative sample of 1,542 Swiss farmers using a self-administered questionnaire. To investigate the effect of the type of farming on reported symptoms, the farmers were subdivided into seven groups according to the time farmers spent in different animal confinement buildings. A multivariate analysis was performed by the methods of binary and multivariate logistic regression adjusted for age and smoking habits. RESULTS: In farmers the prevalence rate was 16.0% for chronic bronchitis, 15.4% for asthma symptoms, and 42.0% for reporting at least one work-related symptom. Using logistic regression analysis, it was established that poultry farming and pig/cattle farming was a risk factor for reporting nasal irritation at work [OR 5.33, (1.57-18.0), OR 3.37 (1.04-10.87)]. Poultry farmers experienced the highest symptom rates. In crop farmers, the prevalence for chronic bronchitis was increased [OR 2.32 (1.03-5.23)]. Over 4 hr spent per day in animal confinement buildings more than doubled the risk for reporting chronic bronchitis [OR 2.61 (1.01-6.76)] and phlegm [OR 2.3 (0.99-5.4)] independent of the type of farming. The comparison of Swiss farmers with the Swiss population showed a twofold elevated risk of reporting chronic bronchitis [OR 1.89 (1.32-2.95)] and a 4.5-fold elevated risk for bringing up phlegm regularly [OR 4.5 (3.25-6.69)] in farmers. In contrast, the risk of farmers to report nasal allergies was less than half as high [OR 0.40 (0.29-0.56)] as that of the general population. CONCLUSIONS: This study shows that agricultural work in Switzerland is associated with an elevated risk for reporting symptoms of chronic bronchitis and chronic phlegm compared with the general Swiss population. These main results most likely indicate occupational disorders as the exposure-response relationship (hours spent in animal confinements) was particularly obvious for these symptoms. AU - Danuser B AU - Weber C AU - Kunzli N AU - Schindler C AU - Nowak D LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 16 IP - DP - 2001 Jan 01 TI - Endotoxin exposures during potato processing PG - 1079-1087 AB - AU - Ewers LM AU - Tapp LC LA - PT - DEP - TA - Appl Occup Environ Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 31 IP - DP - 2001 Jan 01 TI - The worldwide problem of occupational asthma PG - 1-4 AU - Hendrick DJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 108 IP - DP - 2001 Jan 01 TI - Outcomes of a natural rubber latex control program in an Ontario teaching hospital PG - 623-633 AB - BACKGROUND Allergy to natural rubber latex (NRL) has been frequently reported in health care workers. However, there is little published evidence of the outcome of hospital intervention programs to reduce exposure and detect cases of sensitization early. OBJECTIVE This study assesses the effects of intervention to reduce NRL allergy in an Ontario teaching hospital with approximately 8000 employees. METHODS A retrospective review assessed annual numbers of employees visiting the occupational health clinic, allergy clinic, or both for manifestations of NRL allergy compared with the timing of introduction of intervention strategies, such as worker education, voluntary medical surveillance, and hospital conversion to low-protein, powder-free NRL gloves. RESULTS The number of workers identified with NRL allergy rose annually, from 1 in 1988 to 6 in 1993. When worker education and voluntary medical surveillance were introduced in 1994, a further 25 workers were identified. Nonsterile gloves were changed to low-protein, powder-free NRL gloves in 1995: Diagnoses fell to 8 workers that year, and 2 of the 3 nurses who had been off work because of asthma-anaphylaxis were able to return to work with personal avoidance of NRL products. With a change to lower protein, powder-free NRL sterile gloves in 1997, allergy diagnoses fell to 3, and only 1 new case was identified subsequently up to May 1999. No increased glove costs were incurred as a result of consolidated glove purchases. CONCLUSIONS This program to reduce NRL allergy in employees was effectively achieved without additional glove costs while reducing expenses from time off work and workers' compensation claims. AU - Tarlo SM AU - Easty A AU - Eubanks K et al LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 107 IP - DP - 2001 Jan 01 TI - Occupational Asthma In Symptomatic Workers Exposed To Natural Rubber Latex: Evaluation Of Diagnostic Procedures PG - 542-547 AB - BACKGROUND Natural rubber latex (NRL) has been increasingly identified as a cause of occupational asthma (OA). OBJECTIVE We sought to examine the accuracy of the clinical history, immunologic tests, and assessment of nonspecific bronchial hyperresponsiveness in diagnosing OA caused by latex compared with that of the specific inhalation challenge (SIC). METHODS Forty-five consecutive patients referred for investigation of possible OA caused by latex underwent a diagnostic protocol, including an open medical questionnaire, skin prick testing against latex, measurement of bronchial responsiveness to histamine, and inhalation challenge with latex gloves. Recorded clinical history was judged retrospectively by 4 physicians who were blinded for the results of other objective tests. RESULTS The clinical history, skin prick testing against NRL, and assessment of nonspecific bronchial hyperresponsiveness showed a high sensitivity (87%, 100%, and 90%, respectively) but a low specificity (14%, 21%, and 7%, respectively) when compared with the results of the SIC. Logistic regression analysis showed that combining the results of skin prick tests against latex with the clinical history enhanced the negative predictive value from 50% to 71%, whereas the positive predictive value remained virtually unchanged (75% vs 76%). CONCLUSION The clinical history and immunologic tests were the most useful procedures in diagnosing NRL-induced asthma, although combining the 2 procedures remained less accurate than SIC. Further examination of the predictive values of available tests is warranted to recommend diagnostic strategies that are specific to the various agents causing OA. AU - Vandenplas O AU - BinardVanCangh F AU - Brumagne A et al LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 18 IP - DP - 2001 Jan 01 TI - Respiratory risk in carpenters and cabinet makers PG - 615-622 AU - LaraquiHossini CH AU - LaraquiHossini O AU - Rahhali AE AU - Verger C AU - Tripodi D AU - Caubet A AU - Curtes JP AU - AlaouiYazidi A LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 39 IP - DP - 2001 Jan 01 TI - Respiratory Symptoms Among Crab Processing Workers In Alaska: Epidemiological And Environmental Assessment PG - 598-607 AB - Background Crab processing workers may develop respiratory symptoms and specific IgE responses, but the risk factors have not been fully described. Methods In 1998, 107 workers at a crab processing facility completed a survey both at the beginning and end of the processing season. The surveys included standardized symptom questionnaires, spirometry, and serological testing, as well as measurement of workplace airborne crab allergens and microscopic analysis of aerosolized materials. Results Over the crab processing season, asthma-like symptoms developed in 26% of study participants and bronchitic symptoms in 19%. Only 9% of those with new asthma-like symptoms were IgE-sensitized to crab at the end of the season. Among the crab processing jobs, butchering and degilling workers had the highest incidence of respiratory symptoms. Conclusions Both personal and process-related factors appear to affect the development of respiratory symptoms in crab processing workers. In this study, crab specific IgE was not detected in most of the workers with new symptoms. AU - Ortega HG AU - Daroowalla F AU - Petsonk EL et al LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 27 IP - DP - 2001 Jan 01 TI - Exposure to hexahydrophthalic and methylhexahydrophthalic anhydrides--dose-response for sensitisation and airway effects PG - 327-334 AU - Nielsen J AU - Welinder H AU - Jonsson B et al LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 58 IP - DP - 2001 Jan 01 TI - Role of skin prick test and serological measurement of specific IgE in the diagnosis of occupational asthma resulting from exposure to vinyl sulphone reactive dyes PG - 411-416 AB - OBJECTIVES Some patients with occupational asthma resulting from exposure to reactive dyes have skin reactivity to the causative dyes and specific IgE to reactive dyes have been found in these patients. However, the usefulness of skin prick tests (SPTs) and serological measurement of specific IgE in screening, diagnosis, and monitoring the occupational asthma resulting from exposure to reactive dyes have not yet been assessed. In this study, the clinical validation of SPTs and measurement of specific IgE to vinyl sulphone reactive dyes by enzyme linked immunosorbent assay (ELISA) was evaluated. METHODS 42 Patients with occupational asthma from reactive dyes (true positive group) were enrolled. In these the causative reactive dye was confirmed by bronchial challenge test. 93 Asymptomatic factory workers with negative challenge to the reactive dye (true negative group) and 16 unexposed controls with negative challenge to the reactive dye were also enrolled. Skin prick tests were done with 10 mg/ml reactive dye in 0.4% phenol/0.9% saline. IgE specific to reactive dye conjugated to human serum albumin (HSA) was measured with enzyme linked immunosorbent assays (ELISAs). RESULTS None of the unexposed controls had a positive response to SPTs. The sensitivity (76.2% v 53.7%), specificity (91.4% v 86.0%), positive predictive value (80.0% v 62.9%), and negative predictive value (89.5% v 80.8%) of SPTs were higher than those of ELISAs. The mean weal size of reaction to reactive dye was weakly correlated with the ELISA optical density of IgE to reactive dye conjugate in patients with occupational asthma from reactive dyes (n=41, r=0.337, p<0.05). In four patients with occupational asthma from reactive dyes and eight control subjects exposed to reactive dye, IgE specific to reactive dye conjugated to HSA was detected with ELISA even though they showed negative skin reactivity. Six patients completely avoided the reactive dye for a mean (SD) 27.8 (10.3) months, IgE specific to reactive dyes decreased in all six patients (p<0.05) during this time. CONCLUSIONS Both SPTs and detection of IgE specific to reactive dye in serum samples could be valuable for screening, diagnosis, and monitoring occupational asthma resulting from exposure to reactive dyes. These two tests would complement each other. AU - Park JW AU - Kim CW AU - Kim KS et al LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 11 IP - DP - 2001 Jan 01 TI - Glutathione S-transferase genotypes and allergic responses to di-isocyanate exposure PG - 437-445 AU - Piirila P AU - Wikman H AU - Luukkonen R et al LA - PT - DEP - TA - Pharmacogenetics JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 39 IP - DP - 2001 Jan 01 TI - Subclinical Immunologic And Physiologic Responses In Hexamethylene Di-isocyanate - Exposed Auto Body Shop Workers PG - 587-597 AB - BACKGROUND Diisocyanates are potent sensitizing agents and currently the most commonly identified cause of occupational asthma in industrialized countries. However, diisocyanate asthma is difficult to diagnose and exposure and host risk factors are unclear. Auto body shops, one of the most common hexamethylene diisocyanate (HDI) exposure settings, are particularly difficult to study due to their small size and episodic exposures. Surveillance studies of such workers are limited. OBJECTIVES We have initiated a cross-sectional field epidemiologic study, Survey of Painters and Repairers of Auto bodies by Yale (SPRAY), to characterize the effects of diisocyanate exposures on actively employed auto body shop workers. Methods and Results We present here questionnaire, physiologic, immunologic, and exposure data on 75 subjects enrolled in the study. No overt cases of clinically apparent diisocyanate asthma were identified based on spirometry, methacholine challenge, peak flows, and symptoms. HDI-specific lymphocyte proliferation was present in 30% of HDI-exposed workers and HDI-specific IgG in 34% of HDI-exposed workers, but they were not associated. HDI-specific IgE was detected in two workers. HDI-specific lymphocyte proliferation, increased methacholine responsiveness, and symptoms of chest tightness and shortness of breath were more common in the most heavily HDI-exposed workers, the painters. More long-term follow-up of this cohort should clarify the significance of these HDI-specific immunologic responses, physiologic changes, and symptoms. CONCLUSIONS These findings demonstrate the presence of HDI-specific immune responses in a large proportion of healthy HDI-exposed workers. AU - Redlich CA AU - Stowe MH AU - Wisnewski AV et al LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 51 IP - DP - 2001 Jan 01 TI - SWORD 99: Surveillance Of Work-Related And Occupational Respiratory Disease In The UK PG - 204-208 AB - Systematic reports from chest and occupational physicians under the SWORD and OPRA (Occupational Physicians Reporting Activity) surveillance schemes continue to provide a picture of the incidence of occupational respiratory disease in the UK. An estimated total of 4393 incident cases (comprising 4530 diagnoses) were reported during the 1999 calendar year, an increase of 1427 cases over the previous year. Benign pleural disease was the single most frequently reported condition (28% of all diagnoses reported). Occupational asthma cases (1168; 26%) remained high, as did mesothelioma (1032; 23%). Analysis of trends over the past 8 years shows an increase in mesothelioma cases, but little change in asthma. The annual incidence per 100 000 employed people, 1996–1999, for mesothelioma, lung cancer and pneumoconiosis was high amongst construction workers (28.7), miners and quarrymen (26.5), woodworkers (18.9) and gas, coal and chemical workers (15.2). Trends in mesothelioma incidence by birth cohort continue to show an increase in construction workers and a continuing decline in shipyard and insulation workers. The relative proportion of pneumoconiosis cases attributed to coal mining has fallen steadily in workers born since 1920 and most cases are now in men who have been employed in quarrying and rock drilling. AU - Meyer JD AU - Holt DL AU - Chen Y AU - Cherry NM AU - McDonald J C LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 45 IP - DP - 2001 Jan 01 TI - An exploratory quantitative risk assessment for high molecular weight sensitizers: wheat flour PG - 175-185 AB - Objective Quantitative risk assessments have been made for wheat dust and allergen exposure and wheat sensitization using classical epidemiological approaches based on simple categorizations in exposure groups. Such analyses suggest the existence of an exposure threshold level for wheat specific sensitization and were used as input in recently conducted risk assessments for wheat flour by the American Conference of Governmental Industrial Hygienists and the Dutch Expert Committee on Occupational Standards. More advanced statistical analyses were applied using generalized additive modeling and smoothed plots to evaluate the shape of the exposure response relationship in greater detail and evaluate the presence of exposure thresholds. Methods Data were used from a recently conducted epidemiological study in bakery workers. Information was available on wheat sensitization (IgE antibodies), inhalable dust levels and wheat allergen levels. Initial analyses were based on simple exposure categorizations for inhalable dust and allergen exposure. A more detailed analysis using non-parametric generalized additive models (GAM models) and smoothing plots allowed inspection of the presence of an exposure threshold of evaluation of ‘no’ or ‘lowest observed effect levels’ (NOELs, LOELs) using exposure data on the individual level. Results All analyses showed an increasing sensitization risk with increasing exposure. The classical epidemiological analyses gave evidence for the existence of an exposure threshold or ‘no observed effect level (NOEL)’ for specific wheat sensitization between 0.5 and 1 mg/m3 of inhalable dust. The more advanced analyses did not suggest any evidence for the existence of an exposure threshold. However, estimates of a LOEL obtained by considering an arbitrary increase in sensitization risk between 1.5 and 2 as undesirable, were close to the NOEL from the classical analyses and would therefore not lead to an essentially different exposure limit. The criterion of an increase in wheat sensitization risk was based on the risk in non-wheat dust exposed populations. Conclusion Exposure response modeling using different classical epidemiological approaches and advanced statistical methods resulted in health based LOEL or NOEL estimates within a relatively close range. But when sensitization accompanied by asthma or rhinitis symptoms was considered as critical endpoint, steeper exposure–response relationships were observed which would lead to lower LOEL values. AU - Heederik D AU - Houba R LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 31 IP - DP - 2001 Jan 01 TI - Occupational Asthma As Identified By The Surveillance Of Work-Related And Occupational Respiratory Diseases Programme In South Africa PG - 32-39 AB - BACKGROUND The nationwide Surveillance of Work-related and Occupational Respiratory Diseases in South Africa, SORDSA, was established in 1996 to provide systematic information on occupational respiratory diseases. OBJECTIVE SORDSA's objectives are to monitor the nature, extent and distribution of occupational respiratory diseases, and to increase awareness of their diagnosis and prevention. This paper describes the programme and results obtained for occupational asthma in the first 2 years, ending in October 1998. METHODS SORDSA identifies newly diagnosed cases of occupational respiratory disease through voluntary reporting by pulmonologists, occupational medicine doctors and occupational health nurses. Initially, recruitment of the above health care providers was done through the membership infrastructure of their respective professional societies. Booklets with prescribed monthly reporting forms were distributed annually to all reporting members and a core of reporting providers was established through a proactive method of data collection. Information dissemination and reporting feedback takes place through quarterly newsletters and issue-specific brochures on certain hazardous agents. RESULTS Over the initial 2-year period, 3285 cases of occupational respiratory disease were reported to SORDSA by 203 doctors and 97 occupational health nurses. After pneumoconiosis and associated respiratory conditions, occupational asthma was the second most commonly reported disease with 225 cases (6.9%). The average annual incidence for occupational asthma in South Africa was 13.1 per million employed people, with the highest incidence reported from the Western Cape province (37.6 per million). Latex was the most frequently reported agent for occupational asthma, followed by isocyanates and platinum salts. Low molecular weight agents accounted for 59.6% of the cases of occupational asthma. CONCLUSION The results from this initial phase show that despite some limitations, SORDSA has the potential to obtain useful data on the industries, agents and occupations causing occupational asthma in South Africa. AU - Hnizdo E AU - Esterhuizen TM LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 42 IP - DP - 2001 Jan 01 TI - Occupational asthma in Singapore PG - 373-377 AB - Aim Since the first notified case of occupational asthma in 1983, a total of 90 cases were confirmed as on 31st December 1999. In this study, demographic data, causative agents and impact on the workers were described. Methods The data was derived from notifications to the Ministry of Manpower and referrals to the Occupational Lung Disease Clinic jointly run with Department of Respiratory Medicine, Tan Tock Seng Hospital. Results Of the 90 cases, 19 (21%) were females and 71 (79%) were males. There were 48 (53%) Chinese, 22 (24%) Malays, 14 (16%) Indians and 6 (7%) of other ethnic origins. The mean age at diagnosis was 35.8 ± 9.3 yrs. The mean duration of exposure prior to onset of symptoms was 34.9 ± 57.3 months. The most common causative agent was isocyanates (28 cases, 31%) followed by solder flux (12 cases, 13%) and welding fumes (8 cases, 9%) respectively. Thirteen (14.4%) workers were assessed to have permanent disability under the Workmen’s Compensation Act. Conclusions Since 1990, occupational asthma has overtaken silicosis and asbestosis as the most common occupational lung disease in Singapore. The most common causative agent is isocyanates. Occupational asthma is a condition associated with disability in the workplace and may still be largely under-reported. AU - Kor A C AU - Lee HS AU - Chee C B et al LA - PT - DEP - TA - Singapore Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 56 IP - DP - 2001 Jan 01 TI - Improved Analysis Of Serial Peak Expiratory Flow In Suspected Occupational Asthma PG - 281-288 AB - Serial peak expiratory flow (PEF) records are useful for the screening and diagnosis of patients with occupational asthma. We have presented work on a method based on linear discriminant analysis (OASYS-2) and have now tried to improve on this technique and investigate the repeatabilities of expert interpretation. 268 serial PEF records made by workers with possible occupational asthma were divided into four sets. The first two were development sets; development set 1 was used to develop a discriminant analysis to match the human expert, who scored each complex (a sequence of work days, then rest days, then work days, or its counterpart: rest-work-rest) for its likelihood of having a work-related effect. This was modelled using 729 new measurements from each complex, together with the 50 measurements originally used in the development of OASYS-2. Linear discriminant analysis is a statistical technique which can refine from a large number of indices a narrower range that best predict a known outcome. Combinations of these indices are weighted and used to assign outcomes for novel cases. Models were produced containing a combination of measurements that generated scores best matching the expert. Development set 2 was used to test the model. Sets 3 and 4 were "gold standard" sets where the diagnosis had been made independently of the PEF record. Set 3 was used to set the cut-off for an occupational effect, the sensitivity and specificity for the combined model was determined from the fourth (gold standard) set. The fourth set was also used to determine the sensitivity and specificity of (OASYS-2) and the human expert. The repeatability of the human expert re-scoring the same complexes had a weighted kappa score of 0.71. OASYS-3 was "100%" repeatable. Comparing the scores awarded to whole records by the new (OASYS-3) and OASYS-2 analysis methods with the scores awarded by the human expert revealed mean (95% CI) differences of -0.28 (0.30, -0.26) and -0.34 (-0.37, -0.31) respectively. Hence both OASYS-3 and OASYS-2 tended to score records less positively for work-related changes in PEF than the expert. OASYS-3 scored complexes marginally better than OASYS-2. The sensitivity of OASYS-3 was better than OASYS-2 (82% and 75% respectively) for an equivalent specificity (94%). The sensitivity of the human expert was "100%" with a specificity of 93%. OASYS-3 provides an objective method of interpreting serial peak flow records with a sensitivity and specificity approaching that of a human expert and is a modest improvement on OASYS-2. AU - Bright P AU - Newton DT AU - Gannon PF et al LA - PT - DEP - TA - Monaldi Arch Chest Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 163 IP - DP - 2001 Jan 01 TI - Incidence and host determinants of probable occupational asthma in apprentices exposed to laboratory animals PG - 899-904 AB - Laboratory animal (LA) workers are frequently affected with allergic sensitization and occupational asthma (OA). The role of preexposure host factors, in particular airway responsiveness, on the incidence of OA has not been satisfactorily studied. A prospective cohort study of 417 apprentices in animal-health technology was conducted to investigate the incidence and determinants of probable OA. Questionnaire and skin-prick tests with common and work-specific allergens were administered on entry and at follow-up visits (up to three) from 8 to 44 mo after starting apprenticeship. Responsiveness to inhaled methacholine was assessed at baseline and at follow-up in apprentices who developed a new specific skin sensitization and in control subjects. Preexposure host characteristics and the school attended were compared between cases and all cohort subjects not meeting the criteria for probable OA. Twenty-eight apprentices satisfied the definition for probable OA, i.e., onset of immediate skin reactivity to > 1 occupational inhalant and > 3.2-fold decrease in the provocative concentration causing a 20% reduction in FEV1 (PC20). The incidence of probable OA was 2.7% (28/1,043 person-years). Baseline immediate skin reactivity to pets (rate ratio [RR] 4.1, 95% confidence interval [CI] = 1.6 to 10.8), and bronchial responsiveness (PC20 <= 32 versus PC20 > 32 mg/ ml) (RR = 2.5, 95% CI = 1.0 to 5.8) were associated with an increased risk of probable OA; a lower FEV1 had an apparent, protective effect (RR = 0.58, 95% CI = 0.43 to 0.78). It is concluded that apprentices in animal health show a high incidence of probable OA, and that preexposure airway caliber and responsiveness as well as sensitization to pets are associated with an increased risk. AU - Gautrin D AU - InfanteRivard C AU - Ghezzo H et al LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 17 IP - DP - 2001 Jan 01 TI - Natural history of sensitisation, symptoms and occupational diseases in apprentices exposed to laboratory animals PG - 904-908 AB - The natural history of the development of sensitization and disease due to high-molecular-weight allergens is not well characterized. This study describes the time-course of the incidence of work-related symptoms, skin reactivity and occupational rhinoconjunctivitis (RC) and asthma (OA); and assesses the predictive value of skin testing and RC symptoms in apprentices exposed to laboratory animals, in a 3–4-yr programme. Four-hundred and seventeen apprentices at five institutions were assessed prospectively with questionnaire, skin-testing with animal-derived allergens, spirometry and airway responsiveness (n=373). Depending on the school, students were seen 8 (n=136), 20 (n=345), 32 (n=355) and 44 (n=98) months after starting the programme. At all visits, the incidence was greater for work-related RC symptoms followed in order by skin reactivity, occupational RC, and, almost equally, OA and work-related respiratory symptoms. The incidence-density figures were comparable for each follow-up period and for most indices up to 32 months after entry into the study and then tended to decrease. The positive predictive values (PPVs) of skin reactivity to work-related allergens for the development of work-related RC and respiratory symptoms were 30% and 9.0%, respectively, while the PPVs of work-related RC for the development of OA was 11.4%. Sensitization, symptoms and diseases occur maximally in the first 2–3 yrs after starting exposure to laboratory animals. Skin reactivity to work-related allergens and rhinoconjuctivitis symptoms have low positive predictive values. AU - Gautrin D AU - Ghezzo H AU - InfanteRivard C et al LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 23 IP - DP - 2001 Jan 01 TI - Allergopatie professionali respiratorie: l'esperienza delle Unita Operative Ospedaliere di Medicina del Lavoro in Lombardia dal 1990 al 1998. [Respiratory occupational allergies: the experience of the Hospital Operative Unit of Occupational Medicine in Lombardy from 1990 to 1998] PG - 64-70 AB - A retrospective study on occupational rhinitis and asthma diagnosed in 7 occupational health institutes in Lombardia (North-West Italy) was performed using a standardized card. 141 cases of rhinitis and 281 cases of asthma due to sensitization to occupational agents were analyzed and their clinical characteristics, aetiology, diagnostic methods and associated allergic diseases were determined. In this population the most frequent agents of occupational rhinitis were wheat flour and latex, whereas those of occupational asthma were latex and isocyanate. More than half of the subjects had more than one clinical manifestation of allergy. In 92 out of the 281 asthmatic patients rhinitis was the first clinical manifestation, particularly in subjects sensitized to high molecular weight substances, and preceded, asthma by 12 months as a mean. Specific bronchial provocation tests were useful for the diagnosis of asthma in 153 of the asthmatic patients and 45 of them had an isolated late bronchial reaction following the specific stimulus. At diagnosis 61 subjects (21.7%) had FEV1 < 80% of predicted; factors associated to ventilatory impairment were sensitization to high molecular weight substances, duration of exposure to the sensitizing agent, persistence of exposure after onset of symptoms. AU - Cortona G AU - Pisati G AU - Dellabianca A et al LA - PT - DEP - TA - G Ital Med Lav Ergon JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 45 IP - DP - 2001 Jan 01 TI - Allergen and dust exposure as determinants of work-related symptoms and sensitisation in a cohort of flour-exposed workers; A case-control analysis PG - 97-103 AB - Objectives To estimate the incidence of specific IgE sensitization and allergic respiratory symptoms among UK bakery and flour mill workers; and to examine the roles of flour aeroallergen and total dust exposures in determining these outcomes. Methods A cohort of 300 new employees, without previous occupational exposure to flour, were followed prospectively for a median (range) of 40 (1–91) months. Cases—defined as those developing work-related symptoms or a positive skin prick test to flour or -amylase during follow up—were compared with controls, matched for duration of employment. Exposures to flour aeroallergen and total inhalable dust were estimated using a questionnaire and personal sampling techniques. Results Incidence rates for work-related eye/nose and chest symptoms were 11.8 and 4.1 cases per 100person years (py), respectively. Fewer employees developed positive skin prick tests to flour (2.2cases per 100py) or -amylase (2.5cases per 100py). Positive skin tests to occupational allergens were more common among those with new work-related symptoms. There were clear relationships between the risks of developing work-related symptoms or a positive skin prick test and three categories of estimated exposure to total dust or flour aeroallergen. Atopic employees were more likely to develop a positive skin prick test—but not work-related symptoms. These findings were unaffected by age, sex or cigarette smoking. Conclusions In this population, many work-related symptoms which develop after first employment in modern UK bakeries or flour mills were not accompanied by evidence of IgE sensitization to flour or a-amylase. Although average dust exposures were within current occupational standards, the risks of development of upper and lower respiratory symptoms and of specific sensitization were clearly related to total dust and/or flour aeroallergen exposure. The incidence of work-related chest symptoms in the presence of a positive skin test to flour or a-amylase in this setting was approximately 1 case per 100py. AU - Cullinan P AU - Cook A AU - Nieuwenhuijsen MJ et al LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 51 IP - DP - 2001 Jan 01 TI - Identification of a possible biomarker for colophony exposure PG - 507-509 AU - Jones K AU - Garfitt S J AU - Calverley A AU - Channa K AU - Cocker J LA - PT - DEP - TA - Pol J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 32 IP - DP - 2001 Jan 01 TI - Comparison of registries of interstitial lung diseases in three European countries PG - 114s-118s AB - Few published studies have compared epidemiological data on the prevalence, incidence or relative frequency of the different interstitial lung diseases. In this review, the data of such registries from three countries in Europe (Belgium, Germany and Italy) are compared with those in the USA (Bernalillo County, NM). These registries show some striking similarities, but also discrepancies, which in part may be real, but may also be due to selection bias. Indeed, the registries in the European countries encompass the patients seen by pulmonologists, while the registry in Bernalillo County is based on a general population study in a limited area. In addition, in some studies, prevalences and incidences were registered, while in others, only prevalences or incidences were registered. Finally, most, but not all studies were prospective. Nonetheless, the different studies showed that sarcoidosis, idiopathic pulmonary fibrosis, hypersensitivity pneumonitis, interstitial lung diseases due to collagen vascular diseases and not-defined (or postinflammatory) fibrosis were most frequent. In the majority of disease entities a male predominance was found. Surprisingly large differences in the use of diagnostic techniques, such as high-resolution computed tomography, bronchoalveolar lavage, open lung biopsy and transbronchial lung biopsy, were noted between the different studies. AU - Thomeer MJ AU - Costabel U AU - Rizzato G AU - Poletti V AU - Demedts M LA - PT - DEP - TA - Eur J Respir Dis Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 39 IP - DP - 2001 Jan 01 TI - Hypersensitivity pneumonitis in a metal-working environment PG - 616-628 AB - Background An outbreak of lung disease among workers in a metal-working plant included 16 biopsy-confirmed cases of hypersensitivity pneumonitis and additional patients with asthma, bronchiolitis and emphysema, usual interstitial pneumonitis, and sarcoidosis. Study design Clinical examination of patients; cross-sectional questionnaire survey of the outbreak plant and two control plant areas, one with and one without MWF exposures, in a separate facility; industrial hygiene survey with laboratory characterization of microbial flora; and immunological investigation. Methods Patients with suspected hypersensitivity pneumonitis underwent a clinical examination including detailed lung function, imaging, and tissue studies. A plant walk-through identified metal-working processes, microbial aerosols, and work practices. Microbial characteristics of the three microbial aerosol-producing processes were characterized. Antibodies to those agents were determined in patient sera. A questionnaire survey was conducted in the case plant and in two areas of a control plant, one with and one without metal-working fluids exposure. Results Thirty-nine (79.6%) patients described symptoms consistent with work-related lung disease, eight received other diagnoses, and two did not complete their examinations. Sixteen patients had hypersensitivity pneumonitis confirmed on biopsy. Mean decrements in lung forced expiratory volume in 1 s and force vital capacity from before to after work were similar in the 16 biopsy-confirmed cases of hypersensitivity pneumonitis (?-?6.3%; -?7.2%) and the 19 symptomatic patients without biopsies (?-?11.2%, -?10.1%). Symptoms were more common in the case plant than in a non-MWF control plant area. Three sources of water-based aerosols were identified that grew similar microbial flora. Although machining increased airborne bacterial levels, the increase was not related to the concentration of viable bacteria in the sumps. Antibody testing did not identify a specific single organisms. Endotoxin levels were similar in case and MWF control plant. Conclusions Lung disease in environments with water-based aerosols may be more common than usually recognized. Patients with HP often present with only subtle abnormalities and may be missed if multiple clinical abnormalities are required to document disease AU - Hodgson MJ AU - Bracker A AU - Yang C AU - Storey E AU - Jarvis BJ AU - Milton D AU - Lummus Z AU - Bernstein D AU - Cole S LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 107 IP - DP - 2001 Jan 01 TI - Sensitization to silk and childhood asthma in rural China PG - e80 AB - Objective. Sensitization to perennial aeroallergens is associated with asthma in industrialized countries with a Western lifestyle. Because silk products are commonly used in Chinese society, we were interested in examining the relation between sensitization to silk and asthma. Design. Cross-sectional study of 871 children in 503 families living in Anqing, a predominantly rural province of China. Results. After adjustment for age, gender, familial correlations, and sensitization to other aeroallergens, skin test reactivity to silk was an independent predictor of asthma (odds ratio = 2.6; 95% confidence interval = 1.2-5.7). This association became stronger after inclusion of the eosinophil count and history of parasitic diseases of the participants in the multivariate model (odds ratio = 3.6; 95% confidence interval = 1.4-8.9). Conclusion. Because sericulture is an important activity in China and other countries throughout the world, sensitization to silk may influence the pathogenesis and severity of asthma in people living in these nations AU - Celedon JC AU - Palmer LJ AU - Xu XP AU - Wang BY AU - Fang Z AU - Weiss ST LA - PT - DEP - TA - Pediatrics JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - 119 IP - DP - 2001 Jan 01 TI - Comparisons of Peak Diurnal Expiratory Flow Variation, Postbronchodilator FEV1 Responses, and Methacholine Inhalation Challenges in the Evaluation of Suspected Asthma PG - 1001-1010 AB - Study objectives The validity of peak expiratory flow variation (PEFvar) as defined by National Heart, Lung, and Blood Institute (NHLBI) guidelines as a diagnostic tool for suspected asthma or its comparative value to methacholine inhalation challenge (MIC) or postbronchodilator (BD) FEV1 responses has not been formally assessed. We prospectively analyzed the correlation of 28 different PEFvar indexes (including 4 NHLBI-compatible indexes) with MIC and pre-BD and post-BD FEV1 responses in suspected asthmatic subjects with normal findings on lung examination, chest radiography, and baseline spirometry. Design Participants were asked to record peak expiratory flow four times daily for 2 to 3 weeks, followed by an MIC. During a minimum 6-month follow-up period, a clinical diagnosis of asthma was made or ruled out based on testing results and response to antiasthma therapy. Setting Medical school-affiliated subspecialty private practice of allergy, asthma, and immunology. Participants One hundred twenty-one suspected asthmatic patients with normal findings on lung examination, chest radiography, and baseline spirometry. Measurements and results Fifty-seven subjects completed both the peak flow diary and the MIC and were accepted for statistical analysis. There were no statistically significant correlations between any peak expiratory flow index and MIC. Among the three diagnostic tools evaluated, MIC had the highest sensitivity (85.71%). All the PEFvar indexes and post-BD responses had low sensitivity and high false-negative rates. Conclusions PEFvar and post-BD FEV1 responses are poor substitutes for MIC in the assessment of patients with suspected asthma with normal findings on lung examination, chest radiography, and spirometry. Our findings warrant a reconsideration of the NHLBI guidelines recommendation of the utility of PEFvar as a diagnostic tool for asthma in clinical practice. AU - Goldstein M AU - Veza BA. Dunsky EH AU - Dvorin DJ AU - Belecanech GA AU - Haralabatos IC LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20010101 IS - IS - VI - IP - DP - 2001 Jan 01 TI - Asthmagen? Critical assessments of the evidence for agents implicated in occupational asthma PG - AB - In HSE the process of critical appraisal of toxicological information has been undertaken for a number of years within regulatory programmes associated with the classification of industrial chemicals and the setting of occupational exposure limits. The resulting assessments provide the basis for the individual entries in this compendium. It should be noted that when full information regarding the potential of a substance to cause asthma has already been (or is expected to be) published by HSE elsewhere, eg in a criteria document or risk assessment document, the compendium entry consists of a summary of that information, together with a reference to the original publication. Overall, it is clear that all the relevant information available for each substance needs to be carefully examined against accepted criteria. Proper application of these criteria requires a balance of judgment, with the quality of the available data as well as the numbers of cases (in relation to the size of the exposed population and extent of exposure) being taken into account in order to reach the most reliable assessment of the potential to produce respiratory sensitisation/asthma. The compendium originally comprised 32 such assessments when it was published in 1997, reported in a standard format and arranged alphabetically by common name. A further 12 assessments were added with publication of a Supplement in 1998. The 2001 Supplement comprises an additional 16 assessments. AU - HSE LA - PT - DEP - TA - HSE publications JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 57 IP - DP - 2000 Jan 01 TI - Health complaints and immunological markers of exposure to bioaerosols among biowaste collectors and compost workers PG - 458-464 AB - OBJECTIVES In a cross sectional study, work related health complaints and diseases of 58 compost workers and 53 biowaste collectors were investigated and compared with 40 control subjects. Levels of specific IgG antibodies to moulds and bacteria were measured as immunological markers of exposure to bioaerosols. METHODS With a standardised protocol, the participants of the study were interviewed for work related symptoms, conditions of exposure to bioaerosols at their workplaces, exposure to bioaerosols from other sources, atopic diseases, and smoking habits. They were clinically examined by physicians specialised in occupational medicine. Also, concentrations of specific IgG antibodies against antigens of moulds and actinomycetes occurring regularly at these workplaces were measured and compared with the health complaints of the workers. RESULTS Compost workers had significantly more symptoms and diseases of the airways (p=0.003) and the skin (p=0.02) than the control subjects. Health complaints of biowaste collectors did not differ significantly from those of the control group. Subjects with atopic diseases were underrepresented in the compost workers (p=0.003). Significantly increased antibody concentrations against fungi and actinomycetes were measured in workers at composting plants. The concentrations in biowaste collectors did not differ significantly from those in the control subjects. A significant association between the diseases and increased antibody concentrations were found in the compost workers. CONCLUSION The high exposure to bioaerosols of compost workers is significantly associated with a higher frequency of health complaints and diseases as well as higher concentrations of specific antibodies against moulds and actinomycetes. A healthy worker effect is indicated by the underrepresentation of atopic diseases among the compost workers compared with biowaste collectors and the control group. AU - Bünger J AU - Antlauf-Lammers M AU - Schulz TG AU - Westphal GA AU - Müller MM AU - Ruhnau P AU - Hallier E LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 55 IP - DP - 2000 Jan 01 TI - Asthma to Gammarus shrimp PG - 96-97 AB - Baur et al. reported the case of a patient working in a fish food factory who developed allergic asthma due to shrimp Gammarus. Immunoblotting performed with the Gammarus extract showed several IgE-binding bands in the range of 14 to >?90 kDa AU - Baur X AU - Huber H AU - Chen Z LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 55 IP - DP - 2000 Jan 01 TI - Allergic rhinitis to turtle food PG - 405-406 AB - Allergy. 2000;55:405–6. AU - Gamboa PM AU - Barber D AU - Jauregui I AU - Urrutia I AU - Gonzalez G AU - Antepara I LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 101 IP - DP - 2000 Jan 01 TI - Dry machining: machining of the future PG - 287-291 AB - Machining without the use of any cutting fluid (dry or green machining) is becoming increasingly more popular due to concern regarding the safety of the environment. Most industries apply cutting fluids/coolants when their use is not necessary. The coolants and lubricants used for machining represents 16–20% of the manufacturing costs, hence the extravagant use of these fluids should be restricted. However, it should also be noted that some of the benefits of cutting fluids are not going to be available for dry machining and also dry machining will be acceptable only whenever the part quality and machining times achieved in wet machining are equalled or surpassed. This paper presents recent developments in the dry machining operation. AU - Sreejith P AU - Ngoi B LA - PT - DEP - TA - Journal of Materials Processing Technology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 15 IP - DP - 2000 Jan 01 TI - Characterization of metalworking fluid exposure indices for a study of acute respiratory effects PG - 492-502 AB - Although metalworking fluids have been widely used throughout industry for decades, occupational exposures to metalworking fluid aerosols and their constituents have not been well characterized. This article describes an exposure assessment for a study of metalworking fluid aerosols and acute respiratory effects. This exposure assessment was unique in its inclusion of multiple exposure measures relevant to a complex environment, and extensive personal sampling for bacteria and endotoxin. The specific objectives were to: (1) obtain indices of personal exposure to metalworking fluid aerosols in an automotive transmission plant, either directly (by sampling) or indirectly (by estimation), and (2) identify and adjust for sources of error in exposure/dose measures, where possible. No prior studies have characterized personal exposures to metalworking fluid aerosols so extensively. Exposure data were obtained during a pilot phase and three principal rounds of data collection over a 15-month period in conjunction with spirometric testing. Subjects worked in one of two machining departments, Case and Valve Body, or in a comparison department, Final Assembly. The primary exposure measures for this study were thoracic fraction particulate, thoracic fraction bacteria (viable plus non-viable), and total endotoxin. Mean personal air concentrations of thoracic particulate across all study rounds were 0.13 mg/m3 in Final Assembly, 0.32 mg/m3 in Valve Body, and 0.56 mg/m3 in Case. Average personal exposures to thoracic fraction bacteria were 0.38 bacteria/cc in Final Assembly, 0.87 bacteria/cc in Valve Body, and 2.66 bacteria/cc in Case. Average personal endotoxin measurements, collected in Round 3 of the study, were 16.4 endotoxin units (EU /m3 in Assembly, 34.7 EU/m3 in Valve Body, and 234 EU/m3 in Case. Sump fluid contained on the order of 108 bacteria/ml, and 104?105 EU/ml. Air concentrations of thoracic particulate, thoracic bacteria, and total endotoxin were highly correlated in metalworking operations. Thus, reducing airborne particulate levels should also reduce ambient bacteria and endotoxin, which are suspect agents of respiratory impairment. The elevated endotoxin levels in Final Assembly were unexpected, and suggest an independent source of endotoxin contamination in this department. AU - Abrams L AU - Seixas N AU - Robins T AU - Burge H AU - Muilenberg M AU - Franzblau A LA - PT - DEP - TA - Appl Occup Environ Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 37 IP - DP - 2000 Jan 01 TI - Two year follow-up of a garbage collector with allergic bronchopulmonary aspergillosis (ABPA) PG - 438-442 AB - Background Separate collection of biodegradable garbage and recyclable waste is expected to become mandatory in some western countries. A growing number of persons engaged in garbage collection and separation might become endangered by high loads of bacteria and fungi. Case history and examination A 29 year old garbage collector involved in emptying so-called biological garbage complained of dyspnea, fever, and flu-like symptoms during work beginning in the summer of 1992. Chest x-ray showed streaky shadows near both hili reaching into the upper regions. IgE- and IgG-antibodies (CAP, Pharmacia, Sweden) were strongly positive for Aspergillus fumigatus with 90.5 kU/L and 186%, respectively. Total-IgE was also strongly elevated with 5430 kU/L. Bronchial challenge testing with commercially available Aspergillus fumigatus extract resulted in an immediate-type asthmatic reaction. Two years later he was still symptomatic and antibodies persisted at lower levels. Conclusions Our diagnosis was allergic bronchopulmonary aspergillosis (ABPA) including asthmatic responses as well as hypersensitivity pneumonitis (extrinsic allergic alveolitis) due to exposure to moldy household waste. A growing number of persons engaged in garbage collection and handling are exposed and at risk to develop sensitization to fungi due to exposure to dust of biodegradable waste. Further studies are necessary to show if separate collection of biodegradable waste increases the health risks due to exposure to bacteria and fungi in comparison to waste collection without separation. Am. J. Ind. Med. 37:438–442, 2000 AU - Allmers H AU - Huber H AU - Baur X LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 37 IP - DP - 2000 Jan 01 TI - Irritant-induced asthma: clinical and functional aspects. PG - 267-74 AB - We report on three patients who experienced persistent asthma symptoms after repetitive irritant exposure which took place over a period from several days to months. Airway inflammation was assessed by induction of sputum and functional follow-up information was obtained from serial lung function tests. All patients had bronchial hyperresponsiveness to methacholine at the time of diagnosis. However, induced sputum samples did not show increased differential count of eosinophils. Treatment with inhaled corticosteroids was started in all of the patients and two of them were removed from work. In the two patients who left the workplace, methacholine inhalation test became negative when symptoms disappeared, whereas the patient who continued working had persistent asthma symptoms and a deterioration of bronchial hyperresponsiveness. AU - Quirce S AU - Gala G AU - Perez-Camo I AU - Sanchez-Fernandez C AU - Pacheco A AU - Losada E LA - PT - DEP - TA - J Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 108 IP - DP - 2000 Jan 01 TI - Modeling of exposure to carpet-cleaning chemicals preceding irritant-induced asthma in one patient. PG - 911-3 AB - 42-year-old woman experienced an acute asthma attack, seizures, and unconsciousness immediately after a carpet-cleaning and deodorizing job was conducted in her home. Exposure modeling estimates that she was exposed to approximately 3.4-17 mg/m(3) of sodium tripolyphosphate and more than 14 mg/m(3) volatile organic compounds immediately after the cleaning. I derived two separate exposure models for these estimates that evidenced good consistency of exposure estimates. Asthmatics and carpet-cleaning companies should be advised about safety during carpet-cleaning operations, including adequate warnings about excess risk for asthmatics, temporary removal from the home, reduced detergent levels within cleaners, and reduced overall levels of cleaning solutions used within the home. Further studies of carpet-cleaning exposures are indicated. AU - Lynch RM LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 106 IP - DP - 2000 Jan 01 TI - Specific immunotherapy with a standardized latex extract versus placebo in allergic healthcare workers PG - 585-590 AU - Leynadier F AU - Herman D AU - Vervloet D AU - Andre C LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 42 IP - DP - 2000 Jan 01 TI - ACOEM position statement. Spirometry in the occupational setting. American College of Occupational and Environmental Medicine PG - 228-45 AU - Townsend MC LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 37 IP - DP - 2000 Jan 01 TI - Increase in airway hyperresponsiveness among workers exposed to methylene diphenyldiisocyanate compared to workers exposed to toluene diisocyanate at a petrochemical plant in Korea PG - 663-667 AU - Jang AS AU - Choi IS LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 162 IP - DP - 2000 Jan 01 TI - Hospitalization among workers compensated for occupational asthma PG - 112-118 AU - Liss GM AU - Tarlo SM AU - Macfarlane Y AU - Yeung KS LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 106 IP - DP - 2000 Jan 01 TI - Characterization of airway inflammation after repeated exposures to occupational agents PG - 1163-1170 AU - Lemiere C AU - Chaboilliez S AU - Trudeau C AU - Taha R AU - Maghni K AU - Martin JG AU - Hamid Q LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 356 IP - DP - 2000 Jan 01 TI - Tuberculosis control and molecular epidemiology in a South African gold-mining community PG - 1066-1071 AU - GodfreyFaussett P AU - Sonnenberg P AU - Shearer SC AU - Bruce MC AU - Mee C AU - Morris L AU - Murray J LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 356 IP - DP - 2000 Jan 01 TI - An Outbreak Of Asthma In A Modern Detergent Factory PG - 1899-1900 AB - The striking decrease in the occurrence of protease-induced occupational asthma in the detergent Industry has been attributed to enzyme encapsulation. We report an outbreak of asthma, at least equal in size to those reported in the 1960s, in a modem European factory which has exclusively used encapsulated enzymes. A survey revealed that enzyme sensitisation and work-related respiratory symptoms were positively correlated with airborne enzyme exposure. We suggest that encapsulation alone is insufficient to prevent enzyme-Induced allergy and asthma. AU - Cullinan P AU - Harris JM AU - NewmanTaylor AJ et al LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 57 IP - DP - 2000 Jan 01 TI - Prospective study of work-related respiratory symptoms in trainee bakers PG - 58-61 AB - OBJECTIVES To investigate the occurrence of work related respiratory symptoms and to assess the effect of atopy in a group of trainee bakers. METHODS A prospective study of work related respiratory symptoms among 125 trainee bakers who were investigated with a questionnaire plus skin prick test with wheat flour and alpha-amylase allergens at baseline and then after 6, 18, and 30 months. RESULTS At the baseline examination, four students (3.2%) complained of respiratory symptoms (cough and rhinitis) when working with flours and four were skin positive to wheat flour or alpha-amylase. The incidence of work related respiratory symptoms was 3.4% at 6 months, and the cumulative incidence was 4.8% and 9.0% at 18 and 30 months, respectively. The incidence of skin sensitisation to occupational allergens was 4.6% at 6 months and the cumulative incidence was 4.6% at 18 months and 10.1% at 30 months. The generalised estimating equation approach to longitudinal data showed that work related respiratory symptoms in the study population was significantly associated with a personal history of allergic disease (odds ratio (OR) 5.8, 95% confidence interval (95% CI) 1.8 to 18.2) and skin sensitisation to wheat flour or alpha -amylase (OR 4.3, 95% CI 1.2 to 14.9). Atopy based on prick test was not related to the occurrence of work related respiratory symptoms over time (OR 1.1, 95% CI 0.3 to 3.8). CONCLUSIONS Personal history of allergic disease is a predisposing factor for the development of symptoms caused by exposure to wheat flour and may be a criterion of unsuitability for starting a career as a baker. Atopy based on the skin prick test is useful for identifying subjects with allergic disease, but should not be used to exclude non-symptomatic atopic people from bakery work. AU - DeZotti R AU - Bovenzi M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 57 IP - DP - 2000 Jan 01 TI - Exposure-response relations for self report asthma and rhinitis in bakers PG - 335-340 AB - OBJECTIVES To explore relations between two estimates of exposure to inhalable flour dust, and the incidence rates (IRs) of asthma and rhinitis in bakers. METHODS This was a retrospective cohort study among 2923 bakers. A posted questionnaire registered the disease and work history. For every year, each baker was assigned an estimate of the exposure concentration to inhalable flour dust derived from reported job-tasks and dust measurements. Exposure at onset of disease was expressed as current dust exposure concentration, and as cumulative dose of exposure to dust. A multiple Poisson regression analysis assessed the impacts of the exposure estimates on the IRs of asthma and rhinitis. RESULTS IRs of asthma and rhinitis increased by dust concentration at onset of disease. The IR of asthma for the bakers with highest exposure (dough makers) was 7.3/1000 person-years in men and 6.5 in women and for rhinitis 43.4 and 38.5, respectively. There was a significant association between the dust concentration at onset of disease and the risk for asthma or rhinitis, but not of the cumulative exposure. CONCLUSION The risk of asthma seemed to be increased at inhalable dust concentrations = 3 mg/m3 (dough making or bread forming), whereas the risk of rhinitis was increased at all concentrations = 1 mg/m3, indicating an increased risk in all bakery job-tasks. The risks seemed to be less dependent on the cumulative exposure dust than the inhalable dust concentrations AU - Brisman J AU - Jaervholm B AU - Lillienberg L LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 37 IP - DP - 2000 Jan 01 TI - Incidence Of Occupational Asthma By Occupation and Industry In Finland PG - 451-458 AB - Background Systematic research on occupation or industry-specific incidence of occupational asthma (OA) is sparse. We calculated the incidence of notified OA by occupation, industry and causative agent in Finland for the years 1989-95. Methods The numbers of cases of reported OA were retrieved from the Finnish Registry of Occupational Diseases for the population between 20 and 64 years of age. The numbers of employed workers were retrieved from Statistics Finland. Incidence rates were calculated for each occupation, industry and the total workforce. Results Altogether 2602 cases of OA were notified and the mean annual incidence rate was 17.4 cases/100,000 employed workers. The incidence rate was the highest in bakers, other painters and lacquerers, veterinary surgeons, chemical workers, farmers, animal husbandry workers, other food manufacturing workers, welders, plastic product workers, butchers and sausage makers, and floor layers. Cases caused by animal epithelia, hairs and secretions or flours, grains, and fodders accounted for 60% of the total. Conclusions Estimation of occupation and industry-specific incidence rates forms the basis for successful prevention of OA, but necessitates collection of data over several years from well-established surveillance systems. AU - Karjalainen A AU - Kurppa K AU - Virtanen S AU - Keskinen H AU - Nordman H LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 162 IP - DP - 2000 Jan 01 TI - Occupational asthma in adults in six canadian communities PG - 2058-2062 AB - We examined the prevalence, population attributable risk (PAR), and clinical characteristics of occupational asthma (OA) in a randomly selected population in six communities in Canada. Our study followed the European Community Respiratory Health Survey protocol. A randomly selected population of 18,701 (87% response rate) persons from the study communities, ranging in age from 20 to 44 yr, completed an initial questionnaire, of whom 2,974 (39% response rate) attended the laboratory and completed supplementary questionnaires. Of these latter individuals, 383 had asthma. Asthma was defined as physician-diagnosed asthma, and adult-onset asthma was defined as a first attack at age 15 yr or older. We used several methods for estimating OA as follows: (1) reporting of a high-risk job (occupation and industry) for OA at the time of asthma onset (Probable OA); (2) reporting of exposure to a substance that may cause OA (Possible OA) while not in a high-risk job at the time of asthma onset; and (3) combination of the PAR for high-risk jobs and exposures. The prevalence (95% confidence interval [CI]) of Probable OA and Possible OA combined was 36.1% (31.3 to 41.0%) among subjects with adult-onset asthma. The occupations most commonly reported in association with OA were nursing in the Probable OA group and clerical and food preparation in the Possible OA group. The clinical characteristics and exposures reported by both groups were similar. The PAR for adult-onset asthma in high-risk jobs and exposures was 18.2%. The assessment of occupation and industry alone, rather than of exposures, may underestimate the contribution of occupational exposures to asthma prevalence. AU - Johnson AR AU - DimichWardHD AU - Manfreda J et al LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 15 IP - DP - 2000 Jan 01 TI - Distribution of DRB1 and DQB1 HLA class II alleles in occupational asthma due to western red cedar PG - 911-914 AB - Occupational asthma caused by western red cedar is a common problem in sawmill industries. The objective of this study was to examine a possible association of human leukocyte antigen (HLA) class II genetic markers with susceptibility or resistance to western red cedar induced asthma. The distribution of DRB1 and DQB1 HLA class II alleles and DRB1-DQB1 haplotypes was studied in 56 Caucasian patients with proven red cedar asthma and 63 healthy Caucasian control subjects exposed to red cedar dust. DRB1 and DQB1 high resolution typing was performed by the polymerase chain reaction-based method. Patients with red cedar asthma had a higher frequency of HLA DQB1*0603 and DQB1*0302 alleles compared to a group of healthy exposed control subjects and a reduced frequency of DQB1*0501 allele. The frequency of the DRB1*0401-DQB1* 0302 haplotype was increased and the DRB1*0101-DQB1*0501 haplotype was reduced. These findings suggest that genetic factors such as human leukocyte antigen class II antigens may be associated with susceptibility or resistance to development of red cedar asthma. AU - Horne C AU - Quintana PJ AU - Keown PA et al LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 21 IP - DP - 2000 Jan 01 TI - Clinical and immunologic outcome of 42 individuals with trimellitic anhydride-induced immunologic lung disease after transfer to low exposure PG - 355-359 AB - The purpose of this study is to determine the clinical and immunologic status of trimellitic anhydride (TMA)-exposed employees who have had immunologic lung disease and who have been moved to lower-exposure jobs. In a case series design, 42 consecutive employees with TMA-induced immunologic lung disease were studied after they had been moved to low-exposure jobs for more than 1 year. Pulmonary symptoms were obtained by physician-administered questionnaire. Immunologic studies were performed using ELISA techniques. Spirometry and chest films were obtained annually. Employees with late asthma (n = 4), late respiratory systemic syndrome (LRSS) (n = 13), or both LRSS and asthma (n = 4) had improved symptoms, improved pulmonary functions, and lower IgE against TM-HSA. Fourteen of 21 employees with asthma had improved symptoms, improved pulmonary functions, and lower IgE against TM-HSA. The 7 who did not improve with transfer to low-exposure jobs did improve with transfer to jobs with no TMA exposure. There were no chest film findings in any group that were definitely related to TMA. Most individuals who develop TMA hypersensitivity syndromes improve with transfer to low- exposure jobs, but occasionally, individuals require transfer to a no-exposure job. AU - Grammer LC AU - Shaughnessy MA AU - Kenamore BD LA - PT - DEP - TA - Allergy Asthma Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 105 IP - DP - 2000 Jan 01 TI - Exposure-effect relationship of platinum salt allergy in a catalyst production plant: conclusions from a 5-year prospective cohort study PG - 364-370 AU - Merget R AU - Kulzer R AU - DierkesGlobisch A et al LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 57 IP - DP - 2000 Jan 01 TI - Isocyanate exposure and occupational asthma: a case-referent study PG - 830-836 AB - OBJECTIVE To examine the quantitative relation between exposure to isocyanates and occupational asthma, and to explore the role of atopy and smoking in occurrence of the disease. METHOD A case-referent study was undertaken of cases from two manufacturing companies (A and B) from which referents without disease could be selected and reliable exposure measurements were available. In company A, 27 cases mainly attributed to toluene diisocyanate (TDI) were matched to 51 referents on work area, start and duration of employment, sex, and age. Exposures were estimated from existing measurements by job category. In company B there were seven cases attributed to 4,4'-diphenylmethane diisocyanate (MDI) in two areas of the plant; 12 non-cases from the same areas were used as referents. Personal exposure measurements were available for all cases and 11 referents. RESULTS No difference in peak exposures between cases and referents was found in either plant; but in both, time weighted average (TWA) exposures at the time of onset of asthma were higher for cases. In A, the mean TWA exposure for cases was 1.5 (95% confidence interval (95% CI) 1.2 to 1.8) ppb compared with 1.2 (1.0 to 1.4) ppb for referents. From a matched analysis, the odds ratio (OR) associated with 8 hour TWA exposure to isocyanates greater than 1.125 ppb (the median concentration for the referent group) was 3.2 (95% CI 0.96 to 10.6; p=0.06). Occupational asthma was associated with a pre-employment history of atopic illness (OR 3.5, p=0.04) and, less strongly, with smoking (OR 2.1, p=0.14). In B, small numbers limited analysis, but three of seven cases had at least one TWA exposure measurement greater than 5 ppb compared with one of 11 referents (OR 7.5, p=0.09). CONCLUSION Asthma can occur at low concentrations of isocyanates, but even at low concentrations, the higher the exposure the greater the risk. By contrast with other studies, smoking and atopy seemed to increase the odds of occupational asthma due to isocyanates, but did not affect the estimate of risk associated with exposure. AU - Meredith SK AU - Bugler J AU - Clark RL LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 30 IP - DP - 2000 Jan 01 TI - Association between hla genes and susceptibility to toluene di-isocyanate-induced asthma PG - 651-656 AU - Mapp CE AU - Beghe B AU - Balboni A et al LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 57 IP - DP - 2000 Jan 01 TI - Reported Incidence Of Occupational Asthma In The United Kingdom 1989-97. PG - 823-829 AB - OBJECTIVES: To examine trends in estimated population based incidence of occupational asthma by age, sex, occupation, geographical region, and causal agents based on 9 years of the Surveillance of Work Related and Occupational Respiratory Disease (SWORD) data. METHODS: In January 1989 the SWORD scheme for the surveillance of occupational respiratory disease was established in the United Kingdom to make good the lack of epidemiological information on the incidence of these diseases in the United Kingdom. Between 80% and 90% of chest and occupational physicians report voluntarily all new cases they see, on a monthly or random sampling basis. During the 9 years 1989-97, an estimated 25 674 new cases of occupational respiratory disease, including 7387 of occupational asthma, were reported. Suspected causal agents were classified into 44 categories and estimated annual incidences of asthma were calculated with denominators from the labour force survey. RESULTS: Overall, a third of the suspected causes of asthma were organic, a third chemical, 6% metallic, and the rest miscellaneous, or in 8%, unknown. There was evidence of an increase since 1989 in cases due to latex, and possibly glutaraldehyde, and an apparent drop since 1991 in the proportion of cases attributed to isocyanates. Incidences were higher in men than women and the disparity was especially marked in the population aged 45 years or more in which rates for men were at least twice those for women. Average annual rates per million workers for 1992-7 ranged from 7 (95% confidence interval (95% CI) 5 to 9) for the lowest risk group of professional, clerical, and service workers to 1464 (95% CI 968 to 2173) for coach and other spray painters. Except for laboratory technicians, all other occupations with rates over 100 were concerned with manufacturing and processing that used chemicals, metals, and organic materials. Incidences were two to three times higher in the north and midlands than in East Anglia and the south. The introduction of a sampling scheme in 1992 doubled estimates of reported incidence of occupational asthma, but there was little evidence of other temporal changes. CONCLUSIONS: The SWORD scheme has produced consistent estimates of the causes and incidence of occupational asthma as seen by chest and occupational physicians. It has allowed the epidemiology of occupational asthma in the population to be studied and high risk occupations to be identified. There is certainly more occupational asthma in the population than that which reaches specialists in occupational and chest medicine; therefore the incidence rates presented here are underestimates, but by how much remains unknown. AU - McDonald JC AU - Keynes HL AU - Meredith SK LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 162 IP - DP - 2000 Jan 01 TI - Persistent specific bronchial reactivity to occupational agents in workers with normal nonspecific bronchial reactivity PG - 976-980 AB - Specific bronchial reactivity (SBR) to common inhalants is related to the degree of nonspecific bronchial reactivity (NSBR) and to specific allergen sensitivity. We investigated 16 workers with normal NSBR who had been previously diagnosed with occupational asthma caused by high-molecular-weight agents. The agents were flour in seven workers, psyllium in five, and guar gum in four. The subjects had been removed from exposure to these agents for a mean of 5.7 (± 4.0 SD) yr, no longer showed evidence of persisting asthma, and had a normal lung function. In the present study, the workers were reexposed to the sensitizing agent by specific inhalation challenges, in the same way they were as at the time of the diagnosis, to assess their current SBR to the sensitizer. SBR was estimated as the duration of exposure that induced a 20% decrease in FEV1. Eleven of the 16 subjects had an asthmatic reaction at the time of the study; the duration of exposure necessary to induce the asthmatic reaction was the same as that needed at the time of diagnosis (3.55 ± 0.5 min and 4.2 ± 0.7 min, respectively, p = 0.8). The decrease in specific IgE levels between the two events was much greater in the subjects who failed to react to the second challenge test (from 24.2 ± 37.5% to 3.0 ± 16.9% binding) than in those who reacted on both occasions (from 31.2 ± 27.0% to 21.6 ± 36.7% binding); however, in both groups the change was significant (p = 0.05 and 0.04, respectively). We conclude that SBR to high-molecular-weight agents persists in most cases despite a normalization of NSBR, and that this persistence is associated with a persistence of specific immunization to the agent. AU - Lemiere C AU - Cartier A AU - Malo JL et al LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 118 IP - DP - 2000 Jan 01 TI - Asthma-like symptoms in wood product plant workers exposed to methylene diphenyl di-isocyanate PG - 183-193 AB - Background: Diisocyanates, a group of highly reactive chemicals, have frequently been associated with occupational asthma. We evaluated respiratory health in workers at a new wood products manufacturing plant that uses methylene diphenyl diisocyanate (MDI), and was designed and operated with a goal of minimizing worker exposures. Methods: Health surveys using standardized respiratory questionnaires were done prior to the initial use of diisocyanates in the plant, and semiannually thereafter for a period of 2 years. Other testing included occupational and work practice histories, serial peak flow measurements, spirometry, methacholine challenge, and measurement of specific IgE antibodies to MDI-albumin conjugate. Results: Of 214 plant employees who participated in at least one health survey, a follow-up survey was also available from 178 employees (83%). New-onset asthma-like symptoms (NAS) were reported by 15 of 56 workers (27%) in areas with the highest potential for exposures to liquid MDI monomer and prepolymer, vs 0 of 43 workers in the lowest potential exposure areas (p = 0.001). In the areas with high potential exposure, NAS developed in 47% of workers who had noted MDI skin staining, vs 19% without skin stains (p = 0.07). Working around and cleaning up liquid MDI represented a significant risk for asthma-like symptoms in both current smokers and nonsmokers; work with finished wood products did not. Asthma-like symptoms were associated with variable airflow limitation (odds ratio [OR], 5.0; confidence interval [CI], 1.4 to 18.7) and specific IgE to MDI-albumin (OR, 3.2; CI, 1.1 to 9.0), but not with skin prick tests to common aeroallergens (OR, 1.1; CI, 0.5 to 2.7). Conclusions: During the first 2 years of operation, in a plant designed and operated to control exposure to diisocyanates, the development of asthma-like symptoms was reported in a relatively high proportion of the employees who worked with liquid MDI. To prevent asthma symptoms among workers, careful control of respiratory tract exposures associated with liquid MDI is important, especially during cleanup activities. Strict limitation of skin contact with diisocyanates may also be necessary. AU - Petsonk EL AU - Wang ML AU - Lewis DM et al LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 162 IP - DP - 2000 Jan 01 TI - Long-term follow-up of hexamethylene di-isocyanate-diphenylmethane di-isocyanate-, and toluene di-isocyanate-induced asthma PG - 516-522 AB - In 1976-1992 245 new cases of asthma induced by diisocyanates were diagnosed, caused by hexamethylene diisocyanate (HDI) in 39%, diphenylmethane diisocyanate (MDI) in 39%, and toluene diisocyanate (TDI) in 17% of the cases. Our aim was to study the clinical outcome of diisocyanate-induced asthma. A questionnaire was sent to the 235 patients alive in 1995, and validated by reexamining clinically 91 of them. The study was carried out on average 10 () yr after the diagnosis. Of the patients 82% experienced symptoms of asthma, 34% used no medication, and 35% were on regular medication. The patients having displayed immunoglobulin E (IgE) antibodies to isocyanates used less medication (OR 0.273; CI 0.098, 0.758) and had fewer symptoms of asthma (OR 0.329; CI 0.124, 0.875) than the IgE-negative ones. They also had a significantly shorter duration of symptoms (p = 0.0025), latency period (p = 0.0249), and duration of exposure (p = 0.0008) than the IgE-negative patients. This did not, however, entirely explain the more favourable outcome of the IgE-positive patients. Patients with HDI-induced asthma used less medication (OR 0.412; CI 0.229, 0.739) than patients with MDI- and TDI-induced asthma. The results confirm the generally rather poor medical outcome of diisocyanate-induced asthma; the persistence of symptoms and unspecific bronchial reactivity were pronounced in TDI-induced asthma. A more favourable outcome was associated with IgE mediation and HDI inducement. AU - Piirila PL AU - Nordman H AU - Keskinen HM et al LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 57 IP - DP - 2000 Jan 01 TI - Two patients with occupational asthma who returned to work with dust respirators PG - 62-64 AB - OBJECTIVES To assess the efficacy of dust respirators in preventing asthma attacks in patients with occupational asthma (asthma induced by buckwheat flour or wheat flour). METHODS The effect of the work environment was examined in two patients with occupational asthma with and without the use of a commercially available mask or a dust respirator. Pulmonary function tests were performed immediately before and after work and at 1 hourly intervals for 14 hours after returning to the hospital. RESULTS In patient 1, environmental exposure resulted in no symptoms during and immediately after work, but coughing, wheezing, and dyspnoea developed after 6 hours. Peak expiratory flow rate (PEFR) decreased by 44% 7 hours after leaving the work environment, showing only a positive late asthmatic reaction (LAR). In patient 2, environmental exposure resulted in coughing and wheezing 10 minutes after initiation during bread making, and PEFR decreased by 39%. After 7 hours, PEFR decreased by 34%. The environmental provocation tests in both patients were repeated after wearing a commercial respirator. This resulted in a complete suppression of LAR in patient 1 and of immediate asthmatic reaction (IAR) and LAR in patient 2. CONCLUSIONS Two patients with asthma induced by buckwheat flour or wheat flour in whom asthmatic attacks could be prevented with a dust respirator are reported. Dust respirators are effective in preventing asthma attacks induced by buckwheat flour and wheat flour. AU - Obase Y AU - Shimoda T AU - Mitsuta K et al LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 118 IP - DP - 2000 Jan 01 TI - Asthmatic subjects symptomatically worse at work: prevalence and characterization among a general asthma clinic population PG - 1309-1314 AU - Tarlo SM AU - Leung K AU - Broder Iet al LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 162 IP - DP - 2000 Jan 01 TI - Incidence and determinants of IgE-mediated sensitization in apprentices. A prospective study PG - 1222-1228 AU - Gautrin D AU - Ghezzo H AU - InfanteRivard C AU - Malo JL LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 15 IP - DP - 2000 Jan 01 TI - Risk factors for bronchial hyperresponsiveness in workers exposed to acid anhydrides PG - 710-715 AU - Barker RD AU - vanTongeren MJ AU - Harris JM AU - Gardiner K AU - Venables KM AU - Newman Taylor AJ AU - LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 44 IP - DP - 2000 Jan 01 TI - Natural rubber latex aeroallergen exposure in rubber plantation workers and glove manufacturers in Thailand and health-care workers in a UK hospital PG - 79-88 AB - Objectives—To estimate personal airborne natural rubber latex (NRL) concentrations for three occupational exposure groups; rubber plantation workers and NRL glove manufacturers in Thailand and health care workers in the UK. To utilise these data to classify the populations into appropriate exposure groups for the exposure-response analysis in the epidemiological study on latex allergy. Methods—Two rubber plantations (110 workers), three NRL glove manufacturing factories (583 workers) in Thailand and one UK hospital (490 workers) were selected for the study. A preliminary workplace survey was carried out at each workplace in order to assign job titles subjectively in to high, moderate or low exposure groups for the purpose of sample selection. Between 5 and 20% of workers from each group for the three populations were then selected randomly for personal measurement of latex airborne allergens. Personal sampling was conducted using a 25 mm PTFE filter loaded in to an IOM sampling head at 2 l. min-1. NRL aeroallergens were measured by an inhibition assay with NRL-specific IgE antibodies from NRL-sensitised people. Results—A total of twenty-two personal samples were collected from plantation workers, sixty-one samples from the glove manufacturer employees and twenty seven from health care workers. The highest geometric mean (GM) NRL aeroallergen concentration was found in the glove manufacturing factories (7.3 µg m-3), followed by the rubber plantations (2.4 µg m-3) and the UK hospital (0.46 µg m-3). Amongst the NRL glove factories, the NRL aeroallergen concentrations were highest for those conducting the following tasks; glove stripping, glove inspections and packing of powdered gloves. The GM NRL aeroallergen for these tasks were in the range of 12.9 to 17.8 µg m-3. Conclusions—In the process from tapping and manufacture of latex gloves through to their use the highest exposure to NRL aeroallergens is likely to occur in the manufacturing factories. Exposure to aeroallergens for the plantation workers was considered to be moderate and that of health care workers to be low. AU - Sri-Akajunt N AU - Sadra S AU - Jones M AU - Burge PS LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 162 IP - DP - 2000 Jan 01 TI - Respiratory symptoms of obstructive lung disease in European crop farmers PG - 1246-1250 AB - Crop farming as a risk factor for respiratory symptoms of obstructive lung disease was assessed. Random samples of crop farmers from four European countries were studied following a cross-sectional design. A questionnaire on respiratory symptoms and occupation was administered to determine prevalences, and the roles of the various crops as risk factors for respiratory symptoms were assessed through logistic regression modeling. The 4,793 crop farmers included in the study (response rate: 85.3%) reported the following respiratory symptoms: wheezing (14.9%), asthma (3.3%), nasal allergy (14.4%), chronic phlegm (12.4%), organic dust toxic syndrome (ODTS) (15.2%), and symptoms at work (22.0%). In the multivariate analysis, adjusting for age, sex, smoking, country, and exposure to other plants or livestock, flower growing was a risk factor for asthma (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.1-3.9) and cultivating oil plants was associated with ODTS (OR 1.5, 95% CI 1.3-1.9), symptoms at work (OR 1.4, 95% CI 1.2- 1.7), and chronic phlegm (OR 1.3, 95% CI 1.1-1.6). Working inside greenhouses was a marginal risk factor for asthma (OR 2.1, 95% CI 0.9-4.5). We conclude that flower and oil plant production is associated with increased risk of respiratory symptoms in European crop farmers. AU - Monso E AU - Magarolas R AU - Radon K AU - Danuser B AU - Iversen M AU - Weber C AU - Opravil U AU - Donham KJ AU - Nowak D LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 54 IP - DP - 2000 Jan 01 TI - Respiratory health risks in working with chickens PG - 37-42 AB - AU - Danuser B LA - PT - DEP - TA - Pneumonologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 162 IP - DP - 2000 Jan 01 TI - Airway inflammation after controlled exposure to diesel exhaust particulates PG - 161-6 AB - Epidemiologic evidence suggests a link between morbidity and mortality and levels of particulate matter in the atmosphere. We studied the inflammatory response to inhalation of diesel exhaust particulates (DEP) in normal volunteers. DEP were collected from the exhaust of a stationary diesel engine and were resuspended in an exposure chamber. Ten nonsmoking healthy volunteers were exposed for 2 h at rest to a controlled concentration of DEP (monitored at 200 microg/m(3) particulate matter of less than 10 microm aerodynamic diameter [PM(10)]) or air in a double-blind, randomized, crossover study. Exposures were followed by serial spirometry and measurement of pulse, blood pressure, exhaled carbon monoxide (CO), and methacholine reactivity, as well as sputum induction and venesection for up to 4 h after exposure, and a repeat of all these procedures at 24 h after exposure. There were no changes in cardiovascular parameters or lung function following exposure to DEP. Levels of exhaled CO were increased ater exposure to DEP, and were maximal at 1 h (air: 2.9 +/- 0.2 ppm [mean +/- SEM]; DEP: 4.4 +/- 0.3 ppm; p < 0.001). There was an increase in sputum neutrophils and myeloperoxidase (MPO) at 4 h after DEP exposure as compared with 4 h after air exposure (neutrophils: 41 +/- 4% versus 32 +/- 4%; MPO: 151 ng/ml versus 115 ng/ml, p < 0.01), but no change in concentrations of inflammatory markers in peripheral blood. Exposure to DEPs at high ambient concentrations leads to an airway inflammatory response in normal volunteers. AU - Nightingale JA AU - Maggs R AU - Cullinan P AU - Donnelly LE AU - Rogers DF AU - Kinnersley R AU - Chung KF AU - Barnes PJ AU - Ashmore M AU - Newman-Taylor A LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 16 IP - DP - 2000 Jan 01 TI - Environmental exposure to air pollution and allergens and peak flow changes PG - 61-66 AB - Laboratory-based studies have shown that ozone and nitrogen dioxide can potentiate the effect of allergen in sensitized asthmatic subjects, but it is not known whether this interaction is important under natural exposure conditions. Thirty-five subjects with clinical diagnoses of asthma or chronic obstructive pulmonary disease and with a provocative dose causing a 20% fall in forced expiratory volume in one second methacholine <12.25 micromol (using the Yan method) kept peak expiratory flow (PEF) records for a 4-week period during late summer, with concurrent measurement of spore and pollen counts and pollution levels. Multiple regression analysis was then used to determine the effect on PEF of aeroallergen, and of the interaction between aeroallergen and pollutant levels. A statistically significant interaction was demonstrated between total spore count and ozone, but not nitrogen dioxide. Mean PEF fell in association with increasing spore count (same-day and 24-h lag level) and PEF variability increased with increasing spore count (24-h lag level only); both changes were greater the higher the prior ozone level. These results suggest that ozone can potentiate the effect of aeroallergens in subjects with bronchial hyperreactivity under natural exposure conditions. However, the effect was small, and the clinical significance of the interaction requires further study. AU - Higgins BG AU - Francis HC AU - Yates C AU - Warburton CJ AU - Fletcher AM. Pickering CAC AU - Woodcock AA LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 161 IP - DP - 2000 Jan 01 TI - Evidence of Airway Inflammation and Remodeling in Ski Athletes with and without Bronchial Hyperresponsiveness to Methacholine PG - 2086-2091 AB - Asthma-like symptoms, methacholine hyperresponsiveness, and use of asthma medication are prevalent in elite cross-country skiers. We quantitated mucosal inflammatory cell infiltration and tenascin expression in the subepithelial basement membrane in endobronchial biopsy specimens of the proximal airways from 40 elite, competitive skiers (mean: 17.5; range: 16 to 20 yr) without a diagnosis of asthma, in 12 subjects with mild asthma, and in 12 healthy controls, through immunohistochemistry and indirect immunofluorescence, respectively. All of the subjects were nonsmokers. T-lymphocyte, macrophage, and eosinophil counts were, respectively, greater by 43-fold (p<0.001), 26-fold (p<0.001), and twofold (p<0.001) in skiers, and by 70-fold (p<0.001), 63-fold (p<0.001), and eightfold (p<0.001) in asthmatic subjects than in controls. In skiers, neutrophil counts were more than twofold greater than in asthmatic subjects, and mast cell counts were notsignificantly different than in controls. Tenascin expression (asmeasured through the thickness of the tenascin-specific immunoreactivityband in the basement membrane) was increased inskiers (median: 6.7mm; interquartile range [IQR]: 5.3 to 8.5mm,p<0.001) and asthmatic subjects (mean: 8.8mm; IQR: 7.2 to 10.8mm, p<0.001) compared with controls (mean: 0.8mm; IQR: 0 to 3.1mm) and did not correlate with inflammatory cell counts. Inflammatory changes were present irrespective of asthmalike symptoms, hyperresponsiveness, or atopy. Prolonged repeated exposure of the airways to inadequately conditioned air may induce inflammation and remodeling in competitive skiers. AU - KARJALAINEN E-M AU - LAITINEN A AU - SUE-CHU M AU - ALTRAJA A AU - BJERMER L LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 49 IP - DP - 2000 Jan 01 TI - Purification of a novel allergen (SAP-1), which induces allergic asthma, from the red soft coral (Alcyonium gracillimum) PG - 213-218 AB - The red soft coral that is found around the spiny lobster represents a major allergen and many fishermen, especially those that catch the spiny lobster, suffer from allergic symptoms. Therefore, in the present study, one of the major fractions of this protein was isolated and purified from the red soft coral (Alcyonium gracillimum). Sodium dodecyl sulfatepolyacrylamide gel electrophoresis and immunoblot analyses showed that the molecular weight of the allergen is approximately 14.4-20.1 kDa. Continuous purification of the protein resulted in a peptide with a molecular weight of 17 kDa. Immunoblotting and ELISA tests showed that the isolated peptide (17 kDa) strongly cross-reacted with the IgE of patients, thus classifying it as a significant allergen. AU - Takeda Y AU - Kawakami H AU - Shigeta S AU - Kamiya H AU - Onizuka R AU - Tanabe K AU - Kato Y LA - PT - DEP - TA - Allergology International JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 57 IP - DP - 2000 Jan 01 TI - Survey of symptoms, respiratory function, and immunology and their relation to glutaraldehyde and other occupational exposures among endoscopy nursing staff PG - 752-759 AB - Objectives To find the nature and incidence of symptoms experienced by a large sample of hospital endoscopy nurses. To find whether nurses in endoscopy units develop asthma under current working conditions in endoscopy units. To obtain analytically reliable data on exposure concentrations of glutaraldehyde (GA) vapour in endoscopy units, and to relate them to individual hygiene and work practices. To characterise any exposure response relations between airborne GA and the occurrence of work related symptoms (WRSs). Due to the growing concern about the perceived increase in WRSs among workers regularly exposed to biocides, all of whom work within a complex multiexposure environment, a cross sectional study was designed. Methods Current endoscopy nurses (n=348) from 59 endoscopy units within the United Kingdom and ex-employees (who had left their job for health reasons (n=18) were surveyed. Symptom questionnaires, end of session spirometry, peak flow diaries, skin prick tests (SPTs) to latex and common aeroallergens,and measurements of total immunoglobulin E (IgE) and IgE specific to GA and latex were performed. Exposure measurements included personal airborne biocide sampling for peak (during biocide changeover) and background (endoscopy room, excluding biocide changeover) concentrations. Results All 18 ex-employees and 91.4% of the current nurses were primarily exposed to GA, the rest were exposed to a succinaldehyde-formaldehyde (SF)composite. Work related contact dermatitis was reported by 44% of current workers exposed to GA, 56.7% of those exposed to SF composite, and 44.4% of ex-employees. The prevalence of WRSs of the eyes, nose, and lower respiratory tract in current workers exposed to GA was 13.5%, 19.8%, and 8.5% respectively and 50%, 61.1%, and 66.6% in the ex-employees. The mean percentage predicted forced expired volume in 1 second (ppFEV1) for ex-employees (93.82, 95% confidence interval (95% CI) 88.53 to 99.11) was significantly lower (p<0.01) than that of current workers exposed to GA (104.08, 95% CI 102.35 to 105.73). Occupational peak flow diaries completed by current workers with WRSs of the lower respiratory tract showed no evidence of bronchial asthma (<15% variation). Six per cent of the population had positive latex SPTs. Positive indications of one GA specific IgE and 4.1% latex specific IgE occurred. There was no conformity between the latex specific IgE and positive SPTs. Positive SPTs to latex were associated with WRSs of dermatitis and ocular WRSs, but no other WRSs. Exposures were above the current maximum exposure limit (MEL) of 0.2 mg/m3 (0.05 ppm) in eight of the units investigated. A significant relation existed between peak GA concentrations and work related chronic bronchitis and nasal symptoms (after adjustment for types of local ventilation) but not to other WRSs. Peak GA concentrations were significantly higher in units that used both negative pressure room and decontaminating unit ventilation. Conclusion This study documents a significant level of symptoms reported in the absence of objective evidence of the physiological changes associated with asthma. Ex-employees and current workers with WRSs warrant further study to elucidate the cause and mechanisms for their symptoms. Ventilation systems used for the extraction of aldehydes from the work area may be less effective than expected and due to poor design may even contribute to high peak exposures. AU - Vyas A AU - Pickering CAC AU - Oldham LA AU - Francis HC AU - Fletcher AM AU - Merrett T LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 117 IP - DP - 2000 Jan 01 TI - Flock Worker’s Lung*: Broadening the Spectrum of Clinicopathology, Narrowing the Spectrum of Suspected Etiologies PG - 251-259 AB - Study objectives: Workers in the nylon flocking industry recently have been found to be at increased risk of chronic nongranulomatous interstitial lung disease. Although a spectrum of cytologic and histopathologic abnormalities has been observed, nonspecific interstitial pneumonia, lymphoid nodules, and lymphocytic bronchiolitis predominated in the 19 previously reported cases of flock worker’s lung. Here we describe five additional patients who appear to expand the histopathologic spectrum and add to the evidence suggesting a causative role for respirable-sized nylon fragments. Methods: We studied all North American patients (n = 5) found in 1998 to satisfy our previous case definition of flock worker’s lung. Two pulmonary pathologists independently reviewed each biopsy specimen. Results: All five patients reported cough and dyspnea. Only one patient had crackles on chest auscultation. High-resolution CT scan, interpreted with attention to subtle ground-glass attenuation, remained a highly sensitive diagnostic test. Pulmonary function tests and plain chest radiograph were less sensitive. One patient’s wedge biopsy showed previously described prototypical findings. Two others had transbronchial biopsies showing some of the same features. The fourth patient’s wedge biopsy showed desquamative interstitial pneumonia. The fifth patient had bilateral synchronous adenocarcinoma but with radiographic evidence of diffuse interstitial fibrosis. These 5 patients and the 19 patients studied previously were exposed to nylon flock manufactured by a rarely used cutting technology. Conclusion: Findings in these five patients appear to broaden the spectrum of the clinicopathology of flock worker’s lung and add to the evidence incriminating respirable-sized nylon particulates produced during the manufacture and use of rotary-cut nylon flock. AU - Kern DG AU - Kuhn C AU - Ely EW AU - Pransky GS AU - Mello CJ AU - Fraire AE LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 57 IP - DP - 2000 Jan 01 TI - Occupational asthma caused by bacillary amylase used in the detergent industry. PG - 840-2 AB - Four cases are reported of occupational asthma due to amylase derived from Bacillus licheniformis, used in detergent washing powders. It is thought that these are the first reported cases of asthma due to this enzyme in the detergent industry. All four employees (men) were from the same factory and none had a history of asthma or atopy. All developed symptoms of wheeze at work after an initial symptom free period. Symptoms improved during periods away from work. All undertook serial peak flow recordings (not diagnostic) and underwent skin prick tests, radio allergosorbent test (RAST) measurement, and specific bronchial provocation testing. The bronchial provocation testing was performed by a dust tipping method in a single blind manner, with lactose as an inert control and powdered amylase, provided by the employer, as an active agent. Serial measurements of forced expiratory volume in 1 second (FEV(1)) were recorded and histamine provocative concentration causing a 20% fall in FEV(1) (PC(20)) tests were determined before and 24 hours after each challenge. Patient 1 developed an isolated early reaction, patient 2 an isolated late reaction, and patients 3 and 4 developed dual reactions. All showed an increased non-specific bronchial responsiveness after active challenge. The introduction of encapsulated enzymes in the detergent industry was followed by a reduction in the incidence of respiratory sensitisation. These patients developed occupational asthma despite working only with encapsulated enzymes. This highlights the importance of careful surveillance after the introduction of new agents in the workplace. AU - Hole AM AU - Draper A AU - Jolliffe G AU - Cullinan P AU - Jones M AU - Taylor AJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 39 IP - DP - 2000 Jan 01 TI - Occupational asthma due to African Cherry (Makore) wood dust PG - 947-949 AU - Obata H AU - Dittrick M AU - Chan H AU - Chan-Yeung M LA - PT - DEP - TA - Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 55 IP - DP - 2000 Jan 01 TI - Asthma to tetramethrin PG - 417-418 AB - PYRETHRUM is extracted from the flowers of Chrysanthemum cinerariifolium (botanic family of Compositae). The active components of pyrethrum are esters of chrisanthemic and pyrethric acids (i.e.pyrethrins, cinerins, and jasmolins), which are collectively referred to as pyrethrins. Pyrethrum and pyrethrins have been used since the early 19th century for control of indoor insect pests as well as for direct application to man and animals. Synthetic analogs, termed the pyrethroids (e.g. permethrin, allethrin, tetramethrin, and permethrin), have been developed to enhance insecticidal activity and photostability. The patient sprayed insecticides. Histamine PC20 was 0.125 mg/ml. After a control challenge with a paint diluent, the subject sprayed an insecticide formulation containing 0.2% tetramethrin and 0.1% fenitrothion, which resulted in a dual asthmatic reaction AU - Vandenplas O AU - Delwiche J-P AU - Auverdin J AU - Caroyer J-M AU - Binard-Van Cangh F LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 55 IP - DP - 2000 Jan 01 TI - Chlorendic anhydride allergy PG - 98-99 AB - n June 1997, a 47-year-old mechanic began to repair old painted forest harvesters by metal-inert-gas (MIG) welding. Next autumn, he experienced immediate erythema and edema of the face and later also dyspnea when welding. Peak expiratory flow (PEF) follow-up (twice a day) showed 22% PEF variation during one work day. Slight bronchial hyperreactivity was found. The symptoms diminished during other work but returned when the subject was exposed in welding again. Our examinations showed normal clinical status. Bronchial hyperreactivity had disappeared. Skin prick tests with common environmental allergens were negative. PEF surveillance pointed strongly to occupational asthma. He had been briefly exposed to the paint fumes for about 10 s, leading to immediate dyspnea, erythema, and edema of the face, and a fall in PEF of 30% (610–430 l/min) and 41% (590–350 l/min). The diurnal PEF variation was <10% during other work days and on days off. In the material safety data sheets of the two-component paint, only two solvents were given. According to the manufacturer, the hardener contained 65% chlorinated polyester and the paint contained 0.9% alkyd resin. Both phthalic anhydride (PA) and chlorendic anhydride (CA) were identified in the fumes generated from the heated paint. CA-HSA-conjugate (1%) induced a positive reaction in the skin prick test and also in the open test. Skin prick tests with several common sensitizing acid anhydride-HSA conjugates were positive. Specific IgE antibodies against CA-HSA-conjugate were found (Phadebas RAST®) against all the other sensitizing anhydrides except trimellitic anhydride. On the basis of these investigations, we diagnosed contact urticaria due to CA and occupational asthma due to the welding fumes of a polyester paint containing PA and CA. Organic acid anhydrides are used as hardeners of epoxy resins and in the manufacture of alkyd and polyester resins. Several anhydrides have been shown to cause IgE-mediated allergies. AU - Keskinen H AU - Pfäffli P AU - Pelttari M AU - Tupasela O AU - Tuomi T AU - Tuppurainen M AU - Hämeilä M AU - Kanerva L AU - Nordman H LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 106 IP - DP - 2000 Jan 01 TI - Allergy to iguana PG - 369-372 AB - Background: Furry animals produce allergens that can cause allergic rhinitis and asthma. In contrast, scaly animals, such as lizards, are assumed not to be allergenic. Objective: We sought to evaluate a 32-year-old man who complained of allergic rhinitis and asthma symptoms that occurred exclusively in his own home. He had dogs and cats at home but denied any increase in symptoms specifically associated with these pets. Skin prick testing initially performed to 42 common aeroallergens, including cat, dog, and house dust mite, elicited negative results. He later reported that the symptoms were worse on exposure to his pet iguanas. Methods: Skin prick tests were subsequently performed to an extract made from scales from his pet iguana. Extracts were also prepared from several zoo reptiles. Immunoassays for IgE antibody, as well as IgE immunoblots, were performed by using these extracts and the patient's serum. Results: The skin prick test result with the pet iguana scale extract was positive. The patient's serum contained IgE antibody to his own pet iguana and to a zoo iguana. Conclusion: Our patient's history, skin test results, and in vitro studies clearly demonstrate that he is allergic to iguana. Physicians should be aware that such allergy to scaly pets may occur and should not restrict history taking to questions about furry pets. AU - Kelso JM AU - Fox RW AU - Jones RT AU - Yunginger JW LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 161 IP - DP - 2000 Jan 01 TI - Airway Hyperresponsiveness in Elite Athletes PG - 1479-1484 AB - It has been suggested that high-level training could contribute to the development of airway hyperresponsiveness (AHR), but the comparative effects of different sports on airway function remains to be determined. We evaluated 150 nonsmoking volunteers 18 to 55 yr of age; 100 athletes divided into four subgroups of 25 subjects each according to the predominant estimated hydrocaloric characteristic of ambient air inhaled during training: dry air (DA), cold air (CA), humid air (HA) and a mixture of dry and humid air (MA), and 50 sedentary subjects. Each subject had a respiratory questionnaire, a methacholine challenge, allergy skin-prick tests, and heart rate variability recording for evaluation of parasympathetic tone. The athletes had a 49% prevalence of AHR (PC20 < 16 mg/ml), with a mean PC20 of 16.9 mg/ml, compared with 28% (PC20: 35.4) in sedentary subjects (p = 0.009). The prevalence (%) of AHR and mean PC20 (mg/ml) varied as followed in the four subgroups of athletes: DA: 32% and 30.9; CA: 52% and 15.8; HA: 76% and 7.3; and MA: 32% and 21.5 (p = 0.002). The estimated parasympathetic tone was higher in athletes (p < 0.001), but this parameter showed only a weak correlation with PC20 (r = 0.17, p = 0.04). This study has shown a significantly higher prevalence of AHR in athletes than in the control group because of the higher prevalence in the CA and HA groups. Parasympathetic activity may act as modulator of airway responsiveness, but the increased prevalence of AHR in our athlete population may be related to the type and possibly the content of inhaled air during training. AU - LANGDEAU J AU - TURCOTTE H AU - BOWIE DM AU - JOBIN J AU - DESGAGNÉ P AU - and BOULET L LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 50 IP - DP - 2000 Jan 01 TI - Seafood processing in South Africa: a study of working practices, occupational health services and allergic health problems in the industry PG - 406-413 AB - The work practices, occupational health services and allergic health problems among workplaces which process seafood in Western Cape province of South Africa were examined. A cross-sectional study was conducted among 68 workplaces that were sent a self-administered postal survey questionnaire. Workplaces reporting a high prevalence of work-related symptoms associated with seafood exposure were also inspected. Forty-one (60%) workplaces responded to the questionnaire. The workforce consisted mainly of women (62%) and 31% were seasonal workers. Common seafoods processed were bony fish (76%) and rock lobster (34%). Major work processes involved freezing (71%), cutting (63%) and degutting (58%). Only 45% of workplaces provided an on-site occupational health service and 58% of workplaces conducted medical surveillance. Positive trends were observed between workplace size and activities such as occupational health service provision (P = 0.002), medical surveillance programmes (P = 0.055) and reporting work-related symptoms (P = 0.016). None of the workplaces had industrial hygiene surveillance programmes to evaluate the effects of exposure to seafood. Common work-related symptoms included skin rashes (78%), asthma (7%) and other non-specific allergies (15%). The annual prevalence of work-related skin symptoms reported per workplace was substantially higher for skin (0-100%) than for asthmatic (0-5%) symptoms. The relatively low prevalence of employer-reported asthmatic symptoms, when compared to epidemiological studies using direct investigator assessment of individual health status, suggests likely under-detection. This can be attributed to under-provision and under-development of occupational health surveillance programmes in workplaces with less than 200 workers. This is compounded further by the lack of specific statutory guidelines for the evaluation and control of bio-aerosols in South African workplaces. AU - Jeebhay MF AU - Lopata AL AU - Robins TG LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 55 IP - DP - 2000 Jan 01 TI - Sensitisation and lung function in workers occupationally exposed to natural thickening products PG - 376-381 AB - Background Three workers engaged in the manufacture of natural thickener products (Cassia spp., guar, and tamarind flour) were occupationally sensitized to Cassia spp. Therefore, a cross-sectional study on the prevalence of sensitization among and respiratory health of the employees of this plant was conducted. Methods and Results Sixty-two workers (36 with high, 26 with low exposure) participated in the survey. Skin prick tests and specific IgE tests with extracts of these components revealed that 11.3% were sensitized to Cassia spp. and 9.7% to at least one species of storage mites, with a significantly higher portion of atopic subjects in the sensitized group. Overall, 55% of the subjects reported work-related symptoms (upper and lower airways, eyes, or skin). FVC % pred. was signifcantly lower in highly exposed workers, while RV % pred. and RV%TLC % pred. were significantly higher in this group. In the multivariate model, sensitization was not a risk factor for impairment of lung function. Conclusions Dust exposure to flours may not only cause allergic sensitization but also induce chronic changes in lung function. AU - Steger A AU - Radon K AU - Pethran A AU - Novak D LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 118 IP - DP - 2000 Jan 01 TI - Unpredictability of deception in compliance with physician-prescribed bronchodilator inhaler use in clinical trial PG - 290-295 AU - Simmons MS AU - Nides M AU - Rand CS AU - Wise RA AU - Tashkin DP LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 355 IP - DP - 2000 Jan 01 TI - Effects of influenza vaccination of health-care workers on mortality of elderly people in long-term care: a randomised controlled trial PG - 93-97 AB - BACKGROUND: Vaccination of health-care workers has been claimed to prevent nosocomial influenza infection of elderly patients in long-term care. Data are, however, limited on this strategy. We aimed to find out whether vaccination of health-care workers lowers mortality and the frequency of virologically proven influenza in such patients. METHODS: In a parallel-group study, health-care workers in 20 long-term elderly-care hospitals (range 44-105 patients) were randomly offered or not offered influenza vaccine (cluster randomisation, stratified for policy for vaccination of patients and hospital size). All deaths among patients were recorded over 6 months in the winter of 1996-97. We selected a random sample of 50% of patients for virological surveillance for influenza, with combined nasal and throat swabs taken every 2 weeks during the epidemic period. Swabs were tested by tissue culture and PCR for influenza viruses A and B. FINDINGS: Influenza vaccine uptake in health-care workers was 50.9% in hospitals in which they were routinely offered vaccine, compared with 4.9% in those in which they were not. The uncorrected rate of mortality in patients was 102 (13.6%) of 749 in vaccine hospitals compared with 154 (22.4%) of 688 in no-vaccine hospitals (odds ratio 0.58 [95% CI 0.40-0.84], p=0.014). The two groups did not differ for proportions of patients positive for influenza infection (5.4% and 6.7%, respectively); at necropsy, PCR was positive in none of 17 patients from vaccine hospitals and six (20%) of 30 from no-vaccine hospitals (p=0.055). INTERPRETATION: Vaccination of health-care workers was associated with a substantial decrease in mortality among patients. However, virological surveillance showed no associated decrease in non-fatal influenza infection in patients. AU - Carman WF AU - Elder AG AU - Wallace LA AU - McAulay K AU - Walker A AU - Murray GD AU - Stott DJ LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 59 IP - DP - 2000 Jan 01 TI - Bupropion: a review of its use in the management of smoking cessation. PG - 1007-1024 AB - Sustained release bupropion (amfebutamone) is a non-nicotine agent that is indicated as an aid to smoking cessation. In 2 large well designed clinical trials, sustained release bupropion 300 mg/day (the recommended dose) for 7 or 9 weeks was associated with considerably and significantly higher smoking abstinence rates (continuous abstinence and 7-day point prevalence rates) than placebo during treatment and at follow-up at 6 and 12 months. Point prevalence rates at 12 months in 2 studies were 23.1 and 30.3% with bupropion, whereas values for placebo were 12.4 and 15.6%. Continuous abstinence rates at 12 months, available from 1 trial, were 18.4% with bupropion and 5.6% with placebo. Furthermore, bupropion was associated with significantly higher quitting rates than nicotine patch in a comparative study. Combination therapy with bupropion and nicotine patch provided slightly higher abstinence rates than bupropion alone, although differences were not statistically significant. The combination was superior to nicotine patch alone. Data from a preliminary report of long term bupropion treatment (52 weeks) showed that the drug was associated with significantly higher continuous abstinence rates than placebo only to 6 months. However, point prevalence abstinence rates were significantly higher with bupropion than placebo to 18 months. Bupropion 300 mg/day recipients reported nicotine withdrawal symptoms during treatment; however, the symptoms were significantly less severe with bupropion than placebo. Patients receiving bupropion 300 mg/day or bupropion in combination with nicotine patch for smoking cessation generally gained less bodyweight than placebo recipients. The benefits of bupropion for preventing weight gain persisted after the completion of long term, but not short term therapy. Bupropion was well tolerated in clinical trials, and the only adverse events that were significantly more common with bupropion than placebo were insomnia and dry mouth. Data published so far suggest that sustained release bupropion has a low potential for inducing seizures (seizure rate approximately 0.1% in patients with depression). Conclusions: Bupropion is an effective and well tolerated smoking cessation intervention. Further studies with long term follow-up will be useful in determining whether abstinence rates are maintained with bupropion. In addition, clarification of its efficacy in comparison with other therapies used for smoking cessation would help to establish its clinical value. The reduced potential for weight gain with bupropion and the ability to use bupropion in combination with nicotine replacement therapy make the drug a useful treatment option for smoking cessation. AU - Holm KJ AU - Spencer CM LA - PT - DEP - TA - Drugs JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 55 IP - DP - 2000 Jan 01 TI - Occupational asthma caused by aluminium PG - 779-780 AB - Respiratory disease in aluminium potroom workers has been well recognized since the first Norwegian report in 1936. There is still controversy whether this is an irritant reaction to hydrogen fluoride or a specifc reaction to aluminium fluoride. We report the first case of aluminium asthma in a foundry worker with a positive specific challenge test to aluminium chloride, raising the possibility that potroom asthma is due to a reaction to aluminium fluoride. AU - Burge PS AU - Scott JA AU - McCoach J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 73 IP - DP - 2000 Jan 01 TI - Quarternary ammonium compounds and occupational asthma PG - 423-427 AB - Objective: Quaternary ammonium compounds, among which benzalkonium chloride is one of the best-known, are commonly used as antiseptics, disinfectants, detergents and preservatives. They can cause occupational asthma, which however, has been rarely reported so far, despite wide use of these products. We report three such cases. Possible mechanisms causing asthma are discussed, taking into account their characteristics. Methods and results: Our patients, all female nurses, manifested asthma symptoms upon handling disinfectant solutions containing benzalkonium chloride. Work-related fall in PEFR was observed in all of them. The diagnosis was confirmed by challenge tests where the patients were exposed, in a closed chamber, to suspected disinfectant contained in a tray. All of the women developed early or delayed symptoms upon exposure. Similar challenge tests to placebo or other disinfectants devoid of quaternary ammonium compound were negative. Conclusion: These three cases, in addition to others reported in the literature, point out an as yet poorly known etiology of occupational asthma to quaternary ammonium compounds in hospital employees. The exact mechanism of the action remains unexplained. AU - Purohit A AU - KopferschmitKubler MC AU - Moreau C AU - Popin E AU - Blaumeiser M AU - Pauli G LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 7 IP - DP - 2000 Jan 01 TI - The prevention of occupational asthma in industries. PG - 377-379 AB - This paper discusses criteria for the primary and secondary prevention of occupational asthma. The former involves intervention in the workplace to prevent onset of the disease, while the latter is based on early diagnosis. These forms of prevention are applied in this study, particularly to work involving laboratory animals, the use of latex gloves, wheat flour, proteolytic enzymes and simple chemical compounds (isocyanates). AU - Fabri G LA - PT - DEP - TA - Journal of Investigational Allergology & Clini JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 155 IP - DP - 2000 Jan 01 TI - Specific IgE-dependent sensitization, atopy, and bronchial hyperresponsiveness in apprentices starting exposure to protein- derived agents. PG - 1841-1847 AB - Atopy, specific IgE sensitization, and bronchial hyperresponsiveness (BHR) were examined in a cohort of 769 apprentices starting career programs in animal health or veterinary medicine (Group 1), pastry making (Group 2), and dental hygiene (Group 3). The hypothesis were that: (1) a proportion of subjects can be "sensitized" although no significant specific occupational exposure has occurred; and (2) there is a relationship between baseline specific sensitization to work-related antigens and host characteristics. Skin tests were administered using 11 common inhalants and specific allergens, including six laboratory animal extracts, three cereal antigens, alpha-amylase, and latex. Methacholine challenge tests were performed. The prevalence of atopy was 54.4% in Group 1, 58.1% in Group 2, and 52.5% in Group 3. Skin reactivity to work-specific proteins was as follows: laboratory animal proteins, 13.8% in Group 1, 14.0% in Group 2, and 15.6% in Group 3. No subject was sensitized to alpha-amylase, whereas 1.2% in Group 1, 5% in Group 2, and 4.1% in Group 3 were sensitized to flour. Five subjects reacted to latex. BHR (PC20 < or = 8 mg/ml) was present in 17.6%, 21.2%, and 14.8% of subjects in Groups 1, 2, and 3, respectively. Specific sensitization was associated with positive skin reactions to common allergens, work-related symptoms, and BHR. These results suggest that students starting career programs with exposure to high-molecular-weight allergens have a low but substantial frequency of specific sensitization to work-related allergens that is related to atopy and BHR. AU - Gautrin D AU - InfanteRivard C AU - Dao TV AU - MagnanLarose M AU - Desjardins D AU - Malo JL LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 30 IP - DP - 2000 Jan 01 TI - Colophony hypersensitivity revisited PG - 158-9 AB - Colophony (or rosin as it is sometimes called) is a common cause of occupational sensitization. In the UK it ranks in the top five causes of occupational asthma [1] and the top 10 causes of contact dermatitis. It is also a cause of rhinitis and eye irritation, and perhaps of headache and allergic alveolitis [2-4]. It is an ‘old fashioned’ small molecular weight chemical used in the early days of the plastics industry as a basis for semisynthetic resins. It is derived from the resin of pine trees, either by direct tapping of the sap, by extraction from dead stumps (wood rosin), or from tall oil left over after paper manufacture (tall oil rosin); the latter two products tending to have more oxidised resin acids than native colophony. Colophony consists of a variable mixture of resin acids, some of which are relatively unstable, and a neutral fraction. Occupational asthma usually results from inhalation of the fume from heated colophony in soft soldering fluxes [5], or occasionally in hot melt glues [6] or depilatory mixtures [7]. However, cases have occurred in a chemical worker with colophony heated to 90º C [8] and from unheated colophony dust [9]. Colophony or colophony derivatives have caused occupational asthma when added as a deodorant to coolant oils [10] and floor cleaning products [11]. The occupational asthma resulting from colophony exposure usually has the features of a sensitizing reaction, with a latent interval from first exposure to first symptom (averaging 6.5 years in one heavily exposed group [12]), only a proportion of similarly exposed workers are affected, and asthma is induced in affected workers with exposures which have no effect in asymptomatic exposed workers [13]. There is only a weak relationship between non-specific reactivity and the concentration of colophony required to elicit an asthmatic reaction [13], again pointing to some mechanism requiring specificity. Colophony fumes at levels found in some soldering operations can sometimes produce reactions which are probably irritant in some individuals who have no interval between first exposure and first symptom. Colophony has induced asthma in previously unexposed hyperresponsive asthmatics. Colophony and plicatic acid have both damaged pulmonary epithelial cells following direct application [14]. Some small molecular weight chemicals elicit specific immunoglobulin (Ig) E to hapten-protein conjugates , which can be infrequent (about 20% with isocyantes [15]), moderately prevalent (about 40% with plicatic acid, the principal resin acid from Western Red Cedar [16]), or usual (such as with acid anhydrides [17,18]). In the first two situations workers with and without specific IgE are clinically indistinguishable and appear to have the same prognosis. So far there are no reports where specific IgE to colophony conjugates have been described. In this issue elms and colleagues speculated that the lack of colophony IgE antibodies was due to inappropriate conjugates. They investigated the in vitro potential of colophony to interact with immune cells and the cells response to colophony [19]. Colophony at 5-50 µg/mL was incubated with various cell lines. Cells with neutrophil or monocyte differentiation showed increased intracellular peroxide after a 1-min colophony intubation, suggesting that reactive oxygen species were being induced which could oxidise colophony in vivo to resin acid epoxides and hydroperoxides. The epoxides are thought to be implicated in colpphony contact dermatitis [20], and might be a hapten for IgE antibodies. The control of a hazard casuing occupational asthma requires the causative agent to be indentified and a method devised fro its measurement. Until recently the control standard for colophony fume was based on its aldehyde content which correlated poorly with fume concentration [5] and had many sources of bias (e.g. from off-gassing of particle board). A methoed has been developed for estimation of the resin acid content of soldering fume [21] and an exposure standard based on this assay introduced [22]. The ingredients are now in place for the control of one of the commoner cause of occupational sensitization. AU - Burge PS LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 15 IP - DP - 2000 Jan 01 TI - Tuberculosis among health care workers during three recent decades PG - 304-307 AU - Raitio M AU - Tala E LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 108 IP - DP - 2000 Jan 01 TI - Criteria air pollutants and toxic air pollutants PG - 625-633 AU - Suh MW AU - Badadori T AU - Vallarino J AU - Spengler JD LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 161 IP - DP - 2000 Jan 01 TI - Raised exhaled nitric oxide in healthy children is associated with domestic formaldehyde levels PG - 1757-1759 AU - Franklin P AU - Dingle P AU - Stick S LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 55 IP - DP - 2000 Jan 01 TI - Indoor air pollutants in schools: nasal patency and biomarkers in nassal lavage PG - 163-170 AU - Norback D AU - Walinder R AU - Wieslander G AU - Smedje G AU - Erwall C AU - Venge P LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 55 IP - DP - 2000 Jan 01 TI - Effects of ventilation systems on prevalence of symptoms associated with sick buildings in Brazilian commercial establishments PG - 279-283 AU - Costa MF AU - Brickus LS LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 118 IP - DP - 2000 Jan 01 TI - Airway inflammation and aetiology of acute exacerbations of chronic bronchitis PG - 1557-1565 AU - Sethi S AU - Muscarella K AU - Evans N AU - Klingman KL AU - Grant BJ AU - Murphy TF LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 10 IP - DP - 2000 Jan 01 TI - Effects on eyes and nose in humans after experimental exposure to airborne office dust PG - 237-245 AU - Pan Z AU - Molhave L AU - Kjaergaard SK LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 10 IP - DP - 2000 Jan 01 TI - The effects of outdoor air suppy rate in an office on perceived air quality, sick building syndrome (SBS) symptoms and productivity PG - 222-226 AU - Wargocki P AU - Wyon DP AU - Sundell J AU - Clausen G AU - Fanger PO LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 57 IP - DP - 2000 Jan 01 TI - Building sickness syndrome in healthy and unhealthy buildings: an epidemiological and environmental assessment with cluster analysis PG - 627-634 AB - OBJECTIVES Building sickness syndrome remains poorly understood. Aetiological factors range from temperature, humidity, and air movement to internal pollutants, dust, lighting, and noise factors. The reported study was designed to investigate whether relations between symptoms of sick building syndrome and measured environmental factors existed within state of the art air conditioned buildings with satisfactory maintenance programmes expected to provide a healthy indoor environment. METHODS Five buildings were studied, three of which were state of the art air conditioned buildings. One was a naturally ventilated control building and one a previously studied and known sick building. A questionnaire was administered to the study population to measure the presence of building related symptoms. This was followed by a detailed environmental survey in identified high and low symptom areas within each building. These areas were compared for their environmental performance. RESULTS Two of the air conditioned buildings performed well with a low prevalence of building related symptoms. Both of these buildings out performed the naturally ventilated building for the low number of symptoms and in many of the environmental measures. One building (C), expected to perform well from a design viewpoint had a high prevalence of symptoms and behaved in a similar manner to the known sick building. Environmental indices associated with symptoms varied from building to building. Consistent associations between environmental variables were found for particulates (itchy eyes, dry throat, headache, and lethargy) across all buildings. There were persisting relations between particulates and symptoms (headache, lethargy, and dry skin) even in the building with the lowest level of symptoms and of measured airborne particulates (building B). There were also consistent findings for noise variables with low frequency noise being directly associated with symptoms (stuffy nose, itchy eyes, and dry skin) and higher frequency noise being relatively protective across all buildings. CONCLUSIONS This is the first epidemiological study of expected state of the art, air conditioned buildings. These buildings can produce an internal environment better than that of naturally ventilated buildings for both reported symptoms and environmental variables. The factors associated with symptoms varied widely across the different buildings studied although consistent associations for symptoms were found with increased exposure to particulates and low frequency noise. AU - Niven RM AU - Fletcher AM AU - Pickering CAC AU - Faragher EB AU - Potter IN AU - Booth WB AU - Jones TJ AU - Potter PD LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 30 IP - DP - 2000 Jan 01 TI - Colophony: an in vitro model for the induction of sensitisation PG - 209-213 AB - BACKGROUND The potential of colophony fumes from soldering flux to induce asthma has been known since the 1970s, however, no direct in vitro or in vivo evidence has been reported. The present study investigated the potential of colophony to stimulate human phagocytic cells to produce reactive oxygen species. METHODS The human cell line HL-60 was differentiated to produce cells with a monocyte-like and a neutrophil-like phenotypes. A number of procedures were used to confirm the phenotype of these differentiated cells including morphology, esterase activity, flow cytometry and phagocytosis. The potential of colophony to stimulate human phagocytic cells to produce reactive oxygen species was monitored using flow cytoenzymology. RESULTS We were able to show that intracellular peroxide levels were increased in both monocyte-like and neutrophil-like cells, but not in undifferentiated HL-60 cells following the addition of colophony. CONCLUSIONS The resin acid epoxides and hydroperoxides which have been suggested to be sensitizers in contact allergy, are degraded during the soldering process. However, conditions for the oxidation of colophony may occur in vivo as a result of the colophony-induced oxidative burst from neutrophils and monocytes. These oxidation products may then interact with body proteins to further initiate immune responses. Therefore for the preparation of low molecular weight chemical (LMWC)-protein conjugates, consideration must be taken to determine whether the LMWC is undergoing a reaction in vivo before it is interacting with body proteins. AU - Elms J AU - Allan LJ AU - Pengelly I AU - Fishwick D AU - Beckett PN AU - Curran AD LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - IP - DP - 2000 Jan 01 TI - Latex and you PG - - AU - Health and safety executive LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 30 IP - DP - 2000 Jan 01 TI - Anaphylaxix to chlorhexidine. Case report. Implication of immumoglobulin E antidodies and identification of an allergenic determinant PG - 1001-1007 AB - Anaphylaxix to chlorhexidine. Case report AU - Pham NH AU - Weiner JM AU - Reisner GS AU - Baldo BA LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 20000101 IS - IS - VI - 57 IP - DP - 2000 Jan 01 TI - Prevalence and risk factors for latex allergy PG - 501-501 AB - We read with interest the cross sectional study of latex allergy of workers in a United Kingdom hospital.1 We have also tried to study healthcare workers in a district general hospital and have had problems with the response rate for skin prick testing and also blood taking. We have, however, used standardised and evaluated skin prick test materials from Stallergen (1:200) and the Pharmacia CAP for latex and have found a high percentage of symptomatic workers with positive skin tests and specific IgE. We also found that workers in general wards were exposed to as much airborne latex as those in operating theatres, accident and emergency, and intensive care, areas which we previously thought of as high exposure. Median concentrations of latex in air were 0.44 µg/m3 in our high exposure areas and 0.48 µg/m3 in our lower exposure areas, perhaps because lower quality gloves were used in the general medical wards. We obtained questionnaires from 73% of our sample workers but only 60% response from symptomatic workers who were invited for skin prick testing and blood taking. There were a few significant diVerences between groups but there was a greater relation between the number of gloves worn a day than the hours of glove wearing. Work related symptoms relative to glove use are shown in the table. Seven of 48 symptomatic workers had at least a 3 mm weal to the latex allergen and nine had positive RAST (>0.7 ku/l). All skin prick positive workers had itching skin, four out of seven had eye irritation, two out of seven wheeze, and three out of seven rhinitis. Any study of this sort is likely to miss the most severely affected workers who cannot tolerate latex at present in the air in ordinary hospital environments. AU - Chaiear N AU - Foulds IS AU - Burge PS LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 1 IP - DP - 1999 Jan 01 TI - The effect of progressive reduction in smoking on sick building syndrome symptoms in a large office building PG - 80-85 AU - Raynal A AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 15 IP - DP - 1999 Jan 01 TI - A rat model of neurobehavioral sensitization to toluene. PG - 356-369 AB - Some individuals report that, following either a single high-level or repeated lower-level exposures to chemicals (initiation), subsequent exposure to very low concentrations of chemicals (triggering) produces a variety of adverse effects, including disruption of cognitive processes. Our objective was to model this two-step process in a laboratory animal. Two groups of 16 rats, eight male and eight female, received whole-body inhalation exposure to toluene, either at 80 ppm for 6 h/day for 4 weeks (Repeat group) or to 1600 ppm for 6 h/day on one day only (Acute group). Two other groups (Trigger group and Clean group) of 16 were sham-exposed. After 17 days without toluene exposure, the Acute, Repeat and Trigger groups began a series of daily toluene 'trigger' exposures (10 ppm for 1 h) followed immediately by testing on an operant repeated-acquisitions task requiring learning within and across sessions. The Clean group was sham-exposed prior to operant testing. Trigger or sham exposures and operant testing continued 5 days/week for 17 sessions. Analysis of variance revealed a variety of statistically significant (P < 0.05) differences between treatment groups. Furthermore, the patterns of differences between groups differed (P < 0.05) for female and male rats. For example, male rats of the Trigger group made the most responses, and female rats of the Repeat group responded most slowly. The observation of important changes in the operant behavior of female and male rats previously exposed to toluene, at relatively low concentrations (80 or 1600 ppm) and then later re-exposed at very low concentrations (10 ppm), is consistent with the experiences of humans reporting cognitive difficulties following acute or chronic exposures to chemicals. AU - Rogers WR AU - Miller CS AU - Bunegin L LA - PT - DEP - TA - Toxicology & Industrial Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 35 IP - DP - 1999 Jan 01 TI - Latex sensitization: occupational versus general population prevalence rates PG - 196-200 AB - BACKGROUND: Natural rubber latex (NRL) has become an important occupational health concern in recent years, particularly among health care workers. It has been suggested in some reports that the prevalence of latex sensitization among occupationally exposed groups is not different from that in the general population. METHODS: The findings of prevalence studies conducted among occupationally-exposed and general population groups were reviewed to determine whether there is evidence to support this suggestion. RESULTS: Numerous surveys of HCWs have demonstrated that the prevalence of sensitization to latex ranged in most studies from 5 to 12%; sensitization of HCWs may produce clinical effects including urticaria, rhinoconjunctivitis, occupational asthma, and potentially life-threatening anaphylactic shock. More than a decade ago, data from Finland indicated that the prevalence of latex allergy in the general population was less than 1%. Recent reports from Finland have confirmed this, with observations that 0.7-1.1% of large series of patients were NRL-allergic, while among 804 unselected patients, the prevalence of latex skin prick test (SPT) positivity was 0.12%. In contrast, other studies have suggested that from 4 to 6.4% of individuals tested were positive for serum latex-specific IgE antibodies. However, the specificity of these assays has been reported to be low. In three recent studies based on SPTs, published in 1997, the prevalence of positive reactions to latex was about 1% or less. The prevalence was 0.7% (95% CI 0.3-1.4) among 758 apprentices in Quebec, Canada; and 1.1% among more than 3,000 children tested in Finland (1.0% confirmed on latex use test). There were no first- and second-year dental students with positive latex SPTs in Ontario, Canada. CONCLUSIONS: These recent investigations provide further evidence consistent with earlier studies based on skin testing that the prevalence of latex sensitization in occupationally-unexposed groups is quite low (< 1%). The marked differences in the findings based on serological assays may relate to the nonspecificity of these assays and deserve further investigation AU - Liss GM AU - Sussman GL LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 35 IP - DP - 1999 Jan 01 TI - Respiratory and immunological findings in brewery workers PG - 68-75 AB - BACKGROUND: Occupational exposure of brewery workers to organic dusts such as hops, barley, and brewery yeast has the potential to change respiratory function and immunological status. METHODS: Ninety-seven male workers employed in a brewery plant were studied. The mean age of the workers in this plant was 40 years, the mean duration of their employment was 16 years. In addition, a group of 76 unexposed workers was studied as a control. Respiratory symptoms were recorded. Lung function was measured by recording maximum expiratory flow-volume (MEFV) curves. Immunological testing was performed on all brewery workers and some control volunteers using skin prick testing with hops, barley, and yeast antigens as well as other nonoccupational allergens, and by determining total serum IgE levels. RESULTS: There was a significantly higher prevalence of most of the chronic respiratory symptoms in brewery workers compared to controls (P < 0.01). Occupational asthma, however, was recorded in only 2 (2.1%) of the brewery workers. Logistic regression analysis showed that smoking was the major studied factor responsible for the high prevalence of chronic respiratory symptoms in workers. A large number of brewery workers complained of acute symptoms that developed during the work shift. Lung function tests were decreased compared to predicted. Multivariate analysis of these respiratory function parameters suggested the importance of workplace exposure in explaining lung function abnormalities. Significantly higher prevalences of positive skin prick tests were recorded in 37 brewery workers for molds, hops, and barley than in controls. Increased serum levels of total IgE were documented in 34/97 (45.1%) brewery workers and in 1/76 (2.7%) of the control workers (P < 0.01). However, workers with positive skin prick tests had prevalences of chronic respiratory symptoms and lung function changes similar to those of workers with negative skin prick tests. CONCLUSION: Our data suggest that both smoking and dust exposure in the brewery industry may be responsible for the development of respiratory impairment and immunological reactions AU - GodnicCvar J AU - Zuskin E AU - Mustajbegovic J AU - Schachter EN AU - Kanceljak B AU - Macan J AU - Ilic Z AU - Ebling Z LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 16 IP - DP - 1999 Jan 01 TI - Occupational asthma in a Senegalese car sprayer. Diagnostic and medico-legal problems PG - 199-203 AB - The industrial development policy adopted by African countries since their independence has contrasted with the relative rarity of occupational asthma in workers exposed to different situations and substances known to generate occupational asthma. Asthma occurring in a Senegalese car sprayer had persisted for twenty years before the its work-related nature was recognized. This observation demonstrates the need for: 1. Education to make health care personnel, as well as workers and employers, more aware of the clinical aspects of asthma. Educational programs should include diagnostic and preventive measures for respiratory occupational diseases including occupational asthma. 2. A registration system for occupational diseases so the occupational nature of diseases can acquire legal recognition. 3. Cooperative efforts between general practitioners, occupational physicians, physiologists and lung specialists in order to create reference laboratories where tests can be performed to confirm the diagnosis of occupational asthma, a disease which has not yet been included on the list of occupational diseases AU - Ndiaye M AU - Fall C AU - Ndir M AU - Mbaye I AU - Ba O AU - Cissokho S AU - Dia M AU - Kandji M AU - Seck G AU - Sow ML AU - Hane AA LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 115 IP - DP - 1999 Jan 01 TI - The association between occupation and asthma in general medical practice PG - 1259-1264 AB - BACKGROUND: In general practice settings, the proportion of adult asthma attributable to occupational factors is not known. OBJECTIVE: The goal of this study was to estimate the proportion of adult asthma cases that can be attributed to occupational factors initiating new disease onset and exacerbating preexisting disease. METHODS: We performed a cross-sectional analysis of interview data for 150 adults with asthma recruited from a random sample of family practice specialists. We ascertained the asthma and work histories of the subjects and estimated the proportion with likely work-initiated asthma and work-related asthma recrudescence. RESULTS: Seventy-four subjects (49%) reported adult-onset asthma while employed; an additional 25 (17%) reported recrudescence of previously quiescent childhood-onset asthma during employment. Of those with new-onset asthma while employed, 15 (10% of the study group; 95% confidence interval, 5 to 15%) were employed in occupations at increased risk of occupational asthma initiation on the basis of an independent job scoring matrix. Of those with asthma recrudescence in adulthood, seven (5% of the study group; 95% confidence interval, 2 to 8%) were employed in occupations at increased risk of exposures aggravating asthma. CONCLUSIONS: Among adults with asthma treated in general practice settings, > 1 in 10 patients has a work history strongly suggestive of a potential relationship between exposure and disease AU - Blanc PD AU - Eisner MD AU - Israel L AU - Yelin EH LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 35 IP - DP - 1999 Jan 01 TI - Preliminary report of mortality among workers compensated for work-related asthma PG - 465-471 AB - BACKGROUND: Although fatalities due to asthma have been reported among subjects with occupational asthma (OA) associated with re-exposure, groups of subjects with work-related asthma have not been systematically followed up for mortality. During a review of compensation claims for asthma in Ontario, we identified 3 respiratory deaths among subjects previously compensated for OA for whom their surviving spouses received death benefits. This suspected &quot;cluster&quot; prompted us to undertake an investigation to examine mortality pattern among workers compensated for work-related asthma. METHODS: Subjects receiving compensation for OA or aggravation of asthma (AA) between 1980 and 1993, and a comparison sample of workers with claims for musculoskeletal injuries during the same period were identified from the Ontario Workers' Compensation Board. We also identified another comparison group of non-compensated asthmatic patients seen at a hospital clinic during the same period. The files of those with work-related asthma were reviewed to determine if OA or AA was adequately documented. Mortality was ascertained by linkage with the Mortality Database at the Ontario Cancer Registry through 1996. We compared the mortality of the three groups with that expected in the general population of Ontario using SMRs, and directly by proportional-hazards regression. RESULTS: The study included 3,070 subjects: 1,112 with work-related OA/AA with adequate documentation, 1,556 with work-related injuries, and 402 patients with non-work-related asthma. Of the 66 deaths identified, only 2 deaths were due to asthma, both in the work-related asthma group: one from the index cluster and one not previously identified. A second index death was coded as dying from COPD not elsewhere classified (ICD9 496), while the third index death also died of asthma but there was not sufficient information documenting OA to include the subject in the analyses. As compared with the general population, there were fewer deaths than expected from most causes, except for deaths among the work-related asthma claimants and the nonwork-related asthma patients from respiratory diseases (SMRs 1.3 and 5.9, respectively; 0.5 among injury claimants), all chronic obstructive lung disease (ICD9 490-496; SMRs 2.3 and 7.7, respectively), and asthma (SMRs 18.2 and 0, respectively). In direct comparison of the work-related asthma claimants with the injury claimants, the risk of death appeared elevated from respiratory disease (RR 2.6) and ischemic heart disease (IHD) (RR 2.8) but the confidence intervals included unity. CONCLUSIONS: This preliminary report raises the possibility that serious outcomes, including excess deaths from respiratory disease, in particular asthma, may occur among those with work-related asthma even in the absence of re-exposure. However, the findings are inconclusive given that the number of deaths was small and we identified only one new asthma death in addition to the index cluster. We also observed for the first time that deaths due to circulatory disease, particularly IHD, may also be increased among such workers; this needs to be confirmed elsewhere AU - Liss GM AU - Tarlo SM AU - Banks D AU - Yeung KS AU - Schweigert M LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 103 IP - DP - 1999 Jan 01 TI - Specific IgG response to monomeric and polymeric diphenylmethane diisocyanate conjugates in subjects with respiratory reactions to isocyanates PG - 749-755 AB - BACKGROUND: Isocyanates are a frequent cause of occupational asthma and can also induce hypersensitivity pneumonitis. OBJECTIVES: It is still unclear whether antibodies to diphenylmethane diisocyanate (MDI), which are elicited in some subjects with these conditions, are specific for this type of isocyanate. Moreover, preparation of conjugates to human serum albumin (HSA) with the polymeric formulation rather than monomeric MDI might result in improved detection of antibodies. METHODS: We addressed these issues by testing the sera of 13 subjects with asthma (n = 12) and hypersensitivity pneumonitis (n = 1) induced by MDI (n = 4 or 5, see below) by comparing them with sera obtained from subjects with occupational asthma caused by toluene diisocyanate (TDI; n = 5) and hexamethylene diisocyanate (HDI; n = 2). Conjugate preparations were compared by using SDS-PAGE, absorbance spectral analysis, and isolectric focusing. Immunologic screening was done by ELISA. RESULTS: Specific IgG antibodies that recognize MDI-HSA conjugates were detected in all but 1 of the MDI-exposed workers and could not be found in TDI-exposed and HDI-exposed workers. The levels of specific IgG antibodies were more elevated when tested against the HSA conjugates formed with polymeric MDI compared with the HSA conjugates formed with monomeric MDI. CONCLUSION: This study shows that specific IgG antibodies to MDI appear to be specific for MDI without cross-reactivity with TDI and HDI and higher by use of polymeric rather than monomeric MDI-HSA test antigens AU - Aul DJ AU - Bhaumik A AU - Kennedy AL AU - Brown WE AU - Lesage J AU - Malo JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 54 IP - DP - 1999 Jan 01 TI - Occupational asthma caused by esparto grass (Stipa tenacissima) fibers PG - 86-87 AU - Baz G AU - Hinojosa M AU - Quirce S AU - Cuevas M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - IP - DP - 1999 Jan 01 TI - Latex and amoxicillin-provoked occupational asthma PG - - AU - Ventura MT AU - Di Corato R AU - Giuliano G AU - Tursi A LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 14 IP - DP - 1999 Jan 01 TI - Wheat antigen content of inhalable dust in bakeries: modeling and an inter-study comparison. PG - 791-798 AB - The purposes of this study were (a) to compare wheat antigen content of inhalable bakery dust in Canada and the Netherlands and, (b) to evaluate the validity of dust exposure measurement as a surrogate of specific antigen exposure. Wheat antigen exposure data from the studies of Canadian and Dutch bakeries were used to explore the correlation between dust and antigen levels, and identify factors explaining variability of the antigen content of bakery dust. Direct comparison and pooling of the data were possible because the same antigen assay was used in both studies. Wheat antigen exposure samples totaling 544 were available, all originating from personal full-shift monitoring of bakery workers. The wheat antigen content of bakery dust varied greatly between the two studies and with different products within each study. Bakery dust from the Canadian study had a much higher wheat antigen content. Therefore, the interstudy difference in the wheat antigen content of bakery dust was by far the most significant in undermining the validity of the use of dust levels as a surrogate measures of wheat antigen exposure. The production of croissants, wheat bread and buns, puff pastry, bagels, and cinnamon buns was associated with increased wheat antigen content of bakery dust, while in rye bread production, bakery dust with less wheat antigen content was emitted. Although we can, in part, account for the pattern of variability in the wheat antigen content of bakery dust (explaining 49% of it), we concluded that the effort involved in modeling it accurately would probably exceed that expended in direct measurement of the antigen level. Therefore, for the exposure assessments carried out for the purpose of managing occupational risks of aeroallergen exposure in bakeries, we recommend the use of analytical techniques that can directly measure antigen exposure. AU - Burstyn I AU - Heederik D AU - Bartlett K AU - Doekes G AU - Houba R AU - Teschke K AU - Kennedy SM LA - PT - DEP - TA - Appl Occup Environ Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 54 IP - DP - 1999 Jan 01 TI - Asthma to latex in a seamstress PG - 290-291 AU - Weytjens K AU - Labrecque M AU - Malo JL AU - Cartier A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 56 IP - DP - 1999 Jan 01 TI - Occupational IgE sensitisation to phytase, a phosphatase derived from Aspergillus niger. PG - 454-459 AB - OBJECTIVE: Phytase is a phosphatase derived from Aspergillus niger that> enhances phosphate bioavailability in the gut, and therefore has been increasingly used as an animal feed additive since the early 1990s. The aim of this study was to assess whether work related respiratory symptoms among workers in a so called premix factory producing animal feed additives, could be due to type I (mediated by immunoglobulin E (IgE) allergic sensitisation to phytase. METHODS: Preparations of specific IgE against phytase as used in the factory were assessed by enzyme immunoassay (EIA) in serum samples of 11 exposed workers who regularly handled the enzyme, in 11 office and laboratory workers of the same plant (non-exposed internal controls), and in 19 laboratory animal workers as external controls. The factory workers also completed a questionnaire on common and work related respiratory symptoms. RESULTS: Depending on the cut off level in the EIA for IgE, and the preparation used as coated allergen, antiphytase sensitisation was found in one to four of the 19 external controls, in one to five of the 11 internal controls, and in four to 10 of the 11 exposed workers. Strongest IgE reactions were found in four exposed workers who reported work related respiratory symptoms, particularly wheezing, and in one internal control who possibly had become sensitised because the structure of the factory building did not preclude airborne exposure in the offices and corridors of the plant. Experiments with inhibition EIA for IgE showed that (a) phytase of another commercial source was only partially cross reactive with phytase as used in the premix factory, and (b) phytase used as an animal feed additive did not cross react with common mould extracts, except for extracts from the species of origin, Aspergillus niger. The amount of IgE binding phytase in Aspergillus niger was estimated to be between 0.1% and 1% of the extractable mould proteins. CONCLUSIONS: Phytase is a potentially important new occupational allergen causing specific IgE immune responses among exposed workers. Such IgE sensitisation could probably be the cause of work related asthmatic and other respiratory symptoms if no effective measures are taken to prevent airborne occupational exposure at sites where phytase is handled, particularly during addition of enzyme preparations to animal feed. AU - Doekes G AU - Kamminga N AU - Helwegen L AU - Heederik D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 103 IP - DP - 1999 Jan 01 TI - Control strategies for aeroallergens in an animal facility. PG - 139-146 AB - BACKGROUND: Prevalence of the occupational disease laboratory animal allergy could be reduced if aeroallergen reduction strategies are identified. OBJECTIVE: To reduce worker exposure to Mus m 1, an allergen from laboratory mice, the effect of filter cage tops, increased room ventilation, negatively pressurized ventilated cages, and ventilated cage-changing tables were evaluated. METHODS: Aeroallergen was collected in the ambient air and in the breathing zone and quantified by using a competitive immunoassay. RESULTS: When mice were housed in unventilated cages, ambient allergen was reduced from 5.1 ng/m3 with no cage top to 1.3 ng/m3 with a simple filter-sheet top and 0.8 ng/m3 with a fitted filter-bonnet top (P <. 05). Room ventilation was increased from 6 to 10, 15, and 20 air changes per hour and had little effect on aeroallergen levels and no impact on airborne particulate matter. When mice were housed in ventilated cages, ambient allergen was significantly reduced from 1. 1 ng/m3 at positive cage pressure to 0.3 ng/m3 at negative cage pressure (P <.05). Negative cage pressure combined with handling animals under a ventilated table reduced breathing zone allergen from 28 ng/m3 with neither control strategy in place to 9 ng/m3 (P <. 05). Use of a ventilated table controlled bacterial contamination, measured as colony forming units, found in negatively pressurized cages. CONCLUSION: Three aeroallergen control strategies are use of filter cage tops, operation of negatively pressurized cages, and use of ventilated changing tables. AU - ReebWhitaker CK AU - Harrison DJ AU - Jones RB AU - Kacergis JB AU - Myers DD AU - Paigen B LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 14 IP - DP - 1999 Jan 01 TI - Allergy to laboratory animals in children of parents occupationally exposed to mice, rats and hamsters. PG - 352-356 AB - Sensitization to laboratory animals (LA) has a high prevalence among laboratory workers. It is unknown whether transportation of LA allergens can be a risk factor for sensitization of subjects outside the laboratory environment. The aim of the study was to investigate the prevalence of sensitization to LA among children whose parents were and were not occupationally exposed to LA. The first group consisted of 50 children (age 12.3+/-4.3 yrs) whose parents were occupationally exposed to mice, rats and hamsters. The second group consisted of 40 children (age (mean+/-SD) 10.8+/-3.0 yrs) whose parents were not occupationally exposed to LA. Children having LA at home were eliminated from the study. All children responded to a questionnaire, underwent spirometry and were also tested with skin prick tests with the use of common allergens and prick tests with hair extracts from mouse, hamster and rat. Total immunoglobulin (Ig)E levels and the presence of specific IgE against LA were also estimated. Children of parents occupationally exposed to LA presented significantly more positive skin prick tests against allergens from the hair of laboratory animals compared to children of nonexposed parents. Five children from the first group were also found to have specific IgE against LA, with three of these five children complaining of rhinitis and cough while visiting their parents' workplace. It is concluded that the observed increased sensitization to laboratory animals among children of occupationally exposed parents could be the result of poor hygienic conditions at their parents' workplace. Hence, parents' job seems to be an additional risk factor of sensitization and should be taken into consideration when recording an allergic history. AU - Krakowiak A AU - Szulc B AU - Gorski P LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 93 IP - DP - 1999 Jan 01 TI - Tuberculosis in health care workers in Malawi PG - 32-35 AB - Although sub-Saharan Africa has the highest rates of tuberculosis (TB) and human immunodeficiency virus (HIV) infection in the world, the rates of TB amongst its health care workers (HCWs) are poorly documented. We therefore conducted a country-wide investigation. All district/government and mission hospitals in Malawi that diagnose and care for TB patients were visited in order to obtain information on hospital-based HCWs and their incidence of TB in 1996. Hospital TB case loads, country-wide TB notification numbers and national population estimates for 1996 were obtained, which enabled TB case notification rates to be calculated. In 1996, 108 (3.6%) of 3042 HCWs from 40 hospitals were registered and treated for TB: 22 with smear-positive pulmonary TB (PTB), 40 with smear-negative PTB and 46 with extrapulmonary TB. The overall case fatality rate was 24%. Compared with the adult general population aged > or = 15 years, the relative risk [95% confidence interval (CI)] in HCWs of all types of TB was 11.9 [9.8-14.4], of smear-positive PTB 5.9 [3.9-9.0], of smear-negative PTB 13.0 [9.5-17.7] and of extrapulmonary TB 18.4 [13.8-24.6], P < 0.05. The 1996 hospital TB case load ranged from 29 to 915: there were no cases of TB in HCWs in hospitals whose case load was < or = 100 patients, while the TB case rate among HCWs was similar in hospitals with annual case loads of 101-300 or > 300. The annual risk of TB was high among all categories of HCW, especially clinical officers. This study shows a high rate of TB in HCWs in Malawi, and emphasizes the need for practical and affordable control measures for the protection of HCWs from TB in low-income countries AU - Harries AD AU - Nyirenda TE AU - Banerjee A AU - Boeree MJ AU - Salaniponi FM LA - PT - DEP - TA - Transactions of the Royal Society of Tropical Medi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 2 IP - DP - 1999 Jan 01 TI - Tuberculosis acquired in laboratories and necropsy rooms. [Review] PG - 161-167 AB - The resurgence of tuberculosis, and the increasing number of cases that are HIV-related and/or multidrug resistant, has renewed interest in the occupational hazards posed by tuberculosis to staff in laboratories and necropsy rooms. A search undertaken using Medline and Pre-Medline identified few comprehensive reviews: the last was published in 1982. Staff may acquire pulmonary infection by inhalation of aerosols and skin lesions through cuts and abrasions. Particular hazards for laboratory staff include specimen containers contaminated on the outside, unfixed sputum smears, and the generation of aerosols during examination procedures. Examination of patients with tuberculosis not diagnosed during life constitutes a particular risk to necropsy room staff. Staff of laboratories and necropsy rooms are estimated to be between 100 and 200 times more likely than the general public to develop tuberculosis. Training in good laboratory practice is the most important aspect of staff protection, especially in resource-poor countries where well-maintained safety cabinets are rarely available. This article summarises requirements and recommendations for safe handling of tuberculous material and the available guidelines for work in developed and resource-poor countries. AU - Collins CH AU - Grange JM LA - PT - DEP - TA - Commun Dis Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 3 IP - DP - 1999 Jan 01 TI - Increased risk of Mycobacterium tuberculosis infection related to the occupational exposures of health care workers in Chiang Rai, Thailand PG - 377-381 AB - SETTING: Chiang Rai, the northernmost province of Thailand. OBJECTIVE: To evaluate the occupational risk for tuberculous infection of health care workers (HCWs) and the utility of tuberculin skin test (TST) in a developing country setting. DESIGN: A cross-sectional TST survey, including a risk assessment questionnaire, of Chiang Rai Hospital HCWs. RESULTS: Of 911 HCWs tested, 623 (68%) had indurations of > or = 10 mm and 322 (35%) indurations of > or = 15 mm. Factors most predictive for TST positivity, using either cut-off, were employment > 1 year, frequent direct patient contact, and male sex. Moreover, having a bacillus Calmette-Guerin (BCG) scar was predictive of a > or = 10 mm, but not a > or = 15 mm, reaction. CONCLUSIONS: Chiang Rai Hospital HCWs had an increased risk for Mycobacterium tuberculosis infection, which was significantly associated with occupational exposure. Where BCG coverage is high, a TST cut-off of > or = 15 mm may correlate better with M. tuberculosis infection than does a cut-off of > or = 10 mm. Effective, affordable infection control measures are needed for health care facilities in developing countries such as Thailand, where HCWs may be at increased risk for M. tuberculosis infection from occupational exposures AU - Do AN AU - Limpakarnjarat K AU - Uthaivoravit W AU - Zuber PL AU - Korattana S AU - Binkin N AU - Mastro TD AU - Jarvis WR LA - PT - DEP - TA - Int J Tuberc Lung Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 17 IP - DP - 1999 Jan 01 TI - Tuberculosis in a social health care center: epidemiologic study and prevention activities PG - 130-134 AB - BACKGROUND: The high prevalence of infection and the often atipic presentation of tuberculosis in older people constitute an important risk factor for the nosocomial spread of the infection in the long-term care hospitals. PATIENTS AND METHOD: After a tuberculosis case, in a patient with positive sputum smears, in a long-term care hospital with 220 beds, we established a preventive programme that was based on: a) the determination, by the tuberculin test, of the prevalence of tuberculosis infection; b) the early detection of new cases of the disease, and c) the evaluation of the indications of the chemoprophylaxis. RESULTS: The global prevalence of the tuberculosis infection was 44%. 16% of the patients with a significant reaction to tuberculin showed lung fibrosis in the X-ray of the thorax and 27% of them were diagnosed as active tuberculosis. During the first year of the study, the rate of illness between the infected cases was 6.45%. After 2 years the conversion rate of the tuberculin test was 6.25%. CONCLUSIONS: Tuberculosis is an endemic infection in our long-term care hospital and the diagnostic delay of the active illness is an important risk factor for its dissemination. The difficulty of the interpretation of the response to the tuberculin test in old people, the evidence of the hidden illness in patients with lung fibrosis and some physic-psychological conditions of those patients, make the application of the chemoprophylaxis difficult AU - Serrate G AU - Vaqueiro M AU - Nunez M AU - Tobar M AU - Cascales E AU - Segura F LA - PT - DEP - TA - Enferm Infecc Microbiol Clin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 14 IP - DP - 1999 Jan 01 TI - Occupational tuberculosis among deputy sheriffs in connecticut: a risk model of transmission PG - 768-776 AB - OBJECTIVES: The purpose of this study was to identify risk factors for tuberculin skin test conversions among non-infected deputy sheriffs in Connecticut and during an out-break in an urban lock-up. METHODS: 377 tuberculin skin-test negative sheriffs statewide in 1994-1995 and 37 sheriffs in the lock-up in 1995 were screened and questionnaires administered. Cellblock volumetric air flow was measured. The Wells-Riley model of airborne transmission [C = S(1-e-Iqpt/Q)] was applied to the epidemiologic and ventilation data. RESULTS: Statewide, of 377 sheriffs screened, 22 (5.8%) had positive skin tests. Risk factors included older age (p < .0075) and longer tenure (p < .036). In the lock-up, of 37 sheriffs screened, 4 (10.8%) had positive skin tests. Measured mean outside air flow per occupant (8.0 cfm; S.D. = 2.2) was below design (15 cfm) and recommended (20 cfm) standards. Mathematical modeling estimated that TB transmission would be reduced by 62.5 percent with ventilation at design specifications. CONCLUSIONS: Inadequate ventilation may increase the risk for occupational transmission of tuberculosis. Since lock-ups do not have the time to conduct inmate TB screenings, supplemental engineering controls may be required. AU - CooperArnold K AU - Morse T AU - Hodgson M AU - Pettigrew C AU - Wallace R AU - Clive J AU - Gasecki J LA - PT - DEP - TA - Appl Occup Environ Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 56 IP - DP - 1999 Jan 01 TI - Pulmonary function and respiratory symptoms in a population of airport workers PG - 118-123 AB - OBJECTIVES: To assess the prevalence of respiratory symptoms and to measure spirometry in a sample of employees of Birmingham International Airport, United Kingdom, to examine whether occupational exposure to aircraft fuel or jet stream exhaust might be associated with respiratory symptoms or abnormalities of lung function. METHODS: Cross sectional survey by questionnaire and on site measurement of lung function, skin prick tests, and exhaled carbon monoxide concentrations. Occupational exposure was assigned by job title, between group comparison were made by logistic regression analysis. RESULTS: 222/680 full time employees were studied (mean age 38.6 y, 63% male, 28% current smokers, 6% self reported asthma, 19% self reported hay fever). Upper and lower respiratory tract symptoms were common and 51% had one or more positive skin tests. There were no significant differences in lung function tests between exposure groups. Between group comparisons of respiratory symptoms were restricted to male members of the medium and high exposure groups. The adjusted odds ratio (OR) for cough with phlegm and runny nose were found to be significantly associated with high exposure (OR 3.5, 95% confidence interval (95% CI) 1.23 to 9.74 and 2.9, 1.32 to 6.40 respectively) when the measured confounding effects of age and smoking, and in the case of runny nose, self reported hay fever had been taken into account. There was no obvious association between high exposure and the presence of shortness of breath or wheeze, or for the symptoms of watering eyes or stuffy nose. CONCLUSIONS: These findings support an association in male airport workers, between high occupational exposures to aviation fuel or jet stream exhaust and excess upper and lower respiratory tract symptoms, in keeping with a respiratory irritant. It is more likely that these effects reflect exposure to exhaust rather than fuel, although the effects of an unmeasured agent cannot be discounted AU - Tunnicliffe WS AU - O'Hickey SP AU - Fletcher TJ AU - Miles JF AU - Burge PS AU - Ayres JG LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 54 IP - DP - 1999 Jan 01 TI - EUROSCOP, ISOLDE and the Copenhagen city lung study [editorial] PG - 287-288 AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 16 IP - DP - 1999 Jan 01 TI - Occupational asthma in a teacher after repeated exposure to tear gas PG - 558-559 AB - Acute exposure to tear gas causes generally reversible cutaneous and mucosal irritations. Lasting respiratory manifestations after exposure are exceptional. We report the case of a 26-year-old female teacher with no history of respiratory disease who developed asthma after repeated exposure to tear gas discharged in her class room. The disorders occurring during these repeated exposures to the irritating gas were consistent with the recently described low level reactive airway dysfunction syndrome (low level RADS) AU - BayeuxDunglas MC AU - Deparis P AU - Touati MA AU - Ameille J LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - Suppl 1 IP - DP - 1999 Jan 01 TI - Incidence of occupational asthma: A comparison by reporting systems PG - 130-133 AU - Nordman H AU - Karjalainen A AU - Keskinen H LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 60 IP - DP - 1999 Jan 01 TI - Evaluation of exposure to methyl methacrylate among dental laboratory technicians PG - 625-628 AB - Following the diagnosis of two cases of occupational asthma among dental technicians, an industrial hygiene survey was conducted in two dental laboratories to determine time-weighted average and peak concentrations of methyl methacrylate vapor and time-weighted average concentration of acrylic dust. The time- weighted average concentrations of methyl methacrylate vapor were 0.7 ppm and 1.6 ppm and average peak concentrations were 9.3 ppm and 9.7 ppm for the first and second laboratory, respectively. The use of a local exhaust ventilation system was significant in reducing the peak concentration of methyl methacrylate vapor in the breathing zone of dental technicians. However, the local exhaust ventilation was not efficient in reducing the concentration of airborne acrylic dusts. Occupational exposure of dental technicians to dental materials, in particular to methyl methacrylate, requires further investigation. Local exhaust ventilation systems can reduce the concentration of methyl methacrylate in the dental laboratories to a significant extent if installed and used properly AU - Nayebzadeh A AU - Dufresne A LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 29 IP - DP - 1999 Jan 01 TI - Neutrophil activation following TDI bronchial challenges to the airway secretion from subjects with TDI-induced asthma PG - 1395-1401 AB - BACKGROUND: The immunopathological mechanism for occupational asthma induced by toluene diisocyanate (TDI) remains to be further clarified. There have been few reports suggesting involvement of neutrophils in inducing bronchoconstriction after TDI inhalation. OBJECTIVES: To further understand the role of neutrophils in the pathogenesis of TDI-induced asthma. MATERIALS AND METHODS: Eight TDI-induced asthmatic subjects were classified as group I, and five exposed workers who had complained of work-related symptoms and worked in the same workplace, but showed negative bronchial challenges were enrolled as controls (group II). Serum neutrophil chemotactic activity during TDI bronchial challenge test was measured by the Boyden chamber method. Induced sputum was collected before and after the TDI bronchial challenge test. The myeloperoxidase (MPO) and interleukin (IL) -8 levels in the sputum were measured using RIA and ELISA. RESULT: Serum neutrophil chemotactic activity significantly increased at 10 min (P = 0.01), then decreased at 60 min (P = 0.02) and remained unchanged for up to 420 min (P = 0.07) in group I subjects, while no significant changes were found in group II subjects (P > 0.05). MPO and IL-8 were abundantly present in the sputum of all the TDI-induced asthmatic subjects and they increased significantly at 420 min after the bronchial challenges (P = 0.02, P = 0.03, respectively), while no significant changes were noted in group II subjects (P > 0.05). CONCLUSION: These findings support the view that activated neutrophils may contribute to bronchoconstriction induced by TDI which may be associated with IL-8 release AU - Park H AU - Jung K AU - Kim H AU - Nahm D AU - Kang K LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 54 IP - DP - 1999 Jan 01 TI - Sensitization to triglycidylisocyanurate (TGIC) with cutaneous and respiratory manifestations PG - 752-756 AB - The case is presented of a man with allergic contact dermatitis and occupational asthma due to triglycidylisocyanurate (TGIC), which is used as a hardener in thermosetting powder paint. The contact dermatitis was confirmed by patch testing (TGIC 0.5% and 5% in petrolatum), and the occupational asthma was confirmed by bronchial provocation testing: two challenges to an aerosol of lactose containing TGIC (0.05% and 0.1%, w/w, each for 0.5+1+2+4 min) led to a maximal decrease in FEV1 of 22% and 31% after 6 and 4 h, respectively. Skin prick tests with unconjugated TGIC were possibly positive. This case confirms that exposure to TGIC in powder paints may cause not only contact dermatitis, but also occupational asthma AU - Meuleman L AU - Goossens A AU - Linders C AU - Rochette F AU - Nemery B LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 4 IP - DP - 1999 Jan 01 TI - Evidence for neutrophil activation in occupational asthma. PG - 303-306 AB - In order to evaluate the role of neutrophils in the pathogenesis of occupational asthma (OA), 15 toluene diisocyanate (TDI)-asthma and six grain dust-asthma patients were recruited. Controls were the same number of subjects showing negative bronchoprovocation test (BPT) and six house dust mite-sensitive asthma. Bronchoscopic biopsy specimens were stained with monoclonal antibodies to mast cell (AA1), eosinophil (EG2), pan T cell (CD3) and neutrophil (NE). Serum neutrophil chemotactic activity (NCA) was measured before and 10-420 min after BPT. Sputum interleukin-8 (IL-8) and myeloperoxidase (MPO) were also measured. There was a significant increase of NE+ cells as well as AA1+ and EG2+ cells in grain dust- and TDI-asthma compared with house dust-sensitive asthma (P < 0.05). Neutrophil+ cells and AA1+ cells showed a significant correlation in TDI-asthma (r = 0.73, P = 0.02). Serum NCA was significantly increased at 10 min after BPT and decreased at 60 min in subjects with TDI-asthma. In grain dust-asthma, serum NCA increased at 30 min and decreased at 240 min after BPT (P < 0.05). Sputum IL-8 and MPO were significantly increased after BPT in both TDI- and grain dust-asthma (P < 0.05). These findings suggested that neutrophils in the lungs might contribute to bronchoconstriction induced by either TDI or grain dust. The possible involvement of IL-8 in activation of neutrophils was also suggested. AU - Jung KS AU - Park HS LA - PT - DEP - TA - Respirology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 54 IP - DP - 1999 Jan 01 TI - Occupational asthma in a grain worker due to Lepidoglyphus destructor, assessed by bronchial provocation test and induced sputum PG - 884-889 AB - BACKGROUND: Occupational asthma (OA) can be a debilitating disease even when removal from the workplace is achieved. Today, the "gold standard" in the assessment of OA is the bronchial provocation test (BPT). Induced sputum is a non-invasive method of exploring airway inflammation which can provide additional information about such challenges and thus could be applied in OA diagnosis and monitoring. METHODS: We report the study carried out in a grain worker sensitized to Lepidoglyphus destructor (Ld), who suffered from mild asthma at the workplace. Skin prick test and specific serum IgE were measured. Ld-BPT was performed, and the changes in eosinophil rates, and ECP and tryptase levels in induced sputum were studied 30 min and 18 h after Ld-BPT. We also determined the changes in nonspecific bronchial hyperresponsiveness (NSBH), given as PD20 values. To assess the specificity of the changes, we also carried out sputum induction and methacholine challenge after barley-BPT. RESULTS: An isolated immediate response was obtained with Ld-BPT, while barley-BPT was negative. Induced sputum showed higher tryptase levels 30 min after Ld-BPT, and higher eosinophil and epithelial cell percentages and ECP levels 18 h after Ld-BPT. There was also a decrease in methacholine PD20 values after Ld-BPT. Those changes were not observed after barley-BPT. CONCLUSIONS: The study of eosinophilic and mast-cell markers in induced sputum provides additional knowledge about the inflammatory process occurring in the airways, suggesting that the study of induced sputum should be considered in the assessment of OA AU - Alvarez MJ AU - Castillo R AU - Rey A AU - Ortega N AU - Blanco C AU - Carrillo T LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 16 IP - DP - 1999 Jan 01 TI - Occupational asthma caused by a coloring reagent PG - 384-386 AB - A case of occupational asthma associated with rhinitis and conjunctivitis occurred in a patient working in a textile factory and exposed to different coloring reagents is reported. Symptoms appeared in phases correlated with changes in the use of the coloring reagents. Prick tests were carried out with the different coloring reagents and were positive for the yellow color. The test was followed by a clear increase in bronchial hyperreactivity to methacholine. Some individual preventive measures, such as wearing a face mask, led to reduction then disappearence of the symptoms AU - Spirlet F AU - KopferschmittKubler MC AU - Bessot JC AU - BlaumeiserKapps M AU - Pauli AU - G LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 14 IP - DP - 1999 Jan 01 TI - The control of press cleaning solvent vapors in a small lithographic printing establishment PG - 329-338 AB - Small businesses frequently have inadequate in-house expertise to solve a variety of safety and health problems. The National Institute for Occupational Safety and Health (NIOSH) has therefore conducted a demonstration project in the commercial lithographic printing industry, which consists largely of small companies, in an effort to establish suitable control technology for airborne solvent vapors released primarily during press cleaning operations. These solvent vapors have a number of potential adverse health effects, including narcosis, kidney and liver damage, and cancer. Also, airborne anti-offset powder is a potential allergic sensitizer and cause of occupational asthma. As a means of controlling worker exposures to the vapors and dust, a local exhaust inlet was attached to the side of the press adjacent to the paper delivery point. Tempered outside air was introduced through ceiling outlets installed to make up for the exhausted air. Measurements of press operator exposure and area concentrations of solvent vapors and area concentration of anti-offset powder were made before and after installation of the new ventilation controls. Vapor concentrations were reduced by 73 percent for the press operators. Area concentrations of the vapors were reduced by 86 percent and dust concentration by 67 percent. The ventilation system was found to be suitable for vapor and dust control, although substitution of a cleaning solution containing non-carcinogenic solvents for solutions containing carcinogens was recommended AU - Crouch KG AU - Gressel MG LA - PT - DEP - TA - Appl Occup Environ Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 14 IP - DP - 1999 Jan 01 TI - Conjugation of 7-oxodehydroabietic acid to lysine, a haptenation mechanism for an oxidized resin acid with dermal sensitizing properties PG - 171-176 AB - This article explores protein conjugation of 7-oxodehydroabietic acid, a resin acid found in both aerosol from soldering with rosin flux and in rosin solids. In a murine model, conjugation (haptenation) of resin acids to proteins is required to generate antibodies against rosin. Hydroperoxy resin acids are dermal sensitizers, with haptenation thought to occur via radical mechanisms. Dermal sensitization to 7-oxodehydroabietic acid has been observed, although no radical haptenation mechanism has been proposed to explain the sensitizing properties of this compound. Conjugation of L-lysine to 7-oxodehydroabietic acid was predicted, with a Schiff base (or imine) linkage formed between C-7 of the resin acid and a free amino group of lysine. Fast atom bombardment mass spectrometry provided evidence of the conjugate; a small peak was seen for the conjugate (M+H)+ ion in aqueous ethanol with 20 mM concentrations of the free resin and amino acids. A larger conjugate peak was observed with addition of tertiary amine as a mild basic catalyst, and the intensity of the conjugate peak exceeded that of the precursors upon replacement of the ethanol with benzene. Resin acids accumulate in the plasma membrane, a non-aqueous environment apparently conducive to conjugation of 7-oxodehydroabietic acid with lysine side chains of membrane proteins. The result would be dehydroabietic acid covalently bound to protein, which could lead to interaction with immune cells having resin acid specificity. The haptenation mechanism presented may be involved in allergic contact dermatitis and occupational asthma observed from exposure to resin acid solids and aerosols. As sampling and analytical methods have been previously demonstrated for 7-oxodehydroabietic acid, this compound may be a useful exposure marker with relevance to negative health effects such as occupational asthma AU - Smith PA AU - Bowerbank CR AU - Savage PB AU - Drown DB AU - Lee ML AU - Alexander W AU - Jederberg WW AU - Still K LA - PT - DEP - TA - Appl Occup Environ Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 54 IP - DP - 1999 Jan 01 TI - Occupational asthma caused by champignon flies PG - 521-525 AB - BACKGROUND: Occupational bronchial asthma in mushroom (champignon) workers is unusual, although reports on it appeared in 1938 and 1951; we have not found any others since those dates. Here we report the case of a 52-year-old man who works as a champignon cultivator. He suffered rhinoconjunctivitis and asthma attacks whenever he entered the champignon culture caves. We studied flies as a possible antigen source. We collected these insects from the growing sites in order to identify them, and then prepare an extract; the samples turned out to be of two families of insects of the order Diptera, 98% from the Phoridae family (Brachycera suborder) and 2% from the Sciaridae (Nematocera suborder). METHODS: Skin prick tests, conjunctival provocation tests, serum specific IgE, specific IgE-binding fractions in immunoblotting, and monitoring of PEFR (at work and off work) were performed. RESULTS: IgE-mediated hypersensitivity to these flies was demonstrated by skin prick test, conjunctival provocation test, serum specific IgE, and IgE-binding fractions in immunoblotting. Monitoring of PEFR both at work and off work showed a clear relationship between symptoms, or fall in PEFR, and the workplace. CONCLUSIONS: We report the case of a patient suffering from asthma and rhinoconjunctivitis caused by hypersensitivity to fly proteins AU - Cimarra M AU - MartinezCocera C AU - Chamorro M AU - Cabrera M AU - Robledo T AU - Lombardero M AU - Alonso A AU - Catellano A AU - Bartolome JM LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 54 IP - DP - 1999 Jan 01 TI - Occupational asthma to diacrylate PG - 289-290 AU - Weytjens K AU - Cartier A AU - Lemiere C AU - Malo JL LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 54 IP - DP - 1999 Jan 01 TI - Occupational IgE-mediated asthma, rhinoconjunctivitis, and contact urticaria caused by Easter lily (Lilium longiflorum) and tulip PG - 273-277 AB - BACKGROUND: We report on IgE-mediated asthma, rhinoconjunctivitis, and contact urticaria to two Liliaceae plants, tulip and Easter lily (Lilium longiflorum), diagnosed in a floral shop worker. METHODS: Occupational asthma was diagnosed according to patient history, PEF monitoring, and a work-simulating provocation test. Flower-specific IgE was studied, and RAST inhibition tests were performed. RESULTS: Skin prick testing showed positive reactions to tulip, Easter lily, and chrysanthemum. Total IgE was 180 kU/I, and specific IgE to tulip was 2.6 and to Easter lily 6.5 kU/I. In the RAST-inhibition test, no cross-reactivity was found. Occupational asthma was diagnosed by peak flow monitoring at work and at home, as well as specific inhalation challenge with Easter lily, with an immediate 18% reduction in PEF. In addition, contact urticaria and conjunctivitis were diagnosed. After a 9-year follow-up without exposure to lilies, the skin prick tests to L. longiflorum and tulip were still positive, but the specific IgE had disappeared. CONCLUSIONS: A case of IgE-mediated occupational asthma, rhinoconjunctivitis, and contact urticaria caused by L. longiflorum and tulip is presented. RAST inhibition tests indicated concomitant sensitization to the two Liliaceae plants AU - Piirila P AU - Kanerva L AU - Alanko K AU - Estlander T AU - Keskinen H AU - PajariBackas AU - M AU - Tuppurainen M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 13 IP - DP - 1999 Jan 01 TI - Occupational asthma induced by cephalosporins PG - 1189-1191 AB - A 20-yr-old pharmaceutical worker who developed attacks of shortness of breath and wheezing 9 months after beginning work on a process in which cefadroxil powder was bottled or encapsulated will be described. Skin test with cefaxodril was negative. Baseline spirometry and methacholine inhalation test were normal. A controlled bronchial challenge test was carried out in a closed-circuit system with assessment of respirable dust concentration. Exposure to cefadroxil powder at a mean concentration of 10 mg x m(-3) for 10 min elicited an isolated immediate asthmatic response, but no response was observed to control challenge with lactose. Single-blind oral challenge test with amoxicillin up to 500 mg was well tolerated, whereas the oral challenge with cephalexin (25 mg) elicited an immediate asthmatic response. This patient had developed occupational asthma caused by inhalation of cefadroxil as confirmed by specific inhalation test. Since she tolerated oral amoxicillin, a synthetic penicillin with the side-chain identical to that of cefadroxil, it seems that she may be sensitized to the dihydrothiazine ring of cephalosporins AU - Sastre J AU - Quirce S AU - Novalbos A AU - LluchBernal M AU - Bombin C AU - Umpierrez A LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 90 IP - DP - 1999 Jan 01 TI - Occupational asthma caused by dioctyl-phthalate in a bottle cap production worker [Italian] PG - 513-518 AB - The authors describe a clinical case of occupational asthma due to dioctyl-phthalate in a worker using a conveyor belt for bottle stoppers. The dioctyl-phthalate is used for the production of PVC and as a compound of many other substances. The literature describes many cases of occupational asthma do to phthalate anhydride but few cases do to dioctyl phthalate. The clinical history, the environmental monitoring data, the pulmonary function tests such as bronchodilatation test by salbutamol, peak flow meter daily monitoring for three weeks, and stop and start work test showed a good correlation with the work and the worker's asthma. The authors emphasize that a detailed clinical history and a careful analysis of the production cycle are very useful and, as simple and non invasive tests, can play an important role in the diagnosis of occupational asthma AU - Cipolla C AU - Belisario A AU - sassi C AU - Auletti G AU - Nobile M AU - Raffi GB LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - CDC IP - DP - 1999 Jan 01 TI - Surveillance of work-related asthma in selected U.S. states using surveillance guidelines for state health departments--California, Massachusetts, Michigan, and New Jersey, 1993-1995 PG - 1-20 AB - PROBLEM/CONDITION: Cases of work-related asthma (WRA) are sentinel health events that indicate the need for preventive intervention. WRA includes new-onset asthma caused by workplace exposure to sensitizers or irritants and preexisting asthma exacerbated by workplace exposures. REPORTING PERIOD: This report reviews cases of WRA identified by state health departments from January 1, 1993, through December 31, 1995, as well as follow-up investigations of cases and associated workplaces conducted through June 30, 1998. DESCRIPTION OF THE SYSTEMS: State-based surveillance and intervention programs for WRA are conducted in California, Massachusetts, Michigan, and New Jersey as part of the Sentinel Event Notification Systems for Occupational Risks (SENSOR) cooperative agreement program, initiated by CDC's National Institute for Occupational Safety and Health (NIOSH). RESULTS: From 1993 through 1995, a total of 1,101 cases of WRA were identified by SENSOR surveillance staff members in California, Massachusetts, Michigan, and New Jersey. Of these 1, 101 cases, 19.1% were classified as work-aggravated asthma, and 80.9% were classified as new-onset asthma. Objective evidence substantiating asthma work-relatedness was documented in the medical records of 3.4% of WRA cases identified in the two states (Michigan and New Jersey) where medical records are routinely reviewed for this information. Indoor air pollutants, dusts, cleaning materials, lubricants (e.g., metalworking fluids), and diisocyanates were among the most frequently reported causes of WRA. In addition, a well-recognized cause of occupational asthma -natural rubber latex - was identified in a new setting, the healthcare industry. The most common industries associated with WRA cases included transportation equipment manufacturing (19.3%), health services (14.2%), and educational services (8.7%). Air sampling for agents known to induce occupational asthma was performed in Michigan for comparison with established federal time-weighted average exposure limits. Sixteen (13.4%) of 119 workplaces tested had airborne concentrations exceeding NIOSH recommended exposure limits (RELs); 11 (9.1%) of 121 workplaces had concentrations exceeding permissible exposure limits (PELs) of the Michigan Occupational Safety and Health Act (MIOSHA) program. INTERPRETATION: The surveillance data findings confirm well-recognized causes of asthma and have identified new putative causes (e.g., cleaning materials and metalworking fluids). Because the surveillance program depends on physicians' recognizing asthma work-relatedness and reporting diagnosed cases, the data are considered an underestimate of the magnitude of the WRA problem. The data also indicate that physicians are not commonly performing objective physiologic tests to substantiate a WRA diagnosis. Workplace findings suggest a need to evaluate existing exposure standards for specific agents known to induce occupational asthma (e.g., diisocyanates). Case-based surveillance can help improve the recognition, control, and prevention of WRA. The SENSOR model also provides a mechanism for workers and physicians to request workplace investigations aimed at primary prevention for other workers. PUBLIC HEALTH ACTION: NIOSH and state health department representatives are working to establish a long-term agenda for state-based surveillance of work-related conditions and hazards. The results from the SENSOR WRA programs described in this report support inclusion of WRA as a priority condition warranting surveillance at the state level. AU - Jajosky RA AU - Harrison R AU - Reinisch F AU - Flattery J AU - Chan J AU - Tumpowsky C AU - Davis L AU - Reilly MJ AU - Rosenman KD AU - Kalinowski D AU - Stanbury M AU - Schill DP AU - Wood J LA - PT - DEP - TA - Morbidity & Mortality Weekly Report JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 107 IP - DP - 1999 Jan 01 TI - Occupational asthma and contact dermatitis in a spray painter after introduction of an aziridine cross-linker PG - 599-601 AB - A 23-year-old spray painter developed contact dermatitis and respiratory difficulty characterized by small airways obstruction shortly after the polyfunctional aziridine cross-linker CX-100 began to be used in his workplace as a paint activator. The symptoms resolved after he was removed from the workplace and was treated with inhaled and topical steroids. Painters may have an increased risk of asthma due to exposure to a variety of agents, such as isocyanates, alkyd resins, and chromates. This case illustrates the importance of using appropriate work practices and personal protective equipment to minimize exposure. Occupational asthma is diagnosed by a history of work-related symptoms and exposure to known causative agents. The diagnosis is confirmed by serial pulmonary function testing or inhalational challenge testing. The risk of asthma attributable to occupational exposures is probably underappreciated due to underreporting and to inappropriate use of narrow definitions of exposure in epidemiologic studies of attributable risk AU - Leffler CT AU - Milton DK LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 89 IP - DP - 1999 Jan 01 TI - Health care worker disability due to latex allergy and asthma: a cost analysis PG - 1024-1028 AB - OBJECTIVES: The reported prevalence of occupational allergy to natural rubber latex is 8% to 17%, and that of latex-induced occupational asthma is 2.5% to 6%. Conversion of medical facilities to "latex-safe" can reduce employee sensitization, impairment, and disability. The purpose of this study was to determine the cost of a latex-safe approach, compared with that of continued latex glove use, and to identify the level of worker disability required to make the latex-safe approach financially preferable to a health care institution. METHODS: The costs of 2 strategies--latex-safe vs the status quo--were calculated from the perspective of 3 health care institutions. A break-even point was calculated for each facility. RESULTS: In all facilities, the cost of using nonlatex gloves exceeded the cost of using latex gloves. In all 3 facilities, however, 1% or fewer of those at risk would have to become fully disabled or fewer than 2% would have to become partially disabled for the continued use of latex gloves to exceed the cost of the latex-safe approach. CONCLUSION: Health care facilities, regardless of size, are likely to benefit financially from becoming latex-safe even if latex-related disability levels are extremely low AU - Phillips VL AU - Goodrich MA AU - Sullivan TJ LA - PT - DEP - TA - Am J Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 37 IP - DP - 1999 Jan 01 TI - Cobalt PG - 201-206 AB - Cobalt is a relatively rare magnetic element with properties similar to iron and nickel. The two valance states are cobaltous (II) and cobaltic (III) and the former is the most common valance used in the chemical industry. Cobalt occurs in nature primarily as arsenides, oxides, and sulfides. Most of the production of cobalt involves the metallic form used in the formation of cobalt superalloys. The term "hard metal" refers to compounds containing tungsten carbide (80-95%) combined with matrices formed from cobalt (5-20%) and nickel (0-5%). For the general population, the diet is the main source of exposure to cobalt. In the occupational setting, exposure to cobalt alone occurs primarily during the production of cobalt powders. In other industrial exposures (e.g., hard metal, diamond polishing), additional agents (tungsten) modulate the toxicity of cobalt. Cobalt is an essential element necessary for the formation of vitamin B12 (hydroxocobalamin); however, excessive administration of this trace element produces goiter and reduced thyroid activity. In 1966, the syndrome "beer drinker's cardiomyopathy" appeared in Quebec City, Canada, and was characterized by pericardial effusion, elevated hemoglobin concentrations, and congestive heart failure. An interstitial pulmonary fibrosis has been associated with industrial exposure to hard metal dust (tungsten and cobalt), but not to cobalt alone. Exposure to cobalt alone produces an allergic contact dermatitis and occupational asthma. Treatment of cobalt toxicity is primarily supportive. AU - Barceloux DG LA - PT - DEP - TA - Journal of Toxicology - Clinical Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 13 IP - DP - 1999 Jan 01 TI - Sputum eosinophils and exhaled nitric oxide during late asthmatic reaction in patients with western red cedar asthma PG - 489-495 AB - Examination of sputum for eosinophils and measurement of exhaled nitric oxide have been proposed as noninvasive methods of assessing airway inflammation in asthma. The use of these tests in the evaluation of patients with occupational asthma has not been reported. This study investigated the changes in sputum eosinophils and exhaled NO before and at intervals after inhalation challenge with plicatic acid in patients with suspected western red cedar asthma. Of 17 subjects who underwent challenge, nine had a positive bronchoconstrictor reaction (responders) and eight had a negative reaction (nonresponders). At 6 and 24 h after plicatic acid challenge, there was a significant increase in sputum eosinophils among responders, which was inversely related to the fall in forced expiratory volume in one second (FEV1) at 6 h. An increase in sputum eosinophils was also found in three nonresponders. Levels of exhaled NO increased at 24 h after challenge with plicatic acid in both responders and nonresponders, being significant only in nonresponders. No correlation was found between the increase in nitric oxide and the magnitude of the functional changes in the airways. There were significant correlations between the degree of sputum eosinophilia and the level of exhaled NO before and after methacholine and plicatic acid challenge. In conclusion, the late asthmatic reaction induced by plicatic acid in patients with western red cedar asthma is associated with an increase in sputum eosinophils. The usefulness of measuring sputum eosinophils and exhaled nitric oxide in the clinical evaluation of patients with suspected occupational asthma caused by low molecular weight compounds has yet to be determined AU - Obata H AU - Dittrick M AU - Chan H AU - ChanYeung M LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 13 IP - DP - 1999 Jan 01 TI - Diagnosing occupational asthma: use of induced sputum PG - 482-488 AB - The diagnosis of occupational asthma (OA) needs to be made with as much objective evidence as possible. If there is airway inflammation, measurement of this should be an asset. The objective of this study was to investigate whether there is an increase in induced sputum and blood eosinophils and eosinophil cationic protein (ECP) in OA after work exposure. Patients were assessed after a 2-4 week period at work and away from work with cell counts and ECP assays performed blind to the clinical data. They were considered to have OA if symptoms were worse at work and there was a fall in forced expiratory volume in one second (FEV1) > or =20% or in the provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) of four-fold or more compared with away from work. Patients whose symptoms were worse at work but had a change in FEV1 of <20% and in methacholine PC20 of less than four-fold were considered as controls. Sixteen patients were studied. Ten had OA and six were controls. Patients with OA had a significant increase in median (interquartile range) sputum eosinophils and ECP when at work compared with the periods out of work, 10.0 (17.05) versus 0.8 (1.6)% (p=0.007) and 3,840 (6,076) versus 116 (180) microg x L(-1) (p=0.01). They also had a higher blood eosinophil count, 0.3 (0.5) x 10(9) versus 0.2 (0.1) x 10(9) x L(-1) (p=0.013), and a trend towards higher serum ECP levels, 44.0 (20.0) versus 32.0 (18.5) microg x L(-1) (p=0.07). In conclusion, the proportion of eosinophils and levels of eosinophil cationic protein in sputum are particularly high at work in patients with occupational asthma, suggesting that the measurement of these factors can supplement other physiological outcomes in establishing the diagnosis of occupational asthma AU - Lemiere C AU - Pizzichini MM AU - Balkissoon R AU - Clelland L AU - Efthimiadis A AU - O'Shaughnessy D AU - Dolovich J AU - Hargreave FE LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 6 IP - DP - 1999 Jan 01 TI - Occupational neutrophilic asthma PG - 194-196 AB - Occupational asthma is typically associated with an eosinophilic bronchitis. The case of a 41-year-old woman who developed symptoms of asthma after occupational exposure to metal working fluids is reported. The diagnosis of asthma was confirmed by an forced expiratory volume in 1 s (FEV1) of 1.7 (59% predicted), with 11% reversibility after inhaled bronchodilator and a provocation concentration of methacholine to cause a fall in FEV1 of 20% (PC20) of 0.4 mg/mL. Induced sputum examination showed a marked neutrophilia. Over the next six months, serial sputum analyses confirmed the presence of a marked sterile neutrophilic bronchitis during periods of occupational exposure to metal working fluids, which resolved when the patient was away from work and recurred when she returned to work. The sputum findings were mirrored by corresponding changes in spirometry and PC20 methacholine. The findings indicate the occurrence of occupational asthma associated with an intense, sterile neutrophilic bronchitis after exposure to metal working fluids AU - Leigh R AU - Hargreave FE LA - PT - DEP - TA - Can Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - IP - DP - 1999 Jan 01 TI - Statement on 2-chlorobenzylidene malononitrile (CS) and CS spray PG - - AU - Committees on toxicity ma consumer products and the environment LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 159 IP - DP - 1999 Jan 01 TI - Occupational asthma caused by isocyanates: patterns of asthmatic reactions to increasing day-to-day doses PG - 1879-1883 AB - Inhalation challenges to isocyanates are conducted in specialized centers to confirm occupational asthma. The pattern of asthmatic reactions due to consecutively increasing daily doses of isocyanates is unknown. We conducted a study involving 24 subjects who had undergone specific inhalation challenges to isocyanates (toluene diisocyanate [TDI], n = 8; hexamethylene diisocyanate [HDI], n = 10; and methylene diisocyanate [MDI], n = 6) on three or more consecutive days. Challenge tests were given through a closed-circuit apparatus (n = 12) or in small cubicles (n = 12), allowing assessment of the total inhaled dose (concentration x duration). The pattern of asthmatic reactions was described. In addition, dose-response curves were analyzed and tested for their linear and quadratic trends. Four patterns of response were observed: (1) linear (n = 10); (2) minimal effect followed by a brisk change (n = 7); (3) significant change followed by tachyphylaxis or a plateau (n = 4); (4) biphasic (i.e., significant change followed by a reduction in the effect and significant change on the last day of exposure [n = 3]). Subjects with a linear dose-response pattern had been exposed to isocyanates at work for a significantly shorter interval (7.2 +/-6.7 yr) than subjects with a nonlinear pattern (20.0 +/- 13.1 yr). An analysis of variance covering a 3-d period for all subjects showed a significant linear model for the response (p < 0.0001); there was no quadratic trend. However, when the analysis was done on subjects with four or more days of challenge (n = 10), we found both linear and quadratic significant components. This analysis shows that the most common pattern of asthmatic reactions to inhaled isocyanates generated on consecutive days is linear; however, other patterns are also observed. In some individuals, particularly those in whom more days of challenge are required, we observed in addition to a strong linear component a quadratic component manifested by a brisk change on the last day of exposure AU - Malo JL AU - Ghezzo H AU - Elie R LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 82 IP - DP - 1999 Jan 01 TI - Occupational asthma and IgE sensitization to cellulase in a textile industry worker PG - 174-178 AB - BACKGROUND: Although there have been a few reports of occupational asthma due to cellulase in several occupational settings, this is the first case of cellulase-induced occupational asthma in an employee working in the textile industry. Its pathogenetic mechanism remains to be further clarified. OBJECTIVE: It is important to alert physicians to the possibility of occupational asthma caused by cellulase in workers of the textile industry. METHODS AND RESULTS: The patient had atopy and strong positive responses to cellulase extract on skin prick tests. Bronchoprovocation test showed an early asthmatic response to cellulase extract. Serum specific IgE and specific IgG4 antibodies to cellulase were detected by enzyme-linked immunosorbent assay (ELISA). In order to further characterize the allergenic component of the extract, sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and electroblotting studies were performed. Eight IgE binding components ranging from 6 to 97.5 kD were detected within the cellulase extract. CONCLUSION: These findings suggest that inhalation of cellulase can induce IgE-mediated bronchoconstrictions in employees working in the textile industry AU - Kim HY AU - Nahm DH AU - Park HS AU - Choi DC LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 35 IP - DP - 1999 Jan 01 TI - Metal working fluid-associated hypersensitivity pneumonitis: an outbreak investigation and case-control study PG - 58-67 AB - Occupational exposure to bacterial or fungal antigens has been associated with hypersensivity pneumonitis (HP), an immunologically-mediated pulmonary disease. Between August 1995 and April 1996, 34 employees working in machining and assembly areas of an engine manufacturing plant were clinically diagnosed with HP. Of these, 20 employees met an epidemiologic case definition. In a case-control study, no exposure variables, including duration and intensity of metal working fluid (MWF) exposure, were statistically associated with an increased risk of disease. Neither cases nor controls demonstrated precipitin reactivity against unused samples of the seven MWF and two biocides used in the plant. HP cases had a significantly higher prevalence of positive precipitin reactions to used oil soluble and synthetic MWFs. Reactivity to used but not unused MWF suggests a biocontaminant, probably bacteria or fungi, is the causative antigen in the development of HP in this setting AU - Fox J AU - Anderson H AU - Moen T AU - Gruetzmacher G AU - Hanrahan L AU - Fink J LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 49 IP - DP - 1999 Jan 01 TI - Occupational induction of hypersensitivity after an accidental exposure to chloromethylisothiozolinone and methylisothiozolinone (CMI/MI) in an industrial worker PG - 51-53 AU - Kujala V AU - Niinimaki A LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 99:5 IP - DP - 1999 Jan 01 TI - Floor cleaning materials as a cause of occupational asthma PG - 459-464 AB - Floor cleaning materials are increasingly being recognised as a cause of asthma in the workplace. In the West Midlands (UK) alone, there have been seventeen cases of occupational asthma reported to Shield where the most likely or proven cause was the floor cleaning material. There are a number of common constituents present in these materials which are possible causes of occupational asthma, the most frequently occurring substances are rosins, i.e. colophony based products, and benzalkonium chloride. Eight of the reported workers have completed serial peak flows analysis by OASYS-2 confirming occupational asthma. Six of these workers also underwent specific bronchial provocation tests to the constituents of the floor cleaning materials. In all of these cases, the results have confirmed that the floor cleaning materials are the cause of their occupational asthma. Most of the workers were only indirectly exposed in their workplace. Floor cleaning materials should be considered as a cause of occupational asthma when a direct cause is absent. AU - McCoach JS AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 16 IP - DP - 1999 Jan 01 TI - Assessment of exposure to asbestos [French] PG - Suppl 2:S18-24 AB - The aim of the study is to present the principles of assessing asbestos exposure in two different contexts: that of a patient suffering from pleuropulmonary pathology that could be attributed to asbestos and that of a group possibly exposed to asbestos. In the first case this evaluation concerns past exposure and depends typically on information obtained during the course of an interview with the patient. In the second case, the exposure is assessed by atmospheric analysis. Jobs in which occupational exposure to asbestos occurs should be examined, the tasks which entail this exposure and objects containing asbestos are discussed in the first part of the article. The accent is placed on the source of exposure, and the use of materials containing asbestos outside the asbestos industry. Some guidelines enabling the appreciation of the intensity of asbestos exposure as a function of the jobs involved and the objects handled are suggested. Regulations and the principle of quantifying asbestos in the atmosphere during direct exposure in the working environment on the one hand and during the course of passive exposure in the environment on the other are discussed in the second part of the article AU - Orlowski E AU - Galland MA LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 37 IP - DP - 1999 Jan 01 TI - The IS6110 restriction fragment length polymorphism in particular multidrug-resistant Mycobacterium tuberculosis strains may evolve too fast for reliable use in outbreak investigation PG - 788-791 AB - To study possible nosocomial transmission of multidrug-resistant (MDR) Mycobacterium tuberculosis, strain types and other information on 24, mostly human immunodeficiency virus-positive patients, were collected. Isolates from 11 patients had identical IS6110 restriction fragment length polymorphism (RFLP) patterns as well as spoligotype patterns and resistance profiles. Noticeably, nine other isolates from related cases also exhibited identical spoligotypes but slightly different RFLP patterns. These results indicate that for some MDR strains, the evolutionary clock of IS6110 RFLP may run too fast for reliable interpretation of strain typing results over a period of a few years AU - Alito A AU - Morcillo N AU - Scipioni S AU - Dolmann A AU - Romano MI AU - Cataldi A AU - van Soolingen D LA - PT - DEP - TA - Journal of Clinical Microbiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 56 IP - DP - 1999 Jan 01 TI - 20 years of medical surveillance on exposure to allergenic and non-allergenic platinum compounds: the importance of chemical speciation PG - 191-196 AB - OBJECTIVES: Chloroplatinates are potent allergens but other soluble platinum compounds such as tetraammine platinum dichloride (TPC) do not provoke reactions in subjects who are sensitive to chloroplatinates. TPC has been used in the manufacture of autocatalysts for 20 years. This study analyses 20 year data on exposure to soluble platinum compounds and medical surveillance to confirm that TPC is not allergenic. METHODS: Workers in three distinct operations were exposed to soluble platinum compounds as chloroplatinates, chloroplatinates with TPC, or to TPC alone. Results of personal air sampling for soluble platinum compounds were compared together with the results of medical surveillance. RESULTS: The levels of exposure to soluble platinum compounds in each operation were comparable but the incidence of allergy was significantly different. In a subgroup of workers consistently exposed to chemical processes in each operation, the cumulative chance of being sensitised after 5 years of exposure was estimated as 51% for chloroplatinate exposure, 33% for mixed exposure, and 0% for TPC alone. The differences in sensitisation rates could not be explained by age, sex, and atopy. Nor could they be explained by the increased frequency of smoking in the workers with chloroplatinate exposure, despite the markedly higher risk of sensitisation in smokers. The differences could only be explained by the chemical stability of TPC. CONCLUSIONS: This study shows that the soluble platinum compound TPC is not allergenic under normal industrial conditions. Characterisation of the chemical compound (speciation) is essential to prevent stringent exposure limits being imposed for all soluble compounds on a generic basis. AU - Linnett PJ AU - Hughes EG LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 159 IP - DP - 1999 Jan 01 TI - Change in airway responsiveness among apprentices exposed to metalworking fluids PG - 87-93 AB - Occupational Hygiene Program, Respiratory Division, Department of Medicine, and Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada To investigate early pulmonary responses to metalworking fluid exposure, we enrolled first-year machinist apprentices and apprentices in three other trades into a 2-yr longitudinal study. We obtained complete data for 82 machinists and 159 control subjects. Tests included respiratory questionnaires, spirometry, methacholine challenge, and allergy skin tests. Details on duration of exposure were collected by interview and 68 representative full shift personal samples for "total aerosol" were obtained from 13 shops (mean: 0.46 mg/m3, range: < 0.7 to 3.65 mg/m3). Machinists and control subjects did not differ at baseline. At follow-up, average change in bronchial responsiveness was double in machinists compared with control subjects (p = 0.05), and machinists were more likely to have developed new bronchial hyperresponsiveness (BHR) with asthmalike symptoms. In linear regression analysis, for predictors of methacholine slope, increased BHR was associated with duration of exposure to both synthetic and soluble metalworking fluids (p < 0.05); in logistic regression analysis, for predictors of BHR, only duration of exposure to synthetic fluids was a significant predictor. Results were not changed when workers with PC20 < 8 mg/ml at baseline were excluded. We conclude that exposure to water-based metalworking fluids (especially synthetic fluids) is associated with increasing BHR during the first 2 yr of exposure AU - Kennedy SM AU - ChanYeung M AU - Teschke K AU - Karlen B LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 54 IP - DP - 1999 Jan 01 TI - Occupational asthma caused by honey PG - 189-190 AU - Johnson A AU - Dittrick M AU - ChanYeung M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 56 IP - DP - 1999 Jan 01 TI - Follow up investigation of workers in synthetic fibre plants with humidifier disease and work related asthma PG - 403-410 AU - Pal TM AU - De Monchy JG AU - Groothoff JW AU - Post D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 150 IP - DP - 1999 Jan 01 TI - Office equipment and supplies: a modern occupational health concern? PG - 1223-1228 AU - Jaakkola MS AU - Jaakkola JJ LA - PT - DEP - TA - Am J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 9 IP - DP - 1999 Jan 01 TI - Association of ventilation rates and CO2 concentrations with health and other responses in commercial and industrial buildings PG - 226-252 AU - Seppanen OA AU - Fisk WJ AU - Mendell MJ LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 54 IP - DP - 1999 Jan 01 TI - Increased risk of allergy in children due to formaldehyde expodure in homes PG - 330-337 AU - Garrett HM AU - Hooper MA AU - Hooper BM AU - Rayment PR AU - Abramson MJ LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 37 IP - DP - 1999 Jan 01 TI - In vivo and in vitro effect of ozone and formaldehyde on human mucociliary transport system PG - 56-60 AU - Schafer D AU - Brommer C AU - Riechelmann H AU - Mann JW LA - PT - DEP - TA - Rhinology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 340 IP - DP - 1999 Jan 01 TI - A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation PG - 685-691 AB - BACKGROUND AND METHODS: Use of nicotine-replacement therapies and the antidepressant bupropion helps people stop smoking. We conducted a double-blind, placebo-controlled comparison of sustained-release bupropion (244 subjects), a nicotine patch (244 subjects), bupropion and a nicotine patch (245 subjects), and placebo (160 subjects) for smoking cessation. Smokers with clinical depression were excluded. Treatment consisted of nine weeks of bupropion (150 mg a day for the first three days, and then 150 mg twice daily) or placebo, as well as eight weeks of nicotine-patch therapy (21 mg per day during weeks 2 through 7, 14 mg per day during week 8, and 7 mg per day during week 9) or placebo. The target day for quitting smoking was usually day 8. RESULTS: The abstinence rates at 12 months were 15.6 percent in the placebo group, as compared with 16.4 percent in the nicotine-patch group, 30.3 percent in the bupropion group (P<0.001), and 35.5 percent in the group given bupropion and the nicotine patch (P<0.001). By week 7, subjects in the placebo group had gained an average of 2.1 kg, as compared with a gain of 1.6 kg in the nicotine- patch group, a gain of 1.7 kg in the bupropion group, and a gain of 1.1 kg in the combined-treatment group (P<0.05). Weight gain at seven weeks was significantly less in the combined-treatment group than in the bupropion group and the placebo group (P<0.05 for both comparisons). A total of 311 subjects (34.8 percent) discontinued one or both medications. Seventy-nine subjects stopped treatment because of adverse events: 6 in the placebo group (3.8 percent), 16 in the nicotine- patch group (6.6 percent), 29 in the bupropion group (11.9 percent), and 28 in the combined-treatment group (11.4 percent). The most common adverse events were insomnia and headache. CONCLUSIONS: Treatment with sustained-release bupropion alone or in combination with a nicotine patch resulted in significantly higher long-term rates of smoking cessation than use of either the nicotine patch alone or placebo. Abstinence rates were higher with combination therapy than with bupropion alone, but the difference was not statistically significant. AU - Jorenby DE AU - Leischow SJ AU - Nides MA AU - Rennard SI AU - Johnston JA AU - Hughes AR AU - Smith SS AU - Muramoto ML AU - Daughton DM AU - Doan K AU - Fiore MC AU - Baker TB LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 13 IP - DP - 1999 Jan 01 TI - Higher dosage nicotine patches increase one-year smoking cessation rates: results from the European CEASE trial. Collaborative European Anti-Smoking Evaluation. European Respiratory Society PG - 238-246 AB - The Collaborative European Anti-Smoking Evaluation (CEASE) was a European multicentre, randomized, double-blind placebo controlled smoking cessation study. The objectives were to determine whether higher dosage and longer duration of nicotine patch therapy would increase the success rate. Thirty-six chest clinics enrolled a total of 3,575 smokers. Subjects were allocated to one of five treatment arms: placebo and either standard or higher dose nicotine patches (15 mg and 25 mg daily) each given for 8 or 22 weeks with adjunctive moderately intensive support. The 12 month sustained success rates were: 25 mg patch for 22 weeks (L-25), 15.4%; 25 mg patch for 8 weeks (S-25), 15.9%; 15 mg patch for 22 weeks (L- 15), 13.7%; 15 mg patch for 8 weeks (S-15), 11.7%; and placebo (P-0) 9.9% (placebo versus 15 mg, p<0.05; 25 mg versus 15 mg, p<0.03; 25 mg versus placebo, p<0.001, Chi-squared test). There was no significant difference in success rate between the two active treatment durations. Of the first week abstainers (n=1,698), 25.1% achieved success at 12 months as opposed to first week smokers, 2.7% of 1,877 subjects (p< 0.001). In summary, a higher than standard dose of nicotine patch was associated with an increase in the long-term success in smoking cessation but continuation of treatment beyond 8-12 weeks did not increase the success rates. AU - Tonnesen P AU - Paoletti P AU - Gustavsson G AU - Russell MA AU - Saracci R AU - Gulsvik A AU - Rijcken B AU - Sawe U LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 93 IP - DP - 1999 Jan 01 TI - Health beliefs and compliance with inhaled corticosteroids by asthmatics in primary care practice PG - 88-94 AU - Chambers CV AU - Markson L AU - Diamond JJ AU - Lasch L AU - Berger M LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 14 IP - DP - 1999 Jan 01 TI - Generational increase of self-reported first attack of asthma in fifteen industrialized countries. European Community Respiratory Health Study (ECRHS) PG - 885-891 AB - The prevalence of asthma has increased worldwide. However, there is only local evidence for changes in incidence. Data from the European Community Respiratory Heath Survey (ECRHS) can be analysed to reconstruct trends in incidence from 1946-1991 in cohorts born between 1946-1971 in 35 areas corresponding to 15 countries. The authors report the time trends in self-reported first occurrence of asthma and its geographical distribution. All centres completed the same cross-sectional study in 1991-92. A total of 17,613 individuals (63% of those randomly selected) were included. Recall of age of first asthma attack was recorded at an interview at one point in time in subjects aged 20-44 yrs. Relative risk of asthma by cohort was estimated using survival methods with age as the time scale. Yearly incidence of asthma increased progressively by birth cohort. The relative risks were 1.12 (0.94-1.34), 1.39 (1.17-1.66), 2.01 (1.60-2.51), and 2.33 (1.81-2.98) for the cohorts born in the years 1951-55, 1956-60, 1961-65, and 1966-71, respectively, in comparison with the cohort born in the years 1946-50. The increase occurred concurrently in most of the countries, in both males and females, and both in childhood and adulthood onset asthma. These results are consistent with a generational increase in asthma incidence during the previous decades (explained by both a period and/or a cohort effect), although some of the findings could be explained by generational increases in asthma diagnosis AU - Sunyer J AU - Anto JM AU - Tobias A AU - Burney P LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 14 IP - DP - 1999 Jan 01 TI - Prevalence of respiratory and atopic disorders among children in the East and West of Germany five years after unification PG - 862-870 AB - Living conditions in eastern Germany have changed rapidly since unification in 1990 and little is known about how these changes affect the prevalence of atopic diseases. This study describes methods and prevalences of a large epidemiological project investigating determinants of childhood asthma and allergies in eastern (Dresden and Leipzig) and western (Munich) Germany in 1995/1996. Community based random samples of 9-11 yr old children in Dresden (n=3,017) and Munich (n=2,612), and of 5-7 yr old children in Dresden (n=3,300), Leipzig (n=3,167) and Munich (n=2, 165) were studied by parental questionnaires, bronchial challenges with hypertonic saline, skin examination, skin-prick tests, and measurements of specific and total serum immunoglobulin (Ig)E using Phase II modules of the International Study of Asthma and Allergies in Childhood (ISAAC). In 9-11 yr old children, the prevalence of physician diagnosed asthma (7.9% versus 10.3%; p<0.01) and bronchial hyperresponsiveness (15.7% versus 19.9%; p<0.05) was lower in Dresden than in Munich. No difference between Munich and Dresden was observed in the prevalence of diagnosed hay fever, skin test reactivity to > or = 1 allergen, and increased levels (>0.35 kU x L(-1)) of specific IgE against inhalant and food allergens. Symptoms and visible signs of atopic eczema tended to be more prevalent in Dresden. Similar East-West differences between the three study areas were seen in the younger age group. These findings are in line with recently observed increases in the prevalence of hay fever and atopic sensitization, but not of asthma and bronchial hyperresponsiveness, among 9-11 yr old children in Leipzig AU - Weiland SK AU - von Mutius E AU - Hirsch T AU - Duhme H AU - Fritzsch C AU - Werner B AU - Husing A AU - Stender M AU - Renz H AU - Leupold W AU - Keil U LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 81 IP - DP - 1999 Jan 01 TI - Hay fever, eczema, and wheeze: a nationwide UK study (ISAAC, international study of asthma and allergies in childhood) PG - 225-230 AB - OBJECTIVES: To describe the prevalence of atopic symptoms in children throughout the UK. METHOD: A questionnaire survey of 12-14 year olds throughout England, Wales, Scotland, and the Scottish Islands using the international study of asthma and allergies in childhood (ISAAC) protocol. RESULTS: A total of 27 507 (86%) children took part. Recent rhinoconjunctivitis was reported by 18.2%, with 6.2% reporting symptoms between March and September; 16.4% reported itchy flexural rash in the past 12 months. The prevalence of atopic symptoms was higher in girls and subjects born within the UK. The prevalence of severe wheeze was highest in subjects reporting perennial rhinoconjunctivitis, as opposed to summertime only symptoms. Winter rhinoconjunctivitis was associated with severe wheeze and severe flexural rash. One or more current symptoms were reported by 47.6% of all children and 4% reported all three symptoms. CONCLUSION: In general, geographical variations were small but the prevalence of symptoms was significantly higher in Scotland and northern England. The study demonstrates the importance of atopic diseases both in their own right and in association with asthma AU - Austin JB AU - Kaur B AU - Anderson HR AU - Burr M AU - Harkins LS AU - Strachan DP AU - Warner AU - JO LA - PT - DEP - TA - Arch Dis Child JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 116 IP - DP - 1999 Jan 01 TI - The occurrence, recrudescence, and worsening of asthma in a population of young adults: impact of varying types of occupation PG - 614-618 AB - OBJECTIVE: To describe the rates of exacerbation of existing asthma and incidence of new disease in Israeli men during military service. DESIGN: All 17-year-old Israeli nationals are obliged by law to appear at the Israel Defense Forces (IDF) recruiting office for medical examination. The medical history of army recruits was noted during the 30-month period after their induction into the IDF, and medical examinations were performed by pulmonary specialists in all suspected cases of asthma. The duty status of the soldiers in combat units (CUs), maintenance units (MUs), and clerical tasks was related to their asthma status. RESULTS: Of a total of 59,058 recruits, 1.0% developed asthma during the 30 months of this study; of those in CUs, 1.2% developed asthma; of those in MUs, 0.8% developed asthma; and of those performing clerical tasks, 0.6% developed asthma. The relative risk for developing or worsening of asthma was related to both the preexisting asthma status of the recruit and the environment in which he carried out his military service. The annual incidence of occupational-related asthma in MUs was found to be 800/million: five to six times the rates reported elsewhere. CONCLUSIONS: Service in CUs was associated with an increased frequency of exacerbation of asthma among recruits with previous disease and with the appearance of disease de novo. "Normal" conscripts with a history of childhood asthma are at a higher risk of developing overt asthma when compared to subjects with no such history. We found a 25% relative excess of incident cases of asthma in soldiers posted in MUs compared to those performing clerical tasks [(0.8 to 0.6%)/0.8%]. This difference is probably attributed to the difference in occupational hazards in these categories. Further studies are needed to determine if this represents the elicitation of underlying preexisting airway lability by new work demands or other environmental conditions, or if this represents a new development of airway lability because of specific immune or nonimmune factors AU - Katz I AU - Moshe S AU - Sosna J AU - Baum GL AU - Fink G AU - Shemer J LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 29 IP - DP - 1999 Jan 01 TI - Ten years of the SWORD project. Surveillance of Work-related and Occupational Respiratory Disease PG - 750-753 AU - Ross DJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 115 IP - DP - 1999 Jan 01 TI - Incidence and prevalence of asthma among adult Finnish men and women of the Finnish Twin Cohort from 1975 to 1990, and their relation to hay fever and chronic bronchitis PG - 928-936 AB - STUDY OBJECTIVES: To examine the prevalence of asthma and hay fever, and the incidence and temporal relationships of asthma, hay fever, and chronic bronchitis among adult twins during a 15-year period. DESIGN: Prospective cohort study. PARTICIPANTS: A population of 11,540 Finnish adult men and women, initially 18 to 45 years of age, who returned a health questionnaire in 1975, 1981, and 1990 as part of the Finnish Twin Cohort study. METHODS: Age-standardized prevalences and cumulative incidences among individuals were calculated for asthma, hay fever, and chronic bronchitis. The incidence of asthma among subjects with and without hay fever or chronic bronchitis was analyzed in the entire cohort as well as in twin pairs discordant for incident asthma. RESULTS: The prevalence of asthma increased slightly from 1975 (2.0% in men and 2.2% in women) to 1990 (2.9% in men and 3.1% in women). The prevalence of hay fever showed a larger increase in men and women (from 6.8% and 9.8% to 11.8% and 15.3%, respectively). Compared with figures for 1976 to 1981, no significant increase in asthma incidence occurred from 1982 to 1990, whereas the incidence of hay fever was lower during the latter period among men (incidence rate ratio, 0.7; 95% confidence interval, 0.6 to 0.9) as was the incidence of chronic bronchitis among women (incidence rate ratio, 0.7; 95% confidence interval, 0.6 to 0.9). Hay fever and chronic bronchitis were usually diagnosed before asthma. Both diseases increased the risk of asthma significantly on the basis of analyses of all individuals and of discordant twin pairs. CONCLUSIONS: The pattern of increase in asthma and hay fever prevalence with time was similar, and hay fever was a strong predictor of asthma. These diseases showed no significant increase in incidence AU - Huovinen E AU - Kaprio J AU - Laitinen LA AU - Koskenvuo M LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 3 IP - DP - 1999 Jan 01 TI - Incidence rate of adult-onset asthma in relation to age, sex, atopy and smoking: a Swedish population-based study of 15813 adults PG - 192-197 AB - SETTING: Our knowledge about asthma incidence in an adult population is limited. The aim of the present investigation was to estimate the incidence rate of adult-onset asthma in relation to age, sex, atopy and smoking in a random population sample. METHODS: A random sample of 20000 subjects 20 to 50 years of age was investigated using a short respiratory questionnaire. It was answered by 15813 persons. Adult-onset asthma was defined as a positive response to 'physician-diagnosed' asthma from 16 years of age. Subjects were also asked to report the year of asthma diagnosis, and also, when relevant, the year of smoke-start and smoke-stop. Incidence rates of adult-onset asthma and incidence rate ratios (IRR) were calculated. RESULTS: The incidence rate of adult-onset asthma among females was 1.3 cases/1000 person-years compared with 1.0/1000 person-years for males (IRR 1.3, 95% confidence interval [CI] 1.0-1.6). The incidence rate was high (3.0/1000 person-years) among females aged 16-20 years. There was a strong association between the incidence rate of adult-onset asthma and hay fever, atopic dermatitis and family history of atopy. Compared with never-smokers, the IRR for female smokers was 1.6 (95% CI 1.1-2.2), while for male smokers it was unity. Both male and female ex-smokers had moderately increased rate ratios, of 1.5 and 1.1, respectively. CONCLUSIONS: In this retrospective study, reported atopic symptoms and family history of atopy were strongly associated with incidence of adult-onset asthma. Tobacco smoking may be associated with an increased incidence rate of adult-onset asthma, especially among women AU - Toren K AU - Hermansson BA LA - PT - DEP - TA - Int J Tuberc Lung Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 149 IP - DP - 1999 Jan 01 TI - Asthma visits to emergency rooms and soybean unloading in the harbors of Valencia and A Coruna, Spain PG - 315-322 AB - Soybean unloading in the harbor of Barcelona, Spain, has been associated with large increases in the numbers of asthma patients treated in emergency departments between 1981 and 1987. In this study, the association between asthma and soybean unloading in two other Spanish cities, Valencia and A Coruna, was assessed. Asthma admissions were retrospectively identified for the period 1993-1995, and harbor activities were investigated in each location. Two approaches were used to assess the association between asthma and soybean unloading: One used unusual asthma days (days with an unusually high number of emergency room asthma visits) as an effect measure, and the other estimated the relative increase in the daily number of emergency room visits by autoregressive Poisson regression, adjusted for meteorologic variables, seasonality, and influenza incidence. No association between unusual asthma days and soya unloading was observed in either Valencia or A Coruna, except for one particular dock in Valencia. When the association between unloaded products and the daily number of emergency asthma visits was studied, a statistically significant association was observed for unloading of soya husk (relative risk = 1.50, 95% confidence interval 1.16-1.94) and soybeans (relative risk = 1.31, 95% confidence interval 1.08-1.59) in A Coruna. In Valencia, a statistical association was found only for the unloading of soybeans at two particular docks. Although these findings support the notion that asthma outbreaks are not a common hidden condition in most harbors where soybeans are unloaded, the weak associations reported are likely to be causal. Therefore, appropriate control measures should be implemented to avoid soybean dust emissions, particularly in harbors with populations living in the vicinity AU - Ballester F AU - Soriano JB AU - Otero I AU - Rivera ML AU - Sunyer J AU - Merelles A AU - Verea H AU - Marin J AU - Anto JM LA - PT - DEP - TA - Am J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 5 IP - DP - 1999 Jan 01 TI - Lipoid pneumonia due to mentholated petroleum jelly (Vicks Vaporub) PG - 38 AB - Exogenous lipoid pneumonia is an uncommon condition resulting from aspiration or inhalation of fat-containing material. Oil-based laxatives such as liquid paraffin and aerosolised oils are most commonly implicated. These substances ellicit a foreign body reaction and proloferative fibrosis in the lung. We descibe 2 patients with exogenous lipoid pneumonia in whom clinical history confirmed heavy long-term use of Vicks Vaporub as the causative agent. Other features of these cases are: Patient 1 is a 56 year old poorly controlled epileptic, whose mother regularly applied Vicks Vaporub into each nostril during grand mal seizures. She is asymptomatic but a diffuse fine reticulo-nodular pattern was an incidental finding on routine chest X-ray. Further observations confirmed cyanosis, diffuse bi-basal crackles, type 2 respiratory failure, and early features of cor pulmonale. Pulmonary function showed moderate obstruction and the CO-transfer factor was 40% predicted. Transbronchial biopsy showed features of lipoid pneumonia with excessive fibrosis. The patient refused treatment. Patient 2 was a diebetic who presented with a 4 month history of cough productive of white sputum and worsening shortness of breath. No history of other respiratory illness or any exposure history was obtained. Bibisal late inspiratory crackles were audible. CXR showed a bilateral reticular infiltrate. Pulmonary function tests showed a mild restrictive defect with a CO-transfer factor 30% predicted. Transbronchial biopsy revealed foreign body granulomara with fibrosis and foamy histiocytes. She was treated with prednisone but continued to deteriorate, developed cor pulmonale and respiratory failure and died after 36 months. AU - Abdullah I AU - Bateman ED AU - Ainslie GM LA - PT - DEP - TA - S Afr Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 56 IP - DP - 1999 Jan 01 TI - The prevalence and risk factors for latex allergy: a cross-sectional study in a UK hospital PG - 833-836 AB - OBJECTIVES: To determine the prevalence and risk factors for symptoms related to gloves, and the relation between symptoms and immunological evidence of type 1 hypersensitivity to latex in a United Kingdom health care setting. METHODS: A cross sectional survey was carried out among 773 employees at a British hospital. A self administered questionnaire was used to collect information about symptoms related to gloves and associated risk factors in a sample of hospital staff who were likely to use gloves at work. All of those who reported symptoms suggestive of type 1 hypersensitivity were invited for skin prick testing and measurement of specific IgE to latex (RAST). RESULTS: Among the 372 responders, symptoms related to gloves were common, 49% reported redness or itching of the hands, 14% reported urticaria, and 6% reported chest tightness. However, the frequency of positive skin prick tests and RASTs was surprisingly low (only two subjects tested positive). CONCLUSIONS: These findings indicate the need for caution in the interpretation of symptoms related to gloves even when they seem to suggest type 1 hypersensitivity. AU - Smedley J AU - Jury A AU - Bendall H AU - Frew A AU - Coggon D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 6 IP - DP - 1999 Jan 01 TI - RESPIRATORY DISEASES AMONG AGRICULTURAL INDUSTRY WORKERS IN INDIA: A CROSS-SECTIONAL EPIDEMIOLOGICAL STUDY PG - 115-126 AB - Abstract: Epidemiological survey for respiratory diseases among agricultural industry workers, such as bakeries, poultry farms, granaries and a sugar refinery was carried out using a medical questionnaire on various respiratory symptoms such as cough, breathlessness, rhinitis. The questionnaire was filled up by two doctoral students during personal visits to these work environments. The survey revealed that 40–59% of workers in different occupational work environments suffered from one or more respiratory ailments. As much as 36–40% of the workers reported work-related symptoms which is close to similar data from Western countries. A higher incidence of respiratory disorders was recorded in workers with longer duration of employment. Older workers suffered more than the young ones. Family history of atopy was found to have least effect on the incidence of cough, breathlessness and rhinitis in the workers. Smoking was found to have definite impact on the incidence of cough and breathlessness. AU - Singh AB AU - Singh A AU - Pandit T LA - PT - DEP - TA - Ann Agric Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 3 IP - DP - 1999 Jan 01 TI - Occupational Asthma PG - 93-98 AU - Awad NT LA - PT - DEP - TA - Indian J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 13 IP - DP - 1999 Jan 01 TI - Occupational asthma caused by palladium PG - 213-216 AB - Occupational exposure to complex platinum salts is a well-known cause of occupational asthma. Although there is evidence that platinum refinery workers may also be sensitized to other precious metals, such as palladium or rhodium, no instances of occupational asthma due to an isolated sensitization to palladium have been reported. A case is reported of occupational rhinoconjunctivitis and asthma in a previously healthy worker exposed to the fumes of an electroplating bath containing palladium. There was no exposure to platinum. Sensitization to palladium was documented by skin-prick tests. The skin-prick test was positive with Pd(NH3)4Cl2, but not with (NH4)2PdCl4. Corresponding salts of platinum were all negative. A bronchial provocation test with Pd(NH3)4Cl2 (0.0001% for a total of 315 s, followed by 0.001% for a total of 210 s) led to an early decrease in forced expiratory volume in one second (-35%). A similar exposure (0.001% for a total of 16 min) in an unrelated asthmatic gave no reaction. This case shows that an isolated sensitization to palladium can occur and that respiratory exposure to palladium is a novel cause of metal-induced occupational asthma. AU - Daenen M AU - Rogiers P AU - de Van Walle C AU - Rochette F AU - Demedts M AU - Nemery B LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 56 IP - DP - 1999 Jan 01 TI - Follow up of workers previously exposed to silver solder containing cadmium PG - 553-558 AB - OBJECTIVES: To study longitudinal biological monitoring data on urinary and blood cadmium collected in a small cohort of nine workers who had been brazing for several years with solders containing cadmium. METHODS: Cadmium was measured by neutron activation analysis in livers and kidneys, and estimates of renal function were carried out in 1983 and 1995. During the intervening period exposure to cadmium was dramatically reduced by local exhaust ventilation control and substitution of the solder containing cadmium. RESULTS: From urinary protein measurements there was evidence within the group of increasing renal tubular damage over the 12 year period, even though exposure to cadmium was dramatically reduced over this period and almost eliminated by 1995. There was no evidence from serum creatinine of decreasing glomerular filtration rate, and the renal tubular handling of calcium, phosphate, or urate had not worsened significantly. Blood and urinary cadmium concentrations reduced significantly over the 12 year period but were still substantial in 1995. Blood cadmium concentrations tended to reflect cadmium body burden in 1995 when exposure had been low for several years, and decreased most significantly during 1983-90. By contrast urinary cadmium concentrations only decreased significantly from about 1990 onwards. Urinary cadmium was not significantly correlated with liver or kidney cadmium concentration in either 1983 or 1995. This may be due to the level of tubular dysfunction in the cohort. Calculated cumulative excretion of cadmium over the 12 year period was substantially greater than the loss of cadmium measured in livers and kidneys and the derived loss in body burden. Reasons for this are discussed. It is possible that in cohorts, where renal damage is apparent, urinary concentrations reflect a substantial component of current exposure rather than stored body losses. CONCLUSIONS: The data reinforce the concept that blood cadmium concentrations may not always reflect recent exposure, but may reflect body burden derived from historical exposure depending on the degree of current exposure; and that the decline in urinary and blood cadmium measurements after removal from, or reduction in, exposure will be slow and depend on the historical body burden. AU - Mason HJ AU - Williams N AU - Armitage S AU - Morgan M AU - Green S AU - Perrin B AU - Morgan WD LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 160 IP - DP - 1999 Jan 01 TI - A randomized clinical trial of a1-antitrypsin augmentation therapy. PG - 1468-1472 AB - We have investigated whether restoration of the balance between neutrophil elastase and its inhibitor,a1-antitrypsin, can prevent the progression of pulmonary emphysema in patients with a1-antitrypsin deficiency. Twenty-six Danish and 30 Dutch ex-smokers with a1-antitrypsin deficiency of PI*ZZ phenotype and moderate emphysema (FEV1 between 30% and 80% of predicted) participated in a double-blind trial of a1-antitrypsin augmentation therapy. The patients were randomized to either a1-antitrypsin (250 mg/kg) or albumin (625 mg/kg) infusions at 4-wk intervals for at least 3 yr. Self-administered spirometry performed every morning and evening at home showed no significant difference in decline of FEV1 between treatment and placebo. Each year, the degree of emphysema as quantified by the 15th percentile point of the lung density histogram derived from computed tomography (CT). The loss of lung tissue measured by CT (mean +/- SEM) was 2.6 +/- 0.41 g/L/yr a1-antitrypsin infusion (p=0.07).Power analysis showed that this protective effect would be significant in a similar trial with 130 patients. This is in contrast to calculations based on annual decline of FEV1 showing that 550 patients would be needed to show a 50% reduction of annual decline. We conclude that lung density measurements by CT may facilitate future randomized clinical trials of investigational drugs for a disease in which little progress in therapy has been made in the past 30 yr. AU - Dirksen A AU - Dijkman JH AU - Madsen F AU - Stoel B AU - Hutchison DCS AU - Ulrik CS AU - Skovgaard LT AU - Kok-Jensen A AU - Rudolphus A AU - Seersholm N AU - Vrooman HA AU - Reiber JHC AU - Hansen NC AU - Heckscher T AU - Viskum K AU - Stolk J. LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 113 IP - DP - 1999 Jan 01 TI - Occupational asthma due to isocyanates: a study of 21 patients PG - 659-662 AB - BACKGROUND: A descriptive-evolutive study of a series of patients diagnosed with bronchial occupational asthma due to isocyanate exposure. SUBJECTS AND METHODS: Retrospective study of 21 patients diagnosed with bronchial occupational asthma due to isocyanates. Family story, clinical data, functional respiratory study, allergic and laboratory tests were collected. Clinical and functional performance one year after diagnosis was evaluated in patients who had and who had not stopped causal exposure. RESULTS: 17 men and 4 women aged 22 to 59 years were evaluated. In 5 cases (23.8%) family story of atopy was documented and 12 (57.14%) patients were smokers. Seven out of 21 patients were exposed to paint related products at work being this the most common reason. Average time (SD) from the beginning of exposure to development of symptoms was 16.10 (22.5) months. IgE levels were high in 6 (28.57%) and specific IgE to isocyanates was high in 8 (38%), in all cases bronchial hyperreactivity was detected. In 18 patients (85.7%), the study of maxim expiratory flow (MEF) register demonstrated occupational asthma while in the remaining 3 patients a provocation test was performed with positive result. In the annual follow up visit, the 17 patients who avoided casual exposure showed clinical improvement, 7 of them also with functional improvement while in the remaining 10 patients no significant functional change was observed. On the other hand, 3 of the 4 patients who, although protected, underwent exposure, became clinical and functionally worse (p = 0.003, Fisher test). CONCLUSIONS: The etiology of occupational asthma due to isocyanates is not often assessed and usually lately diagnosed. This aspect is worth considering as the illness prognosis seems related to casual agent avoidance. AU - Orriols R AU - Drobnic ME AU - Munoz X AU - Rodrigo MJ AU - Morell F LA - PT - DEP - TA - Medicina Clinica JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 41 IP - DP - 1999 Jan 01 TI - Occupational IgE-mediated contact urticaria from diphenylmethane-4,4-diisocyanate (MDI). PG - 50-51 AB - Case report of asthma (not further substantiated) and urticaria with positive skin prick to to MDI/HSA (4mm wheal) and negative isocyanate patch tests. Glued wood pannels with 2 pack MDI AU - Kanerva L AU - Grenquist-Norden B AU - Piirila P LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 4 IP - DP - 1999 Jan 01 TI - The preparation of nitrogen trichloride for specific bronchial challenge PG - 459-464 AU - McCoach JS AU - Sadra S AU - Birrell L AU - Burge PS LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 5 IP - DP - 1999 Jan 01 TI - An Evaluation Of The Incidence Of Work-Related Asthma In The United States PG - 1-8 AB - The objective of the study was to estimate the incidences of physician-diagnosed cases of work-related asthma (WRA) in Michigan and the entire United States. The statewide surveillance system for WRA in Michigan receives reports primarily from three sources: physicians, hospital discharge data, and worker's compensation claims. Knowledge of the overlap in reports from these sources was used in conjunction with capture-recapture methods to estimate the total number of diagnosed cases of WRA, and incidence rates were calculated using the estimated number of civilian employees in Michigan as the population at risk. For the entire United States, the product of a national incidence rate for asthma among adults and estimates of the proportion that is work-related was used. A total of 933 cases of WRA were reported to the Michigan surveillance program during 1988-1995, of which 904 were reported by at least one of the three main sources and equaled an average incidence of 27 cases/10(6)/year. This estimate was less than the range of estimates 58 to 204 cases/10(6)/year in Michigan arrived at using the capture-recapture methods. The national estimates of WRA ranged from 63 to 441 cases/10(6)/year. The authors' indirect estimates are closer to estimates from Canada, Sweden, and Finland than most existing direct estimates in the United States, but probably still underestimates the magnitude of WRA incidence because of the limitations of physician recognition of the work-relatedness of asthma among adults. AU - Henneberger PK AU - Kreiss K LA - PT - DEP - TA - Int J Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 49 IP - DP - 1999 Jan 01 TI - A review of current literature on epidemiology of immediate glove irritation and latex allergy PG - 3-9 AU - Kujala AU - V LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 49 IP - DP - 1999 Jan 01 TI - Is atopy and smoking important in the workplace? PG - 197-200 AU - Niven RM AU - Pickering CAC LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 49 IP - DP - 1999 Jan 01 TI - Health surveillance in milling, baking and other food manufacturing operations--five years' experience PG - 147-153 AB - The objective of this study was to describe the incidence of allergic respiratory disease and its outcome in terms of symptoms and jobs, across different flour-using industries. It uses the findings of a health surveillance programme in a large food organization over a five-year period. The population under surveillance consisted of 3,450 employees with exposure to ingredient dusts, of whom 400 were in flour milling, 1,650 in bread baking, 550 in cake baking and 850 in other flour-using operations. A total of 66 employees with either asthma or rhinitis symptoms attributable to sensitization to allergens in the workplace were identified. The majority of these (48/66) had become symptomatic prior to the commencement of the health surveillance programme in 1993. The incidence rates (per million employees per year) for those who developed symptoms between 1993 and 1997 were 550 for flour milling, 1,940 for bread baking, 0 for cake baking and 235 for other flour-using operations. The agent believed to be responsible for symptoms was most commonly grain dust in flour millers and fungal amylase in bread bakers. Wheat flour appeared to have a weaker sensitizing potential than these other two substances. In terms of outcome, at follow-up 18% of symptomatically sensitized employees had left the company. Two of the ex-employees retired through ill health due to occupational asthma. Of those still in employment, 63% described an improvement in symptoms, 32% were unchanged and 4% were worse than when first diagnosed. Over half the cases still in employment were continuing to work in the same job as at the time of diagnosis AU - Smith TA AU - Patton J LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 160 IP - DP - 1999 Jan 01 TI - Asthma-related work disability in Sweden : the impact of workplace exposures PG - 2028-2033 AU - Blanc PD AU - EllbjaerS LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 49 IP - DP - 1999 Jan 01 TI - Small bakeries - A cross-sectional study of respiratory symptoms, sensitization and dust exposure PG - 237-241 AB - This cross-sectional study investigated the prevalence of respiratory symptoms and sensitization to dust components in 224 individuals in 18 small bakeries in Scotland. Each work practice in the bakeries was characterized by an assessment of dust exposure and assigned to a category with either a direct exposure to flour dust or an indirect exposure to flour dust. We found that work-related respiratory symptoms were significantly associated with specific $$$gE to wheat flour and amylase but not to exposure category (except for nasal/eye symptoms). However, specific $$$gE to wheat flour was significantly associated with exposure category. There was a higher prevalence of immunological sensitization, reporting of work-related respiratory symptoms and exposure to dust than in other studies and of the 144 personal dust sample results taken, 21(14.6%) of the total exceeded 10 mg/m3 the substantial dust concentration as outlined by the COSHH Regulations. Follow-up of those with work-related asthma symptoms (questionnaire response) was inconclusive of the work-relatedness of their symptoms, although it did confirm respiratory morbidity. AU - Jeffrey P. Griffin P. Gibson M. Curran AD LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 25 IP - DP - 1999 Jan 01 TI - Adult-onset asthma and occupational exposures PG - 430-435 AB - OBJECTIVES: This study examined certain occupational exposures and the risk for adult-onset asthma. METHODS: A nested case-referent study of adult-onset asthma was performed on a random population sample (N=15813), aged 21 to 51 years. Cases for the study included 2 groups: subjects reporting "physician-diagnosed" asthma (N=251) and a broader "asthma" group (N=362). The "asthma" group consisted of subjects with "physician-diagnosed" asthma (N=251) and subjects reporting asthma-like symptoms without having "physician-diagnosed" asthma (N=111). The referents (N=2044) were randomly selected from the whole population sample. The case-referent sample was investigated with a comprehensive questionnaire about occupational exposures, asthma, respiratory symptoms, smoking, and atopy. Odds ratios were calculated with stratification for gender, year of diagnosis, and birth year. RESULTS: The highest odds ratio for "physician-diagnosed" asthma was associated with exposure to flour dust [odds ratio (OR) 2.8, 95% confidence interval (95% CI) 1.5-5.2] and the occupational handling of resin-based paints (isocyanates) (OR 3.0, 95% CI 1.6-5.9). Exposure to welding fumes, textile dust, and work with glues containing acrylates was also associated with an increased odds ratio for "physician-diagnosed" asthma. Including persons with asthma-like symptoms (ie, the asthma group) showed similar results. CONCLUSION: This population-based case-referent study from Sweden indicates that occupational exposure to acrylate-based compounds and welding fumes is associated with increased risk for adult-onset asthma. AU - Toren K AU - Jaervholm B AU - Brisman J et al LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 56 IP - DP - 1999 Jan 01 TI - Exposure-response relations of alpha-amylase sensitisation in British bakeries and flour mills PG - 197-201 AB - OBJECTIVES: To describe the levels of exposure to fungal alpha-amylase in British bakeries and flour mills, and to describe the relation between exposure to alpha-amylase and sensitisation to fungal alpha- amylase. METHODS: 495 personal flour dust samples were taken in seven British bakeries and flour mills and analysed for alpha-amylase with an immunoassay. Workers at the sites were asked to fill out questionnaires on work related symptoms, smoking history, and work history, and they were skin prick tested with common allergens and fungal alpha-amylase to assess sensitisation. RESULTS: Exposure to high concentrations of alpha-amylase occur in a few areas of British bakeries and flour mills, and there can be considerable differences in exposures to alpha-amylase between sites and between exposure groups, and even within similar exposure groups from different sites. Exposure to the highest concentrations of alpha-amylase was found in the dispensing and mixing areas of the bakeries (geometric mean (GM) 39.7 ng/m3). Exposure to alpha-amylase showed only a moderate correlation with concentrations of dust (r = 0.42) and flour aeroallergen (r = 0.46). The results also showed a relation between exposure to alpha-amylase and sensitisation to fungal alpha-amylase (prevalence ratio (PR) for medium exposure 3.9, 95% confidence interval (95% CI) 0.8 to 20.2, PR for high exposure 9.9, 95% CI 2.8 to 34.6) compared with the low exposure category). Atopic subjects had an increased risk of sensitisation, but this was not significant. CONCLUSION: This study suggests that exposure to alpha- amylase is a considerable health risk in British bakeries and flour mills. A small proportion of workers are exposed to alpha-amylase at concentrations that result in high rates of sensitisation. A reduction in exposure to alpha-amylase is likely to reduce this risk. AU - Nieuwenhuijsen MJ AU - Heederik D AU - Doekes G et al LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 160 IP - DP - 1999 Jan 01 TI - Interaction of HLA phenotype and exposure intensity in sensitisation to complex platinum salts PG - 435-438 AB - The development of sensitization to inhaled allergens is determined by the interaction of multiple genetic and environmental influences. Occupational sensitization to low-molecular-weight chemicals allows a specific immunological response to an inhaled hapten to be studied in a well-defined population with characterized exposure. We investigated the workforce of a large platinum refinery exposed to ammonium hexachloroplatinate (ACP) to test the hypothesis that the development of IgE-associated sensitization to ACP was influenced by human leukocyte-associated antigen (HLA) phenotype, especially in those with lower ACP exposure. We performed HLA typing in 44 cases with a positive skin prick test to ACP, and 57 nonsensitized referents matched on age, race, duration of employment, and category of ACP exposure. An HLA-DR3 phenotype was more common among cases (odds ratio [OR] 2.3), and more so in those with low (OR infinite) than with high exposure (OR 1.6); HLA-DR6 was less common among the cases (OR 0.4), an association also stronger in the low-exposure group (OR 0.1 versus 0.5). These results provide evidence that HLA phenotype is a significant determinant of sensitization to complex platinum salts and for the first time show that the strength of this association varies with intensity of exposure to the sensitizing agent. They imply that as exposure-control measures are taken to prevent occupational sensitization and, by analogy, sensitization to allergens outside the workplace, disease incidence will increasingly be determined by genetic susceptibility. AU - Newman Taylor AJ AU - Cullinan P AU - Lympany PA et al LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 72 IP - DP - 1999 Jan 01 TI - Outcome of occupational asthma due to platinum salts after transferral to low-esposure areas PG - 33-39 AB - OBJECTIVE: To assess the health effects of transferral to low-exposure jobs on subjects with occupational asthma (OA). METHODS: We performed a cross-sectional survey of 83 workers in 2 platinum (Pt) refineries and 2 catalyst production plants, all with diagnosed OA due to Pt salts. In all, 9 workers (group A; 11%) continued to be exposed at the time of examination, 16 subjects (group B; 19%) had been transferred to other workplaces within the production building, 39 subjects (group C; 47%) had been transferred to areas outside the building but inside the plant, and 19 subjects (group D; 23%) had left the plant. The median period from transferral to examination was 54 months (lower quartile 23 months, upper quartile 84 months, n = 74). Symptoms, skin-prick tests (SPT) with environmental allergens and Pt salt, total serum IgE, lung function, and bronchial hyperresponsiveness were assessed by standard procedures. RESULTS: Asthma symptoms were reported by all subjects in the production area but by only 37 of 74 subjects (50%) after transferral, with no difference being found between groups B, C, and D. Both the proportion of subjects sensitized to Pt salts (100%, 88%, 67%, and 42% in groups A, B, C, and D, respectively) and the degree of sensitization were associated with exposure (P < 0.0002). Total IgE was higher in group A as compared with groups B, C, or D (P < 0.002). There was no association between bronchial hyperresponsiveness and exposure. Although no univariate difference in FEV1 was found between the groups, regression analysis showed an association between FEV1 and exposure (P < 0.002). In all, 13 subjects demonstrated a predicted FEV1 value of <80% (22%, 6%, 10%, and 32% in groups A, B, C, and D, respectively). They were older (median 49 versus 37 years; P < 0.002) and had worked over longer periods in high-exposure areas in spite of symptoms (median 43 versus 10 months; P < 0.003). Fifteen subjects of groups C or D had been removed from areas B previously, eight of them due to respiratory symptoms. CONCLUSIONS: For the majority of subjects with OA due to Pt salts transfer to low exposure areas as defined in this study may not be associated with a more unfavorable outcome as compared with complete removal from exposure sources AU - Merget R AU - Schulte A AU - Gebler A AU - Breitstadt R AU - Kulzer R AU - Berndt ED AU - Baur AU - X AU - SchultzeWerninghaus G LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 115 IP - DP - 1999 Jan 01 TI - Occupational asthma: A longitudunal study on the clinical and socioeconomic outcome after diagnosis PG - 249-256 AB - AIM: To evaluate the clinical outcome and socioeconomic consequences of occupational asthma (OA). SUBJECTS AND METHODS: Twenty-five patients with OA both to high- and low-molecular-weight agents (3 and 22, respectively) confirmed by specific inhalation challenge were followed up for 12 months after the diagnosis. Upon diagnosis, each patient received a diary on which to report peak expiratory flow rate (PEFR), symptoms, drug consumption, expenses directly or indirectly related to the disease, as well as information regarding personal socioeconomic status. At each follow-up visit (1, 3, 6, and 12 months), the patients underwent clinical examination, spirometry, methacholine (Mch) challenge, and assessment of diary-derived parameters and socioeconomic status. Asthma severity (AS) was classified into four levels, based on symptoms, drug consumption, and PEFR variability. RESULTS: At 12 months, 13 patients (group A) had ceased exposure; the remaining 12 patients (group B) continued to be exposed. At diagnosis, FEV1 percent and provocative dose causing a 20% fall in FEV1 (PD20) of Mch were lower in group A than in group B; patients of group A were also characterized by significantly higher basal AS levels. At 12 months, no significant variation in FEV1 percent or PD20 was found for either group, while AS levels improved in both groups, the change being more marked for group A than group B. Pharmaceutical expense at 12 months significantly (p < 0.05) decreased, as compared with the first month, in group A, whereas it tended to increase in group B. In group A, 9 of 13 subjects had reported a deterioration of their socioeconomic status as compared with 2 of 12 in group B (p < 0.01). A significant loss of income was registered in patients of group A (median 21.45, 25th to 75th percentiles 16.9 to 25.8 Italian liras x 10(6) on the year preceding diagnosis and 15.498, 10.65 to 21.087 Italian liras x 10(6) on the year after diagnosis; p < 0.01), whereas no significant change was seen for patients in group B. CONCLUSIONS: In OA, cessation of exposure to the offending agent results in a decrease in asthma severity and in pharmaceutical expenses, but it is associated with a deterioration of the individual's socioeconomic status (professional downgrading and loss of work-derived income). There appears to be a great need for legislation that facilitates the relocation of these patients AU - Moscato G AU - Dellabianca A AU - Perfetti L AU - Brame B AU - Galdi E AU - Niniano R AU - Paggiaro P LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 281 IP - DP - 1999 Jan 01 TI - Powder-free protein-poor natural rubber latex gloves and latex sensitisation PG - 988 AU - Levy D AU - Allouache S AU - Chabane MH et al LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 49 IP - DP - 1999 Jan 01 TI - SWORD '98: surveillance of work-related and occupational respiratory disease in the UK PG - 485-489 AB - The SWORD surveillance scheme, now 10 years old, uses systematic reporting from physicians to provide a picture of the incidence of occupational respiratory disease in the United Kingdom. An estimated total of 2966 incident cases was derived from reports by chest and occupational physicians during the 1998 calendar year. Occupational asthma continues to be the most-reported respiratory condition, with an estimated 822 cases (27% of total cases). The proportion of cases of mesothelioma (23%), benign pleural disease (21%) pneumoconiosis (7%) and inhalation injuries (6%) remain similar to those estimated in past years, although fewer cases overall were reported. The most commonly identified agents causing asthma in 1998 were enzymes, isocyanates, laboratory animals and insects, colophony and fluxes, flour, latex, and glutaraldehyde. An increased incidence of respiratory diseases of short latency was seen in mining, whilst cases in chemical, mineral products and motor vehicle manufacture remained high; lower rates were noted in wood products and textile manufacture when compared with 1997 figures. Inhalation accidents over the past 3 years were reviewed; gaseous agents and combustion products accounted for nearly half of cases. High rates for inhalation injuries were seen in coal miners, fuel production, motor vehicle manufacturing, water purification, and chemical manufacturing. AU - Meyer JD AU - Holt DL AU - Cherry NM et al LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 103 IP - DP - 1999 Jan 01 TI - Exposure-response relationships for work-related sensitisation in workers exposed to rat urinary allergens: results from a pooled study PG - 678-684 AB - BACKGROUND: Recent studies in a few industries have shown that the likelihood of IgE-mediated sensitization increases with increasing exposure. The shape of the exposure-response relationships and modification by age, sex, and smoking habit has hardly been studied. OBJECTIVE: The purpose of this study was to determine exposure sensitization relationships for rat sensitization and to evaluate the influence of atopy, smoking habits, and sex. METHODS: Data from 3 cross-sectional studies in The Netherlands, the United Kingdom, and Sweden were used and involved 1062 animal laboratory workers. Selection criteria were harmonized, and this resulted in a study population of 650 animal laboratory workers (60.6% female) with less than 4 years of exposure. Air allergen levels were assessed previously and converted on the basis of an interlaboratory allergen analysis comparison. Available sera were analyzed for the presence of specific antibodies against common allergens (house dust mite, cat, dog, and grass and birch pollen) and work-related allergens (rat and mouse urinary proteins). Questionnaire items on work-related respiratory symptoms, hours worked with rats per week, job performed, smoking habits, and sex were used in this analysis RESULTS: The prevalence of work-related sensitization to rat urinary allergens (IgE >0.7 KU/L) was 9.7 % (n = 63). Thirty-six of the sensitized workers had work-related symptoms (asthma or rhinitis). Two hundred forty-eight workers (38.2%) were atopic (defined as specific IgE to 1 of the common allergens). The sensitization rate increased with increasing air allergen exposure. Atopic workers exposed to low levels of allergen had a more than 3-fold increased sensitization risk compared with nonexposed atopic workers. For atopic subjects, the risk increased little with increasing exposure, whereas for nonatopic subjects, a steadily increasing risk was observed. Smoking and sex did not modify the sensitization risk. CONCLUSION: Rat urinary allergen- sensitization risk increased with increasing exposure intensity. Workers who were atopic had a clearly elevated sensitization risk at low allergen exposure levels. AU - Heederik D AU - Venables KM AU - Malmberg P AU - Hollander A AU - Karlsson AS AU - Renstrom A AU - Doekes G AU - Nieuwenhuijsen MJ AU - Gordon S LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 82 IP - DP - 1999 Jan 01 TI - New occupational allergen in citrus farmers: citrus red mite (Panonychus citri) PG - 223-228 AU - Kim YK AU - Son JW AU - Kim HY et al LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 35 IP - DP - 1999 Jan 01 TI - Isocyanate Medical Surveillance: Respiratory Referrals From A Foam Manufacturing Plant Over A Five Year Period PG - 87-91 AB - This study assesses the causes of medical surveillance changes leading to specialist referral from one isocyanate-using company where 39 workers (about 20% of all employees) were referred to a hospital occupational clinic during a 5-year period for concerns regarding their surveillance respiratory questionnaire or spirometry results. The respiratory assessment determined that the questionnaire had detected 5 workers with non-occupational asthma, 2 with possible occupational asthma (OA), and 1 with subsequently confirmed OA, while no additional asthmatics were detected by spirometry without questionnaire findings. The surveillance questionnaire in this study was sensitive but not specific (no additional compensation claims for OA were made during this time period): workplace spirometry, however, did not add to the detection rate of asthma AU - Kraw M AU - Tarlo SM LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 353 IP - DP - 1999 Jan 01 TI - Occupational asthma in europe and other industrialised areas: a population-based study PG - 1750-1754 AB - BACKGROUND: There are no large population-based studies on occupational asthma, and few estimates of the proportion of asthma attributed to occupation, even though asthma is the most common occupational respiratory disorder in industrialised countries. METHODS: We assessed data on 15,637 people aged 20-44, randomly selected from the general population of 26 areas in 12 industrialised countries. Asthma was assessed by methacholine challenge test and by questionnaire data on respiratory symptoms and use of medication. Occupation was defined by job-titles and a job exposure matrix was constructed. FINDINGS: Highest risk of asthma, defined as bronchial hyperresponsiveness and reported asthma symptoms or medication, was shown for farmers (odds ratio 2.62 [95% CI 1.29-5.35]), painters (2.34 [1.04-5.28]), plastic workers (2.20 [0.59-8.29]), cleaners (1.97 [1.33-2.92]), spray painters (1.96 [0.72-5.34]), and agricultural workers (1.79 [1.02-3.16]). Similar risks were shown for asthma defined as reported asthma symptoms or medication. The most consistent results across countries were shown for farmers and cleaners. Excess asthma risk was associated with high exposure to biological dusts, mineral dusts, and gases and fumes. The proportion of asthma among young adults attributed to occupation was 5%-10%. INTERPRETATION: The prevalence of occupational asthma in women and in specific occupations has been underestimated. Given a mean prevalence of asthma of about 5%, about 0.2%-0.5% of young adults become asthmatics or have their asthma exacerbated because of their occupations AU - Kogevinas M AU - Anto JM AU - Sunyer J AU - Tobias A AU - Kromhout H AU - Burney P LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 107 IP - DP - 1999 Jan 01 TI - How much adult asthma can be attributed to occupational factors? PG - 580-587 AB - PURPOSE: Many occupational factors can cause asthma or reactivate preexisting disease. We carried out a critical review and synthesis of the available literature to estimate the proportion of adult asthma that is attributable to workplace factors. METHODS: We reviewed published citations from 1966 through May 1999 as well as recent abstracts of studies providing risk estimates for asthma among various occupations. We extracted published attributable risk estimates, derived others from published data, and extrapolated estimates from the incidence rates of occupational asthma. We used a semiquantitative score to rank studies based on their characteristics. RESULTS: We obtained 43 attributable risk estimates from 19 different countries: 23 were published estimates, 8 were derived from published data, and 12 were extrapolated from incidence data. The median value for the attributable risk of occupationally associated asthma was 9%(25th to 75th interquartile range: 5% to 19%). The derived estimates (median attributable risk = 25%) were significantly greater than published values (median = 9%, P = 0.002), whereas the extrapolated estimates were significantly lower (median = 5%, P = 0.04). The 12 highest scored studies based on their characteristics yielded a median risk estimate of 15%. CONCLUSION: Occupational factors are associated with about 1 in 10 cases of adult asthma, including new onset disease and reactivation of preexisting asthma. AU - Blanc PD & Toren K LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 54 IP - DP - 1999 Jan 01 TI - Glutaraldehyde: an occupational hazard in the hospital setting PG - 1105-1109 AB - BACKGROUND We report a series of 24 health-care workers with respiratory symptoms suggestive of occupational asthma due to glutaraldehyde exposure. METHODS The history of asthmatic symptoms was investigated with peak expiratory flow rate (PEFR) monitoring, and in eight of the subjects, the specific bronchial provocation test (SBPT) was applied as reference standard for diagnosis of occupational asthma. Levels of glutaraldehyde were monitored in the challenge chamber during the SBPT. Work environmental levels of glutaraldehyde were measured from air samples collected at least once during the PEFR monitoring of endoscopy and theatre nurses. Specific IgE antibodies to glutaraldehyde were measured with a series of glutaraldehyde modified proteins. RESULTS In the eight workers who underwent SBPT, the diagnosis of occupational asthma was confirmed by a positive reaction (late and dual reaction in five and in three subjects, respectively). The mean level of glutaraldehyde observed during the challenge tests was 0.075 mg/m3 (range 0.065-0.084 mg/m3). In 13 out of the 16 remaining workers, the serial PEFR monitoring showed a work-related effect. In three workers, there was no physiological confirmation of occupational asthma. Levels of glutaraldehyde from the air samples collected in the workplace were as follows: personal short-term samples (mean 0.208 mg/m3; median 0.14 mg/m3; range 0.06-0.84 mg/m3), personal long-term samples (mean 0.071 mg/m3; median 0.07 mg/m3; range 0.003-0.28 mg/m3). Measurements of specific IgE antibodies to glutaraldehyde-modified proteins were positive in seven patients (29.1%) according to a cutoff value of 0.88% RAST binding. The presence of atopy to common environmental allergens and smoking was not associated with specific IgE positivity (P>0.05; Fisher's exact test). CONCLUSIONS Our report indicates the importance of glutaraldehyde as an occupational hazard among exposed health-care workers. Intervention in the workplace, training of personnel handling this chemical, and accurate health surveillance may reduce the risk of developing occupational asthma due to glutaraldehyde. AU - Di Stefano F AU - Siriruttanapruk S AU - McCoach J AU - Burge PS LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 56 IP - DP - 1999 Jan 01 TI - Efficacy of measures of hygiene in workers sensitised to acid anhydrides and the influence of selection bias on the results PG - 202-205 AB - OBJECTIVES Organic acid anhydrides are potential sensitisers and cause occupational airway diseases. In an intervention study the efficacy of measures of hygiene at the workplace and possible selection bias were investigated. METHODS A first investigation with 110 workers exposed to hexahydrophthalic acid anhydride (HHPA) and methyltetrahydrophthalic acid anhydride (MTHPA) was carried out in July 1991. The results (skin prick test, specific serum IgE) showed that 20 people were sensitised, and in a challenge test the clinical relevance of the sensitisation was confirmed in six subjects. In December 1991, the hygiene conditions at the plant were improved. In November 1995 a second investigation of 84 people was performed (anamnesis, skin prick test, specific IgE, spirometry, and ambient and biological monitoring). The 27 people who had left the plant in the meantime were asked their reasons for leaving. RESULTS The relative risk of people sensitised in 1991 of leaving the plant between 1991 and 1995 was 2.6 (95% confidence interval (95% CI) 1.4 to 4.9) compared with people without any sign of sensitisation. The percentage of people identified as sensitised in 1991, who were still working at the plant and came to the second investigation, was higher than for people without evidence of sensitisation (10/10 v 47/73; p < 0.05). In all the 10 sensitised people in 1991 the findings of the first investigation were confirmed in 1995. The rate of sensitisation in 1995 was 21%. None of the six people employed after 1991 showed evidence of sensitisation. Of the six people with clinically relevant sensitisation confirmed by a challenge test in 1991, five were still at their workplace. From 1991 they were only exposed to MTHPA at a reduced concentration (< 0.5-36 micrograms/m3 in 1995). All of them reported fewer symptoms than in 1991. No signs of bronchial obstruction were detected by spirometry at the workplace. CONCLUSIONS In cross sectional studies there is a selection bias with a risk of underestimating the incidence of allergic diseases. The results further suggest that the improved hygiene conditions probably had a positive effect on the symptoms in sensitised people. AU - Drexler H AU - Schaller KH AU - Nielsen J et al LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 49 IP - DP - 1999 Jan 01 TI - Occupational asthma: a community based study PG - 217-219 AB - The incidence and prevalence of occupational asthma has been extensively studied in industry settings and specialist clinics. However, it has been much less studied in the community. This study looked at the general practice notes of asthmatics in an attempt to assess the overall load of occupational asthma in the community. Eightysix per cent of the patients with adult onset asthma in the practice population studied had at least one occupation recorded in their notes. Nearly a third of these (32%) were in jobs known to be significant causes of occupational asthma, yet a potential link between their occupation and symptoms had only been recorded in 18% of patients in these jobs. Overall 4% of the patients with adult onset asthma had been given a diagnosis of occupational asthma although in nearly half these cases the diagnosis had been made by a general practitioner and not a specialist. AU - deBono J AU - Hudsmith L LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 13 IP - DP - 1999 Jan 01 TI - Allergen exposure, atopy and smoking as determinants of allergy to rats in a cohort of laboratory employees PG - 1139-1143 AB - This study aimed to examine the relationship between exposure to rat urinary allergens, atopic status, smoking and the development of allergic symptoms and specific sensitization. It is a case-referent analysis of a cohort of 342 newly employed laboratory animal workers. Cases comprised persons developing symptoms of laboratory animal allergy or a positive skin prick test to rat urinary allergens; each was matched with up to two asymptomatic referents. Subjects were assigned to categories of exposure based on measurements of airborne rat urinary allergens. Of the cases, 80% reported that their symptoms started within 2 yrs of employment. The odds ratio (OR) for development of each symptom type (respiratory, eye or nose and skin) and of an immediate skin test reaction was increased in those with direct contact with rats. A gradient of increasing OR for the development of any such symptom across exposure categories was found; for respiratory symptoms and skin test reactions the OR for subjects in the highest exposure category were lower than those in intermediate categories, a pattern attenuated when the analysis was confined to outcomes developing within 2 yrs of first exposure. Atopy increased the OR of most outcomes as did cigarette smoking, although there was no evidence of a relationship between smoking and the development of a specific skin test reaction. In conclusion, allergen exposure was confirmed as the most important determinant of laboratory animal allergy; by implication, measures to reduce exposure may be the most effective means to reduce its incidence. AU - Cullinan P AU - Cook A AU - Gordon S AU - Nieuwenhuijsen MJ AU - Tee RD AU - Venables KM AU - McDonald JC AU - Newman Taylor AJ LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 116 IP - DP - 1999 Jan 01 TI - The outcome of asthma related to workplace irritant exposures: a comparison of irritant-induced asthma and irritant aggravation of asthma PG - 1780-1785 AU - Chatkin JM AU - Tarlo SM AU - Liss G AU - Banks D AU - Broder I LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 89 IP - DP - 1999 Jan 01 TI - Phillips VL, Goodrich MA, Sullivan TJ. Health care worker disability due to latex allergy and asthma: a cost analysis PG - 1024-1028 AU - Phillips VL AU - Goodrich MA AU - Sullivan TJ LA - PT - DEP - TA - Rev Panam Salud Publica JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 41 IP - DP - 1999 Jan 01 TI - Immunoglobulin E antibody against environmental allergens in subjects with trimellitic anhydride-induced asthma PG - 190-194 AB - The purpose of this study was to assess the relationship between atopy and the development of occupational asthma as a consequence of exposure to trimellitic anhydride (TMA). A case-control study was performed, which comprised 16 employees identified as having TMA-induced asthma and 44 similarly exposed controls. Specific immunoglobulin E measurements in response to cat, dust mite, ryegrass, and ragweed antigens were performed. Fifty-six percent of cases and 29% of controls were found to be atopic (P = 0.098). We demonstrated that there was a trend toward employees with TMA asthma being more atopic than those without TMA asthma. Atopy as an assessment of risk for the development of TMA asthma is unlikely to be useful, although further investigation may be warranted AU - Sikora R AU - Harris KE AU - Kenamore B AU - Grammer LC LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 14 IP - DP - 1999 Jan 01 TI - The effect of patient technique and training on the accuracy of self-recorded peak expiratory flow PG - 28-31 AB - Background The aim of this study was to investigate the difference between encouraged and self-recorded peak expiratory flow (PEF) with unobserved readings and to investigate any long-term changes in PEF self-recording Method Patients were trained in the PEF technique and asked to keep 2-hourly PEF records until the next clinic visits. The patients PEF were then rechecked at the second clinic visit by a series of two unobserved, an observed and an encouraged PEF measurement. A subgroup of patients were reassessed at a third clinic visit. Results Forty-one patients produced serial PEF recordings. Significant differences between unobserved and encouraged readings were detected; there was a mean decrement of 21 litres/min and limits of agreement suggested that the decrement could be as high as 60 litres/min. Visual and statistical analysis of the serial PEF provided showed a consistent deterioration in PEF over the record in 54% and 39% of cases, respectively. No significant differences were found in the subgroup who attended a third clinic visit. Conclusion The results suggest that significant inaccuracies in unobserved PEF readings can occur between clinic visits and this can be reflected as a consistent deterioration in some. This should be kept in mind when interpreting self-recorded PEF measurements. Re-evaluation at the third visit following the retraining effect of the second visit on PEF technique appears to reduce inaccuracies. It is believed that PEF technique should be re-evaluated at each clinic visit. AU - Gannon PFG AU - Belcher J AU - Pantin CFA AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 56 IP - DP - 1999 Jan 01 TI - Development of an expert system for the interpretation of serial peak expiratory flow measurements in the diagnosis of occupational asthma PG - 758-764 AB - If asthma is due to work exposures there must be a relationship between these exposures and the asthma. Asthma causes airflow obstruction which can be measured with portable meters, which usually measure peak expiratory flow, or sometimes FEV1, which can be measured serially (for instance two-hourly) over several weeks at and away from work. Once occupational asthma develops, the asthma will be induced by many non-specific triggers common to non-occupational asthma. The challenge is to identify changes in peak expiratory flow due to work amongst other non-occupational causes. Standard statistical tests have been found insensitive or non-specific, principally because of the variable period for deterioration to occur following exposure, and the sometimes prolonged time for recovery to occur, such that days away from work may initially have lower measurements than days at work. We have developed a computer assisted diagnostic aid (Oasys), to separate occupational from non-occupational causes of airflow obstruction. Oasys-2 is based on a discriminant analysis, and achieved a sensitivity of 75% and a specificity of at least 94%. A neural network version in development has improved on this. Both have been based on expert interpretation of peak flow measurements plotted as daily maximum, mean and minimum, with the first reading at work taken as the first reading of the "day". Oasys has been evaluated against measurements made in a wide range of occupational situations using independent criteria. Oasys is sufficiently developed to be the initial method for the confirmation or exclusion of occupational asthma. AU - Burge PS AU - Pantin CFA AU - Newton DT AU - Gannon PFG AU - Bright P AU - Belcher J AU - McCoach J AU - Baldwin DR AU - Burge CBSG and the Midlands Thoracic Society Research Group LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 54 IP - DP - 1999 Jan 01 TI - IgG antibodies, chronic bronchitis, and pulmonary function values in farmer's lung patients and matched controls PG - 1181-1187 AB - We measured IgG antibody levels against eight different microbes in farmer's lung (FL) patients an average of 14 years after the first diagnosed episode of FL and in matched controls. The study population consisted of 87 FL patients and 81 control farmers, matched by age, sex, and smoking habits. Clinical studies included the measurement of IgG antibody levels against Absidia corym-bifera, Aspergillusumbrosus, A. fumigatus, Humicola grisea, Saccharopolyspora rectivirgula, Penicillium brevicompactum, Rhodotorula glutinis, andThermoactinomyces vulgaris, in addition to spirometry, pulmonary diffusing capacity (DLCO), and the evaluation of chronic bronchitis. Median IgG antibody levels were two or more times higher in FL patients than control farmers against Ab. corymbifera, S. rectivirgula, and T. vulgaris (P<0.001). Against A. fumigatus, H. grisea, and R. glutinis, FL patients also had significantly higher antibody levels. FL patients often had positive antibody titers against several microbes, whereas control farmers usually had a positive titer against one or two microbes. A positive association between IgG antibody levels and chronic bronchitis and DLCO was observed in FL patients, but not in control farmers. It is suggested that the high antibody levels noted in FL patients were due not only to high exposure but also to individual sensitivity to environmental microbes. AU - Erkinjuntti-Pekkanen R AU - Kokkarinen JI AU - Tukiainen HO AU - Reiman M AU - Terho EO LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 49 IP - DP - 1999 Jan 01 TI - Occupational asthma: a community based study PG - 217-219 AB - The incidence and prevalence of occupational asthma has been extensively studied in industry settings and specialist clinics. However, it has been much less studied in the community. This study looked at the general practice notes of asthmatics in an attempt to assess the overall load of occupational asthma in the community. Eighty six per cent of the patients with adult onset asthma in the practice population studied had at least one occupation recorded in their notes. Nearly a third of these (32%) were in jobs known to be significant causes of occupational asthma, yet a potential link between their occupation and symptoms had only been recorded in 18% of patients in these jobs. Overall 4% of the patients with adult onset asthma had been given a diagnosis of occupational asthma although in nearly half these cases the diagnosis had been made by a general practitioner and not a specialist. AU - de Bono J AU - Hudsmit L LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 5 IP - DP - 1999 Jan 01 TI - Mycobacterium sp. as a Possible Cause of Hypersensitivity Pneumonitis in Machine Workers PG - 270-273 AB - Hypersensitivity pneumonitis (HP) in workers exposed to metal removal fluids (MRFs) is increasing. This study supports the hypothesis that aerosolized mycobacteria colonizing the MRFs likely cause the disease. Three case studies of HP outbreaks among metal workers showed potentially high exposures to a rare and newly proposed Mycobacterium species. Retrospective review of samples submitted to our laboratory showed an association between presence of mycobacteria and HP. AU - Shelton BG AU - Flanders WD AU - Morris GK LA - PT - DEP - TA - Emerg Infect Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 93 IP - DP - 1999 Jan 01 TI - Evaluation of bronchodilator response in patients with airway obstruction PG - 930-936 AB - The aim of this study was to define the most useful index of expressing bronchodilator response and to distinguish between asthma and COPD. A prospective study was carried out of bronchodilator response in 142 asthmatics and 58 COPD patients in a university hospital. Reversibility was expressed as: 1. absolute change (dabs); 2. % of initial (A %init); 3. % of predicted (A %pred) and 4. % of maximum possible response (A %max). Dependence on forced expirations volume in 1 set (FEV,) as % of predicted and sensitivity and specificity for diagnosis of asthma were established. A relationship between dabs and initial FEVl was not found in asthma (dabs vs. % initial FEV1. r= 0.07) or COPD (I = 0.02). A%pred did not show a correlation in asthma (v=O.lO) or COPD (u= 0.06). A?/oinit was dependent on the baseline value in asthma (r=0.38 , Pi 0,001 ) but not in COPD (r=O.lS , P=n.s.). dmax was dependent in both. The combination of best sensitivity and specificity to separate asthma and COPD was obtaiced with dabs (70.4 or 70.6%). The worst specificity for asthma diagnosis was obtained with A% init (50%). The best likelihood ratios were obtained with dabs and A%pred and the worst likelihood ratio with A%init A%init is not recommended as an index for differential diagnosis between asthma and COPD; 2) A%init overscores bronchodilator response in patients with low FEV,. The independence of each bronchodilator response index should be verified in clinical trials for each selected sample. AU - QUADRELLI SA AU - RONCORONI AJ AU - MONTIEL GC LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 54 IP - DP - 1999 Jan 01 TI - Occupational asthma to perfume PG - 1334-1335 AB - Patients with airway diseases often experience asthmalike symptoms upon contact with perfumes. Up to now, they were mainly assumed to be due to the irritative effects of perfumes in patients with preexisting unspecific bronchial hyperreactivity. A 44-year-old woman worked in a drugstore from 1970 until 1996. Since 1988, she had noticed dyspnoea while presenting customers with various perfume brands. In 1996, she experienced a severe asthma attack. Because of the respiratory problems, she could no longer work in her profession. Her case history revealed neither previous respiratory disorders nor an atopic disposition. She had smoked 10±15 cigarettes per day for 18 years. Total serum IgE was 65 kU/l and within the normal range. Skin prick tests with 20 common environmental allergens revealed no type I sensitization. The epicutaneous tests with the European standard reagents panel indicated a delayed type-IV reaction to a mixture of odorous substances (HAL,DuÈ sseldorf, Germany). The medical examination did not provide evidence for lung disorders. Lung-function tests showed a moderate and reversible obstructive ventilation pattern (airway resistance Rt=0.52 kP*s/l; FEV%VC 62%; intrathoracic gas volume and residual volume were within normal ranges). Workplace-related specific challenges with nine different brands of perfumes as well as with one individual perfume resulted in increased nasal airflow resistance and in significant bronchial obstruction (Fig. 1). Cases of airway irritation by perfumes without clinical symptoms or occupational exposure have been described (1, 2), but the question of whether perfumes alone could cause the development of bronchial asthma has not been answered. There are contradictory opinions about the pathogenetic role of perfumes. Some authors could not find a correlation between bronchial hyperreactivity, as verified by methacholine, and perfume-related asthma (3, 4), while others (5, 6) reported a clear correlation between the methacholine response and the severity of airway obstruction caused by perfumes. In this otherwise healthy woman, case history and clinical findings suggest obstructive airway disease as a result of occupational exposure to perfumes over a period of 26 years. The long-term exposure to perfumes in the workplace obviously initiated the manifestation of chronic asthma, which persisted even after the patient avoided further contact. The causative role of perfumes was confirmed by specific challenges when she showed immediate-type asthmatic reactions. However, it should be considered that perfumes are a complex mixture of natural and synthetic substances, including volatile oils, aldehydes, ethanol, and other ingredients, so that an exact identification of the asthma triggering substance(s) cannot be made. Nevertheless, such hypersensitive reactions are relevant not only to workers' claims of compensation but also to prevention, because an increasing number of air-fresheners used in homes and stores may also contain perfumes, making primary prevention quite difficult. AU - Baur X AU - Schneider EM AU - Wieners D AU - Czuppon AB LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19990101 IS - IS - VI - 54 IP - DP - 1999 Jan 01 TI - Long term outcome of soybean epidemic asthma after an allergen reduction intervention PG - 670-674 AB - BACKGROUND Asthma outbreaks due to the inhalation of soybean dust released from handling of soybean in the city harbour occurred in Barcelona, Spain from 1981 to 1987. The installation of bag filters in the responsible silo was followed by a substantial reduction of airborne soybean dust released into the atmosphere and the disappearance of asthma outbreaks. A study was undertaken to assess the relevant outcomes in asthma patients affected by soybean epidemic asthma eight years after this environmental intervention. METHODS A repeat case-control study was performed in 1995 on a population of subjects with epidemic and non-epidemic asthma previously assessed in 1989. The same protocol was used in both surveys to collect data from patients via a questionnaire and respiratory function, skin and laboratory tests were performed under blinded conditions with regard to epidemic and non-epidemic status. Environmental soybean allergen in pollution filters was measured by means of a RAST inhibition technique. RESULTS During 1995 and 1996 the 24 hour mean airborne levels of soybean allergen on a sample of 39 unloading days (range 31–269?U/m3) were systematically below the lowest level ever detected during an epidemic day (1500?U/m3). Measurable levels of serum IgE antibodies against soybean were still present in 55% of patients with epidemic asthma compared with 6.0% of those with non-epidemic asthma (p<0.05). These proportions were almost identical to those observed in 1989. The proportion of patients with soybean asthma with symptoms in 1989 who reported the absence of symptoms in 1995 was similar to the control subjects, so most of the relative risks (RRs) of improvement were near to 1. The only statistically significant differences between the two groups were a smaller proportion of patients with epidemic asthma showing improvement in terms of being woken up by attacks of coughing (RR improvement 0.47; 95% CI 0.22 to 0.99) and the need for treatment at the emergency room (RR improvement 0.63; 95% CI 0.41 to 0.96). CONCLUSIONS Eight years after a large reduction in the levels of airborne soybean allergen half of the former soybean epidemic asthma patients were still sensitised to soybean. These results indicate an initial improvement in soybean epidemic asthma in the two years following the intervention with no further improvement in subsequent years. AU - Antó JM AU - Soriano JB AU - Sunyer J AU - Rodrigo MJ AU - Morell F AU - Roca J AU - Rodríguez-Roisín R AU - Swanson MC LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 92 IP - DP - 1998 Jan 01 TI - Differences in sensitivity, maximal response and position of the concentration-response curve to methacholine between asthmatics, patients with allergic rhinitis and healthy subjects PG - 88-94 AU - Prieto L AU - Gutierrez V AU - Morales C AU - Marin J LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 158 IP - DP - 1998 Jan 01 TI - Long-term Risk of Emphysema in Patients with Farmer's Lung and Matched Control Farmers PG - 662-665 AB - We evaluated the long-term outcome of farmer's lung (FL) patients and matched control farmers using high-resolution computed tomography (HRCT). The study population consisted of 88 FL patients and 83 control farmers, matched by age, sex, and smoking habits. The mean time after the first diagnosed episode of FL was 14 yr. The great majority, 82%, of the studied subjects were nonsmokers. Clinical studies included HRCT, spirometry, and pulmonary diffusing capacity. Emphysema was found significantly more often (23%) in FL patients than in control farmers (7%) (p = 0.006). The presence of emphysema was 18% in nonsmoking and 44% in smoking FL patients, the respective values being 4% and 20% in control farmers. Patients with recurrent attacks of FL tended to have emphysema more often (p = 0.08) than patients who had experienced only a single attack. Fibrosis was observed in 17% of the FL patients and in 10% of the control farmers (p = 0.2). Miliary changes were found in 12% of the FL patients compared with 4% of the control farmers (p = 0.07). Both emphysematous and fibrotic but not miliary changes correlated significantly with impaired pulmonary function. In conclusion, farmer's lung disease seems to be associated with an increased risk of developing emphysema. Erkinjuntti-Pekkanen R, Rytkönen H, Kokkarinen JI, Tukiainen HO, Partanen K, Terho EO. Long-term risk of emphysema in patients with farmer's lung and matched control farmers. AU - ERKINJUNTTI-PEKKANEN R AU - RYTKÖNEN H AU - KOKKARINEN J AU - TUKIAINEN H AU - PARTANEN K AU - TERHO E LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 42 IP - DP - 1998 Jan 01 TI - Baker's Asthma: a Case Report PG - 953-959 AU - Wongtim S AU - Limthongkul S LA - PT - DEP - TA - Chula Medical Journal JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Respiratory symptoms, bronchial responsiveness, and cellular characteristics of induced sputum in elite swimmers PG - 346-352 AB - To investigate respiratory symptoms, increased bronchial responsiveness, and signs of airway inflammation in elite swimmers, we examined 29 swimmers from the Finnish national team and 19 healthy control subjects (nonasthmatic, symptom-free). They answered a questionnaire and were interviewed for respiratory symptoms. Lung volumes were measured and bronchial responsiveness assessed by a histamine challenge test. Induced sputum samples were also collected. Fourteen (48%) of the swimmers and three (16%) of the control subjects showed increased bronchial responsiveness (P<0.05). The sputum cell differential counts of eosinophils (mean 2.7% vs 0.2%) and neutrophils (54.7% V5 29.9%) from swimmers were significantly higher than those from controls (P<0.01). Eosinophilia (sputum differential eosinophil count of >4%) was observed in six (21%) of the swimmers and in none of the controls (P<0.05). Symptomatic swimmers had significantly more sputum eosinophils than did the symptom-free. The concentrations of sputum eosinophil peroxidase (EPO) and human neutrophil lipocalin (HNL) were significantly higher in swimmers than control subjects (P<0.001 and P=0.05). We conclude that elite swimmers had significantly more often increased tjronchial responsiveness than control subjects. Sputum from swimmers contained a higher percentage of eosinophils and neutrophils, and higher concentrations of EPO and HNL than sputum from controls. Long-term and repeated exposure to chlorine compounds in swimming pools during training and competition may contribute to the increased occurrence of bronchial hyperresponsiveness and airway inflammation in swimmers. AU - Helenius IJ AU - Rytilä P AU - Metso T AU - Haahtela T AU - Venge P AU - Tikkanen HO LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 40 IP - DP - 1998 Jan 01 TI - Case-Control Study of Idiopathic Pulmonary Fibrosis and Environmental Exposures PG - 363-367 AB - The authors conducted a matched case-control study of interstitial lung disease (ILD) using a self-administered questionnaire. All cases in the practice of two pulmonary specialists were identified. Cases were excluded if they were thought to have occupational exposures as a contributor, hypersensitivity pneumonitis or sarcoidosis, or some other well-recognized cause. Three controls were matched by sex and age (one year) as identified through orthopedic surgeons at the same institutions. Two rounds of a questionnaire were mailed; 17 cases (37.7%) and 94 controls (32.4%) responded to the questionnaire, although many of the case addresses were no longer valid. Individuals with ILD were 16.0 times as likely to report mold exposure and 11.1 times as likely to report silica as were controls in their workplace. Odds ratios associating ILD with moisture indicators in the home were in the same range as previously published associations between such indicators and wheezing. ILD may have environmental and occupational causes that warrant more systematic exploration. AU - Mullen J AU - Hodgson M AU - DeGraff AC AU - Godar T LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 1 IP - DP - 1998 Jan 01 TI - Interpretation of serial peak flow records for the diagnosis of occupational asthma – a method based on pattern recognition technology. PG - 1-20 AB - Several attempts have been made to produce a statistical analysis of occupational serial peak flow charts but few have approached the sensitivity and specificity of human experts. The problem is essentially one of pattern recognition. We have designed and tested a neural network to interpret PEF records plotted as daily maximum, mean and minimum. The records of 248 subjects investigated for the presence of occupational asthma were used. Subjects were asked to record PEF (best of 3) 2 hourly through the day, for a minimum of 21 days. Each record was divided into work-rest-work (WRW) or rest-work-rest (RWR) periods and scored blind by a human expert for the presence of work-related effect. The records were then divided into 3 sets (A-172, B-33, C-43), sets A and B were used to “teach” and “test” the neural network, set C to judge its success. The resulting network was then used to score records from a group of subjects with and without occupational asthma (gold standard set 1), diagnosed by other means to ascertain a cut-off score. Finally the sensitivity and specificity of the neural network was obtained by scoring a further set of gold standard records (set 2). The weighted kappa for WRW periods from set C was 0.83, 0.74 for RWR periods. 2 cut-off points were chosen, at a whole record score of 2 and 3, with a “grey” area between. The sensitivities and specificities for sets 1 and 2 are shown at these points, and the midpoint of 2.5. Gold standard set 1 Gold standard set 2 Cut point Sensitivity Specificity Sensitivity Specificity 2 100 78.6 100 97.8 2.5 93.8 91.1 89.3 100 3 81.3 100 80.4 100 These results show that the neural network is at least as good as the human expert in interpreting occupational serial peak flow records for the presence of work-related effect. AU - Bright P AU - Pantin CFA AU - Newton D AU - Burge PS LA - PT - DEP - TA - Unpublished JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - - IP - DP - 1998 Jan 01 TI - Interpretation of serial peak flow records for the diagnois of occupational asthma – a method based on pattern recognition technology. PG - - AB - Aim To develop a neural network based pattern recognition system trained to classify serial PEF records for the presence of work related changes in the PEF based on the classification of such records by a human expert. To test the result in the new set of peak flow readings against a diagnosis made independently of the peak flow record. AU - Bright P AU - Pantin C AU - Newton D AU - Burge PS LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 24 IP - DP - 1998 Jan 01 TI - Occupational skin and respiratory diseases among hairdressers PG - 398-406 AU - Leino T AU - Tammilehto L AU - Hytonen M AU - Sala E AU - Paakkulainen H AU - Kanerva L LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Effect of the number of peak expiratory flow measurements per day on the estimation of diurnal variation PG - 790-792 AB - Background The number of peak expiratory flow (PEF) readings required per day to assess diurnal variation accurately is not known; published studies have used between two and seven PEF readings per day. This study compares the diurnal variation calculated using 2-10 PEF readings per day. Methods All days with 10 readings were selected from a database of PEF records. For each day, diurnal variations calculated using 2-9 of the readings available were compared with that calculated using the full 10 PEF readings. Diurnal variation calculated using all 10 readings was taken as the true diurnal variation. When less than 10 readings were used the readings were evenly spaced over waking hours. Diurnal variation was calculated as (maximum-minimum) / predicted. Results Two hundred and 25 days with 10 readings per day were selected from PEF records provided by 63 individuals. When only two PEF readings per day were used, the limits of agreement suggested a possible underestimate of true diurnal variation, calculated using all 10 readings, of 1.23-15.10%. The possible underestimate fell to 0.27-3.96% when calculated using four evenly spaced readings. Analysis of the timing of the highest PEF reading of the day was undertaken for rest and work days. This showed a mean (SD) timing of 13:56 (4:56 hours) for rest days and 11:47 (5:59 hours) for work days. Conclusions Clinically significant underestimates of true diurnal variation may be seen when only small numbers of PEF readings per day are used in its calculation. At and above four readings the results suggest that the underestimate becomes increasingly insignificant in terms of the diagnosis and treatment of asthma. Analysis of the timing of the highest PEF reading of the day showed a wide variation, precluding the ability to capture the true diurnal variation with just two or three carefully timed PEF readings per day. The authors suggest that at least four readings per day should be performed, evenly spaced during waking hours, to obtain an accurate assessment of diurnal variation in PEF. AU - Gannon PFG AU - Newton DT AU - Pantin CFA AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 40 IP - DP - 1998 Jan 01 TI - A seven year follow-up study of lung function and metacholine responsiveness in sensitised and non-sensitised workers handling laboratory animals PG - 118-124 AU - Sjoestedt L AU - Willers S LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 3 IP - DP - 1998 Jan 01 TI - Occupational asthma and IgE sensitization to grain dust PG - 275-280 AU - Park HS AU - Nahm DH AU - Suh CH AU - Kwon OY AU - Kim KS AU - Lee SW AU - Chung HK LA - PT - DEP - TA - J Korean Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 40 IP - DP - 1998 Jan 01 TI - Respiratory function and immunological status in paper-recycling workers PG - 986-993 AU - Zuskin E AU - Mustajbegovic J AU - Schachter EN AU - Kanceljak B AU - Kern J AU - Macan J AU - Ebling Z LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 40 IP - DP - 1998 Jan 01 TI - Prevention of laboratory animal allergy PG - 609-613 AB - Laboratory animal allergy (LAA) is a significant occupational hazard for workers in a number of research settings, including the pharmaceutical industry. Prevention of allergy and asthma is important because the illness can affect health and career. In a major pharmaceutical company, in an effort to prevent LAA, a comprehensive program to reduce exposure to environmental allergens was developed. The program included education, engineering controls, administrative controls, use of personal protective equipment, and medical surveillance. A prospective survey of five years of data was completed to determine the effect of the program on the prevalence and incidence of LAA. After instituting this program, we found that the prevalence of LAA ranged from 12%-22% and that the incidence was reduced to zero during the last two years of observation. We concluded that LAA is preventable through the implementation of a comprehensive effort to reduce exposure to allergens. AU - Fisher R AU - Saunders WB AU - Murray SJ AU - Stave GM LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 101 IP - DP - 1998 Jan 01 TI - Occupational asthma caused by tetrachlorophthalic anhydride: a 12-year follow-up PG - 717-719 AU - Barker RD AU - Harris JM AU - Welch JA et al LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 102 IP - DP - 1998 Jan 01 TI - Baker's asthma: still among the most frequent occupational respiratory disorders PG - 984-997 AB - BACKGROUND Baker's asthma and rhinitis are among the most frequent occupational respiratory disorders. OBJECTIVE The aim of the study was to evaluate the frequency of work-related symptoms and the clinical relevance of sensitization to allergens in screened and symptomatic bakers. METHODS Eighty-nine bakers participating in a screening study and 104 bakers filing a claim for compensation were examined with regard to occupational and clinical case history, lung function parameters, and sensitization to bakery allergens by skin prick tests, specific IgE analyses, and inhalative challenge tests. RESULTS A high prevalence of respiratory disorders, abnormal lung function parameters, and sensitization to bakery allergens exists. Most frequently, bakers with workplace-related respiratory symptoms showed sensitization to wheat flour (64%), rye flour (52%), soy bean flour (25%), and alpha-amylase (21%). The correlation between these sensitizations and asthma case history and inhalative challenge test responses was significant. However, approximately 29% of the bakers with respiratory symptoms showed no sensitization to these bakery allergens, whereas 32% of the sensitized bakers in the screening group had no workplace-related symptoms. Atopic status defined by skin prick test sensitization to common allergens or elevated total IgE levels was found to be a risk factor for the development of sensitization to bakery allergens and respiratory symptoms. On the other hand, there is evidence for an increased frequency of elevated total IgE as the result of occupational allergen exposure because respective findings were observed in bakers without symptoms. CONCLUSION Sensitization to bakery allergens seems to be the main cause of baker's asthma and rhinitis but cannot explain the asthma case history in each case. Further methods are required to objectively assume irritative pathomechanisms. Our findings indicate the necessity for an improved primary prevention of exposure to inhalative noxae in bakeries. AU - Baur X AU - Degens PO AU - Sander I LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 33 IP - DP - 1998 Jan 01 TI - Relation Between Occupational Asthma Case History, Bronchial Methachlorine Challenge, And Specific Challenge Test In Patients With Suspected Occupational Asthma PG - 114-122 AB - Inhalative methacholine challenge (MC) was performed in 229 subjects presumed to suffer from occupational asthma due to exposure to airborne latex allergens (n = 62), flour (n = 28), isocyanates (n = 114), or irritants in hairdressers' salons (n = 25). They were also subjected to specific challenges with the occupational agents they were exposed to, completed a questionnaire using an abbreviated version of the ATS-DLD, and were interviewed by an experienced physician. Bronchial hyperresponsiveness in MC was defined by the results obtained in a previous study with 81 healthy volunteers. The threshold in these controls was set at a cumulative MC dose of 0.3 mg, corresponding to a sensitivity of 95%. The main purpose of the study was to investigate whether the MC and/or the occupational asthma case history are reliable predictors of the specific challenge test outcomes. In 40-72% of examined subjects, workplace-related asthma complaints occurred, with bronchial hyperreactivity in the MC ranging from 48% to 61%. However, only 12-25% demonstrated a significant bronchoconstructive reaction in the specific challenge test. MC results are only moderately associated with workplace-related asthma case histories. Positive outcomes of challenges with occupational agents are well correlated with positive MC results plus occupational asthma case histories. The combination of MC and occupational asthma case history shows a relatively high specificity (62%, 86%, 80%), but the sensitivity was moderately low (83%, 71%, 52%). MC sensitivities were 92%, 71%, and 62% (case histories of hairdressers were not available). We conclude that in most cases, occupational asthma (as defined by a specific challenge test response) is combined with bronchial hyperresponsiveness and workplace-related asthmatic symptoms. However, subjects of each exposure group demonstrated bronchial hyperresponsiveness and complained of workplace-related asthmatic symptoms, but occupational asthma could not be proved in the specific challenge test. In subjects with a positive occupational asthma case history, a negative MC test result can almost rule out a positive specific challenges test result. Hence, the MC test can reduce performance of the laborious specific challenge test AU - Baur X AU - Huber H AU - Degens PO AU - Allmers H AU - Ammon J LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 102 IP - DP - 1998 Jan 01 TI - Inhalation challenge testing of latex-sensitive health care workers and the effectiveness of laminar flow HEPA-filtered helmets in reducing rhinoconjunctival and asthmatic reactions PG - 998-1004 AB - BACKGROUND There are few data relating latex aeroallergen concentrations to biologic responses in latex-sensitized persons. OBJECTIVES We sought to investigate acceptable latex aeroallergen concentrations below which latex-sensitive health care workers do not experience symptoms and to study the effect of high-efficiency particle arrest (HEPA)-filtered laminar flow helmets in preventing latex-induced symptoms. METHODS Under challenge chamber conditions, latex-sensitive health care workers underwent 7 sequential inhalation challenge tests by donning and discarding either vinyl gloves (challenge 1), low latex-allergen powder-free gloves (challenge 2), or high latex-allergen powdered gloves (challenges 3 to 7) for up to 1 hour. Volunteers wore a laminar flow helmet during all challenges; HEPA filters in the helmet were in place only during challenges 3 and 4. Flow-volume loops, symptom scores, and latex aeroallergen concentrations were measured before and during each test. RESULTS At 60 minutes, latex aeroallergen concentrations during challenges 3 to 7 (mean, 7600 ng/m3; range, 93 to 54,000 ng/m3 ) were significantly higher than during challenges 1 or 2 (mean, 65 ng/m3; range, nondetectable to 100 ng/m3 ) (P <.001). During challenges 5 and 6, mean maximum percent falls in FEV1 (-16% and -11%, respectively) were significantly greater compared with those measured during challenges 3 and 4 (-3% and -1%, respectively) (P =.03). Mean maximum change from baseline symptom scores during challenges 5 and 6 was significantly higher than that during challenges 3 and 4 (P =.006). During challenges with high latex-allergen gloves, 4 volunteers had reproducible FEV1 falls of 20% or greater at cumulative inhaled latex aeroallergen doses ranging from less than 100 ng to 1500 ng. CONCLUSION The laminar flow helmets were effective in reducing latex-induced symptoms. Only 1 volunteer exhibited a fall in FEV1 of 20% or greater after a cumulative inhaled latex aeroallergen dose of less than 100 ng, and no volunteer showed a decline in FEV1 after exposure to powder-free low allergen gloves. AU - Laoprasert N AU - Swanson MC AU - Jones RT AU - et al LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 158 IP - DP - 1998 Jan 01 TI - Wheat Sensitisation and Work-related Symptoms in the Baking Industry Are Preventable. An Epidemiologic Study PG - 1499-1503 AB - A cross-sectional study was conducted among 393 workers from 21 bakeries to study the relationship between wheat allergen exposure and wheat sensitization and work-related allergic symptoms. Exposure to wheat allergens was characterized by a recently developed and validated immunoassay. Specific IgE antibodies against wheat flour and common allergens were measured by immunoassays, and work-related allergic symptoms were registered by questionnaire. A strong and positive association was found between wheat flour allergen exposure and wheat flour sensitization. This relationship was steepest and strongest in atopics. Prevalence ratios for high and medium wheat allergen exposure were 5.2 (95% confidence interval [CI], 1.6-16.2), and 2.7 (0.5-14.5) for atopic workers, and 2.5 (0.8-7.5) and 1.4 (0. 3-6.4) for nonatopics, compared with workers with low wheat allergen exposure. In sensitized bakers those with an elevated allergen exposure had more often work-related symptoms, with prevalence ratios for high and medium wheat allergen exposure of 3.5 (CI 1.6-7. 5) and 2.6 (CI 0.9-7.8), respectively, compared with workers with low wheat allergen exposure. The existence of exposure-sensitization gradients suggests that work-related sensitization risk will be negligible when exposure levels will be reduced to averageexposure concentration of 0.2 microgram/m3 wheat allergen or approximately 0.5 mg/m3 inhalable dust during a work shift. AU - Houba R AU - Heederik D AU - Doekes D LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 11 IP - DP - 1998 Jan 01 TI - Work-Related Changes In Peak Expiratory Flow Among Laboratory Animal Workers PG - 929-936 AB - Laboratory animal workers are at risk of developing allergic symptoms, of which asthmatic symptoms are the most severe. The aim was to study the relationship between allergic symptoms due to working with rats and variability and changes in peak expiratory flow (PEF). Several indices were used on the basis of the amplitude of the PEF or the differences in PEF between days with and without exposure to rat aeroallergens. Of the 398 rat workers, 73% completed PEF readings on at least 9 days, of whom 208 had PEF readings on working days with and without contact with animals. The overall prevalence rate of allergic symptoms (asthmatic, eye, nose and/or skin) among rat workers during the handling of rats was 17.3%. Asthmatic symptoms were reported by 6.7%. The PEF of the workers who reported asthmatic symptoms due to working with rats decreased significantly on days working with the animals (difference between the minimum PEF averaged over working days with animals and over days without animals (deltaPEFmin-min) = -73 L x min(-1)), compared to the workers without symptoms (2.2 L x min(-1)). This effect was more pronounced among workers with a late asthmatic response, i.e. the presence of asthmatic symptoms several hours after working with rats (deltaPEFmin-min = -11.6 L x min(-1)). Multiple regression analyses showed that only those with asthmatic symptoms several hours after working with rats and those with allergic symptoms had an increased deltaPEFmin-min. In addition, workers with asthmatic symptoms were also more likely to have a higher PEF variability than workers without asthmatic symptoms. However, no difference in PEF variability between days with and without animals contact was observed. This study shows that the peak expiratory flow of workers who reported asthmatic symptoms due to working with rats decreased significantly on days working with laboratory animals. AU - Hollander A AU - Heederik D AU - Brunekreef B LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 114 IP - DP - 1998 Jan 01 TI - Utility of antibody in identifying individuals who have or will develop anhydride-induced respiratory disease PG - 1199-1202 AB - OBJECTIVE: To define the utility of serum antibody against trimellitic anhydride (TMA) in predicting which individuals employed, at Amoco Corporation, in the manufacture of TMA have or will develop immunologically mediated respiratory disease, such as asthma, due to exposure to TMA. METHODS: In 1990 we initiated a clinical and immunologic cross-sectional study of 181 subjects exposed to TMA for at least 1 year who had not been diagnosed with an immunologic respiratory disease. We then clinically and immunologically followed 119 of these subjects for the next 5 years to determine whether they would develop an immunologic respiratory disease due to TMA exposure. RESULTS: Of the 16 individuals with IgE against TMA conjugated to human serum albumin (TM-HSA) in 1990, 3 had immediate asthma and another 6 developed asthma during the 5-year follow-up. Of the 165 individuals without IgE against TM-HSA, none had immediate asthma in 1990 and only 1 of 102 individuals followed for 5 years developed asthma. Of the 44 subjects with IgG against TM-HSA, 6 had an immunologic respiratory disease in 1990 and 2 more developed it in the ensuing 5 years. Of the 137 subjects without IgG against TM-HSA, none had an immunologic respiratory disease in 1990 and none of the 80 subjects followed for 5 years developed it. CONCLUSIONS: Development of antibody against TM-HSA, both IgE and IgG, is predictive of subjects who have or will develop immunologically mediated respiratory disease due to TMA exposure. The absence of antibody is a potent negative predictor AU - Grammer L AU - Shaughnessy M AU - Kenamore B LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 33 IP - DP - 1998 Jan 01 TI - Risk And Incidence Of Asthma Attributable To Occupational Exposure Among HMO Members PG - 1-10 AB - Occupational asthma may account for a significant proportion of adult-onset asthma, but incidence estimates from surveillance of physician reports and workers' compensation data (0.9 to 15/100,000) are lower than expected from community-based cross-sectional studies of asthma patients. We conducted a prospective cohort study of 79,204 health maintenance organization members between the ages of 15 and 55 at risk for asthma. Computerized files, medical records, and telephone interviews were used to identify and characterize asthma cases. Evidence for asthma attributable to occupational exposure was determined from work-related symptoms and workplace exposure. The annual incidence of clinically significant, new-onset asthma was 1.3/1,000, and increased to 3.7/1,000 when cases with reactivation of previously quiescent asthma were included. Criteria for onset of clinically significant asthma attributable to occupational exposure were met by 21% (95% CI 12-32%) of cases giving an incidence of 71/100,000 (95% CI 43-111). Physicians documented asking about work-related symptoms in 15% of charts, and recorded suggestive symptoms in three cases, but did not obtain occupational medicine consultation, diagnose occupational asthma, report to the state surveillance program, or bill workers' compensation for any of them. These data suggest that the incidence of asthma attributable to occupational exposures is significantly higher than previously reported, and accounts for a sizable proportion of adult-onset asthma. AU - Milton DK AU - Solomon GM AU - Rosiello RA et al LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 158 IP - DP - 1998 Jan 01 TI - Comparison Of Serial Monitoring Of Peak Expiratory Flow And FEV1 In The Diagnosis Of Occupational Asthma PG - 927-832 AB - Peak expiratory flow (PEF) monitoring is often used to establish the relationship between occupational exposure and asthma. FEV1 has been found to be a better physiologic index than PEF in the measurement of airflow obstruction. The aim of this study was to compare the accuracy of serial monitoring of PEF and FEV1 in the diagnosis of occupational asthma. Twenty consecutive subjects referred for possible occupational asthma were asked to perform serial monitoring of PEF and FEV1 using a portable ventilometer. Two sets of graphs were plotted for both PEF and FEV1: graphs with the best of all values and graphs with the best of two reproducible values. Three observers interpreted both PEF and FEV1 recordings by the visual method in a blind, randomized manner as either compatible with occupational asthma or not. Eleven of the subjects had a positive inhalation challenge test (high-molecular-weight agents, n = 6; low-molecular-weight agents, n = 5). In the case of analysis of the graphs plotted with the best of all values, the sensitivity of the PEF recording interpreted by the three observers was 82, 73, and 73%, and of the FEV1 recording as 55, 55, and 45%; specificity of PEF recording was 89, 100, and 100%, and of FEV1 was 56, 89, and 100%. When an agreement between two of the three readers was required to define occupational asthma, sensitivity and specificity were 73 and 100% for PEF and 55 and 89% for FEV1. Lower sensitivities were found when the same analyses were performed with the graphs plotted with the best of two reproducible values. It was concluded that unsupervised FEV1 is not more accurate than unsupervised PEF monitoring in the diagnosis of occupational asthma. Plotting graphs using the best value gives better diagnostic accuracy than plotting them with the best of two reproducible values AU - Leroyer C AU - Perfetti L AU - Trudeau C AU - L'Archeveque J AU - ChanYeung M AU - Malo JL LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 12 IP - DP - 1998 Jan 01 TI - Protective effect of respiratory devices in farmers with occupational asthma PG - 569-572 AB - To the authors' knowledge there have been no previous reports on the protection afforded by powered filtering respirators in farmers with occupational asthma attributed to the inhalation of organic dust. In order to investigate this question, 26 farmers with occupational asthma were challenged with an exposure to work-related dusts for up to 60 min. This resulted in highly significant increases in airway resistance (Raw), thoracic gas volume (TGV) and specific airway resistance (sRaw) compared to baseline values. After a mean period of 21 weeks the farmers were subjected to a second challenge, this time wearing a protective respiratory device (RD) with a P2 filter. Significant increases in Raw, TGV and sRaw were again observed, but on average these were 50-80% smaller than the increases seen when RDs were not worn. These differences were found to be statistically significant. This shows that the use of a respiratory device in farmers suffering from occupational asthma reduces the development of bronchial obstruction but does not prevent it. The use of this kind of respiratory device cannot substitute for the proper management of asthma since the devices do not offer complete protection. AU - MullerWening D AU - Neuhauss M LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Prevalence of occupational asthma among automobile and furniture painters in the center of Sekisehir (Turkey): the effects of atopy and smoking habits on occupational asthma PG - 1096-1100 AB - BACKGROUND: Occupational asthma (OA) is a respiratory disorder characterized by airway hyperreactivity caused by agents present in the workplace. For determination of the prevalence of OA among car and furniture painters exposed to isocyanate in the center of Eskisehir, Turkey, a clinical and epidemiologic prospective study in three phases was done, incorporating 312 (89.4%) of the painters. METHODS: Of these subjects, 190 (61%) were furniture painters and 122 (39%) automobile painters. In the first phase of the study, a modified questionnaire and pulmonary function test (PFT) were done. During the second phase, peak expiratory flow rate (PEFR) was monitored in 52 subjects whose complaints were confirmed and who agreed to a month of such monitoring. In the third phase, nonspecific bronchial provocation tests (NSBPT) with histamine were done on 23 of the PEFR-monitored workers. RESULTS: Finally, through questionnaire, typical history, PFT, PEFR monitoring, and NSBPT, 30 workers (9.6%) were diagnosed as having OA. Smoking habits and atopy in the OA-diagnosed workers were found to be statistically significantly high in comparison to the other workers. CONCLUSIONS: It was concluded that OA is a common disorder among automobile and furniture painters, and smoking habits and atopy were seen to have a significant effect on OA occurrence AU - Ucgun I AU - Ozdemir N AU - Metintas M AU - Metintas S AU - Erginel S AU - Kolsuz M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 101 IP - DP - 1998 Jan 01 TI - Specific Ige To Isocyanates: A Useful Diagnostic Role In Occupational Asthma PG - 709-715 AB - BACKGROUND: Isocyanates are the most frequent cause of occupational asthma in industrialized countries. OBJECTIVE: We sought to investigate the utility of specific IgE measurement in the diagnosis of isocyanate-induced asthma. METHODS: Fifty-eight of 101 patients referred for investigation were diagnosed as having isocyanate-induced occupational asthma by means of history, serial peak flow records, and bronchial provocation tests. Specific IgE antibodies to toluene diisocyanate:human serum albumin (HSA), diphenylmethane diisocyanate:HSA, and hexamethylene diisocyanate: HSA were measured in all patients by Phadebas RAST. RESULTS: Twenty patients had a RAST ratio of 2 or greater to at least one isocyanate. Thirteen (28%) of the 46 patients with a positive provocation test response had a RAST ratio of 2 or greater, and nine (20%) had a RAST ratio of 3 or greater. Raising the RAST cut-off from 2 or greater to 3 or greater reduced its sensitivity but increased the specificity of the test to 100%. RAST measurement was most likely to be positive within 30 days of exposure. Serial measurements suggested that the half-life of the IgE antibodies was approximately 6 months. Evidence of cross-reactivity between isocyanate RAST responses was found in eight subjects. CONCLUSION: Specific IgE to isocyanates is a more specific than sensitive index of occupational asthma. With a RAST score of 3 or greater, it is wholly specific and therefore diagnostic of isocyanate-induced asthma. The sensitivity of specific IgE measurement is highest when blood is taken less than 30 days from last exposure, which is consistent with the observed half-life. AU - Tee RD AU - Cullinan P AU - Welch JA AU - Burge PS AU - Newman Taylor AJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 48 IP - DP - 1998 Jan 01 TI - Health and employment after a diagnosis of occupational asthma: a descriptive study PG - 219-225 AB - The objectives of this study were to describe changes in asthma and employment after diagnoses of occupational asthma reported to the SWORD project. Questionnaires were sent to 312 physicians for all 1,940 cases of occupational asthma reported from 1989–92; 1,769 (91%) were returned but information was available for only 1,317 (68%). Of patients reported by occupational physicians, 45% had recovered from asthma compared to only 14% of those reported by chest physicians (excluding medicolegal cases), presumably because of differences in severity. Proportions with the same employer were 49% and 48% respectively. Patients exposed for a year or more after diagnosis recovered from asthma less frequently but were more often employed than those exposed for less than a year. Among those whose asthma was attributed to high molecular weight agents, smokers had developed asthma earlier after exposure began than others but had the best prognosis. Asthma developed following a single high exposure in 18 cases (2%), of which 13 were to irritants and five to known sensitizers. AU - Ross DJ AU - Mcdonald JC LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 24 IP - DP - 1998 Jan 01 TI - Powered dust respirator helmets in the prevention of occupational asthma among farmers PG - 503-507 AB - OBJECTIVES This study investigated the value of powered dust respirator helmets in the treatment of farmers with occupational asthma. METHODS The study population consisted of 33 asthmatic agricultural workers, 24 with occupational asthma induced by cow dander or grains, 2 with other forms of atopic asthma, and 7 with nonatopic asthma. The efficiency of a powered dust respirator helmet with a P2-class filter in preventing asthmatic symptoms was assessed for 1 year. Morning and evening peak expiratory flow rates and daily symptoms of the subjects were monitored for 3 months without the use of the helmet and for 10 months with the helmet. RESULTS Objective evidence of protection was obtained for farmers with occupational asthma. The morning peak flow rate increased and the variation in daily peak flow rate and the symptoms of cow-barn rhinitis diminished significantly during the helmet period. In the group of farmers with nonatopic asthma there was no improvement in peak flow rate or symptoms of asthma, although some of these farmers also seemed to benefit from helmet use. CONCLUSIONS The results of this study suggest that especially dairy farmers with occupational asthma benefit from the use of a powered dust respirator helmet. AU - Taivainen AI AU - Tukiainen HO AU - Terho EO et al LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 40 IP - DP - 1998 Jan 01 TI - Between- And Within- Observer Agreement For Expert Judgment Of Peak Flow Graphs From A Working Population PG - 969-972 AB - Expert judgment of peak flow-time graphs provides an important tool to detect occupational asthma. This technique has mainly been used in clinics to evaluate reversible airflow obstruction and to assess potential work-related patterns. The reproducibility of this technique in an open working population is unknown. Agreement between and within nine experts was studied using peak flow-time graphs of 49 potato-processing workers. All graphs were classified into four categories by the nine experts, while seven experts read ten graphs at two occasions. Thirty-four graphs (69%) were classified as "no airway obstruction" while four graphs (8%) showed "work-related airway obstruction." There was only slight agreement between the nine experts; mean Cohen's kappa (kappa) was 0.19. Agreement within experts was moderate; mean kappa was 0.47 for judging graphs twice. Our results suggest that in a "healthy" working population, judgment of peak flow graphs is not a favorable method for detection of airway obstruction. If this technique is applied in epidemiological studies, judgment of the graphs should be done by more than one expert AU - Zock JP AU - Brederode D AU - Heederik D LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 113 IP - DP - 1998 Jan 01 TI - The spectrum of irritant-induced asthma: sudden and not-so-sudden onset and the role of allergy PG - 42-49 AB - A retrospective investigation of 86 asthmatic subjects defined clinical features of irritant-induced asthma and assessed the contributory role of an allergic predisposition. Three categories of asthma were evaluated: (1) occupational asthma due to a sensitizer (11 subjects, 13%); (2) irritant-induced asthma (54 persons, 63%); and (3) not occupational/environmental exposure-related asthma (21 subjects, 24%). Two distinct clinical presentations of irritant-induced asthma emerged: the first was sudden onset (29 subjects) and the second was not so sudden in onset (25 subjects). Sudden-onset, irritant-induced asthma was analogous to the reactive airways dysfunction syndrome. Clinical manifestations began immediately or within a few hours (always within 24 h) following an accidental, brief, and massive exposure. In contrast, for the not-so-sudden-onset asthma subjects, the causative irritant exposure was not brief, usually not massive, continued for >24 h, and the initiation of asthma took longer to evolve. Eighty-eight percent of individuals with not-so-sudden irritant-induced asthma displayed an atopy/allergy status (p<0.01). Some of the atopy/allergy subjects with presumed new-onset asthma were found to have suffered preexisting asthma that had been clinically quiescent for at least 1 year before the triggering exposure (16 persons). We conclude that preexisting allergic/atopy and/or preexisting asthma were significant contributors to the pathogenesis of not-so-sudden, irritant-induced asthma and emphasizes a critical interaction between environmental and host factors in the pathogenesis of asthma. AU - Brooks SM AU - Hammad Y AU - Richards I AU - Giovinco-Barbas J AU - Jenkins K AU - LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 24 IP - DP - 1998 Jan 01 TI - Determinants Of Asthma In A Farming Population PG - 262-269 AU - Melbostad E AU - Eduard W AU - Magnus P LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 215 IP - DP - 1998 Jan 01 TI - Risk in cleaning: chemical and physical exposure PG - 135-156 AB - Cleaning is a large enterprise involving a large fraction of the workforce worldwide. A broad spectrum of cleaning agents has been developed to facilitate dust and dirt removal, for disinfection and surface maintenance. The cleaning agents are used in large quantities throughout the world. Although a complex pattern of exposure to cleaning agents and resulting health problems, such as allergies and asthma, are reported among cleaners, only a few surveys of this type of product have been performed. This paper gives a broad introduction to cleaning agents and the impact of cleaning on cleaners, occupants of indoor environments, and the quality of cleaning. Cleaning agents are usually grouped into different product categories according to their technical functions and the purpose of their use (e.g. disinfectants and surface care products). The paper also indicates the adverse health and comfort effects associated with the use of these agents in connection with the cleaning process. The paper identifies disinfectants as the most hazardous group of cleaning agents. Cleaning agents contain evaporative and non-evaporative substances. The major toxicologically significant constituents of the former are volatile organic compounds (VOCs), defined as substances with boiling points in the range of 0 degree C to about 400 degrees C. Although laboratory emission testing has shown many VOCs with quite different time-concentration profiles, few field studies have been carried out measuring the exposure of cleaners. However, both field studies and emission testing indicate that the use of cleaning agents results in a temporal increase in the overall VOC level. This increase may occur during the cleaning process and thus it can enhance the probability of increased short-term exposure of the cleaners. However, the increased levels can also be present after the cleaning and result in an overall increased VOC level that can possibly affect the indoor air quality (IAQ) perceived by occupants. The variety and duration of the emissions depend inter alia on the use of fragrances and high boiling VOCs. Some building materials appear to increase their VOC emission through wet cleaning and thus may affect the IAQ. Particles and dirt contain a great variety of both volatile and non-volatile substances, including allergens. While the volatile fraction can consist of more than 200 different VOCs including formaldehyde, the non-volatile fraction can contain considerable amounts (> 0.5%) of fatty acid salts and tensides (e.g. linear alkyl benzene sulphonates). The level of these substances can be high immediately after the cleaning process, but few studies have been conducted concerning this problem. The substances partly originate from the use of cleaning agents. Both types are suspected to be airway irritants. Cleaning activities generate dust, mostly by resuspension, but other occupant activities may also resuspend dust over longer periods of time. Personal sampling of VOCs and airborne dust gives higher results than stationary sampling. International bodies have proposed air sampling strategies. A variety of field sampling techniques for VOC and surface particle sampling is listed. AU - Wolkoff P AU - Schneider T AU - Kildesø J AU - Degerth R AU - Jaroszewski M AU - Schunk H LA - PT - DEP - TA - Sci Total Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 88 IP - DP - 1998 Jan 01 TI - "Lifeguard Lung": Endemic granulomatous pneumonitis in an indoor swimming pool PG - 1795-1800 AB - OBJECTIVES: Two sequential outbreaks of respiratory disease among lifeguards at an indoor swimming pool with water spray features were investigated. METHODS: Questionnaires were administered to recreation center employees following each outbreak. Respondents reporting 2 or more pool-related symptoms were offered clinical evaluation, including bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. Pool air and water were sampled for fungi, bacteria, amoebae, endotoxin, and respirable particulates. RESULTS: Thirty-three lifeguards had noncaseating granulomas on biopsy and/or bronchoalveolar lavage lymphocytosis. Attack rates for the outbreaks were 27% and 65%. Case patients had higher cumulative hours of work and tended to work more hours per week. Analyses indicated increased levels of endotoxin in pool air and water (relative to control pools) and gram-negative bacterial colonization of water sprays. Use of water spray features generated a 5.2-fold increase in the number of respirable particles and up to an 8-fold increase in air endotoxin levels. CONCLUSIONS: Lifeguards in this indoor swimming pool developed granulomatous lung disease associated with endotoxin-containing respirable bioaerosols from water spray features, which ventilation system improvements did not prevent. AU - Rose CS AU - Martyny JW AU - Newman LS AU - Milton DK AU - King TE AU - Jr AU - Beebe JL AU - McCammon AU - JB AU - Hoffman RE AU - Kreiss K. LA - PT - DEP - TA - Am J Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 85 IP - DP - 1998 Jan 01 TI - Long-range correlations of serial FEV1 measurements in emphysematous patients and normal subjects PG - 259-263 AB - In obstructive lung disease the annual change in lung function is usually estimated from serial measurements of forced expiratory volume in 1 s (FEV1). Frequent measurements in each patient may not improve this estimate because data are not statistically independent; i.e., the measurements are autocorrelated. The purpose of this study was to describe the correlation structure in time series of FEV1 measurements. Nineteen patients with severe a1-antitrypsin deficiency (phenotype PiZ) and moderate to severe emphysema and two subjects with normal lungs were followed for several years with daily self-administered spirometry. FEV1measurements fulfilling standard criteria were detrended, and the autocorrelation profile and the power spectrum were calculated. On average the subjects were followed for >3 yr and performed >1,000 acceptable spirometries. The autocorrelation of FEV1 measurements in the emphysematous patients was ~0.35 for short intervals and decreased almost exponentially with a half time of 38 days. Between 3 and 4 mo, the autocorrelation function became negative. It reached a minimum of -0.1 at ~8 mo and then increased toward zero over the following 12 mo. The autocorrelation function in the two normal subjects showed a similar pattern, but with a faster decay toward zero. In the patients, the power spectrum had a peak at 1 cycle/wk and showed a 1/f pattern, wheref is frequency, with a slope of -0.88 at lower frequencies. We conclude that serial spirometric measurements show long-range correlations. The practical implication is that FEV1 need not be measured more often than once every 3 mo in studies of the long-term trends in lung function. AU - Dirksen A AU - Holstein-Rathlou N AU - Skovgaard LT AU - Ulrik CS AU - Heckscher T AU - Kok-Jensen A LA - PT - DEP - TA - J Appl Physiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 129 IP - DP - 1998 Jan 01 TI - Flock worker's lung: chronic interstitial lung disease in the nylon flocking industry PG - 261-272 AB - BACKGROUND: Two young men working at a nylon flocking plant in Rhode Island developed interstitial lung disease of unknown cause. Similar clusters at the same company's Canadian plant were reported previously. OBJECTIVE: To define the extent, clinicopathologic features, and potential causes of the apparent disease outbreak. DESIGN: Case-finding survey and retrospective cohort study. SETTING: Academic occupational medicine program. PATIENTS: All workers employed at the Rhode Island plant on or after 15 June 1990. MEASUREMENTS: Symptomatic employees had chest radiography, pulmonary function tests, high-resolution computed tomography, and serologic testing. Those with unexplained radiographic or pulmonary function abnormalities underwent bronchoalveolar lavage, lung biopsy, or both. The case definition of "flock worker's lung" required histologic evidence of interstitial lung disease (or lavage evidence of lung inflammation) not explained by another condition. RESULTS: Eight cases of flock worker's lung were identified at the Rhode Island plant. Three cases were characterized by a high proportion of eosinophils (25% to 40%) in lavage fluid. Six of the seven patients who had biopsy had histologic findings of nonspecific interstitial pneumonia, and the seventh had bronchiolitis obliterans organizing pneumonia. All seven of these patients had peribronchovascular interstitial lymphoid nodules, usually with germinal centers, and most had lymphocytic bronchiolitis and interstitial fibrosis. All improved after leaving work. Review of the Canadian tissue specimens showed many similar histologic findings. Among the 165-member study cohort, a 48-fold or greater increase was seen in the sex-adjusted incidence rate of all interstitial lung disease. CONCLUSIONS: Work in the nylon flocking industry poses substantial risk for a previously unrecognized occupational interstitial lung disease. Nylon fiber is the suspected cause of this condition. AU - Kern DG AU - Crausman RS AU - Durand KT AU - Nayer A AU - Kuhn C LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 38 IP - DP - 1998 Jan 01 TI - Occupational immediate type squid allergy. Two cases PG - 713-715 AB - Poissons et crustacés sont des causes très fréquentes d'allergie alimentaire par ingestion. Cependant, les allergies au calmar n'ont pas été décrites en milieu professionnel. Nous en rapportons deux observations chez des aides cuisinières. Seafood and fish are common causes of food allergies. They are also responsible for occupational asthma in processors of food. To our knowledge, no case of occupational asthma or urticaria caused by proteins derived from squid have been described. We report here two cases of occupationalsquidallergy in cooks. AU - Tabka F AU - Choudat D AU - Vacher JG AU - Thomas-Alliel S AU - Martin JC AU - Conso F LA - PT - DEP - TA - Rev Fr Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 57 Suppl 1 IP - DP - 1998 Jan 01 TI - Arctic snow crab-related lung disease PG - 601-608 AU - Smith DD AU - Sechena R LA - PT - DEP - TA - Int J Circumpolar Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 12 IP - DP - 1998 Jan 01 TI - High prevalence of bronchial hyperresponsiveness and asthma in ice hockey players PG - 13-16 AB - The prevalence of asthma was studied in a ice hockey team compared with both a floor ball team and the Swiss population. Lung function, bronchial hyperresponsiveness to methacholine, asthma symptoms and exercise-induced asthma were measured in a cross-sectional prospective study. A positive response to the methacholine bronchial provocation test was found in 34.6% of the ice hockey players and 20.8% of the floor ball players (Swiss population 16.4%). The provocative dose causing a 20% fall in the forced expiratory volume in one second (PD20) was significantly lower in ice hockey players than in floor ball players, but there was no significant difference in the dose-response slopes between the two groups. Asthma was diagnosed in 19.2% of the ice hockey players and in 4.2% of the floor ball players (Swiss population 6.8%), whereas exercise-induced asthma was found in 11.5% of the ice hockey players and in 4.2% of the floor ball players. In conclusion, asthma and bronchial hyperresponsiveness seemed to be more common in ice hockey players than in floor ball players and in the Swiss population. Strenuous exercise at lower temperatures may be a risk factor for the higher prevalence of asthma and bronchial hyperresponsiveness, as well as the increased severity of bronchial hyperresponsiveness, particularly in ice hockey players AU - Leuppi JD AU - Kuhn M AU - Comminot C AU - Reinhart WH LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 11 IP - DP - 1998 Jan 01 TI - Asthma and allergies among children in West and East Germany: a comparison between Munster and Greifswald using the ISAAC phase I protocol. International Study of Asthma and Allergies in Childhood PG - 840-847 AB - The study aim was to compare the prevalence of asthma, rhinitis and eczema in children living in Munster, western Germany, and Greifswald, eastern Germany, and to investigate associations of several characteristics and exposures with atopic disease symptoms. In 1994 and 1995, questionnaire information was gathered on 5-8 yr old children (n=3,741 in Munster and n=2,857 in Greifswald) and 12-15 yr olds (n=4,003 and n= 3,153, respectively) using the phase I protocol of the International Study of Asthma and Allergies in Childhood (ISAAC). The 12 month period prevalences of reported atopic disease symptoms in 5-8 yr olds were generally higher in Munster than in Greifswald, whereas only a few prevalence differences were observed in 12-15 yr olds. In both age groups the reported lifetime prevalences of asthma, hay fever and eczema were lower in Greifswald. Indoor exposures such as wood or coal heating and feather bedding were negatively associated with symptoms, whereas exposures such as truck traffic in a residential street or active smoking were positively associated with symptoms. Wood or coal heating could partly explain the prevalence difference of allergic rhinitis symptoms among 5-8 yr olds between Munster and Greifswald. The findings provide additional evidence for a role of several characteristics and exposures as potential determinants of asthma and allergies in children AU - Duhme H AU - Weiland SK AU - Rudolph P AU - Wienke A AU - Kramer A AU - Keil U LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 351 IP - DP - 1998 Jan 01 TI - Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee PG - 1225-1232 AB - BACKGROUND: Systematic international comparisons of the prevalences of asthma and other allergic disorders in children are needed for better understanding of their global epidemiology, to generate new hypotheses, and to assess existing hypotheses of possible causes. We investigated worldwide prevalence of asthma, allergic rhinoconjunctivitis, and atopic eczema. METHODS: We studied 463,801 children aged 13-14 years in 155 collaborating centres in 56 countries. Children self-reported, through one-page questionnaires, symptoms of these three atopic disorders. In 99 centres in 42 countries, a video asthma questionnaire was also used for 304,796 children. FINDINGS: We found differences of between 20-fold and 60-fold between centres in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema, with four-fold to 12-fold variations between the 10th and 90th percentiles for the different disorders. For asthma symptoms, the highest 12-month prevalences were from centres in the UK, Australia, New Zealand, and Republic of Ireland, followed by most centres in North, Central, and South America; the lowest prevalences were from centres in several Eastern European countries, Indonesia, Greece, China, Taiwan, Uzbekistan, India, and Ethiopia. For allergic rhinoconjunctivitis, the centres with the highest prevalences were scattered across the world. The centres with the lowest prevalences were similar to those for asthma symptoms. For atopic eczema, the highest prevalences came from scattered centres, including some from Scandinavia and Africa that were not among centres with the highest asthma prevalences; the lowest prevalence rates of atopic eczema were similar in centres, as for asthma symptoms. INTERPRETATION: The variation in the prevalences of asthma, allergic rhinoconjunctivitis, and atopic-eczema symptoms is striking between different centres throughout the world. These findings will form the basis of further studies to investigate factors that potentially lead to these international patterns AU - Anonymous LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Occupational asthma due to glutaraldehyde. PG - 50-55 AB - In recent years glutaraldehyde has emerged as the main cause of occupational asthma among healthcare workers. Presently glutaraldehyde is the best biocide agent for high-level disinfection and cold sterilization and its use has become widespread in hospitals. Surveillance schemes in the UK, Finland and the USA have reported an increasing number of cases of occupational asthma due to glutaraldehyde. The real magnitude of the problem is not well known as epidemiological studies carried out on a large scale among healthcare workers are not yet available. In countries where surveillance schemes are implemented, reports of occupational asthma cases due to glutaraldehyde should be circumstantiated by more diagnostic details and the diagnosis confirmed by objective means, to avoid an overestimation of frequency of disease. The pathogenetic mechanisms of occupational asthma due to glutaraldehyde are debatable as with other low molecular weight chemicals. A recent study has documented the first evidence of immunological sensitization in healthcare workers exposed to this chemical. Occupational asthma caused by glutaraldehyde can develop at levels of exposure well below the standards accepted in most countries. In the UK the Occupational Exposure Standard (OES) of this agent will be lowered from 0.2 ppm (parts of vapour per million parts of air by volume) to 0.05 ppm. Substitution of glutaraldehyde with an alternative agent is not currently feasible. Intervention in the workplace and education of personnel handling this chemical remain irreplaceable parts of any prevention strategy. Early detection of disease and prompt removal of personnel from further exposure are the only ways of avoiding any deterioration of occupational asthma. AU - Di Stefano F AU - Siriruttanapruk S AU - McCoach JS AU - Burge PS LA - PT - DEP - TA - Monaldi Arch Chest Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 11 IP - DP - 1998 Jan 01 TI - Guidelines for mineral fibre analyses in biological samples: report of the ERS Working Group. European Respiratory Society. PG - 1416-1426 AB - Microscopic techniques for analysing asbestos fibres in lung tissue and bronchoalveolar lavage have provided major information in the understanding of asbestos-related diseases. These analyses are increasingly applied for clinical work and medicolegal problems. Differences in sampling, preparation and counting techniques, definitions of reference populations and expression of results have caused major difficulties in comparing results from different laboratories. Therefore it appeared necessary to set a goal to harmonize these analyses between the European laboratories active in this field. This article summarizes the work of a European Respiratory Society working group with participation from nine European laboratories. The five main issues touched upon are: 1) definitions of control populations and reference levels; 2) sampling, preparation and analytical techniques; 3) asbestos fibres in lung tissues in different pathologies; 4) asbestos bodies in lung tissue, bronchoalveolar lavage and sputum; and 5) basis for the interpretation of fibres and asbestos bodies in biological samples. These guidelines indicate the crucial importance of several factors for the interpretation of the results; namely, adequate sampling, comparable analytical procedures and expression of the results, the use of well- defined reference populations, and a comprehensive understanding of the factors affecting the fibre retention and the dose-responses associated with the different asbestos- related diseases. AU - De Vuyst P AU - Karjalainen A AU - Dumortier P AU - Pairon JC AU - Monso E AU - Brochard P AU - Teschler H AU - Tossavainen A AU - Gibbs A LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 15 IP - DP - 1998 Jan 01 TI - Asthme et polluants chemiques domestiques (a l'exception tabac) PG - 11-24 AU - Krieger P AU - De Blay F AU - Pauli G AU - Kopferschmitt MC LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 11 IP - DP - 1998 Jan 01 TI - Occupational allergy to aldehydes in health care workers. Clinical observations. Experiments PG - 349-358 AU - KiecSwierczynska M AU - Krecisz B AU - Krysiak B AU - Kuchowicz E AU - Rydzynski K LA - PT - DEP - TA - Int J Occup Med Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 71 IP - DP - 1998 Jan 01 TI - Sick Building symptoms in office workers in north-eastern France: a pilot study PG - 353-356 AU - Tecelescu DB AU - Sauleau EA AU - Massin N AU - Bohadana AB AU - Buhler O AU - Benamghar L AU - Muir JM LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 34 IP - DP - 1998 Jan 01 TI - Objective assessments of ocular and respiratory alterations in employees in a sick building PG - 79-88 AU - Muzi G AU - dell'Omo M AU - Abbritti G AU - Accattoli P AU - Fiore MC AU - Gabrielli AR LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 55 IP - DP - 1998 Jan 01 TI - Epidemiology of sick building syndrome and its associated risk factors in Syngapore PG - 188-193 AU - Ooi PL AU - Goh KT AU - Phoon MH AU - Foo SC AU - Yap HM LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - IP - DP - 1998 Jan 01 TI - Guidance on dust control and health surveillance in bakeries PG - - AU - Health and safety in bakeries liason committee LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Cross-reactivity between buckwheat and latex PG - 538-539 AU - De MaatBleeker F AU - Stapel SO LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 42 IP - DP - 1998 Jan 01 TI - Exposure to chloramines in a green salad processing plant PG - 437-451 AU - Hery M AU - Gerber JM AU - Hecht G AU - Subra I AU - Possoz C AU - Aubert S AU - Dieudonne M AU - Andre JC LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Latex allergy in fruit allergic patients PG - 532-536 AU - Garcia Ortiz JC AU - Moyano JC AU - Alvarez M AU - Bellido J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Determination and characterisation of cross-reacting allergens in latex, avocado, banana and kiwi fruit PG - 289-296 AU - Moller M AU - Kayma M AU - Vieluf D AU - Paschke A AU - Steinhart H LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Coal mining and chronic obstructive pulmonary disease: a review of the evidence PG - 398-407 AU - Coggon D AU - Newman Taylor AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Occupational asthma to hyacinth PG - 328-329 AU - Piirila P AU - Hannu T AU - Keskinen H AU - Tuppurainen M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Occupational allergy to the umbrella tree (Schefflera) PG - 1008-1009 AU - Grob M AU - Wuthrich B LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 1 IP - DP - 1998 Jan 01 TI - Legionnaires' disease in residents of England and wales: 1997 PG - 252-258 AU - Joseph CA AU - Harrison TG AU - IlijicCar D AU - Bartlett CL LA - PT - DEP - TA - Commun Dis Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Occupational asthma caused by sunflower-seed dust PG - 907-908 AU - Vandenplas O AU - Vander Borght T AU - Delwiche JP LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Occupational asthma and food allergy due to carmine PG - 897-901 AB - Carmine (E120), a natural red dye extracted from the dried females of the insect Dactylopius coccus var. Costa (cochineal), has been reported to cause hypersensitivity reactions. We report a case of occupational asthma and food allergy due to carmine in a worker not engaged in dye manufacturing. A 35-year-old nonatopic man, who had worked for 4 years in a spice warehouse, reported asthma and rhinoconjunctivitis for 5 months, related to carmine handling in his work. Two weeks before the visit, he reported one similar episode after the ingestion of a red-colored sweet containing carmine. Peak flow showed drops higher than 25% related to carmine exposure. Prick tests with the cochineal insect and carmine were positive, but negative to common aeroallergens, several mites, foods, and spices. The methacholine test was positive. Specific bronchial challenge test with a cochineal extract was positive with a dual pattern (20% and 24% fall in FEV1). Double-blind oral challenge with E120 was positive. The patient's sera contained specific IgE for various high-molecular-weight proteins from the cochineal extract, as shown by immunoblotting. Carmine proteins can induce IgE-mediated food allergy and occupational asthma in workers using products where its presence could be easily overlooked, as well as in dye manufacture workers AU - Acero S AU - Tabar AI AU - Alvarez MJ AU - Garcia BE AU - Olaguibel JM AU - Moneo I LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Nasal response in subjects undergoing challenges by inhaling occupational agents causing asthma through the nose and mouth PG - 840-848 AB - BACKGROUND: Subjects with occupational asthma (OA) often report nasal symptoms, but nasal reactions to inhalation challenges with occupational agents have not been well characterized. METHODS: Fifteen subjects with OA (eight due to high-molecular-weight agents--flour and guar gum--and seven due to isocyanates) underwent inhalational challenges using closed-circuit devices (dry particles for high-molecular-weight agents and gas generator for isocyanates) on two occasions, 2-4 weeks apart in a random fashion. On one occasion, they inhaled through the nose and, on another, through the mouth. The FEV1 was monitored for up to 8 h afterward, and symptoms were documented with a standardized questionnaire on nasal symptomatology, assessment of nasal resistance by rhinomanometry, and nasal lavage for the examination of cells and mediators. RESULTS: Inhaling through the mouth and through the nose: 1) yielded similar asthmatic responses (25+/-8% and 22+/-10% maximum changes in FEV1) 2) more than doubled the peak nasal symptoms and nasal resistance when the maximum daily response was compared with prechallenge results. This increase occurred on the days of inhalational challenges through the mouth and through the nose. There were some significant responses assessed by nasal lavage in terms of cells and mediators, again with no differences between the days of challenges through the mouth and through the nose. CONCLUSIONS: Inhaling occupational agents of high or low molecular weight, including isocyanates, whether through the mouth or nose: 1) results in a similar asthmatic response 2) causes a significant nasal response in terms of symptoms and an increase in nasal resistance 3) causes some significant changes in inflammatory cells and mediators AU - Desrosiers M AU - Nguyen B AU - Ghezzo H AU - Leblanc C AU - Malo JL LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 34 IP - DP - 1998 Jan 01 TI - Hypersensitivity pneumonitis in a machinist PG - 387-392 AB - Hypersensitivity pneumonitis (HP), or extrinsic allergic alveolitis, is a patchy, interstitial lung disease that involves an immunologic reaction of the lung to repeated inhalation of foreign antigens. In this report, we describe a machinist with exposure to metalworking fluids (MWFs) and biopsy-confirmed HP. Return to work, which could be equated with a retrospective workplace-specific bronchoprovocation test, proved that working within an environment in which MWFs were used was associated with clinical deterioration in the patient's pulmonary status and with clinical improvement after removal from exposure AU - Freeman A AU - Lockey J AU - Hawley P AU - Biddinger P AU - Trout D LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 15 IP - DP - 1998 Jan 01 TI - Occupational asthma to metabisulfites . Three cases PG - 537-540 AB - Sulfites are compounds which are mainly used in the agricultural, food and pharmaceutical industry as preservatives. The possibility of manifestations of acute hypersensitivity appearing after the ingestion or inhalation of sulfites has already been described several times, over the past twenty years. Amongst these manifestations and indeed the one that is most often present is bronchospasm, which can sometimes be severe. A few cases of occupational intolerance through contact eczema to sulfites have also been published. The idea of occupational asthma to metabisulphates is, on the other hand, extremely recent; its legal recognition only dates back to 1989. The authors present three new cases of occupational asthma to metabisulphites stressing the value of a specific provocation test and the different hypotheses for the pathogenesis of the disorder are reviewed. Preventative measures are always preferable to avoid the development of severe occupational asthma. In all cases, notification of occupational asthma is necessary AU - Agard C AU - NicoletAkhavan F AU - Bouillard J AU - Sandron D LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 52 IP - DP - 1998 Jan 01 TI - Quantification of inhaled exposure to alpha-amylase in 2 bakeries PG - 440-443 AB - BACKGROUND: Baker's asthma and baker's rhinitis are among the most frequent occupational diseases. A major cause is the high exposure to flour dust in the workplace and to allergenic enzymes like alpha-amylase from Aspergillus oryzae (allergen name: Asp o 2). METHODS: To quantify allergen exposure in the workplace, 31 personal dust samples in a conventional small bakery (six workers) and in a biobakery (seven workers) were collected. Using a recently developed two-site enzyme-linked immunosorbent assay based on monoclonal antibodies to alpha-amylase from Aspergillus oryzae, the allergen content of these dust samples was determined. RESULTS: Dust exposure in the biobakery was in the range between 3.5 and 12 mg/m3 (median: 5.2 mg/m3) and in the conventional bakery between 0.9 and 118 mg/m3 (median 8.5 mg/m3). 23 out of 31 exposure measurements showed values higher than 4 mg/m3 (threshold limit value for inhalable dust). In the biobakery, no fungal alpha-amylase could be detected. 15 out of 17 samples taken in the conventional bakery contained fungal alpha-amylase in the range between 0.2 and 88 ng per mg dust. The geometric mean of alpha-amylase exposure in this bakery was 13 ng Asp o 2/m3, and the maximum exposure was 4.8 micrograms/m3. In four cases, fungal alpha-amylase was detected although exposure to dust was below the threshold limit of 4 mg/m3. CONCLUSIONS: This study in two German bakeries shows that preventive measures to reduce contact to allergens have not been sufficiently realised. Relevant alpha-amylase exposure occurred at low dust levels illustrating that dust measurements are not adequate to control alpha-amylase exposure. For fungal alpha-amylase an additional threshold limit should be established AU - Sander I AU - NeuhausSchroder C AU - RaulfHeimsoth M AU - Doekes G AU - Heederik D AU - Baur X LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 102 IP - DP - 1998 Jan 01 TI - Occupational asthma by Anisakis simplex PG - 831-834 AB - BACKGROUND: No cases of occupational asthma caused by the inhalation of antigens from Anisakis simplex have been published. OBJECTIVE: The purpose of this study was to evaluate the possibility that A simplex can play a role in the asthma experienced by 2 workers when handling fish and fish flour. METHODS: Skin prick and bronchial challenge tests with A simplex were performed. We also carried out measurements of specific IgE to A simplex and immunoblotting. RESULTS: Both patients had strong positive skin test responses, challenge test responses, and specific IgE to A simplex. Immunoblotting showed that both patients also had IgE against several bands in the fish flour extract, suggesting contamination by Anisakis allergens. CONCLUSION: These 2 patients provide evidence for occupational asthma caused by A simplex, based on in vivo and in vitro tests for Anisakis-specific IgE AU - Armentia A AU - Lombardero M AU - Callejo A AU - Martin Santos JM AU - Gil FJ AU - Vega AU - J AU - Arranz ML AU - Martinez C LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 102 IP - DP - 1998 Jan 01 TI - Occupational asthma: what have we learned?. PG - S90-5 AB - Occupational asthma is one of the most frequent work-related diseases and may represent between 2% and 6% of all cases of asthma. It is defined as asthma causally and specifically related to exposure to airborne dusts, gases, vapors, or fumes in the working environment. Because it may cause long-lasting disability, it is important to properly identify affected workers and to withdraw them from exposure to the sensitizing agent as soon as possible. Although the history is the clue to the diagnosis, it is not sensitive or specific. The diagnosis should be confirmed by objective means, essentially by monitoring of peak expiratory flow and nonallergic bronchial responsiveness or by specific inhalation challenges. In this article the author reviews the investigation of occupational asthma. AU - Cartier A LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 28 IP - DP - 1998 Jan 01 TI - Oilseed rape allergy presented as occupational asthma in the grain industry PG - 1159-1163 AB - BACKGROUND: There have been several reports on respiratory allergic symptoms induced by pollen of oilseed rape. To the best of our knowledge, this is the first report dealing with oilseed rape dust mainly composed of seeds, as an occupational allergen in the grain industry. In this paper, we present a case of occupational asthma caused by oilseed rape dust from the Animal Feed Industry, which proved to be induced by an IgE-mediated reaction. METHODS AND RESULTS: The patient displayed positive responses to Dermatophagoides farinae as well as oilseed rape dust extract. The bronchoprovocation test showed an early asthmatic response to oilseed rape dust extract. Serum specific IgE antibody to oilseed rape antigen was detected by enzyme-linked immunosorbent assay (ELISA). ELISA inhibition test showed significant inhibitions with addition of oilseed rape antigen. In order to further identify the allergenic components of extract, sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblot analysis were performed. Fourteen IgE-binding components ranging from 10 to 160kDa were detected within the oilseed rape extract. CONCLUSION: These results suggest that the inhalation of oilseed rape dust, not pollen, can cause IgE mediated bronchoconstriction in an exposed worker of the grain industry AU - Suh CH AU - Park HS AU - Nahm DH AU - Kim HY LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 36 IP - DP - 1998 Jan 01 TI - Respiratory tract inflammation in swine confinement workers studied using induced sputum and exhaled nitric oxide PG - 557-565 AB - OBJECTIVE: To further define the asthma-like syndrome seen in swine confinement workers. DESIGN: A cross-sectional study was performed at a swine confinement facility in rural Nebraska and at the University of Nebraska Medical Center, Omaha, Nebraska. Participants: 24 swine confinement workers and 14 urban normal control subjects. All subjects completed a questionnaire concerning respiratory complaints. We performed hypertonic saline challenges on the swine confinement workers and control subjects in order to induce expectoration of sputum. Cell counts and cell differentials were determined in the induced sputum samples. Nasal, mean, and peak exhaled nitric oxide was measured in both groups. Spirometry was also done. RESULTS: Swine confinement workers were significantly more likely to report wheezing, cough, and sinusitis symptoms than controls (p = .003). Macrophages were significantly elevated in the induced sputum samples of the swine confinement workers vs the control subjects (0.59 macrophages/mL +/- 0.1 SEM vs 0.36 +/- .16; p = .006), while there was no difference in numbers of neutrophils. No eosinophils were observed. A small elevation in mean exhaled nitric oxide was seen in the swine confinement workers compared to normal controls (11.7 ppb +/- 0.6 SEM vs 10.2 +/- 1.6; p = 0.023). Spirometry values did not differ statistically between swine confinement workers and the control group. CONCLUSIONS: Swine confinement workers have signs and symptoms of lower respiratory tract inflammation when studied using induced sputum and exhaled nitric oxide. Findings in the swine confinement workers differ from those in asthmatics and chronic bronchitis AU - Von Essen SG AU - Scheppers LA AU - Robbins RA AU - Donham KJ LA - PT - DEP - TA - Journal of Toxicology - Clinical Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 5 Suppl A IP - DP - 1998 Jan 01 TI - Investigation of occupational asthma. [Review] PG - 71A-6A AB - Occupational asthma is one of the most frequent lung diseases related to work. It is defined as asthma causally and specifically related to exposure to airborne dusts, gases, vapours or fumes in the working environment. Because occupational asthma may cause long-lasting disability, it is important to identify affected workers correctly and to remove them as soon as possible from the sensitizing agent. Although history is the clue to the diagnosis, it is not sensitive nor specific enough, and the diagnosis should be confirmed by objective means. This article reviews the different steps (with their advantages and disadvantages) involved in making the diagnosis: history, confirmation of the diagnosis of asthma, work visit, skin tests and serology, monitoring of peak expiratory flows and nonallergic bronchial responsiveness. The gold standard remains specific inhalation challenges in the laboratory or at work. AU - Cartier A LA - PT - DEP - TA - Can Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 5 IP - DP - 1998 Jan 01 TI - Canadian Thoracic Society guidelines for occupational asthma PG - 289-300 AB - OBJECTIVE: To provide broad guidelines and principles to help primary care physicians, occupational physicians, allergists and respirologists with the recognition, diagnosis and management of patients with occupational asthma (OA). OPTIONS: These guidelines are mainly directed towards OA induced by a workplace sensitizing agent. However, irritant-induced asthma and workplace aggravation of underlying asthma are also addressed, and some consideration is given to other differential diagnoses. OUTCOMES: To enable the assessing physician to investigate patients with possible OA appropriately and to provide guidelines for appropriate early referral when specialized investigations are required. To provide an understanding of the appropriate management strategies following objective diagnosis. EVIDENCE: The key diagnostic and management recommendations were based on a critical review of the literature and by specialist consensus meetings. VALUES: Evidence was categorized as follows. Level 1: Evidence from at least one randomized, controlled trial. Level 2: Evidence from at least one well-designed clinical trial without randomization, from cohort or case-control analytical studies, preferably from more than one centre, from multiple time series or from dramatic results in uncontrolled experiments. Level 3: Evidence from the opinions of respected authorities based on clinical experience, descriptive studies or reports of expert committees. Evidence was further subdivided as follows: A. Good evidence to support a recommendation for use; B. Moderate evidence to support a recommendation for use; C. Poor evidence to support a recommendation for or against use; D. Moderate evidence to support a recommendation against use; E. Good evidence to support a recommendation against use. BENEFITS, HARM AND COSTS: The medical and socioeconomic risks and benefits of an incorrect diagnosis of OA and of failure to diagnose true OA were considered in the recommendations. VALIDATION: The document has been reviewed and endorsed by the Canadian Thoracic Society, the Canadian Society of Allergy and Clinical Immunology, and The College of Family Physicians of Canada. CONCLUSIONS: There is good evidence for rapid investigation and objective categorization of presented symptoms into OA, aggravation of underlying asthma, unrelated asthma or other diagnoses. OA should be suspected in all adult onset asthmatics whose asthma begins or worsens while they are working. Investigations should be directed to an objective assessment of asthma and then to an assessment of the work relationship, using a combination of investigations as feasible, which may include immunological tests, pulmonary function assessed during work periods and away from work, and specific challenge tests. Early specialist referral is recommended for diagnosis. Management strategies include general asthma management in addition to measures to avoid further exposure to a relevant workplace sensitizer. Compensation issues and other workers at risk of developing OA also need to be considered when the diagnosis is made. AU - Tarlo SM AU - Boulet LP AU - Cartier A AU - Cockcroft D AU - Cote J AU - Hargreave FE AU - Holness L AU - Liss G AU - Malo JL AU - ChanYeung M LA - PT - DEP - TA - Can Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 40 IP - DP - 1998 Jan 01 TI - The spectrum of respiratory disease associated with exposure to metal working fluids PG - 640-647 AB - Occupational respiratory diseases have been reported following exposure to metal working fluids. We report a spectrum of respiratory illnesses occurring in an outbreak in 30 workers of an automobile parts engine manufacturing plant. Workers presented with respiratory complaints and, after clinical and laboratory evaluations, were classified as those having hypersensitivity pneumonitis, occupational asthma, or industrial bronchitis, or those without occupational lung disease. Hypersensitivity pneumonitis affected seven workers, with six exhibiting serum precipitins to Acinetobacter Iwoffii. Occupational asthma and industrial bronchitis affected 12 and six workers, respectively. Oil-mist exposures were below current recommendations. Gram-negative bacteria, but no fungi, Thermophiles, or Legionella, were identified. Although specific agents responsible for each individual case could not be identified, probably both specific sensitizing agents and non-specific irritants from metal working fluids, additives, or contaminants contributed to this spectrum of occupational respiratory illness AU - Zacharisen MC AU - Kadambi AR AU - Schlueter DP AU - Kurup VP AU - Shack JB AU - Fox JL AU - Anderson HA AU - Fink JN LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Characterized allergens causing bakers' asthma. [Review] PG - 562-566 AB - Although airborne allergens in bakeries and confectioneries cause one of the most common forms of occupational asthma, namely, bakers' asthma, only a few of them are known in detail so far. Here we summarize current knowledge of bakery allergens and describe our own two-dimensional (2-D) immunoelectrophoresis studies of wheat-flour allergens as well as the allergenic baking enzyme Asp o 2. Out of approximately 700 soluble wheat polypeptides, 70 show IgE binding; the following wheat-flour allergens could be identified and characterized: members of the alpha-amylase inhibitor family (14-18 kDa), acyl-CoA oxidase (26 kDa), peroxidase (36 kDa), and fructose-bisphosphate aldolase (37 kDa). However, the great majority of the soluble wheat-flour allergens, mainly located in the 27-, 55-, and 70-kDa areas of the 2-D immunoblots with pI values of 5.8-6.8, 5.9-6.5, and 5.5-6.1, respectively, are not known at present. Asp o 2, to which approximately 25% of all bakers with respiratory symptoms are sensitized, is a well-characterized starch-cleaving enzyme. We conclude that great effort is still needed to describe all major wheat-flour allergens. As shown by Asp o 2, knowledge of the causative allergens and their characteristics enables us to initiate very effective preventive measures such as the introduction of granulated allergenic products. AU - Baur X AU - Posch A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 55 IP - DP - 1998 Jan 01 TI - Occupational asthma due to amylase PG - 361-361 AU - Flindt ML LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 55 IP - DP - 1998 Jan 01 TI - Changes in airway function and bronchial responsiveness after acute occupational exposure to chlorine leading to treatment in a first aid unit PG - 356-359 AB - OBJECTIVES: To describe the baseline characteristics and the time course of changes in lung function in workers accidentally inhaling high concentrations of chlorine in a prospective study. METHODS: Baseline spirometry and methacholine challenge test were performed in a cohort of 278 workers at risk of accidental inhalation of chlorine. Workers in whom accidental inhalation led to intervention in a first aid unit were reassessed five to 25 days after the accident and serially thereafter when there where notable changes. RESULTS: During a four year follow up period, 13 workers were seen at the first aid unit after a symptomatic accidental inhalation. Three of them experienced notable functional changes: one worker experienced a 10% fall in forced expiratory volume in one second (FEV1), and the other two had a notable fall in the concentration of methacholine that caused a 20% fall in FEV1 (PC20). Two workers were smokers and one had a personal history of atopy. Baseline assessment was within the normal range in these three workers. Recovery was complete three months after the accidental inhalation. CONCLUSION: Transient but notable decreases in airway function or increases in bronchial responsiveness can occur after an accidental inhalation of high concentrations of chlorine in workers at risk AU - Leroyer C AU - Malo JL AU - InfanteRivard C AU - Dufour JG AU - Gautrin D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 13 IP - DP - 1998 Jan 01 TI - Role of specific IgE, IgG and IgG4 antibodies to corn dust in exposed workers PG - 88-94 AB - BACKGROUND AND METHODS: To evaluate the role of specific antibodies to corn dust (CD) and their relationship to respiratory dysfunction, we detected serum specific IgE(slgE) and IgG4(slgG4) antibodies by ELISA in 42 employees working in the animal feed industry and 27 unexposed controls. RESULTS: Our survey revealed that 15 (34.9%) subjects had work-related respiratory dysfunction associated with or without nasal symptoms. Among these subjects, eight had airway hyper-responsiveness to methacholine. Significant differences were noted in slgE and slgG4 between exposed and unexposed groups (p = 0.04, p = 0.00 respectively), but no difference was noted in slgG (p = 0.1). Although there was no significant differences in the prevalence of specific IgE antibody between symptomatic (29%) and asymptomatic groups (19%, p = 0.55), the specific IgE levels were significantly higher in symptomatic workers than in asymptomatic workers (p = 0.03). Specific IgG antibody was detected in 1 (6%) symptomatic and 4 (15%) asymptomatic workers (p = 0.46). Specific IgG4 antibody was detected in 11 (73%) of symptomatic and 21 (78%) of asymptomatic workers (p = 0.90). The higher prevalence of slgG4 antibody was noted in workers with slgE antibody (p = 0.001). The correlation between slgG and exposure duration was significant (r = 0.36, p = 0.02). There was no association between the prevalence of slgE, slgG, and slgG4 to exposure intensity, smoking or atopic status. CONCLUSION: These results suggested that the existence of slgG and slgG4 might represent a response to CD exposure, and that some unexposed subjects had slgG to CD. Specific IgE might play a role in the development of respiratory symptoms AU - Park HS AU - Nahm DH AU - Kim HY AU - Suh CH AU - Kim KS LA - PT - DEP - TA - Korean J Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 11 IP - DP - 1998 Jan 01 TI - Prevalence of respiratory diseases in the textile industry. Relation with dust levels PG - 301-309 AB - Many workers in the textile industry have respiratory symptoms that are related to their work environment. In this study we observed the dust level conditions of eleven textile industries of the North of Portugal. The dust levels determined were between 0.1 mg/m3 and 1.25 mg/m3, in many cases above the Portuguese standard levels of exposure (VLE). For these dust levels we found a prevalence of 23% of workers with respiratory symptoms with occupational characteristics in 10.8%, and 5.7% presenting byssinosis. Workers exposed to cotton fibres in spinning areas have the highest prevalence of symptoms, and reduction of the FEV1. These characteristics were related to dust levels and were higher in the initial phases of the spinning processes. We found no cases of byssinosis in workers exposed to synthetic fibres, or in workers from weaving areas. Smoking habits were related to the reduction of the FEV1, and severity of respiratory illness but not to the presence of byssinosis AU - Da Costa JT AU - Barros H AU - Macedo JA AU - Ribeiro H AU - Mayan O AU - Pinto AS LA - PT - DEP - TA - Acta Med Port JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 34 IP - DP - 1998 Jan 01 TI - Dermal and respiratory sensitization to chromate in a cement floorer PG - 169-176 AB - BACKGROUND: To report a well-documented case of both allergic contact dermatitis and occupational asthma due to chromate exposure in a 48-year-old floorer. METHODS AND RESULTS: A 48-year-old floorer, occupationally exposed to cement and with a documented chromate contact dermatitis, reported dyspnea and wheezing after work. These conditions were demonstrated by self-measured sequential peak expiratory flows. A first bronchial provocation (BPT) with potassium dichromate (K2Cr2O7) (0.3% nebulized for a total of 60 minutes) led to pronounced and sustained decreases in forced expiratory volume in 1 second (FEV1) and forced vital capacity, accompanied by pruritus, a decrease in arterial PO2, a slight rise in temperature, and peripheral blood leukocytosis. (This concentration of K2Cr2O7 is not recommended for BPT). Bronchoalveolar lavage performed 2 days later showed 18% eosinophils. Tow years later, a BPT with a lower dose of K2Cr2O7 (0.01% for the total of 31 min) led to an "earl late" reaction (FEV1 dropped by 195 compared with the initial FEV1 value), accompanied by pruritus. A BPT with dry cement, containing 12 ppm hexavalent chromium, was borderline (FEV1 dropped by 13%), and a similar result (FEV1 dropped by 14%) was obtained after smoking five cigarettes, laced with 10 mg of cement per cigarette. CONCLUSIONS: This report illustrates that a subject, with allergic contact dermatitis to chromates, may develop a respiratory allergic reaction to an airborne source of this metal. The main novelty of our report is that the smoking of cigarettes contaminated with cement may have been significant factor in the causation or elicitation of these reactions AU - De-Raeve H AU - Vandecasteele C AU - Demedts M AU - Nemery B LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 34 IP - DP - 1998 Jan 01 TI - Work-related respiratory symptoms and lung function in New Zealand mussel openers PG - 163-168 AB - Our objectives were to measure the prevalence of work-related and nonwork-related respiratory symptoms in a group of New Zealand mussel openers who open green-lipped mussels, and to relate these to demographic factors, work history, smoking history, and pulmonary function measurements. A cross-section study of respiratory symptoms and lung function was performed on 224 New Zealand mussel openers (99.6% of the study population) at nine work sites. In addition, peak expiratory flow (PEF) change across-shift was measured at one work site in 19 workers. The mean age of all mussel openers was 33.4 years and the mean duration of mussel opening was 5.0 years; 25% were male, 54.7% were current smokers, and 13.9% were ex-smokers. The reported symptom prevalences were: any wheeze, 35%; work-related wheeze, 23%; any chest tightness, 30.5%; work-related chest tightness, 20.2% (work-related symptoms were defined as symptoms improving on rest days or worse at work). Seventy-two mussel openers (32.3%) answered positively to at least 1 of 4 questions concerning work-related symptoms. The mean predicted FEV1 (SD) for this group was 74.3% (14.5), and the mean predicted FVC (SD) was 79.2 (16.0). Nineteen workers completed serial PEF, and the mean percentage change was +1.5% at 7 hr, but 8 workers had falls ranging between 1.1-14% after either 1 or 7 hr of work. Duration of mussel opening of greater than 2 years, but less than 7 years (OR = 2.29; 95% CI, 1.07-4.91), and duration of mussel opening greater than 7 years (OR = 3.72; 95% CI, 1.52-9.11), were significant predictors of work-related respiratory symptoms. Female sex (OR = 1.73; 95% CI, 0.83-3.60) was also associated with the presence of work-related symptoms. No relationship was found with measured hygiene parameters of cleaning agents used. In conclusions, duration of work as a mussel opener was associated with the present of work-related respiratory symptoms, after adjustment of age, sex, and smoking habit. There were marked abnormalities in mean FEV1 and FVC, although no consistent changes across working shift were noted AU - Glass WI AU - Power P AU - Burt R AU - Fishwick D AU - Bradshaw LM AU - Pearce NE LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 34 IP - DP - 1998 Jan 01 TI - Pathomechanisms and pathophysiology of isocyanate-induced diseases--summary of present knowledge. [Review] PG - 137-143 AB - During recent years in Western countries, diisocyanates are one of the main causes of occupational asthma. The mechanism of diisocyanate-induced asthma is still unknown but recent evidence suggests immunological mechanisms, including cell-mediated immune responses. Immune responses to isocyanates may result in different illnesses, cell- and/or antibody-mediated entities. In addition, irritative, toxic, and mutagenic effects may occur. This review summarizes current knowledge of the pathomechanisms, including immunological and nonimmunological (mutagenic and genotoxic) aspects of isocyanate disorders. AU - RaulfHeimsoth M AU - Baur X LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 114 IP - DP - 1998 Jan 01 TI - Follow-up of occupational asthma after removal from or diminution of exposure to the responsible agent: relevance of the length of the interval from cessation of exposure PG - 398-403 AB - STUDY OBJECTIVE: We set the hypothesis that follow-up surveys of occupational asthma (OA) could now show better improvement in the asthmatic condition because of a more prolonged interval since removal from exposure than in previously reported studies. P ATIENTS/METHODS: Ninety-nine subjects with OA were assessed and were separated into two groups according to the duration of cessation of exposure: (1) group removed for > or = 5 years: 48 subjects studied 8.9+/-2.2 years after cessation of exposure; (2) group removed for <5 years: 51 subjects with OA, comparable in terms of history and functional results at time of diagnosis, with a time lapse from last exposure of 3.1+/-1.2 years. On the follow-up visit, questionnaires including information on the current and previous use of inhaled steroids, spirometry, and methacholine tests were administered and results were compared with those obtained at the time of diagnosis. RESULTS: At the follow-up visit, no significant changes in spirometry were observed in the two groups. However, a significant improvement in provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) from a mean value of 1.5 to 3.7 mg/mL was documented (p<0.001). The proportion of subjects having normal PC20 at the follow-up visit was significantly higher in the group removed from exposure for >5 years than in the group removed for < or = 5 years (16/33 vs 8/42; p=0.01). Stepwise logistic regression showed that follow-up PC20 could be predicted from baseline PC20 (p<0.001, odds ratio [OR]=4.1, 95% confidence interval [CI]=1.8 to 9.1), duration of exposure (p=0.04, OR=0.9, 95% CI=0.8 to 1.0), the interval since removal from exposure (p=0.002, OR=1.7, 95% CI=1.2 to 2.5), and the type of agent; subjects with OA due to high-molecular-weight agent showed a less favorable outcome (p=0.04, OR=0.2, 95% CI=0.03 to 1.0). Current and past treatments with inhaled steroids were not significant predictors. CONCLUSION: Results obtained in the group of this study removed for >5 years show better prognostic figures than those reported in most previous studies. Comparison with the group removed for a shorter interval and the stepwise logistic regression analysis suggest that the longer duration of the interval from cessation of exposure appears to be a factor determining this difference AU - Perfetti L AU - Cartier A AU - Ghezzo H AU - Gautrin D AU - Malo JL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 105 IP - DP - 1998 Jan 01 TI - Health effects of airborne pollutants, particularly in swine confinement stalls, from the viewpoint of occupational medicine PG - 225-234 AB - From the point of view of occupational respiratory medicine, an overview on potential health effects of airborne pollutants particularly in swine confinement houses is presented. Airway diseases are the most frequent occupational disorders among farmers in many countries around the world including Germany. Due to various methodological reasons, epidemiological studies in farming populations are more difficult to perform than among non-farmers. Major constituents of swine confinement dust include bacteria, endotoxin, mites, fungal spores, and animal dander. Gaseous pollutants include ammonia, methane, and hydrogen sulfide. In a variety of cross-sectional studies, high prevalences of respiratory symptoms and non-obstructive (and obstructive) bronchitis and Organic Dust Toxic Syndrome have been reported in pig farmers. Nasal and bronchial provocation challenges with swine confinement dust include influx of neutrophils and other inflammatory cells as well as mediators. In cross-sectional and longitudinal studies, endotoxin turns out as the probably most relevant parameter associated with lung function impairment. Further studies are clearly needed focusing on the prognosis of non-obstructive bronchitis in swine farmers and on health effects of reducing airborne contaminants in swine confinement houses AU - Nowak D LA - PT - DEP - TA - Dtsch Tierarztl Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 28 IP - DP - 1998 Jan 01 TI - Exposure-response relationships of occupational inhalative allergens. PG - 537-544 AB - Only a few threshold limit values exist at present for allergens in the workplace known to cause bronchial asthma. This contrasts with the great number of occupational asthma cases observed in industrialized countries. Recently published studies provide clear evidence for exposure intensity response relationships of occupational allergens of plant, microbiological, animal or man-made origin. If allergen exposure levels fall short of determined limit values, they are not associated with an increased risk of occupational asthma. Corresponding data are available for wheat flour (1-2.4 mg/m3), fungal alpha-amylase (0.25 ng/m3), natural rubber latex (0.6 ng/m3), western red cedar (0.4 mg/m3) and rat allergens (0.7 microg/m3). It is suggested to stipulate legally binding threshold limit values (TLV/TWA) on this basis in order to induce more effective primary preventive measures. If no reliable data on the health risk of an occupational airborne noxa exist, the lowest reasonably practicable exposure level has to be achieved. Appropriate secondary preventive measures have to be initiated in all workplaces contaminated with airborne allergens. Verified exposure-response relationships provide the basis for risk assessment and for targeted interventions to reduce the incidence of occupational asthma also in consideration of cost benefit aspects. 'Occupational asthma is a disease characterized by variable airflow limitation and/or airway hyperresponsiveness due to causes in a working environment. These causes can give rise to asthma through immunological or non-immunological mechanisms. Up to 15% of all asthma cases are of occupational origin or have at least a significant causal occupational factor. According to the New Zealand part of the European Respiratory Health Survey, an increased risk of asthma prevalence was found for several occupations such as laboratory technicians, food producers, chemical workers, plastic and rubber workers. The Spain part of this study comprising 2646 Spanish subjects showed an asthma risk to be attributed to occupational exposures between 5 and 6.7%. Main asthma-inducing agents in the workplace are flour, grain and feed dust, animal dander/urinary proteins and isocyanates. Further, several inhalative irritants such as chlorine, acid or alkaline aerosols play a pivotal role. Many low molecular weight chemicals have irritative as well as allergenic effects on the airways, e. g. isocyanates and acid anhydrides. In addition to chronic or repetitive exposures, also singular accidental exposure to high concentrations of irritative or toxic airborne substances can cause occupational asthma. This condition is frequently called reactive airways dysfunction. AU - Baur X AU - Chen Z AU - Liebers V LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 11 IP - DP - 1998 Jan 01 TI - Occupational asthma caused by aluminium welding PG - 1182-1184 AB - Work-related asthma has been documented in workers employed in the primary aluminium industry and in the production of aluminium salts. The role of aluminium in the development of occupational asthma has, however, never been convincingly substantiated. We investigated a subject who experienced asthmatic reactions related to manual metal arc welding on aluminium. Challenge exposure to aluminium welding with flux-coated electrodes, as well as with electrodes without flux, elicited marked asthmatic reactions. Manual metal arc welding on mild steel did not cause significant bronchial response. The results of inhalation challenges combined with exposure assessments provided evidence that aluminium can cause asthmatic reactions in the absence of fluorides. Awareness of this possibility may be relevant to the investigation of asthma in workers exposed to aluminium AU - Vandenplas O AU - Delwiche JP AU - Vanbilsen ML AU - Joly J AU - Roosels D LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 158 IP - DP - 1998 Jan 01 TI - Hypersensitivity pneumonitis in peat moss processing plant workers PG - 412-417 AB - A nonsmoking 54-yr-old man, employed in a peat moss packaging plant, developed dyspnea and recurrent fever. The diagnosis of hypersensitivity pneumonitis (HP) was made. Thirteen of 14 coworkers and 13 nonexposed control subjects were studied. Five workers were nonsmokers, two were minimal smokers, and six were smokers. HP was found in another subject. Monocillium sp. and Penicillium citreonigrum, 4.6 x 10(7) CFU/g, were found in the peat moss. Three nonsmokers, the two minimal smokers (including the subject with HP), and the index case had antibodies to these microorganisms; none of the six heavy smokers had antibodies. Serum TNF-alpha was higher in the workers than in the control subjects (0.930 +/- 0.177 versus 0. 350 +/- 0.076). Three of the four asymptomatic seropositive workers and two seronegative smokers were further evaluated. All three seropositive workers had normal lung functions and CT but they all had a lymphocytic alveolitis (30, 34, and 68% lymphocytes in their bronchoalveolar lavage [BAL]). The smokers had normal lung functions, CT, and percentage of BAL lymphocytes (3 and 13%). This study identified a previously unrecognized work environment that can lead to HP and documented a protective effect of smoking on the response to antigens AU - Cormier Y AU - IsraelAssayag E AU - Bedard G AU - Duchaine C LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 92 IP - DP - 1998 Jan 01 TI - Leukocyte counts in hypertonic saline-induced sputum in subjects with occupational asthma PG - 550-557 AB - We measured markers of eosinophilic inflammation in the blood and in the sputum induced by hypertonic saline (HS) inhalation of 24 subjects with occupational asthma who were still exposed to high molecular weight compounds (HMWCs, n = 8) or to low molecular weight compounds (LMWCs, n = 16); all subjects were symptomatic and showed bronchial hyperresponsiveness to methacholine at the time of study. Sputum cell counts were also measured in 14 normal subjects and in 24 subjects with non-occupational asthma with asthma severity similar to that of occupational asthmatics. Both occupational and non-occupational asthmatic subjects showed higher neutrophil percentages in HS-induced sputum than normal subjects, asthmatics with LMWC-induced asthma showing the highest values. Eosinophil percentages in HS-induced sputum were higher in non-occupational asthmatics and in asthmatics with HMWC-induced asthma than in normal subjects and in subjects with occupational asthma due to LMWCs. No difference in bronchial responsiveness, peak expiratory flow variability and serum eosinophil cationic protein (ECP) levels were observed among the different asthma groups. Although sputum eosinophil percentages significantly correlated with blood eosinophil percentages, sputum allowed the detection of a higher number of subjects with eosinophilic inflammation than blood. Serum ECP levels were normal in most asthmatic subjects. A significant correlation between sputum eosinophil percentages and bronchial hyperresponsiveness to HS was observed. Despite a similar degree of functional abnormalities, subjects with asthma due to LMWCs and still exposed to the occupational sensitizer showed a lower degree of eosinophilic inflammation and a higher degree of neutrophilic inflammation in the airways than subjects with occupational asthma due to HMWCs or non-occupational asthmatics. Furthermore, sputum eosinophil counts detect, better than blood indices, the degree of airway inflammation in both occupational and non-occupational asthma AU - Di Franco A AU - Vagaggini B AU - Bacci E AU - Bartoli ML AU - Cianchetti S AU - Carnevali S AU - Dente FL AU - Giannini D AU - Macchioni P AU - Ruocco L AU - Paggiaro AU - PL LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 13 IP - DP - 1998 Jan 01 TI - Heterogeneity of IgE response to TDI-HSA conjugates by ELISA in toluene diisocyanate (TDI) -induced occupational asthma (OA) patients PG - 147-152 AB - Toluene diisocyanate (TDI), a low molecular weight reactive chemical, is known to be a main cause of occupational asthma (OA) in Korea. Although it is thought that inhaled TDI may act as a hapten, the precise mechanisms of TDI-induced OA are unknown. In this study, TDI-human serum albumin (HSA) conjugates (5, 10, 20 and 30 min) were prepared in the range of 1.5 to 5.0 TDI mole/HSA mole. Specific binding of serum IgE to TDI-HSA (30 min) was observed using IgE ELISA as well as ELISA inhibition assay. Around 40% of TDI-induced OA patients were positive for serum specific IgE by ELISA. Degrees of serum IgE binding were different depending on which TDI-HSA conjugate was used as an antigen. Moreover, binding patterns were different depending on the individuals. Interestingly, higher binding of IgE to TDI-HSA (5 min) than to TDI-HSA (30 min) which was more highly substituted was observed in some patients. Probably new antigenic epitopes on carrier proteins were targets of the specific IgE. The results of this study indicated that IgE responses to TDI-HSA conjugates were heterogeneous in TDI-induced OA patients and self-proteins modified by reactive chemicals can become a major target antigen of IgE in certain cases AU - Son M AU - Lee M AU - Kim YT AU - Youn JK AU - Park H LA - PT - DEP - TA - J Kor Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 8 IP - DP - 1998 Jan 01 TI - Reactive airways dysfunction syndrome: two case reports PG - 119-122 AB - Reactive airways dysfunction syndrome (RADS) is a type of asthma that develops in subjects without prior pulmonary disease, following single or multiple exposure to high levels of nonimmunogenic irritants. The main difference from classic occupational asthma is the absence of a latency period. Non-specific bronchial hyperresponsiveness is characteristic of the disease and usually persists after cessation of exposure. We report the cases of two subjects in whom RADS developed after occupational exposure to irritants AU - Tabar AI AU - Alvarez MJ AU - Acero S AU - Olaguibel JM AU - Garcia BE AU - Quirce S LA - PT - DEP - TA - Journal of Investigational Allergology & Clini JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 316 IP - DP - 1998 Jan 01 TI - Identifying asthma and chronic obstructive pulmonary disease in patients with persistent cough presenting to general practitioners: descriptive study PG - 1286-1290 AB - OBJECTIVE: To determine the prevalence of asthma and chronic obstructive pulmonary disease in patients not known to have these disorders, who present in general practice with persistent cough, and to ascertain criteria to help general practitioners in diagnosis. DESIGN: Descriptive study. SETTING: Primary healthcare centre in the Netherlands. SUBJECTS: 192 patients aged 18-75 years, not known to have asthma or chronic obstructive pulmonary disease, attending their general practitioner with cough persisting for at least 2 weeks. : A diagnosis of asthma or chronic obstructive pulmonary disease was based on the recurrence of airway symptoms in the past year accompanied by spirometric measurements (including bronchodilator testing) and methacholine provocation tests. A scoring formula to estimate the probability of asthma or chronic obstructive pulmonary disease, based on history and physical examination, was generated by means of logistic regression. RESULTS: 74 patients (39%) were classified as having asthma, 14 (7%) as having chronic obstructive pulmonary disease. The best formula for predicting asthma or chronic obstructive pulmonary disease used scores for three symptoms: (reported) wheeze, (reported) dyspnoea, and allergen induced symptoms, together with prolonged expiration, pack years of smoking, and female sex. Variables were scored 1 when present and 0 when absent, except for allergen induced symptoms (1.5) and number of pack years of smoking (n/25). With a cut off value of 3 on the scoring formula, 76% of the patients could be classified correctly. CONCLUSIONS: About half of patients with persistent cough who present to a general practitioner have asthma or chronic obstructive pulmonary disease. With a simple formula based on three symptoms and prolonged expiration, pack years of smoking, and female sex, most patients may be identified correctly in general practice AU - Thiadens HA AU - de Bock GH AU - Dekker FW AU - Huysman JA AU - van Houwelingen JC AU - Springer MP AU - Postma DS LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 101 IP - DP - 1998 Jan 01 TI - T-lymphocyte responses to plicatic acid-human serum albumin conjugate in occupational asthma caused by western red cedar PG - 841-847 AB - BACKGROUND: T cells are known to play a major role in the pathogenesis of atopic allergic asthma, but it is less clear whether they are involved in occupational asthma caused by low molecular weight chemicals such as plicatic acid. OBJECTIVES: We sought to determine whether peripheral blood T cells from patients with western red cedar asthma (WRCA) recognize plicatic acid (PA) conjugated to human serum albumin (HSA) as judged by proliferation or cytokine production and to analyze the response to PA inhalation with flow cytometry. RESULTS: Significant proliferative responses to PA-HSA were observed in eight of 33 patients with WRCA, none of 10 exposed nonasthmatic cedar workers, and one of 18 nonasthmatic control subjects. Two of 25 patients with WRCA also showed proliferative responses to unconjugated PA. All the WRCA responders were either currently exposed to cedar or had ceased exposure within the preceding 2 years. None of the four patients receiving oral steroids responded, but inhaled steroids did not seem to influence responsiveness. No correlations were found between the maximum stimulation response and any of the current FEV1 values, the current PC20 methacholine values, or the magnitude of the late asthmatic response to PA. Peripheral blood T-cell subset proportions and their degree of activation were similar in patients with WRCA and exposed control subjects. There was no change in T-cell phenotypes or their activation markers after PA inhalation challenge. In vitro, PA-HSA stimulation did not affect subset ratios but led to release of small amounts of IL-5 and IFN-gamma, with no detectable increase in IL-4. CONCLUSIONS: PA-HSA-specific T lymphocytes seem to be present in small numbers in the peripheral blood of patients with WRCA and may respond to antigenic exposure by producing IFN-gamma and IL-5. However, the proportion of responding cells would appear to be lower than in comparable studies of atopic asthma AU - Frew A AU - Chang JH AU - Chan H AU - Quirce S AU - Noertjojo K AU - Keown P AU - ChanYeung AU - M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 157 IP - DP - 1998 Jan 01 TI - Occupation, asthma, and chronic respiratory symptoms in a community sample of older women PG - 1864-1870 AB - We evaluated the role of occupational factors on the prevalence of self-reported asthma, chronic bronchitis, and asthma-like respiratory symptoms among women >= 55 yr. Occupational history, smoking, and respiratory conditions were collected through an interviewer-administered questionnaire from 1,226 women. Lung function data from 820 subjects were used for group "validation" of the outcome variables. Significant associations were observed between the respiratory conditions and occupational groupings based on the longest occupation held. Artists, writers, decorators, and photographers (odds ratio [OR] = 3.1), and women in service occupations (OR = 2.4) had a significantly increased risk of asthma. The odds of asthma-like symptoms was significantly elevated among nurses and other nonphysician health workers (OR = 2.9), social workers (OR = 2.9), and homemakers (OR = 2.4). Exposure to dusts, gas, vapors, fumes, or sensitizers was associated with a significantly increased odds of asthma (OR = 1.8) and with a marginally significant increased odds of asthma-like symptoms (OR = 1.4). Smoking accounted for a large proportion of asthma and asthma-like conditions in this population (population attributable risk [PAR] = 40.5% and 35.0%, respectively); employment in occupations with a high probability of exposures to dusts, gas, vapors, fumes, or sensitizers also contributed significantly to the burden of asthma (PAR = 15.1 to 20.0%) and asthma-like symptoms (PAR = 7.5 to 10.2%) AU - Forastiere F AU - Balmes J AU - Scarinci M AU - Tager IB LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 39 IP - DP - 1998 Jan 01 TI - Occupational asthma caused by orangutan in a zoo animal handler PG - 127-128 AB - A zoo animal handler developed bronchial asthma for the first time from handling orangutans (Pongo pygmaes). He had prior allergic reactions (rhinoconjunctivitis and urticarial rash), but no asthma, to deer and other hoofed animals in the zoo. In a worksite challenge, immediate and late onset of asthmatic symptoms and airflow obstruction were provoked by carrying a baby orangutan for about 20 minutes AU - Ng TP LA - PT - DEP - TA - Singapore Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Can reactive airways dysfunction syndrome (RADS) transform into occupational asthma due to "sensitisation" to isocyanates? PG - 152-153 AB - The case history is described of a worker who presented with a history suggestive of reactive airways dysfunction syndrome which occurred after an acute high level inhalation of diphenylmethane diisocyanate. Further exposure at work, at a time when concentrations of isocyanates were no longer "irritant", suggested occupational asthma; this diagnosis was confirmed by a specific inhalation challenge test AU - Leroyer C AU - Perfetti L AU - Cartier A AU - Malo JL LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 48 IP - DP - 1998 Jan 01 TI - Nasal challenge test in the diagnosis of allergic respiratory diseases in subjects occupationally exposed to a high molecular allergen (flour) PG - 91-97 AB - The objective of this study was the evaluation of the usefulness of the nasal challenge test in the diagnosis of allergic respiratory diseases in subjects occupationally exposed to flour. A single-blind, placebo controlled study was conducted in 100 subjects with occupational atopic asthma with rhinitis. The control groups consisted of 20 atopic subjects not sensitized to investigated allergens and 20 healthy subjects. A 'nasal pool' technique was used to evaluate the changes of the cellular response and protein level in nasal washings after topical provocation with allergen or placebo. The concentrations of eosinophil cationic protein and mast cell-derived tryptase in nasal fluid were evaluated in 60 cases. There were significant increases in eosinophil and basophils number, albumin/total protein ratio, eosinophil cationic protein and tryptase levels in occupationally sensitized patients challenged with specific allergens. There were neither severe bronchial reactions or an increase of bronchial hyperreactivity in occupationally sensitized patients after the nasal provocation with flour. The nasal challenge test appears to be a very useful and safe tool for diagnosing occupational allergy AU - Gorski P AU - Krakowiak A AU - Pazdrak K AU - Palczynski C AU - Ruta U AU - Walusiak J LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Is tyrosine kinase activation involved in basophil histamine release in asthma due to western red cedar? PG - 139-143 AB - Occupational asthma due to western red cedar is associated with histamine release from basophils and mast cells on exposure to plicatic acid (PA), but the mechanisms underlying this response remain unclear. Specific kinase inhibitors were used to study the role of tyrosine and serine/threonine kinases in PA-induced histamine release from human basophils. Pretreatment with the tyrosine kinase inhibitor methyl 2,5-dihydroxy-cinnamate (MDHC) attenuated histamine release from basophils triggered by anti-IgE (29.8% inhibition; n = 15; P < 0.01) or grass pollen (48% inhibition; n = 6; P < 0.01). Inhibition was concentration-dependent and could be reversed by washing the cells in buffer, while the inactive stereoisomer of MDHC did not affect histamine release. In contrast, the protein kinase C inhibitor staurosporine did not affect histamine release by either anti-IgE or grass pollen. Pretreatment with MDHC partially inhibited PA-induced histamine release from basophils of 6/9 patients with red cedar asthma (25.4% vs 33.8%; P = NS). Staurosporine gave a similar level of inhibition of PA-induced histamine release (25.3% vs 33.8%; P = NS). Thus, signal transduction of the human basophil Fc epsilon RI appears to depend upon tyrosine kinase activation, but not on protein kinase C (serine/threonine kinase) activation. The lack of specific effect on plicatic acid-induced histamine release in basophils obtained from patients with occupational asthma due to western red cedar suggests that tyrosine kinases are not as important in this disease as in atopic asthma, and is consistent with the view that histamine release in red cedar asthma is largely IgE-independent AU - Frew A AU - Chan H AU - Salari H AU - ChanYeung M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 28 IP - DP - 1998 Jan 01 TI - Occupational asthma in fruit salad processing PG - 363-367 AB - BACKGROUND: Three subjects employed in the preparation of fruit for fruit salads reported work-related respiratory symptoms. Their work entailed removing the peel from citrus fruits, primarily oranges, following soaking of the fruits in a bath of enzymes including fungal derived pectinase and glucanase. Objectives To investigate the respiratory symptoms reported by these workers and determine their causes. METHODS: The three workers were investigated by a respiratory physician, including spirometry and serial peak flow measurements. Blood was taken for the measurement of IgE and IgG antibody responses against the enzyme solution. RESULTS: Predominant symptoms in these workers were shortness of breath, chest tightness and wheezing which were all alleviated at weekends and holidays only to occur when returning to work. Serial peak flow measurements showed a clear work-related pattern. All three had strong IgE responses to the enzyme solution used at the workplace and showed distinct patterns of binding in immunoblots. All three improved immensely following withdrawal from the workplace environment. CONCLUSION: Enzymes appear to be widely used in the preparation of fruit and although they are used in liquid form, exposure can occur to induce immunological sensitization and asthma AU - Sen D AU - Wiley K AU - Williams JG LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 28 IP - DP - 1998 Jan 01 TI - Diethanolamine-induced occupational asthma, a case report PG - 358-362 AB - BACKGROUND: Amino alcohols are low molecular weight chemicals used widely in industrial processes, often as minor constituents. They have been found to cause allergic contact dermatitis. Marked exposure through airways is uncommon in other than occupational settings where chemicals containing amino alcohols may be heated or vaporized, liberating free amino alcohols into the ambient air. A few cases of asthma and allergic rhinitis have been reported, but the amounts inducing the airway reactions have not been defined. OBJECTIVE: To further characterize ethanolamine-induced asthma and define the concentration inducing the asthmatic reaction, a case of diethanolamine-induced occupational asthma in a patient handling diethanolamine containing cutting fluid is reported. METHODS: Suspicion of work related asthma was raised by symptoms and peak expiratory flow monitorings at work and at home. Specific bronchial provocation tests with the cutting fluid containing DEA and with DEA aerosol at two different concentration below the American Conference of Governmental Industrial Hygienists threshold limit value of DEA (2.0 mg/m3) were done. RESULTS: DEA caused asthmatic airway obstruction at two different concentrations below the ACGIH TLV. A slight dose-response relationship was observed. Specific IgE-antibodies against DEA could not be found. CONCLUSIONS: DEA is able to induce occupational asthma by a sensitization mechanism, the exact pathophysiological mechanism of which is not known AU - Piipari R AU - Tuppurainen M AU - Tuomi T AU - Mantyla L AU - HenriksEckerman ML AU - Keskinen H AU - Nordman H LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 330 IP - DP - 1998 Jan 01 TI - Identification of the major allergens in wheat flour responsible for baker's asthma PG - 1229-1234 AB - Baker's asthma, a typical occupational allergic disease, is a serious problem in the food industries. In this study, purification and identification of major allergens recognized by IgEs in sera of allergic patients were performed. Major immunoreactive proteins were purified from the albumin fraction by gel filtration on a Toyopearl HW-50 column followed by reverse-phase HPLC. The N-terminal amino acid sequences and molecular masses measured by MS indicated that the major immunoreactive proteins are members of the alpha-amylase inhibitor family, 0.19 and 0.28. Significant leukotriene release by each purified protein was observed in cell-associated stimulation tests, suggesting in vivo activity of these antigens. Carbohydrate analyses of major allergens indicated that they are monoglycosylated but not N-glycosylated in spite of the presence of a potential N-glycosylation site. Recombinant 0.19 expressed in Escherichia coli showed the same reactivity with IgE as native wheat 0.19 in Western blotting and ELISA using methyl vinyl ether maleic anhydride co-polymer as an immobilizing reagent, suggesting that the allergenic epitopes are located in the peptide portions AU - Amano M AU - Ogawa H AU - Kojima K AU - Kamidaira T AU - Suetsugu S AU - Yoshihama M AU - Satoh T AU - Samejima T AU - Matsumoto I LA - PT - DEP - TA - Biochem J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 42 IP - DP - 1998 Jan 01 TI - Mechanisms of occupational asthma induced by isocyanates. PG - 33-36 AB - Isocyanates are some of the most important low molecular weight chemicals associated with occupational asthma. These compounds are often volatile and they are highly reactive on mucous membranes, especially the conjunctivae and respiratory tract. Despite numerous data derived from experimental and clinical investigations, there is no agreement concerning the real mechanisms involved in isocyanate-induced occupational asthma. In fact, the cause of occupational asthma is multifactorial. The aim of this paper is to review the involved physiological causes of isocyanate-induced asthma; the main mechanisms are immunological, pharmacological and/or irritative. AU - Deschamps F AU - Prevost A AU - Lavaud F AU - Kochman S LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 33 IP - DP - 1998 Jan 01 TI - A case of sarcoidosis that developed three years after the onset of hard metal asthma. PG - 379-383 AB - A 23-year-old man who worked at a hard metal factory from 1988 had developed bronchial asthma in 1990. He was diagnosed as having bronchial asthma by inhalation challenge with cobalt. He never developed a severe attack after that by avoiding inhalation of cobalt. In 1993, he developed iridocyclitis, and his chest radiograph showed bilateral hilar lymph node swelling. He was diagnosed as having sarcoidosis with pathological certainty and an increased serum angiotensin-converting enzyme (ACE) level. On second admission, an inhalational challenge with cobalt resulted in no significant decrease of FEV1. Cobalt is well known to cause occupational asthma and other interstitial lung diseases. Although we could not get clear evidence suggesting an association between the sarcoidosis and his history of cobalt exposure, there is a possibility that changes in the immune reaction to cobalt might explain the improvement of asthma followed by sarcoidosis in this case. AU - SatohKamachi A AU - Munakata M AU - Kusaka Y AU - Amishima M AU - Furuya K AU - Takahashi T AU - Kawakami Y LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 52 IP - DP - 1998 Jan 01 TI - Spinach powder-induced exogenous allergic alveolitis [German] PG - 61-65 AB - A 51-year old woman developed hypersensitivity pneumonitis to spinach powder, which is used as a food dye. The diagnosis was confirmed by demonstration of IgG2-antibodies in the patient's serum to distinct bands of spinach extract by Western blotting. Furthermore an exposure test with the natural allergen was positive. Severe disease with fever, chills and dyspnoea developed after inhalation of native spinach powder. Arterial pO2 dropped significantly and pulmonary function tests showed severe restrictive impairment and reduction of diffusion capacity. Leucocyte count and the serum concentrations of the cytokines TNF alpha and IL6 and of the soluble IL2-receptor rose significantly in peripheral blood, whereas the concentration of neopterine did not change. 24 hours after exposure bronchoalveolar lavage showed an increase of neutrophils. In lung parenchyma mononuclear interstitial infiltrates and an epitheloid cell granuloma were seen AU - Schreiber J AU - Muller E AU - Becker WM AU - Zabel P AU - Schlaak M AU - Amthor M LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 71 IP - DP - 1998 Jan 01 TI - Occurrence of occupational asthma in aluminum potroom workers in relation to preventive measures PG - 53-59 AB - The purpose of this study was to investigate whether preventive measures such as reduction of exposure and the introduction of the histamine provocation test (HPT) as a selection instrument resulted in a lower incidence of potroom asthma (PA) and a longer time lag between the commencement of employment and the occurrence of PA. Between 1970 and 1990, 179 cases of PA were diagnosed. This period was divided into three periods. During period 1 (1970-1975), no exposure data were available. Period 2 (1976-1981) is characterized by known exposure data obtained by means of fluoride determinations in urine. At the beginning of period 3 (1982-1990) the HPT was incorporated into the preemployment medical examination. We computed the incidence density (ID) in the three periods and analyzed the timelag in relation to the year of employment and confounding factors such as age, atopic history, blood eosinophil counts, lung function, smoking habits at preemployment, and exposure level. After introduction of the preemployment HPT the ID decreased, but cases continued to occur (ID 11.6 in period 2 versus 2.5 in period 3). The time lag was did not differ when subjects with bronchial hyperresponsiveness were screened out. The exposure level and an atopic history were factors associated with the period of employment and, therefore, confounded the results. The results of this study support the role of an atopic history as a risk factor for development of PA at lower exposure levels and suggest that potroom exposure not only incites asthmatic symptoms but also acts as an inducer of respiratory disease AU - Sorgdrager B AU - De Looff AJ AU - De Monchy JG AU - Pal TM AU - Dubois AE AU - Rijcken B LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 38 IP - DP - 1998 Jan 01 TI - Contact urticaria caused by obeche wood (Triplochiton scleroxylon) PG - 170-171 AU - Kanerva L AU - Tuppurainen M AU - Keskinen H LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 13 IP - DP - 1998 Jan 01 TI - Immunohistochemical characterization of the cellular infiltrate in airway mucosa of toluene diisocyanate (TDI)-induced asthma: comparison with allergic asthma PG - 21-26 AB - Toluene diisocyanate (TDI) is the most prevalent agent in occupational asthma (OA) in Korea. The immuno-pathologic mechanism for TDI-induced bronchoconstriction remains to be clarified. We studied the immunohistochemical finding of inflammatory cells in bronchial mucosa in subjects with TDI-induced asthma. Fiberoptic bronchial biopsy specimens were obtained from nine subjects with TDI-induced asthma. Six allergic asthma sensitive to house dust mite were enrolled as controls. Bronchial biopsy specimens were examined by immunohistology with a panel of monoclonal antibodies to mast cell tryptase (AA1), secretary form of eosinophil cationic protein (EG2), pan T-lymphocyte (CD3) and neutrophil elastase (NE). There was a significant increase in the number of AA1+, EG2+ and NE+ cells in TDI-induced asthma compared to those of allergic asthma (p=0.02, p=0.04, p=0.03, respectively). No significant differences were observed in the number of CD3+ cells (p=0.27). These findings support the view that neutrophil recruitment together with eosinophil and mast cell, may contribute to the bronchoconstriction induced by TDI AU - Park HS AU - Hwang SC AU - Nahm DH AU - Yim HE LA - PT - DEP - TA - J Kor Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Occupational asthma in the community: risk factors in a western Mediterranean population PG - 93-98 AB - Risk factors and prevalence of occupational asthma in the general population were examined in a cross-sectional community study conducted in north Barcelona. A self-administered questionnaire that contained questions about bronchial asthma and occupation was mailed to a random sample of 4000 adults who lived in north Barcelona; the response rate was 31.0%. Investigators made phone calls to nonresponders to determine response bias. Risk factors for occupational asthma were assessed with logistic regression. Investigators, who sought a definite diagnosis of occupational asthma, offered a chest examination to all subjects who reported asthma in life and who experienced clinically relevant occupational exposures. The examination included skin tests to common allergens, forced spirometry with reversibility test, and peak expiratory flow rate at and away from work. Cumulative prevalences obtained from responders were good estimates for the general population: asthma in life, 9.0%; clinically relevant occupational exposure, 28.9%; and respiratory symptoms at work, 18.3%. Adjustments were made for age, sex, and smoking habits, and relevant exposure caused an increase in asthma risk (odds ratio [OR] = 1.9; 95% confidence interval [95% CI] = 1.1, 3.2); however, when investigators introduced specific occupations in the model as independent variables, only occupational exposure to leather (OR = 12.8 [95% CI = 4.4, 37.4]), animals (OR = 10.3 [95% CI = 1.6, 65.2]), dyes (OR = 5.6 [95% CI = 2.1, 15.3]), and flour (OR = 4.6 [CI = 1.3, 15.7]) persisted as significant risk factors. A 1.7/1000 minimum prevalence of occupational asthma for the north Barcelona population was estimated from chest examination results. Occupational risk for asthma appeared to be associated with exposure to leather, animals, dyes, or flour in the north Barcelona area AU - Monso E AU - MunozRino F AU - Izquierdo J AU - Roca J AU - Masia N AU - Rosell A AU - Morera J LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 5 IP - DP - 1998 Jan 01 TI - Irritant-induced asthma and reactive airways dysfunction syndrome PG - 66-67 AU - Malo JL LA - PT - DEP - TA - Can Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 2 IP - DP - 1998 Jan 01 TI - Bronchial asthma in two chemical fertilizer producing factories in eastern Saudi Arabia PG - 330-335 AB - SETTING: Two urea fertilizer producing factories in Saudi Arabia. OBJECTIVE: To determine the prevalence of respiratory symptoms and diseases in employees exposed to ammonia gas. DESIGN: A cross-sectional study involving 161 exposed subjects and 355 controls. All completed a respiratory symptoms questionnaire, with additional questions on present and past occupations. Ammonia concentrations were measured in the different sections of the factories. RESULTS: The ammonia levels in factory B were well below the threshold limit value (TLV) (range 0.02-7.0 mg/m3 of air). In factory A the range was 2.0-130.4 mg/m3. The control and exposed groups were comparable with respect to their smoking habits. The exposed subjects in factory A had significantly higher relative risks (RR) for all respiratory symptoms; the same was true for haemoptysis (RR: 4.1, 95% confidence interval: 1.63-10.28). Bronchial asthma, chronic bronchitis, and a combined diagnosis were significantly higher among those exposed to high cumulative ammonia levels. However, in the logistic regression analysis ammonia concentration was significantly related to cough, phlegm, shortness of breath with wheezing and bronchial asthma. CONCLUSION: Exposure to ammonia gas in the workplace is significantly associated with increase in respiratory symptoms and bronchial asthma. Re-engineering measures to lower the levels of ammonia in factory A are strongly recommended. The affected employees should be removed from further exposure and followed up AU - Ballal SG AU - Ali BA AU - Albar AA AU - Ahmed HO AU - alHasan AY LA - PT - DEP - TA - Int J Tuberc Lung Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 55 IP - DP - 1998 Jan 01 TI - Stepwise health surveillance for bronchial irritability syndrome in workers at risk of occupational respiratory disease PG - 119-125 AB - OBJECTIVES: Questionnaires, lung function tests, and peak flow measurements are widely used in occupational health care to screen for subjects with respiratory disease. However, the diagnostic performance of these tests is often poor. Application of these tests in a stepwise manner would presumably result in a better characterisation of subjects with respiratory disease. METHODS: Cross sectional data from workers exposed to acid anhydrides, to laboratory animals, and to flour dusts were used. Sensitivity and specificity were calculated from cross tables of different (combinations of) tests for bronchial hyperresponsiveness and bronchial irritability in the past four weeks (BIS). From sensitivity and specificity likelihood ratios were computed and change in probability of BIS was calculated. RESULTS: The prevalence of BIS was 7%, 7%, and 5%, respectively. In all groups questionnaire data provided excellent sensitivity but poor specificity, which was inherent on the broad definition of symptoms. Adding the forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio yields almost perfect specificity, and peak expiratory flow (PEF) variability is intermediate in populations in which smoking induced or non-allergic respiratory diseases predominates. In occupational groups in which asthma is a problem, adding PEF measurements will optimise sensitivity and specificity in detection of BIS. The probability of BIS for subjects with a negative combined test outcome was lower than the probability before testing. Subjects with a positive combined test outcome had a probability of BIS after the tests at least three times the probability before. CONCLUSIONS: Combined testing yields better sensitivity and specificity. An advantage of combined testing is an economy in the effort to screen for subjects with BIS. Combined testing resulted in more detailed estimation of the probability of BIS AU - Post WK AU - Venables KM AU - Ross D AU - Cullinan P AU - Heederik D AU - Burdorf A LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 40 IP - DP - 1998 Jan 01 TI - Irritant-associated vocal cord dysfunction PG - 136-143 AB - Vocal cord dysfunction (VCD) is a poorly understood entity that is often misdiagnosed as asthma. We report eleven cases of VCD in which there was a temporal association between VCD onset and occupational or environmental exposure. We conducted a case-control study to determine if the characteristics of irritant-exposed VCD (IVCD) cases differed from non-exposed VCD controls. Chart review of VCD patients at the authors' institution produced 11 cases that met IVCD case criteria. Thirty-three control VCD subjects were selected by age matching. There were statistical differences between the groups in ethnicity and chest discomfort. There were no statistical differences between the groups for gender, tobacco, smoking habits, symptoms, or pulmonary function parameters. Varied irritant exposures were associated with IVCD. IVCD should be considered in patients presenting with respiratory symptoms occurring after irritant exposures AU - Perkner JJ AU - Fennelly KP AU - Balkissoon R AU - Bartelson BB AU - Ruttenber AJ AU - Wood RP 2nd AU - Newman LS LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Occupational asthma specific to amoxicillin PG - 104-105 AU - Jimenez I AU - Anton E AU - Picans I AU - Sanchez I AU - Quinones MD AU - Jerez J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 101 IP - DP - 1998 Jan 01 TI - Environmental and clinical study of latex allergy in a textile factory PG - 327-329 AU - Pisati G AU - Baruffini A AU - Bernabeo F AU - Falagiani P LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 33 IP - DP - 1998 Jan 01 TI - Respiratory function and immunological status in workers employed in a latex glove manufacturing plant PG - 175-181 AB - A study was performed in 17 female workers employed in a latex glove manufacturing plant. The mean age of these workers was 42 years and the mean duration of their employment was 19 years. The employees were primarily nonsmokers or light smokers. The presence of chronic respiratory symptoms and acute work-related symptoms was recorded for these workers. Ventilatory capacity was measured during the morning work shift by recording maximum expiratory flow-volume curves from which forced vital capacity (FVC), 1-second forced expiratory volume (FEV1) and maximum expiratory flow at 50%, and the last 25% of the vital capacity (FEF50, FEF75) were measured. A control group of 17 nonexposed women workers was also studied. The prevalence of chronic respiratory symptoms was greater among latex workers than among control confectionary packer workers, varying from 5.9% (vs. 0% in controls) for occupational asthma to 58.8% (vs. 0% in controls) for dyspnea grades 3 or 4. There was also a high prevalence of acute work-related symptoms in this industry, in particular, eye irritation (76.5%), dryness of the nose (70.6%), throat burning (70.6%), dryness of the throat (64.7%), and cough (58.8%). Among exposed workers, measured ventilatory capacity data were significantly lower than among controls, particularly FEF75 (75.1% +/- 10.5%). One of the 17 studied workers (5.9%) had a positive skin reaction to latex and had symptoms compatible with occupational asthma. Our data suggest that in addition to occupational asthma, the manufacture of latex gloves is associated with frequent, nonspecific respiratory findings AU - Zuskin E AU - Mustajbegovic J AU - Kanceljak B AU - Schachter EN AU - Macan J AU - Budak AU - A LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 111 IP - DP - 1998 Jan 01 TI - Latex occupational asthma in the production of chewing gum. A case report PG - 399-399 AU - Martinez Rivera C AU - Monso Molas E AU - Izquierdo Ramirez J AU - Morera Prats J LA - PT - DEP - TA - Medicina Clinica JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 12 IP - DP - 1998 Jan 01 TI - Determinants of the bronchial response to high molecular weight occupational agents in a dry aerosol form PG - 885-888 AB - In occupational challenge tests with isocyanate vapours, bronchial responsiveness is determined by the total dose rather than the concentration or duration of exposure. Whether the same applies for high molecular weight (HMW) agents in powder form is unknown. The aim of this study was to determine whether the total dose of HMW agents in powder form is responsible for the immediate reaction documented in specific challenge tests. Included in the study were nine subjects (seven males and two females) with a diagnosis of occupational asthma proved by specific challenge tests carried out on a preliminary visit. Two challenge tests (using a closed-circuit exposure chamber) were performed at an interval of 2 weeks; the concentrations administered in a random order on these two visits were half and double the one that had caused a 20% fall in forced expiratory volume in one second (FEV1) on a preliminary visit. The duration of exposure was adjusted until a significant fall in FEV1 (target of 20%) occurred. The two concentrations obtained were significantly different, by 2.07+/-0.36-fold (SD). The observed durations of exposure leading to a 20% fall in FEV1 on the two visits also differed significantly by 0.46+/-0.32-fold. Consequently, the cumulative efficient doses were not significantly different between the two visits: 12+/-5.4 and 9+/-5 mg x mL(-1) x min(-1), respectively. The corresponding cumulative dose ratio was 0.96+/-0.61. The expected duration of exposure (10.8+/-24 min) was not significantly different from the observed duration (5.4+/-9 min). The mean and 95% confidence interval for the difference in concentration between the two visits was 1.83-fold (1.48-2.21). In conclusion, the total dose rather than the concentration or duration of exposure per se determines bronchial responsiveness to high molecular weight agents in powder form AU - Nguyen B AU - Weytjens K AU - Cloutier Y AU - Ghezzo H AU - Malo JL LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 81 IP - DP - 1998 Jan 01 TI - Serum IgG antibodies against Wallemia sebi and Fusarium species in Finnish farmers PG - 585-592 AB - BACKGROUND: Wallemia sebi and Fusarium species are common fungi in agricultural environments. Because Fusarium species are difficult to culture, and W. sebi has only recently been found in an agricultural environment with the use of a new culture medium, immunochemical methods may be important for evaluating exposure to these fungi. OBJECTIVE: Immunoglobulin (Ig) G antibodies against W. sebi and two Fusarium species were measured in the sera of Finnish farmers to estimate exposure to fungi. METHODS: Serum-specific IgG antibody levels against the fungi were determined in farmers with farmer's lung disease and asthma, as well as in asymptomatic farmers with low and high IgG antibody levels against other agricultural microorganisms, and in control persons (printing and office workers). Both enzyme-linked immunosorbent assay (ELISA) and enzyme-linked immunofiltration assay (ELIFA) techniques were used. RESULTS: Significantly higher IgG antibody levels against the fungi studied were observed in farmer's lung patients and asymptomatic farmers with high IgG levels against other agricultural fungi, than in the control group. On the other hand, the development of IgG antibodies to the fungi in asthmatic farmers remained unclear because of a discrepancy between the ELISA and ELIFA results. Cross-reactivity between Fusarium species was detected. CONCLUSIONS: The results indicate that Finnish farmers are exposed to W. sebi and Fusarium species in their work environment to a greater extent than has earlier been evaluated with air sampling and microbiologic methods AU - Lappalainen S AU - Pasanen AL AU - Reiman M AU - Kalliokoski P LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 8 IP - DP - 1998 Jan 01 TI - Obstruction of the small airways in the spirometric diagnosis of occupational bronchial asthma PG - 300-303 AB - The aim of this study was to evaluate spirometric changes after inhalation challenge in steel and tobacco factory workers suffering from bronchial asthma suspected to be of occupational origin. In 49 patients the spirometric changes were analyzed immediately after and 24 h (delayed reaction) after inhalation challenge at work. A decrease in spirometric parameters of 20% compared to baseline was considered significant. The suspicion of occupational bronchial asthma was based on anamnesis and skin patch tests. The atopy features in examined patients were evaluated according to anamnesis, skin prick tests with aeroallergens, as well as total IgE serum level and blood eosinophils. The significant decrease in spirometric parameters after the inhalation challenge at work was confirmed in 25 (51%) patients. In 16 of them (64%), the decrease of FEV1 value together with the decrease of the MEF 25-75% VC values were noted. A significant isolated decrease in the FEV1 was observed in only four (16%) patients. However, in five (20%) patients a significant decrease in MEF 25-75% VC values was only found as a confirmation of airways obstruction. The studies emphasize the diagnostic value of small airways obstruction in the evaluation of inhalation challenge tests in patients suspected of occupational bronchial asthma AU - Obtulowicz K AU - Laczkowska T AU - Kolarzyk E AU - Hudzik A LA - PT - DEP - TA - Journal of Investigational Allergology & Clini JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 55 IP - DP - 1998 Jan 01 TI - Risk factors for sensitisation and respiratory symptoms among workers exposed to acid anhydrides: a cohort study PG - 684-691 AB - OBJECTIVES: To examine the relation between exposure to acid anhydrides and the risk of developing immediate skin prick test responses to acid anhydride human serum albumin (AA-HSA) conjugates or work related respiratory symptoms; to assess whether these relations are modified by atopy or smoking. METHODS: A cohort of 506 workers exposed to phthalic (PA), maleic (MA), and trimellitic anhydride (TMA) was defined. Workers completed questionnaires relating to employment history, respiratory symptoms, and smoking habits. Skin prick tests were done with AA-HSA conjugates and common inhalant allergens. Exposure to acid anhydrides was measured at the time of the survey and a retrospective exposure assessment was done. RESULTS: Information was obtained from 401 (79%) workers. Thirty four (8.8%) had new work related respiratory symptoms that occurred for the first time while working with acid anhydrides and 12 (3.2%) were sensitised, with an immediate skin prick test reaction to AA-HSA conjugates. Sensitisation to acid anhydrides was associated with work related respiratory symptoms and with smoking at the time of exposure to acid anhydride. When all subjects were included and all three acid anhydrides were taken into account there was no consistent evidence for an exposure-response relation, but with the analysis restricted to a factory where only TMA was in use there was an increased prevalence of sensitisation to acid anhydrides and work related respiratory symptoms with increasing full shift exposure. This relation was apparent within the current occupational exposure standard of 40 micrograms.m-3 and was not modified significantly by smoking or atopy. CONCLUSIONS: Intensity of exposure and cigarette smoking may be risk factors for sensitisation to acid anhydrides. Exposure is also a risk factor for respiratory symptoms. As there was evidence for sensitisation to TMA at full shift exposures within the occupational exposure standard this standard should be reviewed AU - Barker RD AU - van Tongeren MJ AU - Harris JM AU - Gardiner K AU - Venables KM AU - Newman Taylor AJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 55 IP - DP - 1998 Jan 01 TI - Prevalence and predictors of work related respiratory symptoms in workers exposed to organic dusts PG - 668-672 AB - OBJECTIVES: The aims of this study were to document the prevalence of work related upper and lower respiratory tract symptoms in workers exposed to organic dusts and to identify variables predictive of their occurrence. METHODS: A cross sectional survey with an administered questionnaire (a previously validated adaptation of the Medical Research Council (MRC) respiratory questionnaire) was performed. Symptoms were classified as work related by their periodicity. Demographic data, smoking habits, and occupational histories were recorded. Personal exposures to dust and endotoxin were measured and individual subjects ascribed an exposure value specific to occupation, site and industry. Cos regression techniques were used to identify variables predictive of work related upper and lower respiratory tract symptoms. Information was stored using Dbase 3 and analysed with SPSS. RESULTS: 1032 Workers (93% of the target population) were studied in nine different industries. The highest prevalences of work related lower respiratory tract symptoms (38.1%), upper respiratory tract symptoms (45.2%), and chronic bronchitis (15.5%) were found among poultry handlers. White workers were significantly more likely to complain of upper and lower respiratory tract symptoms. An individual in the swine confinement industry had a symptom complex compatible with byssinosis. Increasing current personal exposures to dust or endotoxin were found to be predictive of upper and lower respiratory tract symptoms, chronic bronchitis, and byssinosis. In a univariate analysis a relation between current exposures and the organic dust toxic syndrome was found. Present smoking and previously documented respiratory tract illness were significantly predictive of work related lower respiratory tract symptoms. Women were more likely to report work related upper respiratory tract symptoms. CONCLUSIONS: People exposed to organic dusts may have a high prevalence of work related respiratory tract symptoms which are related to dust exposures and smoking habits. Action should be taken to reduce exposures to dust and endotoxin and stopping smoking should be promoted among workers exposed to organic dusts to reduce morbidity AU - Simpson JC AU - Niven RM AU - Pickering CA AU - Fletcher AM AU - Oldham LA AU - Francis HM LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 52 IP - DP - 1998 Jan 01 TI - German Society of Pneumology. Recommendations for prevention of occupational asthma PG - 504-514 AB - Wissenschaftliche Sektionen Allergologie und Immunologie und Epidemiologie, Arbeits-, Umwelt- und Sozialmedizin, Deutschen Gesellschaft fur Pneumologie AU - Baur X AU - Bergmann KC AU - Kroidl R AU - Merget R AU - MullerWening D AU - Nowak D LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 34 IP - DP - 1998 Jan 01 TI - Occupational respiratory allergy in bakery workers: a review of the literature. [Review] PG - 529-546 AB - Baker's asthma has long been recognized as a serious disease among workers in the bakery industry and the number of cases with baker's asthma is steadily increasing. This paper presents a review of the available literature on baker's allergy with a special focus on the allergens involved, the epidemiologic research and issues on exposure assessment, evidence of exposure-response-relationships, and possible prevention strategies. A large number of potential allergens have been identified and are described here. At present little is known about the incidence of baker's allergy. On the other hand, a large number of cross-sectional studies have been performed, showing that sensitization and work-related symptoms are common among bakery workers. Only atopy and exposure level have consistently been reported as determinants of this occupational disease. Age, gender, and smoking habits do not seem to be associated with sensitization or work-related respiratory symptoms. Recently, immunochemical methods have been developed to measure specific allergens in the bakery industry, which have been used to unravel the role of allergen exposure in the development of baker's asthma. Clear exposure-response-relationships have been found. The implications of these recent findings for prevention strategies and standard setting are discussed. AU - Houba R AU - Doekes G AU - Heederik D LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 65 IP - DP - 1998 Jan 01 TI - Occupational asthma due to chromium PG - 403-405 AB - We describe a 28-year-old subject employed as a roofer in a construction company since the age of 19, who developed work-related symptoms of a cough, shortness of breath, wheezing, rhinitis and headaches. A description of a usual day at work suggested that the symptoms worsened while he was sawing corrugated fiber cement. Baseline spirometry was normal, and there was a mild bronchial hyperresponsiveness to carbachol. A skin patch test to chromium was negative. A specific inhalation challenge showed a boderline fall in forced expiratory volume in 1 s (FEV1) after exposure to fiber cement dust. Exposure to nebulization of potassium dichromate (K2Cr2O7), at 0.1 mg.ml-1 for 30 min, was followed by an immediate fall by 20% FEV1. Simultaneously, a significant increase in bronchial hyperresponsiveness was demonstrated AU - Leroyer C AU - Dewitte JD AU - Bassanets A AU - Boutoux M AU - Daniel C AU - Clavier J LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 36 IP - DP - 1998 Jan 01 TI - Chronic hypersensitivity pneumonitis due to isocyanate in a patient presenting with acute symptoms 1 month after environmental exposure PG - 627-632 AB - Division of Respiratory Medicine, Hiratsuka Kyosai Hospital, Kanagawa, Japan A 51-year-old man who had been working for 10 years with polyurethane paint containing isocyanate (MDI) was admitted to our hospital with complaints of fever and exertional dyspnea. Fine crackles were heard in both bases, and the patient had clubbed fingers. A chest X-ray film and computed tomograms of the lungs revealed patchy infiltrative shadows in both lung fields and subpleural honeycombing associated with irregular linear areas. Examination of bronchoalveolar lavage fluid showed increased T lymphocytes and a decreased CD 4/8 ratio. Specimens obtained by transbronchial lung biopsy revealed lymphoplasmacytic infiltration into the thickened alveolar walls, macrophage accumulation, and micro-epithelioid cell granulomas in the alveolar sacs. Hypersensitivity pneumonitis was suspected although the causative antigen was not identified because the results of short-term environmental provocation tests were negative in the patient's home and workplace. After discharge, the patient continued working as a paint sprayer. His acute symptoms recurred 1 month after exposure to isocyanate. Similar episodes occurred on two separate occasions. In addition, the patient tested positive for antibody to MDI-HSA in bronchoalveolar fluid. From the above observations, the patient was given a diagnosis of chronic hypersensitivity pneumonitis due to isocyanate (MDI). This condition is extremely rare. Furthermore, it is interesting that acute symptoms recurred 1 month after environmental exposure to the causative antigen AU - Yoshimura N AU - Nodera H AU - Ohkouchi M AU - Tsukimoto K AU - Beppu H AU - Atarashi K AU - Ichioka M AU - Yoshizawa Y AU - Matsubara O LA - PT - DEP - TA - Nihon Kokyuki Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 48 IP - DP - 1998 Jan 01 TI - Respiratory symptoms and sensitization in bread and cake bakers PG - 321-328 AB - This purpose of this study was to examine the relationship between exposure to wheat flour, soya flour and fungal amylase and the development of work-related symptoms and sensitization in bread and cake bakery employees who have regular exposure to these substances. The study populations consisted of 394 bread bakery workers and 77 cake bakery workers whose normal jobs involved the sieving, weighing and mixing of ingredients. The groups were interviewed with the aim of identifying the prevalence, nature and pattern of any work-related respiratory symptoms. They were also skin-prick tested against the common bakery sensitizing agents, i.e., wheat flour, soya flour, rice flour and fungal amylase. The results of personal sampling for sieving, weighing and mixing operations at the bakeries from which the study groups were taken were collated in order to determine typical exposures to total inhalable dust from the ingredients, expressed as 8 hour time-weighted average exposures. Data from the health surveillance and collated dust measurements were compared with the aim of establishing an exposure-response relationship for sensitization. The prevalence of work-related symptoms in bread bakery and cake bakery ingredient handlers was 20.4% and 10.4% respectively. However, in a large proportion of those reporting symptoms in connection with work, the symptoms were intermittent and of short duration. It is considered that the aetiology of such symptoms is likely to be due to a non-specific irritant effect of high total dust levels, rather than allergy. None of the cake bakers and only 3.1% of the bread bakers had symptoms which were thought to be due to allergy to baking ingredients. Using skin-prick testing as a marker of sensitization, the prevalence of positive tests to wheat flour was 6% for the bread bakers and 3% for the cake bakers. Comparable prevalences for soya flour were 7% and 1% respectively. However, the prevalence of positive skin-prick tests to fungal amylase was 16% amongst the bread baking group with only a single employee (1%) in the cake baking group having a positive test. Furthermore, this employee had previously worked in a bread bakery. The difference in rates of sensitization to wheat flour between the bread and cake bakers is not statistically significant, whereas the difference for soya flour is at the borderline of statistical significance (p = 0.045). In contrast, the difference in fungal amylase sensitization is significant at the 0.1% level. For both bread and cake bakers, the 8 hour time-weighted average exposures for each of the activities showed a wide variation with mixing having the lowest average exposure and sieving the highest. Out of the allergens studied in this investigation, fungal amylase is the principal sensitizer in large scale bread bakeries, with the main source of exposure being the handling of bread improvers. In contrast, the risk of sensitization to wheat flour is low in both bread and cake bakeries. The absence of positive skin-prick tests in the subgroup of cake bakery employees who regularly handle fungal-amylase-containing flour suggests that their levels of exposure are below the threshold for sensitization to amylase. AU - Smith TA AU - Smith PW LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 49 IP - DP - 1998 Jan 01 TI - Ficus benjamina--the hidden allergen in the house PG - 2-5 AB - The weeping fig, Ficus benjamina (Fb), is a relatively common indoor allergen. Many cases of perennial allergic rhinoconjunctivitis and allergic asthma caused by Fb hypersensitivity are not detected. These patients typically have proven sensitization to housedust mites and do not improve after avoidance of exposure (encasing) and specific immunotherapy. The number of Fb sensitizations is increasing in Germany, which can partly be explained by the cross-reactivity between Hevea brasiliensis (Hb) latex and Fb and the rapidly increasing number of mostly occupational latex allergies. But Fb itself is a potential sensitizer which is widely spread as ornamental plant in homes and offices. As relevant indoor allergen Fb ranks third after housedust mites and pets but before molds among our allergy patients. For diagnosis, prick-tests with Fb-latex seem to be more sensitive than in vitro-methods (RAST, CAPRAST). Fb plants should not be kept in the homes of atopic individuals or persons with latex (Hb) allergy AU - Schenkelberger V AU - Freitag M AU - Altmeyer P LA - PT - DEP - TA - Hautarzt JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 168 IP - DP - 1998 Jan 01 TI - A case series of 71 patients referred to a hospital-based occupational and environmental medicine clinic for occupational asthma PG - 98-104 AB - In a ten-year period at the Occupational and Environmental Medicine Program (OEMP) of the University of Washington in Seattle, 71 patients were determined by attending physicians to have work-related asthma. In this cross-sectional descriptive study, we describe these patients. Data were obtained from a database maintained by the OEMP and from chart reviews. We found that the three most common specific agents causing asthma were isocyanates, red cedar, and crabs. At least one pulmonary function study was available for all patients and was positive in 56 patients (79%). Among the 71 asthma cases reported in this article, 18 (25%) were attributed to reactive airways dysfunction syndrome (RADS); 19 (27%) to exacerbation of pre-existing asthma; 27 (38%) to sensitization; and 7 (10%) had undetermined causes. We conclude that occupational asthma presents as a result of diverse exposures in multiple work settings and with an array of characteristics. Prevention efforts need to recognize this diversity AU - Wheeler S AU - Rosenstock L AU - Barnhart S LA - PT - DEP - TA - West J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 28 IP - DP - 1998 Jan 01 TI - Changes in IgE-mediated allergy to ubiquitous inhalants after removal from or diminution of exposure to the agent causing occupational asthma PG - 66-73 AB - BACKGROUND: One possibility, among others, for explaining the persistence of asthma symptoms in occupational asthma (OA) after the cessation of exposure to the causal agents may be that subjects become sensitized to ubiquitous inhalants. OBJECTIVE: The aim of this study was to evaluate the development or increase of IgE-mediated sensitization to ubiquitous allergens, both to high- and low-molecular-weight agents, in 100 subjects with OA after cessation of exposure. METHODS: Subjects were evaluated on a first visit, at the time of diagnosis of OA, coinciding with the cessation or diminution of exposure to the causal agent, and on a second visit, 5.8+/-3.3 years afterwards. At each visit, a history of ocular, nasal and asthmatic symptoms related to exposure to common allergens was obtained together with spirometry and assessment of bronchial responsiveness to methacholine. We analysed total IgE and specific IgE to Dermatophagoides farinae, D. pteronyssinus, birch, ragweed and timothy grass pollens, cat and dog danders, and Alternaria, using enzyme allergosorbent test (EAST) from blood samples taken on each visit. RESULTS: Total IgE levels showed a tendency to diminish. No changes were found in the number of positive EAST (presence of detectable levels of specific IgE) or in the levels of specific IgE. Although significantly more symptoms of rhinoconjunctivitis and asthma in contact with house dust (P < 0.05) and pets (P < 0.01) were reported on the second visit than on the first, no significant changes in the frequency of symptomatic sensitized subjects were found. CONCLUSION: Subjects with OA are unlikely to develop IgE-dependent sensitization to common inhalants after removal from exposure to occupational agents AU - Perfetti L AU - Hebert J AU - Lapalme Y AU - Ghezzo H AU - Gautrin D AU - Malo JL LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 33 IP - DP - 1998 Jan 01 TI - Respiratory function and immunological status in cocoa and flour processing workers PG - 24-32 AB - Respiratory function and immunological status were studied in 40 cocoa and 53 flour processing workers employed as packers in a confectionery industry and in 65 unexposed control workers in the same industry. A high prevalence of chronic respiratory symptoms was recorded in exposed workers, varying from 5.0% to 30.0% in cocoa workers and from 5.7% to 28.3% in flour workers. Occupational asthma was diagnosed in 2 (5%) of the cocoa workers and in 3 (5.7%) of the flour workers. None of the control workers suffered from occupational asthma. The prevalence of almost all chronic respiratory symptoms was significantly greater in cocoa and flour workers than in control workers. There was also a high prevalence of acute symptoms that developed during the work shift, being highest for cough (cocoa: 57.5%; flour: 50.9%) and eye irritation (cocoa: 50.0%; flour: 54.7%). Significant across-shift reductions of ventilatory capacity were recorded in exposed workers, being largest for flow rates at 50% and the last 25% of the vital capacity on maximum expiratory flow-volume (MEFV) curves (FEF50, FEF75). The prevalence of positive skin tests for cocoa (60.2%) was significantly higher than the prevalence of positive skin tests for flour (25.8%) among the 93 exposed workers (p < 0.05). Control workers had significantly lower prevalences of positive skin tests to cocoa (4.6%) and flour (12.3%) than exposed workers (p < 0.01). Increased total serum IgE levels were found in 17.5% of cocoa and in 18.7% of flour workers; none of the control workers had increased IgE levels. Bronchoprovocation testing demonstrated significant decreases in lung function following inhalation of cocoa dust extract and flour dust in workers with respiratory symptoms and large across-shift reductions in lung function. Dust concentrations in the working environment were higher than those recommended by Croatian standards. These data suggest that workers employed in the processing of cocoa and flour may be at a high risk for the development of allergic sensitization and respiratory impairment AU - Zuskin E AU - Kanceljak B AU - Schachter EN AU - GodnicCvar J AU - Mustajbegovic J AU - Budak A LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 27 IP - DP - 1998 Jan 01 TI - Risk of house staff tuberculin skin test conversion in an area with a high incidence of tuberculosis PG - 826-833 AB - We prospectively evaluated rates of tuberculin skin test (TST) conversion from July 1992 to June 1997 among house staff in the Emory University Affiliated Hospitals Training Program following implementation of expanded infection control measures for tuberculosis at Grady Memorial Hospital (Atlanta), which cares for approximately 200 patients with tuberculosis per year. Over 5 years, documented TST conversions occurred for 52 (2.4%) of 2,144 house staff. Conversion rates decreased after the first 6 months from 5.98 to 1.09 per 100 person-years worked over the next 4.5 years (P < .001). Multivariate analysis revealed that risk factors for TST conversion included graduation from a foreign medical school and being part of the house staff in the Department of Medicine; race or ethnicity, gender, and age were not risk factors. Over the last 4.5 years, the TST conversion rate among U.S. medical school graduate house staff (n = 1,928) was 0.72 per 100 person-years worked, and there was no significant difference in conversion rates between house staff in the Department of Medicine and house staff in other departments. In summary, TST seroconversion rates decreased significantly following full implementation of expanded infection control measures for tuberculosis and were low (< 1% per year) among U.S. medical school graduates despite their caring for large numbers of patients with tuberculosis at an inner-city public hospital AU - Blumberg HM AU - Sotir M AU - Erwin M AU - Bachman R AU - Shulman JA LA - PT - DEP - TA - Clin Infect Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 26 IP - DP - 1998 Jan 01 TI - APIC and CDC survey of Mycobacterium tuberculosis isolation and control practices in hospitals caring for children. Part 2: Environmental and administrative controls. Association for Professionals in Infection control and Epidemiology, Inc PG - 483-487 AB - BACKGROUND: The 1994 Centers for Disease Control and Prevention draft Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities did not exempt pediatric facilities from instituting controls to prevent nosocomial tuberculosis (TB) transmission. Many researchers contend that TB disease in children does not require such rigid controls. We surveyed acute-care pediatric facilities in the United States to determine adherence to environmental and administrative control recommendations. METHODS: The study included 4 mailings of a survey to infection control professionals at 284 US children's hospitals and adult acute-care hospitals with > 30 pediatric beds. RESULTS: Isolation rooms (IRs) generally conformed to recommended guidelines; 92% of respondents reported IRs with > or = 6 air changes per hour, 90% reported 1-pass air and negative pressure, and 89% reported that IRs were private rooms. A sufficient number of inpatient IRs were reported by 88%, but only 42% had IRs in outpatient areas, and 19% had IRs in off-site clinics. Employee tuberculin skin-test programs were in place at 98% of facilities, but policies pertaining to implementation varied. Employees' use of personal respirators increased at respondent hospitals from 1991 to 1994, but as late as 1994, nearly one third still used surgical masks for high-risk procedures. CONCLUSIONS: Environmental and administrative controls used by respondent hospitals largely conformed to published guidelines. Because definitive studies that quantify the risk of nosocomial M tuberculosis transmission in pediatric settings have yet to be performed, pediatric facilities are required to have the same protections in place as do their adult counterparts AU - Kellerman SE AU - Simonds D AU - Banerjee S AU - Towsley J AU - Stover BH AU - Jarvis W LA - PT - DEP - TA - American Journal of Infection Control JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 92 IP - DP - 1998 Jan 01 TI - Increasing frequency of tuberculosis among staff in a South African district hospital: impact of the HIV epidemic on the supply side of health care PG - 500-502 AB - To describe the changing frequency of tuberculosis among staff in a South African hospital, and to compare incidence in health workers with that in ancillary staff, the number and type of cases of tuberculosis among staff diagnosed between 1991 and 1996 were ascertained. The incidence rate of tuberculosis among health workers and ancillary staff was compared with the age-specific rate in the community (20-59 years old). In 1991-1992, 2 cases of tuberculosis were diagnosed among hospital staff; but in 1993-1996 there were 20 cases diagnosed (annualized incidence rates 138/100,000 and 690/100,000; P < 0.0001). Of 14 cases tested (64%), 12 (86%) were infected with human immunodeficiency virus (HIV). Most cases (82%) successfully completed treatment, but 4 died (18%). The incidence of tuberculosis amongst health workers (558/100,000 person-years of observation [PYO]) and ancillary staff (445/100,000 PYO) was not significantly different (P = 0.7), but it was lower than the incidence rate among 20-59 years old people in the community (1543/100,000). Tuberculosis has increased amongst hospital staff, secondary to the impact of HIV. The HIV epidemic is having a substantial impact on the health of hospital staff and interventions to counter this are urgently needed AU - Wilkinson D AU - Gilks CF LA - PT - DEP - TA - Transactions of the Royal Society of Tropical Medi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 26 IP - DP - 1998 Jan 01 TI - A continuing outbreak of multidrug-resistant tuberculosis, with transmission in a hospital nursery PG - 303-307 AB - We investigated an increase in cases of multidrug-resistant tuberculosis (MDRTB) at a large urban facility where a prior nosocomial outbreak of MDRTB had occurred. Nosocomial transmission appeared to account for this outbreak as well, including a cluster of cases in a newborn nursery. Seven of 24 patients (29%) described in this investigation may have been exposed in the hospital nursery during an approximately 2-week period. We believe this to be the first documented outbreak of MDRTB in a hospital nursery. The transmission in the nursery demonstrates that the possibility of exposure to unrecognized active tuberculosis in nursery and hospital personnel is always present. Infection and active disease in the infants developed after a relatively short period of exposure. These findings underscore the need for adherence to published infection control guidelines in health care settings AU - Nivin B AU - Nicholas P AU - Gayer M AU - Frieden TR AU - Fujiwara PI LA - PT - DEP - TA - Clin Infect Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 15 IP - DP - 1998 Jan 01 TI - The assessment of asbestos exposure PG - 239-245 AB - The aim of the study is to present the principles of assessing asbestos exposure in two different contexts: that of a patient suffering from pleuropulmonary pathology that could be attributed to asbestos and that of a group possible exposed to asbestos. In the first case this evaluation concerns past exposure and depends typically on information obtained during the course of an interview with the patient. In the second case, the exposure is assessed by atmospheric analysis. Jobs in which occupational exposure to asbestos occurs should be examined, the tasks which entail this exposure and objects containing asbestos are discussed in the first part of the article. The accent is placed on the source of exposure, and the use of materials containing asbestos outside the asbestos industry. Some guidelines enabling the appreciation of the intensity of asbestos exposure as a function of the jobs involved and the objects handled are suggested. Regulations and the principle of quantifying asbestos in the atmosphere during direct exposure in the working environment of the one hand and during the course of passive exposure in the environment of the other are discussed in the second part of the article AU - Orlowski E AU - Billon Galland MA LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - EH40 IP - DP - 1998 Jan 01 TI - Occupational exposure limits PG - - AU - Health and safety executive LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 48 IP - DP - 1998 Jan 01 TI - Mushroom worker's lung resulting from indoor cultivation of Pleurotus osteatus PG - 465-468 AB - Third Department of Internal Medicine, Kagoshima University School of Medicine, Japan Indoor cultivation of oyster mushroom Pleurotus osteatus lead to an outbreak of extrinsic allergic alveolitis in two workers. High titer of indirect fluorescent antibody and positive precipitins against basidiospores of P. osteatus were demonstrated in sera of the patients. Mushroom workers should protect themselves from the basidiospores, being aware of their pathogenicity AU - Mori S AU - NakagawaYoshida K AU - Tsuchihashi H AU - Koreeda Y AU - Kawabata M AU - Nishiura Y AU - Ando M AU - Osame M LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 48 IP - DP - 1998 Jan 01 TI - Respiratory symptoms among glass bottle workers--cough and airways irritancy syndrome? PG - 455-459 AB - Glass bottle workers have been shown to experience an excess of respiratory symptoms. This work describes in detail the symptoms reported by a cohort of 69 symptomatic glass bottle workers. Symptoms, employment history and clinical investigations including radiology, spirometry and serial peak expiratory flow rate records were retrospectively analyzed from clinical records. The results showed a consistent syndrome of work-related eye, nose and throat irritation followed after a variable period by shortness of breath. The latent interval between starting work and first developing symptoms was typically 4 years (median = 4 yrs; range = 0-28). The interval preceding the development of dysponea was longer and much more variable (median = 16 yrs; range = 3-40). Spirometry was not markedly abnormal in the group but 57% of workers had abnormal serial peak expiratory flow rate charts. Workers in this industry experience upper and lower respiratory tract symptoms consistent with irritant exposure. The long-term functional significance of these symptoms should be formally investigated AU - Gordon SB AU - Curran AD AU - Fishwick D AU - Morice AH AU - Howard P LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 52 IP - DP - 1998 Jan 01 TI - Asthma and rhinoconjunctivitis caused by castor bean dust PG - 539-540 AB - A 57 years old trader of agricultural goods with chronic asthma had attended our medical department for diagnosis and therapy. Since more than 35 years the patient had always experienced work-related asthma episode and rhinoconjunctivities when he worked in workplace where castor-bean oil cake as fertilizer was sold. With the intensive contact with castor-bean containing goods beginning about eight years ago, his asthma attack had become chronic. The allergological diagnosis confirmed that he had high-degree type I-allergy to castor-bean allergens AU - Baur X AU - Chen Z AU - Hurter T LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 120 IP - DP - 1998 Jan 01 TI - Sensitivity to latex and other rubber substances--an important occupational risk for health personnel (case report) PG - 213-214 AB - Sensitization to latex and rubber additives has been acknowledged during the last 10 years as a major occupational health problem among health-care workers. In sensitized persons, respiratory and/or skin symptoms may be present. Pathophysiologic mechanisms of senzitisation involve allergic reactions types I and IV (Coombs and Gell). In this case report we described a female health-care worker with sensitization to latex and rubber additives simultaneously present on the skin and in the respiratory system, caused by wearing protective rubber gloves. The complex diagnostic procedure involved in determination of occupational allergic diseases is discussed AU - KanceljakMacan B AU - Macan J AU - Plavec D AU - Zavalic M LA - PT - DEP - TA - Lijec Vjesn JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 33 IP - DP - 1998 Jan 01 TI - Occupational asthma: prevention by definition [editorial] PG - 427-429 AU - Wagner GR AU - Wegman DH LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 1 IP - DP - 1998 Jan 01 TI - A large outbreak of Q fever in the West Midlands: windborne spread into a metropolitan area? PG - 180-187 AB - The largest outbreak of the zoonotic disease Q fever recorded in the United Kingdom (UK) occurred in Birmingham in 1989. One hundred and forty-seven cases were identified, 125 of whom were males, and 130 of whom were between 16 and 64 years of age. Fewer cases of Asian ethnic origin were observed than expected (p < 0.01), and more smokers (p < 0.005). A case control study (26 cases and 52 matched controls) produced no evidence that direct contact with animals or animal products had caused the outbreak. The epidemic curve suggested a point source exposure in the week beginning 10 April. The home addresses of cases were clustered in a rectangle 11 miles (18.3 km) north/south by 4 miles (6.7 km) east/ west, and attack rates became lower towards the north. Directly south of this area were farms engaged in outdoor lambing and calving, a potent source of coxiella spores. A retrospective computerised analysis showed that the geographical distribution of cases was associated with a source in this area (p < 0.00001). On 11 April, unusual southerly gales of up to 78 mph (130 km/h) were recorded. The probable cause of the outbreak was windborne spread of coxiella spores from farmland to the conurbation AU - Hawker JI AU - Ayres JG AU - Blair I AU - Evans MR AU - Smith DL AU - Smith EG AU - Burge PS AU - Carpenter MJ AU - Caul EO AU - Coupland B AU - Desselberger U AU - Farrell ID AU - Saunders PJ AU - Wood MJ LA - PT - DEP - TA - Commun Dis Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 28 IP - DP - 1998 Jan 01 TI - Exhaled and nasal nitric oxide is increased in laboratory animal allergy. PG - 876-880 AB - BACKGROUND: Allergens from rats, mice, guinea pigs or rabbits cause up to 30% of exposed persons to develop specific immunoglobulin E (IgE) responses. Laboratory animal allergy (LAA) is among the highest occupational risks for asthma in the UK. Elevated levels of nitric oxide (NO) are found in exhaled breath in asthma. In LAA symptoms may progress from conjunctivitis, rhinitis to asthma. Health surveillance aims to detect early sensitization. OBJECTIVE: To assess whether an association exists between LAA and exhaled NO. METHODS: A cross-sectional study was performed in 39 laboratory workers undergoing LAA health surveillance. Volunteers completed two health questionnaires, had skin-prick tests, spirometry, total IgE and RAST tests. Exhaled and nasal NO was measured by chemiluminescence analyser (LR2000, Logan Research, Rochester, UK). RESULTS: There were 23 asymptomatic subjects (mean age 29.53 years) and 16 symptomatic subjects (29.63 years, P=0.95); 9 early LAA, seven LAA asthma. Exhaled NO was raised in those with LAA symptoms 17.97 ppb+/-1.24 (mean+/-SEM) compared with asymptomatics 6.08 ppb+/-1.15, P < 0.05. A trend of increased NO by allergic status was observed; asymptomatic, to early LAA, to asthma. One-way analysis of variance compared differences between groups (F ratio 13.93, P < 0.001). Symptomatic subjects also had raised nasal NO, vs asymptomatic subjects (mean difference 378 ppb, P < 0.05). A trend was again observed by allergic status (F ratio 5.28, P=0.01). CONCLUSION: Raised NO levels in LAA increasing with symptom severity suggest NO may prove a useful additional tool in monitoring for LAA, and possibly the response to exposure reduction or allergy due to other respiratory sensitizers. AU - Adisesh LA AU - Kharitonov SA AU - Yates DH AU - Snashell DC AU - Newman Taylor AJ AU - Barnes PJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 24 IP - DP - 1998 Jan 01 TI - Determinants of airborne rat and mouse urinary allergen exposure. PG - 228-235 AB - OBJECTIVES: The purpose of this study was to determine the factors affecting exposure to rat and mouse urinary allergens. METHODS: Ambient and personal air sampling was performed on a large scale in 7 laboratory animal facilities. RESULTS: Allergens were mainly present as large particles (>5.8 microm). The higher the number of animals in a room, the higher the allergen concentrations. Allergen levels were twice as high on Mondays as on other days due to the tasks performed on Mondays. Filter tops on animal cages were associated with 6-17 times lower ambient allergen levels. An inverse day-night rhythm for rats produced > or = 10 times higher rat urinary allergen levels. Personal exposure to rat and mouse urinary allergens differed between job titles but especially between facilities, probably because of differences in task performance and technology. Task-specific sampling revealed that the highest personal exposure levels occurred when contaminated bedding and high numbers of conscious animals were handled. The proportion of time spent on these tasks determined the degree of allergen exposure to a large extent. CONCLUSIONS: This study showed that the number of animals present in the room, use of filter top cages, and an inverse day-night rhythm were important determinants of rat and mouse urinary allergens in ambient air. Personal exposure to rat and mouse urinary allergens was predominantly determined by the task and site and, to a limited extent, by ambient exposure levels. The presented determinants can be used to develop exposure reduction strategies and also to aid epidemiologic studies of laboratory animal allergy. AU - Hollander A AU - Heederik D AU - Doekes G AU - Kromhout H LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 102 IP - DP - 1998 Jan 01 TI - Laboratory animal allergy. PG - 99-112 AB - Approximately one third of laboratory animal workers have occupational allergy to animal danders, and a third of these have symptomatic asthma. Sensitization generally occurs with the first 3 years of employment, and risk factors include atopic background, as well as job description as it relates to the intensity of exposure. A symptomatic worker can reduce allergen exposure with personal protective devices. A laboratory can further reduce exposure with generally available equipment, such as laminar flow caging, and procedures, such as frequent wet washing of vivaria and careful maintenance of ventilation systems. It is advisable to institute periodic medical screening of all laboratory animal workers with questionnaires and allergy skin testing in addition to providing them with training programs to reduce personal exposure. AU - Bush RK AU - Wood RA AU - Eggleston PA LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 55 IP - DP - 1998 Jan 01 TI - Decline in lung function related to exposure and selection processes among workers in the grain processing and animal feed industry. PG - 349-355 AB - OBJECTIVES: To follow up workers in the grain processing and animal feed industry five years after an initial survey, and to monitor exposures to organic dust and endotoxin and changes in prevalence of respiratory symptoms and lung function. METHODS: Outcome measures in the present survey were decline in lung function over five years, rapid annual decline in forced expiratory volume in one second (FEV1) above 90 ml.s-1, and loss to follow up. RESULTS: Among 140 workers included in the longitudinal analysis, annual decline in FEV1 and maximal mid-expiratory flow (MMEF) were significantly related to occupational exposure to dust and endotoxin in the grain processing and animal feed industry. Assuming a cumulative exposure over a working life of 40 years with an exposure of 5 mg.m-3, the estimated effect on the FEV1 would be a decline of 157 ml.s-1 (95% CI 13 to 300)-- that is, about 4% of the group mean FEV1 and 473 ml.s-1 (95% CI 127 to 800) of the MMEF (about 12%). Workers with a dust exposure > 4 mg.m-3 or endotoxin concentrations > 20 ng.m-3 at the 1986-8 survey had significantly higher risk of rapid decline in FEV1 (odds ratio (OR) 3.3, 95% CI 1.02 to 10.3). The relations between occupational exposure and decline in lung function in this study occurred, despite the selection through the healthy worker effect that occurred as well. Increasing working years was related to decreasing annual decline in FEV1 and fewer people with rapid decline in FEV1 (OR 0.04, 95% CI 0 to 0.61 for over 20 v < 5 working years in the grain processing and animal feed industry). The presence of respiratory symptoms at baseline was a strong predictor of subsequent loss to follow up. Baseline lung function was not found to be predictive of subsequent loss to follow up. However, among workers lost to follow up the number of working years was more strongly negatively related to baseline lung function than among the workers who were studied longitudinally. CONCLUSIONS: The existence of the healthy worker effect implies that an exposure-response relation in the grain processing and animal feed industry may well be underestimated. This should be taken into account when health based recommended limit values are to be developed. AU - Post W AU - Heederik D AU - Houba R LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 42 IP - DP - 1998 Jan 01 TI - Individual-based and group-based occupational exposure assessment: some equations to evaluate different strategies. PG - 115-119 AB - Basically, two strategies can be considered for the analysis of hazardous pollutants in the work environment: group-based and individual-based strategies. This paper provides existing and recently derived equations for both strategies describing the influence of several factors on attenuation and on the standard error of an estimated linear regression coefficient relating a continuous exposure variable and a continuous health outcome via asimple linear regression model. We applied these equations using exposure variability information from industry-wide surveys over the past decade in order to gain more insight into the effects of various sources of exposure variability on choices among different analysis strategies. In general, for the modeling scenario considered here, there is not a straightforward criterion for choosing an optimal analysis strategy. Researchers have to decide between individual-based strategies generating precise, though biased, estimates or group-based strategies generating less precise but essentially unbiased estimates. For most exposure variability scenarios evaluated, an individual-based strategy yielded substantial attenuation. It is the authors' contention that the choice between individual-based and group-based strategies should be based on validity, rather than on precision, of the estimated exposure-response coefficient. AU - Tielemans E AU - Kupper LL AU - Kromhout H AU - Heederik D AU - Houba R LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 53 IP - DP - 1998 Jan 01 TI - Occupational asthma caused by exposure to asparagus: detection of allergens by immunoblotting PG - 1216-1220 AB - BACKGROUND: Vegetables of the Liliaceae family, such as garlic or onion, have been reported to cause occupational asthma. However, there are few data on adverse reactions to asparagus. We evaluated the role of asparagus as a cause of asthma in a patient with respiratory symptoms occurring at work (horticulture) and studied relevant allergens. METHODS: A 28-year-old man complained of rhinoconjunctivitis and asthma when harvesting asparagus at work. Eating cooked asparagus did not provoke symptoms. A positive skin test reaction was observed with raw asparagus, Alternaria alternata, and grass-pollen extracts. The methacholine test demonstrated mild bronchial hyperresponsiveness. The patient had an immediate asthmatic response after challenge with raw asparagus extract. Bronchial provocation tests with boiled asparagus, A. alternata, and control extracts were negative. Two unexposed subjects with seasonal allergic asthma did not react to the raw asparagus extract. RESULTS: The double-blind, placebo-controlled food challenge with raw asparagus was negative. Serum asparagus-specific IgE was 13.9 kU(A)/l. By SDS-PAGE immunoblot, at least six IgE-binding components, ranging from 22 to 73 kDa, were detected only in raw asparagus. CONCLUSIONS: We report a case of occupational asthma caused by asparagus inhalation, confirmed by specific bronchoprovocation. Immunoblot analysis showed that asparagus allergens are very labile and quite sensitive to heat denaturation AU - LopezRubio A AU - Rodriguez J AU - Crespo JF AU - Vives R AU - Daroca P AU - Reano M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 48 IP - DP - 1998 Jan 01 TI - SWORD '97: surveillance of work-related and occupational respiratory disease in the UK. PG - 481-485 AB - SWORD is one of seven clinically based reporting schemes which together now provide almost comprehensive coverage of occupational diseases across the UK. Although SWORD is now in its tenth year, participation rates remain high. Of an estimated 3, 903 new cases seen this year, 1,031 (26%) were of occupational asthma, 978 (25%) of mesothelioma, 794 (20%) of non-malignant pleural disease, 336 (9%) of pneumoconiosis and 233 (6%) of inhalation accidents. Incidence rates of occupational asthma were generally highest among workers in the manufacture of wood products, textiles and food (particularly grain products and crustaceans) and additionally, in the production of precious and non-ferrous metals, rubber goods, detergents and perfumes, and in mining. Health care workers were noted to have a surprisingly high incidence of inhalation accidents. Occupational asthma attributed to latex has increased dramatically; the highest rates are among laboratory technicians, shoe workers and health care workers. AU - Ross DJ AU - Keynes HL AU - McDonald JC LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 49 IP - DP - 1998 Jan 01 TI - Respiratory function and allergic reactions in paper recycling workers [Serbo-Croatian (Roman)] PG - 165-177 AB - Respiratory function and allergic reactions were studied in 101 male workers in paper recycling and in 87 nonexposed male control workers. Ventilatory capacity was measured by recording maximum expiratory flow-volume (MEFV) curves with readings on forced vital capacity (FVC), one-second forced expiratory volume (FEV1), and maximum expiratory flows at 50% and the last 25% (FEF50 and FEF25, respectively). Skin prick test with paper dust allergens, some nonoccupational allergens, and total immunoglobulin IgE analysis were used to assess immunological status. Significantly higher prevalences of all chronic respiratory symptoms were recorded in the exposed workers than in controls. The highest prevalence was recorded for chronic cough (36.6%), followed by chronic phlegm (34.7%), chronic bronchitis (33.7%), sinusitis (31.7%), nasal catarrh (29.7%), and dyspnea (16.8%). Occupational asthma was diagnosed in four paper recycling workers only (4.0%). Values of FEF50 and FEF25 were significantly lower than predicted, indicating obstructive changes located mostly in the smaller airways. Skin tests to paper allergens were found positive in 16 (15.8%) paper recycling workers and none in controls. An increase in total immunoglobulin IgE was found in 21 of 101 paper recycling workers and in two of 37 of controls (P < 0.05). Our data indicate that exposure to air pollutants in paper recycling industry may lead to the development of respiratory symptoms accompanied by lung function and immunological impairment AU - Zuskin E AU - Mustajbegovic J AU - KanceljakMacan B AU - Macan J AU - DeckovicVukres V AU - Vitale K LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 92 IP - DP - 1998 Jan 01 TI - Increase in non-specific bronchial hyperresponsiveness without specific response to isocyanate in isocyanate-induced asthma: a pilot study PG - 1093-1098 AB - Increased non-specific bronchial hyperresponsiveness (BHR) has been reported after positive reaction to isocyanates in patients with isocyanate-sensitive asthma. The increased responsiveness may, however, also precede the asthma attack. We therefore compared non-specific BHR to a cholinergic agent before and after exposure to toluene-diisocyanate (TDI) that induced no asthma symptoms in 11 workers with isocyanate-related asthma. Patients were exposed for 3 consecutive days to progressively increasing doses of TDI (5, 10, and 20 ppb min-1 for 20 min) in an exposure chamber with continuous TDI monitoring. No immediate nor late asthmatic bronchial reaction was observed in any patient after any dose of TDI during or after challenge. A significant increase in non-specific BHR was noted 24 h after the last dose of TDI challenge, however. This increase was at least one doubling dose for seven of 11 patients. In conclusion, our study shows that, in patients with isocyanate-induced asthma, exposure to TDI induces a slight but significant increase in non-specific BHR in the absence of any immediate or late bronchial response to isocyanate. This result, which requires further confirmation, may justify a proposal to measure non-specific BHR, even after a negative specific inhalation test to TDI, as an additional diagnostic element for TDI-induced occupational asthma, to help lower the percentage of the undetected occupational asthma cases AU - KopferschmittKubler MC AU - Frossard N AU - Rohde G AU - Pauli G LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 28 IP - DP - 1998 Jan 01 TI - Occupational respiratory hypersensitivity caused by preparations containing acrylates in dental personnel PG - 1404-1411 AB - BACKGROUND: Allergic contact dermatitis caused by acrylate compounds is common in dental personnel; they also often complain of work-related respiratory or conjunctival symptoms. OBJECTIVE: The aim of the present study was to report the cases of acrylates induced respiratory hypersensitivity in dental personnel diagnosed in Finland during the last 6 years. METHODS: Occupational asthma, rhinitis, laryngitis and pharyngitis cases were diagnosed according to patient history, PEF monitoring, and a work-simulating provocation test. RESULTS: Twelve cases of respiratory hypersensitivity caused by acrylates diagnosed in dental personnel (six dentists and six dental nurses) in 1992-97 are reported. During this period one case of conjunctivitis and one of laryngitis have been published separately. Nine cases of occupational asthma, two rhinitis cases, and one laryngitis case were verified according to the challenge tests with dental acrylate compounds (acrylates, methacrylates and epoxy acrylates). Only three patients had positive skin-prick test reactions to common environmental allergens, and none reacted to acrylates in the skin-prick tests. Five patients had an elevated total IgE (>110 kU/L). PEF follow-up showed an occupational effect in all examined eight patients with diagnosed asthma. The mean duration of exposure to acrylates was 22 years, and the duration of respiratory symptoms 8 years. CONCLUSIONS: The results indicate that acrylates constitute an important hazard for dental workers. The mechanism of respiratory hypersensitivity is still unknown, and it is probably not IgE-mediated AU - Piirila P AU - Kanerva L AU - Keskinen H AU - Estlander T AU - Hytonen M AU - Tuppurainen M AU - Nordman H LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 102 IP - DP - 1998 Jan 01 TI - Diisocyanate antigen-enhanced production of monocyte chemoattractant protein-1, IL-8, and tumor necrosis factor-alpha by peripheral mononuclear cells of workers with occupational asthma PG - 265-274 AB - BACKGROUND: Previous studies have shown a significant association between confirmed diisocyanate-induced asthma (DOA) and in vitro production of diisocyanate antigen-stimulated histamine-releasing factors by PBMCs. Chemokines found in PBMC supernatants are known to express histamine-releasing factor activity. OBJECTIVE: PBMCs of diisocyanate-exposed workers were tested in vitro for diisocyanate antigen-specific enhancement of monocyte chemoattractant protein-1 (MCP-1), monocyte chemoattractant protein-3 (MCP-3), macrophage inflammatory protein-1alpha, RANTES, IL-8, and T-cell cytokines that could play a regulatory role in chemokine synthesis (IL-4, IL-5, IFN-gamma, and TNF-alpha. METHODS: Secretion of chemokines and cytokines was determined by quantitative immunochemical assays of PBMC supernatants. Synthesis of mRNA for beta-chemokines was determined by reverse transcription-polymerase chain reaction. RESULTS: PBMCs of workers with DOA showed significantly enhanced secretion for MCP-1 compared with diisocyanate-exposed asymptomatic workers (P < .05). In vitro induction of antigen-stimulated MCP-1 mRNA synthesis in cultured PBMCs was demonstrated by reverse-transcription polymerase chain reaction. Quantitation of cytokines in supernatants showed increased mean production of IL-8 and TNF-alpha. IFN-gamma, IL-4, and IL-5 were not enhanced in subjects with DOA. CONCLUSION: Antigen stimulation of MCP-1 and TNF-alpha suggest that diisocyanate-specific cellular immune reactions result in activation of macrophages, which may be important in the pathogenesis of DOA AU - Lummus ZL AU - Alam R AU - Bernstein JA AU - Bernstein DI LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 55 IP - DP - 1998 Jan 01 TI - Occupational asthma due to porcine pancreatic amylase [letter] PG - 434-434 AU - Blain PG AU - Loughney E LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 28 IP - DP - 1998 Jan 01 TI - Neutrophil infiltration and release of IL-8 in airway mucosa from subjects with grain dust-induced occupational asthma PG - 724-730 AB - BACKGROUND: The immuno-pathological mechanism for occupational asthma induced by grain dust (GD) remains to be clarified. There have been few reports suggesting the involvement of neutrophils inducing bronchoconstriction after inhalation of GD. OBJECTIVE: To further understand the role of neutrophil in the pathogenesis of GD-induced asthma. MATERIALS AND METHODS: We studied the phenotype of leucocytes of the bronchial mucosa in patients with GD-induced asthma. Bronchial biopsy specimens were obtained by fibreoptic bronchoscopy from six subjects with GD-induced asthma. Six allergic asthma patients sensitive to house dust mite were enrolled as controls. Bronchial biopsy specimens were examined by immunohistochemistry with a panel of monoclonal antibodies to tryptase-containing mast cell (AA1), activated eosinophil (EG2), pan T-lymphocyte (CD3) and neutrophil elastase (NE). Induced sputum was collected before and after the GD-bronchoprovocation test. The IL-8 level in the sputum was measured using ELISA. RESULTS: There was a significant increase in the number of AA1+ and NE+ cells in bronchial mucosa of GD-induced asthma, compared with those of allergic asthma (P=0.01, P=0.01, respectively). No significant differences were observed in the number of EG2+ and CD3+ cells (P = 0.13, P=0.15, respectively). IL-8 was abundant in the sputum of all GD-induced asthma patients and significantly increased after the bronchial challenges compared with the baseline value (P = 0.03). CONCLUSION: These findings support the view that neutrophil recruitment together with mast cells may contribute to the bronchoconstriction induced by GD. A possible involvement of IL-8 was suggested AU - Park HS AU - Jung KS AU - Hwang SC AU - Nahm DH AU - Yim HE LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 40 IP - DP - 1998 Jan 01 TI - Long-term health and employment outcomes of occupational asthma and their determinants PG - 481-491 AB - Occupational asthma is common, yet little is known about long-term outcomes in the United States. A case series of 55 (of 72) occupational asthma patients were interviewed in follow-up 31 (+/-15) months after removal from the cause to evaluate asthma severity and employment outcomes. Standard criteria were used to rate severity. At follow-up, 54 subjects (98%) had active asthma, of which 26 cases (47%) were "severe." Multivariate analysis showed increased risk of "severe" asthma for women (odds ratio [OR] = 13.8; 95% confidence interval [95% CI] = 1.3 to 151.7) and industrial sector workers (OR = 11.9; 95% CI = 1.3 to 109.8). Thirty-eight subjects (69%) were unemployed, risk being greater for those with "severe" asthma (OR = 20.9; 95% CI = 1.9 to 229.8) and for those without a college degree (OR = 7.3; 95% CI = 1.2 to 43.4). These results indicate that occupational asthma is disabling and probably irreversible for most patients referred to a specialty clinic, despite prolonged removal from causative agents. Women, industrial workers, and those with severe asthma or lack of a college degree appear to be at risk for worse outcomes. Greater efforts at primary and secondary prevention should lessen the burden of long-term illness and unemployment due to occupational asthma AU - Gassert TH AU - Hu H AU - Kelsey KT AU - Christiani DC LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 33 IP - DP - 1998 Jan 01 TI - Airway response to formaldehyde inhalation in asthmatic subjects with suspected respiratory formaldehyde sensitization PG - 274-281 AB - The aim of the study was to characterize the mechanism of formaldehyde (FM)-induced nasal and bronchial response in asthmatic subjects with suspected FM allergy. Ten subjects purported to have FM rhinitis and asthma and 10 healthy subjects submitted to an inhalation provocation in an exposure chamber with FM at a dose of 0.5 mg/m3 over 2 hr. Spirometry at rest and following bronchial provocation with histamine (PC20) were recorded before and after FM inhalation. In addition, FM-specific serum IgE antibodies were measured and cellular, biochemical, and mediator changes were assessed in nasal lavage before, and immediately after, provocation and at 4 hr and 24 hr later. Provocation with FM caused only transient symptoms of rhinitis in both groups. None of the subjects supposed to have occupational asthma developed clinical symptoms of bronchial irritation. No specific IgE antibodies to FM were detected in persons with occupational exposure to FM. No differences in the nasal response to FM were found between subjects reporting to have occupational allergic respiratory diseases and healthy subjects (P > 0.05). In summary, inhaled formaldehyde at a level as low as 0.5 mg/m3 did not induce a specific allergic response either in the upper or in the lower part of the respiratory tract. Moreover, there is no difference in nasal response to FM in asthmatic subjects occupationally exposed to FM and healthy subjects AU - Krakowiak A AU - Gorski P AU - Pazdrak K AU - Ruta U LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 33 IP - DP - 1998 Jan 01 TI - Respiratory findings in synthetic textile workers PG - 263-273 AB - We studied 308 female and 92 male textile workers employed in a factory that produced synthetic fiber hosiery. The mean age of the women was 38 years, their mean duration of employment 16 years. The mean age of the men was 39 years with a mean duration of employment of 16 years. A control group of 160 female and 78 male nonexposed workers was also studied. Chronic and acute work related symptoms were recorded for all workers. Ventilatory capacity was measured by recording maximum expiratory flow-volume (MEFV) curves from which the forced vital capacity (FVC), the 1-sec forced expiratory volume (FEV1) and maximum expiratory flow rates at 50% and the last 25% (FEF50, FEF75) were read. There was a higher prevalence of all chronic respiratory symptoms in exposed than in control workers, although the differences were statistically significant only for dyspnea, sinusitis, and nasal catarrh (P < 0.01) in female synthetic textile workers, and for nasal catarrh (P < 0.01) in male synthetic textile workers. Occupational asthma was recorded in 3 (0.9%) of the women textile workers, and in 1 (1.1%) of male textile workers. There was a high prevalence of acute symptoms during the work shift, which was greatest for cough (female: 46%; male: 59%), dryness of the throat (female: 49%; male: 40%), dryness of the nose (female: 53%; male: 43%) and eye irritation (female: 46%; male: 36%). Ventilatory capacity data among the synthetic textile workers demonstrated significantly decreased FEF75 compared to predicted (P < 0.05). Our data suggest that inhalation of dust in synthetic textile plants causes the respiratory impairment AU - Zuskin E AU - Mustajbegovic J AU - Schachter EN AU - Kern J AU - Budak A AU - GodnicCvar J LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19980101 IS - IS - VI - 52 IP - DP - 1998 Jan 01 TI - Effectiveness of secondary preventive programs for patients with asthma and rhinitis in the baking industry PG - 656-665 AB - Berufsgenossenschaft Nahrungsmittel und Gaststatten, Mannheim Since 1992 the German industrial professional association for the food industry and gastronomy (Berufsgenossenschaft Nahrungsmittel und Gaststatten), which is responsible for statutory accident insurance has been offering a specific patient education programme to bakers suffering from occupationally induced obstructive pulmonary disease or allergic rhino-conjunctivitis, who do not quit their jobs and wish to continue working as bakers. The programme aims at preventing aggravation of the disease 74 male bakers with a mean duration of illness of 10 years on entering the programme were examined between 1 and 5 years (mean: 2.9) after participating in the patient education seminar. For a subpopulation of 55 of these patients spirometric measurements were available for the time before programme entry and at follow-up. Data on time spent at the bakehouse, prevalence of symptoms, frequency of symptoms at the site of working and during leisure hours, sleep disturbances and emergency situations were collected at the follow-up examination both for the time before programme entry and at follow-up, respectively. Direct ratings of the amount of changes in distress caused by the disease and of the quality of life were also obtained. The prevalence of 8 of the 9 most frequently reported symptoms decreased significantly, e.g. dysponoea from 70% to 42% and fear of suffocation from 30% to 3%. Participants reported on highly significant reductions in the frequency of disease-specific complaints during work and outside the working place, sleep disturbances and situations requiring immediate medical intervention. Between 64% and 85% of the patients experienced improvement of distress, physical and work performance, private and family life, and ability for self-management. Lung function did not deteriorate: mean FEV1 was 88% (+/- 23) at first and 90% (+/- 19) at second measurement. These results could not be explained by changes in medication. It is concluded that the programme is effective in reducing symptoms and distress and in improving quality of life in bakers with occupational respiratory disease who voluntarily continue to work as bakers AU - Grieshaber R AU - Nolting HD AU - Rosenau C AU - Stauder J AU - Vonier J LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 47 IP - DP - 1997 Jan 01 TI - SWORD '96: surveillance of work-related and occupational respiratory disease in the UK PG - 377-381 AU - Ross DJ AU - Keynes HL AU - McDonald JC LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 118 IP - DP - 1997 Jan 01 TI - Cytokine mRNA expression in lung tissue from toxic oil syndrome patients: a TH2 immunological mechanism PG - 61-70 AB - In 1981, an epidemic occurred in Spain, toxic oil syndrome (TOS), in people who consumed rapeseed oil denatured with 2% aniline, and it was one of the largest intoxication epidemics ever recorded. In 1989, a similar disease, eosinophilia-myalgia syndrome (EMS) was reported in the USA and was associated with the ingestion of L-tryptophan. The pathologic findings in TOS showed primary endothelial injury, with cell proliferation and perivascular inflammatory infiltrates. Immunologic mechanisms have presumably been operative in the pathogenesis and perpetuation of TOS. Our previous findings pointed to a T-cell activation during acute phase of the disease. In order to analyze which T-cell subset is involved on TOS, we have developed an mRNA extraction procedure from paraffin-embedded lung tissues in patients with pulmonary involvement. We analyzed mRNA expression from different cytokines (IL-1, IL-2, IL-4, IL-5, IFN-gamma, GM-CSF) and CD25 (interleukin 2 receptor) and CD23 (low affinity IgE receptor), using RT-PCR technique. In lung tissues from these patients a T-cell activation was observed. We found a significant increase in Th1 (P = 0.006) and Th2 (P = 0.003) cytokine profile in TOS patients with respect to controls. The increment in TH2 response with respect to TH1 is significant (P = 0.03) in TOS lung specimens. Non-significant differences were obtained in other cytokines and receptors studied as IL-1, CD25, CD23 and GM-CSF. Data presented in this paper are the first clear evidence that an immunological mechanism is directly implicated in this illness AU - del Pozo V AU - de Andres B AU - Gallardo S AU - Cardaba B AU - de ArrudaChaves E AU - Cortegano MI AU - Jurado A AU - Palomino P AU - Oliva H AU - Aguilera B AU - Posada M AU - Lahoz C LA - PT - DEP - TA - Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 54 IP - DP - 1997 Jan 01 TI - Prevalence of the sick building syndrome symptoms in office workers before and six months and three years after being exposed to a building with an improved ventilation system PG - 49-53 AB - OBJECTIVE: The prevalence of symptoms associated with the sick building syndrome (SBS) has recently been shown to decrease by 40% to 50% among office workers six months after they were exposed to a building with an improved ventilation system. The objective of the present study was to find whether the decrease in the prevalence of symptoms was maintained three years later. METHODS: Workers from the same organisation occupied five buildings in 1991 and moved during that year to a single building with an improved ventilation system. All buildings had sealed windows with mechanical ventilation, air conditioning, and humidification. Workers completed a self administered questionnaire during normal working hours in February 1991 before moving, in February 1992 six months after moving, and in February 1995, three years after moving. The questionnaire encompassed symptoms of the eyes, nose and throat, respiratory system, skin, fatigue, and headache, as well as difficulty concentrating, personal, psychosocial, and workstation factors. During normal office hours of the same weeks, environmental variables were measured. RESULTS: The study population comprised 1390 workers in 1991, 1371 in 1993, and 1359 in 1995, which represents 80% of the population eligible each year. The prevalence of most symptoms decreased by 40% to 50% in 1992 compared with 1991. This was similar in 1995. These findings were significant and remained generally similar after controlling for personal, psychosocial, and work related factors. CONCLUSION: In this study, the decrease of 40% to 50% in the prevalence of most symptoms investigated six months after workers were exposed to a new building with an improved ventilation system was maintained three years later. The results of the present follow up study provide further support for a real effect of exposure to a new building with an improved ventilation system on the prevalence of symptoms associated with the SBS AU - Bourbeau J AU - Brisson C AU - Allaire S LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Dampness and respiratory symptoms among workers in daycare centers in a subtropical climate PG - 68-71 AB - We evaluated the association between measures of dampness in daycare centers (N = 56) in the Taipei area and symptoms of respiratory illness in 612 employees. Dampness was found in 75.3% of the centers, visible mold in 25.8%, stuffy odor in 50.0%, water damage in 49.3%, and flooding in 57.2%. Furthermore, prevalence of sick building syndrome symptoms in the daycare workers was statistically significant among those who worked in centers that had mold or dampness. Also, the observed numerous incidences of dampness or mold in centers were very common in this subtropical region, and dampness was a strong predictor of sick building syndrome symptoms AU - Li CS AU - Hsu CW AU - Lu CH LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Ocupational asthma causes by black henna PG - 231-232 AU - Scibilia J AU - Galdi E AU - Biscaldi G AU - Moscato G LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Anaphylaxis to thiamine (vitamin B1) PG - 958-959 AU - Fernandez M AU - Barcelo M AU - Munoz C AU - Torrecillas M AU - Blanca M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 156 IP - DP - 1997 Jan 01 TI - Risk of tuberculin conversion according to occupation among health care workers at a New York City hospital PG - 201-205 AU - Louther J AU - Rivera P AU - Feldman J AU - Villa N AU - DeHovitz J AU - Sepkowitz KA LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 350 IP - DP - 1997 Jan 01 TI - Are CS sprays safe? PG - 605-606 AU - Jones GRN LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Hypersensitivity pneumonitis induced by exposure to the legume algarroba PG - 478-479 AU - FrancoVicario R AU - Gamboa P AU - Escalante M AU - Pueyo V AU - Sanz ML AU - Solano D AU - Miguel F LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 31 IP - DP - 1997 Jan 01 TI - The clinical spectrum of humidifier disease in synthetic fiber plants PG - 682-692 AB - In a synthetic fiber production site with recirculating cold water humidification systems and small-size-particle (> 0.1 mu < 1 mu) oil mist exposure, humidifier disease was diagnosed in several workers. The patients could be divided into three groups illustrating the clinical spectrum of humidifier disease: humidifier fever (toxic inhalation fever) (12 patients): an asthma-like syndrome (8 patients); and allergic alveolitis (4 patients). Natural challenge at the work place, monitored by parameters such as peak-flow, spirometry, blood leucocyte count, and body temperature, provided important diagnostic information. In patients with chronic allergic alveolitis, a gradual recovery during an exposure-free period indicated a work-related causation, more than changes during challenge in normal work. In some patients, the fungus Sporothrix schenckii, hitherto unknown as a sensitizer, may have been at least one of the causative antigens. Measured levels of viable fungi (< or = 100 CFU/m3) and endotoxin (64 pg/m3) in air samples were much lower than those at which health effects usually are reported. Small-size-particle oil mist exposure may have underestimated the exposure to microorganisms, but otherwise an adjuvant role to this type of co-exposure might also be postulated. In contrast to allergic alveolitis, the asthma-like syndrome appeared to be more common in patients with a history of atopy and of smoking AU - Pal TM AU - De Monchy JG AU - Groothoff JW AU - Post D LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 88 IP - DP - 1997 Jan 01 TI - Occupational asthma: considerations on epidemiology and criteria of damage evaluation PG - 3-12 AB - The authors review the available data on occupational asthma in Italy; it is estimated that 500-600 cases occur per year, although it is difficult to establish the real prevalence of this disease; it is in any case under estimated. The author also reviews the medical/legal criteria used for diagnosis and compensation purposes, and criteria are proposed for the assessment of residual permanent damage. This assessment should be based not only on the degree of bronchial obstruction (as in the case of pneumoconiosis and chronic bronchitis), but also on the degree of bronchial hyper-reactivity and the need to take drugs (mainly steroid drugs orally). As examples, the author quotes the guidelines of the American Thoracic Society and the compensation system in force in Quebec in Canada, where these aspects are adequately taken into account. Assessment of residual permanent damage can only be performed when the clinical conditions of the patient, the spirometry and bronchial hyper-reactivity levels are stabilized (usually two years after cessation of exposure to the agent responsible for the disease); otherwise the damage may be overestimated or a false underestimation may result. The author stresses the importance of medical rehabilitation and retraining of the occupational asthmatic if resumption of his former job, which caused the disease, is not feasible. Early diagnosis of occupational asthma is necessary not only in order to avoid clinical aggravation of the disease but also to limit the social and economic costs AU - Innocenti A LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 Suppl 1 IP - DP - 1997 Jan 01 TI - Mechanisms of occupational asthma. PG - 47-54 AU - Maestrelli P AU - Saetta M AU - Mapp C AU - Fabbri LM LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 Suppl 1 IP - DP - 1997 Jan 01 TI - Aetiology of occupational asthma. [Review] PG - 41-46 AU - Cullinan P AU - Newman Taylor AJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 IP - DP - 1997 Jan 01 TI - Occupational asthma caused by triglycidyl isocyanurate (TGIC) PG - 510-514 AB - BACKGROUND: Polyester powder paints are extensively used in metal painting. Triglycidyl isocyanurate (TGIC), an epoxy compound, is often used as a hardener. Several cases of allergic eczema from occupational exposure to TGIC have been reported in the literature. OBJECTIVE: We examined a 36-year-old non-smoking man who worked mainly as a spray painter, using a polyester powder paint containing 4% TGIC. During painting he used protective clothing and a motorized breathing protector. After 4 years he developed eczema on his hands, face and body, and an occupational allergic eczema caused by TGIC was diagnosed. He also suffered from powder-paint-related asthmatic symptoms. METHODS: Occupational asthma was diagnosed in accordance with the accepted guidelines. Inhalation challenge tests were performed with the paint and TGIC. RESULTS: Spirometry showed slight obstruction; the blood eosinophils and serum IgE value were elevated. Skin-prick tests with common environmental allergens were negative. The challenge test with lactose powder was also negative. A challenge test with a paint containing TGIC (4%) induced a dual reaction in PEF and a late 23% fall in FEV1. A test with TGIC (4%) mixed with lactose induced a dual PEF reaction, and also dual changes in spirometry. The PD15 in the histamine challenge test decreased significantly after the challenge tests. CONCLUSIONS: To our knowledge this is the first diagnosed case of occupational asthma caused by TGIC. This case report emphasizes the importance of protecting both the skin and respiratory tract of workers against chemicals such as TGIC, capable of causing skin and respiratory allergy AU - Piirila P AU - Estlander T AU - Keskinen H AU - Jolanki R AU - Laakkonen A AU - Pfaffli AU - P AU - Tupasela O AU - Tuppurainen M AU - Nordman H LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 51 IP - DP - 1997 Jan 01 TI - Absence of association of specific and nonspecific bronchial hyperreactivity in occupational asthma caused by platinum salts [German] PG - 345-350 AB - There is evidence that bronchial responsiveness to allergen is quantitatively correlated with bronchial responsiveness to nonspecific stimuli in subjects with allergic asthma. This association has been questioned in occupational asthma due to low molecular weight substances. It was the aim of this study to assess the quantitative association of bronchial responsiveness to methacholine (MCH) and platinum salts (Pt), in the form of hexachloroplatinic acid, in workers with occupational asthma due to Pt salts. Fifty-seven subjects with exposure to Pt, work-related asthma, and a positive bronchial challenge with Pt underwent skin prick test with Pt and bronchial challenge with MCH. Using the provocation concentration causing a > or = 50% fall in specific airway conductance (PC50sGaw(Pt)) as a dependent variable, anamnestic data (period from first symptoms to removal, period between removal from exposure and diagnosis, and smoking), season of the investigation, skin prick tests with environmental allergens, total immunoglobulin E (IgE), skin reactivity to Pt (Pt concentration causing a 2 mm wheal), and PC50sGaw(MCH) were included as independent variables for regression analysis. Fifty-two subjects (91%) showed a PC50sGaw(MCH) < 8 mg.mL-1 (geometric mean for all subjects 1.6 mg.mL-1). Responsiveness to Pt varied widely between subjects (geometric mean of PC50sGaw(Pt) 9 x 10(-5) mol.L-1, range 2 x 10(-7) to 10(-2) mol.L-1). There was no univariate correlation between bronchial responsiveness to MCH and Pt, but there was a correlation between skin reactivity to Pt and PC50sGaw(Pt) (r = 0.6). This association could not be improved by considering PC50sGaw(MCH), the period from first symptoms to removal, or the period between removal from exposure and diagnosis. The parameters that showed the highest (negative) associations with PC50sGaw(Pt) were skin reactivity to Pt and the period between removal from exposure and diagnosis (r = 0.65). We conclude that there is a moderate association between bronchial responsiveness to platinum salts and skin reactivity to platinum salts. However, there is no association between methacholine responsiveness and bronchial responsiveness to allergen in occupational asthma due to platinum salts AU - Merget R AU - Dierkes A AU - Ruckmann A AU - Bergmann EM AU - SchultzeWerninghaus G LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 31 IP - DP - 1997 Jan 01 TI - Occupational sensitization to lactase PG - 570-571 AB - Occupational sensitization to lactase is reported in workers formulating and packaging this consumer product, which is used for the relief of gastrointestinal symptoms caused by intolerance to lactose. Allergic rhinitis, conjunctivitis, and some cases of asthma were noted. There was suggestive evidence that atopic individuals may be at greater risk of sensitization. Lactase should be added to the list of potential occupational respiratory sensitizers AU - Muir DC AU - Verrall AB AU - Julian JA AU - Millman JM AU - Beaudin MA AU - Dolovich J LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 54 IP - DP - 1997 Jan 01 TI - Occupational asthma in New Zealanders: a population based study PG - 301-306 AB - OBJECTIVES: To examine the effect of occupation on respiratory symptoms in a randomly selected adult population aged 20-44 years. METHODS: It is based on the phase II sampling of the New Zealand part of the European Community respiratory health survey. 1609 people (63.9% response rate) completed a detailed respiratory questionnaire. Of those responding, 1174 (73%) underwent skin tests and 1126 (70%) attended to undergo methacholine bronchial challenge. Current occupation was recorded and a previous occupation was also recorded if it had led to respiratory problems. 21 occupational groups were used for analysis for the five definitions of asthma wheezing in the previous 12 months; symptoms related to asthma; bronchial hyperresponsiveness (BHR); BHR with wheezing in the previous 12 months; and BHR with symptoms related to asthma. RESULTS: Prevalence odds ratios (ORs) were significantly increased for farmers and farm workers (OR 4.16, 95% confidence interval (95% CI) 1.33 to 13.1 for the combination of wheezing and BHR). Increased risks of prevalence of asthma were also found for laboratory technicians, food processors (other than bakers), chemical workers, and plastic and rubber workers. Workers had also been divided into high and low risk exposure categories according to relevant publications. The prevalence of wheezing was greater in the high risk group (OR 1.57, 95% CI 0.83 to 2.95) than in the low risk group. Atopy was associated with asthma, but the prevalence of atopy did not differ significantly between occupational exposure groups. The attributable risk of wheezing that occurred after the age of 15 years and that was estimated to be due to occupational exposure (based on the defined high risk group) was 1.9%, but this increased to 3.1% when farmers and food processors (other than bakers) were also included in the high risk group. CONCLUSIONS: This population based study has identified certain occupations significantly associated with combinations of asthmatic symptoms and BHR AU - Fishwick D AU - Pearce N AU - D'Souza W AU - Lewis S AU - Town I AU - Armstrong R AU - Kogevinas M AU - Crane J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 11 IP - DP - 1997 Jan 01 TI - Legionnaires' disease in residents of England and Wales: 1996 PG - R153-R159 AU - Joseph CA AU - Harrison TG AU - IlijicCar D AU - Bartlett CLR LA - PT - DEP - TA - CDR (Lond Engl Rev) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 31 IP - DP - 1997 Jan 01 TI - Exposure to potential occupational asthmogens: prevalence data from the National Occupational Exposure Survey PG - 195-201 AB - Few data are available about the prevalence of occupational exposures to agents which can cause occupational asthma or aggravate preexisting asthma (asthmogens). Using potential occupational exposure data from the National Occupational Exposure Survey (NOES) of 1980-1983, we investigated the number of asthmogen exposures, asthmogen-exposure(s) per production worker, and unprotected occupational asthmogen exposures in different industries and occupations. Data for the entire United States were used to generate estimates of occupational exposure at two selected state and local levels. It was estimated that 7, 864,000 workers in the surveyed industries were potentially exposed to one or more occupational asthmogen(s) in the United States. The average number of observed potential exposures per asthmogen-exposed worker was 4.4, and varied from 11.9, in the Water Transportation industry, to 1.2 in Local and Suburban transportation. The largest number of observed potential exposures was recorded in the Apparel and Other Finished Products (garment) industry. This work and further analyses using this approach are expected to contribute to a better understanding of the epidemiology of occupational asthma, and to serve as a guide to target future occupational asthma surveillance efforts 0 (Allergens). 0 (Bronchoconstrictor Agents). AU - de la Hoz RE AU - Young RO AU - Pedersen DH LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - IP - DP - 1997 Jan 01 TI - Occupational bronchial asthma due to organic solvents [Russian] PG - 24-26 AB - Thorough clinical, allergologic and immunologic examination of 65 patients who worked as building painters in contact with organic solvents proved these agents, not being allergens, to contribute in formation of occupational bronchial asthma. This type of bronchial asthma is characterized by some clinical features and pathogenetic mechanisms. A complex of clinical, allergologic and immunologic methods was elaborated to diagnose this type of bronchial asthma AU - Ozhiganova VN AU - Grishina TI AU - Snegova EA LA - PT - DEP - TA - Med Tr Prom Ekol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 31 IP - DP - 1997 Jan 01 TI - Respiratory function of textile workers employed in dyeing cotton and wool fibers PG - 344-352 AB - 97209016 Andrija Stampar School of Public Health, Zagreb, Croatia A group of 135 textile dyeing workers (97 male and 38 female) was studied for the prevalence of acute and chronic respiratory symptoms and lung function changes. Respiratory symptoms were elicited by a standardized questionnaire, and lung function testing was performed before and after the morning shift by recording maximum expiratory flow-volume (MEFV) curves. In addition, 103 nonexposed control workers were studied. The prevalence of all chronic respiratory symptoms was significantly higher in the exposed than in the control workers; in particular, the prevalence of occupational asthma was 6%. The exposed nonsmoking workers had more complaints than the controls who were nonsmokers. As expected, most of the symptoms were more prevalent in smokers than in nonsmokers. Nonsmokers with both long- and short-term work exposure had higher prevalences of dyspnea and rhinitis than control workers. Smokers exposed for 10 years or less had significantly higher prevalences of chronic phlegm than nonsmokers with the same duration of exposure (p < 0.05). In workers exposed for > 10 years, there were significantly higher prevalences of chronic cough, chronic phlegm, and chronic bronchitis in smokers than in nonsmokers (p < 0.01). A high prevalence of shift-related symptoms was found in exposed workers. Significant across-shift reductions of ventilatory capacity tests were documented in this cohort and varied from an average of 4.0% for FVC to 14.2% for FEF25. Preshift values of ventilatory capacity were significantly lower in this exposed population compared to predicted values suggesting a chromic effect. Our data suggest that textile dyeing workers develop acute and chronic respiratory impairment as a result of their exposures. These findings are exacerbated by cigarette smoking 0 (Dyes) AU - Zuskin E AU - Mustajbegovic J AU - Schachter EN AU - DokoJelinic J LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 64 IP - DP - 1997 Jan 01 TI - Death due to asthma at workplace in a diphenylmethane diisocyanate-sensitized subject. PG - 111-113 AB - Total cases of fatal asthma in the occupational setting reported in the literature are reviewed and the case of a 39-year-old foundry worker who died at work is described. A diagnosis of occupational asthma induced by diphenylmethane diisocyanate (MDI) had been assessed 5 years in advance through a 0.005-ppm exposure inhalation challenge. Postmortem microscopic examination of the lung showed epithelial desquamation, eosinophilic/neutrophilic infiltration of the mucosa, dilatation of bronchial vessels, edema, hypertrophy and disarray of smooth muscle. Fatal asthma attack in a MDI-sensitized individual, to our knowledge, has not been previously described. AU - Carino M AU - Aliani M AU - Licitra C AU - Sarno N AU - Ioli F LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 3 IP - DP - 1997 Jan 01 TI - Special problems of the asthmatic patient. [Review] PG - 72-79 AB - Environmental factors and physical activity present special problems for the asthmatic patient. Bronchoconstriction due to workplace exposure is one of the most common forms of occupational lung disease and has similar pathogenic mechanisms to nonoccupational asthma. Diagnosing occupational asthma may be difficult because the association between symptoms during or after work and a causative agent may be obscure. Nevertheless, it is important to recognize occupational asthma because even trace amounts of the causative agent may trigger bronchoconstriction, and the affected employee must almost always avoid exposure. Bronchoconstriction induced by exercise has affected the lifestyles of many asthmatic patients and has created special problems for numerous accomplished athletes. Although exercise-induced asthma (EIA) characteristically occurs immediately after cessation of exertion, a recent study suggests that it may sometimes begin during sustained exertion. Asthmatic patients who participate in winter sports are particularly susceptible to EIA. Vocal cord dysfunction in athletes who participate in intense competition can mimic EIA. In addition to beta-agonists used immediately before exercise, newer drugs that show promise in the treatment of EIA include the leukotriene inhibitors and furosemide. Asthmatic patients are susceptible to extremes in atmospheric pressure and have increased risk of barotrauma and arterial gas embolism during scuba diving. During longer stays at high altitude, however, asthmatic patients appear to have attenuated bronchial responsiveness. AU - Wallace JM AU - Stein S AU - Au J LA - PT - DEP - TA - Curr Opin Pulm Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Occupational asthma due to a widely used soft solder flux not containing colophony PG - 238-240 AB - A 19 year old woman presented with symptoms suggestive of occupational asthma. The causative agent was thought to be a soft solder flux, which did not contain colophony. The diagnosis was established by specific inhalation challenge tests, which demonstrated both late asthmatic reactions and short-lived increases in airway responsiveness AU - Convery RP AU - Ward RJ AU - Hendrick DJ LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 112 IP - DP - 1997 Jan 01 TI - Differentiation between cosensitization and cross-reactivity in wheat flour and grass pollen-sensitized subjects PG - 378-385 AB - BACKGROUND: To diagnose baker's asthma, occupational sensitization to wheat flour should be distinguished clearly from influences of cosensitization such as it may exist in pollinosis patients. To define the route of sensitization, the cross-reactivity between wheat flour and grass pollen allergens was investigated. METHODS: Two groups of atopic individuals with or without professional contact to wheat flour were screened by skin prick test for their sensitization to wheat flour and grass pollen and, in the case of hints for cosensitization, by Enzyme Allergo Sorbent Test (EAST). Cross-reactivity between wheat flour and grass pollen allergens was investigated by IgE binding inhibition assay using sera of 20 cosensitized individuals and by immunoblots. RESULTS: The immunological cross-inhibition between wheat flour and grass pollen proves some proteins to share common allergenic determinants. Significant differences between bakers and individuals not occupationally exposed to flour could be seen in the inhibition of IgE binding to wheat flour. While the IgE binding to wheat flour allergens was only slightly inhibited by grass pollen proteins in baker's sera its inhibition was nearly complete by this extract in sera of nonexposed atopics. Immunoblots indicate that wheat proteins with a molecular weight of about 8-12 and 22 kD preferentially react with sensitized bakers' IgE and not with IgE of other individuals. IgE binding to grass pollen allergens in immunoblots and inhibition experiments showed no differences between bakers and other subjects. CONCLUSION: In the group of atopics without professional contact to flour, the positive test results from wheat flour obviously ensue from contact to cross-reacting grass pollen proteins whereas bakers are exposed and sensitized to allergens of both sources. Such cross-inhibition experiments help to identify the source of sensitization which may be difficult to obtain in case of cross-reacting allergens AU - Sander I AU - RaulfHeimsoth M AU - Duser M AU - Flagge A AU - Czuppon AB AU - Baur X LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 155 IP - DP - 1997 Jan 01 TI - The risk of asthma attributable to occupational exposures: a population-based study in Spain [letter] PG - 382-383 AU - Milton D AU - Christiani D LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Interplay of cigarette smoking and occupational exposure on specific immunoglobulin E antibodies to cobalt PG - 124-128 AB - The results of a cross-sectional survey of an occupational population (n = 706) exposed to hard metal dust revealed distribution of specific immunoglobulin E antibodies against cobalt-conjugated serum albumin (Co-HSA). This population was segregated with respect to smoking and dust-exposure doses. Standard deviations (0.08-0.13) of Co-HSA RAST were sufficiently small (< 7%) to warrant reproducibility. Confirming evidence for 8 workers who had mean + 3 standard deviations of Co-HSA RAST indices and who had been diagnosed with occupational asthma also provided better sensitivity (8/19) and specificity (687/687) of hard metal asthma, rather than metal-induced asthma. Cobalt exposure resulted in significant increases in Co-HSA RAST indices in males, whose mean index was 1.16 +/- 0.13 in nonexposed subjects and 1.37 +/- 0.13 in exposed subjects. There was no difference, however, in the females. This difference between males and females cannot be explained by differences in ages or dust-exposure doses. Furthermore, the specific RAST indices against Co-HSA displayed a strong correlation not only to the intensity of cobalt exposure (r = .488, p < .001), but to log(total exposure doses) (r = .578, p < .001). These results suggest that Co-HSA RAST might be useful as a biological marker for the allergic etiology of hard metal asthma. Nonexposed smokers had similar mean RAST indices: 1.18 +/- 0.12 IU/ml, compared with 1.15 +/- 0.16 IU/ml for nonexposed subjects who had never smoked. There was no correlation between Brinkman indices (i.e., number of cigarettes/d x y) and RAST indices in any of the male groups. Higher, but not significant, mean RAST indices were found for ex-smokers in both the nonexposed (1.18 +/- 0.14) and exposed subjects (1.26 +/- 0.12), compared with subjects who had never smoked. Serum immunoglobulin E levels in the ex-smokers declined with age after they quit smoking, irrespective of exposure status. In contrast, hard metal (cobalt) exposure elevated specific immunoglobulin E. The results of the study suggest that elimination of hard dust exposure is more important than cessation of smoking in the minimization of risk of bronchial asthma. Hard metal exposure may be a preventable risk factor for occupational asthma AU - Shirakawa T AU - Morimoto K LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 IP - DP - 1997 Jan 01 TI - Detection of snow-crab antigens by air sampling of a snow-crab production plant PG - 75-78 AB - BACKGROUND AND OBJECTIVE: We previously assessed the prevalence of occupational asthma (OA) to snow-crab in production plant workers. We also showed that this type of OA is related to immediate immunological reactivity as demonstrated by skin reactivity and increased specific IgE antibodies. However, we did not show that snow-crab antigens causing immunological reactivity and OA could be found in the air sampling in the plants atmosphere. This was the purpose of the current work. MATERIAL AND METHODS: Area air samples worn by workers at four different worksites of a snow-crab producing plant were obtained on PVC filters with an SKC pump run at 1.5 L/min for 2 h. Snow-crab was being boiled and processed during the air sampling periods. Filters were analysed by RAST inhibition in a blind manner (i.e. without knowledge of the worksite where the filter originated). RESULTS: Eluate from one of the four sites (:2) had the highest protein concentration and yielded the highest per cent inhibition of RAST--13% inhibition with the snow-crab meat, 23% and 28% inhibition with the snow crab water RAST in two separate assays. An eluate taken from a filter at another site (:1) showed borderline reactivity (1% and 10% inhibition in two assays) whereas the two other ones and a control filter were negative. The two filters that contained snow-crab proteins were the ones nearest the boiling process, site :2 being the nearest followed by site :1. It was estimated that a 28% inhibition corresponded to approximately 8.6 micrograms of proteins and to approximately 1.5 micrograms of allergens on the filter. CONCLUSION: This study suggests that airborne snow-crab-derived proteins, released during the boiling process, are the cause of immunological reactivity and of OA to snow-crab AU - Malo JL AU - Chretien P AU - McCants M AU - Lehrer S LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 IP - DP - 1997 Jan 01 TI - Feather mites are potentially an important source of allergens for pigeon and budgerigar keepers PG - 60-67 AB - BACKGROUND: Previous studies on allergy to feathers have not addressed whether organisms living on feathers (mites, lice, moulds) are a source of allergens. OBJECTIVE: To investigate whether feather mites produced allergens of clinical relevance to bird keepers. METHODS: We examined serum IgE responses of 96 pigeon breeders to an extract of feather mites from pigeons (predominantly Diplaegidia columbae), using Western blotting, specific IgE assay using AlaSTAT EIA and RAST inhibition. RESULTS: Feather mites are a major source of soluble proteins derived from feathers, accounting for up to 10% of the total weight of the feather. Forty-three sera had a negative score (0) for anti-feather mite IgE, 27 were weakly positive (1-2) and 26 had strongly positive scores (3-4). Fewer pigeon breeders with scores > or = 3 were asymptomatic than those with negative scores (12 versus 40%), more had late onset symptoms (with or without early onset symptoms: 77% versus 44%) and had IgE antibody against house dust mite (89% versus 23%). Western blotting of eight sera against the extract of Diplaegidia columbae revealed 20 IgE-binding components ranging from 22 to 200 kDa. A high diversity of components was recognized by each serum: arithmetic mean 7 (range 2-14). RAST inhibition indicated feather mites had species-specific epitopes as well as ones that cross-reacted with Dermatophagoides pteronyssinus. CONCLUSION: Strongly-positive AlaSTAT scores to pigeon feather mite were associated with allergic symptoms of late onset in pigeon breeders. We conclude that feather mites are a major source of clinically-relevant allergens for pigeon breeders AU - Colloff MJ AU - Merrett TG AU - Merrett J AU - McSharry C AU - Boyd G LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 39 IP - DP - 1997 Jan 01 TI - Repeated case-control studies as a method of surveillance for asthma in occupations PG - 51-57 AB - Our aim was to establish whether the case-control design may be applied in surveillance for occupational asthma. In a region with intensive manufacturing industries, we carried out one case-control study from 1974 to 1978 and another from 1989 to 1993; 325 and 387 pairs of cases of asthma and of age- and sex-matched control subjects, respectively, were selected. Current risks were found to be higher than past estimates for painters, farmers, millers/bakers, textile, wood/ furniture, and chemical workers. High risks for asthma have recently appeared in leather, polyurethane plastics, hospital and food industry workers, welders, and shoemakers. It is concluded that the case-control approach may be used to describe variations in asthma risk by occupational categories and time. A method to measure the efficiency of the diagnostic process for occupational asthma is also proposed AU - Mastrangelo G AU - Bombana S AU - Priante E AU - Gallo A AU - Saia B LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 58 IP - DP - 1997 Jan 01 TI - Control of ethyl methacrylate exposures during the application of artificial fingernails PG - 214-218 AB - In 1990 six cases of physician-diagnosed occupational asthma in cosmetologists working with artificial fingernails prompted the Colorado Department of Health to request the assistance of National Institute for Occupational Safety and Health (NIOSH) researchers in the evaluation and control of nail salon technician exposure. A commercially available recirculating downdraft table with charcoal filters was purchased and evaluated. Researchers from NIOSH made modifications to the table that included increasing the downdraft air volume; enlarging the plenum for more consistent airflow rates at the face of the table; removing the charcoal filters while incorporating a ventilation system to the outdoors; and putting an extension around the duct leading to the perforated plate at the downdraft face of the table. An evaluation was performed using the following two configurations: the modified table with the downdraft ventilation on (vented) and without the downdraft ventilation on (unvented). Each of the two configurations was sampled for 3 days in random order. Testing included the use of XAD-2 solid sorbent tubes for determining ethyl methacrylate and methyl methacrylate concentrations. Relative concentrations of organics were examined and used to analyze work practices. The geometric mean ethyl methacrylate exposure for personal breathing zone samples when using the modified table for approximately 6 hours was 0.6 ppm; when using the unventilated conventional table, the geometric mean exposure was 8.7 ppm. The difference in the values is statistically significant (p = 0.0045). Methyl methacrylate concentrations were nondetectable on all sorbent tubes AU - Spencer AB AU - Estill CF AU - McCammon JB AU - Mickelsen RL AU - Johnston OE LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 24 IP - DP - 1997 Jan 01 TI - Environmental factors in PEF variability PG - 64S-66S AU - Paoletti P AU - Paggiaro PL AU - Lebowitz MD LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 24 IP - DP - 1997 Jan 01 TI - Diurnal variation of PEF and its use in epidemiological studies PG - 49S-56S AB - Diurnal variability in peak expiratory flow (PEF) has been an accepted clinical method in the management of asthma and the evaluation of occupational asthma. In this paper, the basis for this usage together with other clinical and epidemiological applications is discussed. The measured characteristics of PEF diurnal variability are described in asthmatics and asymptomatic subjects, showing the greater variability in asthmatics, and the "morning dip" related to circadian rhythm. PEF measured by pneumotachograph and the mini-Wright meter are shown to be in good agreement, but PEF measured by the latter and other small PEF meters is different in terms of absolute values, and both intraindividual variability within test sets and diurnally. The use of PEF meters, and the daily diaries in which the subject or patient records PEF and related factors are described AU - Lebowitz MD AU - Krzyzanowski M AU - Quackenboss JJ AU - O'Rourke MK LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 31 IP - DP - 1997 Jan 01 TI - What to do about softwood? A review of respiratory effects and recommendations regarding exposure limits. [Review] PG - 385-398 AB - Wood dust has been classified as a human carcinogen by the International Agency for Research on Cancer with a footnote that the evaluation was based on a marked excess of sino-nasal cancer among workers exposed primarily to hardwood dusts. Because the epidemiologic data on the carcinogenic effects of softwoods are weaker than for hardwoods, standard setting for softwood dust presents a greater dilemma. Unfortunately, the studies of wood dust and cancer do not have the quantitative exposure data necessary for standard setting for either hardwoods or softwoods. Asthma, non-asthmatic airflow obstruction, and both upper and lower respiratory symptoms have been associated with exposure to both 'allergenic' and 'non-allergenic' softwood dusts, and an association with increasing intensity of exposure has been observed in multiple studies. The available evidence seems to indicate that to prevent these nonmalignant effects, the level of exposure to all softwood dust should be at least as low 2 mg/m3. A standard of 1 mg/m3 may be more appropriate to provide a safety margin to protect more sensitive workers. It may be that some of the health effects observed are due to the natural components of wood, such as resin acids or monoterpenes, or to molds. AU - Demers PA AU - Teschke K AU - Kennedy SM LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 46 Suppl 1 IP - DP - 1997 Jan 01 TI - Does inhalation allergy to pig exist? PG - S65-6 AU - Larsen FO AU - Roepstort V AU - Sigsgaard T AU - Hjort C AU - Poulsen LK AU - Norn S LA - PT - DEP - TA - Inflamm Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Occupational asthma and rhinitis caused by ash (Fraxinus excelsior) wood dust PG - 196-199 AB - An 18-year-old man who worked in a furniture factory reported rhinitis and asthma when he was exposed to ash wood dust. Monitoring of the patient's peak expiratory flow rate (PEFR) when off work and at work showed increased variations of PEFR at work. Basal PC20 methacholine was 1.41 mg/ml. A bronchial provocation test (BPT) with a 1:1000 w/v ash wood dust extract induced a dual asthmatic response with a 7.5-fold increase of nonspecific bronchial responsiveness. Intradermal testing with ash wood extract elicited a positive immediate response. IgE antibodies against ash wood were found in the patient's serum with a RAST value of 0.57 PRU/ ml. Similar skin tests, BPT, and RAST with ash wood dust performed in control patients were all negative. All the studies performed suggest that our patient had occupational rhinitis and asthma caused by exposure to ash wood dust in which a type I immunologic mechanism was implicated AU - FernandezRivas M AU - PerezCarral C AU - Senent CJ LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 349 IP - DP - 1997 Jan 01 TI - Occupational asthma. [Review] PG - 1465-1469 AB - Occupational asthma is a common disorder that may be caused by several hundred agents and has a variety of pathogenetic mechanisms. Level of exposure is an important risk factor, and reduction of exposure is the only certain method of prevention. Atopy and smoking are further risk factors for IgE-mediated asthma but have not been found to increase risk in forms of the disorder that have other mechanisms. The key to diagnosis is a low threshold of suspicion; several investigative procedures can be used to confirm the diagnosis. Many patients suffer from continued asthma despite cessation of exposure; early diagnosis and early removal from exposure are the most important factors for improving the long-term outcome. AU - Venables KM AU - ChanYeung M LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 41 IP - DP - 1997 Jan 01 TI - Airway symptoms among house painters in relation to exposure to volatile organic compounds (VOCS)--a longitudinal study PG - 155-166 AB - The increased use of water-based paint (WBP) for indoor application during the last decade has drastically changed the exposure conditions for Swedish house painters. WBP has a lower emission of volatile organic compounds (VOCs) than solvent-based paint (SBP), but contains more reactive compounds, such as biocides, glycol ethers, and other high molecular solvents. The aim of this study was to compare the incidence of airway symptoms and self-reported asthma in house painters with a different degree of use of WBP and SBP. The incidence of seven general airway symptoms, and three work-related symptoms, was analysed by means of a self-administered questionnaire, in a cohort of 207 house painters followed from 1989 to 1992. Different airway symptoms were compared with clinical information obtained by a methacholine challenge test and dynamic spirometry in a selected subgroup of 44 painters. Information on the degree of use of SBP and WBP was used to estimate the total exposure to volatile organic compounds (TVOC) for each individual. In total, 175 men in the cohort worked as painters during the study period. No increase of asthma or respiratory symptoms was observed among those 50 painters with a pure exposure to WBP (estimated TVOC 1-3 mg m-3). Most painters (N = 125) had a mixed exposure to SBP and WBP, the main source of the TVOC being the limited use of SBP. WBP was perceived as less irritative than SBP, but complaints on airway irritation from WBP increased during the study period. The most pronounced increase of airway irritation in relation to both SBP and WBP, was observed among those 35 painters with the highest solvent exposure (estimated TVOC 100-380 mg m-3). An increase of respiratory symptom index and shortness of breath, in relation to estimated TVOC exposure was also observed. Selection effects were detected. Painters leaving their job during the study period had more non-specific hyper-reactivity symptoms, and more airway irritation from WBP, as compared to painters remaining at their occupation. Our study indicates that VOC emissions from SBPs may contribute to the development of respiratory symptoms and airway irritation. We found no increase of respiratory symptoms among painters exposed only to WBPs. There were, however, indications that VOC exposure from WBPs may cause airway irritation in some subjects. Because of selection effects, cross-sectional studies on respiratory symptoms in relation to occupational exposure to paint emissions may be inconclusive AU - Wieslander G AU - Norback D AU - Edling C LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 112 IP - DP - 1997 Jan 01 TI - IgE antibody response against Aspergillus umbrosus in farmer's lung disease PG - 313-316 AB - IgG and IgA antibodies against fungus Aspergillus umbrosus have been found in the sera of patients with farmer's lung (FL) disease and healthy exposed farmers in Finland. To determine the IgE response to antigens of A. umbrosus and Candida albicans, sera from 20 patients with FL, 20 healthy farmers and 20 nonfarming controls were tested by nitrocellulose radioallergosorbent test (RAST). The values of RAST indices were low in each group and the only statistically significant difference was found between the groups of FL patients and nonfarming controls against A. umbrosus polysaccharide antigen. Individual IgE responses to polysaccharide antigens of A. umbrosus and C. albicans correlated among FL patients, however, no cross-reacting IgE antibodies could be shown. To conclude, the IgE antibody levels of A. umbrosus polysaccharide and crude antigens were low in FL patients, healthy exposed farmers and nonfarming controls. Neither polysaccharide nor crude antigen-specific IgE antibodies of A. umbrosus have any diagnostic value in FL disease AU - Kaukonen K AU - Savolainen J AU - Nermes M AU - Viander M AU - Terho EO LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 112 IP - DP - 1997 Jan 01 TI - Cow hair allergen (Bos d 2) content in house dust: correlation with sensitization in farmers with cow hair asthma PG - 231-237 AB - Farmers (N = 45) suffering from occupational cow hair asthma were visited at home to evaluate the concentration of cow hair major allergen Bos d 2 in the house dust and to correlate these results with measures of avoidance, degree of sensitization, clinical symptoms, and lung function. Bos d 2 was determined by rocket immunoelectrophoresis. In dust of tiles and linoleum Bos d 2 was difficult to detect, whereas dust samples of carpets often contained high concentrations of the allergen (50-520 micrograms/g fine dust). Bos d 2 levels were significantly higher when barn and living quarters were in the same building. Concentrations of cow hair-specific IgE were correlated with concentrations of Bos d 2 in house dust samples. A concentration of 20-29 micrograms Bos d 2 per gram of house dust could be established as threshold value for relevant IgE sensitization. Avoiding the barn is not a sufficient avoidance measure for cow hair asthmatics if the partner continues cattle farming. Cessation of cattle farming and avoiding the former barn results in a marked reduction in Bos d 2 concentration in living quarters, a decreased degree of sensitization, and a reduced symptom score. Farmers with cow hair asthma should avoid cattle and thoroughly clean all carpets in the living quarters to avoid continuous cow allergen exposure AU - Hinze S AU - Bergmann KC AU - Lowenstein H AU - Hansen GN LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 99 IP - DP - 1997 Jan 01 TI - Occupational asthma caused by hypersensitivity to ground bugs PG - 267-268 AU - Garcia Lazaro MA AU - Abengozar Muela R AU - Arias Irigoyen J AU - Cabanes Higuero AU - N AU - Ventas Alguacil P AU - Moral de Gregorio A AU - Senent CJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 78 IP - DP - 1997 Jan 01 TI - New occupational allergen in a pharmaceutical industry: serratial peptidase and lysozyme chloride PG - 225-229 AB - BACKGROUND: Serratial peptidase and lysozyme are often used as anti-inflammatory agents. There have been very few documented cases of occupational allergy caused by these substances. We report a case of a pharmaceutical industry worker who developed occupational asthma and rhinitis caused by both serratial peptidase and lysozyme chloride. OBJECTIVE: It is important to alert physicians to the possibility of occupational asthma when dealing with workers in the pharmaceutical industry. METHOD AND RESULT: The patient had strong positive responses to peptidase and lysozyme extracts on skin-prick tests. Bronchoprovocation tests showed a dual asthmatic response to peptidase and an early asthmatic response to lysozyme. Serum specific IgE antibodies to peptidase and lysozyme were detected by enzyme-linked immunosorbent assay (ELISA). In order to further characterize the allergenic component of these extracts, sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and electroblotting studies were also performed. More than ten components ranging form 7.3 to 83.1 kD were found in peptidase extracts, and two IgE binding components (67, 10.9 kD) were detected within the lysozyme extracts. CONCLUSION: These findings suggest that inhalation of peptidase and lysozyme can induce IgE-mediated bronchoconstrictions in an exposed worker AU - Park HS AU - Nahm DH LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 33 IP - DP - 1997 Jan 01 TI - Extrinsic allergic alveolitis in male plaster worker (letter) [Spanish] PG - 56-56 AU - Prieto de Paula JM AU - de la Cueva Gallo JA AU - Cancelo Suarez P LA - PT - DEP - TA - Arch Bronconeumol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Occupational asthma due to chrome and nickel electroplating PG - 28-32 AB - BACKGROUND: Exposure to chromium during electroplating is a recognised though poorly characterised cause of occupational asthma. The first series of such patients referred to a specialist occupational lung disease clinic is reported. METHODS: The diagnosis of occupational asthma was made from a history of asthma with rest day improvement and confirmed by specific bronchial provocation testing with potassium dichromate and nickel chloride. RESULTS: Seven workers had been exposed to chrome and nickel fumes from electroplating for eight months to six years before asthma developed. One subject, although exposed for 11 years without symptoms, developed asthma after a single severe exposure during a ventilation failure. This was the only subject who had never smoked. The diagnosis was confirmed by specific bronchial challenges. Two workers had isolated immediate reactions, one a late asthmatic reaction, and four a dual response following exposure to nebulised potassium dichromate at 1-10 mg/ml. Two of the four subjects were also challenged with nebulised nickel chloride at 0.1-10 mg/ml. Two showed isolated late asthmatic reactions, in one at 0.1 mg/ml, where nickel was probably the primary sensitising agent. Four workers carried out two hourly measurements of peak expiratory flow over days at and away from work. All were scored as having occupational asthma using OASYS-2. Breathing zone air monitoring was carried out in 60 workers from four decorative and two hard chrome plating shops from workers with similar jobs to those sensitised. No measurement exceeded the current occupational exposure standard for chromate or nickel, the mean levels of chromate exposure for jobs similar to those of the affected workers were 9-15 micrograms/m3. CONCLUSION: Chrome used in electroplating is a potential cause of occupational asthma. Sensitivity to chrome in electroplaters may occur in situations where exposure levels are likely to be within the current exposure standards. There may be cross reactivity with nickel. Inhalation challenge with nebulised potassium dichromate solution is helpful in making the specific diagnosis where doubt exists AU - Bright P AU - Burge PS AU - O'Hickey SP AU - Gannon PF AU - Robertson AS AU - Boran A LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Chronic bronchitis in textile workers PG - 22-27 AB - BACKGROUND: Exposure to cotton is known to produce a specific occupational disease known as byssinosis. A large population of textile workers was investigated to determine whether such exposure was also associated with chronic bronchitis once other possible aetiological factors had been accounted for. METHODS: A total of 2991 workers were investigated for the presence of symptoms compatible with chronic bronchitis. An MRC adapted respiratory questionnaire and MRC definition of chronic bronchitis were used for diagnostic labelling. Current and lifetime exposure to dust was estimated by personal and work area sampling, and the use of records of retrospective dust levels previously measured over the preceding 10 years. Airborne endotoxin exposure was measured using a quantitative turbidometric assay. Lung function tests were performed to measure forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). A control group of workers exposed to man-made fibre textiles was identified. The comparative prevalence of chronic bronchitis in the two populations was assessed, allowing for sex, age, smoking habit, and ethnic origin. Two case referent studies were also performed; cases of chronic bronchitis were separately matched with controls from the cotton and control populations to determine the effect of the symptomatic state on lung function. RESULTS: After controlling for smoking (pack years), workers in a cotton environment were significantly more likely to suffer from chronic bronchitis and this was most marked in workers over 45 years of age (odds ratio 2.51 (CI 1.3 to 4.9); p < 0.01). Regression analysis of all possible influencing parameters showed that cumulative exposure to cotton dust was significantly associated with chronic bronchitis after the effects of age, sex, smoking, and ethnic group were accounted for (p < 0.0005). In the intra-cotton population case control study a diagnosis of chronic bronchitis was associated with a small decrement in lung function compared with controls: percentage predicted FEV1 in cases 81.4% (95% CI 78.3 to 84.6), controls 86.7% (84.9 to 88.5); FVC in cases 89.9% (95% CI 87.0 to 92.9), controls 94.6% (92.8 to 96.4). After controlling for cumulative past exposure and pack years of smoking the effect of the diagnostic state remained significant for both FEV1 (p < 0.01) and FVC (p < 0.05). CONCLUSIONS: Chronic bronchitis is more prevalent in cotton workers than in those working with man-made fibre and exposure is additive to the effect of smoking. The diagnosis of chronic bronchitis is associated with a small but significant decrement in lung function AU - Niven RM AU - Fletcher AM AU - Pickering CA AU - Fishwick D AU - Warburton CJ AU - Simpson JC AU - Francis H AU - Oldham LA LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 241 IP - DP - 1997 Jan 01 TI - Decreased pulmonary perfusion in hypersensitivity pneumonitis caused by Shiitake mushroom spores PG - 85-88 AB - Hypersensitivity pneumonitis is an occupational hazard of mushroom workers. We describe a patient with severe hypersensitivity pneumonitis caused by spores of the Shiitake mushroom (Lentinus edodes) who showed a marked decrease in pulmonary perfusion, as demonstrated by pulmonary scintigraphy. This patient was treated successfully with prednisolone. These results suggest that pulmonary vasculitis may be associated with patients with hypersensitivity pneumonitis, and that steroid therapy may be clinically useful in treatment AU - Murakami M AU - Kawabe K AU - Hosoi Y AU - Hojo S AU - Dobashi K AU - Iriuchijima T AU - Nakazawa T AU - Mori M LA - PT - DEP - TA - J Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 47 IP - DP - 1997 Jan 01 TI - Respiratory disease in workers exposed to colophony solder flux fumes: continuing health concerns PG - 491-496 AB - The objectives of this study were to establish the prevalence of respiratory, eye, nose and throat symptoms of likely work-relation in workers exposed to colophony solder flux fumes and to assess their lung function. A cross-sectional study was conducted in four medium-sized electronics firms in which control measures to capture solder flux fume were absent or visibly ineffective. All female solders and women working adjacent to soldering stations completed an administered questionnaire concerning symptoms, work history and current soldering frequency. Measurements were made of their forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) during the course of a working shift, using a Vitallograph-Compact portable spirometer. Using weekly hours of soldering as a crude index of current exposure, workers were classified into high (>= 37 h/wk) and low (<= 20 h/wk) exposure groups, and their health responses were compared in the analysis. Individuals with symptoms suggestive of work-related asthma were also asked to provide serial peak flow measurements over a further 2-week period, and adequate returns were charted and read by two physicians experienced in the diagnosis of occupational asthma. Data were collected on 152 female workers (overall participation rate = 97%). Symptoms of recurrent, persistent wheeze and/or chest tightness were reported by 75 (49%) of interviewees; 36 (24%) gave a history typical of occupational asthma and six more (4%) a history of pre-existing asthma worsened at work. Twenty-one (14%) of the workforce complained of recurrent breathlessness on moderate exertion; 41 workers (27%) had work-related symptoms of the nose or throat and 25 (16%) had work-related eye symptoms. The odds ratios for 'all wheeze', shortness of breath, and work-related eye, nose and chest symptoms were all significantly greater (raised about 4-5 fold) in women who soldered >= 37 h/wk when compared with those soldering <= 20 h/wk. After adjustment by logistic regression for atopy, age and smoking status even higher risk estimates were generally obtained. The odds ratios (OR) and 95% confidence intervals (CI) for high vs. low were: for 'all wheeze', OR = 7.2, CI = 2.5-20.7; for work-related eye symptoms, OR = 5.2, CI = 1.4-19.8; for work-related nasal symptoms, OR = 4.0, CI = 1.4-11.1 and for occupational asthma symptoms, OR = 5.2, CI = 1.4-14.2. Mean FEV1 and FVC percentage difference from expected were slightly lower in full-time solderers than in part-time solderers, but the differences were not significant. Thirty-seven of the 51 workers (73%) who were asked to carry out serial peak flow measurements completed an adequate return: 27 of these records confirmed the presence of asthma, and in all of the cases the history suggested onset post-dating employment in soldering. Eleven peak flow records were indicative of occupational asthma. The health problems associated with colophony solder flux were documented over 18 years ago, but are still clearly apparent in situations where adequate control has not been achieved AU - Palmer K AU - Crane G LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 47 IP - DP - 1997 Jan 01 TI - Brewer's asthma due to malt contamination PG - 397-400 AB - We describe a case of a 28 year old brewery worker who developed asthma whilst grinding malt. Lung function measurements demonstrated deterioration and improvement in lung function associated with work and absence from work. Inhalation challenge with ground malt from the brewery was positive but with ground malt from another source was negative suggesting a contaminant of the malt was responsible. Culture of the brewery malt showed heavy contamination with Aspergillus niger, but A. niger skin test was negative and aspergillus-specific IgG was not detected in the patients serum. Removal of the subject from the grinding room resulted in resolution of symptoms and normal lung function. We discuss the role of A. niger as an aetiological agent for occupational asthma with reference to the above case AU - Heaney LG AU - McCrea P AU - Buick B AU - MacMahon J LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 47 IP - DP - 1997 Jan 01 TI - Occupational asthma and rhinitis caused by 1,2-benzisothiazolin-3-one in a chemical worker PG - 249-251 AB - We report a case of occupational asthma and rhinitis caused by inhalation of 1,2-benzisothiazolin-3-one, an additive used as a microbicidal in detergent production, in a 26-year-old man employed in a chemical factory producing detergents. The subject's task consisted of pouring raw materials into the recipient of a machine which mixed the substances. Two months after the beginning of this job the patient complained of rhinitis and asthma at the workplace. The specific challenge test with 1,2-benzisothiazolin-3-one, one of the raw materials to which the subject was exposed, provoked an immediate prolonged asthmatic response and nasal symptoms, whereas exposure to other agents (e.g., alpha-amylase, alcalase or bezalkonium chloride) to which the patient was also exposed at work did not. To our knowledge this is the first case of occupational asthma and rhinitis caused by this compound AU - Moscato G AU - Omodeo P AU - Dellabianca A AU - Colli MC AU - Pugliese F AU - Locatelli C AU - Scibilia J LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 41 IP - DP - 1997 Jan 01 TI - Grouping strategies for exposure to inhalable dust, wheat allergens and alpha-amylase allergens in bakeries. PG - 287-296 AB - This paper describes repeated measurements of inhalable flour dust, wheat allergens and alpha-amylase allergens in the bakery industry. A total of 571 full-shift personal dust samples was collected. Wheat allergens and alpha-amylase allergens were measured in 449 and 507 samples, respectively, by the use of recently developed immunoassays. For all three measures of exposure, the main components of exposure variability were determined. Different grouping strategies for studying exposure-response relationships were compared. The specific job of a bakery worker was identified as the most important source of variability in inhalable flour dust concentrations. For exposure to wheat allergens, the job performed was also the most important source of variation, but type of bakery also explained some of the variability. For alpha-amylase allergen exposure, information on type of bakery was more important then job information. For exposure to inhalable dust and wheat allergens, a classification by job title would lead to sufficient contrast in average exposure levels. By contrast, a grouping strategy based on a combination of job and type of bakery appeared to be essential to obtain a useful classification of exposure to alpha-amylase allergens. 1997 British Occupational Hygiene Society. AU - Houba R AU - Heederik D AU - Kromhout H LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 99 IP - DP - 1997 Jan 01 TI - Airborne levels of alpha-amylase allergens in bakeries. PG - 286-292 AB - BACKGROUND: In the baking industry the use of enzymes has increased throughout the 1980s. Several studies have reported sensitization and respiratory disorders among bakery workers caused by enzymes in dough improvers. Fungal alpha-amylase is the most frequently reported cause of allergy. alpha-Amylase allergen exposure levels in the bakery industry, however, have not yet been reported. OBJECTIVE: The main objective of this study was to quantify personal alpha-amylase exposure levels of bakery workers. METHODS: alpha-Amylase allergens were measured in 507 personal samples of airborne dust taken in bakeries by using a newly developed sandwich enzyme immunoassay with affinity-purified polyclonal rabbit IgG antibodies. A cascade impactor was used to estimate the size of dust particles carrying alpha-amylase allergens. RESULTS: The rabbit IgG antibodies used in the assay showed, in immunoblotting with commercially available alpha-amylase, a reaction profile very similar to that of IgE from sensitized bakers. The enzyme immunoassay appeared to be highly specific for fungal amylase. Allergen exposure levels varied considerably among bakery workers, depending on the type of bakery and job category (range, 0 to 40 ng/m3). In confectioneries no alpha-amylase allergens were detected. In other bakeries alpha-amylase exposure was only found for workers directly involved in dough making. Measurements of the particle size distribution in these bakeries showed that alpha-amylase allergens are most likely to be deposited in the nose and ciliated airways. CONCLUSION: This study shows that personal monitoring of fungal amylase allergen exposure in bakeries is possible. This permits the identification of high-risk tasks and allergen sources, as well as the study of exposure-response relationships. AU - Houba R AU - Van Run P AU - Doekes G AU - Heederik D AU - Spithoven J LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 99 IP - DP - 1997 Jan 01 TI - Latex sensitivity in dental students and staff: a cross-sectional study PG - 396-401 AB - BACKGROUND: Dental practitioners, like other health care providers who regularly use latex gloves, are at increased risk for latex sensitivity. They are also at risk for irritant or allergic contact dermatitis. OBJECTIVE: This study was carried out to determine the prevalence of latex sensitivity and possible risk factors in staff and students of a Faculty of Dentistry. METHODS: A cross-sectional study was performed by using a questionnaire and allergy skin prick testing. RESULTS: Two hundred three students and staff members completed the questionnaire. Five percent reported asthma symptoms on exposure to rubber products, 13% reported symptoms of rhinitis or conjunctivitis, and 17% reported pruritus or urticaria within minutes of exposure to rubber. Overall, 10% of 131 subjects who underwent skin prick tests had a positive response to natural rubber latex. Among the students tested, there were increasing percentages of positive skin test responses to latex with increasing years of study (0% of Year 1 and 2 students tested; 6% of Year 3; and 10% of Year 4). Positive responses were seen as early as Year 3 in students (in their second year of clinical activity and glove use). Positive skin prick test responses to latex were related to a personal history of atopy (p = 0.005), positive prick test responses to common allergens (p < 0.005), latex-attributed immediate pruritus or urticaria (p < 0.05), rhinoconjunctivitis (p < 0.001), and asthma symptoms (p < 0.001). CONCLUSION: Dental school students and faculty are at high risk for latex sensitization. This occurs as early as the second year of glove use. Overall prevalence of skin sensitization was 10% of those tested. Preventive strategies in this group merit further investigation AU - Tarlo SM AU - Sussman GL AU - Holness DL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 241 IP - DP - 1997 Jan 01 TI - Occupational asthma: a GP's guide. PG - 28-24 AU - Burge PS LA - PT - DEP - TA - Practitioner JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 54 IP - DP - 1997 Jan 01 TI - Survey of the use of personal protective equipment and prevalence of work related symptoms among dental staff PG - 125-134 AB - OBJECTIVES: Dental instruments such as the right angle or straight handpiece, air turbine, and ultrasonic scaler have the ability to produce dental aerosols containing water, saliva, microorganisms, blood, tooth particles, lubricating oil, and restorative materials. The purpose of this study was to find out whether personal protective equipment (mask, glasses) was used by dental personnel, and to investigate possible work related disease in the dental profession. METHODS: Cross sectional data were collected with a self administered questionnaire sent to 69 randomly chosen general dental practices in the West Midlands Region. All members of the dental team completed questionnaires (dentists (n = 122); nurses (n = 115); hygienists (n = 86); and receptionists (n = 74) and answered questions on use of personal protective equipment and the prevalence of upper and lower respiratory tract, eye, and skin symptoms (reported and work related). Reception staff were included as a low exposure, control group. Also, a longitudinal study of dental hygienists was carried out on 31 people who had taken part in a similar study five years earlier. RESULTS: Use of a face mask and glasses differed between clinical groups with hygienists and nurses being the most and least prevalent users respectively. Although several reported symptoms were significantly more prevalent among clinical staff, only one work related symptom (skin rashes or itchy or dry skin) was reported by the clinical staff more than by the non-clinical receptionists. Among female clinical staff, age < 35 years and atopy were the factors that predisposed to work related symptoms. Also, reported symptoms were related to duration of use of instruments that generated aerosols. CONCLUSIONS: This study shows a low level of work related symptoms in dentistry, but highlights a group vulnerable to prolonged exposures to dental aerosols. It also supports the need for enforcement of the use of personal protective equipment among dental nurses AU - Allsopp J AU - Basu MK AU - Browne RM AU - Burge PS AU - Matthews JB LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 47 IP - DP - 1997 Jan 01 TI - The impact of the COSHH regulations on workers with occupational asthma PG - 101-104 AB - In the UK, the COSHH Regulations give specific guidance that employers have duties to inform, instruct and train their employees about occupational risks and provide them with suitable health surveillance. The aim of the study was to evaluate the impact of the Regulations on employees with occupational asthma. One hundred consecutive patients attending an occupational lung disease clinic completed a questionnaire assessing the implementation of the COSHH Regulations in their workplace. Twenty-eight per cent had a pre-employment inquiry about asthma, 31% had regular health surveillance by questionnaires and 19% had regular lung function assessment at work. Pre-employment spirometry was carried out in 44% of the workers who were exposed to one of the original seven prescribed agents, significantly more than those who were exposed to other agents (19%) (p < 0.05). Moreover, figures for spirometry during employment were 31% and 8% respectively (p < 0.05). The patients who worked after 'COSHH' but before 'MS25' had a tendency to be provided with health surveillance more than those who worked after both 'COSHH' and 'MS25'. Ninety-one per cent of the patients had never been informed about the risks of getting asthma at work and 73% had never seen the safety data sheets. The workers who (1) worked after 'COSHH' introduction; (2) worked in larger firms and (3) were exposed to one of the original seven prescribed' agents, had a tendency to be informed, instructed and trained more than the rest. However, there were only significant statistical differences (p < 0.05) in terms of the safety data sheet position between the cases who worked before the time of the legislation and those employed afterwards AU - Siriruttanapruk S AU - Burge PS LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 4 IP - DP - 1997 Jan 01 TI - The management of occupational asthma and hyperreactive airways disease in the workplace PG - 200-214 AU - Burge PS LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Peak expiratory flow: conclusions and recommendations of a working party of the European Respiratory Society PG - 2s-8s AU - Quanjer PH AU - Lebowitz MD AU - Gregg I AU - Miller MR AU - Pedersen OF LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - EIS 17 IP - DP - 1997 Jan 01 TI - Assessing exposure to rosin (colophony) based solder flux fume PG - - AU - Health and safety executive LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - MDHS 83 IP - DP - 1997 Jan 01 TI - Resin acids in rosin (colophony) solder flux fume PG - - AU - Health and safety executive LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Tuberculosis in National Health Service hospital staff in the west Midlands region of England, 1992-5 PG - 994-997 AB - BACKGROUND: This study was designed to assess the current incidence of tuberculosis (TB) in National Health Service hospital staff in the West Midlands region of England and to evaluate the effectiveness of occupational health screening and surveillance procedures. METHODS: A four year prospective study (1992-5) was carried out with case ascertainment through occupational health departments and the Midlands Thoracic Society registry of rare respiratory diseases. RESULTS: No case was known to an occupational health department that was not notified by the registry and, in addition, the registry yielded a further six cases. There were 26 cases of active TB, of which 24 presented with symptoms and 12 had no pre-employment screening. All except one doctor were foreign born--mainly from the Indian subcontinent (ISC)--and of recent UK entry, whilst all except one nurse were white females. The following are annual TB incidences per 10(4) (95% confidence interval): ISC and non-white doctors 17.0 (7.8 to 26.2), not significantly greater than in the local ISC and non-white social class 1 working age population (11.8 (8.5 to 15.1)); white nurses 0.6 (0.2 to 1.0), significantly greater (p < 0.05) than that of white women in the local social class 2 working age population (0.2 (0.1 to 0.3)); others (mortuary attendant, physiotherapist, radiographer and theatre technician) 1.0 (0.02 to 2.0), not significantly greater than in the local social class 2 working age population (0.6 (0.5 to 0.7)). CONCLUSIONS: Case ascertainment via the registry was complete. Most cases of TB were in nurses and doctors, more commonly in doctors. However, all but one of the doctors were foreign born and probably had reactivation of infection acquired abroad rather than infection occupationally acquired in the UK. All but one of the nurses, however, were UK born and may have had occupationally acquired disease, their incidence being higher than in the community. As most cases present with symptoms, there needs to be continued emphasis on prompt reporting of suspicious symptoms both before and during employment, and pre-employment BCG vaccination where appropriate AU - Hill A AU - Burge A AU - Skinner C LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 87 IP - DP - 1997 Jan 01 TI - Incidence of tuberculosis infection among New York State prison employees PG - 2012-2014 AB - OBJECTIVES: This study examined tuberculosis skin test conversions among 24,487 New York State prison employees in 1992. METHODS: Conversions were analyzed by prison and by job category. RESULTS: The conversion rate was 1.9%. Employees in prisons with low and high numbers of prisoner cases had odds ratios for conversion of 1.67 (95% confidence interval [CI] = 1.27, 2.19) and 2.20 (95% CI = 1.69, 2.87), respectively, relative to employees in prisons with no prisoner cases. In prisons with cases, guards and medical personnel had odds ratios of 1.64 (95% CI = 1.11, 2.43) and 2.39 (95% CI = 1.40, 4.08), respectively, relative to employees with little prisoner contact. CONCLUSIONS: In 1992, approximately one third of new infections among New York State prison employees were due to occupational exposure AU - Steenland K AU - Levine AJ AU - Sieber K AU - Schulte P AU - Aziz D LA - PT - DEP - TA - Am J Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 12 IP - DP - 1997 Jan 01 TI - Tuberculosis in the health care industry. PG - 767-774 AB - Between 1986 and 1992, a resurgence of tuberculosis in the United States made this disease once again a significant risk to health care workers. Traditional approaches remain viable methods of reducing present-day hazards. AU - McDiarmid MA LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 26 IP - DP - 1997 Jan 01 TI - BCG vaccination to prevent tuberculosis in health care workers: a decision analysis PG - 201-207 AB - OBJECTIVE: To perform a decision analysis to determine the optimal strategy to prevent tuberculosis (TB) in health care workers with negative tuberculin skin tests. METHODS: We used a Markov model to study the occurrence of events each year and compared BCG vaccination to annual tuberculin testing plus isoniazid (INH) preventive therapy for those who become skin test positive. The outcome measures studied were the number of cases and deaths from TB and BCG and/or INH adverse reactions over 10 years. RESULTS: Annual tuberculin testing decreases the number of TB cases by 9% and BCG vaccination decreases the number by 49%, relative to no prevention intervention. BCG vaccination results in fewer deaths than annual tuberculin testing if the workplace incidence of Mycobacterium tuberculosis infection is greater than 0.06%, BCG vaccination effectiveness exceeds 3%, or the rate of fatal BCG adverse reactions is less than 15 times the rate reported in the literature. CONCLUSIONS: BCG vaccination results in less morbidity and mortality than annual tuberculin skin testing for health care workers in workplaces with documented TB transmission despite comprehensive infection control policies and procedures. Current policy on the prevention of TB among health care workers should be reconsidered AU - Marcus AM AU - Rose DN AU - Sacks HS AU - Schechter CB LA - PT - DEP - TA - Prev Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 278 IP - DP - 1997 Jan 01 TI - Transmission of Mycobacterium tuberculosis by a fiberoptic bronchoscope. Identification by DNA fingerprinting PG - 1093-1095 AB - CONTEXT: An ongoing restriction fragment length polymorphism (RFLP) study of Mycobacterium tuberculosis isolates from tuberculosis (TB) cases revealed an identical 10-banded IS6110 RFLP pattern unique to 2 patients diagnosed as having TB 6 months apart. Their only identifiable link was care at the same hospital. OBJECTIVE: To determine if nosocomial transmission had occurred. DESIGN: Traditional and molecular epidemiologic investigation. MEASUREMENTS: We reviewed medical charts and bronchoscopic records, examined hospital locations visited by both patients, evaluated hospital ventilation systems, and observed cleaning and disinfection of bronchoscopes. RESULTS: A patient with cough, hoarseness, and fever underwent bronchoscopy and was diagnosed as having TB. A second patient with a mediastinal mass underwent bronchoscopy 2 days later and was diagnosed as having small cell carcinoma. Following 6 months of chemotherapy and radiation therapy, the second patient developed fever and an infiltrate of the right upper lobe of the lung. Bronchoscopic washings revealed acid-fast bacilli and were culture positive for M tuberculosis. Both patients had undergone bronchoscopy with the same instrument in the same operating room with no intervening bronchoscopies. Bronchoscope cleaning and disinfection procedures were inconsistent with national guidelines. CONCLUSIONS: A contaminated bronchoscope was the most likely source of M tuberculosis transmission between these 2 patients. The RFLP analysis of M tuberculosis isolates was responsible for detecting this nosocomial source of transmission and led to the implementation of public health measures to prevent further spread of infection and disease. This study emphasizes the need for continued vigilance in endoscope cleaning techniques AU - Michele TM AU - Cronin WA AU - Graham NM AU - Dwyer DM AU - Pope DS AU - Harrington S AU - Chaisson RE AU - Bishai WR LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 91 IP - DP - 1997 Jan 01 TI - Nosocomial transmission of tuberculosis in Africa documented by restriction fragment length polymorphism PG - 318-318 AU - Wilkinson D AU - Crump J AU - Pillay M AU - Sturm AW LA - PT - DEP - TA - Transactions of the Royal Society of Tropical Medi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 11 IP - DP - 1997 Jan 01 TI - Prevention of nosocomial transmission of Mycobacterium tuberculosis. PG - 385-409 AB - The recent resurgence of TB together with the ongoing HIV epidemic has resulted in a larger number of infectious TB patients being admitted to US health care facilities. These patients have become a source for both nosocomial (patient-to-patient) and occupational (patient-to-health care worker) M. tuberculosis transmission. Infectious MDR-TB patients serve as even greater potential infectious sources because they often remain AFB smear and culture positive for months to years. The keys to the prevention of nosocomial and occupational transmission of M. tuberculosis is conducting a risk assessment for each area of the facility and instituting appropriate control measures, having a high index of suspicion by clinicians for infectious TB in those who present with consistent signs and symptoms, rapid triage of such patients to isolation areas and their appropriate clinical work-up, and the institution of effective antituberculous therapy. Infection control personnel should ensure that infectious TB patients are isolated in appropriate isolation rooms (i.e., negative pressure, greater than or equal to 6 ACH, and direct external exhaust of the room air). Health care workers with infectious TB patient contact should be instructed in the epidemiology of M. tuberculosis transmission, the role of respirators in protecting the health care worker from airborne inoculation, and the importance of periodic health care worker TST. The nosocomial TB outbreaks in the 1980s and 1990s document that M. tuberculosis can be transmitted to both patients and health care workers in US health care facilities when appropriate infection control measures are not fully implemented. Follow-up studies at some of these institutions, however, document that when infection control measures similar to the 1990 or 1994 CDC TB Guidelines are fully implemented, M. tuberculosis transmission to both patients and health care workers can be reduced or eliminated. Protection of both patients and health care workers from M. tuberculosis infection is dependent on an understanding and full implementation of the 1994 CDC TB Guidelines. AU - Cookson ST AU - Jarvis WR LA - PT - DEP - TA - Infect Dis Clin North Am JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 183 IP - DP - 1997 Jan 01 TI - A survey in the West Midlands on the use of the courtesy title 'Dr' by UK dental practitioners PG - 289-292 AB - OBJECTIVE: To assess the 1995 General Dental Council's decision to remove restrictions on GDPs using the courtesy title 'Dr'. METHODS: In 1996 this survey undertook a qualitative analysis of the views of four groups involved in primary dental care: 72 GDPs, 25 medical practitioners, 46 vocational dental practitioners, 89 patients. RESULTS: These indicated that some respondents thought that there would possibly be better quality of patient care due to improved medical history taking, that the public's image of the dental profession might be enhanced and that 87% of newly qualified dentists were in favour of the use of the title 'Dr'. CONCLUSIONS: Use of the title appears to be on the increase and if use of the title does become widespread, then all practitioners will need to re-evaluate their choice of personal titles. GDPs need to consider if using the title 'Dr' will encourage patients to give more detailed medical histories AU - Thomas DJ AU - Allsopp J LA - PT - DEP - TA - Brit Dental J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 54 IP - DP - 1997 Jan 01 TI - Relation between decline in FEV1 and exposure to dust and tobacco smoke in aluminium potroom workers PG - 27-31 AB - OBJECTIVES: To investigate the relation between pulmonary function and occupational exposure in aluminium pot operators. METHODS: 2795 observations were obtained in 630 workers over six years of follow up. An autoregressive method of analysis was used. RESULTS: After adjustment for FEV1 in the three previous years, the effect of smoking v no smoking on FEV1 was -43.1 ml, 95% confidence interval (95% CI) -72.3 to -13.9. Similarly, an increase in the exposure to particulates by 1 mg/m3 corresponded to a decrease in FEV1 of -11.9 ml, 95% CI -19.9 to -3.9. Age was a significant predictor of both FEV1 and FVC. CONCLUSION: Exposure to particulates in aluminium potrooms seems to increase the decline in FEV15 thereby increasing the risk of development of chronic obstructive lung disease in pot operators AU - Soyseth V AU - Boe J AU - Kongerud J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 58 IP - DP - 1997 Jan 01 TI - A test chamber for experimental hydrogen fluoride exposure in humans PG - 521-525 AB - An inhalation chamber was built to perform experimental studies with hydrogen fluoride (HF), other gases, and particulate matter. The present study sought to describe a new gas delivery system and the distribution and concentration of HF gas in the chamber. The aluminum chamber has a volume of 19.2 m3 and a variable ventilation rate of about 1 to 10 air changes per hour. The negative pressure difference between the chamber and outside air can be regulated from 0 to 300 Pa. HF was fed at concentrations of up to 4000 mg/m3 directly into the ventilation duct feeding the chamber through openings with diameters as small as 50 microns, oriented opposite to the airflow. Gas flow was varied from about 0.1 dm3/min at a pressure of 4 atm. The dilution factor of HF concentration from cylinder to chamber was on the order of 10(3) to 10(4). The standard deviation (SD) of the HF concentrations at a fixed measurement point during a 1-hour test was typically 0.05 mg/m3 at a time-weighted average (TWA) concentration of 2.66 mg/m3. The SD of the TWA HF concentrations at six locations in the chamber was typically 0.05 mg/m3 and 0.29 mg/m3 at 0.61 and 3.46 mg/m3, respectively. Human exposure could be predicted from calculations based on ventilation data, gas flow, and observed ratio between calculated and measured concentrations. When the target exposure concentration was 1.5 mg/m3, the measured mean exposure concentration was typically 1.54 mg/m3 (range: 1.4-1.7 mg/m3, SD 0.09 mg/m3, n = 8). The chamber is well-suited for inhalation studies in humans. Chamber atmosphere was controlled and has proved to be stable and homogeneous, even in tests with HF, a highly reactive gas in the class of superacids AU - Sostrand P AU - Kongerud J AU - Eduard W AU - Nilsen T AU - Skogland M AU - Boe J LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 18 IP - DP - 1997 Jan 01 TI - Hypersensitivity pneumonitis due to inhalation of fungi-contaminated esparto dust in a plaster worker PG - 355-357 AB - Hypersensitivity pneumonitis or extrinsic allergic alveolitis can be defined as a lung disease caused by a wide group of antigens that reach the lung by inhalation of organic and/or inorganic dust of various sources. The esparto (Stipa Tenacissima and Ligeum Spartum) is an herbaceous of the grass family used in the production of ropes, canvas, sandals, mats, baskets, and so forth. It is also used in the construction industry for the production of paper paste. Inhalation of esparto dust has been reported as cause of hypersensitivity pneumonitis. The existence of precipitating antibodies against esparto extract has been proved. During the esparto fiber manufacturing process, esparto grass can be contaminated by moulds and thermophilic actinomycetes, which have been described as the causing antigens of hypersensitivity pneumonitis in plaster workers. We present a case of occupational hypersensitivity pneumonitis in a plaster worker. Clinical findings, precipitating antibodies, and evolution, after having removed him from his work, confirmed the diagnosis. In our case, Aspergillus species contaminating esparto are probably the antigens that caused the disease AU - MorenoAncillo A AU - Padial MA AU - LopezSerrano MC AU - Granado S LA - PT - DEP - TA - Allergy Asthma Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 IP - DP - 1997 Jan 01 TI - Expression of interleukin (IL)-4 and IL-5 proteins in asthma induced by toluene diisocyanate (TDI) PG - 1292-1298 AB - BACKGROUND: TDI-induced asthma exhibits clinical, functional and morphological similarities with allergen-induced asthma, suggesting that an immunological mechanism is involved in the sensitization to TDI. In vitro studies using the technique of cloning lymphocytes demonstrated that a great proportion of T-cell clones derived from bronchial mucosa of subjects with TDI-induced asthma produced IL-5 and interferon-gamma, but not IL-4, upon in vitro stimulation. OBJECTIVES: To investigate in vivo the role of IL-4 and IL-5 on the inflammatory response of the bronchial mucosa to TDI in sensitized subjects, we performed a quantitative analysis of bronchial biopsies. METHODS: We obtained bronchial biopsies from six subjects with TDI asthma 48 h after an asthmatic reaction induced by TDI challenge (challenged group), in six subjects with TDI asthma 1-4 weeks after the last exposure to TDI (chronic group), and in six non-asthmatic controls. The number of eosinophils, mast cells, T-lymphocytes, and IL-4 and IL-5 protein positive cells was determined by immunohistochemistry in the area 100 microm beneath the epithelial basement membrane. RESULTS: The characteristic increase of submucosal eosinophils, but not of mast cells and T-lymphocytes, was observed in the subjects with TDI-induced asthma when compared with controls. No differences were detected between the two groups of asthmatics. In the subjects with TDI-induced asthma, cell immunoreactivity for IL-5 was increased when compared with normal controls. There was no difference in the expression of IL-5 protein between challenged and chronic asthmatics. In contrast, the expression of IL-4 protein was increased only in the asthmatic subjects tested after recent exposure to TDI. CONCLUSIONS: We demonstrated that TDI asthma 48 h after specific bronchial challenge was associated with increased numbers of cells expressing IL-4 and IL-5, whereas chronic TDI asthma was associated with increased expression of IL-5, but not of IL-4. The results suggest that subjects who developed TDI asthma exhibit increased production of IL-5 even in the absence of a recent trigger by the exogenous sensitizer and that production of TH2-like cytokines in TDI-induced asthma may not always be co-ordinately regulated in vivo AU - Maestrelli P AU - Occari P AU - Turato G AU - Papiris SA AU - Di Stefano A AU - Mapp CE AU - Milani GF AU - Fabbri LM AU - Saetta M LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 124 IP - DP - 1997 Jan 01 TI - Respiratory sensitization to konjac flour in guinea pigs PG - 115-124 AB - Medical reports linking asthma and occupational exposure to airborne powder produced during the manufacture of konjac flour have been reported in the literature. This study was conducted to investigate whether exposure to food grade konjac flour, which is the end product of the manufacturing process, could produce respiratory hypersensitivity using an animal bioassay developed by Karol et al. (Karol, Y., Ioset, H.H., Riley, E.J., Alarie, Y.C., 1978. Am. Ind. Hyg. Assoc. J. 39, 546-556). Groups of guinea pigs were randomly assigned to a negative control, a konjac flour exposure group, or a positive control group exposed to trimellitic anhydride (TMA). The study design included five consecutive days of inhalation induction exposures followed by three inhalation challenge exposures on days 19, 26 and 40. Positive control guinea pigs were exposed to 98 mg/m3 TMA during the induction exposures and 57-67 mg/m3 TMA during the challenge exposures. The mean (+/-S.D.) konjac flour concentration during the induction exposures was 111+/-8.3 mg/m3 and the exposure concentrations of konjac flour during the challenge exposures ranged from 50 to 68 mg/m3. The criteria used to define respiratory tract sensitization (an increase in respiratory rate of 36% and a change in the respiratory waveform) were met by 25% of the animals at each challenge in the konjac flour group. In addition, a few animals responded with slightly lower increases in respiratory frequency and a change in waveform suggestive of a slight pulmonary hypersensitivity response. Guinea pigs that responded during the first challenge also responded during subsequent challenges. No changes in respiratory rate or waveform were noted in animals assigned to the negative control group when challenged with konjac flour. The results of this study indicate that respiratory hypersensitivity to food grade konjac flour can be induced in guinea pigs following repeated inhalation exposure. Therefore, proper engineering controls or personal protection equipment should be utilized to prevent respiratory sensitization in those who may be occupationally exposed to food grade konjac flour AU - Werley MS AU - BurleighFlayer H AU - Mount EA AU - Kotkoskie LA LA - PT - DEP - TA - Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 7 IP - DP - 1997 Jan 01 TI - Asthma due to inhalation of foods. [Review] PG - 320-321 AU - Losada Cosmes E LA - PT - DEP - TA - Journal of Investigational Allergology & Clini JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 IP - DP - 1997 Jan 01 TI - Wheat flour peroxidase is a prominent allergen associated with baker's asthma PG - 1130-1137 AB - BACKGROUND: Putative wheat allergens with molecular sizes around 35kDa have been repeatedly detected in immunoblots using sera from patients with baker's asthma. However, none of these allergens had been previously isolated. OBJECTIVE: To purify and characterize a major component of the 35 kDa allergenic band which seems to be present in flour from diploid, tetraploid (pasta) and hexaploid (bread) wheats. METHODS: Gel-filtration chromatography followed by RP-HPLC have allowed the purification of a new wheat allergen. Immunodetection with sera from allergic patients and with a specific serum for asparagine-linked complex glycans, as well as amino acid sequencing, were used to identify the isolated protein. RESULTS: A 36 kDa allergen has been purified from wheat flour. Its N-terminal and internal sequences, N-linked glycans, and enzymatic activity indicated that this allergen is a seed-specific peroxidase. Sera from six out of 10 patients hypersensitive to wheat flour displayed positive reactions when assayed against the purified dot-blotted allergen. CONCLUSION: Seed-specific peroxidases from cereals (flours) seem to be important allergens in hypersensitive diseases associated with the manipulation of these plant materials. A new enzyme has thus been involved in IgE-mediated diseases AU - SanchezMonge R AU - GarciaCasado G AU - LopezOtin C AU - Armentia A AU - Salcedo G LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 IP - DP - 1997 Jan 01 TI - Identification of the major water/salt insoluble wheat proteins involved in cereal hypersensitivity PG - 1120-1129 AB - BACKGROUND: Several studies have investigated water/salt soluble proteins which comprise 50% of the proteins in wheat. The remaining 50% of wheat proteins, are water/salt insoluble proteins of which there is limited information on their role in cereal hypersensitivity. OBJECTIVES: To investigate the allergenicity of the water/salt insoluble gliadin and glutenin proteins (prolamins). METHODS: RAST, electrophoresis and Western blotting were used to identify water/salt insoluble wheat allergens. Competitive RAST inhibition was conducted to investigate cross-reactivity between prolamins and water/salt soluble wheat proteins. RESULTS: Specific IgE to alpha-gliadin and to total glutenins were detected in all sera. IgE to beta-, gamma-, fast omega-, and slow omega-gliadin were present in lower numbers of sera. Prolamin allergens of 90-11 kDa were identified by immunoblotting. Water/salt soluble proteins crossreacted with alpha-gliadin and total glutenins. CONCLUSIONS: Individuals who are hypersensitive to water/salt soluble wheat proteins produce specific IgE to water/salt insoluble wheat proteins. Western blotting has shown that gliadins, glutenins and proteins with similar molecular weights as the endogenous water/salt soluble wheat enzyme inhibitors are important allergens. Alpha and fast omega- are the most allergenic gliadins. The water/salt insoluble proteins share cross-reacting epitopes with water/salt soluble proteins. These data show that the numbers of proteins involved in the development of cereal hypersensitivity is greater than previously believed and that the development of specific IgE to alpha-gliadin may in part depend on the presence of cross-reacting antibodies to water/salt soluble flour allergens AU - Sandiford CP AU - Tatham AS AU - Fido R AU - Welch JA AU - Jones MG AU - Tee RD AU - Shewry AU - PR AU - Newman Taylor AJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 IP - DP - 1997 Jan 01 TI - Baker's asthma: diversity of allergens PG - 1111-1113 AU - Savolainen J LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Occupational asthma caused by cacao PG - 778-780 AU - Perfetti L AU - Lehrer SB AU - McCants M AU - Malo JL LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Occupational asthma in an isothiazolinone manufacturing plant PG - 746-748 AB - A chemical plant operator developed asthma five months after starting work in an isothiazolinone manufacturing plant. He described symptoms of late asthmatic reactions after work with isothiazolinone. Airway responsiveness to methacholine improved tenfold when he was removed from the plant for 18 days. A workplace challenge study then resulted in a deterioration in airway responsiveness to its earlier level and in progressive falls in forced expiratory volume in one second (FEV1) over three days at work compared with control days, indicating statistically significant late asthmatic reactions of increasing severity AU - Bourke SJ AU - Convery RP AU - Stenton SC AU - Malcolm RM AU - Hendrick DJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 114 IP - DP - 1997 Jan 01 TI - Measurement of airborne flour exposure with a monoclonal antibody-based immunoassay PG - 278-284 AB - BACKGROUND: The development of simple and standardised methods to measure airborne levels of workplace biological allergens is an important step in reducing the incidence of occupational asthma. Such a method would be useful for measuring wheat flour allergens which cause asthma in bakers. Measurement of allergen per se rather than total dust enables exposure to be better defined. METHODS: Monoclonal antibodies were produced, their specificity analysed by immunoblotting and then used to affinity-purify a putative flour allergen. The importance of this protein as an allergen was tested by RAST using sera from allergic bakers and it was identified by N-terminal sequencing. Suitable monoclonal antibodies were chosen to develop an enzyme-linked immunosorbent assay. Commercial baking flours and personal airborne dust samples were analysed using the immunoassay. RESULTS: A sensitive and specific monoclonal antibody-based enzyme-linked immunosorbent assay was developed to measure a wheat alpha-amylase inhibitor. The wheat alpha-amylase inhibitor content of bulk wheat flours was 0.124% (95% confidence limits 0.083-0.164%) and airborne levels in bakeries had a geometric mean of 744 ng/m3 (95% confidence limits 371-1,496 ng/m3). CONCLUSION: This assay is suitable for widespread use as the monoclonal antibodies and standards are well defined and potentially infinitely available. The assay therefore offers distinct advantages over those exposure assessment methods currently in use. Comparable results would be obtained by different investigators over a prolonged time period. The assessment of flour allergen exposure and the relationship with clinical response could then be investigated using a multi-centered approach AU - Wiley K AU - Smith MM AU - Allan LJ AU - Griffin P LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 47 IP - DP - 1997 Jan 01 TI - Flour protein antigens in occupational flour hypersensitivity PG - 341-343 AB - Thirty serum samples from clinical cases of flour hypersensitivity were analyzed for wheat or rye flour protein antibodies. The patients included 20 bakers and 10 others who also had occupational flour exposure. Twenty-three cases had antiflour antibodies which recognized antigens other than control sera in the flour protein patterns. The immunologic response of individual cases seemed very variable in view of the numerous differences between the cases in the antigen-antibody reactions. For the practical purposes, the flour protein antigens were divided in three groups, i.e., those larger than 80 kDa, those between 80 and 50 kDa and those smaller than 50 kDa. Cases with flour-induced dermatitis (n = 8) showed sensitization towards antigens in all size classes while those with rhinitis or asthma showed more antigens with a molecular weight less than 50 kDa. The test offers a possibility to independently verify an exposure to flour while it does not substitute for the conventional immunologic diagnostic tests AU - Savolainen H LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 38 IP - DP - 1997 Jan 01 TI - Lung function in workers in a chicken slaughterhouse in the city of Maracaibo, Venezuela [Spanish] PG - 171-190 AB - In order to evaluate the respiratory health status in workers exposed to antigenic substances (chicken feathers, serum and dropping), typical of usual practice in the avian slaughter-house, pulmonary function was studied on 49 exposed workers, and in a sample of 49 people with similar anthropometric characteristics, non exposed to these substances, by means of occupational-medical history, spirometric tests, hematologic and biochemical tests, and postero-anterior chest x-rays. The values for the spirometric parameters varied with sex, age, weight, size, smoking habits, length of employment and exposure time, and there were no significant differences between exposed and control groups as a whole; showing significant differences with decreasing values for CVF, VEF1, PFE, FEF-25% and FEF-50% in the intermediate zone workers, and in subjects with short exposure time (< 1 year). Prevalence of clinical findings in the exposed population was significantly higher than the non exposed group (p < 0.001). Laboratory tests showed reduction of monocytes cells in the exposed group (p < 0.05) in addition, in the exposed women there was an increase of the eosinophiles, total proteins and globulines (p < 0.05). The frequency of radiographic findings was significantly higher in the exposed group (p < 0.006), and they were no specific. The lack of association between clinical findings, laboratory and radiographic findings, with the spirometric results, could be explained by the short period of exposure, individual and collectives hygienic conditions and size of the sample AU - Chacin B AU - Corzo G AU - Montiel M LA - PT - DEP - TA - Invest Clin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 IP - DP - 1997 Jan 01 TI - Occupational asthma due to blackwood (Acacia Melanoxylon) [letter] PG - 452-453 AU - WoodBaker R AU - Markos J LA - PT - DEP - TA - Aust N Z J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 70 IP - DP - 1997 Jan 01 TI - Occupational asthma in hairdressers: results of inhalation tests with bleaching powder PG - 419-423 AB - STUDY OBJECTIVE: To analyze the extent to which the clinical diagnosis of bleach-induced asthma can be confirmed by laboratory tests and to determine the role of work-related exposure to bleaching powder in a group of hairdressers with respiratory complaints. METHODS: The study population consisted of 55 female hairdressers who had regular contact with various hair products and a clinical history of job-related rhinitic and/or asthmatic symptoms. We divided the individuals into two groups: group I, with asthmatic symptoms (n = 38), and group II, without asthmatic symptoms (control group, n = 17). All subjects underwent immunological, pulmonary-function, and nonspecific bronchial provocation tests, and 46 study participants were subjected to a standardized bleaching-powder test in a designated chamber. RESULTS: There were 13 positive responses to bleaching powder in the skin test, and 32 individuals showed positive bronchial responsiveness to acetylcholine; positive responses to the challenge with bleaching powder occurred in 9 women (22% of those tested). None of the women in group II reacted to bleaching powder. There was no significant difference between persons with a positive or a negative bronchial provocation test with regard to the evaluated parameters. CONCLUSIONS: In the diagnostic workup of hairdressers with work-related respiratory symptoms, bleaching powder is one of the products that need to be tested. As not every patient with an asthmatic response to bleaching powder shows a positive response to the acetylcholine challenge test, in doubtful cases a specific exposure test may be recommendable AU - Schwaiblmair M AU - Vogelmeier C AU - Fruhmann G LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 70 IP - DP - 1997 Jan 01 TI - A follow-up study of respiratory function in workers exposed to acid aerosols in a food-processing industry PG - 413-418 AB - A follow-up investigation was performed on 49 female workers studied 2 years earlier in a vegetable-pickling plant. Acute and chronic respiratory symptoms and ventilatory capacity measurements were recorded during the original and the follow-up studies. Maximal expiratory flow-volume (MEFV) curves were recorded during the Monday morning work shift. The forced vital capacity (FVC), 1-s forced expiratory volume (FEV1), and flow rates at 50% and the last 25% of the FVC (FEF50, FEF25) were measured. There were small increases in the prevalence of chronic symptoms between the two studies for both smokers and nonsmokers, but these did not reach statistical significance. Five workers at the time of the initial study had a diagnosis of occupational asthma; only one of these was still working at the time of follow-up. Workers lost to the follow-up had lower lung function than those seen at follow-up. In workers who were followed, larger than expected mean annual declines were noted for all ventilatory capacity parameters in both smokers (FVC 0.070 1, FEV1 0.070 1; FEF50 0.3551/s, FEF25 0.270 1/s) and nonsmokers (FVC 0.045 1, FEV1 0.045 1, FEF50 0.285 1/s; FEF25 0.130 1/s). The decrease was particularly pronounced for FEF50 and FEF25. The accelerated decline in ventilatory capacity tests noted in the female nonsmokers suggests an independent effect on lung function of work exposure in this environment. Our data confirm that work in the pickling industry, particularly in small, poorly regulated plants, has deleterious effects on respiratory function AU - Zuskin E AU - Mustajbegovic J AU - Schachter EN AU - Pavicic D AU - Budak A LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 51 IP - DP - 1997 Jan 01 TI - Occupational asthma in a cheese packer PG - 408-408 AB - Occupational asthma is an increasingly common clinical problem. A worker who develops asthma for the first time when starting work in a new environment may be straightforward to diagnose. However, when asthma occurs after a latent period following initial exposure, or when a pre-existing asthmatic develops work-related symptoms, the occupational link may be less easy to appreciate. This case report concerns a cheese factory worker with pre-existing asthma who experienced severe symptoms when a new process was introduced for drying grated cheese and was able to return to work only after the process was modified. The drying agent responsible has not been previously reported as a cause of asthma AU - Fawcett IW LA - PT - DEP - TA - Int J Clin Pract JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - Journal Su IP - DP - 1997 Jan 01 TI - Do the isocyanate monomer standards still protect against attacks of occupational asthma? Should a standard including polyisocyanates be evolved? PG - 2000-2007 AB - Field surveys of diisocyanates at the workplaces in Switzerland and particularly in car repair shops, where HDI was the most used, showed that the monomer levels comply with the Swiss permissible exposure limit (PEL) in the great number of situations. Cases of medical surveillance associated with industrial hygiene measurements demonstrate that occupational asthma was also observed in situations where the monomer concentrations are low although high peaks of prepolymers are often recorded. From the statistical data on compensations, the annual incidence of occupational asthma over the period 1988 to 1992 remains around 54 cases with a mean cost of 21,000 sFr. per case per year. It is suggested that a PEL on the prepolymers should be introduced in the Swiss PEL list to enhance the efficiency of prevention policy. AU - VuDuc T AU - Huynh CK AU - Savolainen H LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Asthma to latex and amoxicillin PG - 1147-1149 AU - Vandenplas O AU - Delwiche JP AU - De Jonghe M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 100 IP - DP - 1997 Jan 01 TI - Occupational eosinophilic bronchitis without asthma: an unknown occupational airway disease PG - 852-853 AU - Lemiere C AU - Efthimiadis A AU - Hargreave FE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 100 IP - DP - 1997 Jan 01 TI - Occupational asthma induced by garlic dust PG - 734-738 AB - BACKGROUND: Garlic dust has not been a frequently encountered cause of IgE-mediated disease. OBJECTIVE: We report on 12 patients (all of them garlic workers) with the clinical criteria for occupational asthma. METHODS: Skin prick tests and serum-specific IgE determinations were performed with common inhalants, garlic, and other members of the Liliaceae family (onion, leek, and asparagus). Bronchial challenge test with garlic powder was performed in all patients. Garlic and onion extract proteins were separated by sodium dodecylsulfate-polyacrylamide gel electrophoresis. Immunoblot and IgE immunoblot inhibition analyses were performed with patients' sera on extracts of garlic, onion, and pollens of Phleum pratense and Chenopodium album. RESULTS: Garlic sensitization was demonstrated by bronchial challenge test in seven patients (group 1) and ruled out in the remaining five (group 2). Clinical data were similar in both groups. The patients with garlic allergy had a mean age of 27 years, and all of them had pollen allergy; sensitization to other members of the Liliaceae family was also common. Electrophoresis of garlic extract revealed two major protein bands at approximately 12 and 54 kd. During IgE immunoblotting, the pool of sera reacted with garlic proteins mainly at 54 kd. Preincubation with onion, Phleum, and Chenopodium partially abolished the IgE binding to several allergens of garlic. CONCLUSION: We report on seven patients in whom an occupational garlic allergy was demonstrated. Garlic allergy is relatively rare but seems to affect young subjects with pollen allergy, and sensitization to other members of the Liliaceae family is common. The results of this study confirm the presence of some structurally similar allergens in garlic, onion, and certain pollens AU - Anibarro B AU - Fontela JL AU - De La Hoz F LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Inhalation challenges with agents causing occupational asthma. [Review] PG - 2612-2629 AB - Occupational asthma (OA) is steadily emerging as the principal cause of respiratory disease due to the workplace environment. One of the key means to ascertain diagnosis of OA is specific inhalation challenge (SIC) with occupational agents. This review: 1) describes the methodology of SIC, with a special emphasis on procedures aimed at increasing the safety and validity of these tests; and 2) outlines the roles of SIC in the diagnosis of OA in clinical and medicolegal assessment, epidemiological studies, surveillance programmes and the investigation of the pathophysiological mechanisms of asthma and OA. We discuss areas of future development, including the development of apparatus which allows exposure of subjects to low and stable concentrations of the occupational agent and the assessment of preventive procedures. AU - Vandenplas O AU - Malo JL LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Longitudinal study of respiratory health in dairy farmers: influence of artificial barn fodder drying PG - 2522-2528 AB - Factors influencing respiratory consequences of dairy farming have not been extensively investigated to date. To evaluate the effects of barn fodder drying on respiratory symptoms and lung function, a 5 yr follow-up study was performed in the Doubs (France). A cohort of male dairy farmers was analysed in 1990. The initial cross-sectional results suggested that barn-drying fodder may protect dairy farmers from lung function impairment. In 1995, 113 barn-drying farmers (92%) and 231 traditional-drying farmers (84%) were re-analysed. Barn and traditional fodder-drying farmers were compared for prevalence of symptoms and spirometric measures of lung function. After controlling for age, smoking status, altitude and cumulative exposure, barn-drying farmers compared to traditional-drying farmers had a lower prevalence of chronic bronchitis (4 versus 10%; p<0.05) and slightly higher values of forced expiratory volume in one second (FEV1) (p=0.06) and FEV1/vital capacity (VC) (p<0.01). Nevertheless, decline of the respiratory function parameters was not significantly different between the two groups. Variables positively and significantly associated to longitudinal decline of lung function parameters were: age (FEV1, FEV1/VC); altitude (VC, FEV1) and chronic bronchitis and dyspnoea at the initial survey (FEV1/VC). Persistence and emergence of chronic bronchitis, dyspnoea and symptoms at exposure were also significantly associated to an acceleration in the annual decline of the respiratory function. In conclusion, the mode of fodder drying does not seem to significantly influence the decline in lung function. Nevertheless, this study confirms the results of the initial cross-sectional analysis and supports the hypothesis that barn drying fodder may have a protective effect on respiratory health in dairy farming AU - Mauny F AU - Polio JC AU - Monnet E AU - Pernet D AU - Laplante JJ AU - Depierre A AU - Dalphin JC LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Annual variability in methacholine responsiveness in nonasthmatic working adults PG - 2515-2521 AB - Change in airway responsiveness is used frequently as a clinical as well as an epidemiological tool. Changes in airway responsiveness can be superior to other measures of lung function in that they are more sensitive indicators of an environmental effect. However, normal variation in test results must be defined before change can be interpreted. To characterize annual variability in airways responsiveness, we administered a high-dose methacholine challenge at 1 yr intervals for up to 4 yrs to 105 healthy, nonasthmatic working subjects. Using this high-dose protocol, the majority of tests (83%) produced at least a 20 % fall in forced expiratory volume in one second (FEV1), allowing standard calculation of the provocative dose of methacholine causing a 20% fall in FEV1 (PD20). An annual change in methacholine responsiveness by one or more doubling doses was seen in at least 30% of subjects each year. The components of variance of airways responsiveness measures were estimated to allow direct comparison of within-subject and between-subject variability. The within-subject variability in PD20, was markedly greater than the comparable within-subject variability in FEV1. Level of FEV1 and age were both significant determinants of methacholine responsiveness. Comparison of two methods of expressing methacholine responsiveness (PD20 using the full challenge up to 250 mg x mL(-1) methacholine, and the dose-response slope using data up to 32 mg x mL(-1) methacholine as the maximum dose) had similar annual variability in censored data and mixed-effects models. We then developed an approach to statistical analysis of "right-censored" methacholine challenge data using a maximum likelihood estimation under a censored Gaussian model. These studies of methacholine responsiveness provide normative data on annual test variability in healthy, nonasthmatic working adults, and show that a shorter low-dose challenge has comparable annual variability to a lengthier high-dose challenge AU - Beckett WS AU - Pace PA AU - Sferlazza SJ AU - Carey VJ AU - Weiss ST LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 21 IP - DP - 1997 Jan 01 TI - Use of polymer materials in dental clinics, case study PG - 149-159 AB - Dentistry uses a variety of different polymer materials. Dental polymer materials are based on methacrylate, its polymer, and polyelectrolytes. The setting of restorative materials and adhesives is initiated chemically by mixing two components or by light. In both cases, polymerisation is incomplete and monomers, not reacted, release. Studies have documented that monomers may cause a wide range of adverse health effects such as irritation to skin, eyes or mucous membranes, allergic dermatitis, asthma, parenthesise in the fingers, and disturbances from central nervous system such as; headache, pain in the extremities, nausea, loss of appetite, fatigue, sleep disturbances, irritability, loss of memory and changes in blood parameters. Dental personnel are occupationally exposed when handling the non reacted monomers. The use of gloves do not give enough protection as monomers, released from the material, easily penetrate all gloves used in dentistry. Face masks do not prevent inhalation of monomers. Ordinary glasses do not protect the eyes against vapor from monomers. The result from this study demonstrate the need for the development of ergonomic procedures and practices for safe handling of such materials in dental clinics AU - Lonnroth EC AU - Shahnavaz H LA - PT - DEP - TA - Swed Dent J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 2 IP - DP - 1997 Jan 01 TI - Testing airway responsiveness using inhaled methacholine or histamine. [Review] PG - 97-105 AB - Airway responsiveness assessed using histamine and methacholine is safe, reproducible and relatively easily undertaken in adults and children. Results are similar for methacholine and histamine although methacholine is better tolerated. Responsiveness is increased in children and the elderly, and in women compared to men, possibly due to body size effects. Baseline lung function confounds the interpretation of airway responsiveness and may explain the effect of smoking in most studies. Results are most usefully expressed as the provocative dose producing a 20% fall in FEV1 (PD20FEV1) or the dose-response slope (DRS). When technical factors are controlled the reproducibility of the test is from one to two doubling doses. Measurements of airway responsiveness have been widely used in clinical and research practice. However, assessing their value in diagnosing asthma is limited by the lack of a gold standard for the definition of asthma. Using a cut-off value of 8 mg/mL or 8 mumol for PD20, the tests will discriminate asthmatic from non-asthmatic subjects (based on questionnaire definitions of asthma) with a sensitivity of around 60% and a specificity of around 90%. These properties of the test result in positive and negative predictive values of 86% and 69% when the prevalence of asthma is high (50%-as in the clinical setting) and 40% and 95% when the prevalence of asthma is low (10%, as in general population studies). In the usual clinical setting, assessing the significance of atypical or non-specific symptoms, the tests are of intermediate value in predicting the presence of asthma and less useful in excluding asthma. The additional benefit of testing airway responsiveness to measuring peak flows or to a trial of therapy has yet to be fully assessed. Testing of airway responsiveness may be of value in assessing occupational asthma, asthma severity and the effects of potential sensitizers or treatments. In research, tests of airway responsiveness are more useful for excluding cases of asthma. In population studies, they serve as an objective marker of abnormal airway function which may be genetically determined and, like allergy, are strongly associated with asthma. The predictive value of airway hyperresponsiveness for the development of airway disease is yet to be clearly established. In epidemiology the benefits of measuring airway responses must be weighed against the added inconvenience and cost that is incurred. AU - James A AU - Ryan G LA - PT - DEP - TA - Respirology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 33 IP - DP - 1997 Jan 01 TI - An epidemic of asthma caused by soybean in L'Hospitalet de Llobregat (Barcelona) PG - 453-456 AB - Twenty-six epidemics of asthma occurred in Barcelona between 1981 and 1987 in relation to inhalation of soy dust from grain silo unloading in the harbor. No further epidemics occurred after filters were installed, until a 1994 outbreak of asthma due to soy was detected in L'Hospitalet de Llobregat, a city on the outskirts of Barcelona. We describe 9 patients who presented with acute asthma attacks of sudden onset within a time span of 135 minutes. Counts of total IgE and IgE specific to soy extract were analyzed in all patients. Skin prick tests confirmed exposure to soy in all cases. Atmospheric levels of alcoholic fractions of soy particles (beta-sitosterol and stigmasterol) registered in L'Hospitalet de Llobregat were higher than those detected in Barcelona. We confirmed that soy had been unloaded in the harbor the same day, and that climatic conditions favored the movement of air from the port toward the city of L'Hospitalet. We postulate the need to periodically review preventive measures given the potential severity of the such epidemics AU - Pont F AU - Gispert X AU - Canete C AU - Pinto E AU - Dot D AU - Monteis J LA - PT - DEP - TA - Arch Bronconeumol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 159 IP - DP - 1997 Jan 01 TI - Mealworm allergy PG - 6532-6533 AB - A 24 year-old female employed in a pet shop developed occupationally related asthma, rhinoconjunctivitis and contact urticaria caused by exposure to the yellow mealworm (Tenebrio molitor Linnaeus) sold as food for birds and reptiles. A wholebody extract of the mealworm showed positive prick test and histamine release AU - Bygum A AU - BindslevJensen C LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 14 IP - DP - 1997 Jan 01 TI - Occupational asthma caused by buckwheat flour PG - 319-321 AB - Buckwheat flour, mainly used for pancakes, may induce asthma following inhalation and anaphylactic reactions following ingestion. These allergic reactions are mediated by specific IgE and may be confirmed by skin test and radio-allergo-sorbent test. The occupational asthma of a patient working in pancake restaurant was confirmed by specific challenge test with a computerised device to generate particles. A very small amount of buckwheat flour (10 micrograms) induced an immediate fall of the FEV1 to 56% of the initial value. No bronchial reaction was observed with lactose nor with wheat flour. Specific bronchial challenge identifies the allergen responsible for asthma, measures the level of sensitization and thus can prevent the occupational exposure AU - Choudat D AU - Villette C AU - Dessanges JF AU - Combalot MF AU - Fabries JF AU - Lockhart A AU - Dall'Ava J AU - Conso F LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 23 IP - DP - 1997 Jan 01 TI - More on progressive latex allergy syndrome [letter] PG - 396-397 AU - Barton J LA - PT - DEP - TA - J Emerg Nurs JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 70 IP - DP - 1997 Jan 01 TI - Exposure assessment in occupational epidemiology: measuring present exposures with an example of a study of occupational asthma. PG - 295-308 AB - The aim of the present paper is to present a comprehensive review of the issues involved in exposure assessment for occupational epidemiology studies and to provide an example. Exposure assessment for occupational epidemiology studies is becoming more quantitatively refined. This paper discusses important issues that need to be taken into account for exposure assessment, with particular reference to occupational asthma. It discusses issues such as survey design, data collection, the effect of measurement error and data interpretation. It presents recently developed methodology to evaluate exposure variability and its effect on the attenuation of risk estimates. It also presents methodology to control for such variability. It uses examples from a recent cohort study of flour millers and bakers. This example shows various characteristics of exposure and demonstrates that various measures of exposure, such as peak and full-shift exposure measurements, are regularly correlated, which has consequences for the analyses of exposure-response relationships. This paper stresses the importance of the recognition and evaluation of exposure variability and its effect on risk estimates and shows that with different exposure grouping schemes, different health risk estimates can be obtained. Quantitative exposure assessment is generally difficult, time-consuming and expensive and many issues need to be taken into account, but it can be rewarding and has become an absolute necessity for many occupational epidemiology studies. Evaluation of components of exposure variance is absolutely necessary. Exposure variability could lead to serious attenuation of risk estimates. AU - Nieuwenhuijsen MJ LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 75 IP - DP - 1997 Jan 01 TI - Seroimmunological characteristics of Korean workers exposed to toluene diisocyanate PG - 1-6 AB - Since type I allergy caused by specific IgE antibodies may play principal roles and IgG antibody-mediated reactions have been thought to be involved in some parts of the pathogenesis, this study was performed to investigate the role of IgE- or IgG-mediated hypersensitivity reactions in development of toluene diisocyanate (TDI) asthma in Korean workers. For 81 TDI spray painters, self-administrative questionnaires and direct interviews on respiratory symptoms, chest auscultation, and measurements of forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV1.0) were performed. The TDI concentration in their working environments was measured. Levels of serum IgE and IgG specific to TDI were estimated by radioallergosorbent test (RAST) and ELISA using p-tolyl isocyanate-human serum albumin (TMI-HSA) as the antigen. When sputum, cough, and dyspnea aggravated by work or wheezing existed, when FVC or FEV1.0 was less than 80% of the normal reference value, or when IgE RAST for TDI was positive, the peak expiratory flow rate (PEFR) was recorded four times per day for over 2 weeks. If decrease of PEFR was over 20% of baseline PEFR and changing pattern of PEFR was closely related to workshift in time, then a diagnosis of TDI asthma was made. Changing patterns of PEFR of 8 (9.9%) workers corresponded to the diagnostic criteria of TDI-related occupational asthma. Levels of the specific IgE were increased in 9 (11.1%) of the 81 subject workers and in 3 (37.5%) of the 8 PEFR-positive workers. Levels of the specific IgG were increased in 9 (11.1%) workers, and in only 1 (12.5%) of the asthmatics sensitive to TDI. Neither elevated TDI-specific IgE levels nor PEFR test positivities were associated with increased IgG levels. The mean titer of the PEFR-test-positive workers was slightly lower than that of the PEFR-negative workers and that of the IgE RAST-positive workers lower than that of the test-negative workers, but there was no statistical significance. These results suggest that IgG is not deeply involved in the pathogenesis of TDI-induced occupational asthma in Korean workers AU - Kim H AU - Kim YD AU - Choi J LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Clinical evaluation of occupational asthma. PG - 469-473 AB - In this paper, the procedures in the assessment of occupational asthma (OA) are discussed. Only the most common subtype of OA is considered here, i.e. that in which symptoms appear after a latency period from the beginning of exposure. OA is characterized by variable bronchial obstruction, and variable bronchial hyperresponsiveness caused by specific agents inhaled at work. The clinical investigation of OA is a stepwise approach which includes a comprehensive history together with physiological and immunological studies. The first step is to identify symptoms and relate exposure at work to the presence in the workplace of substances known to provoke OA. The presence of bronchial asthma must then be confirmed; this is achieved by assessing the reversibility of bronchial obstruction and/or the presence of nonspecific bronchial hyperreactivity and/or the presence of significant peak expiratory flow (PEF) variability. The relationship between work and symptoms may first be assessed by means of serial measurements of PEF and of nonspecific bronchial hyperreactivity during periods at work and away from work. When the suspected agent is a high-molecular-weight (HMW) or a low-molecular-weight (LMW) agent known to act through an immunoglobulin E (IgE)-mediated mechanism, skin tests and/or research for specific IgE should be performed. In case of sensitization, where a relationship between asthma and work has been demonstrated by means of serial monitoring of PEF, a diagnosis can be made. If the suspected agent is a LMW agent, a specific inhalation challenge test in the laboratory or at the workplace is necessary. AU - Moscato G AU - Perfetti L AU - Galdi E LA - PT - DEP - TA - Monaldi Arch Chest Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Irritant exposure, bronchial reactivity and asthma. [Review] PG - 461-468 AB - The role of irritant exposure in the pathogenesis of bronchial reactivity and asthma is uncertain. This paper reviews the evidence from environmental epidemiological surveys, studies of occupationally exposed populations and chamber studies of asthmatic and nonasthmatic subjects exposed to irritant fumes. The reactive airways dysfunction syndrome and occupational asthma due to irritant exposure are considered in the context of these results. Although several irritants cause acute bronchoconstriction by a number of mechanisms in chamber studies, there is little convincing evidence to suggest that irritant exposure without pulmonary injury is a risk factor for the development of bronchial hyperresponsiveness. This is the case both in relatively intense concentrations, such as those experienced in industrial or chamber exposure, and at the levels experienced by the general population. AU - Gordon SB AU - Morice AH LA - PT - DEP - TA - Monaldi Arch Chest Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 48 IP - DP - 1997 Jan 01 TI - Allergic conditions for diseases of the respiratory tract from occupational exposure to acid anhydrides PG - 687-694 AB - Acid anhydrides are highly reactive, low molecular weight compounds that are used widely in industry. Work-related exposure to this group of substances may cause occupational asthma. Because of low molecular weight, these compounds are not able to induce antibody responses without conjugating with human proteins. Acid anhydrides may act as haptens when conjugated with human serum albumin (HSA). The induction mechanism of immediate and late bronchial hyperresponsiveness to acid anhydrides appears to be at least partly mediated by IgE antibodies. Other clinical syndromes, which may be caused by acid anhydrides such as pulmonary disease-anemia (PDA), and late respiratory systemic syndrome (LRSS) associated with TMA exposure, appear to be associated with IgG antibodies to TMA as well as with IgE. Significant cross-reaction occurs between different compounds of this group, particularly regarding IgE antibodies. As inhalational exposure to acid anhydrides may result in serious pulmonary disease, adequate protection of potentially exposed workers or their removal, if affected, from exposure is essential. AU - Wittczak T AU - Gorski P LA - PT - DEP - TA - Med Pr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 88 IP - DP - 1997 Jan 01 TI - Allergic pathology due to enzymes: a case report of asthma due to pectinase (polygalacturonase) PG - 489-494 AB - The paper described the case of a worker handling pectinase, an enzyme used in the manufacture of food additives. This enzyme is a carbohydrase (polygalacturonase) obtained by extraction, and consists of three active phases. After little more than a year at the job, the subject complained of bouts of asthma, especially when she had to weigh the enzyme in dust form. Symptoms appeared even when this operation was performed by others near her work station. An allergological examination revealed skin hypersensitivity to the enzyme, without atopy. The methods of preparing the tests performed are described. The authors stress the need to perform similar investigations on other exposed workers in order to assess the allergogenic potential of the substance and adjust environmental preventive measures accordingly AU - Augenti M AU - Galluzzo V AU - Nava C LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 47 IP - DP - 1997 Jan 01 TI - Concomitant alveolitis and asthma following exposure to triphenylmethane triisocyanate PG - 504-506 AB - A 36-year-old man was admitted to hospital with increasing breathlessness. He had been exposed to triphenylmethane triisocyanate. Pulmonary function tests demonstrated physiological abnormalities consistent with both asthma and alveolitis. Exposure to less common isocyanates may not be immediately apparent. Asthma developing after isocyanate exposure is well recognized. Pneumonitis is a relatively rare complication. Measurement of gas transfer may be helpful in the investigation of isocyanate toxicity AU - Buick JB AU - Todd GR LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 24 IP - DP - 1997 Jan 01 TI - Changes in peak expiratory flow in healthy subjects and in patients with obstructive lung disease. [Review] PG - 69S-71S AU - Brand PL AU - de Gooijer A AU - Postma DS LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 88 IP - DP - 1997 Jan 01 TI - Specific bronchial provocation tests with flour in the diagnosis of occupational bronchial asthma PG - 406-415 AB - The gold standard in the diagnosis of occupational asthma is the specific bronchial provocation test (sBPT), but other diagnostic criteria have been proven to have a similar sensitivity, mainly in asthma due to high molecular weight compounds. In order to assess wether some clinical findings can predict the positive response to sBPT, we studied 37 subjects (14 millers and 23 bakers) with suspected occupational asthma who underwent sBPT with wheat flour dust (dust exposure in a small cabin: geometric mean 12.1 mg/m3 for up to 30 min). A positive response to sBPT (FEV1 > 20%) was elicited in 20 subjects (11 early, 4 late, and 5 dual responses). There was no significant difference between subjects with positive or negative sBPT as regards mean age, smoking, length of employment, duration of symptoms, atopy (skin positivity to one or more common allergens) and PD20FEV1 methacholine. The percentage of subjects with work-related symptoms was significantly higher in subjects with positive sBPT with respect to subjects with negative sBPT (81% versus 41.2%, p < 0.01 by chi 2 test); furthermore, FEV1 was significantly lower in subjects with positive sBPT. The percentage of positive skin response to wheat flour extract (mean wheal diameter > or = 3 mm) was mildly but not significantly higher in subjects with positive sBPT (68.4% versus 41.2%). None of the following clinical factors (age < 35 years, asthma symptoms pre-existing occupational exposure, non smokers, atopy and bronchial hyperresponsiveness to methacholine), alone or in combination, were associated with higher prevalence of positive sBPT. We conclude that the response to sBPT in subjects with suspected occupational asthma due to flour dust can not be adequately predicted by other clinical, allergologic and functional data. Therefore, sBPT with flour dust should always be performed in subjects with suspected occupational asthma AU - Carletti AM AU - Talini D AU - Carrara M AU - Macchioni P AU - Taccola M AU - De Santis M AU - Masino E AU - Paggiaro PL LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 34 IP - DP - 1997 Jan 01 TI - Comparison between peak expiratory flow and forced expiratory volume in one second (FEV1) during bronchoconstriction induced by different stimuli PG - 105-111 AB - To evaluate the sensitivity of peak expiratory flow (PEF), obtained by portable peak flow meter, in detecting mild changes in airway caliber as assessed by forced expiratory volume in 1 sec (FEV1), we studied 184 subjects who underwent different bronchial challenge tests for suspected bronchial asthma. We measured FEV1 and PEF during bronchoconstriction induced by different stimuli: allergen, methacholine, toluene diisocyanate vapors, exercise, or distilled water inhalation; a total of 186 tests were examined. Before and at different times after challenge, FEV1 was measured, and immediately after, PEF was obtained by Mini-Wright or Assess Peak Flow Meter; each time FEV1 and PEF were taken as the best of three satisfactory tracings. The median FEV1 change from baseline value of all steps in the different challenge tests was 7.5% (range: 0-66%). The correlation coefficients between FEV1 and PEF percent changes in different challenge tests were low (Spearman's p: 0.27-0.69), with high scattering of the data. The concordance between classes of percent changes in FEV1 and PEF was also low (Cohen's weighted kappa: 0.28-0.42). In subjects with a FEV1 fall > 15% after challenge, the median PEF change after bronchoconstriction was lower than the corresponding FEV1 change [17% (0-52) vs. 27% (17-66)]. When different cutoff limits of PEF percent change were considered, the sensitivity of PEF to detect a significant change in FEV1 (15 or 20% change) during bronchoconstriction was low; specificity was in general higher than sensitivity. We conclude that PEF and FEV1 changes are poorly related during mild bronchoconstriction induced by different stimuli. The low sensitivity of PEF to detect mild changes in airway caliber may represent a limit in the use of PEF in the day-to-day monitoring of asthma AU - Giannini D AU - Paggiaro PL AU - Moscato G AU - Gherson G AU - Bacci E AU - Bancalari L AU - Dente FL AU - Di Franco A AU - Vagaggini B AU - Giuntini C LA - PT - DEP - TA - J Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Effect of gender on hospital admissions for asthma and prevalence of self-reported asthma: a prospective study based on a sample of the general population. Copenhagen City Heart Study Group PG - 287-289 AB - BACKGROUND: Women are more often admitted to hospital for asthma than men. A study was undertaken to determine whether this is caused by gender differences in the prevalence or severity of the disease. METHODS: Admissions to hospital for asthma in 13,540 subjects were followed from 1977 to 1993. RESULTS: At baseline 315 subjects (2.3%) reported asthma, 2.2% of women and 2.5% of men. During follow up 160 subjects were admitted to hospital for asthma. After controlling for self-reported asthma and smoking, women had a higher risk of being admitted to hospital than men (relative risk 1.7, 95% confidence interval 1.2 to 2.4). This increased risk was not due to misclassification of chronic obstructive pulmonary disease (COPD) as asthma. CONCLUSIONS: These findings indicate gender-related differences in either the severity, perception, or management of asthma AU - Prescott E AU - Lange P AU - Vestbo J LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 24 IP - DP - 1997 Jan 01 TI - Relationship between peak expiratory flow (PEF) and FEV1 PG - 39S-41S AU - Paggiaro PL AU - Moscato G AU - Giannini D AU - Di Franco A AU - Gherson G LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Blood markers of early and late airway responses to allergen in asthmatic subjects. Relationship with functional findings PG - 32-40 AB - We evaluated the relationship between blood markers of mast-cell (plasma histamine and serum level of heat-stable neutrophil chemotactic activity [NCA]) and eosinophil (serum eosinophil cationic protein [ECP]) activation during early airway response (EAR) and late airway response (LAR) to allergen inhalation in 24 asthmatic subjects. After EAR, 14 subjects showed significant LAR (FEV1 fall: > or = 25%), while 10 subjects showed equivocal LAR (FEV1 fall: 15-20%). A significant increase from baseline value was observed in plasma histamine and in serum NCA during both EAR and LAR, while serum ECP significantly increased only during LAR. The sensitivity of different markers to detect significant FEV1 fall during EAR and LAR was low, except for NCA. Changes in blood mediators were similar in both groups with significant and equivocal LAR. There was a significant relationship between the increase in NCA during EAR and the severity of LAR. Stepwise regression between changes in different blood markers showed a significant relationship between histamine increase during EAR and ECP increase during LAR. Thus, serum NCA is a more sensitive marker of EAR and LAR than plasma histamine and serum ECP, and its increase during EAR seems predictive of the severity of the subsequent LAR AU - Bancalari L AU - Dente FL AU - Cianchetti S AU - Prontera C AU - Taccola M AU - Bacci E AU - Carletti A AU - Di Franco A AU - Giannini D AU - Vagaggini B AU - Ferdeghini M AU - Paggiaro PL LA - PT - DEP - TA - Allergy: European Journal of Allergy & Clinica JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 54 IP - DP - 1997 Jan 01 TI - Occupational asthma due to porcine pancreatic amylase PG - 762-764 AB - A case of occupational asthma in a 41 year old histopathology laboratory technician attributable to a powder preparation of the porcine pancreatic enzyme amylase is reported. The diagnosis was confirmed by a double blind, placebo controlled, inhalation challenge study which showed immediate and late asthmatic reactions associated with a significant increase in airway responsiveness to methacholine AU - Aiken TC AU - Ward R AU - Peel ET AU - Hendrick DJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 35 IP - DP - 1997 Jan 01 TI - Adverse effects of colophony. [Review] PG - 1-7 AB - Regarding colophony, the use in industries, adverse effects, diagnosis, pathophysiology and control are reviewed. Colophony is an unhomogeneous mixture of resin acids as like abietic acid and neutral substances. Colophony is used everywhere, in industry, daily life and medical supplies. Soldering workers are exposed to the colophony fumes heated up to the temperature of soldering irons. The effects of exposure to colophony are classified into bronchial asthma and contact dermatitis. Colophony fumes cause bronchial asthma by its nonspecific irritation. Inhalation challenge test and repeated spirometry during working day may help the diagnosis of colophony induced asthma. Improvement of working environment for soldering and development of new flux instead of colophony will be necessary. A study on contact dermatitis revealed that colophony and its related compounds are one of major causes for contact dermatitis. Cases of dermatitis by depilatory agents used to remove hair from slaughtered swine, anti-slipping cream for ballet shoes or resin for cello strings have been reported. Patch test may contribute to the diagnosis of dermatitis caused by colophony. AU - Keira T AU - Aizawa Y AU - Karube H AU - Niituya M AU - Shinohara S AU - Kuwashima A AU - Harada H AU - Takata T LA - PT - DEP - TA - Ind Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 78 IP - DP - 1997 Jan 01 TI - Occupational allergic rhinoconjunctivitis and asthma due to fennel seed PG - 37-40 AB - BACKGROUND: A patient with complaints of rhinitis and asthma occurring at work presented for consultation. OBJECTIVES: To evaluate the role of the foods and spices with which he worked, in the causation of his complaints, and to evaluate his immune reactivity to these materials. METHODS: Allergy skin testing and in vitro RAST assays were carried out. After demonstrating specific reactivity to fennel, SDS-PAGE electrophoreses was carried out. RESULTS: Positive skin tests to grass, ragweed, and freshly prepared fennel seed were found. Serum IgE antibodies to fennel were quite high. Immunoblotting studies showed reactions to two components in fennel extract as well as to components in mugwort, paprika, short ragweed and black pepper. CONCLUSION: This case of occupational rhinitis and asthma in an atopic individual involves sensitivity to unique allergens in fennel, with molecular weights of 67 to 75 KD AU - Schwartz HJ AU - Jones RT AU - Rojas AR AU - Squillace DL AU - Yunginger JW LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 111 IP - DP - 1997 Jan 01 TI - Fatal cases of farmer's lung in a Canadian family. Probable new antigens, Penicillium brevicompactum and P olivicolor PG - 245-248 AB - Three Canadian farmers, including a married couple and another close relative, died from progressive pulmonary fibrosis. Their histories and investigations were compatible with chronic farmer's lung (FL). Our environmental and immunologic studies indicate Penicillium brevicompactum and P olivicolor as probable new antigens of FL in a cool and dry climate AU - NakagawaYoshida K AU - Ando M AU - Etches RI AU - Dosman JA LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - IP - DP - 1997 Jan 01 TI - Criteria document for hexavalent chromium PG - - AU - Cross HJ AU - Faux SP AU - Sadra S AU - Sorahan T AU - Levy LS AU - Aw TC AU - Braithwaite R AU - McRoy C AU - Hamilton L AU - Calvert IA LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 155 IP - DP - 1997 Jan 01 TI - Comparison of mean daily diurnal variation in PEF and FEV1 PG - A137- AU - Bright P AU - Burge PS LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 155 IP - DP - 1997 Jan 01 TI - Comparison of PEF and FEV1 monitoring with specisic inhalation challenge in the diagnosis of occupational asthma PG - A137- AU - Leroyer C AU - Perfetti L AU - Trudeau C AU - Ghezzo H AU - ChanYeung M AU - Malo JL LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 100 IP - DP - 1997 Jan 01 TI - Asthma caused by occupational exposure to pectin PG - 575-576 AU - Jaakkola MS AU - Tammivaara R AU - Tuppurainen M AU - Lahdenne L AU - Tupasela O AU - Keskinen H LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Effects of new ventilation system on health and well-being of office workers PG - 360-367 AU - Menzies D AU - Pasztor J AU - Nunes F AU - Leduc J AU - Chan CH LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - The British guidelines on asthma management PG - S1-S21 AU - Anonymous LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 99 IP - DP - 1997 Jan 01 TI - Asthma caused by Dermestdae (black carpet beetle): a new allergen in house dust PG - 147-149 AU - Cuestaherranz J AU - de las Heras M AU - Satre J AU - et al LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Occupational asthma due to triglycidyl isocyanurate PG - A74- AU - Mc Coach JS AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Measurement of absolute lung volumes by imaging techniques PG - 2427-2431 AU - Clausen J LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 50 IP - DP - 1997 Jan 01 TI - A recommended occupational exposure limit for formaldehyde based on irritation PG - 217-263 AU - Paustenbach D AU - Alarie Y AU - Kulle T AU - Schachter N AU - Smith R AU - Swenberg J AU - Witschi H AU - Horowitz SB LA - PT - DEP - TA - J Toxicol Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 54 IP - DP - 1997 Jan 01 TI - Changes in respiratory function after one and three hours of exposure to formaldehyde in non-smoking subjects PG - 296-300 AU - AkbarKhanzadeh F AU - Mlynek JS LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Risk factors for asthma in young adults. Spanish group ot the European Community Respiratort Health Survey PG - 2490-2494 AU - Sunyer J AU - Anto JM AU - Kogevinas M AU - Barcelo MA AU - Soriano JB AU - Tobias A AU - Muniozguren N AU - MartinezMoratalla J AU - Payo F AU - Maldonado JA LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 24 IP - DP - 1997 Jan 01 TI - Serial peak expiratory flow measurement in the diagnosis of occupational asthma. PG - 57S-63S AB - Serial measurement of peak expiratory flow (PEF) is the most appropriate initial confirmatory test for occupational asthma suggested by a history of asthmatic symptoms improving on days away from work. PEF recordings need to be taken every 2 h during waking hours, both on days at and away from work. A minimum positive record includes recordings taken over two work periods, and two rest periods, and a minimum negative record will also include a rest period of at least 10 days duration. Exposures at work, medication, and length of time after waking for the first recording should be kept constant. Records may be interpreted by plotting the recordings (usually as maximum, mean and minimum against time, with appropriate shading of days including work). Analysis of cycles and rhythms within the record may also reveal an effect of work. Statistical methods can also be used to detect differences between recordings at and away from work. At present, expert visual assessment of plotted records appears to be the most specific and sensitive method of interpretation. It does require experience, as it involves qualitative judgements. Work is currently being carried out to quantify these judgements. A number of factors may interfere with interpretation by any method. These include; intermittent exposure to suspect agents at work; irregular medication; irregular timing of the first reading after waking; respiratory tract infection; and variable patient peak expiratory flow measurement technique. AU - Gannon PFG AU - Burge PS LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 54 IP - DP - 1997 Jan 01 TI - Variation in incidences of tuberculosis in subgroups of South African gold miners. PG - 636-641 AB - OBJECTIVES: To determine risk factors and to identify groups at high risk of tuberculosis (TB) among South African gold miners. METHODS: A retrospective cohort analysis was carried out with hospital and personnel databases on a random sample of the workforce of Freegold Mines, served by Ernest Oppenheimer Hospital, Welkom, South Africa. The outcome measure of interest was a reported first episode of TB while employed at Freegold. A person-years analysis was carried out to estimate incidence ratios between different categories of age group, period, cumulative service, mining occupation, and silicosis status. A separate analysis was carried out on a subgroup of men (non-random) whose HIV status was known. RESULTS: The main finding of the study was that TB was more strongly associated with age than expected with a rate ratio of reported incidence of 21 for the oldest age group compared with the youngest, after adjustment for period, cumulative service, occupation, and silicosis status. There was also a significant association between TB and occupations such as drilling with a rate ratio of 2.3 compared with low dust surface and maintenance workers, after adjustment for age, period, cumulative service, and silicosis. Analysis of the HIV tested subgroup showed that these results are unlikely to be the result of confounding due to HIV infection. Prevalence of HIV in this group has been rising sharply since 1991, but the increase was slowing towards the end of the study period. CONCLUSION: A profile of mineworkers who are at high risk of TB can be defined by age, mining occupation, silicosis status, and HIV infection with predicted rates of 100/1000 person-years. TB screening programmes should take special cognisance of high risk groups of gold miners. AU - Kleinschmidt I AU - Churchyard G LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - IP - DP - 1997 Jan 01 TI - Anti-tuberculous drug resistance in the world: the WHO/IUATLD global project on antituberculous drug resistance surveillance 1994-1997 PG - - AU - WHO LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 IP - DP - 1997 Jan 01 TI - Occupational sensitization to laboratory animals PG - 603-605 AU - Gordon S LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 38 IP - DP - 1997 Jan 01 TI - Progress of emphysema in severe alpha-1-antitrypsin deficiency as assessed by annual CT PG - 826-832 AU - Dirksen A AU - Friis M AU - Olesen KP AU - Skovgaard LT AU - Sorensen K LA - PT - DEP - TA - Acta Radiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 8 IP - DP - 1997 Jan 01 TI - Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC) PG - 161-176 AB - BACKGROUND: As part of the International Study of Asthma and Allergies in Childhood (ISAAC), prevalence surveys were conducted among representative samples of school children from locations in Europe, Asia, Africa, Australia, North and South America. SUBJECTS: 257,800 children aged 6-7 years from 91 centres in 38 countries, and 463,801 children aged 13-14 years from 155 centres in 56 countries. METHODS: Written symptom questionnaires were translated from English into the local language for self-completion by the 13-14-year-olds and completion by the parents of the 6-7-year-olds. Rhinitis was described as a problem with sneezing, or a runny, or blocked nose when you (your child) DID NOT have a cold or the flu. Additional questions were asked about rhinitis associated with itchy-watery eyes, interference with activities and a history of hay fever ever. RESULTS: The prevalence of rhinitis with itchy-watery eyes ("rhinoconjunctivitis") in the past year varied across centres from 0.8% to 14.9% in the 6-7-year-olds and from 1.4% to 39.7% in the 13-14-year-olds. Within each age group, the global pattern was broadly consistent across each of the symptom categories. In centres of higher prevalence there was great variability in the proportion of rhinoconjunctivitis labelled as hay fever. The lowest prevalences of rhinoconjunctivitis were found in parts of eastern Europe, south and central Asia. High prevalences were reported from centres in several regions. CONCLUSION: These results suggest substantial worldwide variations in the prevalence and labelling of symptoms of allergic rhinoconjunctivitis which require further study. These differences, if real, may offer important clues to environmental influences on allergy AU - Strachan D AU - Sibbald B AU - Weiland S AU - AitKhaled N AU - Anabwani G AU - Anderson HR AU - Asher MI AU - Beasley R AU - Bjorksten B AU - Burr M AU - Clayton T AU - Crane J AU - Ellwood AU - P AU - Keil U AU - Lai C AU - Mallol J AU - Martinez F AU - Mitchell E AU - Mont LA - PT - DEP - TA - Pediatric Allergy & Immunology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Incidence of asthma in adults--report from the Obstructive Lung Disease in Northern Sweden Study PG - 1071-1078 AB - Incidence studies offer a better opportunity to study risk factors for asthma than do prevalence studies. However, regular prospective follow-ups of large cohorts are difficult to perform, and that is why direct measurement of the incidence rate of asthma is almost impossible. Thus, cross-sectional follow-up studies of defined cohorts can be used to provide data on incidence. In 1986, a postal questionnaire survey on respiratory symptoms and diseases was performed in the northernmost province of Sweden. The population sample comprised all subjects born in 1919-20, 1934-5, and 1949-50 in eight representative areas of the province, which comprises 25% of the total area of Sweden. Completed answers were given by 5698 subjects (86%) of the 6610 subjects invited to the study. In 1992, the cohort was invited to a follow-up survey during the same season as in 1986, and 6215 subjects were traced. Of the 5393 subjects who answered the questionnaire, 4932 had participated in the 1986 survey, or 87% of those who participated in 1986. For the period 1986-92, the cumulative incidences of asthma were 4.9 and 5.0%, respectively, as assessed by the questions, "Have you ever had asthma?" and "Have you been diagnosed as having asthma by a physician?" Thus, the results indicate a mean annual cumulative incidence of asthma of 0.8%. After correction of the results for subjects who were diagnosed as having asthma in the clinical part later in the 1986 study, the mean annual cumulative incidence of asthma was found to be 0.5%. Risk factors were family history of asthma (OR 3.46) and current and former smoking, while female sex was a strong trend AU - Ronmark E AU - Lundback B AU - Jonsson E AU - Jonsson AC AU - Lindstrom M AU - Sandstrom T LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Variation in bronchial responsiveness in the European Community Respiratory Health Survey (ECRHS) PG - 2495-2501 AB - Attempts to compare bronchial responsiveness between populations have been hampered by between-study differences in the pharmacological agent of provocation, the method of administration and the summary statistic employed. The European Community Respiratory Health Survey used methacholine challenge delivered by Mefar dosimeter according to a standardized protocol used in 35 centres in 16 countries. Data were obtained from 13, 161 men and women, aged 20-44 yrs at the start of the study. The dose of methacholine producing a 20% fall in forced expiratory volume in one second (FEV1) (PD20) and the regression coefficient of percentage decline in FEV1 with log dose, were calculated ("slope", after transformation), with and without calibration of nebulizers by weight and adjustment for nonresponse bias. Standardization for baseline lung function and variation in smoking prevalence was applied to slope. Results were robust to whichever summary measure was used, and to the various adjustments. Responsiveness was low in Iceland and Switzerland, and in most centres in Sweden, Italy and Spain, and high in New Zealand, Australia, the USA, Britain, France, Denmark and Germany. Bronchial responsiveness varies considerably in Europe, and high levels are not confined to the English-speaking world AU - Chinn S AU - Burney P AU - Jarvis D AU - Luczynska C LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Effect of thunderstorms and airborne grass pollen on the incidence of acute asthma in England, 1990-94 PG - 680-685 AB - BACKGROUND: Thunderstorms and prior grass pollen counts were investigated as predictors of daily hospital admissions for asthma in England. This study was motivated by reports in the literature of spectacular asthma epidemics associated with thunderstorms, particularly in the grass pollen season. METHODS: Asthma admissions for two age groups (0-14 years and 15 and over) were measured using the Hospital Episodes System (HES) in the 14 regional health authorities (RHAs) in England. Thunderstorms were measured daily in each RHA using densities of sferics (lightning flashes). Relative asthma excesses for moderate positive and exceptionally high sferic densities, with or without previous high grass pollen counts, were measured using log linear autoregression--allowing for weekly, seasonal, and longer term background variation--and pooled over RHAs by calculating geometric means. RESULTS: Relative risks from all RHAs were pooled to form geometric means. Exceptional sferic densities were associated with a relative excess risk of around 25% in both age groups. Moderate sferic densities were associated with a smaller excess, statistically significant in the two age groups taken together. In five RHAs in which grass pollen counts were available, high pollen counts for the previous five days were associated with an amplification of the excess associated with thunderstorms. CONCLUSION: Very large sferic densities are associated with moderate rises in hospital admissions for acute asthma. However, typical thunderstorm days are not associated with spectacular asthma epidemics of the scale previously reported in the literature. Thunderstorm-associated excesses are amplified after a run of high pollen counts AU - Newson R AU - Strachan D AU - Archibald E AU - Emberlin J AU - Hardaker P AU - Collier C LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Prevalence of asthma symptoms in video and written questionnaires among children in four regions of Finland PG - 1787-1794 AB - The aim of this study was to determine whether there are regional differences in the prevalence of childhood asthma in Finland. A secondary objective was to assess the concordance between a written and a video questionnaire on asthma symptoms. In 1994-1995, the self-reported prevalence of asthma symptoms in four regions of Finland was studied among 11,607 schoolchildren aged 13-14 yrs, as part of the International Study of Asthma and Allergies in Childhood (ISAAC). The ISAAC written and video (AVQ 3,0) questionnaires were administered in the school setting. The prevalences of any wheezing during the previous 12 months in the ISAAC video questionnaire were 10% in East Finland (Kuopio County, n=2,821), 12% in South Finland (Helsinki area, n=2,771), 12% in Southwest Finland (Turku and Pori County, n=2,983), and 11% in North Finland (Lapland, n=3,032). The prevalences in the ISAAC written questionnaire were 13, 20, 15, and 16%, respectively. The surveys were performed during winter, except in Helsinki where the survey was carried out mainly during the spring pollen season. During autumn, the prevalence in the written questionnaire in Helsinki was 16%. In multivariate analysis, boys had a lower prevalence than girls, and smokers a threefold higher prevalence than nonsmokers. In conclusion, the prevalence of childhood asthma is lower in Finland than in other European countries, and may be even lower in the eastern part of the country. In contrast to the results from some other European countries, prevalences were lower in the video than in the written questionnaire, which suggests that translating the word "wheezing" into other languages, including Finnish, may produce results that cannot be compared. The strong association of smoking with wheeze both in the video and written questionnaires should be considered in further analysis of the ISAAC study AU - Pekkanen J AU - Remes ST AU - Husman T AU - Lindberg M AU - Kajosaari M AU - Koivikko A AU - Soininen L LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Physician-diagnosed asthma and drug utilization in the European Community Respiratory Health Survey PG - 1795-1802 AB - The aim of this analysis was to estimate the geographical variation in the prevalence of physician-diagnosed asthma and treatment practice for asthma in young adults. The results are based on an ecological analysis of 34 centres in 14 countries, in which a total of 17,029 randomly selected subjects (52% females, age 20-48 yrs) underwent a structured interview and spirometry as part of the European Community Respiratory Health Survey. The sample was enriched with 2,903 symptomatic subjects when investigating treatment in subjects with physician-diagnosed asthma. The prevalence of physician-diagnosed asthma was highest in New Zealand and Australia (11-13%) and lowest in Erfurt, Germany (1.2%) and Spain (1.5-3.0%). The reported use of antiasthma medication in the last 12 months was also highest in New Zealand and Australia (12-16%) and correlated closely with the prevalence of diagnosed asthma (r=0.89, p<0.001). Herbal remedies against breathing problems had been used by 13% of subjects in Hamburg but the reported use of alternative remedies for breathing problems was low in most other centres. The use of inhaled anti-inflammatory drugs in subjects with physician-diagnosed asthma ranged from 49% in the UK to 17% in Italy and correlated with the prevalence of doctors' consultations within the last 12 months (r=0.66, p<0.05). The prevalence of anti-inflammatory treatment was positively related to the prevalence of nocturnal asthma symptoms (p<0.05). We conclude that there is a wide geographical variation in the prevalence of physician-diagnosed asthma and use of antiasthma medication. The geographical variation in the use of anti-inflammatory drugs among individuals with diagnosed asthma may be related to variations in asthma severity, as well as differences in treatment practices between countries AU - Janson C AU - Chinn S AU - Jarvis D AU - Burney P LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 39 IP - DP - 1997 Jan 01 TI - A state-based surveillance system for work-related asthma PG - 415-425 AB - The current national surveillance system for occupational illnesses underestimates the incidence of work-related asthma. This article describes a state-based surveillance system for work-related asthma. The Michigan surveillance system enables us to estimate the incidence of work-related asthma, describe the characteristics of affected individuals, and facilitate public health interventions in the form of workplace inspections. The data presented are based on interviews with a case-series of individuals with work-related asthma reported to the Michigan Department of Public Health (MDPH) from 1988 to 1994. We also present cross-sectional data on coworkers of the index cases, who were interviewed during the workplace investigations, and exposure measurements from those investigations. Potential cases were reported by physicians, hospitals, or the Michigan Department of Labor. Case eligibility was based on the criteria for work-related asthma developed by the National Institute for Occupational Safety and Health (NIOSH). Between 1988 and 1994, 725 people who met the NIOSH criteria for work-related asthma were reported to the MDPH. Seventy-six percent of the reports were from physicians, 17.1% were from hospitals, 7.3% were from workers' compensation records, and 3.5% were from other health professionals. Eighty-three percent of the reports were for individuals with the onset of newly diagnosed asthma after a period of symptomless exposure, 7.3% were for aggravation of preexisting asthma, and 9.5% were for reactive airway dysfunction syndrome (RADS). The overall annual average incidence rate of work-related asthma in Michigan was 2.9 cases per 100,000 workers. Rates were 0.8/100,000 in the service industry and 8.5/100,000 in manufacturing. Isocyanates and machining coolants were the two most common causes of asthma among workers reported to the surveillance system. Demographics of the individuals reported are described. During workplace follow-up investigations, 861 fellow workers were identified as having possible work-related asthma. Another 151 coworkers were identified from the company-maintained injury and illness logs as having possible work-related asthma. In addition, the investigations identified two new causes of work-related asthma. The primary limitations of the surveillance system include a lack of objective testing to confirm the diagnosis of work-related asthma and underreporting of cases. Despite these limitations, this state-based surveillance system has proven successful in identifying new cause of asthma and identifying workplaces with a high prevalence of workers with respiratory symptoms who may benefit from public health interventions AU - Rosenman KD AU - Reilly MJ AU - Kalinowski DJ LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 39 IP - DP - 1997 Jan 01 TI - Occurrence of asthma and chronic bronchitis among female hairdressers. A questionnaire study PG - 534-539 AB - We carried out a retrospective cohort study using a self-administered questionnaire to assess the risk of hairdressers to develop asthma and chronic bronchitis. A representative sample of 4433 female hairdressers and an equal number of shop personnel in employment in 1980 was drawn from the Longitudinal Census Data File of Statistics Finland. Physician-diagnosed asthma, chronic bronchitis, and other respiratory diseases in 1980 and 1995 were inquired about in the respiratory part of the questionnaire. The response rate to the questionnaire was 82% for the hairdressers (n = 3484) and 79% for the referents (n = 3357). The prevalence of asthma among the hairdressers was 5.6% in 1980 and 10.1% in 1995, and the prevalence of chronic bronchitis was 3.9% in 1980 and 5.6% in 1995. The relative risk for asthma (odds ratio [OR]: 1.7, 95% confidence interval [CI]: 1.3 to 2.3 in 1980; and OR: 1.7, 95% CI: 1.4 to 2.2 in 1995) and for chronic bronchitis (OR: 2.2, 95% CI: 1.5 to 3.2 in 1980; and OR: 1.9, 95% CI: 1.4 to 2.6 in 1995) among hairdressers was almost twice that in the reference group. The incidence rate of asthma in 1980 through 1995 was 2.2 and of chronic bronchitis was 1.1 cases per 1000 person-years among hairdressers, whereas the rate in the reference group was 1.3 asthma cases and 0.9 chronic bronchitis cases per 1000 person-years. The relative risk for developing asthma during the 15 years observation time was 1.7 (95% CI: 1.1 to 2.5) and for chronic bronchitis was 1.2 (95% CI: 0.7 to 1.9) among hairdressers, compared with referents. Our results indicate that hairdressers are at higher risk for developing asthma AU - Leino T AU - Tammilehto L AU - Paakkulainen H AU - Orjala H AU - Nordman H LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 110 IP - DP - 1997 Jan 01 TI - Occupational asthma and other nonasbestos occupational respiratory diseases notified between 1993 and 1996 PG - 246-249 AB - AIM: To review notifications to the Occupational Safety and Health Service of the Department of Labour Notifiable Occupational Disease System since its inception until June 1996. METHODS: All notifications received for non asbestos related occupational respiratory disease were reviewed to evaluate the outcome of the notification and to identify the causative agent where possible. RESULTS: There were 277 cases notified and investigated including worksite investigations. Of these 73 cases were confirmed as having occupational asthma, 35 by the asthma validation panel. Nineteen cases of other occupational respiratory disease were notified of which 11 were reviewed by the panel. Extrinsic allergic alveolitis secondary to organic dusts was the most common such notification. CONCLUSIONS: Isocyanates are well recognised as a cause of occupational asthma in New Zealand. It is suspected that occupational asthma and other occupational respiratory diseases are poorly notified to this system. Better mechanisms are needed to identify occupational causes of respiratory (and other) disease AU - Walls C AU - Crane J AU - Gillies J AU - Wilsher M AU - Wong C LA - PT - DEP - TA - N Z Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 IP - DP - 1997 Jan 01 TI - Comparison of the ISAAC video questionnaire (AVQ3.0) with the ISAAC written questionnaire for estimating asthma associated with bronchial hyperreactivity PG - 540-545 AB - BACKGROUND: A standardized protocol is essential for international comparisons of asthma prevalence and severity. The International Study of Asthma and Allergies in Childhood (ISAAC) used a standardized written questionnaire (WQ) and a video questionnaire (AVQ3.0) to survey the prevalence and severity of asthma in 13-14-year-old schoolchildren in different countries. OBJECTIVE: To compare the effectiveness of WQ and AVQ3.0 in predicting bronchial hyperresponsiveness (BHR), defined as having a provocation dose of inhaled methacholine causing a 20% fall in baseline FEV1 of 7.8 mumol. METHODS: One hundred and eighty-nine Chinese schoolchildren completed a written questionnaire followed by a video questionnaire on asthma symptoms. They then underwent bronchial challenge to methacholine. RESULTS: Fair correlations were seen between the first two corresponding questions (moderate wheezing at rest and exercise wheeze) in the two questionnaires with Kapper indices of 0.44 and 0.43, respectively. The ability to predict BHR, as indicated by the Youden's index, was similar between the corresponding questions of the two questionnaires, except for 'severe wheeze' which had a significantly higher Youden's index in AVQ3.0 (0.44) than the corresponding question in WQ (0.11, P < 0.05). CONCLUSION: The ISAAC International video questionnaire is at least as effective as the ISAAC written questionnaire in predicting BHR. It therefore provides a simple and valid tool for international comparisons of asthma prevalence and severity AU - Lai CK AU - Chan JK AU - Chan A AU - Wong G AU - Ho A AU - Choy D AU - Lau J AU - Leung R LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 IP - DP - 1997 Jan 01 TI - Hay fever, asthma and number of older siblings--a twin study PG - 515-518 AB - BACKGROUND: It has been suggested that allergic sensitization is inversely related to the number of siblings in the family. OBJECTIVES: To study whether a similar relation can be observed for hay fever and asthma among Finnish adolescents in a population with relatively low prevalence of atopic diseases. METHODS: A questionnaire mailed to a nationwide sample of 1849 families with 16-year-old twins assessing the cumulative incidence of doctor-diagnosed hay fever and asthma among the adolescents and the number of older siblings in the family by parental report. RESULTS: The cumulative incidence of hay fever was significantly lower among the adolescents with three or more older siblings (3.9%, 95% CI = 1.2-6.5%) compared with adolescents with fewer older siblings (12.7%, 95% CI = 11.4-14.0%). There was no difference in the cumulative incidence of asthma among the adolescents according to the number of older siblings in the family. CONCLUSIONS: Large number of older siblings appears to be protective against the development of hay fever AU - Rasanen M AU - Laitinen T AU - Kaprio J AU - Koskenvuo M AU - Laitinen LA LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 26 IP - DP - 1997 Jan 01 TI - The effect of season-of-response to ISAAC questions about asthma, rhinitis and eczema in children PG - 126-136 AB - BACKGROUND: To examine whether responses to questions about the lifetime prevalence and 12-month period prevalence of symptoms of asthma and allergies are affected by the season in which the questions are asked. METHODS: The international Study of Asthma and Allergies in Childhood (ISAAC) Phase One was undertaken in six New Zealand centres; in three centres the effect of season was studied. Over three school terms at least 3000 children were studied in each of two age groups per centre (6-7 years; 13-14 years), one-third in each term respectively. The ISAAC standardized written questionnaires were used to identify asthma, rhinitis and eczema symptoms. The written questionnaire in the younger age group was completed by the parent/guardian. The older age group self-completed the written questionnaire and also a video questionnaire about asthma symptoms. RESULTS: The total number of respondents was 21,437, approximately half in each age group. The season of responding had no effect on the level of response to eczema questions. For the written asthma questionnaire no season-of-response effect was present for 6-7 year olds; for 13-14 year olds there was a trend to a higher rate of positive responses by those responding in winter, but in only one question did this reach statistical significance. With the video questionnaire there was a similar trend for a higher rate of positive responses when questions were asked in winter, but this did not reach statistical significance. For rhinitis symptoms there was a statistically significant season-of-response effect in both age groups with two questions; the fewest positive responses by the winter responders. CONCLUSIONS: There was no significant effect of season-of-response to questions on eczema symptoms, and most questions on asthma symptoms. There was a season-of-response effect on responses to questions on rhinitis symptoms suggesting a recall bias relating to recency of symptoms AU - Stewart AW AU - Asher MI AU - Clayton TO AU - Crane J AU - D'Souza W AU - Ellwood PE AU - Ford AU - RP AU - Mitchell EA AU - Pattemore PK AU - Pearce N LA - PT - DEP - TA - Int J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 99 IP - DP - 1997 Jan 01 TI - The distribution of total and specific serum IgE in the European Community Respiratory Health Survey PG - 314-322 AB - BACKGROUND: Variations in the prevalence of atopy could provide important clues to the etiology of atopy and asthma. Although estimates of prevalence are available from different studies, a lack of standardization makes comparisons difficult. OBJECTIVE: This study was conducted to estimate the variation of geometric mean levels of serum IgE and the prevalence of specific IgE to common allergens between populations as part of the European Community Respiratory Health Survey (ECRHS), a multicenter survey of asthma and risk factors for asthma. METHODS: Random samples of subjects living in 37 centers in 16 countries who had answered a questionnaire about their respiratory symptoms were invited for further assessment including total serum IgE and the presence of specific IgE against house dust mite (Dermatophagoides pteronyssinus), timothy grass, cat, Cladosporium herbarum, and a local allergen. Sera were tested from 13,883 persons. RESULTS: The estimated prevalence of atopy, defined as the presence of at least one positive specific IgE, ranged from 16% in Albacete (Spain) to 45% in Christchurch (New Zealand). The geometric mean total serum IgE varied from 13 kU/L in Reykjavik (Iceland) to 62 kU/L in Bordeaux (France). There was no relation between the geometric mean total serum IgE in a center and the prevalence of atopy. CONCLUSIONS: There are substantial variations in the prevalence of atopy and the level of serum IgE. These variations are independent of each other and likely to be largely environmental in origin AU - Burney P AU - Malmberg E AU - Chinn S AU - Jarvis D AU - Luczynska C AU - Lai E LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Occupational asthma caused by fish inhalation PG - 866-869 AB - Occupational asthma (OA) due to fish inhalation, confirmed by specific bronchial challenge (SBC), has not been described as yet in medical literature, as far as we know. We describe two patients whose asthma was induced by occupational exposure to fish and confirmed by serial measurements of PEFR and SBC. Two fish-processing workers reported asthma symptoms related to their workplace. They were skin tested with fish extracts and their sera assayed for IgE antibodies to various fish species. Nonspecific bronchial reactivity was assessed by methacholine challenge. The occupational relationship was confirmed by PEFR monitoring in working and off-work periods. SBC with fish extracts was carried out to confirm the diagnosis of OA. Skin tests with raw and cooked plaice, salmon, hake, and tuna in patient 1 and anchovy, sardine, trout, salmon, Atlantic pomfret, and sole in patient 2 were positive. Specific IgE serum antibodies were found to salmon in patient 1 and to trout, anchovy, and salmon in patient 2. PEFR measurements differed significantly (P < 0.001) between work and off-work periods for both patients. A bronchial challenge with methacholine was positive in patient 1. SBC with raw hake, salmon, plaice, and tuna extracts in patient 1 and raw salmon extract in patient 2 were all positive with an immediate response. SBC with Dermatophagoides pteronyssinus extract was entirely negative in both patients. In three asthmatic, non-fish-allergic controls, SBC with tuna, hake, salmon, and plaice were all negative. These results suggest that fish inhalation can elicit IgE-mediated occupational asthma. AU - Rodríguez J AU - Reaño M AU - Vives R AU - Canto G AU - Daroca P AU - Crespo JF AU - Vila C AU - Villarreal O AU - Bensabat Z. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Allergic alveolitis following exposure to epoxy polyester powder paint containing low amounts (<1%) of acid anhydrides PG - 948-951 AB - Only one case report concerning allergic alveolitis caused by polyester powder paint has been published previously. The aim of this study was to determine whether phthalic anhydride (PA) or trimellitic anhydride (TMA) is the alveolitis-causing agent in such paint. A 61 year old woman showed recurrent symptoms of chills, cough, and fever whilst at work. She was working in a plant where epoxy polyester powder paints were used to paint metal. The paint was found to contain low (<1%) amounts of TMA and PA. The patient showed shadowing on chest radiographs. In bronchoalveolar lavage, lymphocytosis (67%) and a low T-helper/T-suppressor ratio (0.2) were found. Transfer factor was within normal limits, but a slight reduction was verified after re-exposure to the paint. The symptoms, exposure, reduction in transfer factor, findings on chest radiographs and bronchoalveolar lavage were consistent with allergic alveolitis. In conclusion, the polyester powder paint used in the plant caused allergic alve olitis in this patient. Of the constituents in the paint, trimellitic anhydride and phthalic anhydride were the possible causative agents. AU - Piirila P AU - Keskinen H AU - Anttila S AU - Hyvonen M AU - Pfaffli P AU - Tuomi T AU - Tupasela O AU - Tuppurainen M AU - Nordman H LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 156 IP - DP - 1997 Jan 01 TI - Bronchiolitis obliterans in a man who used his wood-burning stove to burn synthetic construction materials. PG - 1171-1173 AB - This paper reports a case of cough, dyspnea, and fever arising 4 hours after burning construction materials including polystyrene insulation (which dissociates to styrene at lower temperatures than wood decomposes) and wood particle-board paneling in an open wood-burning stove. He presented after 11 days and had an open lung biopsy supporting BO. The presumed exposures were nitrogen oxides from the particle board binders, styrene, and bromine. The authors make an unsupported statement that styrene causes bronchial epithelial necrosis. Obviously they don’t claim to know the cause other than toxic inhalation, but people burn particle board all the time. AU - Janigan DT AU - Kilp T AU - Michael R AU - McCleave JJ. LA - PT - DEP - TA - Can Med Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 205 IP - DP - 1997 Jan 01 TI - Mosaic attenuation pattern on thin-section CT scans of the lung: differentiation among infiltrative lung, airway, and vascular diseases as a cause. PG - 465-470 AB - PURPOSE: To determine whether infiltrative lung, airway, or vascular disease can be differentiated as the cause of mosaic attenuation on thin-section computed tomographic (CT) scans of the lung. MATERIALS AND METHODS: Thin-section CT scans were reviewed in 70 patients examined at three institutions. A mosaic attenuation pattern and pathologic or clinical proof of a specific type of disease were demonstrated. Causes of the mosaic pattern included infiltrative lung disease (n = 37), airway disease (n = 22), and vascular disease (n = 11). Thin-section CT findings were assessed independently by two observers blinded to clinical findings. RESULTS: The type of disease was identified correctly at CT in 58 (83%) of 70 patients by observer 1 and 57 (81%) of 70 patients by observer 2. Infiltrative lung disease was diagnosed correctly by both observers in 34 (92%) of 37 cases. Observer 1 identified 21 (95%) of 22 cases of airway disease and three (27%) of 11 cases of vascular disease. Observer 2 identified 19 (86%) of 22 cases of airway disease and four (36%) of 11 cases of vascular disease. CONCLUSION: Infiltrative lung disease and airway disease may be differentiated reliably as the cause of mosaic attenuation on lung CT scans, whereas vascular disease is often misinterpreted as infiltrative lung disease or airway disease. AU - Worthy SA AU - Müller NL AU - Hartman TE AU - Swensen SJ AU - Padley SP AU - Hansell DM LA - PT - DEP - TA - Radiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 203 IP - DP - 1997 Jan 01 TI - Obliterative bronchiolitis: individual CT signs of small airways disease and functional correlation. PG - 721-726 AB - PURPOSE: Individual features of small airways disease depicted at computed tomography (CT) were correlated with functional indexes in patients with obliterative bronchiolitis. MATERIALS AND METHODS: Fifteen patients (all women) who fulfilled the strict criteria for diagnosis of obliterative bronchiolitis underwent thin-section CT at full inspiration and at end expiration. The CT scans were scored by two observers for extent of decreased attenuation of the lung parenchyma; end-expiration CT signs of air trapping; and bronchial dilation, wall thickening, and mucous plugging. The functional importance of each CT sign was evaluated. RESULTS: Areas of decreased attenuation were present in all patients (median score at end expiration, 61%; range, 21%-83%). Bronchial wall thickening was identified in 13 of the 15 patients. Correlations of the extent of decreased attenuation and measures of air-flow obstruction were strongest between decreased attenuation at end expiration and air flow at low lung volumes (r(s) = -.70, P < .005). This relationship remained intact after correction for the severity of bronchial wall thickening. CONCLUSION: In patients with obliterative bronchiolitis, the extent of decreased attenuation at CT was most strongly related to depression of pulmonary function tests of the small airways. Decreased attenuation is the cardinal sign for further quantitative studies of obliterative bronchiolitis. AU - Hansell DM AU - Rubens MB AU - Padley SP AU - Wells AU LA - PT - DEP - TA - Radiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 39 IP - DP - 1997 Jan 01 TI - Toxicity of waterproofing spray is influenced by the mist particle size PG - 332-334 AB - In a previous study, we showed that waterproofing sprays that are toxic generate mists with smaller particles than do nontoxic products. In this study, we made 4 waterproofing sprays (A, B, C and D) with identical ingredients but with different mist particle sizes and compared the pathological changes produced in the lungs of mice. The mist particle diameters were 32.8 +/- 3.2, 62.0 +/- 3.8, 89.1 +/- 4.1 and 143.2 +/- 5.0 microns for sprays A, B, C and D, respectively. Pathological lung changes were evaluated by a 6-criteria grading system (thickening of the alveolar septum, cellular infiltrations in the alveolar septum, alteration of the bronchial mucous membrane, hyperemia of the alveolar wall, transudative hemorrhage, and alveolar collapse). Sprays A and B caused significantly greater scores as compared to the control group for all the criteria except mucosal changes, whereas the changes from sprays C and D were slight and the differences in scores were not significant. These results suggest that toxicity of waterproofing spray is influenced by the mist particle size generated and may help manufacture safer waterproofing spray products AU - Yamashita M AU - Yamashita M AU - Tanaka J AU - Hirai H AU - Suzuki M AU - Kajigaya H LA - PT - DEP - TA - Vet Hum Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 32 IP - DP - 1997 Jan 01 TI - Prospective epidemiologic evaluation of laboratory animal allergy among university employees PG - 665-669 AB - OBJECTIVES: Evaluation of incidence and risk factors for development of laboratory animal allergy (LAA) among new hires previously unexposed to lab animals. METHODS: Baseline, 6-month and yearly follow-up, questionnaires, pulmonary functions, and methacholine challenges were collected from 98 never-before occupationally exposed and 90 control laboratory researchers. The two groups were followed between 6 and 36 months. RESULTS: At baseline, there were no differences in atopy, pulmonary functions, or methacholine reactivity between the two groups. The incidence of work-related asthma was comparable in the two groups, approximately 2.5% at 6 months and 4.5% at 24 months. The rate of decline in FEV1 was statistically significantly greater in the animal-exposed than nonanimal-exposed workers, and animal-exposed smokers' FEV1 declined significantly more rapidly than any other groups'. CONCLUSION: Despite the low incidence of laboratory-animal allergy and work-related asthma in this group, this study corroborates previously described interaction between smoking and animal exposure. AU - Fuortes LJ AU - Weih L AU - Pomrehn P AU - Thorne PS AU - Jones M AU - Burmeister L AU - Merchant JA LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 IP - DP - 1997 Jan 01 TI - Reduction of exposure to laboratory animal allergens in the workplace PG - 744-751 AB - OBJECTIVES: Evidence is now accumulating that the prevalence of allergy to laboratory animals is related to the intensity of exposure to animal allergens. Whilst airborne animal allergen concentrations may be influenced by the litter type, cage design and stock density, the effectiveness of methods to reduce personal exposure has not been objectively assessed. METHODS: Air samples were collected at 2 L/min and 180 L/min onto polytetrafluoroethylene (PTFE) filters and the rat urinary aeroallergen (RUA) and mouse urinary aeroallergen (MUA) concentrations were measured by radioallergosorbent test (RAST) inhibition. RESULTS: When 545 mice (11.l mice/m3) were housed in ventilated cages (Thoren Maximiser cage system) operated at positive pressure to the environment, the static MUA concentration (n = 24, median = 0.10 microg/m3) was reduced sevenfold when compared with conventional cage systems (n = 12, median =0.67 microg/m3, P< 0.001). MUA could be further reduced if the ventilated cage system was operated at lower pressure; static samples (n = 1) collected at 180 L/min at negative, ambient and positive pressure registered < 0.003, 0.02 and 0.28 microg/m3, respectively. During cleaning out, the intensity of personal exposure to RUA was apparently reduced twofold when soiled litter was removed by vacuum (n = 17, median = 22.87 microg/m3) when compared with tipping (n = 18, median = 38.15 microg/m3), P = 0.002) although the task took twice as long to perform. The RUA exposure associated with handling rats was'reduced 25-fold when performed in a ventilated cabinet (n = 21, median = 2.67 microg/m3) compared with handling of rats on an open bench (n = 17, median = 54.39 microg/m3, P = 0.0001). CONCLUSIONS: Effective reduction of exposure to animal allergens can now be achieved by the use of ventilated systems both for housing and handling rats and mice providing safety equipment is used correctly. The vacuum removal of soiled litter during the task of cleaning out was less efficient and additional respiratory protection is therefore recommended for this procedure. AU - Gordon S. Wallace J. Cook A. Tee RD. Taylor AJN LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 52 IP - DP - 1997 Jan 01 TI - Multiple IgE-mediated sensitisations to enzymes after occupational exposure: evaluation by skin prick test, RAST, and immunoblot PG - 928-934 AU - Zentner A AU - Jeep S AU - Wahl R et al LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 156 IP - DP - 1997 Jan 01 TI - Human leukocyte antigen associations in occupational asthma induced by isocyanates PG - S139-143 AB - Exposure to diisocyanates is recognized as a leading cause of occupational asthma. Occupational asthma induced by isocyanates shares many characteristics with immunoglobulin E (IgE)-mediated asthma: in both, the responsible agent is known, and the clinical presentation, response to inhalation challenge in the laboratory, and response to antiasthma drugs are similar. Although asthma mediated by an IgE mechanism occurs in atopic subjects, occupational asthma induced by isocyanates occurs mostly in nonatopic asthmatics, and an IgE-mediated mechanism has not been consistently demonstrated. However, activated T lymphocytes, methacromatic cells, and eosinophils are increased in the bronchial mucosa of allergic and nonallergic asthmatics and subjects with occupational asthma induced by isocyanates, suggesting similar, probably immunologically mediated mechanisms for both nonoccupational and occupational asthma. Occupational asthma occurs in up to 5-10% of the exposed subjects. Evaluation of major histocompatibility complex (MHC) class II genes in exposed subjects who develop toluene diisocyanate (TDI) asthma has shown a negative association with HLA-DQB1*0501 and a positive association with HLA-DQB1*0503 alleles. In addition, a high proportion of TDI asthmatics express the HLA-DQB1*0503-associated aspartic acid at residue 57, suggesting that HLA-DQ may have a key role in conferring susceptibility. Thus, asthma induced by the low-molecular-weight agent TDI may result from an immunologic reaction due to the interaction of genetic susceptibility with exposure in the workplace. AU - Mapp CE AU - Balboni A AU - Baricordi R AU - Fabbri LM LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 155 IP - DP - 1997 Jan 01 TI - Adult patients may outgrow their asthma: a 25-year follow-up study PG - 1267-1272 AU - Panhuysen CI AU - Vonk JM AU - Koeter GH AU - Schouten JP AU - van Altena R AU - Bleecker ER AU - Postma DS LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 54 IP - DP - 1997 Jan 01 TI - Physician based surveillance system for occupational respiratory diseases: the experience of PROPULSE, Quebec, Canada PG - 272-276 AB - OBJECTIVE: To evaluate the feasibility of implementing a physician based surveillance system of occupational respiratory diseases (PROPULSE) in Quebec with regard to physician participation rate, characteristics of reported cases, and comparison with official statistics from the Workers' Compensation Board (WCB). METHODS: All chest physicians and allergists in Quebec were asked to report suspected new cases of occupational respiratory diseases, on a monthly basis, between October 1992 and September 1993. For each case, personal information was collected and the physician's opinion on whether the condition was related to work was categorised as highly likely, likely, and unlikely. RESULTS: Of the 161 physicians initially approached, 68% participated. Physicians rated 48% of suspected cases as highly likely, 29% as likely, and 20% as unlikely. The most often reported diagnosis was asthma (63%), followed by diseases related to asbestos (16%). Silicosis was less frequent (5%) but it was reported for six workers under 40 of whom five were involved in sandblasting activities. The high proportion of cases of asthma probably reflects the increasing importance of this disease but may also reflect the different patterns of reporting among physicians with different expertise. The distribution of cases by diagnostic category is quite different between the PROPULSE system and that of the WCB (annual mean number of compensated cases during a four year period). Asthma and allergic alveolitis are more frequent in PROPULSE, reactive airways dysfunction syndrome are about the same in both systems, and other diseases are more frequent among compensated cases. The most frequent sensitising agents reported for asthma were the same in both systems (isocyanates, flour, and wood dust). 15% of the PROPULSE cases were not covered by the WCB, and therefore would not be found in the board's official statistics. CONCLUSIONS: A physician based reporting procedure can be implemented as part of a surveillance system to supplement data from other sources and thus provide a better understanding of the occurrence of occupational respiratory diseases AU - Provencher S AU - Labreche FP AU - De Guire L LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 32 IP - DP - 1997 Jan 01 TI - No Evidence For The Influence Of HLA Class II In Alleles In Isocyanate-Induced Asthma PG - 522-527 AU - Rihs HP AU - Kroells TB AU - Huber H et al LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 32 IP - DP - 1997 Jan 01 TI - Assessment of the relationship between isocyanate exposure levels and occupational asthma PG - 517-521 AB - As part of a previous study, we identified Ontario cases of isocyanate-induced occupational asthma (OA) and the companies at which they worked. The Ontario Ministry of Labour maintained a computerized database including isocyanate air sampling determinations conducted by the Ministry. Within this database, we compared levels of isocyanate concentrations measured at 20 case companies [with compensated isocyanate asthma (OA) claims] with 203 noncase companies, based on air samples collected during the same 4-year period during which the OA claims arose. The proportion of case companies that were ever recorded as having a measured ambient isocyanate concentration of > or = 0.005 ppm was greater than that for noncase companies, for TDI users (43% vs 22%), and for MDI users (40% vs 27%). This reached conventional significance when combined across companies and isocyanate types (50% vs 25%; P < 0.05). This provides some evidence that facilities having OA claims have higher isocyanate exposures than do those without claims. AU - Tarlo SM AU - Liss GM AU - Dias C et al LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 54 IP - DP - 1997 Jan 01 TI - Outcome determinants for isocyanate induced occupational asthma among compensation claimants PG - 756-761 AB - OBJECTIVES To compare the outcome of occupational asthma (OA) induced by isocyanates in Ontario (where a surveillance programme for exposed workers has been in place for over 15 years), with the outcome of OA induced by other work agents. METHODS Compensated OA claims during the period 1984-88 in Ontario were retrospectively reviewed in a standardised way. RESULTS 136/235 compensated claims were attributed to isocyanates. Compared with other causes of OA, those attributed to isocyanates had a shorter latent period before onset (5.9 v 7.9 years, P < 0.05), shorter duration of symptoms before diagnosis (2.0 v 3.0 years, P < 0.05), and less associated atopy (43% v 58%, P < 0.05). Outcome at a mean of 1.9 years after initial assessment was significantly better in those with OA induced by isocyanates; 73% cleared or improved v 56% with other causes of OA (P < 0.05). Ten subjects with OA induced by isocyanates stayed at the same work; none cleared and four had worsened at follow up. A better outcome in OA induced by isocyanates was associated with early diagnosis (P < 0.05), and early removal from isocyanates after the onset of asthma. CONCLUSIONS The outcome in the group with OA induced by isocyanates is similar to previous follow up studies. However, it is better than the outcome in our comparison group with OA due to other causes, perhaps because of earlier diagnosis in the group with OA induced by isocyanates. This may be attributable to the medical surveillance of workers exposed to isocyanates in Ontario, either directly from the surveillance assessments, or indirectly by increasing awareness of the condition. AU - Tarlo SM AU - Banks D AU - Liss G et al LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 23 IP - DP - 1997 Jan 01 TI - Sensitisation to industrial enzymes in enzyme research and production PG - 385-391 AB - OBJECTIVES: This study investigated sensitization to industrial enzymes in Finnish enzyme production and in Finnish laboratories. METHODS: A cross-sectional study was conducted in 2 plants producing industrial enzymes and in their product development and research laboratories. Sensitization to enzymes and environmental allergens was examined by skin prick tests and specific immunoglobulin E determinations (radioallergosorbent test). The employees were interviewed for work-related respiratory symptoms. Altogether 173 employees were examined. RESULTS: The skin prick test showed 21 employees (12%) to be sensitized to one or more enzymes. Sixteen positive persons also had specific immunoglobulin E. Atopy was distinctly associated with enzyme sensitization. An exposure-response relationship was found for enzyme sensitization and for respiratory symptoms during work. For sensitization, the exposure-response linear trend was statistically significant. It weakened but remained statistically significant after stratification for atopy. For symptoms, likewise, the exposure-response linear trend was statistically significant, and the statistical significance remained after stratification for atopy. CONCLUSION: The study confirmed that industrial enzymes are potent sensitizers. The handling of dry enzymes in laboratory work may cause sensitization. Sensitization may even follow minute degrees of exposure, such as among office personnel. Atopics are more susceptible to sensitization than nonatopics. Nonatopics are also clearly at risk; the demonstrated exposure-response relationship emphasizes the need for and advantages of proper exposure control. AU - Vanhanen M AU - Tuomi T AU - Nordman H et al LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 27 IP - DP - 1997 Jan 01 TI - Prognostic factors for toluene di-isocyanate-induced occupational asthma after removal from exposure PG - 1145-1150 AB - BACKGROUND: The outcome of isocyanate-induced occupational asthma remains to be further defined. There have been few studies on the role of specific antibodies in prognosis of toluene diisocyanate (TDI) induced occupational asthma. Moreover, to the best of our knowledge, there have been no studies on the improvement pattern of airway hyperresponsiveness (AH). We analysed the prognostic factors that affected the outcome of 35 toluene diisocyanate-induced occupational asthma. OBJECTIVES: To define clinical and laboratory parameters predicting favourable prognosis for TDI-induced occupational asthma. METHODS AND RESULTS: After confirmation of bronchial sensitivity by TDI bronchoprovocation test (BPT), 35 patients were recommended to avoid exposure to TDI; they were also given anti-asthmatic medications including inhaled steroids and monitored for 2 years. Seventeen (49%) recovered completely with disappearance of airway hyperresponsiveness (AH) to methacholine during the follow-up period (mean duration: 12 months, range of 3-30 months). Eleven (31%) showed a significant improvement in AH for first year, which improvement stabilized in the next year with mild symptoms. Seven (20%) patients did not show any evidence of improvement in AH and had persistent symptoms. Favourable prognosis was associated with a short duration of asthmatic symptoms before diagnosis (P < 0.05), immediate cessation of exposure after diagnosis (P < 0.05), milder degree of AH at diagnosis (P < 0.05), and the presence of specific IgE antibodies to TDI-human serum albumin conjugate (0.05 < P < 0.1). No association was found with atopic and smoking status, age, exposure duration, or length of latent period (P > 0.05). CONCLUSION: These data suggest that early detection of TDI-induced asthma and immediate cessation of exposure are important factors for a favourable prognosis AU - Park HS AU - Nahm DH LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Prevalence and intensity of rhinoconjunctivitis in subjects with occupational asthma PG - 1513-1515 AB - Subjects with occupational asthma may also report symptoms of rhinoconjunctivitis. The aims of this study were: 1) to assess the prevalence of rhinoconjunctivitis in association with occupational asthma, and the severity of rhinoconjunctivitis according to the type of agent (high (HMW) and low (LMW) molecular weight agents) causing occupational asthma; and 2) to evaluate the timing of occurrence of symptoms of rhinoconjunctivitis in relation to those of occupational asthma. A questionnaire on symptoms of rhinoconjunctivitis and its timing in relation to the development of chest symptoms was prospectively addressed to 143 subjects consecutively referred to an occupational asthma clinic. Objective testing through specific inhalation challenges confirmed the diagnosis of occupational asthma in 40 subjects. Symptoms of rhinitis were reported at some time by 37 of the 40 subjects (92%), and of conjunctivitis by 29 of the 40 subjects (72%). The prevalence of symptoms was not different for HMW and LMW agents, although rhinitis was more intense for HMW (19 out of 24 subjects with three or more of the following symptoms: runny nose, itchy nose, nasal blockage, and sneezing) than for LMW (5 out of 14 subjects) (p<0.01). There were significantly fewer subjects with occupational asthma due to LMW agents, with rhinitis appearing before asthma (p=0.03). Figures for conjunctivitis showed a similar trend, but did not reach statistical significance. In conclusion, symptoms of rhinoconjunctivitis are often associated with occupational asthma. Rhinitis is less pronounced in the case of low molecular weight agents, but more often appears before occupational asthma in the case of high molecular weight agents. AU - Malo JL AU - Lemiere C AU - Desjardins A et al LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 54 IP - DP - 1997 Jan 01 TI - Respiratory allergy in laboratory animal workers: a retrospective cohort study using pre-employment screening data PG - 830-835 AB - OBJECTIVES: To study the role of exposure, atopy, and smoking in the development of laboratory animal allergy (LAA) in a retrospective cohort study. METHODS: Between 1977 and 1993, 225 people received a pre-employment screening when they started a job at a Dutch research institute where they were going to work with laboratory animals. After active follow up 136 of them (60.4%) could be traced and were sent a questionnaire with extensive questions on allergic symptoms, smoking habits, and job history. 122 people (89.7%) sent back a completed questionnaire. Those who were accepted for a job at the institute and did not have allergic symptoms at the start of the job were selected as cohort members. After selecting people with complete data on start and end date of jobs, exposure intensity, atopy, and smoking, the cohort consisted of 99 people with an average time of follow up of 9.7 years. LAA was defined as a positive response to a set of questions in the questionnaire. The mean number of hours a week a person was exposed to laboratory animals at entry of the cohort was used as a surrogate for exposure, and was divided into four categories. RESULTS: 19 cohort members (19.2%) reported LAA. More people with asthmatic symptoms were found in the high exposure categories. More atopic than non-atopic people reported asthmatic symptoms (13% v 6%). The mean time until development of symptoms of LAA was about 109 months in non-atopic people (n = 9), and 45 months in atopic people (n = 10) (t test; P < 0.05). Time until development of symptoms of LAA was shorter at a higher intensity of exposure, except for those exposed for less than two hours a week. A proportional hazard regression analysis showed that exposure and atopy were significant determinants of LAA. An increased relative risk (RR) was found for non-atopic people exposed to laboratory animal allergens for more than two hours a week. Atopic people had an even higher risk when exposed to laboratory animals for more than two hours a week (RR above 7.3). Sex, smoking, and age were not risk factors. More atopic than non-atopic people were absent from work or transferred because of allergies. CONCLUSIONS: This study showed that exposure and atopy are significant predictors of LAA and that the risk of developing LAA remained present for a much longer period (> 3 y) than considered before AU - Kruize H AU - Post W AU - Heederik D AU - Martens B AU - Hollander A AU - van der Beek E LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Occupational respiratory diseases in laboratory animal workers; initial results PG - 31-36 AB - Laboratory-animal allergy (LAA) is a well-known occupational hazard to workers employed in biological or medical research institutes and in the pharmaceutical industry. The aim of this study was to focus on the problem of LAA and to assess factors predisposing to sensitization among subjects occupationally exposed to animals. Sixty workers were examined in our study. They responded to a questionnaire and underwent spirometry (Vital Capacity, VC and Forced Expiratory Volume in one second, FEV1). In addition, Peak Expiratory Flow (PEF) and the histamine provocation test were estimated in 5 subjects that had been hospitalized in the Department of Occupational Diseases. Skin prick tests with common allergens and with hair extracts from laboratory animals were performed, and total IgE levels and specific IgE antibodies were also measured. Among 60 subjects who had been working with animals, 26 had positive skin prick tests for one or more of the common allergens. Five subjects supposed to have occupational bronchial asthma and four with occupational allergic rhinitis showed positive skin prick tests for one or more animal allergens, increased total IgE levels and specific serum IgE antibodies. All these subjects had smoked for years. Conclusions: 1) Laboratory animal allergy develops within first years of exposure; 2) atopy and smoking predispose to laboratory animal sensitization and to a development of bronchial asthma and allergic rhinitis. AU - Krakowiak A AU - Szulc B AU - Gorski P LA - PT - DEP - TA - Int J Occup Med Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 54 IP - DP - 1997 Jan 01 TI - Allergy risk in an enzyme producing plant: a retrospective follow up study PG - 671-675 AB - OBJECTIVE To investigate the risk of enzyme sensitisation and clinical allergy in workers exposed to enzymes at Novo Nordisk A/S. METHODS The study was a retrospective follow up study based on medical history and test data originally collected at routine screenings for enzyme allergy by the Occupational Health Service (OHS) of Novo Nordisk A/S during the period 1970-92. Workers were exposed to proteases, lipases, cellulases, and carboxyhydrases. Medical records of 3815 subjects were registered in the OHS database. According to criteria including possible enzyme exposure, allergy tests at the time of engagement, and participation in the allergy screening programme 1064 were selected for the present study. Outcomes were allergy symptoms, specific IgE test (radioallergosorbent test (RAST)) to enzymes, skin test reactions to common allergens and enzymes, forced expiratory volume in one second (FEV1), and forced vital capacity (FVC). Potential risk factors were smoking habits, workplace, type of job, age, and sex. RESULTS Sensitisation occurred to all types of enzymes handled in the plant, most often in production areas and laboratories; 8.8% developed clinical enzyme allergy during the first three years of employment. The risk declined during the period. The frequency of enzyme sensitisation, expressed as RAST values > 0.5 SU, was 36%, and the frequency of significant RAST values > or = 2 SU was 8%. Ranking diagnoses of enzyme allergy by severity, the frequency of asthma was 5.3%, rhinitis 3.0%, and urticaria 0.6%. Half of the cases occurred within the first 15 months of exposure. Smoking was an independent risk factor for clinical enzyme allergy (odds ratio (OR) = 2.3 (95% exact confidence interval (95% CI) 1.4 to 3.9), measurable RAST > or = 0.5 SU (OR = 1.5 (95% CI 1.1 to 2.1)), and RAST > or = 2 SU (OR = 4.5 (95% CI 2.2 to 8.4)). Atopic predisposition at the time of engagement was not a significant risk factor for enzyme allergy. This could be due to various selection mechanisms. AU - Johnsen CR AU - Sorensen TB AU - Ingemann Larsen A et al LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Consequences of occupational asthma on employment and financial status: a follow-up study PG - 55-58 AB - The aim of this study was to describe changes in employment and income following a diagnosis of occupational asthma, and to determine what factors might affect these changes. Two hundred and nine patients with occupational asthma were reviewed on average 3.1 yrs after the diagnosis had been made. They were contacted by telephone or were sent a self-administered questionnaire by post. Multiple logistic regression models were constructed to determine which variables were associated with loss of employment after the diagnosis. At the time of review, 44% of patients had left their previous job and 25% were currently unemployed. Remarkably, 32% remained exposed to the offending agents in the same job. Forty six percent of the patients had suffered a reduction of income (84% of those who had left their employer versus 19% of those still employed in the same company (p < 0.001)). Claims for compensation, size of the company, level of education, and age at the time of diagnosis were significantly associated with a risk for becoming unemployed or having a new employer after the diagnosis of occupational asthma. Occupational asthma results in severe socioeconomic consequences. The French compensation system for occupational asthma should be revised, as the criteria currently used to determine compensation for this disease largely underestimate the social and occupational damages. AU - Ameille J AU - Paton JC AU - Bayeux MC et al LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 99 IP - DP - 1997 Jan 01 TI - T-cell receptor V beta gene segment expression in di-isocyanate-induced occupational asthma PG - 245-250 AB - BACKGROUND: Diisocyanates are the most common cause of occupational asthma induced by low-molecular-weight chemicals. The disease appears to be immunologically mediated but is independent of IgE antibody synthesis. An underlying genetic susceptibility is suggested by the fact that the disease only develops in approximately 5% to 10% of exposed workers. OBJECTIVE: The study was designed to determine whether disease susceptibility is influenced by HLA and T-cell receptor V beta gene segment usage. METHODS: T-cell receptor V beta repertoires were quantitated by using primer pairs specific for V beta gene segments in conjunction with a common C beta region primer. One group of workers with diisocyanate-induced occupational asthma produced diisocyanate-specific IgG and IgE antibodies, whereas the other group did not produce specific antibodies. Occupational asthma was previously confirmed by either workplace challenge or laboratory specific diisocyanate bronchoprovocation. Control groups consisted of diisocyanate-exposed workers who were free of symptoms, patients with nonoccupational asthma, and unexposed subjects who were free of symptoms. RESULTS: Lymphocytes from workers with diisocyanate-induced occupational asthma had significantly decreased V beta 1 and V beta 5 gene segment expression before in vitro exposure to diisocyanates, compared with control groups. Percent V beta 1 and V beta 5 gene segment expression was selectively increased when peripheral blood mononuclear cells were stimulated in vitro with diisocyanate-conjugated proteins. Low-resolution HLA class II phenotyping revealed no significant differences in the distribution of HLA-DR or HLA-DQ alleles between diisocyanate-induced occupational asthma and control groups. CONCLUSIONS: These findings are consistent with a hypothesis that antigen-specific T-cell subpopulations may be sequestered in the lungs of workers with diisocyanate-induced occupational asthma and clonally expand after further exposure to diisocyanates AU - Bernstein JA AU - Munson J AU - Lummus ZL AU - Balakrishnan K AU - Leikauf G LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 47 IP - DP - 1997 Jan 01 TI - Screening Questionnaires For Bakers' Asthma - Are They Worth The Effort? PG - 361-366 AB - The use of a respiratory screening questionnaire is recommended annually to screen bakery workers in the UK. We compared questionnaire screening with other methods of detecting workers with asthmatic symptoms and then assessed the significance of these symptoms with careful investigation and follow-up. Reasons for questionnaire failures were then explored. A questionnaire was issued to 362 flour-exposed workers in a large bakery. All positive respondents to respiratory symptom questions were interviewed by an occupational nurse. Workers with occupationally related symptoms at this interview were referred to the chest clinic. In addition, workers with negative questionnaires were screened using attendance records, sick notes and direct workplace observations. Workers with frequent absence from work or sick notes with respiratory diagnoses were interviewed in the same manner as those answering the questionnaire positively and then referred to clinic. At clinic, a diagnosis was made for each worker on the basis of clinical assessment, spirometry, serial peak expiratory flow rate (PEFR) analysis and radioallergosorbent testing (RAST) testing for specific IgE. Using the clinic diagnoses, the referral routes were audited to assess the rates of case detection of asthma and occupational asthma. The respiratory screening questionnaire identified 68 workers with respiratory symptoms. Of these, 21 proceeded to full assessment. A diagnosis of asthma was made in five cases, one of which was bakers' asthma. In addition, 11 workers not reporting any symptoms by questionnaire were referred to clinic and five were diagnosed as having asthma. Screening questionnaires may lead to an underestimate of the prevalence of asthmatic symptoms and as such should not be used alone in workplace screening AU - Gordon SB AU - Curran AD AU - Murphy J AU - Sillitoe C AU - Lee G AU - Wiley K AU - Morice AU - AH LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 88 IP - DP - 1997 Jan 01 TI - Respiratory symptoms and occupational sensitisation in a group of trainee bakers: results of a 6-month follow up PG - 155-165 AB - We investigated the prevalence of atopy by 4 different criteria (personal and family atopy, atopy by prick test and by serum IgE levels), and sensitization to wheat flour and alpha amylase in a group of trainee bakers and in a group of trainee graphic artists as controls (baseline check-up). The follow-up was performed 6 months later only among trainee bakers (90 cases), based on an updating questionnaire and on repeated skin prick test with wheat flour and alpha amylase extracts. Trainee bakers and controls were similar with respect to age, number of smokers, atopy evaluated by 4 different criteria, and detection of serum IgE (RAST) and IgG specific to wheat flour. Positive skin prick test to wheat flour (4%) and alpha amylase (1%) were found only among trainee bakers. At the baseline control 4 students (4.4%) complained of respiratory symptoms when working with wheat flour (WRS). At the six month follow up 6.6% of the trainee bakers complained of WRS: 3.3% had persistent symptoms, 3.3% were new cases and 1.1% had become asymptomatic. Five cases (5.5%) were skin positive to wheat flour or alpha amylase, but only one was unchanged, while 4.4% were new cases and 3.3% turned negative. None of these changes was statistically significant (McNemar test). The trainee bakers complaining of WRS at the baseline or at follow-up (7 cases, when compared with the non-symptomatics, showed a higher prevalence of personal atopy and skin sensitization to occupational allergens; there were no differences, however, with regard to atopy by prick test, IgE levels or the presence of wheat specific IgE and IgG. The trainee bakers skin positive to the occupational allergens (8 cases) showed prevalences of personal atopy and atopy by prick test significantly higher than trainee bakers skin negative to wheat flour or alpha amylase (p < or = 0.01). Evaluating wheat flour specific IgE and IgG in the serum of trainee bakers and controls provided us with more information about the specificity of such tests and suggests caution in attributing the presence of these immunoglobulins in the serum to specific occupational exposure or to specific occupational sensitization. A six-month follow up is likely to be too short an interval to observe significant changes in work-related symptoms and in skin sensitization to occupational allergens. The results, however, emphasize the important role of personal atopy as a predisposing factor in the development of occupational disease among trainee bakers. AU - DeZotti R AU - Bovenzi M AU - Molinari S et al LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 47 IP - DP - 1997 Jan 01 TI - Enzyme exposure, smoking and lung function in employees in the detergent industry over 20 years. Medical Subcommittee of the UK Soap and Detergent Industry Association PG - 473-478 AB - This study was undertaken to examine the long term relationship between lung function, smoking and exposure to enzymes in the detergent industry. A total of 731 male workers from five locations in the United Kingdom were subject to respiratory health surveillance including lung function testing over a period of 4-20 years. Exposure groups were defined by job history. Significantly different rates of fall in FEV1 and FVC with time were found by geographical location and by smoking habit, but there were no consistent trends with enzyme exposure AU - Cathcart M AU - Nicholson P AU - Roberts D AU - Bazley M AU - Juniper C AU - Murray P AU - Randell M LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - The relationship between peak expiratory flow and respiratory symptoms PG - 67s-68s AB - Records of peak expiratory flow rate (PEFR), commonly used in hospital in the management of asthma, have not been evaluated as a method of identifying cases of asthma in population surveys. Four observers were asked to report on whether asthma was present or absent in 61 graphs of PEFR recorded two hourly for four weeks during surveys of working population. Agreement within individual observers was measured using a subset of 29 graphs which had been copied and distributed at random among the set of 61; agreement was good, from 90% in one observer to "100%" in two. Agreement between observers was measured on the basis of all 61 graphs. Agreement occurred between all four observers in 69% of graphs, between at least three out of four in 97%, and, when pairs of observers were examined, between 72% and 93% of graphs. Graphs assessed as showing asthma demonstrated more within day PEFR variability (expressed as the number of days in which the difference between maximum and minimum readings was at least 15%) than graphs assessed as not showing asthma. Some graphs with little within day variability were assessed as showing asthma, apparently because they demonstrated between day PEFR variability. AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 31 IP - DP - 1997 Jan 01 TI - Epidemic of asthma in a wood products plant using methylene diphenyl diisocyanate PG - 56-63 AU - Woellner RC AU - Hall S AU - Greaves I AU - Schoenwetter WF LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 32 IP - DP - 1997 Jan 01 TI - Metalworking fluid-associated hypersensitivity pneumonitis: a workshop summary PG - 423-432 AB - A workshop discussing eight clusters of hypersensitivity pneumonitis in the automotive industry among metalworking fluid-exposed workers concluded that a risk exists for this granulomatous lung disease where water-based fluids are used and unusual microbial contaminants predominate. Strong candidates for microbial etiology are nontuberculous mycobacteria and fungi. Cases of hypersensitivity pneumonitis occur among cases with other work-related respiratory symptoms and chest diseases. Reversibility of disease has occurred in many cases with exposure cessation, allowing return to work to jobs without metalworking fluid exposures or, in some situations, to jobs without the same metalworking fluid exposures. Cases have been recognized with metalworking fluid exposures generally less than 0.5 mg/m3. The workshop participants identified knowledge gaps regarding risk factors, exposure/response relationships, intervention efficacy, and natural history, as well as surveillance needs to define the extent of the problem in this industry. In the absence of answers to these questions, guidance for prevention is necessarily limited. AU - Kreiss K AU - Cox-Ganser J. LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 15 IP - DP - 1997 Jan 01 TI - Unexpected nerve gas exposure in the city of Matsumoto: Report of rescue activity in the first sarin gas terrorism PG - 527-528 AB - This report describes the rescue activities and the exposure of rescue and hospital personnel from the first unexpected nerve gas terrorist attack using sarin (isopropyl methylphophonofluoridate) in the city of Matsumoto at midnight on June 27, 1994. The details of the emergency activities in the disaster were studied based on the records from emergency departments of the affiliated hospitals and records from the firehouse. About 600 people, including residents and rescue staff, were exposed to sarin gas. Fifty-eight residents were admitted to hospitals, and 7 died. Among 95 rescuers and the duty doctor from the doctor car, 8 had mild symptoms of poisoning. All the rescue activity took place without gas masks or decontamination procedures. In this case of unexpected mass exposure to sarin gas, the emergency rescue system for a large disaster in Matsumoto city, which had been established for a conflagration or a local earthquake, was effective. AU - Okudera H AU - Morita H AU - Iwashita T AU - Shibata T AU - Otagiri T AU - Kobayashi S AU - Yanagisawa N LA - PT - DEP - TA - The American Journal of Emergency Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 10 IP - DP - 1997 Jan 01 TI - Long-term outcome of pulmonary function in farmer's lung: a 14 year follow-up with matched controls PG - 2046-2050 AB - The long-term outcome of pulmonary function was evaluated in farmer's lung (FL) patients compared to representative control farmers. This is, to our knowledge, the first such study which has included a control group. Clinical examinations were conducted in 89 FL patients and 84 control farmers, matched by age, sex, and smoking habits. The mean time after the first diagnosed episode of FL was 14 yrs. The mean transfer factor of the lung for carbon monoxide (TL,CO) was on average 12% lower (p < 0.001) in FL patients compared to control farmers. In spirometry, the mean maximum expiratory flow at 50% of vital capacity (MEF50) was lower (p = 0.08) in FL patients but there were no differences in mean vital capacity (VC) or forced expiratory volume in one second (FEV1) between FL patients and control farmers. However, airway obstruction, defined as an FEV1/VC less than 88% of predicted, was more common in FL patients than in control farmers (33 versus 17%; p = 0.02). Patients who had had recurrent episodes of FL had a significantly lower mean TL,CO compared to those FL patients who had experienced only a single episode. In conclusion, impairment of the pulmonary transfer factor is the most important long-term consequence of farmer's lung. However, farmer's lung may also lead to development of airway obstruction. AU - Erkinjuntti-Pekkanen R AU - Kokkarinen JI AU - Tukiainen HO AU - Pekkanen J AU - Husman K AU - Terho EO LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 314 IP - DP - 1997 Jan 01 TI - Respiratory morbidity 10 years after the Union Carbide gas leak at Bhopal: a cross sectional survey PG - 338 AB - Objective: To examine the role of exposure to the 1984 Bhopal gas leak in the development of persistent obstructive airways disease. Design: Cross sectional survey. Setting: Bhopal, India. Subjects: Random sample of 454 adults stratified by distance of residence from the Union Carbide plant. Main outcome measures: Self reported respiratory symptoms; indices of lung function measured by simple spirometry and adjusted for age, sex, and height according to Indian derived regression equations. Results: Respiratory symptoms were significantly more common and lung function (percentage predicted forced expiratory volume in one second (FEV1), forced vital capacity (FVC), forced expiratory flow between 25% and 75% of vital capacity (FEF25-75), and FEV1/FVC ratio) was reduced among those reporting exposure to the gas leak. The frequency of symptoms fell as exposure decreased (as estimated by distance lived from the plant), and lung function measurements displayed similar trends. These findings were not wholly accounted for by confounding by smoking or literacy, a measure of socioeconomic status. Lung function measurements were consistently lower in those reporting symptoms. Conclusion: Our results suggest that persistent small airways obstruction among survivors of the 1984 disaster may be attributed to gas exposure. AU - Cullinan P AU - Acquilla S AU - Ramana Dhara V AU - on behalf of the International Medical Commission on Bhopal LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 23 IP - DP - 1997 Jan 01 TI - Asbestos, asbestosis, and cancer: the Helsinki criteria for diagnosis and attribution PG - 1-6 AB - The International Expert Meeting on Asbestos, Asbestosis, and Cancer was convened in Helsinki on 20-22 January 1997 to discuss disorders of the lung and pleura in association with asbestos and to agree upon state-of-the-art criteria for their diagnosis and attribution with respect to asbestos. The group decided to name this document The Helsinki Criteria. The requirement for diagnostic criteria was perceived in part because of new developments in diagnostic methods, with better identification of asbestos-related disorders. Such developments enhance awareness of health hazards imposed by asbestos, lead to practical prevention and appropriate compensation, and also provide an opportunity to carry out international comparisons. They also provide possible models for the risk assessment of other mineral dusts. The meeting was attended by 19 participants from 8 countries not producing asbestos. The chairmen were Professor Douglas W Henderson (Flinders Medical Centre, Australia) and Professor Jorma Rantanen (Finnish Institute of Occupational Health, Finland). The group was a multidisciplinary gathering of pathologists, radiologists, occupational and pulmonary physicians, epidemiologists, toxicologists, industrial hygienists, and clinical and laboratory scientists specializing in tissue fiber analysis. Collectively, the group has published over 1000 articles on asbestos and associated disorders. This document is based on a more comprehensive report providing scientific evidence for the conclusions and recommendations (People ard Work Research Reports, no 14, Finnish Institute of Occupational Health, Helsinki, 1997). Asbestosis is generally associated with relatively high exposure levels with radiological signs of parenchymal fibrosis. However, it is possible that mild fibrosis may occur at lower exposure levels, and the radiological criteria need not always be fulfilled in cases of histologically detectable parenchymal fibrosis. The recognition of asbestosis by chest radiography is best guided by standardized methods such as the classification of the International Labour Organisation (ILO) and its modifications. Standard films must always be used. For research and screening purposes, radiological findings of small opacities, grade 110, are usually regarded as an early stage of asbestosis. Inspiratory basilar sales, restrictive impairment, small airway obstruction, and gas exchange disturbances in pulmonary function are considered valuable information for clinical diagnosis, for occupational health practice, and for attribution purposes. HRCT can confirm radiological findings of asbestosis and show early changes not seen on chest X rays, but should be performed only in selected cases. Smoking effects should be considered in the evaluation of early asbestosis, lung function tests, and respiratory symptoms. A histological diagnosis of asbestosis requires the identification of diffuse interstitial fibrosis in well inflated lung tissue remote from a lung cancer or other mass lesion, plus the presence of either 2 or more asbestos bodies in tissue with a section area of 1 cm2 or a count of uncoated asbestos fibers that falls into the range recorded for asbestosis by the same laboratory. There is evidence that rare cases of asbestosis occur without significant numbers of asbestos bodies. These cases are recognizable - and distinguishable from idiopathic pulmonary fibrosis - only by analysis of the uncoated fiber burden. Rare cases of asbestosis in relation to the inhalation of pure chrysotile can occur, with a prolonged interval between the last exposure and the diagnosis and few or no detectable asbestos bodies and a low fiber burden. The existence of such cases is speculative and, if the diagnosis can be made, it must be done from other compelling clinical or radiological grounds combined with exposure data. Fibro-inflammatory patterns other than conventional asbestosis have also been described for workers with occupational exposure to asbestos, including a DIP pattern Estimates of the relative risk for asbestos-associated lung cancer are based on different-sized populations. Because of the high incidence of lung cancer in the general population, it is not possible to prove in precise deterministic terms that asbestos is the causative factor for an individual patient, even when asbestosis is present. However, attribution of causation requires reasonable medical certainty on a probability basis that the agent (asbestos) has caused or contributed materially to the disease. The likelihood that asbestos exposure has made a substantial contribution increases when the exposure increases. Cumulative exposure, on a probability basis, should thus be considered the main criterion for the attribution of a substantial contribution by asbestos to lung cancer risk. For example, relative risk is roughly doubled for cohorts exposed to asbestos fibers at a cumulative exposure of 25 fiber-years or with an equivalent occupational history, at which level asbestosis may or may not be present or detectable. Heavy exposure, in the absence of radiologically diagnosed asbestosis, is sufficient to increase the risk of lung cancer. Cumulative exposures below 25 fiber-years are also associated with an increased risk of lung cancer, but to a less extent. The presence of asbestosis is an indicator of high exposure. Asbestosis may also contribute some additional risk of lung cancer beyond that conferred by asbestos exposure alone. Asbestosis diagnosed clinically, radiologically (including HRCT), or histologically can be used to attribute a substantial causal or contributory role to asbestos for an associated lung cancer. Pleural plaques are an indicator of exposure to asbestos fibers. Because pleural plaques may be associated with low levels of asbestos exposure, the attribution of lung cancer to asbestos exposure must be supported by an occupational history of substantial asbestos exposure or measures of asbestos fiber burden. Bilateral diffuse pleural thickening is often associated with moderate or heavy exposures, as seen in cases with asbestosis, and should be considered accordingly in terms of attribution. A minimum lag-time of 10 years from the first asbestos exposure is required to attribute the lung cancer to asbestos. Not all exposure criteria need to be fulfilled AU - Consensus report LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 54 IP - DP - 1997 Jan 01 TI - Does occupational exposure to iron promote infection? PG - 529-534 AB - THE BATLE FOR FREE IRON There is evidence that pathogens adapt in a variety of ways to obtain the iron they need-for example, by producing their own low molecular weight iron chelators, by modifications to their outer membrane proteins, and by the elaboration of haemolysins which liberate iron from haem." Host organisms counter this by restricting iron availability during infection. Additional iron binding capacity may be recruited in inflammatory exudate, as polymorphonuclear leucocytes degranulate, releasing lactoferrin;" " while the amount of iron bound to serum transferrin falls (the hypoferraemia of infection) by a mechanism that may entail lactoferrin release, macrophage sequestration of Fe'+-transferrin complexes, and increased synthesis of ferritin. " Dietary iron assimilation is suppressed by as much as 80%; and iron efflux from macrophages that have digested effete red blood cells is reduced by as much as 70%.6 Other interactions between organism and host may also operate, including the host's immune response to foreign iron sequestering proteins, and the proteolytic cleavage of transferrin and lactoferrin by certain bacteria.' The essential point is that a critical balance exists between commensal or pathogen and host in the fight for available iron. The normal flora of the respiratory tract reflect in part the nutrient limited balance so achieved. In situations where the balance is disturbed, as for example when exogenous or endogenous supplies of iron exceed the capacity of the iron binding protein system, overgrowth of organisms may be encouraged. Similar considerations may apply in viral infection: although viruses do not require iron, the host cells they infect need iron before viral replication can occur, and the hypoferraemia of infection has been found in children infected with mumps and chickenpox. OTHER MECHANISMS OF ACTION Apart from its role as a nutrient for pathogens, there are other possible ways in which iron could promote infection, especially respiratory tract infection. Iron may be implicated through a mechanism of free radical injury: in vivo iron dependent reduction of hydrogen peroxide generates hydroxyl radicals, the toxic properties of which have recently been reviewed. Studies have shown that metal particles, or carbon coated with metals, can be cytotoxic to macrophages,and short term inhalation experiments in animals have produced a cytotoxic response at ambient concentrations down to 0.1 mg/m.n '9 Factors that interfere with the efficiency of phagocytosis are liable to render the host more susceptible to infection, independent of any effect on the nutrient status of the pathogen. AU - Palmer K AU - Coggon D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 36 IP - DP - 1997 Jan 01 TI - Evaluation of the utility of spirometry in a regional public health screening program for workers exposed to welding fumes PG - 130 AB - The objective of this study was to determine the usefulness of spirometry in the screening of chronic pulmonary problems related to exposure to welding fumes, in a regional public health-based screening program. Pulmonary questionnaires and spirometric tests were administered twice at 5-year intervals on 229 welders/cutters (mean age, 39.9 years) from 31 metal manufacturing plants. The baseline mean value at the first test for the forced expiratory volume in one second (FEV 1 ) was 102% of predicted, the forced vital capacity (FVC) was 107%, and the FEV 1 /FVC ratio was 79%. The mean annual changes in the three spirometric indicators were -47 mL, -46 mL, and -0.3%, respectively. The usefulness of spirometry was assessed by looking at the relationship between exposure to welding fumes and changes in spirometric indices, in multivariate linear regression analysis, accounting for age, height, and smoking. A high lifetime exposure to welding fumes was associated with better lung functions in the cross-sectional approach (healthy worker effect) but not in the longitudinal approach, where no association was found. We concluded that the public health regional application of this screening program generated too many sources of variation for spirometry to fulfill the objective of early detection of pulmonary function decline related to exposure to welding fumes. Based on these observations, we recommend that maintaining questionnaire screening, with spirometry reserved as a second-line diagnostic intervention. AU - Rossignol M AU - Seguin P AU - DeGuire L LA - PT - DEP - TA - Occupational Health and Industrial Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19970101 IS - IS - VI - 54 IP - DP - 1997 Jan 01 TI - Bronchial reactions to exposure to welding fumes PG - 836-839 AB - Objective-To study the airway response and its mechanism to welding fumes in six welders with respiratory symptoms. Methods-Methacholine and welding challenge tests were carried out. The concentration of welding fumes during the exposure test was measured. On two subjects who developed bronchoconstriciton to welding challenge, additional tests were carried out including prick, patch, and inhalation challenges with metal salt solutions. Results-Three subjects developed immediate bronchial reaction to exposure to welding fume; one to mild steel and stainless steel welding, another to mild steel and galvanised welding, and one only to galvanized welding. They all had a moderate to pronounced degree of non-specific bronchial hyperresponsiveness. The concentration of fumes during welding tests, particularly to galvanised welding, was high. An inhalation challenge test with zinc chloride salt solution in two subjects who reacted to galvanised welding was negative Conclusions-The airway response to welding in these subjects is non-specific and is due to irritation rather than to sensitisation. AU - Contreras GR AU - Chan-Yeung M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Comparison of soybean epidemic asthma and occupational asthma PG - 743-749 AB - Epidemic versus occupational asthma: similarities and differences We here consider the similarities and differences between epidemic and occupational asthma and the way in which these could affect previous comparisons. Among the similarities the most important relates to the novelty of exposure. In both epidemic and occupational asthma a given population is exposed to a novel allergen from a particular point of time. This important time sequence is usually well established in studies of epidemic and occupational asthma and allows identification of a causal relationship. Studies of occupational and soybean epidemic asthma have been able to assess aetiological models which have included risk factors such as atopy and smoking, providing a more complete knowledge of the aetiology. In addition, other important features such as the latency interval and the intensity of exposure are amenable to observation in both occupational and soybean epidemic asthma. A proportion of patients with epidemic asthma experienced asthma attacks during outbreaks in areas far from the soybean point source, similar to occupational asthma where a worker may develop asthma without being directly exposed. Clearcut avoidance of exposure has allowed investigation of the subsequent evolution of the disease in occupational and soybean epidemic asthma; sensitisation, airways hyperresponsiveness, and symptoms may persist for long periods of time, if not indefinitely, after avoidance of exposure. The fact that soybean epidemic asthma and most cases of occupational asthma are associated with specific IgE adds biological coherence to the comparative review presented here. In contrast, some relevant differences should be highlighted. Soybean epidemic asthma involved the exposure of a total community, whereas occupational asthma reflects the exposure of a selected working population. At least two consequences arise from this difference. Firstly, the important finding that children were only rarely affected by soybean epidemic asthma cannot be tested for occupational asthma and, similarly, it is difficult to test whether older workers are at a higher risk of occupational asthma as was the case in the soybean epidemic asthma because of the limited age range of working populations and their possible assignation to lower exposures. Secondly, the healthy worker effect may reduce the risk of developing occupational asthma, whereas in epidemic asthma those with previous asthma may well have been more susceptible to soybean allergy. Finally, allergens are not inhaled as isolated particles but as complex aerosols which may differ both between occupational and epidemic asthma and between different occupational exposures. AU - Antó JM AU - Sunyer J AU - Newman Taylor AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Placebo-controlled challenges with perfume in patients with asthma-like symptoms PG - 434-439 AB - A group of nine patients with respiratory symptoms after nonspecific irritating stimuli, but without any IgE-mediated allergy or demonstrable bronchial obstruction, were referred to the asthma/allergy outpatient department for evaluation of suspected asthma. In order to find a provocation model and objectively assess these patients' symptoms in controlled studies, provocation with perfume or placebo was performed. The same patients were also subjected to perfume provocation with or without a carbon filter mask to ascertain whether breathing through a filter with active carbon could prevent the symptoms. The patients breathed through the mouth during the provocations, as they used a nasal clamp to prevent any smell of perfume. We found that the patients' earlier symptoms could be verified by perfume provocation. Breathing through the carbon filter had no protective effect. The conclusion is that symptoms suggesting hyperreactivity of the respiratory tract and asthma can be provoked by perfume without the presence of bronchial obstruction, and that using a carbon filter mask has no preventive effect. The symptoms are not transmitted via the olfactory nerve, since the patients could not smell the perfume, but they may have been induced by a trigeminal reflex via the respiratory tract or by the eyes. AU - Millqvist E AU - Löwhagen O LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 63 IP - DP - 1996 Jan 01 TI - Asthmatic reactions after nasal allergen provocation. PG - 84-87 AB - Three bronchoconstrictive responses associated with acute rhinitis and occurring in two patients were observed among 400 nasal allergen challenges. Causative substances were birch pollen, Dermatophagoides pteronyssinus and HSA-conjugated pyromellitic dianhydride. Both subjects showed bronchial hyperreactivity and immediate-type sensitization to these allergens. It is concluded that bronchoobstruction nearly occurs in nasal allergen challenges. The underline pathophysiological mechanism remains unclear. AU - Baur X LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 13 IP - DP - 1996 Jan 01 TI - Hydrochloric acid inhalation: who needs admission? PG - 422-424 AB - Nine pharmaceutical workers were exposed to hydrochloric acid (HCI) fumes. Four were discharged with no symptoms after a 4 h observation period in the accident and emergency (A&E) department. The remaining five were admitted to the medical unit because of severe symptoms, reduced peak expiratory flow rate (PEFR), or hypoxaemia. Treatment was symptomatic and discharge followed 24 h later. Only one patient, discharged from the medical unit, developed long term airway hyper-reactivity, superimposed on a background of chronic obstructive airways disease. Thus patients who are minimally symptomatic with normal PEFR and oxygen saturation values can be safely discharged from the A&E department after a short observation period of 4 h with advice to return if dyspnoea occurs. Caution should be employed in severely symptomatic patients, those with pre-existing lung pathology or reduced PEFR, and hypoxaemic patients, where observation for at least 24 h is recommended AU - Boyce SH AU - Simpson KA LA - PT - DEP - TA - J Accid Emerg Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 46 IP - DP - 1996 Jan 01 TI - Hydrogen sulphide PG - 367-371 AB - Hydrogen sulphide (H2S) is the primary chemical hazard in natural gas production in 'sour' gas fields. It is also a hazard in sewage treatment and manure-containment operations, construction in wetlands, pelt processing, certain types of pulp and paper production, and any situation in which organic material decays or inorganic sulphides exist under reducing conditions. HjS dissociates into free sulphide in the circulation. Sulphide binds to many macromolecules, among them cytochrome oxidase. Although this is undoubtedly an important mechanism of toxicity due to H2S, there may be others. H2S provides little opportunity for escape at high concentrations because of the olfactory paralysis it causes, the steep exposure-response relationships, and the characteristically sudden loss of consciousness it can cause which is colloquially termed 'knockdown.1 Other effects may include mucosal irritation, which is associated at lower concentrations with a keratoconjunctivitis called 'gas eye' and at higher concentrations with risk of pulmonary oedema. Chronic central nervous system sequelae may possibly follow repeated knockdowns: this is controversial and the primary effects of H2S may be confounded by anoxia or head trauma. Treatment is currently empirical, with a combination of nitrite and hyperbaric AU - Guidotti TL LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 46 IP - DP - 1996 Jan 01 TI - Feasibility study of respiratory questionnaire and peak flow recordings in autobody shop workers exposed to isocyanatecontaining spray paint: Observations and limitations PG - 197-204 AB - Diisocyanates, highly reactive monomers which cross-link polyurethane, are the most widely recognized causes of occupational asthma. Many exposed workers are end-users, including autobody spray painters who form a large population at risk. Neither the factors which determine incidence rate nor strategies for control have been adequately studied in this setting. We have conducted a cross-sectional survey of 23 (about one in five)' autobody shops in the New Haven area to determine the feasibility of clinical epidemiological studies in this population. Among 102 workers, there was a high rate of airway symptoms consistent with occupational asthma (19.6%). Symptoms were most prevalent among those with the greatest opportunity for exposure (dedicated spray painters) and least among office workers; part-time painters had intermediate rates. Atopy was not associated with risk while smoking seemed to correlate with symptoms. Regular use of air-supplied respirators appeared to be associated with lower risk among workers who painted part- or full-time. We were unable to validate the questionnaire responses with peak expiratory flow record data attempted on a 1/3 sample of the workers. Despite intensive training and effort, subject compliance was limited. Among those who provided adequate data (24 of 38), only two demonstrated unequivocal evidence of labile airways; two others demonstrated lesser changes consistent with an occupational effect on flow rates. There was no clear association between these findings and either questionnaire responses or exposure classification. Overall, the survey suggests that there is a high prevalence of airway symptoms among workers in autobody shops, at least in part due to work-related asthma. However, there is need for both methodological and substantive research in this setting to document rates of occupational asthma and to develop a scientific basis for its effective control. AU - Cullen MR AU - Redlich CA AU - Beckett WS AU - Weltmann B AU - Sparer J AU - Jackson G AU - Ruff T AU - Rubinstein E AU - Holden W LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 13 IP - DP - 1996 Jan 01 TI - Sarin: guidelines on the management of victims of a nerve gas attack PG - 202-206 AB - Sarin is now a weapon of the terrorist. Its acute effects are primarily due to unrestricted cholinergic activity at both muscarinic and nicotinic receptors. Treatment is based on the use of large doses of atropine and pralidoxime which may lead to practical problems of sufficient drug supplies for the average hospital. Ventilation may be necessary and present problems. Victim decontamination involves use of bleach, soap and water. Staff handling casualties need protection with respirators and butyl rubber boots and gloves. Diagnosis Nerve agent poisoning is diagnosed clinically, based on exposure to an agent with resulting meiosis and blurred vision with bronchospasm and salivation. More severe cases may lead to respiratory failure secondary to pulmonary oedema and respiratory muscle paralysis. Muscle fasciculation with abdominal cramps and urinary and faecal incontinence may also be a feature. With the organophosphate insecticides, it is typical to find bradycardia and excess salivation as presenting features. In the reports of the Tokyo poisonings, tachycardia and hypertension, a nicotinic, presynaptic effect, was common and excess secretions were only seen in the most severely poisoned patients. General management In the military situation, at risk personnel are issued with nuclear, chemical and biological warfare (NCB) suits. Oral pyridostigmine is taken prophylactically if a real risk of attack is perceived and "combo pens" of atropine (2 mg) and pralidoxime (4 g) are issued for self treatment on exposure to a nerve agent. Soldiers are trained in symptom recognition and agent identification as well as safe procedures in the presence of such agents. In civilian life this level of preparedness is unlikely. AU - Volans AP LA - PT - DEP - TA - J Accid Emerg Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 9 IP - DP - 1996 Jan 01 TI - Experimental research into the pathogenesis of cobalt/hard metal lung disease PG - 1024-1028 AB - ABSTRACT: In recent years clinical, epidemiological and experimental evidence has accumulated indicating that cobalt metal particles, when inhaled in association with other agents such as metallic carbides (hard metals) or diamond dust, may produce an interstitial lung disease termed "hard metal disease" or "cobalt lung". This article summarizes the progress accomplished in our two laboratories to understand the pathogenesis of this disease. Gaps and weaknesses in our current knowledge have also been highlighted in order to suggest potential avenues for further research. Whilst animal models have proved useful for the demonstration of the toxic synergy between cobalt and carbides (e.g. tungsten carbide), most animal models have remained descriptive and have not provided information on the mechanism for this synergy. In particular, the bizarre multinucleated giant cells which are an important hallmark of the human disease, have not been reproduced consistently in experimental animals. Since cobalt is a known sensitizer, there may also be a need to develop experimental models to test the possible involvement of immunological mechanisms in the pathogenesis of the interstitial disease. In vitro systems including macrophage cell cultures and physico-chemical tests have been useful to investigate the mechanism underlying the toxic synergy. The recent finding that, in vitro, cobalt and metallic carbides interact with oxygen to produce toxic activated oxygen species opens a new avenue of research and may offer an alternative interpretation of the fact that only a limited proportion of exposed workers develop interstitial disease. Besides the possible involvement of immunological mechanisms, it may be speculated that individuals with a lower antioxidant defence are more susceptible to the toxic effect of activated oxygen species produced by cobalt-containing dusts from hard metal. AU - Lison D AU - Lauwerys R AU - Demedts M AU - Nemery B LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - IP - DP - 1996 Jan 01 TI - Health Hazard Evaluation Report HETA 96-0156-2712 PG - 0156-2712 AB - Ford Electronics and Refrigeration Corporation, Connersville, Indiana. 163 MWF exposed 84 unexposed (different department) Exposed workers had significantly elevated ORs (range 1.7–3.5) for six respiratory and two constitutional symptoms AU - Trout D AU - Reh B AU - Weber A. LA - PT - DEP - TA - Health Hazard Evaluation Report HETA 96-0156-2712 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 Suppl 3 IP - DP - 1996 Jan 01 TI - Number preference in reading peak expiratory flow meters PG - A42 AB - Number preference for tens digits 0 and 5 by subjects when reading the peak expiratory flow (PEF) from mechanical meters may reduce the diagnosis of asthma and especially occupational asthma from serial PEF records. The records of 274 subjects (set A) recorded using mini-Wright PEF meters and 35 subjects (set B using electronic logging turbine spirometers (Micromedical) were examined for the ratio of tens digits 0 and 5 to the remaining tens digits (NP ratio; NPR). 24 records from set A and no records from set B were classified as having NP by visual inspection. No record from set B had a NPR >0.42 (mean 0.26, SD 0.08). NPR from set B were positively skewed (mean 1.81, SD 12.33). We chose a cut of 0.75 between no NP and possible NP and 1 between possible and definite NP. A further set (C1) of records recorded on mini-Wright peak flow meters was taken all with NPR <0.75. NP was induced in these records by rounding to the nearest 50l/min (set C2). The mean diurnal variation (DV, amp % predicted) did not change (paired t test p=0.87). Maximum change in amplitude was 23.4l, DV 5.7% and % of record with DV >15% was 47.6%. For OASYS-3 scored records the whole record score tended to decrease (paired t test p<0.001) but not for OASYS-NN scored records (paired t test p=0.93). Changes in classification of records is shown. OASYS-NN OASYS-3 Work effect ? Work effect No Work effect Work effect No work effect Work effect 42 6 1 29 4 ? Work effect 4 16 10 No Work effect 0 10 67 5 112 NP can cause records with a possible work effect to be erroneously classified as no work effect. DV is not greatly affected but large changes can occur in amplitude of variation and % of record with a DV >15%. AU - Bright P AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 Suppl 3 IP - DP - 1996 Jan 01 TI - Repeatability of home measurements of peak expiratory flow (PEF) and FEV1 PG - A70 AB - Serial measurements of PEF and increasingly FEV1 are used in the diagnosis of occupational asthma. Repeatability criteria for these indices are well established for measurements made in the clinical setting. We have investigated the repeatability of PEF and FEV1 from records of subjects performing home lung function monitoring. Subjects were asked to perform 3 maximal 2-second exhalations every 2 hours fro waking to sleeping for a minimum of 21 days. The 2 second exhalations were self-timed. Subjects (n=24) used portable turbine spirometers (Micromed) which stored the PEF and FEV1 for all blows for later downloading to a computer. For each session the repeatability (absolute difference between the best and next best reading) and as a % of the best) for PEF and FEV1 was found. We report the median repeatabilities (95% CI) for PEF and FEV1 for whole records and correlation between reading number (first to fortieth) and median repeatabilities. For PEF the median absolute repeatabilities were 31.8 L/min (25.2, 36.0). Repeatability % best was 9.0 (7.0, 12.0). For FEV1 the median absolute repeatabilities were 0.16L (0.12, 0.24) and 8.0 (5.2, 13.8) respectively. For PEF 21 subjects had median repeatabilities (% best) >5%. Below are the correlations with repeatability and reading number. Comparison r p (t test) PEF (absolute) 0.15 0.47 PEF (% best) 0.02 0.53 FEV1 (absolute) 0.02 0.91 FEV1 (% best) 0.13 0.51 Conclusion There is only an insignificant correlation between repeatability and reading number suggesting that the quality has not deteriorated during the duration of the record. Most subjects when performing home monitoring of PEF and FEV1 fail to meet standard limits of repeatability. This supports the use of meters with inbuilt quality control to improve the standard of data collected. AU - Bright P AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 Suppl 3 IP - DP - 1996 Jan 01 TI - Characterisation of laze and learning effects on serial peak flow records PG - A70 AB - Serial PEF records plotted as daily maximum, mean and minimum may show longitudinal declines (lazes) or inclines (learns) which are not related to work or medication. If such phenomena represent true laze or learning by the subject then interpretation of the PEF record may be difficult. We have investigated the properties of lazes and learns of PEF records. Subjects investigated for occupational asthma were asked to perform 2-hourly measurements of PEF from waking to sleeping for a minimum of 21 days. Records containing lazes (n=17) and learns (n=26) were identified visually. They were investigated for the slope of the daily maximum, mean and minimum, the number of readings per day, dispersion of readings (lazes only) and diurnal variation (DV % predicted). Comparisons were made between the period of the record affected and the remainder of the record. The impact of removing visually identified laze and learn effects was tested using a computer-based analysis program (OASYS-NN). All lazes had a decline in the daily mean, 14 in the minimum and 15 in the maximum. All learns had a rise in the daily mean, 11 in the minimum and 10 in the maximum. Neither lazes nor learns had a difference in the number of readings/day (paired t-tests, p=0.54 and 0.5 respectively). There was no difference in the dispersion of readings for lazes (paired t test, p=0.30). Lazes had no difference in DV (paired t test, p=0.62), learns did have a higher DV (26.4% vs. 17.65% for the rest of the record (paired t test, p=0.04). All learns started within 2 days of the record start, lazes were equally split between the beginning (8), middle (9) and end (9) of the record. Removal of the learns did not affect the number of records as having definitely no work effect (14), but increased those with a definite work effect from 5 to 7. Removal of lazes decreased the number of records as having no definite work effect from 10 to 8, and increased those with definite work effect from 3 to 5. Apart from characteristic changes in the slope especially in the daily mean, lazes and learns do not have other features that theoretically should be present if they were true lazing and learning. This raises the possibility that other factors may be the cause of the phenomena, e.g. progressive deterioration in PEF due to prolonged recovery from exposure. Removal of lazes particularly can lead to reclassification of records by a computer analysis program, the records tending to become more positive for a work effect. AU - Bright P AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 Suppl 3 IP - DP - 1996 Jan 01 TI - Does the delay in the time of the first reading of the day produce falsely positive records in patients performing serial peak flow for the diagnosis of occupational asthma? PG - A71 AB - Later recording of peak expiratory flow (PEF) after waking on rest days has resulted in falsely positive assessment of occupational asthma on serial PEF records (Venables, Thorax 44:760-761). We have investigated the times of the first PEF measurements of the day in 43 workers with suspected occupational asthma, comparing work and rest days. We have also examined the effect of timing of first reading on subjective and computer analysis (OASYS-NN) assessment of work-related changes in the PEF record. Records were kept for a minimum of 21 days (mean 43.5 days) with mean 7.9 readings per day. The time of the first reading was significantly later on rest than work days, 08.27 (95% CI 08.08, 08.50) vs 06.56 (95% CI 06.28, 07.25) respectively (paired t test, p<0.001). There was a weak and insignificant correlation between the time of the first reading and the overall score for work-related effects in the serial PEF record for OASYS-NN, r=0.20 (95% CI -0.18, 0.35), for subjective assessment r=0.18 (95% CI -0.19, 0.34). The correlation was therefore lower for records least likely to show an occupational effect, when false positive assessments are potentially a problem. This suggests that in clinical practice the effect of late first reading on rest days is unlikely to alter the assessment of work-related changes in the serial PEF record using OASYS-NN. AU - Bright P AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 Suppl 3 IP - DP - 1996 Jan 01 TI - Computer assisted interpretation of occupational serial peak flow plots: OASYS-N PG - A71 AB - Several attempts have been made to produce a statistical analysis of occupational serial peak flow charts but few have approached the sensitivity and specificity of human experts. The problem is essentially one of pattern recognition. We have designed and tested a neural network to interpret PEF records plotted as daily maximum, mean and minimum. The records of 248 subjects investigated for the presence of occupational asthma were used. Subjects were asked to record PEF (best of 3) 2 hourly through the day, for a minimum of 21 days. Each record was divided into work-rest-work (WRW) or rest-work-rest (RWR) periods and scored blind by a human expert for the presence of work-related effect. The records were then divided into 3 sets (A-172, B-33, C-43), sets A and B were used to “teach” and “test” the neural network, set C to judge its success. The resulting network was then used to score records from a group of subjects with and without occupational asthma (gold standard set 1), diagnosed by other means to ascertain a cut-off score. Finally the sensitivity and specificity of the neural network was obtained by scoring a further set of gold standard records (set 2). The weighted kappa for WRW periods from set C was 0.83, 0.74 for RWR periods. 2 cut-off points were chosen, at a whole record score of 2 and 3, with a “grey” area between. The sensitivities and specificities for sets 1 and 2 are shown at these points, and the midpoint of 2.5. Gold standard set 1 Gold standard set 2 Cut point Sensitivity Specificity Sensitivity Specificity 2 100 78.6 100 97.8 2.5 93.8 91.1 89.3 100 3 81.3 100 80.4 100 These results show that the neural network is at least as good as the human expert in interpreting occupational serial peak flow records for the presence of work-related effect. AU - Bright P AU - Newton DT AU - Pantin CFA AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 Suppl 3 IP - DP - 1996 Jan 01 TI - Comparison of mean daily diurnal variation in peak expiratory flow and FEV1 PG - A71 AB - Historically serial PEF measurements have been used to assess variation in airway calibre over a period of time in the monitoring and diagnosis of asthma. Some have questioned whether the FEV1 which is thought to better reflect the size of small airways would be a better indicator of changes in airway calibre. This study aims to compare the average diurnal variation (% predicted) in PEF and FEV1 with both indices measured from the same exhalation manoeuvre. Subjects attending a specialist clinic for investigation of occupational asthma were asked to serially record their lung function using a MicroMedical diarycard spirometer. The device records and stores PEF, FEV1 and FVC by directly measuring flow and then calculating volume. Subjects were instructed to produce 3 maximum forced exhalations for at least 2 seconds following a maximal inhalation, every 2 hours from waking to sleeping for at least 21 days. Following instruction subjects were observed performing 10 practice manoeuvres in clinic before returning home. Each reading was screened to make sure that the FVC exceeded the FEV1. The best PEF and FEV1 from each set of 3 was used in calculations provided that the next best reading was within 20l/min for PEF and 5% or 0.1L for FEV1. Records with <21 days were excluded, as well as days with <4 readings. The diurnal variation was calculated for each day of the record as amplitude % predicted. The diurnal variation for each eligible day was used to calculate the mean diurnal variation for PEF and FEV1. 31 subjects kept records fulfilling these criteria. The mean number of days with =4 readings was 16.5 (SD 6.3). The mean daily diurnal variation for FEV1 was 12.13% and 12.95% for PEF (paired t test p=0.23). 10 records had a mean diurnal variation >15% PEF with one extra record having diurnal variation >15% FEV1. There is no evidence that FEV1 is more sensitive in measuring variation in airway calibre than PEF. AU - Bright P AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 9 IP - DP - 1996 Jan 01 TI - Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France. PG - 1463-1469 AB - A nationwide retrospective study of exogenous lipid pneumonia (ELP) was carried out to update the data on this disease, with emphasis on thoracic computed tomography (CT) scan and bronchoalveolar lavage (BAL) findings. The inclusion criteria were: 1) presence of abnormal imaging features compatible with the diagnosis of ELP; 2) presence of intrapulmonary lipids; and 3) exogenous origin of the lipid pneumonia. Forty four cases were included (20 males and 24 females; mean age 62 +/- 11 yrs), of which four were occupational (chronic inhalation of cutting mist or oily vapour in an industrial environment). Thirty of the 40 nonoccupational cases were related to aspiration of liquid paraffin used for the treatment of constipation. A condition possibly favouring oil aspiration or inhalation was present in 34 patients (77%), most commonly gastro-oesophageal reflux (n = 20) and neurological or psychiatric illness (n = 14). Fever (39%), weight loss (34%), cough (64%), dyspnoea (50%) and crepitations (45%) were the most frequent symptoms. BAL was performed in 39 cases: 23% had a lymphocytic alveolitis; 14% neutrophilic alveolitis; and 31% a mixed alveolitis (lymphocytic and neutrophilic). Alveolar consolidations (57%), ground glass opacities (39%), and alveolar nodules (23%) were the most common radiological abnormalities. The changes were bilateral (79%), predominant in the posterior and lower zones of the lobes concerned (74%), hypodense (71%), and spared the subpleural zones (52%). In 13 cases, hypodensity was retrospectively established on CT scan by the presence of a "positive angiogram". This sign may be of diagnostic value when the density measurement is either not possible or not reliable. In conclusion, this study provides an update of the clinical, biological and radiological profile of exogenous lipid pneumonia and, in particular, confirms the diagnostic benefit of computed tomography scan, which revealed bilateral and hypodense changes in a large majority of cases. AU - Gondouin A1 AU - Manzoni P AU - Ranfaing E AU - Brun J AU - Cadranel J AU - Sadoun D AU - Cordier JF AU - Depierre A AU - Dalphin JC. LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 153 IP - DP - 1996 Jan 01 TI - Influence of inhaled steroids on recovery from occupational asthma after cessation of exposure: An 18-month double-blind crossover study PG - 953-960 AB - Occupational asthma (OA) is a useful model for the study of asthma in humans. The possibility that inhaled corticosteroids, in addition to withdrawal from the workplace, could improve clinical and functional recovery from OA can be hypothesized. We assessed clinical, functional, and behavioral characteristics of 32 subjects (22 male, 10 female), in all but one of whom OA was confirmed by specific inhalation challenges induced by either high- (n=13) or low-molecular-weight (n=19) agents within 3 mo after cessation of exposure. In this randomized, crossover, double-blind study, subjects (paired for baseline PC20 and duration of symptoms after exposure) received either placebo or 1, 000 micrograms of inhaled beclomethasone daily for 1 yr, followed by the alternate medication for 6 mo. Various clinical, functional, and behavioral parameters were examined at each 3-mo visit. Significant improvement in clinical (nocturnal symptoms, cough), functional (morning and evening peak expiratory flow rates), and behavioral (quality of life) parameters were detected in the active-treatment period, although the magnitude of the improvement was relatively small. Side effects (oropharyngeal, reduced cortisol) were similar in the placebo and treatment groups. Distinguishing subjects who started with the active preparation from those who were given placebo first showed that most clinical and behavioral parameters improved in the former instance, whereas there was no significant difference in the latter. We conclude that inhaled corticosteroids induce a small but significant overall improvement of the asthmatic condition in subjects with occupational asthma caused by high- and low-molecular-weight agents after withdrawal from exposure. The beneficial effect is, however, more pronounced if inhaled steroids are given early after diagnosis AU - Malo JL AU - Cartier A AU - Cote J AU - Milot J AU - Leblanc C AU - Paquette L AU - Ghezzo H AU - Boulet LP LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 98 IP - DP - 1996 Jan 01 TI - Occupational asthma caused by roasted coffee: immunologic evidence that roasted coffee contains the same antigens as green coffee, but at a lower concentration PG - 464-466 AB - This report also shows the presence of allergens in roasted coffee beans of the same nature but in lower concentrations than in green coffee beans. These roasted coffee beans are not related to castor beans, which were originally thought to be responsible for sensitization to green coffee. This study demonstrates that roasted coffee beans can sensitize coffee workers, probably because of residual green coffee bean allergens that survive the roasting process. AU - Lemiere C AU - Malo JL AU - McCants M AU - Lehrer S LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 46 IP - DP - 1996 Jan 01 TI - Feasibility study of respiratory questionnaire and peak flow recordings in autobody shop workers exposed to isocyanate-containing spray paint: observations and limitations PG - 197-204 AB - Diisocyanates, highly reactive monomers which cross-link polyurethane, are the most widely recognized causes of occupational asthma. Many exposed workers are end-users, including autobody spray painters who form a large population at risk. Neither the factors which determine incidence rate nor strategies for control have been adequately studied in this setting. We have conducted a cross-sectional survey of 23 (about one in five) autobody shops in the New Haven area to determine the feasibility of clinical epidemiological studies in this population. Among 102 workers, there was a high rate of airway symptoms consistent with occupational asthma (19.6%). Symptoms were most prevalent among those with the greatest opportunity for exposure (dedicated spray painters) and least among office workers; part-time painters had intermediate rates. Atopy was not associated with risk while smoking seemed to correlate with symptoms. Regular use of air-supplied respirators appeared to be associated with lower risk among workers who painted part- or full-time. We were unable to validate the questionnaire responses with peak expiratory flow record data attempted on a 1/3 sample of the workers. Despite intensive training and effort, subject compliance was limited. Among those who provided adequate data (24 of 38), only two demonstrated unequivocal evidence of labile airways; two others demonstrated lesser changes consistent with an occupational effect on flow rates. There was no clear association between these findings and either questionnaire responses or exposure classification. Overall, the survey suggests that there is a high prevalence of airway symptoms among workers in autobody shops, at least in part due to work-related asthma. However, there is need for both methodological and substantive research in this setting to document rates of occupational asthma and to develop a scientific basis for its effective control AU - Cullen MR AU - Redlich CA AU - Beckett WS AU - Weltmann B AU - Sparer J AU - Jackson G AU - Ruff T AU - Rubinstein E AU - Holden W LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Development Of OASYS-2: A System For The Analysis Of Serial Measurement Of Peak Expiratory Flow In Workers With Suspected Occupational Asthma PG - 484-489 AB - Background: Serial peak expiratory flow (PEF) measurement is usually the most appropriate first step in the confirmation of occupational asthma. Visual assessment of the plotted record is more sensitive and specific than statistical methods so far reported. The use of visual analysis is limited by lack of widespread expertise in the methods. A computer assisted diagnostic aid (OASYS-2) has been developed which is based on a scoring system developed from visual analysis. This removes the requirement for an experienced interpreter and should lead to the more widespread use of the technique. Methods: PEF records were collected from workers attending an occupational lung disease clinic for investigation of suspected occupational asthma and from workers participating in a study of respiratory symptoms in a postal sorting office. PEF records were divided into two development sets and two gold standard sets. The latter consisted of records from workers in which a final diagnosis had been reached by a method other than PEF recording. An experienced observer scored individual work and rest periods for the two development set PEF records; linear discriminant analysis was used to compare measurements taken from development set 1 records with visual scores. Two equations were produced which allowed prediction of scores for individual work or rest periods. The development set 2 was used to determine how these scores should be used to produce a whole record score. The first gold standard set was used to determine the whole record score which best separated those with and without occupational asthma. The second set determined the sensitivity and specificity of the chosen score. Results: Two hundred and sixty eight PEF records were collected from 169 workers and divided into two development sets (81 and 60 records) and two gold standard sets (60 and 67 records). Linear discriminant analysis produced equations predicting the score for work periods incorporating five indices of PEF change and one for rest periods using seven indices. These equations correctly predicted the score for development set 1 work and rest periods on 61% of occasions (kappa = 0.47). The whole record score for development set 2 records, after weighting for definite or definitely no occupational effect, correlated with the visual score (correlation coefficient 0.86). Comparison with gold standard set 1 identified a cut off which proved to have a sensitivity of 75% and a specificity of 94% for an independent diagnosis of occupational asthma when applied to gold standard set 2. Conclusions: These results suggest that the sensitivity and specificity of analysing PEF records for occupational asthma using OASYS-2 approaches that of visual analysis, but it should be absolutely reproducible. The performance of OASYS-2 is more specific and approaches the sensitivity of other statistical methods of analysis. The evaluation of a large number of PEF records from workers exposed to different sensitising agents suggests that these results should be robust and should be repeatable in clinical practice. AU - Gannon PF AU - Newton DT AU - Belcher J AU - Pantin CF AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 127 IP - DP - 1996 Jan 01 TI - Risk factors for immunologically mediated disease in workers with respiratory symptoms when exposed to hexahydrophthalic anhydride PG - 443-447 AU - Grammer LC AU - Shaughnessy MA AU - Yarnold PR LA - PT - DEP - TA - J Lab Clin Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 9 IP - DP - 1996 Jan 01 TI - Association between toluene di-isocyanate-induced asthma and DQB1 markers: a possible role for aspartic acid at position 57 PG - 207-210 AB - Toluene diisocyanate (TDI) is the most common cause of occupational asthma in western countries. The aim of this study was to investigate whether genetic factors are involved in toluene diisocyanate-induced asthma. We studied the frequency of human leucocyte antigen (HLA) class II genetic markers in three groups of subjects: 1) subjects with TDI-induced asthma (n = 30); 2) exposed subjects with no history of TDI-induced asthma (n = 12); and 3) normal subjects not exposed to TDI (n = 126). Venous blood samples were collected from the three groups and the polymorphic second exon of DQA and DQB genes was amplified by the polymerase chain reaction (PCR) method. Evaluation of HLA class II gene products in TDI-induced asthma cases showed a positive association with HLA-DQB1 * 0503 and a negative association with HLA-DQB1 * 0501 alleles, which differed at residue 57 for a single amino acid, i.e. aspartic acid in DQB1 * 0503 and valine in DQB1 * 0501. No significant difference was found in the distribution of DQA1 alleles between asthmatics and controls. Our results confirm the hypothesis that HLA-DQB1 * 0503 has a role in conferring susceptibility to TDI-induced asthma and that residue 57 of HLA-DQB1 is a potentially critical location AU - Balboni A AU - Baricordi OR AU - Fabbri LM AU - Gandini E AU - Ciaccia A AU - Mapp CE LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 154 IP - DP - 1996 Jan 01 TI - The risk of asthma attributable to occupational exposures. A population-based study in Spain. Spanish Group of the European Asthma Study PG - 137-143 AB - The prevalence of occupational asthma has usually been estimated from registers of cases rather than population surveys. We examined the causes and derived estimates of the risk of asthma attributable to occupational exposures in a randomly selected population of five areas of Spain. The study is part of the EC Respiratory Health Survey and comprises 2,646 subjects age 20 to 44 yr. Bronchial reactivity was determined in 1,797 subjects and atopy in 2,164. Twenty-one occupational sets were defined using information on current occupation, or in subjects reporting change of occupation due to respiratory problems, their occupation at that time. The highest risk of asthma was observed for laboratory technicians, spray painters, bakers, plastics and rubber workers, welders, and cleaners. The risk of asthma attributed to occupational exposures after adjusting for age, sex, residence, and smoking status was 5.0% when asthma was defined as "bronchial reactivity and a report of wheezing or whistling in the chest during the last 12 mo," and 6.7% when asthma was defined as "bronchial reactivity and a report of asthma-related symptoms or medication." Estimates of the attributable risk for adult onset asthma were higher. Occupational exposures constitute a substantial cause of asthma in the young adult Spanish population AU - Kogevinas M AU - Anto JM AU - Soriano JB AU - Tobias A AU - Burney P LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 154 IP - DP - 1996 Jan 01 TI - Exposure-sensitisation relationship for alpha-amylase allergens in the baking industry PG - 130-136 AB - Fungal alpha-amylase is an important occupational allergen in the bakery industry. Epidemiologic studies focusing on the relationship between alpha-amylase allergen exposure and work-related respiratory allergy, however, have not been reported yet. In this cross-sectional study, sensitization to occupational allergens and work-related symptoms were studied in 178 bakery workers and related to allergen exposure. Alpha-amylase allergen concentrations were measured in personal dust samples, using a sandwich enzyme immunoassay. All workers were categorized into groups on the basis of their job histories and the alpha-amylase exposure levels of their job titles. Of all workers 25% had one or more work-related symptoms. As much as 9% of the bakery workers showed a positive skin prick test reaction to fungal amylase, and in 8% amylase-specific IgE was demonstrated. Alpha-amylase exposure and atopy appeared to be the most important determinants of skin sensitization, with prevalence ratios for atopy of 20.8 (95% CI, 2.74 to 158) and for medium and high alpha-amylase exposure groups of 8.6 (95% CI, 1.01 to 74) and 15.9 (95% CI, 1.95 to 129), respectively. Furthermore, a positive association was found between positive skin prick tests to alpha-amylase and work-related respiratory symptoms. In conclusion, this study has shown that there is a strong and positive relationship between alpha-amylase allergen exposure levels in bakeries and specific sensitization in bakery workers AU - Houba R AU - Heederik DJ AU - Doekes G AU - van Run PE LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 98 IP - DP - 1996 Jan 01 TI - Compliance With Peak Expiratory Flow Readings Affects The Within- And Between-Reader Reproducibility Of Interpretation Of Graphs In Subjects Investigated For Occupational Asthma PG - 1132-1134 AB - Serial recording of peak expiratory flow (PEF)has been proposed as an interesting means in the investigation of occupational asthma (OA). 1, 2 The use of this means of assessment has lately been the object of reappraisal and was presented in a recent statement. 2 The advantages include its ability to assess patient's lung function outside the laboratory in a natural setting, the simplicity of measurement with inexpensive and handy devices, the feasibility in nonspecialized centers where specific challenges cannot be performed, and its usefulness in differentiating between nonoccupational and work-related asthma. The limitations of this type of testing include patient's motivation and honesty, organizational difficulties in having patient return to work, and requirement for rather long monitoring. Among these limitations, patient compliance, an aspect that has recently been assessed in two prospective studies, 3, 4 has been shown to be marginally superior to 50% only. It is unknown, however, whether this could have affected the within- and between-reader reproducibility of interpretation of graphs. We therefore decided to pool the data obtained from these two studies to assess the within and between-reader reproducibility of interpretation. AU - Malo JL AU - Cartier A AU - Ghezzo H AU - ChanYeung M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 154 IP - DP - 1996 Jan 01 TI - Outcome of specific bronchial responsiveness to occupational agents after removal from exposure PG - 329-333 AB - A decrease in specific bronchial responsiveness (SBR) could occur after removal from exposure to an agent causing occupational asthma as a result of loss of immunologic and/or nonspecific bronchial reactivity (NSBR). We studied 15 subjects with occupational asthma (eight to a high- and seven to a low-molecular-weight agent, isocyanate in all instances), proved by specific inhalation challenges (SIC) done 2 yr or more before. Subjects were reexposed in the same way as in the initial SIC: for subjects who did not react, the exposure was increased until either an asthmatic reaction occurred or a maximum of 2 h was reached. NSBR was assessed before and after SIC. Subjects had a decrease in their SBR if the total dose of agent necessary to induce asthmatic reaction was greater by twofold compared with the initial SIC. There was a significant improvement in NSBR in seven of 15 subjects. Nine of 15 subjects (60%) had a decrease in their SBR. Only one had a complete loss of SBR. Changes in NSBR, molecular weight of the offending agent, decrease of antibody level against offending agents, or duration of exposure at work did not explain the decrease in SBR. We conclude that after removal from exposure to the offending agent a majority of subjects (60%) show a decrease but a persistence of SBR to high- and low-molecular-weight agents. AU - Lemiere C AU - Cartier A AU - Dolovich J et al LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 9 IP - DP - 1996 Jan 01 TI - Absence Of Relationship Between Degree Of Nonspecific And Specific Bronchial Responsiveness In Occupational Asthma Due To Platinum Salts PG - 211-216 AB - There is evidence that bronchial responsiveness to allergen is quantitatively correlated with bronchial responsiveness to nonspecific stimuli in subjects with allergic asthma. This association has been questioned in occupational asthma due to low molecular weight substances. It was the aim of this study to assess the quantitative association of bronchial responsiveness to methacholine (MCh) and platinum salts (Pt), in the form of hexachloroplatinic acid, in workers with occupational asthma due to platinum salts. Fifty seven subjects with exposure to Pt, work-related asthma, and a positive bronchial challenge with Pt, underwent skin prick tests with Pt and bronchial challenge with MCh. Using the provocation concentration causing a > or = 50% fall in specific airway conductance (PC50sGaw(Pt)) as dependent variable, anamnestic data (period from first symptoms to removal, period between removal from exposure and diagnosis, and smoking), season of the investigation, skin prick tests with environmental allergens, total immunoglobulin E (IgE), skin reactivity to Pt (Pt concentration causing a 2 mm wheal), and PC50sGaw(MCh) were included as independent variables for regression analysis. Fifty two subjects (91%) showed a PC50sGaw(MCh) < 8 mg.mL-1 (geometric mean for all subjects 1.6 mg.mL-1). Responsiveness to Pt varied widely between subjects (geometric mean of PC50sGaw 9 x 10-5 mol.L-1, range 2 x 10-7 to 10-2 mol.L-1). There was no univariate correlation between bronchial responsiveness to MCh and Pt, but there was a correlation between skin reactivity to Pt and PC50sGaw(Pt) (r = 0.6). This association could not be improved by considering PC50sGaw(MCh), the period from first symptoms to removal, or the period between removal from exposure and diagnosis. The parameters that showed the highest (negative) associations with PC50sGaw(Pt) were skin reactivity to Pt and the period between removal from exposure and diagnosis (r = 0.65). We conclude that there is a moderate association between bronchial responsiveness to platinum salts and skin reactivity to platinum salts. However, there is no association between methacholine responsiveness and bronchial responsiveness to allergen in occupational asthma due to platinum salts AU - Merget R AU - Dierkes A AU - Rueckmann A AU - Bergmann EM AU - SchultzeWerninghaus G LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 110 IP - DP - 1996 Jan 01 TI - Incidence of occupational asthma and persistent asthma in young adults has increased in Finland PG - 58-61 AB - To investigate the incidence of occupational asthma and its relationship to new cases of persistent asthma, the data was collected from two national registers which cover practically all new cases of both diseases. In 1986 to 1993, the annual incidence of persistent asthma in adults (from 15 to 64 years) increased from 6,645 to 8,056 (21%). The incidence of asthma in women increased from 3,302 to 4,717 (43%). In the age group of 15 to 29 the increase was 91%, in 30 to 49 it was 60%, and in 50 to 64 the increase was 7%. Among men, the annual incidence remained stable. However, in the age group of 15 to 29 it increased by 87%, in 30 to 49 by 46%, while a decrease of 43% was detected in the age group of 50 to 64 years. During the same period, the annual incidence of occupational asthma increased from 227 to 386 (70%), from 109 to 185 (70%) in women and from 118 to 201 (70%) in men. In 1993 the population in Finland in the age range from 15 to 64 was 2.026 million. Thus, the incidence of persistent asthma was 0.4%. The proportion of newly diagnosed occupational asthma out of all new cases of asthma was 4.8%. AU - Reijula K AU - Haahtela T AU - Klaukka T et al LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 53 IP - DP - 1996 Jan 01 TI - Allergy to complex platinum salts: A historical prospective cohort study PG - 525-257 AB - OBJECTIVE To assess the incidence of allergy to complex platinum salts in a platinum refinery. METHODS A historical prospective cohort study was carried out on 77 workers (67 men) who started work between 1 January 1979 and 31 December 1991 and who were not atopic on skin prick tests to three common allergens at the time of recruitment. Skin prick tests with complex platinum salts were carried out and diagnosis of allergy to complex platinum salts made by the company's doctor. Skin tests and medical examinations were carried out routinely every six months. Follow up was until 30 September 1992 or until leaving refinery work. RESULTS 18 workers developed a positive result on skin tests and 23 developed symptoms, including all 18 subjects with positive skin tests; the probability of surviving (95% confidence interval (95% CI)) for 72 months after joining the company, with negative skin test results was 0.67 (0.51-0.79) or with no symptoms was 0.63 (0.49-0.75). The incidence of positive skin tests and symptoms was highest during the first two years of work. Symptoms occurred more frequently in September and October than during the other months of the year. The exclusion of atopic subjects did not seem to have resulted in a lower incidence of sensitisation. Smoking was a significant predictive factor for both positive skin tests (estimated relative risk 5.53) and symptoms (4.70). CONCLUSION The findings confirm that smoking is and that atopy may not be a high risk factor for the development of allergy to complex platinum salts. The high incidence of sensitisation and the available data on the clinical course of sensitised workers show that sensitised workers must be promptly and completely removed from exposure. AU - Niezborala M AU - Garnier R LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 30 IP - DP - 1996 Jan 01 TI - Human leukocyte antigens in occupational allergy: a possible protective effect of HLA-B16 in laboratory animal allergy PG - 415-420 AB - Human leukocyte antigens (HLA-A, -B, -C, and -DR loci) and possible associations with occupational allergy to laboratory animals and atopy indicators were studied in laboratory animal workers with airway symptoms (n = 92) and in those who were symptom free (n = 27), as well as in a population reference group of blood donors in good health (n = 123). The laboratory animal workers, but not the population reference group, were allergologically examined with skin prick testing to common environmental and animal allergens together with measurement of total serum IgE levels. Seven HLA antigens, i.e., HLA-A9, -B5, -B12, -B16, -DR4, -DR5, and -Drw6, suggested possible associations with symptoms and/or atopy indicators. When correcting the p-values for the number of studied antigens, only the HLA-B16 differences remained statistically significant. HLA-B16 was elevated in symptom-free subjects compared to the population reference group and in subjects with serum IgE < 10 kU/L. Subjects with serum IgE > 100 kU/L and sensitized against environmental and/or laboratory animals, including LAA asthmatics, lacked HLA-B16. It is suggested that HLA-B16 or an immunosuppressive gene linked to HLA-B16 reduce the risk of producing IgE antibodies against animal protein allergens. However, our a priori hypothesis of a possible risk associated with HLA B15-DR4 could not be confirmed AU - Sjostedt L AU - Willers S AU - Orbaek P LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 2 IP - DP - 1996 Jan 01 TI - Allergy: Screening and Occupational Asthma PG - S18-S23 AU - Venables KM LA - PT - DEP - TA - Int J Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 2 IP - DP - 1996 Jan 01 TI - Allergy: Accuracy, relevance, “need/necessity,” and consequences associated with occupational testing for atopy PG - S24-S26 AU - Casteleyn L LA - PT - DEP - TA - Int J Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Clinical and immunological evaluation of workers exposed to glutaraldehyde PG - 826-832 AB - We describe immunologic responses in subjects exposed to glutaraldehyde (GA) who were diagnosed as having occupational asthma, or who described work-related respiratory symptoms. A series of GA-modified proteins was characterized, and used to analyse sera from 20 GA-exposed workers and 21 unexposed workers for IgE antibodies. Inhibition studies were used to determine the specificity of binding. The reaction of GA with albumin in different molar ratios produced a range of modified proteins, which were used to measure specific IgE antibodies. A significant difference between exposed and unexposed subjects with serum IgE less than 150 kU/l could be detected for GA-specific IgE antibodies (P - 0.026), and 31% of exposed workers with occupational asthma had antibody levels greater than the unexposed population (mean +2.5 SD). False-positive results were obtained with serum from unexposed workers who had total IgE levels greater than 150 kU/l, but this binding was not inhibited by GA-modified proteins. We report the first evidence of immunologic sensitization in some workers exposed to GA. However, GA may behave like many other low-molecular-weight chemicals in that specific antibodies can be detected in only a small percentage of exposed workers who report work-related respiratory symptoms. AU - Curran AD AU - Burge PS AU - Wiley K LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 46 IP - DP - 1996 Jan 01 TI - Potential problems in peak expiratory flow data used to diagnose occupational asthma PG - 239-241 AU - Miller MR LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 17 IP - DP - 1996 Jan 01 TI - Anaphylaxis to the Ingestion and Inhalation of Tenebrio Molitor (Mealworm) and Zophobas Morio (Superworm) PG - 215-219 AB - It has been well documented, worldwide, that inhalation and/or contact with airborne particulate insect products has resulted in sensitivity to insect proteins and is manifested by such common entities as dermatitis, conjunctivitis, rhinitis, and asthma. However, the deliberate ingestion of a variety of insects (undertaken to prove their edibility and nutrient value) resulted in subsequent sensitization of some individuals. Such an outcome has not previously been reported in the literature. The objective was to document the anaphylactic reaction to the purposeful ingestion of mealworm in an individual known to be sensitized to the inhalation of beetle larvae. We used the occasion of the Centennial Celebration of The New York Entomological Society to expose members and guests of the Society to the ingestion of various insects. The subjects of the study consisted of: 1) Three members who were adversely affected; 2) One individual with Baker's asthma; and 3) A number of controls with no known hypersensitivity to insect products. The investigation was undertaken by food challenges, inhalation challenges, skin testing to the individual insect allergens, a) Tenebrio molitor (TM), b) Zophobas morio (ZM), c) Blattella germanica (BG), skin testing to common indoors and outdoor allergens, and direct bind ELISA and ELISA inhibition. One individual manifesting hypersensitivity both by ingestion and inhalation to mealworm was identified. This sensitivity was documented clinically as well as by objective testing. AU - Freye HB AU - Esch RE AU - Litwin CM AU - Sorkin L LA - PT - DEP - TA - Allergy Asthma Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 199 IP - DP - 1996 Jan 01 TI - Hypersensitivity pneumonitis: correlation of individual CT patterns with functional abnormalities. PG - 123-128 AB - PURPOSE: To correlate the pattern and extent of abnormalities on thin-section computed tomographic (CT) scans with pulmonary function test results in subacute and chronic hypersensitivity pneumonitis. MATERIALS AND METHODS: Thin-section scans (1-3 mm collimation) obtained in 22 patients were assessed for pattern of abnormality and extent of disease. CT scores were correlated with functional parameters by using Spearman rank correlation and forward stepwise regression analysis. RESULTS: The most common CT patterns were decreased attenuation and mosaic perfusion (n = 19), ground-glass opacification (n = 18), small nodules (n = 12), and a reticular pattern (n = 8). Areas of decreased attenuation correlated with severity of air trapping indicated by residual volume (r = .58, P < .01), whereas ground-glass opacification and reticulation correlated independently with restrictive lung function. CONCLUSION: Areas of decreased attenuation and mosaic perfusion are an important ancillary CT finding in hypersensitivity pneumonitis, and obstructive functional abnormalities indicate that this phenomenon is caused by bronchiolitis. AU - Hansell DM AU - Wells AU AU - Padley SP AU - Müller NL LA - PT - DEP - TA - Radiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 77 IP - DP - 1996 Jan 01 TI - Immunopathogenesis of fish allergy: identification of fish–allergic adults by skin test and radioallergosorbent test PG - 48-54 AU - Helbling A AU - McCants ML AU - Musmand JJ LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 312 IP - DP - 1996 Jan 01 TI - Incidence and prognosis of asthma and wheezing illness from early childhood to age 33 in a national British cohort PG - 1195-1199 AB - OBJECTIVE--To describe the incidence and prognosis of wheezing illness from birth to age 33 and the relation of incidence to perinatal, medical, social, environmental, and lifestyle factors. DESIGN--Prospective longitudinal study. SETTING--England, Scotland and Wales. SUBJECTS--18,559 people born on 3-9 March 1958. 5801 (31%) contributed information at ages 7, 11, 16, 23, and 33 years. Attrition bias was evaluated using information on 14, 571 (79%) subjects. MAIN OUTCOME MEASURE--History of asthma, wheezy bronchitis, or wheezing obtained from interview with subjects' parents at ages 7, 11, and 16 and reported at interview by subjects at ages 23 and 33. RESULTS--The cumulative incidence of wheezing illness was 18% by age 7, 24% by age 16, and 43% by age 33. Incidence during childhood was strongly and independently associated with pneumonia, hay fever, and eczema. There were weaker independent associations with male sex, third trimester antepartum haemorrhage, whooping cough, recurrent abdominal pain, and migraine. Incidence from age 17 to 33 was associated strongly with active cigarette smoking and a history of hay fever. There were weaker independent associations with female sex, maternal albuminuria during pregnancy, and histories of eczema and migraine. Maternal smoking during pregnancy was weakly and inconsistently related to childhood wheezing but was a stronger and significant independent predictor of incidence after age 16. Among 880 subjects who developed asthma or wheezy bronchitis from birth to age 7, 50% had attacks in the previous year at age 7; 18% at 11, 10% at 16, 10% at 23, and 27% at 33. Relapse at 33 after prolonged remission of childhood wheezing was more common among current smokers and atopic subjects. CONCLUSION--Atopy and active cigarette smoking are major influences on the incidence and recurrence of wheezing during adulthood AU - Strachan DP AU - Butland BK AU - Anderson HR LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 347 IP - DP - 1996 Jan 01 TI - Association of respiratory symptoms and lung function in young adults with use of domestic gas appliances PG - 426-431 AB - BACKGROUND: There is evidence from some studies that people living in homes with gas stoves and other unvented gas appliances experience more respiratory symptoms than those who use other fuels for cooking and heating, but other studies have found no such association. We have investigated whether the use of gas appliances is associated with an increased risk of respiratory symptoms and whether sensitisation to common environmental allergens modifies any such association. METHODS: A stratified random sample of 15,000 adults aged 20-44 years, living in three towns in East Anglia, UK, were sent a questionnaire on asthma and hayfever. From those who responded, a random sample of 1864 were invited to complete an extended questionnaire that included questions on use of gas appliances, to give blood samples for measurements of total IgE and specific IgE to common allergens, and to undergo tests of respiratory function, 659 women and 500 men agreed to an interview. The association of the use of gas appliances with respiratory symptoms, total IgE, specific IgE, and respiratory function was assessed by logistic and multiple regression models. FINDINGS: Women who reported they mainly used gas for cooking had an increased risk of several asthma-like symptoms during the past 12 months including wheeze (odds ratio 2.07 [95% CI 1.41-3.05]), waking with shortness of breath (2.32 [1.25-4.34]), and asthma attacks (2.60 [1.20 -5.6]). Gas cooking increased the risk of symptoms more in women who were atopic than in non-atopic women but the difference did not reach significance (p . 0.05). Women who used a gas stove or had an open gas fire had reduced lung function (forced expiratory volume in 1 s [FEV1]) and increased airways obstruction (FEV1 as a percentage of forced vital capacity) compared with women who did not. These associations were not observed in men. INTERPRETATION: In East Anglia, the use of gas cooking is significantly associated with subjective and objective markers of respiratory morbidity in women but not in men. Women may be more susceptible than men to the products of gas combustion or they may have greater exposure to high concentrations of these products because they cook more frequently than men AU - Jarvis D AU - Chinn S AU - Luczynska C AU - Burney P LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 11 IP - DP - 1996 Jan 01 TI - Latex protein allergy: a prospective study of factory workers PG - 240-246 AU - Azizah MR AU - Shahnaz M AU - Hasma H AU - Mok KL AU - Nasuraddin BA LA - PT - DEP - TA - J Nat Rubb Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 17 IP - DP - 1996 Jan 01 TI - Prevention of nosocomial influenza. PG - 641-648 AB - OBJECTIVE: To study compliance with preventive strategies at a university hospital during an outbreak of nosocomial influenza A during the winter of 1988, and the rates of vaccination of healthcare workers and of nosocomial influenza following changes in vaccine practices after the outbreak. DESIGN: Retrospective review of employee health, hospital epidemiology, hospital computing; and clinical microbiology records. SETTING: A university hospital. INTERVENTIONS: Unvaccinated personnel with exposure within the previous 72 hours to an unisolated case of influenza were offered influenza vaccine and 14 days of amantadine hydrochloride prophylaxis. Personnel with exposure more than 72 hours before evaluation were offered vaccine. A mobile cart was introduced for vaccinating personnel after the 1988 outbreak. RESULTS: An outbreak of influenza with 10 nosocomial cases occurred in 1988. Only 4% of exposed employees had been vaccinated previously and 23% of exposed, unvaccinated employees agreed to take vaccine, amantadine, or both. A mobile-cart vaccination program was instituted, and annual vaccination rates steadily increased from 26.3% in 1989 to 1990 to 38% in 1993 to 1994 (P < .0001). The relative frequency of documented cases of influenza in employees with symptoms of influenza decreased significantly during this period (P = .025), but nosocomial influenza rates among patients did not change significantly. CONCLUSION: A mobile-cart influenza vaccination program was associated with a significant increase in compliance among healthcare workers, but a majority still remained unvaccinated. The rate of nosocomial influenza among patients was not reduced by the modest increase in the vaccination rate, but influenza rates remained acceptably low, perhaps due to respiratory isolation of patients and furlough of employees with influenza. AU - Adal KA AU - Flowers RH AU - Anglim AM AU - Hayden FG AU - Titus MG AU - Coyner BJ AU - Farr BM LA - PT - DEP - TA - Infect Control Hosp Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 275 IP - DP - 1996 Jan 01 TI - Origin and interstate spread of a new york city multidrug- resistant mycobacterium tuberculosis clone family PG - 452-457 AB - OBJECTIVE--To determine whether isolates of Mycobacterium tuberculosis from New York and elsewhere that are resistant to four or more primary antimicrobial agents and responsible for widespread disease in the 1990s represent a newly emerged clone or a heterogeneous array of unrelated organisms. SETTING--New York City area and selected locations in the United States. PATIENTS--M tuberculosis isolates from 1953 patients in New York and multidrug-resistant isolates from six patients from other US communities. DESIGN--Convenience sample of all M tuberculosis strains (M tuberculosis isolates resistant to rifampin, streptomycin, isoniazid, and ethambutol, and sometimes ethionamide, kanamycin, capreomycin, or ciprofloxacin) submitted to the Public Health Research Institute Tuberculosis Center since 1991 and samples submitted to the Centers for Disease Control and Prevention from throughout the United States. The samples submitted were representative of the New York City strains of M tuberculosis. MAIN OUTCOME MEASURE--Characterization of resistant M tuberculosis strains studied by IS6110 and polymorphic GC-rich repetitive sequence (PGRS) hybridization patterns, multiplex polymerase chain reaction (PCR) analysis, and automated DNA sequencing of genes containing mutations associated with resistance to rifampin (rpoB), isoniazid (katG and inhA locus), and streptomycin (strA and rrs). RESULTS--Multidrug-resistant M tuberculosis isolates were recovered from 253 New York City patients and had the same or closely allied IS6110 and PGRS patterns, multiplex PCR type, and gene mutations associated with resistance to rifampin, isoniazid, and streptomycin. Isolates with these same molecular characteristics were recovered from patients in Florida and Nevada, health care workers in Atlanta, Ga, and Miami, Fla, and an individual who recently moved from New York City to Denver, Colo, and caused disease or skin test conversion in at least 12 people in a nursing home environment. CONCLUSIONS--The results document the molecular origin and spread of progeny of a closely related family of multidrug-resistant M tuberculosis strains that have recently shared a common ancestor and undergone clonal expansion. The multidrug-resistant phenotype in these organisms arose by sequential acquisition of resistance-conferring mutations in several genes, most likely as a consequence of antibiotic selection of randomly occurring mutants in concert with inadequately treated infections. Dissemination of these difficult-to-treat bacteria throughout New York City and to at least four additional US cities has adverse implications for tuberculosis control in the 21st century. AU - Bifani PJ AU - Plikaytis BB AU - Kapur V AU - Stockbauer K AU - Pan X AU - Lutfey ML AU - Moghazeh SL AU - Eisner W AU - Daniel TM AU - Kaplan MH AU - Crawford JT AU - Musser JM AU - Kreiswirth BN LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 45 IP - DP - 1996 Jan 01 TI - The role of bcg vaccine in the prevention and control of tuberculosis in the united states. a joint statement by the advisory council for the elimination of tuberculosis and the advisory committee on immunization practices PG - 1-18 AB - This report updates and replaces previous recommendations regarding the use of Bacillus of Calmette and Guerin (BCG) vaccine for controlling tuberculosis (TB) in the United States (MMWR 1988;37:663-4, 669-75). Since the previous recommendations were published, the number of TB cases have increased among adults and children, and outbreaks of multidrug-resistant TB have occurred in institutions. In addition, new information about the protective efficacy of BCG has become available. For example, two meta-analyses of the published results of BCG vaccine clinical trials and case-control studies confirmed that the protective efficacy of BCG for preventing serious forms of TB in children is high (i.e., > 80%). These analyses, however, did not clarify the protective efficacy of BCG for preventing pulmonary TB in adolescents and adults; this protective efficacy is variable and equivocal. The concern of the public health community about the resurgence and changing nature of TB in the United States prompted a re-evaluation of the role of BCG vaccination in the prevention and control of TB. This updated report is being issued by CDC, the Advisory Committee for the Elimination of Tuberculosis, and the Advisory Committee on Immunization Practices, in consultation with the Hospital Infection Control Practices Advisory Committee, to summarize current considerations and recommendations regarding the use of BCG vaccine in the United States. In the United States, the prevalence of M. tuberculosis infection and active TB disease varies for different segments of the population; however, the risk for M. tuberculosis infection in the overall population is low. The primary strategy for preventing and controlling TB in the United States is to minimize the risk for transmission by the early identification and treatment of patients who have active infectious TB. The second most important strategy is the identification of persons who have latent M. tuberculosis infection and, if indicated, the use of preventive therapy with isoniazid to prevent the latent infection from progressing to active TB disease. Rifampin is used for preventive therapy for persons who are infected with isoniazid-resistant strains of M. tuberculosis. The use of BCG vaccine has been limited because a) its effectiveness in preventing infectious forms of TB is uncertain and b) the reactivity to tuberculin that occurs after vaccination interferes with the management of persons who are possibly infected with M. tuberculosis. In the United States, the use of BCG vaccination as a TB prevention strategy is reserved for selected persons who meet specific criteria. BCG vaccination should be considered for infants and children who reside in settings in which the likelihood of M. tuberculosis transmission and subsequent infection is high, provided no other measures can be implemented (e.g., removing the child from the source of infection). In addition, BCG vaccination may be considered for health-care workers (HCWs) who are employed in settings in which the likelihood of transmission and subsequent infection with M. tuberculosis strains resistant to isoniazid and rifampin is high, provided comprehensive TB infection-control precautions have been implemented in the workplace and have not been successful. BCG vaccination is not recommended for children and adults who are infected with human immunodeficiency virus because of the potential adverse reactions associated with the use of the vaccine in these persons. In the United States, the use of BCG vaccination is rarely indicated. BCG vaccination is not recommended for inclusion in immunization or TB control programs, and it is not recommended for most HCWs. Physicians considering the use of BCG vaccine for their patients are encouraged to consult the TB control programs in their area. AU - Anonymous LA - PT - DEP - TA - MMWR JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 46 IP - DP - 1996 Jan 01 TI - Effectiveness of in-room air filtration and dilution ventilation for tuberculosis infection control. PG - 869-882 AB - Tuberculosis (TB) is a public health problem that may pose substantial risks to health care workers and others. TB infection occurs by inhalation of airborne bacteria emitted by persons with active disease. We experimentally evaluated the effectiveness of in-room air filtration systems, specifically portable air filters (PAFs) and ceiling-mounted air filters (CMAFs), in conjunction with dilution ventilation, for controlling TB exposure in high-risk settings. For each experiment, a test aerosol was continuously generated and released into a full-sized room. With the in-room air filter and room ventilation system operating, time-averaged airborne particle concentrations were measured at several points. The effectiveness of in-room air filtration plus ventilation was determined by comparing particle concentrations with and without device operation. The four PAFs and three CMAFs we evaluated reduced room-average particle concentrations, typically by 30% to 90%, relative to a baseline scenario with two air-changes per hour of ventilation (outside air) only. Increasing the rate of air flow recirculating through the filter and/or air flow from the ventilation did not always increase effectiveness. Concentrations were generally higher near the emission source than elsewhere in the room. Both the air flow configuration of the filter and its placement within the room were important, influencing room air flow patterns and the spatial distribution of concentrations. Air filters containing efficient, but non-high efficiency particulate air (HEPA) filter media were as effective as air filters containing HEPA filter media. AU - MillerLeiden S AU - Lobascio C AU - Nazaroff WW AU - Macher JM<R LA - PT - DEP - TA - Journal of the Air & Waste Management Associat JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 153 IP - DP - 1996 Jan 01 TI - Eosinophil and neutrophil activity in asthma in a one-year trial with inhaled budesonide. The impact of smoking PG - 1519-1529 AU - Pedersen B AU - Dahl R AU - Karlstrom R AU - Peterson CG AU - Venge P LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 109 IP - DP - 1996 Jan 01 TI - Long-term oxygen therapy at home PG - 1144-1150 AU - Pepin J AU - Barjhoux CE AU - Deschaux C AU - Brambilla C AU - on behalf of the ANTADIR working group LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 26 IP - DP - 1996 Jan 01 TI - Is formaldehyde an important cause of allergic respiratory disease? PG - 247-249 AU - Smedley J LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 26 IP - DP - 1996 Jan 01 TI - Exposure to gaseous formaldehyde induces IgE-mediated sensitization to formaldehyde in school-children PG - 276-280 AU - Wantke F AU - Demmer CM AU - Tappler P AU - Gotz M AU - Jarisch R LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Outcome of occupational asthma due to platinum salts PG - A41-A41 AU - Assoufi BK AU - Venables KM AU - Cook A AU - Stevens J AU - Dally MB AU - Linnett PJ AU - Newman Taylor AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - The effects of cigarette smoking and duration of work on the lung function in coal miners PG - A43- AU - Sandhu PS AU - Bourke SJ AU - Hendrick DJ AU - Stenton SC LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 30 IP - DP - 1996 Jan 01 TI - Hypersensitivity pneumonitis-like reaction and occupational asthma associated with 1,3-bis(isocyanatomethyl) cyclohexane pre-polymer PG - 48-55 AB - Twenty-three of 34 workers who had worked in the injection molding operation making polyurethane foam parts at an automobile parts manufacturing plant developed respiratory symptoms and/or systemic symptoms over a 2-month period following the full production use of a new diisocyanate paint that contained 1,3-bis(isocyanatomethyl)cyclohexane pre-polymer (BIC)(CAS :75138-76-0, 38661-72-2). At 3 months, all subjects underwent an interview, physical examination, pre- and post-shift pulmonary function tests, and either methacholine challenge test or bronchodilator challenge at an occupational health clinic. The most frequently cited symptoms were dyspnea (65%), cough (61%), chest tightness (57%), chills (57%), wheezing (30%), and myalgias, arthralgias, and nausea (26%). Thirteen subjects had either a positive methacholine challenge test or a positive response to bronchodilator challenge, making the overall prevalence of airway hyperresponsiveness 38%. The overall prevalence of hypersensitivity pneumonitis-like reactions among line operators in the injection molding process was 27%. This disease outbreak suggests that 1,3-bis(isocyanatomethyl)cyclohexane pre-polymer may cause asthma and hypersensitivity pneumonitis-like reactions. The use of BIC was discontinued 6 months after the first workers developed symptoms AU - Simpson C AU - Garabrant D AU - Torrey S AU - Robins T AU - Franzblau A LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 13 IP - DP - 1996 Jan 01 TI - Occupational respiratory risks in workers exposed to enzymes in detergents PG - 485-492 AB - The addition of encapsulated enzymes (proteases and lipases) to detergents in Morocco dates from 1993. We have carried out a retrospective survey which has enabled us to evaluate the prevalence of the clinical symptoms and respiratory function problems in two groups, one exposed and the other non-exposed. This enquiry which concerns 32 exposed workers and 42 non-exposed consisted of a questionnaire (CECA OMS), a chest x-ray and some respiratory function tests. The medical study involves a question in the workplace with an evaluation of dust levels (weight of dust and enzyme activity). Fifty seven per cent of those exposed had clinical respiratory symptomatology against only 7 per cent of those who were not exposed. Rhinitis, asthma, cough, chronic bronchitis, eczema and conjunctivitis were significantly more frequent in those exposed than in the non-exposed. Respiratory function was altered in 65.5 per cent of the exposed against only 38.6 per cent of those who were not exposed. The overall lung function was of an obstructive type. The peak flow (VEMS) were more frequently reduced in those exposed (25 per cent) than in the non-exposed (7.14 per cent). These anomalies were worst at the end of a day's work. Atopy seems to be a potentiating factor. Tobacco interferes significantly in the alteration of respiratory function parameters. The enquiry in the work place revealed evidence of insufficient means of protection for the work force and elevated levels of dust which pass the mean recommended atmospheric values (500 mcg per cubic mm). On the other hand, enzymatic activity of the dust collected remained within normal limits (< 0.5 GU/m3). It is thus imperative to develop means for collective prevention (a more effective encapsulation of the enzymes, work in closed areas, ventilation with more effective dust extraction) and individuals (protective clothing and specific respiratory masks for the enzymes) to maximally reduce the risk AU - Laraqui C AU - Harourate K AU - Belamallem I AU - Benhaymoud N AU - Verger C LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 16 IP - DP - 1996 Jan 01 TI - Evaluation of the sensitizing potential of eugenol and isoeugenol in mice and guinea pigs PG - 459-464 AB - The sensitizing properties of the fragrances eugenol and isoeugenol have been investigated experimentally. The potential of these materials to induce sensitization of the respiratory tract was examined using the mouse IgE test, a novel but as yet unvalidated method for the predictive identification of chemical respiratory allergens. Comparisons were made with the activity of eugenol and isoeugenol in two predictive tests for contact sensitization potential: the murine local lymph node assay and the guinea pig maximization test. Both chemicals elicited positive responses in these tests, isoeugenol exhibiting a greater potential for contact sensitization than eugenol. Isoeugenol was negative at all concentrations examined in the mouse IgE test. In the same assay, exposure to eugenol was associated with a statistically significant increase in serum IgE concentrations when initial application concentrations of 2.5% were used. However, at higher test concentrations eugenol was negative in the mouse IgE test. It is concluded that neither eugenol nor isoeugenol have a significant potential to cause sensitization of the respiratory tract, a conclusion that is apparently consistent with the lack of evidence for occupational respiratory allergy associated with exposure to these chemicals. The evidence for isoeugenol lacking respiratory sensitization activity is particularly strong and it is proposed that this chemical may be of value as a negative control in the development and validation of new predictive test methods for the identification of chemical respiratory allergens AU - Hilton I AU - Dearman RJ AU - Fielding I AU - Basketter DA AU - Kimber I LA - PT - DEP - TA - J Appl Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 106 IP - DP - 1996 Jan 01 TI - The reactive airways dysfunction syndrome induced by glue (letter) [Review] [Spanish] PG - 517-518 AU - Alvarez MJ AU - Tabar AI AU - Lizaso MT AU - Quirce S LA - PT - DEP - TA - Med Clin (Barc) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 98 IP - DP - 1996 Jan 01 TI - Hypersensitivity pneumonitis in workers exposed to esparto grass (Stipa tenacissima) fibers PG - 985-991 AB - Esparto grass (Stipa tenacissima), which is commonly found in the Mediterranean countries, has a wide variety of uses. Five stucco makers who had cough, dyspnea, malaise, and fever after exposure to esparto fiber used in their jobs showed a significant decrease in symptoms when they were away from work. Precipitating antibodies against an esparto extract were found in the sera of all patients. Specific IgG antibodies against the esparto extract were also demonstrated in all patient sera, as were IgG antibodies to Aspergillus fumigatus and thermophilic microorganisms (Micropolyspora faeni and Thermoactinomyces vulgaris) by means of an ELISA method. Esparto activity was inhibited in different ranges by the above antigens by inhibition ELISA. Only A. fumigatus could be identified after microbiologic evaluation of the esparto fiber samples. After inhalation challenge tests were performed with esparto extracts, all patients showed significant decreases in forced vital capacity, transfer lung CO, and PaO2 blood gas from baseline values. Fever, chills, malaise, dry cough, tachycardia, tachypnea, and rales on chest auscultation were also observed in all patients. Findings from bronchoalveolar lavage were suggestive of allergic alveolitis. Transbronchial biopsy specimens showed interstitial alveolitis with lymphocyte-macrophage infiltrate and granuloma. Unexposed control subjects did not exhibit reactivity to any of the tests listed above. The dust derived from esparto fibers can cause hypersensitivity pneumonitis in exposed subjects. Organisms such as A. fumigatus and thermophilic actinomyces could be the causative antigens. "Stipatosis" might be an appropriate name for this disorder AU - Hinojosa M AU - Fraj J AU - de la Hoz B AU - Alcazar R AU - Sueiro A LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 98 IP - DP - 1996 Jan 01 TI - Rostrum. Stop the sensitization PG - 857-858 AU - Kelly KJ AU - Sussman G AU - Fink JN LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 11 IP - DP - 1996 Jan 01 TI - Isocyanate-induced occupational asthma: challenge and immunologic studies PG - 314-318 AB - Isocyanate is the most prevalent agent in occupational asthma(OA) in Korea. We analyzed 43 toluene diisocyanate(TDI) induced OA patients of whom 81% were found to be spray painters. The bronchial sensitivity of all subjects was confirmed by TDI-bronchial challenge test. Serum-specific IgE antibodies to isocyanate-human serum albumin(HSA) conjugate were detected by RAST technique(Pharmacia, Sweden). Bronchial challenge test results revealed 21(57%) early, 5 late only, 4 dual, and 12 atypical responders(5 prolonged immediate, 6 square-shaped, 1 progressive). Four(9%) subjects had negative results on the methacholine bronchial challenge test. High levels of serum specific IgE antibody to isocyanate-HSA were found in 17(40%) patients. The prevalence of a specific IgE antibody was not associated with a type of TDI-bronchial challenge test response, smoking and atopic status, presence of rhino-sinusitis and systemic symptoms, or a degree of airway hyperresponsiveness to methacholine(p > 0.05). The period of latency, ranging from 3 to 132 months, was significantly longer in high specific IgE responders (p < 0.05). These data suggest that 40% of isocyanate-induced occupational asthma patients had high specific IgE antibody to isocyanate-HSA conjugate. The presence of specific IgE antibody does not seem to correlate with clinical parameters AU - Park HS AU - Nahm DH LA - PT - DEP - TA - J Kor Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 40 IP - DP - 1996 Jan 01 TI - Asthma following inhalation accidents reported to the SWORD Project. Surveillance of Work-related and Occupational Respiratory Disease PG - 645-650 AB - A follow-up study in 1994 of all inhalation accidents reported to the Surveillance of Work-related and Occupational Respiratory Disease project (SWORD) found that in 11 (3%) of 406 cases reported by occupational physicians and in 39 (18%) of 217 cases reported by chest physicians the patients had developed asthma-like symptoms. In a further follow-up in 1995, physicians who had reported these 50 cases were asked whether they still considered that their patients had developed asthma as consequence of the inhalation accident and further details were sought. Of the 11 cases reported by occupational physicians, seven were considered due to the inhalation accident, compared with 27 of 39 from chest physicians. The majority (88%) of diagnoses were supported by respiratory function tests. Accidents with prescribed sensitizing agents more frequently resulted in asthma than those with other agents. Of 34 cases, only six had recovered when last seen, so it was unlikely to have been due to transient bronchial hyperreactivity. The positive predictive value of respiratory symptoms increased with the number and duration of symptoms but was low for occupational physicians AU - Ross DJ AU - McDonald JC LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 17 IP - DP - 1996 Jan 01 TI - Asthma and rhinitis in wooding workers PG - 199-203 AB - We present some cases of rhinitis and asthma in wooding workers exposed to hard or soft woods. The specific provocation test confirmed the diagnosis of rhinitis in three patients and of asthma in four. Rhinitis was caused by oak, beech, and pine, while asthma was caused by obeche, chestnut, acacia, and iroko. Occupational exposure to the specific wood, before onset of symptoms (symptom latency) was shorter for patients with asthma. All seven patients with respiratory symptoms were nonsmokers; three were atopics and four, all with asthma, had nonspecific bronchial hyperreactivity. Twenty-four hours after the test, PD20FEV1 had decreased in two cases with rhinitis and two with asthma, although the data did not reach statistical significance (Wilcoxon matched-pairs test: NS). After the SBPT, blood eosinophils increased in two cases with rhinitis and three with asthma, and the data were at the limit of statistical significance (P = 0.046). The study confirms that not only hard essences, but also soft woods can cause respiratory symptoms, although the pathogenetic mechanisms are still unclear. A specific provocation test is still the best and sometimes only means of diagnosing wood asthma; standardized protocols with repeated measurements of nonspecific airway responsiveness and of eosinophils in the blood may be helpful for a better understanding of the pathogenetic mechanism and predisposing factors AU - De Zotti R AU - Gubian F LA - PT - DEP - TA - Allergy Asthma Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 154 IP - DP - 1996 Jan 01 TI - An epidemiologic investigation of asthma in welders PG - 1394-1400 AB - To clarify whether asthma may be caused by fume from welding mild steel and to evaluate the possible strength of such an effect, we quantified airway responsiveness among young shipyard workers with different levels of fume exposure. Clinical investigation comprised a cross-sectional survey of 19- to 27-yr-old workers who were completing 3 to 9 yr of employment in various trades, and a control group of 15- to 17-yr-old school leavers who were applying for apprenticeships within the same trades. Both groups were subdivided into negligible-, ambient-, or high-exposure subgroups according to expected levels of fume exposure. Actual exposures were assessed in a parallel environmental survey. Participants were investigated by questionnaire, skin prick tests, spirometry, and methacholine tests. Complete data sets were obtained from 1,024 of the 1,070 eligible subjects (96%). Among the workers but not the school leaver controls, there was an increasing prevalence of positive methacholine tests across the exposure subgroups-negligible 37%, ambient 44%, high 49% (p < 0.05). Regression analyses showed that in males after allowing for the effects of atopy, current smoking, and age, the estimated geometric mean level of airway responsiveness of regular welders was twice that of workers with negligible exposure after 5 yr of work. This implies that fume exposure may have been critical in causing asthma in about 1% of the welders. A lesser effect (though not significantly so) was noted among the workers with ambient exposure AU - Beach JR AU - Dennis JH AU - Avery AJ AU - Bromly CL AU - Ward RJ AU - Walters EH AU - Stenton SC AU - Hendrick DJ LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 49 IP - DP - 1996 Jan 01 TI - Latex allergy: a South Dakota problem PG - 119-120 AB - Latex allergy has become a major problem nationally and in South Dakota. It manifests itself with a range of presentations including anaphylaxis, asthma, allergic rhinitis, and contact urticaria. This is an immunoglobulin E mediated disease. Healthcare workers, spina bifida patients, and others with a high exposure to latex are at the greatest risk of developing this allergy. In South Dakota, 1,170 healthcare workers are likely afflicted. Diagnosis is mainly by a history of symptoms with exposure. Confirmatory allergy testing is now available. Avoidance of latex products is essential and is the main treatment. This predominantly will involve the patient, co-workers and healthcare providers using non-latex gloves. Patients must be identified in their records and with MedicAlerts. As do patients with other allergies, they may also need medical care involving epinephrine, bronchodilators, corticosteroids and antihistamines. Physicians have a dual role in latex allergy--recognizing it in patients and, potentially, being patients themselves AU - Bubak ME LA - PT - DEP - TA - S D J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 25 IP - DP - 1996 Jan 01 TI - Occupational asthma from welding: a case report PG - 293-295 AB - Occupational asthma is one of the commonest occupational lung diseases. This is a case of asthma related to arc-welding in a shipyard. Serial peak expiratory flow rate readings were taken with and without exposure to the welding process. The results showed that the patient had occupational asthma from welding. This case report serves to remind us of the need to ask every adult with asthma for their occupational history. It emphasises the need for early diagnosis and removal from the cause of asthma. A delay in diagnosis may lead to non-specific bronchial reactivity and persistence of symptoms AU - Khoo GT LA - PT - DEP - TA - Ann Acad Med Singapore JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 9 IP - DP - 1996 Jan 01 TI - Disinfectant use as a risk factor for atopic sensitization and symptoms consistent with asthma: an epidemiological study PG - 1407-1413 AB - Exposure to some nonallergenic compounds has been shown to increase the risk of atopic sensitization and asthmatic symptoms. In order to gain more insight into the largely unknown aetiology of respiratory symptoms in pig farmers, we studied the role of nonallergic exposure. We evaluated associations between chronic respiratory symptoms, specific and total serum immunoglobulin E (IgE) levels, use of disinfectants, and endotoxin exposure levels in a population of 194 Dutch pig farmers. Atopic sensitization (defined as increased production of IgE to common allergens) was found to occur more frequently in farmers who used disinfectants containing quaternary ammonium compounds (QACs) (odds ratio (OR) 7.4; 95% confidence interval (95% CI) 1.3-43.1). ORs for other disinfectants ranged 2.3-4.1 (NS). Atopic sensitization was not found to occur more frequently in farmers with a high endotoxin exposure. The use of disinfectants was only related to respiratory symptoms consistent with asthma in atopics. This is illustrated by the significantly elevated ORs for farmers with IgE to common allergens (house dust mite, grass pollen, birch pollen), and who used disinfectants containing QACs, in the total population and in a subgroup of the total population restricted according to bronchial hyperresponsiveness to histamine (symptomatics with a provocation dose of histamine producing a > or = 10% decrease in forced expiratory volume in one second (PC10) < or = 16 mg.mL-1, compared with asymptomatics with a PC10 > 16 mg.mL-1) (OR 4.4, 95% CI 1.3-14.6; and OR 8.2, 95% CI 1.6-42.6, respectively). Atopy and use of QACs and endotoxin exposure level taken individually were not associated with respiratory symptoms. A combination of atopic sensitization and high endotoxin exposure (> 101 ng.m-3) was strongly associated with respiratory symptoms in the restricted population (OR 6.1; 95% CI 1.0-36.2). Our results suggest that occupational exposure to nonallergenic agents (disinfectants) may induce immunoglobulin E sensitization to common aeroallergens, and that the combination of atopy and exposure to nonallergenic agents (disinfectants and endotoxin) is an important risk factor for development of symptoms consistent with asthma AU - Preller L AU - Doekes G AU - Heederik D AU - Vermeulen R AU - Vogelzang PF AU - Boleij AU - JS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 26 IP - DP - 1996 Jan 01 TI - Identification of the reactive subunits of Aspergillus umbrosus involved in the antigenic response in farmer's lung PG - 689-696 AB - BACKGROUND: Farmer's lung (FL) is the most common form of extrinsic allergic alveolitis and the fungus Aspergillus umbrosus has frequently been associated with FL among Finnish farmers. IgG and IgA class antibodies against Aspergillus umbrosus are found in the serum of FL patients and healthy exposed farmers. So far the immunologically reactive subunits of Aspergillus umbrosus are unknown. OBJECTIVES: The purpose of the study was to identify and localize the reactive subunits of Aspergillus umbrosus that are involved in the antigenic response in FL. METHODS: The distribution of the primary antibody on the outer wall layers of 4- and 11 day-old fungi Aspergillus umbrosus was studied by pre-embedding immunolabelling with fluorescein isothiocyanate (FITC)-and gold-conjugated antibodies. The surface carbohydrates of the outer wall layers were studied using FITC-conjugated lectins. RESULTS: FITC-conjugated antibodies from FL patient sera reacted with spores (conidia), phialides and hyphae, whereas the fruiting body, cleistothecia, remained unstainable. Immunofluorescence labelling was confirmed by immunolabelling electron microscopy, and gold-conjugated IgG antibodies were found on the outer cell walls of spinulose conidia, and in a less degree on the outer cell walls of hyphae and phialides. Only single gold particles were found scattered on the surfaces of cleistothecia. The surface carbohydrates of Aspergillus umbrosus conidia, vesicles, phialides and hyphae had a high affinity to GlcNAc beta 1- and Man alpha 1-/Glc alpha 1-specific lectins and only GlcNAc beta 1-specific lectins also reacted with the outer cell walls of cleistothecia. Blocking of the antigenic sites of Aspergillus umbrosus by preincubating antigen-coated enzyme linked immunosorbent assay (ELISA) plates with lectins caused some inhibition, indicating that sites with the highest affinity for lectins were not always antigenic sites. CONCLUSION: Gold-and FITC -conjugated antibodies were distributed mostly on the outer wall layers of conidia, hyphae and phialides of Aspergillus umbrosus and GlcNAc beta 1-linked lectins had the strongest affinity to the outer wall layers AU - Kaukonen K AU - Pelliniemi LJ AU - Savolainen J AU - Terho EO LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 26 IP - DP - 1996 Jan 01 TI - Immune reactivity of cow-asthmatic dairy farmers to the major allergen of cow (BDA20) and to other cow-derived proteins. The use of purified BDA20 increases the performance of diagnostic tests in respiratory cow allergy PG - 188-196 AB - BACKGROUND: Cow dust is one of the most important inducers of occupational allergic diseases in Finland. For example, in 1991 it accounted for almost 40% of the new occupational asthma cases. OBJECTIVE: This study compares the performance of the purified major cow allergen (BDA20) and crude bovine epithelial extract (BEA) in diagnostic tests and examines the role of milk allergy-associated bovine proteins (bovine serum albumin, alpha-lactalbumin, beta-lactoglobulin, casein) in respiratory cow allergy. METHODS: The humoral responses of cow-asthmatic and healthy farmers to the various components of BEA were analysed with sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting. The levels of specific IgE and IgG antibodies were quantificated with enzyme-linked immunosorbent assays (ELISAs). The cellular responses were analysed with antigen-specific lymphocyte proliferation tests. RESULTS: The specific anti-BDA20 IgE measurement was found to be best in distinguishing between the asthmatic farmers and their healthy colleagues. It proved possible to determine a cut-off value that gave the analysis a specificity and sensitivity of 100%; the distinction between the two groups was highly significant (P < 0.0001). In the lymphocyte proliferation analysis, cow asthma was more closely associated with reactivity to BDA20 than to BEA. In the measurement of anti-BDA20 and anti-BEA IgG antibody levels, considerable overlap between the groups was observed, suggesting that these antibodies are not directly involved in cow allergy. When proteins associated with milk allergy were used as test reagents, no statistically significant differences could be observed between the groups, except for anti-casein IgE antibodies the level of which, however, overlapped considerably between the farmer groups. CONCLUSION: These findings suggest that purified BDA20 is better than BEA for diagnosing cow asthma and that proteins associated with milk allergy are of only marginal significance in this disease AU - Virtanen T AU - Zeiler T AU - Rautiainen J AU - Taivainen A AU - Pentikainen J AU - Rytkonen M AU - Parkkinen S AU - Pelkonen J AU - Mantyjarvi R LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 26 IP - DP - 1996 Jan 01 TI - Wheat antigen exposure assessment for epidemiological studies in bakeries using personal dust sampling and inhibition ELISA PG - 154-163 AB - BACKGROUND: Asthma in bakery workers caused by exposure to wheat flour proteins is an important occupational health problem. Until recently, gravimetric dust measurements were the only available technique for quantitative exposure assessment in bakeries. However, it is questionable whether dust levels are a good exposure parameter or only give a crude approximation of the actual flour allergen concentration. OBJECTIVE: In the present study we have investigated a method to measure wheat flour antigens with immunochemical methods. METHODS: Wheat flour antigens were measured in 449 personal dust samples taken in bakeries, using enzyme-linked immunosorbent assay (ELISA) inhibition and an anti-wheat IgG4 serum pool. Western-blotting was performed to compare the wheat flour proteins detected by IgE and IgG4. RESULTS: Electrophoresis and immunoblotting showed that many wheat flour proteins can bind IgG4 and IgE, but also a reasonable similarity in major allergens detected by our IgG4-serum pool and IgE-positive sera. Inhibition tests showed some cross-reactivity with some cereal species, but not with other ingredients used in bakeries. In bakeries, large differences in personal airborne flour levels were found between occupational titles. For several groups clear differences in wheat antigen exposure levels existed, where no differences in dust exposure levels could be found. The relationship between dust and wheat antigen exposure varied considerably, depending on the specific bakery occupation, the size of the bakery, and the type of product produced by the bakery. This study also shows that personal sampling of wheat antigens is possible on a large scale and can be used for epidemiological field studies. CONCLUSION: Measurement of airborne wheat antigens in bakeries is a more specific and sensitive measurement tool than measuring dust samples, and will probably be essential for epidemiologic field studies focusing on exposure-response relationships AU - Houba R AU - Van Run P AU - Heederik D AU - Doekes G LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 26 IP - DP - 1996 Jan 01 TI - Diversity of allergens causing occupational asthma among cereal workers as demonstrated by exposure procedures [see comments] PG - 147-153 AB - BACKGROUND: Occupational asthma among cereal workers is frequently due to cereals but other allergens can also be responsible. OBJECTIVE: We evaluated the allergens causing occupational asthma in the patients who had been diagnosed in our Department during the last 5 years. Specific bronchial reactivity to the implicated allergens was assessed and compared by standardized bronchial challenge. METHODS: Twenty-one patients (12 bakers, three millers and six farmers) were studied. We carried out in vivo tests (skin and challenge tests) and in vitro tests (specific IgE measurement) with cereals, enzymes, soyabean, storage mites and egg. A definitive diagnosis was established by means of specific bronchial provocation tests (BPT), except in three patients in whom it could not be carried out due to the severity of their asthma. In these cases the causative agent had to be determined by means of conjunctival challenge. RESULTS: Cereals were the main sensitizers among bakers (75%) and farmers (66%). Bakers were also sensitive to alpha-amylase (41%) and soyabean (25%), and farmers, to soyabean (33%) and storage mites (33%). Occupational asthma was due to cereals, soyabean and storage mites among millers. CONCLUSIONS: Besides cereals, other allergens such as enzymes, leguminous, egg and storage mites can be the causative agents of occupational asthma among cereal workers. Sensitization to different allergens in the different jobs is very likely due to differences in exposure AU - Alvarez MJ AU - Tabar AI AU - Quirce S AU - Olaguibel JM AU - Lizaso MT AU - Echechipia AU - S AU - Rodriguez A AU - Garcia BE LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 77 IP - DP - 1996 Jan 01 TI - Bronchial responsiveness to ultrasonic "fog" in occupational asthma due to low molecular weight chemicals PG - 378-384 AB - BACKGROUND: In a previous work we have demonstrated that the use of an indirect stimulus such as ultrasonically nebulized distilled water (UNDW, "fog") challenge, in addition to methacholine, in the assessment of occupational asthma due to TDI improves our ability in detecting sensitized subjects. OBJECTIVE: In the present study we aimed to determine the validity of "fog" in the assessment of occupational asthma induced by various low molecular weight substances. METHODS: Fourty subjects exposed to low molecular weight substances with work-related respiratory symptoms underwent methacholine, UNDW and specific bronchial challenge tests. Diagnosis of occupational asthma was made in 20 of 40 patients who developed bronchoconstrictive responses to the specific challenges (reactors). Sensitivity and specificity of UNDW alone, of methacholine alone, and of the combination of the two tests were determined at two different cutpoints of PD20FEV1 of methacholine, with the results of the specific challenge as the "gold standard". RESULTS: Frequency and severity of bronchial hyperresponsiveness both to UNDW and to methacholine were significantly higher in reactors than in nonreactors. Ultrasonically nebulized distilled water had higher specificity (80% versus 60%) but lower sensitivity (65% versus 75% to 90%) than methacholine. As compared with methacholine alone, the combination in series of the two challenges (both challenges positive) substantially improved specificity (85% versus 60%). CONCLUSIONS: In conclusion, in the assessment of low molecular weight chemical-induced asthma diagnosed with the specific challenge as the "gold standard," UNDW challenge proves more specific than methacholine for occupational asthma, but it is considerably less sensitive. The combination of the two challenges results in very high sensitivity and high specificity for occupational asthma, therefore, although further investigations are required for the definitive diagnosis, it should be regarded as a useful means to confirm objectively a suggestive history AU - Dellabianca A AU - Omodeo P AU - Colli MC AU - Bianchi P AU - Scibilia J AU - Moscato G LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational asthma caused by aromatic herbs PG - 647-649 AB - We describe a subject with occupational asthma caused by several aromatic herbs: thyme, rosemary, bay leaf, and garlic. The diagnosis was confirmed by several inhalation challenges in the laboratory. Although immediate skin reactivity was demonstrated to the herbs the subject reacted to by inhalation, RAST showed that garlic was the most potent allergen by weight, the other herbs showing less reactivity. These aromatic herbs, bay leaf, thyme, and rosemary, should be included among agents causing occupational asthma in the food industry AU - Lemiere C AU - Cartier A AU - Lehrer SB AU - Malo JL LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Allergy to pine nuts in a bird fancier PG - 741-744 AB - A patient is described with the bird-egg syndrome who experienced an anaphylactic reaction after eating some of her parrot's food (pine nuts: Pinus pinea). Specific IgE against this nut and another pine nut (P. cembra) was demonstrated by RAST. Cross-reactivity between these botanically related seeds was shown by RAST inhibition. Besides avian antigens, bird food antigens should be taken into consideration when symptoms of allergy occur on exposure to birds AU - Jansen A AU - Vermeulen A AU - Dieges PH AU - van Toorenenbergen AW LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - IP - DP - 1996 Jan 01 TI - Occupation exogenous allergic alveolitis [Russian] PG - 72-75 AB - In 510 patients with exogenous allergic alveolitis (EAA), including poulterers (n = 110), tobacco growers (n = 116), wood workers (n = 132), cotton workers (n = 102), methods for detecting the diseases, its clinical features, course, and treatment were studied. The paper gives a scheme of alveolitis development. The most effective detection methods were questionnaires and tests for specific serum antibodies. EAA runs more severely in poulterers and tobacco growers. Its management includes no contact with the allergen, as well as drugs and extracorporeal treatment. Fungal infection exerts a substantial effect on the course of the disease AU - Khomenko AG AU - Ozerova LV LA - PT - DEP - TA - Probl Tuberk JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational asthma caused by mink urine PG - 364-365 AU - Jimenez Gomez I AU - Anton E AU - Picans I AU - Jerez J AU - Obispo T LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational asthma induced by aniseed PG - 337-339 AB - This report deals with clinical and immunologic studies in a butcher with work-related asthma. Both the positive methacholine inhalation test and the significant changes observed in PEFR measurements supported the diagnosis of asthma. The significant fall observed in PEFR measurements when the patient handled aniseed supported the diagnosis of occupational asthma. Skin prick tests carried out with 13 spices showed positive reactions only to aniseed extract. The patient had high levels of specific antianiseed IgE antibodies. The bronchial challenge test with an aniseed extract showed an immediate response without a late response. These findings suggest that the respiratory symptoms in our patient were induced by the inhalation of aniseed dust through an IgE-mediated immunologic mechanism of immediate hypersensitivity. This study established the diagnosis of occupational asthma from aniseed dust sensitization AU - Fraj J AU - Lezaun A AU - Colas C AU - Duce F AU - Dominguez MA AU - Alonso MD LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 11 IP - DP - 1996 Jan 01 TI - Increased neutrophil chemotactic activity is noted in alminum-induced occupational asthma PG - 69-73 AB - A worker with occupational exposure to aluminum powder developed asthmatic symptoms three years and six months after starting work. Skin tests (prick and intradermal) to aluminum chloride (AlCl3) were negative. Inhalation challenge test with 10 mg of aluminum powder and 10 mg/ml of AlCl3 solution induced an early asthmatic response. Sodium cromoglycate pre-treatment reduced AlCl3-induced bronchoconstriction. Neutrophil chemotactic activity was markedly increased one and seven hours after the challenge procedure, which was lessened with sodium cromoglycate pre-treatment. Aluminum can induce occupational asthma in exposed worker, which may be mediated by a non-immunologic mechanism and the possible role of neutrophils was suggested AU - Park HS AU - Uh ST AU - Park CS LA - PT - DEP - TA - Korean J Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational asthma to lobster and shrimp PG - 272-273 AU - Lemiere C AU - Desjardins A AU - Lehrer S AU - Malo JL LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Reactive airways dysfunction syndrome induced by exposure to a mixture containing isocyanate: functional and histopathologic behaviour PG - 262-265 AB - A 31-year-old machinist experienced acute symptoms of rhinoconjunctivitis, coughing, shortness of breath, and wheezing after sudden exposure to fumes containing isocyanates and solvents. Lung function tests carried out 11 days after the event showed reduced flow rates. Forty days after the acute inhalational injury, expiratory flows improved, and the PC20 was 0.8 mg/ml, showing moderate bronchial hyperresponsiveness. Six days later, the subject underwent bronchoscopy. Bronchial biopsies showed a marked loss of epithelial cells, severe subepithelial oedema, and inflammatory cells infiltrate (mainly lymphocytes). The subject was given inhaled steroids. The PC20 was back to normal 42 days later. Bronchial biopsies then showed incomplete regeneration of the epithelial layer with few ciliated cells and persistence of inflammation (lymphocyte infiltrate) in epithelia and connective tissue. We conclude that irritant exposure to a mixture of isocyanates and solvents can cause occupational asthma without a latency period, i.e., reactive airways dysfunction syndrome AU - Lemiere C AU - Malo JL AU - Boulet LP AU - Boutet M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 86 IP - DP - 1996 Jan 01 TI - Asthma in goldminers PG - 804-807 AB - OBJECTIVES: To determine whether asthma in goldminers is caused by or contributed to by their working environment. DESIGN: A case-control study in which men with asthma working underground in goldmines were compared with underground goldminers without asthma in relation to their age, duration of exposure to the underground environment, atopy and family history of asthma. SETTING: An in- and outpatient facility providing for the medical needs of approximately 90 000 miners employed on goldmines in the Free State. OUTCOME MEASURES: Occupational history, atopy and family history of asthma were compared in the two groups. The age of onset of asthma and duration of occupational exposure were examined in the men with asthma. RESULTS: The study sample included 78 underground miners with asthma and 46 without asthma. The men in the two groups were of similar age, but those with asthma had worked underground for a longer period than the men without asthma. Twenty of the asthmatic and none of the control group had been exposed to paint and cement in the course of their work. Fifty of the asthmatic and only 3 of the control group were atopic. The mean age of onset of asthma (+/-SD) was 30.6 +/-10.73 years. Six of the men had developed asthma before starting to work in the mines, and the disease had developed 13.4 +/- 8.22 years after starting to work underground in the remaining 72. CONCLUSION: The late age of onset and the onset after exposure to the underground environment suggest that the disease was work-related AU - Cowie RL AU - Mabena SK LA - PT - DEP - TA - S Afr Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 50 IP - DP - 1996 Jan 01 TI - Different threshold concentrations for sensitization by cattle hair allergen Bos d 2 in atopic and non-atopic farmers [German] PG - 177-181 AB - Several threshold values for indoor allergens leading to IgE sensitization were proposed. Currently such values exists for allergens of house dust mite, cat, dog, and cockroach and cattle. A high sensitization is known as an important risk factor in the development of asthma. This study was undertaken to examine threshold values of major cow hair allergen Bos d 2 in the house dust of atopic and nonatopic cow hair asthmatic farmers. 45 patients with cow hair asthma were visited at their homes. House dust samples were taken from corridor, living room, and bedroom. The concentration of Bos d 2 was determined by means of rocket immunoelectrophoresis. Additionally, samples of venous blood were taken to demonstrate specific IgE towards cow epithelia by CAP-RAST. Five patients were excluded from further investigations because they have given up their cattle for less than 6 months. In 21 patients occurred typical atopic stigmata like infantil history of atopic eczema, hay fever or milk crust, while the other 19 subjects did not show an atopic diathesis. High sensitization towards cow epithelia (specific IgE > 0.7 kU/l in CAP-RAST) occurred significantly more often in atopics than in nonatopics. In atopic subjects the allergen concentrations leading to IgE sensitization amounted to 1-20 micrograms Bos d 2/g dust, whereas in nonatopics were found higher Bos d 2 threshold values (25-50 micrograms/g dust). The present study suggests that in nonatopic cow hair asthmatics high indoor Bos d 2 levels lead to IgE sensitization as well as the close contact to cattle AU - Hinze S AU - Bergmann KC AU - Lowenstein H AU - Hansen GN LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 93 IP - DP - 1996 Jan 01 TI - A study of occupational asthma in New Jersey. [Review] PG - 32-34 AU - Hudgins JF AU - Karetzky MS LA - PT - DEP - TA - N J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 87 IP - DP - 1996 Jan 01 TI - Changes in blood eosinophils and nonspecific bronchial reactivity after exposure tests to wheat flour and TDI [Italian] PG - 152-161 AB - We studied non-specific bronchial responsiveness (NSBR) and blood eosinophils before and 24 hours after a bronchoprovocation test (SBPT) with wheat flour (22 cases) and TDI (32 cases). Twelve patients developed asthma after exposure to wheat flour (7 early and 5 dual/late asthma), and 12 after exposure to TDI (6 early and 6 late/dual asthma). Responders and non responders to wheat flour exposure were similar for all general characteristics except IgE levels (p = 0.036) and NSBR (p = 0.047). A higher degree of airway responsiveness to methacholine was the only characteristic which differentiated responders from non responders to TDI exposure (p = 0.043). Airway responsiveness, assessed 24 hours after the SBPT (44 cases), did not show any change compared to pretest values; the data were similar both among non responders to wheat flour (Wilcoxon p = 0.1) or to TDI (p = 0.2) and responders to TDI (p = 0.6) or wheat flour (p = 0.3); also no significant changes were observed among early and dual/late asthma caused by wheat flour and TDI. Twenty-four hours after the SBPT, blood eosinophils were higher than pretest, but only among the 24 patients with asthma (Wilcoxon p = 0.002); the blood eosinophil increase was statistically significant among patients with early and late/dual asthma caused by wheat flour, and among those with early and late/dual TDI asthma. In our study, NSBR was confirmed as a common feature of occupational asthma, either IgE mediated (wheat flour) or non-IgE mediated (TDI). Twenty four hours after the specific exposure, among patients with asthma induced by wheat flour and TDI, there was an increase in blood eosinophils while in the same time interval no variation in non-specific bronchial responsiveness was observed AU - De Zotti R AU - Gubian F AU - Negro C LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 22 IP - DP - 1996 Jan 01 TI - Latex allergy. [Review] PG - 384-392 AU - Wooding LG AU - Teuber SS AU - Gershwin ME LA - PT - DEP - TA - Compr Ther JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 26 IP - DP - 1996 Jan 01 TI - Buckwheat flour hypersensitivity: an occupational asthma in a noodle maker PG - 423-427 AB - BACKGROUND: There have been very few reports of occupational allergies caused by inhalation of buckwheat flour. In this paper, we present a case of occupational asthma and rhinitis caused by buckwheat flour inhalation. METHODS AND RESULTS: The patient had strong positive responses to grass and ragweed pollens as well. The bronchoprovocation test showed early asthmatic response to buckwheat flour extracts. Serum specific IgE antibody to buckwheat flour was detected by enzyme-linked immunosorbent assay (ELISA). In order to further identify the allergenic component of the extracts, sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and electroblotting studies were performed. Eight IgE binding components (9-55 kDa) were detected within the buckwheat flour extracts. CONCLUSION: These results suggest that inhalation of buckwheat flour can caused IgE mediated bronchoconstriction AU - Park HS AU - Nahm DH LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 38 IP - DP - 1996 Jan 01 TI - Total serum IgE in trimellitic anhydride-induced asthma PG - 347-351 AB - The objective of this study was to determine whether total serum IgE levels are elevated in workers with trimellitic anhydride-induced asthma as compared with anhydride-exposed workers without an occupational immunologic syndrome. Sera from 12 highly exposed workers with trimellitic anhydride-induced asthma, and from 31 similarly exposed workers without occupational immunologic disease, were assayed for total immunoglobulin E (IgE) levels by Total IgE II FAST analysis. The mean total IgE levels were 176.74 ng/mL and 34.55 ng/mL respectively. The difference between the two groups was statistically significant, but considerable overlap of IgE levels between groups was seen. In conclusion, although mean total IgE levels are significantly different between TMA-exposed workers with or without occupational asthma, the significant amount of overlap and poor sensitivity of the test preclude the use of this assay in the individual evaluation of these workers AU - Backman KS AU - Shaughnessy MA AU - Harris KE AU - Grammer LC LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 35 IP - DP - 1996 Jan 01 TI - Hypersensitivity pneumonitis induced by spores of Pholiota nameko PG - 301-304 AB - A 42-year-old man experienced recurrent episodes of nonproductive cough, fever, and dyspnea on exertion. He had worked as a mushroom farmer for 10 years. The diagnosis of hypersensitivity pneumonitis was confirmed immunologically by detecting a precipitin to spores of Pholiota nameko but not to other antigens. After separation from the antigen along with an addition of corticosteroid therapy, the symptoms, inflammatory findings and a reduced level of PaO2 quickly subsided AU - Inage M AU - Takahashi H AU - Nakamura H AU - Masakane I AU - Tomoike H LA - PT - DEP - TA - Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 26 IP - DP - 1996 Jan 01 TI - Comparison between hypertonic and isotonic saline-induced sputum in the evaluation of airway inflammation in subjects with moderate asthma PG - 1395-1400 AB - BACKGROUND: Hypertonic saline-induced sputum has recently been used for the evaluation of airway inflammation in asthma. OBJECTIVE: To assess the effect of hypertonicity on airway inflammation. METHODS: We compared the inflammatory cell composition of hypertonic saline-induced sputum with that of isotonic saline-induced sputum in 21 asthmatic subjects and, at baseline and 30 min after each sputum induction, we measured bronchial hyper-responsiveness to methacholine as an indirect marker to detect increased airway inflammation. On two different days, the patients inhaled hypertonic saline (3-5% NaCl) or isotonic saline (0.9% NaCl) for 30 min via an ultrasonic nebulizer, while monitoring FEV1. Sputum was collected for inflammatory cell analysis. RESULTS: There was no difference in inflammatory cell percentages obtained with the two methods. Eosinophils were > 1% in 20 subjects after hypertonic saline and in 16 subjects after isotonic saline, but this difference was not statistically significant. Intraclass correlation coefficients for sputum inflammatory cells obtained with the two methods were +0.642 for eosinophils, +0.644 for neutrophils, +0.544 for lymphocytes and +0.505 for macrophages. Hypertonic saline induced bronchoconstruction in a significantly greater number of subjects than isotonic saline. Also, hypertonic saline increased bronchial responsiveness to methacholine, while isotonic saline did not. CONCLUSION: We conclude that hypertonicity does not affect sputum cell composition, suggesting that inflammatory cells in hypertonic saline-induced sputum are probably preexisting and not acutely recruited in the airways by the hypertonic stimulus. However, the bronchoconstriction and the increase in bronchial hyper-responsiveness after hypertonic saline inhalation may imply the release of inflammatory mediators. This fact must be considered in the evaluation of soluble markers of inflammation in hypertonic saline-induced sputum AU - Bacci E AU - Cianchetti S AU - Paggiaro PL AU - Carnevali S AU - Bancalari L AU - Dente FL AU - Di Franco A AU - Giannini D AU - Vagaggini B AU - Giuntini C LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 110 IP - DP - 1996 Jan 01 TI - Tolerance to the protective effect of salmeterol on allergen challenge PG - 1452-1457 AB - Long-term treatment with inhaled beta 2-agonists may be associated with a deterioration in asthma control, potentially due to tolerance. Regular use of short-acting beta 2-agonists has been shown to induce tolerance to allergen or adenosine 5'-monophosphate challenge. The aim of the study was to detect the efficacy of a single dose and a short-term treatment with salmeterol, a long-acting beta 2-agonist, to protect against early asthmatic reaction (EAR) to allergen. Eight subjects with mild allergic asthma underwent two treatment periods in which subjects performed an allergen challenge (specific bronchial provocation test) protected by a single dose (50 micrograms) of salmeterol (Salm-1) followed by a second specific bronchial provocation test after regular treatment with salmeterol for 1 week (Salm-2), or a single dose of placebo (Plac-1) and regular treatment (1 week) with placebo (Plac-2). Each subject performed both treatments in a randomized order. Each time allergen challenge was performed 1 h after last drug inhalation and it was stopped when the same provocative dose of allergen of a previous screening allergen challenge was achieved. The maximum decrease in FEV1 and area under curve in the first hour after allergen inhalation were significantly lower in Salm-1 (max delta FEV1 %, median [range]: 4%[0 to 9]) with respect to Salm-2, Plac-1, Plac-2 (24%[13 to 38], 31%[19 to 50], 30%[6 to 44], respectively, p < 0.001); there was no difference among Salm-2, Plac-1 and Plac-2. In Salm-1, all subjects were protected against EAR, whereas in Salm-2 only 2 subjects showed a partial protection. In conclusion the protective effect of a single dose of salmeterol against allergen-induced EAR was lost after regular treatment with salmeterol for 1 week. The clinical relevance of this mechanism remains to be elucidated AU - Giannini D AU - Carletti A AU - Dente FL AU - Bacci E AU - Di Franco A AU - Vagaggini B AU - Paggiaro PL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 9 IP - DP - 1996 Jan 01 TI - Comparison of inhaled salmeterol and individually dose-titrated slow-release theophylline in patients with reversible airway obstruction. European Study Group PG - 1689-1695 AB - The aim of this study was to compare the clinical efficacy of salmeterol versus theophylline in the treatment of moderate-to-severe asthma. One hundred and eighty nine asthmatic patients (forced expiratory volume in one second (FEV1) or peak expiratory flow (PEF) >50% of predicted) were randomized to receive either salmeterol dry powder, 50 microg b.i.d. via a Diskhaler (n=92) or dose-titrated slow-release theophylline capsules ("Theo-Dur") b.i.d. (n=97), in a double-blind, double-dummy, parallel group study for 4 weeks. Patients had previously been titrated with theophylline to a serum theophylline level of 10-20 microg x mL-1. The median percentage of nights with no asthma symptoms rose from 14% in both groups at baseline to 71% with salmeterol and to 46% with theophylline (p=0.044). There was also a significant increase for salmeterol in the median percentage of nights with no rescue salbutamol use (from 36 to 86%) compared with theophylline (from 71 to 78%; p=0.002). The mean morning PEF increased from 337 L x min-1 in the salmeterol group and 332 L x min-1 in the theophylline group to 372 and 357 L x min-1, respectively. No significant difference between the two treatments was observed for PEF, symptoms or additional salbutamol medication during the day. The incidence of gastrointestinal symptoms (gastric irritation, nausea and vomiting) was greater among patients receiving theophylline (11%) than with salmeterol (3%). These findings suggest that inhaled salmeterol is more effective in relieving symptoms of asthma, and better tolerated than theophylline in patients with moderate-to-severe asthma AU - Paggiaro PL AU - Giannini D AU - Di Franco A AU - Testi R LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 347 IP - DP - 1996 Jan 01 TI - Mortality in adults with self-reported asthma. Copenhagen City Heart Study Group PG - 1285-1289 AB - BACKGROUND: On the question of whether asthma shortens survival the published work gives no clear answer. We have prospectively analysed overall and cause-specific mortality in persons with self-reported asthma. METHODS A sample of 13 540 individuals (6104 men) 20 years of age or older, randomly selected from the general population of the city of Copenhagen, was followed for 17 years. FINDINGS: Survival in participants with self-reported asthma was significantly poorer than in non-asthmatics, the excess mortality being limited to pulmonary mortality. After statistical adjustment for age, length of school education, and smoking, women with asthma had a 1.7 higher risk of dying than women without asthma (95% confidence interval 1.3--2.2). Although the relative risk (RR) of dying with asthma was slightly lower in men (RR = 1.5, 95% Cl 1.2-1.9) the difference between sexes was not significant. The results were similar within smoking groups and the highest risk of death associated with asthma was seen among never-smokers (RR = 2.1, 95% Cl 1.6-2.3). Inclusion of one-second forced expiratory volume, in % predicted, in the mortality analyses showed that the increased risk of death associated with asthma was mediated mainly through reduced lung function. INTERPRETATION: We conclude that, in the general population, self-reported asthma is associated with a slight excess of mortality, mainly from respiratory diseases AU - Lange P AU - Ulrik CS AU - Vestbo J LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 2 IP - DP - 1996 Jan 01 TI - Reactive airways dysfunction syndrome. [Review] PG - 104-110 AB - Two types of occupational asthma have been identified and are distinguished by whether they appear after a latency period. Asthma without a latency period is best illustrated by irritant-induced asthma. The reactive airways dysfunction syndrome is a subset of irritant-induced asthma. Although case reports appeared in the literature before 1985, the term reactive airways dysfunction syndrome was coined in 1985. Since that report a number of case reports of asthma-like illnesses developing as the direct consequence of massive toxic inhalation exposure have been published. Not all experts, however, are certain that reactive airways dysfunction syndrome is a real and distinct clinical entity. Most studies and reviews, although acknowledging the current gap in our knowledge of the epidemiology, pathogenesis, and pathologic findings, conclude that the available scientific evidence supports the conclusion that reactive airways dysfunction syndrome and irritant-induced asthma are valid disorders. AU - Alberts WM AU - Brooks SM LA - PT - DEP - TA - Curr Opin Pulm Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 2 IP - DP - 1996 Jan 01 TI - Assessment of peak expiratory flow in asthma. PG - 75-80 AB - Assessment of peak expiratory flow is a test of airway caliber that is simple, inexpensive, and easily performed on an outpatient basis. Because asthma is characterized by fluctuations in airway caliber, such a test can be useful in the diagnosis and assessment of the condition's severity. Although this approach is useful, it has several pitfalls: peak expiratory flow is less sensitive than forced expiratory volume in 1 second in the assessment of airway caliber; compliance with daily assessment on a long-term basis is generally not satisfactory; and daily monitoring of airway caliber may not be more sensitive than symptoms recorded in a diary to identify flare-ups. Peak expiratory flow may be a useful means of asthma assessment for subjects who either under- or over-estimate their symptoms, if the tests are conducted over short intervals of monitoring, and specifically in the investigation of occupational asthma. AU - Malo JL LA - PT - DEP - TA - Curr Opin Pulm Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - IP - DP - 1996 Jan 01 TI - Latex sensitisation in the health care setting (use of latex gloves) PG - - AU - O'Gilvie W LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Allergen sensitization and exposure to irritants in infancy PG - 719-723 AB - We investigated the relationship between residence in the neighbourhood of an aluminium smelter and the prevalence of atopy in schoolchildren (7-13 years of age). Atopy was assessed in 556 of the 620 participants by a skin prick test with eight common aeroallergens. The median exposures to sulphur dioxide and fluoride during the pollen season in the age interval 19-36 months were 24 and 3.1 micrograms/m3 in the spring and 20 and 3.3 micrograms/m3 in the summer, respectively. The odds ratio (OR) of having atopy was 2.0 (95% CI: 1.2-3.3) in those children who had lived in the index area for 7 years or more compared with those who had lived there less than 7 years (cumulative effect). The OR of atopy was 2.5 (1.4-4.4) in those who had lived in the index area during the age interval of 19-36 months compared with rural residence during this age-interval (age-specific effect). When the age-specific effect and the cumulative effect were compared in the same logistic model, the former decreased to 1.1 (0.4-3.0), whereas the latter was 2.2 (0.7-6.6). The results indicate that exposure to these low levels of irritants during early childhood increases allergen sensitization in children AU - Soyseth V AU - Kongerud J AU - Boe J LA - PT - DEP - TA - Allergy: European Journal of Allergy & Clinica JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 3 IP - DP - 1996 Jan 01 TI - The vocational training scheme: decision-making in relation to general dental practitioners participating as scheme trainers PG - 36-42 AB - In recent years, well-documented changes have occurred in the patterns of oral disease and, as a result, the scope and complexity of dental treatments has widened considerably. In response to this the Department of Health has introduced a compulsory one-year postgraduate vocational training scheme [VTS]. In this scheme, new graduates spend time in approved general dental practices, trained by selected general dental practitioners [GDPs] who are seen as having 'best practice' standards. For the VTS to succeed it will require the continued support of these 'best quality' GDPs who at the moment are competing for places as trainers. Such competition has not always existed and this paper describes a decision-making model for trainers which was developed because future external influences could reverse this competitive scenario, with a major effect on the postgraduate training programme AU - Thomas D AU - Davies G AU - Allsopp J LA - PT - DEP - TA - Prim Dent Care JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 22 IP - DP - 1996 Jan 01 TI - Transmission of Mycobacterium tuberculosis among health care workers infected with human immunodeficiency virus PG - 597-598 AU - Blumberg HM AU - Moore P AU - Blanchard DK AU - Ray SM LA - PT - DEP - TA - Clin Infect Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 10 IP - DP - 1996 Jan 01 TI - Hazards to the orthopaedic trauma surgeon: occupational exposure to tuberculosis. Risk reduction, testing, and treatment (a review article). PG - 366-370 AB - Infection with tuberculosis (TB) in the United States has risen over the last decade. In the past 5 years, health care worker exposure to multidrug-resistant TB has lead to more than 100 skin-test conversions, 17 cases of active TB, and at least six deaths. As with human immunodeficiency virus, hepatitis B virus, and hepatitis C virus, the orthopaedic traumatologist is at risk of exposure and infection because, in many cases, the medical histories of patients encountered in the trauma bay cannot be determined until well into the course of care. Risk depends principally on two factors: (a) likelihood of exposure (large urban settings, prisons, concentration of persons from countries with high TB prevalence), and (b) immune status of the surgeon. Prompt recognition, isolation, and appropriate treatment of patients with infectious TB; engineering controls; and the use of personal protective respiratory equipment can help prevent the transmission of TB to health care workers. AU - Esterhai JL Jr AU - Reynolds MR AU - Chou L LA - PT - DEP - TA - Journal of Orthopaedic Trauma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 77 IP - DP - 1996 Jan 01 TI - Tuberculin skin testing and the health care worker: lessons of the Prophit Survey PG - 81-85 AB - SETTING: Concern about occupationally-acquired tuberculosis continues to grow, even as control of tuberculosis in the USA has improved. Many health care workers have developed occupationally-acquired tuberculosis in recently described outbreaks and several have died. Regulatory agencies are struggling to develop a rational policy that promises both worker safety as well as cost-effectiveness. Future infection control efforts will be evaluated by results of tuberculin skin tests of employees. However, unlike many modern diagnostic tests, the tuberculin skin test is poorly understood, may be unreliable, and requires individual physician interpretation. DESIGN: Review of the British Prophit Survey, conducted from 1933-1944, which involved tuberculin testing of 10, 000 young adults, with the goal of defining 'the relationship between tuberculin sensitivity and tuberculous immunity'. RESULTS: Four findings are particularly pertinent to the current debate: 1. job-specific rates of tuberculin conversion and subsequent development of disease; 2. risk of exogenous re-infection among already-tuberculin positive health care workers; 3. rates of tuberculin skin test reversion; and 4. implications of induration size. CONCLUSION: The British Prophit Survey produced a great deal of meaningful information regarding the meaning of a positive tuberculin skin test, a negative test, and a change in tuberculin status. Proper interpretation of this test requires full appreciation of its many idiosyncrasies AU - Sepkowitz KA LA - PT - DEP - TA - Tubercle & Lung Disease JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 30 IP - DP - 1996 Jan 01 TI - Asbestos plaques in a typical Veteran's hospital population PG - 726-729 AB - Previous authors have described several pleural abnormalities on chest radiology as being pathognomonic for asbestos exposure. We sought to determine the percentage of admissions and outpatients at a typical Veteran's Affairs hospital with these findings, and researched medical records to verify the frequency at which patients having positive radiographs were suspected either by clinical/occupational history or radiologically to have had prior significant exposure to asbestos. Radiographs of 1,212 consecutive patients were evaluated by a certified B reader, and the medical records as well as previous radiology reports of all positive patients were reviewed. Twenty-eight (2.3%t) of the radiographs had pleural abnormalities consistent with asbestos exposure, with the patients, all male, ranging in age from 50 to 98 years (mean 75.6). Radiology reports described pleural plaques in only 12 of the 21 (57%) cases with prior exams available; in only seven (33%) was an asbestos etiology considered by the interpreting radiologist. The plaques were misdiagnosed in four instances as being indicative of other, unrelated pathology. A history of known dust exposure was expressed by only five patients (18%). Eleven described working in occupations now known to have a high incidence of exposure, but neither patient nor examining physician expressed consideration of dust inhalation. In conclusion, we have found that a significant percentage of patients in certain subpopulations show radiographic evidence of asbestos exposure that may be a harbinger of related pathology. Unfortunately, because of a low index of suspicion, thorough environmental histories are often deferred, many radiographic changes are either not recognized or are misdiagnosed, and these patients are not followed with the stringent protocols they deserve AU - Miller JA AU - Zurlo JV LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Calibrating the calibrators PG - 969-969 AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational lung disease. 8. The diagnosis of occupational asthma from serial measurements of lung function at and away from work. PG - 857-863 AU - Bright P AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 17 IP - DP - 1996 Jan 01 TI - OSHA Revises TB enforcement PG - 332-333 AU - Anonymous LA - PT - DEP - TA - Infect Control Hosp Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 154 IP - DP - 1996 Jan 01 TI - The association between occupation and tuberculosis. A population-based survey PG - Pt 1):587-93 AB - There has been increasing interest in the potential association between occupation and the risk of tuberculosis. Therefore, we analyzed occupational information collected on all patients with clinically active tuberculosis in 29 states from 1984 to 1985. Census data were used to estimate the number of persons in each of the occupations. Information on employment and occupation was ascertained for 9,534 (99%) of the working age (16 through 64 yr) tuberculosis patients. The overall case rate of tuberculosis in this age group in the study areas was 8.4 per 100,000 persons, which was slightly lower than the national rate of 9.3 per 100, 000 persons. As a group, health care workers had rates of tuberculosis similar to the general population (standardized morbidity ratio [SMR]: 1.0; 95% CI: 0.9 to 1.1). However, elevated rates were observed for inhalation therapists (SMR: 2.9; 95% CI: 1.2 to 6.0), and lower-paid health care workers (SMR: 1.3; 95% CI: 1.1 to 1.5). Elevated rates were also noted for funeral directors (SMR: 3.9; 95% CI: 2.2 to 6.1) and farm workers (SMR: 3.7; 95% CI: 3.4 to 4.1). These data suggest that even in communities with relatively low rates of tuberculosis certain occupations may be associated with an elevated risk AU - McKenna MT AU - Hutton M AU - Cauthen G AU - Onorato IM LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 180 IP - DP - 1996 Jan 01 TI - Tuberculosis: a re-emerging problem for health care workers. PG - 376-381 AB - The current upward trend in the incidence of tuberculosis, particularly in the USA, and the problems of treating multiply drug resistant strains of Mycobacterium tuberculosis have caused a resurgence of interest in this infection. This review describes the microbiology, routes of transmission and epidemiology of Mycobacterium tuberculosis infections. The emergence and problems of treating multiply drug resistant strains are outlined. The significant potential for occupationally acquired infection among health care workers is discussed, together with a summary of the available infection control measures currently being examined. The true level of occupational risk to dental personnel remains uncertain. AU - Bagg J LA - PT - DEP - TA - Brit Dental J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 46 IP - DP - 1996 Jan 01 TI - Occupational tuberculosis and a failed postgraduate medical examination PG - 87-88 AB - A 40 year old pathologist presented with a tuberculous pleural effusion approximately one year after performing an autopsy as part of a postgraduate medical examination. She had made a diagnosis of disseminated tuberculosis but was told that this was incorrect and failed the examination. Bladder tissue from the cadaver was subsequently found to have grown M tuberculosis though none was cultured from lung tissue. No particular precautions against airborne infection were taken at the time of the autopsy and we speculate not only that the pathologist's original diagnosis was correct but that she became infected with M tuberculosis during the examination AU - Stenton SC AU - Hendrick DJ LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 97 IP - DP - 1996 Jan 01 TI - The relationship between latex skin prick test responses and clinical allergic responses PG - 1202-1206 AB - BACKGROUND: Allergic responses to latex have been reported more frequently in the past 5 years. Although commercial skin prick test solutions are available and can be used in the diagnosis of latex allergy in some countries, the characteristics of patients sensitized to latex relative to their skin test responses have not been reported. OBJECTIVE: The purpose of this study is to relate the clinical characteristics of patients with latex sensitivity to the size of their latex skin prick test response. METHODS: A retrospective review of patients who were attending a hospital-based allergy and asthma clinic and who had positive skin test responses to a commercial latex skin test solution was undertaken. RESULTS: Of 47 patients who had skin test responses to latex, 36 had a mean wheal diameter at least 3 mm greater than the negative control (diluent). Sixty-eight percent were health care workers. There was a positive association between the size of skin test response and severity of latex-induced symptoms (p < 0.001). A history of banana sensitivity was also associated with larger skin test responses (p < 0.05). CONCLUSION: The size of the skin prick test response to latex solution that is commercially available in Canada reflects the severity of latex-induced clinical allergic responses AU - Hadjiliadis D AU - Banks DE AU - Tarlo SM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 154 IP - DP - 1996 Jan 01 TI - On modeling longitudinal pulmonary function data PG - S217-S222 AU - Sherrill DL AU - Viegi G LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 46 IP - DP - 1996 Jan 01 TI - SWORD '95: surveillance of work-related and occupational respiratory disease in the UK PG - 379-381 AB - An estimated 2,741 new cases of occupational respiratory diseases were reported by chest and occupational physicians in 1995. Total cases reported by 'core' chest physicians and occupational physicians have risen but cases reported by 'sample' physicians have fallen by 32%, reducing the estimated total overall by approximately 16% from 1994. Steps are being taken to reverse this downward trend. Occupational asthma remains the single most frequently reported disease of which more than two thirds of cases were attributed to sensitization. Non-malignant pleural disease was the next most frequently reported, with pleural plaques predominating in 71% of cases. In a study of a selected sample of 158 cases of non-malignant pleural disease, 81 (51%) were seen for medico-legal reasons; of the remainder 13% had signs or symptoms ascribed to the disease AU - Keynes HL AU - Ross DJ AU - McDonald JC LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 46 IP - DP - 1996 Jan 01 TI - Occupational asthma in greenhouse tomato growing PG - 163-164 AB - An employee working in a commercial tomato growing greenhouse developed asthma of increasing severity over a period of 8 years. She was diagnosed as having occupational asthma by a chest physician. The cause was obscure and initial allergy testing was negative. Further investigation of the workplace gave rise to suspicion of allergy to insects. Immunological testing confirmed sensitization to Red Spider Mite AU - Erlam AR AU - Johnson AJ AU - Wiley KN LA - PT - DEP - TA - Occup Med (Oxford) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 53 IP - DP - 1996 Jan 01 TI - Longitudinal decline in lung function in patients with occupational asthma due to western red cedar PG - 753-756 AB - BACKGROUND: There are few reports about longitudinal changes in lung function in asthmatic patients. Patients with asthma had a greater loss of lung function than normal healthy adults. To date, there have been no studies about the longitudinal changes in lung function in patients with occupational asthma. METHODS: 280 male patients with red cedar asthma (RCA) who were followed up for at least one year were the study group. The exposed controls consisted of 399 male sawmill workers. Forced expiratory volume in one second (FEV1) was measured with a Collins water spirometer. Changes in FEV1 over time (FEV1 slope) were calculated by a two point method for each subject. Atopy was considered to be present if the subjects showed at least one positive response to three allergens by skin prick test. RESULTS: Multiple regression analysis was carried out to examine factors that might affect longitudinal decline in FEV1. Patients with RCA who were still exposed had a greater decline in FEV1 slope (-26 ml/y) than sawmill workers. Smokers also showed a greater rate of decline in FEV1 (-43 ml/y) than non-smokers. CONCLUSIONS: Patients with RCA who continued to be exposed had a greater rate of decline in FEV1 than sawmill workers. Early diagnosis of occupational asthma and removal of these patients from a specific sensitiser is important in the prevention of further deterioration of lung function and respiratory symptoms AU - Lin FJ AU - DimichWard H AU - ChanYeung M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational asthma to amaryllis PG - 847-849 AU - Jansen AP AU - Visser FJ AU - Nierop G AU - de Jong NW AU - Waandersde Lijster de AU - Raadt J AU - Vermeulen A AU - van Toorenenbergen AW LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 26 IP - DP - 1996 Jan 01 TI - Occupational allergy due to spider mites: Tetranychus urticae (Koch) and Panonychus citri (Koch) PG - 1262-1267 AB - BACKGROUND: Allergy to both house dust and storage mites is well established, but information about other species of mites is scant. OBJECTIVE: One hundred and fifty patients directly exposed to an occupational environment were studied to assess whether spider mites (Tetranychidae) caused their allergic symptoms. We also studied a group of 50 patients from an urban environment, who were not occupationally exposed to spider mites, with a strong sensitization to Dermatophagoides pteronyssinus (RAST class 4). METHODS: Case history (including questions about work-related symptoms), skin tests, RAST and conjunctival provocation tests were performed in both groups using Tetranychus urticae and Panonychus citri extracts as allergens. Cross-reactivity between spider mites and D. Pteronyssinus was determined by RAST inhibition. RESULTS: Fifty-four of 150 rural workers were positive to Tetranychidae and in all cases there was an associated sensitization to D. pteronyssinus. All individuals belonging to the urban group were positive to spider mites. RAST inhibition demonstrated a significant cross-reactivity between Tetranychidae and D. pteronyssinus. Five of fifty-four rural workers sensitized to spider mites developed symptoms only when they handled plants or fruits infested with spider mites and they became asymptomatic when exposure ceased. CONCLUSION: In the rural population studied, 36% of workers were found to be sensitized to spider mites and 10% had symptoms associated with occupational exposure. Since specific IgE antibodies to spider mites could not be detected in the absence of the specific IgE antibodies to D. pteronyssinus, and as all the affected workers were RAST positive to D. pteronyssinus, prior sensitization to house dust mites may be a risk factor for occupational allergy to spider mites AU - Burches E AU - Pelaez A AU - Morales C AU - Braso JV AU - Rochina A AU - Lopez S AU - Benito AU - M LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 38 IP - DP - 1996 Jan 01 TI - Increased variability in bronchial responsiveness in aluminum potroom workers with work-related asthma-like symptoms PG - 66-69 AB - In a longitudinal study, we studied the variability in bronchial responsiveness (BR) to methacholine in aluminum potroom workers suffering from work-related asthma-like symptoms (WASTH) and in symptom-free workers. In the index group, 26 men suffering from WASTH were selected from a cross-sectional survey. The reference group comprised 45 symptom-free men recruited from the enrollment of new employees. Bronchial responsiveness was expressed as the dose-response slope (DRS) of the line through origin and the last data point. The standard deviation of the log-transformed DRS was positively associated with symptom score (P = .012) and the mean BR (P < .001). Our results indicate that the severity of respiratory symptoms in aluminum potroom workers with WASTH reflects the variability in BR AU - Soyseth V AU - Kongerud J AU - Boe J LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 22 IP - DP - 1996 Jan 01 TI - Bronchial asthma and air pollution at workplaces PG - 451-456 AB - OBJECTIVES: This case-referent study was performed to investigate the possibility of nonspecific air pollution at workplaces increasing the risk of bronchial asthma for formerly healthy adults. METHODS: Seventy-nine cases of asthma, diagnosed at a lung clinic, among persons aged 20-65 years were compared with 304 referents drawn randomly from the population of the catchment area. Questionnaire information was obtained regarding occupation, exposure to suspect allergens, place of residence, smoking habits, and atopy. The subjects' occupations were categorized into four air pollution classes based on how the referents reported air pollution in their respective occupations. RESULTS: Three years or more of work in air-polluted occupations resulted in an odds ratio of 3.0 (OR) (95% confidence interval 1.5-6.1) in a comparison with work in occupations with slight or no air pollution. Stratification of the material for smoking habits or atopy did not alter the results. Nor did the exclusion of specific exposures to asthmatogenic agents such as ioscyanates, stainless steel welding, or aluminum salts change the effects of the nonspecific air pollution at workplaces. Smoking per se was associated with an almost doubled risk for asthma (OR 1.9, 95% confidence interval 1.1-3.4). CONCLUSION: The results of this study support an association between occupational exposure to nonspecific air pollution and the development of bronchial asthma AU - Flodin U AU - Ziegler J AU - Jonsson P AU - Axelson O LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Cheese workers' lung PG - 959-960 AU - Marcer G AU - Franchini M AU - Gemignani C AU - Zancanaro A AU - Semenzato G AU - Tassinari C AU - Cipriani A AU - Festi G AU - Saia B LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 44 IP - DP - 1996 Jan 01 TI - Latex-induced asthma in a dental assistant PG - 424-426 AB - In this case report, latex-induced asthma is described in a dental assistant with an associated history of contact dermatitis, contact urticaria, and rhinitis. She switched to vinyl gloves, which eliminated her cutaneous symptoms, but her respiratory symptoms continued. Skin-testing to latex was strongly positive. Methacholine challenge and peak expiratory flow rates (PEFR) were abnormal during the workweek but normalized after a two-week vacation. Nebulized latex was implicated in the development of occupational asthma, and personal latex-avoidance measures did not prevent the condition AU - Friesen CD AU - O'Connell M AU - Schkade PA AU - Dyer PD LA - PT - DEP - TA - Gen Dent JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 50 IP - DP - 1996 Jan 01 TI - List of potential etiological agents in occupationally-induced asthmatic diseases [Review] [German] PG - 875-888 AU - Nowak D LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 24 IP - DP - 1996 Jan 01 TI - Multiple chemical sensitivity: state of the art symposium. The role of chemical allergens. [Review] PG - S28-31 AB - Multiple chemical sensitivity (MCS) has been defined as "an acquired disorder of recurrent symptoms, referable to multiple organ systems, occurring in response to chemically unrelated compounds at doses far below those established in the general population to cause harmful effects" [Cullen, State Art Rev. Occup. Med. 2, 655 (1987)]. The pathophysiologic basis for the MCS syndrome has not been clearly defined. However, allergic reactions to specific chemicals encountered in the environment are much better understood. AU - Bernstein DI LA - PT - DEP - TA - Regul Toxicol Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - ISBN 0 717 IP - DP - 1996 Jan 01 TI - Health and Safety Commission annual report 1995/1996 PG - - AU - LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Simian virus 40 large T antigen (SV40LTAg) primer specific DNA amplification in human pleural mesothelioma tissue PG - 1074-1076 AB - BACKGROUND: DNA sequences and immunoreactivity associated with Simian virus 40 transforming factors, large T and small t antigens (SV40LTAg), suggestive of an aetiopathogenetic link have been identified in fresh frozen tissue of a high proportion of recent cases of pleural mesotheliomas from the United States, Italy and Germany. SV40 is not normally infective in man though it can transform human cells in tissue culture. A large cohort of people in the western world was accidentally parenterally inoculated with live SV40 through contaminated polio vaccines given between 1959 and 1961, and this might be a factor in the current continuing rise in the incidence of mesothelioma in the United States, Britain and Europe. The present study investigated the presence of SV40LTAg DNA in recently diagnosed cases of mesothelioma in Britain and the feasibility of detecting the SV40 DNA in archival tissue for retrospective analysis of cases in the peri-vaccination period. METHODS: DNA was extracted from fresh frozen and/or rehydrated formalin fixed, paraffin embedded tissue sections from nine recently diagnosed cases of mesothelioma, nine cases of pulmonary adenocarcinoma, and three reactive pleurae, and amplified by the polymerase chain reaction (PCR) using the primer pairs used previously on fresh frozen tissues-namely, the SV primer set directed at the LTAg gene sequence unique to SV40 and the PYV primer set directed at a sequence shared by SV40 and papovavirus strains BK and JC, respectively. RESULTS: PCR positivity with the SV primer set was restricted to four of the nine cases of mesothelioma. In contrast, six of the nine mesotheliomas, two of the nine adenocarcinomas, and one of the three reactive pleurae showed positivity with the PYV primers. The fresh frozen and corresponding formalin fixed, paraffin embedded tissue results concorded well with each other. CONCLUSIONS: Our data provide evidence for the association of SV40LTAg primer specific DNA with human pulmonary mesothelioma in the British population AU - Pepper C AU - Jasani B AU - Navabi H AU - WynfordThomas D AU - Gibbs AR LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 5 IP - DP - 1996 Jan 01 TI - Simian virus 40 and pleural mesothelioma in humans PG - 473-475 AB - It has been reported that DNA of SV40, a virus of Asian macaques that is tumorigenic for rodents and can transform human cells in vitro, is present in pleural mesotheliomas and in several other cancers. To verify these observations, we tested paraffin sections from mesothelioma tissues of 50 patients for SV40 DNA using PCR with two separate sets of primers. The analytic sensitivity for detection of SV40 DNA was 1-10 genome copies. We also tested the specimens for beta-globin by PCR to assess the suitability of the specimen DNAs for amplification. beta-Globin amplification was detected in 48 of the 50 specimens, but SV40 DNA was not detected in any tumors, with either of two SV40 primer sets. Furthermore, sera from 34 additional patients with mesothelioma, 33 patients with osteosarcoma (another cancer reported to be SV40-related) and 35 controls were tested for SV40 antibodies by a plaque neutralization assay. The serological data, like the DNA results, did not support an association of SV40 with mesothelioma or with osteosarcoma; antibodies to SV40 were detected in three mesothelioma patients, in one osteosarcoma patient, and in one control. These findings call into question the association of SV40 with mesothelioma AU - Strickler HD AU - Goedert JJ AU - Fleming M AU - Travis WD AU - Williams AE AU - Rabkin CS AU - Daniel RW AU - Shah KV LA - PT - DEP - TA - Cancer Epidemiology Biomarkers & Prevention JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 15 IP - DP - 1996 Jan 01 TI - Acute effects of the potent lacrimator o-chlorobenzylidene malononitrile (CS) tear gas PG - 461-465 AB - 1. The use of tear gas to control civil unrest is accepted practice by government authorities worldwide. It is rarely used in Hong Kong but during a recent riot at a Vietnamese detention centre large quantities were used and this was cause for some concern. 2. All patients presenting to the British Red Cross Clinic after the incident were seen by one of the authors. To establish if exposure to tear gas had serious effects on the health of the detainees, the case records of the 184 patients with symptoms consistent with CS exposure were reviewed 2 months later. 3. The most common complaints were burns (52%), cough (38%), headache (29%), shortness of breath (21%), chest pain (19%), sore throat (15%) and fever (13%). However, the only common findings on examination by a physician were burns (52%) and an inflamed throat (27%). All burns could be categorised as "minor' according to the American Burns Association classification and all were consistent with CS gas exposure. 4. Some patients complained of other symptoms that had not been previously reported in the literature, such as haemoptysis (8%) and haematemesis (4%), but these were only confirmed in one patient. 5. The majority of patients had recovered within 2 weeks of exposure although one asthmatic patient complained of shortness of breath lasting for 33 days and a sore throat lasting for 38 days after the incident. She had abnormally low peak expiratory flow readings, but had a clinical history of asthma. 6. No serious sequelae were encountered, but the incidence of burns in these patients was higher than would be expected from a review of the literature. However, very little data on the effects of tear gas in a riot situation has been published. There have been reports of high concentrations of CS gas causing reactive airways dysfunction but this was not seen in our group of patients AU - Anderson PJ AU - Lau GS AU - Taylor WR AU - Critchley JA LA - PT - DEP - TA - Hum Exp Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 38 IP - DP - 1996 Jan 01 TI - RADS after exposure to a riot-control agent: a case report [letter] PG - 863-865 AU - Roth VS AU - Franzblau A LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 17 IP - DP - 1996 Jan 01 TI - Microbial contamination of dental unit waterlines: origins and characteristics. PG - 538-540 AB - Microbial adherence to the internal surface of dental tubing and the formation of a highly protective biofilm layer is predictable, given the ideal growth conditions in the tubing. The slime layer is the most common cause of dental water contamination. Various environmental and human-derived potential pathogens have been reported worldwide. Dental equipment such as retracting shut-off valves, antiretracting valves that tend to fail, or waterlines that are inaccessible contribute to a situation in which virtually every standard dental unit contains contaminated water. While exposure to Pseudomonas, Moraxella, Staphylococcus, and Legionella has been linked to dental water, the medical risk of dental unit waterline contamination is most significant to immune-deficient individuals. Regulations and technological devices are emerging to manage dental water quality. AU - Williams JF AU - Molinari JA AU - Andrews N LA - PT - DEP - TA - Compendium of Continuing Education in Dentistry JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 24 IP - DP - 1996 Jan 01 TI - Legionella urinary antigen testing: potential impact on diagnosis and antibiotic therapy. [Review] PG - 129-139 AB - Although Legionella is an important cause of severe pneumonia, difficulty still exists in its diagnosis. Because at least 80% of patients with legionellosis excrete the Legionella antigen in their urine, various methods have been investigated for urinary antigen detection. Specificity for these methods has been reported to be 100%, and sensitivity has been shown to vary between 70 and 100%. The advantages of these methods include ease of specimen collection, the ability to obtain large quantities of specimen for concentration, the ability to detect antigen after initiation of ant obtain results quickly. Disadvantages include the ability to only reliably detect urinary L. penumophila serogroup 1 antigen and the inability to diagnose relapse or reinfection due to persistence of antigen excretion. Of the commercially-available detection methods, the polyclonal enzyme-linked immunosorbent assay (ELISA) appears to be most efficient. Its use with routine Legionella screening procedures should be considered in target populations, with the intent of early diagnosis and antibiotic therapy streamlining. AU - Kashuba AD AU - Ballow CH LA - PT - DEP - TA - Diagnostic Microbiology & Infectious Disease JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 24 IP - DP - 1996 Jan 01 TI - The use of nasal lavage for objective measurement of irritant-induced nasal inflammation. [Review] PG - Pt 2):S76-8 AU - Peden DB LA - PT - DEP - TA - Regul Toxicol Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational rhinitis and bronchial asthma due to morphine: evidence from inhalational and nasal challenges PG - 914-918 AB - A case of occupational bronchial asthma due to morphine in a nonatopic 46-year-old woman is presented. The following diagnostic tests were used: a workplace trial with bronchodilator and placebo, and single-blind, placebo-controlled nasal and bronchial challenge with 0.5% morphine HCl. For the nasal challenge, four asthmatic patients were selected as a control group. The nasal washings were done before and 30 min, 3 h, 24 h, and 48 h after all challenges. In the nasal lavage fluid, the total numbers of eosinophils, neutrophils, basophils, and mast cells were counted, and, after the nasal challenge, total protein and albumin levels were measured. During the workplace trial, the PEF variability ratio increased from 5% to 38%. After the challenges, a decrease in the spirometric parameters (VC and FEV1) of about 30–40% was observed, with minimums at 24 and 48 h. An influx of granulocytes with an increase in the relative number of eosinophils and basophils from 3 h until 48 h after the challenge was observed in the nasal lavage fluid. The protein level in the nasal lavage fluid increased from 190 to 1275 µg/ml 24 h after the challenge with an increase of relative albumin level from 24% to 40% at 24 h. In the control group, no changes in relative number of basophils and eosinophils and albumin/total protein ratio in the nasal lavage fluid or in the spirometric parameters were observed after the challenge. AU - Ulinski S AU - Palczynski C AU - Gorski P LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational asthma in a cheese worker PG - 960-961 AU - Bausela BA AU - Fontela JL LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 22 IP - DP - 1996 Jan 01 TI - Allergic alveolitis in a school environment PG - 311-314 AB - BACKGROUND: A considerable fraction of newly constructed buildings have indoor air problems associated with health effects, usually of the nonspecific sick building syndrome variety. Specific health effects such as asthma, rhinitis, and allergic alveolitis can also occur. CASE: On 1 September 1988 a school teacher showed symptoms of an acute respiratory illness, which was first interpreted as pulmonary embolism and then later as atypical sarcoidosis. The illness slowly progressed over six years, at which time the diagnosis was revised to chronic allergic alveolitis, related to her school environment. The school had had indoor-air quality problems off and on for several years. CONCLUSIONS: The case illustrates the difficulties of diagnosing cases of chronic allergic alveolitis, especially when it appears in environments where it is not generally encountered. It also raises questions regarding a possible relation between environments associated with the sick building syndrome and the occurrence of building-associated illnesses AU - Thorn A AU - Lewne M AU - Belin L LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 22 IP - DP - 1996 Jan 01 TI - Sick building syndrome, work factors and occupational stress. PG - 243-250 AB - The sick building syndrome has been associated with certain buildings and environmental characteristics and is estimated to affect up to 30% of new or renovated buildings. Investigations have concentrated on physical factors, and it is only recently that psychological factors have been examined. Work and personal factors have also been considered. Occupational stress has been found to be correlated with symptoms of the sick building syndrome, but much of the research has been of a cross-sectional nature, and it does not indicate whether stress is an active element or an outcome. There is a clear need for further research in this area to examine stress, personality and physical factors associated with the sick building syndrome longitudinally. There is also a clear need to assess the validity of the historical and self-report methods used to assess the sick building syndrome. AU - Crawford JO AU - Bolas SM LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 25 IP - DP - 1996 Jan 01 TI - Secondary prevention: detection of the allergen. [Review] PG - 145-153 AU - Karlberg AT AU - Gafvert E LA - PT - DEP - TA - Current Problems in Dermatology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 86 IP - DP - 1996 Jan 01 TI - Exposure to varying levels of contaminants and symptoms among workers in two office buildings PG - 1629-1633 AB - OBJECTIVES: We hypothesized that exposure to contaminants would be associated with symptoms reported by office workers. METHODS: In two mechanically ventilated office buildings in. Montreal, the outdoor air supply was manipulated for 6 weeks, while symptoms were reported and environmental parameters were measured at multiple sites. RESULTS: Contaminant concentrations varied considerably, in part related to experimental changes in outdoor air supply. Eye symptoms were reported with higher dust and with higher concentrations of nitrogen dioxide. Mucosal symptoms were increased with higher TVOCs, higher nitrogen dioxide, and higher total contaminant load. Systemic symptoms were associated with higher dust levels. CONCLUSIONS: Symptoms reported by the workers were associated with increased concentrations of several contaminants and a summary measure of all contaminants AU - Menzres D AU - Tamblyn RM AU - Nunes F AU - Hanley J AU - Tamblyn RT LA - PT - DEP - TA - Am J Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 65 IP - DP - 1996 Jan 01 TI - Inadequate air distribution and poor mixing cause IAQ problems. Moving partitions, walls, and furniture may change the air flow, often for the worse PG - 20-21 AU - Burton DJ LA - PT - DEP - TA - Occup Health Saf JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 121 IP - DP - 1996 Jan 01 TI - Microbial volatile organic compounds--what substances can be found in sick buildings? PG - 1203-1205 AB - There is a relationship between damp buildings and health complaints. Damp conditions in building constructions also favour the growth of micro-organisms. Growth of micro-organisms results in the production of volatile organic compounds, which has been shown to have an impact on Indoor-air monitored via a microbial volatile organic compound (MVOC) analysis. In order to widen the applicability of MVOC analysis, it is necessary to increase this analysis by including more volatiles. By active sampling on Anasorb 747 and selected ion monitoring on a mass spectrometer equipped with a quadropole detector, it is possible to determine these volatiles with sufficient accuracy in indoor air of non-industrial buildings AU - Wessen B AU - Schoeps KO LA - PT - DEP - TA - Analyst JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 59 IP - DP - 1996 Jan 01 TI - Toxigenic molds in water-damaged buildings: dechlorogriseofulvins from Memnoniella echinata PG - 553-554 AB - An investigation of a cluster of cases of pulmonary hemosiderosis in infants in Cleveland, OH, led to the isolation of many isolates of Stachybotrys atra and two isolates of a related toxigenic fungus, Memnoniella echinata. M. echinata produces two cytotoxic trichothecene mycotoxins, trichodermol (1a) and trichodermin (1b), as well as several griseofulvins. Dechlorogriseofulvin (2a) and epidechlorogriseofulvin (2b) were the major compounds isolated. This is the first report of a fungus outside the Penicillium genus producing griseofulvins AU - Jarvis BB AU - Zhou Y AU - Jiang J AU - Wang S AU - Sorenson WG AU - Hintikka EL AU - Nikulin M AU - Parikka P AU - Etzel RA AU - Dearborn DG LA - PT - DEP - TA - Journal of Natural Products JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 16 IP - DP - 1996 Jan 01 TI - Fungal colonization of fiberglass insulation in the air distribution system of a multi-story office building: VOC production and possible relationship to a sick building syndrome PG - 280-285 AB - Complaints characteristic of those for sick building syndrome prompted mycological investigations of a modern multi-story office building on the Gulf coast in the Southeastern United States (Houston-Galveston area). The air handling units and fiberglass duct liner of the heating, ventilating and air conditioning system of the building, without a history of catastrophic or chronic water damage, demonstrated extensive colonization with Penicillium spp and Cladosporium herbarum. Although dense fungal growth was observed on surfaces within the heating-cooling system, most air samples yielded fewer than 200 CFU m-3. Several volatile compounds found in the building air were released also from colonized fiberglass. Removal of colonized insulation from the floor receiving the majority of complaints of mouldy air and continuous operation of the units supplying this floor resulted in a reduction in the number of complaints AU - Ahearn DG AU - Crow SA AU - Simmons RB AU - Price DL AU - Noble JA AU - Mishra SK AU - Pierson DL LA - PT - DEP - TA - Journal of Industrial Microbiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 53 IP - DP - 1996 Jan 01 TI - Prevalence of the sick building syndrome symptoms in office workers before and after being exposed to a building with an improved ventilation system PG - 204-210 AB - OBJECTIVE: To find if the prevalence of symptoms associated with sick building syndrome decreased among office workers after moving to a building with improved ventilation (after controlling for potential confounders). METHODS: Workers in five buildings in 1991 all moved in 1992 into a single building with improved design, operation, and maintenance of the ventilation system. All buildings had sealed windows with mechanical ventilation, air conditioning, and humidification. Workers completed a self administered questionnaire during normal working hours in February 1991 and February 1992. The questionnaire encompassed symptoms of the eyes, nose and throat, respiratory system, skin, fatigue, headache, and difficulty concentrating, personal, psychosocial, and work related factors. During normal office hours of the same week environmental variables were measured. RESULTS: The study population comprised 1390 workers in 1991 and 1371 workers in 1992 who represented more than 80% of the eligible population. The prevalence of most symptoms decreased when workers moved to the new building: skin (54%), respiratory system (53%), nose and throat (46%), fatigue (44%), headache (37%), eyes (23%). These findings were all significant and remained generally similar after controlling for personal, psychosocial, and work related factors. Furthermore, more than 60% of workers symptomatic in 1991 were asymptomatic in 1992 for all types of symptoms. In contrast, less than 15% of workers were asymptomatic in 1991 but symptomatic in 1992 for all types of symptoms. CONCLUSION: In this study, the prevalence of most symptoms usually associated with the sick building syndrome decreased by 40% to 50% after workers were transferred to a building with an improved ventilation system. The results show that it is possible to diminish the prevalence of symptoms associated with the sick building syndrome among office workers occupying a building with mechanical ventilation, air conditioning, and sealed windows AU - Bourbeau J AU - Brisson C AU - Allaire S LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 22 IP - DP - 1996 Jan 01 TI - Health effects of indoor-air microorganisms [Review] PG - 5-13 AB - The review provides a summary and discussion of current data on exposure to indoor-air microorganisms and their health effects, for example, respiratory irritation and nonspecific symptoms, respiratory infections, asthma and allergy, alveolitis and organic dust toxic syndrome, and chronic bronchitis, as well as a summary and discussion of the health effects of mycotoxins. AU - Husman T LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 109 IP - DP - 1996 Jan 01 TI - Rates of sick building type symptoms in New Zealand offices [letter] PG - 173-173 AU - Dryson EW LA - PT - DEP - TA - N Z Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 140 IP - DP - 1996 Jan 01 TI - Transmission of multiresistant tuberculosis in a Dutch hospital PG - 2293-2295 AB - Nosocomial transmission of multiresistant tuberculosis in the Netherlands is described for the first time in this article. It was detected by systematic country-wide DNA-fingerprinting. By the time the contact case (a man aged 35) developed disease he was residing in another part of the country. Contact-investigation by the Municipal Health Services involved revealed that the (HIV negative) contact case had been in contact with the index case (a man aged 27) during hospitalisation two years earlier. An analysis of the infection control measures applied, showed that inadequate treatment, early discharge from isolation and lack of bacteriological control (no sputum conversion documented) led to this hospital transmission AU - Lambregtsvan Weezenbeek CS AU - Keizer ST AU - Sebek MM AU - ScheppBeelen JC AU - van der Loo CJ LA - PT - DEP - TA - Nederlands Tijdschrift voor Geneeskunde JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 86 IP - DP - 1996 Jan 01 TI - The transcontinental transmission of tuberculosis: A molecular epidemiological assessment PG - 551-553 AB - Many tuberculosis control activities are based on principles learned from studies of tuberculosis transmission. To date, these have largely been limited to outbreak investigations in confined geographical regions. In this report conventional and computerized DNA fingerprint- based approaches were integrated to demonstrate that the most widely prevalent strain of Mycobacterium tuberculosis from New York City was cultured from only 1 of 755 patients in San Francisco, Calif, who was a traveling salesman. Large-scale molecular epidemiologic studies may provide a better understanding of the dynamics of tuberculosis transmission between geographic regions and suggest rational measures to interrupt such transmission AU - Casper C AU - Singh SP AU - Rave S AU - Daley CL AU - Schecter GS AU - Riley LW AU - Kreiswirth BN AU - Small PM LA - PT - DEP - TA - Am J Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 85 IP - DP - 1996 Jan 01 TI - Occupational asthma [Review] [Japanese] PG - 234-239 AU - Fujimura N LA - PT - DEP - TA - Nippon Naika Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 77 IP - DP - 1996 Jan 01 TI - Asthma to carob bean flour [letter] PG - 81-81 AU - Scoditti A AU - Peluso P AU - Pezzuto R AU - Giordano T AU - Melica A LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 53 IP - DP - 1996 Jan 01 TI - Work related respiratory symptoms in radiographers PG - 450-454 AB - OBJECTIVE--To determine the prevalence of work related symptoms among radiographers compared with a control group of physiotherapists. METHOD--A postal questionnaire was used to collect information from radiographers and physiotherapists who registered in the United Kingdom during 1985-9. RESULTS--Satisfactory questionnaires were returned by 2354 (65%) of the radiographers and 3048 (69%) of the physiotherapists. There was a clear excess of work related symptoms among the radiographers. In particular, they were more likely to complain of symptoms that were worse at work, mouth soreness, sore, itchy, or runny eyes, persistent blocked nose, persistent itchy nose or sneezing, sore throat, headache, and of lower respiratory tract symptoms, which were also worse on workdays. These symptoms were associated particularly with the use of automatic processing machines. 235 radiographers gave a history of wheeze or chest tightness that had been worse at work or on days when at work. CONCLUSIONS--Work related symptoms suggesting irritation of the eyes and upper airways were more common in radiographers than controls, and may be related to exposure to x ray film processing chemicals. Men and women who reported work related wheeze or chest tightness will be followed up in more detail to assess the prevalence of occupational asthma in the cohort AU - Smedley J AU - Inskip H AU - Wield G AU - Coggon D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 53 IP - DP - 1996 Jan 01 TI - Decreased ventilatory function in hard metal workers PG - 194-199 AB - OBJECTIVES: To study individual effects on pulmonary function of exposure to hard metal including cobalt. METHODS: All of the workers in a hard metal company (583 men and 120 women) were examined for smoking, respiratory symptoms, ventilatory function, occupational history of exposure to hard metal, and present exposure to airborne cobalt. The ventilatory function indices (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory volume in one second per cent (FEV1%), peak expiratory flow (PEF), mid-maximal flow (MMF), forced expiratory flow at 50% vital capacity (V50), forced expiratory flow at 25% vital capacity (V25)) were standardised for height and age and expressed as a percentage of predicted values. RESULTS: Two way analysis of variance of indices of ventilatory function showed that an interaction of hard metal exposure and smoking decreased %V50 for both men and women. Among the currently exposed men, those with asthmatic symptoms (defined as reversible dispnoea with wheeze) had significantly lower %FVC, %FEV1%, %PEF, %MMF, %V50, and %V25 than did workers without asthma. The ventilatory disfunction did not differ between exposed and non-exposed workers with asthmatic symptoms. Even among the men without asthmatic symptoms, %V50 was significantly lowered by the interaction of hard metal exposure and smoking. The multilinear regression analysis of indices of ventilatory function for all of the subjects on sex, smoking (Brinkman index), exposure to hard metal, and asthmatic symptoms showed that asthmatic symptoms and smoking had significant effects on all variables and that the decrease in %V25 was associated with hard metal exposure. In the currently exposed and non-exposed workers, multilinear regression analysis applying indices for cobalt exposure (mean cobalt concentration, duration of exposure, and cumulative dose) showed that not only asthmatic symptoms or smoking but also duration of exposure had significant decreasing effects on %FVC, %MMF, and %V25. CONCLUSIONS: Occupational exposure to hard metal probably causes impairment of ventilatory function in a dose dependent manner AU - Kusaka Y AU - Iki M AU - Kumagai S AU - Goto S LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 53 IP - DP - 1996 Jan 01 TI - Epidemiological study of hard metal asthma PG - 188-193 AB - OBJECTIVES: To elucidate factors contributing to hard metal asthma, the entire workforce of a corporation producing hard metal tools (n = 703) was examined. METHODS: The variables evaluated were the atopy reflected by immunoglobulin E (IgE) antibody against mite allergen, history of exposure to hard metal, smoking, concentration of airborne cobalt, specific IgE antibody reaction against cobalt, and the respiratory symptom of attacks of reversible dyspnoea with wheeze (asthmatic symptoms). RESULTS: Univariate analysis showed that the prevalence of the asthmatic symptoms was significantly higher in formerly and currently exposed male workers than in non-exposed male workers. Positive IgE reaction against cobalt was found in seven men (2.0%), all of whom had asthmatic symptoms. Furthermore, it was found that atopy, positive IgE antibody against cobalt, and age of 40 or older were significantly correlated with asthmatic symptoms. Multilogistic analysis on the same factors and smoking in all of the workers showed that the age, experience of hard metal exposure, and atopy were significant risk factors associated with the asthmatic symptoms. Multilogistic analysis of data for currently exposed and non-exposed workers also showed that age and atopy were risk factors, and that the exposure to cobalt at the low concentration (at or below 50 micrograms/m3) but not at the higher concentration was a significant risk factor. Exposure to mist of coolants containing ionic cobalt, used during grinding, was not found to be any more hazardous in terms of onset of asthmatic symptoms than exposure to hard metal dust containing metallic cobalt. CONCLUSIONS: Accordingly, it is concluded that both environmental factors and individual susceptibility should be taken into consideration in efforts to reduce the prevalence of hard metal asthma AU - Kusaka Y AU - Iki M AU - Kumagai S AU - Goto S LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 45 IP - DP - 1996 Jan 01 TI - Diagnosis of latex allergy: comparison of histamine release and flow cytometric analysis of basophil activation PG - S35-6 AU - SainteLaudy J AU - Vallon C AU - Guerin JC LA - PT - DEP - TA - Inflamm Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational asthma and rhinoconjunctivitis caused by senna PG - 181-184 AB - Occupational sensitization to senna is seldom reported. We describe a 21-year-old male atopic factory worker who developed IgE-mediated asthma and rhinoconjunctivitis 5 months after exposure to senna while he was working for a company manufacturing hair dyes. In the bronchial challenge test with senna, he exhibited a strong reaction. The skin prick test gave a 12-mm wheal reaction. The radioallergosorbent test (RAST) with senna was highly positive (33.6 PRU/ml, class 4), and could not be inhibited with pollens or foods. In protein staining with SDS-PAGE, two heavy bands were detected in senna at about 14 and 25 kDa, and two faint bands were visible at 19 and 21 kDa, In IgE immunoblotting with the patient's serum, one heavy band was detected at about 16 and four faint bands at 23, 25, 28, and 38 kDa. The patient became symptom free after he had changed his job within the same company AU - Helin T AU - MakinenKiljunen S LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 29 IP - DP - 1996 Jan 01 TI - Biological miracles and misadventures: identification of sensitization and asthma in enzyme detergent workers PG - 99-110 AB - concern of an industrial physician as to the possibility of pulmonary damage due to the proteolytic nature of the material. This caused a search for possible cases of enzyme-related illness. Careful history-taking led to a hypothesis concerning sensitization and allergic illness which was supported experimentally by skin prick tests and inhalation challenge tests, and later by radioallergosorbent tests (RAST). It seems that the consequences of handling this potentially allergenic material as a fine powder had not been anticipated; and failure to analyze cases of sickness, to identify asthma, and to consider its workplace source had prevented its recognition elsewhere. Contributing to this failure was the pattern of development and manifestations of allergic illness, which seldom occurred in the workplace and was not confined to enzyme workers or atopics. In some cases the incidence of illness had been suppressed, or investigation prevented AU - Flindt ML LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 29 IP - DP - 1996 Jan 01 TI - Epidemiologic assessment of laboratory animal allergy among university employees PG - 67-74 AB - The prevalence of, and risk factors for, laboratory animal allergy (LAA) among university employees were evaluated in a cross-sectional university-based study. A stratified random sample was drawn based on current or no laboratory animal exposure and smoking status. Participants received a modified ATS questionnaire; spirometry; methacholine challenge; and intradermal allergen skin tests. One hundred three currently animal-exposed and 113 never-occupationally-exposed employees participated. Controlling for smoking, currently exposed workers were significantly more likely than controls to describe work-related cough, odds ratio (O.R.) = 6.87; wheeze, O.R. = 12.96; and chest tightness, O.R. = 2.89. Skin test reactivity to non-animal antigens was associated in a dose-response fashion with both upper and lower respiratory symptoms, O.R. = 1.45 and 1.65, respectively, for each additional positive skin test. Exposed workers were significantly more likely than controls to react to methacholine at either 10 or 25 mg/ml, while controlling for smoking status, prior allergy, or asthma. Multiple logistic regression analysis revealed history of hay fever, family history of allergy, non-animal skin test positivity, animal bites, age, and smoking status to each be associated with work-related respiratory symptoms. These data suggest that atopy and smoking status are risk factors for LAA symptoms. Smoking was associated with work-related respiratory symptoms among animal-exposed workers, but not with skin test positivity. It is therefore recommended that periodic screening evaluations be performed on laboratory animal workers and that workers who are atopic, are smokers, or are symptomatic be placed in low exposure settings. These data further, support the need for efficient exhaust ventilation, personal protective clothing and, among high risk workers, the use of efficient respiratory protection AU - Fuortes LJ AU - Weih L AU - Jones ML AU - Burmeister LF AU - Thorne PS AU - Pollen S AU - Merchant JA LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 47 IP - DP - 1996 Jan 01 TI - Clinical state, bronchial reactivity and atopic symptoms in patients with occupational bronchial asthma 3-4 years after cessation of occupational exposure PG - 347-352 AB - The results of numerous studies of occupational bronchial asthma proved that bronchial spasticity and nonspecific bronchial hyperreactivity persists after cessation of occupational exposure. The aim of the study was to evaluate the condition of patients with bronchial asthma after cessation of occupational exposure. A group of 23 patients with bronchial asthma had been observed twice: 1-6 months after cessation of occupational exposure and then 36 or 48 months later. An analysis of the clinical progress, both during the diagnostic process and the control examination, was based on a questionnaire including questions on cough intensity, dysponca, mean daily use of aerosol beta-mimetics and daily oral and inhalatory doses of corticosteroids. The analysis covered the month during the year proceeding the examination in which patients found themselves in the best psychosomatic condition. During both periods considered by patients themselves as the best ones from the clinical point of view, respiratory function tests and allergological tests were performed. The majority of patients with occupational bronchial asthma had reported, 2-3 years after cessation of occupational exposure, subjective complaints which indicated the improvement of their clinical condition. In those patients, the decrease in the intensity of specific allergic reactions was not observed. In the majority of patients with occupational bronchial asthma nonspecific bronchial hyperreactivity has not diminished despite a two-year break in occupational exposure AU - Kolacinska B AU - Gorski P LA - PT - DEP - TA - Medycyna Pracy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 68 IP - DP - 1996 Jan 01 TI - A new risk of occupational disease: allergic asthma and rhinoconjunctivitis in persons working with beneficial arthropods PG - 133-135 AB - Allergic asthma and rhinoconjunctivitis have been reported in workers who are constantly in close contact with arthropods during the course of breeding and research. We investigated a group of ten people working with beneficial arthropods in a "bio-factory." The following tests were carried out: skin prick test with allergens present in the workplace, baseline pulmonary function test, aspecific bronchial provocation test with ultrasonically nebulized distilled water, and pulmonary function test after workplace exposure in two subjects. The results demonstrated a good correlation between skin prick test, previous RAST positive reactions, clinical symptoms, and exposure. Pulmonary function test after workplace exposure proved positive in one asthmatic subject and in one subject with rhinoconjunctivitis. It is concluded that the evidence supports the occupational nature of these allergic diseases and that there is a need for careful surveillance and environmental monitoring within the workplace AU - Cipolla C AU - Lugo G AU - sassi C AU - Bonfiglioli R AU - Maini S AU - Tommasini MG AU - Raffi GB LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 9 IP - DP - 1996 Jan 01 TI - Fever and leucocytosis accompanying asthmatic reactions due to occupational agents: frequency and associated factors PG - 517-523 AB - Fever is sometimes associated with asthmatic reactions following specific inhalation challenges with occupational agents. Our aims were to estimate the prevalence of fever in subjects with occupational asthma confirmed by specific inhalation challenge and to examine the characteristics and clinical correlates of subjects who develop fever on specific inhalation challenge. We performed a retrospective analysis of 317 subjects who had positive specific inhalation challenge to occupational agents and a comparison of subjects who developed fever after specific inhalation challenge with a random sample of those who did not. Fifteen subjects (5%) developed fever associated with positive specific inhalation challenge. They were compared with a random sample of 60 subjects who did not develop fever. The fever group: 1) showed a larger increase in absolute number of blood neutrophils, and a larger decrease both of blood lymphocytes and forced vital capacity after specific inhalation challenge; 2) included fewer atopics; 3) had been exposed more frequently to low rather than high molecular compounds; and 4) always experienced a late reaction and had more atypical reactions. We conclude that after positive specific inhalation challenge; fever occurs infrequently, and is associated with an increase in blood neutrophils and a decrease in blood lymphocytes and forced vital capacity. Such reactions seem more likely to occur in nonatopic subjects exposed to low molecular weight agents AU - Lemiere C AU - Gautrin D AU - Trudeau C AU - Ghezzo H AU - Desjardins A AU - Cartier A AU - Malo JL LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 85 IP - DP - 1996 Jan 01 TI - Latex allergy: from contact urticaria to asthma PG - 978-982 AB - Latex, a natural plant material, has gained increasing interest over the last years because of its allergenic potency inducing problems in medical professions as well as in daily life. Since 1979 reports on allergic spontaneous reactions induced by latex products (such as gloves, condoms, balloons, cofferdam) have increased steadily. Symptoms manifest clinically as contact urticaria, rhinoconjunctivitis, asthma or anaphylactic shock. Some of these patients may additionally have an alimentary allergy (avocado, banana, maron i.e.), possibly containing agents cross-reacting with latex. Pathophysiologically the allergy is IgE-mediated, because antigen-specific IgE antibodies have been found in vitro as well as in vivo. Health professionals, workers in gum manufacturing and individuals with spina bifida have been found to be at special risk for a latex allergy therefore, it is important that these persons at risk are recognized and occasionally tested prior to interventions or operations. Strict avoidance of the use of latex products is the primary preventive measure, which may occasionally be difficult, particularly in patients with respiratory diseases. AU - Helbling A LA - PT - DEP - TA - Schweiz Rundsch Med Prax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 85 IP - DP - 1996 Jan 01 TI - Protection of health care personnel against tuberculosis PG - 967-970 AB - Protection of people who are working in health care against tuberculosis has been evaluated recently in several publications and guidelines. The following aims of guidelines are the reduction of emission from infections patients, limitation of aerosol transmission and protection of personnel and other patients against inhalation of infections particles. Because these protective means cannot abolish risk, a survey of the exposed personnel is mandatory as well as a preventive treatment of those infected AU - Zellweger JP LA - PT - DEP - TA - Schweiz Rundsch Med Prax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 348 IP - DP - 1996 Jan 01 TI - Granulomatous pneumonitis and mediastinal lymphadenopathy due to photocopier toner dust [letter] PG - 690-690 AU - Armbruster C AU - Dekan G AU - Hovorka A LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 110 IP - DP - 1996 Jan 01 TI - Isolated late asthmatic reaction after exposure to a high-molecular-weight occupational agent, subtilisin PG - 823-824 AB - High-molecular-weight agents generally induce immediate asthmatic reactions. We report the case of a subject who experienced a reaction that started after the first hour following exposure to subtilisin, a high-molecular-weight occupational agent. Any occurrence of immediate reaction was ruled out by measuring both FEV1 and lung volumes every 10 min in the first hour. This reaction was IgE-mediated as shown by immediate skin reactivity and increased specific IgE levels AU - Lemiere C AU - Cartier A AU - Dolovich J AU - Malo JL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 38 IP - DP - 1996 Jan 01 TI - Airway function and respiratory symptoms in sanitation workers PG - 522-527 AB - The prevalence of acute and chronic respiratory symptoms and lung-function changes was studied in a group of 81 municipal sanitation workers. In addition, the prevalence of chronic respiratory symptoms and lung function was studied in 65 control workers. There were significantly higher prevalences of all chronic respiratory symptoms among the sanitation workers than among the control workers. Sanitation workers (smokers and nonsmokers) 40 years of age or older had higher prevalences of all chronic respiratory symptoms than younger workers. In addition, sanitation workers (both smokers and nonsmokers) employed for 10 years or longer had significantly higher prevalences of chronic respiratory symptoms than control workers. There was also a high prevalence of acute symptoms, which developed among the sanitation workers during work shifts. Of these symptoms, prevalences were highest for dryness of the nose and throat, followed by throat and eye irritation. Lung-function testing demonstrated significantly diminished forced vital capacity (FVC) and 1-second forced expiratory volume (FEV1) for the 81 sanitation workers compared with control values. These differences only become significant after 10 or more years of employment in the sanitation industry and were not entirely explained by smoking. These differences were smaller and not statistically significant for maximum flow rates at 50% and the last 25% of the vital capacity. Our data suggest that sanitation worker--particularly those with long periods of work exposure--may develop acute and/or chronic respiratory symptoms accompanied by decreases in lung function (primarily FVC and FEV1) AU - Zuskin E AU - Mustajbegovic J AU - Schachter EN AU - Kern J AU - Pavicic D AU - Budak A LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 313 IP - DP - 1996 Jan 01 TI - Are healthcare workers in England and Wales at increased risk of tuberculosis? PG - 522-525 AB - OBJECTIVE: To determine whether healthcare workers in England and Wales are at increased risk of tuberculosis and to examine the frequency of drug resistance in this population. DESIGN: Comparison of notification rates by occupation obtained from national tuberculosis notification surveys in 1988 and 1993, with denominators from the 1991 census. SUBJECTS: People with notified tuberculosis in professional and associate professional occupations from the two surveys. MAIN OUTCOME MEASURES: Rates of notified tuberculosis in health professionals (mainly doctors) and health associate professionals (mainly nurses) compared with rates in other professional and associate professional occupations, adjusted for ethnic group, sex, and age. RESULTS: 119 cases of tuberculosis were identified in healthcare workers, including 61 nurses and 42 doctors. The crude notification rate in healthcare workers was 11.8 per 100,000 per year (95% confidence interval 9.8 to 14.1) compared with 3.3 per 100,000 per year (2.9 to 3.6) in other professional and associate professional occupations; rate ratios were higher (range 1.7 to 3.2) in all ethnic groups. The relative risk adjusted for ethnic group, sex, and age was 2.4 (95% confidence interval 2.0 to 3.0), slightly higher for health professionals (2.7 (1.9 to 3.8)) than for associate professionals (2.0 (1.5 to 2.6)). No multiple drug resistant strains of tuberculosis were identified in healthcare workers. CONCLUSIONS: Better detection and notification of cases of tuberculosis in healthcare workers may account for some of the apparent increased risk, but these findings imply that tuberculosis remains a hazard for healthcare workers and highlight the importance of ensuring that occupational health monitoring and protection workers are not neglected AU - Meredith SK AU - Watson JM AU - Citron KM AU - Cockcroft A AU - Darbyshire JH LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational hypersensitivity to sesame seeds PG - 69-70 AU - Alday E AU - Curiel G AU - LopezGil MJ AU - Carreno D AU - Moneo I LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 24 IP - DP - 1996 Jan 01 TI - Allergic reaction to molluscs and crustaceans [Spanish] PG - Suppl 1:36-44 AU - Laffond Yges E LA - PT - DEP - TA - Allergol Immunopathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational asthma in a coal miner PG - 867-868 AB - Occupational asthma in coal miners is hardly recognised. A report is presented of a coal miner whose clinical picture suggested a respiratory allergy which occurred only in the mine where he worked. Serum specific IgE levels, skin tests, and bronchial provocation tests with different commercial extracts showed sensitisation to Rhizopus nigricans. Rhizopus spp were found inside the mine, as demonstrated by cultures on petri plates AU - Gamboa PM AU - Jauregui I AU - Urrutia I AU - Antepara I AU - Gonzalez G AU - Mugica V LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational asthma due to latex in a hospital administrative employee PG - 452-453 AB - A case is described of occupational asthma caused by indirect exposure to airborne latex allergens in an administrative hospital employee who never used latex gloves AU - Vandenplas O AU - Delwiche JP AU - Sibille Y LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational asthma: measures of frequency from four countries PG - 435-440 AB - Disease registers and surveillance schemes are not necessarily designed to measure incidence and prevalence, but their data can provide useful epidemiological insights. Their main functions are the detection and identification of hazards so that further cases can be prevented, and to provide a database for research to improve our understanding of the determinants and consequences of disease. Occupational asthma probably accounts for only a small proportion of adult asthma, of the order of 2-6% in the UK. On the other hand, asthma is very common and so thousands of people in the UK and in other western countries have asthma as a result of their work. The frequency of the disease in less developed countries is unknown but is potentially very large. Information on incidence is patchy but from Finland, where ascertainment is most complete, there are approximately 140 per million working people affected each year, and even there disease in the self- employed is probably missed. Data for the UK are limited to cases seen by specialist physicians and the best estimate is that the annual incidence of such cases is about 50 per million. Through internal comparisons and analysis it is possible to judge the extent to which variation in ascertainment and reporting have affected the frequency of reported disease, but so far it has not been possible to measure the underestimation due to persons with work-related symptoms not seeking medical attention or not being referred to a specialist AU - Meredith SK AU - Nordman H LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 52 IP - DP - 1996 Jan 01 TI - Occupational asthma: medical and social prognosis [Review] [French] PG - 104-109 AB - The medical and social prognosis of occupational asthma has only been assessed with retrospective studies. The main findings are analyzed here. The wide range of methods used to obtain a positive diagnosis of occupational asthma and more or less complete eviction of the causal agent hinder interpretation of the results. Nevertheless, the findings reported in 15 studies focusing on the medical prognosis have shown that in 70% of the cases, occupational asthma remains symptomatic after eviction. The number of years the asthma existed at diagnosis is higher in subjects who remain symptomatic after eviction. In most patients with occupational asthma, the absence of eviction leads to accentuation of the obstructive syndrome and non-specific bronchial hyperreactivity. When the occupational disease has been recognized, the social-professional consequences unfortunately often include loss of employment and lower revenue. AU - Pauli G AU - KopferschmittKubler MC AU - Gassman V AU - Autelitano AM AU - Blaumeiser M LA - PT - DEP - TA - Revue de Pneumologie Clinique JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 47 IP - DP - 1996 Jan 01 TI - Respiratory system reactions to organic aerosol exposure [SerboCroatian (Roman)] PG - 57-67 AB - The effects of organic aerosols (coffee, teas, spices, confectionery, soy, animal feed) on the respiratory system of workers occupationally exposed to these aerosols are presented. Described are possible mechanisms responsible for the development of respiratory impairment. Our studies indicate the possibility of development of respiratory impairment in exposed workers. The prevalence of chronic respiratory symptoms and diseases varied from 2.7 to 56.3% and of acute symptoms from 9.9 to 78.9% of exposed workers. Statistically significant acute reductions of ventilatory capacity (FVC, FEV1, FEF50, FEF25) were recorded during the work shift. Described are some immunological changes which can develop in exposure to organic aerosols. Experimental studies with water organic dust extracts on isolated guinea pig trachea suggest that bronchoconstrictive changes in humans may be reproduced in non-sensitized guinea pigs. The need for taking preventive medical examinations in order to prevent development of respiratory and/or immunological impairment is stressed AU - Zuskin E AU - Kanceljak B AU - Saric M AU - Mustajbegovic J AU - Bradic V LA - PT - DEP - TA - Arh Hig Rata Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 174 IP - DP - 1996 Jan 01 TI - Occupational asthma due to isocyanates. [Review] PG - 23-30 AU - Baur X LA - PT - DEP - TA - Lung JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 53 IP - DP - 1996 Jan 01 TI - Sump bay fever: inhalational fever associated with a biologically contaminated water aerosol PG - 106-111 AB - OBJECTIVE: To investigate the clinical, serological, and environmental features of a work related inhalational fever associated with exposure to an aerosol generated from a biologically contaminated 130,000 gallon water pool in a building used for testing scientific equipment. METHOD: Cross sectional survey of all exposed subjects (n = 83) by symptom questionnaire, clinical examination, spirometry, and serology for antibody to Pseudomonads, pool water extract, and endotoxin. In symptomatic patients diffusion capacity was measured, and chest radiology was performed if this was abnormal. Serial peak flow was recorded in those subjects with wheeze. Bacterial and fungal air sampling was performed before and during operation of the water pool pump mechanism. Endotoxin was measured in the trapped waters and in the pumps. Serum cotinine was measured as an objective indicator of smoking. RESULTS: Of the 20 symptomatic subjects, fever was most common in those with the highest exposure (chi 2 42.7, P < 0.001) in the sump bay when the water was (torrentially) recirculated by the water pumps. Symptoms occurred late in the working day only on days when the water pumps were used, and were independent of the serum cotinine. Pulmonary function was normal in most subjects (spirometry was normal in 79/83, diffusion capacity was low in five subjects, chest radiology was normal). Peak flow recording did not suggest a work relation. The bacterial content of the aerosol rose from 6 to > 10,000 colony forming units per cubic metre (cfu/m3) (predominantly environmental Pseudomonads) when the pumps were operating. High endotoxin concentrations were measured in the waters and oil sumps in the pumps. Low concentrations of antibody to the organisms isolated were detected (apart from two subjects with high antibody) but there was no relation to exposure or the presence of symptoms and similar antibody was found in the serum samples from a non-exposed population. The fever symptoms settled completely with the simple expedient of changing the water and cleaning the pumps. CONCLUSION: Given the results of our study, the development of inhalational fever in this unique environment and clearly restricted cohort was closely related to the degree of exposure to contaminated aerosol and mainly occurred in the absence of distinct serological abnormality and independent of cigarette smoking AU - Anderson K AU - McSharry CP AU - Clark C AU - Clark CJ AU - Barclay GR AU - Morris GP LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 111 IP - DP - 1996 Jan 01 TI - Characterization of histamine releasing factors in diisocyanate-induced occupational asthma PG - 191-206 AB - Immunologic mechanisms contributing to diisocyanate-induced occupational asthma (OA) are poorly defined. There is a relatively low incidence of diisocyanate-specific IgE antibody responses. The frequent occurrence of delayed onset asthmatic responses in workers with diisocyanate asthma suggests a role for cellular immune mechanisms. We have shown in vitro production of antigen-specific mononuclear cell-derived histamine releasing factors (HRF) by peripheral blood mononuclear cells (PBMCs) of workers with OA. Monocyte chemoattractant protein-1 (MCP-1) and RANTES (acronym for "regulated on activation normal T expressed and secreted") are chemokines found in PBMC supernatants that express HRF activity. Diisocyanate-exposed workers were tested for diisocyanate antigen-stimulated enhancement of HRF, MCP-1, and RANTES production in supernatants of PBMCs and for serum specific IgE and IgG antibody levels to diisocyanate antigens bound to human serum albumin (HSA). PBMCs of workers with diisocyanate OA showed significantly increased production of antigen-specific HRF activity and MCP-1 ( > 300 ng/ml) compared to diisocyanate-exposed asymptomatic workers (P < 0.05). Antigen-stimulated enhancement of MCP-1 mRNA was demonstrated by reverse-transcription PCR. RANTES mRNA and chemokine secretion ( < 1 ng/ml) was also demonstrated in PBMCs, but did not show antigen enhancement in OA workers. Hapten specificity for the diisocyanate chemical to which a patient had been exposed was demonstrated for HRF enhancement and for IgG antibody reactions, but not for IgE reactions. HRF production was demonstrated in PBMC subpopulations, including lymphocytes and purified T cells. OA subjects showed increased CD8+ cells by immunofluorescence (mean CD4+: CD8+ = 1.2 +/- 0.2). The results suggest that diisocyanate antigen enhancement of HRF and MCP-1 production are stimulated by hapten-specific T cell reactions. Since a weak association has been found between IgE antibody synthesis and induction of diisocyanate OA, the role of T cell cytokines and chemokines in the pathogenesis of OA requires further investigation AU - Lummus ZL AU - Alam R AU - Bernstein JA AU - Bernstein DI LA - PT - DEP - TA - Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 111 IP - DP - 1996 Jan 01 TI - Overview of diisocyanate occupational asthma. [Review] PG - 181-189 AB - Surveillance programs established around the world have determined that diisocyanate chemicals are the most common cause of occupational asthma. In the United States approximately 100, 000 workers are exposed to these chemical compounds in the workplace each year and 5-10% of these workers will develop occupational asthma. There are no known reliable risk factors or biomarkers which can be used to predict which exposed worker will develop diisocyanate-occupational asthma. Diisocyanate-occupational asthma workers manifest characteristic physiologic responses after specific bronchoprovocation which correlate with pathologic changes in their airways. However, the mechanism(s) for diisocyanate-occupational asthma remains unclear. Specific IgE antibody production to diisocyanates is found in only 10-30% of these workers. Bronchial biopsies and bronchoalveolar lavage have confirmed the presence of T-lymphocytes and eosinophils in the airways of these workers suggesting that T-cell mediated immune responses are more likely to play a central role in this disease. It is essential to diagnose diisocyanate-occupational asthma as early as possible in order to prevent or reduce the significant asthma morbidity associated with continuous long term exposure to these chemicals. Treatment of choice is removal of the worker from further exposure. Prospective studies evaluating larger populations of diisocyanate-exposed workers is essential for a better understanding of the pathogenesis and natural course of diisocyanate-occupational asthma. AU - Bernstein JA LA - PT - DEP - TA - Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Increase in non-specific bronchial hyperresponsiveness as an early marker of bronchial response to occupational agents during specific inhalation challenges PG - 472-478 AB - BACKGROUND: Specific bronchial reactivity to occupational agents may decline after exposure in the workplace ceases leading to falsely negative specific inhalation challenges. A study was carried out to assess prospectively whether increases in nonspecific bronchial hyperresponsiveness could be useful in detecting the bronchial response to occupational agents during specific inhalation challenges. METHODS: Specific inhalation challenges were performed in 66 subjects with possible occupational asthma due to various agents. After a control day the subjects were challenged with the suspected agent for up to two hours on the first test day. Those subjects who did not show an asthmatic reaction were rechallenged on the next day for 2-3 hours. The provocative concentration of histamine causing a 20% fall (PC20) in the forced expiratory volume in one second (FEV1) was assessed at the end of the control day as well as six hours after each challenge that did not cause a > or = 20% fall in FEV1. The subjects who had a significant (> or = 3.1-fold) reduction in PC20 value at the end of the second challenge day were requested to perform additional specific inhalation challenges. RESULTS: The first test day elicited an asthmatic reaction in 25 subjects. Of the other 41 subjects five (12%, 95% confidence interval (CI) 4% to 26%) exhibited a > or = 3.1-fold fall in the PC20 value after the inhalation challenge and developed an asthmatic reaction during the second (n = 3) or third (n = 2) challenge exposure. The offending agents included persulphate (n = 1), wood dust (n = 2), isocyanate (n = 1), or amoxycillin (n = 1). These five subjects had left their workplace for a longer period (mean (SD) 21 (14) months) than those who reacted after the first specific inhalation challenge (8 (11) months). CONCLUSIONS: The increase in non-specific bronchial hyperresponsiveness after a specific inhalation challenge can be an early and sensitive marker of bronchial response to occupational agents, especially in subjects removed from workplace exposure for a long time. Non-specific bronchial hyperresponsiveness should be systematically assessed after specific inhalation challenges in the absence of changes in airway calibre AU - Vandenplas O AU - Delwiche JP AU - Jamart J AU - Van de Weyer R LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 50 IP - DP - 1996 Jan 01 TI - Occupational asthma: definition--epidemiology--etiologic substances--prognosis--prevention--diagnosis--expert assessment aspects PG - 356-363 AU - Merget R AU - SchultzeWerninghaus G LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 47 IP - DP - 1996 Jan 01 TI - Bronchial asthma with inflammation of the nose mucous membrane induced by occupational exposure to methyl methacrylate in a dental technician PG - 259-266 AB - A case report of a 40-year-old female dental technician with a 13-year history of methyl methacrylate exposure is presented. Symptoms of dyspnea, wheezing, coughing and rhinorrhea occurred 6- 8 months after the first occupational contact with methyl-methacrylate containing substances. Skin tests performed with a battery of common allergens produced negative results. While performing a provocation test with methyl-methacrylate, the patient developed severe stridor and dyspnea with concomitant decrease in I second forced expiratory volume (FEV1) and peak respiratory flow (PEF). The increase in leukocytes, eosinophils, basophils, albumin, eosinophil cationic protein (ECP) and mast cell tryptase occurred in nasal lavage fluid after bronchial provocation test. The authors conclude that methyl-methacrylate may cause asthma (probably non-atopic) in persons occupationally exposed to its effect AU - Wittczak T AU - Palczynski C AU - Szulc B AU - Gorski P LA - PT - DEP - TA - Medycyna Pracy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 17 IP - DP - 1996 Jan 01 TI - Occupational asthma caused by FD&C blue dye no. 2 PG - 31-34 AB - We report the case of a 55-year-old male who experienced cough, dyspnea, wheezing, and nasal congestion immediately upon exposure to FD&C Blue Dye No. 2 (Indigotine) at work. The patient had worked for 10 years mixing and grinding powdered synthetic red, yellow, and blue dyes for use in foods; symptoms had occurred for 2 years and only with exposure to Indigotine (C16H8N2Na2O8S2), a free flowing blue powder. Prick testing to Indigotine (20 mg/mL) was negative. ELISA failed to detect specific IgE, IgA, IgM, or IgG to Indigotine-HSA conjugates. Bronchial challenge was done according to the method of Pepys et al. beginning with 4 x 10(-4) lactose dilution of Indigotine powder. After 5 minutes of exposure to 4 gm Indigotine/100 gm lactose, the patient developed dyspnea and audible wheezing. At 20 minutes postexposure, there was a 20% decline in FEV1 from prechallenge baseline; no late phase response was observed. A second bronchial challenge with sodium sulfate, the major nondye product additive was negative. To our knowledge, this is the first documented case of occupational asthma due to FD&C Blue Dye No. 2. The pathogenesis is uncertain but does not appear to be IgE mediated AU - Miller ME AU - Lummus ZL AU - Bernstein DI LA - PT - DEP - TA - Allergy Asthma Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 53 IP - DP - 1996 Jan 01 TI - A cross sectional study of chemical industry workers with occupational exposure to persulphates PG - 422-426 AB - OBJECTIVES: Hair bleaches containing persulphates have been identified as the cause of occupational asthma in hairdressers. Also employees in persulphate production with occupational asthma have been described. It was the aim of this study to give an estimate of the prevalence of asthma due to persulphates in chemical workers with exposure to ammonium and sodium persulphate. METHODS: A cross sectional study was performed in 32 of 33 employees of a persulphate producing chemical plant. Eighteen of 23 workmen from the same plant with no exposure to persulphates were taken as controls. Also, information was collected from medical records of the seven subjects who had left the persulphate production for medical reasons since 1971. Data were recalled by a questionnaire, skin prick tests were performed with five environmental allergens, and ammonium and sodium persulphate (80 mg/ml). Specific immunoglobulin E (IgE) to the same environmental allergens as in the skin test, and total IgE were measured. Lung function and bronchial responsiveness to histamine were assessed by standard procedures. Workplace concentrations of ammonium and sodium persulphate were estimated by area and personal monitoring. The amount of persulphate was analysed as sulphur by inductively coupled plasma emission spectrometry. RESULTS: Work related rhinitis was reported by one subject with exposure to persulphates, conjunctivitis and bronchitis were reportedly related to work by two controls. There were no cutaneous reactions to persulphates in either group. Four non-atopic subjects exposed to persulphates, and two controls, one atopic and one non-atopic, were considered to be hyperresponsive to histamine. Three subjects exposed to persulphates with bronchial hyperresponsiveness (provocation dose of histamine causing a 15% fall in forced expiratory volume in one second (PD15 FEV1) < or = 1 mg) did not show variability in peak expiratory flow of > or = 20%, the rest refused peak flow measurements. None of the variables showed significant differences between the groups (P > 0.05). Six of the exworkers left because of work related contact dermatitis. Mean values for workplace concentrations of ammonium and sodium persulphate within the bagging plant were below 1 mg/m3, and the maximal concentrations were 1.4 mg/m3 and 3.6 mg/m3, respectively. CONCLUSION: Exposure to workplace concentrations of ammonium and sodium persulphate of about 1 mg/m3 in this chemical plant was not associated with a risk of occupational asthma AU - Merget R AU - Buenemann A AU - Kulzer R AU - Rueckmann A AU - Breitstadt R AU - Kniffka A AU - Kratisch H AU - Vormberg R AU - SchultzeWerninghaus G LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Can inhalation of garlic dust cause asthma? PG - 137-138 AU - Armentia A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational asthma due to different spices PG - 117-120 AB - We describe a 27-year-old subject who developed rhinitis and asthma symptoms 1 year after starting to prepare a certain kind of sausage. He was previously diagnosed as having allergy to coconut, banana, and kiwi and allergic rhinitis to horse, cat, dog, and cow. A positive immediate skin prick test (SPT) for paprika (dry powder of Capsicum annuum [Solanaceae]), coriander (Coriandrum sativum [umbelliferous]), and mace (shell of nutmeg, Myristica fragrans [Myristicaceae]) at a concentration of 10% (w/v) was obtained. SPT with other sausage ingredients, mites, pollens, and molds were negative. By ELISA, specific IgE antibodies to paprika, coriander, and mace were demonstrated. By ELISA-inhibition assays, a partial cross-reactivity was found among IgE-binding components from paprika and mace. The immunoblot analysis showed two IgE-reactive protein bands able to bind to IgE from mace of 20 and 40 kDa and two other bands from coriander extract of 50 and 56 kDa. No bands were detected from paprika extract. Specific bronchial inhalation challenges showed an immediate asthmatic reaction to extracts from paprika, coriander, and mace with a maximum fall in FEV1 of 26%, 40%, and 31%, respectively, with no late asthmatic reactions. In summary, we demonstrate that inhalation of dust from paprika, coriander, and mace can result in an IgE-mediated reaction to these spices. In this patient, occupational asthma was due to spices from botanically unrelated species AU - Sastre J AU - Olmo M AU - Novalvos A AU - Ibanez D AU - Lahoz C LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Occupational IgE-mediated rhinitis caused by ninhydrin PG - 114-116 AB - Ninhydrin is a laboratory chemical used as a reagent in the detection of free amino and carboxyl groups in proteins and peptides. We present the case of a laboratory technician who developed symptoms of rhinitis when handling papers immersed in a solution containing ninhydrin. Prick tests for ninhydrin and ninhydrin RAST were positive. The inhalation provocation test in an exposure chamber gave an immediate nasal response. A positive prick test to ninhydrin, an elevated level of specific IgE antibodies to ninhydrin, and the RAST inhibition test confirmed an IgE-mediated type I allergic reaction. We are not aware of any other report of ninhydrin as a cause of IgE-mediated allergy AU - Hytonen M AU - Martimo KP AU - Estlander T AU - Tupasela O LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 29 IP - DP - 1996 Jan 01 TI - Humoral and cellular immune responses in asthmatic isocyanate workers: report of two cases PG - 467-473 AB - Two workers (23 and 28 years old) developed rhinitis and bronchial asthma after occupational contact with the isocyanate MDI. Positive skin prick test results for MDI-HSA and IgE antibodies to all isocyanate-HSA conjugates were obtained in both cases, and the inhalation challenge test with MDI produced immediate and late asthmatic reactions. In the patch test and the stimulation assay of peripheral mononuclear blood cells, a specific sensitization to the diamine MDA (in both cases) and to further amines (in one case), as well as to hydrolysates of the respective diisocyanates, was seen, which appears to be independent of the IgE response to isocyanate-HSA conjugates. Our results offer evidence of IgE-mediated, as well as lymphocyte, responses induced by exposures to isocyanate products over several months or years AU - Baur X AU - Seemann U AU - Marczynski B AU - Chen Z AU - RaulfHeimsoth M LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 13 IP - DP - 1996 Jan 01 TI - Asthma to green coffee of environmental origin [French] PG - 308-309 AB - A case of rhinitis and environmental asthma caused by unroasted coffee has been reported in an adolescent living in a building in which there is an installation for roasting coffee. The diagnosis, suggested by the case history, is confirmed by the presence of specific IgE, by the positive result of the skin test using unroasted coffee extract and also of a broncho-provocation test entailing the manipulation of dust from the coffee roasting room. An amelioration of the room and work conditions is recommended AU - Mairesse M AU - Casel S AU - Ledent C LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 13 IP - DP - 1996 Jan 01 TI - Asthma, rhinitis and urticaria following occupational exposure to cyanoacrylate glues [French] PG - 305-307 AB - Cyanoacrylate glues are more and widely used in the industry because of easy handling and great sticking power. These very volatile and chemically reactive glues may not only cause contact eczema, but also rhinitis and asthma. Nineteen cases of asthma have been reported to date. We report two new cases of occupational asthma as well as one case of urticaria, a clinical symptom not yet described, to our knowledge. In the three cases, diagnosis was made based on a compatible medical history and positive realistic exposure tests. The mechanism is still unknown, due to the physical properties of cyanoacrylate glues; in fact, it is not possible to perform prick tests or specific IgE measurements. Besides the usual preventive measures, maintaining a relative humidity greater than 55% seems to induce polymerization of free monomers of alkyl cyanoacrylate, thereby reducing their volatility. Rhinitis and asthma due to cyanoacrylate glue may receive compensation as occupational diseases in France AU - KopferschmitKubler MC AU - Stenger R AU - Blaumeiser M AU - Eveilleau C AU - Bessot JC AU - Pauli G LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 106 IP - DP - 1996 Jan 01 TI - Extrinsic allergic alveolitis caused by isocyanates (letter) [Spanish] PG - 756-757 AU - Pedrouzo Bardelas J AU - de Aspe de la Iglesia E AU - Suarez Sambade D LA - PT - DEP - TA - Medicina Clinica JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 109 IP - DP - 1996 Jan 01 TI - Closed-circuit apparatus for specific inhalation challenges with an occupational agent, formaldehyde, in vapor form PG - 1631-1635 AB - Specific inhalation challenges are an important tool for confirming occupational asthma. In recent years, we have described two closed-circuit apparatuses that allow exposure to stable and controlled concentrations of particles and isocyanate gases. More recently, we developed a similar apparatus that generates chemicals in vapor form. The aim of this work is to describe its performance in the specific case of formaldehyde. This instrument is made of four parts: a generator as such, an exposure chamber, a monitor, and an automated regulatory system. This apparatus was assessed in four subjects suspected of having formaldehyde-induced asthma or alveolitis. The concentrations of formaldehyde were increased from 0.5 to 1 mg/m3 to 3 mg/m3 keeping the concentration at a value of 3 mg/m3 or less (threshold limit value). The dispersion of obtained values by comparison with the median data (6 values) was as follows: maximum value, 12 to 84%; minimum value, 20 to 58%; interquartile range, 0.13 to 0.9 mg/m3. We observed that target concentrations took a few minutes to be reached, but, once they were obtained, delivered concentrations were stable. The new vapor-delivery apparatus allows us to obtain concentrations of formaldehyde that are close to target concentrations with an acceptable dispersion of values around target concentration. Its use should be extended to other chemicals besides formaldehyde AU - Lemiere C AU - Cloutier Y AU - Perrault G AU - Drolet D AU - Cartier A AU - Malo JL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 29 IP - DP - 1996 Jan 01 TI - Machining operations and associated machining fluid exposures: issues for health and safety intervention in manufacturing PG - 397-401 AB - The outline for a workshop discussion of intervention research in manufacturing industry is presented. The example used is the control of machining fluid exposures, a widespread exposure that is associated with risk of cancer, pulmonary disease, dermatitis, and several types of accident-related injuries. Relevant technical considerations for conducting intervention research include the selection of machining fluid for different machining purposes, the management of fluids in use, and the selection and maintenance of environmental controls. Equally important are nontechnical considerations including the need for creating labor-management health and safety committees, the use of administrative rules on job performance for both workers and management, and training on the role of individuals from either group in exposure control. Clarity concerning the objectives for an intervention study and plans for clear means to evaluate study outcomes is critical. Important study variables will include site selection, plant size, plant demographics, the involvement of workers in the study, a willing management, and concern for susceptible workers AU - Wegman DH LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 47 IP - DP - 1996 Jan 01 TI - Sugar beet pollen allergy as a rare occupational disease [German] PG - 462-464 AB - Although there are a few isolated reports in the literature suggesting that sugar beet pollen is highly antigenic, hypersensitivity to components of sugar beet is not a common disease. We report a 29-year-old man with a history of atopic dermatitis who developed both contact dermatitis and allergic rhinitis from sugar beet pollen through his job in a seed nursery AU - Hohenleutner S AU - Pfau A AU - Hohenleutner U AU - Landthaler M LA - PT - DEP - TA - Hautarzt JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 17 IP - DP - 1996 Jan 01 TI - Tuberculosis in the workplace: OSHA's compliance experience PG - 159-164 AB - OBJECTIVE: Inspections of 272 facilities were performed between May 1992 and October 1994 to determine compliance with applicable Occupational Safety and Health Administration (OSHA) requirements for prevention of tuberculosis (TB) transmission. DESIGN: Retrospective record review of two data sources: (1) OSHA's Computerized Integrated Management Information System and (2) an inspector-completed questionnaire on inspection results. SETTING/PARTICIPANTS: Inspections of five types of facilities: healthcare institutions, correctional facilities, homeless shelters, long-term-care facilities for the elderly, and others, including drug treatment centers that the Centers for Disease Control and Prevention (CDC) identified as having a higher than expected rate of TB. METHODS: The OSHA Compliance Memorandum, based on the 1990 CDC Guidelines, which outlined elements of a TB prevention program, was used in performing 272 inspections of facilities between May 1992 and October 1994. Elements of compliance were recorded and reviewed from the IMIS database and inspectors' questionnaires. RESULTS: Regulated facilities were not fully compliant with OSHA guidance. Generally, healthcare facilities performed better than other facilities. Most facilities (79%) were compliant with administrative elements of a comprehensive TB control program, such as early identification of known or suspected infectious TB patients and skin testing of workers. Only 29% of inspected facilities were found to have acceptable respiratory protection programs for the prevention of occupational TB. CONCLUSION: Facilities have not been fully compliant with the OSHA memorandum describing protection of workers from TB. Facility compliance was better with some traditionally recognized TB infection control elements, but was weaker in the area of respiratory protection programs. This may reflect a lack of familiarity with the latter type of hazard protection AU - McDiarmid M AU - Gamponia MJ AU - Ryan MA AU - Hirshon JM AU - Gillen NA AU - Cox M LA - PT - DEP - TA - Infect Control Hosp Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - IP - DP - 1996 Jan 01 TI - Recommendations for prevention and control of tuberculosis at the local level PG - - AU - Interdepartmental working group on tuberculosis LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 45 IP - DP - 1996 Jan 01 TI - The role of BCG vaccine in the prevention and control of tuberculosis in the United States. A joint statement by the Advisory Council for the Elimination of Tuberculosis and the Advisory Committee on Immunization Practices PG - 1-18 AB - This report updates and replaces previous recommendations regarding the use of Bacillus of Calmette and Guerin (BCG) vaccine for controlling tuberculosis (TB) in the United States (MMWR 1988;37:663-4, 669-75). Since the previous recommendations were published, the number of TB cases have increased among adults and children, and outbreaks of multidrug-resistant TB have occurred in institutions. In addition, new information about the protective efficacy of BCG has become available. For example, two meta-analyses of the published results of BCG vaccine clinical trials and case-control studies confirmed that the protective efficacy of BCG for preventing serious forms of TB in children is high (i.e., > 80%). These analyses, however, did not clarify the protective efficacy of BCG for preventing pulmonary TB in adolescents and adults; this protective efficacy is variable and equivocal. The concern of the public health community about the resurgence and changing nature of TB in the United States prompted a re-evaluation of the role of BCG vaccination in the prevention and control of TB. This updated report is being issued by CDC, the Advisory Committee for the Elimination of Tuberculosis, and the Advisory Committee on Immunization Practices, in consultation with the Hospital Infection Control Practices Advisory Committee, to summarize current considerations and recommendations regarding the use of BCG vaccine in the United States. In the United States, the prevalence of M. tuberculosis infection and active TB disease varies for different segments of the population; however, the risk for M. tuberculosis infection in the overall population is low. The primary strategy for preventing and controlling TB in the United States is to minimize the risk for transmission by the early identification and treatment of patients who have active infectious TB. The second most important strategy is the identification of persons who have latent M. tuberculosis infection and, if indicated, the use of preventive therapy with isoniazid to prevent the latent infection from progressing to active TB disease. Rifampin is used for preventive therapy for persons who are infected with isoniazid-resistant strains of M. tuberculosis. The use of BCG vaccine has been limited because a) its effectiveness in preventing infectious forms of TB is uncertain and b) the reactivity to tuberculin that occurs after vaccination interferes with the management of persons who are possibly infected with M. tuberculosis. In the United States, the use of BCG vaccination as a TB prevention strategy is reserved for selected persons who meet specific criteria. BCG vaccination should be considered for infants and children who reside in settings in which the likelihood of M. tuberculosis transmission and subsequent infection is high, provided no other measures can be implemented (e.g., removing the child from the source of infection). In addition, BCG vaccination may be considered for health-care workers (HCWs) who are employed in settings in which the likelihood of transmission and subsequent infection with M. tuberculosis strains resistant to isoniazid and rifampin is high, provided comprehensive TB infection-control precautions have been implemented in the workplace and have not been successful. BCG vaccination is not recommended for children and adults who are infected with human immunodeficiency virus because of the potential adverse reactions associated with the use of the vaccine in these persons. In the United States, the use of BCG vaccination is rarely indicated. BCG vaccination is not recommended for inclusion in immunization or TB control programs, and it is not recommended for most HCWs. Physicians considering the use of BCG vaccine for their patients are encouraged to consult the TB control programs in their area AU - Anonymous LA - PT - DEP - TA - MMWR JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - IP - DP - 1996 Jan 01 TI - Tuberculosis PG - 219-235 AU - Salisbury DM AU - Begg NT LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - IP - DP - 1996 Jan 01 TI - Occupational diseases caused by indoor polution in a X-ray department of a hospital PG - in press- AU - Bakke JV AU - Eldoen G LA - PT - DEP - TA - Healthy Buildings 96 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - IP - DP - 1996 Jan 01 PG - - AU - Baranski B LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 109 IP - DP - 1996 Jan 01 TI - Longitudinal pattern of reported respiratory symptoms and accelerated ventilatory loss in asbestos-exposed workers PG - 120-126 AB - Studies investigating the relation between respiratory symptoms and change in ventilatory function have been limited by use of reported symptoms at a single point in time. To assess the relation between the longitudinal pattern of reported cough, phlegm, wheeze, and dyspnea and ventilatory loss, we prospectively investigated changes in FVC and FEV1 associated with development, resolution, or persistence of these symptoms over a 3- to 5-year period in 446 asbestos-exposed workers. Longitudinally reported symptoms changed frequently, with 52 to 61% of subjects reporting a specific symptom noting resolution or development of that symptom during follow-up. Initially reported symptoms were not predictive of accelerated loss of FVC or FEV1. In contrast, development of any new respiratory symptom, and to a lesser extent persistence of symptoms during follow-up, were associated with significantly greater ventilatory losses compared with asymptomatic individuals, ranging from 28 mL/yr in FEV1 for newly developed dyspnea, to 67 mL/yr in FVC for developed wheeze (p < 0.01). We conclude that development or persistence of respiratory symptoms over time, rather than the presence of symptoms per se, is predictive of future ventilatory loss. Recognition of interval changes in symptom reporting during surveillance of asbestos-exposed workers may effectively identify groups at risk for progressive ventilatory impairment AU - Brodkin CA AU - Barnhart S AU - Checkoway H AU - Balmes J AU - Omenn GS AU - Rosenstock L LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 153 IP - DP - 1996 Jan 01 TI - Asbestos-related bilateral diffuse pleural thickening: natural history of radiographic and lung function abnormalities PG - 301-306 AB - Sixty-four subjects with asbestos-related diffuse pleural thickening attending the London Medical Boarding Centre for Respiratory Diseases (formerly, the Central Pneumoconiosis Panel) were studied to investigate symptomatology, lung function, and radiographic change over an average period of 8 to 9 yr. Chest pain was a common symptom, occurring in over half of the subjects. Approximately one-third of the subjects had a history of pleurisy or pleural effusion. Full long function, available in all cases, showed a highly significant decrement (p < 0.001) compared with predicted values in all variables except gas transfer coefficient (Kco) at initial presentation, consistent with a restrictive ventilatory defect. Longitudinal lung function, available over a mean period of 8.9 yr in 36 subjects, showed a significant decrement above that predicted in FEV1 and FVC only (p < 0.05). Decreases in other parameters were observed, although statistical significance was not achieved. Radiographic score increased with time but there was no correlation between change in lung function and increasing radiographic score, probably reflecting the initial severity of the disease in subjects studied. These observations confirm an initial decrement in lung function in diffuse pleural thickening which is followed by comparatively little change over time AU - Yates DH AU - Browne K AU - Stidolph PN AU - Neville E LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 153 IP - DP - 1996 Jan 01 TI - Decrements in spirometry values associated with chlorine gassing events and pulp mill work PG - 225-231 AB - accidental exposures to high levels of irritant gases depended on cumulative levels of pulp mill exposure and cigarette smoking. Many of those subjects were older and retired. A new study was initiated to assess whether gassing events were a problem among current workers. Three hundred white male pulp and paper workers from the mill in Berlin, New Hampshire, were surveyed in 1992. Testing included spirometry and questionnaires. The mean age was 40.4 yr, and the mean tenure with the company was 18.5 yr. A total of 105 of the 300 subjects (35%) reported ever having an episode of high exposure to chlorine gases (i.e., being gassed). The percentage gassed was 51% for pulp mill workers and only 13% for other employees. For subjects with no more than 26 pack-years of cigarette smoking, obstruction (i.e., abnormally low FEV1 and FEV1/FVC) was observed only among those with a history of gassing. Also, the combination of high cigarette smoking (i.e., > 26 pack-years) and gassing had a greater than additive effect on obstruction. These findings suggest that additional controls are needed to minimize the number of gassing events in this and other chemical pulp mills AU - Henneberger PK AU - Lax MB AU - Ferris BG Jr LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 153 IP - DP - 1996 Jan 01 TI - Mineral fiber content of lungs in patients with mesothelioma seeking compensation in Quebec PG - 711-718 AB - Asbestos fibers (AF) and ferruginous bodies (FB) in lung parenchyma from 50 workers seeking compensation from the Workers' Compensation Board of Quebec for pleural or peritoneal mesothelioma were analyzed using transmission electron microscopy (TEM) equipped with energy-dispersive spectrometer (EDS) and phase-contrast microscopy (PCM). These workers had been occupationally exposed in mining and milling activities (12 were from Asbestos Township and 11 from Thetford Mines) and 27 were from other types of industry (asbestos factory, shipyard, etc.). For comparison, analyses of lung tissue at autopsy were done in a group of 49 subjects from a reference population. A 95% confidence interval upper limit of 540 AF < 5 microns/mg and a 95% confidence interval upper limit of 161 AF > or = 5 microns/mg dried lung tissue were found for the reference population. Similarly, a concentration of FB of 142 FB/g constituted the upper limit of detectable FB in the lungs of the reference population. Forty-eight of the 50 workers with mesothelioma had either a ferruginous body or total asbestos fiber count greater than the 95% confidence interval for the reference population; the remaining two had amosite and/or crocidolite concentrations greater than the 95% confidence interval for the reference population. The fiber types were different in the three groups, with the lungs of workers from Thetford Mines containing only chrysotile and tremolite, those from Asbestos Township containing chrysotile, tremolite, amosite, and crocidolite, and those in other industries containing largely amosite and crocidolite. We conclude that in this population of workers seeking compensation for mesothelioma, fiber analysis confirmed occupational asbestos exposure in every case. The fiber types responsible for the tumors are probably different in the three different groups AU - Dufresne A AU - Begin R AU - Churg A AU - Masse S LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 153 IP - DP - 1996 Jan 01 TI - Persistent wheeze in grain elevator workers should not be ignored PG - 701-705 AB - We investigated the relationship between annual change in pulmonary function and changes in respiratory symptoms among male grain elevator workers who participated in a health surveillance program mandated by Labour Canada. The surveillance was conducted every 3 yr starting from the period 1978 to 1981. The 1,211 workers who participated in the second (1981 to 1984) and fifth (1990 to 1993) surveillance were included in the analysis and the mean duration of the follow-up was 8.6 yr. In the analysis we also included the pulmonary function measurements that were available for some subjects at the third and fourth surveillance. The subjects who reported persistent wheeze had the largest mean annual rate change in FEV1 (-44.4 ml/yr) and FVC (-55.3 ml/yr). When adjusted for age, height, weight change, smoking, baseline lung function, location of grain elevators, and duration of employment, the subjects with persistent wheeze had an annual rate change of -28.3 ml/yr (SE 10.5; p = 0.007) in FEV1 and -37.3 ml/yr (SE = 12.3; p = 0.003) in FVC in comparison to subjects without any respiratory symptoms. The subjects who reported new onset of wheeze had significantly greater annual rate changes only in FEV1 (-13.7 ml/yr; SE 6.0; p = 0.02) in comparison to asymptomatic subjects' symptoms. Persistent wheeze is an important predictor of decline in lung function among grain elevator workers and should not be ignored in surveillance programs or clinical evaluations AU - Senthilselvan A AU - Pahwa P AU - Wang P AU - McDuffie HH AU - Dosman JA LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 53 IP - DP - 1996 Jan 01 TI - Lung function in Lancashire cotton and man made fibre spinning mill operatives PG - 46-50 AB - OBJECTIVES--This survey was conducted to investigate current lung function levels in operatives working with cotton and man made fibres. Dust concentrations, smoking history, and occupational details were recorded so that factors influencing lung function could be identified. METHODS--A cross sectional study of respiratory symptoms and lung function was made in 1057 textile spinning operatives of white caucasian extraction. This represented 96.9% of the total available working population to be studied. Most (713) worked currently with cotton. The remainder worked with man made fibre. Lung function was assessed by measuring forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Exposure to cotton dust was measured in the work area and personal breathing zones, and retrospective exposure to cotton dust over a working life was estimated with accurate work history and best available hygiene data. RESULTS--3.5% of all operatives had byssinosis, 55 (5.3%) chronic bronchitis, 36 (3.5%) work related persistent cough, 55 (5.3%) non-byssinotic work related chest tightness, and 56 (5.3%) work related wheeze. A total of 212 static work area dust samples (range 0.04-3.23 mg/m3) and 213 personal breathing zone samples (range 0.14-24.95 mg/m3) were collected. Percentage of predicted FEV1 was reduced in current smokers (mean 89.5, 95% confidence interval (95% CI) 88-91) in comparison with non-smokers (93.1, 90.5-94.1) and FVC was reduced in operatives currently working with man made fibre (95.3, 93.8-96.9) in comparison with cotton (97.8, 96.6-99.0). Regression analysis identified smoking (P < 0.01), increasing age (P < 0.01), increasing time worked in the waste room (P < 0.01), and male sex (P < 0.05) as being associated with a lower FEV1 and FVC. Current and retrospective cotton dust exposures did not appear as predictor variables in the regression analysis although in a univariate analysis, FEV1 was reduced in those operatives exposed to high dust concentrations assessed by personal and work area sampling. DISCUSSION--This study has documented loss of lung function in association with exposure to cotton dust. Those operatives with work related symptoms had significantly lower FEV1 and FVC than asymptomatic workers. Although lung function seemed to be affected by high dust exposures when operatives were stratified into high and low exposure groups, regression analysis did not identify current dust concentrations as an independent factor influencing loss. Smoking habit was found to explain most of the measured change in FEV1 and FVC. It is likely that smoking and dust exposure interact to cause loss of lung function in cotton textile workers AU - Fishwick D AU - Fletcher AM AU - Pickering CAC AU - McL Niven R AU - Faragher EB LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 97 IP - DP - 1996 Jan 01 TI - Baker's asthma caused by Saccharomyces cerevisiae in dry powder form PG - 131-134 AU - BelchiHernandez J AU - MoraGonzalez A AU - IniestaPerez J LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 127 IP - DP - 1996 Jan 01 TI - Latex hypersensitivity: its prevalence among dental professionals PG - 83-88 AB - Reports of hypersensitivity to latex are growing among oral health care workers, who have a high degree of exposure to latex products. The authors undertook a study to determine the prevalence of latex hypersensitivity among oral health care workers in a hospital dental practice. Among the 34 people who participated in the study, 12 percent had positive results in a skin prick test for latex. This suggests that the true prevalence rate of immediate hypersensitivity to latex in this group of oral health care workers is similar to that in other health care workers who use latex gloves frequently AU - Safadi GS AU - Safadi TJ AU - Terezhalmy GT AU - Taylor JS AU - Battisto JR AU - Melton AL Jr LA - PT - DEP - TA - Journal of the American Dental Association JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 109 IP - DP - 1996 Jan 01 TI - Occupational asthma in a community-based survey of adult asthma PG - Suppl):56S-57S AU - Blanc PD AU - Cisternas M AU - Smith S AU - Yelin E LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 334 IP - DP - 1996 Jan 01 TI - Transmission of multidrug-resistant Mycobacterium tuberculosis during a long airplane flight PG - 933-938 AB - BACKGROUND. In April 1994, a passenger with infectious multi-drug resistant tuberculosis traveled on commercial-airline flights from Honolulu to Chicago and from Chicago to Baltimore and returned one month later. We sought to determine whether she had infected any of her contacts on this extensive trip. METHODS. Passengers and crew were identified from airline records and were notified of their exposure, asked to complete a questionnaire, and screened by tuberculin skin tests. RESULTS. Of the 925 people on the airplanes, 802 (86.7 percent) responded. All 11 contacts with positive tuberculin skin tests who were on the April flights and 2 of 3 contacts with positive tests who were on the Baltimore-to-Chicago flight in May had other risk factors for tuberculosis. More contacts on the final, 8.75-hour flight from Chicago to Honolulu had positive skin tests than those on the other three flights (6 percent, as compared with 2.3, 3.8, and 2.8 percent). Of 15 contacts with positive tests on the May flight from Chicago to Honolulu, 6 (4 with skin-test conversion) had no other risk factors; all 6 had sat in the same section of the plane as the index patient (P=0.001). Passengers seated within two rows of the index patient were more likely to have positive tuberculin skin tests than those in the rest of the section (4 of 13, or 30.8 percent, vs. 2 of 55, or 3.6 percent; rate ratio, 8.5; 95 percent confidence interval, 1.7 to 41.3; P=0.01). CONCLUSIONS. The transmission of Mycobacterium tuberculosis that we describe aboard a commercial aircraft involved a highly infectious passenger, a long flight, and close proximity of contacts to the index patient AU - Kenyon TA AU - Valway SE AU - Ihle WW AU - Onorato IM AU - Castro KG LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 9 IP - DP - 1996 Jan 01 TI - The epidemiology of mesothelioma in historical context PG - 1932-1942 AU - McDonald JC AU - McDonald AD LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 40 IP - DP - 1996 Jan 01 TI - Inhalation accidents reported to the SWORD surveillance project 1990-1993 PG - 211-221 AB - Inhalation accidents are the fifth most common cause of illness reported by occupational and chest physicians to the SWORD surveillance scheme, with an estimated total of 1180 cases in the 5-year period 1989-1994. Questionnaires were sent to all physicians still participating, to record the circumstances of each inhalation accident they had reported between January 1990 and July 1993, covering case management and any resultant effects on health or employment; 93% of physicians returned the forms completed with adequate data on 85% of cases. From the information provided, 30% of the accidents resulted from lack of effective respiratory protection or other contraventions of safety regulations, 19% from leaks or spills and 13% from equipment failure. Resultant symptoms were described in 92% of cases: of these 48% were respiratory, 12% non-respiratory or toxic and 39% a combination of the two. The symptoms persisted often with absence from work for 1 month or more, in 26% of cases, including 9% with asthma or reactive airways dysfunction syndrome (RADS), 11% other respiratory diseases, 3% non-respiratory conditions and 3% unspecified. It was evident that cases reported by chest physicians were more seriously ill than those from occupational physicians, but of those with persistent symptoms the proportion with asthma or RADS was fairly similar in the two groups (24 and 37%, respectively). Agents associated with asthma or RADS were mainly respiratory irritants and those associated with non-respiratory conditions were organic chemicals or combustion products. Published by Elsevier Science Ltd AU - Sallie B AU - McDonald C LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 196 IP - DP - 1996 Jan 01 TI - Adverse effects on the respiratory system in textile printing sprayers [Spanish] PG - 157-161 AB - OBJECTIVE. To study the initial respiratory effects and those observed 18 months later after the inhalation of toxic and irritant substances in textile aerography workers. SUBJECTS. Seventeen patients (14 women and 3 men), with a mean age of 21 years (range: 18-38). METHODS. Initially, pulmonary effects were assessed by pathological (transbronchial biopsy and/or video-thoracoscopy) and functional findings [spirometry with lung volumes and study of diffusion capacity of CO (DLCO)]. Eighteen months later a challenge bronchial test with histamine was performed. RESULTS. Forty-one per cent of patients had pathologic lesions with intraalveolar fibrin, 35% had minimal non-specific lesions, 18% bronchiolitis obliterans with organized pneumonia (BOOP) and 6% pulmonary fibrosis and BOOP. Functional respiratory test showed two patients with a slight restrictive pattern, one patient with very severe restriction and six patients with low DLCO. The challenge tests was positive for 59% of patients. CONCLUSION. After the massive inhalation of irritant and/or toxic substances, patients presented different types of pathological response at pulmonary level. In our workers histological repairing lesions--of high or low degree--were found, BOOP being the lesions observed most frequently, and different patterns of functional involvement. Fifty-nine per cent of cases developed non-specific bronchial hyperreactivity consistent with a reactive airways dysfunction syndrome AU - Sole Jover A AU - b1rtinez Frances ME AU - Cordero Rodriguez PJ AU - Vallterra Musoles J AU - Macian Gisbert V LA - PT - DEP - TA - Revista Clinica Espanola JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 97 IP - DP - 1996 Jan 01 TI - Occupational asthma induced by Chrysonilia sitophila in the logging industry PG - 1409-1413 AB - Fungal antigens are common aeroallergens that are relevant to asthma. These antigens have less commonly been implicated as the causative agents of occupational asthma. Fungi may be a contaminant of vegetable matter, such as cereal crops, in which Cladosporiurn and Alternaria species and Didyrnella exitalis are common causes of asthma during harvest time. In addition, Alternaria and AspergiUus species have been identified as a cause of baker's asthma. Altemaria, Penicilliurn, and Pullularia species may also contaminate wood bark and can cause hypersensitivity pneumonitis in exposed carpenters and papermill and sawmill workers. Neurospora species have been described as causing ccupational asthma in one previous patient, a plywood factory worker. However, anamorphs (the asexual states) of Neurospora species, such as Chrysonilia sitophila, the common red bread mold, have not been previously reported as a cause of respiratory disease. The patient described here had occupational asthma as a likely result of repeated exposure to this mold while working in the logging industry. Skin testing and RAST for specific IgE antibodies confirmed sensitization to C. sitophila, and a clinic skin test survey with an extract of this fungus indicated that it has distinct antigenicity from the other most common outdoor fungal spores in this geographic region. AU - Tarlo SM AU - Wai Y AU - Dolovich J AU - Summerbell R LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 116 IP - DP - 1996 Jan 01 TI - Assessment of causal relationship in work-related pulmonary diseases. An epidemiological approach [Norwegian] PG - 736-738 AB - A competent assessment of causal relationships in the case of work-related lung disorders depends on correct diagnosis, a detailed occupational history and updated epidemiological knowledge about causal relationships, obtained from the literature. Assessments for purposes of compensation demand, in addition, an explicit choice of methods for calculating causes, before a meaningful attempt can be made to weight the various factors in and outside the working environment. If adequate epidemiological knowledge is available, the causal probability, based on the etiological fraction among the exposed persons (attributable risk) may be a useful tool for apportioning the different causal factors AU - Kjuus H AU - Hauge OA AU - Kongerud J AU - Aasen TB LA - PT - DEP - TA - Tidsskr Nor Laegeforen JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 109 IP - DP - 1996 Jan 01 TI - Nasal lavage cellularity, grain dust, and airflow obstruction PG - 1086-1092 AB - The University of Iowa, Iowa City, USA To evaluate the clinical utility of nasal lavage (NL), we performed post-work shift NL on 172 grain workers and 78 postal worker control subjects. The grain worker group included a higher percentage of current smokers (25.7% vs 16.7%) and a lower percentage of former smokers (21.15% vs 35.9%) compared with the postal workers. The control subjects included more female workers and were slightly older than the grain workers. Compared with the postal workers, the grain workers were exposed to significantly greater concentrations of total dust (0.1 +/- 0.0 vs 6.8 +/- 1.4 mg/m3; mean +/- SEM) and total endotoxin (4.3 +/- 0.8 vs 2,372.4 +/- 653.8 endotoxin units/m3). NL from gain workers showed a higher concentration of total cells (55,000 +/- 14,000 vs 25,000 +/- 5,000 cells per milliliter; p=0.03), a higher concentration of squamous epithelial cells (17,029.0 +/- 4,177 .0 vs 7,103.7 +/-1,479.8 cells per milliliter; p=0.03), and a higher concentration of neutrophils (40,058.0 +/- 12,803.2 vs 17,891.0 +/- 3,822.3 cells per milliliter; p=0.10) compared with postal workers. Importantly, these differences in NL cellularity between grain workers and postal workers were observed within the three strata of smokers. To further assess the importance of total cells, squamous epithelial cells, and neutrophils in the NL fluid of grain workers, we investigated the relationship between these cell concentrations and (1) measures of dust and endotoxin exposure during the work shift. (2) spirometric measures of airflow obtained immediately before the NL, and (3) work-related respiratory symptoms. The concentration of total cells, the concentration of squamous epithelial cells, or the concentration of neutrophils in the NL was not associated with ambient levels of dust or endotoxin, with baseline or cross-shift changes in lung function, or with work-related respiratory symptoms. These findings suggest that increased NL cellularity may be seen in workers exposed to high dust levels. However, the NL cellularity does not appear to be associated with ambient concentrations of dusts or endotoxins, with signs of airflow obstruction, or with work-related respiratory symptoms AU - Blaski CA AU - Watt JL AU - Quinn TJ AU - Thorne PS AU - Schwartz DA LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 109 IP - DP - 1996 Jan 01 TI - Pulmonary abnormalities and serum immunoglobulins in facsimile machine repair technicians exposed to butyl methacrylate fume PG - 1010-1018 AB - Seven repair technicians (RT, site A) repeatedly exposed to facsimile machine fume developed recurring sore throat, fever, lymphadenopathy, chest tightness, dry cough, and dyspnea. The fume concentration was low (0.6 mg/m3 of breathing-zone air) but it contained butyl methacrylate (BMA), a known skin sensitizer. Although chest radiographs were normal, three of the seven RT-A had lung crackles and spirometric abnormalities, and increased serum levels of immunoglobulins IgE or IgM. Symptoms and most other abnormalities improved when exposure to BMA was stopped. We later evaluated workers in two other sites (B and C). Six RT-B had daily contact with BMA fume (0.14 to 0.40 mg/m3 of air) at a field repair depot. Six administrative and six sales staff members (AS-B, SS-B) without regular fume exposure served as controls. All RT-B had elevated serum IgE levels (202+/-69 U/mL [SEM]; normal <41 U/mL). IgE and fume levels were positively correlated (r=0.83). four RT-B had lung crackles, but few symptoms and normal results of spirometry. The crackles cleared 8 weeks after substitution of a BMA-free paper, but IgE levels remained high (201+/-69). The nonexposed AS-B and SS-B had no crackles. Their IgE levels were normal (19+/-4 U/mL [SEM]; p<0.01). The crackles suggest BMA fume might have caused inflammation in terminal airways units. The significance of the IgE elevations is also uncertain since this class of antibodies is usually associated with asthma, not pneumonitis. In view of these uncertainties, BMA was eliminated from the facsimile transceiver process. Follow-up of group C workers (n=32) found no symptoms, lung crackles, or abnormal results of spirometry. However, IgE concentrations were elevated in 15 and remained so for 21 months, perhaps because of continuing exposure to residual low levels of BMA. These findings suggest that BMA-bearing facsimile fume caused increased IgE levels in RT at sites A, B, and C, and might have resulted in permanent lung injury if such exposure had continued AU - Raymond LW LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 76 IP - DP - 1996 Jan 01 TI - Occupational asthma due to deer dander PG - 423-426 AB - BACKGROUND: The literature on allergy to deer is limited. The allergenic component remains to be identified. METHODS: We report a case of occupational asthma and rhinitis caused by deer dander. A 44-year-old male farmer had raised three red deer on his farm for 2 years, prior to occurrence of asthmatic symptoms. Dander extract was prepared from the patient's deer. RESULTS: Skin-prick test elicited positive reactions to dander extracts from goat, sheep, camel, and cow as well as to deer dander extract. Bronchoprovocation test with deer dander extract elicited an early asthmatic response. Serum-specific IgE antibody to the deer dander extract was detected by enzyme-linked immunosorbent assay (ELISA). Sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblot analysis showed five IgE binding components (110, 72, 59, 45, and 21 kilodalton) within the deer dander extract. CONCLUSIONS: These results suggest that deer dander can induce occupational asthma through an IgE-mediated mechanism in a farmer raising deer AU - Nahm DH AU - Park JW AU - Hong CS LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 153 IP - DP - 1996 Jan 01 TI - Coal mine dust exposure and spirometry in experienced miners PG - 1560-1566 AB - In a previous study of new miners from the National Study of Coal Workers' Pneumoconiosis (NSCWP), researchers examined changes in spirometry values associated with coal mine dust exposure (Br J Ind Med 1993; 50:929-937). An unusual pattern of dust-related effects was observed: initial sharp decrements in FVC and FEV1 were followed by partial recovery. In the current study, similar methods were used to analyze data from experienced miners. Each of 1,915 male subjects contributed data from two of the NSCWP field surveys: either Round 1 (1969-71) and Round 2 (1972-75) and Round 4 (1985-88). From the cross-sectional analysis at Round 1 or Round 2 (R1/R2), changes of +0.6 ml FVC and -0.5 ml FEV1 were associated with each mg/m3-yr of cumulative coal mine dust exposure, but were not statistically significant (p > 0.05). From the analysis of longitudinal change in spirometry from R1/R2 to Round 4 (R4), annual declines in FVC (-0.10 ml/yr per mg/m3-yr, p = 0.003) and FEV1 (-0.07 ml/yr per mg/m3-yr, p = 0.006) were associated with pre-R1/R2 exposure. Both the pattern and the magnitude of the exposure-response relationship were different for experienced versus new miners. Possible reasons for these contrasts include differences in cumulative exposure between the two groups and the healthy worker effect among experienced miners AU - Henneberger PK AU - Attfield MD LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 153 IP - DP - 1996 Jan 01 TI - Respiratory health of California rice farmers PG - 1553-1559 AB - Rice farmers are occupationally exposed to agents that may affect respiratory health, including inorganic dusts and smoke from burning of agricultural waste. To assess respiratory health of this occupational group, we conducted a cross-sectional study, including a self-administered health and work questionnaire, spirometry, and chest radiography among 464 male California rice farmers. Mean age +/- SD was 48.3 +/- 15.2 yr; mean duration of rice farming was 25.7 +/- 14.3 yr. Prevalences for respiratory symptoms were: chronic bronchitis (6.3%), physician-diagnosed asthma (7.1%), and persistent wheeze (8.8%). Chronic cough was reported by 7.1% of respondents and was associated with reported hours per year burning rice stubble. Mean FEV1 and FVC were at expected values. FEV1 was inversely associated with years working in rice storage and use of heated rice dryers. Mean FEF25-75 was 93% of expected and was inversely associated with rice storage activities involving unheated rice driers. ILO profusion scores > or = 1/0 for small irregular opacities were seen in 18 (10.1%) of 178 chest radiographs. Study findings suggest increased asthma prevalence among California rice farmers. Radiologic findings consistent with dust or fiber exposure were increased compared with those of the general population, although no associations with specific farming activities were identified AU - McCurdy SA AU - Ferguson TJ AU - Goldsmith DF AU - Parker JE AU - Schenker MB LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 153 IP - DP - 1996 Jan 01 TI - Increased bronchial responsiveness in workers sawing Scots pine PG - 948-952 AB - The purpose of the present investigation was to study bronchial responsiveness and pulmonary function in Swedish sawmill workers, who are not exposed to plicatic acid, the sensitizer in red wood cedar asthma. Bronchial responsiveness, transfer factor, spirometry, and precipitating antibodies in serum against sawmill fungi were measured in 164 workers at five sawmills. The results from workers inside the sawing area (sawyers, n=59), in the trimming department (trimmers, n=66), and from other workers in the sawmill (sawyer-referents, n=39) were compared. Sawyers had higher bronchial responsiveness than referents. In 55% of the sawyers FEV1 decreased by 20% or more within the highest dose of methacholine compared with 31% of sawyer-referents and 41% of trimmers (p<0.01, sawyers/referents). Sawyers decreased 74% more in FEV1 per milligram of inhaled methacholine compared with referents (geometric means, p<0.01). The transfer test in never-smokers was 13% lower in sawyers than in trimmers (p<0.01) and 8% lower compared with sawyer-referents (nonsignificant p<0.1). Presence of precipitating antibodies was not associated with changes in pulmonary function. Some agents in the sawing area of sawmills appear to increase bronchial responsiveness and decrease diffusion capacity AU - Malmberg PO AU - RaskAndersen A AU - Larsson KA AU - Stjernberg N AU - Sundblad BM AU - Eriksson K LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Hypersensitivity pneumonitis induced by a smut fungus Ustilago esculenta PG - 650-651 AU - Yoshida K AU - Suga M AU - Yamasaki H AU - Nakamura K AU - Sato T AU - Kakishima M AU - Dosman JA AU - Ando M LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 34 IP - DP - 1996 Jan 01 TI - Hard metal lung with diffuse small nodular shadows [Japanese] PG - 465-470 AB - A 32-year-old woman was admitted to Niigata University Hospital with dyspnea and a non-productive cough. She had been exposed to hard metal dust for 4 years in a metal-polishing factory. Chest X-ray and CT films showed diffuse small nodular shadows in both lung fields and pulmonary-function tests revealed severe restrictive impairment. Specimens obtained by thoracoscopic lung biopsy showed fibrosis in the centers of lobules and in peribronchiolar regions. Giant-cell interstitial pneumonia-like findings were also noted. Tungsten carbide and cobalt were detected in these specimens, with an X-ray microanalyzer. Hard metal lung was diagnosed. By 1 year after she changed her place of work and began corticosteroid treatment her symptoms and pulmonary function had improved remarkably, although shadows on chest X-ray films remained to some extent AU - Yokota T AU - Hasegawa T AU - Murakami S AU - Kurashige K AU - Maruyama M AU - Satoh M AU - Suzuki E AU - Arakawa M LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Brief reversible bronchospasm resulting from bichromate exposure PG - 221-226 AB - A 50-y-old male worker developed an asthmatic reaction after exposure to bichromate in a metal-plating plant. Evaluation included skin tests, bronchial provocation tests, and specific radioallergosorbent tests with metal salts. A 49-y-old worker who suffered from hard metal asthma was the control. These workers were not atopic, and they exhibited similar bronchial hyperresponsiveness in methacholine-PC20 (74 mg/ml versus 81 mg/ml, respectively) and IgE titers (129 IU/ml versus 130 IU/ml). Positive intradermal and patch tests to bichromate were found in the subject. A bronchial provocation test with inhalation of .01 % bichromate produced an immediate decrease in forced vital capacity in 1 s, followed by a rapid recovery within 5 min absent any treatment. There was no reaction to cobalt (1% cobalt chloride) or to nickel (2% nickel sulfate) salts. In the control, a positive bronchial provocation occurred (absent chromium) with cobalt and nickel. Administration of a subcutaneous preparation of 1 mg atropine sulfate or of 1 puff of disodium cromoglycate or beta-stimulant reduced bronchial responsiveness to methacholine-PC20, and no asthmatic reaction occurred following inhalation of 1% bichromate. No blocking of asthmatic reaction occurred after pretreatment with beclomethasone dipropionate inhalation. Administration of propranolol, however, potentiated the acute bronchoconstriction induced by bichromate. The 50-y-old worker had evidence of IgE antibody to chromium-conjugated human serum albumin and to chromium-conjugated exchange resin. His serum selectively bound 51Cr, but antibodies specific to cobalt and nickel were absent. These results, if viewed collectively, suggest that bichromate exposure causes brief reversible bronchospasm via alteration of autonomic balance and increased vagal activation AU - Shirakawa T AU - Morimoto K LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 22 IP - DP - 1996 Jan 01 TI - A fatal case of hard-metal disease PG - 62-65 AB - OBJECTIVES. The purpose of this report is to present a case of hard-metal disease in which the symptoms and findings were minimal early in the disease, but further exposure rapidly led to a fatal outcome. HISTORY. A 22-year-old nonsmoking white male, employed for over four years in hard-metal tool grinding, started experiencing a dry cough and shortness of breath during exercise. Preliminary investigations did not reveal any cause for these symptoms, and the patient continued to work. Several months later he developed clinically apparent alveolitis with recurrent pneumothorax. Pulmonary infiltrates in chest radiographs did not disappear during corticosteroid treatment. Soon it was evident that the patient had irreversible pulmonary failure, and a bilateral lung transplantation was performed. No signs of rejection were seen in the resected lungs. The patient died of pneumonia five months later, but no signs of hard-metal disease were found in the transplanted lung. CONCLUSIONS. This fatal case of hard-metal lung disease demonstrates that symptoms and findings in pulmonary function tests or chest radiographs may be minimal or misleading in the early stages of the disease. Cobalt-exposed workers with inexplicable respiratory symptoms should be closely monitored and the exposure should be suspended AU - Ruokonen EL AU - Linnainmaa M AU - Seuri M AU - Juhakoski P AU - Soderstrom KO LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 45 IP - DP - 1996 Jan 01 TI - Biopsy-confirmed hypersensitivity pneumonitis in automobile production workers exposed to metalworking fluids--Michigan, 1994-1995 PG - 606-610 AB - In 1994, union and management officials and local physicians in southeastern Michigan noted the occurrence among automobile production workers of respiratory illness consistent with hypersensitivity pneumonitis (HP). Local and national health authorities reviewed medical records, and in June 1994, individual employees and the union requested that CDC's National Institute for Occupational Safety and Health (NIOSH) evaluate potential occupational exposures associated with these illnesses. This report summarizes preliminary findings of the evaluation, including detailed information about one HP case and a summary description of the six biopsy-confirmed cases among automobile production workers from three different plants (plants A, B, and C) in southeastern Michigan; all six workers had jobs that entailed frequent exposure to metalworking fluids (MWFs). The findings suggest the need for further evaluation of a possible association of occupational exposure to MWFs with HP AU - Anonymous LA - PT - DEP - TA - MMWR JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 80 IP - DP - 1996 Jan 01 TI - Nonsensitizing causes of occupational asthma. [Review] PG - 749-774 AB - Irritant-induced asthma and RADS are related conditions that need further study focusing on the following questions: (1) Are there differences between the pathologic and functional features that follow single or multiple exposures to an irritant material? (2) What is the time course of the changes? (3) What are the physiologic correlates in terms of onset of airway hyperresponsiveness? (4) What are the risk markers (besides exposure)? (5) Are there means of modulating the reaction by using anti-inflammatory preparations? Developing an animal model of irritant-induced asthma and conducting prospective epidemiologic surveys in high-risk workers may be most effective routes to provide satisfactory answers to these questions. Further examination of the physiopathology of such conditions as byssinosis, grain-dust-induced respiratory disease, and aluminum potroom asthma as well as of the differences from and similarities to OA is also warranted. AU - Lemiere C AU - Malo JL AU - Gautrin D LA - PT - DEP - TA - Medical Clinics of North America JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 21 IP - DP - 1996 Jan 01 TI - Occupational laryngitis with immediate allergic or immediate type specific chemical hypersensitivity PG - 42-48 AB - Reports of allergic laryngitis are sparse. In some reports allergy has been mentioned as an aetiological factor, but the diagnosis has not been confirmed with provocation tests. This paper reports on 20 patients in order to show that laryngitis can be caused by organic substances and chemicals with mechanisms of immediate allergy or immediate type specific hypersensitivity. The agents in the former group consisted of flours, obeche, plants and acid anhydrides, whereas these in the latter group included chemicals like formaldehyde, acrylate compounds, and chemicals used in hairdressing. All the cases were confirmed with provocation tests in which the patients displayed a change in vocal cord status. Thirteen patients had positive skin-prick test results with suspected causative agents. Eleven of these 13 patients had an elevated level of specific IgE-antibodies to the same agents AU - Sala E AU - Hytonen M AU - Tupasela O AU - Estlander T LA - PT - DEP - TA - Clinical Otolaryngology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 46 IP - DP - 1996 Jan 01 TI - Work-related asthma in a population exposed to grain, flour and other ingredient dusts PG - 37-40 AB - The purpose of the study was to determine the prevalence and causation of work-related asthmatic symptoms in a population exposed to grain, flour and other ingredient dusts. Where workers complained of asthmatic symptoms which were the result of dust exposure, follow-up aimed to identify whether the symptoms were the result of sensitisation or of non-specific irritation. A questionnaire was presented to 3,450 workers who had exposure to dust during the course of flour milling (528), bread baking (1, 756), cake baking (209) and other activities in food preparation (957). Those with positive responses were followed-up by taking a formal history, examination, skin prick testing and serial peak flow measurement. The overall prevalence of work-related asthmatic symptoms was 4.4% (153 out of 3,450). In the group who were followed-up (128 out of 153), non-specific respiratory irritation was thought to be the cause in 90 (2.6%), whilst sensitisation was responsible for symptoms in 12 (0.3%). Of the 12 cases due to sensitisation, the agents responsible were: fungal amylase (10 cases, all associated with bread baking), flour (one case, associated with flour packing), and grain (one case, associated with flour milling). Non-specific irritation is considerably more common than sensitisation as the cause of work-related asthmatic symptoms in flour milling, baking and other flour-based industries. The prevalence of sensitisation to flour is very low (less than 1 in 1,000) in all these industries. The principal sensitiser encountered in modern plant bakeries appears to be fungal amylase. The most important source of exposure to fungal amylase is probably the debagging, sieving, weighing and mixing of bread improvers AU - Smith TA AU - Lumley KP LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 46 IP - DP - 1996 Jan 01 TI - Health surveillance for hospital employees exposed to respiratory sensitizers PG - 33-36 AB - Seventy-eight National Health Service occupational health departments were invited to take part in an audit of health surveillance for employees exposed to respiratory sensitising agents. Most of the departments had responsibility for workers using glutaraldehyde, formaldehyde, methyl methacrylate and X-ray processing chemicals, but the extent to which health surveillance was provided for these employees varied. Many departments had no written policies for surveillance, and the methods used were often unnecessarily labour intensive. Only a minority of departments had made arrangements for communicating the collective results of screening to employees, failure to do so indicating a breach of statutory duty. There were major discrepancies between departments in criteria for excluding employees from work with respiratory sensitising agents. Occupational physicians caring for hospital staff should discuss and establish guidelines for effective surveillance of people working with the commonly encountered sensitisers AU - Smedley J AU - Coggon D LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 106 IP - DP - 1996 Jan 01 TI - Espartosis or plasterer's lung? (letter) [Spanish] PG - 318-318 AU - Perez Arellano JL AU - Barrios Gonzalez MN AU - Orfao Matos A AU - Jimenez Lopez A LA - PT - DEP - TA - Medicina Clinica JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 121 IP - DP - 1996 Jan 01 TI - The latency period between exposure and the symptoms in allergy to natural latex. Suggestions for prevention PG - 823-828 AB - BASIC PROBLEM AND OBJECTIVE OF STUDY. Among persons working in the health care system allergies caused by natural rubber latex (NRL) are more common than among the general population, because the frequent use of latex gloves and other latex articles may cause sensitisation. A retrospective study was undertaken to determine the period before such an allergy occurs. PATIENTS AND METHODS. 63 patients (53 women and 10 men; mean age 31.3 +/- 8.3 years) with symptoms of type 1 (immediate response; IgE-mediated) allergy to NRL filled in a special questionnaire asking, among other items, about occupational history, duration and frequency of contact with latex gloves, as well as the course of occupational or other symptoms. All but five of the group had been in their job for less than 15 years. A prick test with 21 ubiquitous environmental allergens was performed on 62 of the patients. RESULTS. Two thirds of the patients had atopy. First symptoms of an allergy to latex developed at an average of 5 years (58.7 +/- 59.3 months) after starting work involving contact with latex products. In 59 persons the first symptoms were contact urticaria, in some together with rhinitis or dyspnea. The interval until onset of symptoms relating to the lower respiratory tract averaged a further 25.3 +/- 34.6 months. Symptoms developed earlier in patients with atopy than in those without (51.9 +/- 54.3 vs 76 +/- 69 months). CONCLUSIONS. The use of powdered natural rubber latex gloves should be discontinued to prevent the increasing incidence of sensitization to aerogenic latex and to protect those already sensitized from developing allergic bronchial asthma AU - Allmers H AU - Kirchner B AU - Huber H AU - Chen Z AU - Walther JW AU - Baur X LA - PT - DEP - TA - Deutsche Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 138 IP - DP - 1996 Jan 01 TI - Vanadium-induced chemokine mRNA expression and pulmonary inflammation PG - 1-11 AB - Occupational exposure to vanadium is common in petrochemical, mining, steel, and utilities industries and results in toxic effects largely confined to the respiratory system. Vanadium exposure has been associated with inflammatory changes in the upper and lower respiratory tracts in addition to changes in pulmonary function. We investigated the abilities of several vanadium compounds to increase mRNA levels for selected cytokines in bronchoalveolar lavage (BAL) cells and also to induce pulmonary inflammation. Rats (200-250 g) were intratracheally instilled with either sodium metavanadate (NaVO3), vanadyl sulfate (VOSO4), vanadium pentoxide (V2O5) at several concentrations, or vehicle alone. Pulmonary inflammation was assessed by cytologic analysis of cells recovered from the respiratory tract (1 hr to 10 days postexposure). All three vanadium compounds were capable of inducing pulmonary inflammation in a dose-dependent manner. Neutrophil influx was greatest following exposure to VOSO4 (peaked at approximately 40% of cell population) and lowest following exposure to V2O5 (peaked at approximately 20 %). Significant neutrophil influx was detected as early as 4 hr following the instillation of NaVO3 and VOSO4 but not until 24 hr upon exposure to V2O5. The VOSO4-induced inflammatory response persisted longer (5 days) than that induced by NaVO3 and V2O5. Analysis of inflammatory cytokine mRNA expression closely followed these cytologic observations. Levels of mRNA for macrophage inflammatory protein-2 (MIP-2) and KC, considered the principal neutrophil chemotactic factors expressed in the rat, were rapidly induced as early as 1 hr following exposure, continued to be expressed throughout 48 hr, and were low but detectable at 5 and 10 days. NaVO3 and VOSO4, both very soluble forms of vanadium, tended to induce pulmonary inflammation and inflammatory cytokine mRNA expression more rapidly and more intensely than the less soluble form, V2O5. Analysis of KC mRNA expression in BAL cells 24 hr after instillation of NaVO3 by PCR in situ hybridization confirmed the increase in KC mRNA levels and indicated that alveolar macrophages have the highest expression level observed. Vanadium content of lavage fluid, BAL cells, and lung indicated rapid clearance of the metal from the lung surface and substantial accumulation by BAL cells and lung tissue. The rapid expression of MIP-2 and KC mRNA in BAL cells prior to the observed neutrophilia implicate them as important in the initiation of inflammation AU - Pierce LM AU - Alessandrini F AU - Godleski JJ AU - Paulauskis JD LA - PT - DEP - TA - Toxicology & Applied Pharmacology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Epidemic outbreak of interstitial lung disease in aerographics textile workers--the "Ardystil syndrome": a first year follow up PG - 94-95 AB - BACKGROUND: The longer term respiratory effects of massive inhalational exposure of textile printing sprayers to Acramin (the "Ardystil syndrome") are not well established. METHODS: A 12 month follow up of 27 heavily exposed textile sprayers was performed. RESULTS: Twenty one patients experienced cough, 18 dyspnoea, and 17 nose bleeding at initial exposure, with histological evidence of organising pneumonia in 13 cases, radiological abnormalities detected by computed tomographic scanning in 20 cases, and diminution of diffusion capacity to below 80% of predicted in seven cases. At one year after exposure symptoms persisted in 15 cases, radiological alterations in six, and diffusion capacity was reduced in nine. CONCLUSIONS: Whilst most of our patients showed improvement at one year, evidence of persistent lung involvement was present in an appreciable minority of exposed cases AU - Sole A AU - Cordero PJ AU - Morales P AU - Martinez ME AU - Vera F AU - Moya C LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 47 IP - DP - 1996 Jan 01 TI - Allergic reaction to merthiolate (a disinfectant) based on material from the Occupational Medicine Institute in Lodz [Polish] PG - 125-131 AB - Incidence and causes of allergy to merthiolate (thimerosal) was studied in 685 patients, examined in the Nofer Institute of Occupational Medicine, during the period from 1 September 1993 to 15 October 1995. Allergy to thimerosal was diagnosed in 39 persons (5.7%) including 25 (6.3%) females and 14 (4.9%) males. Health service workers predominated among those sensitized (13.8% of all medical personnel examined during that period). In 19 persons only allergy to mercury was observed. Among them 7 showed no skin changes, 6 manifested symptoms of hand dermatitis, in 4 patients atopic dermatitis and in 2 dermatitis diseminata were diagnosed. Two patients suffered from allergic rhinitis. It was found that the general vaccination of health service workers against viral hepatitis as well as immunotherapy with pollen preparations containing thimerosal (Catalet, Biomed, Poland) were the main causes of allergy to mertiolate. Allergy to thiosalicyclic acid was not observed and two persons reacted positively to mercuric chloride AU - KiecSwierczynska M LA - PT - DEP - TA - Medycyna Pracy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 97 IP - DP - 1996 Jan 01 TI - Occupational asthma caused by imbuia wood dust [case report] PG - 1025-1027 AB - Imbuia (Brazilian Walnut; Phoebe porosa) challenge immediate reaction joiner wood AU - Jeebhay MF AU - Prescott R AU - Potter PC AU - Ehrlich RI LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 24 IP - DP - 1996 Jan 01 TI - Profile of work-related health complaints among Swedish dental laboratory technicians PG - 138-144 AB - The purpose of the present investigation was to assess the prevalence and nature of occupation-related health problems among Swedish dental laboratory technicians. A 4-page questionnaire listing seven groups of health complaints was completed by 489 male and 242 female technicians, representing 56% of the active members of their organization. Similar information from 163 males and 160 females with other occupations was used for comparison. The biannual prevalence of health problems among the technicians was 79%, comprising musculoskeletal (68%), dermal (34%), respiratory 31%, neurological (26%), systemic (19%) and eyesight/hearing problems (15%). Job-specific ergonomic and stress factors were responsible for musculoskeletal and neurological (finger) reactions whereas chemical insults, grinding dusts and indoor climate caused dermal, respiratory and systemic reactions. There was no age prevalence as regards health complaints, but female technicians consistently showed a large prevalence of musculoskeletal, dermal systemic and neurological complaints than their male counterparts (P < 0.05, chi2). A similar sex difference was also present in the control group. A considerable part of the reactions were perceived to be of minor importance, bringing the total biannual prevalence down to 57%. However, the prevalence of job-related health complaints was still higher among the technicians than in control groups for all indicators except systemic and eyesight/hearing problems. The profile of health complaints among dental laboratory technicians was characterized by musculoskeletal, neurological and dermal reaction, underlining the importance of job-specific ergonomic and chemical hazards. Only a few of the technicians had consulted medical personnel AU - Jacobsen N AU - Derand T AU - HenstenPettersen A LA - PT - DEP - TA - Community Dentistry & Oral Epidemiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 5 IP - DP - 1996 Jan 01 TI - Sick building syndrome symptoms among the staff in schools and kindergartens: are the levels of volatile organic compounds and carbon dioxide responsible? PG - 235- AU - Willers S AU - Andersson S AU - Andersson R AU - Granten J AU - Sverdrup C AU - Rosell L LA - PT - DEP - TA - Indoor Built Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Comparison of soybean epidemic asthma and occupational asthma PG - 743-749 AU - Anto JM AU - Sunyer J AU - Newman Taylor AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Byssinosis: a review PG - 632-637 AU - Niven RM AU - Pickering CAC LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 51 IP - DP - 1996 Jan 01 TI - Respiratory irritants encountered at work PG - 541-545 AU - Newman Taylor AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 46 IP - DP - 1996 Jan 01 TI - Smoking and exposure to occupational hazards in 8,304 workers in Ghangzhou, China PG - 351-355 AU - Lam TH AU - Jiang CQ AU - Liu WW AU - Zhang WS AU - He JM AU - Zhu CQ LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 44 IP - DP - 1996 Jan 01 TI - Report of an outbreak: nursing home architecture and influenza-A attack rates. PG - 910-913 AB - OBJECTIVE: To determine factors that might account for a significantly lower attack rate in a newly constructed nursing building during an epidemic of type A influenza. SETTING: A four-building, long-term carefacility for veterans and their spouses, with an average daily census of 690. DESIGN: Prospective surveillance with retrospective analysis. PARTICIPANTS: Symptomatic residents submitting to viral culture. MEASUREMENTS: Number of respiratory illnesses and influenza cultures in consenting symptomatic residents. Building characteristics. RESULTS: An influenza A (H3N2) outbreak was culture-confirmed in 68 nursing home residents. Influenza A was isolated in 3/184 (2%) residents in Building A, 31/196 (16%) in Building B, 18/194 (9%) in Building C, and 16/116 (14%) in Building D. Denominators are average daily census during the outbreak. Building A had significantly fewer culture-confirmed cases than the other buildings (P < .001). Fewer residents in Building A, 47% compared with 61% in Buildings B, C, and D, were participants in a formal study of influenza. Eight of 15 respiratory illnesses identified during the outbreak that were not cultured occurred in Building A. These factors could not account for the difference in attack rates. Building A has a unique ventilation system, more square feet of public space per resident, and does not contain office space that serves the entire four-building facility. CONCLUSION: Our retrospective observation suggests that architectural design may influence the attack rate of influenza A in nursing homes. AU - Drinka PJ AU - Krause P AU - Schilling M AU - Miller BA AU - Shult P AU - Gravenstein S LA - PT - DEP - TA - J Am Geriatr Soc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19960101 IS - IS - VI - 9 IP - DP - 1996 Jan 01 TI - Comparison of mean daily diurnal variation in peak expiratory flow and FEV1 PG - 91s- AU - Bright P AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - Results of a national survey of tuberculosis notification in England and Wales in 1993 PG - 442P- AU - Watson JM AU - on behalf of a PHLS/BTS/DH collaborative group LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 16 IP - DP - 1995 Jan 01 TI - Nosocomial tuberculosis: an outbreak of a strain resistant to seven drugs PG - 152-159 AB - OBJECTIVE: To evaluate nosocomial transmission of multidrug-resistant (MDR) tuberculosis (TB). DESIGN: Outbreak investigation: review of infection control practices and skin test results of healthcare workers (HCWs); medical records of hospitalized TB patients and mycobacteriology reports; submission of specimens for restriction fragment length polymorphism (RFLP) typing; and an assessment of the air-handling system. SETTING: A teaching hospital in upstate New York. RESULTS: Skin-test conversions occurred among 46 (6.6%) of 696 HCWs tested from August through October 1991. Rates were highest on two units (29% and 20%); HCWs primarily assigned to these units had a higher risk for conversion compared with HCWs tested following previous incidents of exposure to TB (relative risk [RR] = 53.4, 95% confidence interval [CI95] = 6.9 to 411.1; and RR = 37.4, CI95 = 5.0 to 277.3, respectively). The likely source patient was the only TB patient hospitalized on both units during the probable exposure period. This patient appeared clinically infectious, was associated with a higher risk of conversion among HCWs providing direct care (RR = 2.37; CI95 = 1.05 to 5.34), and was a prison inmate with TB resistant to seven antituberculosis agents. The MDR-TB strain isolated from this patient also was isolated from other inmate and noninmate patients, and a prison correctional officer exposed in the hospital. Mycobacterium tuberculosis isolates from all of these patients had matching RFLP patterns. Infection control practices closely followed established guidelines; however, several rooms housing TB patients had marginal negative pressure with variable numbers of air changes per hour, and directional airflow was disrupted easily. CONCLUSIONS: These data strongly suggest nosocomial transmission of MDR-TB to HCWs, patients, and a prison correctional officer working in the hospital. Factors contributing to transmission apparently included prolonged infectiousness of the likely source patient and inadequate environmental controls. Continued urgent attention to TB infection control is needed AU - Ikeda RM AU - Birkhead GS AU - DiFerdinando GT Jr AU - Bornstein DL AU - Dooley SW AU - Kubica GP AU - Morse DL LA - PT - DEP - TA - Infect Control Hosp Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 33 IP - DP - 1995 Jan 01 TI - A case of hypersensitivity pneumonitis probably caused by a humidifier in winter [Japanese] PG - 202-208 AB - A 64-year-old man was admitted complaining of cough, hemoptysis, dyspnea, and fever. His chest X-ray film on admission showed reticulo-granular shadows in both lung fields. Ausculation of his chest revealed fine crackles in both lower zones. After admission, he was treated with antibiotics, but his chest-radiographic appearance worsened temporarily, and sputum cytology results were repeatedly positive. Diagnosis was difficult. Differential cell count of the bronchoalveolar lavage fluid showed lymphocytosis, with a high CD 4/8 ratio. Transbronchial lung biopsy specimens revealed Masson bodies and alveolitis. With antibiotic therapy alone, his condition improved, and he was discharged. Five and a half hours later, his symptoms worsened and he was readmitted. His chest X-ray film on the second admission was almost the same as that on the first admission. His symptoms became less severe, and his condition improved without treatment. Hypersensitivity pneumonitis was diagnosed. Because the onset was in February, this was not considered to be a case of so-called summer type hypersensitivity pneumonitis a provocation test was done with water from the humidifier he had been using at home. The white blood cell count increased and PaO2 decreased significantly, so the result of the provocation test was thought to be positive. Therefore, so-called humidifier lung was strongly suspected. The results of sputum cytology on the first admission were probably falsely positive AU - Nakagawa A AU - Yamaguchi T AU - Takao T AU - Amano H LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Ventilation rate in office buildings and sick building syndrome PG - 709-714 AU - Jaakkola J AU - Miettinen P LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - Occupational asthma due to glutaraldehyde and formaldehyde in endoscopy and X-ray departments PG - 156-159 AB - BACKGROUND Glutaraldehyde is the best disinfectant for fibreoptic endoscopes. It is also used in the processing of x ray films. A number of studies have reported eye, nose, and respiratory symptoms in exposed workers. Three individual case reports of occupational asthma in endoscopy workers and a radiographer have also been published. We describe a further seven cases of occupational asthma due to glutaraldehyde in endoscopy and x ray departments, together with exposure levels measured during the challenge tests and in 19 endoscopy and x ray departments in the region. METHODS Eight workers were referred for investigation of suspected occupational asthma following direct or indirect exposure to glutaraldehyde at work. They were investigated by serial measurements of peak expiratory flow (PEF) and specific bronchial provocation tests. Glutaraldehyde levels were measured using personal and static short and longer term air samples during the challenge tests and in 13 endoscopy units and six x ray darkrooms in the region where concern about glutaraldehyde exposure had been expressed. Three of the workers investigated with occupational asthma came from departments where glutaraldehyde air measurements had been made; the others came from other hospitals or departments. RESULTS The diagnosis of occupational asthma was confirmed in seven workers, all of whom had PEF records suggestive of occupational asthma and positive specific bronchial challenge tests to glutaraldehyde. Bronchial provocation testing was negative in one worker who was no longer exposed and who had a less clearcut history of occupational asthma. Three workers also had a positive specific bronchial challenge to formaldehyde. The mean level of glutaraldehyde in air during the challenge tests was 0.068 mg/m3, about one tenth of the short term occupational exposure standard of 0.7 mg/m3. The levels obtained in the challenge chamber were similar to those measured in 13 endoscopy suites and six x ray darkrooms where median short term levels were 0.16 mg/m3 during decantation in endoscopy suites and < 0.009 mg/m3 in darkrooms. CONCLUSIONS Glutaraldehyde can cause occupational asthma. The exposure levels measured in the workplace suggest that sensitisation may occur at levels below the current occupational exposure standard. AU - Gannon PFG AU - Bright P AU - Campbell M AU - O'Hickey SP AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 5 IP - DP - 1995 Jan 01 TI - How much does environmental tobacco smoke contribute to the building symptom index? PG - 22-28 AB - Environmental tobacco smoke (ETS) has been identified as one of the factors associated with the symptoms of the sick building syndrome (SBS). We investigated the role of ETS in an office building during the phased introduction of a smoking ban. Over a two-year period we measured symptoms using a validated questionnaire, environmental nicotine levels and salivary cotinine as a biological marker of nicotine absorption in a stratified systemic sample of 375 office employees (91% response rate). In addition, 26 persons from a non-smoking office were studied as a control group. This report describes the findings derived from a cross-sectional analysis of the initial baseline data. Amongst the validated nonsmokers, symptoms increased with increasing nicotine exposure from ETS (r= 0.165 p < 0. 01), supporting the role of ETS in the SBS. Smokers reported significantly fewer symptoms than non-smokers, as has been found before, but were exposed to higher levels of airborne nicotine as expected. We suggest that this factor, along with the misclassification of smoking status, may have obscured an association between ETS exposure and the SBS in previous studies. An analysis of the findings after implementation of the smoking ban should provide further information on how much of the SBS is attributable to ETS in this study population. AU - Raynal A AU - Burge PS AU - Robertson AS AU - Jarvis M AU - Archibald M AU - Hawkin D LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 27 IP - DP - 1995 Jan 01 TI - Respiratory symptoms, ventilatory impairment, and bronchial reactivity in oil mist-exposed automobile workers PG - 247-256 AB - Studies concerning the respiratory effects of oil mists are sparse and contradictory. The aim of this study was to determine the respective effects of occupational exposure to straight cutting oils and soluble mineral oils on the prevalence of respiratory symptoms, ventilatory impairment, and bronchial reactivity. The population study consisted of 308 male workers of a large French car-making plant, including 40 subjects chronically exposed to straight cutting oils (group S), 51 subjects chronically exposed to soluble mineral oils (group E), 139 subjects with chronic dual exposure to straight cutting oils and soluble mineral oils (group D), and 78 unexposed assembly workers used as a control group (group C). Worker evaluation included a standardized questionnaire, measurement of pulmonary function, and a methacholine challenge. Oil mist concentration at the work place was determined by gravimetric analysis. The arithmetic mean concentration was 2.6 +/- 1.8 mg/m3. The geometric mean concentration was 2.2 +/- 1.9 mg/m3. The prevalence of respiratory symptoms did not differ significantly among the four groups. However, the subjects exposed to straight cutting oils (group S + group D) had a significantly higher prevalence of chronic cough and/or phlegm than the others (group E + group O): 25.7% vs. 16.3% (p = 0.048). Furthermore, the prevalence of cough and/or phlegm increased significantly (p = 0.03) with increasing duration of exposure to straight cutting oils after adjustment on smoking categories. Lung function tests did not differ significantly among the four groups but we observed a significant decrease of forced expiratory volume in 1 sec (FEV1), forced expiratory flow during the middle half of forced vital capacity (FEF25-75), and maximal flow rate at 50% and 25% of exhaled forced vital capacity (V50 and V25) according to duration of exposure among smokers exposed to straight cutting oils, suggesting a synergistic effect of tobacco and insoluble oils. No effect of exposure to mineral oils on bronchial reactivity was demonstrated. It is concluded that despite low levels of pollution by oil mists, the present study has shown tenuous adverse chronic effects of straight cutting oils on respiratory symptoms and lung function. However, no adverse effect of soluble mineral oils was demonstrated. These results suggest that threshold limit values for mineral oils should be reassessed 0 (Air Pollutants, Occupational). 8020-83-5 (Mineral Oil) AU - Ameille J AU - Wild P AU - Choudat D AU - Ohl G AU - Vaucouleur JF AU - Chanut JC AU - Brochard P LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 95 IP - DP - 1995 Jan 01 TI - Hypersensitivity pneumonitis (extrinsic allergic alveolitis) induced by isocyanates PG - Pt 1):1004-10 AB - BACKGROUND: Chemical-induced hypersensitivity pneumonitis has been so far rarely described. The purpose of this study was to find out whether hypersensitivity pneumonitis is a common disorder in isocyanate workers. METHODS: Company physicians' case histories of 1780 isocyanate workers were evaluated. In 16 subjects suspected of having isocyanate-induced hypersensitivity pneumonitis, chest x-ray films were made; levels of IgE and IgG antibodies to isocyanate-human serum albumin were estimated; conjugates and isocyanate challenge tests, bronchoalveolar lavage fluid analyses, and/or lung histologic investigations were performed. RESULTS: Each of the 14 study patients who had hypersensitivity pneumonitis had work-related dyspnea and fever occurring several hours after the start of work with isocyanates. Typical clinical findings were the reduction of lung diffusing capacity (n = 10), reticular or nodular lung patterns in the x-ray film (n = 9), and serum IgG antibodies specific to isocyanate-human serum albumin conjugates (n = 10). Restrictive ventilation patterns in the inhalation challenge tests (n = 5), lymphocytic and/or neutrophilic alveolitis seen in bronchoalveolar lavage fluid analyses (n = 7), and lymphohistiocytic patterns mostly associated with mild fibrosis in lung histology (n = 5) confirmed the diagnosis. CONCLUSIONS: Occupational exposure to isocyanate vapors and aerosols induces typical hypersensitivity pneumonitis in at least 1% of the isocyanate workers with symptoms. Diphenylmethane diisocyanate was found to be the main cause of this disorder 0 (Allergens). 0 (IgG). 0 (Isocyanates). 101-68-8 (4,4'-diphenylmethane diisocyanate) AU - Baur X LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 364 IP - DP - 1995 Jan 01 TI - A major baker's asthma allergen from rye flour is considerably more active than its barley counterpart PG - 36-40 AB - A rye flour protein of about 13.5 kDa, as well as its barley homologue, have been isolated. The rye component was recognized in vitro by IgE of allergic patients and provoked positive responses in 15 out of 21 baker's asthma patients (71%) when skin prick tests were performed. Its barley homologue showed no detectable in vitro reactivity and caused positive responses in only one-third of patients. Although no inhibitory activity against different alpha-amylases or trypsin was found for these two proteins, their N-terminal sequencing revealed considerable similarity to several members of the cereal alpha-amylase/trypsin inhibitor family 0 (amylase-trypsin inhibitor). 0 (Allergens). 0 (Plant Proteins) 37341-29-0 (IgE) AU - GarciaCasado G AU - Armentia A AU - SanchezMonge R AU - Sanchez LM AU - LopezOtin C AU - Salcedo G LA - PT - DEP - TA - FEBS Lett JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 107 IP - DP - 1995 Jan 01 TI - Peak flow as a measure of airway dysfunction in swine confinement operators PG - 1303-1308 AB - To evaluate the usefulness of a portable peak flow meter in predicting airway dysfunction in symptomatic swine confinement workers, we conducted a study using an established cohort of swine workers in Iowa. Participants were randomly selected from a group of 207 swine confinement workers and a group of nonconfinement farmers who had been followed longitudinally. Swine confinement workers with work-related symptoms were identified, and two control groups (swine confinement workers and nonconfinement workers) without work-related symptoms were frequency matched by age, sex, and smoking status to the symptomatic swine confinement workers. Peak flow measures were obtained for 7 days using a mini-Wright peak flow meter and comparisons were made between the symptomatic swine confinement farmers (n = 24) and both groups of asymptomatic workers: swine confinement workers (n = 21) and neighborhood farmer controls (n = 25). Peak flow readings were recorded by subjects five times per day for 7 days, initially on awakening, then after chores, before lunch, before dinner, and before bedtime. The actual hour of day for each measurement of peak flow was similar between the three groups. Percent changes from initial AM peak flow did not significantly differ between subject groups. However, symptomatic swine confinement workers consistently exhibited significantly lower initial and subsequent mean peak flow values compared with asymptomatic swine confinement workers and neighborhood control farmers, controlling for age, height, gender, and smoking status. These differences occurred on most of the measures of peak flow throughout the work day. The persistence of these lower values throughout the work day is remarkably consistent during the study period and is suggestive of airway disease in the symptomatic swine confinement workers. Our findings suggest that peak flow meters are a useful indicator of potential airway injury and offer an additional portable, diagnostic tool in the assessment of symptomatic workers AU - Quinn TJ AU - Donham KJ AU - Merchant JA AU - Schwartz DA LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 37 IP - DP - 1995 Jan 01 TI - Oil mist exposure in industrial health--a review PG - 113-122 AB - Many reports dealing with the toxicity of oil mist in industrial health have been published. The condition appears to be worldwide in distribution and the number of reported cases increases with increasing clinical awareness. In 158 reports published from 1965 to 1993 the following diseases were observed: Skin--contact dermatitis, oil acne and photosensitive allergic dermatitis; Scrotum--benign and malignant tumors; Respiratory system-nasal discomfort symptoms, rhinitis, nasal mucosal dysplasia, nasal mucosal tumor, laryngeal cancer, bronchitis, lipoid pneumonia, lung fibrosis, lung cancer and bronchial asthma; Others--possible carcinogenicity, high incidence of chromosomal change. This shows that oil mist appears to be involved in many industrial diseases, however, cause-and-effect relationship still remains a matter of conjecture; in which exposure dose and/or duration-dependent toxicity is highly probable. Further investigations will be required including immunotoxicological as well as environmental studies for oil mist exposure. [References: 65] AU - Karube H AU - Aizawa Y AU - Nakamura K AU - Maeda A AU - Hashimoto K AU - Takata T LA - PT - DEP - TA - Sangyo Eiseigaku Zasshie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 74 IP - DP - 1995 Jan 01 TI - Hypersensitivity pneumonitis in a raptor handler and a wild bird fancier PG - 437-441 AB - BACKGROUND: Hypersensitivity pneumonitis has been associated with a variety of antigens in various settings. We have recently encountered one case of hypersensitivity pneumonitis from owl droppings and another case from a wild Moluccan cockatoo. OBJECTIVE: It is important to alert physicians to the possibility of hypersensitivity pneumonitis when dealing with wildlife workers and wild bird fanciers. METHOD: A report of two cases with progress and response to therapy. RESULTS: Clinical and serologic information are of value in the diagnosis of hypersensitivity pneumonitis due to birds and avoidance is the optimal approach. CONCLUSION: There are many raptor handlers and wild bird fanciers across the United States and the world. Given the incidence of hypersensitivity pneumonitis in pigeon breeders, this may herald a new variant of allergic disease among wildlife workers and wild bird fanciers AU - Choy AC AU - Patterson R AU - Ray AH AU - Roberts M LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 74 IP - DP - 1995 Jan 01 TI - Latex allergy in housekeeping personnel PG - 415-418 AB - BACKGROUND: Latex allergy has been well described in healthcare workers and children with spina bifida. Cost effective measures to avoid latex allergic reactions are possible in these recognized risk groups. OBJECTIVE: To study the prevalence of latex allergy among hospital housekeepers regularly exposed to latex gloves. METHODS: Fifty members of the housekeeping staff at a Toronto teaching hospital were screened by questionnaire for latex allergy. Patients with possible atopy or symptoms suggestive of latex allergy (20) were skin tested with latex (Bencard Laboratories) eight common allergens and histamine control. RESULTS: Four of 20 tested had a positive latex prick skin test representing an 8% prevalence overall within this group, and a 20% prevalence among atopic housekeepers. Based on an expected 1% prevalence in the general population, this was statistically significant (P < .005). Latex-positive patients had extensive exposure to high protein-unlined latex gloves. Positive patients had a similar yet completely unique immunoblot pattern of IgE binding. All four positive patients had unrecognized latex allergic symptoms (hand dermatitis, rhinoconjunctivitis). One housekeeper experienced itchiness of her face, angioedema, and lightheadedness immediately after inflating a latex balloon. CONCLUSIONS: The 8% prevalence of a positive latex skin test in regularly exposed hospital housekeepers is similar to that observed among healthcare workers suggesting this is a new risk group 0 (Latex) AU - Sussman GL AU - Lem D AU - Liss G AU - Beezhold D LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 61 IP - DP - 1995 Jan 01 TI - Legionella contamination of dental-unit waters PG - 1208-1213 AB - Water samples collected from 28 dental facilities in six U.S. states were examined for the presence of Legionella pneumophila and other Legionella spp. by the PCR-gene probe, fluorescent- antibody microscopic, and viable-plate-count detection methods. The PCR and fluorescent-antibody detection methods, which detect both viable and viable nonculturable Legionella spp., gave higher counts and rates of detection than the plate count method. By the PCR-gene probe detection method, Legionella spp. were detected in 68% of the dental-unit water samples and L. pneumophila was detected in 8%. Concentrations of Legionella spp. in dental-unit water reached 1,000 organisms per ml or more in 36% of the samples, and 19% of the samples were in the category of 10,000/ml or above. L. pneumophila, when present in dental-unit water, never reached concentrations of 1,000/ml or more. Microscopic examination with fluorescent-antibody staining indicated that the contamination was in the dental-unit water lines rather than in the handpieces. Legionella spp. were present in 61% of potable water samples collected for comparative analysis from domestic and institutional faucets and drinking fountains; this percentage was not significantly different from the rate of detection of Legionella spp. in dental-unit water. However, in only 4% of the potable water samples did Legionella spp. reach concentrations of 1,000 organisms per ml, and none was in the 10,000 organisms-per- ml category, and so health-threatening levels of Legionella spp. in potable water were significantly lower than in dental-unit water. L. pneumophila was found in 2% of the potable water samples, but only at the lowest detectable level.(ABSTRACT TRUNCATED AT 250 WORDS) 0 (DNA Probes) AU - Atlas RM AU - Williams JF AU - Huntington MK LA - PT - DEP - TA - Applied & Environmental Microbiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 27 IP - DP - 1995 Jan 01 TI - Respiratory dysfunction in swine production facility workers: dose-response relationships of environmental exposures and pulmonary function PG - 405-418 AB - Human respiratory health hazards for people working in livestock confinement buildings have been recognized since 1974. However, before comprehensive control programs can be implemented, more knowledge is needed of specific hazardous substances present in the air of these buildings, and at what concentrations they are harmful. Therefore, a medical epidemiological and exposure-response study was conducted on 207 swine producers using intensive housing systems (108 farms). Dose-response relationships between pulmonary function and exposures are reported here. Positive correlations were seen between change in pulmonary function over a work period and exposure to total dust, respirable dust, ammonia, respirable endotoxin, and the interactions of age-of-producer and dust exposure and years-of-working-in-the-facility and dust exposure. Relationships between baseline pulmonary function and exposures were not strong and therefore, not pursued in this study. The correlations between exposure and response were stronger after 6 years of exposure. Multiple regression models were used to identify total dust and ammonia as the two primary environmental predictors of pulmonary function decrements over a work period. The regression models were then used to determine exposure concentrations related to pulmonary function decrements suggestive of a health hazard. Total dust concentrations > or = 2.8 mg/m3 were predictive of a work period decrement of > or = 10% in FEV1. Ammonia concentrations of > or = 7.5 ppm were predictive of a > or = 3% work period decrement in FEV1. These predictive concentrations were similar to a previous dose-response study, which suggested 2.5 mg/m3 of total dust and 7 ppm of NH3 were associated with significant work period decrements. Therefore, dust > or = 2.8 mg/m3 and ammonia > or = 7.5 ppm should be considered reasonable evidence for guidelines regarding hazardous exposure concentrations in this work environment 0 (Air Pollutants, Occupational). 0 (Endotoxins). 7664-41-7 (Ammonia) AU - Donham KJ AU - Reynolds SJ AU - Whitten P AU - Merchant JA AU - Burmeister L AU - Popendorf WJ LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 89 IP - DP - 1995 Jan 01 TI - Asthmatic symptoms, airway responsiveness and recognition of bronchoconstriction PG - 181-185 AB - During an epidemiological investigation of asthma in an occupational setting, 1126 subjects completed a modified Medical Research Council respiratory questionnaire, then underwent airway responsiveness measurements as PD20FEV1 to methacholine. Previous experience of bronchoconstriction was assessed in the 481 subjects with measurable airway responsiveness (PD20FEV1 < 6400 g) by asking 'have you ever felt like this before' at the end of their methacholine challenge tests, i.e. when the subjects were bronchoconstricted by FEV1 decrements of at least 20%. The responses to this question bore no relationship to the previously administered questionnaire responses about wheezing, chest tightness, coughing, or breathlessness. However, there was an inverse relationship with PD20FEV1 measurements (P < 0.001), the positive response rate to the question falling from 92% among those with PD20FEV1 < 50 micrograms to 27% among those with PD20FEV1 in the highest measurable range (3200-6400 micrograms). This suggests that airway responsiveness measurements are a more reliable guide to subjects' previous experience of substantial bronchoconstriction (i.e. asthma) than are the responses to respiratory questionnaires 55-92-5 (Methacholine Chloride) AU - Stenton SC AU - Beach JR AU - Avery AJ AU - Hendrick DJ LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Airway hyperresponsiveness in workers exposed to low levels of irritants PG - 53-61 AB - The purpose of this study was to assess the association between occupational exposure to low levels of airway irritants, and airway responsiveness to histamine. In 688 male workers, symptom prevalence was assessed according to the British Medical Research Council (BMRC) questionnaire. All subjects performed a 30 s tidal breathing challenge test. Airway hyperresponsiveness (AHR) was defined as a 20% fall in forced expiratory volume in one second (FEV1) at < or = 32 mg.ml-1 histamine. On the basis of job titles and working department, the exposure status of all workers was characterized into seven groups: 1) reference group; 2) white collars; 3) SO2, HCl, SO4(2-); 4) polyester vapour; 5) oil mist and oil vapour; 6) polyamide and polyester vapour; and 7) multiple exposures. Using multiple logistic regression, no association was found between the exposure groups and a higher prevalence of AHR. A higher prevalence was significantly associated with a low FEV1, a history of allergy, and the presence of chronic respiratory symptoms. Subjects in the SO2 group and the oil mist group with < or = 5 exposure years had a lower prevalence of AHR, probably due to pre-employment selection procedures. There was some trend for subjects with more than 5 yrs exposure to polyester vapour and to oil mist and to oil vapour to have a higher prevalence of AHR. Analyses using the dose-response slope according to O'Connor, revealed similar results and provides no additional information. We conclude that no association could be demonstrated between low grade exposure to airway irritants and airway hyperresponsiveness, and that further research is needed to elucidate this relationship 0 (Air Pollutants, Occupational). 0 (Irritants) AU - Kremer AM AU - Pal TM AU - Schouten JP AU - Rijcken B LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 39 IP - DP - 1995 Jan 01 TI - Surveillance systems for occupational disease PG - 257-260 AU - Meredith SK AU - McDonald C LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 125 IP - DP - 1995 Jan 01 TI - Value of antibody level in diagnosing anhydride-induced immunologic respiratory disease PG - 650-653 AB - The objective of this study was to determine whether immunologic anhydride-induced respiratory disease could be predicted on the basis of the level of specific immunoglobulin E (IgE) or immunoglobulin G (IgG) antibody. Eight-one anhydride-exposed employees in one plant were studied. Fourteen had disease and 67 did not. Immunologic studies were performed by enzyme-linked immunosorbent assay and expressed as titers. When optimal discriminant analysis was used, IgE < 1:5 and IgG < or = 1:10 were found to be the optimal titers for separating employees with and without immunologic respiratory disease caused by anhydrides. When IgG < or = 1:10 was used, 62 of 81 workers were correctly classified; the sensitivity was 100%, the positive predictive value was 45%, the specificity was 75%, and the negative predictive value was 100%. When IgE < 1:5 was used, 73 of 81 workers were correctly classified; the sensitivity was 86%, the positive predictive value was 67%, the specificity was 91%, and the negative predictive value was 97%. In conclusion, anhydride disease status can be predicted on the basis of specific IgG or IgE antibody level 0 (Antibodies). 0 (Epoxy Resins). 0 (Phthalic Anhydrides) 37226-48-5 (araldite). 37341-29-0 (IgE) AU - Grammer LC AU - Shaughnessy MA AU - Hogan MB AU - Berggruen SM AU - Watkins DM AU - Yarnold PR LA - PT - DEP - TA - Journal of Laboratory & Clinical Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 24 IP - DP - 1995 Jan 01 TI - Phenyl isocyanate-induced asthma in rats following a 2-week exposure period PG - 217-228 AB - This study was conducted to assess the toxic effects of repeated inhalation exposures to phenyl isocyanate vapor in male Wistar rats. Rats were exposed to design concentrations of 0, 1, 4, 7, or 10 mg/m3 phenyl isocyanate air for 2 weeks (6 hr/day, 5 days/week). The rats were assessed for normal toxicologic parameters, and pulmonary function tests, blood gas measurements, and analysis of bronchoalveolar lavage fluid (BALF) parameters were utilized shortly after exposures as well as 2 months postexposure. The results indicated that rats exposed to 7 and 10 mg/m3 experienced decreased body weights, hypoactivity, hypothermia, signs of respiratory tract irritation, delayed onset of mortality, and changes in organ weights. In addition, pulmonary function tests demonstrated decreased forced expiratory flow rates and quasistatic lung compliance. Arterial blood gases showed an arterial hypoxemia and changes consistent with a pronounced venous-admixture-like perfusion, suggesting severe mismatch of the ventilation/perfusion relationship. Delayed onset of mortality appeared to be associated with respiratory acidosis and hypoxemia. Biochemical and cellular components in BALF complemented the results of the functional alterations. Remarkable changes were indicated by increased activities of the BALF parameters, gamma-GPT, protein, and sialic acid. Histopathological findings provided evidence of increased secretory cell activity and a concentration-dependent increase in goblet cell hyperplasia at concentrations of 4 mg/m3 and above. In rats exposed to 7 mg/m3 further findings consisted of intraluminal inflammation of airways, hypertrophia of bronchial smooth muscle, epithelial desquamation, and eosinophilia of the airways. A complete regression of morphological lesions was not found in the animals exposed to 4 mg/m3 and above at the 2-month postexposure time period. In conclusion, the damage to the airways comprise most of the features characteristic of chronic airway inflammation or asthma 0 (Irritants). 0 (Isocyanates). 103-71-9 (phenyl isocyanate) AU - Pauluhn J AU - Rungeler W AU - Mohr U LA - PT - DEP - TA - Fundamental & Applied Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 151 IP - DP - 1995 Jan 01 TI - Which index of peak expiratory flow is most useful in the management of stable asthma? PG - 1320-1325 AB - Calculation of diurnal peak expiratory flow (PEF) variability using values before and after bronchodilator is no longer possible for many asthmatic patients because they now use beta- agonists "as needed" for symptoms rather than regularly. This study assesses the usefulness of a number of alternative PEF indices as markers of airway liability in subjects with stable, although not necessarily well-controlled, asthma. Forty-six adult subjects completed a questionnaire about symptoms and treatment in the previous 3 mo. Spirometric function and airway hyperresponsiveness (AHR) were assessed; AHR was expressed as dose response ratio (DRR) (maximal percent fall in FEV1 divided by final dose of histamine). Subjects recorded PEF morning and evening, before and after bronchodilator (if used) for 2 wk. Nine different PEF indices were calculated. Diurnal variability (amplitude percent maximum) without bronchodilator was significantly less than diurnal variability with bronchodilator. Normal indices of PEF lability were found in 42% of subjects with reduced maximal midexpiratory flow (MMEF). Most of the PEF indices correlated strongly with DRR, and less strongly with symptom score and airway obstruction. Minimum morning prebronchodilator PEF over a week (expressed as percent recent best or percent predicted) is recommended as the best PEF index of airway lability in patients with stable asthma because it correlates strongly with AHR, patients are more likely to comply with a once-daily reading, the calculation is simple, and regular use of a beta-agonist is not required 0 (Adrenergic beta-Agonists). 0 (Bronchodilator Agents) AU - Reddel HK AU - Salome CM AU - Peat JK AU - Woolcock AJ LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Maintenance of stellite and tungsten carbide saw tips: respiratory health and exposure-response evaluations PG - 185-191 AB - OBJECTIVE--To study exposure to cobalt and chromium in saw maintenance rooms and test respiratory health among saw filers at lumber mills. Hard-metal lung disease is associated with cobalt in the manufacture of tungsten carbide tools; recently it has also been reported among tool maintenance workers. Lumber mills often use saws tipped with tungsten carbide or with a newer alloy, stellite (containing more cobalt, as well as chromium). METHODS-- A cross sectional study of 118 saw filers at eight lumber mills was carried out that included a standardised questionnaire, spirometry, personal air sampling, and examination of tasks every 10 minutes (by observation). Comparison data were from a study of bus mechanics tested with similar methods. RESULTS AND CONCLUSION- -Cobalt exposure was associated with tungsten carbide grinding but not with stellite grinding. Chromium exposure was associated mainly with stellite welding. Saw filers had a twofold increase in phlegm and wheeze (P < 0.01) and a threefold increase in cough, phlegm, and wheeze related to work (P < 0.001), but no increase in breathlessness. Stellite welding was associated with a significant increase in nasal symptoms and cough related to work and a small decrease in airflow (forced expiratory volume in one second/forced vital capacity (FEV1/FVC%), P < 0.05). Saw filers wet grinding with tungsten carbide had significant reductions in forced expiratory lung volumes (FEV1 and FVC, P < 0.05) and were significantly more likely to have FEV1 and FVC values in the abnormal range. Cobalt exposure (in wet grinding) and duration of work that involved tungsten carbide grinding were both associated with significant reductions in FEV1 and FVC. Average cobalt exposures in this study were about 5 micrograms/m3, well below the currently accepted permissible concentration, which suggests that the current workplace limit for cobalt may be too high 0 (Chromium Alloys). 0 (Tungsten Compounds). 11130-73-7 (tungsten carbide). 7440-47-3 (Chromium). 7440-48-4 (Cobalt) AU - Kennedy SM AU - ChanYeung M AU - Marion S AU - Lea J AU - Teschke K LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - Pneumoconiosis and systemic sclerosis following 10 years' exposure to polyvinylchloride dust PG - - AU - Studnicka MJ AU - Menzinger G AU - Drlicek M AU - Maruna H AU - Neumann MG LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - Occupational asthma due to gas metal arc welding on mild steel PG - 587-589 AB - Occupational asthma has been documented in electric arc welders exposed to manual metal arc welding on stainless steel. A subject is described who developed late and dual asthmatic reactions after occupational-type challenge exposure to gas metal arc welding on uncoated mild steel. AU - Vandenplas O AU - Dargent F AU - Auverdin J AU - Boulanger J AU - Bossiroy J AU - Roosels D AU - Vande Weyer R LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - Occupational asthma caused by dry metabisulphite PG - - AB - A case is described of occupational asthma in a worker with no previous history of asthma who sprinkled dried metabisulphite powder onto potatoes and developed work-related symptoms. Occupational asthma was confirmed by specific inhalation challenges. AU - Malo JL AU - Cartier A AU - Desjardins A LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 9 IP - DP - 1995 Jan 01 TI - Causality in occupational health: the Ardystil case [Spanish] PG - 371-379 AB - Establishing causal relationships has been and is today a matter of debate in epidemiology. The observational nature of epidemiological research rends difficult the proving of these relationships. Related to this, different models and causal criteria have been proposed in order to explain health and disease determinants, from pure determinism in Koch postulates, accepting unicausal explanation for diseases, to more realistic multicausal models. In occupational health it is necessary to formulate causal models and criteria to assess causality, and frequently causal assessment in this field has important social, economic and juridical relevance. This paper deal with evaluation of causal relationships in epidemiology and this evaluation is illustrated with a recent example of an occupational health problem in our milieu: the Ardystil case AU - Garcia Garcia AM AU - Benavides FG LA - PT - DEP - TA - Gaceta Sanitaria JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Respiratory health effects of man-made vitreous (mineral) fibres. [Review] PG - 2149-2173 AB - The group of man-made mineral or vitreous fibres (MMMFs or MMVFs) includes glass wool, rock wool, slag wool, glass filaments and microfibres, and refractory ceramic fibres (RCFs). Experimental observations have provided evidence that some types of MMVF are bioactive under certain conditions. The critical role of size parameters has been demonstrated in cellular and animal experiments, when intact fibres are in direct contact with the target cells. It is, however, difficult to extrapolate the results from these studies to humans since they bypass inhalation, deposition, clearance and translocation mechanisms. Inhalation studies are more realistic, but show differences between animal species regarding their sensibility to tumour induction by fibres. Fibre biopersistence is an important factor, as suggested by recent inhalation studies, which demonstrate positive results with RCF for fibrosis, lung tumours and mesothelioma. There is no firm evidence that exposure to glass-, rock- and slag wool is associated with lung fibrosis, pleural lesions, or nonspecific respiratory disease in humans. Exposure to RCF could enhance the effects of smoking in causing airways obstruction. An elevated standard mortality ratio for lung cancer has been demonstrated in cohorts of workers exposed to MMVF, especially in the early technological phase of mineral (rock slag) wool production. During that period, several carcinogenic agents (arsenic, asbestos, polycyclic aromatic hydrocarbons (PAH)) were also present at the workplace and quantitative data about smoking and fibre levels are lacking. It is not possible from these data to determine whether the risk of lung cancer is due to the MMVFs themselves. No increased risk of mesothelioma has been demonstrated in the cohorts of workers exposed to glass-, slag-or rock wool. There are in fact insufficient epidemiological data available concerning neoplastic diseases in RCF production workers because of the small size of the workforce and the relatively recent industrial production. AU - De Vuyst P AU - Dumortier P AU - Swaen GM AU - Pairon JC AU - Brochard P LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Cross-sectional assessment of workers with repeated exposure to chlorine over a three year period PG - 2046-2054 AB - Airflow obstruction has been described in workers who experienced symptoms after acute exposure to chlorine. Persistent bronchial hyperresponsiveness has also been assessed, but mainly in case studies. In this cross-sectional study, we have assessed the relationship between inhalational accidents ("puffs") involving chlorine and persistent symptoms as well as hyperresponsiveness in 239 out of 255 at-risk workers (94%). No relationship was found between persistent symptoms and the exposure variables studied. Forced vital capacity (FVC) was higher in subjects who had had no symptoms after a "puff", compared with those who had experienced mild symptoms. Forced expiratory volume in one second (FEV1) and FVC were significantly lower in subjects who experienced more than 10 puffs with mild symptoms than in subjects who reported no symptomatic puff. The presence of bronchial hyperresponsiveness was not related to exposure, but the methacholine dose-response slope showed a tendency to increased bronchial responsiveness with increased exposure. A significant difference was shown in subjects who experienced more than 10 puffs with mild symptoms. In this group of workers, repeated exposure to chlorine with acute respiratory symptoms was associated with a slight but significant reduction in expiratory flow rates, together with an increase in bronchial responsiveness, without long-term symptoms AU - Gautrin D AU - Leroyer C AU - L'Archeveque J AU - Dufour JG AU - Girard D AU - Malo JL LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 86 IP - DP - 1995 Jan 01 TI - European multicentric case control study on risk for mesothelioma after non-occupational (domestic and environmental) exposure to asbestos PG - 496-500 AB - The paper presents the European multicentric case-control study on risk for mesothelioma after non-occupational (domestic and environmental) exposure to asbestos. The study includes eight centres in seven European countries (Belgium, Denmark, Greece, Italy, Spain, Sweden and Switzerland). It is focused on the measurement of mesothelioma risk in relation to low intensity exposure to asbestos and to exposure to MMMF and other agents. It includes incident cases of pleural malignant mesothelioma (histologically diagnosed and verified) and a random sample of the population AU - Mollo F AU - Magnani C LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - IP - DP - 1995 Jan 01 TI - Early diagnosis and effective prevention of occupational allergies caused by hexavalent chromium [RUSSIAN] PG - 34-37 AB - Clinical and allergologic evaluation covered a large group of workers engaged into alumina production and exposed to chromate. Those workers were also subjected to long-standing follow-up. The studies helped to find correlation of chromium concentration in air with occurrence of the occupational allergies and latent sensibilization of respiratory tract to chromium. Immune modulator Levamisol was proved to act as a desensibilizer in prophylaxis of the occupational allergies in individuals with the latent sensibilization AU - Budanova LF LA - PT - DEP - TA - Meditsina Truda i Promyshlennaia Ekologiia JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - The outcome of occupational asthma in the UK PG - 301s- AU - Ross DJ AU - McDonald JC LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 108 IP - DP - 1995 Jan 01 TI - Lung health in sawmill workers exposed to pine and spruce PG - 642-646 AB - Workers exposed to a variety of wood dusts have been shown to exhibit occupational asthma, lung function deficits, and elevated levels of respiratory symptoms. Despite the popularity of pine and spruce, the health effects of exposures to these woods have not been extensively investigated. A study was undertaken to investigate the respiratory health of a group of sawmill workers processing pine and spruce (n = 94). Data collection included a respiratory symptom questionnaire, spirometry, and allergy skin testing. The sawmill workers were compared with a group of oil field workers from the same geographic area who underwent the same study protocol (n = 165). The results showed that the sawmill workers had significantly lower average values for FEV1 and FEV1/FVC (%), adjusted for age, height, and smoking. The largest differences were for current smokers. Significantly elevated age and smoking-adjusted odds ratios (OR) were detected for shortness of breath (2.83; 95% confidence interval [CI], 1.47 to 5.46) and wheeze with chest tightness (2.58; 95% CI, 1.18 to 5.62). Nonsignificant elevations were also seen for usual cough (1.47; 95% CI, 0.68 to 3.16), usual phlegm (1.94; 95% CI, 0.98 to 3.87), shortness of breath with exercise (1.45; 95% CI, 0.66 to 3.20), chest tightness (1.43; 95% CI, 0.80 to 2.57), and attacks of wheeze (1.70; 95% CI, 0.79 to 3.68). Sawmill workers were 2.5 times as likely as oil field workers to report current asthma (95% CI, 0.76 to 8.32). Workers employed more than 3 years showed significantly more asthma (OR = 3.67; 95% CI, 1.00 to 13.5) and bronchitis (OR = 2.14; 95% CI, 1.02 to 4.52). Sawmill workers were only 43% as likely to report a history of hay fever (95% CI, 0.20 to 0.94). These health effects were noted despite an average concentration of respirable dust of 1.35 mg/m3 (range, 0.1 to 2.2 mg/m3). These levels are below the present occupational standard AU - Hessel PA AU - Herbert FA AU - Melenka LS AU - Yoshida K AU - Michaelchuk D AU - Nakaza M LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 46 IP - DP - 1995 Jan 01 TI - Respiratory symptoms and ventilatory function of the lungs in wool textile industry workers PG - 323-332 AB - Subjects in the study were 158 female wool textile workers and 87 control non-exposed workers. Respiratory symptoms were assessed by means of a questionnaire. Ventilatory capacity was measured in wool workers by recording maximum expiratory flow-volume (MEFV) curves on Monday before and after the work shift. Forced vital capacity (FVC), one-second forced expiratory volume (FEV1) and flow rates at 50% and the last 25% of the vital capacity (FEF50, FEF25) were measured on MEFV curves. Significantly higher prevalences of all chronic respiratory symptoms were recorded in exposed than in control workers (P < 0.01). Exposure to wool dust caused significant across shift reductions of ventilatory capacity varying from 2.0 to 9.1%. Those reductions were similar in textile workers exposed to wool for more than 10 years showed similar across shift reductions of ventilatory capacity tests as those with shorter exposure. Smokers and non-smokers had similar acute and chronic lung function changes. In a larger number of wool workers FEF50 and FEF25 were below 70% of predicted normal values. Bronchoprovocation testing with wool dust extract did not demonstrate correlation with respiratory impairment. Our data suggest that dust exposure in wool textile mills may be associated with the development of chronic respiratory symptoms and impaired lung function AU - Zuskin E AU - Mustajbegovic J AU - GodnicCvar J AU - SimunovicSublin A AU - KanceljakMacan B AU - Sonicki Z LA - PT - DEP - TA - Arh Hig Rata Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 27 IP - DP - 1995 Jan 01 TI - Pleural mesotheliomas are underreported as occupational cancer in Sweden PG - 577-580 AB - Department of Occupational Medicine, Sahlgrenska University Hospital, S:t Goteborg, Sweden The aim of this study was to estimate to what degree malignant pleural mesotheliomas were reported as occupational cancers. The study included all malignant pleural mesotheliomas (n = 210) found in the Cancer Registry 1980-1989 from four Swedish counties. Whether or not a case was reported as occupational cancer was found in the Swedish Register of Reported Occupational Diseases. To evaluate the presence of exposure histories, the chest department files for 58 mesotheliomas from one county were reviewed. The reporting was low, with only 75 mesotheliomas (36%) reported. All the cases were men, and for the men, the reporting frequency was 42%. The reporting was significantly lower for the last part of the decade than for the first part. The reporting frequency decreased with age. In the review of the chest department files, an exposure history was found in 93% of the reported cases and in 47% of the unreported cases. It is concluded that physicians must give more priority to exposure histories in patients with pleural mesotheliomas AU - Andersson E AU - Toren K LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - An outbreak of naphthalene di-isocyanate-induced asthma in a plastics factory PG - 337-340 AB - Seven cases of possible naphthalene di-isocyanate-related occupational asthma occurred in 1987 and 1988. These cases were reported to the National Institute for Occupational Safety and Health by personnel at a Midwest factory that manufactured plastic wheels for fork-lift trucks. The reporting of cases prompted (a) an evaluation of the workplace, including a medical screening of workers, to detect additional cases; and (b) an industrial-hygiene survey to determine the level of exposure to isocyanates AU - Fuortes LJ AU - Kiken S AU - Makowsky M LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 67 IP - DP - 1995 Jan 01 TI - Thermophilic actinomycetes in cane sugar mills: an aeromicrobiologic and seroepidemiologic study PG - 339-344 AB - Aerial prevalence of clinically important thermophilic actinomycetes and occurrence of precipitating antibodies against them in sera of 153 exposed workers have been reported. The study was carried out in two cane sugar mills namely, the Upper Doab Sugar Mills and the Ramala Sugar Mills, located in north-west India. In both the sugar mills, T. sacchari was the predominant species, it accounted for 55.1% and 50.3% of the total population of thermophilic actinomycetes, followed by T. vulgaris (19.7% and 23.7%), T. thalpophilus (21.1% and 17.1%), Saccharomonospora viridis (3.4% and 5.0%) and Saccharopolyspora rectivirgula (Faenia rectivirgula) (0.7% and 3.9%), respectively. Precipitating antibodies against thermophilic actinomycetes were demonstrable in 34 (22.2%) workers; T. sacchari alone accounted for 20 of the positive precipitin reactions, followed by S. rectivirgula in 10. The mean absorbance values for IgG antibody activity against T. sacchari as well as S. rectivirgula were found to be elevated significantly in the symptomatic workers than in the asymptomatic workers (p < 0.05) or unexposed controls (p < 0.001). However, the difference in IgG antibody activity was insignificant between precipitin-positive symptomatic workers and precipitin-positive asymptomatic workers. The results indicate that clinically important thermophilic actinomycetes are widely prevalent in cane sugar mills, and T. sacchari and S. rectivirgula are the major species involved in the sensitization of the bagasse workers in India AU - Khan ZU AU - Gangwar M AU - Gaur SN AU - Randhawa HS LA - PT - DEP - TA - Antonie Van Leeuwenhoek JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - Peak expiratory flow variation and bronchial hyperresponsiveness in asthmatic children during periods of antigen avoidance and reexposure PG - 366-369 AB - Changes of diurnal variation of peak expiratory flow rate (%PEF variation) and their relationship with bronchial hyperresponsiveness (BHR) to methacholine (PC20) were evaluated in 12 children with mild-to-moderate asthma and house-dust mite allergy, during successive periods of stay in a mite-free environment at high altitude (1756 m) and at their home at sea level. The children remained at the high altitude from October until the end of December; then they spent a 3-week period at home and returned to high altitude residence in January. PEF was measured daily, in the morning and in the evening, during the 3 months' stay at high altitude and them for 10 days after the return in January. PC20 was assessed in 8/12 children, once a month from October to December, and at the return in January. Mean absolute PEF values did not change significantly throughout the study. From October to December, patients showed a significant decrease of mean %PEF variation (P = 0.04), while PC20 showed an increase (P = 0.05). After the 3 weeks at home, both %PEF variation (P = 0.03) and PC20 (P = 0.05) significantly worsened. The correlation between PC20 values and mean %PEF variation in the 2 days before and after each methacholine test was r = -0.63 (P = 0.001). Our data suggest that there is a beneficial effect of a prolonged stay in a mite-free environment, on both PEF variability and BHR, also in asthmatic children with good pulmonary function. PEF variability and bronchial responsiveness to methacholine were significantly correlated also for small changes of the two variables AU - Valletta EA AU - Comis A AU - Del Col G AU - Spezia E AU - Boner AL LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - Exposure to cobalt chromium dust and lung disorders in dental technicians PG - 769-772 AB - BACKGROUND--Dental technician's pneumoconiosis is a dust-induced fibrotic lung disease of fairly recent origin. This study was carried out to estimate its occurrence in Sweden. METHODS--Thirty seven dental technicians in central and south eastern Sweden with at least five years of exposure to dust from cobalt chromium molybdenum (CoCrMo) alloys, identified by postal survey, agreed to undergo chest radiography and assessment of lung function and exposure to inorganic dust. RESULTS--Six subjects (16%; 95% confidence interval 6% to 23%) showed radiological evidence of dental technician's pneumoconiosis. The lung function of the study group was reduced compared with historical reference material. With local exhaust ventilation dust levels were generally low, whereas in dental laboratories without such equipment high levels of dust, particularly cobalt, were found. CONCLUSIONS--Pneumoconiosis may result from exposure to inorganic dust in the manufacturing of CoCrMo-based dental constructions. It is possible to reduce this hazard substantially by local exhaust ventilation 0 (Chromium Alloys). 14808-60-7 (Quartz) AU - Selden AI AU - Persson B AU - BornbergerDankvardt SI AU - Winstrom LE AU - Bodin LS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 33 IP - DP - 1995 Jan 01 TI - Persistent reactive airway dysfunction syndrome after exposure to chromate [Review] [Japanese] PG - 759-764 AB - A 42-year-old man was admitted to the hospital because of wheezing and dyspnea that began 20 minutes after accidental exposure to irritant gas containing chromate at a chrome pellet manufacturing plant. The patient had a positive skin reaction to chromite (Cr2O3). Reduction of FEV1.0 was observed 120 minutes after Cr2O3 inhalation challenge. By 150 minutes after Cr2O3 inhalation, FEV1.0 had decreased by 32%. Chest X-ray film revealed no abnormalities. Histological findings of the lung tissue obtained by open lung biopsy revealed bronchospasm and peri-bronchial inflammatory cell infiltration without bronchiolar obstruction, and thus bronchiolitis obliterans was ruled out. This patient fulfilled the criteria of reactive airway dysfunction syndrome (RADS) proposed by Brooks; onset of symptoms very soon after a single exposure to an irritant, persistence of asthmatic symptoms, obstructive pulmonary dysfunction, and the presence of airway hyperreactivity to methacholine. During the initial hospital stay, asthmatic symptoms were relieved by intensive anti-asthmatic treatment including oral and parenteral corticosteroids. However, the patient's asthmatic symptoms have lasted for eight years and necessitate the use of systemic steroids, and regular use of inhaled steroids and bronchodilators. We know of no previous reported case of RADS after chromate exposure. AU - Nagasaka Y AU - Nakano N AU - Tohda Y AU - Nakajima S LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 96 IP - DP - 1995 Jan 01 TI - Work-related late asthmatic response induced by latex allergy PG - 457-464 AB - BACKGROUND: The occupational uses of latex gloves may be associated with asthma. Hypersensitivity to latex has been shown to be IgE-mediated. The asthmatic reaction to latex is usually early; however, the natural history of latex asthma is still unknown. OBJECTIVE: The purposes of this study were to investigate asthmatic responses induced by natural rubber latex and to assess the long-term respiratory consequences of latex-induced asthma after removal from exposure. METHODS: This report describes the clinical and immunologic study of six nurses with work-related respiratory and skin disorders induced by the use of latex gloves. To determine whether the symptoms induced by latex gloves were IgE-mediated, we assessed latex IgE antibody levels by skin prick tests (SPTs) and RASTs with latex extracts. To confirm work-related latex reactions, we assessed respiratory symptoms, skin reactions, and FEV1 after a glove exposure test and an inhalation provocation test with latex gloves. All subjects were followed up for 7 months to 7 years after the first observation. RESULTS: All subjects had positive SPT and RAST responses to latex extracts, positive double prick test responses to latex gloves, and negative SPT responses to cornstarch and common allergens. Ten atopic and 10 nonatopic control subjects had negative SPT responses to latex and cornstarch extracts and negative double prick test responses to latex gloves. In three subjects latex allergy was associated with allergy to fruit (banana and chestnut). After the glove exposure test, four of six subjects had contact urticaria, all had rhinoconjunctivitis, and two had a late asthmatic response. The inhalation provocation test was performed on four subjects: all had rhinoconjunctivitis, two had urticaria and late asthmatic response, and one had laryngeal edema. A late asthmatic response was recorded in four subjects. Three subjects continued to have chronic asthma, and four subjects had increased nonspecific bronchial responsiveness 7 months to 7 years after being assigned to duties not involving latex gloves. CONCLUSIONS: This study of six nurses shows that latex is a potential cause of occupational asthma, rhinoconjunctivitis, and urticaria-angioedema. Latex seems to include antigens that elicit IgE-mediated hypersensitivity and may cause a late asthmatic reaction. Occupational asthma caused by latex may lead to permanent respiratory disability, even after removal from exposure AU - Brugnami G AU - Marabini A AU - Siracusa A AU - Abbritti G LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 96 IP - DP - 1995 Jan 01 TI - Skin test responses to latex in an allergy and asthma clinic PG - 431-432 AU - Hadjiliadis D AU - Khan K AU - Tarlo SM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 96 IP - DP - 1995 Jan 01 TI - Recurrent allergic reactions to latex in a hospitalized pediatric patient PG - 423-425 AU - Sullivan TJ AU - Magera BE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 16 IP - DP - 1995 Jan 01 TI - Occupational asthma in horticulture caused by Lathyrus odoratus PG - 135-139 AU - Jansen A AU - Vermeulen A AU - van Toorenenbergen AW AU - Dieges PH LA - PT - DEP - TA - Allergy Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 25 IP - DP - 1995 Jan 01 TI - Occupational respiratory and skin sensitization caused by polyfunctional aziridine hardener PG - 432-439 AB - Polyfunctional aziridine (PFA) is increasingly used as a water-based crosslinker in two-component paints, paint primers, lacquers, topcoats and other protective coatings. The crosslinker is made by reacting multifunctional acrylic monomer with a highly reactive aziridine compound. Respiratory allergy or hypersensitivity from PFA has not been reported previously. During 1978-1991 we came across nine cases with hypersensitivity from PFA: two had allergic contact dermatitis (ACD), four had occupational asthma and three had both of them. Five of the patients were parquet layers, two were fibreboard painters, one was a spray painter and one was a salesman of PFA products. ACD was diagnosed by positive allergic patch test reactions with PFA in a dilution series in petrolatum: 0.32%-0.5% gave a 2(+)-3+ allergic reaction in the five cases with ACD but 0.1% gave only a weak reaction in one case, whereas the methacrylate patch test series was negative. The diagnosis of seven cases of occupational asthma due to PFA hardener was based on symptoms related to exposure to PFA hardener at work, and on positive provocation tests with PFA hardener. One had an immediate type reaction, one a had a dual reaction, and the others had late reactions. The positive reactions with the PFA hardener and the negative reactions with the acrylate compounds indicate that PFA caused ACD which is different from the previous reports in which acrylates present as impurities in the PFA hardener caused the sensitization.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Kanerva L AU - Keskinen H AU - Autio P AU - Estlander T AU - Tuppurainen M AU - Jolanki R LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 37 IP - DP - 1995 Jan 01 TI - Bronchiolitis obliterans from exposure to incinerator fly ash PG - 850-855 AB - Inhalation of toxic substances in the workplace can result in a variety of respiratory disorders. One relatively rare sequela of the inhalation of toxic fumes is bronchiolitis obliterans, a condition characterized by fibrosis and narrowing of the small airways. Several substances have been reported to cause bronchiolitis obliterans, including ammonia, chlorine, hydrogen fluoride, hydrogen sulfide, nitrogen dioxide, ozone, phosgene, and other irritant fumes. Little has been reported on the pulmonary effects of fly ash produced by the incineration of coal and oil. We report a case of bronchiolitis obliterans with a component of partially reversible airway obstruction in a 39-year-old male occupationally exposed to incinerator fly ash AU - Boswell RT AU - McCunney RJ LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Occupational hypersensitivity pneumonitis in Japan: data on a nationwide epidemiological study PG - 570-574 AB - OBJECTIVES--Diagnostic criteria were prepared for hypersensitivity pneumonitis (HP) and a nationwide survey was conducted to investigate epidemiological and clinical characteristics of HP in Japan. The results are presented with special focus on occupational HP and on the key to the diagnosis of HP. METHODS--A questionnaire was completed by 185 doctors from 185 hospitals (response rate 89.5%). All cases were verified according to diagnostic criteria; 835 cases were classified as HP (653 definite and 182 probable). These 835 cases (total HP) and 99 possible cases of HP diagnosed during the 1980s were analysed and presented as a case series study. RESULTS--Occupational HP was noted in 115 cases (13.8%). 21 occupations, and 20 aetiological antigens were listed. Farmer's lung: 68 cases (59% of occupational HP) was the most prevalent diagnosis followed by 19 industrial workers who handled chemicals (for example, isocyanate) and 10 office workers. Unique cases of mushroom, greenhouse, and silkworm farmers, and a new type of bagassosis are also described. Adverse environmental conditions, immunological findings on examination, antigen challenge, and pathological findings were all significantly lower for possible than for total HP. This was not true for clinical findings. The differences in antibody analysis (6% positive of possible HP v 59% of total HP) and environmental challenge (3% v 74%) were notable. CONCLUSION--These data suggest that a careful interview about the environment and an antigen panel matched to variations in exposure are the key to the diagnosis AU - Yoshida K AU - Suga M AU - Nishiura Y AU - Arima K AU - Yoneda R AU - Tamura M AU - Ando M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 13 IP - DP - 1995 Jan 01 TI - The epidemiology of occupational contact dermatitis. [Review] PG - 671-680 AB - The dermatologist who is aware of the epidemiology of occupational contact dermatitis (OCD) can find this information helpful in making a diagnosis, determining etiology, and recommending preventive efforts. This article reviews some of the available epidemiologic data sources and their limitations. These data sources provide important information on the prevalence and incidence, the public health importance, the risk factors, the common etiologic agents, the prognosis, and the preventive measures for OCD. AU - Lushniak BD LA - PT - DEP - TA - Dermatologic Clinics JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 32 IP - DP - 1995 Jan 01 TI - The 12-year prognosis of hand dermatosis in 896 Finnish farmers PG - 233-237 AB - In all, 896 Finnish farmers (305 men and 587 women), representing 77% of those reporting hand or forearm dermatosis in a questionnaire survey in 1979, were asked again about their dermatosis and current work in 1991. More than 50% of the study population had left farming since 1979. In 1991, 26% of men and 21% of women had a current dermatosis on the hands or forearms, and altogether, 44% of men and 39% of women reported a hand dermatosis within the past 12 months. Significant determinants of persistent hand dermatosis, in a logistic regression model, were continuation of farm work, history of skin atopy, symptoms of metal allergy, and age under 45 years. Handling cattle, e.g., milking, was considered an exacerbating factor of the dermatosis by 37% of those who had milked sometimes in their lives. In this group, 75% of hand dermatoses in those who had finished milking work had healed. The results indicate that giving up or changing work improves the prognosis of hand dermatosis in farming AU - Susitaival P AU - Hannuksela M LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 21 IP - DP - 1995 Jan 01 TI - Dermatoses determined in a population of farmers in a questionnaire-based clinical study including methodology validation PG - 30-35 AB - OBJECTIVES: The study analyzed skin diseases in a population sample of Finnish farmers descriptively and in the process validated the question "Do you have a skin disease now?" METHODS: All farmers from one Finnish municipality were surveyed for dermatoses, first with a questionnaire and then with a clinical examination of those who reported dermatoses. Another population of farmers answered a set of questions immediately before a clinical examination, and the self-report of current dermatosis was validated. RESULTS: Eczema was diagnosed for 66% of the women and 53% of the men who had reported dermatosis in the questionnaire study 6 to 12 months earlier. Toe-web maceration, psoriasis, folliculitis, and acne were, after eczema, the most frequent diagnoses (in that order). In more than 50% of the cases, the location of clinically determined dermatoses corresponded with the skin disease areas reported 6 to 12 months earlier. In the validation study, everyone who reported a skin disease immediately before the clinical examination were found to have a skin disease. In addition 22% of those not reporting dermatosis were found to have a skin disease. Toe-web maceration was the most common dermatosis not reported by the farmers. CONCLUSIONS: Finnish farmers suffered from the same type of dermatoses as other populations. The prevalence of eczema and hand eczema was similar to that of other risk populations. A self-report of current dermatosis is probably a good indicator of the point prevalence of explicit skin diseases in populations AU - Susitaival P AU - Husman L AU - Hollmen A AU - Horsmanheimo M LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 22 IP - DP - 1995 Jan 01 TI - Immediate allergy to rubber gloves: a questionnaire study of hospital personnel PG - 19-23 AB - We conducted a questionnaire study of immediate allergy to natural rubber gloves among 2,408 medical workers who had used rubber gloves at Kumamoto University Hospital and allied hospitals. The response rate was 64.5% (1,321 workers). Among them, 8.5% (7.0-10.0% at 95% confidence limit) replied that they had experienced immediate allergy to rubber gloves. There were significant correlations among the frequency of rubber glove use, a history of atopic dermatitis or contact dermatitis, and the presence of skin lesions due to allergic reactions to rubber gloves. In 27 workers, skin lesions were associated with general symptoms. Of 59 workers who experienced immediate allergy and were tested for latex-specific IgE, 4 persons were positive. We conclude that the frequency of contact allergy to natural rubber products is substantially prevalent among Japanese hospital personnel and that education and awareness of this allergy are important AU - Mizutari K AU - Kuriya N AU - Ono T LA - PT - DEP - TA - Journal of Dermatology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Influence of indoor air quality and personal factors on the sick building syndrome (SBS) in Swedish geriatric hospitals PG - 170-176 AB - OBJECTIVES--Sick building syndrome (SBS) involves symptoms such as irritation to the eyes, skin, and upper airways, headache, and fatigue. The relations between such symptoms and both personal and environmental factors were studied in 225 female hospital workers, working in eight hospital units in the south of Sweden. METHODS--Symptoms of SBS and personal factors were measured by means of a standardised self administered questionnaire. The technical investigation comprised a building survey and measurements of room temperature, supply air temperature, air humidity, and exhaust air flow. RESULTS--The prevalence of symptoms differed from one unit to another. The mean value of weekly complaints of fatigue was 30%, of eye irritation 23%, and of dry facial skin 34%. Eye irritation was related to work stress, self reported exposure to static electricity, and was also more common in buildings with a high ventilation flow and a high noise level (55 dB(A)) from the ventilation system. Nasal symptoms were related to asthma and hay fever only. Throat symptoms were more common in smokers, subjects with asthma or hay fever, new buildings, and in buildings with a high ventilation flow. Facial skin irritation was related to a lack of control of the work conditions, and was more common in new buildings, and buildings with a high ventilation flow and ventilation noise. General symptoms, such as headache and fatigue, were related to current smoking, asthma or hay fever, work dissatisfaction, and static electricity. CONCLUSION--As the prevalence of symptoms was high, there is a need to improve the indoor environment as well as the psychosocial environment in hospitals. These improvements could include a reduction of ventilation noise, minimised smoking, and improvements in the psychosocial climate. Further research is needed to identify indoor climatic factors that cause the increased prevalence of symptoms of SBS in new buildings AU - Nordstrom K AU - Norback D AU - Akselsson R LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 70 IP - DP - 1995 Jan 01 TI - Respiratory function in poultry workers and pharmacologic characterization of poultry dust extract PG - 11-19 AB - A group of 343 workers (252 males and 91 females) employed in four poultry farms in Croatia was studied for the prevalence of acute and chronic respiratory symptoms and lung function changes. There were significantly higher prevalences of chronic cough, chronic phlegm, chronic bronchitis, and chest tightness in poultry workers than in control workers. Male poultry workers who were smokers had significantly higher prevalences of chronic cough, chronic phlegm, and chronic bronchitis than poultry workers who were nonsmokers (P<0.01). Poultry workers exposed for more than 10 years had significantly higher symptoms prevalences than those workers with shorter exposures (except among female smokers). There was also a high prevalence in poultry workers of acute symptoms which developed during the work shift. The measured FVC, FEV1, and FEF25 in poultry workers were significantly lower than predicted normal values. Workers exposed for more than 10 years had lower ventilatory capacity tests (expressed as percentage of predicted) than those workers with shorter exposures. Changes in FEV1, FEF50, and FEF25 were less pronounced than FVC. Additionally we showed that a water-soluble poultry dust extract obtained from this workplace caused a dose-related contraction of nonsensitized guinea pig tracheal smooth muscle when studied in vitro. Pharmacologic studies of this response indicate that it may result from the release of multiple endogenous mediators. Our data suggest that work in poultry farms may, for some workers, cause the development of acute and chronic respiratory symptoms and lung function changes AU - Zuskin E AU - Mustajbegovic J AU - Schachter EN AU - Kern J AU - Rienzi N AU - Goswami S AU - Marom Z AU - Maayani S LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 117 IP - DP - 1995 Jan 01 TI - Respiratory function in poultry workers [SerboCroatian (Roman)] PG - 121-125 AB - A group of 343 workers (252 male and 91 female) employed in poultry farms was studied for the prevalence of acute and chronic respiratory symptoms and lung function changes. There were significantly higher prevalences of most of the chronic respiratory symptoms in poultry workers than in controls (p < 0.01 or < 0.05). Poultry male smokers had significantly higher prevalences of chronic cough, chronic phlegm and chronic bronchitis than poultry male nonsmokers (p < 0.01). Poultry workers employed for more than 10 years had also significantly higher prevalences of these symptoms than those with shorter employment (except female smokers). There was also a high prevalence of acute symptoms in poultry workers which develop during work shift. The measured FVC, FEV1 and FEF25 in poultry workers were significantly lower than predicted normal values. Changes were particularly pronounced in workers employed for more than 10 years. We showed additionally that a water-soluble poultry extract causes a dose-related contraction of nonsensitized guinea pig tracheal smooth muscle when studied in vitro. Our data suggest that the work in poultry farms may in some workers cause the development of acute and chronic respiratory impairment AU - Zuskin E AU - Mustajbegovic J AU - Kern J AU - SitarSrebocan V LA - PT - DEP - TA - Lijec Vjesn JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 67 IP - DP - 1995 Jan 01 TI - Early reaction type allergies and diseases of the respiratory passages in employees from persulphate production PG - 413-417 AB - was tested in a cross-sectional study on 52 employees of a company producing persulphates after a case of "persulphate asthma" was observed. A random test of 13 persons without occupational exposure to persulphates served as controls; among them all the skin-prick test reactions were negative. Eight company employees showed a positive skin-prick test reaction to at least one of the persulphate solutions tested. Employees showed lower lung function results with a positive prick test reaction than did employees with a negative result. The positive skin-prick reactions correspond well to the anamnestic data and indicate a possible relationship to obstructive ventilation disorders. The results therefore suggest an IgE-induced, allergic pathomechanism of "persulphate asthma" triggered by persulphates AU - Wrbitzky R AU - Drexler H AU - Letzel S LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 67 IP - DP - 1995 Jan 01 TI - A clinical and immunological study on 92 workers occupationally exposed to anhydrides PG - 395-403 AB - in addition to those of phthalic anhydride, maleic anhydride and trimellitic anhydride, in a group of 92 exposed workers in two German chemical plants. Of the 92 workers, 56 reported work-related complaints with a predominance of phlegm and dyspnoea in those exposed to anhydride dust for less than 1 year. Haemorrhagic rhinitis occurred only after a prolonged exposure of more than 15 years. Specific IgE antibodies to anhydride-HSA conjugates could be detected in 15 exposed subjects, 12 of whom had work-related symptoms. The IgE-positive group had significantly more impaired lung function parameters than the IgE-negative group. The proportion of IgE-positive subjects was highest in the groups with dyspnoea (5/18), cough (6/24) and rhinitis (11/44) whereas only 1 of 11 workers with haemorrhagic rhinitis had such antibodies. A follow-up study of 23 affected workers was performed after 10 months to assess clinical symptoms, lung function and IgE antibody levels. This follow-up study showed the absence of obstructive ventilation patterns in three out of six subjects in addition to cessation of symptoms in most initially affected workers who were no longer exposed. On the other hand, 14 workers under continuous exposure had comparable pathological findings on re-examination. Our results confirm that anhydrides including the lesser known PMDA, behave as respiratory irritants and as immediate-type sensitizers. They predominantly induced reversible symptoms in workers whose exposure stopped after a working period of about 0.7 years. Abnormal lung function parameters normalized in nearly 50% of these subjects AU - Baur X AU - Czuppon AB AU - Rauluk I AU - Zimmermann FB AU - Schmitt B AU - EgenKorthaus M AU - Tenkhoff N AU - Degens PO LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Chronic effects of welding exposure on pulmonary function tests and respiratory symptoms PG - 800-803 AB - OBJECTIVES--The respiratory effects of exposure to welding fumes have been investigated in numerous studies; but results of these studies have not been consistent. The aim of the present study was to investigate the respiratory effects of welding exposure in a large group of manual are welders exposed primarily to mild steel welding processes in confined spaces without respiratory protection. METHODS--Respiratory symptoms and spirometry were studied in 110 welders and 55 controls. The welders and controls were of similar average age and height; smoking habits of the groups were similar. Chest x ray films were taken to exclude people with radiological abnormalities that may influence pulmonary function tests. Welders were grouped according to smoking habits and duration of employment (< 20 years or > 20 years). RESULTS--No gross radiological abnormalities were found. Respiratory symptoms and chronic bronchitis were more prevalent in welders (P < 0.05). Welders who were smokers showed a higher frequency of chronic bronchitis than controls who smoked (P < 0.05). No significant difference in the occurrence of chronic bronchitis was found between welders who smoked and welders who were non-smokers or exsmokers. Compared with the controls, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), and maximum midexpiratory flow (MMEF) were significantly lower in welders (mean values of FVC for welders and controls were 86.06 (25.74) and 96.40 (13.03); and values for FEV1 were 87.54 (13.70) and 95.36 (12.40) respectively; P < 0.01). There was no significant difference in pulmonary function tests between welders who were non-smokers and controls who were non-smokers; whereas FVC, FEV1, PEF, and MMEF were significantly lower in welders who smoked than controls who smoked (P < 0.01). There were no significant differences in pulmonary function tests and occurrence of chronic bronchitis between welders with more or less than 20 years at work. CONCLUSION--Welders working in conditions of inadequate ventilation, have increased risk of chronic bronchitis and impairment of pulmonary function AU - Ozdemir O AU - Numanoglu N AU - Gonullu U AU - Savas I AU - Alper D AU - Gurses H LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 34 IP - DP - 1995 Jan 01 TI - Summer-type hypersensitivity pneumonitis. PG - 707-712 AB - Summer-type hypersensitivity pneumonitis (SHP), the most prevalent type of HP in Japan, is caused by seasonal mold contamination in the home environment. The causative agent of the disease is Trichosporon cutaneum. The fungus grows in warm, moldy, decaying organic matter, and scatters in the air from the colonizing places. The inhaled fungi sensitize susceptible patients intratracheally and induce the disease. Glucuronoxylomannan of the fungus has a potent antigenicity that causes granulomatous alveolitis. Assay of anti-T. cutaneum antibody is very useful to establish the diagnosis of the disease because the antibody activity is virtually positive in all cases of the disease. Elimination of T. cutaneum from the colonizing places prevents recrudescence. SHP, a new form of HP, had been considered to be peculiar to Japan, but the first case of SHP outside Japan was identified in Korea last year. Soon it will be recognized in many countries of temperate and tropical clime. AU - Ando M AU - Suga M AU - Nishiura Y AU - Miyajima M LA - PT - DEP - TA - Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 34 IP - DP - 1995 Jan 01 TI - Smoking promotes insidious and chronic farmer's lung disease, and deteriorates the clinical outcome PG - 966-971 AB - Although the prevalence of serum precipitating antibodies for farmer's lung disease (FLD) is lower in smokers than in nonsmokers and FLD predominates in nonsmokers, the affects of smoking on the clinical course of the disease is not known. We compared the clinical findings and the prognosis between 12 smokers (SM-FLD) and 31 non-smokers with FLD (NS-FLD). There was no difference in age, sex, working years on farm, clinical symptoms, laboratory findings, radiographic findings, between the two groups. However, for the type of onset on the first visit for FLD, "acute single episode" type was less common, and "recurrent" and "insidious onset" types were more common in SM-FLD than in NS-FLD (8.3 vs 58.1, 91.7 vs 41.9%, respectively, p < 0.05). Although working status and mask wearing status were not significantly different between the two groups after the diagnosis of FLD, patients with symptoms and/or radiographic abnormalities of FLD of more than 6 months were found more frequently in SM-FLD than in NS-FLD (66.7 vs 19.4%, p < 0.005). And also SM-FLD had more recurrences of FLD than NS-FLD after the initial diagnosis of FLD (1.58 +/- 1.56 vs 0.47 +/- 1.07, p < 0.05). SM-FLD tended to have lower % VC than NS-FLD (73.6 +/- 7.4 vs 88.5 +/- 3.9%, respectively, p = 0.06). Regarding the prognosis, the 10-year survival rates were 70.7% in SM-FLD, and 91.5% in NS-FLD (p < 0.05). These results suggest that smoking may make FLD insidious and chronic, and deteriorates the clinical outcome AU - Ohtsuka Y AU - Munakata M AU - Tanimura K AU - Ukita H AU - Kusaka H AU - Masaki Y AU - Doi I AU - Ohe M AU - Amishima M AU - Homma Y AU - et al LA - PT - DEP - TA - Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 12 IP - DP - 1995 Jan 01 TI - Chronic course of reactive bronchial dysfunction syndrome. Apropos of 6 further cases PG - 471-477 AB - The reactive airways dysfunction syndrome (RADS) occurs as a persistent bronchial hyper-reactivity with asthmatic-type dyspnoea and occurs after a single and massive inhalation of irritant gases, smoke or vapours, in subjects who had previously had no respiratory disease. We report six cases in patients without any previous asthmatic history or history of atopy who had developed RADS after being exposed to different irritants. The symptoms evolved over 5-84 months after the initial accident. Only moderate airflow obstruction was found, but all subjects had bronchial hyper-reactivity to methacholine. A bronchial biopsy was performed in a patient and this showed moderate sub-epithelial mononuclear inflammatory infiltrate. A specific feature of this syndrome is the facility to inaugurate a susceptibility to asthma after the initial accident and for this to progress of its own accord with secondary aggravation, even in the absence of new exposure to the irritating agent. Its frequency is probably under-estimated because it remains little known in France. It is very important both to recognise and notify inhalational accidents at work to be able, should the nedd arise, to identify the worker and to enable a move to a different job if necessary AU - Rivoire B AU - Carre P AU - Boissinot E AU - Renjard L AU - Lasfargues G AU - Lavandier M LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - Statement on self-monitoring of peak expiratory flow in the investigation of occupational asthma. Subcommittee on Occupational Allergy of the European Academy of Allergology and Clinical Immunology PG - 711-717 AU - Moscato G AU - GodnicCvar J AU - Maestrelli P AU - Malo JL AU - Sherwood Burge P AU - Coifman R LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 96 IP - DP - 1995 Jan 01 TI - Statement on self-monitoring of peak expiratory flows in the investigation of occupational asthma. Subcommittee on Occupational Allergy of European Academy of Allergy and Clinical Immunology PG - 295-301 AU - Moscato G AU - GodnicCvar J AU - Maestrelli P LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 75 IP - DP - 1995 Jan 01 TI - Statement on self-monitoring of peak expiratory flows in the investigation of occupational asthma. Subcommittee on Occupational Allergy of European Academy of Allergy and Clinical Immunology, American Academy of Allergy and Immunology, European Respiratory Society, American College of Allergy, Asthma and Immunology PG - 233-238 AU - Moscato G AU - GodnicCvar J AU - Maestrelli P AU - Malo JL AU - Burge PS AU - Coifman R LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 33 IP - DP - 1995 Jan 01 TI - Hypersensitivity pneumonitis caused by a home humidifier [Review] [Japanese] PG - 1024-1029 AB - A 33-year-old man was admitted complaining of a fever, dyspnea, and a dry cough almost every night since December of 1992. He had been using an ultrasonic humidifier at home. The chest CT scan and roentgenogram showed bilateral reticulonodular shadows. After admission, the symptoms resolved spontaneously. These findings were suggestive of hypersensitivity pneumonitis. After analysis of fluid obtained by bronchoalveolar lavage and of a specimen obtained by transbronchial biopsy, "humidifier lung" was diagnosed. Ten species of microorganisms were isolated from the water left in the patient's humidifier. On precipitation and complement fixation tests of the patients serum, the results were positive for three of those microorganisms: Flavobacterium multivorum, Yersinia pseudotuberculosis, and Aureobacterium liquefaciens. The titer on the complement fixation test increased immediately after a provocation test. The laboratory results suggest that at least one of these three microorganisms was the causative antigen in this case. AU - Hagiwara S AU - Ishii Y AU - Sugiyama Y AU - Kitamura S LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 10 IP - DP - 1995 Jan 01 TI - Cobalt-induced occupational asthma associated with systemic illness PG - 200-204 AB - We report a case of occupational asthma caused by cobalt associated with systemic symptoms. He was a non-atopic, ex-smoker and had worked in a glassware factory for 14 months. A skin prick test with CoSO4 up to 100 mg/ml showed a negative result. A bronchoprovocation test with CoSO4 demonstrated an isolated asthmatic response with systemic symptoms such as fever, arthralgia and myalgia. Although an initial methacholine bronchial challenge test showed a negative result, the following methacholine bronchial challenge test which was done 24 hours after the challenge testing demonstrated an increased airway hyperresponsiveness at 2.5 mg/ml which recovered 7 days later. An intradermal skin test with 10 mg/ml and 100 mg/ml CoSO4 solution demonstrated positive responses respectively(13 x 12/40 x 32, 20 x 15/40 x 37 <mm>, histamine 16 x 14/64 x 50). A patch test including cobalt showed a negative result. Bronchoalveolar lavage fluid after the cobalt inhalation testing and other laboratory findings showed no evidence of hypersensitivity pneumonitis. These results suggested that cobalt could induce occupational asthma with systemic illness in an exposed worker AU - Baik JJ AU - Yoon YB AU - Park HS LA - PT - DEP - TA - J Korean Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - IgE-mediated allergy to wood dusts probably does not explain the high prevalence of respiratory symptoms among Swedish woodwork teachers PG - 559-562 AB - A previous study revealed an increased occurrence of work-related respiratory complaints among Swedish woodwork teachers. For determination of whether an IgE-mediated mechanism was the cause of the symptoms, 127 woodwork teachers and 111 reference subjects (other school personnel) in Stockholm gave serum for analysis of total IgE, Phadiatop, and RAST to extract of sawdust from five commonly used Scandinavian woods (pine, birch, juniper, alder, and linden). The total serum-IgE level was similar in the woodwork teachers (geometric mean 35, range < 2-1700 kU/l) and the reference group (34, < 2-860 kU/l), and the frequency of positive Phadiatop was equal (29.9% and 31.5%, respectively). RAST was positive only in three cases, two reference subjects (birch and pine) and one woodwork teacher (alder). Hence, no correlation between exposure and sensitization to wood dust was found, and the results do not support the assumption that the complaints related to exposure to dusts from the examined Scandinavian woods are IgE mediated AU - Ahman M AU - van HageHamsten M AU - Johansson SG LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 21 IP - DP - 1995 Jan 01 TI - High rate of transmission of tuberculosis in an office: impact of delayed diagnosis PG - 1170-1174 AB - We identified two cases of tuberculosis (TB) in office co- workers in Melbourne, Victoria, Australia; the Mycobacterium tuberculosis isolates were found to be identical with use of restriction fragment length polymorphism. Contact tracing was performed for 195 of 210 workers by means of the tuberculin skin test. Risk of infection was assessed according to a number of variables. Office contacts were exposed to infectious TB for 4 months; at least 24% of employees were infected. There was an association between sitting in proximity to the case during the period of exposure (OR, 4.24; 95% CI, 1.06-19.67). On-site workers had a higher risk of being infected (OR, 5.48; CI, 1.51- 23.54) than did visiting workers. Workers in this office were exposed to open pulmonary TB for prolonged periods. The prevalence of TB infection (24%) among these workers was high compared with the infection rate (2%-7%) in the general community. Delay in diagnosis was the major factor responsible for the spread of TB in this office AU - MacIntyre CR AU - Plant AJ AU - Hulls J AU - Streeton JA AU - Graham NM AU - Rouch GJ LA - PT - DEP - TA - Clin Infect Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 14 IP - DP - 1995 Jan 01 TI - Chemical respiratory allergy. Toxicological and occupational health issues PG - 735-736 AU - Kimber I AU - Wilks MF LA - PT - DEP - TA - Hum Exp Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Statement on self-monitoring of peak expiratory flows in the investigation of occupational asthma. Subcommittee on Occupational Allergy of the European Academy of Allergology and Clinical Immunology. American Academy of Allergy and Clinical Immunology. European Respiratory Society. American College of Allergy, Asthma and Immunology PG - 1605-1610 AU - Moscato G AU - GodnicCvar J AU - Maestrelli P AU - Malo JL AU - Burge PS AU - Coifman R LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Allergic sensitization is associated with increased bronchial responsiveness: a prospective study of allergy to laboratory animals PG - 1514-1519 AB - The purpose of this prospective study was to investigate the extent of change in bronchial responsiveness and the prognostic value of methacholine provocation in early sensitization to laboratory animals. Thirty eight laboratory technicians were studied during training (before first exposure) and after having been exposed to laboratory animals for a median 18 (range 5-33) months. On both occasions they were subjected to spirometry, bronchial methacholine challenge, skin-prick tests and blood sampling, and responded to questionnaires. Nine (24%) developed laboratory animal allergy (LAA), defined as animal work-related symptoms (n = 8), or specific immunoglobulin E (IgE) (n = 7) or both. In the LAA group, bronchial responsiveness was normal before employment, but had increased significantly at follow-up compared to technicians who had not developed LAA. Six of the nine LAA subjects had a more than threefold increase in bronchial responsiveness, and three of these reported chest symptoms. Spirometric values were not different between the groups prior to exposure or at follow-up, and had no prognostic value. However, a pre-employment level of total IgE > 100 kU.L-1 predicted the development of LAA (relative risk 2.8). Thus, early LAA was associated with increased bronchial responsiveness in most subjects. In contrast to total IgE, the level of pre-employment bronchial responsiveness or lung function did not influence the magnitude of change in responsiveness, nor predict sensitization AU - Renstrom A AU - Malmberg P AU - Larsson K AU - Larsson PH AU - Sundblad BM LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 115 IP - DP - 1995 Jan 01 TI - Health status of cement workers in the United Arab Emirates PG - 378-381 AB - (UAE). A cross-sectional sample of 304 workers was selected randomly from four cement factories in four Emirates. Most of the workers (88%) were from India, married (84%) and had received primary education or above (93%). Smoking was prevalent among 27% of the workers and about 24% consumed alcoholic beverages. Personal hygiene was found to be satisfactory among the workers. The main health symptoms reported by the cement workers were chronic cough, chronic bronchitis, burning, itching and runny eyes, headache and fatigue. Chronic bronchitis (p < 0.007), burning, itching and runny eyes (p < 0.002) and fatigue (p < 0.004) were significantly increased with age of workers. Smoking was significantly associated with chronic cough (p < 0.03) and chronic bronchitis (p < 0.01). However, the chance of smokers getting respiratory health problems was two to five times greater compared with non-smokers. Future studies on the health of workers in UAE should include more investigations using specialised equipment to detect and diagnose health problems AU - AbouTaleb AN AU - Musaiger AO AU - Abdelmoneim RB LA - PT - DEP - TA - J R Soc Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 96 IP - DP - 1995 Jan 01 TI - Royal jelly-induced asthma and anaphylaxis: clinical characteristics and immunologic correlations PG - 1004-1007 AU - Leung R AU - Thien FC AU - Baldo B AU - Czarny D LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 67 IP - DP - 1995 Jan 01 TI - Chronic and acute respiratory effects among grain mill workers PG - 311-315 AB - Exposure to flour dust may induce chronic respiratory manifestations as well as acute ventilatory effects. We compared the prevalence of respiratory symptoms, ventilatory impairment, and variations in pulmonary function over the workshift in a group of mill workers exposed to wheat flour and in referent workers. One hundred and forty-two men exposed to flour in a mill and 37 referent workers were included in this study. Each subject completed a standardized questionnaire. Pulmonary function tests were performed before and after the workshift. The assessment of environmental exposure to flour showed high concentrations during some jobs with a high percentage of inhalable particles and a low concentration of respirable particles. The exposed workers had a significantly higher prevalence of usual cough and usual phlegm than the referents. The prevalence of asthma, based on the questionnaire, was similar. Before the workshift, the exposed workers had significantly lower mean lung function values for peak flow rate and forced expiratory flow rate at 75% of the vital capacity than the referents. After the workshift, all the lung function values showed a slight decrease, significant for forced vital capacity and forced expiratory volume during 1 s in both groups. Among the exposed workers, the asthmatic subjects had a significantly higher decrease across the shift than the nonasthmatic workers. This result is probably linked to bronchial hyperreactivity. Among nonasthmatic subjects, the decrease was larger in nonexposed workers than in exposed workers. A higher prevalence of respiratory symptoms and lower pulmonary function values were observed among mill workers by comparison with referents. Moreover, the data suggest that asthmatic status and the time of spirometric measurements need to be taken into account in epidemiological studies on exposure to airborne allergens. In addition, the study does not exclude a healthy worker effect with selection of dust-resistant subjects or better identification of asthmatic subjects among the workers exposed to an allergenic substance than among the nonexposed workers AU - Gimenez C AU - Fouad K AU - Choudat D AU - Laureillard J AU - Bouscaillou P AU - Leib E LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 37 IP - DP - 1995 Jan 01 TI - An epidemic of occupational allergy to latex involving health care workers PG - 1204-1209 AB - IgE-mediated sensitivity to natural rubber latex is being recognized more frequently among health care workers. Between January 1990 and June 1993, we evaluated 342 consecutive Mayo Medical Center employees who reported symptoms suggestive of latex allergy. All were interviewed and underwent puncture skin testing with extracts of rubber gloves. In some cases, latex-specific IgE antibodies were measured by immunoassay. One hundred four of the 342 employees evaluated (30%) were latex-allergic. Risk factors for sensitization included frequent use of disposable gloves, presence of prior atopic disease, and prior or current hand dermatitis. The peak onset of symptoms occurred in late 1989 and early 1990 and did not correlate with a peak in glove usage at our medical center, which continued to rise. Most sensitized employees (78%) reported contact urticaria from rubber gloves, and over two thirds also experienced allergic rhinitis, conjunctivitis, or asthma when working in areas where large numbers of gloves were being used. Sixteen episodes of rubber-induced anaphylaxis were documented in 12 employees; six episodes occurred after latex skin testing and were easily reversed with appropriate therapy. Our findings substantiate a local epidemic of latex allergy among medical center employees. Epidemiologic studies are needed to assess the effects of various interventions to reduce occupational exposure to latex allergens. Although prick skin testing with concentrated latex glove extracts presents some risk of systemic reaction, pending availability of commercial diagnostic extracts, such testing is generally safe when performed by skilled laboratory personnel. Skin testing is warranted to investigate health care workers suspected of being latex-sensitive AU - Hunt LW AU - Fransway AF AU - Reed CE AU - Miller LK AU - Jones RT AU - Swanson MC AU - Yunginger JW LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 33 IP - DP - 1995 Jan 01 TI - Contact dermatitis and asthma from sodium metabisulfite in a photographic technician PG - 65-66 AU - Jacobs MC AU - Rycroft RJ LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Occupational asthma due to ceftazidime PG - 1421-1423 AB - A worker employed in the manufacture of the new third generation cephalosporin antibiotic, ceftazidime, developed asthmatic symptoms, and a series of inhalation challenge tests was undertaken to investigate the problem. The inhalation of increasing daily doses of ceftazidime up to 3.2 mg, using a double-blind challenge protocol gave rise to symptoms, late asthmatic reactions, and increases in airway responsiveness to methacholine. A repeat challenge with the 3.2 mg dose additionally gave rise to a clear immediate reaction. Ceftazidime was, thus, shown to be capable of inducing occupational asthma AU - Stenton SC AU - Dennis JH AU - Hendrick DJ LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Lung function and chronic respiratory symptoms of pig farmers: focus on exposure to endotoxins and ammonia and use of disinfectants PG - 654-660 AB - OBJECTIVES--The prevalence of chronic respiratory symptoms among pig farmers is known to be high, but the aetiology of these symptoms is not yet unravelled. Long term average exposure to dust was evaluated, endotoxins and ammonia and use of disinfectants were compared with chronic respiratory symptoms and depressed base line lung function. METHODS--A cross sectional study was performed among 194 Dutch pig farmers, of whom 100 had not and 94 had chronic respiratory symptoms. Exposure-response relations were evaluated with multiple logistic and linear regression analysis. Estimates of long term average exposure were based on two personal exposure measurements, taken on one day in summer and one day in winter. Information on use of disinfectants and disinfection procedures was assessed by a walk through survey and interview by telephone. RESULTS--Exposure to dust, endotoxins, and ammonia were not related to chronic respiratory symptoms. Duration of the disinfection procedure and pressure used at disinfection were strongly and positively related to chronic respiratory symptoms. A significant inverse association between base line lung function and endotoxin exposure was found only among asymptomatic farmers. Ammonia exposure and duration of the disinfection procedure were significantly associated with base line lung function in the entire population. CONCLUSION--Results suggest that use of disinfectants is an important aetiological factor in chronic respiratory health effects of pig farmers. This factor has not been studied before. Results also suggest an aetiological role for exposure to endotoxins and ammonia in development of chronic respiratory health effects, but longitudinal studies with detailed exposure assessment strategies are required to assess their roles AU - Preller L AU - Heederik D AU - Boleij JS AU - Vogelzang PF AU - Tielen MJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Exposure assessment in industry specific retrospective occupational epidemiology studies PG - 625-633 AB - Quantitative estimation of exposure for occupational epidemiology studies has received increasing attention in recent years and, as a result, a body of methodological literature has begun to take form. This paper reviews the generic issues in the methodology of exposure assessment, particularly methods for quantitative retrospective assessment studies. A simple framework, termed an exposure data matrix (EDM), for defining and analysing exposure data is proposed and discussed in terms of the definition of matrix dimensions and scales. Several methods for estimation, interpolation, and extrapolation, ranging from subjective ratings to quantitative statistical modelling are presented and discussed. The various approaches to exposure assessment based on the EDM concept are illustrated with studies of lung disease among coal miners and other dust and chemically induced chronic occupational diseases. The advantages of validated statistical models are emphasised. The importance of analysis and control of errors in exposure assessments, and integration of the exposure assessment and exposure-response processes, especially for emerging occupational health issues, is emphasised AU - Seixas NS AU - Checkoway H LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 73 IP - DP - 1995 Jan 01 TI - Indoor environmental risk factors in young asthmatics: a case-control study PG - 408-412 AB - One hundred and ninety three children with asthma and 318 controls aged 1-4 years were evaluated for atopic heredity and exposure to possible indoor risk factors for asthma-for example exposure to furred pets, tobacco smoke, and home dampness. A subgroup of cases were classified as cat and/or dog allergic on the basis of skin prick tests. Heredity for asthma was a significant risk factor (odds ratio (OR) 3.0, confidence interval (CI) 2.1 to 4.6). Environmental tobacco smoke was associated with an excess risk for asthma (OR 1.7, CI 1.1 to 2.3) and signs of home dampness tended to increase this risk (OR 1.3, CI 0.9 to 2.0). High dose exposure to cat and/or dog resulted in an increased risk only in asthma cases sensitised to cat and/or dog (OR 2.7, CI 1.0 to 7.3). A combination of high dose exposure to cat and/or dog, environmental tobacco smoke and damp housing was associated with an OR of 8.0 (CI 1.9 to 34.1). Raised indoor humidity has been shown to reflect low air exchange, which may also lead to increased doses of inhaled aeroallergens and tobacco smoke, and contribute to the interaction between the three risk factors AU - Lindfors A AU - Wickman M AU - Hedlin G AU - Pershagen G AU - Rietz H AU - Nordvall SL LA - PT - DEP - TA - Arch Dis Child JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 109 IP - DP - 1995 Jan 01 TI - Latex-induced allergic rhinitis in a laboratory nurse PG - 1094-1096 AB - A case of occupational rhinitis in association with natural rubber latex hypersensitivity is presented. In the nasal provocation test for natural rubber latex glove powder the nurse experienced rhinorrhoea. A significant increase in the amount of nasal secretion and mucosal oedema could be detected. The patient also showed a positive skin prick test to natural rubber latex allergens, and an elevated natural rubber specific IgE level in her serum. This, to our knowledge, has not been previously reported in the literature AU - Kujala V AU - Pirila T AU - Niinimaki A AU - Reijula K LA - PT - DEP - TA - Journal of Laryngology & Otology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 103 IP - DP - 1995 Jan 01 TI - Occupational asthma. [Review] PG - Suppl 6:249-52 AB - Many toxic compounds found in air emissions may induce bronchoconstriction. In the workplace, workers are exposed to these compounds, often in much higher concentrations. Some of these compounds act as sensitizers. Of these, some compounds induce asthma by producing specific IgE antibodies to the compound or its protein conjugate, while others induce asthma through yet unidentified immunologic mechanisms. Some compounds, when inhaled in high concentrations, act as irritants and produce bronchoconstriction probably by inducing acute airway inflammation. The latter condition is called Reactive Airways Dysfunction Syndrome (RADS) or irritant-induced asthma. Occupational asthma is an excellent model to study the pathogenesis and the natural history of adult onset asthma because the responsible agent can be identified, complete avoidance is possible, and exposure can be measured or estimated. AU - ChanYeung M LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 151 IP - DP - 1995 Jan 01 TI - Determinants of longitudinal changes in spirometric function among swine confinement operators and farmers PG - 47-53 AB - To assess whether working in a swine confinement facility causes an excess or accelerated decline in lung function, we conducted a population-based study to evaluate the determinants of longitudinal changes in airflow in a population of swine confinement operators. Spirometric measures of lung function were compared between swine confinement operators (N = 168) and neighborhood farmer control subjects (N = 127). Study subjects were randomly selected from a cohort of swine confinement operators in eastern Iowa. The control farming population was matched by geographic location, age, and sex to the swine confinement operators. On average, the follow-up time was approximately 2 yr, with a range of follow-up between 56 and 1, 900 d. Although swine confinement operators and neighborhood farmers had similar demographic characteristics (age, gender, racial background, smoking history, and atopy status), swine confinement operators tended to have less farming experience and were more extensively followed (more measures of lung function and longer periods of observation) than the neighborhood farmer control group. Swine confinement operators were also exposed to higher environmental dust concentrations and other irritants than the farmer control subjects. Interestingly, the cross-sectional data indicated that swine confinement operators tended to have slightly lower measures of airflow and greater workshift declines in forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and mid-expiratory flow (FEF25-75) than the neighborhood farmer control group. AU - Schwartz DA AU - Donham KJ AU - Olenchock SA AU - Popendorf WJ AU - Van Fossen DS AU - Burmeister LF AU - Merchant JA LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 151 IP - DP - 1995 Jan 01 TI - NHLBI Workshop summary. Stress and asthma. [Review] PG - 249-252 AU - Busse WW AU - KiecoltGlaser JK AU - Coe C AU - Martin RJ AU - Weiss ST AU - Parker SR LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 95 IP - DP - 1995 Jan 01 TI - Hypersensitivity pneumonitis caused by soybean antigens PG - 622-626 AU - Zubeldia JM AU - Gil P AU - Miralles P AU - de Barrio M AU - Aranzabal A AU - Herrero T AU - Rubio M AU - Bouzas E AU - Baeza ML LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 95 IP - DP - 1995 Jan 01 TI - Anacardium occidentale (cashew) pollen allergy in patients with allergic bronchial asthma PG - 501-504 AB - BACKGROUND: The cashew tree grows in abundance in the hills and plains of Goa, India. Because of the financial yield, more and more trees are being planted each year. The cashew tree flowers once a year between January and March, but pollination is mostly entomophilous. OBJECTIVE: For the first time, a study was conducted to establish the possible role of the cashew pollen in triggering allergic asthma. METHODS: A stock solution of pollen extract was prepared with the standard weight/volume method for intradermal skin tests and a bronchial provocation tests (BPTs). The protein content of the antigen, estimated with the use of Folin phenol reagent and a spectrophotometer, was 28.72 mg/ml. Ten healthy volunteers and 65 subjects with allergic asthma, as documented by previous positive skin test reactions to various pollens, were studied. RESULTS: Of the 65 patients, 26 (40%) had positive skin test reactions in various grades. BPTs were performed in 22 of the 26 patients after their baseline peak expiratory flow volume was assessed. Twenty (90.9%) patients had a positive BPT result, and the majority of patients had grade III and grade IV reactions. None of the control subjects (n = 10) had positive responses to either intradermal tests or the BPT. Serum IgE levels, estimated by ELISA, were high in patients with positive skin test responses and showed a linear correlation with cutaneous sensitivity. Control subjects showed normal levels of IgE (39.0 +/- 7.87 IU/ml). CONCLUSIONS: This study provided us with knowledge of an additional pollen, Anacardium occidentale, which could trigger an asthmatic response in allergic individuals AU - Fernandes L AU - Mesquita AM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 28 IP - DP - 1995 Jan 01 TI - Immunological reactions and respiratory function in wool textile workers PG - 445-456 AB - Immunological status and respiratory function were studied in a group of 64 wool textile workers (52 women and 12 men). A group of 46 workers not exposed to wool dust served as a control for the respiratory symptoms and immunologic testing. Skin testing was performed with different wool allergens (domestic and Australian) as well as with common allergens. Ventilatory capacity was measured in wool workers on Mondays before and after the work shift. The prevalence of positive skin tests to all allergens was higher in wool than in control workers, although the difference was statistically significant only for washed domestic wool (wool workers: 42.2%; control workers: 19.6%; p < 0.05). Increased serum IgE levels were more frequent in wool (26.6%) than in control workers (3.1%) (p < 0.01). In wool textile workers there was a high prevalence of acute and chronic respiratory symptoms. Significant across-shift reductions in ventilatory capacity tests, as well as abnormal baseline lung function, were recorded in wool textile workers. Individual data demonstrated that many of the wool workers had FEF25 lower than 70% of predicted. In general, the prevalence of symptoms and the lung function abnormalities did not correlate with the results of specific (wool) skin tests. Our data indicate that exposure to wool dust in some workers may be associated with the development of acute and chronic respiratory symptoms and impairment of lung function. Immunologic abnormalities, although frequent in this group, do not appear to be associated with the severity of these changes 37341-29-0 (IgE) AU - Zuskin E AU - Kanceljak B AU - Mustajbegovic J AU - GodnicCvar J AU - Schachter EN LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 95 IP - DP - 1995 Jan 01 TI - alpha-Amylase contained in bread can induce food allergy PG - 132-133 AU - Kanny G AU - MoneretVautrin DA LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 273 IP - DP - 1995 Jan 01 TI - Latex-induced asthma among health care workers [news] PG - 764-764 AU - Voelker R LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 107 IP - DP - 1995 Jan 01 TI - Peak expiratory flow rate variability in population surveys. Does the number of assessments matter? PG - 418-423 AB - We investigated the effect of reducing the number of daily peak expiratory flow (PEF) measurements on (1) the amplitude of PEF variability and (2) the relationships of this amplitude to bronchial reactivity to methacholine. One hundred seventeen workers (mean age = 38.7 years +/- 9.5; men = 86.3%) recorded their highest of three PEF measurements, every 3 waking hours, ie, 5 times a day, for 7 days, each using a newly purchased peak flowmeter (Vitalograph), and underwent methacholine challenge tests. The variability of PEF of each subject was expressed using the three sets of indices: amp%mean, ie, highest of the daily measurements considered minus the lowest/mean x 100, averaged over 6 days from the second to the seventh, amp%highest (same as amp%mean, but with the highest daily measurements as denominators) and SD%mean (calculated initially as single measures using the data of the 6 days considered, with standard deviation (SD) of each subject's PEF measurements). For each set, we used the indices constructed with the five daily measurements of each day (gold standard), with the first, third, fourth, and fifth, the first, third, and fourth, the first and third, and the first and fourth. The PEF variability was significantly reduced when reducing the number of daily measurements, only when the amp%mean and the amp%highest sets were used. No decrease was observed with the SD%mean set of indices, and SD%mean constructed with the first, third, fourth, and fifth daily measurement was satisfactory. Whatever the sort of index used, three daily measurements were sufficient to identify the group of subjects with excessive variability in relation to methacholine reactivity AU - Zureik M AU - Liard R AU - Segala C AU - Henry C AU - Korobaeff M AU - Neukirch F LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 151 IP - DP - 1995 Jan 01 TI - Bronchial inflammation in occupational asthma due to western red cedar PG - Pt 1):340-4 AB - Bronchoalveolar lavage cells and bronchial biopsies were obtained from nine patients with red cedar asthma, six atopic asthmatics and six non-atopic, non-asthmatic control subjects. There were similar proportions of neutrophils, mast cells, lymphocytes, and macrophages in BAL samples from all three groups, but eosinophil numbers were elevated in patients with cedar asthma and atopic asthma (3.0 and 2.5% respectively versus 0.5% in control subjects; p < 0.05 for each group). In bronchial mucosal biopsies, mean numbers of T cells were elevated in both asthmatic groups (cedar asthma 9.8 times, and atopic asthma 2.6 times, control values). CD4+ cells accounted for most of the increase in T-cell numbers, while CD8+ cell numbers were elevated in biopsies from a minority of cedar asthma patients. Absolute numbers of CD25+ (IL-2 receptor-bearing) cells were increased in cedar asthma but the proportion of T cells expressing CD25, was similar in all three groups. Activated eosinophils (EG2+) were increased in both asthmatic groups, with mean numbers 2.5 times greater in the cedar asthma biopsies than in atopic asthmatics. Thus both cedar asthma and atopic asthma are associated with increased numbers of T-cells and activated eosinophils in the bronchial mucosa. There was no major histologic difference between atopic asthma and red cedar asthma AU - Frew AJ AU - Chan H AU - Lam S AU - ChanYeung M LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 27 IP - DP - 1995 Jan 01 TI - Airway responsiveness to methacholine, respiratory symptoms, and dust exposure levels in grain and flour mill workers in eastern France PG - 859-869 AB - Our goal was to assess the relation between dust exposure levels and the respiratory health status of workers in grain and flour mills in eastern France. We studied 118 male workers from 11 mills and 164 unexposed male controls. Dust concentration was measured by personal sampling methods. Outcome variables included respiratory symptoms, routine pulmonary function tests, and indices of airway responsiveness to methacholine. A great within-and between-area variability of inhalable dust concentration was found in all mills. A dose-response relationship was observed between dust exposure levels and chronic respiratory symptoms, suggesting that exposure to grain and flour dust may lead to chronic bronchitis. A significant relation was found between dust exposure and airway hyper-responsiveness; this finding is important since it has been hypothesized that the latter abnormality may lead to or be a predisposing factor in subsequent chronic, irreversible airflow obstruction AU - Massin N AU - Bohadana AB AU - Wild P AU - KoloppSarda MN AU - Toamain JP LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 27 IP - DP - 1995 Jan 01 TI - Respiratory symptoms and lung function in wool textile workers PG - 845-857 AB - Our study investigated a group of 216 wool textile workers (158 women and 58 men). Respiratory symptoms were assessed by questionnaire in wool textile workers and in 130 not exposed (control) workers. Ventilatory capacity was measured in wool workers by recording maximum expiratory flow-volume (MEFV) curves on Monday before and after the work shift. Forced vital capacity (FVC), 1-second forced expiratory volume (FEV1), and flow rates at 50% and the last 25% of the vital capacity (FEF50, FEF25) were measured on the MEFV curves. Analysis of the data demonstrated a significantly higher prevalence of all chronic respiratory symptoms in wool workers than in controls, being the highest in wool workers for nasal catarrh (M: 63.8%; F: 44.9%) and for sinusitis (M: 62.1%; F: 43.0%). A high prevalence of acute symptoms, associated with the work shift, was also noted in wool workers. Exposure to wool dust caused significant across-shift reductions of ventilatory capacity varying from 1.4% for FEV1 to 9.1% for FEF50. Textile workers exposed to wool for > 10 years in the workplace had similar across-shift reductions of ventilatory capacity tests as those with shorter exposures. In a large number of these wool workers, FEF50 and FEF25 were below 70% of predicted normal values. Smokers had acute and chronic lung function changes similar to those of nonsmokers, indicating that smoking did not account for all the respiratory effects seen in wool processing workers. Our data suggest that dust exposures in wool textile mills may be associated with the development of chronic respiratory symptoms and impaired lung function AU - Zuskin E AU - Mustajbegovic J AU - Schachter EN AU - Kanceljak B AU - GodnicCvar J AU - SitarSrebocan V LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 37 IP - DP - 1995 Jan 01 TI - Occupationally related cancer risk among coke oven workers: 30 years of follow-up PG - 597-604 AB - This study concerns the update of cause-specific mortality among coke oven workers. Updated information provides 3 decades of work history and vital status follow-up on 15,818 workers. Mortality patterns are summarized by race, cumulative exposure, and period of follow-up. The findings are consistent with those from earlier assessments, indicating that occupational exposure to coke oven emissions is associated with significant excess mortality from cancer of the respiratory system and of the prostate. Depending on the segment of the population considered, the respiratory cancer risk for coke oven workers ranged as high as 4.45 times that for non-oven workers. Relative risk values for cancer of the prostate ranged as high as 1.93. Rates of respiratory cancer across period of follow-up are declining, suggesting that the implementation of emissions control and occupational exposure limits has been beneficial AU - Costantino JP AU - Redmond CK AU - Bearden A LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 12 IP - DP - 1995 Jan 01 TI - Is atopy a risk factor of occupational asthma? [Review] [French] PG - 231-239 AB - General reviews about occupational asthma divide the susceptible allergens capable of initiating asthma into two distinct groups: those of high and of low molecular weight. Atopy would be a risk factor for developing occupational asthma to high molecular weight allergens but not to those of low molecular weight. In this work we have examined several studies and have analysed in a critical manner the relationship which exists between atopy and occupational asthma. The high molecular weight allergens studied were: snow crabs, laboratory animals, flour, proteolytic enzymes and psyllium. Those of low molecular weight were: red cedar, isocyanates, phthalic anhydride. Amongst allergens of high molecular weight there is a undeniable relationship between atopy and sensitisation to the allergen incriminated. However, the relation between atopy and asthma is more debatable except for baker's asthma. For more allergens of low molecular weight, atopy does not seem to favour the appearance of asthma, however, it may play a role in the occurrence of asthma to red cedar. The difference between the two groups of allergens is not as clear-cut as in the work that has appeared up until now and the exclusion of atopics from being hired would appear excessive. AU - Lemiere C AU - Charpin D AU - Vervloet D LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 23 IP - DP - 1995 Jan 01 TI - Occupational health problems among dental hygienists PG - 177-181 AB - A questionnaire survey on work-related health complaints was performed among dental hygienists. Valid information was received fom 189 hygienists, representing about half of all active members of the Norwegian Association of Dental Hygienists. Parallel information was received from similar number of female and male control persons in other occupations. The present report presents data on the nature and etiology of the chemically induced health complaints. About half of the hygienists had experienced one or more health problem of dermal, systemic, sensory (eye) or respiratory nature during the last year, as compared to 37% of the female and 19% of the male control group. The most frequent complaint was dermatoses of hands and fingers (37%), caused by different chemical, work-related factors. Latex gloves were responsible for 1/3 of these reactions. The role of immunological and irritant latex reactions were discussed and the prevalence of non-dermatological reactions compared with similar findings among women in other occupations AU - Jacobsen N AU - HenstenPettersen A LA - PT - DEP - TA - Community Dentistry & Oral Epidemiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 152 IP - DP - 1995 Jan 01 TI - The role of endotoxin in grain dust-induced lung disease PG - 603-608 AB - To identify the role of endotoxin in grain dust-induced lung disease, we conducted a population-based, cross-sectional investigation among grain handlers and postal workers. The study subjects were selected by randomly sampling all grain facilities and post offices within 100 miles of Iowa City. Our study population consisted of 410 grain workers and 201 postal workers. Grain workers were found to be exposed to higher concentrations of airborne dust (p = 0.0001) and endotoxin (p = 0.0001) when compared with postal workers. Grain workers had a significantly higher prevalence of work-related (cough, phlegm, wheezing, chest tightness, and dyspnea) and chronic (usual cough or phlegm production) respiratory symptoms than postal workers. Moreover, after controlling for age, gender, and cigarette smoking status, work-related respiratory symptoms were strongly associated with the concentration of endotoxin in the bioaerosol in the work setting. The concentration of total dust in the bioaerosol was marginally related to these respiratory problems. After controlling for age, gender, and cigarette smoking status, grain workers were found to have reduced spirometric measures of airflow (FEV1, FEV1/FVC, and FEF25-75) and enhanced airway reactivity to inhaled histamine when compared with postal workers. Although the total dust concentration in the work environment appeared to have little effect on these measures of airflow obstruction, higher concentrations of endotoxin in the bioaerosol were associated with diminished measures of airflow and enhanced bronchial reactivity. Our results indicate that the concentration of endotoxin in the bioaerosol may be particularly important in the development of grain dust-induced lung disease AU - Schwartz DA AU - Thorne PS AU - Yagla SJ AU - Burmeister LF AU - Olenchock SA AU - Watt JL AU - Quinn TJ LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 23 IP - DP - 1995 Jan 01 TI - Bronchial asthma induced by hypersensitivity to legumes PG - 38-40 AB - We report the case of a 54-year-old female patient, diagnosed of nasal polyposis and intrinsic corticodependent bronchial asthma, who since a year has developed episodes of asthma when exposed to vapours from cooking some kinds of legumes (peas, chick-peas, beans, lentils) and an oral allergy syndrome with peanuts. We prepared extract with these legumes. The skin tests were clearly positive for legumes but negative for pneumoallergens. Specific IgE by CAP was strongly positive for legumes. CAP inhibition was preformed and the results show the presence of cross-reactivity among legumes AU - Garcia Ortiz JC AU - LopezAsunsolo A AU - Cosmes P AU - Duran AM LA - PT - DEP - TA - Allergol Immunopathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 67 IP - DP - 1995 Jan 01 TI - Bronchial responsiveness decreases in relocated aluminum potroom workers compared with workers who continue their potroom exposure PG - 53-57 AB - We have compared the bronchial responsiveness (BR) of 12 aluminum potroom workers (index group) who were relocated due to work-related asthmatic symptoms (WASTH) and 26 subjects (reference group) with WASTH who continued to work in potrooms. The subjects were examined at regular intervals during a 2-year follow-up period. BR was expressed as the log-transformed dose-response slope [Ln(DRS 5)]. The monthly change in BR (delta BR) in the index group was -4.87 x 10(-2) compared with -1.58 x 10(-2) in the reference group. After adjustment for potential confounders, the difference between the index group and the reference group was -2.39 x 10(-2) (95% CI: -4.07 x 10(-2) to -0.71 x 10(-2)), i.e. 49% of the decrease in BR in the index group could be explained by the removal from exposure. No improvement in lung function was found in the index group compared with the reference group. The results indicate that the removal of potroom workers from exposure causes a decrease in BR AU - Soyseth V AU - Kongerud J AU - Aalen OO AU - Botten G AU - Boe J LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 86 IP - DP - 1995 Jan 01 TI - Atopy, asthma and the judgement of preemployment fitness [Review] [Italian] PG - 303-308 AB - The preemployment medical examination is a practice viewed as important by recently introduced Italian laws (D.L. 277/91 and 626/94), even if its efficacy with regard to atopy is frequently a matter of controversy. It has been assumed that atopy (with a prevalence in the general population around 30%) is a predictive discriminant in the prevention of occupational allergic asthma, but a review of the literature shows that the hypothetical exclusion of 23 per cent of total job applicants (because they are atypical) would seem to prevent only 55 per cent of asthma cases. At the present time, the concept of discrimination in employment founded on presence of atopy is scientifically unsubstantiated and ethically unacceptable. AU - Innocenti A LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 96 IP - DP - 1995 Jan 01 TI - Occupational asthma caused by grass juice PG - Pt 1):693-5 AU - Subiza J AU - Subiza JL AU - Hinojosa M AU - Varela S AU - Cabrera M AU - Marco F LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 96 IP - DP - 1995 Jan 01 TI - Allium cepa seeds: a new occupational allergen PG - Pt 1):690-3 AU - Navarro JA AU - del Pozo MD AU - Gastaminza G AU - Moneo I AU - Audicana MT AU - Fernandez de Corres L LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 28 IP - DP - 1995 Jan 01 TI - Bronchiolitis obliterans in an animal feed worker PG - 437-443 AB - A nonsmoking animal feed worker developed severe irreversible airflow obstruction during a 2-year occupational exposure to organic matter, microorganisms, proteolytic enzymes, and both amorphous and synthetic silicates. Her pulmonary dysfunction failed to improve despite removal from the workplace and treatment with bronchodilators and corticosteroids. Open lung biopsy demonstrated peribronchiolar inflammation, scarring within the small airways, and neolumen formation, findings consistent with bronchiolitis obliterans. Energy dispersive analysis of both the bronchoalveolar lavage fluid as well as the biopsy specimens revealed the presence of silicate particles, suggesting a potential link between the silica exposure and the pathologic findings. This case suggests bronchiolitis obliterans can occur as a consequence of occupational exposure in the animal feed industry. In addition, this entity should henceforth be considered when evaluating symptomatic patients with exposure to amorphous and synthetic silicates AU - Spain BA AU - Cummings O AU - Garcia JG LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 28 IP - DP - 1995 Jan 01 TI - Prevalence and predictors of asthma in working groups in British Columbia PG - 411-423 AB - We evaluated the prevalence of asthma and its predictors in studies of several male working groups: 619 cedar sawmill, 724 grain elevator, 399 pulpmill, 798 aluminum smelter, and 1,127 unexposed workers. These workers had taken part in health studies for assessment of chronic respiratory effects of various workplace exposures between 1979 and 1982. The American Thoracic Society Adult Questionnaire (ATS-DLD-78) was used for these studies. Allergy skin tests were also performed. The participation rates were > 80%. The overall prevalance of physician-diagnosed asthma was 4.6%, and current asthma 3%. The prevalence of asthma after employment in the current industry, as a surrogate for work-related asthma, was 3.9 times higher in cedar sawmill workers, 2.2 times higher in pulpmill and aluminum smelter workers, and 1.7 times higher in grain elevator workers compared with unexposed workers. Atopy and a positive parental history of asthma, but not smoking, were important risk factors for asthma before the onset of first employment. Also, for asthma after employment in the current industry, atopy and a positive parental history of asthma were important risk factors. Smoking was associated with a significant reduction in the risk for asthma after employment in the current industry. Within specific work groups, the prevalence of atopy was significantly higher among pulpmill workers with asthma after employment in current industry than those without asthma. Conversely, cedar sawmill workers who had asthma after employment in the current industry were nonatopic and nonsmokers 7429-90-5 (Aluminum) AU - Siracusa A AU - Kennedy SM AU - Dybuncio A AU - Lin FJ AU - Marabini A AU - ChanYeung M LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 14 IP - DP - 1995 Jan 01 TI - Issues in occupational health and safety. Gluteraldehyde causes nurse's asthma PG - 20-21 AU - Anonymous LA - PT - DEP - TA - Queensland Nurse JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 163 IP - DP - 1995 Jan 01 TI - Allergy to laboratory animals among animal handlers PG - 415-418 AB - OBJECTIVE: To determine the prevalence among laboratory animal handlers of allergy to laboratory animals and of asthma and the factors associated with their development. DESIGN: A cross-sectional survey. SETTING: Teaching and research institutions in Sydney, between January 1989 and December 1992. PARTICIPANTS: Laboratory animal handlers (teaching and research staff, animal house workers and animal husbandry students and teachers). MAIN OUTCOME MEASURES: Duration of exposure to laboratory animals, allergic symptoms on contact, skin reactivity to laboratory and domestic animal allergens and evidence of current asthma. RESULTS: 228 subjects were surveyed. Allergy symptoms occurred in 73 (56%) of the subjects exposed to laboratory animals for three months or more. This group also had significantly higher prevalences of skin reactivity to laboratory animal allergens (62%) and bronchial hyperresponsiveness (21%) than those with shorter exposure (14% and 8%, respectively). Atopic subjects exposed to laboratory animals (particularly those sensitised to domestic animals) and animal attendants (with a high intensity of exposure to laboratory animals) had significantly higher frequencies of skin reactivity to laboratory animals and asthma than other subjects (77% and 30%, respectively, among exposed atopic subjects and 84% and 33%, respectively, among animal attendants). CONCLUSIONS: Allergy to laboratory animals is an occupational hazard among laboratory animal handlers, especially for those who are atopic and sensitised to domestic animals, and may lead to the development of asthma. Screening for atopy and skin reactivity to laboratory animals before and during employment would enable those at risk to take precautions AU - Bryant DH AU - Boscato LM AU - Mboloi PN AU - Stuart MC LA - PT - DEP - TA - Medical Journal of Australia JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 346 IP - DP - 1995 Jan 01 TI - Occupational asthma induced by ethylene oxide [letter] PG - 1434-1435 AU - Verraes S AU - Michel O LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 67 IP - DP - 1995 Jan 01 TI - Mortality study among workers producing chromate pigments in France PG - 147-152 AB - In a follow-up study of 294 men who had worked for at least 6 months in a chromate-producing factory in France between 1958 and 1987, only 16 were lost to follow-up and the number of person-years in the study was 5207. Occupational data were provided by the administration of the plant. The causes of deaths were ascertained from hospital and general practitioners' records. The observed numbers of deaths were compared with the expected numbers based on local rates with adjustment for age, sex and calendar time (standardized mortality ratio, SMR). The overall mortality did not differ significantly from that expected (SMR = 1.20, 95% CI = 0.98-1.47), whereas mortality due to lung cancer was in significant excess (SMR = 3.60, 95% CI = 2.13-5.68). Significantly higher lung cancer SMRs were found for workers whose duration of employment was more than 10 years. A non-significant excess was observed for all forms of digestive tract cancer (SMR = 1.30, 95% CI = 0.60-2.47). There were two cases of brain cancer when 0.24 was expected (SMR = 8.44, 95% CI = 1.02-30.49). No previous report has mentioned an association of brain cancer with chromate pigments; however, because of the small numbers involved, a chance excess should be considered 0 (Chromates) AU - Deschamps F AU - Moulin JJ AU - Wild P AU - Labriffe H AU - Haguenoer JM LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 33 IP - DP - 1995 Jan 01 TI - Rubber latex in the air: an occupational and environmental cause of asthma?. [Review] PG - 895-899 AU - Hopkins J LA - PT - DEP - TA - Food & Chemical Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 75 IP - DP - 1995 Jan 01 TI - Inhalation challenge effects of perfume scent strips in patients with asthma PG - 429-433 AB - BACKGROUND: Perfume- and cologne-scented advertisement strips are widely used. There are, however, very few data on the adverse effects of perfume inhalation in asthmatic subjects. OBJECTIVES: This study was undertaken to determine whether perfume inhalation from magazine scent strips could exacerbate asthma. METHODS: Twenty-nine asthmatic adults and 13 normal subjects were included in the study. Histories were obtained and physical examinations performed. Asthma severity was determined by clinical criteria of the National Heart, Lung, and Blood Institute (NHLBI). Skin prick tests with common inhalant allergens and with the perfume under investigation were also performed. Four bronchial inhalation challenges were performed on each subject using commercial perfume scented strips, filter paper impregnated with perfume identical to that of the commercial strips, 70% isopropyl alcohol, and normal saline, respectively. Symptoms and signs were recorded before and after challenges. Pulmonary function studies were performed before and at 10, 20, and 30 minutes after challenges. RESULTS: Inhalational challenges using perfume produced significant declines in FEV1 in asthmatic patients when compared with control subjects. No significant change in FEV1 was noted after saline (placebo) challenge in asthmatic patients. The percent decline in FEV1 was significantly greater after challenge in severely asthmatic patients as compared with those with mild asthma. Chest tightness and wheezing occurred in 20.7% of asthmatic patients after perfume challenges. Asthmatic exacerbations after perfume challenge occurred in 36%, 17%, and 8% of patients with severe, moderate, and mild asthma, respectively. Patients with atopic asthma had greater decreases in FEV1 after perfume challenge when compared with patients with nonallergic asthma. CONCLUSIONS: Perfume-scented strips in magazines can cause exacerbations of symptoms and airway obstruction in asthmatic patients. Severe and atopic asthma increases risk of adverse respiratory reactions to perfumes AU - Kumar P AU - CaradonnaGraham VM AU - Gupta S AU - Cai X AU - Rao PN AU - Thompson J LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 152 IP - DP - 1995 Jan 01 TI - Airway obstruction in boilermakers exposed to fuel oil ash. A prospective investigation PG - Pt 1):1478-84 AB - We prospectively investigated the lower airway response in boilermakers overhauling an oil-powered boiler. We studied 26 male boilermakers with a mean age (SD) of 43.3 (8.6) yr. Pre-exposure spirometry and methacholine challenge tests were performed before beginning the boiler overhaul; postexposure tests were performed after approximately 4 wk of work on the boiler. Exposure to particulates with an aerodynamic diameter of 10 microns and smaller (PM10) and respirable vanadium dust were estimated using daily work diaries and a personal sampling device for respirable particles. Using these estimates, we calculated average and peak exposure between pre- and postexposure tests for each subject. The average PM10 concentration ranged from 1.44 to 6.69 mg/m3, with a mean (SD) of 3.22 (1.42) mg/m3; the average vanadium concentration ranged from 2.2 to 31.3, with a mean (SD) of 12.2 (9.1) micrograms/m3. The mean postexposure fall in FEV1 was 140 +/- 160 ml (p < 0.01); 24 of 26 subjects had a drop in FEV1. For each subject, the adjusted change in FEV1 (delta FEV1.adj) was calculated by dividing the change in FEV1 by the average of the pre- and postexposure FEV1 values. The delta FEV1.adj was regressed, controlling age and current smoking status, on average and peak exposure to both PM10 and vanadium. There was a dose-response relationship between average and peak PM10 exposure and delta FEV1.adj: beta = -0.91% per mg/m3, p = 0.08 and beta = -1.03% per mg/m3, p = 0.03, respectively. However, there was no relationship between delta FEV1.adj and respirable vanadium dust concentration. Furthermore, there was no postexposure change in nonspecific airway responsiveness. In summary, we found a significant fall in FEV1 and a dose-response relationship between delta FEV1.adj and average and peak PM10 exposure. AU - Hauser R AU - Elreedy S AU - Hoppin JA AU - Christiani DC LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 252 IP - DP - 1995 Jan 01 TI - Allergic rhinitis in laboratory workers caused by occupational exposure to guinea pigs: an immunological and clinical study PG - 304-307 AB - Occupational exposure in laboratory workers to various animals can result in clinically significant respiratory allergies. We used clinical and immunological methods to study five laboratory workers who exhibited symptoms of nasal allergy upon occupational exposure to guinea pigs. As compared with a control group of ten nonallergic laboratory workers, the symptomatic workers generally had positive skin test reactions for allergens derived from the urine, saliva, and pelts of the guinea pigs. The study group with symptoms also showed high serum levels of specific IgE and demonstrated an immediate, positive reaction to nasal provocation testing with urine-derived antigen. However, specific IgG values in the sera of these patients did not differ significantly from control values. Overall results indicated that a type 1 allergy was involved 0 (IgG). 37341-29-0 (IgE) AU - Hanada T AU - Shima T AU - Ohyama M LA - PT - DEP - TA - European Archives of Oto-Rhino-Laryngology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 37 IP - DP - 1995 Jan 01 TI - Irritant-induced asthma [letter] PG - 662-662 AU - Shusterman D AU - Balmes J AU - Cone J LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 4 IP - DP - 1995 Jan 01 TI - Subjective indoor air quality in hospitals- the influence of building age, ventilation flow, and personal factors PG - 37-44 AU - Nordstrom K AU - Norback D AU - Akselsson R LA - PT - DEP - TA - Indoor Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 108 IP - DP - 1995 Jan 01 TI - Machine operator's lung. A hypersensitivity pneumonitis disorder associated with exposure to metalworking fluid aerosols PG - 636-641 AB - Six auto parts manufacturing workers were referred for evaluation of a 6-week history of work-related dyspnea, cough, and fatigue. Two workers also reported fever and weight loss. All six worked in a machining area where a waterbased metalworking fluid was used and recirculated under high pressure, thereby creating an aerosol. Chest radiographs revealed pulmonary interstitial infiltrates in four workers. Lung function tests showed that four workers had decreased diffusing capacity. After removal from the work area, all workers recovered. The metalworking fluid was cultured for bacteria and fungi. Isolates from broth cultures were sonicated to obtain antigen extracts. Serum precipitins to one or more of the microbial isolates were identified in all six workers but not in eight of nine nonexposed control subjects. The most frequent precipitin response (six of six workers) was against antigens of Pseudomonas fluorescens, which was cultured from the metalworking fluid. In all workers, precipitins to at least one other cultured organism were detected; these included Aspergillus niger, Staphylococcus capitas, an acid-fast Rhodococcus sp, and Bacillus pumilus. This represents the first report of hypersensitivity pneumonitis associated with industrial exposure to aerosolized metalworking fluid. Observed precipitin responses to a variety of microbial contaminants in metalworking fluid strongly suggest a causative role for microbial antigens in the induction and elicitation of this manifestation of hypersensitivity pneumonitis AU - Bernstein DI AU - Lummus ZL AU - Santilli G AU - Siskosky J AU - Bernstein IL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 37 IP - DP - 1995 Jan 01 TI - Mortality in agricultural workers after compensation claims for respiratory disease, pesticide illness, and injury PG - 160-169 AB - The long-term mortality experience of California agricultural workers who filed workers' compensation claims for respiratory diseases, pesticide illnesses, and injuries between 1946 and 1975 was observed until 1991 and compared to U.S. death rates. The respiratory disease claimants had an elevated relative risk of 3.27 (95% CI 2.09-4.86) for mortality from nonmalignant respiratory diseases (NMRD). Emphysema mortality was particularly high, with a relative risk of 5.94 (95% CI 2.56-11.70). NMRD mortality peaked 5 to 9 years after the claims were filed (relative risk 9.83, 95% CI 4.47-18.57) and was most strongly associated with exposure to wood, rice, coffee, and flour dusts. Among the pesticide illness claimants, mortality from heart disease was slightly elevated in the subcohort with systemic pesticide illness (SMR = 1.32, 95% CI 0.86-1.94). Among the injury claimants, risk was increased for motor vehicle deaths (relative risk 1.62, 95% CI 0.74-3.08). It was concluded that respiratory disease claimants in agriculture have a significantly elevated risk of mortality from respiratory diseases and that the risk is highest (10-fold) 5-9 years after claims are filed 0 (Pesticides) AU - Beaumont JJ AU - Goldsmith DF AU - Morrin LA AU - Schenker MB LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 37 IP - DP - 1995 Jan 01 TI - Respiratory effects of occupational exposure to aerosolized pentamidine PG - 145-150 AB - To determine the respiratory effects on health care workers of occupational exposure to aerosolized pentamidine (AP) used for the prophylaxis of Pneumocystis carinii pneumonia, we designed a clinical prospective study using subjects as their own controls. Sixteen health care workers whose job duties included administration of AP at one or more of nine San Francisco Bay Area medical centers participated in the study. Pentamidine concentrations ranged in breathing zone samples from < 0.03 to 62.2 micrograms/m3. Pentamidine was not detected in the urine of any of the subjects. There were no significant increases in symptoms on days when AP was administered. Cross-workshift spirometry on days when AP was administered showed a statistically significant mean decrease (0.14 liter) in forced expiratory volume in 1 second. There was no statistically significant difference in mean diurnal variation of peak expiratory flow rate on days when AP was administered. Methacholine inhalation challenge testing did not show a statistically significant mean change in airway responsiveness across the workweek. The ambient concentrations of pentamidine that we measured document that detectable occupational exposure to AP can occur in poorly ventilated treatment rooms. The cross-workshift decrement in forced expiratory volume in 1 second that we observed in association with AP administration supports the respiratory tract irritant potential of inhaled pentamidine. We recommend that steps be taken to minimize health care worker exposure to AP 0 (Aerosols). 0 (Air Pollutants, Occupational). 100-33-4 (Pentamidine) AU - Balmes JR AU - Estacio PL AU - Quinlan P AU - Kelly T AU - Corkery K AU - Blanc P LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 5 IP - DP - 1995 Jan 01 TI - Occupational asthma and contact urticaria caused by mukali wood dust (Aningeria robusta) PG - 113-114 AB - Mukali (Aningeria robusta) is an exotic wood from the Sapotaceae family. We describe the case of a 31-year-old woman who developed bronchial asthma and contact urticaria after occupational exposure to mukali. A positive immediate response was observed in the skin prick test, bronchial challenge and the rubbing test performed with a mukali wood extract. We suggest that an IgE-mediated immunological mechanism could explain these findings. Our case report identifies another wood dust capable of inducing occupational asthma AU - Garces Sotillos MM AU - Blanco Carmona JG AU - Juste Picon S AU - Rodriguez Gaston P AU - Perez Gimenez R AU - Alonso Gil L LA - PT - DEP - TA - Journal of Investigational Allergology & Clini JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - Allergy to Ficus benjamina (weeping fig) in nonatopic subjects PG - 284-285 AB - Occupational allergy to Ficus benjamina (Fb), or weeping fig, occurs in about one in four plant-keepers. Sensitization to this plant occurs in about 3-4% of persons with clear-cut atopy. I now report on four female nonatopic patients with rhinoconjunctivitis who were sensitized only to weeping fig. All four had a positive skin prick test and RAST test to Fb. The identification of a preventable respiratory allergen is of considerable importance for the patient. Inclusion of Fb in the standard prick test panel may therefore be considered. Furthermore, the findings suggest that it may be unwise to choose Fb as an ornamental indoor plant 0 (Allergens). 37341-29-0 (IgE) AU - Axelsson IG LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - Occupational rhinoconjunctivitis and bronchial asthma due to Phoenix canariensis pollen allergy PG - 277-280 AB - We report a case of occupational bronchial asthma and rhinoconjunctivitis caused by Phoenix canariensis (PC) pollen. The canary palm is a type of palm tree, belonging to the Arecaceae family, which is widely distributed in frost-free regions as an ornamental tree. Our patient was referred because he suffered symptoms of bronchial asthma, rhinoconjunctivitis, and contact urticaria when pruning dried leaves from PC during the pollination months. The skin prick test (SPT) with a PC pollen extract was positive, as was the specific IgE to PC pollen determined by Phadezym RAST, indicating an IgE-mediated sensitization. The nonspecific bronchial provocation test (BPT) performed with methacholine disclosed a mild bronchial hyperreactivity, and specific BPT with PC pollen elicited an immediate fall of 25% in FEV1 with respect to baseline. On RAST inhibition studies, a significant cross-reactivity was found between PC pollen and date palm (P. dactylifera) pollen. These results suggest that PC pollen could be a potential allergen in PC-growing areas 37341-29-0 (IgE) AU - Blanco C AU - Carrillo T AU - Quiralte J AU - Pascual C AU - Martin Esteban M AU - Castillo R LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 115 IP - DP - 1995 Jan 01 TI - Respiratory tract symptoms among farmers keeping animals in Midt-Norge [Norwegian] PG - 2524-2528 AB - In this survey from central Norway, the prevalence of respiratory symptoms in a representative sample of 1,580 farmers who kept domestic animals was compared with the prevalence of such symptoms among 655 controls, both sexes included. The farmer group experienced more symptoms that were exacerbated by work than the controls did (mucous membrane irritation 19% versus 10%, tightness in the chest 7% versus 4%, dyspnoea 4% versus 1% and cough with phlegm 25% versus 22%). No difference could be found between the groups as regards the prevalence of organic dust toxic syndrome or chronic bronchitis. The occurrence of symptoms was correlated to the number of working hours per day, and to the number of years the person had worked with animals. Farmers who kept cattle, pigs or poultry all showed raised prevalence of respiratory symptoms. The results indicate that the working environment of farmers who kept domestic animals may cause respiratory disorders 0 (Air Pollutants, Occupational) AU - Varslot M AU - Hilt B AU - Qvenild T LA - PT - DEP - TA - Tidsskr Nor Laegeforen JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 49 IP - DP - 1995 Jan 01 TI - Components of hair bleaches as triggers of bronchial hypersensitivity--studies using a model for occupationally-induced lung damage [German] PG - 418-427 AB - Ammonium persulfate (APS) is used as an oxidant in many industrial branches and is contained in bleaching substances used in hair cosmetic industry. In addition to skin diseases, respiratory disorders have been frequently reported. We examined whether APS can induce bronchial hyperresponsiveness (BHR) which has to be regarded as a first step in the development of obstructive respiratory disorders. In a rabbit model we tested the influence of aerosolized APS-solutions in concentrations of 0.1, 0.01 and 0.001 M (50, 5, 0,5 ppm in air) for about four hours on the contractile bronchial reaction. Exposure to APS-aerosols does not alter basal airway Resistance (RI), dynamic Elastance (Edyn), slope of inspiratory pressure generation (delta Poes/tI), arterial blood pressure and blood gases (PaO2, PaCO2). Before, after two and after four hours the influence of APS application on the bronchial reactivity to 0.2%- and 2% acetylcholine-aerosols (ACH) was tested. Exposure to an aerosol from 0.1 M APS solution, which is equivalent to a concentration of 50 ppm APS in air for two hours induces a significant increase in bronchoconstrictory responses to ACH. A nebulized 0.01 M APS solution causes an increased ACH response after four hours of exposure. However, inhalation of 0.001 M APS (0.5 ppm in air) does not alter sensitivity to ACH within four hours of exposure. In bronchoalveolar lavage an increased number of inflammatory cells was found. Our results demonstrate, aerolized APS-solutions to cause bronchial hyper-responsiveness after few hours of exposure presumably under the participation of inflammatory cells 0 (Aerosols). 0 (Hair Dyes). 7727-54-0 (ammonium peroxydisulfate). 7783-20-2 (Ammonium Sulfate) AU - Mensing T AU - Marek W AU - RaulfHeimsoth M AU - Baur X LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 67 IP - DP - 1995 Jan 01 TI - 4,4'-Methylenedianiline in hydrolysed serum and urine from a worker exposed to thermal degradation products of methylene diphenyl diisocyanate elastomers PG - 73-77 AB - A 45-year-old mechanic employed in blowing hot air (350 degrees-600 degrees C) onto the surface of a polyurethane methylene diphenyl diisocyanate (MDI) conveyer belt developed dyspnoea, rhinoconjunctivitis and fever. The illness was suggestive of an MDI-associated illness, compatible with both immediate hypersensitivity and a complement-mediated immune-complex reaction. In his serum there were specific IgG and IgE antibodies against MDI and other isocyanates, and high values of circulating immune complexes. The patient's blood and urine samples were analysed for the presence of 4,4'-methylenedianiline (MDA) in hydrolysed urine and plasma. MDA was derivatized to amides using pentafluoropropionic acid anhydride (PFPA). Gas chromatography-mass spectrometry determinations were made monitoring the (M-20; M = molecular mass) fragments from the MDA-PFPA and the [2H2]MDA-PFPA derivative. The first urine sample was obtained 22 h and the last sample 114 h after start of exposure. The urine concentrations of MDA were corrected for creatinine. The half-time of MDA was 70-80 h. The first serum sample was obtained 19 h and the last sample 1967 days after the start of exposure. The half-time was 21 days, which suggests the presence of MDI/MDA plasma protein adducts in the exposed worker 0 (Aniline Compounds). 0 (Isocyanates). 101-77-9 (4,4'-diaminodiphenylmethane). 9006-04-6 (Rubber) AU - Skarping G AU - Dalene M AU - Littorin M LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 67 IP - DP - 1995 Jan 01 TI - Work-related respiratory problems in industrial arts teachers PG - 111-118 AB - Because of reports of respiratory complaints in Swedish industrial arts (IA) teachers, a cross-sectional study was performed on 130 IA teachers in Stockholm to study the relationship between the work environment and health, and especially the aforementioned complaints. One hundred and twelve other school employees served as control subjects. Sex, age, and smoking habit distribution were similar in the two groups. All subjects answered a questionnaire about their health problems, and the IA teachers answered questions about their work environment. The work environment consisted of many old and neglected workshops (hereafter called shops). Compared to the control subjects, the IA teachers had more complaints in respect of the skin, eyes, nose, throat, and lower airways--including chronic bronchitis (OR 12.4, 95% confidence interval 2.95-110.5). A higher occurrence of symptoms existed in shops with bad ventilation and dust-spreading machines and in shops where dust-spreading cleanup methods were used. A suspected interaction between smoking and work environment was noted for some symptoms, especially impaired smell and chronic bronchitis. In conclusion, several factors in the work environment were identified as risk factors for health. Identification of these risk factors should result in a program to reduce the health problems in the work environment AU - Ahman M AU - Soderman E AU - Cynkier I AU - KolmodinHedman B LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 20 IP - DP - 1995 Jan 01 TI - Acute severe bronchoconstriction precipitated by coal tar bandages PG - 58-59 AB - We report the occurrence of severe symptomatic bronchoconstriction in an atopic asthmatic subject following the application of coal tar bandages. Investigations showed that this was likely to have been caused by inhalation of coal tar vapour. We suggest that coal tar preparations should be used with caution in asthmatic subjects 8007-45-2 (Coal Tar) AU - Ibbotson SH AU - Stenton SC AU - Simpson NB LA - PT - DEP - TA - Clin Exp Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 37 IP - DP - 1995 Jan 01 TI - Pulmonary effects of simultaneous exposures to MDI formaldehyde and wood dust on workers in an oriented strand board plant PG - 461-465 AB - A study was undertaken in a plant producing oriented strand board (OSB) from aspen and balsam wood, bonded by methylene diisocyanate (MDI) and phenol formaldehyde. A group of 127 production workers in the plant was compared to 165 oil workers from the same geographic area. Measurements of MDI ranged from 6 to 33 micrograms/m3 (0.001-0.003 ppm), of respirable dust ranged from 0.05 to 0.5 mg/m3, and of formaldehyde were 0.05 ppm or less. The ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) was significantly lower among the OSB workers compared to the oil workers, and this was more pronounced for ex-smokers and current smokers. A number of respiratory symptoms suggestive of airway reactivity were significantly more common among the OSB workers. It was known that changes to reduce worker exposure had been made in the plant before the study, and it is unclear whether the health effects documented were the result of these low levels or if previous, probably higher levels were responsible 0 (Air Pollutants, Occupational). 0 (Isocyanates). 0 (Phenols) 101-68-8 (4,4'-diphenylmethane diisocyanate). 50-00-0 (Formaldehyde) AU - Herbert FA AU - Hessel PA AU - Melenka LS AU - Yoshida K AU - Nakaza M LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 152 IP - DP - 1995 Jan 01 TI - Farmer's lung and variables related to the decision to quit farming PG - 997-1002 AB - An exploratory strategy was used to investigate why 55% of patients with farmer's lung (FL) disease quit farming. Three groups were recruited: 47 patients with FL disease who quit farming because of the disease (FLq), 76 patients with FL disease who continued farming (FLc), and 123 control farmers without a history of FL disease. The severity of FL disease at diagnosis was similar in both groups of patients. For example, single-breath carbon monoxide diffusion capacity predicted for FLq and FLc was 64.4 +/- 28.2 and 63.9 +/- 22.0, respectively. Relying on a cognitive-behavior theory, numerous physiological, behavioral, cognitive, affective, and social variables were assessed. Results showed that the decision to quit farming was based on cognitive and behavioral motives rather than physiological factors. Subjects in the FLq group showed more negative beliefs toward FL and had more fears of FL disease. FLq subjects also reported that family members, friends, and family doctors were more inclined to consider that FL disease could stop them from farming. However, self-efficacy to continue farming despite having FL disease and perceived hindrance caused by FL disease played the most important roles in the decision to quit farming AU - Bouchard S AU - Morin F AU - Bedard G AU - Gauthier J AU - Paradis J AU - Cormier Y LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Predictors of spirometric test failure: a comparison of the 1983 and 1993 acceptability criteria from the European Community for Coal and Steel PG - 547-553 AB - OBJECTIVES--To identify, in this general population study, predictors of spirometric test failure on the 1983 and 1993 acceptability criteria from the European Community for Coal and Steel (ECCS). METHODS--All men aged 30-46 years living in western Norway (n = 45,380) were invited to join a cross sectional community survey. Respiratory symptoms, smoking habits, and marital status were found from self administered questionnaires, and measurements of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were performed with dry wedge bellow spirometers. RESULTS--Altogether 29,611 subjects (65%) participated in this survey. Spirometric recordings were obtained in 26,803 of these (91%) of whom 1.6% failed the 1983 criterion (< or = 300 ml between the two highest FVC values) and 9.5% failed the 1993 criteria (< or = 5% or 100 ml between the two highest FEV1 and the two highest FVC values). Spirometric failures on both criteria were more prevalent in never smokers, single men, and subjects with respiratory symptoms than in ever smokers, married, and asymptomatic subjects. Failure of the 1993 criteria increased with age and declining height. Morning cough and phlegm, breathlessness uphill, attacks of breathlessness, and wheezing were related to failure of the 1993 criteria after adjustment for demographic variables and smoking, whereas only breathlessness uphill was related to failure of the 1983 criterion. CONCLUSIONS--In men aged 30-46 years, spirometric test failures on both the 1983 and 1993 ECCS acceptability criteria occurred more often in never smokers than in smokers and ex-smokers after adjustment for other covariables. Spirometric test failure with the 1993 criteria also varied with height and most respiratory symptoms. The higher failure rates found in non-smokers, in shorter, and in single men could be due to late compression of the airways, smaller lung volumes, and poor general health, respectively AU - Humerfelt S AU - Eide GE AU - Kvale G AU - Gulsvik A LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - An "occupational miliary" due to nitrous gases PG - 199-200 AB - The authors report the case of a patient suffering from chemical pneumonia due to nitrous gases of occupational origin which was mistakenly taken for military tuberculosis. Anamnestic, clinical and anatomopathological aspects of this disease, which successively analysed, often make the diagnosis difficult due to their complexity and lack of specificity 0 (Gases). 7664-41-7 (Ammonia). 7697-37-2 (Nitric Acid) AU - Monti S AU - Ferliga M AU - Simoni P AU - Vanoni O LA - PT - DEP - TA - Monaldi Arch Chest Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 45 IP - DP - 1995 Jan 01 TI - SWORD '94: surveillance of work-related and occupational respiratory disease in the UK PG - 175-178 AB - Chest and occupational physicians participating in SWORD are estimated to have seen some 3300 cases of work-related respiratory disease in 1994, similar to the totals for 1992-1993. Occupational asthma was the single most frequent diagnosis (941 cases), but asbestos exposure was considered the cause in 1529 cases of diseases of long latency. Large-scale follow-up studies showed (i) that most patients with occupational asthma failed to recover and that half had left their employer, and (ii) that many patients had long-term respiratory illness including asthma following inhalation accidents. Over the six years of the scheme there have been slight changes in attributed agents for occupational asthma and in the frequency of various diagnoses; for example, there has been a gradual reduction in reports of pneumoconiosis. A decline with birth cohort in the proportion of mesotheliomas in men employed in shipyards is shown, with some evidence of a compensatory trend in construction trades AU - Ross DJ AU - Sallie BA AU - McDonald JC LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 123 IP - DP - 1995 Jan 01 TI - Using quality-control analysis of peak expiratory flow recordings to guide therapy for asthma PG - 488-492 AB - OBJECTIVE: To compare the action points in published asthma management plans with those derived from quality-control analysis of peak expiratory flow recordings. DESIGN: Longitudinal observational study. SETTING: An ambulatory asthma education and management program in a tertiary care hospital. PATIENTS: 35 adults with asthma and exacerbation of asthma. MEASUREMENTS: Peak expiratory flow diaries and symptom recordings. RESULTS: Asthma action points from published asthma management guidelines had poor operating characteristics. The success rate was 35% when the action point was a peak expiratory flow rate less than 60% of the patient's best peak flow. The success rate improved to 88% when the action point was a peak expiratory flow rate less than 80% of the patient's best peak flow. Published action points had a high failure rate. Peak flow decreased to below the published action points during a stable period of asthma in 7% to 51% of patients studied. Action points defined using quality-control analysis did significantly better. A peak flow value less than 3 standard deviations below the patient's mean peak flow detected 84% of exacerbations and had a low failure rate (19%). Other quality-control tests had sensitivities of 91% and 71%. Quality-control action points could detect exacerbations up to 4.5 days earlier than conventional methods. CONCLUSIONS: Individualized action points can be derived for patients with asthma by applying quality-control analysis to peak flow recordings. These action points are more sensitive in detecting exacerbations of asthma and have fewer false-positive results. Action plans developed in this manner should be more useful for the early detection of deteriorating asthma AU - Gibson PG AU - Wlodarczyk J AU - Hensley MJ AU - MurreeAllen K AU - Olson LG AU - Saltos N LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 47 IP - DP - 1995 Jan 01 TI - The use and effects of glutaraldehyde: a review. PG - 238-239 AU - Abbott L LA - PT - DEP - TA - Occup Health (Lond) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Occupational asthma due to formaldehyde resin dust with and without reaction to formaldehyde gas PG - 861-865 AB - We report the cases of three subjects who developed asthma after being exposed to formaldehyde dust or gas. For two subjects, specific bronchial provocation tests with formaldehyde gas did not cause significant bronchoconstriction, whereas exposure to formaldehyde resin dust did. One subject experienced asthmatic reaction after being exposed to formaldehyde resin dust and gas. These findings suggest that the physical and chemical properties of formaldehyde are relevant to its likelihood of causing asthma 0 (Air Pollutants, Occupational). 0 (Gases). 0 (Resins). 50-00-0 (Formaldehyde) AU - Lemiere C AU - Desjardins A AU - Cloutier Y AU - Drolet D AU - Perrault G AU - Cartier A AU - Malo JL LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 108 IP - DP - 1995 Jan 01 TI - Occupational asthma caused by oak wood dust PG - 856-858 AB - Three cases of occupational asthma caused by oak wood dust are presented. The diagnosis was confirmed by specific inhalation challenges, which induced a dual asthmatic reaction in two subjects and an atypical prolonged immediate reaction in one subject AU - Malo JL AU - Cartier A AU - Desjardins A AU - Van de Weyer R AU - Vandenplas O LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 19 IP - DP - 1995 Jan 01 TI - Spirometric reference values for white European children and adolescents: Polgar revisited PG - 135-142 AB - We analyzed six spirometric data sets collected in the Netherlands, Austria, the United Kingdom, Spain, and Italy. The objectives were to establish whether (1) it was possible to describe spirometric indices from childhood to adulthood, taking into account the adolescent growth spurt, and (2) there are systematic differences in ventilatory function between children and adolescents in different parts of Western Europe. The study comprised 2,269 girls and 3,592 boys, aged 6-21 years. The range in standing height was 110-185 in girls, 110-205 in boys. The model applicable to all data sets was ln FVC or ln FEV1 = a + (b + c x A) x H, where H = standing height and A = age; this model prevents the phase shift between the adolescent growth spurt in length and lung volume from leading to an age-dependent bias in predicted values. There was surprising agreement between most of the data sets; systematic differences are probably due to technical factors arising from ATPS-BTPS corrections and from defining the end of breath with pneumotachometer systems. Taking those into account, prediction equations for FVC, FEV1, and FEV1%FVC were developed with "lower limits of normal" which should be applicable to children and adolescents of European descent. It is proposed that the approach of analyzing available data sets should also be applied to other ventilatory indices, data collected in adults and elderly subjects, or in other ethnic groups, and that an international data base be set up to that end AU - Quanjer PH AU - Borsboom GJ AU - Brunekreff B AU - Zach M AU - Forche G AU - Cotes JE AU - Sanchis J AU - Paoletti P LA - PT - DEP - TA - Pediatric Pulmonology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Frequency response of variable orifice type peak flow meters: requirements and testing PG - 849-855 AB - Little is known about the response of variable orifice peak flow meters to high frequency flow input. The purpose of this study was to define and test dynamic requirements for such peak flow meters. In a population sample we measured peak expiratory flow (PEF), rise time (tr), from 10-90% PEF and the duration of the flow in excess of 97.5, 95 and 90% of PEF, by use of a carefully calibrated Fleisch pneumotachograph with known and adequate frequency response. Three peak flow meters (Mini Wright, Vitalograph and Ferraris) were tested with an explosive decompression calibrator adjusted to values for PEF and tr as close as possible to the 95th and 5th percentile values, respectively, both for males and females, and with peak durations between 5 and more than 100 ms. The 95th percentile values of PEF were 597 L.min-1 for females and 894 L.min-1 for males. The 5th percentile values of tr were, respectively 55 and 45 ms. The duration of flow in excess of 95% PEF was longer than 10 ms in 99% of the subjects. For all meters, the deviation of PEF corrected for alinearity were less than 5% at a peak duration of 10 ms. We conclude that PEF, rise time, and peak duration can be used for description of dynamic properties of variable orifice meters, and that the tested meters had a satisfactory frequency response for recording PEF in mostly normal subjects AU - Pedersen OF AU - Rasmussen TR AU - Kjaergaard SK AU - Miller MR AU - Quanjer PH LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Reference values for residual volume, functional residual capacity and total lung capacity. ATS Workshop on Lung Volume Measurements. Official Statement of The European Respiratory Society. [Review] PG - 492-506 AU - Stocks J AU - Quanjer PH LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 345 IP - DP - 1995 Jan 01 TI - Is lung cancer associated with asbestos exposure when there are no small opacities on the chest radiograph? PG - 1074-1078 AB - This study was designed to test the hypothesis that the risk of lung cancer from asbestos exposure is confined to persons with radiographic evidence of pulmonary fibrosis. Occupational and smoking histories were obtained from 271 patients with a confirmed diagnosis of primary lung cancer and 678 referents (279 with other respiratory disease and 399 with cardiac disease). Histories were reviewed blind to assess the timing, duration, and probability of exposure to asbestos. To allow for a lag between asbestos exposure and the development of lung cancer, subjects were classified by the time they had spent in an occupation entailing definite or probable exposure more than 15 years before diagnosis. The presence and extent of fibrosis was assessed blindly from chest radiographs by three readers and scored for small opacities with the ILO 1989 International Classification of Radiographs of the Pneumoconioses. 93 (34.3%) cases had worked in an occupation with definite or probable asbestos exposure compared with 176 (25.8%) referents (crude odds ratio for lung cancer 1.49, 95% CI 1.09-2.04). After adjustment for age, sex, smoking history, and area of referral, the odds ratio (95% CI) was 2.03 (1.00-4.13) in the subgroup of 211 with a median ILO score for small parenchymal opacities of 1/0 or more, and 1.56 (1.02-2.39) in the 738 with a score of 0/1 or less (ie, those without radiological evidence of pulmonary fibrosis). These results suggest that asbestos is associated with lung cancer even in the absence of radiologically apparent pulmonary fibrosis 1332-21-4 (Asbestos) AU - Wilkinson P AU - Hansell DM AU - Janssens J AU - Rubens M AU - Rudd RM AU - Taylor AN AU - McDonald C LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 85 IP - DP - 1995 Jan 01 TI - Tests for sensitisation in occupational medicine practice--the soy bean example PG - 522-525 AB - OBJECTIVE. To determine the prevalence of sensitisation to soy bean measured by specific IgE and skin prick tests (SPTs) and to examine the association between evidence of sensitisation to soy bean allergens and symptoms of allergic disease. DESIGN. Cross-sectional study. Questionnaire survey. A venous blood sample was taken for specific IgE testing, and SPTs for common allergens and soy bean dust were performed. SETTING. Soy bean mill. PARTICIPANTS. A volunteer sample of 22 workers exposed to soy bean dust; the first 20 non-exposed workers presenting to the National Centre for Occupational Health clinic formed the control group. MAIN OUTCOME MEASURE. Immunological tests for sensitisation and symptoms of respiratory and allergic disease. RESULTS. Eight of the exposed workers had positive skin reactions to either full-fat or defatted soy bean. None of the controls was SPT-positive. Eight of the exposed workers had increased levels of soy-specific IgE of whom only 4 were SPT-positive and had an increased level of soy-specific IgE. One of the control workers had an increased level of soy-specific IgE. Workers with an increased specific IgE or SPT positive to soy bean did not have more symptoms than workers with negative tests. However, work-related breathlessness was significantly higher in the exposed group (P < 0.05). CONCLUSIONS. The data suggest that the immunological tests for sensitisation were not useful in identifying workers with soy bean-related disease but that tests for sensitisation were linked to exposure 37341-29-0 (IgE) AU - Roodt L AU - Rees D LA - PT - DEP - TA - S Afr Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 34 IP - DP - 1995 Jan 01 TI - Bronchoalveolar mast cells in summer-type hypersensitivity pneumonitis: increase in numbers and ultrastructural evidence of degranulation PG - 357-363 AB - To investigate the role of mast cells in the development of summer-type hypersensitivity pneumonitis (SHP), which is the most common type of hypersensitivity pneumonitis in Japan, bronchoalveolar lavage fluid (BALF) cells from 13 patients with this disease was studied by light and electron microscopy. The proportion and number of BALF mast cells recovered from SHP patients were significantly greater than those from patients with sarcoidosis and from control subjects. The BALF mast cells from the SHP patients showed various ultrastructural changes such as the transformation of granules, cytoplasmic vacuolation, and an increase of lipid droplets. These findings appeared to reflect activation and degranulation of bronchoalveolar mast cells, suggesting that mast cells play a role as inflammatory cells in the development of SHP AU - Ishida T AU - Matsui Y AU - Matsumura Y AU - Fujimori N AU - Furutani M LA - PT - DEP - TA - Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Variability of FVC and FEV1 due to technician, team, device and subject in an eight centre study: three quality control studies in SAPALDIA. Swiss Study on Air Pollution and Lung Disease in Adults PG - 371-376 AB - Lung function testing of a random population sample in the eight SAPALDIA (Swiss study on air pollution and lung diseases in adults) centres had to be performed simultaneously, within one year, by eight teams and 23 technicians. We conducted quality control studies to test for technician, team and device related systematic measurement errors. To assess technician effects, each centre conducted a study involving 12-19 subjects. Two studies with 13 participants each addressed team and device effects. In all studies, volunteers repeatedly performed spirometry with different technicians or devices. Effects due to technician, team or device were estimated (analysis of variance). Neither "technician" within any of eight teams nor "team" accounted for significant differences of forced vital capacity (FVC) or forced expiratory volume in one second (FEV1). The Device Effect Study revealed 10% lower FVC values for device No. 1 due to a technical problem occurring during the test day but not in the main SAPALDIA study. Further investigations revealed potential hardware and software sources of error which are not recognizable by trained technicians. These studies gave no evidence for systematic errors due to technician, team or device during the main SAPALDIA study. However, they revealed potential sources of error in modern devices, which function as "black boxes". Manufacturers should improve spirometry software to further enhance the technicians' attempts at accurate assessment AU - Kunzli N AU - AckermannLiebrich U AU - Keller R AU - Perruchoud AP AU - Schindler C LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 10 IP - DP - 1995 Jan 01 TI - Hypersensitivity pneumonitis in a pearl nucleus worker PG - 134-137 AB - A 37-year-old woman had worked for 4 years in a shell-processing factory where considerable airborne dust was produced cutting and polishing fresh water shells into pearl nuclei. She had a dry cough and dyspnea. Transbronchial lung biopsy showed noncaseating granulomas and cellular intraalveolar infiltrates. High-resolution lung computed tomography (HRCT) showed diffuse small nodules and ground-glass opacities. Hypersensitivity pneumonitis caused by shell dust should be considered in the appropriate clinical setting in a patient with the appropriate radiographic abnormalities AU - Mitani M AU - Satoh K AU - Kobayashi T AU - Kawase Y AU - Hosokawa N AU - Takashima H AU - Kobayashi S AU - Tanabe M LA - PT - DEP - TA - J Thorac Imaging JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 151 IP - DP - 1995 Jan 01 TI - Dairy farmers have increased methacholine bronchial responsiveness independent of sensitization to mold antigens PG - 1794-1798 AB - Patients with farmer's lung disease (FLD) and dairy farmers have nonspecific bronchial hyperresponsiveness. To examine the factors determining bronchial hyperresponsiveness among dairy farmers, we studied airway functions, airway responses to inhaled methacholine, serum total IgE levels, and antigen-specific IgE levels in 37 dairy farmers and 11 local control subjects. The 37 dairy farmers consisted of three groups; 12 farmers with episodes of FLD (FLD group), 13 farmers with serum antibody to Micropolyspora faeni (MF) and/or Thermoactinomyces vulgaris (TV) but without episodes of FLD (Ab(+) group), and 12 farmers without serum antibodies to MF and TV and without episodes of FLD (Ab(-) group). Pulmonary function tests showed small airways disorders among farmers (each of the three groups versus control subjects; p < 0.05). Methacholine provocation test, utilizing PD35Grs (a cumulative dose of methacholine that induces 35% reduction in respiratory conductance [Grs]), showed bronchial hyperresponsiveness in each group of dairy farmers compared with that in control subjects (Log PD35Grs, mean +/- SEM: 1.22 +/- 0.18, 1.00 +/- 0.17, and 1.20 +/- 0.20, respectively, versus 2.10 +/- 0.09; p < 0.001). However, there was no statistically significant difference in bronchial responsiveness among the three groups of dairy farmers. In addition, there was no significant difference in serum total IgE levels and specific IgE antibodies among the four groups. These results suggest that the bronchial hyperresponsiveness to methacholine among dairy farmers is not due to past episodes of FLD or sensitization to MF and/or TV, but is possibly due to the occupational environment of dairy farming 0 (Antibodies, Bacterial). 37341-29-0 (IgE). 55-92-5 (Methacholine Chloride) AU - Amishima M AU - Munakata M AU - Ohtsuka Y AU - Satoh A AU - Takahashi T AU - Taguchi H AU - Nasuhara Y AU - Ohe M AU - Doi I AU - Homma Y AU - et al LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Study of the respiratory health of employees in seven European plants that manufacture ceramic fibres PG - 97-104 AB - OBJECTIVES--To study the relation between occupational exposure to ceramic fibres during manufacture and respiratory health. METHODS--The respiratory health of 628 current employees in the manufacture of ceramic fibres in seven European plants in three countries was studied with a respiratory questionnaire, lung function tests, and chest radiography. Simultaneous plant hygiene surveys measured subjects' current exposure to airborne ceramic fibres from personal samples with optical microscopy fibre counts. The measured exposures were combined with occupational histories to derive estimates of each subject's cumulative exposure to respirable fibres. Symptoms were related to current and cumulative exposure to ceramic fibres and lung function and findings from chest radiographs were related to cumulative exposure. RESULTS--The mean duration of employment was 10.2 years and mean (range) cumulative exposure was 3.84 (0-22.94) (f.ml-1.y). Eye and skin symptoms were frequent in all plants and increased significantly, as did breathlessness and wheeze, with increasing current exposure. Dry cough and stuffy nose were less common in the least exposed group but did not increase with increasing exposure. After adjustment for the effects of age, sex, height, smoking, and past occupational exposures to respiratory hazards, there was a significant decrease in both forced expiratory volume in one second (FEV1) and forced midexpiratory flow related to cumulative exposure in current smokers (P < 0.05) and in FEV1 in ex-smokers (P < 0.05). Small opacities were found in 13% of the chest radiographs; their prevalence was not related to cumulative exposure to ceramic fibres. CONCLUSIONS--It is concluded that exposure to ceramic fibres is associated with irritant symptoms similar to those seen in other exposures to man made mineral fibres (MMMFs) and that cumulative exposure to respirable ceramic fibres may cause airways obstruction by promoting the effects of cigarette smoke 0 (Air Pollutants, Occupational). 0 (Ceramics) AU - Trethowan WN AU - Burge PS AU - Rossiter CE AU - Harrington JM AU - Calvert IA LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Are the respiratory health effects found in manufacturers of ceramic fibres due to the dust rather than the exposure to fibres? PG - 105-109 AB - OBJECTIVES--To determine whether the respiratory symptoms and decrements in lung function found in manufacturers of ceramic fibres are related to exposure to the respirable fibre or inspirable mass constituents of the air in the working environment. METHODS--Cross sectional survey of all current European primary producers of ceramic fibre was carried out, with measurement of exposure to respiratory fibres by personal samplers that measured inspirable and total mass, together with a health survey with an expanded respiratory questionnaire and standardised measurement of lung function. Odds ratios were calculated for symptoms and current exposure by multiple logistic regression, and multiple linear regression coefficients for lung function related to cumulative exposures controlled for the effects of respirable fibre and inspirable mass separately and together. RESULTS--Significant effects of current exposure to both inspirable dust and respirable fibres were related to dry cough, stuffy nose, eye and skin irritation and breathlessness. The decrements found in smokers and to some extent in ex-smokers in forced expiratory volume in one second and forced expiratory flow from 25% to 75% of expiratory volume, seem to be related to the respirable fibres rather than the inspirable mass constituents of the environment. CONCLUSIONS--Current symptoms were related to both current exposure to inspirable dust and respirable fibre. The decrements in lung function were related to the fibre constituent of the exposure 0 (Air Pollutants, Occupational). 0 (Ceramics) AU - Burge PS AU - Calvert IA AU - Trethowan WN AU - Harrington JM LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 107 IP - DP - 1995 Jan 01 TI - The sequence of symptoms, sensitization and bronchial hyperresponsiveness in early occupational asthma due to platinum salts PG - 406-407 AU - Merget R AU - Caspari C AU - Kulzer R AU - Breitstadt R AU - Rueckmann A AU - SchultzeWerninghaus G LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 33 IP - DP - 1995 Jan 01 TI - Hypersensitivity pneumonitis induced by dust from an automatic bed cleaner PG - 564-568 AB - A 49-year-old woman used an automatic bed cleaner on October 18, 1990. Eight hours later, she was admitted to a hospital complaining of coughing and fever. The chest X-ray film showed small granular shadows in both lower lung fields. After a few days of antibiotic therapy, these symptoms had disappeared. She used the bed cleaner again on the afternoon of November 15, 1990. The next day, she was admitted to our hospital because of coughing and fever. An environmental provocation test with the bed cleaner induced the same symptoms. Dust from the bed cleaner stimulated her lymphocytes. Hypersensitivity pneumonitis from the dust of a bed cleaner was diagnosed 0 (Allergens) AU - Fujiuchi S AU - Nishigaki Y AU - Yamaguchi S AU - Akiba Y AU - Osanai S AU - Yamazaki Y AU - Nakano H AU - Ohsaki Y AU - Kikuchi K LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 45 IP - DP - 1995 Jan 01 TI - Skin-prick tests for hypersensitivity to alpha-amylase preparations PG - 151-155 AB - Twenty-five asthmatic subjects with suspected alpha-amylase hypersensitivity were studied by skin-prick tests, a capture ELISA, immunoblotting and bronchial provocation tests. At the same time, different amylases were analysed by SDS-PAGE and immunoblotting using a polyclonal rabbit antiserum. Eight patients showed a positive bronchial response to amylase. Seven of them had positive skin-prick tests, with this method being the most sensitive approach for diagnosis. However, in four cases, skin tests were also positive although the patients had a negative provocation test, thus demonstrating that skin tests are not specific. ELISA and blotting showed similar results in terms of sensitivity and specificity. The enzymes used by the workers included several antigens besides alpha-amylase. The rabbit antiserum to alpha-amylase detected a protein in a wheat flour extract. In one case, the IgE antibodies were specific only for a contaminant of lower molecular weight than amylase. These facts suggest that proteins from the culture medium could be responsible for some cases of amylase hypersensitivity, making the diagnosis difficult. The presence of amylase in another enzymatic extract, a protease produced by Aspergillus oryzae, was proved by means of skin tests and immunoblotting, thus demonstrating the allergenic properties of this enzymatic preparation EC 3-2-1-1 (alpha-Amylase) AU - Moneo I AU - Alday E AU - SanchezAgudo L AU - Curiel G AU - Lucena R AU - Calatrava JM LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - Occupational allergy caused by spathe flower (Spathiphyllum wallisii) PG - 174-178 AB - Occupational allergy caused by plants is seldom reported although it is probably relatively common. We report on a 22-year- old male atopic caretaker of plants who developed IgE-mediated allergic rhinitis, laryngitis, pharyngitis, and contact and generalized urticaria caused by exposure to spathe flower (Spathiphyllum wallisii) while he was working for a firm that supplied plants to offices. He also had an asthmatic attack at work, but in bronchial provocation tests conducted 8 months after he had stopped doing the work in question, he developed rhinoconjunctivitis, pharyngitis, and laryngitis, but exhibited neither bronchial reaction nor fall in PEF values. Prick tests with spathe flower gave 3+ reactions for exudates from the flower, pollen, stem, and leaves. He also had several positive reactions to fruits, vegetables, and spices, but not to natural rubber latex. The radioallergosorbent test with spathe flower was positive (3.4 PRU/ml, close to class 3). In protein staining with SDS-PAGE, one heavy band was detected at about 14 kDa, and other faint bands were visible on both sides. Six faint bands were detected at the mol. mass range of 30-67 kDa. In IgE immunoblotting, one heavy band was detected at about 14 kDa. The patient became symptomless after he had ceased working with plants AU - Kanerva L AU - MakinenKiljunen S AU - Kiistala R AU - Granlund H LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 32 IP - DP - 1995 Jan 01 TI - Allergy to latex among hospital employees PG - 239-240 AU - Holm JO AU - Wereide K AU - Halvorsen R AU - Thune P LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 32 IP - DP - 1995 Jan 01 TI - Immunologic contact urticaria due to airborne methylhexahydrophthalic and methyltetrahydrophthalic anhydrides PG - 204-209 AB - Acid anhydrides are low-molecular-weight chemicals known to cause respiratory irritancy and allergy. Skin allergy has on rare occasions been reported. 2 workers contracted hives and itching on uncovered skin after 2 months exposure to methyltetrahydrophthalic anhydride (MTHPA) and methylhexahydrophthalic anhydride (MHHPA), to which they had airborne exposure. Later, the patients also developed conjunctivitis, rhinitis, sore throat, cough or asthma. In addition to MTHPA, 1 worker was also exposed to unsaturated polyester resin (UP). Both patients' immediate allergy to MTHPA and MHHPA was verified by positive prick tests to MTHPA and MHHPA, conjugated with human serum albumin (HSA), and positive radioallergosorbent tests (RASTs) to these anhydrides. On prick testing, both patients also reacted to a phthalic anhydride (PA)-HSA-conjugate and 1 of the patients to UP-HSA-conjugate. Specific immediate allergy to UP was shown by RAST. RAST inhibition with MTHPA, MHHPA and UP-resin conjugates confirmed IgE-mediated allergy and cross-reactivity between anhydrides. Our patients had developed airborne contact urticaria caused by phthalic anhydrides, in addition to respiratory allergy. Phthalic anhydride contained in the UP resin was possibly responsible for the immediate reaction of the skin 0 (Air Pollutants). 0 (Phthalic Anhydrides). 19438-60-9 (4-methylcyclohexyl-1,6-dicarboxylic acid anhydride). 26590-20-5 (methyltetrahydrophthalic anhydride). 37341-29-0 (IgE). 85-44-9 (phthalic anhydride) AU - Tarvainen K AU - Jolanki R AU - Estlander T AU - Tupasela O AU - Pfaffli P AU - Kanerva L LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 12 IP - DP - 1995 Jan 01 TI - Atopy and reaction to nail dust inhalation. [Review] PG - 275-278 AB - Inhalation of nail dust is a chronic problem facing podiatric physicians. This problem is compounded in physicians who develop allergic reactions to nail dust. This article defines atopy, reviews the characteristics of nail dust, and suggests methods to reduce the potential hazard that nail dust presents to the podiatric physicians and their employees. [References: 7] 0 (Air Pollutants, Occupational) AU - Ward PE LA - PT - DEP - TA - Clinics in Podiatric Medicine & Surgery JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 25 IP - DP - 1995 Jan 01 TI - Identification of crossreacting wheat, rye, barley and soya flour allergens using sera from individuals with wheat-induced asthma PG - 340-349 AB - We have conducted radio allergosorbent test (RAST), competitive RAST inhibition, sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and Western blotting using sera from patients with wheat-induced asthma to investigate the immunological relationship between wheat, rye, barley and soya, and to identify common proteins between these flours. RAST showed strong associations between the levels of specific IgE to wheat flour and those of rye and barley flour. Competitive RAST inhibition showed that wheat, rye, barley and soya flours contained crossreacting proteins, in decreasing concentrations. Wheat, rye and barley flours had similar protein profiles on gel electrophoresis. Soya flour contained a number of high molecular weight proteins not present in the other cereals. Western blotting using sera from 21 wheat flour hypersensitive individuals identified a large number of allergens in the different flours. Proteins of 69, 33, 26, 21 and 12 kDa were identified as major wheat flour allergens. Rye flour proteins of 21 and 12 kDa, and barley flour proteins of 69, 52 and 10 kDa were the major allergens identified by serum from wheat hypersensitive individuals. The major common protein of soya and wheat flour had a molecular weight of 21 kDa. The majority of crossreacting allergens identified between the different flours have molecular weights similar to those of known flour enzymes or enzyme inhibitors 0 (Allergens) AU - Sandiford CP AU - Tee RD AU - Newman Taylor AJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 123 IP - DP - 1995 Jan 01 TI - Safe use of latex rubber [letter] PG - 234-235 AU - Shepherd GM LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 95 IP - DP - 1995 Jan 01 TI - Fatal asthma attack during an inhalation challenge with ultrasonically nebulized distilled water PG - 1285-1287 AU - Saetta M AU - Di Stefano A AU - Turato G AU - De Caro R AU - Bordignon D AU - Holgate ST AU - Fabbri LM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 95 IP - DP - 1995 Jan 01 TI - Reproducibility of allergen-induced early and late asthmatic responses PG - 1191-1195 AB - BACKGROUND: Constant-dose allergen inhalation challenges are frequently used to examine the effect of antiasthma drugs on the allergen-induced early and late asthmatic responses. The end- point measurements in such studies are the maximal early and late percent decreases in the forced expiratory volume in 1 second (FEV1). OBJECTIVE: Our purpose was to observe the reproducibility and to determine the sample sizes required for such studies. METHODS: Twenty-eight subjects with allergen-induced early and late responses were studied with two constant-dose allergen challenges separated by 2 to 12 weeks. The early response was measured as the maximum percent decrease in FEV1 during the first 2 hours and the late response as the maximum percent decrease in FEV1 between 3 to 7 hours. RESULTS: The mean +/- SEM early responses were 23.1% +/- 1.0% and 24.7% +/- 2.0%, whereas the mean late responses were 23.3% +/- 2.0% and 24.5% +/-2.2%. Reproducibility of measurements were such that fewer than eight subjects are required, to show 50% attenuation of either the early or late response (with 90% power). CONCLUSIONS: The method of constant-dose allergen challenge is a sensitive tool for detecting changes in early and late asthmatic responses after the use of antiasthma medication 0 (Allergens) AU - Inman MD AU - Watson R AU - Cockcroft DW AU - Wong BJ AU - Hargreave FE AU - O'Byrne PM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 29 IP - DP - 1995 Jan 01 TI - An epidemiologic study on pulmonary fibrosis caused by hard alloy dust PG - 70-72 AB - A cross-sectional study, with 1,237 employees solely exposed to hard alloy dust and 502 controls in four hard metal works and two tool and grinder manufacturers in China, was conducted. Results showed prevalence of symptoms of respiratory system, and abnormalities in lung function and serum level of ceruloplasmin and urine cobalt content in exposed group were significantly higher than those in controls. Eight cases of pneumoconiosis were detected by chest X-ray films with a prevalence of 0.65% and an average length of employment in dust environment of 25.2 years. It suggested hard alloy dust could cause pulmonary fibrosis and pneumoconiosis in exposed workers 0 (Alloys). 7440-33-7 (Tungsten). 7440-48-4 (Cobalt) AU - Zou S AU - Zou T AU - Ma F LA - PT - DEP - TA - Chung Hua Yu Fang I Hsueh Tsa Chih JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Upper airway response in workers exposed to fuel oil ash: nasal lavage analysis PG - 353-358 AB - OBJECTIVES--Among other constituents, fuel oil ash contains vanadium pentoxide, a known respiratory irritant. Exposure to ambient vanadium pentoxide dust has been shown to produce irritation of the eyes, nose, and throat. The usefulness of nasal lavage in detecting an inflammatory response to exposure to fuel oil ash among 37 boilermakers and utility workers was investigated. METHODS--A baseline lavage was performed on the morning of the first day back to work after an average of 114 days away from work (range 36 hours to 1737 days). A lavage was performed after exposure on the morning three days after the baseline lavage. Exposure to respirable particulate matter of diameter < or = 10 microns (PM10) and respirable vanadium dust were estimated with daily work diaries and a personal sampling device for respirable particulates. These estimates were made for each subject on each workday during the three days between lavages. For each subject, the adjusted change in polymorphonuclear cells was calculated by dividing the change in polymorphonuclear cell counts by the average of the counts before and after exposure. The association between the adjusted polymorphonuclear cell counts and exposure was assessed with multiple linear regression, adjusted for age and current smoking. RESULTS--Personal sampling (one to 10 hour time weighted average) showed a range of PM10 concentrations of 50 to 4510 micrograms/m3, and respirable vanadium dust concentration of 0.10 to 139 micrograms/m3. In smokers the adjusted polymorphonuclear cell count was not significantly different from zero (-0.1%, P > 0.5), but in nonsmokers it was significantly greater than zero (+50%, P < 0.05). In both non-smokers and smokers, there was considerable variability in adjusted polymorphonuclear cell counts and a dose- response relation between these adjusted cell counts and either PM10 or respirable vanadium dust exposure could not be found. CONCLUSION--A significant increase in polymorphonuclear cells in non-smokers but not smokers was found. This suggests that in non- smokers, exposure to fuel oil ash is associated with upper airway inflammation manifested as increased polymorphonuclear cell counts. The lack of an increase in polymorphonuclear cells in smokers may reflect either a diminished inflammatory response or may indicate that smoking masks the effect of exposure to fuel oil ash 0 (Vanadium Compounds). 1314-62-1 (vanadium pentoxide) AU - Hauser R AU - Elreedy S AU - Hoppin JA AU - Christiani DC LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Longitudinal study of the health of cotton workers PG - 328-331 AB - OBJECTIVES--To follow up a group of newly employed workers in a cotton mill, and to report changes in symptoms over time. METHODS--A group of 110 mill workers at a cotton mill in Shijiazhuang, China, was investigated by questionnaire, skin testing, and spirometric measurements of airway responsiveness through forced expiratory volume in one second (FEV1). The workers were examined before starting work, at 10 weeks, and at one year. RESULTS--Decreases in FEV1 over shifts were small at 10 weeks and one year, and slightly higher among people with skin reactions to cotton dust extracts. Airway responsiveness, defined as the average decrease in FEV1 after 1.25 mg methacholine was increased at 10 weeks. It remained about the same after one year, except in the workers positive for the skin test, in whom it was further increased. Subjective symptoms of chest tightness and cough with phlegm increased progressively at 10 weeks and one year; nasal irritation remained unchanged and dry cough decreased between 10 weeks and one year. CONCLUSION--The results suggest that the airway inflammation caused by cotton dust increases with increasing exposure time and that the changes are more notable in workers with reactivity to cotton dust extract 0 (Endotoxins). 55-92-5 (Methacholine Chloride) AU - Li D AU - Zhong YN AU - Rylander R AU - Ma QY AU - Zhou XY LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Evaluation of the respiratory health of dock workers who load grain cargoes in British Columbia PG - 273-278 AB - OBJECTIVES--To investigate the respiratory health of dock workers who load grain cargoes. METHODS--The respiratory health of 118 dock workers who load grain cargoes in the ports of Vancouver and Prince Rupert was compared with that of 555 grain elevator workers from the same regions. 128 civic workers were used as an unexposed control group. RESULTS--The prevalences of chronic cough and phlegm were at least as high in dock workers as those found in the elevator workers, and when adjusted for differences in duration of employment and smoking, dock workers had an eightfold higher risk of developing chronic phlegm than did civic workers. Symptoms of eye and skin irritation that were experienced at least monthly were highest for dock workers. Average percentage of the predicted FEV1 and FVC for dock workers (mean 100.6% and 105.3% respectively) were similar to the civic workers but significantly higher than those found for elevator workers. Higher subjective estimates of duration of exposure to grain dust (hours/day) were associated with lower values of FEV1. CONCLUSIONS--The more intermittent grain dust exposure patterns of dock workers may have allowed for some recovery of lung function, but chronic respiratory symptoms were less labile AU - DimichWard HD AU - Kennedy SM AU - Dittrick MA AU - Dybuncio A AU - ChanYeung M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Byssinosis in Guangzhou, China PG - 268-272 AB - OBJECTIVES--To study the prevalence of byssinosis and other respiratory abnormalities in workers exposed to cotton dust in Guangzhou in two factories that processed purely cotton. METHODS-- All the 1320 workers exposed were included. The controls were 1306 workers with no history of occupational dust exposure. Total dust and inhalable dust were measured by Chinese total dust sampler and American vertical elutriator respectively. A World Health Organisation questionnaire was used. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were measured by a Vitalograph spirometer. RESULTS--The median inhalable dust concentrations ranged from 0.41 to 1.51 mg/m3 and median total dust concentrations from 3.04 to 12.32 mg/m3. The prevalence of respiratory abnormalities in the cotton workers were (a) typical Monday symptoms 9.0%; (b) FEV1 fall by > or = 5% after a shift 16.8%; (c) FEV1 fall by > or = 10% after a shift 4.2%; (d) FEV1 < 80% predicted 6.1%; (e) FEV1/FVC < 75% 4.0%; (f) cough or phlegm 18.2%; (g) chronic bronchitis 10.9%; and (h) byssinosis, defined by (a) plus (b) 1.7%. With the exception of (d), most of the prevalences increased with increasing age, duration of exposure, and cumulative inhalable dust exposure. No increasing trends of respiratory abnormalities were found for current total dust, inhalable dust, and cumulative total dust concentrations. Compared with controls, after adjustment for sex and smoking, with the exception of (d), all the pooled relative risks of respiratory abnormalities were raised for cotton exposure. CONCLUSION--It is concluded that cumulative inhalable cotton is likely to be the cause of byssinotic symptoms, acute lung function decrements, cough, or phlegm, and chronic bronchitis AU - Jiang CQ AU - Lam TH AU - Kong C AU - Cui CA AU - Huang HK AU - Chen DC AU - He JM AU - Xian PZ AU - Chen YH LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 152 IP - DP - 1995 Jan 01 TI - Standardisation of spirometry, 1994 update PG - 1107-1136 AU - American Thoracic Society LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 suppl 19 IP - DP - 1995 Jan 01 TI - Patterns of peak expiratory flow response to upper respiratory infections in asthmatics PG - 272S- AU - O'Brian C AU - Bright P AU - Nicholson C AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 33 IP - DP - 1995 Jan 01 TI - A case of chronic hypersensitivity pneumonitis due to long term exposure to toluene diisocyanate PG - 429-432 AB - A 55-year-old paint sprayer, who had been working with paint containing toluence diisocyanate since age 20, was admitted to our hospital with a complaint of exertional dyspnea. Physical examination revealed clubbed fingers, and fine crackles were audible in both lower lung fields. The thoracic CT film showed diffuse linear and ringed shadows in both lung fields. Open lung biopsy disclosed alveolitis and fibrosis as well as infiltration of mononuclear cells, but no Masson bodies or granulomas. Toluene diisocyanate-specific antibody was positive. Based on these results, we diagnosed chronic hypersensitivity pneumonitis due to the chemical. To our knowledge, there has been no previously reported case of chronic hypersensitivity pneumonitis due to isocyanate 584-84-9 (Toluene 2,4-Diisocyanate) AU - Nakamura Y AU - Fujimoto H AU - Uetani K AU - Sumda T AU - Higashimoto Y AU - Funasako M AU - Ohata M LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Occupational asthma, rhinitis and urticaria due to piperacillin sodium in a pharmaceutical worker PG - 467-469 AB - A 28 year old man with no history of atopy was referred to our hospital for possible work-related asthma. He had been employed in the production section of a pharmaceutical company for 2 yrs, and in the last 2 months he had complained of dyspnoea, wheezing, chest tightness, symptoms of rhinitis and a cutaneous rash when exposed to powdered antibiotics. Symptoms disappeared after being transferred to the packaging section. When the subject was admitted to our department he was asymptomatic. Basal lung function tests were in the normal range. Bronchial challenges with methacholine and with ultrasonically-nebulized distilled water were negative. Skin-prick test with piperacillin sodium gave a strong positive response at a very low concentration. Specific inhalation challenge with piperacillin sodium resulted in an immediate asthmatic reaction, and also reproduced rhinitis symptoms and the cutaneous rash. A control challenge with lactose, and the specific challenge test with cefuroxime sodium (another antibiotic to which the patient was exposed at the workplace) were negative. We conclude that piperacillin sodium is an agent that can cause occupational asthma 0 (Powders). 61477-96-1 (Piperacillin) AU - Moscato G AU - Galdi E AU - Scibilia J AU - Dellabianca A AU - Omodeo P AU - Vittadini G AU - Biscaldi GP LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 25 IP - DP - 1995 Jan 01 TI - Purification and characterization of the serotype-specific polysaccharide antigen of Trichosporon cutaneum serotype II: a disease-related antigen of Japanese summer-type hypersensitivity pneumonitis PG - 265-272 AB - Summer-type hypersensitivity pneumonitis (SHP) is a unique type of hypersensitivity pneumonitis and the most prevalent in Japan. Our previous study clarified that the causative agent of the disease is Trichosporon cutaneum, and that the patients with SHP have high titres of antibodies against the serotype-specific antigen of polysaccharide nature which exist in the high molecular weight fraction of the culture supernatant of the yeast. In this study, we purified the serotype-specific antigen of serotype II T. cutaneum by gel filtration and affinity chromatography using a monoclonal antibody, D-8, specific for a high molecular weight antigen of serotype II T. cutaneum, and elucidated the structure of the antigen. This affinity-purified antigen was shown to be an essentially acidic polysaccharide comprising mannose, xylose, and glucuronic acid (6:44:4.7). Chemical analysis showed that this polysaccharide antigen contains a (1-3)-linked mannan backbone attached with short side chains of (1-4)-linked mannose and a small proportion of (1-2)-linked xylose residues by substituting the 2- or 4-positions of the (1-3)-linked mannose residues of the main chain. Approximately one-fifth of the side chains were terminated with glucuronic acid residues. The antigenic epitope of the serotype-specific antigen was shown to involve the terminal glucoronic acid residues as revealed by immunodiffusion test and sandwich enzyme-linked immunosorbent assay using monoclonal antibody D-8 0 (Antibodies, Monoclonal). 0 (Antigenic Determinants). 0 (Antigens, Fungal). 0 (Glucuronates). 0 (Polysaccharides). 0 (Xylose). 31103-86-3 (Mannose). 576-37-4 (glucuronic acid) AU - Mizobe T AU - Ando M AU - Yamasaki H AU - Onoue K AU - Misaki A LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 66 IP - DP - 1995 Jan 01 TI - Immunological reactivity in ranitidine factory workers PG - 407-411 AB - The involvement of immunological reactivity to ranitidine base (R-b) and ranitidine hydrochloride (R-HCl) in the development of occupationally related symptomatology was analyzed in 40 subjects employed in a pharmaceutical plant producing ranitidine and in 33 nonexposed controls, using a specific dose-response lymphocyte proliferative test (lymphocyte transformation test: LTT). Of the 40 workers, 11 (28%) gave positive reactions to LTT: 3/11 to R-b, 4/11 to R-HCl, and 4/11 to both compounds. None of the controls gave positive reactions. Cutaneous, oculonasal, or respiratory work-related symptoms were cited by 23 of the 40 (58%) subjects; ten of these 23 subjects (43%) were LTT positive. One asymptomatic case was LTT positive. The present results indicate that specific immune reactivity to ranitidine, analyzed by LTT, is associated with the presence of occupational symptomatology; R-HCl and R-b seem to share some antigenic determinants, because of the partial cross-reactivity shown by the examined compounds. Nonimmunological, probably irritative, mechanisms are also present in some of the symptomatic subjects 66357-35-5 (Ranitidine) AU - Riviera AP AU - Pezzini A AU - Zanoni G AU - Rocca M AU - Pagani M AU - Tridente G LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 107 IP - DP - 1995 Jan 01 TI - Occupational asthma caused by pea flour [letter] PG - 1772-1772 AU - Bhagat R AU - Swystun VA AU - Cockcroft DW LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 173 IP - DP - 1995 Jan 01 TI - Cellular and mediator profile in bronchoalveolar lavage of guinea pigs after toluene diisocyanate (TDI) exposure PG - 57-68 AB - Toluene diisocyanate (TDI) is a volatile, highly reactive chemical widely used as a polymerizing agent in the production of polyurethane foams, lacquers, adhesives, and other items. Repeated airway exposures in the workplace to TDI may cause a concentration-dependent risk of developing chronic airway disorders. Different pathomechanisms are involved. IgE-mediated sensitization and irritative effects were clearly demonstrated in exposed subjects as well as in animals. In this study we examined the cellular and mediator composition in bronchoalveolar lavage fluid (BALF) of guinea pigs (eight in each group) exposed to TDI (10, 20, or 30 ppb) on 5 consecutive days for 2 hours each. Increased numbers of eosinophils and significantly elevated levels of LTB4 and LTC4/LTD4/LTE4 were obtained in BALF of all exposed animals when compared to nonexposed control animals. PGD2 and TXB2 remained unaltered in BALF. Stimulation of BALF cells of exposed and control animals with Ca-ionophore A23187 and arachidonic acid induced an increased generation of LTB4. Furthermore, BALF cells of the exposed animal groups generated immunoreactive LTC4/LTD4/LTE4, whereas controls did not show peptido-leukotriene formation in the presence and absence of stimuli. Our data clearly demonstrate an influx of eosinophils into the airways associated with mediator release and higher cellular responsiveness after TDI exposure 0 (Inflammation Mediators). 0 (Leukotrienes). 41598-07-6 (Prostaglandin D2). 506-32-1 (Arachidonic Acid). 52665-69-7 (Calcimycin). 54397-85-2 (Thromboxane B2). 584-84-9 (Toluene 2,4-Diisocyanate) AU - Raulf M AU - Tennie L AU - Marczynski B AU - Potthast J AU - Marek W AU - Baur X LA - PT - DEP - TA - Lung JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - The determinants of bronchial hyperresponsiveness in a cohort of workers exposed to acid anhydrides PG - 193s- AU - Barker RD AU - Harris JM AU - van Tongeren M AU - Venables KM AU - Newman Taylor AJ LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 310 IP - DP - 1995 Jan 01 TI - Industrial injury benefit for occupational asthma in north east of England PG - 1299-1300 AU - Stenton SC AU - Sandhu PS AU - Hendrick DJ LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Repeatability of home measurements of peak expiratory flow and FEV1 PG - 271s- AU - Bright P AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Computer assisted interpretation of occupational peak flow plots; OASYS-N PG - 220s- AU - Bright P AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 345 IP - DP - 1995 Jan 01 TI - Environmental determinants of asthma [Review] PG - 296-299 AU - Newman Taylor AJ LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - In vivo models of occupational asthma due to low molecular weight chemicals. [Review] PG - 539-543 AU - Hayes JP AU - Newman Taylor AJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 39 IP - DP - 1995 Jan 01 TI - Flour dust exposure variability in flour mills and bakeries PG - 299-305 AB - As part of a longitudinal study to explore the exposure-response relationship between flour dust exposure and work-related symptoms and skin sensitivity the authors formed exposure groups and estimated various components of variability. This paper describes the between-exposure group, the between-worker and the within-worker variation of personal flour dust exposure in bakeries, flour mills and packing stations. In total 346 samples were collected in 13 exposure groups. The geometric means of the exposure groups ranged from 0.3 up to 9.0 mg m-3. Between-worker variances within exposure groupings were less than the overall between-worker component although substantial differences in exposure between workers remained in some exposure groups. Overall the largest variance component was the between-exposure group component followed by the considerably smaller between-worker and within-worker components AU - Nieuwenhuijsen MJ AU - Lowson D AU - Venables KM AU - Newman Taylor AJ LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 39 IP - DP - 1995 Jan 01 TI - Correlation between different measures of exposure in a cohort of bakery workers and flour millers PG - 291-298 AB - This paper describes the relationship between continuous and 'grouped' variables for several measures of exposure in a longitudinal study of bakery workers and flour millers. Average shift and peak levels, both for dust and for flour aeroallergen were measured, duration of exposure obtained from questionnaire and cumulative exposure both for dust and for flour aeroallergen calculated. Neither for dust nor for flour aeroallergen was there a correlation between duration of exposure and intensity measures of exposure (peak and average). Moderate to good correlation existed between the various intensity measures of exposures both for dust and for flour aeroallergen. Good correlations existed between measures of exposure of dust and measures of exposure for flour aeroallergen. The degree of correlation was reflected by the fact that the number of workers changing categories depended on which measure of exposure was considered. The higher the correlation coefficient between various measures of exposure the fewer workers changed category. This information provides important information for a better understanding of the exposure-response relationship amongst bakery workers and flour millers AU - Nieuwenhuijsen MJ AU - Lowson D AU - Venables KM AU - Newman Taylor AJ LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 39 IP - DP - 1995 Jan 01 TI - Peak exposure concentrations of dust and flour aeroallergen in flour mills and bakeries PG - 193-201 AB - As part of an epidemiological study amongst workers exposed to flour we measured peak exposure levels to total dust and flour aeroallergen with personal samplers in bakeries, flour mills and packing stations. Short-term tasks which were expected to give rise to high concentrations of exposure (peaks) were identified. The frequency and duration of these tasks were estimated and their levels of exposure to dust and flour aeroallergen measured. In total 209 samples were taken. The highest exposure concentrations both for dust (geometric mean > 30 mg m-3) and for flour aeroallergen (geometric mean > 500 micrograms m-3) were measured during certain operations. Exposure concentrations for the tasks were often much higher than the levels we had measured over a shift in a previous study. This might be important for sensitization and for the development of asthma. Peak exposure concentrations could be used to explore the exposure-response relationship more comprehensively. In general average flour aeroallergen concentrations increased linearly with average dust concentrations, although there were some exceptions AU - Nieuwenhuijsen MJ AU - Sandiford CP AU - Lowson D AU - Tee RD AU - Venables KM AU - Newman Taylor AJ LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 292 IP - DP - 1995 Jan 01 TI - Neurogenic goblet cell secretion and bronchoconstriction in guinea pigs sensitised to trimellitic anhydride PG - 127-134 AB - Trimellitic anhydride is a cause of occupational asthma in humans. We have previously found that tracheal instillation of trimellitic anhydride conjugated to guinea pig serum albumin induces acute bronchoconstriction and airway plasma exudation in sensitised animals, responses mediated primarily via histamine release. In the present study, neural mechanisms mediating bronchoconstriction and goblet cell secretion were determined in trimellitic anhydride-sensitised guinea pigs using the ganglionic blocker hexamethonium to eliminate efferent reflex mechanisms, pretreatment with capsaicin to eliminate afferent mechanisms, or cimetidine and mepyramine to eliminate histamine-mediated mechanisms. The magnitude of secretion of intracellular mucus from tracheal goblet cells was quantified morphometrically as a mucus score which is inversely related to the degree of discharge. Guinea pigs were injected intradermally either with 0.1 ml 0.3% trimellitic anhydride in corn oil or with corn oil alone as control. Fourteen to eighteen days later all sensitised animals had developed specific immunoglobulin (Ig) G1 antibodies whereas the controls had not. Tracheal instillation of conjugated trimellitic anhydride in anaesthetised animals significantly increased airway lung resistance (RL) 24-fold in sensitised guinea pigs (34.3 +/- 7.9 cm H2O.ml-1.s) compared with controls (1.4 +/- 0.1 cm H2O.ml-1.s). Mucus score was significantly reduced by 51% (indicating goblet cell secretion) in sensitised guinea pigs (183 +/- 22 mucus score units) compared with controls (372 +/- 41 mucus score units). The antihistamines significantly inhibited conjugated trimellitic anhydride-induced bronchoconstriction by 89%, but did not significantly affect goblet cell discharge. Hexamethonium alone did not significantly affect conjugated trimellitic anhydride-induced bronchoconstriction or goblet cell secretion.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Hayes JP AU - Kuo HP AU - Rohde JA AU - Newman Taylor AJ AU - Barnes PJ AU - Chung KF AU - Rogers DF LA - PT - DEP - TA - Eur J Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - IP - DP - 1995 Jan 01 TI - Global strategy for asthma management and prevention. NHLBI/WHO workshop PG - 6- AU - Lenfant C AU - Khaltaev N LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 89 IP - DP - 1995 Jan 01 TI - Occupational asthma due to chloramine-T solution PG - 693-695 AU - Kujala VM AU - Reijula KE AU - Ruotsalainen E AU - Heikkinen K LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - IP - DP - 1995 Jan 01 TI - Tuberculosis PG - 43-52 AU - Skinner C LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 76 IP - DP - 1995 Jan 01 TI - The increase in tuberculosis notifications in England and Wales since 1987 PG - 196-200 AB - SETTING: A retrospective study of tuberculosis notifications in England and Wales published by the Office of Population Censuses and Surveys. OBJECTIVE: To analyse the rise in tuberculosis notifications in England and Wales by different sub groups over the time period 1982-91. DESIGN: The average annual percentage change in tuberculosis notification rates (per 100,000) for the groups were analysed by age, sex, standard region and disease site. RESULTS: The average annual increase in tuberculosis notifications from 1987-91 in females was +2.55 (95% confidence interval [CI] 0.5-4.7); males showed no significant change (-0.6%, 95% CI: -2.9 to +2.7). The increase was greater in younger subjects: 3.2% in females aged 25-44 (95% CI 0.9-5.5) and 4.3% in males aged 15-24 (95% CI 1.7-6.9). Only three standard regions showed an increase: the South East, the West Midlands, Yorkshire and Humberside. This increase was significant only in females from the South East, and was predominantly in non-respiratory tuberculosis. CONCLUSION: The rise in tuberculosis notification rates from 1987-91 has been predominantly in females, in those under 65, has occurred in 3 regions, and predominantly in non-respiratory tuberculosis. The analysis highlights some of the inadequacies of the present notification system for tuberculosis AU - Doherty MJ AU - Spence DP AU - Davies PD LA - PT - DEP - TA - Tubercle & Lung Disease JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 155 IP - DP - 1995 Jan 01 TI - Tuberculosis in health care workers at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis PG - 854-859 AB - OBJECTIVE: Investigate reports of tuberculosis in health care workers employed at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis. DESIGN: Case series of tuberculosis in health care workers, January 1, 1989, through May 31, 1992. Antimicrobial susceptibility testing and restriction fragment length polymorphism analysis of M tuberculosis isolates. Longitudinal analysis of cumulative tuberculin skin test surveillance data. Assessment of infection control. The patients consisted of 361 health care workers who had either serial tuberculin skin tests or tuberculosis. RESULTS: Six health care workers, the largest number linked to one multidrug-resistant tuberculosis outbreak, had disease due to M tuberculosis that matched the outbreak strain from hospitalized patients. The two who were seropositive for human immunodeficiency virus died, one of tuberculous meningitis and the other of multiple causes including tuberculosis. The estimated risk of a skin test conversion was positively associated with time and increased by a factor of 8.3 (1979 to 1992). In 1992 the annual risk for workers in the lowest exposure occupational group was 2.4%. In comparison, nurses and housekeepers had relative risks of 8.0 (95% confidence interval, 3.2 to 20.3) and 9.4 (95% confidence interval, 2.7 to 32.3), respectively. Laboratory workers had a relative risk of 4.2 (95% confidence interval, 1.1 to 15.5). Tuberculosis admissions increased, but the hospital had inadequate ventilation to isolate tuberculosis patients effectively. There were lapses in infection control practices. CONCLUSIONS: Health care workers who were exposed during a hospital outbreak of multidrug-resistant tuberculosis had occupationally acquired active disease. The human immunodeficiency virus-infected health care workers with tuberculosis had severe disease and died. The risk of skin test conversion increased during the study period, and higher exposure occupations had elevated risk. Effective infection control is essential to prevent the transmission of tuberculosis to health care workers AU - Jereb JA AU - Klevens RM AU - Privett TD AU - Smith PJ AU - Crawford JT AU - Sharp VL AU - Davis BJ AU - Jarvis WR AU - Dooley SW LA - PT - DEP - TA - Arch Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - IP - DP - 1995 Jan 01 TI - Out of the shadow: detecting and treating tuberculosis amongst single homeless people PG - - AU - Citron KM LA - PT - DEP - TA - Crisis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 5 IP - DP - 1995 Jan 01 TI - Tuberculosis in England and Wales 1982-1993: notifications exceed predictions PG - R29-33 AB - About 8000 more cases of tuberculosis were notified in the years 1988 to 1993 than would have been expected if previous trends had continued (95% confidence interval (CI) 3000-12,000). Tuberculosis notifications were analysed to determine the population groups and geographical areas in which increases occurred. Increases were greatest in regional health authorities (RHAs) with large conurbations, while rates generally continued to decline in RHAs that serve more rural areas. The rate of notification rose significantly in males aged 15 to 34 years and fell in men over 35. In females, the rate increased only in the 35 to 64 year age group. Non-respiratory tuberculosis accounted for 21% of notifications in 1987 and 27% in 1993. In most age, sex, and geographical groups significant increases were confined to non-respiratory tuberculosis, but the rate of both respiratory and non-respiratory tuberculosis rose in males aged 15 to 34 years in North Thames RHAs. A number of factors may have contributed to the observed increase. Reporting of cases may have improved following the appointment of consultants in communicable disease control in 1988, whose role includes improving notification practices. Such improvements might explain the increased proportion of notifications of non-respiratory tuberculosis, as this may have been undernotified to a greater extent than respiratory tuberculosis in the past. Other factors associated with recent increases are discussed AU - Hayward AC AU - Watson JM LA - PT - DEP - TA - CDR (Lond Engl Rev) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 49 IP - DP - 1995 Jan 01 TI - Tuberculosis among the homeless at a temporary shelter in London: report of a chest x ray screening programme PG - 629-633 AB - STUDY OBJECTIVE--To estimate the prevalence of active pulmonary tuberculosis in a homeless population in London and to assess whether those with suspected disease could be integrated into the existing health care system for further follow up and treatment. DESIGN--Voluntary screening programme based on a questionnaire survey and chest x ray. SETTING AND CASES--Screening programmes were set up over the Christmas period in 1992 and 1993 at a shelter for the homeless in London. An offer of screening was made to all individuals who visited the centre and an interviewer administered questionnaire was completed on those who volunteered for the screening. Chest x rays were carried out, developed, and read on site. Individuals with chest x rays features suggestive of tuberculosis or other medical problems were referred to a hospital of their choice. RESULTS AND OUTCOME--In 1992 nearly 1600 people visited the centre, of whom 372 volunteered for the screening and 342 were x rayed. Nineteen of the 342 (5.6%) had radiological features suggestive of active tuberculosis. In 1993 around 2000 homeless people visited the centre, of whom 270 volunteered for the screening and 253 were x rayed. Eleven (4.3%) had features consistent with active tuberculosis on the basis of the chest x rays and clinical examination by a chest physician. Overall, of 595 people x rayed in the two surveys, 30 (5%) had changes suggestive of active tuberculosis. Further investigations confirmed nine (1.5%) with active pulmonary disease and eight with no active tuberculosis. In 13, the diagnosis was not determined as four declined further investigation and nine did not attend their hospital appointment. CONCLUSION--Tuberculosis among the homeless remains a cause for concern. Follow up and treatment present unique difficulties. Services for the homeless need to include mechanisms for timely diagnosis and monitored treatment. Control programmes designed for the needs of the homeless are required AU - Kumar D AU - Citron KM AU - Leese J AU - Watson JM LA - PT - DEP - TA - Journal of Epidemiology & Community Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 21 IP - DP - 1995 Jan 01 TI - Tuberculosis among urban health care workers: a study using restriction fragment length polymorphism typing PG - 1098-1101 AB - Cases of tuberculosis identified during 1992-1994 through an active tuberculosis surveillance network among six hospitals that serve New York City (the TBNetwork) were analyzed according to the occupational status of the patients. Clinical data were obtained by review of medical records, and restriction fragment length polymorphism (RFLP) typing of Mycobacterium tuberculosis isolates was performed. No known nosocomial outbreaks of tuberculosis occurred at these hospitals in the study period. Occupational status was known for 142 of 201 patients whose isolates were available for strain typing. Patients infected by organisms with a clustered strain typing pattern, as determined by RFLP analysis, were presumed to have recently acquired disease. RFLP typing revealed that isolates from 13 (65%) of 20 health care workers and 50 (41%) of 122 non-health care workers had a clustered RFLP pattern. The strains infecting eight (89%) of nine health care workers seropositive for human immunodeficiency virus (HIV) had a clustered RFLP pattern. Multivariate analysis of 75 patients with known HIV and occupational status revealed that HIV status (P = .03) and health care worker status (P = .02; RR = 2.77) were independent risk factors for a clustered RFLP strain. These findings suggest that many of the apparently sporadic cases of tuberculosis among health care workers may be due to unrecognized occupational transmission AU - Sepkowitz KA AU - Friedman CR AU - Hafner A AU - Kwok D AU - Manoach S AU - Floris M AU - Martinez D AU - Sathianathan K AU - Brown E AU - Berger JJ AU - et al LA - PT - DEP - TA - Clin Infect Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 310 IP - DP - 1995 Jan 01 TI - Increasing incidence of tuberculosis in England and Wales: a study of the likely causes PG - 967-969 AB - OBJECTIVE--To examine factors responsible for the recent increase in tuberculosis in England and Wales. DESIGN--Study of the incidence of tuberculosis (a) in the 403 local authority districts in England and Wales, ranked according to Jarman score, and (b) in one deprived inner city district, according to ethnic origin and other factors. SETTING--(a) England and Wales 1980-92, and (b) the London borough of Hackney 1986-93. MAIN OUTCOME MEASURE--Age and sex adjusted rate of tuberculosis. RESULTS--In England and Wales notifications of tuberculosis increased by 12% between 1988 and 1992. The increase was 35% in the poorest 10th of the population and 13% in the next two; and in the remaining 70% there was no increase. In Hackney the increase affected traditionally high risk and low risk ethnic groups to a similar extent. In the "low risk" white and West Indian communities the incidence increased by 58% from 1986-8 (78 cases) to 1991-3 (123), whereas in residents of Indian subcontinent origin the increase was 41% (from 51 cases to 72). Tuberculosis in recently arrived immigrants--refugees (11% of the Hackney population) and Africans (6%)--accounted for less than half of the overall increase, and the proportion of such residents was much higher than in most socioeconomically deprived districts. The local increase was not due to an increase in the proportion of cases notified, to HIV infection, nor to an increase in homeless people. CONCLUSIONS--The national rise in tuberculosis affects only the poorest areas. Within one such area all residents (white and established ethnic minorities) were affected to a similar extent. The evidence indicates a major role for socioeconomic factors in the increase in tuberculosis and only a minor role for recent immigration from endemic areas AU - Bhatti N AU - Law MR AU - Morris JK AU - Halliday R AU - Moore-Gillon J LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 310 IP - DP - 1995 Jan 01 TI - Socioeconomic deprivation and notification rates for tuberculosis in London during 1982-91 PG - 963-966 AB - OBJECTIVES--To investigate the association between four sociodemographic measures (unemployment, overcrowding, low social class, and the proportion of migrants from areas of high prevalence of tuberculosis) and average level and rate of change of notification rates for tuberculosis. DESIGN--Ecological analysis of both the average and the rate of change of standardised annual notification rates for tuberculosis from 1982-91 and sociodemographic measures from the 1981 and 1991 censuses. SETTING--32 London boroughs. SUBJECTS AND DATA--Sociodemographic measures from the 1981 and 1991 censuses and tuberculosis notification rates for 1982-91. MAIN OUTCOME MEASURES--A measure of the association between average levels and rate of change in tuberculosis notification rates and four sociodemographic measures in 1981 and between the rate of change in tuberculosis notification rates between 1981 and 1991 and changes in sociodemographic measures between 1981 and 1991. RESULTS--The average level of notifications was correlated with overcrowding and the proportion of migrants but not with unemployment or social class. No significant association was found between the rate of change in notification rates and sociodemographic measures in 1981. An association was found between increases in unemployment and the rate of change in notification rates, but the effect was small. Changes in the levels of unemployment explained 23% of the variation between boroughs in the rate of change in their notification rates. CONCLUSION--The average tuberculosis notification rates were related to overcrowding and the proportion of migrants in 1981. Only increases in unemployment from 1981 to 1991, however, were significantly associated with the rate of change in notifications over the same period AU - Mangtani P AU - Jolley DJ AU - Watson JM AU - Rodrigues LC LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 4 IP - DP - 1995 Jan 01 TI - Glutaraldehyde--controlling the risk to health PG - 13-13 AB - The Control of Substances Hazardous to Health Regulation 1988 (COSHH) is one of the most important pieces of health and safety legislation to affect the workplace since the Health and Safety at Work Act of 1974. The regulations require that the exposure to all hazardous chemicals and micro-biological agents be reviewed and measures put in place to control the risk to health. An evaluation survey that reported in mid-1993 showed many workplaces had simply collected data sheets on hazardous agents but failed to carry out the all important next steps to evaluate the risks arising from the hazards, to monitor exposure and implement control measures to institute health surveillance where appropriate to inform and train employees. The lack of effective control of the exposure to glutaraldehyde in endoscope cleaning activity was highlighted, along with other deficiencies, in a recent inspection by the Health and Safety Executive of an NHS Trust in East Anglia. It is recognised that glutaraldehyde has posed particular problems in the operating theatre environment of the NHS AU - Menzies D LA - PT - DEP - TA - British Journal of Theatre Nursing JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 332 IP - DP - 1995 Jan 01 TI - Tuberculosis among health care workers. PG - 92-98 AU - Menzies D AU - Fanning A AU - Yuan L AU - Fitzgerald M LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 152 IP - DP - 1995 Jan 01 TI - Transmission of multidrug-resistant tuberculosis in a large urban setting PG - 355-359 AB - Multidrug resistance has become an increasingly important problem in the control and prevention of tuberculosis in large urban centers. Although several small outbreaks of multidrug-resistant (MDR) tuberculosis in New York City have been reported, the increase in the number of cases is not fully explained by these recognized outbreaks, and the modes of transmission have not been clearly delineated. Transmission patterns of MDR tuberculosis in New York City, therefore, were studied by stratifying Mycobacterium tuberculosis isolates from 167 newly diagnosed tuberculosis patients according to their DNA restriction fragment length polymorphisms (RFLP). Forty-three (34%) of 127 drug-susceptible isolates and 19 (79%) of 24 multidrug-resistant isolates had RFLP patterns representing possible recent exogenous infection (primary tuberculosis). Patients who had such isolates were more likely to be seropositive for human immunodeficiency virus (58%; p < 0.05), non-Hispanic black (56%; p < 0.005), U.S.-born (57%; p < 0.001), and have MDR tuberculosis (79%; p < 0.0005). In a logistic regression model, primary tuberculosis remained significantly associated with MDR tuberculosis and black race. In contrast to previous reports, in New York City recent exogenous transmission accounts for most new cases of multidrug-resistant tuberculosis AU - Friedman CR AU - Stoeckle MY AU - Kreiswirth BN AU - Johnson WD Jr AU - Manoach SM AU - Berger J AU - Sathianathan K AU - Hafner A AU - Riley LW LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 96 IP - DP - 1995 Jan 01 TI - The efficacy of bacillus Calmette-Guerin vaccination of newborns and infants in the prevention of tuberculosis: meta-analyses of the published literature PG - Pt 1):29-35 AB - OBJECTIVE: To quantify the efficacy of vaccination of infants with bacillus Calmette-Guerin (BCG) against tuberculosis. DATA SOURCES: MEDLINE with index terms BCG vaccine, tuberculosis, and human; lists of all known studies provided by experts at the Centers for Disease Control and Prevention, the World Health Organization, and other organizations. STUDY SELECTION: A total of 1264 articles and abstracts were reviewed for details on BCG vaccination, the availability of concurrent vaccinated and unvaccinated groups, and a tuberculosis outcome. Seventy articles were reviewed in depth for method of vaccine allocation used to create comparable groups, age at vaccination of study participants, comparability of surveillance and follow-up of recipient and concurrent control groups in trials, an appropriately defined control group in case-control studies, and outcome measures (tuberculosis cases and/or deaths). Five prospective trials and eleven case-control studies of vaccination during infancy were included in the present analyses. DATA EXTRACTION: We recorded study design, age range of study population, number of patients enrolled, efficacy of vaccine, location of the study, and a series of items to assess the potential for bias in study design, follow-up, and diagnosis. We extracted or computed vaccine efficacy by years since vaccination wherever possible. At least two readers independently extracted data and evaluated data validity. DATA SYNTHESIS: The relative risk (RR) or odds ratio (OR) for tuberculosis in vaccinated versus unvaccinated infants was the measure of vaccine efficacy analyzed. A random-effects method estimated a weighted average RR or OR from data extracted from the trials and case-control studies. The protective effect was then computed by 1-RR or 1-OR. Overall, the protective effect of vaccination against cases of tuberculosis was 0.74 (95% confidence interval [95% CI], 0.62 to 0.83) when estimated from four randomized controlled trials, and 0.52 (95% CI, 0.38 to 0.64) when estimated from nine case-control studies. Five trials reporting deaths from tuberculosis showed a BCG protective effect of 0.65 (95% CI, 0.12 to 0.86), five studies reporting on meningitis showed a protective effect of 0.64 (95% CI, 0.30 to 0.82), and three studies of disseminated tuberculosis showed a protective effect of 0.78 (95% CI, 0.58 to 0.88). Three case-control studies included separate results for laboratory-confirmed cases of tuberculosis. These studies documented a protective effect of 0.83 (95% CI, 0.58 to 0.93). In a random-effects regression model of the nine case-control studies, study validity score explained 15% of the heterogeneity among study-estimated protective effects, suggesting that better studies reported greater efficacy. Three trials and six case-control studies provided some age-specific information that allowed us to examine the duration of BCG efficacy. Most of this evidence suggested that BCG efficacy may persist through 10 years after infant vaccination. CONCLUSION: BCG vaccination of newborns and infants significantly reduces the risk of tuberculosis--by over 50%, on average. Protection has been observed across many populations, study designs, and forms of tuberculosis. Rates of protection against cases that are confirmed by laboratory tests, reflecting reduced error in disease classification and consequently more accurate estimates of BCG efficacy, are highest at 83% AU - Colditz GA AU - Berkey CS AU - Mosteller F AU - Brewer TF AU - Wilson ME AU - Burdick E AU - Fineberg HV LA - PT - DEP - TA - Pediatrics JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - IP - DP - 1995 Jan 01 TI - Health and personal social service statistics for England 1993 PG - - AU - Government Statistical Service LA - PT - DEP - TA - Department of Health London JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 31 IP - DP - 1995 Jan 01 TI - Pneumonitis secondary to the inhalation of isocyanates. An analysis of 2 cases [Review] [Spanish] PG - 365-367 AB - We present two patients with diffuse interstitial lung disease attributed to two different forms of presentation of pneumonitis due to inhalation of isocyanates. The first case was acute and accidental and the second was due to longer workplace exposure. In both cases, clinical, radiological and lung function findings as well as results of bronchoalveolar lavage were similar to those of hypersensitivity pneumonitis triggered by organic agents. AU - Haro M AU - Coloma R AU - Izquierdo M AU - Perez MI AU - Arevalo M AU - Vizcaya M LA - PT - DEP - TA - Archivos de Bronconeumologia JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 95 IP - DP - 1995 Jan 01 TI - Fatal asthma attack associated with inhalation of nebulized distilled water PG - 1285-1287 AB - The medical history included bronchial asthma from the age of 10 years and positive skin test results for mites. The family history was positive for allergic asthma. Immunotherapy for mites was performed from the age of 16 to the age of 20 but did not provide significant benefits. The patient had no known drug sensitivities, history of aspirin-induced asthma, or food allergy. He had never been hospitalized for treatment of severe asthma attacks. He had been treated irregularly with inhaled beclomethasone and fenoterol. In April 1992 he started regular therapy with inhaled beclomethasone 500 Iug twice daily, inhaled salmeterol 50 Iug twice daily, and fenoterol on an as-needed basis. In June 1992, he was referred to the pulmonary function laboratory for assessment of the degree of airway responsiveness to ultrasonically nebulized distilled water. At that time he was free of symptoms, and his baseline spirometry demonstrated normal lung volumes (forced expiratory volume in 1 second = 85% of predicted value and forced expiratory volume in 1 second/vital capacity = 88%). After spirometry was performed, he was invited to inhale ultrasonically nebulized distilled water through a rubber face mask. One minute after the beginning of the inhalation, a severe asthma attack occurred and progressed so rapidly that it could not be reversed by prompt treatment with salbutamol 10 puffs, oxygen therapy, methylprednisolone 200 mg administered intravenously, epinephrine 2 mg administered subcutaneously, and mechanical ventilation. During the treatment he also had an episode of vomiting. Within 15 minutes of the beginning of the attack the patient was dead. https://doi.org/10.1016/S0091-6749(95)70088-9 AU - Saetta M AU - Di Stefano A AU - Turato G AU - De Caro R AU - Bordignon D AU - Holgate ST AU - Fabbri LM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 40 IP - DP - 1995 Jan 01 TI - Cardiorespiratory disease in men and women in urban Scotland: baseline characteristics of the Renfrew/Paisley (midspan) study population PG - 102-107 AB - STUDY OBJECTIVE. To describe the distribution of risk factors, risk behaviors, symptoms and the prevalence of cardiorespiratory disease in men and women in an urban area with high levels of socioeconomic deprivation. A cross-sectional survey of 15,411 men and women aged 45-64, comprising an 80% response rate from the general population in Paisley and Renfrew, Scotland. MAIN RESULTS: The main characteristics of the male Renfrew/Paisley population, compared to previous British studies, were shorter stature, higher blood pressure, a higher proportion of smokers who continue to smoke, lower FEV1 and higher levels of reported angina, breathlessness on effort and chronic bronchitis. In comparison with men, the main characteristics of the female Renfrew/Paisley population were shorter stature, higher plasma cholesterol, lower FEV1, fewer current and ex-smokers, and a higher prevalence of breathlessness on effort. There were only small differences between men and women in the prevalence of angina, ECG evidence of myocardial ischaemia and chronic bronchitis. CONCLUSIONS: Middle-aged men and women in an urban area with high levels of socio-economic deprivation have different cardio-respiratory risk and disease profiles compared to previous population in the UK, based on occupational groups and random national samples AU - Hawthorne VM AU - Watt GC AU - Hart CL AU - Hole DJ AU - Smith GD AU - Gillis CR LA - PT - DEP - TA - Scot Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 86 IP - DP - 1995 Jan 01 TI - Asthma due to isocyanates: a mail survey in a 1% sample of furniture workers in the Veneto region, Italy PG - 503-510 AB - To ascertain the prevalence and risk factors in isocyanate asthma, we made a mail survey in a sample of workers in the wooden furniture industry, which uses large quantities of isocyanate-paints. Firms making up the initial sample, chosen from a register in the Veneto region, were asked to cooperate in the study. The study population, selected from the respondent firms, consisted of 1,430 subjects (about 2% of the parent population). Each subject received a self-administered questionnaire on respiratory symptoms and occupational history; this was mailed to his/her workplace. Completed questionnaires were returned by 730 subjects, who made up 51% of the population under examination (about 1% of the parent population). Fifteen subjects had suffered their first attack of asthma while in their present job: of these 7 were among the 121 who used paints (5.8% prevalence), and 8 were among the 609 who had no exposure (1.4% prevalence). The risk of asthma in the former group was therefore almost 5 times the risk in the latter. This result, however, is probably an underestimation because of the cross-sectional design of our study; at the time of study many asthmatics had already left their factory. There was a dose-response relationship between asthma and the length of exposure to isocyanates, the prevalence increasing from 2.2% in subjects with less than 20 years to 27.3% in workers with over 20 years' exposure. Lower prevalence of isocyanate asthma was found in the larger firms, where airborne exposure to isocyanate was believed to be lower. The continuous mode of exposure increased the risk of developing symptoms of asthma rather than intermittent acute exposure to high concentrations of isocyanates. Among painters, the prevalence of asthma ranged from 7.1% in non-smokers to 2.9% in smokers. As smoking appears to increase IgE production, a nonallergic mechanism may underlie isocyanate-induced occupational asthma AU - Mastrangelo G AU - Paruzzolo P AU - Mapp C LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 20 IP - DP - 1995 Jan 01 TI - Drug resistance in Mycobacterium tuberculosis. PG - 701s-713s AB - During the last decade, there has been a marked increase in the number of gravity of tuberculosis cases both in developing countries and in industrialized nations. This is, in part, due to the acquired immune deficiency syndrome (AIDS) pandemic, but global economic depression, increased homelessness and declining control programmes have also contributed. One of the more insidious consequences of this resurgence has been the recent emergence and nosocomial transmission of multidrug-resistant strains of Mycobacterium tuberculosis, thus raising the possibility that untreatable forms of the disease may become widespread. Somewhat surprisingly, given the difficulties of working with this slow-growing pathogen, remarkable progress has been made in a relatively short time, in understanding the molecular epidemiology, the genetic basis, and the biochemical mechanisms of drug resistance. Furthermore, a number of promising molecular tools are now available to help counter tuberculosis and to further understanding. AU - Cole ST AU - Telenti A LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 16 IP - DP - 1995 Jan 01 TI - Efficacy of portable filtration units in reducing aerosolized particles in the size range of Mycobacterium tuberculosis PG - 391-398 AB - OBJECTIVE: To evaluate engineering control measures to prevent nosocomial transmission of diseases such as tuberculosis, we studied four portable high-efficiency air filtration units, including three high-efficiency particulate air (HEPA) filtration units, for their ability to remove aerosolized particles. DESIGN: Studies were conducted in either a nonventilated aerosol chamber or in a hospital isolation room that met CDC guidelines for TB control (negative pressure, > or = 6 air changes per hour, air exhausted directly to the outside). The rooms were challenged with aerosolized mineral oil in the size range of 0.3 to 5.0 microns at levels 10 to 20 times the normal airborne particle load in the room at baseline. Airborne particles were counted with a laser counter capable of simultaneously measuring sizes > or = 0.3, > or = 0.5, > or = 1.0, and > or = 5.0 microns. Experimental runs were conducted with the filtration units in the center or corner of the chamber or room, and the particle counter in the center of the room or at the exhaust vent. RESULTS: Portable filtration units were effective in accelerating the removal of aerosolized submicron particles. In the nonventilated room, time required by the various portable filtration units for removal of 90% of aerosolized particles (> or = 0.3 microns) ranged from a low of 5 to 6 minutes to a high of 18 to 31 minutes, compared to the control (no filtration unit), > 171 minutes. In the hospital room, individual filtration units removed 90% of aerosolized particles (> or = 0.3 microns) in times ranging from 5 to 8 minutes to 9 to 12 minutes, compared to the control (no filtration unit), 12 to 16 minutes. The location of the portable filtration unit (center versus corner) did not affect the clearance rate of airborne particles. CONCLUSION: Our data indicate that portable filtration units can rapidly reduce levels of airborne particles similar in size to infectious droplet nuclei and, therefore, may aid in reducing the risk of tuberculosis exposure AU - Rutala WA AU - Jones SM AU - Worthington JM AU - Reist PC AU - Weber DJ LA - PT - DEP - TA - Infect Control Hosp Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 85 IP - DP - 1995 Jan 01 TI - Tuberculosis drug resistance in the Western Cape PG - 499-504 AB - OBJECTIVES. Drug resistance is a serious problem in the treatment of tuberculosis and a threat to successful tuberculosis control programmes. Local health workers have expressed concern that the increasing tuberculosis epidemic in the Western Cape is partly attributable to drug resistance. The aim of this study was to determine the prevalence of tuberculosis drug resistance (including multidrug resistance) and to investigate possible relationships between drug resistance and patient demographic characteristics. DESIGN, SETTING, SUBJECTS, OUTCOME MEASURES. During a defined period, all adult (> or = 15 years) patients with pulmonary tuberculosis (confirmed by culture) from all tuberculosis clinics in the Western Cape were included. Previous tuberculosis treatment history was obtained by interviews, utilising a standardised questionnaire. Acquired drug resistance was determined on cultures from patients with a prior history of tuberculosis treatment, while initial resistance was determined from tuberculosis cases with no history of previous treatment. RESULTS. Data from 7,266 patients were analysed. After adjusting for missing information by way of a random sample validation study, 32% of patients were found to have a history of previous treatment, 63% indicated no previous treatment, and in 5% the treatment history was unknown. Rates for initial resistance were found to be low at 3,9% for isoniazid, 1,1% for rifampicin and 0, 2% for ethambutol. Combined resistance to isoniazid and rifampicin (multidrug resistance) was found to be 1,1% in patients not treated before. Acquired resistance rates were higher at 10,8% for isoniazid, 4,2% for rifampicin, 0,3% for ethambutol and 4,0% for multidrug resistance. Logistic regression analysis of the data indicated that drug resistance was not influenced by population group, gender or age. Patients with a history of tuberculosis treatment were found to be at an increased risk of developing drug resistance (relative risk 2,6). Some regions in the Western Cape had higher proportions of previously treated patients with consequent higher acquired resistance rates. CONCLUSIONS. Results from this study indicated that drug resistance is currently not a major problem in the Western Cape, rates comparing favourably with those reported from developed countries and being much lower than those for developing countries. Every effort should therefore be made to maintain the status quo and to prevent the emergence of further resistance. The priority for tuberculosis control in the Western Cape should remain to limit transmission of the disease by reducing the infectious pool through improved cure of (especially) smear-positive cases AU - Weyer K AU - Groenewald P AU - Zwarenstein M AU - Lombard CJ LA - PT - DEP - TA - S Afr Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 171 IP - DP - 1995 Jan 01 TI - Temporal trends and transmission patterns during the emergence of multidrug-resistant tuberculosis in New York City: a molecular epidemiologic assessment PG - 170-176 AB - To ascertain the role of human immunodeficiency virus (HIV) and Mycobacterium tuberculosis transmission on multidrug-resistant (MDR) tuberculosis (TB) emergence in New York City, medical records, drug susceptibilities, and restriction fragment length polymorphisms (RFLPs) of TB cases at a city hospital between two 9-month periods (1987-1988 and 1990-1991) were reviewed. The proportion of TB patients with MDRTB increased from 10% (27/267) to 17% (38/222; P = .03). Among MDRTB patients of known HIV status, the proportion with HIV increased from 16% (3/19) to 58% (22/38; P = .006). HIV-infected MDRTB patients were more likely than the seronegative ones to have initial MDRTB (88% vs. 56%; P = .03). Among 56 MDR cases with RFLP results, 12 had unique patterns; 44 belonged to one of six clusters. During 1990-1991, 27 (75%) of 36 MDRTB patients were infected with strains isolated from HIV-seronegative patients during 1987-1988. The increase in MDRTB caused by transmission from immunocompetent to immunocompromised persons underscores the urgency of TB control in populations with increasing HIV prevalence AU - Shafer RW AU - Small PM AU - Larkin C AU - Singh SP AU - Kelly P AU - Sierra MF AU - Schoolnik G AU - Chirgwin KD LA - PT - DEP - TA - Journal of Infectious Diseases JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 24 IP - DP - 1995 Jan 01 TI - Facial skin symptoms in visual display terminal (VDT) workers. A case-referent study of personal, psychosocial, building- and VDT-related risk indicators PG - 796-803 AB - BACKGROUND. The Office Illness Project in northern Sweden, comprising both a screening questionnaire study of 4943 office workers and a case-referent study of facial skin symptoms in 163 subjects was recently completed. Previously published results from the survey showed that female gender, asthma/rhinitis, high psychosocial work load, visual display terminal (VDT) and paperwork were related to an increased prevalence of facial skin symptoms. METHODS. The case-referent study presented in this paper used data from the questionnaire supplemented by information from a clinical examination, a survey of psychosocial factors at work, building data and VDT-related factors from inspection and measurements taken at the work site. RESULTS. Psychosocial conditions and exposure to electromagnetic fields or conditions associated with such factors were related to an increased occurrence of skin symptoms. The results also indicated that personal factors such as atopic dermatitis and physical exposure factors influencing indoor air quality, such as paper exposure and cleaning frequency were related to an increased prevalence of symptoms. CONCLUSIONS. The results suggest that skin symptoms reported by VDT users have a multifactorial background AU - Stenberg B AU - Eriksson N AU - Mild KH AU - Hoog J AU - Sandstrom M AU - Sundell J AU - Wall S LA - PT - DEP - TA - Int J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 56 IP - DP - 1995 Jan 01 TI - Beyond air quality--factors that affect prevalence estimates of sick building syndrome PG - 1141-1146 AB - If the prevalence of sick building syndrome (SBS) is estimated before intervention begins, then a reduction in the estimate may later be used to measure success of the intervention, and in particular, those efforts toward improving air quality. However, the measure of success will be distorted if factors other than air quality affect the SBS prevalence estimate. In this study the background prevalence of SBS was estimated and study factors identified that alone affected the estimate. Two symptom questionnaires were randomly administered to workers from 39 offices before routine physical examinations; one questionnaire described the SBS study, the other did not. SBS was defined as a symptom in the prior 24-hour or 7-day recall period that was more severe at work and not related to suspected confounders--allergy, cold, flu. Prevalence and prevalence ratios were estimated along with 95% confidence intervals (CI). Symptoms were reported by 45% of 1088 workers surveyed, but most reported them as more severe outside work or related them to confounders. SBS prevalence was 5%. It was 3.2 times higher (95% CI: 1.8, 5.7) among workers cognizant of the study relative to those blinded, 2.2 times higher (95% CI: 1.2, 4.1) for the 7-day relative to the 24-hour recall period, and 2.5 times higher (95% CI: 1.4, 5.0) for females. SBS prevalence did not differ by workday or age. Since study factors alone affected prevalence estimates, a standardized assessment method seems necessary for SBS AU - Mikatavage MA AU - Rose VE AU - Funkhouser E AU - Oestenstad RK AU - Dillon K AU - Reynolds KD LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 152 IP - DP - 1995 Jan 01 TI - Does the protective effect of neonatal BCG correlate with vaccine-induced tuberculin reaction? PG - Pt 1):1575-8 AB - A case-control study was conducted in Saudi Arabia, where the same strain of BCG has been used and surveys had shown that up to 88% of vaccinated children remain tuberculin negative. Active cases were obtained by surveying the seven tuberculosis centers in 1 yr. Control subjects were obtained from a nationwide survey of normal individuals. Vaccination in both groups was ascertained by history and BCG scar. Relative risk of contracting active tuberculosis in the vaccinated versus unvaccinated and protection was calculated. Protection was as follows: age group 5 to 14 yr, 82% (55 to 93%); age group 15 to 24 yr, 67% (55 to 77%); and age group 25 to 34 yr, 20% (-6 to 37%). We document the uninterrupted record of protection by BCG administered in the neonatal period and discuss the significance of vaccination timing. We concur with other studies that protection lapsed after about 20 yr. More importantly, this is the first large study that documents a lack of tuberculin sensitivity despite protection. This challenges the view that sensitization is essential for protection and supports the "two-pathway" theory that BCG vaccination could trigger either protective (Lister type) or antagonistic (tuberculin or Koch type) reactions and that the most protective vaccines would have little tuberculin-sensitizing effect because the two pathways are competitive AU - alKassimi FA AU - alHajjaj MS AU - alOrainey IO AU - Bamgboye EA LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 21 IP - DP - 1995 Jan 01 TI - Antimicrobial chemotherapy for legionnaires' disease: a review. PG - Suppl 3:5265-76 AB - Controlled trials of antimicrobial chemotherapy for legionnaires' disease have not been performed, although erythromycin and tetracycline appear to be effective therapies. Laboratory data indicate that the activities of the fluoroquinolone and newer macrolide/azalide agents against Legionella pneumophila are superior to that of erythromycin, and case reports substantiate that the activities of these agents are at least equal. Results of clinical treatment with and laboratory testing of macrolides, tetracyclines, co-trimoxazole, chloramphenicol, aminoglycosides, fluoroquinolones, beta-lactam agents, and streptogramins are reviewed. The drugs of choice for the treatment of legionnaires' disease in immunocompromised or severely ill patients should be one of the fluoroquinolone antimicrobials rather than erythromycin. AU - Edelstein PH LA - PT - DEP - TA - Clin Infect Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 62 IP - DP - 1995 Jan 01 TI - Prevalence of pneumonia due to Legionella pneumophila and Mycoplasma pneumoniae in a population admitted to a department of internal medicine PG - 331-335 AB - We studied 177 patients with pneumonia admitted to an internal medicine department over a period of 3 years to determine the incidence of two emerging pathogens, Legionella pneumophila and Mycoplasma pneumoniae. Clinical, radiological and laboratory tests were performed and included blood cultures, serology, gram staining and sputum cultures. L. pneumophila was the agent involved in 9 patients (5.1%) and M. pneumoniae in 12 (6.8%). These prevalences were about in the middle of the range of previously published figures. Legionella pneumonia is a rare illness, which even in the absence of suggestive clinical signs must be considered because of its possibly serious course and to allow appropriate therapeutic decisions to be made AU - Bozzoni M AU - Radice L AU - Frosi A AU - Vezzoli S AU - Cuboni A AU - Vezzoli F LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 16 IP - DP - 1995 Jan 01 TI - Prevalence of PPD positivity among new employees at a hospital in New York City PG - 344-347 AB - OBJECTIVE: To determine the prevalence of tuberculin reactivity among all new employees at a hospital in New York City. DESIGNS: Prospective measurement of purified protein derivative (PPD) status in consecutive new employees at a hospital in New York City from 1991 to 1993. All employees are tested as part of a preemployment physical, assuring complete compliance. Aplisol (Parke-Davis, Morris Plains, NJ) was used in 1991 and 1992, and Tubersol (Connaught, Swiftwater, PA) in 1993. Tests were applied and interpreted by trained employee health personnel. RESULTS: Of 313 consecutive new employees, comprising all job categories, 40% were PPD positive at time of initial hire, including 20% of US-born and 70% of foreign-born employees. Of 114 persons who had received BCG vaccination, 67% were PPD positive. By multivariate regression analysis, age, BCG vaccination history, and foreign country of birth were independent predictors of a reactive PPD test. CONCLUSIONS: The high prevalence of tuberculin reactivity may reflect high rates of Mycobacterium tuberculosis infection and disease in the community, complicating interpretation of the efficacy of Centers for Disease Control and Prevention (CDC) guidelines to prevent the spread of tuberculosis in healthcare facilities AU - Sepkowitz KA AU - Fella P AU - Rivera P AU - Villa N AU - DeHovitz J LA - PT - DEP - TA - Infect Control Hosp Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 95 IP - DP - 1995 Jan 01 TI - Specific IgE and IgG serum antibodies to thiamine associated with anaphylactic reaction PG - Pt 1):1059-60 AU - Proebstle TM AU - Gall H AU - Jugert FK AU - Merk HF AU - Sterry W LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 111 IP - DP - 1995 Jan 01 TI - Asthma and rhinitis due to chloramine T-powder in instrument maintenance personnel [Finnish] PG - 921-925 AU - Keskinen H AU - Nordqvist E AU - Tuppurainen M AU - Sala E AU - Nordman H LA - PT - DEP - TA - Duodecim JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 2 IP - DP - 1995 Jan 01 PG - - AU - Goldstein H LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 142 IP - DP - 1995 Jan 01 TI - Relation of FEV1 and peripheral blood leukocyte count to total mortality. The Normative Aging Study PG - 493-8; discussion 49 AB - Increased peripheral blood leukocyte count and decreased level of pulmonary function have both been implicated as causes of increased total mortality in population-based studies. The extent to which these factors are independent of cigarette smoking is controversial. The authors explored the relation of leukocyte count and the level of forced expiratory volume in 1 second to total mortality in the Normative Aging Study population in the Boston, Massachusetts, area. Other covariates examined included forced vital capacity, height, body mass index, systolic and diastolic blood pressure, and total cholesterol. The sample for the current analysis consisted of 1,956 men who underwent the baseline Normative Aging Study examination during 1961-1969. Subjects ranged in age from 21 to 80 years of age at the time of entry. A total of 170 deaths occurred over the 30 years of follow-up. Statistical analysis was conducted utilizing Cox proportional hazards modeling and regression trees for censored survival data. The Cox proportional hazards model suggested that age, forced expiratory volume in 1 second, and peripheral blood leukocyte count were the three most important predictors of increased mortality in this cohort. A regression tree analysis in general confirmed these results. Both methods of analysis suggest that forced expiratory volume in 1 second and peripheral blood leukocyte count were predictors of mortality, independent of cigarette smoking AU - Weiss ST AU - Segal MR AU - Sparrow D AU - Wager C LA - PT - DEP - TA - Am J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 345 IP - DP - 1995 Jan 01 TI - Relation of exposure to airway irritants in infancy to prevalence of bronchial hyper-responsiveness in schoolchildren PG - 217-220 AB - To find out whether exposure to sulphur dioxide during infancy is related to the prevalence of bronchial hyper-responsiveness (BHR), we studied schoolchildren (aged 7-13 years) from two areas of Norway--a valley containing a sulphur-dioxide-emitting aluminium smelter and a similar but non-industrialised valley. Bronchial responsiveness was assessed in 529 of the 620 participants. The median exposures to sulphur dioxide and fluoride were 37.1 micrograms/m3 and 4.4 micrograms/m3 at ages 0-12 months and 37.9 micrograms/m3 and 4.4 micrograms/m3 at 13-36 months. The risk of BHR increased with exposure to sulphur dioxide and fluoride at these ages; the odds ratio for a 10 micrograms/m3 increase in sulphur dioxide exposure at 0-12 months was 1.62 (95% CI 1.11-2.35) and that for a 1 microgram/m3 increase in fluoride exposure was 1.35 (1.07-1.70) at 0-12 months and 1.38 (1.05-1.82) at 13-36 months. Exposure to these low concentrations of airway irritants during early childhood is associated with an increased prevalence of BHR in schoolchildren AU - Soyseth V AU - Kongerud J AU - Haarr D AU - Strand O AU - Bolle R AU - Boe J LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 10 IP - DP - 1995 Jan 01 TI - Case reports: epidemic eye and upper respiratory irritation in poultry processing plants PG - 43-49 AU - Sanderson WT AU - Weber A AU - Echt A LA - PT - DEP - TA - Appl Occup Environ Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Risk factors for death and hospitalization from pneumonia. A prospective study of a general population PG - 1694-1698 AB - The aim of this study was to identify possible risk indicators for pneumonia leading to death and hospitalization in the general population. We followed 6,158 men and 7,265 women aged 30-70 years, who participated in the Copenhagen City Heart Study, a prospective population study, for 12 years with regard to mortality and hospital admissions for pneumonia. A total of 260 deaths with pneumonia as main or contributory death cause had occurred, and 405 subjects had been admitted to hospital at least once because of pneumonia. Mortality and hospitalization were analysed by multivariate Cox regression models. In addition to increasing age, forced expiratory volume in one second (FEV1) was strongly and consistently related to both pneumonia related mortality and hospitalization. Women with FEV1 < 60% predicted had a relative risk of 5.7 (95% confidence interval: 2.9-11) and 3.6 (2.1-6.4) for death and hospitalization, respectively, when compared with women with FEV1 > or = 100% predicted. Similar, although lower, relative risks were observed in men. Other significant risk indicators for hospitalization were: self-reported asthma (women), mucus hypersecretion (women and men), history of stroke (men) and smoking (women). We conclude that, in addition to age, reduced FEV1 is the most important risk indicator for severe pneumonia AU - Lange P AU - Vestbo J AU - Nyboe J LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Chest radiography and high resolution computed tomography in the evaluation of workers exposed to silica dust: relation with functional findings PG - 262-267 AB - OBJECTIVES--To compare the usefulness of high resolution computed tomography (HRCT) with chest radiography (CR) in the diagnosis and assessment of severity of silicosis. METHODS--27 workers exposed to silica underwent CR, HRCT, and pulmonary function tests. Two experienced readers independently evaluated CR by International Labour Office classification, and grouped the results into four categories. HRCT categories of nodule profusion and the extent of emphysema were graded on a four point scale; in 20 subjects the percentage distribution of lung densities were measured by HRCT. RESULTS--Concordance between readers was higher for HRCT than for CR (K statistic = 0.49 and 0.29 respectively). There was poor concordance between CR and HRCT in the early stage of silicosis. No significant difference in pulmonary function tests was found among different CR categories, but forced expiratory volume in one second (FEV1), maximal expiratory flow at 50% and 75% of FVC (MEF50, MEF75), and diffusion capacity significantly decreased with increasing HRCT categories. Subjects with simple silicosis detected by HRCT had a lower FEV1 than subjects without silicosis, whereas subjects with conglomerated silicosis showed higher residual volume and functional residual capacity than subjects with simple silicosis. These relations were not affected by smoking or symptoms of chronic bronchitis. Different grades of emphysema detected by HRCT were significantly different in diffusion capacity. Only the HRCTs of the lowest and the highest categories of profusion of parenchymal opacities were significantly different in their distribution of density classes. CONCLUSION--HRCT is more reproducible and accurate than CR, as suggested by the higher agreement between readers and the better correlation with pulmonary function tests, irrespective of smoking and chronic bronchitis; however, these data do not support the hypothesis that HRCT is more sensitive than CR in the early detection of silicosis AU - Talini D AU - Paggiaro PL AU - Falaschi F AU - Battolla L AU - Carrara M AU - Petrozzino M AU - Begliomini E AU - Bartolozzi C AU - Giuntini C LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - Relation between respiratory symptoms, pulmonary function and peak flow variability in adults PG - 121-126 AB - BACKGROUND--A study was carried out to determine whether subjects with respiratory symptoms are more likely to have impaired lung function or increased airway lability, and to quantify these relationships in a population of adults. METHODS--Data were collected from 511 participants (aged 20-70 years) from the Dutch part of the European Community Respiratory Health Survey (ECRHS). The symptoms analysed were: wheeze, dyspnoea > or = grade 3, nocturnal dyspnoea, cough and phlegm, and history of allergy. Lung function was measured by peak expiratory flow (PEF) and forced expiratory volume in one second (FEV1). PEF variability was used as an index for bronchial lability. RESULTS--Both FEV1 and PEF were decreased with increasing numbers of symptoms. Subjects with one symptom had an increased risk of having an FEV1 value of < 70% (OR = 4.2) and this risk increased with an increasing number of symptoms. Subjects with three or more symptoms had an increased risk of having a PEF value of < 70%, a diurnal variation in PEF of > 10% (both OR = 4.4), and an increased risk of high between day variation (OR = 6.6). CONCLUSIONS--Subject-reported symptoms are related to impaired lung function and to increased variability of peak flow AU - Boezen HM AU - Schouten JP AU - Postma DS AU - Rijcken B LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 7 IP - DP - 1995 Jan 01 TI - Latex hypersensitivity in children. [Review] PG - 671-675 AB - Latex is a natural substance used in the manufacture of thousands of products. Although latex allergy is uncommon in the general population, health care workers and children with spina bifida appear to be at high risk for latex allergy. These patients may experience urticaria, rhinoconjunctivitis, bronchospasm, and anaphylaxis following contact with or inhalation of latex antigens. Several protein allergens in latex have been identified, some of which appear to cross-react clinically and immunochemically with fruit antigens. Good diagnostic tests are available for latex allergy, but strict avoidance is still the only available treatment. AU - Cahaly RJ AU - Slater JE LA - PT - DEP - TA - Curr Opin Pediatr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 39 IP - DP - 1995 Jan 01 TI - Exposure to chloramines in the atmosphere of indoor swimming pools PG - 427-439 AB - Specific sampling and analytical methods were developed to assess the concentration of chloramines in the atmosphere of indoor swimming pools because swimming instructors had complained of irritation (mainly eye and lung). The sampling method is based upon the reduction of chloramines to chlorides which are then analysed by ion chromatography. The chloramine concentration in the atmosphere of 13 swimming pools (including five recreational centres and one reeducation centre) was measured, showing that the concentrations were higher in the recreational centres. The influence of slides, bubbling baths, waves and other activities were demonstrated. A correlation was made between the level of pollutants and the complaints registered, leading to the proposal of a 'comfort' limit value. AU - Hery M AU - Hecht G AU - Gerber JM AU - Gendre JC AU - Hubert G AU - Rebuffaud J LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Asthmatic symptoms and volatile organic compounds, formaldehyde, and carbon dioxide in dwellings PG - 388-395 AU - Norback D AU - Bjornsson E AU - Janson C AU - Widstrom J AU - Boman G LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 333 IP - DP - 1995 Jan 01 TI - The effectiveness of vaccination against influenza in health, working adults PG - 889-893 AU - Nichol KL AU - Lind A AU - Margolis KL AU - Murdoch M AU - McFadden R AU - Hauge M AU - Magnan S AU - Drake M LA - PT - DEP - TA - NEJM JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 88 IP - DP - 1995 Jan 01 TI - Acute infective exacerbations of chronic bronchitis PG - 61-68 AU - Ball P AU - Harris JM AU - Lowson D AU - Tillotson G AU - Wilson R LA - PT - DEP - TA - QJM JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - IP - DP - 1995 Jan 01 TI - A Questionnaire for studies of Sick Building Syndrome PG - - AU - Raw GJ AU - Whitehead C AU - Robertson AS AU - Burge PS AU - Kelly CA AU - Leinster P LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 345 IP - DP - 1995 Jan 01 TI - Continuing increase in mesothelioma mortality in Britain PG - 535-539 AU - Peto J AU - Hodgson JT AU - Mathewa FE AU - Jones JR LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 123 IP - DP - 1995 Jan 01 TI - The efficacy of influenza vaccine in elderly persons. A meta- analysis and review of the literature. PG - 518-527 AB - OBJECTIVE: To quantify the protective efficacy of influenza vaccine in elderly persons. DATA SOURCES: A MEDLINE search was done using the index terms influenza vaccine, vaccine efficacy, elderly, mortality, hospitalized, and pneumonia. Appropriate references in the initially selected articles were also reviewed. STUDY SELECTION: Only cohort observational studies with mortality assessment were included in the meta-analysis. In addition, 3 recent case-control studies, 2 cost-effectiveness studies, and 1 randomized, double-blind, placebo-controlled trial were reviewed. DATA EXTRACTION: Vaccine and epidemic virus strains, age and sex of patients, severity of illness, patient status, and study design were recorded. Upper respiratory illness, hospitalization, pneumonia, and mortality were used as outcome measures. DATA SYNTHESIS: In a meta-analysis of 20 cohort studies, the pooled estimates of vaccine efficacy (1-odds ratio) were 56% (95% Cl, 39% to 68%) for preventing respiratory illness, 53% (Cl, 35% to 66%) for preventing pneumonia, 50% (Cl, 28% to 65%) for preventing hospitalization, and 68% (Cl, 56% to 76%) for preventing death. Vaccine efficacy in the case-control studies ranged from 32% to 45% for preventing hospitalization for pneumonia, from 31% to 65% for preventing hospital deaths from pneumonia and influenza, from 43% to 50% for preventing hospital deaths from all respiratory conditions, and from 27% to 30% for preventing deaths from all causes. The randomized, double-blind, placebo-controlled trial showed a 50% or greater reduction in influenza-related illness. Recent cost-effectiveness studies confirm the efficacy of influenza vaccine in reducing influenza-related morbidity and mortality and show that vaccine provides important cost savings per year per vaccinated person. CONCLUSION: Despite the paucity of randomized trials, many studies confirm that influenza vaccine reduces the risks for pneumonia, hospitalization, and death in elderly persons during an influenza epidemic if the vaccine strain is identical or similar to the epidemic strain. Influenza immunization is an indispensable part of the care of persons 65 years of age and older. Annual vaccine administration requires the attention of all physicians and public health organizations. AU - Gross PA AU - Hermogenes AW AU - Sacks HS AU - Lau J AU - Levandowski RA LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 21 IP - DP - 1995 Jan 01 TI - Occurrence of self-reported asthma among Swedish bakers PG - 487-493 AB - OBJECTIVE: The purpose of this study was to estimate the risk of bakers to develop asthma. METHODS: A retrospective cohort study was performed among persons trained as bakers in Swedish trade schools in 1959-1989 (N = 2923). One group of referents (I) comprised persons who followed another program in the trade schools (N = 1258), and another (II) was randomly selected from the population register (N = 1258). A questionnaire on physician-diagnosed asthma, year of onset of asthma, asthma-like symptoms, consumption of antiasthmatic drugs, change of work due to asthma, familial atopy, and work history was mailed to all the participants. The incidence rates for persons trained as bakers were estimated separately for time as a baker and time in other occupations. RESULTS: The response rate was about 75% in all three groups. There were no differences in the prevalence of asthma, asthma-like symptoms, consumption of antiasthmatic drugs, or familial atopy between the groups. Of the bakers, 2.5% had changed work due to asthma, significantly more than the referents (1.1% of reference groups I and II had changed, P < 0.05). The incidence rate for asthma among the men not working as bakers was 0.9-1.9 cases per 1000 person-years; male bakers had an incidence rate of 3.0. The relative risk for male bakers compared with all the referents was 1.8 (95% confidence interval 1.3-2.6). Women had an incidence rate of 2.3-3.0 cases per 1000 person-years, and there was no increased relative risk during work as a baker. CONCLUSIONS: Male Swedish bakers, mainly those working during the 1970s and 1980s, have an approximately doubled risk to develop asthma AU - Brisman SJ AU - Jarvholm BG LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - Incidence of asthma in Swedish teenagers: relation to sex and smoking habits PG - 260-264 AB - BACKGROUND--The prevalence of asthma and the use of asthma drugs is increasing worldwide. Studies of the incidence of asthma are few but are of interest in finding factors associated with onset of the disease. A study was performed to estimate the incidence of asthma and its relation to sex and to tobacco smoking between the ages of 16 and 19 years, and to compare the incidence of asthma with the proportion of individuals receiving a prescription of an asthma drug for the first time during one year. METHODS--A questionnaire was sent in 1990 to all 3627 individuals born in 1974 living in the county of Jamtland and Gastrikland, the southern part of the county of Gavleborg in central Sweden. Individuals reporting airways disease or obstructive symptoms were investigated with a further interview and lung function tests. The cross sectional questionnaire study was repeated in 1993. The incidence of asthma was calculated in the 2308 individuals who answered the questionnaire in both surveys and who were found not to have asthma in 1990. RESULTS--The yearly incidence of asthma defined from self reported disease, physician diagnosed asthma, drug use, or asthma associated symptoms was between 0.8% and 1.3%, depending on the criteria used. All criteria used resulted in a higher incidence in female subjects. Female sex was a risk factor for asthma when standardised for smoking, and smoking was also a risk factor for asthma when standardised for sex to all but two of the criteria used. In all the criteria the increased risk of asthma combined with smoking was greater in female subjects. CONCLUSION--The yearly incidence of asthma was about 1% between the ages of 16 and 19 years. Smoking and female sex were found to be risk factors for asthma. The incidence of asthma was close to the incidence of new drug use for asthma AU - Larsson L LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 24 IP - DP - 1995 Jan 01 TI - Measuring the prevalence of bronchial hyper-responsiveness in children PG - 597-602 AB - BACKGROUND. The aim of this study was to assess the effectiveness of an asthma prevalence video questionnaire (involving the audiovisual presentation of clinical asthma), a standard written questionnaire (based on the IUATLD Bronchial Symptoms Questionnaire) and a new written questionnaire (designed for an international study of asthma and allergies in childhood [ISAAC]) in predicting bronchial hyper-responsiveness (BHR) (PD20 < or = 7.8 mumol methacholine). METHODS. The IUATLD and video questionnaires were administered to 193 schoolchildren (13-16 years). The ISAAC questionnaire was administered to 87 of these children. All children subsequently underwent bronchial challenge to methacholine. RESULTS. The sensitivity and specificity for predicting BHR were similar for individual questions from the IUATLD and video questionnaires. The video questions with the highest Youden's index related to moderate wheezing at rest (0.46), severe wheezing at rest (0.38), and nocturnal wheezing (0.37). The ISAAC questionnaire was similar in effectiveness to the IUATLD questionnaire in predicting BHR. CONCLUSIONS. The video questionnaire is a valid method of assessing the prevalence of BHR, and may be particularly useful when comparing populations with differing languages and cultures. Some video questions appeared more effective than others in relation to predicting BHR. A new written questionnaire (ISAAC) designed for a large international asthma prevalence study in children also is an effective method for measuring the prevalence of BHR AU - Shaw R AU - Woodman K AU - Ayson M AU - Dibdin S AU - Winkelmann R AU - Crane J AU - Beasley R AU - Pearce N LA - PT - DEP - TA - Int J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods PG - 483-491 AB - The aetiology of asthma and allergic disease remains poorly understood, despite considerable research. The International Study of Asthma and Allergies in Childhood (ISAAC), was founded to maximize the value of epidemiological research into asthma and allergic disease, by establishing a standardized methodology and facilitating international collaboration. Its specific aims are: 1) to describe the prevalence and severity of asthma, rhinitis and eczema in children living in different centres, and to make comparisons within and between countries; 2) to obtain baseline measures for assessment of future trends in the prevalence and severity of these diseases; and 3) to provide a framework for further aetiological research into genetic, lifestyle, environmental, and medical care factors affecting these diseases. The ISAAC design comprises three phases. Phase 1 uses core questionnaires designed to assess the prevalence and severity of asthma and allergic disease in defined populations. Phase 2 will investigate possible aetiological factors, particularly those suggested by the findings of Phase 1. Phase 3 will be a repetition of Phase 1 to assess trends in prevalence AU - Asher MI AU - Keil U AU - Anderson HR AU - Beasley R AU - Crane J AU - Martinez F AU - Mitchell AU - EA AU - Pearce N AU - Sibbald B AU - Stewart AW AU - et al LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 50 IP - DP - 1995 Jan 01 TI - Allergic reactions associated with airborne fish particles in IgE-mediated fish hypersensitive patients PG - 257-61 AB - We evaluated the clinical characteristics found in 21 children who showed allergic reactions upon incidental inhalation offish odors or fumes, from 197 diagnosed with IgE-mediated fish hypersensitivity. Allergic reactions to fish via ingestion began in most patients (86%) within the first 24 months of life. The vast majority (19/21) of patients showed cutaneous symptoms, either alone or, less frequently, associated with other clinical manifestations. Hake and flounder were the species offish most frequently implicated in eliciting clinical manifestations upon ingestion. After diagnosis, all these patients were placed on a strict fish-avoidance diet. During this period of avoidance, patients reported allergic reactions (mean age 7 years) after incidental exposure to airborne fish odors or fumes. Clinical manifestations through inhalation were respiratory (mainly wheezing) in 12 patients and cutaneous (mainly urticaria) in nine patients. Nineteen of 21 patients reported three or more episodes upon exposure to fish aerosols; in most cases, these episodes occurred at home when other people were eating fish. In conclusion, incidental inhalation of fish odors or fumes could play an important role in accidental and unknown encounters with fish in children on fish-avoidance diets for fish IgE-mediated hypersensitivity. Such exposures could elicit clinical symptoms and could have some effect in delaying the development of tolerance. AU - Crespo FJ AU - Pascual C AU - Dominguez C AU - Ojeda I AU - Munoz MF AU - Esteban MM LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 151 IP - DP - 1995 Jan 01 TI - The association of HLA-DR3 with specific IgE to inhaled acid anhydrides PG - 219-221 AB - We have undertaken a case referent study of the association between HLA allele frequency and specific IgE antibody to acid anhydride-human serum albumin (AA-HSA) conjugates among acid anhydride workers. Thirty cases with radio-allergosorbent test score versus AA-HSA conjugates > 2 were compared with 30 referents without specific IgE selected from the same factory sites as the cases and matched for age, sex, duration of exposure, atopic status, and smoking habit. We found a significant excess of HLA-DR3 in the cases with specific IgE to acid anhydrides when compared with the referents (50% versus 14%, Fisher's statistic = 8.4; odds ratio = 6, p = 0.05 corrected). The excess of HLA-DR3 was particularly associated with IgE versus trimellitic anhydride, with HLA-DR3 present in eight of 11 workers with and in two of 14 referents without IgE (Fisher's statistic = 8.5, odds ratio = 16, p = 0.004). The proportion of HLA-DR3 among the phthalic anhydride workers was not different in those with IgE (two of 12) from their referents (two of 14). These findings suggest MHC II proteins are an important determinant of the specificity of the IgE response to an inhaled hapten. AU - Young RP AU - Barker RD AU - Pile KD AU - Cookson WO AU - Newman Taylor AJ LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 86 IP - DP - 1995 Jan 01 TI - Atopy and pre-employment medical examination PG - 303-308 AU - Innocenti A LA - PT - DEP - TA - Med del Lavoro JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Pre-employment screening among trainee bakers PG - 279-283 AU - Zotti R de AU - Molinari S LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 27 IP - DP - 1995 Jan 01 TI - Respiratory allergies among symptomatic bakers and pastry cooks: initial results of a prevalence study PG - 7-10 AU - Bataille A AU - Anton M AU - Mollat F AU - Bobe M AU - Bonneau C AU - Caramaniam MN AU - Geraut C AU - Dupas D LA - PT - DEP - TA - Allerg Immunol (Paris) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 107 IP - DP - 1995 Jan 01 TI - HLA class II molecules and asthma induced by toluene diisocyanate PG - 400-401 AU - Fabbri LM AU - Mapp CE AU - Balboni A AU - Baricordi R LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 39 IP - DP - 1995 Jan 01 TI - Exposure To Acid Anhydrides In Three Resin And One Cushioned Flooring Manufacturing Plants PG - 559-571 AU - Tongeren MJ van; Barker RD LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 27 IP - DP - 1995 Jan 01 TI - Respiratory symptoms and pulmonary function in flour processing workers in the baking industry PG - 359-365 AU - Shamssain MH LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 25 IP - DP - 1995 Jan 01 TI - Factors related to the development of sensitisation to green coffee and castor bean allergens among coffee workers PG - 643-650 AB - Background Occupational allergic respiratory symptoms in coffee workers have been frequently reported, but the ultimate cause of sensilization is still debated, castor bean being considered besides green coffee beans. Atopy and cigarette smoking have been suggested as promoting factors of sensitizalion for several occupational allergens. Objective This study was carried out to assess the prevalence of allergic respiratory symptoms and of sensitization to both green coffee beans and castor bean in the whole workforce of a coffee manufacturing plant. Furthermore we wanted to ascertain both the presence of castor bean antigens in the settled dust of the green coffee beans warehouse and the possible crossreactivity between the two beans. Meanwhile, the effect of smoking and atopy was considered. Method: Two-hundred and eleven workers were examined. A questionnaire on oculorhinitis and asthma was administered and skin-prick tests for green coffee beans, castor bean and 15 common inhalant allergens were carried out. Isoelectric focusing, isoelectric focusing immunoblot and radioallergosorbent assay (RAST) inhibition were performed on samples of settled environmental dust from the green coffee area, as well as on castor bean and green coffee beans. Results Ten per cent of the workers complained of oculorhinitis alone and 16% of asthma (nearly always associated with oculorhinitis). The overall prevalence of skin-sensitization was: 15% for green coffee beans, 22% for castor bean, 22% for common allergens. Evidence of sensitization to occupational allergens was more common in smokers, with a more than twofold increase in relative risk. The strong association between skin positivity to common and occupational allergens suggests that atopy acts as an enhancing host factor towards occupational sensitization. The analysis of the dust confirmed the presence of castor bean antigens. Conclusion Our findings indicate that castor bean is the major cause of occupational sensitization among coffee workers, whereas smoking and atopy act as enhancing factors. AU - Romano C AU - Sulotto F AU - Piolatto G et al LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 152 IP - DP - 1995 Jan 01 TI - Peak Expiratory Flow Monitoring Is Not A Reliable Method For Establishing The Diagnosis Of Occupational Asthma PG - 1100-1102 AB - This is a study of the reliability of peak expiratory flow (PEF) monitoring using a portable computerized peak flow meter, the VMX Mini-log, in 17 subjects referred for suspected occupational asthma. Subjects were requested to monitor their PEF six times daily using the VMX Mini-Log for 2 wk at work and at least 10 d away from work. They were unaware that their readings were stored by the flow meter in addition to the digital readout. Four subjects (22%) were unable to complete the monitoring. The results recorded by the subjects were compared with the results recorded by the VMX. Of those who completed the monitoring, only 55.3% of the records were completely accurate in terms of the value and the timing of the measurements, 23.3% were inaccurate either in terms of the recorded value or of the timing of the measurement, and the remainder were fabricated results (not recorded by the Mini-Log). Our results suggest that PEF monitoring using ordinary peak flow meters for assessment of work-relatedness of asthma has limitations and is not reliable AU - Quirce S AU - Contreras G AU - Dybuncio A AU - ChanYeung M LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 151 IP - DP - 1995 Jan 01 TI - Prevalence of occupational asthma due to latex among hospital personnel PG - 54-60 AB - Latex has been documented as causing immediate hypersensitivity reactions ranging from contact urticaria to severe anaphylaxis. Latex proteins may also act as airborne allergens causing rhinitis and asthma. The prevalence of occupational asthma due to latex gloves among health care workers is unknown. We surveyed the employees of a primary care hospital including nurses (n = 201), members of the cleaning staff (n = 50), and laboratory technologists (n = 38). In the initial part of the study, a questionnaire and skin-prick tests with latex and common inhalant allergens were administered to 273 of 289 (94%) members of the target population. Thirteen of the 273 subjects (4.7%; 95% CI: 2.6 to 8.1%) showed skin reactivity to latex. All latex-sensitive subjects reported glove-related urticaria, which was associated with rhinoconjunctivitis in 12 subjects and asthma in five subjects. No subject had a history suggestive of occupational asthma among those who had negative skin tests to latex. In the second part of the study, a histamine inhalation challenge was performed on 12 of 13 latex- sensitive subjects, including the five subjects with a history of occupational asthma. These 12 subjects demonstrated significant bronchial hyperresponsiveness. All underwent specific inhalation challenges with latex gloves in the laboratory. Seven subjects developed a significant bronchial response (four immediate and three dual reactions) to latex glove exposure. We conclude that occupational asthma due to latex occurred in 2.5% (95% CI: 1.0 to 5.2%) of hospital employees. Widespread use of latex gloves should therefore be considered a significant risk to the respiratory health of hospital employees. AU - Vandenplas O AU - Delwiche JP AU - Evrard G et al LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 151 IP - DP - 1995 Jan 01 TI - Latex Gloves With A Lower Protein Content Reduce Bronchial Reactions In Subjects With Occupational Asthma Caused By Latex PG - 887-891 AB - Latex gloves have been documented as causing rhinitis and asthma. Using inhalation challenges, we evaluated the bronchial response to hypoallergenic gloves in eight health care workers with latex-induced asthma. The subjects were exposed to the powdered latex gloves causing asthma at work and various brands of gloves with a lower protein content, either low-powdered, nonpowdered, or powdered. Exposure to hypoallergenic gloves resulted in the absence (in six subjects) or a significant reduction (in two subjects) of bronchial response. The effects of repeated exposure to hypoallergenic gloves was assessed in two subjects who did not demonstrate changes in peak expiratory flow rates and nonspecific bronchial responsiveness to histamine. This study on a limited number of patients suggests that the use of hypoallergenic gloves could be an effective means of reducing the risk of asthmatic reactions in health care workers with latex-induced asthma when complete avoidance cannot be achieved. The long-term effect of exposure as well as the widespread use of hypoallergenic gloves warrant further investigation on larger cohorts of subjects. AU - Vandenplas O AU - Delwiche JP Depelchin S et al LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 107 IP - DP - 1995 Jan 01 TI - A workers' compensation claim population for occupational asthma. Comparison of subgroups PG - 634-641 AB - STUDY OBJECTIVE (1) To compare patients with claims submitted to the Ontario Workers' Compensation Board (WCB) for occupational asthma, in relation to the WCB decisions reached of occupational asthma (OA); aggravation of asthma from irritant exposures (AA); unrelated asthma; no asthma; and (2) to assess determinants of outcome of WCB accepted claims at permanent disability assessments. DESIGN A retrospective review of 609 claims submitted to the WCB 1984 to 1988. RESULTS The WCB decision reached was OA in 39% of claims, mostly attributed to isocyanates (57% of these). A further 39% were accepted for AA. Exposure to a known sensitizer occurred in 91% with OA and to an irritant in 67% with AA. Forty percent with AA were attributed to a spill or accidental exposure and 68% had preceding asthma. Those with AA were more likely to have clearing of symptoms by the time of their main assessment (43% vs 20% with OA) and were more likely to have remained in the same work (35% vs 20% with OA). Of 200 OA accepted claims reviewed at a mean of 1.9 years later, clearing of asthma occurred in 19% and milder asthma in 47%. Outcome was best with early diagnosis (p < 0.05), and milder impairment of pulmonary function at initial assessment (p < 0.05). CONCLUSIONS Patients with asthma induced by a workplace sensitizer demonstrate some differences from those related to workplace irritants. Accurate categorization and early removal of those with OA offers the best prognosis. AU - Tarlo SM AU - Liss G AU - Corey P et al LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - New Method For An Occupational Dust Challenge Test PG - 54-56 AB - OBJECTIVES Specific challenge tests with a suspected allergen in the workplace are standard to confirm the diagnosis of asthma. Facilities for sophisticated exposure tests are available only in a few institutions. A pilot study was carried out that used a novel approach for an occupational dust challenge test with a rotahaler. METHODS Nine consecutive patients were enrolled in this study. Six of these proved to have asthma to red cedar by challenge tests with plicatic acid. They were challenged with a maximum dosage of 80 mg of red cedar dust and spruce dust (control) with a rotahaler on separate days in a single blinded manner. A positive reaction was defined as a fall in the forced expiratory volume in one second (FEV1) or the peak expiratory flow (PEF) after a challenge test of > or = 20% below the baseline value. RESULTS Three of the six patients who reacted to plicatic acid also had a positive response to red cedar dust delivered through a rotahaler. All three patients with a negative response to challenge with plicatic acid also showed a negative response to red cedar dust. CONCLUSIONS This pilot study showed that a positive challenge test with a rotahaler to deliver red cedar dust was specific in the diagnosis of red cedar asthma but a negative response could not rule out the diagnosis. The rotahaler has merits of being easy to operate, safe, inexpensive, and readily available. The usefulness of this method and its reproducibility have to be examined in a series of patients. AU - Lin FJ AU - Chen H AU - ChanYeung M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 96 IP - DP - 1995 Jan 01 TI - Do Subjects Investigated For Occupational Asthma Through Serial Peak Expiratory Flow Measurements Falsify Their Results? PG - 601-607 AB - BACKGROUND AND AIM: Serial assessment of peak expiratory flow (PEF) rates has been advocated as a sensitive and specific means of investigating occupational asthma. The possibility that, for several reasons, subjects do not accurately report their values has been raised. The availability of portable instruments that assess PEF and store timings and values now make it possible to estimate compliance and accuracy of results. METHODS: Twenty-one subjects consecutively investigated for occupational asthma were asked to assess their PEF every 2 hours during the day, both at work and away from work, with a VMX instrument (Clement Clarke International, Columbus, Ohio) and record the times and values on a sheet of paper. The subjects were not aware that the data were also being stored on a computer chip. The diagnosis was occupational asthma in eight subjects, personal asthma in four subjects, and neither condition in nine subjects. RESULTS: The mean duration of recording was 36 days (range, 14 to 79 days). At least 6048 values should have been recorded, but only 4839 (80%) were either recorded or stored. Reported values corresponded precisely to stored values in 2533 of 4839 recordings (52%). The timing of the recording was also examined in relation to the time at which the recording was solicited; values recorded within 1 hour of the solicited time were judged as acceptable. Of the total of 3342 recordings stored, 2375 (71%) satisfied this criterion. Compliance was significantly less satisfactory in those referred by the Workers' Compensation Board (n = 11). CONCLUSION: In this survey of 21 subjects investigated for possible occupational asthma, compliance with PEF recording, as assessed by comparing recorded and stored results and the time at which the recording was solicited, was poor AU - Malo JL AU - Trudeau C AU - Ghezzo H AU - L'Archeveque J AU - Cartier A LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 45 IP - DP - 1995 Jan 01 TI - A Comparison Of Some Of The Characteristics Of Patients With Occupational And Non-Occupational Asthma PG - 109-111 AB - Occupational asthma is the most frequently diagnosed occupational lung disease reported to the SWORD (Surveillance of Work-related and Occupational Respiratory Disease) scheme. However, diagnosing occupational asthma is not straightforward, and establishing a link with work may be difficult. This study was undertaken to determine the differences between patients with occupational asthma and those with non-occupational asthma which might help in their diagnosis. Information was collected using a self-completed questionnaire. Questionnaires were distributed to 30 subjects aged 18-65 years at each of two clinics--one for patients with occupational asthma and one for those with cryptogenic and environmental asthma. Replies were received from 26 patients with occupational asthma (87%) and 29 patients with non-occupational asthma (97%). The age of onset was significantly higher for those with occupational asthma (42.6 vs 20.7 years). Significantly more subjects with occupational asthma reported improvement on holiday, whereas no significant difference was found in the numbers reporting worsening of symptoms on work days. Those with occupational asthma were less likely to report seasonal variation in symptoms, exacerbation by allergies, pets and stress, or a family history of asthma. Subjects with occupational asthma were more likely to become unemployed (50% vs 3%). Recognition of some of these features in a patient's history may help in the difficult task of differentiating occupational from non-occupational asthma, potentially avoiding the need for exhaustive investigations in some patients. The high prevalence of holiday improvement among subjects with non-occupational asthma suggested that domestic or environmental allergies arising outside the workplace may have been making an important contribution to ongoing symptoms in these subjects. AU - Axon EJ AU - Beach JR AU - Burge PS LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 96 IP - DP - 1995 Jan 01 TI - Diagnostic Validation Of Specific Ige Antibody Concentrations, Skin Prick Testing, And Challenge Tests In Chemical Workers With Symptoms Of Sensitivity To Different Anhydrides PG - 489-494 AB - BACKGROUND The diagnostic possibilities of sensitization to various acid anhydrides are limited because of the lack of standardized allergens for the different test systems. This makes the diagnosis of IgE-mediated sensitization caused by occupational exposure difficult. METHODS We prepared conjugates of human serum albumin with phthalic, maleic, trimellitic, and pyromellitic anhydrides to be used for IgE estimation by enzyme-allergosorbent test, skin prick tests, and nasal and bronchial challenge tests. Nine anhydride workers, who complained of various respiratory symptoms, were studied. RESULTS Of the nine workers, four had immediate-type skin test responses to one or more conjugates. All four subjects had elevated IgE concentrations in addition to two other workers. Three of six nasal challenges and four of nine bronchial challenges resulted in positive responses. All but one of the positive nasal or bronchial test responses were associated with elevated IgE levels. The seven positive challenge test results included five positive skin test responses. On the other hand, in all but two of the subjects with negative challenge test results, no specific IgE could be detected. In these two subjects the negative results were associated with low levels of IgE, and in one, with the absence of asthma. None of the results of tests with unconjugated anhydrides were positive. CONCLUSIONS Anhydrides investigated in this study can induce IgE-mediated hypersensitivity, which can be diagnosed by using the respective human serum albumin in estimation of specific IgE and in skin, nasal, and bronchial challenge tests. Estimation of IgE was demonstrated to be more sensitive than skin prick testing. AU - Baur X AU - Czuppon A LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 52 IP - DP - 1995 Jan 01 TI - Platinum salt sensitivity in refinery workers: incidence and effects of smoking and exposure PG - 661-666 AB - OBJECTIVE To measure the incidence of platinum salt sensitivity (PSS) in refinery workers and examine the influence of cigarette smoking and exposure to platinum salts on sensitisation. DESIGN A prospective cohort study with examination of workers at quarterly intervals for 18 months, and again at 24 months. SETTING A South African primary platinum refinery. SUBJECTS 78 new recruits, selected by the refinery's usual procedure, without apparent atopy and in good respiratory health. RESULTS After 24 months 32 (41%) subjects had been diagnosed PSS and were subsequently medically separated. Twenty two (28%) cases were confirmed by positive skin prick test to platinum salts, 10 (13%) cases were symptomatic but skin prick negative. Incidence of cases per 100 person-months was 1.9 skin prick positive and 0.8 negative. Risk of sensitisation was about eight times greater for smokers than non-smokers, and six times greater for high exposure than low exposure. CONCLUSION Smoking and intensity of exposure were definitely associated with development of PSS. Positive responses to platinum salt skin prick test had a 100% positive predictive value for symptoms and signs of PSS if exposure continued. AU - Calverley AE AU - Rees D AU - Dowdeswell RJ et al LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 311 IP - DP - 1995 Jan 01 TI - Consequences of occupational asthma PG - 602-603 AU - Cannon J AU - Cullinan P AU - NewmanTaylor AJ LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 346 IP - DP - 1995 Jan 01 TI - Occupational asthma caused by automated salmon processing PG - 737-740 AB - Within 3 months of the opening of a salmon-processing plant in the UK, some workers complained of symptoms suggestive of occupational asthma. A survey of all 291 employees identified 24 (8.2%) with occupational asthma. The employees worked near machines which generated respirable aerosols containing salmon-serum proteins. The IgE response to these proteins was associated with occupational asthma (p < 0.001), with increasing severity of symptoms (p < 0.001), and with working distance from the aerosol source (p = 0.037). The main factor which predisposed to IgE-antibody production and asthma was cigarette smoking (p < 0.001), whereas atopy and a previous allergic history did not. The affected employees were reallocated to a low-exposure worksite and factory ventilation was improved. Eleven showed significant clinical and pulmonary function improvement, and continued in employment. Thirteen who still had symptoms were advised to leave, thereafter becoming symptom-free, and regaining normal respiratory function. Early recognition of symptoms and prompt action to reduce aerosol exposure avoided the long-term reduction in pulmonary functions often associated with occupational asthma. AU - Douglas JD AU - McSharry C AU - Blaikie L AU - Morrow T AU - Miles S AU - Franklin D LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 IP - DP - 1995 Jan 01 TI - Occupational asthma in aluminium potroom workers related to pre-employment eosinophil count PG - 1520-1524 AU - Sorgdrager B AU - Pal TM AU - deLooff AJ AU - Dubois AE AU - deMonchy JG LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 96 IP - DP - 1995 Jan 01 TI - Occupational IgE-mediated sensitization and asthma caused by clam and shrimp PG - 608-617 AB - BACKGROUND To confirm occupational asthma caused by clam and shrimp in a food company worker, the following investigation was planned in 60 other exposed workers (56 participants). METHODS Before the production period of clam and shrimp, a medical and occupational questionnaire was carried out and skin and RAST testing were done with common inhalants and clam, shrimp, crab, and lobster extracts. During the production period, environmental monitoring was performed with personal and general samplers; inhalation testing with methacholine was proposed to subjects with immediate skin reactivity to clam, shrimp, or both. After the production period, all subjects with an immediate skin reactivity to clam, shrimp, or both and either a history of rhinoconjunctivitis, asthma, or bronchial hyperresponsiveness were seen by a specialist. RESULTS Including the index case in whom occupational asthma to clam and shrimp had been confirmed, four (7%) subjects had a history of rhinoconjunctivitis and two (4%) had a history of asthma during the period of clam production, whereas three (5%) subjects had rhinoconjunctivitis and two (4%) had asthma during the shrimp production. Three (5%) subjects had immediate skin reactivity to clam, and nine (16%) subjects to shrimp. Four (7%) subjects had increased specific IgE antibodies (RAST binding > or = 3%) to clam and eight (14%) to shrimp. Significant associations were found between immunologic reactivity to clam and shrimp on the one hand and to crab and lobster on the other. Environmental monitoring demonstrated clam and shrimp on the air sampling filters. Occupational asthma caused by clam was confirmed by specific inhalation challenges in one subject in addition to the index case. These two subjects had skin reactivity and increased specific IgE antibodies to clam, shrimp, or both. CONCLUSION By including the initial subject, the prevalence of immediate sensitization is 5% to 7% to clam and 14% to 16% to shrimp. Two (4%) subjects had occupational asthma caused by clam, and one (2%) had occupational asthma caused by shrimp. AU - Desjardins A AU - Malo JL AU - L'Archeveque J AU - Cartier A AU - McCants M AU - Lehrer SB LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 37 IP - DP - 1995 Jan 01 TI - STUDY OF EMPLOYEES WITH ANHYDRIDE-INDUCED RESPIRATORY DISEASE AFTER REMOVAL FROM EXPOSURE PG - 820-825 AU - Grammer LC AU - Shaughnessy MA LA - PT - DEP - TA - J Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 151 IP - DP - 1995 Jan 01 TI - Airway wall remodeling after cessation of exposure to isocyanates in sensitized asthmatic subjects PG - 489-494 AU - Saetta M AU - Maestrelli P AU - Turato G AU - Mapp CE AU - Milani G AU - Pivirotto F AU - Fabbri LM AU - DiStefano A LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 2 IP - DP - 1995 Jan 01 TI - Occupational asthma PG - 1262-1280 AU - Burge PS LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 8 Suppl 19 IP - DP - 1995 Jan 01 TI - Patterns of peak expiratory flow response to upper respiratory tract infections in asthmatics PG - 272s AB - Introduction Virus infections are a common confounding factor when analysing serial peak flow records for occupational asthma. Here we try to define a method for automatically identifying upper respiratory tract infection patterns in serial peak flow records, without identifying similar patterns that are due to an occupational effect. The techniques are based on "Patterns of Peak Expiratory Flow Response to Upper Respiratory Tract Infection in Adults with Asthma" (1). In (1) the first day of symptoms is known. The start of the pattern is the first daily mean below the 95% confidence interval of the baseline. The end of the infection pattern is defined by the first of three consecutive daily means within or above the 95% confidence interval of the baseline. In (1) the baseline is made from the first 7 days of the records. If there is an infection in the first 7 days then the last 7 days are used. The baseline is the mean and standard deviation of the daily mean. Duration and Decline It is difficult to use time to nadir, time from nadir, total duration or maximal decline to differentiate between infection and work related patterns. Infection patterns show very large variation in these measures. There are trends, but setting sensible limits to these measures would also include virtually all work related patterns. Methods In (1) four types of infection pattern are identified, but by far the most common is Pattern A (Decline with Recovery). We will use half of these (41 records) for setup and the other half to evaluate. To look at the effect on records with occupational asthma the positive gold standard’s from (2), roughly half will be used for setup and the other’s for evaluation. These will be filtered so that all records are of adequate quality (3), are free from confounding factors and so that there are no two records from the same patient in each group. There are 29 control records in the setup group and 32 in the evaluation group. In (1) only patterns with a significant deterioration are considered. A significant deterioration is defined as two or more consecutive daily means below the 95% confidence interval for the baseline. The end of a pattern is defined as the first of three consecutive daily means within baseline. In (1) the baseline is taken from the first 7 days of the record, unless it contains an infection, in which case the last 7 days are used. Infection records have 2 readings a day every day. The occupational asthma control records have between 0 and 11 readings per day. The following methods of identifying infections are tried Baseline Infections are defined as a certain number of consecutive days below the 95% confidence interval for the baseline. The start and end of the infection are defined as a certain number of consecutive days within or above the 95% confidence interval for the baseline. Baselines are calculated in a variety of ways to find the most effective. What do we do for days with no readings? Line Generalisation A line graph is shown for the mean PEF for each day. Cartographic techniques for line generalisation are then used to simply the line. Any resulting dips in the line graph were said to be infections. “Perpendicular Distance Algorithm” and “Angular Tolerance Algorithm” are tried. A variety of angular and perpendicular tolerances are tried to find the most effective. Peak / Trough Detection (4) provides a mathematical definition of peaks and troughs in a physiological signal. Various tolerances are used to identify troughs that are due to infection. Baseline Method 2 and 3 days within the 95% confidence interval are tried to define the start and end of an infection. 2 days below the 95% confidence interval is used to define the infection. Common sense is used to decide if a calculated pattern matches a validated infection pattern. The identification of a pattern is considered more important than the exact duration of it. Generally if a calculated pattern and a validated pattern overlap they are considered a match. In some cases two patterns may be identified in the place of one validated infection pattern (where the pattern has a double dip). The first of two such patterns is said to identify the infection and the second is ignored (not regarded as a false positive). Various methods to remove false positives are tried. Patterns with a maximal decline significantly less than the highest maximal decline for a record. Patterns with a maximal duration significantly less than the highest maximal duration for a record. Many patterns that correspond to the number of work periods and the workday baseline method (see below). Percentage of the Highest Daily means This technique calculates a 95% confidence interval on a certain percentage of the highest daily mean. If the record contains an infection the affected days will probably not be included in the baseline. The baseline will be higher than that for the whole record. 30 – 100% is tried Percentage of the Median Daily means This technique calculates a 95% confidence interval on a certain percentage of the median daily means. If the record contains an infection the affected days will probably not be included in the baseline. The baseline mean will probably be similar to the whole record mean. The baseline confidence interval will be lower than that for the whole record. 30 – 100% is tried Workday This technique uses a certain percentage range of the lowest daily mean PEFs for work days only to calculate the baseline. In occupational asthmatics this will probably be lower than the whole record baseline which may prevent patterns due to occupational asthma being identified as infections. In no occupational subjects this will be slightly lower than the whole record baseline. 35%-95%, 45%-95%, 55%-95%, 40%-100%, 50-100% and 60-100% are tried. Line Generalisation Two local processing routines are used to simplify a line graph of the daily mean PEF, the “Perpendicular Distance Algorithm” and the “Angular Tolerance Algorithm”. Local processing routines use a point’s neighbours to decide whether to retain it. These are some of the simplest line gerneralisation techniques, more complex algorithms could be studied in a follow up paper. Perpendicular Distance Algorithm Angular Tolerance Algorithm Peak / Trough Detection A point in the line (i) is said to dominate point (j) if and only if i > (j + d) and the line between i and j is bounded by i above and j below, where d is the tolerance. A peak is a point in the line that dominates a preceding and a subsequent point. A trough is a point in the line that is dominated by a preceding and a subsequent point. In order to avoid transitory one day patterns a line graph is created whereby each point relates to the rolling mean for ‘n’ days. For example the first point is the mean of days 1 – n. The second point is the mean of days 2 – n + 1 and so on. N values from 1 to 4 are tried. If any of the days that are used to make up the rolling mean have no readings then no point is created. The tolerance is set to the 1.96 and 2.57 standard deviations of the baselines so that only exceptional peaks / troughs are detected. The ((mean of all PEFs on workdays) – (mean of all PEFs on restdays)) is added to the tolerance, if this value is positive. This will probably increase the tolerance of occupational asthmatics which will prevent identification of patterns due to occupational asthma. This will have little or no effect on non occupational records. Examples of peak . trough detection on neonatal chest movement. Vertical lines show which peaks and troughs are detected. Maybe redo these pictures on serial peak flow data? A high tolerance detects only the large peaks A smaller tolerance detects the smaller peaks as well This technique detects the trough of an infection pattern, it does not attempt to define the start and end of the pattern. An infection is considered identified if the method finds a trough within the duration of the pattern as defined in (1). An infection false positive is defined as a trough that is not within a pattern defined in (1). A control false positive is any trough found in a control record. Peaks are ignored. Solar data is used to find the infections. - do we want to average all readings of average the mean for each day - have done mean of daily means - v1071 is a good example of this - it kind of gets the nadir in the wrong place We are using solar data to calculate the infections so the wasif score will not be so good. How much do we worry about this? Need to discuss it in paper. – potential problem when there are exclusions as a lot of the data could then be missing. – Readings also created and removed and stuff which would be a little strange. To show the start and end of the infection on the graph it is better to work out the start and end using the same interpretation as the graph is using. Results Baseline Method Defining an infection as 2 days below the 95% confidence interval was much better at picking out infections. The Workday baseline was the best compromise between identifying infections and preventing false positives. Excluding patterns on maximal decline was the best method of removing further false positives and can be combined the workday baseline method. 60% was the best cut off. Maximal duration and many patterns were relatively poor at removing false positives. This table shows the results of various baselines on the setup set. Infections are identified by 2 days below the 95% confidence interval. The pattern with the largest decline in a record is identified as an infection. Any other patterns with a maximal decline less than 60% of the largest maximal decline are excluded. Baseline Infections (of 42) Infection False Positives Control False Positives (29 records) Whole record Mean 41 10 41 All Work Days 42 10 25 35-95% of Work Days 41 9 18 45-95% of Work Days 38 9 14 55-95% of Work Days 36 8 11 40-100% of Work Days 38 7 13 50-100% of Work Days 36 9 11 60-100% of Work Days 35 7 8 Line Generalisation Method This method did not perform well at any point and was dropped very early on. Peak / Trough Detection The table below shows the results of peak / trough detection on the setup set for various combinations of tolerance and number of days used to produce the rolling mean. In all cases the ((mean of all PEFs on workdays) – (mean of all PEFs on restdays)) is added to the tolerance, if this value is positive. The tolerance is the number of standard deviations stated of the baseline. The baseline is calculated from all of the daily mean PEFs. No patterns have been excluded on maximal decline as it seemed unnecessary. Standard deviations Days Infections (of 42) Infection False Positive Control False Positive (29 records) 1.96 1 42 35 16 2.576 1 36 15 6 1.96 2 37 15 4 2.576 2 31 4 2 1.96 3 33 6 3 1.96 4 29 1 2 Evaluation Peak / Trough detection seems to be the best method. It identifies less infections than the baseline method but for every infection missed two false positives are also eliminated. The table below shows the results of peak / trough detection on the evaluation set for a tolerance of 1.96 standard deviations of the baseline of all the daily means + ((mean of all PEFs on workdays) – (mean of all PEFs on restdays)) (if this value is positive. A rolling 4 day mean is used to calculate the points in the signal that is used to detect peaks and troughs. Standard deviations Days Identified (of 45) Infection False Positive Control False Positive (29 records) 1.96 4 32 2 1 Specificity 71% Sensitivity 97% (based on control records) Discussion Won’t work if only one work period which has the infection in because the algorithm will think that is a occupational asthma pattern. Start and end of pattern must be in record for it to be detected (so learning effects and laze effects will not be found). Infection records have two readings a day every day. What do control records have – find out. References 1. Patterns of Peak Expiratory Flow Response to Upper Respiratory Tract Infection in Adults with Asthma 2. The development of Oasys-2; a system for the analysis of serial measurement of peak expiratory flow in workers with suspected occupational asthma 3. Wasif’s Quality paper (publish it soon man!) 4. An algorithm for the detection of peaks and troughs in physiological signals, Bryan S. Todd, Oxford University Computing Laboratory. AU - OBrien C AU - Bright P AU - Nicholson C AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 1 IP - DP - 1995 Jan 01 TI - Bhopal—A Case Study of International Disaster PG - 58-69 AB - This paper outlines what is known about the probable events leading up to the disaster in Bhopal, India, in 1984, wherein release of a gas cloud from an industrial plant killed over 3,800 people. It briefly reviews the toxicology of methyl isocyanine, a major component of the cloud; presents an overview of the acute and chronic health effects of the gas exposure from published human and animal studies; identifies some of the clinical dilemmas and medical management and epidemiologic issues being debated; provides an insight into national and transnational implication; and summarizes the lessons learned or not learned from this disaster of global significance. AU - Dhara R AU - Dhara VR LA - PT - DEP - TA - Int J Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19950101 IS - IS - VI - 74 IP - DP - 1995 Jan 01 TI - Hypersensitivity pneumonitis from residential composting: residential composter's lung PG - 45-47 AB - Hypersensitivity pneumonitis results when a susceptible individual is exposed to sufficient airborne material capable of inducing a systemic and pulmonary immune response. We describe a man who had all the classic manifestations of hypersensitivity pneumonitis but in whom the circumstances of sensitization, residential yard work with composted yard clippings, has not previously been reported. We call this new entity residential composter's lung. AU - Brown JE AU - Masood D AU - Couser JI AU - Patterson R LA - PT - DEP - TA - Ann Allergy Asthma Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Comparison of sulphur dioxide and metabisulphite airway reactivity in subjects with asthma PG - 250-256 AB - Background - In asthmatic subjects bronchoconstriction is induced by inhalation of the common food preservatives sulphur dioxide (SO2) and metabisulphite (MBS). SO2 and MBS challenges share many similarities, but it is not known whether they are equivalent. In this study of subjects with mild clinical asthma equivalence was assessed by comparing SO2 and MBS reactivity by estimating the total dose of SO2 inhaled during SO2 and MBS challenges, and by calculating SO2 uptake during both challenges. In addition, as the MBS solutions inhaled were acidic and hyperosmolar, the effect of these factors on MBS responsiveness was investigated. Methods - Fifteen subjects were challenged on separate days with doubling (0 5 to 8-0 ppm) concentrations of SO2 gas inhaled during three minute periods of isocapnic hyperventilation and MBS administered in doses ranging from 0-1 to 12-8 umol using the Wright protocol. On two other days SO2 and MBS challenges were preceded by a challenge with phosphate buffered saline (PBS) solutions of pH and osmolarity similar to MBS solutions. Response was measured as the dose or concentration causing a 20% fall in FEV, (PD20 or PC20). Results- All subjects reacted to MBS and 14 responded to SO2. Geometric mean histamine PD20 was 1-61 umol (95% confidence interval 0-72 to 3 60). MBS and SO2 airway responsiveness were not significantly related. Estimates of the mean concentration of SO2 inhaled during SO2 and MBS challenges differed, as did estimates of the mean SO2 uptake during both challenges. MBS and SO2 reactivity were not affected by prior challenge with PBS solutions. Conclusions - SO2 and MBS challenges are not comparable. MBS reactivity was not affected by the hyperosmolar, acidic nature of its solutions. AU - Field PI AU - McClean M AU - Simmul R AU - Berend N LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 105 IP - DP - 1994 Jan 01 TI - Exercise testing revisited: the response to exercise in normal and atopic children PG - 1127-1132 AB - Background Wide differing criteria are used to define the normal airway response to exercise, and as a consequence the estimated incidence of exercise-induced bronchospasm (EIB) in atopic children is wide. The purpose of this study was to establish normal range for changes in spirometry after exercise in children and then to use these normal values to assess the incidence of EIB in atopic children. Methods Pulmonary function was assessed before, and 2, 5, and 10 min after 6 min of free running exercise in a group of 48 normal and 96 atopic children (70 asthmatics, 17 with allergic rhinitis, and 9 with atopic dermatitis/food hypersensitivity). Results The EIB (defined as the normal group mean value –2 SD) occurred with a >10 percent fall in FEV1, >17.5 percent fall in peak expiratory flow rate (PEFR), >26 percent fall in mean forced expiratory flow during the middle half of the forced vital capacity (FEF25-75), and >40 percent fall in FEF25. Sixty-three of 70 asthmatic patients had EIB by at least one of these definitions, most marked at 5 min post exercise. The combination of FEV1 and FEF25-75 criteria enabled detection of all subjects with EIB. By FEV1 and FEF25-75 criteria, none of the subjects with allergic rhinitis or dermatitis had EIB. The fall in FEV1 after exercise in children with allergic rhinitis was within the range of normal, but with a significantly lower mean value than control subjects. Conclusions EIB should be defined by using more than one maximum expiratory flow-volume curve parameter (ie, FEV1 and FEF25-75). The EIB (defined as a fall in FEV1 and FEF25-75) was only seen in asthmatic children and not in other atopic groups.. AU - Custovic A AU - Arifhodzic N AU - Robinson A AU - Woodcock A. LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 66 IP - DP - 1994 Jan 01 TI - Occupational exposure to hydrogen sulfide in the sour gas industry: some unresolved issues PG - 153-160 AB - Occupational exposure to hydrogen sulfide (H2S) and the medical management of H2S-associated toxicity remains a problem in the sour gas industry and some other industrial settings. The acute effects of exposure to H2S are well recognized, but accurate exposure-response data are limited to acutely lethal effects, even in animal studies. Odor followed by olfactory paralysis and kerato-conjunctivitis are the characteristic effects of H2S at lower concentrations. H2S-induced acute central toxicity leading to reversible unconsciousness is a “knockdown”; it is controversial whether repeated or prolonged knockdowns are associated with chronic neurologic sequelae but the evidence is suggestive. Knockdowns can be acutely fatal as a consequence of respiratory paralysis and cellular anoxia. Pulmonary edema is also a well-recognized acute effect of H2S toxicity. Human studies of sublethal exposure with satisfactory exposure assessment are almost nonexistent. There are indications, poorly documented at present, of other chronic health problems associated with H2S exposure, including neurotoxicity, cardiac arrhythmia, and chronic eye irritation but apparently not cancer. Rigorous and comprehensive studies in the sour gas industry are difficult, in part because of confounding exposures and uncertain end points. AU - Guidotti TL LA - PT - DEP - TA - Int J Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 33 IP - DP - 1994 Jan 01 TI - Airborne microorganisms and endotoxin in animal houses PG - 85-90 AB - Concentrations of microorganisms, dust and bacterial endotoxin were determined in the air of 18 animal houses (four cowsheds, nine horse stables and five piggeries) in eastern Poland. Total mesophilic bacteria numbered 568.7–1480.7 colony forming units (CFU)x103 m-3 in piggeries, 43.9–280.5 CFU×103 m-3 in cowsheds, and 26.2–150.1 CFU×103 m-3 in horse stables. Corynebacteria (Corynebacterium spp., Arthrobacter spp.) predominated. Concentrations of Gram-negative bacteria, thermophilic actinomycetes and fungi were smaller (mostly in the range of 102-104 CFU m-3) except for one cowshed and two stables where concentrations of thermophilic actinomycetes exceeded 100 CFU×103 m-3. Thermoactinomyces vulgaris and Saccharopolyspora rectivirgula, both known to be strongly allergenic, were the predominant actinomycetes. Concentrations of airborne dust were 0.15–14.05 mg m-3. There were large concentrations of bacterial endotoxin in the air of piggeries, in the range 1.88–75.0 µg m-3, but concentrations were much smaller in other houses and mostly did not exceed a safe level of 0.1 µg m-3. The results show that the farm workers and housed animals can be exposed to large quantities of airborne microbes and their products that pose a potential risk of respiratory disease resulting from the immunomodulatory action of these organisms. AU - Dutkiewicza J AU - Pomorskib ZJH AU - Sitkowskaa J AU - Krysinska-Traczyka E AU - Skórskaa C AU - Prazmoa Z AU - Wójtowicza GCH LA - PT - DEP - TA - Grana JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 4 IP - DP - 1994 Jan 01 TI - Sick building syndrome in office workers and facial skin symptoms amongst VDT-workers in relation to building and room characteristics. Two case-referent studies PG - 83-94 AU - Sundell J AU - Lindvall T AU - Stenberg B AU - Wall S LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 93 IP - DP - 1994 Jan 01 TI - Is reactive airways dysfunction syndrome a variant of occupational asthma? PG - 12-22 AU - Gautrin D AU - Boulet LP AU - Boutet M AU - Dugas M AU - Bherer L AU - L'Archeveque J AU - Laviolette M AU - Cote J AU - Malo JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Airway inflammation after removal from the causal agent in occupational asthma due to high and low molecular weight agents PG - 1567-1575 AB - In order to determine 1) the features of airway inflammation after removal from exposure to high (HMW) and low (LMW) molecular weight agents 2) if there are any differences in the pattern of inflammation induced by these two types of agents, we studied 18 subjects with a recently confirmed diagnosis of occupational asthma (OA) due to HMW (n=11) and LMW (n=7)agents. The duration of asthma symptoms varied from 2 to 108 months (mean 33 months),and withdrawal from exposure to the sensitizing agent from 3 to 24 weeks (mean 10 weeks). All subjects underwent measurements of expiratory flow rates, methacholine inhalation tests, and a flexible bronchoscopy with bronchoalveolar lavage (BAL) and bronchial biopsies. Endoscopic findings were compared with a group of 10 normal subjects. At the time of the bronchoscopy, asthma symptoms were minimal in most subjects. Although 15/18 subjects had normal forced expiratory volume in one second (FEV1>80% pred), all subjects had increased airway responsiveness to methacholine (provocation concentration producing a 20% fall in FEV1=0.2-10.0 mg·ml-1). BAL analysis showed similar median percentages of the total number of cells and differentials in control subjects and those exposed to HMW and LMW agents. Bronchial biopsies showed that mean inflammatory cell count, both epithelial and sub-epithelial, was similarily raised in OA subjects exposed to either HMW or LMW agents, compared to controls, except for epithelial lymphocyte count. In contrast to the controls, bronchial biopsy of both groups with OA also showed other changes such as extensive epithelial desquamation, ciliary abnormalities of the epithelial cells, smooth muscle hyperplasia and subepithelial fibrosis. Bronchial biopsies from subjects with occupational asthma showed similar significant inflammatory changes after withdrawal from exposure to either high or low molecular weight sensitizing agent, even when symptoms were minimal. AU - Boulet LP et al LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 94 IP - DP - 1994 Jan 01 TI - Prognosis of occupational asthma PG - 761-767 AU - Paggiaro PL AU - VagagginiB AU - BacciE et al LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 93 IP - DP - 1994 Jan 01 TI - Occupational asthma and immunologic responses induced by inhaled carmine among employees at a factory making natural dyes PG - 44-52 AB - Carmine is a natural red dye widely used as a food coloring agent and for cosmetic manufacture. It is extracted from the dried females of the insect Dactylopius coccus var. Costa (cochineal). Although it has been reported that inhalation of carmine may give rise to occupational asthma and extrinsic allergic alveolitis, there is little evidence of its immunogenic capacity. We studied nine current employees at a factory making natural dyes and one former employee who had left this plant after occupational asthma developed. A current employee had work-related symptoms of rhinitis and asthma that were confirmed by bronchial provocation tests, and another worker had rhinitis. Immunologic sensitization to carmine and cochineal was evaluated by means of skin testing and determination of serum-specific IgE and IgG subclass antibodies by RAST and ELISA, respectively. The specificity of the RAST assay was investigated by RAST inhibition with different fractions of carmine. The three workers with respiratory symptoms had positive skin prick test reactions to both carmine and cochineal. An immediate response to the bronchial provocation test with carmine and cochineal was observed in the current employee with asthma. Specific IgE antibodies against carmine and cochineal were found only in this worker. RAST inhibition studies indicated that the main allergen had a molecular weight between 10 and 30 kd. Specific IgG antibodies against carmine and cochineal, mainly the subclasses IgG1, IgG3, and IgG4, were found in the 10 subjects surveyed. These findings suggest that carmine may induce immunologic responses, most likely IgE mediated in workers with symptoms of occupational asthma AU - Quirce S AU - Cuevas M AU - Olaguibel JM AU - Tabar AI LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 66 IP - DP - 1994 Jan 01 TI - Respiratory symptoms and immunological status in poultry food processing workers PG - 339-342 AU - Zuskin E AU - Kanceljak B AU - Mustajbegovic J AU - Schachter EN AU - Stilinovic L LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 24 IP - DP - 1994 Jan 01 TI - Occupational asthma caused by chromium PG - 676-681 AU - Park H S AU - Yu H J AU - Jung KS LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 36 IP - DP - 1994 Jan 01 TI - Risk factors for immunologically mediated respiratory disease from hexahydrophthalic anhydride PG - 642-646 AB - Our objective was to identify risk factors for development of immunologically mediated respiratory disease in workers exposed to hexahydrophthalic anhydride. We performed a medical and immunologic survey study of 57 workers in a workplace molding operation utilizing hexahydrophthalic anhydride. The main outcome measurements were the development of a respiratory disease due to specific IgE antibody (asthma and/or rhinitis) or specific IgG antibody (hypersensitivity pneumonitis or hemorrhagic rhinitis). Of the 57 workers, 7 had both IgE- and IgG-mediated disease, whereas 9 had only IgE-mediated disease. Although neither smoking, age, nor race were risk factors for development of immunologically mediated disease, exposure level and specific antibody were. In conclusion, development of immunologically mediated respiratory disease due to hexahydrophthalic anhydride is most closely associated with exposure level and development of specific IgE or IgG antibodies. AU - Grammer LC AU - Shaughnessy MA AU - Lowenthal M et al LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Work-related symptoms, sensitisation, and estimated exposure in workers not previously exposed to flour PG - 579-583 AB - Findings are presented from the initial cross sectional phase of a cohort study of employees exposed to flour in bakeries or mills. Of 401 eligible workers in seven sites 344 (86%) were surveyed; symptoms assessed by self completed questionnaire, and sensitisation measured by the response to skin prick tests, were related to intensity of exposure both to total dust and to flour aeroallergen. Among 264 subjects without previous occupational exposure to flour, work related symptoms which started after first employment at the site were related to exposure intensity, especially when exposure was expressed in terms of flour aeroallergen. The relations with eye/nose and skin symptoms were independent of atopic status and cigarette smoking. Positive skin test responses to mixed flour and to alpha amylase were also more frequent with increasing exposure intensity, although this was confounded by atopic status. There was only a weak association between symptoms and specific sensitisation. AU - Cullinan P AU - Lowson D AU - Nieuwenhuijsen MJ et al LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Allergic airway disease in Italian bakers and pastry makers PG - 548-552 AU - DeZotti R AU - Larese F AU - Bovenzi M et al LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 149 IP - DP - 1994 Jan 01 TI - HLA class II alleles in isocyanate-induced asthma PG - 71-75 AB - Studying genetic factors that control human immune responsiveness may further our understanding of specific types of asthma in which the role of immune factors is uncertain to date. HLA Class II gene products are involved in the control of immune responses. Therefore, we investigated whether HLA Class II genetic markers contribute to susceptibility or resistance to isocyanate-induced asthma (IAA) in exposed workers. We collected venous blood samples from two groups of unrelated white adults: (1) patients with isocyanate-induced asthma documented by a positive inhalation challenge; and (2) exposed individuals with no history of IAA. The second exon of DQA1, DQB1, DPB1, and DRB genes was selectively amplified by the polymerase chain reaction (PCR) method. HLA typing was carried out by the PCR-RFLP method, which allowed discrimination of most HLA DQA1, DQB1, DPB1, and DRB alleles. No significant difference was found in the distribution of DPB1 alleles between patients and control subjects. Allele DQB1*0503 and allelic combination DQB1*0201/0301 were associated with susceptibility to the disease. Conversely, allele DQB1*0501 and the DQA1*0101-DQB1*0501-DR1 haplotype conferred significant protection to exposed healthy control subjects. Our results are consistent with the hypothesis that immune mechanisms are involved in isocyanate-induced asthma and that specific genetic factors may increase or decrease the risk of developing IAA in exposed workers. AU - Bignon JS AU - Aron Y AU - Ju LY et al LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 150 IP - DP - 1994 Jan 01 TI - Nonspecific and specific bronchial responsiveness in occupational asthma caused by platinum salts after allergen avoidance PG - 1146-1149 AB - Most data about the course of occupational asthma after removal from exposure are based upon the longitudinal assessment of employees exposed to substances inducing late asthmatic reactions in bronchial provocation tests. It was the aim of this study to describe the course of immediate-type occupational asthma after allergen avoidance. Twenty- four platinum refinery workers were examined on two occasions. All subjects reported work-related asthma while they worked in the refinery department. The diagnosis of platinum salt asthma was established by a positive bronchial challenge test with hexachloroplatinic acid in each case. Eleven of the 24 subjects were still exposed to platinum salts at the time of the first investigation, but all had been removed from exposure for 19 mo (1 to 77) on the second investigation. Asthma was still reported by 17 subjects, and all but two showed bronchial hyperresponsiveness (PC50SGaw < 8 mg/ml) on the second investigation. Bronchial responsiveness to methacholine, skin reactivity, and bronchial responsiveness to platinum salt, as well as FEV1, did not change between assessments. Total serum IgE decreased from 126 to 103 U/ml (p < 0.005). Analysis of variance showed no association of the individual differences in PC50 (methacholine) between both investigations with smoking, time from the onset of symptoms to removal, time from removal to the first or second investigation, skin sensitization to environmental allergens, or total IgE. We conclude that both nonspecific and specific bronchial responsiveness do not decrease after removal from exposure in immediate-type asthma caused by platinum salts. AU - Merget R AU - Reineke M AU - Rueckmann A et al LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 85 IP - DP - 1994 Jan 01 TI - Response to bronchoprovocation test and outcome of occupational asthma. A follow-up study of subjects with TDI asthma PG - 134-141 AU - Marabini A AU - Brugnami G AU - Curradi F et al LA - PT - DEP - TA - Med del Lavoro JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 97 IP - DP - 1994 Jan 01 TI - The IgE and IgG antibody responses to aerosols of Nephrops norvegicus (prawn) antigens: the association with clinical hypersensitivity and with cigarette smoking. PG - 499-504 AB - Raised levels of serum IgE antibodies to prawn antigens were found in 15 of 26 seafood factory process workers with respiratory symptoms and in one of 26 case-matched asymptomatic controls (P < 0.001). Raised IgG antibody titres against the same antigens were found in 18 subjects in each symptom grouping, and the median titres of this antibody did not differ significantly between the groups. The prawn-specific IgE antibody response was significantly associated with atopy (IgE antibody response to common allergens) and with a history of cigarette smoking, confirmed by level of serum cotinine, a major nicotine metabolite. Non-atopic non-smokers were unlikely to become sensitized. The titre of the prawn-specific IgE antibody correlated with the duration of exposure and with the duration of symptoms. Discriminant analysis of the serological profile (anti-prawn IgE, total IgE and cotinine) was sufficient to assign individuals correctly into symptomatic or asymptomatic categories in 77% of subjects. The titres of the IgE and IgG antibody responses to prawn antigens did not correlate, and the main factor which seemed to determine the antibody isotype response to these inhaled antigens was cigarette smoking. IgE antibody was produced mainly by smokers, whereas IgG antibody was the predominant isotype produced by non-smokers AU - McSharry C AU - Anderson K AU - McKay IC AU - Colloff MJ AU - Feyerabend C AU - Wilson AU - RB AU - Wilkinson PC LA - PT - DEP - TA - Clin Exp Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 44 IP - DP - 1994 Jan 01 TI - Latex-induced asthma in four healthcare workers in a regional hospital PG - 161-164 AB - Hypersensitivity to latex gloves has often been reported in patients who have undergone surgical treatment. Recent reports suggest that latex antigens can produce cutaneous and respiratory symptoms in workers occupationally exposed to latex. Four such cases of healthcare workers who were sensitized through exposure to latex have been observed. Two of these workers presented dermatitis as well as work-related respiratory symptoms, while the others only showed symptoms suggesting occupational asthma. The subjects were diagnosed as having latex hypersensitivity after skin prick-testing, and the immunoglobulin E serum level against latex gave positive results. In addition, changes in methacholine responsiveness also took place. In one case, an occupational exposure test was carried out which resulted in a 24% drop in the FEV1 value after 25 min of inhalation exposure. At least one year after the diagnosis, two nurses (subjects A and D) who had been removed completely from latex exposure experienced no further latex-induced symptoms. The other workers, who have continued working in the same laboratories using vinyl gloves, now display less severe symptoms but require regular anti-allergy treatment. AU - Valentino M AU - Pizzichini MA AU - Monaco F et al LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 44 IP - DP - 1994 Jan 01 TI - SWORD '93. Surveillance of work-related and occupational respiratory disease in the UK PG - 177-182 AB - Some 3500 new cases of occupational respiratory disease are estimated to have been seen annually by SWORD participants in 1992 and 1993 with little important difference between the two years. As the number of new cases recognized and reported by chest physicians is close to complete, the estimated incidence is essentially correct. The pattern of disease which clearly emerges shows that at least half is attributable to asbestos exposure, despite the fact that lung cancer from this cause may be under-reported. Benign pleural disease comprises a large proportion of the cases, the long-term implications of which are unknown. Almost 40% of the cases reported are of occupational asthma or inhalation accidents, both due to a very large number of different agents and affecting many and varied occupations. These cases are preventable providing their occupational aetiology is recognized and appropriate measures of control are intensified. AU - Sallie BA AU - Ross DJ AU - Meredith SK et al LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Prospective study of laboratory animal allergy: factors predisposing to sensitisation and development of allergic symptoms PG - 548-552 AB - In a prospective study of laboratory technicians, selected indicators of allergy and atopy were studied in an attempt to determine predictors of laboratory-animal allergy (LAA). Laboratory technicians underwent spirometry, methacholine provocation tests, and blood sampling, and responded to a questionnaire during training and after 2 years' work. Among 38 laboratory-animal-exposed subjects, total IgE before exposure gave the best correlation (P < 0.01; Mann-Whitney U-test) to reported symptoms caused by laboratory animals (n = 8) at follow-up. The prevalence of atopy and allergic symptoms had increased in exposed technicians at follow-up, but this was also found among unexposed matched referents (n = 36 pairs). One subject in the exposed group reported asthma before exposure, compared with seven at follow-up (P < 0.05; Fisher's exact test). However, the prevalence of asthma had increased from two to six (not significant) also among unexposed technicians. There were no significant differences between the groups in any measured variable at follow-up. Among 43 subjects who later worked with laboratory animals, 21% had a positive skin prick test for common allergens, as compared with 37% among 112 without animal exposure (P = 0.06; chi2 test), suggesting selection for laboratory animal work. AU - Renstrom A AU - Malmberg P AU - Larsson K et al LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 93 IP - DP - 1994 Jan 01 TI - Control of airborne latex by use of powder-free latex gloves PG - 985-989 AU - Tarlo SM. Sussman G. Contala A. Swanson MC LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - "Occupational asthma": a matter of concern [editorial] PG - 1-1 AU - Mapp CE LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Mechanisms and pathology of occupational asthma. PG - 544-554 AB - Since the pathogenesis and the pathological features of occupational asthma are similar to those of nonoccupational asthma, the former represents a very useful model for the investigation of the pathogenesis of asthma in general. More than one mechanism may be operative in occupational asthma. Among the mechanisms proposed, immunological mechanisms and airway inflammation play an important role. There is evidence to confirm that T-lymphocyte activation and local accumulation in the bronchial wall of activated eosinophils occurs in asthma of diverse aetiology, i.e. immunoglobulin E (IgE)-mediated, occupational and intrinsic. Neurogenic pathways should be further investigated as a potential mechanism of modulation and amplification of airway inflammation in occupational asthma. AU - Mapp CE AU - Saetta M AU - Maestrelli P AU - Di Stefano A AU - Chitano P AU - Boschetto P AU - Ciaccia A AU - Fabbri LM LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 270 IP - DP - 1994 Jan 01 TI - The effects of toluene diisocyanate and of capsaicin on human bronchial smooth muscle in vitro PG - 167-173 AB - Toluene diisocyanate contracts guinea-pig bronchial smooth muscle through a mechanism involving capsaicin-sensitive sensory nerves. In the present study, we investigated the effects of toluene diisocyanate, capsaicin and tachykinins on isolated human bronchi. In 44 rings, toluene diisocyanate (0.3 mM) produced a relaxation which averaged 16.9 +/- 1.1%, in ten rings it produced a shortening that was 15.1 +/- 3.3% and in ten preparations it gave no response. A second administration of toluene diisocyanate (0.3 mM) always produced a relaxation (n = 13, 18.1 +/- 3.9%). Capsaicin (0.03 mM) produced shortening in 15 (35 +/- 6.6%) and relaxation in 11 preparations (41 +/- 6.8%), whereas a second administration caused shortening in nine (25.1 +/- 6.1%) and relaxation in 16 rings (36.4 +/- 4.9%). When toluene diisocyanate was given after two consecutive capsaicin administrations, we observed shortening in two rings (10.0 +/- 3.6%), relaxation in ten rings (15.9 +/- 3.6%), and no response in four preparations. To test the role of NK1 and NK2 receptors in these conflicting responses, we performed concentration-response curves to different tachykinins. Substance P, neurokinin A and neurokinin A-(4-10), a specific NK2 receptor agonist, gave a concentration-dependent shortening, with neurokinin A being the most effective and neurokinin A-(4-10) the least. The specific NK1 receptor agonist, [Sar9, Met(O2)11]substance P, produced both shortening and relaxation. We conclude that toluene diisocyanate and capsaicin may produce both shortening and relaxation in isolated human bronchi through NK1 receptors AU - Chitano P AU - Di Blasi P AU - Lucchini RE AU - Calabro F AU - Saetta M AU - Maestrelli P AU - Fabbri LM AU - Mapp CE LA - PT - DEP - TA - Eur J Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 56 IP - DP - 1994 Jan 01 TI - Parameterisation of continuous time autoregressive models for irregularly sampled time series data PG - 141-155 AU - Belcher J AU - Hampton JS AU - Tunicliffe Wilson G LA - PT - DEP - TA - J Royal Statistical Society Series B JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Sauna builder's asthma caused by obeche (Triplochiton scleroxylon) dust PG - 622-623 AB - Two carpenters developed rhinitis, conjunctivitis, bronchial wheezing, and dyspnoea while using obeche (Triplochiton scleroxylon, African maple) at their work while they built saunas. Skin prick tests showed an immediate reaction, specific IgE to obeche was detected in their serum, and bronchial provocation test with obeche gave an immediate reaction with decrease of FEV1 and PEF values. The symptoms disappeared after avoiding the use of obeche. Obeche may cause a health hazard to carpenters who are exposed to this dust and who may develop allergic symptoms after the exposure AU - Reijula K AU - Kujala V AU - Latvala J LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - - IP - DP - 1994 Jan 01 TI - Occupational Asthma and Byssinosis PG - 727 AU - Newman Taylor AJ AU - Pickering CAC LA - PT - DEP - TA - Occupational Lung Disorders, ed Parks WR, pub Nutterworth-Heinemann Oxford, 3rd Edition JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Occupational asthma caused by ethanolamines. PG - 877-81 AB - Amino alcohols are used in various industries, often as minor constituents of compounds to modify the properties of the compound. Generally, they are considered to be safe, but they have been known to cause local skin irritation at higher concentrations in solutions. We report on three cases of occupational asthma caused by ethanolamines: two metal workers exposed to a cutting fluid containing triethanolamine, and one cleaner exposed to a detergent containing monoethanolamine. The diagnosis was based on work-related symptoms and on a chamber challenge with the suspected agent. Persistence of the symptoms after exposure ended was a common feature of the three cases. AU - Savonius B AU - Keskinen H AU - Tuppurainen M AU - Kanerva L LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 87 IP - DP - 1994 Jan 01 TI - Management of allergic bronchopulmonary aspergillosis without maintenance oral corticosteroids: a fifteen-year follow-up PG - 529-537 AB - Five non-smoking patients were diagnosed as having allergic bronchopulmonary aspergillosis in 1978/9. All have been treated since then with inhaled corticosteroids, using short courses of self-administered oral corticosteroids for symptomatic exacerbations. Over a mean 15 years of follow-up, they have required on average less than one course of oral drugs per annum. Regular monitoring of spirometry has shown no evidence of deterioration, and all have close to normal gas transfer. All have some localized bronchiectasis on CT scanning, in two cases probably occuring after treatment started, but in no case is there any respiratory disability. We conclude that this is a safe and effective method for the management of allergic bronchopulmonary aspergillosis when diagnosed before persistent hyphal colonization of the airways has occurred. AU - SEATON A AU - SEATON RA AU - WIGHTMAN AJA LA - PT - DEP - TA - Q J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Occupational respiratory diseases in British Columbia, Canada in 1991 PG - 710-712 AU - Contreras GR AU - Rousseau R AU - ChanYeung M LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 331 IP - DP - 1994 Jan 01 TI - The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community PG - 778-784 AU - Nichol KL AU - Magolis KL AU - Wuorenma J AU - Von Sternberg T LA - PT - DEP - TA - NEJM JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 26 IP - DP - 1994 Jan 01 TI - Formaldehyde exposure, acute pulmonary response, and exposure control options in gross anatomy laboratory PG - 61-75 AU - AkbarKhanzadeh F AU - Vaquerano MU AU - AkbarKhanzadeh M AU - Bisesi MS LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 38 IP - DP - 1994 Jan 01 TI - Development of a method for measuring exposure to resin acids in solder fume PG - 765-776 AB - A method has been developed for measuring personal exposure to the resin acids released from rosin core solder wire during soldering. The particulate fraction of the solder fume is collected on a membrane filter and the resin acids recovered by solvent extraction with ether. After evaporation of the solvent and methylation, the resin acid esters are analysed by gas chromatography. Field comparisons have been carried out between paired samplers located in the traditional position on the operator's lapel and in a position close to the breathing zone. In most cases, the exposure measured near the breathing zone was at least twice that measured on the lapel. The method can be easily adapted to also measure volatile components of the fume. AU - Pengelly MI AU - Groves JA AU - Foster RD AU - Ellwood PA AU - Wagg RM LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Investigation of the relative contributions of cigarette smoking and mineral dust exposure to activation of circulating phagocytes, alterations in plasma concentrations of vitamin C, vitamin E, and beta carotene, and pulmonary dysfunction in South African gold miners PG - 564-567 AB - OBJECTIVES--To determine the relative effects of cigarette smoking and mineral dust exposure on numbers and activity of circulating phagocytes, plasma nutritional antioxidant state, and pulmonary function in South African gold miners. METHODS--Pulmonary function was assessed spirometrically, whereas reactive oxidant generation by circulating phagocytes, and plasma concentrations of the nutritional antioxidative nutrients vitamin C and vitamin E and beta carotene were measured with chemiluminescence, spectrophotometry, or high performance liquid chromatography respectively. RESULTS--Cigarette smoking, but not mineral dust exposure, was associated with increased numbers and pro-oxidative activity of circulating neutrophils and monocytes, decreased plasma concentrations of vitamin C, and pulmonary dysfunction. DISCUSSION--In this study group occupational exposure to mineral dust has not been found to promote increases in the numbers or reactivity of circulating phagocytes or to be a significant cause of pulmonary dysfunction, the changes found being due primarily to cigarette smoking AU - Theron AJ AU - Richards GA AU - Myer MS AU - van Antwerpen VL AU - SluisCremer GK AU - Wolmarans L AU - Van der Merwe CA AU - Anderson R LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Airways obstruction, coal mining, and disability PG - 234-238 AU - Lapp NL AU - Morgan WKC AU - Zaldivar G LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Sensitivity of peak flow monitoring to detect occupational asthma in relationship with specific bronchial challenge PG - 312s- AU - Giannini D AU - di Pede F AU - Moscato G AU - Bacci E AU - Carletti A AU - Carrara M AU - et al LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 14 IP - DP - 1994 Jan 01 TI - Comparison of the sensory irritation response in mice to chlorine and nitrogen trichloride PG - 405-409 AU - Gagnaire F AU - Azim S AU - Bonnet P AU - Hecht G AU - Hery M LA - PT - DEP - TA - J Appl Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Quantitative relation between emphysema and lung mineral content in coalworkers PG - 400-407 AB - The relation between quantified emphysema and measured lung content of coal and silica was investigated in the lungs of 264 deceased underground coalworkers who had been exposed to mixed coal and silica dust. Lung specimens obtained at postmortem and inflated and fixed under standard conditions were used to quantify the extent of emphysema and then to measure the amount of coal and silica present in the lungs at the time of death. These data were combined with clinical and other pathological information from the subjects. Multiple regression analysis showed that the extent of emphysema (E score) had a strong positive quantitative relation with coal content of the lungs (p < 0.0003), age (p < 0.0001), and smoking (p < 0.0001). There was a significant negative interaction of uncertain biological importance between coal content of the lungs and smoking (p < 0.004; E score = -1.79 + 0.62 coal + 0.06 age + 0.21 smoking -0.17 coal x smoking; adjusted R2 = 0.25). In lifelong non-smokers emphysema was particularly strongly related to coal content and age (coal: p < 0.001; age: p < 0.002; E score = -1.56 + 0.78 coal + 0.06 age; adjusted R2 = 0.66). The relation was basically unchanged by adding a lung silica content term. Emphysema score was highly negatively correlated with forced expiratory volume in one second (FEV1; % predicted, obtained within five years of death) (r = -0.44, p < 0.0001). Degree of lung fibrosis was highly positively associated with lung silica content (chi 2(1) = 12.9, p < 0.0003).(ABSTRACT TRUNCATED AT 250 WORDS) AU - Leigh J AU - Driscoll TR AU - Cole BD AU - Beck RW AU - Hull BP AU - Yang J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Completely reversible respiratory insufficiency with persisting ultrastructural ciliary abnormalities PG - 1532-1536 AB - A male nonsmoker, born in 1946, suffered from hypersecretory bronchitis and recurrent upper and lower respiratory tract infections since adolescence. In 1983 he developed pulmonary insufficiency. In 1984, some months after daily occupational exposure to printing inks and glues, forced expiratory volume in one second (FEV1) was 1.1 l (28% pred) and arterial oxygen tension (PaO2) 44 mmHg (5.9 kPa). Open lung biopsy showed a centri-acinar bronchiolitis-alveolitis suggestive of an airborne toxic pathology. Ultrastructural examination of the bronchial mucosa revealed microtubular abnormalities in about 10% of the cilia. Treatment consisted of stopping work from December 1985, oral corticosteroids until 1988, bronchodilators on a regular basis and intermittent antibiotics (1 week/month). The evolution was remarkable because: 1) from a severe pulmonary insufficiency, refractory to bronchodilators and corticosteroids for several years, lung function slowly improved to supernormal values, without residual functional signs of small airways disease; and 2) a repeat ultrastructural nasal mucosa examination in 1992 still showed persisting microtubular abnormalities in about 10% of the cilia, which disappeared on sequential monolayer-suspension culture, thus indicating secondary ciliary abnormalities AU - Malysse I AU - Jorissen M AU - Verbeken E AU - Vaerenberg C AU - Demedts M LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 150 IP - DP - 1994 Jan 01 TI - Aluminium potroom asthma confirmed by monitoring of forced expiratory volume in one second. PG - Pt 1):1714-7 AB - Chronic airflow obstruction has long been seen among aluminium potroom workers. Currently referred to as "potroom asthma," it is debatable as to whether it is occupational asthma or nonspecific airway obstruction. A 35-yr-old male lifelong nonsmoker, with no history of asthma or atopy, was hired by an aluminium plant that had begun its operation in 1986. Preemployment screening, consisting of spirometry and a chest radiograph, was normal. During his 12-h shifts, he replaced 10 to 20 anodes (prebake type), spending 5 min each time close to open pots releasing hot fumes. The patient experienced episodes of cough and dyspnea, which were resolved during withdrawal from work in January and December 1991. He resumed work in the potrooms in March 1992, his dyspnea recurred at work and at night with 25% drops in peak expiratory flow rates (PEFR), associated with mild-to-moderate bronchial hyperresponsiveness (PC20 histamine, 1.0 mg/ml). After a chest physician's assessment, he was withdrawn from the potroom department. Assessment of the bronchial response to the occupational exposure in potrooms carried out in November 1992 revealed a pattern of dual asthmatic response, paralleled by a drop in PC20 methacholine from 5.1 to 0.7 mg/ml. A similar pattern was seen again during repeat workplace challenges 3 wk later. Spirometry obtained on control days was stable. We conclude that asthmatic reactions can exist among workers in aluminium smelters. AU - Desjardins A AU - Bergeron JP AU - Ghezzo H AU - Cartier A AU - Malo JL LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Contact allergy to resin acid hydroperoxides. Hapten binding via free radicals and epoxides PG - 260-266 AU - Gafvert E AU - Shao LP AU - Karlberg AT AU - Nilsson U AU - NilssonJLG LA - PT - DEP - TA - Chem Res Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 150 IP - DP - 1994 Jan 01 TI - Decline of lung function in adults with bronchial asthma PG - 629-634 AB - To investigate the annual decline of lung function in subjects with self-reported asthma, we analyzed data from a longitudinal epidemiologic study. The Copenhagen City Heart Study. The study sample consisted of 10,952 subjects (4,824 men), 20 to 90 yr of age, randomly selected from the city of Copenhagen followed over a 5-yr period. The overall prevalence of asthma was 3.7% (n = 177) in men and 3.6% (n = 219) in women. Subjects who reported asthma at the first examination had, in general, lower values for lung function than did nonasthmatic subjects, which was also the case for subjects who developed asthma during follow-up (new asthma). The annual loss of FEV1 increased with age among both asthmatics and nonasthmatics. Multiple regression analysis showed a higher decline of FEV1 in subjects with new asthma. The excess decline was, on average, 39 ml/yr in men (p = 0.002) and 11 ml/yr in women (NS), respectively, compared with that in nonasthmatic subjects. In subjects with chronic asthma, the decline was not increased compared with that in nonasthmatic subjects. Separate analyses of lifelong nonsmokers revealed that the excess decline of FEV1 in subjects with new asthma was, on average, 33 ml/yr, whereas it was not significantly increased in subjects with chronic asthma. In conclusion, this study of a large sample from the general population showed that the rate of decline of FEV1 is increased in subjects with new asthma, whereas in subjects with chronic asthma the decline of FEV1 did not differ significantly from the decline in the nonasthmatic subjects AU - Ulrik CS AU - Lange P LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - IP - DP - 1994 Jan 01 TI - Contact allergy to CN and CS tear gas PG - 12-14 AB - Tear gases are used as riot control agents on account of their irritant properties. Five cases of allergic contact dermatitis due to omega-chloroacetophenone (CN) and one case additionally due to 2-chlorobenzylidene-malonitrile (CS) are reported AU - Fuchs T AU - Ippen H LA - PT - DEP - TA - Derm Beruf Umwelt JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 20 IP - DP - 1994 Jan 01 TI - Asbestos in New York City public school buildings--public policy: is there a scientific basis? PG - 161-169 AB - The most recent of New York City's asbestos emergencies occurred in the late summer of 1993. It prevented schools from opening that fall, precipitated much media excitement, and caused a flurry of widespread abatement activities. This resulted in large measure from the U.S. Environmental Protection Agency's subjective school building inspection policy concerning identification of asbestos hazards in buildings and the subsequent Asbestos Hazard Emergency Response Act mandate for inspection. Data on concentrations of asbestos in the air, important for the calculation of risk to building occupants, were not required and therefore not obtained, as part of the abatement strategy or priority setting. Based on fiber-in-air measurements obtained elsewhere, the calculated risk to NYC school children, using the most pessimistic models, was less than six excess cancer deaths per million lifetimes equivalent to smoking less than a dozen cigarettes in a lifetime. The NYC administration responded to pressure from parent groups concerned with perceived asbestos risks to their children by closing the schools. The hysteria occurred because much of EPA's policy lacked a scientific basis for risk evaluation and assessment AU - Wilson R AU - Langer AM AU - Nolan RP AU - Gee JB AU - Ross M LA - PT - DEP - TA - Regul Toxicol Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - Journal IP - DP - 1994 Jan 01 TI - Acute exposure to CS tear gas and clinical studies PG - 2056-2060 AB - A case of serious intoxication with CS tear gas (o-chlorobenzylidene-malononitrile) is reported in a previously healthy male subject of 43 years involving pulmonary edema complicated by pneumonia, signs of heart failure and evidence of hepatocellular damage. Comparison with animal and human exposures supports the etiologic and pathogenetic role of CS tear gas in the present case. The pulmonary edema may have been the consequence of unusual conditions of exposure and/or increased individual susceptibility. The question of the "safety" of CS tear gas is discussed AU - Krapf R AU - Thalmann H LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 43 IP - DP - 1994 Jan 01 TI - Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994 PG - 1-33 AU - Bozzi CJ AU - Burwen DR AU - Dooley SW AU - Simone PM AU - BeckSague C AU - Bolyard EA AU - Jarvis WR AU - Bierbaum PJ AU - Hudson CA AU - Hughes RT AU - Martin LS AU - Mullan RJ AU - Willis BM LA - PT - DEP - TA - MMWR JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - IP - DP - 1994 Jan 01 TI - Dental amalgam [letter] PG - 649-649 AU - Fedun ZW LA - PT - DEP - TA - Journal Canadian Dental Association JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 32 IP - DP - 1994 Jan 01 TI - Restriction fragment length polymorphism Mycobacterium tuberculosis strains isolated from Greenland during 1992: evidence of tuberculosis transmission between Greenland and Denmark PG - 3018-3025 AB - In order to describe the transmission of tuberculosis (TB) at the clonal level in a defined geographic region during a certain period of time, all isolates of Mycobacterium tuberculosis collected during 1992 from Greenland were subjected to analyses of DNA restriction fragment length polymorphism (RFLP). The RFLP patterns obtained by probing the genomic DNA with the repetitive insertion segment IS6110 revealed a high degree of similarity among the isolates, indicating a relatively high transmission rate and a close relationship between the individual M. tuberculosis clones. This was further confirmed by reprobing the Southern blots with two more-stable genetic markers, IS1081 and the DR sequence. The RFLP patterns were compared with those of 245 M. tuberculosis strains collected from Denmark during the same period (representing 91% of all new, bacteriologically verified cases of TB in Denmark in 1992). One of the three prevalent IS6110-defined clusters was traced to a group of immigrants from Greenland living in a small, defined geographical region in Denmark and to a group of Danish citizens either with known contact with these immigrants or, in other cases, with a record of previous travel or working activities in Greenland. The study showed that the present technique is extremely helpful in monitoring the spread of TB and thereby also contributing to improved disease control AU - Yang ZH AU - de Haas PE AU - van Soolingen D AU - van Embden JD AU - Andersen AB LA - PT - DEP - TA - Journal of Clinical Microbiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 9 IP - DP - 1994 Jan 01 TI - Control of tuberculosis in the workplace: engineering controls. PG - 609-630 AB - In this review of engineering controls that can be used to check the spread of tuberculosis in health care settings, the authors address types of ventilation and supplements to ventilation such as HEPA filtration and ultraviolet germicidal irradiation. They also specifically cover engineering controls for use during medical procedures that pose an increased risk for transmission of TB. AU - Nagin D AU - Pavelchak N AU - London M AU - DePersis RP AU - Melius J LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 1983 IP - DP - 1994 Jan 01 TI - Tuberculosis in unvaccinated children, adolescents, and young adults: a city epidemic PG - 1471-1473 AB - In an epidemic of tuberculosis 41 new patients presented with the disease or were traced. The index patient was a part time barman in a public house. Four children in his family and four who lived in the same block of flats were infected. Only seven of the 41 patients had been vaccinated with BCG. This epidemic indicates that the schools vaccination programme should be continued and the public made aware that tuberculosis still exists AU - Hill JD AU - Stevenson DK LA - PT - DEP - TA - Br Med J (Clin Res Ed) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - IP - DP - 1994 Jan 01 TI - NHS hospital and community health services non-medical staff in England 1983-1993 PG - 1-14 AU - Government Statistical Service LA - PT - DEP - TA - Statistical Bulletin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 1985 IP - DP - 1994 Jan 01 TI - National survey of notifications of tuberculosis in England and Wales in 1983. Medical Research Council Tuberculosis and Chest Diseases Unit PG - 658-661 AB - In a survey of all notifications of tuberculosis in England and Wales for the first six months of 1983 56% of the 3002 newly notified patients who had not been treated before were of white and 37% were of Indian subcontinent (Indian, Pakistani, or Bangladeshi) ethnic origin, findings similar to those of a survey in 1978-9. In the four and a quarter years between the surveys the number of patients notified had declined by 26%, the decline being 28% among those of white and 23% among those of Indian subcontinent ethnic origin. The white patients were on average older than the patients of Indian subcontinent ethnic origin, and a higher proportion of them had respiratory disease (82% compared with 66%). The pulmonary lesions were on average larger and more often bacteriologically positive in the white patients. There were considerable differences between the ethnic groups in the estimated yearly rates of notifications per 100 000 population in England in 1983. The highest rates occurred in the Indian (178) and the Pakistani and Bangladeshi (169) populations and were roughly 25 times the rate in the white population (6 X 9). In the Indian subcontinent ethnic groups the highest rates occurred among those who had arrived in the United Kingdom within the previous five years AU - Anonymous LA - PT - DEP - TA - Br Med J (Clin Res Ed) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 1983 IP - DP - 1994 Jan 01 TI - Control and prevention of tuberculosis: a code of practice PG - 1118-1121 AB - The Joint Tuberculosis Committee has compiled a report that is designed to answer the questions most commonly asked about the control and prevention of tuberculosis. Advice is given on assessing the degree of infectivity and on the segregation of patients. The measures necessary to protect National Health Service workers depend on the risk of exposure, and health authorities should follow the advice given by the Department of Health and Social Security. Chest x ray examinations may be recommended for those entering the teaching profession and may be necessary for staff and children when tuberculosis is discovered in a school child. The diagnostic, protective, and therapeutic measures required for contacts depend on the degree of infectivity in the index case, the closeness of contact, and the ethnic group of the index case. The incidence of tuberculosis is much higher among some immigrant populations than among the native population and screening programmes are needed (a) to detect cases of active tuberculosis, (b) to identify infected individuals without active disease, and (c) to identify those in need of vaccination. Finally, the current recommendation that BCG vaccinations should be offered routinely in schools to children aged 10-14 has been highly effective in preventing tuberculosis and should be maintained AU - Anonymous LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 271 IP - DP - 1994 Jan 01 TI - Efficacy of BCG vaccine in the prevention of tuberculosis. Meta- analysis of the published literature PG - 698-702 AB - OBJECTIVE--To quantify the efficacy of BCG vaccine against tuberculosis (TB). DATA SOURCES--MEDLINE with index terms BCG vaccine, tuberculosis, and human. Experts from the Centers for Disease Control and Prevention and the World Health Organization, among others, provided lists of all known studies. STUDY SELECTION--A total of 1264 articles or abstracts were reviewed for details on BCG vaccination, concurrent vaccinated and unvaccinated groups, and TB outcome; 70 articles were reviewed in depth for method of vaccine allocation used to create comparable groups, equal surveillance and follow-up for recipient and concurrent control groups, and outcome measures of TB cases and/or deaths. Fourteen prospective trials and 12 case-control studies were included in the analysis. DATA EXTRACTION--We recorded study design, age range of study population, number of patients enrolled, efficacy of vaccine, and items to assess the potential for bias in study design and diagnosis. At least two readers independently extracted data and evaluated validity. DATA SYNTHESIS--The relative risk (RR) or odds ratio (OR) of TB provided the measure of vaccine efficacy that we analyzed. The protective effect was then computed by 1-RR or 1-OR. A random-effects model estimated a weighted average RR or OR from those provided by the trials or case-control studies. In the trials, the RR of TB was 0.49 (95% confidence interval [CI], 0.34 to 0.70) for vaccine recipients compared with nonrecipients (protective effect of 51%). In the case-control studies, the OR for TB was 0.50 (95% CI, 0.39 to 0.64), or a 50% protective effect. Seven trials reporting tuberculous deaths showed a protective effect from BCG vaccine of 71% (RR, 0.29; 95% CI, 0.16 to 0.53), and five studies reporting on meningitis showed a protective effect from BCG vaccine of 64% (OR, 0.36; 95% CI, 0.18 to 0.70). Geographic latitude of the study site and study validity score explained 66% of the heterogeneity among trials in a random-effects regression model. CONCLUSION--On average, BCG vaccine significantly reduces the risk of TB by 50%. Protection is observed across many populations, study designs, and forms of TB. Age at vaccination did not enhance predictiveness of BCG efficacy. Protection against tuberculous death, meningitis, and disseminated disease is higher than for total TB cases, although this result may reflect reduced error in disease classification rather than greater BCG efficacy AU - Colditz GA AU - Brewer TF AU - Berkey CS AU - Wilson ME AU - Burdick E AU - Fineberg HV AU - Mosteller F LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Control and prevention of tuberculosis in the United Kingdom: Code of Practice 1994. Joint Tuberculosis Committee of the British Thoracic Society PG - 1193-1200 AB - BACKGROUND--The guidelines on control and prevention of tuberculosis in the United Kingdom have been reviewed and updated. METHODS--A subcommittee was appointed by the Joint Tuberculosis Committee (JTC). Each member of this group drafted one or more sections of the guidelines, and drafts were made available to all members of the group. In the course of several meetings drafts were altered and incorporated into a final text. The guidelines were approved by the full JTC and by the Standards of Care Committee of the British Thoracic Society. In revising the guidelines the authors took account of new published evidence and recent concerns about drug resistance and possible effects of HIV on tuberculosis. CONCLUSIONS--(1) All cases of tuberculosis must be notified. (2) A few patients need hospital admission. (3) Patients with positive sputum smears and sensitive organisms should be considered infectious until they have received two weeks' chemotherapy. (4) Treatment of all tuberculosis patients should be supervised by a respiratory physician employing standard medication guidelines and monitoring compliance at least monthly. (5) Health care workers at risk should be protected by BCG vaccination and appropriate infection control measures, and evidence of infectious tuberculosis should be sought among prospective NHS staff, school teachers, and others. (6) Prison staff should be protected. (7) Tuberculosis should be considered in the elderly in long stay care with persistent chest symptoms. (8) Contact tracing should be vigorously pursued with chemoprophylaxis, BCG vaccination, or follow up where applicable. (9) Entrants to the UK from high risk countries (tuberculosis incidence more than 40/100,000 population per year) should be screened. (10) BCG vaccination should be offered where appropriate but not in subjects with known or suspected HIV infection. (11) The local organisation of tuberculosis services should be strengthened and should include adequate nursing and support staff. (12) Contracts between purchasers and providers should specify management of tuberculosis in line with this and other JTC guidelines AU - Joint Tuberculosis Committee of the British Thoracic Society LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 120 IP - DP - 1994 Jan 01 TI - Tuberculosis and the health care worker: a historical perspective PG - 71-79 AB - Many hospital outbreaks of tuberculosis have occurred in recent years in the United States, resulting in tuberculosis infection and disease among health care workers and patients. Several hospital workers have died of nosocomially acquired multidrug-resistant tuberculosis. Assuring the safety of the health care worker with respect to tuberculosis has become an urgent priority. A review of the medical literature of the past 100 years reveals that our current view of tuberculosis care as an occupational hazard emerged only in the 1950s, after a fierce and extensive debate. Many authorities had felt that care of the tuberculous patient conferred a health advantage to the care provider. This paper reviews this debate and considers steps taken decades ago, before our current environmental interventions were available to ensure the safety of the health care worker AU - Sepkowitz KA LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - CDR IP - DP - 1994 Jan 01 TI - Legionnaires' disease surveillance: England and Wales 1994 PG - R180-3 AB - One hundred and sixty cases of legionnaires' disease in England and Wales were reported to the PHLS Communicable Disease Surveillance Centre in 1994, a rate of 3.1 cases per million population. Twenty-seven cases died. Eighty-nine cases (56%) were associated with travel, either in the United Kingdom (UK) or abroad, and six with a stay in hospital; the remaining cases were presumed to have acquired infection in the community. Seven outbreaks were detected in England and Wales: one was associated with a holiday centre, one with a hotel in London, two with industrial sites, and three occurred in the community. A further four clusters were associated with travel abroad: Spain, Ibiza, the Channel Islands, and a Mediterranean cruise. One hundred and twenty-eight of the 160 cases (79%) were sporadic--that is, not known to be associated with outbreaks--43 of which (34%) were not associated with travel nor acquired in hospital AU - Joseph CA AU - Hutchinson EJ AU - Dedman D AU - Birtles RJ AU - Watson JM AU - Bartlett CL LA - PT - DEP - TA - Communicable Disease Report JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 1982 IP - DP - 1994 Jan 01 TI - Notification of tuberculosis: a code of practice for England and Wales. Joint Tuberculosis Committee of the British Thoracic Association PG - 1454-1456 AU - Anonymous LA - PT - DEP - TA - Br Med J (Clin Res Ed) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 1988 IP - DP - 1994 Jan 01 TI - Is a preemployment chest radiograph necessary for NHS employees? PG - 1187-1188 AU - Jachuck SJ AU - Bound CL AU - Jones CE AU - Bryson M LA - PT - DEP - TA - Br Med J (Clin Res Ed) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 11 IP - DP - 1994 Jan 01 TI - Airway response. Standardized provocation tests in adults: pharmacological, physical and sensitizing stimuli. Work Group on Standardization of Respiratory Function Tests. European Community for Coal and Steel. Official position of the European Respiratory Society. [French] PG - Suppl 3:53-83 AU - Sterk PJ AU - Fabbri LM AU - Quanjer PH AU - Cockcroft DW AU - O'Byrne PM AU - Anderson SD AU - Juniper EF AU - Malo JL LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 25 IP - DP - 1994 Jan 01 TI - Dust and endotoxin related acute lung function changes and work-related symptoms in workers in the animal feed industry PG - 877-888 AB - Reported respiratory and related symptoms during work were compared between 265 exposed animal feed workers and a control group consisting of 175 external controls and nonexposed workers in the animal feed industry. Symptoms indicating respiratory and nasal irritation were significantly increased in the animal feed workers. Prevalences ranged from 9% (cough) to 21% (sneezing). Reported cough after work was also significantly increased. In 119 workers, a total of 457 across-shift spirometric lung function changes were measured. Almost all lung function variables showed a decrease during the work shift, as could be expected since the circadian rhythm is in a downward phase during the measurement period (2 p.m.-10 p.m.). When the workers were grouped into dust and endotoxin exposure categories according to their job titles, and exposure-response trend was seen for maximum mid-expiratory flow (MMEF) and maximum expiratory flow rate at 50% of vital capacity (MEF50). The effect of endotoxin was stronger than that of dust, both in magnitude and significance. For the same lung function variables and for forced expiratory volume in 1 second (FEV1) and MEF25, a significant across-week change was also detected. The results of this study are in concordance with other studies that indicate acute effects on lung function and elevated prevalences of respiratory symptoms during work caused by exposure to grain dust AU - Smid T AU - Heederik D AU - Houba R AU - Quanjer PH LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 25 IP - DP - 1994 Jan 01 TI - Dust-related decline in lung function among animal feed workers PG - 117-119 AB - The study describes results of the first part of a follow-up study among 50 animal feed and grain elevator workers. The initial results suggest that the change in lung function over a 5 year period is related to the dust exposure. Workers in the high exposure category showed a greater decline in lung function than workers in the low exposure category. The decline in lung function was strongest for workers who were low exposed at the beginning of the study and who became high exposed during the follow-up period AU - Heederik D AU - Smid T AU - Houba R AU - Quanjer PH LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 24 IP - DP - 1994 Jan 01 TI - Measurement of airborne rat urinary allergen in an epidemiological study PG - 1070-1077 AB - The suitability of radioallergosorbent test (RAST) inhibition to quantify occupational exposure to rat urinary aeroallergen (RUA) has been assessed. When using a constant pool of rat allergic sera, the reproducibility of the assay over 1 year was comparable to that reported for other immunoassays; at 50% RAST inhibition the inter-assay coefficient of variation (CV) was 7.0% and the intra-assay CV was 3.0%. The assay was highly specific for rat urine; mouse urine was 1100-fold less potent at inhibiting the rat urine RAST system. Significant inter-assay variation in the 'high' control was not due to batch variation and was relatively small when compared with the variation in RUA concentrations in the occupational environment. Measurement of workplace RUA exposure demonstrated that those directly involved in the care of rats experienced the highest RUA exposure of the nine occupational groups studied (animal technicians GM = 23.10 micrograms/m3), dead animals (e.g. post mortem GM = 1.60 micrograms/m3, scientists GM = 0.67 microgram/m3) and rat tissue (e.g. slide production GM = 0.04 microgram/m3). In view of the complexity of rat allergens, RAST inhibition is an appropriate method for the quantification of occupational exposure to rats AU - Gordon S AU - Tee RD AU - Nieuwenhuijsen MJ AU - Lowson D AU - Harris J AU - Newman Taylor AJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Exposure to dust and rat urinary aeroallergens in research establishments PG - 593-596 AB - As part of an epidemiological study rat urinary aeroallergen (RUA) and total dust concentrations were measured at three research establishments. Personal RUA measurements in nine exposure groups over a workshift showed highest exposure for animal technicians (geometric mean (GM) = 32.4 micrograms/m3) and lowest for workers in slide production and office (GM > or = 0.1 micrograms/m3). Except for slide production workers, contact with rats, their tissues, faeces, or urine comprised less than half the work shift. Exposure during contact with rats was considerably higher. Personal RUA measurements in nine task categories showed high RUA concentrations for handling rats (GM = 68.0 micrograms/m3) and cleaning out (GM = 53.6 micrograms/m3). Traces of RUA could still be measured in tearooms inside and near offices outside the animal houses. Total dust concentrations were low AU - Nieuwenhuijsen MJ AU - Gordon S AU - Tee RD AU - Venables KM AU - McDonald JC AU - Newman Taylor AJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Work related symptoms, sensitisation, and estimated exposure in workers not previously exposed to laboratory rats PG - 589-592 AB - Findings are presented from the initial cross sectional phase of a cohort study of employees exposed to laboratory rats. Of 366 eligible workers at four sites 323 (88%) were surveyed; symptoms assessed by self completed questionnaire and sensitisation measured by the response to skin prick tests were related to intensity of exposure both to total dust and to rat urinary aeroallergen. Among 238 workers, without previous occupational exposure to rats, work related symptoms, which started after first employment at the site were related to exposure intensity (expressed either in terms of dust or of aeroallergen) at the time of onset of symptoms. These relations were stronger in atopic subjects but were unrelated to smoking. Positive skin tests to rat urinary extract were also more frequent with increased exposure, a relation found in both atopic subjects and in smokers. There was a strong association between work related symptoms and specific sensitisation AU - Cullinan P AU - Lowson D AU - Nieuwenhuijsen MJ AU - Gordon S AU - Tee RD AU - Venables KM AU - McDonald JC AU - Newman Taylor AJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Dust and flour aeroallergen exposure in flour mills and bakeries PG - 584-588 AB - As part of an epidemiological study among workers exposed to flour total dust and flour aeroallergen concentrations were measured with personal samplers over a workshift in three large bakeries and four flour mills and packing stations. In the bakeries geometric means for total dust concentrations ranged from 0.4 mg/m3 in the bread wrapping area up to 6.4 mg/m3 at the dough brake. The flour aeroallergen concentrations ranged from 45.5 micrograms/m3 in the bread wrapping area up to 252.0 micrograms/m3 in the confectionary area. In the flour mills and packing stations the concentrations were higher with geometric means for total dust ranging from 0.5 mg/m3 in the office up to 16.9 mg/m3 for hygiene workers in an old mill. The flour aeroallergen concentrations ranged from 101.5 micrograms/m3 for transport workers up to 1728.2 micrograms/m3 for hygiene workers. The relation between total dust and flour aeroallergen concentrations varied for different areas and depended on the use of products other than flour AU - Nieuwenhuijsen MJ AU - Sandiford CP AU - Lowson D AU - Tee RD AU - Venables KM AU - McDonald JC AU - Newman Taylor AJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 267 IP - DP - 1994 Jan 01 TI - Cadmium selectively inhibits fibroblast procollagen production and proliferation PG - Pt 1):L300-8 AB - Chronic inhalation of cadmium fumes has been associated with the development of emphysema, a disease characterized by extensive disruption of lung connective tissue. Cadmium is also an important contaminant of tobacco and may play a role in cigarette smoking-related emphysema. In this paper we investigated the effect of nontoxic doses of cadmium chloride (CdCl2) on fibroblast procollagen production and proliferation, key features of connective tissue repair following injury. CdCl2 inhibited fibroblast procollagen production in a dose-dependent manner in two different cell lines. For fetal rat fibroblasts, maximal effects were observed at 10 microM CdCl2, with values reduced by 82 +/- 6% (mean +/- SE, n = 6, P < 0.01) relative to control cells. In contrast, noncollagen protein synthesis by these cells was enhanced in the presence of CdCl2. In human fetal lung fibroblasts (HFL1), maximal inhibition of procollagen production (83 +/- 2%, P < 0.01) was observed at 40 microM CdCl2, whereas noncollagen protein synthesis was unaffected. In both cell lines the inhibition of procollagen production was shown to be due to decreased procollagen synthesis and an increase in the proportion of newly synthesized procollagen degraded. Cadmium also affected fibroblast proliferation in response to 2% serum, with values for fetal rat cells depressed by 17 +/- 4, 72 +/- 2, and 86 +/- 4% (all P < 0.01) compared with controls at 1, 5, and 10 microM CdCl2, respectively. These data show that cadmium selectively inhibits fibroblast procollagen production and also attenuates their mitogenic response to serum.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Chambers RC AU - McAnulty RJ AU - Shock A AU - Campa JS AU - Newman Taylor AJ AU - Laurent GJ LA - PT - DEP - TA - American Journal of Physiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Occupational asthma in salbutamol process workers PG - 397-399 AB - Occupational asthma after exposure to salbutamol in the pharmaceutical industry has not been previously reported. The occurrence of occupational asthma is described in two pharmaceutical process workers who were likely to have inhaled doses appreciably in excess of the therapeutic dose range. The findings do not lead to an unequivocal conclusion on the mechanism of the asthma but it was probably a pharmacological consequence of high exposure AU - Agius RM AU - Davison AG AU - Hawkins ER AU - Newman Taylor AJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 65 IP - DP - 1994 Jan 01 TI - The use of multiple parameters to characterize cadmium-induced renal dysfunction resulting from occupational exposure PG - 22-41 AB - Renal function has been examined in a group of 77 subjects occupationally exposed to cadmium fume and dust, together with a referent group of 103 age- and socioeconomically matched subjects. Fourteen biochemical parameters were measured on each subject. Three different ways of combining the information from all 14 tests were used to identify those subjects with renal dysfunction. These were first to count the number of parameters in which a subject recorded an abnormal test result. Second, the z value was computed for each parameter for each person by comparison with the mean and standard deviation of a derived normal population; these z scores were then summed. Lastly a multivariate distance measure, Mahalanobis D2, was determined for each subject from the distribution of normal subjects. The three approaches showed a considerable degree of agreement in identifying subjects with renal dysfunction, but they also displayed complementary strengths and weaknesses. The consensus of the three techniques was then taken to define truly dysfunctional subjects and each of the 14 parameters, and some combinations of pairs of parameters were tested as to their sensitivity and specificity. For this group of subjects, it was not possible to improve greatly on the use of retinol binding protein on its own. Were a second parameter to be chosen, it would be desirable to choose one reflecting the glomerular filtration rate, but the absence of a suitable sensitive biological monitoring parameter precludes a firm recommendation AU - Guthrie CJ AU - Chettle DR AU - Franklin DM AU - Scott MC AU - Mason HJ AU - Wright AL AU - Gompertz DR AU - Davison AG AU - Fayers PM AU - Newman Taylor AJ LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 24 IP - DP - 1994 Jan 01 TI - Eosinophil cationic protein (ECP), histamine and tryptase in peripheral blood before and during inhalation challenge with toluene diisocyanate (TDI) in sensitized subjects PG - 730-736 AB - To determine whether the measurement of specific markers of inflammatory cells in peripheral blood might be used to detect the inflammatory activity in the airways in asthma induced by toluene diisocyanate (TDI), we measured the levels of eosinophil cationic protein (ECP), histamine and tryptase in peripheral blood before and during inhalation challenge with TDI or methacholine in two groups of subjects who exhibited or did not exhibit an asthmatic reaction after exposure to toluene diisocyanate in the laboratory. When the subjects developed a late asthmatic reaction after exposure to TDI, they showed an increase in their ECP serum levels. By contrast, there were no significant changes in serum ECP levels after exposure to TDI in the control group or after methacholine challenge in either group. Tryptase levels in serum were not detectable before or during inhalation challenge with TDI or methacholine. There was no significant increase in plasma histamine levels during inhalation challenge with TDI or methacholine. These results suggest that eosinophils are 'activated' in subjects who develop a late asthmatic reaction after exposure to TDI and that the measurement of ECP levels in peripheral blood may be a useful marker to monitor airway inflammation 0 (eosinophil basic protein). 0 (Blood Proteins). 51-45-6 (Histamine). 584-84-9 (Toluene 2,4-Diisocyanate). EC 3-4-21-59 (tryptase). EC 3-4-21 (Serine Proteinases) AU - Mapp CE AU - Plebani M AU - Faggian D AU - Maestrelli P AU - Saetta M AU - Calcagni P AU - Borghesan F AU - Fabbri LM LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - Journal IP - DP - 1994 Jan 01 TI - Protein antigens in case of asthma, rhinitis and dermatitis in patients occupationally exposed to flour PG - 1046-1051 AB - 21 patients gave sera to clarify their clinical hypersensitivity towards flour proteins. 6 had dermatitis, 3 rhinitis and the others asthma. 3 patients showed a control reactivity towards the electrophoretically separated flour protein antigens while others had antibodies to flour antigen with molecular weights less than 100 kD or 80 kD in the case of rye. Reactivity towards antigens with molecular weight higher than 50 kD was typical of dermatitis patients, while the rhinitis and asthma cases' sera reacted towards lighter flour proteins in the 20-30 kD range. The procedure is simple, a random serum sample (5 ml) suffices, and it allows demonstration of sensitization to flour protein in a way which may be helpful in the evaluation of exposure and the diagnosis of allergic conditions due to flour dust, a major etiology of occupational respiratory disease 0 (Antigens). 0 (Plant Proteins) AU - Schonenberger P AU - Savolainen H LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 106 IP - DP - 1994 Jan 01 TI - Mortality due to farmer's lung in Finland PG - 509-512 AB - Fatal cases of farmer's lung (FL) are rare. We found, based on death certificates, 13 cases of FL with a fatal outcome in Finland between 1980 and 1990. Compared with incidence data from the years 1980 to 1982, the mortality was estimated as 0.7 percent. On average, death occurred 8 years after the diagnosis of FL. One patient died acutely after a heavy mold exposure. The other patients had chronic disease. Among them the immediate cause of death was pneumonia in seven patients, respiratory insufficiency in four, and pneumothorax in one patient. The majority of these patients with a fatal outcome had suffered from symptoms of FL for more than 1 year before the diagnosis was established and fibrotic changes were already visible in the chest radiograph at the time of the diagnosis AU - Kokkarinen J AU - Tukiainen H AU - Terho EO LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Allergens associated with baker's asthma PG - 906-906 AU - Armentia A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Silica exposure and chronic airflow limitation in pottery workers [published erratum appears in Arch Environ Health 1995 Mar-Apr;50(2):174] PG - 459-464 AB - We assessed the relationship between exposure to silica dust and chronic airflow limitation in an epidemiological survey conducted among pottery workers and controls who were of the same socioeconomic status (average age: 35 y; 78% males). Data were collected by questionnaire for respiratory symptoms, allergy, respiratory history, smoking habits, and occupation. Lung function was measured with a computer-equipped Gauthier spirometer. We excluded subjects with silicosis or doubtful chest x-ray, and two exposure levels were defined. No differences were observed between exposed subjects and controls with respect to respiratory conditions. Mean pulmonary function values for men and women were significantly lower, after adjustment for age, height, and smoking habits, in even indirectly exposed pottery workers, compared with controls. These results suggest that exposure to silica dust is a risk factor for chronic airflow limitation and is independent of radiographic changes 7631-86-9 (Silicon Dioxide) AU - Neukirch F AU - Cooreman J AU - Korobaeff M AU - Pariente R LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Exposure to stainless steel welding fumes and lung cancer: a meta-analysis PG - 335-336 AB - Stainless steel welding is associated with exposure to metals including hexavalent chromium and nickel. This study is a meta-analysis of five studies of stainless steel welders and the occurrence of lung cancer. Asbestos exposure and smoking habits have been taken into account. The calculated pooled relative risk estimate was 1.94 with a 95% confidence interval of 1.28-2.93. This result suggests a causal relation between exposure to stainless steel welding and lung cancer 12597-69-2 (Steel) AU - Sjogren B AU - Hansen KS AU - Kjuus H AU - Persson PG LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Is latex a potential source of an aeroallergen? PG - 675-676 AU - Laurent J AU - Lafay M AU - Le Gall C AU - d'Auzac C AU - Sauvaget J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 23 IP - DP - 1994 Jan 01 TI - The Sick Building Syndrome (SBS) in office workers. A case-referent study of personal, psychosocial and building-related risk indicators PG - 1190-1197 AB - BACKGROUND. The Office Illness Project in Northern Sweden, comprising both a screening questionnaire study of 4943 office workers and a case-referent study of Sick Building Syndrome (SBS) in 464 subjects was recently completed. Previously published results from the survey showed that female gender asthma/rhinitis, high psychosocial work load, paper and visual display terminal (VDT) work were related to an increased prevalence of SBS symptoms. METHODS. The case-referent study presented in this paper used data from the questionnaire supplemented with information from a clinical examination, a survey of psychosocial factors at work building data from inspection and measurements taken at the work sites. RESULTS. Personal factors such as atopy and photosensitive skin, psychosocial conditions and physical exposure factors influencing indoor air quality (IAQ), such as outdoor air flow rates and the presence of photocopiers were related to an increased prevalence of the reported SBS symptoms. The results were established using multivariate analysis. CONCLUSIONS. The rate response relationship between actually measured ventilation rates and the prevalence of perceived SBS symptoms presents strong evidence for the association between IAQ factors and health AU - Stenberg B AU - Eriksson N AU - Hoog J AU - Sundell J AU - Wall S LA - PT - DEP - TA - Int J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 36 IP - DP - 1994 Jan 01 TI - Asthma experience in an occupational and environmental medicine clinic. Low-dose reactive airways dysfunction syndrome PG - 1133-1137 AB - The etiology of adult-onset asthma is incompletely understood. High-intensity exposure to irritants is one accepted risk factor and such cases are termed Reactive Airways Dysfunction Syndrome. The contribution to asthma of less intense and less acute exposure to irritants remains to be clarified. We report on 10 cases of nonsensitization adult-onset asthma in settings of exposure to noticeable but distinctly "tolerable" levels of inhalation irritants. This series of 10 cases represent 31% of verified asthma cases seen in our environmental and occupational medicine referral clinic over a 5-year period. We believe further exploration of this phenomenon of low dose Reactive Airways Dysfunction Syndrome is warranted AU - Kipen HM AU - Blume R AU - Hutt D LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - The effect of changing spirometer dead space volume on the accuracy and repeatability of lung function tests PG - 1057P- AU - Bright P AU - Daniels JE AU - Miller MR AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 40 IP - DP - 1994 Jan 01 TI - The mechanisms of allergic damage to the bronchoalveolar apparatus in poultry plant workers PG - 76-81 AB - Specific and non-specific mechanisms of defense and damage were studied in 296 poultry breeders, 20 of them were diagnosed the exogenic allergic alveolitis (EAA), the so-called "breeder's lung". The following characters were found: an increase in the blood leucocyte phagocytic activity, non-specific neutrophilic damage values, specific neutrophilic damage and specific lymphocyte damage values, lactate dehydrogenase activity, circulated immune complexes level, immunoglobulins A and M in blood serum in breeders with EAA. Only breeders with service of 1-5 and 11-15 years have shown no changes in non-specific neutrophilic damage values. A decrease in the T-lymphocyte content, theophylline-sensitive and theophylline-stable lymphocyte subpopulations in blood serum of breeders with EAA were observed as well AU - Reheda MS LA - PT - DEP - TA - Fiziologicheskii Zhurnal JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Peak expiratory flow monitoring in diagnosis and management of occupational asthma. [Review] PG - 425-431 AB - The role of peak expiratory flow (PEF) monitoring in the diagnosis of occupational asthma has recently been assessed by several studies, which agree that this procedure should always be used to confirm the relationship between symptoms and occupational exposure. Some specific issues should be satisfied: a minimum number of four PEF measurements in a day; several weeks of monitoring in and out of work; and the presence of specific patterns of PEF changes. The sensitivity and specificity of PEF monitoring to detect occupational asthma, in comparison with the specific challenge test in the laboratory (the "gold standard") have been shown to be fairly high, although many authors believe that PEF monitoring cannot substitute for the specific challenge test. Limitations include: the low sensitivity of PEF to detect mild changes in airway calibre with respect to forced expiratory volume in one second (FEV1); the blunting effect of pharmacological treatment; the episodic and irregular exposure to the sensitizer in the workplace; and the compliance and honesty of the subject. Further studies are required to select the best indices of daily and day-to-day variability to be used in the evaluation of PEF changes between work and out-of-work periods. AU - Paggiaro PL AU - Giannini D AU - Moscato G AU - Bacci E AU - Bancalari L AU - Carrara M AU - Dente FL AU - Di Franco A AU - di Pede F AU - Petrozzino M AU - et al LA - PT - DEP - TA - Monaldi Arch Chest Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Bronchial asthma caused by exposure to ash wood dust [Polish] PG - 343-344 AB - A 42-year-old man reported attacks of dyspnoea on non-professional exposure to ash wood dust. The skin prick tests with common allergens and ash pollen were positive. Inhalation of ash wood dust (challenge test) elicited a very strong, immediate bronchospastic reaction, associated with profuse watery rhinorrhea, conjunctival congestion and lacrimation. The symptoms did not occurred after inhalation of pine wood dust. A positive skin (prick test) reaction to ash wood extract was documented. When the patient remained unexposed to ash wood dust the dyspnoea subsided and 4-fold decrease in bronchial reactivity to histamine-PC20 increase from 0.53 mg/ml to 2.1 mg/ml (according to Cockroft) was observed. The authors conclude that the immediate bronchial reaction to inhaled ash wood dust and the immediate skin positive response to ash wood extract were due to IgE-allergen reaction. This is the second case of hypersensitivity to ash wood dust reported in the literature AU - Szmidt M AU - Gondorowicz K LA - PT - DEP - TA - Polski Tygodnik Lekarski JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 83 IP - DP - 1994 Jan 01 TI - A case of minocycline-induced hypersensitivity pneumonitis with radiographic finding of multiple nodules PG - 1991-1992 AU - Kameya T AU - Morita T AU - Tanaka I AU - Koshida H AU - Igarachi Y AU - Horikami K AU - Nagai T AU - Kato M AU - Nanbu S LA - PT - DEP - TA - Nippon Naika Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 102 IP - DP - 1994 Jan 01 TI - Toxicological and epidemiological evidence for health risks from inhaled engine emissions. [Review] PG - Suppl 4:165-71 AB - Information from toxicological and epidemiological studies of the cancer and noncancer health risks from inhaled diesel engine exhaust (DE) and gasoline engine exhaust (GE) was reviewed. The toxicological database is more extensive for DE than for GE. Animal studies have shown that heavy, chronic exposures to both DE and GE can cause lung pathology and associated physiological effects. Inhaled GE has not been shown to be carcinogenic in animals. Chronically inhaled DE at high concentrations is a pulmonary carcinogen in rats, but the response is questionable in mice and negative in Syrian hamsters. The response in rats is probably not attributable to the DE soot-associated organic compounds, as previously assumed, and the usefulness of the rat data for predicting risk in humans is uncertain. Experimental human exposures to DE show that lung inflammatory and other cellular effects can occur after single exposures, and sparse data suggest that occupational exposures might affect respiratory function and symptoms. Epidemiology suggests that heavy occupational exposures to exhaust probably increase the risks for mortality from both lung cancer and noncancer pulmonary disease. The small magnitudes of the increases in these risks make the studies very sensitive to confounding factors and uncertainties of exposure; thus, it may not be possible to resolve exposure-response relationships conclusively by epidemiology. Our present knowledge suggests that heavy occupational exposures to DE and GE are hazardous but does not allow quantitative estimates of risk with a high degree of certainty. AU - Mauderly JL LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 66 IP - DP - 1994 Jan 01 TI - Respiratory and other hazards of isocyanates. [Review] PG - 141-152 AB - Isocyanates are increasingly being used for manufacturing polyurethane foam, elastomers, adhesives, paints, coatings, insecticides, and many other products. At present, they are regarded as one of the main causes of occupational asthma. The large number of workers who are exposed to these chemicals have a concentration-dependent risk of developing chronic airway disorders, especially bronchial asthma. Different pathophysiologic mechanisms are involved. Immunoglobulin E (IgE)-mediated sensitization and irritative effects have been clearly demonstrated in both exposed subjects and animals. Presumably, neural inflammation due to neuropeptide release of capsaicin-sensitive afferent nerves is crucial. We collected data on 1780 isocyanate workers who had been examined by our groups. Of them 1095 (including subjects from outpatient departments) had work-related symptoms, predominantly of the respiratory tract. Specific IgE antibodies were found in 14% of the 1095 subjects. The methacholine challenge test was shown to be an inadequate predictor of the results of inhalative isocyanate provocation tests in workers and in asthmatic controls. Isocyanate (toluene diisocyanate TDI) air concentrations of 10 ppb (0.07 mg/m3) and 20 ppb (0.14 mg/m3), respectively, did not cause significant bronchial obstruction in the majority of previously unexposed asthmatics with bronchial hyperreactivity. IgG-mediated allergic alveolitis, a rare disease among isocyanate workers, was found in approximately 1% of the symptomatic subjects. Experimental studies exhibit dose-dependent toxic effects and give evidence for tachykinin-mediated bronchial hyperreactivity after exposure to isocyanates. The clinical role of genotoxic effects of isocyanates and their by-products demonstrated here in vitro and in vivo has yet to be clarified. AU - Baur X AU - Marek W AU - Ammon J AU - Czuppon AB AU - Marczynski B AU - RaulfHeimsoth M AU - Roemmelt H AU - Fruhmann G LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 36 IP - DP - 1994 Jan 01 TI - Work place challenge: spirometric response in polyurethane (isocyanate) paint workers PG - 73-76 AB - In industrialised countries, isocyanate is probably the most common cause of occupational asthma. The present study was conducted to see the effect on FEV1 in workers who were directly exposed to isocyanate. One hundred and fourteen workers of a rail coach factory who were involved in polyurethane paint spray were studied. Spirometry was done three times, first before starting the work, at two hours and then 6-8 hours after finishing the work to see immediate, late and dual responses. Positive response was considered when there was fall of 20% or more in forced expiratory volume in 1 second (FEV1) from base line. Sixteen per cent of the workers exposed to isocyanate developed immediate reaction, 10% developed late reaction and 6% developed dual reaction. Non-smokers were more prone to develop late and dual responses AU - Whig J AU - Bansal B AU - Mahajan R LA - PT - DEP - TA - Indian J Chest Dis Allied Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 36 IP - DP - 1994 Jan 01 TI - Domestic smoke pollution and prevalence of chronic bronchitis/asthma in a rural area of Kashmir PG - 61-72 AB - An increased prevalence of chronic bronchitis (12.21%) was observed in Gujjar females of a rural area of Kashmir valley in this study. Screening of adult population of two randomly selected village showed an overall prevalence rate of 7.7% for chronic bronchitis and 1.96% for asthma. This increased prevalence of chronic bronchitis was attributed to exposure to domestic smoke pollution, lower socio-economic status, illiteracy, poor housing conditions and overcrowding AU - Qureshi KA LA - PT - DEP - TA - Indian J Chest Dis Allied Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Ocular and nasal irritation in operatives in Lancashire cotton and synthetic fibre mills PG - 744-748 AB - OBJECTIVES--To document the prevalence of work related ocular (eyeWRI) and nasal (noseWRI) irritation in workers in spinning mills of cotton and synthetic textile fibres and to relate the prevalence of symptoms to atopy, byssinotic symptoms, work history, and measured dust concentrations in the personal breathing zone and work area. METHODS--A cross sectional study of 1048 cotton workers and 404 synthetic fibre workers was performed. A respiratory questionnaire was given to 1452 workers (95% of the total available population). Atopy was judged by skin prick tests to three common allergens. Work area cotton dust sampling (WAdust) was carried out according to EH25 guidelines in nine of the 11 spinning mills included in the study. Personal breathing zone dust concentrations were assessed with the IOM sampler to derive total dust exposure (PTdust) and a concentration calculated after the removal of fly (Pless). RESULTS--3.7% of all operatives complained of symptoms of byssinosis, 253 (17.5%) complained of eyeWRI and 165 (11%) of noseWRI. These symptoms did not relate to atopy or byssinosis, or correlate univariately with any measure of cotton dust exposure (noseWRI v WAdust r = 0.153, PTdust r = 0.118, eyeWRI v WAdust r = 0.029, PTdust r = 0.052). Both of these symptoms on logistic regression analysis were related to being of white origin (P < 0.001), female sex (P < 0.001), and younger age (P < 0.001). With regression analysis, there was a negative relation between dust concentration and prevalence of symptoms. CONCLUSION--Work related ocular and nasal irritation are the most common symptoms complained of by cotton textile workers. There was no relation between these symptoms and atopy, byssinosis, or dust concentration. It is likely that they relate to as yet unidentified agents unrelated to concentration of cotton dust AU - Fishwick D AU - Fletcher AM AU - Pickering CAC AU - Niven RM AU - Faragher EB LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 33 IP - DP - 1994 Jan 01 TI - Hypersensitivity pneumonitis induced by inhalation of mushroom (Pholiota nameko) spores PG - 683-685 AB - We describe the hypersensitivity pneumonitis of a 49-year-old woman who had been cultivating the edible mushroom 'Pholiota nameko' for three years. Her clinical manifestations and laboratory findings including transbronchial lung biopsy (TBLB) and bronchoalveolar lavage fluid (BALF) were consistent with those of other forms of hypersensitivity pneumonitis. Counter-immunoelectrophoresis determined the causative antigen to be the spores of Pholiota nameko. The indoor cultivation method appeared to play a major role in the occurrence of the hypersensitivity pneumonitis AU - Ishii M AU - Kikuchi A AU - Kudoh K AU - Konishi K AU - Mohri T AU - Tamura M AU - Tomichi N LA - PT - DEP - TA - Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 24 IP - DP - 1994 Jan 01 TI - Peak expiratory flow meters (PEFMs)--who uses them and how and does education affect the pattern of utilisation? PG - 521-529 AB - BACKGROUND: Asthma control may be assisted by educating patients to use peak expiratory flow meters (PEFMs). AIMS: To find out the sociodemographic and clinical characteristics of asthmatics attending an Emergency Room (ER) who owned PEFMs. METHODS: We undertook a study of 352 asthmatics aged seven to 55 years who attended an ER. The following were analysed: their pattern of peak flow monitoring (PFM), the factors associated with 'appropriate' or daily PFM on entry to the study and then prospectively; whether asthma education influenced utilisation and whether there was a reduction in ER use or admissions in those who acquired a PEFM. RESULTS: Those owning a PEFM at entry to the study (54%) had more asthma morbidity (p = 0.0001), had had asthma for longer (p = 0.0001), had seen their medical practitioners more often in the previous nine months (p = 0.0001), were on more asthma medications (p = 0.0001) and were more likely to have been to an Asthma Clinic (p = 0.0001). Those not owning a PEFM were more likely to be of lower social class (p = 0.016) and of Pacific Island origin (p = 0.0001) suggesting that distribution is not ideal and is influenced by disease severity, amount of health care use and sociodemographics. Patients with a self-management plan (35% of PEFM owners) and those receiving 'good care' or management, were more likely to use PFM 'appropriately' and to mention PFM in a scenario evaluating their response to worsening asthma control and argues for PEFMs to be distributed only in conjunction with a self-management plan, and therefore in close association with the patients' medical practitioners. Most patients (75%) appeared to prefer making management decisions based on symptoms rather than on their peak expiratory flow (PEF) and few (16%) performed daily PFM at entry to the study and fewer (6%) nine months later. There was an improvement in the pattern of PFM after education, but the acquisition of a PEFM made no difference to the frequency of ER use or admission. CONCLUSION: More realistic goals need to be defined in relationship to PFM which may improve patients' acceptance of the strategy, and therefore, hopefully their compliance. Such strategies need to be consistently reinforced over time for them to have an impact on asthma morbidity AU - Garrett J AU - Fenwick JM AU - Taylor G AU - Mitchell E AU - Rea H LA - PT - DEP - TA - Aust N Z J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 23 IP - DP - 1994 Jan 01 TI - A case of occupational asthma due to barley grain dust PG - 734-736 AB - We report a case of occupational asthma due to barley grain dust, species Hordeum Vulgare L, in a 32-year-old storeman of a trading company's department that dealt with packaging of flour, barley and peanuts. He developed immediate symptoms of sneezing, cough and dyspnoea on exposure to barley only. These symptoms showed work relationship. He became asymptomatic after his transfer to another department dealing with sales only. Bronchial provocation testing to the barley confirmed the diagnosis AU - Yap JC AU - Chan CC AU - Wang YT AU - Poh SC AU - Lee HS AU - Tan KT LA - PT - DEP - TA - Ann Acad Med Singapore JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 23 IP - DP - 1994 Jan 01 TI - Case of occupational asthma due to glue containing cyanoacrylate PG - 731-733 AB - Cyanoacrylates are a rare cause of occupational asthma, there being only six cases reported previously. High humidity has been implicated to be protective in the pathogenesis of the asthma. This is a case report of occupational asthma due to cyanoacrylate glue after working three years in a factory manufacturing doors. Diagnosis was made by history, serial peak flow measurements on and off work and specific inhalation challenge which elicited a delayed bronchoconstrictive response. An unusual feature of this case was the positive reaction to cyanoacrylate despite the high ambient humidity in Singapore AU - Chan CC AU - Cheong TH AU - Lee HS AU - Wang YT AU - Poh SC LA - PT - DEP - TA - Ann Acad Med Singapore JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 23 IP - DP - 1994 Jan 01 TI - Serial peak expiratory flow rate monitoring--a useful tool in epidemiological studies on occupational asthma. [Review] PG - 725-730 AB - Occupational asthma is the leading occupational respiratory disease. Epidemiological studies of occupational asthma have made use of the serial peak expiratory flow rate (PEFR) monitoring as a tool to identify cases, describe prevalence and to compare the mean diurnal variation (DV) in PEFR with an unexposed control group. Various indices of PEF variability can be used. The serial PEFR is a useful additional tool to the respiratory questionnaire and spirometry as it measures airway variability. It is also a practical alternative to histamine or methacholine inhalation testing. It has the advantage of providing multiple sequential readings of PEF and simple indices are available to express the airway variability of almost every subject studied. The validity of the serial PEFR recording should be further evaluated considering both the technical and human aspects. The monitoring protocol should be standardised and some criteria for validity should be pre-set. Factors that may affect DV in PEFR such as age, sex, smoking, race and the mean or maximum PEFR should be taken into account when comparing with controls. AU - Lee HS LA - PT - DEP - TA - Ann Acad Med Singapore JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 20 IP - DP - 1994 Jan 01 TI - Occupational asthma - time for prevention. [Review] PG - Spec No:108-15 AB - Incidence figures show that occupational asthma is increasing. It often takes a deteriorating course. Follow-up studies of workers suffering from the disease have uniformly reported persistence of symptoms over long periods, even among formerly exposed workers. New initiators of occupational asthma are continuously being reported. Still "old" agents, such as diisocyanates and flours, remain major causes. There seems to be some disconnection in the dialogue between the medical and the technical parties involved. For prevention, it is essential to ensure that important information not only reaches those who are responsible for designing and maintaining processes, but that it is presented in an intelligible form. Occupational asthma has become an important occupational disease that merits high priority. Recent achievements should facilitate preventive actions. However, prevention is a multidisciplinary enterprise needing the commitment of industrial hygienists and engineers, chemists, and allergologists, in addition to that of occupational health personnel. AU - Nordman H LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 66 IP - DP - 1994 Jan 01 TI - Occupational exposure to water-based paints and self-reported asthma, lower airway symptoms, bronchial hyperresponsiveness, and lung function PG - 261-267 AB - The associations between occupational exposure to water-based paints and the prevalence of self-reported asthma, other lower airway symptoms, bronchial hyperresponsiveness (BHR), and lung function were studied in house painters. Symptom prevalences were obtained from a self-administered questionnaire sent to 415 male painters during 1989-1992. Clinical investigations were carried out in three selected groups: 23 painters with asthmatic symptoms, nine painters with other lower airway symptoms, and 12 painters without airway symptoms. The clinical studies included lung function test, methacholine provocation test, and occurrence of atopy, confirmed by skin prick test to common allergens. In addition, a group of 18 young male painters with no occupational exposure to solvent-based paints were followed with dynamic spirometry before and after a workshift, when only water-based paints were used. The prevalence of self-reported asthma (7%) was somewhat, but not statistically, increased compared to an industrial population without exposure to water-based paints or other airway irritants. A decrease in FEV1 and FVC during the workday was observed in the young painters. In the clinical studies the painters exhibited increased BHR compared to the referents and a decreased FEV1. The number of years working as a painter was related to a decrease in FEV1, which was most pronounced in subjects with atopy who also reported lower airway symptoms in relation to the degree of work with water-based paints, but not to the degree of use of solvent-based paints. Our results indicate that house painters have an increased risk of airway problems.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Wieslander G AU - Janson C AU - Norback D AU - Bjornsson E AU - Stalenheim G AU - Edling C LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 26 IP - DP - 1994 Jan 01 TI - Respiratory symptoms and asthma among workers exposed to paper dust: a cohort study PG - 489-496 AB - The aim of the present cohort study was to investigate whether exposure to paper dust causes increased risk for respiratory symptoms or asthma. The cohort included all workers at a soft paper mill who had worked there for more than 1 year 1960-1986 (n = 1,697). Randomly selected inhabitants of the mill town (n = 781) were used as unexposed referents. Both groups were investigated using a postal questionnaire. From the paper mill cohort, workers with high cumulative exposure (n = 313), with medium cumulative exposure (n = 321), and with low cumulative exposure (n = 338) to paper dust were selected. In the 1960s and 1970s, the dust levels were between 5 and 10 mg/m3. After adjustment for smoking and gender, paper dust exposure resulted in elevated prevalence ratios for chronic cough, chronic phlegm, wheeze, and breathlessness. The prevalence ratios ranged from 1.3 to 2.5. No significantly increased risk of asthma was found among the exposed, incidence rate ratio 1.4 (95% confidence interval 0.93-1.8). Among the exposed, there was an insignificantly increasing incidence rate ratio, 1.0, 1.4, 2.1, with increasing cumulative exposure. In conclusion, an increased risk for respiratory symptoms was observed among workers exposed to paper dust, but the study does not permit any definite conclusions regarding asthma and paper dust exposure AU - Toren K AU - Jarvholm B AU - Sallsten G AU - Thiringer G LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 66 IP - DP - 1994 Jan 01 TI - Occupational asthma caused by decorative flowers: review and case reports. [Review] PG - 131-136 AB - Occupational respiratory symptoms caused by decorative flowers are seldom reported in the literature. In the years 1985-1993 four such cases of occupational asthma were diagnosed at the Institute of Occupational Health of Finland. Occupational asthma was caused by freesias (n = 1), chrysanthemums (n = 1), and tulips (n = 2). The diagnoses were based on work-related respiratory symptoms during flower handling in the patients' histories, specific challenge tests, and allergologic examinations. Flower allergy is rare but can even develop into occupational asthma. It usually leads to a change of profession. AU - Piirila P AU - Keskinen H AU - Leino T AU - Tupasela O AU - Tuppurainen M LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 66 IP - DP - 1994 Jan 01 TI - Frequencies of occupational allergic diseases and gender differences in Finland PG - 111-116 AB - In Finland occupational diseases are registered by diagnosis, causative agent, age, occupation, field of work, and gender. This report analyzes in detail the 1991 statistics on gender differences in occupational allergic diseases. A total of 1314 cases of occupational allergic diseases were reported, comprising 14.2% of all registered occupational diseases. The following allergic occupational diseases were encountered: allergic contact dermatitis (412 cases), bronchial asthma (352), allergic rhinitis (319), contact urticaria/protein contact dermatitis (146), and allergic alveolitis (85). The number of cases of allergic alveolitis (men, 42 cases; women, 43 cases) and bronchial asthma (176 men/176 women) was about equal in both genders. Women were overrepresented in allergic rhinitis (195 women/124 men), allergic contact dermatitis (247 women/165 men), and contact urticaria/protein contact dermatitis (109 women/37 men). According to current knowledge, there are no great gender differences in the development of asthma or allergic rhinitis. The greater number of women with occupational respiratory allergy and immediate skin allergy may indicate that women in Finland are more exposed to type I allergens than men. The greater number of cases of allergic contact dermatitis in women may reveal women's predisposition to delayed-type allergy, or women's greater occupational exposure to contact allergens AU - Kanerva L AU - Jolanki R AU - toikkanen J LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Latex-induced occupational asthma [letter] PG - 1727-1727 AB - The European Respiratory Journal's series on "Occupational Asthma" gives an excellent overview of this important topic in modern pneumology. In particular, the contribution by CHAN-YEUNG and MALO [1], with its appendix listing the many potential causes of occupational asthma, will no doubt prove a very useful source of information. It is, however, a little surprising that an important and increasingly frequent cause of occupational asthma, such as latex, was not considered in the main text and not listed correctly in the appendix. Sensitization to latex (or natural rubber) is an important cause of occupational allergic reactions, including urticaria, rhinitis, conjunctivitis and/or asthma, particularly in rubber industry workers and in health-care or other personnel having to wear latex gloves. Life-threatening anaphylactic reactions have also been described in sensitized individuals exposed to latex outside their work, e.g. through medical, gynaecological or surgical procedures; thus, emphasizing the importance of a correct recognition of the sensitization. The consensus is that these immediate hypersensitivity reactions occur via immunoglobulin E (IgE)-dependent mechanisms directed against proteins from Hevea brasiliensis, the rubber-producing tree [2]. These rubber allergens easily become airborne, as they are absorbed onto the cornstarch powder generally used to lubricate the gloves. It would, therefore, seem appropriate to include latex in the category of "High Molecular Weight Compounds - Plant Proteins", rather than in a category of widely differing "Chemicals", as was done in the table in the article of CHAN-YEUNG and Malo [1]. AU - Nemery B LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Aetiological agents in occupational asthma [Review] PG - 346-371 AB - Occupational asthma has become the most prevalent occupational lung disease in developed countries. At present, about 200 agents have been implicated in causing occupational asthma in the workplace. These agents can be divided into two categories by their mechanism of action: immunological and nonimmunological. Immunological causes can be further divided into those that induce asthma through an immunoglobulin E (IgE)-dependent mechanism, and those that induce asthma through a non-IgE-dependent mechanism. In the latter category, specific IgE antibodies are found only in a small percentage of the patients with proven disease, even though the clinical picture is compatible with an allergic reaction. The immunological mechanism(s) responsible for these agents has yet to be identified. The best known example of nonimmunological asthma is Reactive Airways Dysfunction Syndrome (RADS) or irritant-induced asthma. In this review, examples of types of agents causing occupational asthma are discussed and a compendium table of aetiological agents is given. AU - Chan Yeung M AU - Malo JL LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 20 IP - DP - 1994 Jan 01 TI - CD8 T-cell clones producing interleukin-5 and interferon-gamma in bronchial mucosa of patients with asthma induced by toluene diisocyanate PG - 376-381 AB - OBJECTIVES--The aims of the present study were to determine whether specific in vivo stimulation of asthmatics sensitized with toluene diisocyanate (TDI) induces the activation of T lymphocytes in bronchial mucosa and to characterize their phenotype and cytokine secretion profile. METHODS--Bronchial biopsies from two subjects with occupational asthma due to TDI were obtained 48 h after an asthmatic reaction induced by an inhalation challenge with TDI and after three months of no exposure to TDI, at the time when the subjects had recovered from their asthma. The fragments of bronchial mucosa were cultured in the presence of interleukin-2 so that the in vivo activated T cells present in the tissue would expand, and T blasts were then cloned under limiting dilution conditions. RESULTS--From the two 48-h specimens, 65 and 63 T-cell clones were obtained. Most of the clones exhibited the CD8 phenotype (82 and 83%). All of the CD8 clones produced interferon-gamma and 44% produced interleukin-5, but only 6% secreted interleukin-4 as well. Three months after the cessation of exposure, growing T cells could not be recovered from bronchial biopsies cultured in interleukin-2. CONCLUSIONS--The results suggest that, in sensitized subjects, exposure to TDI induces the activation of a subset of CD8 lymphocytes producing interferon-gamma and interleukin-5 0 (Interleukin-5). 584-84-9 (Toluene 2,4-Diisocyanate). 82115-62-(Interferon Type II) AU - Maestrelli P AU - Del Prete GF AU - De Carli M AU - D'Elios MM AU - Saetta M AU - Di Stefano A AU - Mapp CE AU - Romagnani S AU - Fabbri LM LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 43 IP - DP - 1994 Jan 01 TI - A case of bronchial asthma induced by inhalation of dibekacin sulfate [Japanese] PG - 1277-1279 AU - Shirai T AU - Sato A AU - Kinoshita Y AU - Hayakawa H AU - Chida K AU - Maeda H LA - PT - DEP - TA - Arerugi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Anaphylactic reactions to sunflower seed PG - 517-520 AB - We report on four patients sensitized to sunflower seed. Three of them developed anaphylaxis and one chronic bronchial asthma. All four patients reacted the first time sunflower seeds were ingested, and all had kept cage birds fed on sunflower seeds. Therefore, the route of sensitization was probably by inhalation of airborne sunflower seed allergens. Investigation of this type of hypersensitivity in 84 atopic patients showed that only three patients were RAST-positive, indicating that this allergy is fairly uncommon. On the other hand, when atopic persons are exposed to cage birds, the rate of sensitization is rather high, as indicated by the fact that in this category 79% were skin prick positive and 21% were unequivocably RAST positive to sunflower seed AU - Axelsson IG AU - Ihre E AU - Zetterstrom O LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 20 IP - DP - 1994 Jan 01 TI - Susceptibility to and incidence of hand dermatitis in a cohort of apprentice hairdressers and nurses PG - 113-121 AB - OBJECTIVES--The role of atopic constitution, contact sensitization, transepidermal water loss, and dry skin in the development of hand dermatitis was investigated in a prospective study of 74 apprentice hairdressers and 111 apprentice nurses. METHODS--Base-line measurements included a questionnaire on personal characteristics and anamnestic information, examination of hand skin, measurements of transepidermal water loss, patch tests, and prick tests. The condition of the hands, previous exposure, and transepidermal water loss were followed at intervals of four to six weeks. Cox proportional hazard models were used in the statistical analysis. RESULTS--The average incidence rate of hand dermatitis was 32.8 cases per 100 person-years for the hairdressers and 14.5 cases per 100 person-years for the nurses. The rate ratio of having a dry versus normal skin type was 7.3 for the hairdressers [95% confidence interval (95% CI) 2.2-24.3] and 1.7 for the nurses (95% CI 0.5-6.4). Apprentice nurses with a history of (atopic) mucosal symptoms had a 3.4-fold increased incidence rate of hand dermatitis (95% CI 1.05-11.2). The rate ratio of mucosal atopy for the apprentice hairdressers was 2.2 (95% CI 0.7-6.7). Graphic display of the results suggested an increased risk of hand dermatitis among the apprentice hairdressers with transepidermal water loss on the hand greater than 15 g.m-2.h, but the relative risk of increased transepidermal water loss was not statistically significant. CONCLUSION--The most important endogenous risk factors for hand dermatitis among the apprentice hairdressers and nurses were the presence of dry skin and a history of mucosal atopy. No relationship between increased transepidermal water loss and the risk of hand dermatitis was observed AU - Smit HA AU - van Rijssen A AU - Vandenbroucke JP AU - Coenraads PJ LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 30 IP - DP - 1994 Jan 01 TI - Glove-related skin symptoms among operating theatre and dental care unit personnel (II). Clinical examination, tests and laboratory findings indicating latex allergy PG - 139-143 AB - Following interviews on glove-related skin symptoms, 202 subjects, 56 hospital workers at an operating theatre and 146 workers at dental care centres, were skin prick tested with different latex extracts. Also, in 193 cases, blood samples were RAST-analysed, using the CAP system. Sensitization to latex diagnosed by positive skin prick test and/or by demonstration of specific antibodies in serum analyses was found in 3.5% of the subjects investigated. 4 cases (2%) showed 1 or more positive skin tests, and 4 cases (2%) had positive RAST to latex antigens. Further work on the diagnostic tools is still needed, as are prognostic studies AU - Wrangsjo K AU - Osterman K AU - van HageHamsten M LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 30 IP - DP - 1994 Jan 01 TI - Glove-related skin symptoms among operating theatre and dental care unit personnel (I). Interview investigation PG - 102-107 AB - 233 employees in hospital and dental care participated in an interview investigation on glove-related skin complaints. 37% (87/233) reported skin symptoms related to glove use. 2% (4/233) reported localized contact urticaria provoked by latex gloves, 10% (23/233) hand eczema and 24% (56/233) unclassifiable skin intolerance reactions from gloves. Another 2% (4/233) reported facial irritation from gloves. Glove-related skin symptoms were thus reported by more than 1/3 of the personnel and the reported glove-provoked contact urticaria constituted 5% (4/87) of the intolerance reactions AU - Wrangsjo K AU - Osterman K AU - van HageHamsten M LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 107 IP - DP - 1994 Jan 01 TI - A descriptive study of occupational skin disease PG - 147-149 AB - AIM. To describe the types and proportions of occupational skin disease presenting to a private dermatology practice. METHODS. Patients presenting to a private dermatology practice between May 1987 and May 1993, and in whom a diagnosis of occupational skin disease was confirmed formed the basis of the study. Their files were searched for information on diagnosis, age, sex, and occupation. RESULTS. Contact dermatitis accounted for nearly 70% of cases. The food, hairdressing, and medical industries accounted for over a third of occupational skin diseases. CONCLUSION. These results are similar to Australian studies but at variance with European, American and Asian studies with respect to the types of industry accounting for the majority of occupational skin diseases. Nondermatitis occupational skin diseases are not uncommon but often go unrecognised AU - Judd L LA - PT - DEP - TA - N Z Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 272 IP - DP - 1994 Jan 01 TI - Transmission of Mycobacterium tuberculosis associated with air travel PG - 1031-1035 AB - OBJECTIVE--To investigate potential transmission of Mycobacterium tuberculosis in aircraft from a crew member with tuberculosis. DESIGN--Retrospective cohort study and survey. SETTING--A large US airline carrier. PARTICIPANTS--A total of 212 crew members and 59 passengers who were exposed to a crew member with tuberculosis during a potentially infectious period (May through October 1992). Comparison volunteer sample of 247 unexposed crew members. MAIN OUTCOME MEASURES--Positive tuberculin skin test (TST) result or tuberculosis. RESULTS--Rates of positive TST results were higher among foreign-born persons in all study groups. Among US-born comparisons and contacts, rates of positive TST results did not differ between comparisons and contacts exposed from May through July (5.3% vs 5.9%, respectively). However, contacts exposed from August through October had significantly higher rates of positive TST results than did contacts exposed from May through July (30% vs 5.8%, respectively; P < .001); two had documented TST conversions between September 1992 and February 1993. The risk of infection increased with increasing hours of exposure to the index case. Four (6.7%) of 59 frequent flyers were TST-positive; all flew in October. CONCLUSIONS--Data support the conclusion that M tuberculosis was transmitted from an infectious crew member to other crew members on an aircraft. Because of the clustering of TST-positive frequent flyers in October when the index patient was most infectious, transmission of M tuberculosis to passengers cannot be excluded AU - Driver CR AU - Valway SE AU - Morgan WM AU - Onorato IM AU - Castro KG LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 69 IP - DP - 1994 Jan 01 TI - Investigation of tuberculosis among the necropsy staff and environment in necropsy rooms PG - 549-553 AB - We examined the incidence of tuberculosis among necropsy staff and the environment in the necropsy rooms at five medical institutions carrying out a large number of necropsy annually in the metropolis of Tokyo. The following results were obtained: 1) Incidence of tuberculosis was high among necropsy workers. 2) The method of wearing face masks was inadequate. 3) Tubercle bacilli were detected from the necropsy workers' aprons and the air-conditioning equipment of the necropsy room. 4) Formalin treatment of resected organs, especially the lungs, was inadequate. 5) The air conditioners in necropsy rooms were not effective. Considering these findings, improvement of the working conditions and environment of the necropsy rooms is needed AU - Shishido S AU - Mori T AU - Tokudome O AU - Kawai M LA - PT - DEP - TA - Kekkaku JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 24 IP - DP - 1994 Jan 01 TI - Exposure of emergency department personnel to tuberculosis: PPD testing during an epidemic in the community PG - 418-421 AB - STUDY OBJECTIVE: The present epidemic of tuberculosis has increased the risk of transmission of tuberculosis to health care workers in general and emergency department staff in particular, who often treat patients with tuberculosis before their diagnosis. The purpose of this study was to determine the risk of tuberculosis exposure among the nursing and physician staff of an urban ED. DESIGN: Observational study of self-reported purified protein derivative (PPD) skin test results and tuberculosis exposure. SETTING: Urban, public ED. PARTICIPANTS: Attending physicians, resident physicians, and registered nurses. INTERVENTIONS: None. RESULTS: Questionnaires were sent to all attending physicians, resident physicians, and registered nurses in the ED at Harbor-UCLA Medical Center requesting information on the subject's present and prior PPD status, known exposure to tuberculosis, and duration of time and average number of hours worked in the ED. Ninety-six of 129 questionnaires (74%) were returned. Five of the respondents had been immunized with Bacillus of Calmette and Guerin vaccine (BCG) and 10 of the respondents were PPD positive before beginning work in the ED. Of the other 81 respondents, 31% (25 of 81) had become PPD positive while working in the ED. The majority of these conversions (15 of 25) occurred in the first 6 months of 1993. A Kaplan-Meier survival analysis revealed nearly a 40% risk of PPD conversion after 60 months of full-time work in the ED. CONCLUSION: As measured by self-reported PPD status, a high rate of exposure to tuberculosis has been observed among the ED staff at Harbor-UCLA Medical Center. The highest rate of PPD conversion has been noted most recently, suggesting that there has been a significant increase in staff exposure to tuberculosis during 1992 and the beginning of 1993. Systematic monitoring of PPD conversion rates among ED staff is necessary to determine the adequacy of ED respiratory isolation procedures during the current tuberculosis epidemic AU - Sokolove PE AU - Mackey D AU - Wiles J AU - Lewis RJ LA - PT - DEP - TA - Ann Emerg Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 110 IP - DP - 1994 Jan 01 TI - The diagnosis of asthma caused by cow hair epithelium [Finnish] PG - 1999-2003 AU - Taivainen A AU - Iivonen E AU - Kokkarinen J AU - Tukiainen H AU - Terho EO LA - PT - DEP - TA - Duodecim JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Occupational asthma due to heated polypropylene PG - 415-417 AB - A 35 year-old nonatopic woman was referred to the hospital for possible work-related asthma. She had worked as an operator, at a plant producing polypropylene bags, for the previous four yrs. Her main complaint was a productive cough with dyspnoea and wheezing, as well as rhinitis over the past 3 yrs. She had been absent from work for 6 months on maternity leave, and had improved greatly. She was on a beta 2-adrenergic agent and had to take it at least four times daily. Baseline spirometry whilst at work showed marked airflow obstruction (forced expiratory volume in one second (FEV1) of 43% predicted (pred). After two months away from work FEV1 improved to 89% pred; provocative concentration of histamine causing a 25% fall in FEV1 (PC20) was 3.6 mg.ml-1 (mild airway hyperresponsiveness). Return to work resulted in a marked deterioration in FEV1, and serial peak expiratory flow (PEFR) values. PC20 was 0.11 mg.ml-1 (severe airway hyperresponsiveness) one week after she had returned to work. Specific inhalation challenges with polypropylene heated to 250 degrees C resulted in a late asthmatic reaction. As formaldehyde is one of the degradation products of heating polypropylene, we exposed her to it for up to 2 h, but we elicited no bronchospastic reaction. We conclude that heated polypropylene should be listed as one of the agents that causes occupational asthma AU - Malo JL AU - Cartier A AU - Pineault L AU - Dugas M AU - Desjardins A LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 4 IP - DP - 1994 Jan 01 TI - Dust and the sick building syndrome PG - 223-238 AU - Gyntelberg F AU - Suadicani P AU - Nielsen JW AU - Skov P AU - Valbjorn O AU - Nielsen PA AU - Schneider T AU - Jorgensen O AU - Wolkoff P AU - Wilkins CK AU - Gravesen S AU - Norn S LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 344 IP - DP - 1994 Jan 01 TI - Effects of domestic concentrations of nitrogen dioxide on airway responses to inhaled allergen in asthmatic patients PG - 1733-1736 AB - Nitrogen dioxide is a common indoor pollutant. In the light of suggestions that outdoor air pollution can harm people with asthma, we investigated the effect of 1 h exposures to domestic concentrations of nitrogen dioxide on the airway response to house-dust mite (HDM) allergen in ten patients with mild asthma. Each subject breathed air, 100 ppb nitrogen dioxide, or 400 ppb nitrogen dioxide for 1 h, in double-blind, random order, then immediately underwent a fixed-dose HDM challenge. Baseline forced expiratory volume in 1 s (FEV1) was not affected by any of the gas mixtures. The mean early asthmatic response (maximum percentage change in FEV1 during first 2 h after challenge) was -14.62% (SD 8.03) after air, -14.41% (7.86) after 100 ppb nitrogen dioxide, and -18.64% (7.28) after 400 ppb nitrogen dioxide. The difference between air and 400 ppb (-4.01%) was significant (95% CI -1.34 to -6.69%, p < 0.009), but those between air and 100 ppb and between 100 and 400 ppb were not (0.21 [-3.10 to 3.53]% and -4.23 [-8.75 to 0.29]%). The mean late asthmatic response (maximum percentage change in FEV1) to challenge after air was -2.85% (3.95), after 100 ppb nitrogen dioxide -7.76% (6.92), and after 400 ppb -8.13% (6.64). The difference in means between the air and 400 ppb exposures was significant (-5.28 [-0.73 to -9.83]%, p < 0.02) but those between air and 100 ppb (-4.90 [-10.60 to 0.78]%) and 100 and 400 ppb (0.37 [3.06 to 3.80]%) were not. These findings suggest that nitrogen dioxide, at concentrations encountered in the home environment, can potentiate the specific airway response of patients with mild asthma to inhaled HDM allergen, although the effect is small. AU - Tunnicliffe WS AU - Burge PS AU - Ayres JG LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 44 IP - DP - 1994 Jan 01 TI - Work-related respiratory disease in the United Kingdom, 1989-1992: report of the SWORD project PG - 183-189 AB - ^^ AU - Meredith SK AU - McDonald JC LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 45 IP - DP - 1994 Jan 01 TI - Immunologic reactions in poultry-processing workers [SerboCroatian (Roman)] PG - 31-38 AB - The relationship between respiratory symptoms and immunological reactions was studied in 57 female workers holding jobs in the poultry food processing industry and in 51 non-exposed female workers. The prevalence of all chronic respiratory symptoms was significantly higher in exposed than in control workers (P < 0.01) except for occupational asthma. The prevalence of chronic respiratory symptoms in exposed workers was highest for chronic cough (49.1%), followed by dyspnoea (43.9%), rhinitis (38.6%), chronic phlegm (31.6%) and chronic bronchitis (26.3%). Occupational asthma was found in 5.3% of exposed workers. Exposed workers with positive skin prick test to poultry food demonstrated a higher prevalence of all chronic respiratory symptoms than those with negative skin tests, although the difference was statistically significant only for rhinitis (P < 0.05). The most frequent positive skin reactions were found for poultry food extract (exposed: 66.7%; control: 25.5%; P < 0.05). Increased IgE serum level was found in 19 (33.3%) exposed and in four (7.8%) control workers (P < 0.01). Three exposed workers with occupational asthma demonstrated increased IgE serum level. Our data indicate that occupational exposure to poultry food dust may be associated with the development of chronic respiratory symptoms and immunological changes in exposed workers AU - Zuskin E AU - Mustajbegovic J AU - Kanceljak B AU - Stilinovic L LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 25 IP - DP - 1994 Jan 01 TI - Dust- and endotoxin-related acute lung function changes and work-related symptoms in workers in the animal feed industry PG - 877-888 AB - Reported respiratory and related symptoms during work were compared between 265 exposed animal feed workers and a control group consisting of 175 external controls and nonexposed workers in the animal feed industry. Symptoms indicating respiratory and nasal irritation were significantly increased in the animal feed workers. Prevalences ranged from 9% (cough) to 21% (sneezing). Reported cough after work was also significantly increased. In 119 workers, a total of 457 across-shift spirometric lung function changes were measured. Almost all lung function variables showed a decrease during the work shift, as could be expected since the circadian rhythm is in a downward phase during the measurement period (2 p.m.-10 p.m.). When the workers were grouped into dust and endotoxin exposure categories according to their job titles, and exposure-response trend was seen for maximum mid-expiratory flow (MMEF) and maximum expiratory flow rate at 50% of vital capacity (MEF50). The effect of endotoxin was stronger than that of dust, both in magnitude and significance. For the same lung function variables and for forced expiratory volume in 1 second (FEV1) and MEF25, a significant across-week change was also detected. The results of this study are in concordance with other studies that indicate acute effects on lung function and elevated prevalences of respiratory symptoms during work caused by exposure to grain dust AU - Smid T AU - Heederik D AU - Houba R AU - Quanjer PH LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Late asthmatic response to inhaled glacial acetic acid PG - 727-728 AB - A patient with bronchial asthma who developed a late asthmatic response to inhalation challenge with glacial acetic acid is presented. This is believed to be the first description of a reaction to this allergen in an asthmatic patient AU - Kivity S AU - Fireman E AU - Lerman Y LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 94 IP - DP - 1994 Jan 01 TI - A combined respiratory and cutaneous hypersensitivity syndrome induced by work exposure to quaternary amines PG - 257-9 AB - The quaternary amine, benzalkonium chloride, has been associated with cutaneous and mucosal delayed hypersensitivity reactions and with paradoxical bronchoconstriction after use of aerosolized asthma medications. Until now, quaternary amines have not been reported to cause occupational asthma. We describe a case of occupational asthma caused by prolonged exposure to a cleaning solution containing benzalkonium chloride in the workplace. Single-blind, placebo-controlled, open-room challenges were performed to determine the specific agent responsible for the patient's symptoms. Pulmonary function and epicutaneous challenge tests were also performed. The patient had positive responses to challenges with a liquid toilet bowl cleaner containing benzalkonium chloride but was unreactive to other agents tested. Removal from the workplace resulted in complete resolution of symptoms. The exact mechanisms responsible for occupational asthma induced by quaternary amines remain unknown; however, this case emphasizes the importance of recognizing reactive chemicals as possible causes AU - Bernstein JA AU - Stauder T AU - Bernstein DI AU - Bernstein IL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 22 IP - DP - 1994 Jan 01 TI - The case of TDI-induced reactive airway dysfunction syndrome with the presence of specific IgE antibodies PG - 80-82 AB - Reactive Airways Dysfunction Syndrome defines a chronic, nonallergic bronchoconstriction syndrome due to a brief, single inhalation exposure to highly concentrated irritant factors. Here we describe a case history of RADS in patient exposed to isocyanates with the presence of specific IgE antibodies. According to some authors only RAST ratio > 2.0 is a criterion of an allergic origin or TDI-induced respiratory disease, and a lower ratio is believed to be a proof only of an exposure. Negative effects of bronchial specific provocative tests confirmed the insignificance of the IgE-mediated mechanism in RADS and on the other side emphasized the possibility of incorrect diagnosis of TDI-induced bronchospastic syndromes AU - Palczynski C AU - Gorski P AU - Jakubowski J LA - PT - DEP - TA - Allergol Immunopathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 344 IP - DP - 1994 Jan 01 TI - Outbreak of organising pneumonia in textile printing sprayers. Collaborative Group for the Study of Toxicity in Textile Aerographic Factories PG - 498-502 AB - Eight textile printing factories in Valencia, Spain, with a total workforce of 257 using spraying techniques were investigated as a result of severe interstitial lung disease occurring in three employees, one of whom died. Clinical and radiological data together with biopsy specimens from 71 (27.6%) workers with abnormal respiratory features indicated the occurrence of an outbreak of organising pneumonia resulting in 6 deaths. Epidemiological analysis included the 22 workers who fulfilled the radiological case definition based on chest radiograph and computed tomographic scan showing widespread nodular opacities or confluent patchy consolidation with a lung biopsy corresponding to organising pneumonia. The overall attack rate was 8.9%. Only 2 of the 22 cases never worked in factories A or B. Those who had only worked in factory A had the highest risk of being a case (RR = 24.3; 95% CI = 5.7-104.4). The relationship of case status to period of employment suggested an abrupt change in exposure conditions in the period when Acramin FWR was substituted by Acramin FWN. Although the precise toxicological mechanism is unknown, it is proposed that the lung disease was caused by spraying procedures delivered a respirable aerosol of Acramin FWN to distal airways and pulmonary parenchyma AU - Moya C AU - Anto JM AU - Taylor AJ LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 48 IP - DP - 1994 Jan 01 TI - Epidemiology of predominantly occupationally-induced bronchopulmonary diseases [German] PG - 391-394 AB - During the last years occupational diseases are of increasing interest. This lead to an increased sensibility which results in a continuous increase of the number of announcements of suspicion of an underlying occupational diseases. The rate of cases first remunerated remains nevertheless constant. The number of diseases caused by inorganic and organic dusts and the obstructive airway-diseases increase despite of the continuous decrease of silicosis. Among the diseases first remunerated in 1990, occupational diseases caused by inorganic dusts took up the first place (31.6%). As for the deaths in 1990, 91% are due to diseases caused by inorganic dusts AU - Liebetrau G LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 344 IP - DP - 1994 Jan 01 TI - Siderosilicosis due to photocopier toner dust [letter] PG - 412-413 AU - Gallardo M AU - Romero P AU - SanchezQuevedo MC AU - LopezCaballero JJ LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Medicolegal and compensation aspects of occupational asthma. [Review] PG - 969-980 AB - The medicolegal aspects (primary prevention, secondary prevention or surveillance) and the system of compensation (tertiary prevention) for occupational asthma are reviewed in this article. Due to the significant medical, medicolegal, social and financial consequences, it is of the utmost importance that the diagnosis of occupational asthma be proved by objective means, whenever feasible. Compensation for temporary and permanent disability/impairment should be offered to workers. Attempts to retain subjects rapidly and efficiently are preferable, as occupational asthma generally affects young workers. The evaluation of permanent asthma and the awarding of relative permanent disability compensation should be effected 2 yrs after exposure to the causative agent has ended, as asthma generally persists even after exposure to the causative agent ceases. A tabulated review of prevailing medicolegal compensation systems in various countries is presented. Data on an evaluative assessment of the Quebec system of compensation are included. [References: 49] AU - Dewitte JD AU - ChanYeung M AU - Malo JL LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Management of occupational asthma PG - 961-968 AB - The importance of occupational asthma and its management is usefully set in perspective by considering recent trends of increasing asthma incidence, morbidity and mortality in the population at large. The contribution to incidence made by asthma of occupational origin is of the order 20-100 cases per million workers per year; the individual worker's lifetime risk approaching 5% in some industrial environments. Management of the affected industry inevitably follows different pathways from that of the affected individual, though both need to start from a definitive diagnosis. For the affected industry, managers must identify the causative agent and assess the extent of the problem. Affected workers can then be removed from hazardous settings, and meaningful strategies of prevention can be introduced. The most promising preventive measures involve improvements in industrial hygiene or the substitution of alternative agents in the manufacturing process. The role of worker selection (i.e. the exclusion of applicant workers who may be unduly susceptible because they smoke, or have existing airway hyperresponsiveness or atopy) is small and controversial. More valuable is a strict surveillance programme of workers perceived to be at risk, so that emerging disease is recognized promptly, before it poses any major threat of permanent ill-health. Management choices beyond conventional medication and the avoidance of irritant environmental triggers are greatly limited for the affected individual worker. A change of job environment with complete cessation of exposure to the relevant asthma-inducing agent is to be favoured and offers the best chance of full recovery, but may not be practical if the worker is to avoid permanent unemployment.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Hendrick DJ LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 150 IP - DP - 1994 Jan 01 TI - Respiratory symptoms and dust exposure in Lancashire cotton and man-made fiber mill operatives PG - 441-447 AB - A cross-sectional study of work-related symptoms and cotton dust exposure was made in 404 man-made fiber and 1,048 cotton operatives in Lancashire spinning mills; 39 cotton-exposed operatives (3.7%) had symptoms of byssinosis. This was associated on regression analysis with cumulative lifetime cotton dust exposure (p < 0.001), total years spent carding (p < 0.001), and currently working in the carding area (p = 0.0041). Smoking habit did not differ significantly between byssinotic and nonbyssinotic workers. Other work-related symptoms were common: chronic bronchitis (CB) and persistent cough. The prevalence of CB correlated positively with dust exposure (r = 0.59). Cotton dust sampling was performed in the work area (SDPRES) and personal breathing zone (PD1). A retrospective estimate of lifetime cotton dust exposure based on SDPRES correlated best with the prevalence of byssinosis (r = 0.797), although correlations with PD1 (r = 0.709) and SDPRES (r = 0.594) were also significant AU - Fishwick D AU - Fletcher AM AU - Pickering CAC AU - Niven RM AU - Faragher EB LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Portable peak flow meters: physical characteristics, influence of temperature, altitude, and humidity PG - 991-997 AB - Little is known about the linearity of portable peak flow meters, or about physical gas factors affecting peak expiratory flow (PEF) readings. We therefore tested five portable peak flow meters of three types in an altitude chamber (sea level to 5,500 m) and in a climate chamber at sea level (7-37 degrees C) to determine the influence of the physical conditions of the gas on the reading of the meters. The nonlinear response of the variable orifice meters was confirmed and, when this was corrected for, the readings of these meters were found to be significantly reduced by higher altitude and lower temperature. The readings from a turbine type of peak flow meter were not affected by altitude but were reduced at low temperature. A mathematical model for the variable orifice meters could correct for both their nonlinear behaviour and the effect of gas density (altitude, temperature and humidity). The model showed that correction is not necessary for the differences in gas conditions between calibration and taking of measurements under normal laboratory conditions. All the meters tested had impedances higher than recommended (0.05 kPa.l-1.s) and this may influence PEF at high flows. The mean uncorrected PEF of six healthy subjects when measured with a Mini Wright peak flow meter at sea level and at 3, 000 m fell by 5%, but the mean corrected PEF increased by 12%. This increase in PEF was about 60% of that predicted for fully density-dependent flow and agreed with the findings of other similar studies.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Pedersen OF AU - Miller MR AU - Sigsgaard T AU - Tidley M AU - Harding RM LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 308 IP - DP - 1994 Jan 01 TI - Peak flow meters: a problem of scale [editorial] PG - 548-549 AU - Miller MR AU - Ouanjer PH LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 149 IP - DP - 1994 Jan 01 TI - Discrepancies between longitudinal and cross-sectional change in ventilatory function in 12 years of follow-up PG - 1218-1226 AB - We compared the age dependence of cross-sectional and longitudinal changes in ventilatory function. FEV1, FVC, and data on chronic respiratory symptoms were obtained from 4,395 adults in a longitudinal survey of normal populations in two different areas in the Netherlands. They participated in up to five surveys at 3-yr intervals between 1972 to 1973 and 1984 to 1985. The ventilatory function in the oldest cohorts is substantially lower than might have been expected from the longitudinal change in the youngest cohorts. This holds for males and females, smokers and nonsmokers, subjects with or without symptoms, and for both survey populations. The robustness of the findings is demonstrated by various data-analytic strategies or omitting one or two of the five surveys from the analysis. Selective loss to follow-up cannot explain the discrepancy. It is concluded that the main differences between our longitudinal and cross-sectional findings may be due to a cohort effect. The implication is that in longitudinal studies of populations at risk, reference equations based on cross-sectional surveys may overestimate longitudinal change and hence lead to underestimating effects of exposure. Similarly, in clinical studies, accelerated decline in ventilatory function may be underrated if it is compared with cross-sectional standards. In older people at any one age the ventilatory function seems to improve in successive birth cohorts AU - van Pelt W AU - Borsboom GJ AU - Rijcken B AU - Schouten JP AU - van Zomeren BC AU - Quanjer PH LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Prevention of thermal and condensation errors in pneumotachographic recordings of the maximal forced expiratory manoeuvre PG - 198-201 AB - When recording respiratory manoeuvres using a pneumotachograph (PT), it is customary to heat the pneumotachograph head to avoid condensation errors. It is technically demanding to heat the PT correctly, and this increases the complexity of the equipment. We have studied whether a simpler method can eradicate condensation errors and preserve thermal stability of the PT. We tested the accuracy of a PT by recording the discharge of 1,000 ml of air through the PT before and after a subject had blown through it, thus causing both condensation within the PT and a rise in its temperature. We then determined whether the thermal and condensation errors could be avoided by placing the PT, between blows, on a fan that was blowing air at a constant 1.65 l.s-1. With ambient temperature at 20 degrees C, a single blow through the PT was found to cause a subsequent 4% over-reading in volume, due to condensation and temperature changes in the PT. After five consecutive blows the error was 7%. Placing the PT on the fan for 15 s after a single blow abolished these errors, whereas a wait of 15 s did not. At an ambient temperature of 14 degrees C there was a 5% over-reading of volume after a single blow, and an over-reading of 9% after five blows. At an ambient temperature of 26 degrees C these errors were 3 and 5%, respectively. All of these errors were abolished by placing the PT on the fan for 15 s and 30 s, respectively.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Miller MR AU - Sigsgaard T LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 55 IP - DP - 1994 Jan 01 TI - Size-selective pulmonary dose indices for metal-working fluid aerosols in machining and grinding operations in the automobile manufacturing industry PG - 20-29 AB - The current metal-working fluid exposures at three locations that manufacture automotive parts were assessed in conjunction with epidemiological studies of the mortality and respiratory morbidity experiences of workers at these plants. A rationale is presented for selecting and characterizing epidemiologic exposure groups in this environment. More than 475 full-shift personal aerosol samples were taken using a two-stage personal cascade impactor with median size cut-offs of 9.8 microns and 3.5 microns, plus a backup filter. For a sample of 403 workers exposed to aerosols of machining or grinding fluids, the mean total exposure was 706 micrograms/m3 (standard error (SE) = 21 micrograms/m3). Among 72 assemblers unexposed to machining fluids, the mean total exposure was 187 +/- 10 (SE) micrograms/m3. An analysis of variance model identified factors significantly associated with exposure level and permitted estimates of exposure for workers in the unsampled machine type/metal-working fluid groups. Comparison of the results obtained from personal impactor samples with predictions from an aerosol-deposition model for the human respiratory tract showed high correlation. However, the amount collected on the impactor stage underestimates extrathoracic deposition and overestimates tracheobronchial and alveolar deposition, as calculated by the deposition model. When both the impactor concentration and the deposition-model concentration were used to estimate cumulative thoracic concentrations for the worklives of a subset of auto workers, there was no significant difference in the rank order of the subjects' cumulative concentration. However, the cumulative impactor concentration values were significantly higher than the cumulative deposition-model concentration values for the subjects AU - Woskie SR AU - Smith TJ AU - Hallock MF AU - Hammond SK AU - Rosenthal F AU - Eisen EA AU - Kriebel D AU - Greaves IA LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Comparison of circadian variations using FEV1 and peak expiratory flow rates among normal and asthmatic subjects PG - 775-780 AB - BACKGROUND--Most studies that describe circadian variations in asthma have used maximum rate of peak expiratory flow (PEF) rather than forced expiratory volume in one second (FEV1) to assess airway calibre. This study was designed to assess circadian variations in PEF and FEV1 measured simultaneously and to compare variations in these measurements in normal and asthmatic subjects in a stable clinical state. METHODS--Twenty nine subjects (nine asthmatic subjects on bronchodilators, 10 on inhaled steroids, and 10 normal controls) were asked to record their PEF and FEV1 with a new portable instrument every two hours during the day and once on waking at night for two weeks. Circadian variations were examined in different ways using arithmetical indices and cosinor analysis. RESULTS--78% of PEF values and 75% of FEV1 values were considered to be reproducible and were included in the analysis. Variations obtained using PEF did not differ from those obtained using FEV1. Significant cosinor variations were found in at least 50% of recording days for most of the subjects and showed the same features as for arithmetical indices. Daily variations in PEF and FEV1 were significantly correlated with airway calibre and PC20 methacholine (r approximately 0.5 to approximately 0.6). CONCLUSIONS--PEF is as satisfactory as FEV1 for describing circadian variations among normal subjects and stable asthmatic subjects AU - Troyanov S AU - Ghezzo H AU - Cartier A AU - Malo JL LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 24 IP - DP - 1994 Jan 01 TI - IgE-binding components of wheat, rye, barley and oats recognized by immunoblotting analysis with sera from adult atopic dermatitis patients PG - 481-489 AB - The allergen extracts of wheat, rye, barley and oats flours were characterized by IgE-immunoblotting with serum samples from 40 adult patients; 35 patients with atopic dermatitis, one with rhinitis and four with urticaria. All these patients had been positive when skin-prick testing was carried out with one or more of the four flour extracts or displayed one or more positive cereal RAST results. Four non-atopic sera were used as negative controls. Acidic and neutral protein extracts of wheat, rye, barley and oats flours were processed for the immunoblotting experiments and 35 patients appeared positive in IgE immunoblotting with wheat and rye, 32 with barley and 33 with oats. The IgE immunoblots showed polyspecific binding patterns; wheat exhibited 36 IgE stained bands, rye 35, barley 33 and oats 10. Eighteen of the IgE stained bands could be classified as intermediate allergens for wheat, 23 for rye and 15 for barley. The 66 kDa protein in oats was visualized by 28 out of 33 sera (84%), however, there was evident non-specific binding to this region and thus it may also represent lectin-like binding. The most frequent staining with wheat extract was seen in the 26 kDa protein region (15/35, 43%), with rye in the 40 kDa (16/35, 46%) and with barley in the 26 and 46 kDa protein bands (14/32, 44%). Simultaneous staining with wheat, rye and barley extracts were observed with 16 bands suggesting crossreactivity between these cereals AU - Varjonen E AU - Savolainen J AU - Mattila L AU - Kalimo K LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 24 IP - DP - 1994 Jan 01 TI - Incidence and risk factors for latent sensitization to chymopapain: predictive skin-prick tests in 700 candidates for chemonucleolysis PG - 471-476 AB - Seven hundred patients were investigated prospectively before undergoing chemonucleolysis. A past history of allergy and/or previous exposure to papain, either in food, beverages or drugs, was sought, and a skin-prick test with chymopapain was performed. Based on the results obtained, the subjects were classified into four groups: Group I--225 non-atopic non-papain-exposed subjects; Group II--285 non-atopic papain-exposed subjects; Group III--69 atopic non-papain-exposed subjects; and Group IV--121 atopic papain-exposed subjects. Latent sensitization to papain was observed in 0.4% of subjects in Group I, 3.16% in Group II, 5.8% in Group III and 7.4% in Group IV. The odds ratios were 13.8 for atopy and 7.3 for exposure to papain. Interaction between atopy and papain exposure did not result in a significantly greater risk. Neither sex nor age nor a history of a previous drug reaction were risk factors. Only one patient out of the 23 who were sensitive to papain had no risk factor. The 677 skin-test negative patients then underwent chemonucleolysis and none of them had an anaphylactic reaction. This was significantly less frequent: (P = 0.04) than the incidence in a random population (0.45%). Prick tests performed 6 weeks and 6 months after chemonucleolysis revealed newly acquired sensitization in 36% of the patients. Atopy was not a risk factor for this event.(ABSTRACT TRUNCATED AT 250 WORDS) AU - MoneretVautrin DA AU - Feldmann L AU - Kanny G AU - Baumann A AU - Roland J AU - Pere P LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 24 IP - DP - 1994 Jan 01 TI - Measurement of airborne protein allergens in occupational asthma [editorial; comment] PG - 405-406 AU - Gompertz D LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Animal models of occupational asthma. [Review] PG - 555-568 AB - Occupational asthma is characterized by variable airflow obstruction occurring in the workplace. The presence of airways inflammation and hyperreactivity provides further evidence for the disease. Since its pathogenic mechanism(s) are unknown, animal models have been developed to investigate the various disease processes, as well as to enable study of environmental and genetic factors which may contribute to disease development. Numerous parameters can be measured in animal systems, including specific and total immunoglobulin E (IgE), pulmonary eosinophilia, diaphragm contractions and airflow muscle hypertrophy. It is recognized that no single factor is sufficient to lead to a conclusion of occupational asthma, but rather that a selected combination of parameters is most fitting. Animal species selected for study have included: mice, rats, guinea-pigs, rabbits, sheep, horses and nonhuman primates. A guinea-pig system has been utilized for more than 90 yrs and has contributed to the basic understanding of physiological and immunological processes involved in allergic respiratory sensitization. The benefits as well as the disadvantages to be derived from each of the animal systems have been enumerated in this review. Certain caveats must be recognized in using animal systems. Attention must always be given to identifying differences which exist between animal and human systems, including morphological, physiological and immunological factors. The extent of bronchus-associated lymphoid tissue (BALT) differs greatly among animal species and probably plays a major role in development of allergic responsiveness in animals. In using animal systems, it must be appreciated that animals are only surrogates. Results from such studies must be compared with information obtained from clinical evaluation in order to avoid faulty extrapolations. Prudent employment of animal models is expected to advance the recognition, treatment and prevention of occupationally-based asthma. [References: 64] AU - Karol MH LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Oilseed rape and seasonal symptoms: epidemiological and environmental studies PG - 352-356 AB - BACKGROUND--There is widespread concern that the cultivation of oilseed rape leads to seasonal epidemics of respiratory symptoms in populations living in the neighbourhood, and it has been suggested that the plant is a potent allergen. A study was therefore undertaken to determine the prevalence of seasonal symptoms in rural populations close to and far from areas of oilseed rape cultivation, and to measure the levels of allergen and other potentially harmful substances released by the crop. METHODS--Random samples of 1000 adults from the general practice populations of two villages surrounded by oilseed rape fields, and 1000 adults from one village far from such cultivation, were taken. The subjects completed a previously validated questionnaire on respiratory and other symptoms, including questions on symptom seasonality, occupation, and smoking habits. Pollen and fungal spore counts were made around fields of oilseed rape and in the villages. The chemicals released by oilseed rape were measured in the field. RESULTS--Overall, 86.8% of the subjects completed the questionnaires and the populations of the two samples were generally comparable. Spring and summer exacerbations of symptoms occurred equally in the two areas in approximately 25% of the population. There were small but significant excesses of cough, wheeze, and headaches in spring in the oilseed rape area (2.3% v 1.1%, 6.8% v 4.6%, and 4.8% v 2.8%, respectively), and cough, wheeze, and itchy skin were more prevalent in smokers. Counts of oilseed rape pollen were generally low except adjacent to fields, and counts of fungal spores were mostly higher in the rape than the non-rape areas. Oilseed rape was shown to give off terpenes and these were detected close to fields. CONCLUSIONS--While it is likely that a proportion of the spring symptoms occurring in people living in close proximity to oilseed rape is caused by the plant, the excess of such symptoms is small. This, together with the low levels of pollen in the area, suggests that allergy to oilseed rape pollen is uncommon. The general prevalence of seasonal symptoms in rural areas is of interest, and a proportion of these cases is likely to be caused by factors other than allergy. Release of chemicals by plants and natural rises in summer ozone levels may be contributors AU - Soutar A AU - Harker C AU - Seaton A AU - Brooke M AU - Marr I LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Bronchial responsiveness and decline in FEV1 in aluminium potroom workers PG - 888-894 AB - We have investigated the relationship between annual decline in forced expiratory volume in one second (delta FEV1) and bronchial responsiveness (BR) in aluminium potroom workers. BR was measured in a cross-sectional study of 337 aluminium potroom workers half-way through a 6 yr follow-up study of lung function. A skin-prick test (SPT) was also performed. During follow-up the mean number of measurements of lung function (FEV1) in each subject was 6.8. Mean delta FEV1 was 21.3 ml.yr-1 (within subject SD = 30.5 ml.yr-1). Mean delta FEV1 was 57.0, 44.5 and 16.6 ml.yr-1 in subjects who had provocative concentration producing a 20% fall in FEV1 (PC20) < or = 8.0, 8.1-32.0 and > 32.0 mg.ml-1, respectively. After adjustment for gender, atopy, smoking habit, FEV1, age and familial asthma the association between BR and delta FEV1 was weakened, and was not statistically significant. A significantly accelerated decline in FEV1 with age was found. The difference in delta FEV1 between smokers and nonsmokers was 39.3 ml.yr-1, and between subjects who had a positive skin-prick test compared to subjects with a negative skin-prick test 39.6 ml.yr-1. In subjects reporting work-related asthmatic symptoms the decline in FEV1 was 43.2 ml.yr-1 greater than in asymptomatic subjects. In asymptomatic subjects, positive skin-prick test was also associated with increased delta FEV1. These data indicate that a single measurement of BR is not a predictor of delta FEV1 in aluminium potroom workers. Smoking, work-related asthmatic symptoms, and positive reaction to skin-prick test in asymptomatic workers were risk factors of increased delta FEV1 AU - Soyseth V AU - Kongerud J AU - Kjuus H AU - Boe J LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 25 IP - DP - 1994 Jan 01 TI - Influence of bedding, cage design, and stock density on rat urinary aeroallergen levels PG - 89-89 AU - Taylor AJ AU - Gordon S AU - Tee RD LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 105 IP - DP - 1994 Jan 01 TI - Pleural plaques and risk for bronchial carcinoma and mesothelioma. A prospective study PG - 144-150 AB - From the general population in the county of Uppsala, Sweden, 1, 596 men with pleural plaques fulfilling strict radiologic criteria were identified from 1963 until June 1985. The men have been followed prospectively for 16,369 person-years. The number of mesotheliomas and bronchial carcinomas was compared with the age- and year-specific expected incidence from the official cancer registry of Sweden. Fifty bronchial carcinomas occurred, while 32.1 were expected after correction for smoking habits, a difference which was statistically significant. Patients with radiologic asbestosis were overrepresented among those with bronchial carcinoma. The risk for patients with pleural plaques without asbestosis was increased 1.4 times, which was statistically significant. There were 9 mesotheliomas, while only 0.8 were expected. The mean latency time from first exposure to diagnosis of bronchial cancer was 44.1 years and for mesothelioma was 48.1 years. Thus, pleural plaques on the chest roentgenogram indicate significant exposure to asbestos, with an increased risk for mesothelioma and possibly also for bronchial carcinoma. Any person found to have plaques on chest roentgenogram should be informed of them and should be persuaded to stop smoking AU - Hillerdal G LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 95 IP - DP - 1994 Jan 01 TI - Avidity of Aspergillus umbrosus IgG antibodies in farmer's lung disease PG - 162-165 AB - Farmer's lung disease (FL), the commonest form of allergic alveolitis caused by repeated inhalation of mouldy hay, is associated with exposure to the fungus Aspergillus umbrosus among Finnish farmers. The antigen-binding avidity of A. umbrosus-specific IgG antibodies was measured in 12 FL patients in acute phases of initial and recurrent attacks and during 1 year follow up as well as in 12 healthy farmers and five healthy urban controls. The farmers' groups were further divided into two subgroups: subjects with short exposure (< 7 years) and subjects with long exposure (> 25 years). During the first acute phase FL patients with long exposure exhibited a high avidity of A. umbrosus-specific IgG antibodies that remained high during the 1 year follow up, although the A. umbrosus-specific IgG antibody titre decreased. A re-exposure to mouldy hay leading to a recurrence further enhanced the maturation of the antibody avidity, so that an even higher A. umbrosus-specific IgG avidity with a less significant increase of antibody titre occurred than during the first acute attack. Notably higher IgG antibody avidity was observed in FL patients with long exposure than in healthy farmers or in healthy controls AU - Kaukonen K AU - Savolainen J AU - Viander M AU - Terho EO LA - PT - DEP - TA - Clin Exp Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 92 IP - DP - 1994 Jan 01 TI - Pulmonary fibrosis and occupational exposure to aluminum PG - 59-61 AB - Many reports of respiratory disease attributable to aluminum exposure have appeared in the European medical literature during the last 50 years. Great Britain and Germany are two major industrialized nations that acknowledge a causal relationship between occupational exposure to aluminum and respiratory impairment. For factory workers in these countries, pulmonary disease attributed to respirable aluminum particulates is compensated as a workplace disability. In North America, however, there is a lack of consensus regarding the pathogenicity of aluminum fumes and dust to the worker. This view may be based on a difference in the types of industrial usage, the updated methods of aluminum processing in this country, or the benefits of a modern workplace. It has also been proposed that the development of aluminum-induced pulmonary disease may depend on a particular host factor that has not yet been identified. We describe a patient whom we believe developed severe respiratory compromise and irreversible pulmonary fibrosis from a lifetime of industrial aluminum exposure AU - alMasalkhi A AU - Walton SP LA - PT - DEP - TA - J Ky Med Assoc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 93 IP - DP - 1994 Jan 01 TI - Occupational asthma caused by milk proteins: report on a case PG - 799-801 AU - Rossi GL AU - Corsico A AU - Moscato G LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Bronchial provocation testing in the diagnosis of occupational asthma due to latex surgical gloves PG - 332-336 AB - In sensitized subjects, provocation tests to latex may induce severe systemic reactions and even anaphylactic shock. It is probable that part of the risk is due to the difficulty in grading the stimulating dose and in starting from very low levels of exposure. To identify the aetiological agent of work-related asthma in four nurses with previous allergic contact urticaria to latex surgical gloves dusted with cornstarch powder, we performed a specific bronchial provocation test study, based on exposure on three different days to nonpowdered latex surgical glove extract, powdered latex surgical glove extract and cornstarch powder extract, respectively. Extracts were nebulized in increasing concentrations in a 7 m3 challenge room, in the absence of the patients. The initial extract concentration was a tenfold dilution of the predetermined skin test end-point in the individual undergoing challenge, and the highest concentration was the undiluted extract. After exposure, the patients' forced expiratory volume in one second (FEV1) was monitored for 2 h. If FEV1 decreased by at least 15%, the next scheduled exposure was not carried out and FEV1 was monitored over a period of 24 h. Whereas nebulization of cornstarch powder extract caused no bronchial reaction in the patients, nebulization of nonpowdered latex surgical glove extract induced immediate bronchoconstriction in two subjects as an undiluted solution, and nebulization of powdered latex surgical glove extract induced immediate bronchoconstriction in all subjects at the 1:10 dilution. No systemic reaction was elicited by the bronchial provocation challenges. Our results demonstrate that airborne powder from latex gloves can be an inhalative occupational hazard.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Pisati G AU - Baruffini A AU - Bernabeo F AU - Stanizzi R LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 105 IP - DP - 1994 Jan 01 TI - Eosinophilic lung reaction to aluminium and hard metal PG - 1261-1263 AB - A nonsmoker drill polisher with interstitial lung disease is presented. The environmental exposure was mainly to aluminum oxide, aluminum silicate, and hard metals. Bronchoalveolar lavage revealed high eosinophilia, and transbronchial biopsy specimen disclosed interstitial pneumonia with giant cell infiltrates and peribronchiolar accumulation of macrophages laden with opaque dust. Mineralogic studies done from the tissue revealed a high concentration of exogenous particles that were identified as hard metals and aluminum silicate. These findings are compatible with hard metal pneumoconiosis AU - Schwarz YA AU - Kivity S AU - Fischbein A AU - Ribak Y AU - Fireman E AU - Struhar D AU - Topilsky M AU - Greif J LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 105 IP - DP - 1994 Jan 01 TI - Mast cell and histamine involvement in farmer's lung disease PG - 1184-1189 AB - The aim of this study was to evaluate the cellular and biochemical characteristics of the bronchoalveolar lavage (BAL) fluid in patients with farmer's lung disease (FLD). Total cell numbers in BAL fluids from patients with FLD (n = 30) were significantly higher than in normal subjects (n = 7; p < 0.01), and differential cell counts were significantly different. Lymphocytes were the most numerous cell type in BAL fluids from patients with FLD (65.4 +/- 2.5 percent vs 6.8 +/- 0.5 percent), and analysis of lymphocyte subsets revealed increased percentages of CD3+ and CD8+ cells (91.8 +/- 0.9 percent vs 68.8 +/- 3 percent, p < 0.01, and 54.3 +/- 3.1 percent vs 30.1 +/- 3.2 percent, p < 0.01, respectively). A marked increase in mast cell numbers, as revealed by the specific alcian blue/safranin staining, was observed in patients with FLD (4.2 +/- 0.57 percent, n = 12, vs 0.18 +/- 0.04 percent, n = 7, p < 0.001). Histamine levels in BAL supernatants were increased in patients with FLD (mean = SEM, 4.4 +/- 0.8 ng/ml vs 0.9 +/- 0.1 ng/ml; median, 2.4 ng/ml vs 0.9 ng/ml, p < 0.01), and correlated positively with mast cell numbers and percentages (r = +0.63, p < 0.03, and r = +0.69, p < 0.02, respectively); conversely, a negative correlation was found between histamine levels and CD8+ lymphocyte percentages (r = -0.48, p < 0.01). Raised neutrophil percentages (5.1 +/- 0.8 vs 0.5 +/- 0.18, p < 0.05) and albumin concentrations (29.2 +/- 3.9 mg/dl vs 3.4 +/- 1.3 mg/dl, p < 0.01) were also found in patients with FLD. These findings show that increased numbers of mast cells, lymphocytes, and neutrophils can be found in BAL fluids of patients with FLD. The increased histamine levels in the supernatants of BAL fluids indicate that mast cells are activated. These data allow us to postulate a role for mast cell accumulation and histamine release in the inflammatory process of FLD AU - Miadonna A AU - Pesci A AU - Tedeschi A AU - Bertorelli G AU - Arquati M AU - Olivieri D LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 88 IP - DP - 1994 Jan 01 TI - Induction of respiratory hypersensitivity to diphenylmethane-4, 4'-diisocyanate (MDI) in guinea pigs. Influence of route of exposure PG - 15-30 AB - The induction of respiratory sensitization in guinea pigs to diphenylmethane-4,4'-diisocyanate (MDI), a known human respiratory allergen, has been investigated and different routes of exposure compared. Guinea pigs were exposed to MDI by i.d. injection, by topical application or by inhalation. Pulmonary hypersensitivity was measured subsequently as a function of changes in respiratory rate following challenge with atmospheres containing MDI. In addition, contact hypersensitivity was measured by topical challenge and antibody responses evaluated by enzyme-linked immunosorbent assay (ELISA) and passive cutaneous anaphylaxis (PCA). Attempts to sensitize guinea pigs by inhalation exposure to MDI were unsuccessful. Antibody responses and contact sensitization were both infrequent and low grade, and no animals exhibited pulmonary responses following challenge with atmospheric MDI. In contrast, sensitization by either i.d. injection or topical application of MDI induced antibody responses in the majority of animals. Moreover, a proportion of animals in each case exhibited pulmonary responses following subsequent inhalation challenge. These data indicate that the route of exposure influences markedly the effectiveness of sensitization to respiratory allergens such as MDI and that skin contact may be an important cause of occupational respiratory allergy AU - Rattray NJ AU - Botham PA AU - Hext PM AU - Woodcock DR AU - Fielding I AU - Dearman RJ AU - Kimber I LA - PT - DEP - TA - Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 24 IP - DP - 1994 Jan 01 TI - Sputum eosinophilia after asthmatic responses induced by isocyanates in sensitized subjects PG - 29-34 AB - To assess the nature and the time-course of the cellular component of airway inflammation induced by isocyanates, we examined nine subjects with occupational asthma induced by toluene- or methylene diphenyl-diisocyanate (TDI, MDI) and four control subjects never exposed to isocyanates. Sputum was induced by inhalation of ultrasonically nebulized hypertonic saline (3-4% NaCl) before and 8, 24, 48 h after inhalation challenge with TDI or MDI. Expectorated samples were incubated with dithiothreitol, washed and cytocentrifuged. Differential cell counts were obtained on slides stained with May-Grunwald-Giemsa. Metachromatic cells (mast cells and basophils) were counted on slides stained with toluidine blue at pH 0.1. One occupational asthmatic exhibited a dual reaction to TDI, two exhibited a single early asthmatic reaction to MDI, six exhibited a late asthmatic reaction to TDI (n = 5) or MDI (n = 1), whereas no reactions were observed in control subjects after TDI challenge. In sensitized subjects eosinophils increased from a median value (interquartile range) of 5 (15)% before challenge to 29 (29)% (P = 0.014) and to 30 (31)% (P = 0.031) 8 and 24 h after TDI/MDI challenges, respectively. Sputum eosinophilia was observed both in early and late reactors and declined to near to baseline values 48 hr after challenge. Percentages of eosinophils in control subjects did not exceed 7% during the study.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Maestrelli P AU - Calcagni PG AU - Saetta M AU - Di Stefano A AU - Hosselet JJ AU - Santonastaso A AU - Fabbri LM AU - Mapp CE LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Influence of barn drying of fodder on respiratory symptoms and function in dairy farmers of the Doubs region of France PG - 50-53 AB - BACKGROUND--A previous study showed there to be fewer microorganisms (especially thermophilic actinomycetes) on farms with artificial barn drying of fodder than on those using traditional storage methods. A cross sectional study was performed to see whether barn drying provides protection against respiratory problems in dairy farmers. METHODS--The respiratory symptoms and function of a group of 123 farmers with daily exposure to cattle foddering from farms which had had a barn drying system for at least three years were compared with those of a representative sample of 274 farmers working in farms with traditional storage in five districts in the Doubs region of France. RESULTS--Both groups were comparable for mean age, weight, height, smoking habits, alcohol consumption, past history of respiratory disease, history of allergy, geographical location of the farm, and length of exposure. Retrospectively estimated exposure to fodder was greater in the group using a barn drying system than in the group working with traditional storage. Acute symptoms at exposure (rhinitis, eye irritation, dry cough, asthma symptoms) and chronic symptoms all tended to be less frequent in the barn drying group, although not individually significantly so. Mean (SD) respiratory function parameters were higher in the barn drying group than in the traditional group: % vital capacity (VC) 104 (14) v 102 (15); % forced expiratory volume in one second (FEV1) 99 (14) v 94 (18); % FEV1/VC 96 (11) v 92 (16); % forced mid expiratory flow (FEF25-75) 87 (24) v 79 (25). CONCLUSION--The results of this cross sectional study suggest that barn drying of fodder may protect respiratory function in dairy farmers AU - Dalphin JC AU - Polio JC AU - Pernet D AU - Maheu MF AU - Toson B AU - Dubiez A AU - Monnet E AU - Laplante JJ AU - Depierre A LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Aluminium potroom asthma: the Norwegian experience PG - 165-172 AB - Work-related asthma in aluminium potroom workers, is reviewed and discussed, mainly on the basis of own investigations. The occurrence of work-related asthma has been shown to be associated with the duration of potroom employment, although the prevalence of asthmatic symptoms is not significantly different from that of the general population. Typical manifestations of occupational asthma are described in potroom workers, and a close relationship between the levels of fluoride exposure and work-related asthmatic symptoms has been observed. The existence of occupational asthma in aluminium potroom workers has been confirmed by characteristic patterns of repeated peak flow measurements, supported by changes in methacholine responsiveness in workers with suspected work-related asthma. However, no immunological test is available to establish the diagnosis. Methacholine challenge appears to be inappropriate for screening aluminium potroom workers in order to detect work-related asthma. Current smoking, but not self-reported allergy, is a risk factor for potroom asthma. A family history of asthma and previous occupational exposure may have some effect on the risk of developing symptoms. The prognosis of potroom asthma seems to depend on early replacement to unexposed work. The pathogenetic mechanisms are unknown, although some studies indirectly imply a hypersensitivity reaction. Future studies involving specific bronchial challenge appear to be necessary to find the causal agent(s) of aluminium potroom asthma. [References: 60] AU - Kongerud J AU - Boe J AU - Soyseth V AU - Naalsund A AU - Magnus P LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - The epidemiology of occupational asthma. [Review] PG - 161-164 AB - With the accelerating pace of new knowledge about occupational asthma, systematic epidemiological approaches have yielded important new insights into its clinical characteristics. Such questions as "what proportion of all cases of asthma are caused by occupational exposures?" and "is occupational asthma incidence rising?" can now be answered. Surveillance programmes estimate the number of exposed individuals and the number of incident cases, allowing us to perceive the magnitude of the health problem. Although occupational asthma is a relatively common illness, very little is known about quantitative exposure-response relationships. Epidemiological techniques can quantify the importance of predisposing factors, such as atopy or cigarette smoking, in determining individual risk factors for occupational asthma. Still to be determined are the major, possibly genetic factors which make occupational asthma an "idiosyncratic" illness, affecting only a minority of those with equivalent exposures in the workplace. The goal of applying epidemiological techniques to the study of occupational asthma is ultimately to identify more effective means to prevent its occurrence. [References: 23] AU - Beckett WS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Definition and diagnosis of occupational asthma. PG - 153-160 AB - Asthma is the most frequent occupational lung disease. The diagnosis of occupational asthma, defined as variable airways narrowing, causally related to exposure in the working environment to specific airborne dusts, gases, vapours or fumes, needs to be confirmed by objective means. This article reviews the different steps of investigation which are: history, pulmonary function tests, immunological tests, monitoring of peak expiratory flows and nonallergic bronchial responsiveness and, finally, the gold standard, specific bronchial provocation. AU - Cartier A LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 24 IP - DP - 1994 Jan 01 TI - Hypersensitivity pneumonitis induced by Penicillium expansum in a home environment PG - 383-385 AU - Park HS AU - Jung K AU - Kim SO AU - Kim SJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 44 IP - DP - 1994 Jan 01 TI - Respiratory function in confectionary workers. [SerboCroatian (Roman)] PG - 181-190 AU - Zuskin E AU - Mustajbegovic J AU - Kanceljak B AU - DeckovicVukres V AU - Turcic N LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 41 IP - DP - 1994 Jan 01 TI - Allergen-specific IgG-4 in patients with atopic diseases of the respiratory tract PG - 115-119 AB - Respiratory symptoms and ventilatory capacity were studied in 259 female confectionary workers and in 65 non-exposed controls. Most of the chronic respiratory symptoms appeared more frequently among the exposed workers, particularly if they worked in exposure to flour, talc, starch, acids and alcohol. There was a high prevalence of acute symptoms that developed during work shift. This was true especially of cough, dyspnea, burning and dryness of the throat and eye irritation. The exposed workers exhibited statistically significant acute reductions of ventilatory capacity. Those were particularly pronounced for FEF50 (range: 4.6-13.0%) and FEF25 (range: 4.7-22.3%). The measured preshift values of ventilatory capacity were significantly lower than the predicted normal values. The administration of disodium chromoglycate (DSCG 40 mg) significantly diminished mean across-shift reductions in all ventilatory capacity tests. Data suggest that sensitive confectionery workers may develop acute and chronic respiratory symptoms accompanied by acute and/or chronic changes in ventilatory capacity AU - Kruszewski J AU - Raczka A LA - PT - DEP - TA - Archivum Immunologiae et Therapiae Experimentalis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Age specific interactions between smoking and radon among United States uranium miners PG - 192-194 AB - United States uranium miners who smoked have death rates from lung cancer that are intermediate between the rates predicted by the additive and multiplicative models (on a ratio scale) across all age groups. Age specific patterns of interaction have not been thoroughly examined, and most analyses have been internal ones in which there was no truly non-exposed group. Here age specific death rates of lung cancer among ever smoking uranium miners have been examined for conformity with the additive and multiplicative models. The multiplicative model fits well for the youngest and oldest categories, but poorly for the middle age ranges. In the middle age range, predicted rates under the multiplicative model were quite high, surpassing the corresponding United States death rates for all causes combined. If the multiplicative model is assumed to hold across all ages, one hypothesis that might explain the observed age specific patterns is that the full expression on the multiplicative model might not be seen at certain ages due to a limited pool of miners susceptible to lung cancer. These data, however, have several limitations such as small numbers of deaths from lung cancer among never smokers, the use of qualitative rather than quantitative smoking and radon exposure data, and ignorance of the underlying biological mechanisms of interaction AU - Steenland K LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Respiratory symptoms, immunological responses, and aeroallergen concentrations at a sawmill PG - 165-172 AB - After identification of a case of extrinsic allergic alveolitis due to exposure to wood dust at a sawmill, all employees at the sawmill where he worked were studied with an occupational, environmental, and symptom questionnaire, spirometry, skin prick tests, and serum specific IgG measurements. Ninety five of current and 14 of 17 ex-sawmill workers were studied. As a basis for comparison, a group of 58 workers from a nearby light engineering factory were also studied. Few women (6) were employed and they were excluded from the analysis. Workers at the sawmill were stratified into high and low exposure groups depending on their place of work. This division was supported both by their subjective assessment of the dustiness of their environment and the results of personal dust samples. There were no significant differences between the three groups in age, height, smoking habits, exposure to other causes of extrinsic allergic alveolitis, forced expiratory volume in one second, forced vital capacity, atopic state, or cutaneous reactivity to moulds. In the high exposure group the prevalence of work related cough and nasal and eye symptoms was higher than in the low exposure and comparison groups. The prevalence of work related wheeze was similar in both the high exposure and comparison groups, but was lower in the low exposure group. The prevalences of chronic bronchitis and symptomatic bronchial hyper-reactivity were similar in the high and low exposure groups but were lower in the comparison group. Serum concentrations of specific IgG against extracts of sawdust and Trichoderma koningii were significantly higher in the high exposure group than in the other two groups.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Halpin DM AU - Graneek BJ AU - Lacey J AU - Nieuwenhuijsen MJ AU - Williamson PA AU - Venables KM AU - Newman Taylor AJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Extrinsic allergic alveolitis and asthma in a sawmill worker: case report and review of the literature. PG - 160-164 AB - A 34 year old sawmill maintenance engineer developed a dry cough that was associated with widespread wheezes and crackles in his lungs. His symptoms worsened, with work related lethargy, fever, and breathlessness, and the loss of a stone in weight. At that time, while still at work, he had a neutrophil leucocytosis and increased concentration of gamma globulins. When seen subsequently some two months after stopping work, his chest radiograph and lung function tests were normal, but the cells recovered at bronchoalveolar lavage showed an increase in lymphocytes and mast cells, a pattern consistent with extrinsic allergic alveolitis. Serum precipitins were identified to extracts of sawdust, wood chips, and bark from the sawmill, and to eight species of mould grown from these samples. Specific IgG binding inhibition studies suggested that a common epitope present on Trichoderma koningii might be responsible for the cross reactivity of the patient's serum with the wood and fungal extracts. A diagnosis of wood associated extrinsic allergic alveolitis was made and since changing his job the patient has remained well. Wood associated allergic alveolitis has not previously been described in British sawmill workers, but has been reported in Sweden, with a prevalence of 5%-10% in exposed workers. A review of published data suggests extrinsic allergic alveolitis in wood workers is primarily caused by inhalation of the spores of contaminating fungi, but inhaled wood dust may exert a synergistic effect. [References: 33] AU - Halpin DM AU - Graneek BJ AU - TurnerWarwick M AU - Newman Taylor AJ LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 84 IP - DP - 1994 Jan 01 TI - The respiratory health impact of a large urban fire PG - 434-438 AB - OBJECTIVES In July 1988, a fire destroyed a huge supermarket warehouse in Richmond, Calif, sending smoke into residential neighborhoods for nearly a week. There was no organized public health response. To evaluate the respiratory health impact on the general population, a survey of emergency room visits and hospital admissions to the two acute-care hospitals serving the population downwind was conducted. METHODS Medical records of 489 patients meeting specified diagnostic criteria during the week of the fire and several reference periods were abstracted. Ratios of proportions for respiratory diagnoses (i.e., emergency room visits for a given diagnosis/total emergency room visits) were calculated, comparing the fire week with the reference periods, and 1988 mortality data for the area were reviewed. RESULTS Ratios of proportions for emergency room visits for asthma and all lower respiratory conditions increased significantly during the fire. Respiratory-related hospitalizations also increased. However, there was no observable increase in respiratory mortality. CONCLUSIONS This fire was found to have had a moderate impact on the respiratory health of local residents. Public health intervention is indicated to prevent respiratory morbidity when extended exposure to structural fire smoke is predictable AU - Lipsett M AU - Waller K AU - Shusterman D AU - Thollaug S AU - Brunner W LA - PT - DEP - TA - Am J Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Temporal association between hospital admissions for asthma in Birmingham and ambient levels of sulphur dioxide and smoke PG - 133-140 AB - BACKGROUND A study was performed to determine whether daily and weekly variations in the levels of smoke and sulphur dioxide (SO2) in Birmingham are related to hospital admissions for asthma and acute respiratory diseases. METHODS Daily numbers of hospital admissions for asthma (ICD code 493) and acute respiratory conditions (ICD 466, 480-486, 490-496) for residents of Birmingham between 1988 and 1990 were obtained from West Midlands RHA Korner inpatient data. Average daily levels of sulphur dioxide and smoke were obtained from Birmingham City Council for the same period, together with daily meteorological summaries from the Department of Geography, University of Birmingham. With the exception of one day, all air pollution measurements remained within current EC guide levels. Data were divided into seasons and the relation between hospital admissions and pollutant levels were explored by stepwise least squares regression models. Meteorological variables (temperature, pressure, humidity) were entered into the model if they showed significant association with hospital admissions during the season in question. Analysis was undertaken for daily (same day and lagged by two days) and weekly pollutant levels. Admissions were lagged behind pollution levels to allow for delayed effects of pollutants. RESULTS The mean daily level of smoke was 12.7 micrograms/m3 and of SO2 was 39.1 micrograms/m3, with maxima of 188.3 micrograms/m3 and 126.3 micrograms/m3, respectively. Significant associations were found between hospital admissions for respiratory disease lagged by two days, and smoke and SO2 levels during winter. Associations between admissions for asthma and smoke and SO2 levels were significant at the 5% level. These were independent of temperature, pressure, and humidity. Stepwise regression including both pollutants showed that smoke, but not SO2, was a significant independent predictor of hospital admissions for both asthma and all respiratory conditions. During winter a rise of 100 micrograms/m3 smoke might result in five (95% CI 0.6 to 9) more asthma admissions and 21.5 (95% CI 10 to 33) more acute respiratory admissions each day in Birmingham. A 100 micrograms/m3 rise in SO2 might result in four (0 to 7) more asthma admissions and 15.5 (6 to 25) more respiratory admissions each day. Independent associations were also found between weekly mean smoke and SO2 levels and all respiratory admissions during autumn and winter. During summer, daily mean smoke and SO2 levels were significantly associated with non-lagged daily admissions for all respiratory diseases (p &lt; 0.02). There was no association between air pollution and hospital admissions during spring. CONCLUSIONS Daily variations in smoke and SO2 levels are significantly associated with hospital admissions for asthma and respiratory disease during winter in Birmingham at levels of air pollutants within the EC guide levels. This association was independent of potential confounding effects of weather (temperature, pressure, humidity) and suggests that current levels of air pollution can still produce significant health effects AU - Walters S AU - Griffiths RK AU - Ayres JG LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Clinical reactions to Aspergillus niger in a biotechnology plant: an eight year follow up PG - 54-56 AB - The manufacture of citric acid by fermentation of molasses with Aspergillus niger has previously been described as a cause of occupational asthma in a factory. A longitudinal survey of the workforce of this factory has been carried out from 1984 to 1991. Over this period 160 of the original 278 workers left the workforce, together with 39 of 76 new recruits. Partial enclosure of the process and exhaust ventilation, installed in 1984, was effective in preventing any new cases of occupational asthma over the eight year period, and no new skin sensitisation was detected. Spore counts of A niger averaged about 100 times those in the outside air. Health in the 1984 survey had a striking influence on subsequent retiral; only 11 of the 79 with respiratory symptoms remained in 1991, compared with 90 of the 182 with no symptoms. In conclusion A niger is a weak antigen and simple hygiene measures protect the workforce. Exclusion of recruits with positive skin tests is not necessary if such measures are taken. The survey provided evidence of the selection factors operating within a workforce over this period contributing to retiral of the less healthy AU - Seaton A AU - Wales D LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Airway hyperresponsiveness, prevalence of chronic respiratory symptoms, and lung function in workers exposed to irritants PG - 3-13 AB - The association between occupational exposure to airway irritants and the prevalence of chronic respiratory symptoms and level of lung function, and whether these associations were modified by airway hyperresponsiveness, smoking, and a history of allergy were studied in 668 workers from synthetic fibre plants. Respiratory symptoms were recorded with a self administered Dutch version of the British Medical Research Council questionnaire, with additional questions on allergy. Airway responsiveness was measured by a 30 second tidal breathing histamine challenge test. On the basis of job titles and working department, the current state of exposure of all workers was characterised as (1) no exposure, reference group; (2) white collar workers; (3) SO2 HCl, SO4(2); (4) polyester vapour; (5) oil mist and vapour; (6) polyamide and polyester vapour; (7) multiple exposure. Workers exposed to airway irritants were not simultaneously exposed to airborne dust. Airway hyperresponsiveness (AHR), defined as a 20% fall in forced expiratory volume in one second (FEV1) at < or = 32 mg/ml histamine, was present in 23% of the subjects. The association between exposure groups and prevalence of symptoms was estimated by means of multiple logistic regression; the association with level of lung function (forced vital capacity (FVC), FEV1, maximum mid-expiratory flow rate (MMEF)) was estimated by means of multiple linear regression. Both methods allow simultaneous adjustment for potential confounding factors. The exposure groups were associated with a higher prevalence of chronic respiratory symptoms. Lower prevalence of symptoms was found for workers exposed to SO2, HCl, and SO4(2-), most likely due to pre-employment selection procedures. Current smoking, AHR, and a history of allergy were significantly associated with a higher prevalence of chronic respiratory symptoms, independent of each other, and independent of irritant exposure. The association between exposure and prevalence of symptoms was greater in smokers than in ex-smokers and non-smokers. This difference was most clearly seen in the polyester vapour and polyamide and polyester vapour group. No modification of the association between exposure groups and prevalence of symptoms by airway hyperresponsiveness could be shown. The exposure groups were not significantly associated with a lower level of lung function. Adjustment for chronic respiratory symptoms did not change the results. There were no indications of a possible interaction between exposure and AHR, current smoking, or a history of allergy on lung function.(ABSTRACT TRUNCATED AT 400 WORDS) AU - Kremer AM AU - Pal TM AU - Boleij JS AU - Schouten JP AU - Rijcken B LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Non-fibrous dust load and smoking in dental technicians: a study using bronchoalveolar lavage PG - 23-27 AB - A study was conducted with transmission electron microscopy to find whether bronchoalveolar lavage could be used to identify subjects with occupational exposure to mineral particles. Non-fibrous mineral particles in bronchoalveolar lavage (BAL) fluid from 46 dental technicians and 41 white collar controls with lung diseases but free from occupational exposure to dusts were analysed. The total particle concentration in BAL fluid was significantly higher in dental technicians than in controls (12.18 x 10(5) particles/ml of BAL fluid, v 2.03 x 10(5) particles/ml, p < 0.001). Dental technicians had significantly more crystalline silica, aluminium, and alloys containing nickel and chromium. There was a non-significant twofold increase of total particle concentration in the lungs of dental technicians who were smokers compared with non-smokers. The results strongly support the use of BAL fluid analysis to assess dust accumulation in workers in heavily exposed occupations such as dental technicians. This is a valid method to evaluate occupational exposure to non-fibrous mineral particles, and may be useful to determine the occupational aetiology of some respiratory diseases AU - Bernstein M AU - Pairon JC AU - Morabia A AU - Gaudichet A AU - Janson X AU - Brochard P LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Cancer of the respiratory tract in nickel sinter plant workers: effect of removal from sinter plant exposure PG - 19-22 AB - The risk of death due to cancer of the nose or lung was studied in nickel sinter plant workers during the period after they left the sintering operations. It was found that the excess risk of death from both diseases continued for many years after leaving the sinter plant. No effect of age at first exposure could be found. Possible explanations for the continued risk include an irreversible cellular change or the persistence of carcinogenic nickel compounds in the mucosa AU - Muir DC AU - Jadon N AU - Julian JA AU - Roberts RS LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 5 IP - DP - 1994 Jan 01 TI - A 10-year incidence survey of respiratory cancer and a case-control study within a cohort of nickel mining and refining workers in New Caledonia PG - 15-25 AB - The incidence of lung, pleural, nasal, larynx, and pharynx cancer in relation to work in the nickel mining and refining industry was studied from 1978 to 1987 in the male population of the French territory of New Caledonia in the South Pacific. The results showed no greater risk in the population of nickel workers than in the general male population. The incidence of respiratory cancer in New Caledonia was found to be comparable to that of industrialized countries, except for pleural cancer for which there was an excess risk in New Caledonia. A case-control study within the cohort of nickel industry workers comprised 80 lung cancer, 12 larynx cancer, 20 pharynx cancer cases, and 298 controls, and took account of 18 substances to which workers were exposed, five of them nickel compounds. None of the substances, or any other occupational variable, was shown to increase the risk of respiratory cancer, except for cancer of the larynx in relation to level and duration of exposure to dust and engine exhaust fumes on mining sites (odds ratios ranged from five to 5.4 and were significant). These results provide no evidence that exposures specific to the nickel industry in New Caledonia increase the risk of respiratory cancer. This might be due to the involvement of less airborne nickel than the amount observed in positive studies elsewhere. The high incidence of respiratory cancer in New Caledonia, compared with other South Pacific islands, might be attributable to an environmental risk connected with the presence of mineral fibers in the geologic strata, as well as to tobacco and alcohol consumption levels similar to those prevailing in France AU - Goldberg M AU - Goldberg P AU - Leclerc A AU - Chastang JF AU - Marne MJ AU - Dubourdieu D LA - PT - DEP - TA - Cancer Causes & Control JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 93 IP - DP - 1994 Jan 01 TI - Asthma caused by live fish bait PG - 424-430 AB - BACKGROUND Larvae of insects and worms are commonly used as live fish bait (LFB) by anglers. Asthma, rhinoconjunctivitis, and urticaria related to various kinds of LFB have been reported. METHODS We studied 14 subjects with respiratory symptoms associated with exposure to LFB. Skin prick tests and RASTs with Lucilia caesar, Galleria mellonella, and Tenebrio molitor extracts were carried out in all subjects. Monitoring of peak expiratory flow rate and evaluation of bronchial responsiveness to methacholine before and after exposure to LFB were performed in seven subjects. RESULTS Thirteen subjects had asthma, all 14 had rhinoconjunctivitis, and three had contact urticaria. Eleven subjects had respiratory symptoms after fishing with LFB, and the other three subjects had symptoms during their work in a commercial fish bait farm. Positive skin prick test results or significant RAST binding to L. caesar extract were observed in 13 subjects, to G. mellonella extract in four subjects, and to T. molitor extract in three subjects. After exposure to LFB, two subjects had an early asthmatic response, three had a late asthmatic response, and two had no asthmatic response. Late asthmatic response was associated with a long-lasting increase in bronchial responsiveness. CONCLUSIONS This study demonstrates that emanations from LFB are sensitizers, which have the potential to elicit IgE-mediated asthma. Exposure to LFB is common and LFB should be considered as a possible sensitizing agent for asthma AU - Siracusa A AU - Bettini P AU - Bacoccoli R AU - Severini C AU - Verga A AU - Abbritti G LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 149 IP - DP - 1994 Jan 01 TI - Predictive value of airways hyperresponsiveness and circulating IgE for identifying types of responses to toluene diisocyanate inhalation challenge PG - 611-615 AB - Development of asthma after exposure to toluene diisocyanate (TDI) has been recognized in a variety of occupational settings. However, the pathogenesis of isocyanate-induced asthma remains controversial. In particular, the role of IgE in the development of TDI-induced asthma has remained uncertain. To investigate predictive factors for response to inhalation challenge with TDI, we analyzed data from 63 subjects referred for evaluation of respiratory symptoms thought to be related to TDI sensitization. All subjects underwent interview, routine phlebotomy, spirometry, methacholine challenge, and allergy skin testing prior to TDI challenge. Spirometry and methacholine challenge were repeated 1 day after TDI challenge. The cumulative dose of methacholine needed to produce a 20% decrease in FEV1 (PD20) was determined. A PD20 of 1.4 mg or more was considered normal. Subjects were challenged by exposure to 5 to 10 ppb TDI for up to 30 min in a 9 m3 exposure chamber. A positive response was a 20% or more decrease in FEV1 within 1 h (early) or beyond 1 h (late) after TDI exposure. Thirty-four subjects (54%) had a positive response, of whom 12 (35% of responders) had isolated early responses, 13 (38%) had isolated late responses, and the remainder had dual responses. Thirty-two individuals (51%) had a positive response to methacholine (AR+) prior to TDI challenge. AR+ was strongly associated with a positive TDI challenge: 23 AR+ subjects (72%) had a positive TDI challenge, compared with only 11 AR- subjects (35%) (p < 0.01). AR positivity did not predict the time of onset of TDI response.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Karol MH AU - Tollerud DJ AU - Campbell TP AU - Fabbri L AU - Maestrelli P AU - Saetta M AU - Mapp CE LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 149 IP - DP - 1994 Jan 01 TI - Evaluation of peak expiratory flow variability in an adolescent population sample. The Odense Schoolchild Study PG - 598-603 AB - The validity of peak expiratory flow (PEF) recordings and the sensitivity of PEF variability indices in asthma and asthma-like conditions were examined in an adolescent population. Recordings from 245 randomly selected subjects and from an additional 181 subjects reporting or considered at risk for developing asthma were analyzed. Subjects recorded PEF twice daily for 2 wk using Mini-Wright meters, completed a symptoms questionnaire, and were tested for airway responsiveness to methacholine. The first three recording days showed significant accumulation of lowest PEF values recorded (41%) and were excluded from further analysis. Among nine PEF variability indices, the Two-lowest%mean (the mean of the two lowest PEF values as a percentage of the period mean) had the best sensitivity for physician-diagnosed asthma (28%). The sensitivity of the methacholine dose-response slope (DRS) was 69%. Combining these indices, a sensitivity of 77% for diagnosed asthma was obtained. Among subjects with asthma-like symptoms but no diagnosis of asthma, 14% had increased Two-lowest%mean and the DRS was increased in 17%, but only 3% were identified by both tests. In conclusion, inhomogeneity of PEF data could be corrected by disregarding the first three recording days. PEF variability indices identified some diagnosed asthmatics, and particularly some symptomatic "nonasthmatics," not identified by the DRS, suggesting that the combined use of these indices might be helpful AU - Siersted HC AU - Hansen HS AU - Hansen NC AU - Hyldebrandt N AU - Mostgaard G AU - Oxhoj H LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 149 IP - DP - 1994 Jan 01 TI - Cotton dust and across-shift change in FEV1 as predictors of annual change in FEV1 PG - 584-590 AB - In this report of a 5-yr longitudinal study of workers employed at six cotton textile mills, exposure and across-shift FEV1 change were evaluated as possible predictors of the annual change in FEV1 for yarn manufacturing workers. A total of 611 workers had three repeatable spirometric tests, over at least 3 yr, and at least one (average of three) across-shift test, while always working the same shift. The "same shift" criterion controlled for the effect of diurnal variation. Average exposure was determined from measures of lint-free elutriated cotton dust in combination with job histories. This study found a significant association between the acute and chronic effects of cotton dust exposure. Both exposure and across-shift change proved to be significant predictors of annual change, and excess annual declines in FEV1 were predicted even for exposures of 200 micrograms/m3 and across-shift drops in FEV1 of 200 ml. These results suggest that, to prevent dust-related chronic decline in lung function, current smokers should be excluded from yarn manufacturing work and exposures should be reduced below 200 micrograms/m3, to approximately 100 micrograms/m3 AU - Glindmeyer HW AU - Lefante JJ AU - Jones RN AU - Rando RJ AU - Weill H LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 25 IP - DP - 1994 Jan 01 TI - Inhalation fever and respiratory symptoms in the trimming department of Swedish sawmills PG - 65-67 AB - Mold dust exposure in the trimming departments of sawmills may cause inhalation fever as well as allergic alveolitis. Responses to questionnaires sent to 2,052 workers from trimming departments of 233 Swedish sawmills showed that one of five workers experienced work-related febrile attacks. A single case of allergic alveolitis was found AU - RaskAndersen A AU - Land CJ AU - Enlund K AU - Lundin A LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 25 IP - DP - 1994 Jan 01 TI - Acute exposure to swine dust causes airway inflammation and bronchial hyperresponsiveness PG - 57-58 AB - Exposure to swine dust during a few hours work in a swine confinement building induced bronchial hyperresponsiveness in all (n = 6) of the healthy subjects studied. Bronchoalveolar lavage revealed an inflammatory reaction after exposure, and the cellular response was characterized by a hundredfold increase in neutrophils AU - Larsson K AU - Malmberg P AU - Eklund A LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 25 IP - DP - 1994 Jan 01 TI - Mechanism of occupational asthma due to western red cedar (Thuja plicata) PG - 13-18 AB - Occupational asthma due to Western red cedar is the most common form of occupational asthma in the Pacific Northwest and affects 4-13.5% of the exposed population. It has been shown to be caused by plicatic acid, a low molecular weight compound present uniquely in the wood. The mechanism of asthma induced by plicatic acid is not known, as specific IgG antibodies were found only in about 20% of patients. Sera from patients with red cedar asthma failed to passively sensitize human lung fragments of human basophils. Basophils from patients with this disease released histamine when challenged directly with plicatic acid in a specific manner. Immunologic mechanisms other than Type I hypersensitivity reaction are likely to be involved AU - ChanYeung M LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 25 IP - DP - 1994 Jan 01 TI - Symptoms and exposure to endotoxin among brewery employees PG - 113-115 AU - Carvalheiro MF AU - Gomes MJ AU - Santos O AU - Duarte G AU - Henriques J AU - Mendes B AU - Marques A AU - Avila R LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 36 IP - DP - 1994 Jan 01 TI - Progression of chronic obstructive pulmonary disease after multiple episodes of an occupational inhalation fever PG - 75-78 AB - A carding machine operator in a synthetic fabric plant experienced marked symptomatic deterioration of obstructive pulmonary disease after multiple episodes of an occupational inhalation fever. Polytetrafluoroethylene was used in the industrial process and polymer fume fever is suspected as a cause of his febrile illnesses. A state industrial hygiene inspection revealed that major repairs had been performed on an air scrubber system in close proximity to the patient's work area after he had left the plant because of disability. We believe that this case provides further evidence that polymer fume fever is not always a benign, self-limited illness, especially when workers suffer multiple episodes and/or have underlying pulmonary disease AU - Kales SN AU - Christiani DC LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 36 IP - DP - 1994 Jan 01 TI - Respiratory health status in swine producers relates to endotoxin exposure in the presence of low dust levels PG - 49-56 AB - We conducted an assessment of respiratory health status including questionnaire and spirographic measurements in 54 male swine producers age 36.3 +/- 11.1 years (mean +/- SD) who worked an average of 10.7 +/- 6.3 years in the industry and spent 4.7 +/-2.1 hours per day in the swine barns, and we also measured atmospheric contaminants including carbon dioxide, ammonia, total dust, respirable dust, and airborne endotoxin. Mean atmospheric dust contaminant levels were as follows: carbon dioxide, 2632 +/-807 ppm; ammonia, 11.3 +/- 4.2 ppm; total dust, 2.93 +/- 0.92 mg/m3; respirable dust, 0.13 +/- 0.05 mg/m3; and endotoxin, 11, 332 +/- 13,492 endotoxin units/m3. Of these, endotoxin related to forced vital capacity (P < .05) and endotoxin x hours per day was related to forced vital capacity (P < .05) and to forced expiratory volume in 1 second (P = .06). Respiratory symptoms and lung function studies did not relate to categories of low, medium, and high exposure to respirable dust. However, categories of endotoxin (available on 46 workers) related to respiratory symptoms (cough, P = .02; chronic bronchitis, P = .06; and to forced vital capacity, P < .01). These data suggest that respiratory health status relates to endotoxin levels but not to dust level exposures in the presence of low dust levels and indicates that control measures should include endotoxin as well as dust control AU - Zejda JE AU - Barber E AU - Dosman JA AU - Olenchock SA AU - McDuffie HH AU - Rhodes C AU - Hurst T LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 105 IP - DP - 1994 Jan 01 TI - Normal range of methacholine responsiveness in relation to prechallenge pulmonary function. The Normative Aging Study PG - 661-666 AB - Methacholine airway responsiveness has been observed to be related to prechallenge level of pulmonary function; however, normal ranges of responsiveness for specific levels of lung function have not been reported. We examined methacholine airway responsiveness in relation to level of prechallenge pulmonary function in a sample of 547 middle-aged and elderly men who denied any history of respiratory illness or symptoms and who had normal levels of prechallenge FEV1 and FEV1/FVC ratio. The cumulative dose of methacholine provoking a 20 percent decline in FEV1 (PD20FEV1) was positively correlated with prechallenge FEV1 percent predicted (Spearman correlation r = 0.35, p < 0.0001). The fifth percentile of PD20FEV1, chosen as an estimate of the lower limit of the normal range, varied with the level of prechallenge FEV1. When applied to a larger sample of 838 men with normal pulmonary function, the use of FEV1-specific cut-off values to separate "normal" from "abnormal" PD20FEV1 did not improve the sensitivity or specificity of methacholine challenge as a test for questionnaire-reported asthma or wheezing. These data provide lower limits of normal PD20FEV1 which are specific for a subject's prechallenge FEV1; however, these FEV1-specific lower limits of normal PD20FEV1 provided no greater sensitivity and specificity for detecting asthma and wheezing than did a single lower limit of normal PD20FEV1 for all subjects AU - O'Connor GT AU - Sparrow D AU - Weiss ST LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Acute respiratory effects in the potato processing industry due to a bioaerosol exposure PG - 73-78 AB - The relation between bioaerosol exposure in the potato starch industry and work related respiratory symptoms is described. One group of workers was exposed to high dust concentrations (geometric mean up to 56.0 mg/m3) with low endotoxin and antigen concentrations (geometric mean up to 12.6 ng/m3 and 90 relative antigen units (RAU) per m3). A second group was exposed to low dust concentrations (geometric mean up to 3.9 mg/m3), but the endotoxin and antigen concentrations were high (geometric means of environmental samples up to 72 ng/m3 and 2.9.10(2)RAU/m3). Twenty of the 48 workers had specific IgG4 titres to dust extract. Of these 20 workers, 14 showed an increase in IgG4 titre during the first month of the potato processing season. No specific IgE antibodies to dust extracts were found. Twenty two workers were equipped with a Mini-Wright peak flow meter during a four week period. Two workers showed a work related decline in peak flow values. It was concluded that exposure to dust made airborne during the refining process of potato starch may cause work related respiratory symptoms AU - Hollander A AU - Heederik D AU - Kauffman H LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 25 IP - DP - 1994 Jan 01 TI - Acute effects on forced expiratory volume in one second and longitudinal change in pulmonary function among wood trimmers PG - 551-558 AB - Wood trimmers are exposed to molds that periodically grow on timber, and may develop acute as well as chronic pulmonary function impairment. This study examined whether these acute changes in pulmonary function are predictors for a longitudinal deterioration in pulmonary function, beyond normal aging and exposure. Across-shift changes in pulmonary function, measured during a working week, were evaluated in 15 wood trimmers with a follow-up time of 27 months. Twenty-six sawmill workers, employed at the same plants as the wood trimmers, served as control subjects. The highest concentration of viable mold spores for the wood trimmers was 10(6) colony-forming units (cfu)/m3, i.e., several times higher than the corresponding value for the sawmill workers. At the follow-up, wood trimmers had a lower forced vital capacity (FVC) on average, after adjustment for age and height, compared to the sawmill workers. In addition, a correlation was found between the across-week change in forced expiratory volume in 1 second (FEV1) and the decline in FEV1 between the first and the second occasion, after adjusting for normal aging in nonsmoking wood trimmers (r2 = 84%, p < 0.001). The results from the present study suggest that across-shift decrease in FEV1 (measured during a working week) might serve as a guide to identify subjects being at risk for a further decrement in pulmonary function over and above the effects of normal aging and exposure to mold spores in the wood trimming department AU - Dahlqvist M AU - Ulfvarson U LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 160 IP - DP - 1994 Jan 01 TI - Tuberculosis: medical students at risk PG - 395-397 AB - In 1979 an outbreak of tuberculosis occurred in medical students at the University of Sydney. Eight of 35 Mantoux-negative students who attended the autopsy of an immunosuppressed patient with unsuspected active tuberculosis became infected and one developed clinical disease. A report of the incident was prepared for publication because it supported the then controversial University policy of recommending BCG vaccination to medical and dental students in a country where the reported prevalence of tuberculosis is very low. The report was never published, mainly in order to protect the privacy of the individual students involved, but also because it was felt by the administration of the time that it might undermine confidence in infection control procedures in the autopsy room. The original report, updated and reproduced here, suggested that tuberculosis might be an emerging nosocomial problem. This has been all too clearly realised since its re-emergence as an opportunistic infection in AIDS patients. Worldwide, the problem of antibiotic resistance in Mycobacterium tuberculosis provides an added risk of a return to the situation which prevailed early this century when tuberculosis was a major occupational risk for young health care workers. Infection often restricted career choices, even in those whose disease was relatively benign. Our purpose in bringing this incident to light after so many years is to point out the relevance of the extensive studies of the problem which were conducted in the 1930s and 1940s to the current situation and to suggest that health care students are vulnerable to airborne infections as well as those spread by inoculation injuries. In retrospect, our 1979 conclusions about prospects for preventing nosocomial tuberculosis appear optimistic AU - Wilkins D AU - Woolcock AJ AU - Cossart YE LA - PT - DEP - TA - Med J Aust JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 28 IP - DP - 1994 Jan 01 TI - Fragrance: its biology and pathology. [Review] PG - 133-135 AU - Cooke MA LA - PT - DEP - TA - Journal of the Royal College of Physicians of Lond JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Statistical approaches to the identification of late asthmatic reactions PG - 806-812 AB - Late asthmatic reactions can be difficult to recognize because of their prolonged time course and the confounding effects of superimposed circadian rhythms of ventilatory function. Conventional methods of analysis are rather arbitrary. They depend for example on a 15 or 20% fall in forced expiratory volume in one second (FEV1) from baseline or from time-matched control measurements. We have, therefore, investigated whether statistical approaches applied to individual subjects can assist in the identification of late asthmatic reactions. In two separate series of aerosol inhalation tests, three symptomatic workers, three asthmatic controls and three nonasthmatic controls were challenged blindly with increasing doses of two chemical agents, and saline. One of the agents, sodium isononanoyl oxybenzene sulphonate (SINOS) was a suspected cause of occupational asthma. Prior to the challenges, FEV1 was measured hourly on three control days. Cumulative late changes on both control and active challenge days were quantified as the area between a line extrapolated from a 10.00 h baseline and the actual measurements from 12.00–22.00 h (the 2–12 h area decrement). The area decrement measurements on control and active challenge days were compared using Student's t-tests. The sensitivity of this method for detecting late asthmatic reactions among potentially positive tests (SINOS challenge tests in the workers) was examined, as was its specificity. The latter was determined from the false positive rate among the negative tests. A second statistical method based on the pooled standard deviation of serial (hourly) FEV1 measurements was investigated in the same way. In total, the data from 220 challenge and 30 control days were available for analysis. Late responses associated with falls in FEV1 of 8–16% were statistically significant when a t-test was used to compare area decrement on each active challenge day with three control days. This approach was, therefore, potentially more sensitive than conventional techniques for identifying late asthmatic reactions. The false positive rate was 4%. The serial FEV1 method was more sensitive, identifying a further five positive tests, but was less specific, with a false positive rate of 7%. These results suggest that when the day-to-day variability of lung function has been estimated from at least three control days, statistical tests can be applied to potential late asthmatic reactions, allowing them to be identified with greater precision than conventional clinical techniques. AU - Stenton SC AU - Avery AJ AU - Walters EH AU - Hendrick DJ LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Prevention of occupational asthma PG - 768-778 AB - This paper focuses on the prevention of asthma caused by exposure to sensitizing agents in the workplace. Control of exposure (primary prevention) is the most direct method of reducing the number of incident cases. Screening programmes are also necessary as a "safety net", and have value as secondary prevention, because early detection may improve long-term prognosis. It is recommended that regulatory or advisory bodies with responsibility for occupational asthma publish a guidance document on occupational asthma explaining their current concepts. Surveillance activities provide information on how common asthma is relative to other occupational lung diseases, and on the relative frequency of occurrence of asthma caused by different agents. Publication of a list of sensitizing agents would aid those with responsibility for control of exposure in the workplace. Epidemiological research on exposure-response relations is is necessary as a background to prevention. This paper recommends such studies. Immunotoxicological research also has a role in testing hypotheses that cannot be tested in human subjects. Some standardization of screening programmes in industry is desirable. A short symptoms questionnaire is economical and acceptable to workers, but there are other approaches. Finally, evaluative research on prevention measures gives information on their effectiveness and efficiency AU - Venables KM LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 149 IP - DP - 1994 Jan 01 TI - Persistent asthma after repeated exposure to high concentrations of gases in pulpmills PG - 1676-1680 AB - This is a clinicopathologic study of three subjects with irritant-induced asthma. They were pulpmill workers who had a history of multiple "gassing" episodes that occurred over a period of years. Persistent symptoms of asthma and nonspecific bronchial hyperresponsiveness and/or variable airflow obstruction occurred after at least one episode of "gassing," resulting in symptoms severe enough to require emergency room treatment. One of the three subjects had normal spirometry values before he entered the pulpmill. Bronchial biopsy done on these subjects showed changes compatible with asthma, including thickened basement membrane in two and cellular infiltration with activated eosinophils and mononuclear cells in all three. The results of immunohistology of bronchial mucosal biopsy of these subjects were compared with those of patients with allergic asthma and patients with Western red cedar-induced asthma. Subjects with irritant-induced asthma had a greater density of activated eosinophils and fewer T-lymphocytes, suggesting that cell-mediated immune mechanisms are not involved in the pathogenesis of this condition AU - ChangYeung M AU - Lam S AU - Kennedy SM AU - Frew AJ LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 149 IP - DP - 1994 Jan 01 TI - Endotoxin contamination causes neutrophilia following pulmonary allergen challenge PG - 1471-1475 AB - Segmental bronchoprovocation (SBP) with allergen was used in an attempt to study eosinophils recruited to the airway 24 h after challenge. Unexpectedly, in the first four patients, neutrophils (rather than eosinophils) were recruited in the bronchoalveolar lavage (BAL) fluids, and we hypothesized that the allergen extracts were contaminated with endotoxin. The extracts used for challenge in the first four patients tested positive for bacterial endotoxin in a limulus amebocyte lysate assay. Rechallenge of one patient from the first group with a comparable dose of an endotoxin-free extract and SBP with endotoxin-free extract in five additional patients resulted in preferential recruitment of eosinophils rather than neutrophils. The number of neutrophils recovered from the challenged segments in the patients challenged with endotoxin-free extract was significantly less than that observed in the first four patients. Taken together, these observations suggest that neutrophil recruitment in the 24-h BAL fluids from the first four patients was probably due to endotoxin contamination of the allergen extract. We caution investigators that endotoxin contamination of allergen extract may alter the cellular inflammation during the late airway response following allergen challenge AU - Hunt LW AU - Gleich GJ AU - Ohnishi T AU - Weiler DA AU - Mansfield ES AU - Kita H AU - Sur S LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 149 IP - DP - 1994 Jan 01 TI - Respiratory disorders and atopy in Danish refuse workers PG - 1407-1412 AB - This survey describes respiratory and mucosal symptoms of garbage-handling and recycling workers in Denmark. The study includes 20 paper-sorting workers, eight compost workers, and 44 garbage-handling workers. As a control group, 119 workers from water purification plants of Copenhagen were chosen; workers in our study had a lower mean age and shorter mean employment time than did members of the control group. There was no significant difference in tobacco consumption between the groups. Garbage-handling workers were exposed to a significantly higher mean concentration (SD) of total dust than were water supply workers-0.74 (0.77) mg/m3 compared with 0.42 (0.25) mg/m3 (p < 0.05). Total count of microorganisms was significantly higher in garbage-handling and composting areas compared with paper-sorting as well as water supply areas 0.46 (0.125) x 10(5), 0.54 (0.77) x 10(5), 4.7 (5.89) x 10(3), and 0.08 (0.04) x 10(3) cfu/m3, respectively (p < 0.05). This difference could not be explained as an effect of differential growth requirements. Significantly higher amounts of gram-negative bacteria were found in composting and garbage-handling plants than in water-supply plants. In garbage-handling plants only, there were significantly higher amounts of endotoxins than in paper-sorting plants. Significantly higher prevalence of chest tightness (14%), flu-like symptoms (14%), itching eyes (27%), itching nose (14), and sore or itching throat (21%) were found among garbage-handling workers, compared with, respectively, 1, 1, 11 and 0% among water-supply workers. Furthermore, prevalence of nausea and vomiting or diarrhea rose from 2% and 7% among the water-supply workers to 19% and 27% among the garbage workers.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Sigsgaard T AU - Malmros P AU - Nersting L AU - Petersen C LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 124 IP - DP - 1994 Jan 01 TI - Are amylases in bakery products and flour potential food allergens? PG - 846-851 AB - The enzyme alpha-amylase from the mould Aspergillus oryzae (Asp o II) routinely used for the production of bread, cakes and pastries has in recent years been identified as an inhalative allergen for occupational diseases (bakers' asthma). It is doubtful whether this amylase in the final product, i.e. after the baking procedure, can still be regarded as an allergen. To clarify this question, detailed case histories on 138 subjects were recorded (98 allergics, 20 patients suffering form chronic intestinal diseases, 20 healthy controls). The clinical examinations included prick skin test and IgE antibody determination using one of the customary enzyme preparations. EAST showed a few of these 138 bread consumers to be weakly sensitized to the enzyme. One of the subjects displayed a significant reaction to alpha-amylase heated to 200 degrees C. As expected, eleven bakers sensitized to alpha-amylase by inhaling it in the workplace (positive prick test, positive case history) predominantly exhibited specific IgE antibodies to the native enzyme. Apart from one weakly positive finding, heated alpha-amylase yielded negative results in this collective. Baking conditions vary widely, especially with regard to single components, temperature and duration. Thus, further investigations as to residual allergenicity or the feasible occurrence of new antigenic determinants during the production of bread, cake and pastries are required. 27% of bakers examined and 9% of atopics showed antibodies to a flour inherent enzyme, a beta-amylase. On the whole, the selected conditions hinted at a weakly sensitizing potential inherent in baking flour and in added amylase AU - Baur X AU - Sander I AU - Jansen A AU - Czuppon AB LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 43 IP - DP - 1994 Jan 01 TI - Surveillance for occupational asthma--Michigan and New Jersey, 1988-1992 PG - 9-17 AB - PROBLEM/CONDITION A case of occupational asthma is a sentinel health event indicating a need for preventive intervention. REPORTING PERIOD COVERED 1988-1992. DESCRIPTION OF SYSTEMS As part of the Sentinel Event Notification System for Occupational Risks (SENSOR) Program, initiated by CDC's National Institute for Occupational Safety and Health in 1987, state-based surveillance and intervention programs for occupational asthma (OA) have been under development in Michigan and New Jersey. The initial 5-year projects in these states have been completed. RESULTS From 1988 through 1992, the SENSOR programs in these states identified a total of 535 cases of occupational asthma and related conditions. Of these 535 cases, 328 cases met the SENSOR surveillance case definition for OA. In addition, 128 cases were classified as possible OA, 42 as reactive airways dysfunction syndrome, and 37 as occupationally aggravated asthma. In both Michigan and New Jersey, manufacturing was the industrial sector with the largest proportion of cases. In Michigan, > 40% of the case-patients worked in transportation equipment manufacturing. In New Jersey, 15% of case-patients worked in manufacturing of chemicals and allied products. Overall, isocyanates were the most frequently reported asthma-causing agents (19.4% of cases). Follow-up industrial hygiene sampling measured suspect agents at airborne concentrations generally below the permissible exposure limits established by the Occupational Safety and Health Administration. INTERPRETATION In its first 5 years, the SENSOR system has led to the identification of previously unrecognized causes of occupational asthma. Overall findings indicate the need for more comprehensive control of such well-known occupational allergens as the isocyanates. In addition, SENSOR interventions have prompted improvements in protection for workers. ACTIONS TAKEN Approaches to state-based surveillance and intervention for OA are being developed through newly funded 5-year SENSOR projects in four states (California, Massachusetts, Michigan, and New Jersey). The goal is to develop a model for effective state-based OA surveillance that can be applied by any state health department AU - Reilly MJ AU - Rosenman KD AU - Watt FC AU - Schill D AU - Stanbury M AU - Trimbath LS AU - Romero Jajosky RA AU - Musgrave KJ AU - Castellan RM AU - Bang KM AU - et al LA - PT - DEP - TA - MMWR CDC Surveill Summ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 105 IP - DP - 1994 Jan 01 TI - Persistent asthma after inhalation of a mixture of sodium hypochlorite and hydrochloric acid PG - 1895-1896 AB - Chlorine gas inhalation can lead to temporary mucous membrane irritation, pulmonary edema, and transient bronchospasm. Existence of respiratory sequelae is debated. We report a case of asthma, persisting 2 years after the inhalation of a mixture of sodium hypochlorite and hydrochloric acid. Bronchial histologic findings and transmission electron microscopy examinations showed uncommon abnormalities supporting irritation for cause of this nonimmunologic asthma AU - Deschamps D AU - Soler P AU - Rosenberg N AU - Baud F AU - Gervais P LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 105 IP - DP - 1994 Jan 01 TI - Pulmonary function among cotton textile workers. A study of variability in symptom reporting, across-shift drop in FEV1, and longitudinal change PG - 1713-1721 AB - Longitudinal variability in respiratory responses, including symptom reporting and across-shift change in ventilatory function, were examined in relation to long-term loss of ventilatory function in a group of 447 cotton textile workers in Shanghai, China. The study used a standardized respiratory questionnaire and standardized spirometric testing before and after a work shift on the first day of the workweek. Prediction equations for FEV1 were generated from a group of silk textile workers from the same city. Environmental samples included both vertical elutriated cotton dust and endotoxin levels. There was considerable variability in symptom reporting between the baseline and 5-year follow-up survey for all symptoms. However, subjects who consistently reported symptoms had a significantly accelerated 5-year loss in FEV1 compared with those who never reported symptoms. Subjects with symptoms of chest tightness or dyspnea at one survey lost FEV1 at a rate intermediate between the never or both groups. Moreover, subjects with an across-shift change in FEV1 of more than 5 percent at both surveys had the greatest loss in FEV1 over 5 years (-267 ml) when compared with one-time responders (-224 ml), and nonresponders (-180 ml), though the differences were not significant. Workers with chest tightness and chronic bronchitis in both surveys were overrepresented in the high dust and endotoxin areas. Our results indicate that even with substantial survey-to-survey variability in responses, there is important information contained in both questionnaires and across-shift spirometry. Among cotton workers, consistent responders to either symptom questionnaire or across-shift FEV1 decrements of > or = 5 percent appear to be at increased risk for lung function impairment AU - Christiani DC AU - Ye TT AU - Wegman DH AU - Eisen EA AU - Dai HL AU - Lu PL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Occupational asthma among hospital health care personnel: a cause for concern? [editorial] PG - 198-200 AU - Hayes JP AU - FitzGerald MX LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 83 IP - DP - 1994 Jan 01 TI - A case from practice (294). Isocyanate-induced toxic-irritative bronchitis [German] PG - 583-584 AU - Waber U LA - PT - DEP - TA - Schweiz Rundsch Med Prax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 123 IP - DP - 1994 Jan 01 TI - Immunologic cross-reactivity of acid anhydrides with immunoglobulin E against trimellityl-human serum albumin PG - 869-873 AB - The purpose of this study was to determine whether workers sensitized by one acid anhydride, trimellitic anhydride (TMA), would possibly react immunologically to two other acid anhydrides, phthalic anhydride (PA) or maleic anhydride (MA). We studied serum samples from four workers with TMA asthma and immunoglobin E (IgE) against TMA conjugated to human serum albumin (TM-HSA). In enzyme-linked immunosorbent assay (ELISA) cross-inhibition studies, TM-HSA inhibited IgE binding to TM-HSA, but when 100 times more P-HSA or M-HSA was used, no significant inhibition occurred. However, in ELISA studies of P-HSA and M-HSA, we saw binding of specific serum IgE. Finally, in passive transfer studies in rhesus monkeys with serum from an individual with antibodies to all three acid anhydrides, the following titers were obtained: TM-HSA (1:32), P-HSA (1:8), M-HSA (negative). We conclude that cross-inhibition studies may not be the best method for determining whether an individual sensitized to one antigen will react to a related antigen. The determination of biologic reactivity in a rhesus monkey model of passive cutaneous transfer makes it likely that biologic reactivity would also occur in a human sensitized to TMA and then exposed to another anhydride such as PA AU - Lowenthal M AU - Shaughnessy MA AU - Harris KE AU - Grammer LC LA - PT - DEP - TA - Journal of Laboratory & Clinical Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 35 IP - DP - 1994 Jan 01 TI - Aldehyde disinfectants and health in endoscopy units [letter] PG - 717-717 AU - Stevens AB LA - PT - DEP - TA - Gut JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 15 IP - DP - 1994 Jan 01 TI - Airway management in respiratory emergencies. [Review] PG - 13-34 AB - Securing the airway is an important first step in respiratory emergencies. In this article, general principles of airway management are reviewed. The techniques of tracheal intubation, including surgical routes of airway access, are discussed in reference to special circumstances that can arise in acute airway management. AU - Einarsson O AU - Rochester CL AU - Rosenbaum S LA - PT - DEP - TA - Clin Chest Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Survey of construction workers repeatedly exposed to chlorine over a three to six month period in a pulpmill: II. Follow up of affected workers by questionnaire, spirometry, and assessment of bronchial responsiveness 18 to 24 months after exposure ended PG - 225-228 AB - OBJECTIVE--The aim was to determine the prevalence of persistent respiratory symptoms and bronchial hyper-responsiveness due to reactive airways dysfunction syndrome in a population of construction workers at moderate to high risk of developing the syndrome, at an interval of 18 to 24 months after multiple exposures to chlorine gas during renovations to a pulp and paper mill. DESIGN AND PARTICIPANTS--71 of 289 exposed workers (25%) were identified on the basis of an exposure and the onset of respiratory symptoms shortly after this event (moderate to high risk). A standardised respiratory questionnaire was first presented, followed by spirometry and a methacholine inhalation test on those whose questionnaire suggested the persistence of respiratory symptoms. RESULTS--64 of 71 (90%) subjects completed the respiratory questionnaire at the time of the follow up. The questionnaire suggested a persistence of respiratory symptoms in 58 of the 64 workers (91%). Of the 58 subjects, 51 underwent spirometry and assessment of bronchial responsiveness. All of them used bronchodilators as required (not regularly) and four required inhaled anti-inflammatory preparations. Sixteen had bronchial obstruction (forced expiratory volume in one second) (FEV1 < 80% predicted) and 29 showed significant bronchial hyper-responsiveness. CONCLUSION--Of the subjects (n = 71) who were at moderate to high risk of developing reactive airways dysfunction syndrome after being exposed to chlorine and were seen 18 to 24 months after exposure ended, 58 (82%) still had respiratory symptoms, 16 (23%) had evidence of bronchial obstruction, and 29 (41%) had bronchial hyper-responsiveness AU - Bherer L AU - Cushman R AU - Courteau JP AU - Quevillon M AU - Cote G AU - Bourbeau J AU - L'Archeveque J AU - Cartier A AU - Malo JL LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Survey of construction workers repeatedly exposed to chlorine over a three to six month period in a pulpmill: I. Exposure and symptomatology PG - 219-224 AB - OBJECTIVE--The admission to hospital of three construction workers with acute respiratory distress caused by inhalation of chlorine gas prompted the inspection of a building site located in a kraft pulpmill. The accidental emissions had taken place in the bleach plant and the construction workers assigned there were surveyed to uncover possible large scale health effects. DESIGN AND PARTICIPANTS--A questionnaire was presented to 281 workers (participation rate = 97%); 257 workers reported an average of 24 exposure episodes to chlorine and derivatives over a three to six month period. The air monitoring data available from the pulpmill's industrial hygienist were not useful in linking specific events reported by the workers to environmental conditions in the bleach plant. RESULTS--Over 60% of the workers described a characteristic flu like syndrome that lasted for an average of 11 days and was exacerbated by new bouts of exposure. Irritation of the throat (78%) and eyes (77%), cough (67%), and headache (63%) were the most often reported symptoms. Shortness of breath was reported by 54% of the participants and was not associated with age, smoking state, or history of asthma or chronic bronchitis. First aid self referral was associated with significantly greater reporting of most symptoms, including dyspnoea and cough. A significantly greater proportion of workers in the dyspnoea group had gone at least once for first aid care after a gassing incident (64% as opposed to 48%, p = 0.008). Throat irritation and cough persisted for mean intervals of eight and 11 days respectively. A flu like syndrome lasted for an average of 20 days. Seventy one subjects were considered to be a moderate to high risk of having persisting respiratory symptoms. CONCLUSION--Throat and eye irritation as well as cough and flu like symptoms are frequent occurrences after repeated accidental inhalation of chlorine. Subjects who consulted first aid care stations after a gassing incident are more likely to have persisting dyspnoea AU - Courteau JP AU - Cushman R AU - Bouchard F AU - Quevillon M AU - Chartrand A AU - Bherer L LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Occupational asthma and rhinoconjunctivitis from inhalation of dried cow's milk caused by sensitization to alpha-lactalbumin PG - 189-191 AB - A chocolate candy worker was diagnosed as having occupational asthma and rhinoconjunctivitis on the basis of clinical record and methacholine challenge. Positive conjunctival and bronchial challenge tests with lactalbumin showed that this protein was the pathogenetic agent. Type I hypersensitivity mechanism is demonstrated by means of skin prick test and RAST AU - Bernaola G AU - Echechipia S AU - Urrutia I AU - Fernandez E AU - Audicana M AU - Fernandez de Corres L LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Baker's asthma related to soybean lecithin exposure PG - 159-162 AB - We report two cases of soybean-lecithin-induced asthma in bakers. The patients experienced clinical symptoms in relation to an occupational exposure to this additive. Skin tests were positive with soybean lecithin, RAST showed a sensitization to soybean, and bronchial challenge tests were positive for a dilution of 10(-3) with this allergen. The same tests remained negative among healthy and asthmatic controls. Soybean lecithin, a common additive in bakery, must be added to the list of numerous aeroallergens involved in baker's asthma AU - Lavaud F AU - Perdu D AU - Prevost A AU - Vallerand H AU - Cossart C AU - Passemard F LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Bronchial reactivity in a general population of north Italy: relationships with occupational exposure PG - 15-18 AB - Two thousand eight hundred and forty one subjects, aged 8-73 yrs, took part in the second cross-sectional survey in the Po River Delta area: among them, a subsample of currently employed people, aged 14-71 yrs, was chosen to establish the relationship between occupational exposure to dusts, chemicals or gases and respiratory symptoms, lung function and bronchial reactivity. Each subject filled out the Italian National Research Council (CNR) standardized questionnaire concerning respiratory symptoms, diseases and risk factors. A variable proportion of subjects performed acceptable forced and slow vital capacity manoeuvres, diffusing capacity of carbon monoxide and bronchial challenge test to methacholine. Occupational exposure appeared to be related to prevalence rate of respiratory symptoms (wheeze, dyspnoea, presence of at least one respiratory symptom) and bronchial asthma. Consistent effects on lung function were not evident. With respect to the bronchial challenge test, using the measurement of the provocative dose producing a 20% fall in forced expiratory volume in one second (PD20) a significantly higher percentage of hyperreactive subjects was found among ex-smoker exposed men; a borderline higher percentage of hyperreactive subjects was also found in non-smoker exposed women. The study findings support the suggestion that occupational exposure may play a role in the development of airway obstructive diseases AU - Viegi G AU - Fialdini AM AU - Vellutini M AU - Carrozzi L AU - di Pede F AU - Modena P AU - Pedreschi M AU - Baldacci S AU - Paoletti P AU - Giuntini C LA - PT - DEP - TA - Monaldi Arch Chest Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 31 IP - DP - 1994 Jan 01 TI - Occupational asthma following kapok exposure PG - 243-250 AB - Whether a distinct kapok allergen exists or whether the fiber's allergenicity is due to contamination by other allergens has never been resolved. Several years ago, we evaluated a patient who appeared to develop occupational asthma to kapok. We performed an environmental assessment, cross-shift spirometric testing of the patient's co-workers, and the first reported bronchoprovocation challenge with kapok. The disappearance of the patient's asthma following cessation of kapok exposure, with now 7 years of follow-up, our inability to incriminate any other agent, and the patient's positive specific bronchoprovocation challenge strengthen the evidence, but do not prove definitively, that kapok fiber itself is allergenic AU - Kern DG AU - Kohn R LA - PT - DEP - TA - J Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Symptoms and immunologic markers induced by exposure to methyltetrahydrophthalic anhydride PG - 281-286 AB - A study was performed in 43 workers exposed to methyltetrahydrophthalic anhydride (MTHPA) used as a hardener in an epoxy resin system. Ten workers sensitized to MTHPA (group SS; presence of serum IgE antibodies against a conjugate of MTHPA and human serum albumin (HSA) detected by RAST) had significantly higher levels of tryptase in nasal lavage fluid than 19 nonsensitized workers with work-related nasal symptoms (group NS) and 14 nonsensitized workers without nasal symptoms (group NN). This suggests an ongoing mast-cell-mediated reaction in the sensitized group. No statistically significant differences were found in the three groups concerning eosinophil cationic protein (ECP) and TAME-activity in lavage fluid. However, there was a significant increase in serum ECP in the SS group, as compared with a group of unexposed controls. Nasal challenge with MTHPA-HSA, performed in a subsequent study in seven workers from the SS group, six from the NS group, and seven from the NN, caused a larger increase of symptom score and a more pronounced decrease in nasal inspiratory peak flow in the SS group than in the other two groups. No significant rise was recorded for tryptase and ECP in lavage fluid in any of the three groups after challenge. The combined results of the two studies indicate that specific IgE antibodies play a pathogenetic role in at least some of the cases of work-related nasal symptoms associated with MTHPA exposure AU - Nielsen J AU - Welinder H AU - Bensryd I AU - Andersson P AU - Skerfving S LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 75 IP - DP - 1994 Jan 01 TI - Occupational lung diseases among dental technicians. PG - 99-104 AB - Dental technicians are exposed to various dusts including silica, alloys, and acrylic plastics which may induce pneumoconiosis and probably other occupational lung diseases. The prevalence of pneumoconiosis is very high and related to the duration of exposure: 3 epidemiological studies have found a prevalence of pneumoconiosis 1/0 or greater of about 15% in technicians with 20 or more years' exposure. However, silica is probably not the sole causative agent. In addition to pneumoconiosis, this occupational exposure may induce minor lung function impairment, especially among smokers. However, the effect of cigarette smoking on lung function is greater than the effect of occupational exposure. Cases of occupational asthma, bronchial cancer and mesothelioma, and connective tissue diseases have been reported and are suspected to be work related, but epidemiological studies are needed. Pneumoconiosis is a frequent risk among dental technicians and compensation should be paid to those suffering from this work-related disease. Information about occupational lung diseases and adequate technical prevention measures are necessary for dental technicians. [References: 45] AU - Choudat D LA - PT - DEP - TA - Tubercle & Lung Disease JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 44 IP - DP - 1994 Jan 01 TI - Glutaraldehyde, asthma and work--a cautionary tale PG - 95-98 AB - A 46-year-old endoscopy nurse developed symptoms suggestive of occupational asthma after seven years of exposure to glutaraldehyde. An initial inhalation challenge test at the endoscopy suite caused a very dramatic immediate fall in FEV1 from 3.6 to 1.5 litres. To further evaluate the case and establish a threshold for the response, a technique was devised to allow a series of double-blind inhalation challenges with activated glutaraldehyde vapour at exposure levels of 0.01-0.32 ppm. The results suggested marked dual asthmatic reactions following challenges with 0.032 ppm glutaraldehyde; however, similar 'reactions' were observed on control days. These were associated with an increase in airway responsiveness to methacholine, with the PD20FEV1 falling from > 6400 micrograms to 135 micrograms. The interpretation of these results was potentially confounded by an intercurrent respiratory tract infection and by technically poor FEV1 recordings, so the challenge series was repeated three weeks later. The second series of double-blind inhalation challenges with carefully controlled exposures to glutaraldehyde (up to 0.32 ppm for 10 min) gave rise to no obvious asthmatic reactions, in marked contrast to the results of the unblinded workplace challenge. There was a slight increase in airway responsiveness, with the PD20FEV1 falling from > 6400 micrograms to 1850 micrograms. These results illustrate the potential for misdiagnosis of occupational asthma when unblinded challenge tests are used and show that, even with sophisticated investigatory techniques, a clear-cut diagnostic result may be elusive AU - Stenton SC AU - Beach JR AU - Dennis JH AU - Keaney NP AU - Hendrick DJ LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 43 IP - DP - 1994 Jan 01 TI - A case of eosinophilic bronchitis due to epoxy resin system hardener, methle endo methylene tetrahydro phthalic anhydride [Japanese] PG - 660-662 AU - Kobayashi O LA - PT - DEP - TA - Arerugi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 43 IP - DP - 1994 Jan 01 TI - A study of factors contributing to bakers' allergy symptoms PG - 625-633 AB - It has been known for many years that bakers, who work in an atmosphere filled with wheat flour and other grain products, often suffer from bronchial asthma and other allergy symptoms. We examined 36 cooks (males: 33, females: 3, average age: 29.1 years) exposed to wheat products while baking bread or making confectionaries in a hotel. Their clinical symptoms were investigated, and peripheral blood eosinophils, serum IgE, wheat flour specific IgE, IgG1, IgG4, and antibodies to alpha-amylase and papain were measured. Clinical symptoms were present in some cases, the most common being rhinitis (13), itching and skin eruptions (8), ocular symptoms, including tearing, itching and conjunctival injection (8), and respiratory symptoms, including cough and sputum production (8). Wheat flour specific RAST was positive in 44.4% of cases. Peripheral eosinophils and wheat flour specific IgG1 levels were increased in those with positive RAST scores. Total IgE level and wheat flour specific IgG4 also seemed to be increased in those with positive RAST scores. Wheat flour specific IgG1 and IgG4 seemed to correlate positively with wheat flour specific IgE. The exposure duration correlated with neither total IgE nor wheat flour specific IgE. In those who were wheat flour RAST positive, wheat flour specific IgG1 levels correlated negatively with exposure duration. In RAST negative cases, however, there was no correlation. Similarly, there seemed to be a tendency for wheat flour specific IgG4 levels and exposure duration to correlate negatively in RAST positive cases. The subjects of this study initially worked in poorly ventilated areas.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Matsumura Y AU - Niitsuma T AU - Ito H LA - PT - DEP - TA - Arerugi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 25 IP - DP - 1994 Jan 01 TI - Risks of asthma associated with occupations in a community-based case-control study PG - 709-718 AB - The aim of this study was to identify occupational risk groups which might usefully be targeted for occupational asthma surveillance and control, using a community-based case-control approach. Data on previous and current occupations held by subjects were analyzed for 787 adult patients with bronchial asthma and 1591 nonasthmatic patient controls, aged 20-54 years, belonging to the three major races (Chinese, Malays, and Indians) in five outpatient primary care polyclinics. Odds ratios (OR) and 95% confidence intervals (95% CI) of association were adjusted for sex, age, race, smoking, and clinical atopy. No associated risks of asthma were found for clerical or sales workers in general. Significantly reduced risks of association with asthma were found for professional, technical, administrative, and managerial occupations (OR, 0.62; 95% CI, 0.47-0.82). The associated risks of asthma were generally elevated for service workers (OR, 1.35; 95% CI, 1.04-1.74) and manufacturing production and related workers (OR, 1.49; 95% CI, 1.23-1.81). Among them, increased risks were observed for cleaners, particularly municipal cleaners and sweepers (OR, 1.91; 95% CI, 1.22-2.99), textile workers (OR, 5.83; 95% CI, 1.93-17.57), garment markers (OR, 1.61; 95% CI, 1.01-2.58), electrical and electronic production workers (OR, 1.36; 95% CI, 1.06-1.75), printers (OR, 2.24; 95% CI, 1.17-4.31), and construction/renovation workers (OR, 2.24; 95% CI, 1.30-3.85). The odds ratio of association of asthma with exposures in service and production-related occupations overall, relative to the "nonexposed" reference group of nonmanual professional/technical, administrative/managerial, clerical, and sales occupations, was estimated to be 1.72 (95% CI, 1.36-2.19); the estimated population attributable risk was 0.33 (95% CI, 0.22-0.44) AU - Ng TP AU - Hong CY AU - Goh LG AU - Wong ML AU - Koh KT AU - Ling SL LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 22 IP - DP - 1994 Jan 01 TI - Do latex allergens potentiate other skin tests? PG - 39-41 AB - We report the case of a 33 year old atopic female patient, who worked for the last 4 years as a cleaner in the surgical area of a hospital. One year after starting the work in this area, the patient noticed upper respiratory symptoms and soon later dyspnea immediately after entering the operating room. Other allergic symptoms were perennial rhinoconjunctivitis and urticaria after contact with peaches. Common skin prick tests were positive for Dermatophagoides pteronyssinus. Fifteen min later a skin prick test with latex was done with a strong positive result after 10 min. At the same time, several allergens (cat dander, grass and olive pollens) showed positive results. The patient experienced a fall in the FEV1 that returned to basal levels after two inhalations of a bronchodilator. New skin tests to common allergens performed one week later were only positive to mites AU - Moneo I AU - Alday E LA - PT - DEP - TA - Allergol Immunopathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 94 IP - DP - 1994 Jan 01 TI - Green bean hypersensitivity: an occupational allergy in a homemaker. [Review] PG - 33-35 AB - As a member of the legume family, the green bean is frequently associated with food allergy. However, allergic reactions caused by skin contact or by inhalation of vapors from boiling legumes are rare. This article presents a case of occupational asthma in a homemaker; symptoms occurred during preparation and cooking of raw green beans. Skin prick, rub, and bronchial provocation tests were performed on the patient. In vitro tests were done with the serum samples of the patient and 10 control subjects (5 atopic and 5 nonatopic). Test results indicate that the patient has type I hypersensitivity to raw green bean antigen(s). This case is of interest because it demonstrates that a food allergen, when inhaled, can induce respiratory symptoms in sensitized patients and may even be the source of primary sensitization. [References: 7] AU - Igea JM AU - Fernandez M AU - Quirce S AU - de la Hoz B AU - Diez Gomez ML LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 20 IP - DP - 1994 Jan 01 TI - Associations between type of ventilation and air-flow rates in office buildings and the risk of SBS-symptoms among occupants PG - 239-251 AU - Sundell J AU - Lindvall T AU - Stenberg B LA - PT - DEP - TA - Environ Int JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - in press IP - DP - 1994 Jan 01 TI - Nonspecific symptoms in office workers: a review and summary of the epidemiological literature PG - - AU - Mendell MJ LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 88 IP - DP - 1994 Jan 01 TI - Occupational asthma in a pharmacist induced by Chlorella, a unicellular algae preparation PG - 555-557 AU - Ng TP AU - Tan WC AU - Lee YK LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 20 IP - DP - 1994 Jan 01 TI - Respiratory symptoms and bronchial reactivity among pig and dairy farmers PG - 48-54 AB - OBJECTIVES This study assessed the prevalence of respiratory manifestations among French pig and dairy farmers and determined the relationship between bronchial reactivity and respiratory manifestations. METHODS The pig farmers included 102 men working more than half-time inside swine confinement buildings. There were 51 male dairy farmers and 81 male referents. The demographic characteristics of the three groups were similar except for more smokers among the referents. Each subject completed a standardized questionnaire. Pulmonary function tests were performed before and after a methacholine challenge (cumulative doses 80, 240, and 560 micrograms). Airborne dust, ammonia, and carbon dioxide were measured inside 28 swine confinement buildings. RESULTS The pig farmers were exposed to a total dust level of 2.41 mg.m-3. The respirable particle concentration was low. The pig and dairy farmers had a significantly higher prevalence of cough and morning phlegm than the referents. Before the methacholine challenge, the dairy farmers had nonsignificantly lower mean lung function values than the other groups. Among the subjects with no history of asthma, nonspecific bronchial hyperreactivity was significantly higher among the pig and dairy farmers than among the referents. There was a fall in the forced expiratory volume in 1 s (FEV 1.0) that was greater than 10% in 6.7% of the referents, 17.9% of the swine workers, and 35.6% of the dairy farmers. This result was unchanged after adjustment for the initial FEV1.0. CONCLUSIONS The prevalence of respiratory symptoms was significantly higher among the pig farmers without base-line lung function impairment. However, both the pig and the dairy farmers had increased bronchial reactivity AU - Choudat D AU - Goehen M AU - Korobaeff M AU - Boulet A AU - Dewitte JD AU - Martin MH LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 7 IP - DP - 1994 Jan 01 TI - Respiratory and systemic reaction following exposure to heated electrostatic polyester paint PG - 608-611 AB - A 39 year old nonatopic man developed episodes of cough, dyspnoea, sweating and shivers within 2-3 weeks of starting a new job in a factory where metallic boards were treated with an electrostatic powder paint, made of an epoxy resin and a carboxylated polyester containing polyethylene terephthalate and polybutylene terephthalate. The subject sprayed the metallic boards which were then heated in 200 degrees C ovens. The subject was first seen in an emergency room after being at work for 4 h. The physical examination revealed bilateral wheezing with fever (39 degrees C), hypoxaemia (arterial oxygen tension (PaO2) 58 torr (7.7 kPa), leucocytosis (white blood count cells.mm-3 17,000 (17 x 10(9) cells.l-1) and severe airway obstruction (forced expiratory volume in one second (FEV1)/forced vital capacity, (FVC) 1.3/2.4 l, improving to 2.2/3.8 l after bronchodilator; predicted values = 3.4/4.1 l). The subjects condition improved after being treated with oral steroids. His spirometry was normal two weeks later, although he showed mild bronchial hyperresponsiveness to methacholine with the (provocative concentration producing a 20% fall in FEV1 (PC20) being 1.7 mg.ml-1). The subject underwent specific inhalation challenges at the workplace 4 months later. After being exposed at work for 4 h, he developed a significant fall in FEV1 (-40%), fever, leucocytosis, and a fall in diffusing capacity. Lung function tests were back to normal two weeks later. Exposing the subject to heated granulated polyester for one hour in a hospital laboratory produced a fall in FEV1 of 41%, fever, leucocytosis and a fall in diffusing capacity.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Cartier A AU - Vandenplas O AU - Grammer LC AU - Shaughnessy MA AU - Malo JL LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 66 IP - DP - 1994 Jan 01 TI - Respiratory disease in cotton textile workers: epidemiologic assessment of small airway function PG - 31-43 AB - We performed a cross-sectional study of 705 textile workers in two cotton mills and one silk mill in Shanghai, People's Republic of China, to assess small airway function among cotton textile workers and to compare the FEV1 to the FEF25-75 in detecting airflow obstruction in these workers. All workers had at least 2 years of work experience. Environmental sampling was performed with vertical elutriators and revealed that in the cotton mills mean elutriated dust levels were 1.07 +/- 0.23 mg/m3 in mill 1 and 1.01 mg/m3 +/- 0.24 mg/m3 in mill 2. Mean endotoxin levels were 332 +/- 83 ng/m3 in mill 1 and 101 +/- 46 ng/m3 in mill 2. No differences were found in preshift FEV1 or FEF25-75 between cotton and silk workers. Cotton workers had significantly greater declines than silk workers in FEV1 across a workshift, but not in FEF25-75. These acute changes in FEV1 were noted in both byssinotic and nonbyssinotic workers. Although cotton dust may affect both large and small airways, spirometric measures of small airway function (e.g., FEF25-75) add little to the FEV1 and FVC in detecting airflow limitation in cotton dust-exposed workers AU - Hayes GB AU - Ye TT AU - Lu PL AU - Dai HL AU - Christiani DC LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 150 IP - DP - 1994 Jan 01 TI - Respiratory health among retired grain elevator workers PG - 59-65 AB - Previous studies of grain elevator workers have shown exposure-related increased rates for respiratory symptoms and reduced levels of lung function compared with those of other employed populations. However, some reports have suggested that this effect may be reversible after cessation of exposure. To investigate this, we conducted a respiratory health survey among 75 retired grain elevator workers and 37 retired civic workers. Methods included a standard respiratory questionnaire, routine spirometry, chest radiography, a 6-min walk test, and a specialized questionnaire to assess the impact of breathing trouble on the activities of daily life. Grain retirees were slightly older than civic retirees (69 versus 67 yr, p < 0.05) and less likely to be atopic (7 versus 35%, p < 0.01). Grain elevator retirees reported more dyspnea (44 versus 11%, p < 0.01) and had significantly lower levels for both FEV1 (78.6 versus 88.2% pred) and FVC (90.0 versus 97.7% pred) (both p < 0.05). Compared with civic retirees, grain retirees reported the same average level of breathlessness after the 6-min walk test, but they walked a significantly shorter distance (p < 0.01); they also scored higher on the impairment of activities scale and had a greater proportion of persons reporting impairment of daily activities caused by breathing trouble (p < 0.05). Comparison of the changes in lung function from 1975 to the present study (i.e., from active employment to retirement) showed that grain workers had consistently lower levels of lung function than did civic workers while still employed, with no reversibility after retirement.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Kennedy SM AU - DimichWard H AU - Desjardins A AU - Kassam A AU - Vedal S AU - ChanYeung M LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 106 IP - DP - 1994 Jan 01 TI - Acute lung disease after exposure to fly ash PG - 309-311 AB - A 48-year-old man with no history of pulmonary disease developed acute lung disease after the intensive exposure of fly ash. He subsequently had progressive worsening of shortness of breath and hypoxemia to the point of requiring mechanical ventilation. Fly ash is a compound consisting of silicon dioxide and various other substances and is used in industrial settings to generate electricity. Exposure to fly ash may cause irritation to the mucous membrane of the respiratory tract and even pulmonary fibrosis in humans. To our knowledge, this is the first case report described in the medical literature of acute lung disease developing after fly ash exposure AU - Cho K AU - Cho YJ AU - Shrivastava DK AU - Kapre SS LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 70 IP - DP - 1994 Jan 01 TI - Characteristics of chromate workers' cancers, chromium lung deposition and precancerous bronchial lesions: an autopsy study PG - 160-166 AB - The characteristics of lung cancers induced by inhaled chromate were studied in 13 consecutive autopsies on male ex-chromate workers. In addition to histopathology, we examined: (1) the relationship between the occurrence of lung cancer and the amount of chromium (Cr) deposited in the lung as determined by atomic absorptiometry and (2) the chronological changes in five precancerous lung lesions followed by bronchoscopy till death. Twenty-one cancers were identified, including 16 lung tumours observed either during follow-up or at autopsy. Of these 16 tumours, 13 were found in six subjects, implying a high frequency of multiple cancers. Eleven (69%) out of the 16 tumours were of squamous cell type (including carcinoma in situ), this being twice as frequent as in age-matched controls. A further characteristic was predominance in the central part of lung (69%). The lung Cr burden was very much higher [40-15,800 micrograms g-1 (dry)] in patients with lung tumours than in those without (8-28 micrograms g-1). Five of the precancerous lesions followed by bronchoscopy originated at bronchial bifurcations. Four of these cases showed a return to normal histology at autopsy even without therapy, and the other did not progress AU - Ishikawa Y AU - Nakagawa K AU - Satoh Y AU - Kitagawa T AU - Sugano H AU - Hirano T AU - Tsuchiya E LA - PT - DEP - TA - Br J Cancer JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Relations between respiratory symptoms and sickness among workers in the animal feed industry PG - 440-446 AB - OBJECTIVE--The survey aimed at studying the associations between prevalent respiratory symptoms in an occupational population and sickness absence due to respiratory disorders. METHODS--A cross sectional survey among male workers in an animal feed mill was conducted. A total of 303 production workers and 102 office clerks completed a questionnaire on respiratory complaints, smoking habits, and occupational history. The questionnaire was used to identify workers with respiratory symptoms in the past 12 months. During this period all spells of sickness absence were recorded. Causes of sickness were classified in broad categories encompassing respiratory symptoms, influenza, musculoskeletal disorders, and others. RESULTS--Logistic regression analysis showed that workers with respiratory complaints experienced a higher sickness absence than those without respiratory complaints. Adjusted for age and smoking the odds ratio (OR) for sickness prevalence was 1.9 among office clerks and 2.6 among blue collar workers. Smoking increased the risk on sickness absence with ORs of 2.4 and 1.6, respectively. When restricting the analysis to sickness due to respiratory complaints, subjects with respiratory complaints had significantly higher risks for absence prevalence and absence rate than those without respiratory complaints. There were no differences in sickness absence between workers with asthma like complaints and those with chronic bronchitis like complaints. CONCLUSION--The clear associations between respiratory complaints and prevalence and rate of respiratory sickness absence indicate that workers with respiratory complaints are at risk of temporary disability and, thus, may experience a reduced ability to cope with routine activities at work AU - Post WK AU - Burdorf A AU - Bruggeling TG LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Respiratory symptoms and ventilatory function in confectionery workers PG - 435-439 AB - Respiratory symptoms and ventilatory capacity were studied in a group of 288 workers (259 women and 29 men) employed in a confectionery plant. A group of workers (96 women and 31 men) not exposed to confectionery manufacture were also studied as controls. The prevalence of chronic respiratory symptoms was higher in exposed than in control workers, being greatest for confectionery workers exposed to the dust of flour, talc, and starch and the vapours of alcohol. Chronic bronchitis was reported by 7% of the women and 21% of the men, and chest tightness was reported by 27% of women and 66% of men. There was a high prevalence of acute irritative symptoms during the workshift in all groups of confectionery workers, especially for cough, dyspnoea, burning and dryness of the throat, and eye irritation. For all groups of confectionery workers there were statistically significant across shift reductions in ventilatory capacity, being most pronounced for maximum flow rate at 50% of the control vital capacity (FEF50; range 4.6-13.0%) and at 25% of the control vital capacity (FEF25; range 4.7-22.3%). Preshift values of FEF50 and FEF25 were significantly lower than predicted values. The data suggest that some workers employed in confectionery plants may develop acute and chronic respiratory symptoms associated with changes in lung function AU - Zuskin E AU - Mustajbegovic J AU - Schachter EN AU - Kern J LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 51 IP - DP - 1994 Jan 01 TI - Occupational allergy after exposure to caddis flies at a hydroelectric power plant PG - 408-413 AB - A cross sectional survey was conducted in a hydroelectric power plant in which the workforce was exposed to large numbers of caddis flies. 28 of 57 employees participated. About 50% of the participants reported work related eye, nose, and sinus symptoms and wheezing. Working in locations with greater exposure to caddis flies was significantly associated with work related symptoms. 17 workers (61%) were skin prick positive to a laboratory prepared caddis fly antigen (LCFA) made from the remains of caddis flies present in the plant and 11 (39%) had positive reactions to a commercial caddis fly antigen (CCFA). Workers stationed in heavily exposed areas were 3.7 times as likely to have a positive response to the LCFA (p = 0.009) and 5.3 times as likely to have a positive response to the CCFA (p = 0.036). 13 (46%) of survey respondents reported three or more work related symptoms. 10 (91%) CCFA positive workers reported three or more work related symptoms. Pulmonary function studies revealed slight, but not significantly decreased forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC ratios in workers who were skin test positive to either caddis fly preparation when compared with those who were negative. One worker who was skin test positive to both antigens had a cross shift fall in FEV1 of 20% predicted. Occupational allergy to caddis flies proved to be a significant health problem at this work site AU - Kraut A AU - Sloan J AU - SilviuDan F AU - Peng Z AU - Gagnon D AU - Warrington R LA - PT - DEP - TA - Occup Environ Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Comparison of immunologic tests in the diagnosis of occupational asthma and rhinitis PG - 342-347 AB - In this study, three immunologic tests, skin prick test, RAST, and basophil histamine-release test (BHRT), were compared by provocation in the diagnosis of occupational asthma and rhinitis. Twenty-three positive bronchial or nasal challenges were performed on 16 patients (six farmers, six bakery workers, and four food industry workers) and asthma or rhinitis was diagnosed as caused by cereal flour or grain, cow epithelium, storage mites, garlic, or soy dust. A control group consisted of 12 patients, of whom four (two bakery workers, one food industry worker, and one farmer) were challenge-negative, and the rest suffered from pollen allergy and seasonal rhinitis and were not challenged. The sensitivity and specificity of the prick test, RAST, BHRT, and a panel of them were as follows: 74 and 89%, 57 and 86%, 78 and 93%, and 91 and 71%, respectively. The overall concordance among these three type I allergy tests or between immunologic tests and challenge was relatively good AU - Rasanen L AU - Kuusisto P AU - Penttila M AU - Nieminen M AU - Savolainen J AU - Lehto M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Acute autoimmune response in a case of pyromellitic acid dianhydride-induced hemorrhagic alveolitis PG - 337-341 AB - A 17-year-old man was occupationally exposed to pyromellitic acid dianhydride dust during the production of epoxy resin in a chemical factory. He was clinically diagnosed as having acute hemorrhagic alveolitis associated with anemia. The serologic analysis revealed a high concentration of IgG antibodies against pyromellitic acid dianhydride-treated human serum albumin (PMDA-HSA). Immunoblotting with PMDA-treated human serum as antigen and the patient's serum as the first antibody showed that additional PMDA-modified serum proteins other than HSA were recognized by the patient's IgG antibodies in the higher mol. mass range (> 67 kDa). No specific IgG could be detected against other anhydride conjugates (maleic acid, MA; phthalic acid, PA) with the exception of a reaction with the trimellitic acid anhydride-conjugated HSA (TMA-HSA). No specific IgE antibodies could be detected against any of the above mentioned antigens, but immunoblotting of the patient's serum indicated IgG4-type autoantibodies against in vitro PMDA-treated Ig molecules of normal serum proteins AU - Czuppon AB AU - Kaplan V AU - Speich R AU - Baur X LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Occupational asthma due to indirect exposure to lauryl dimethyl benzyl ammonium chloride used in a floor cleaner PG - 842-843 AB - The case is described of a 44 year old pharmacist who developed severe occupational asthma threatening his continued employment, confirmed by serial measurement of peak expiratory flow at home and work. The cause was found to be the cleaning agent used in his office when it was unoccupied. Bronchial challenge testing identified the specific agent to which he was sensitised as lauryl dimethyl benzyl ammonium chloride, a constituent of the floor cleaner. Substitution of this floor cleaner by a simple detergent cleaner led to a substantial improvement in his asthma, confirmed by repeated serial peak flow measurements AU - Burge PS AU - Richardson MN LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 32 IP - DP - 1994 Jan 01 TI - A case of suspected occupational asthma in an orthopedist, due to cast materials containing MDI PG - 606-609 AB - A 38-year-old male presented complaining of an asthma attack. He had a past history of allergic rhinitis and conjunctivitis, family history of bronchial asthma and atopic dermatitis. He was an orthopedist who had been using cast materials containing methylene diphenyl isocyanate (MDI) for one year, and had developed an early asthmatic response while handling the casts. An acetylcholine inhalation test was done and his value was 20000 micrograms/ml. The scratch test for the cast materials was negative though the inhalation challenge test was positive. We suspected that the patient was suffering from bronchial asthma induced by MDI contained in the cast materials. Studies using isocyanates conjugated with human serum albumin were performed. The results were as follows: IgE-RAST negative, ELISA demonstrated the existence of specific IgG for both toluene diisocyanate (TDI) and MDI, as well as IgG4 for both TDI and MDI. The cast contained MDI but not TDI. We therefore considered TDI to be cross-reactant. It was likely that chronic exposure enhancing specific IgG4 and specific IgG might have caused the high IgG4 value. This is the first case of occupational asthma in an orthopedist due to isocyanates AU - Tanaka Y AU - Satoh F AU - Komatsu T AU - Muto H AU - Akiyama N AU - Arai Y AU - Miyamoto Y AU - Sano Y LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 24 IP - DP - 1994 Jan 01 TI - Occupational rhinoconjunctivitis and asthma caused by Tetranychus urticae (red spider mite). A case report PG - 477-480 AB - This paper highlights a clinical case of a patient suffering bronchial asthma and rhinoconjunctivitis due to sensitization to Tetranychus urticae (TU), commonly known as the red spider mite, which belongs to the Prostigmata sub-order of the Tetranychidae family, in relation to a work environment (a carnation nursery). Both prick and intradermal skin tests were positive, as well as specific bronchial challenge tests with TU extract. Specific IgE was demonstrated by RAST (Class 3). Unspecific bronchial provocation with methacholine was negative. Sodium dodecylsulfate-polyacrylamide gel electrophoresis (SDS-PAGE) immunoblotting revealed the presence of seven main IgE binding proteins, the more intense bands being those appearing at 21, 17 and 15 kDa. This indicates a case of immediated type hypersensitivity to Tetranychus urticae with a clear correlation to occupational environment AU - Delgado J AU - Gomez E AU - Palma JL AU - Gonzalez J AU - Monteseirin FJ AU - Martinez A AU - Martinez J AU - Conde J LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 24 IP - DP - 1994 Jan 01 TI - Isolation and denomination of an important allergen in baking additives: alpha-amylase from Aspergillus oryzae (Asp o II) PG - 465-470 AB - The commercially available alpha-amylase from Aspergillus oryzae which is widely used as a baking additive was compared with a highly purified enzyme preparation. We used enzyme allergosorbent test (EAST), EAST inhibition, sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), isoelectric focussing, immunoblotting, and N-terminal amino acid sequencing to characterize the causative allergen. Our screening comprised 89 partially selected bakers. Forty-three (48%) of them had work-related respiratory symptoms; 14 (32%) of whom were sensitized to the baking additive. Significant immunological differences could not be found between crude and purified sample with the exception that the latter one produced nearly twice as high antibody values. Iodine starch staining demonstrated that the component which was exclusively or predominantly bound by IgE antibodies of symptomatic bakers represents the active alpha-amylase. According to the International Union of Immunological Societies (IUIS) nomenclature, the term Asp o II is suggested for this important occupational allergen AU - Baur X AU - Chen Z AU - Sander I LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 24 IP - DP - 1994 Jan 01 TI - Measurement of airborne proteins involved in Bakers' asthma PG - 450-456 AB - We have developed a competitive inhibition immunoassay to measure airborne flour, using purified polyclonal rabbit IgG antibodies to cereal flour antigens. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) showed different flours contained proteins of molecular weight similar to those present in air sample eluates. Western blotting demonstrated that the purified rabbit IgG antibodies bound to proteins whose molecular weights are similar to human allergens. Air sample eluates obtained from a large bakery had slopes of inhibition parallel to cereal flour when compared in the immuno-inhibition assay. The assay identified airborne proteins from several flours with a detection limit of 1 microgram ml-1. Using this immunoassay we have shown that a wide range of airborne flour concentrations occur in flour mills and a smaller range bakeries. This assay which allows measurement of the concentration of flour aeroallergen in the workplace will be valuable both in epidemiological studies and in examining the effectiveness of interventions to reduce the concentration of flour in the air AU - Sandiford CP AU - Nieuwenhuijsen MJ AU - Tee RD AU - Taylor AJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 24 IP - DP - 1994 Jan 01 TI - Nasal challenge shows pathogenetic relevance of specific IgE serum antibodies for nasal symptoms caused by hexahydrophthalic anhydride PG - 440-449 AB - Hexahydrophthalic anhydride (HHPA) is a component of some epoxy resin systems. A high fraction of HHPA-exposed workers display nasal symptoms, and some of them have specific serum antibodies. To test the pathogenetic relevance of the antibodies nasal challenge tests were performed with a conjugate of HHPA and human serum albumin (HSA) at three increasing concentrations. Eleven subjects, who were IgE-sensitized against HHPA (positive in RAST and in skin-prick test against the HHPA-HSA conjugate), and who reported work-related nasal symptoms, had a significant increase of nasal symptoms and a decrease of nasal inspiratory peak flow after the challenges. The symptoms were associated with specific serum IgE, but with IgG. Further, significant increases were found in eosinophil and neutrophil counts, and in levels of tryptase, and albumin, whereas no clear rise was recorded for eosinophil cationic protein in nasal lavage fluid. Nine subjects, who were not sensitized, but who complained of work-related nasal symptoms, and 11 subjects, who were not sensitized and had no symptoms, displayed no significant change in any of these parameters. It is concluded that the symptoms in some of the workers were caused by an IgE-mediated mast cell degranulation, followed by an inflammatory reaction, engaging eosinophil and neutrophil cells AU - Nielsen J AU - Welinder H AU - Ottosson H AU - Bensryd I AU - Venge P AU - Skerfving S LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 150 IP - DP - 1994 Jan 01 TI - Longitudinal estimates of pulmonary function decline in grain workers PG - 656-662 AB - We conducted a cohort analysis of longitudinal changes in pulmonary function test values in male grain elevator workers in five regions of Canada over a 6-yr period involving three observations. Pulmonary function tests were obtained approximately each 3 yr during an observation interval called a "cycle". The periods of the cycles were 1978-81 (Cycle I), 1981-84 (Cycle II), and 1984-87 (Cycle III), respectively. Data on respiratory symptoms and pulmonary function tests were collected on the same 881 workers in Cycles I and II (mean ages +/- SE: 37.0 +/- 0.48 yr at Cycle I), on the same 1,294 workers in Cycles I, II, and III (34.6 +/- 0.34 yr at Cycle I), and on the same 1, 021 workers in Cycles II and III (33.9 +/- 0.38 yr at Cycle II) for a total of 3,196 workers with two or more observations over the 6-yr period. The proportion of current smokers decreased from Cycle I to Cycle III. Autoregression analysis of longitudinal changes in lung function data showed that predictors of FEV1 were height, years in the industry, smoking status, and geographic region. The mean annual losses in FEV1 (FVC) were 28.7 ml (26.4 ml), 38.4 ml (41.9 ml), and 41.7 ml (32.3 ml) for nonsmokers, ex-smokers, and current smokers, respectively. The annual loss of FEV1 (FVC) was 9.2 ml (21.1 ml) for those who were in the grain industry for less than 5 yr and 52.6 ml (60.8 ml) for those who were exposed for 20 yr or more.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Pahwa P AU - Senthilselvan A AU - McDuffie HH AU - Dosman JA LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Prevalence rates of diagnosis of asthma in general population samples of northern and central Italy PG - 191-196 AB - In order to assess the distribution of asthma in Italy in the 1980s, we have compared the findings of three general population surveys carried out in the North and the Centre of the country. Two cross-sectional investigations were performed in the Po Delta area (North Italy), 6 yrs apart: 1) 3,285 subjects, aged 8-64 yrs, in 1980-1982 (PD1); and 2) 2,841 subjects, aged 8-73 yrs, in 1988-1991 (PD2). One cross-sectional survey was carried out in Pisa (Central Italy): 3,866 subjects, aged 5-90 yrs, in 1985-1988 (PI1). For this analysis we have used data from the standardized questionnaires of those subjects between 18-64 yrs, who were currently employed. The prevalence rate of ever asthma was 3.3-5.5%, that of current asthma 1.3-2.9%; almost all of the diagnoses were confirmed by a doctor. Taking into account only doctor-confirmed asthma, the age of onset of manifestations was most frequently over 18 yrs (41-79%). It also occurred more frequently after the onset of employment. As regards smoking, whilst most asthmatic males were current or former smokers (70-86%), most asthmatic females were nonsmokers. However, the situation changed in PD2, where females showed the same pattern as males. Considering asthmatic subjects with skin-prick test reactivity (data available only in PD2), the vast majority (67% in males, 75% in females) had an age of disease onset under 18 yrs. In conclusion, the prevalence of asthma in Italy in the 1980s was similar to that in other European countries and was affected by atopy and smoking differently in the two sexes.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Viegi G AU - Baldacci S AU - Vellutini M AU - Carrozzi L AU - Modena P AU - Pedreschi M AU - Maggiorelli F AU - di Pede F AU - Paoletti P AU - Giuntini C LA - PT - DEP - TA - Monaldi Arch Chest Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 106 IP - DP - 1994 Jan 01 TI - Occupational exposure to tuberculosis: risk and consequences [editorial] PG - 658-659 AU - Dunlap NE AU - Bailey WC AU - Bass JB Jr AU - Boyd WW AU - Sutton FD AU - Tally WJ LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 78 IP - DP - 1994 Jan 01 TI - Is tooth enamel dust an asthma stimulus? [letter] PG - 3-3 AU - Neiburger EJ LA - PT - DEP - TA - Oral Surg Oral Med Oral Pathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Occupational asthma related to fresh Gypsophila paniculata PG - 478-480 AU - Antepara I AU - Jauregui I AU - Urrutia I AU - Gamboa PM AU - Gonzalez G AU - Barber D LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 49 IP - DP - 1994 Jan 01 TI - Farm workers' occupational allergy to Tetranychus urticae: clinical and immunologic aspects PG - 466-471 AB - A group of 46 farm workers (32 men), affected by a recurrent "occupational disease of undetermined origin", underwent an immunologic investigation with a Tetranychus urticae (TU) whole-body extract (TU-WBE) prepared in our laboratory. The patients suffered from seasonal attacks of rhinitis, during the summer and autumn periods, when working in open fields (30 subjects) or in greenhouse flower cultivation (16 subjects). In most patients, rhinitis was associated with bronchial asthma (16 subjects), urticaria (14 subjects), or both (three subjects). Allergic alveolitis or other common allergic diseases had been excluded, and a diagnosis of "occupational disease of undetermined origin" had been made before by other medical centers. Ten healthy farm workers and 10 atopic townsmen were chosen as control groups. An in vivo and in vitro diagnostic trial by skin prick testing (SPT) and serum specific IgE dosage with TU-WBE were done in all subjects. Thirty-six patients (78%) were found to be positive to both SPT and the IgE enzyme allergosorbent test (EAST), with a good correlation between IgE serum levels and cutaneous wheal size. Control groups did not show any reaction. The IgE-EAST homologous inhibition test was positive. The IgE-EAST cross-inhibition test excluded cross-reactivity between TU and Dermatophagoides pteronyssinus. The TU-exposure test was positive for the 36 patients with TU-WBE-specific IgE. Three patients who were negative for TU-WBE-specific IgE reacted to the TU-exposure test; in these patients, the scratch-chamber test (Finn chamber) with eggs and droppings from TU was positive.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Astarita C AU - Franzese A AU - Scala G AU - Sproviero S AU - Raucci G LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 85 IP - DP - 1994 Jan 01 TI - Alpha-amylase as an occupational allergen in baking industry employees PG - 142-148 AB - In a group of 226 bakers and pastry makers and in 88 students of a training school for bakers, we evaluated skin sensitization to the common allergens, wheat and alpha amylase. Skin prick tests were positive to the enzyme in 17 exposed subjects (7.5%) and in one student with previous occupational exposure as a baker; 27 exposed subjects (11.9%) and 2 students were sensitized to wheat. Among the 42 exposed workers who complained of work-related symptoms, 12 (28.6%) cases were skin positive to amylase and 17 (42.9%) to wheat. Among the 17 workers who were positive to amylase, 16 were also sensitized to wheat and/or common allergens, 12 complained of symptoms at work but since in many cases there was a positive response to wheat, too, it is impossible to speculate on the role of each allergen in inducing symptoms. One case, with work-related rhinoconjunctivitis, had skin sensitization only to alpha amylase but no specific IgE in the serum. These findings confirm that bakers are at risk of sensitization not only to wheat allergen but also to amylase from Aspergillus oryzae. The enzyme should be included in the list of substances to be tested among bakers in whom an occupational allergy is suspected, but particular care should be taken in evaluating the cutaneous response, especially if compared to wheat wheals. Further investigations are also needed to identify the source of risk and to better define the characteristics of the enzyme and the relationship between skin reaction to amylase, sensitization to wheat and atopy.(ABSTRACT TRUNCATED AT 250 WORDS) AU - De Zotti R AU - Larese F AU - Molinari S LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 85 IP - DP - 1994 Jan 01 TI - The response to a specific bronchial provocation test and the evolution of occupational asthma. A longitudinal study in subjects with toluene diisocyanate-induced asthma. PG - 134-141 AB - The aim of this study was to investigate the progression and long-term consequences of occupational asthma and to evaluate the effect of the pattern of response to specific bronchoprovocation test (SBPT) in the prognosis of occupational asthma among 40 subjects with asthma due to toluene diisocyanate (TDI). Nine subjects had immediate asthma, 25 subjects had late asthma and 6 subjects had dual asthma. Respiratory symptoms, persistence of exposure to TDI and lung function have been investigated both at diagnosis and at follow-up examination. At follow-up examination, 70.0% of the subjects were not exposed to TDI, and only 14.3% of "non-exposed" subjects were completely asymptomatic. At follow-up examination, 71.4% of "exposed" subjects and 55.6% of "non-exposed" subjects were regularly treated with medications because of their asthma (no statistical difference). No significant differences have been found in symptoms prevalence or lung function between "exposed" and "non-exposed" subjects. After comparing the results obtained at diagnosis and at follow-up examination, a significant decrease in FVC both in "exposed" and "non-exposed" groups (p < 0.005 and p < 0.0005, respectively) and a significant decrement in FEV1 (p < 0.05) and FVC (p < 0.0005) among the subjects with late asthma, was found. We can conclude that, despite the removal from TDI exposure, occupational asthma can lead to permanent disability with important socio-economic consequences, and late response to SBPT may be a negative prognostic factor in TDI asthma AU - Marabini A AU - Brugnami G AU - Curradi F AU - Severini C AU - Siracusa A LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 36 IP - DP - 1994 Jan 01 TI - New-onset asthma after exposure to the steam system additive 2-diethylaminoethanol. A descriptive study PG - 623-626 AB - Through a leak in the steam heating system, the anticorrosive agent 2-diethylaminoethanol was released into the air of a large office building. Irritative symptoms were experienced by most of the 2500 employees, and 14 workers developed asthma within 3 months of exposure. This study was undertaken to review clinical characteristics of these asthmatics. Environmental exposure monitoring data and medical records were reviewed. Seven of 14 cases were defined as "confirmed" and 7 of 14 as "suspect," using the National Institute for Occupational Safety and Health surveillance case definition of occupational asthma. Spirometry was positive in 4 of 14 of the cases and peak flow testing in 10 of 14. Three cases were diagnosed on the basis of work-related symptoms and physical examination alone. The study suggests that acute exposure to the irritating steam additive 2-diethylaminoethanol was a contributing factor in the development of clinical asthma in this population AU - Gadon ME AU - Melius JM AU - McDonald GJ AU - Orgel D LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 309 IP - DP - 1994 Jan 01 TI - Do asthmatic patients correctly record home spirometry measurements? PG - 1618-1618 AU - Chowienczyk PJ AU - Parkin DH AU - Lawson CP AU - Cochrane GM LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19940101 IS - IS - VI - 308 IP - DP - 1994 Jan 01 TI - Severe anaphylactic reaction to latex rubber surgical gloves PG - 246-247 AU - Mansell PI AU - Reckless JPD AU - Lovell CR LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Peak expiratory flow monitoring and airway response to specific bronchial provocation tests in asthmatics PG - 23-28 AB - To assess the validity of peak expiratory flow (PEF), measured by means of a peak flow meter, in comparison to forced expiratory volume in one second (FEV1) for measuring the airway response during specific bronchial challenges, we registered PEF and FEV1 in a random sequence during 75 positive (decrease in FEV1 of : or = 15% from baseline) and 75 negative (decrease in FEV1 : 15% from baseline) challenges with chemicals or allergens. The correlation between PEF and FEV1 in terms of absolute values and of percentage of change from baseline was statistically highly significant (p : 0.001) in all challenges and in the different pattern of response, immediate, dual and late. Relative operating characteristic analysis showed that an absolute decrease in PEF of : or = 70 l.min-1 in the immediate and of : or = 80 l.min-1 in the late phase of the response (cut-off points) gave optimal discrimination between challenges with a bronchoconstrictive response (defined as a FEV1 decrease : or = 15% from baseline), and challenges without. These cut-off points, however, were highly specific (92 and 93.3%, respectively), but not as sensitive (70.6 and 61.1%, respectively), and smaller absolute changes in PEF from baseline do not exclude a bronchoconstrictive response. Our data suggest that PEF readings are a useful diagnostic tool in assessing the airway response during a specific bronchial challenge in asthmatics, although with some limitations. PEF readings can be used to monitor the late response to a challenge during the evening and the night if PEF readings are carefully considered in relation to clinical symptoms AU - Moscato G AU - Dellabianca A AU - Paggiaro P AU - Bertoletti R AU - Corsico A AU - Perfetti L LA - PT - DEP - TA - Monaldi Arch Chest Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 70 IP - DP - 1993 Jan 01 TI - Hypersensitivity to latex, chestnut and banana PG - 31-34 AU - Rodriguez M AU - Vega F AU - Garcia MT AU - Panizo C AU - Laffond E AU - Montalvo A AU - Cuevas M LA - PT - DEP - TA - Acta Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 8 IP - DP - 1993 Jan 01 TI - Application of peak expiratory flow in epidemiologic studies of occupation PG - 265-277 AB - Investigation of the use of PEF in the measurement of airway variability over a single day or several weeks suggests that serial measures of PEF may prove useful in detecting short-term adverse responses to a variety of environmental agents. Several investigators have already shown how the visual inspection of temporal trends can prove useful in identifying individuals with occupational asthma. The use of statistical summaries of diurnal variation, i.e., the amplitude as a percent of the daily mean, may provide important added information about airway reactivity in response to occupational exposures in a variety of populations. Indeed, there are several groups of investigators presently examining more refined ways, including autoregressive time series models, of linking short-term temporal patterns in serial measurements of PEF with simultaneously measured short-term exposures. As our understanding of the sources and nature of the variability in PEF improves, together with refinements in the statistical techniques used to describe the temporal data, serial measures of PEF are likely to see a far broader application in the study of acute respiratory hazards. Does the utility of PEF as a pulmonary function measurement stem solely from ease of collection and the consequent increase in the amount of data one can gather, or is the PEF a distinctly different and inherently useful measure of pulmonary function? This question cannot yet be answered. The increasing availability of accurate reliable hand-held spirometers means that one can now plan studies using the powerful repeated measures designs previously feasible only with the peak flow meter (see article on Instrumentation, pp 397-408, in this issue). These data will enable side-by-side comparisons of PEF, FEV1, maximum mid-expiratory flow, and other parameters collected simultaneously. Will the FEV1 once again become the preferred measure of airflow? Time will tell AU - Eisen EA AU - Wegman DH AU - Kriebel D LA - PT - DEP - TA - State of the Art Reviews: Occupational Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Effects of air pollution on the prevalence of asthma and allergy: lessons from the German reunification PG - 879-881 AU - Magnussen H AU - Jorres R AU - Nowak D LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Factors affecting peak expiratory flow variability and bronchial reactivity in a random population sample PG - 899-905 AB - Although serial peak expiratory flow (PEF) measurements are often used to assess the variability of airflow obstruction, the range of values to be expected in the general population has never been defined, nor is there any consensus as to how PEF variability should be expressed. We have compared PEF recordings made by 121 subjects selected at random from the population of a small town (Group A) and 221 subjects selected because of wheeze in the last year (Group B). Subjects were asked to record PEF every 2 h during waking hours for 7 days using a mini-Wright peak flow meter. Seven indices of PEF variability were derived for each subject and the range for each index determined. All indices showed a positively skewed distribution in the random sample. Two variability indices, standard deviation percent mean and amplitude percent mean, provided the greatest separation between subjects with both a diagnosis of asthma and wheeze in the last year and subjects with neither feature and also provided the highest intra-class correlation coefficients. We conclude that amplitude percent mean and standard deviation percent mean provide the best means of expressing PEF variability for epidemiological purposes, but that amplitude percent mean is more easily derived and appears to be the index of choice. PEF variability has a continuous distribution in the general population and no clear-cut division between asthmatic and nonasthmatic subjects can be defined AU - Higgins BG AU - Britton JR AU - Chinn S AU - Lai KK AU - Burney PGJ AU - Tattersfield AE LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - Toxicity and immediate allergenicity of latex gloves PG - 618-623 AU - Cormio L AU - Turjanmaa K AU - Talja M AU - Andersson LC AU - Ruutu M LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 8 IP - DP - 1993 Jan 01 TI - Medical screening using periodic spirometry for detection of chronic lung disease PG - 353-361 AB - Approximately half of a worker population may benefit from the addition of a longitudinal comparison of their spirometry results, over only using annual comparisons with a cross-sectional LLN. The ATS recommendation of 15% for year-to-year changes appears to be essentially equivalent to a longitudinal LLN method based on the SEE. Therefore, a practical method for longitudinal interpretations is to establish a baseline value for a worker's FEV1 through several initial spirometric examinations. The FEV1 longitudinal LLN is calculated by taking 85% of this baseline value minus the expected decline over the time period based on the individual's age (e.g., for individuals older than 35 years at their initial examination, one approach is to use 30 mL/year times the number of years of follow-up). However, before any final classification is rendered, the data should be reviewed for stability. This analysis demonstrates that longitudinal spirometry adds sensitivity to spirometry screening efforts. The spirometry examinations should probably be performed annually in order to detect survey biases and determine the stability of the FEV1 measurements. If spirometry results indicate that someone has crossed either the longitudinal or the cross-sectional LLN, intervention activities should be initiated for that individual. As new data and studies become available, these suggested procedures will need to be revised-particularly estimates for the expected annual decline in FEV1 AU - Hankinson JL AU - Wagner GR LA - PT - DEP - TA - State of the Art Reviews: Occupational Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 91 IP - DP - 1993 Jan 01 TI - The case for confirming occupational asthma: Why, how much, how far? PG - 967-970 AU - Malo JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 43 IP - DP - 1993 Jan 01 TI - Occupational asthma - a model to study the natural history and pathogenic mechanisms in asthma PG - 107-118 AB - Occupational agents can give rise to asthma either through producing specific IgE antibodies or through some as yet unidentified immunological mechanism. Study of pathogenic mechanisms of occupational asthma can generate very useful information on the pathogenesis of nonoccupational asthma. Occupational asthma also provides an ideal model to study the natural history of asthma. As the agent responsible for asthma is known, it is possible to design a study to investigate predisposing host factors and level of exposure and their interaction in determining the onset, the severity, and the outcome of the disease AU - ChanYeung M LA - PT - DEP - TA - Agents & Actions - Supplements JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 43 IP - DP - 1993 Jan 01 TI - Isocyanate induced lung disease PG - 119-129 AB - A review of the pathogenesis of isocyanate induced lung disease is given with an emphasis on immunologic mechanisms of disease AU - Zeiss CR LA - PT - DEP - TA - Agents & Actions - Supplements JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 148 IP - DP - 1993 Jan 01 TI - Predictors of asthma and wheezing in adults. Grain farming, sex, and smoking PG - 667-670 AB - We investigated predictors for asthma and wheeze in 1,634 men and women in the age group 20 to 65 yr from the town of Humboldt, Saskatchewan. On the basis of questionnaire responses, subjects were classified into mutually exclusive groups as asthmatic (n = 62), wheezing (n = 444), asymptomatic (n = 908), and symptomatic (n = 220) groups. After excluding the symptomatic group, we used polytomous logistic regression models to determine predictors of asthma and wheezing. Significant predictors for asthma were grain farming (odds ratio [OR] = 1.9, 95% confidence interval [Cl]: 1.1-3.5; p = 0.03) and sex (OR = 1.9, Cl: 1.1-3.2; p = 0.03; males compared with females). Significant predictors for wheezing were smoking (former smoker: OR = 1.8, Cl: 1.3-2.5, p : 0.001; current smoker: OR = 5.0, Cl: 3.8-6.7, p : 0.001; in comparison to nonsmoker) and grain farming (OR = 1.7, Cl: 1.3-2.4, p : 0.001). Age, level of education, and physical activity at work were not significant predictors for asthma or wheezing. None of the interaction effects between the predictors was significant. When stratified by sex, grain farming was a significant predictor of asthma in men but not in women. Nevertheless, smoking and grain farming were significant predictors of wheezing in both men and women. Our study raises the possibility that grain farming might be a risk factor for asthma and asthma-like symptoms AU - Senthilselvan A AU - Chen Y AU - Dosman JA LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 148 IP - DP - 1993 Jan 01 TI - Asthma risk and occupation as a respiratory therapist PG - 671-674 AB - In the modern hospital environment, many health care workers are exposed to hazardous substances. Among these hazards are respiratory sensitizers, irritants, and infectious agents. A previous cross-sectional study of Rhode Island respiratory therapists reported an excess risk of asthma after entry into that profession. Before the results of that study were published, we conducted a confirmatory mailed questionnaire survey of 2,086 Massachusetts respiratory therapists and 2,030 physical therapists and physical therapy assistants. Neither the survey questionnaire nor the accompanying cover letter revealed the focus of our investigation. A history of physician-diagnosed asthma was reported by 16% of respiratory therapists and 8% of control subjects. When analysis was restricted to those who developed asthma after entry into their profession, respiratory therapists still had a significant excess, 7.4 versus 2.8%. The odds ratio for respiratory therapy was 2.5 (95% Cl, 1.6 to 3.3) after adjustment for age, family history, atopic history, smoking, and gender. These results confirm the previous report of excess risk of asthma among respiratory therapists. This excess risk develops after entry into the profession and does not appear to be explained by bias or confounding. Efforts should be directed to identifying potential agents responsible for this form of occupational asthma AU - Christiani DC AU - Kern DG LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 67 IP - DP - 1993 Jan 01 TI - Acute alveolitis induced by hydroxyurea in a patient with myeloproliferative syndrome PG - 133-134 AB - Hydroxyurea is increasingly being used to control myeloproliferative disorders, in part because of its relative lack of side effects. We present a case of life-threatening alveolitis in a patient treated with hydroxyurea for myeloproliferative syndrome. Absence of exposure to other drugs and the clinical course suggest that the alveolitis was induced by hydroxyurea AU - Hennemann B AU - Bross KJ AU - Reichle A AU - Andreesen R LA - PT - DEP - TA - Ann Hematol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 104 IP - DP - 1993 Jan 01 TI - Occurrence of occupational asthma PG - 816-820 AB - To estimate the percentage of adult asthmatics with occupational asthma in Michigan, a sample of 94 patients, aged 20 to 65 years, who were discharged from one of three Michigan hospitals in 1990 with the primary diagnosis of asthma were interviewed. The patients were classified using the National Institute for Occupational Safety and Health (NIOSH) criteria as having either probable occupational asthma, possible occupational asthma, or not having occupational asthma. Three percent of the adult asthmatics interviewed met the criteria for having probable occupational asthma. One patient from each hospital had probable occupational asthma. Fifteen of 60 patients (25 percent) from hospital A, 3 of 25 patients (12 percent) from hospital B, and 2 of the 9 patients (22 percent) from hospital C had probable or possible occupational asthma. After adjusting for the difference in response rate among patients from the three hospitals, the percentage of adult asthmatics in Michigan whose asthma is caused by work exposure is estimated to be between 3 percent and 20.2 percent. In contrast, 25.5 percent of the patients stated their asthma was caused by bad working conditions. If these percentages were generalizable to the whole state, then according to our survey 330 to 2,222 or by self-reports of the patients, 2,800 of the 11,000 hospital discharges per year in Michigan for asthma among adults could be attributed to a work exposure AU - Timmer S AU - Rosenman K LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 92 IP - DP - 1993 Jan 01 TI - Immunologic studies of the mechanisms of occupational asthma caused by western red cedar PG - 466-478 AB - BACKGROUND Occupational asthma caused by western red cedar (Thuja plicata) is a common problem in sawmill industries. The objective of this study was to examine the cellular and immunologic mechanisms of western red cedar asthma (WRCA) more closely. METHODS Bronchial biopsy specimens, bronchoalveolar lavage (BAL) mast cells and peripheral blood basophils from patients with WRCA, patients with atopic asthma, and nonatopic control subjects were challenged in vitro with plicatic acid (PA), PA-human serum albumin conjugate (PA-HSA), grass pollen, or calcium ionophore. RESULTS PA (100 micrograms/ml) released histamine from the basophils of 9 of 11 patients with WRCA, 1 of 7 patients with atopic asthma, and 2 of 7 normal subjects. PA triggered histamine release from 10 of 11 bronchial biopsy specimens and 8 of 8 BAL samples from patients with WRCA. Interestingly, PA released histamine from BAL cells and bronchial biopsy specimens from 3 of 7 normal subjects but in none of the patients with atopic asthma. PA-HSA-induced histamine release from basophils and biopsy specimens was confined to patients with WRCA. PA-specific IgE was not detectable in serum from most patients with WRCA, and their serum did not transfer PA sensitivity to human lung fragments or lactate-stripped basophils. After pretreatment with anti-IgE in the absence of calcium, basophils from 14 subjects with WRCA still responded to PA (mean 64% to 67% of pretreatment response), whereas responses to grass pollen or anti-IgE were abolished. CONCLUSIONS This study confirms that PA releases histamine from bronchial mast cells of most patients with WRCA but not from those of patients with atopic asthma. The PA response of some normal subjects suggests that PA may have both specific and nonspecific actions on mast cells and basophils, whereas the serologic studies indicate histamine release in WRCA cannot simply be attributed to PA-specific IgE AU - Frew A AU - Chan H AU - Dryden P AU - Salari H AU - Lam S AU - ChanYeung M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 92 IP - DP - 1993 Jan 01 TI - Papain-induced allergic rhinoconjunctivitis in a cosmetologist PG - 492-493 AU - Niinimaki A AU - Reijula K AU - Pirila T AU - Koistinen AM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 92 IP - DP - 1993 Jan 01 TI - Effect of a topical corticosteroid on airway hyperresponsiveness and eosinophilic inflammation induced by trimellitic anhydride exposure in sensitized guinea pigs PG - 450-456 AB - BACKGROUND Topical corticosteroids are effective in the treatment of asthma by improving bronchial hyperresponsiveness and reducing airway inflammation. METHODS We assessed the effect of a nebulized corticosteroid, budesonide, on airway hyperresponsiveness and inflammatory response provoked by inhalation of trimellitic anhydride (TMA) dust, a known cause of occupational asthma in human beings, in guinea pigs sensitized to the free hapten. Male Dunkin-Hartley guinea pigs (n = 24) were injected intradermally with 0.1 ml of 0.3% TMA in corn oil, followed by exposure 21 to 28 days later to five consecutive doses of budesonide aerosol (0.5 mg/ml) or saline solution, administered for 10 minutes every 12 hours. They were then exposed (noses only) to TMA dust (8 mg/m3) or air for 1 hour (four groups, n = 6 in each). Airway responsiveness to acetylcholine, defined as the concentration needed to cause a 200% increase in lung resistance (PC200), was measured 8 hours later. RESULTS In saline-treated guinea pigs exposed to TMA, mean PC200 was 0.094 mmol/L (geometric SEM, 1.4 mmol/L) compared with 0.31 mmol/L (geometric SEM, 1.3 mmol/L, p : 0.05) in those guinea pigs pretreated with budesonide. In sham-exposed sensitized guinea pigs, PC200 was 0.35 mmol/L (geometric SEM, 1.2 mmol/L), which was not significantly different from the budesonide-treated group (0.36 mmol/L; geometric SEM, 1.3 mmol/L). There was a significant increase in the number of eosinophils in the subepithelium of guinea pigs further exposed to TMA dust (71.5 +/- 6.8 cells/unit area [mean +/- SEM]) compared with those exposed to air (22.7 +/- 6.7, p : 0.01). Budesonide did not inhibit the number of subepithelial eosinophils of guinea pigs exposed to TMA dust (54.0 +/- 3.7 cells/unit area) or in those exposed to air (24.3 +/- 6.7 cells/unit area) and did not affect the increase in eosinophils found in bronchoalveolar fluid. CONCLUSIONS Budesonide significantly inhibited the increase in airway responsiveness but not the eosinophilic inflammation induced by exposure to TMA dust in sensitized guinea pigs AU - Hayes JP AU - Barnes PJ AU - Taylor AJ AU - Chung KF LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 92 IP - DP - 1993 Jan 01 TI - Airway allergy to trimellitic anhydride in guinea pigs: different time courses of IgG1 titer and airway responses to allergen challenge PG - 425-434 AB - BACKGROUND Trimellitic anhydride (TMA) is a low molecular weight chemical that may cause occupational asthma in human beings. The objectives of this study were to determine the time course of immune and airway responses to TMA in guinea pigs and to relate the immunologic response to the immediate responses in lung resistance (RL) and plasma exudation induced by allergen challenge. METHODS We studied the effects of time course after sensitization on airway response to TMA in guinea pigs actively sensitized to free TMA, given by intradermal injection (0.1 ml of 0.3% TMA in corn oil). During weeks 1, 2, 3, 5, and 8 after sensitization, anesthetized animals were challenged with TMA conjugated to guinea pig serum albumin (TMA-GPSA), instilled via the airway route. Nonsensitized animals were challenged with the same amount of conjugate 4 weeks after intradermal injection of corn oil only. In the same animal, we measured both RL to monitor airflow obstruction and extravasation of Evans blue dye (20 mg/kg) to quantify airway plasma exudation. RESULTS Instillation of TMA-GPSA (0.5%; 50 microliters) into the tracheal lumen caused a significant increase in RL, reaching a maximum at 2.5 minutes after the instillation in the 1-week group (9.0 +/- 5.9 cm H2O/ml/sec) and between 5 and 6 minutes in the 2-, 3-, 5-, and 8-week groups (9.4 +/- 4.8, 12.7 +/- 5.5, 3.7 +/- 1.1, and 1.7 +/-0.2 cm H2O/ml/sec, respectively). The maximal increase in RL after the challenge in nonsensitized animals was 0.39 +/- 0.05 cm H2O/ml/sec. TMA-GPSA also produced significant extravasation of Evans blue dye at all airway levels in the sensitized groups, and the amount of dye in the peripheral airways was significantly greater than that in the trachea. Furthermore, the level of Evans blue dye in airway tissue increased with the time after sensitization, up to the latest time point tested (8 weeks). Specific IgG1 antibodies to TMA-GPSA demonstrated by ELISA were detected in all animals in the 3-, 5-, and 8-week groups, with maximal levels 5 weeks after sensitization. Specific IgG1 titers to TMA-GPSA significantly correlated with the level of Evans blue dye induced by challenge with TMA-GPSA but not with the increase in RL. CONCLUSIONS Intradermal sensitization to free TMA induces specific airway allergy for a long period after sensitization. Specific IgG1 antibodies to allergen may influence allergen-induced plasma exudation rather than the airflow obstruction in this animal model of TMA-induced asthma AU - Arakawa H AU - Lotvall J AU - Kawikova I AU - Tee R AU - Hayes J AU - Lofdahl CG AU - Taylor AJ AU - Skoogh BE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 31 IP - DP - 1993 Jan 01 TI - Specific antibody-forming cells in bronchoalveolar lavage fluid of patients with summer-type hypersensitivity pneumonitis--detection by enzyme-linked immunospot (ELISPOT). [Japanese] PG - 840-847 AB - Antigen-specific antibody-forming cells (AFCs) were assessed in bronchoalveolar lavage (BAL) fluid of patients with summer-type hypersensitivity pneumonitis by the method of enzyme-linked immunospot (ELISPOT). Both Cryptococcus- and Trichosporon-specific AFCs of isotypes of IgG, IgA and IgM were detected in BAL fluid cells. The frequency of isotypes of AFCs was in the order of IgA : IgM : IgG. Antibody activities against both Cryptococcus and Trichosporon antigens were detected in the culture supernatant of BAL cells. A good correlation was observed between the number of AFCs and the degree of antibody activity of culture supernatant of BAL cells, particularly of IgA isotype. For the IgM and IgA isotypes, anti-Cryptococcus antibody activity correlated well with anti-Trichosporon antibody activity (r = 0.98, p : 0.0001). In several cases examined, antigen-specific AFCs were detected in in vitro culture of peripheral blood mononuclear cells of patients after stimulation with PWM. In the present study, we demonstrated that Cryptococcus neoformans and Trichosporon cutaneum antigen-specific AFCs were present in the lungs of patients with summer-type hypersensitivity pneumonitis, and the antibodies secreted therefrom reacted with both these antigens. The presence of memory B cells was also suggested in the peripheral blood of patients AU - Miyagawa T AU - Hamagami S AU - Ohhata I AU - Ochi T AU - Kishimoto S LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 22 IP - DP - 1993 Jan 01 TI - Fenugreek causing a new type of occupational asthma (letter). [French] PG - 922-922 AU - Dugue P AU - Bel J AU - Figueredo M LA - PT - DEP - TA - Presse Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 189 IP - DP - 1993 Jan 01 TI - Subacute and chronic bird breeder hypersensitivity pneumonitis: sequential evaluation with CT and correlation with lung function tests and bronchoalveolar lavage PG - 111-118 AB - PURPOSE To evaluate lung involvement in the subacute (group 1) and chronic (group 2) stages of bird breeder hypersensitivity pneumonitis. MATERIALS AND METHODS Computed tomographic (CT) findings in 45 patients were correlated with pulmonary function testing and bronchoalveolar lavage. Twenty-seven patients underwent sequential CT examination 0.3-4 years apart, with functional evaluation in 20 of them. RESULTS In group 1, CT showed diffuse micronodules, ground-glass attenuation, focal air trapping or emphysema, and mild fibrotic changes, with normal lung volumes but impaired diffusing capacity and a predominant lymphocyte alveolitis. In group 2, two categories of chronic forms were identified at CT on the basis of presence or absence of honeycombing. After cessation of exposure, CT showed a return to normal or dramatic improvement in group 1 and considerable reduction in ground-glass attenuation and micronodules in group 2. CT depicted no fibrotic or emphysematous changes during follow-up. CONCLUSION Subacute bird breeder hypersensitivity pneumonitis may share CT features with other types of hypersensitivity pneumonitis. CT may help in identification of emphysematous and fibrotic forms of chronic disease AU - RemyJardin M AU - Remy J AU - Wallaert B AU - Muller NL LA - PT - DEP - TA - Radiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 16 IP - DP - 1993 Jan 01 TI - Predicting the outcomes of living with asthma PG - 241-250 AB - The purpose of this study was to explore the impact of person and disease predictors on psychosocial and morbidity outcomes in adults with chronic asthma. Ninety-five asthmatic adults were followed for 60 days with standardized questionnaires and three interviews. Amount of distress during an asthma episode, perceived danger from asthma, and appraisal of social support were predictors of emergency room visits. Self-care, perceived life stress, nocturnal symptoms, and amount of distress during an asthma episode were predictors of depression. Financial status and the absence of nocturnal symptoms of asthma predicted life satisfaction AU - JansonBjerklie S AU - Ferketich S AU - Benner P LA - PT - DEP - TA - Res Nurs Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 49 IP - DP - 1993 Jan 01 TI - Gold salt-induced pneumonia and CD4 alveolitis. [French] PG - 27-29 AB - In a 62-year old man who consulted for dyspnoea, clinical, radiological and functional examinations led to the diagnosis of immunoallergic lung disease caused by gold salt therapy. Regression of the symptoms when gold salt therapy was withdrawn supported this diagnosis. Contrary to previously published cases concerning treatment with gold salts, the study of bronchoalveolar lavage (BAL) fluid yielded a lymphocytic alveolitis with a very high CD4/CD8 ratio, as already reported with methotrexate, cyclothiazide and nitrofurantoin. This case can be added to the list of drugs that may induce CD4 alveolitis; it also reminds the existence of gold salt pneumonia and permits to discuss the value of a lymphocyte subpopulation study in the BAL fluid in patients with drug-induced immunoallergic lung diseases AU - Breton JL AU - Westeel V AU - Garnier G AU - Louis JM LA - PT - DEP - TA - Rev Pneumol Clin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 41 IP - DP - 1993 Jan 01 TI - Bronchial provocation test in bronchial asthma. [Japanese] PG - 154-159 AB - Methacholine provocation test, bronchial reversibility test, aspirin inhalation test, and cough provocation test have been performed at our institute to examine pathophysiology and to diagnose bronchial diseases. Bronchial responsiveness to methacholine correlated to baseline pulmonary functions, especially to % predicted value of forced expiratory volume in 1 second (%FEV1) in asthma and sinobronchial syndrome. Bronchial reversibility was greater with beta 2-agonists than with muscarinic antagonists in asthma while it was less with beta 2-agonists than with muscarinic antagonists in sinobronchial syndrome. Our protocol for aspirin inhalation test consists of a screening test and threshold measurement test and is useful for diagnosis of analgesics-induced asthma. Capsaicin provocation test to measure airway cough receptor sensitivity is used to diagnose chronic cough AU - Fujimura M AU - Kamio Y AU - Hashimoto T LA - PT - DEP - TA - Rinsho Byori JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 41 IP - DP - 1993 Jan 01 TI - Analysis of platelet-activating factor and its effect on the lung. [Japanese] PG - 160-169 AB - One of the lipid mediators, platelet-activating factor (PAF), is reported to be involved in a variety of biological phenomena including not only harmful reactions such as allergy or inflammation, but also physiological phenomena like nerve cell differentiation, sperm mobilization, ovulation, implantation, parturition etc. We reviewed the methods of detecting PAF in biological fluids and the effects of PAF on fetal lung maturation and pulmonary diseases. Fetal lung has a capacity to produce PAF and this autacoid is involved in glycogen breakdown to furnish both glycerol backbone, such as dihydroxyacetone phosphate and glycerol-3-phosphate, and the fatty acids utilized to synthesize pulmonary surfactant. PAF also enhances secretion of pulmonary surfactant. However, PAF causes eosinophil recruitment to the lung, activation of eosinophil and neutrophil, bronchoconstriction, and lung edema, and increases bronchial hyperreactivity. All are characteristics of the pathophysiology of bronchial asthma. We examined PAF acetylhydrolase activity in plasma from patients with bronchial asthma, and found the activity was significantly lower in severe cases than that in mild or moderate cases. Ketotifen had no effect on this enzymatic activity. Evaluating PAF acetylhydrolase activity may help determine the severity of bronchial asthma. PAF is also involved in chronic lung disorders of newborns, such as bronchopulmonary dysplasia. We treated a 3-month-old child with frequent pulmonary problems who was made a diagnosis of bronchopulmonary dysplasia during neonatal period. After administration of Ketotifen for one and a half months, his clinical symptoms improved dramatically AU - Maki N AU - Kanda Y AU - Suzuki T AU - Miyauchi K AU - Wada Y AU - Johnston JM LA - PT - DEP - TA - Rinsho Byori JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 35 IP - DP - 1993 Jan 01 TI - A descriptive epidemiological study on pleural plaque cases identified from the worker's periodical health examinations in Kitakyushu, Japan PG - 302-313 AB - Thirty-six pleural plaque (PP) cases, were identified from the worker's periodical health examination and were described in terms of its association with occupational exposure to asbestos and radiographic findings. Based on thorough interviews about job histories, 23 (64%) of the cases were classified to have had "definite" and an additional 5 (14%) with "possible" asbestos-exposed job histories. Asbestos-exposed job histories were represented mostly by plumbing and pipe fitting, insulating, and boiler and pipe insulating. The latency period between initial age of asbestos exposure and age at time of initial plaque detection was 31.1 +/- 10.3 yr. Calcified plaques were most prevalent in the diaphragm and the most frequent combination of multi-site PPs was found in the diaphragm and lung fields. All cases were either current or ex-smokers. The findings suggest that subjects with a history of asbestos exposure can be identified through the detection of PPs in chest X-ray films obtained in the worker's periodical health examinations AU - Takahashi K AU - Sera Y AU - Okubo T LA - PT - DEP - TA - Sangyo Igaku JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 19 IP - DP - 1993 Jan 01 TI - Lung cancer among butchers and slaughterhouse workers PG - 137-147 AB - The following three questions are examined in this critical evaluation of the literature on lung cancer among butchers: (i) do butchers have an excess risk of lung cancer, (ii) if yes, is this excess possibly caused by exposures in the work environment, and (iii) if yes, what then are the possible etiologic exposures? It was concluded that butchers probably have an excess risk of lung cancer. This excess risk can be explained partly, but not entirely, by tobacco smoking. The following four possible etiologic exposures are introduced: human papilloma viruses, nitrite, incomplete combustion products, and fumes from meatpacking materials. Three of these possible explanatory factors (nitrite, combustion products and fumes from packing) are not, or only to a limited extent, substantiated by the empirical data. It was recommended that the hypothesis concerning human papilloma viruses and also the possible role of work stress be tested in future studies AU - Kristensen TS AU - Lynge E LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 123 IP - DP - 1993 Jan 01 TI - Sarrazin allergy: a contribution to buckwheat allergy. PG - 1559-1562 AB - Buckwheat allergy is frequent in Asian countries such as Japan because of widespread use of buckwheat in food and bed furniture. In Switzerland such reactions are very rare and mostly due to ingested buckwheat in the form of pizoccheri and buckwheat bread. We describe 6 cases of allergic reactions due to buckwheat comprising urticaria (all pat.), quincke edema (4 pat.) and asthma (5 pat.). 4 patients reacted to ingestion of buckwheat, and 2 patients with occupational exposure were allergic to inhaled buckwheat. Sensitizations were proven in all patients by positive skin tests and specific IgE (RAST). Treatment consisted of strict allergen elimination AU - Schumacher F AU - Schmid P AU - Wuthrich B LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 9 IP - DP - 1993 Jan 01 TI - Chlorine gas exposure and the lung: a review PG - 439-455 AB - We conducted a review of the literature detailing the respiratory effects of chlorine, an extremely important but toxic halogen. Historically, the heaviest mass inhalational exposures to chlorine resulted from World War I gassing. Currently potential human exposure to chlorine inhalation occurs in a variety of settings in the workplace, as a result of inadvertent environmental releases, and even in the home due to household cleaning mishaps. Chlorine species are highly reactive; tissue injury results from exposure to chlorine, hydrochloric acid, hypochlorous acid, or chloramines. Acute, high level exposure to chlorine gas in occupational or environmental settings results in a variety of dose-related lung effects ranging from respiratory mucus membrane irritation to pulmonary edema. Pulmonary function testing can reveal either obstructive or restrictive deficits immediately following exposure, with resolution over time in the majority of cases. However, some of those exposed may demonstrate long-term persistent obstructive or restrictive pulmonary deficits or increased nonspecific airway reactivity after high level exposure to chlorine gas. Symptoms and signs following inhalation of mixtures of chlorine-containing cleaners in the home are similar to those after occupational exposures and environmental releases. Although generally less severe, these events may be extremely common. Controlled human exposure data suggest that some subjects may be more responsive to the effects of chlorine gas; epidemiologic data also indicate that certain subpopulations (e.g., smokers) may be at greater risk of adverse outcome after chlorine inhalation. Although these findings are intriguing, additional study is needed to better delineate the risk factors that predispose toward the development of long-term pulmonary sequelae following chlorine gas exposure AU - Das R AU - Blanc PD LA - PT - DEP - TA - Toxicology & Industrial Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - Three cases of occupational asthma and rhinitis caused by garlic PG - 1011-1014 AU - Seuri M AU - Taivanen A AU - Ruoppi P AU - Tukiainen H LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - Lack of role of mononuclear cell-derived histamine releasing factor in occupational asthma due to Western Red Cedar PG - 861- AU - Frew AJ AU - Chan H AU - ChanYeung M LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Occupational asthma and contact urticaria from dried flowers of Limonium tataricum PG - 285-290 AB - Dried flowers of Limonium tataricum (LT) are widely used for semipermanent floral arrangements. We report a case of a floral industry worker in whom exposure to LT precipitated rhinoconjunctivitis, asthma, and contact urticaria. Studies revealed the presence of immediate skin test reactivity and positive leukocyte histamine release in response to LT extract. Specific anti-LT antibodies were detected in the patient's serum by direct RAST. Bronchial challenge with LT extract also resulted in an isolated immediate asthmatic response. Both the positive methacholine inhalation test and the significant changes observed in PEFR measurements when the patient handled LT supported the diagnosis of occupational asthma. These findings strongly suggest that an IgE-mediated immunologic mechanism is responsible for the patient's respiratory and cutaneous symptoms AU - Quirce S AU - GarciaFigueroa B AU - Olaguibel JM AU - Muro MD AU - Tabar AI LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 37 IP - DP - 1993 Jan 01 TI - Occupational health problems in processing of X-ray photographic films PG - 287-295 AB - Hazards to health from exposure to chemicals in automatic processing of photographic film is well documented by ILO and others. In the early 1980s increasing reports of miscellaneous health problems including respiratory and skin effects in radiographers processing X-ray films were published. In some cases asthmatic type responses were reported to be so severe as to exclude the radiographer from further work. It has been suggested that the increased number of such cases coincided with process changes, in particular the increased addition of glutaraldehyde as a hardening agent in the developer to offset the softening of the film especially those of low silver content. Attention must also be focused however on other miscellaneous chemicals present and of the possibility of synergistic reactions. The major problems appear to be associated with heavy workloads, poorly designed and ill-ventilated darkrooms or processing rooms, and lack of appropriate safe handling techniques for the chemicals used. Several studies illustrate improvements by attention to good occupational hygiene practice. The necessity for a holistic approach to control of such a complex micro-environment is stressed. It is unlikely that a single causal agent can be identified AU - Hewitt PJ LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Hypersensitivity pneumonitis resulting from Aspergillus fumigatus in a greenhouse PG - 260-262 AB - A 57-y-old female who had cultivated vegetables in a plastic greenhouse developed a case of hypersensitivity pneumonitis from Aspergillus fumigatus. This report exemplifies a potential hazard caused by a thermotolerant fungus, A. fumigatus, in a poorly constructed greenhouse AU - Yoshida K AU - Ueda A AU - Yamasaki H AU - Sato K AU - Uchida K AU - Ando M LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 44 IP - DP - 1993 Jan 01 TI - Immunologic reactions, respiratory symptoms and ventilatory capacity in jute and sisal textile workers. [Czech] PG - 45-54 AB - Allergic reactions in relation to respiratory symptoms and ventilatory capacity were studied in 41 textile workers employed in the processing of jute and sisal. Only 5.0% of the jute workers and 9.5% of the sisal workers demonstrated positive skin reactions to jute or sisal allergens. Increased IgE was found in 9.8% of the textile workers. Among 35 control workers 11.4% reacted with a positive skin reaction to the jute or sisal allergen and 2.9% had increased IgE. Chronic respiratory symptoms as well as changes in ventilatory capacity were found in textile workers with positive and negative skin tests. Our data suggest that immunological reactions are not likely to be responsible for the development of respiratory impairment in textile workers exposed to jute and sisal dust AU - Zuskin E AU - Kanceljak B AU - Mustajbegovic J AU - Kern J LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 104 IP - DP - 1993 Jan 01 TI - Hypersensitivity pneumonitis secondary to Klebsiella oxytoca. A new cause of humidifier lung PG - 627-629 AB - A 30-year-old woman developed recurrent episodes of fever, dyspnea, and nonproductive cough after repeated exposure to a home humidifier. The diagnosis of hypersensitivity pneumonitis was confirmed by detection of serum-binding antibodies at significant titer to Klebsiella oxytoca colonizing the humidifier water but not to other potential antigens. This represents a newly recognized cause of hypersensitivity pneumonitis related to exposure to K oxytoca contaminating a commercially available ultrasonic cold air home humidifier. The potential role for these frequently used home humidifier devices in unexplained pulmonary illness is emphasized. The cause is only infered from the precipitins, no challenge AU - Kane GC AU - Marx JJ AU - Prince DS LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 104 IP - DP - 1993 Jan 01 TI - Asthma and asthma-like symptoms in adults assessed by questionnaires. A literature review PG - 600-608 AB - The first widely used questionnaire in respiratory epidemiology was the questionnaire from the Medical Research Council (MRC) of Great Britain. In the first version, from 1960, there were only a few questions about wheezing, but in later editions, more questions about asthma and asthma-like symptoms were added. The MRC questionnaire initiated the development of other questionnaires such as the European Community for Coal and Steel (ECSC) questionnaire of respiratory symptoms and the questionnaire from the American Thoracic Society and the Division of Lung Diseases (ATS-DLD-78). In Tucson, Ariz, a questionnaire was developed in the 1970s that was focused on the subject's own report of asthma. In Great Britain, a questionnaire was developed in the 1980s with the intention of finding the most valid symptom-based items for identifying asthma, "the IUATLD (1984) questionnaire." When judging the validity of a questionnaire, it is essential to understand sensitivity and specificity. Sensitivity is the fraction of the truly diseased subjects found to be diseased using the questionnaire. Specificity is the fraction of the truly healthy subjects found to be healthy using the questionnaire. Regarding questionnaires dealing with asthma, the situation is confusing because of the absence of any gold standard for asthma. The most usual mode of validation has been to test the questionnaire against the results of a clinical physiologic investigation, often a nonspecific bronchial challenge test. Another approach has been to compare the answers from the questionnaire with the clinical diagnoses of asthma. When validated in relation to bronchial challenge tests, the questions about self-reported asthma have a mean sensitivity of 36 percent (range, 7 to 80 percent) and a mean specificity of 94 percent (range, 74 to 100 percent). The questions about "physician-diagnosed asthma" have even higher specificity, 99 percent. When validated in relation to a clinical diagnosis of asthma, the mean sensitivity for the question about self-reported asthma was 68 percent in the reviewed studies (range, 48 to 100 percent). The specificity was 94 percent (range, 78 to 100 percent). One problem in using the presence of bronchial hyperreactivity (BHR) as a gold standard for asthma is that many people with BHR report no respiratory complaints. In other words, the presence of BHR is a measure with high sensitivity but low specificity for asthma. The effect of using a methacholine challenge test as a standard for the disease will thus be an underestimation of the sensitivity of the questionnaire.(ABSTRACT TRUNCATED AT 400 WORDS) AU - Toren K AU - Brisman J AU - Jarvholm B LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 104 IP - DP - 1993 Jan 01 TI - Pulmonary hemorrhage due to inhalation of vapor containing pyromellitic dianhydride PG - 644-645 AB - Pulmonary hemorrhage due to inhalation of fumes or powders containing trimellitic anhydride (TMA) is well known. We report pulmonary hemorrhage in a young man exposed to epoxy resin vapor containing pyromellitic dianhydride (PMDA). Serum IgG antibodies to PMDA could be detected. We conclude that the pulmonary hemorrhage was mediated by a reaction to PMDA in analogy to the TMA-induced disease. We suggest that exposure to any acid anhydride should be considered a possible cause of pulmonary hemorrhage since these compounds share structural and functional similarities AU - Kaplan V AU - Baur X AU - Czuppon A AU - Ruegger M AU - Russi E AU - Speich R LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 62 IP - DP - 1993 Jan 01 TI - Immediate-type allergy related to okra (Hibiscus esculentus Linn) picking and packing PG - 189-199 AB - Two workers (cases A and B) engaged in picking and packing okra who had complaints of work-related allergic symptoms showed distinct positive intradermal reactions to two brands of okra extracts only with thresholds of 1 x 10(-8) w/v for Case A and 1 x 10(-6) w/v for Case B. Both also showed positive reactions to okra extracts in the Prausnitz-Kustner test and in the provocative nasal test. The radioallergosorbent test scores to the okra extract were determined to be 2 (defined as clear positive) for Case A and 1 (border line) for Case B. These findings indicated that the allergic conditions of these cases were from an IgE-mediated immediate-type allergy induced by handling okra. To confirm the etiology of the two cases 14 farmers engaged in picking and packing okra were examined. Among them, 8 subjects (57%) showed positive intradermal reactions to okra extracts. A close association between intradermal reactions to okra extracts and complaints of work-related allergic symptoms was seen in these subjects. These results confirm that the okra may be capable of inducing IgE-mediated immediate-type allergy to workers handling okra AU - Ueda A AU - Manda F AU - Aoyama K AU - Ueda T AU - Obama K AU - Li Q AU - Tochigi T LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 6 IP - DP - 1993 Jan 01 TI - High prevalence of asthma and related symptoms in teenagers in northern Sweden PG - 834-839 AB - Recent reports have suggested an increased asthma prevalence in the Nordic countries. The prevalence of asthma and related symptoms from lower airways in Umea, Northern Sweden, was investigated in 1987. We used a questionnaire and a skin prick test in 1,112 teenagers. Individuals with symptoms or positive skin prick tests were examined further. The clinical examination included an interview, a ventilatory lung function test, serum specific immunoglobulin E (IgE) test, and a physical examination. Individuals with symptoms from the lower airways underwent a methacholine inhalation test. Asthma was defined as recurrent attacks of dyspnoea and/or wheezing, triggered by known stimuli (excluding infections), and at least one of the following: signs of obstructive airways at examination or provocation concentration giving a 20% fall in forced expiratory volume in one second (PC20) : 8 mg.ml-1. Using this definition, the prevalence of asthma was 6.8%, with a significantly higher prevalence in girls (9.6%) than in boys (4.1%). Furthermore, 16.4% had dyspnoea, wheeze or prolonged cough but did not fulfil our criteria for asthma. The prevalence of asthma and of symptoms from lower airways is higher than has previously been found in Sweden AU - Norrman E AU - Rosenhall L AU - Nystrom L AU - Bergstrm E AU - Stjenberg N LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 31 IP - DP - 1993 Jan 01 TI - Analysis of serotype-specific antibodies to Trichosporon cutaneum types I and II in patients with summer-type hypersensitivity pneumonitis with monoclonal antibodies to serotype-related polysaccharide antigens PG - 1949-1951 AB - Summer-type hypersensitivity pneumonitis is the most prevalent type of hypersensitivity pneumonitis in Japan. We constructed a sandwich enzyme-linked immunosorbent assay system for diagnosis of summer-type hypersensitivity pneumonitis in which monoclonal antibodies were used to bind serotype-related polysaccharides to plastic plates, and this system was proven to have sufficient sensitivity and specificity AU - Mizobe T AU - Yamasaki H AU - Doi K AU - Ando M AU - Onoue K LA - PT - DEP - TA - J Clin Microbiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 101 IP - DP - 1993 Jan 01 TI - Postmortem findings and prenatal diagnosis of Zellweger syndrome. Case report PG - 226-228 AB - The postmortem findings of siderosis, renal cortical cysts, pachygyria, cortical heterotopia of the brain and cerebellar hypoplasia in a seven-week-old infant with craniofacial dysmorphism and hypotonia prompted the diagnosis of Zellweger syndrome. This was confirmed by analysis of very-long-chain fatty acids in blood spots from filter paper, collected in the neonatal period, and allowed first trimester diagnosis in the subsequent pregnancies AU - Lindhard A AU - Graem N AU - Skovby F AU - Jeppesen D LA - PT - DEP - TA - Acta Pathologica Microbiologica et Immunologica Sc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 148 IP - DP - 1993 Jan 01 TI - Farmer's lung. Long-term outcome and lack of predictive value of bronchoalveolar lavage fibrosing factors PG - 216-221 AB - This study evaluates the long-term outcome of farmer's lung (FL), adding high-resolution computed tomograms (HRCT) to previously reported procedures and verifying whether bronchoalveolar lavage (BAL) fluid markers or substrates of fibrosis (hyaluronic acid, Type III procollagen, fibronectin, and fibroblast growth factors) (FF) predict outcome. A total of 33 subjects with a history of FL dating back at least 6 yr were evaluated with pulmonary function tests, chest x-ray (CXR), and HRCT. All subjects had an initial evaluation, which included a BAL, 6 yr before the current study. Subjects were then either in acute FL (n = 19) or in clinical remission despite continued contact (n = 14). In the current study, pulmonary function tests revealed an obstructive profile in 13 subjects, restrictive changes in 1, an isolated decrease in lung diffusion capacity in 3, and normal values in 16. Chest radiographs (CXR) were normal in 22 subjects, abnormal with interstitial or reticulonodular changes in 6, and suggestive of emphysema in 5. HRCT revealed emphysema in 9 subjects; 3 had localized fibrotic changes, 2 a ground-glass pattern, and 19 were normal. There was a good correlation between the findings on pulmonary function tests and HRCT; however, CXR alone did not suggest the existence of emphysema in 4 subjects who had such findings on HRCT. No correlations were found between most outcome parameters and the level of the BAL FF measured 6 yr previously. We conclude that airflow obstruction with or without emphysema is an important long-term sequela of FL and that BAL FF do not predict outcome in this disease AU - Lalancette M AU - Carrier G AU - Laviolette M AU - Ferland S AU - Rodrique J AU - Begin R AU - Cantin A AU - Cormier Y LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 92 IP - DP - 1993 Jan 01 TI - Pigeon breeders' lung; IgG subclasses to pigeon intestinal mucin and IgA antigens PG - 494-499 AB - Sera from all symptomatics with pigeon breeders' lung and many non-symptomatic pigeon breeders react specifically with the pigeon antigens and in particular pigeon intestinal secretions and isolated pigeon intestinal mucin and IgA. In sera from all 82 precipitin-positive pigeon breeders investigated, IgG1 reacted with both IgA and mucin, while IgG2 reacted predominantly with mucin only. Sera from all 32 symptomatic patients with pigeon breeders' lung demonstrated an IgG3 reaction with mucin, but only three sera showed reactivity against IgA and this was very weak. In contrast, only three out of 27 pigeon breeders with pulmonary pathology other than pigeon breeders' lung and only three out of 23 sera from healthy pigeon breeders showed detectable IgG3 reactivity with mucin. IgG4 from eight sera only reacted with mucin (n = 7) or IgA (n = 1) and showed no consistent pattern between subject groups. Precipitin-negative sera from 30 volunteers with no previous pigeon exposure showed no IgG subclass reactivity with either the pigeon intestinal secretions or the isolated mucin and IgA antigens. These results show specific IgG2 and IgG3 subclass reactivity to pigeon intestinal mucin antigen in precipitin-positive sera from pigeon breeders. Further IgG3 subclass reactivity specific to pigeon mucin is strongly associated with sera from patients with the active pigeon breeders' lung disease AU - Todd A AU - Coan R AU - Allen A LA - PT - DEP - TA - Clin Exp Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 6 IP - DP - 1993 Jan 01 TI - Decline in FEV1 and airflow limitation related to occupational exposures in men in an urban community PG - 1095-1103 AU - Humerfelt S AU - Gulsvik A AU - Skjaerven R AU - Nilssen S AU - Kvale G AU - Sulheim O AU - Ramm E AU - Eilertsen E AU - Humerfelt SB LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 342 IP - DP - 1993 Jan 01 TI - Health risk in hospitals through airborne allergens for patients presensitised to latex PG - 1148-1149 AU - Baur X AU - Ammon J AU - Chen Z AU - Beckmann U AU - Czuppon AB LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 43 IP - DP - 1993 Jan 01 TI - Respiratory function in chilli grinders PG - 139-142 AU - Lankatilake KN AU - Uragoda CG LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - Cotton dust and gram-negative bacterial endotoxin correlations in two cotton textile mills PG - 333-342 AB - Exposure to cotton dust is known to cause both acute and chronic respiratory illness. A specific pattern of symptoms called byssinosis is well described to occur among workers in the cotton processing (e.g., yarn preparation) industry. Recent studies have implicated Gram-negative bacterial endotoxin as one of the agents responsible for acute, and possibly chronic, respiratory illness. Laboratory experiments using a model cardroom have found poor correlations between airborne dust and associated endotoxin. This study reports the results of vertical elutriated dust and endotoxin levels in 11 work areas of 2 cotton textile mills in 1986 in Shanghai, China. The overall correlation between dust and endotoxin was strong, rs = 0.66 and 0.79 (p : 0.0001) for mills 1 and 2, respectively. The dust-endotoxin correlation was relatively poor in early yarn preparation in the workshops and improved in the later preparation areas. Our findings suggest that in these mill settings, dust and endotoxin levels may be well correlated in most work areas. Therefore, dust may be a useful index for monitoring populations employed in the cotton textile industry throughout the world. Additional field studies need to be performed which consider the various determinants of dust and endotoxin levels AU - Christiani DC AU - Wegman DH AU - Eisen EA AU - Ye TT AU - Lu PL AU - Olenchock SA LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 148 IP - DP - 1993 Jan 01 TI - Occupational dust exposure and chronic obstructive pulmonary disease. A systematic overview of the evidence PG - 38-48 AB - The object of this study was to assess the relationship between occupational dust exposure and chronic obstructive pulmonary disease (COPD). Studies were identified using MEDLINE (January 1966 to July 1991), SCISEARCH, manual review of reference lists, and personal contact with more than 30 international experts. Studies of COPD, lung function, emphysema, chronic bronchitis, or mortality in workers exposed to nonorganic dust were retrieved. Studies were included if dust exposure was measured quantitatively, and a quantitative relationship between dust exposure and one of the outcomes of interest was calculated while controlling at least for smoking and age. Methodological rigor was assessed, and data regarding the study populations, prognostic factors, and outcomes were extracted independently by two reviewers. Thirteen reports derived from four cohorts of workers met our inclusion criteria. Three of the cohorts were of coal miners and one was of gold miners. All of the studies found a statistically significant association between loss of lung function and cumulative respirable dust exposure. It was estimated that 80 (95% CI, 34 to 137) of 1,000 nonsmoking coal miners with a cumulative respirable dust exposure of 122.5 gh/m3 (considered equivalent to 35 years of work with a mean respirable dust level of 2 mg/m3) could be expected to develop a clinically important (: 20%) loss of FEV1 attributable to dust. Among 1,000 smoking miners the comparable estimate was 66 (95% CI, 49 to 84). The risk of a clinically important loss of lung function attributable to dust among nonsmoking gold miners was estimated to be three times as large as for coal miners at less than one fifth of the cumulative respirable dust exposure (21.3 gh/m3), the maximal exposure observed among the cohort of gold miners. We conclude that occupational dust is an important cause of COPD, and the risk appears to be greater for gold miners than for coal miners. One possible explanation of the greater risk among gold miners is the higher silica content in gold mine dust AU - Oxman AD AU - Muir DC AU - Shannon HS AU - Stock SR AU - Hnizdo E AU - Lange HJ LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Anaphylaxis caused by banana PG - 215-216 AB - An anaphylactic reaction following ingestion of banana occurred in a 32-year-old female cook. The sensitization to banana occurred simultaneously with the development of occupational asthma caused by grain flour. The patient was sensitized to a wide range of airborne and ingestible proteins but not to rubber latex AU - Savonius B AU - Kanerva L LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Respiratory allergy and atopic eczema in a thatcher due to storage and house dust mite allergy PG - 212-214 AU - Vieluf D AU - Przybilla B AU - Baur X AU - Ring J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - Respiratory function in sewage workers PG - 751-761 AB - Respiratory symptoms and ventilatory capacity were studied in a group of 74 sewage workers employed in cleaning the city sewage system of Zagreb, Croatia. Workers were studied by their work stations: closed channels (N = 26), drainage (N = 31), and other sewage workers (N = 17). The prevalence of chronic respiratory symptoms was higher in closed channel and drainage workers than in controls, particularly for chronic cough (range: 41.9-46.2% vs. 14.3%), chronic phlegm (range: 38.7-46.2% vs. 14.3%), chronic bronchitis (range: 32.3-42.3% vs. 8.6%), and chest tightness (range: 29.0-53.8% vs. 0%). In the first two groups of sewage workers there was a high prevalence of acute symptoms which developed during the work shift, being particularly pronounced for eye irritation (range: 16.1-26.9%), dyspnea (16.1-23.1%), dizziness (range: 6.5-23.1%), throat burning (9.7-19.2%), and skin irritation (range: 22.6-26.9%). Baseline ventilatory capacity was significantly decreased compared to predicted values in sewage workers; in particular, values for FEF50 and FEF25 were reduced, suggesting obstructive changes in smaller airways. Our data indicate that sewage workers experience frequent acute and chronic respiratory symptoms and exhibit objective evidence of respiratory dysfunction AU - Zuskin E AU - Mustajbegovic J AU - Schachter EN LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - Respiratory health status in swine producers using respiratory protective devices PG - 743-750 AB - A cross-sectional survey on respiratory health in swine producers showed that 30% of 301 examined men usually used a dust mask when working inside a barn. They did not differ significantly from dust mask nonusers in respect to respiratory symptoms and lung function. This analysis was undertaken to determine whether the respiratory health of dust mask users was associated with reasons why they had started individual respiratory protection. The subjects were recontacted in order to identify those who started using a mask to deliberately prevent symptoms (42 men) and those who started protection because of pre-existing respiratory symptoms (44 men). Not unexpectedly, between-group comparisons of respiratory symptoms and lung function suggest that swine producers who wear dust masks for preventive purposes have better respiratory health than those who wear dust masks because of symptoms or those who do not use individual respiratory protection. The individual reasons for starting dust mask usage should be examined among potential determinants of the outcomes of prospective studies which can then provide more valid assessment of the effect of individual respiratory protection AU - Zejda JE AU - Hurst TS AU - Barber EM AU - Rhodes C AU - Dosman JA LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 148 IP - DP - 1993 Jan 01 TI - A clinical and immunologic study of workers with trimellitic-anhydride-induced immunologic lung disease after transfer to low exposure jobs PG - 54-57 AB - The objective of the study was to determine the clinical and immunologic status of trimellitic anhydride (TMA) workers who have had immunologic lung diseases and who have been moved to lower exposure jobs. Twenty-nine consecutive workers with TMA-induced immunologic lung diseases who had been moved to low exposure jobs for more than 1 yr were studied retrospectively. Pulmonary symptoms were obtained by physician-administered questionnaire. Immunologic studies were performed using radioimmunoassay. Spirometry and chest film were obtained. Workers with late asthma (LA) (n = 3), late respiratory systemic syndrome (LRSS) (n = 8), or both LRSS and asthma rhinitis (A/R) (n = 6) had improved symptoms, improved pulmonary functions, and lower total antibody against TM-HSA. Five of the 12 workers with A/R had improved symptoms, improved pulmonary functions, and lower IgE against TM-HSA, whereas seven continued to have moderate to severe symptoms, abnormal pulmonary functions, and elevated IgE against TM-HSA. There were no chest film findings in any group that were definitely attributed to TMA. Although TMA workers with LA or LRSS improve when moved to lower exposure jobs, only half of workers with A/R improve; elevated IgE against TM-HSA appears to be a marker for the subpopulation of workers with A/R that does not improve AU - Grammer LC AU - Shaughnessy MA AU - Henderson J AU - Zeiss CR AU - Kavich DE AU - Collins MJ AU - Pecis KM AU - Kenamore BD LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 306 IP - DP - 1993 Jan 01 TI - Asbestos and lung cancer in Glasgow and the west of Scotland PG - 1503-1506 AB - OBJECTIVE To quantify the relation between lung cancer and exposure to asbestos in men in west Scotland and to estimate the proportion of lung cancer which may be attributed to exposure to asbestos. DESIGN An ecological correlation study of the incidence of lung cancer in men and past asbestos exposure. The unit of analysis was the postcode sector. Correction was made for past cigarette smoking, air pollution, and deprivation. SETTING The region covered by the west of Scotland cancer registry, containing 2.72 million people and including Glasgow and the lower reaches of the River Clyde, where shipbuilding was once a major industry. SUBJECTS All men diagnosed with lung cancer between 1975 and 1984 whose residence at the time of registration was within the west of Scotland. MAIN OUTCOME MEASURE The population attributable risk for asbestos related lung cancer. RESULTS An estimated 5.7% (95% confidence interval 2.3 to 9.1%) of all lung cancers in men registered in the west of Scotland during the period 1975-84 were asbestos related, amounting to 1081 cases. CONCLUSIONS A considerable proportion of cases of lung cancer in men in Glasgow and the west of Scotland from 1975 to 1984 were asbestos related. Most of these may not have been considered for compensation by the Department of Social Security. Given the very small annual number of recorded cases of asbestosis this condition is probably not a prerequisite for the development of asbestos related lung cancer. A heightened awareness of the increasing incidence of asbestos related neoplasms and their more thorough investigation are recommended AU - De Vos Irvine H AU - Lamont DW AU - Hole DJ AU - Gillis CR LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - Respiratory symptoms, lung function, and pneumoconiosis among self employed dental technicians PG - 443-449 AB - From the registry of self employed workers living in Paris, a group of 105 dental technicians was studied to evaluate occupational exposure, to determine respiratory manifestations, and to investigate immune disturbances. Seventy one dental technicians (age range 43-68: group D), 34 dental technicians younger than 43 or older than 68 (group d), and 68 control workers (age range 43-66: group C) were investigated. The demographic characteristics and the smoking habits of the groups D and C did not differ significantly. The dental technicians often worked alone (43.7%) or in small laboratories without adequate dust control. The mean duration of their exposure was long (group D 34.0 (SD 8.4) years). The prevalence of respiratory symptoms did not differ between groups D and C except for the occurrence of increased cough and phlegm lasting for three weeks or more over the past three years (group D 16.9%, group C 2.9%, p : 0.007). The effect of cigarette smoking on respiratory symptoms and lung function was obvious. All mean values of lung function for dental technicians and controls were within normal limits. Significant decreases in all mean lung function values were found among smokers by comparison with non-smokers, however, and a positive interaction with occupational exposure was established. The x ray films of dental technicians (n = 102, groups D and d) were read independently by four readers and recorded according to the International Labour Office classification of pneumoconioses. The prevalence of small opacities greater than 1/0 was 11.8% with a significant increase with duration of exposure.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Choudat D AU - Triem S AU - Weill B AU - Vicrey C AU - Ameille J AU - Brochard P AU - Letourneux M AU - Rossignol C LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - Occupational exposure to dust and lung disease among sheet metal workers PG - 432-442 AB - A previous large medical survey of active and retired sheet metal workers with 20 or more years in the trade indicated an unexpectedly high prevalence of obstructive pulmonary disease among both smokers and non-smokers. This study utilised interviews with a cross section of the previously surveyed group to explore occupational risk factors for lung disease. Four hundred and seven workers were selected from the previously surveyed group on the basis of their potential for exposure to fibreglass and asbestos. Selection was independent of health state, and excluded welders. A detailed history of occupational exposure was obtained by telephone interview for 333 of these workers. Exposure data were analysed in relation to previously collected data on chronic bronchitis, obstructive lung disease, and personal characteristics. Assessment of the effects of exposure to fibreglass as distinct from the effects of exposure to asbestos has been difficult in previous studies of construction workers. The experienced workers studied here have performed a diversity of jobs involving exposure to many different types of materials, and this enabled exposure to each dust to be evaluated separately. The risk of chronic bronchitis increased sharply by pack-years of cigarettes smoked; current smokers had a double risk compared with those who had never smoked or had stopped smoking. The occurrence of chronic bronchitis also increased with increasing duration of exposure to asbestos. Workers with a history of high intensity exposure to fibreglass had a more than doubled risk of chronic bronchitis. Obstructive lung disease, defined by results of pulmonary function tests at the medical survey, was also related to both smoking and occupational risk factors. Number of pack years smoked was the strongest predictor of obstructive lung disease. Duration of direct and indirect exposure to welding fume was also a positive predictor of obstructive lung disease. Duration of exposure to asbestos was significantly associated with obstructive lung disease but the dose-response relation was inconsistent, especially for those with higher pack-years of smoking exposure. Exposure to fibreglass was not a risk factor for obstructive lung disease AU - Hunting KL AU - Welch LS LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 4 IP - DP - 1993 Jan 01 TI - Radon, cigarette smoke, and lung cancer: a re-analysis of the Colorado Plateau uranium miners' data PG - 204-217 AB - Much of our knowledge regarding the interaction of radon and tobacco smoke in the etiology of human lung cancer derives from studies of uranium miners. In this article, we present a re-analysis of lung cancer mortality in the Colorado Plateau miners' cohort within the framework of the two-mutation clonal expansion model of carcinogenesis. This analysis takes into account the patterns of exposure to radon and cigarette smoke experienced by individuals in the cohort. A simultaneous re-analysis of the British doctors' cohort indicated that those model parameters relating to the effects of tobacco were comparable in the two data sets. We found no evidence of interaction between radon and tobacco smoke with respect to their joint effect on the first or second stage mutation rates or on the rate of proliferation of initiated cells. The age-specific relative risks associated with joint exposure to radon and cigarette smoke, however, were supra-additive but submultiplicative. The analysis also confirmed that fractionation of radon exposures leads to higher lung cancer risks. Finally, we present some estimates of lung cancer risk from environmental radon exposure for non-smokers and smokers AU - Moolgavkar SH AU - Luebeck EG AU - Krewski D AU - Zielinski JM LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 16 IP - DP - 1993 Jan 01 TI - Airway responsiveness. Standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society PG - 53-83 AU - Sterk PJ AU - Fabbri LM AU - Quanjer PH AU - Cockcroft DW AU - O'Byrne PM AU - Anderson SD AU - Juniper EF AU - Malo JL LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 32 IP - DP - 1993 Jan 01 TI - Two-year follow up on the protective value of dust masks against farmer's lung disease PG - 106-111 AB - Some advocate moving away from the farm environment for farmers affected with farmer's lung disease (FLD), but most affected farmers still live on farms. In this study, we evaluated the practicality of dust masks and their effectiveness in prevention of FLD. The dust masks we chose were practically used and no new severe episodes of FLD developed in 20 of 21 farmers with FLD using the masks during a 2-year period. When the farmers took off the dust masks in a farming environmental provocation test, statistically significant reductions in FVC (mean 3.43 to 3.351, p : 0.01), DLco (mean 19.6 to 18.2 ml/torr/min, p : 0.01), and DL/VA (mean 5.1 to 4.8 (x10(-3)) 1/torr/min, p : 0.01) were observed several hours after exposure. These findings suggest that the dust masks were used practically during routine dairy farming and were effective in protection against FLD AU - Kusaka H AU - Ogasawara H AU - Munakata M AU - Tanimura K AU - Ukita H AU - Denzumi N AU - Homma Y AU - Kawakami Y LA - PT - DEP - TA - Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 101 IP - DP - 1993 Jan 01 TI - Incidence of latex allergy in atopic children and hospital workers in Japan PG - 177-181 AB - The incidence of latex-induced allergy has been reported to be increasing in Europe and the US but not in Japan. We thus measured latex-specific IgE antibodies and latex-specific IgG antibodies in sera from 196 atopic children with low serum IgE levels (under 1,000 U/ml; group 1), 108 atopic children with high serum IgE levels (over 1,000 U/ml; group 2) and 601 hospital employees (group 3). Atopic children were diagnosed as having asthma, atopic dermatitis and/or food intolerance. One out of group 1 (0.5%) and 11 out of group 2 (10.2%) were found to have latex-specific IgE by radioallergosorbent assay (RAST), and 7 were further found to be positive for latex antigen by skin test. Fifty-five percent of group 1, 65% of group 2 and 9.7% of group 3 were found to have latex-specific IgG over 100 units/ml by enzyme linked immunosorbent assay (ELISA). Prior to our diagnosis most of the children and employees did not realize they were allergic to latex. These data suggest that caution should be taken regarding latex allergy when atopic children have to be operated upon as atopic children tend to be sensitized to the latex antigen after even minimal contact with latex products AU - Akasawa A AU - Matsumoto K AU - Saito H AU - Sakaguchi N AU - Tanaka K AU - Obata T AU - Tsubaki T AU - Uchiyama H AU - Matsunaga T AU - Kurosaka K AU - et al LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 64 IP - DP - 1993 Jan 01 TI - Occupational allergic rhinitis in Finland PG - 565-568 AB - Between 1980 and 1987 a total of 166 patients were diagnosed as having occupational (mostly allergic) rhinitis at the Institute of Occupational Health. This is about 20% of all the diagnosed cases in Finland. The most common causes were: flour (50 cases), wood dust (30 cases), animal epithelia (19 cases), and natural fibers, mainly cotton (19 cases). Between 1981 and 1987 the number of cases of occupational rhinitis in all of Finland more than doubled (from 61 to 128 cases per year), and in 1991 a total of 319 cases were detected. This was mainly due to the increase in rhinitis caused by animal epithelium and flour dust, which were then the most common causes of occupational rhinitis in Finland. This increase, in turn, was based on changes in the Finnish legislation, which in 1982 was extended to cover farmers. Other causes of the increase were probably the increased awareness of the public and health personnel, but a true increase in occupational rhinitis cannot be excluded AU - Kanerva L AU - Vaheri E LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 31 IP - DP - 1993 Jan 01 TI - A case of hypersensitivity pneumonitis in Pholiota nameko's manufacturer. [Japanese] PG - 275-279 AB - A 58-year-old female was admitted to our hospital because of fever and dyspnea on exertion. She has been working in the factory making Pholiota nameko for 8 years. Her chest X-ray revealed diffuse linear and fine nodular shadows in both lower lung fields. Hypoxemia was seen on blood gas analysis. Bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB) were performed. Differential cell count of the BAL fluid showed lymphocytosis and CD4/8 was decreased. TBLB specimens revealed bronchioloalveolitis. Precipitins against Trichosporon cutaneum were detected by Ouchterlony method. These findings are compatible with hypersensitivity pneumonitis, and Trichosporon cutaneum may have been causative antigen in this case. Trichosporon cutaneum is often detected in the Japanese summer-type hypersensitivity pneumonitis. This case suggests that Trichosporon cutaneum is one cause of hypersensitivity pneumonitis in workers at factories making Pholiota nameko AU - Kishimoto N AU - Mouri M AU - Sakurai S AU - Nanbu Y AU - Ohya N LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 30 IP - DP - 1993 Jan 01 TI - Hypersensitivity pneumonitis presenting as sarcoidosis PG - 497-500 AU - Forst LS AU - Abraham J LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - House-dust mites and associated environmental conditions in Danish homes PG - 106-109 AB - The concentration of house-dust mites (Dermatophagoides pteronyssinus) was investigated in 96 Danish homes with one or more members suffering from asthma. The air-exchange rates, humidity, and temperature were measured in all the homes. A positive correlation was found between indoor air humidity and mite concentration (P : 0.01), and an inverse correlation (P = 0.027) between house-dust mite concentration and indoor air-exchange was found. Homes of mite-allergic persons had a higher concentration of house-dust mites than did those of the non-mite-allergic group. House-dust mite concentration was above the proposed limit of 10 mites/0.1 g dust in 76% of the homes of persons allergic to mites and in 48% of the homes of nonsensitive persons. The high proportion of homes infested with house-dust mites suggests an increased prevalence of house-dust mites in Danish homes. The results support the concept that reduced ventilation in homes involves a risk of increased house-dust mite exposure AU - Harving H AU - Korsgaard J AU - Dahl R LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Respiratory health associated with exposure to automobile exhaust. I. Results of cross-sectional studies in 1979, 1982, and 1983 PG - 53-58 AB - Three cross-sectional studies were conducted in an effort to investigate the effect of automobile exhaust on respiratory symptoms. Female adult subjects were selected from residents who lived near roadways that were subjected to very heavy traffic. A standard questionnaire was administered to approximately 5,000 people. Distances of the residences from the roadside were adopted as an index of exposure to automobile exhaust. The estimated odds ratios for chronic cough, chronic phlegm, chronic wheeze, shortness of breath, and chest cold with phlegm, relative to distance from the roadside--adjusted by age, smoking status, years at residence, occupation, and type of home heating-ranged from 0.76 to 2.75. The 95% confidence limits of the odds ratios for chronic cough and chronic phlegm excluded or approached 1.00 in each of the studies. This suggests that exposure to automobile exhaust may be associated with an increased risk of certain respiratory symptoms AU - Nitta H AU - Sato T AU - Nakai S AU - Maeda K AU - Aoki S AU - Ono M LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 103 IP - DP - 1993 Jan 01 TI - Respiratory health of swine producers. Focus on young workers PG - 702-709 AB - In this report, we compare the respiratory health of swine producers, grain farmers, and nonfarming control subjects, separately in all age groups and in young subjects. We examined 249 swine producers (age 37.7 years), 251 grain farmers (age 44.7 years), and 263 nonfarming subjects (age 40.7 years). Swine producers had significantly more symptoms of chronic bronchitis (15.3 percent) than did grain farmers (7.2 percent) or nonfarming men (5.7 percent). After controlling for age, height, and smoking, the functional indices of airflow (FEV1, FEV1/FVC, FEF25-75, Vmax50, and Vmax25) were slightly but significantly lower in swine producers than in grain farmers. In comparison with nonfarming subjects, swine producers also had significantly lower FEV1/FVC, FEF25-75, and Vmax50. Respiratory symptoms were associated with the number of hours of work per day. This indirect index of exposure was also inversely associated with FVC (p : 0.01) and FEV1 (p = 0.06), after adjustment for age, height, smoking, and dust mask usage. A relative excess of respiratory symptoms and lower lung function variables were found in swine producers aged 26 to 35 years. Also in this age group, a multivariate analysis revealed statistically significant effects of daily duration of work on FVC and FEV1. The results confirm that working in swine confinement units is a risk factor for chronic respiratory symptoms and minor lung function changes. An increased risk in young workers may reflect more intense occupational exposure in this subgroup of swine producers AU - Zejda JE AU - Hurst TS AU - Rhodes CS AU - Barber EM AU - McDuffie HH AU - Dosman JA LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 103 IP - DP - 1993 Jan 01 TI - Goodpasture's syndrome. Unusual presentation after exposure to hard metal dust PG - 956-957 AB - An unusual case of Goodpasture's syndrome in a 26-year-old man with occupational exposure to hard metal dust is described. The patient developed a life-threatening interstitial lung disease that was followed by a rapidly progressive glomerulonephritis two months later. To our knowledge, association of Goodpasture's syndrome and hard metal exposure has not been reported previously AU - Lechleitner P AU - Defregger M AU - Lhotta K AU - Totsch M AU - Fend F LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 35 IP - DP - 1993 Jan 01 TI - Exposure to TMXDI (meta) aliphatic isocyanate and TMI (meta) unsaturated aliphatic isocyanate. Clinical and immunological evaluation of 96 workers PG - 287-290 AB - We evaluated 96 workers employed at facilities that manufacture or use TMXDI (meta) aliphatic isocyanate and TMI (meta) unsaturated aliphatic isocyanate. We used immunoglobulin (Ig) and IgG serum antibody enzyme-linked immunosorbent assay (ELISA) studies and a questionnaire designed to identify symptoms compatible with work-related syndromes such as asthma and hypersensitivity pneumonitis. There were no workers with immunologically induced disease due to TMI isocyanate or TMXDI isocyanate nor were there any workers whose questionnaires suggested new onset of asthma. Approximately 40% of workers experienced some irritant symptoms, mostly upper respiratory or ocular. One worker had low level IgE antibody against TMXDI-HSA but had no work-related respiratory symptoms. Very low-level IgG against TMI-HSA or TMXDI-HSA was present in 7% of workers, all of whom were in the high-exposure category Spills occured during startup. exposures up to 0.5 ppm AU - Grammer LC AU - Shaughnessy MA AU - Davis RA LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 31 IP - DP - 1993 Jan 01 TI - Epidemiology of allergic occupational lung disease PG - 103-118 AU - Venables KM LA - PT - DEP - TA - Monogr Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - IP - DP - 1993 Jan 01 TI - A survey of a small group of workers exposed to toluene di-isocyanate PG - - AB - All 20 workers exposed to toluene di-isocyanate (TDI) in a chemical processing and packing factory were tested for TDI-induced asthma. The assessment included a respiratory symptom questionnaire, spirometry, skin prick tests for common allergens and assessment of total and TDI-specific immunoglobulin E (IgE) levels by radio-allergosorbent tests. Six workers had symptoms suggestive of TDI-related asthma. Three of these 6 workers had a significant cross-shift decline in forced expiratory volume in 1 second (FEV1) (10% or greater). Two of the 6 had high levels of TDI-specific IgE. Of the 14 workers without work-related symptoms, 1 had a significant cross-shift decline in FEV1. There was no significant association between the levels of exposure to TDI and symptoms, lung function parameters or immunological findings. This study demonstrates the difficulties in correlating immunological status with clinical and lung function findings in workers exposed to TDI. Recommendations include a stepwise approach to diagnosing TDI-induced asthma in exposed workers AU - Soderlund N AU - Rees D AU - Wasserfall C AU - Roodt L LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 8 IP - DP - 1993 Jan 01 TI - Airflow obstruction and mining PG - 155-170 AB - Bronchitis and emphysema have long been described as diseases of miners, but the precise contribution of occupational exposures to coal and other mine dusts in causing these disorders, as opposed to cofactors such as social class, environmental pollution, and cigarette smoking, has not been fully defined. Epidemiologic studies have attempted, with varying degrees of success, to determine the incidence and severity of chronic obstructive pulmonary diseases in miners as compared to the general population. The results from these studies, and those in other nonmining industries with dust exposures, are examined AU - Stenton SC AU - Hendrick DJ LA - PT - DEP - TA - State of the Art Reviews: Occupational Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 147 IP - DP - 1993 Jan 01 TI - Important deficits of lung function in three modern colliery populations. Relations with dust exposure PG - 797-803 AB - To determine whether dust-related "clinically important" deficits of lung function still occur in British coal miners we have analyzed the relationship between lifetime cumulative exposure to respirable dust and risk of defined functional deficits in a population of miners who were examined between 1981 and 1986. The study group consisted of a sample of men who had worked at any one of three collieries (South Wales, Yorkshire, and North East England) between 1970, when new dust standards were introduced, and date of medical survey. There were 1,671 men studied, including men who had left the collieries. "Clinically important" deficits of FEV1 from predicted values derived in this population were defined by comparisons with questionnaire data on exercise tolerance limited by breathlessness. The mean FEV1 of men in the South Wales colliery, for example, who said they had to stop for breath when walking at their own pace on level ground was 942 ml less than the predicted value for nonsmokers after taking age and stature into account. Individual cumulative exposures to respirable dust were calculated from a long-term program of measurements of dust concentrations and occupational records commencing in 1953. In the three colliery populations, 24, 24, and 12% in South Wales, Yorkshire, and the North East, respectively, had FEV1 deficits that were at least as severe as the average deficit associated with the severe grade of exertional dyspnea described above. In all collieries deficits were more common in smokers than in nonsmokers, and more common in men who had left the industry than in men still within it.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Soutar C AU - Campbell S AU - Gurr D AU - Lloyd M AU - Love R AU - Cowie H AU - Cowie A AU - Seaton A LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 147 IP - DP - 1993 Jan 01 TI - Mast cells in the airway mucosa and rapid development of occupational asthma induced by toluene diisocyanate PG - 1005-1009 AB - We examined lobar bronchial biopsies taken from 18 subjects with occupational asthma induced by toluene diisocyanate (TDI) and from nine nonasthmatic control subjects. Two groups of asthmatics were identified on the basis of the duration of exposure to TDI before the onset of symptoms of asthma. Group A (n = 8) developed asthma after 2.4 +/- 0.4 yr of exposure to TDI, and Group B (n = 10) developed asthma after 21.6 +/- 3.1 yr of exposure to TDI. Both groups of asthmatic subjects had increased numbers of inflammatory cells in the airway mucosa compared with subjects in the nonasthmatic control group. Comparison between Groups A and B showed that subjects who developed asthma after short-term exposure had a significantly increased number of mast cells both in epithelium and in lamina propria than did subjects who developed asthma after long-term exposure to TDI (p : 0.01). Interestingly, the numbers of mast cells both in the epithelium (rs = -0.52, p : 0.05) and in the lamina propria (rs = -0.81, p : 0.001) were inversely correlated with the length of exposure to TDI before the onset of asthma. In conclusion, subjects who develop asthma after short-term exposure to TDI have an increased number of mast cells in the airway mucosa, suggesting that these cells may be associated with individual susceptibility differences to offending agents AU - Di Stefano A AU - Saetta M AU - Maestrelli P AU - Milani G AU - Pivirotto F AU - Mapp CE AU - Fabbri LM LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 147 IP - DP - 1993 Jan 01 TI - Recovery of pulmonary function in farmer's lung. A five-year follow-up study PG - 793-796 AB - The recovery of pulmonary function in farmer's lung (FL) was studied during a 5-yr follow-up in 101 patients (20 men and 81 women, mean age 47 yr). At the initial evaluation all patients had the first diagnosed attack of FL. Spirometry, measurement of pulmonary diffusing capacity, and arterial blood gas analysis were done at the time of the diagnosis and 1, 3, 6, 12, and 24 months thereafter. The last follow-up measurements were made 4 to 6 yr after the initial evaluation. Mean FVC improved significantly for up to 1 yr. In mean DLCO there was improvement for up to 2 yr. Mean PaO2 rose to its maximum within 1 month of the initial examination and did not change significantly thereafter. No patient had diagnosed asthma at the time of the diagnosis of FL, but asthma was later diagnosed in 7 patients during the follow-up. In conclusion, the pulmonary function of FL patients improved for up to 2 yr after the initial acute episode. In general, PaO2 improved most rapidly; the improvement in FVC was slower, and the recovery of DLCO took the longest time AU - Kokkarinen JI AU - Tukiainen HO AU - Terho EO LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 70 IP - DP - 1993 Jan 01 TI - Bronchial asthma caused by two unrelated vegetables PG - 324-327 AB - Vegetable-induced asthma is an uncommon hazard. We report an atopic housewife, in whom rhinoconjunctivitis and acute asthma were associated with two vegetables of taxonomically unrelated botanical families (Swiss chard/Chenopodiaceae family and green beans/legume family). Type I hypersensitivity to the antigens in Swiss chard and green beans was demonstrated by means of skin tests, histamine release test, and specific IgE determination by RAST. Bronchial responses after specific bronchial challenges indicated that Swiss chard and green beans might be the causative factor for the acute asthma AU - Parra FM AU - Lazaro M AU - Cuevas M AU - Ferrando MC AU - Martin JA AU - Lezaun A AU - Alonso MD AU - SanchezCano M LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Bronchial responsiveness to methacholine in swine confinement building workers PG - 73-77 AB - Bronchial responsiveness to methacholine was measured in 60 swine confinement building workers selected from 461 subjects who participated in a recent epidemiologic survey on the respiratory impact of exposure to this environment. Subjects were divided into the following four groups: group 1, asymptomatic with normal spirometry (n = 16); group 2, asymptomatic with forced expiratory volume in one second/forced vital capacity (FEV1.0/FVC) : 95% predicted (n = 17); group 3, presence of chronic bronchitis with normal respiratory function (n = 13); and group 4, both symptomatic and FEV1.0/FVC : 95% predicted (n = 14). Each subject answered a questionnaire and had a physical examination, PA and lateral chest films, lung volumes and DLCO measurements, and a methacholine bronchoprovocation test. Ages were similar in each group. Physical examination, chest x-rays, and DLCO were normal in all subjects. Values of total lung capacity (TLC) for subjects in group 4 were higher than those of subjects in group 3, and respiratory volume (RV) values of group 4 subjects were higher than those found for all other groups. The provocation dose of methacholine (PC20) was lower for group 4, and the number of subjects with PC20 : 16 mg/ml was greater in this group than in the other groups. We conclude that only swine confinement building workers with both symptoms of chronic bronchitis and abnormal spirometry have an increased bronchial responsiveness to methacholine; however, it is uncertain whether the bronchial responsiveness demonstrated is directly related to the subjects' employment AU - Bessette L AU - Boulet LP AU - Tremblay G AU - Cormier Y LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Lung cancer: a prospective study of smoking, occupation, and nutrient intake PG - 69-72 AB - A cohort study of lung cancer was conducted among 7,961 Japanese-American men who were interviewed and examined during 1965-1968. Information was collected about their smoking history, occupation, and nutrient intake. After 22 y, 227 incident cases of lung cancer were identified. Cigarette smoking significantly increased lung cancer risk. The relative risk (RR) was 3.1 for past smokers and 11.4 for current smokers, compared with never smokers. We separated lung cancer cases according to histological type, and it was found that current smokers had a RRs of 16.0 for squamous/small-cell carcinoma and 6.8 for adenocarcinoma of the lung. Unskilled manual workers had a significantly higher risk (RR = 1.5; 95% confidence interval, 1.1-2.2) for lung cancer than workers who were engaged in nonmanual occupations. There was no association between lung cancer and the 24-h intake of total calories, protein, fat, dietary cholesterol, carbohydrates, and alcohol, but this may have resulted from the limitations of a 24-h dietary questionnaire AU - Chyou PH AU - Nomura AM AU - Stemmermann GN AU - Kato I LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - Lung function in insulation workers PG - 252-256 AB - To evaluate the effects of working with modern insulation materials (rock and glass wool), the members of the Copenhagen Union of Insulation Workers were invited to participate in a study based on a health examination that included lung function tests. Three hundred and forty men (74%) agreed to participate, and 166 bus drivers served as the control group. Age distribution, height, and smoking habits were similar in the two groups. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were used as tests for lung function. There were no differences in FVC between the study and control groups, but the insulation workers had significantly lower values of FEV1 (mean 2.51) compared with the controls (mean 3.4 1), independent of smoking habits. Six years before the present study, 114 of the insulation workers participated in a similar study, and eight years after the initial study, the lung function of 59 of the bus drivers was tested. The decline in FVC in insulation workers who smoked was significantly higher (7.7 cl/year) than in bus drivers who smoked (3.1 cl/year); the decline in FEV1 was significantly higher in insulation workers independent of smoking habits (17.0 cl/year v 2.9 cl/year). Self assessed former exposure to asbestos was not associated with lung function in insulation workers. The study concludes that working with modern insulation materials is associated with increased risk of developing obstructive lung disease AU - Clausen J AU - Netterstrom B AU - Wolff C LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 60 IP - DP - 1993 Jan 01 TI - Airborne endotoxin concentrations in various work areas within a cotton mill in Central America PG - 187-192 AB - Gram-negative bacteria and their endotoxins have been shown to cause profound changes in the structure and function of mammalian lungs. Airborne exposures in humans have resulted in bronchoconstriction and symptoms of chest tightness and dyspnea. Cotton dust is often heavily contaminated and endotoxin has been postulated to be the agent in cotton dust which is responsible for the byssinosis syndrome. Previous studies of cotton dust have revealed variable amounts of contamination by bacterial endotoxin, with the variability determined in large part by botanical and climatic characteristics. We report here the results of an environmental study conducted in a cotton mill located in the tropics of Central America using locally grown cotton. Results indicate that airborne endotoxin was present in all yarn preparation and weaving areas and ranged from a low of 18 EU/m3 in weaving to a high of 3138 EU/m3 in opening areas. Airborne levels and the amount of endotoxin per nanogram of dust were not higher than values obtained in temperate climates AU - Christiani DC AU - Velazquez A AU - Wilcox M AU - Olenchock SA LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 6 IP - DP - 1993 Jan 01 TI - Occupational asthma due to zinc PG - 447-450 AB - We describe a subject who developed asthma symptoms 2 yrs after being employed at a plant where metals were galvanized in heated zinc. The subject was not atopic. Baseline spirometry was normal three months after he left work but there was mild bronchial hyperresponsiveness to methacholine. Monitoring of forced expiratory volume in one second (FEV1) during a day at work showed a maximum fall in FEV1 of 24% at the end of the day and an increase in bronchial responsiveness on the following day. Environmental monitoring revealed that zinc and iron were present in the working environment at concentrations that were lower than the "threshold limit value-short term exposure level" (TLV-STEL) standards. Positive immediate skin tests to zinc sulphate at concentrations of 1 and 10 mg.ml-1 were obtained, although no specific immunoglobulin E (IgE) antibodies to zinc could be found. Skin tests with copper, chromium and cobalt were negative. Specific inhalation challenges were performed, having the subject inhale a solution of zinc sulphate at a 10 mg.ml-1 concentration for 6 min. An immediate reaction was elicited (maximum fall in FEV1 of 23%). We conclude that zinc can cause occupational asthma am zinc 0.26 mg/m3 AU - Malo JL AU - Cartier A AU - Dolovich J LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 64 IP - DP - 1993 Jan 01 TI - Respiratory symptoms and ventilatory capacity in workers in a vegetable pickling and mustard production facility PG - 457-461 AB - A group of 117 women occupationally exposed in a pickling factory were studied for the prevalence of acute and chronic respiratory symptoms and lung function changes. Workers were studied by task which included (1) pickling, (2) mustard making, and (3) packing. Similar prevalences for all respiratory symptoms were seen for the three workers groups, with all groups having significantly higher prevalences of chronic cough (P : 0.05), chest tightness, nasal catarrh, and sinusitis (P : 0.01) than a nonexposed control group from a bottling plant. Prevalences of acute symptoms were greater for pickling than for mustard or packing workers. Measured forced expiratory volume in 1 s and maximum flow rates at 50% and the last 25% of the control vital capacity were in general significantly lower than predicted values for the worker subgroups. Pickling workers exposed for more than 1 year in the industry had greater across-shift reductions for all spirometric parameters tested than those workers exposed for 1 year or less. Our data suggest that extended occupational exposure in the pickling industry results in acute exposure-related respiratory effects and ultimately may lead to the development of chronic respiratory symptoms and changes in baseline lung function AU - Zuskin E AU - Mustajbegovic J AU - Schachter EN AU - Rienzi N LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 91 IP - DP - 1993 Jan 01 TI - Prepolymers of hexamethylene diisocyanate as a cause of occupational asthma PG - 850-861 AB - BACKGROUND Occupational asthma (OA) caused by products that contain hexamethylene diisocyanate (HDI) has been ascribed to the highly volatile monomer of HDI. Most two-component paints are now made up primarily of nonvolatile prepolymers of HDI (30% to 60%) with only trace amounts (: 0.1%) of the monomer. The respective role of the two chemical forms of HDI in causing OA has never been investigated. METHODS Twenty workers who were consecutively referred for possible OA that resulted from exposure to spray paints underwent inhalation challenges on separate days with pure HDI monomer and the commercial formulation of HDI prepolymers to which they had been exposed at work. RESULTS Specific inhalation challenges elicited a positive asthmatic reaction in 10 of the 20 subjects. Among these subjects, four had positive bronchial reactions (two early, one late, and one dual) to both the monomer and the prepolymers. Four other subjects had asthmatic reactions (two early, one late, and one dual) after exposure to the prepolymers but not after exposure to the monomer. The discordance in bronchial response elicited by the monomer and the prepolymers could not be due to differences in the level of baseline nonspecific bronchial reactivity or in HDI concentrations during the tests. One subject showed an atypical progressive reaction after exposure to the monomer but not after exposure to the prepolymer. In this case, the discordant response could be explained by differences in HDI concentration. CONCLUSION These observations show that, although they are nonvolatile, the prepolymers of HDI can induce OA and that asthmatic reactions as a result of exposure to prepolymers but not the monomer is not a rare occurrence AU - Vandenplas O AU - Cartier A AU - Lesage J AU - Cloutier Y AU - Perreault G AU - Grammer LC AU - Shaughnessy MA AU - Malo JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 147 IP - DP - 1993 Jan 01 TI - Asthma mortality in California, 1960-1989; demographic patterns and occupational associations PG - 1454-1460 AU - Schenker MB AU - Gold EB AU - Lopez RL AU - Beaumont JJ LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 106 IP - DP - 1993 Jan 01 TI - Occupational asthma PG - 143-143 AU - Donoghue M LA - PT - DEP - TA - N Z Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 47 IP - DP - 1993 Jan 01 TI - Variability of peak expiratory flow in an unselected sample of school children PG - 82-83 AB - In the framework of an epidemiological study, the information by peak flow variability (PEFV) was compared to the history of asthma in a non-selected population of primary-school children (n = 1812). PEFV as assessed by twice daily recordings of PEF for a one week period (n = 1237) was calculated as average of daily amplitudes (AVAM: average amplitude mean) in the case of at least complete data for five days (n = 991). Elevated PEFV defined as AVAM : 12%, was cross-tabulated with the asthma history (self-administered questionnaire). The median (90%-confidence-interval) of AVAM is 6.3% (2.2-15.9%). In 11.2% (n = 111) of the population, AVAM : 12% occurred). The sensitivity of AVAM : 12% with regard to "doctor's diagnosed asthma" (n = 35) is 37%. Under exclusion of children with recurrent wheezy bronchitis a specificity for AVAM : 12% of 90% is found. Our data on primary-school children suggests that PEFV is a specific but only slightly sensitive measurement with regard to previously diagnosed bronchial asthma AU - Kuhr J AU - Frischer T AU - Karmaus W AU - Meinert R LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - Occupational allergy to bumble bee venom PG - 190-195 AB - The clinical profile of anaphylactic reactions to bumble bees is described and successful immunotherapy with honey bee venom in seven bumble bee allergic patients is reported. The cause of the high frequency of sensitization to pollen in these patients is discussed Cultivating bumble bees on tomato farm, feeding them with various pollens, grass, tree, weed AU - Kochuyt AM AU - Van Hoeyveld E AU - Stevens EA LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 137 IP - DP - 1993 Jan 01 TI - Childhood asthma and indoor environmental risk factors PG - 834-844 AB - In a case-control study carried out in Montreal, Quebec, Canada, between 1988 and 1990, indoor environmental factors were studied in relation to the incidence of asthma among 3- and 4-year-old children. Cases (n = 457), whose parents were recruited at a hospital emergency room, were children who had a first-time diagnosis of asthma (International Classification of Diseases, Ninth Revision, code 493) made by a pediatrician. Controls (n = 457) were chosen from family allowance files and were matched with case children on age and census tract. A telephone interview was administered to the children's parents. A 20% feasibility subsample was chosen to wear a nitrogen dioxide monitoring badge during a 24-hour period. Multiple conditional logistic regression analysis showed that after personal susceptibility factors were controlled for, the following were independent risk factors for asthma: the mother's heavy smoking (odds ratio (OR) = 2.77, 95% confidence interval (CI) 1.35-5.66), use of a humidifier in the child's room (OR = 1.89, 95% CI 1.30-2.74), and the presence of an electric heating system in the home (OR = 2.27, 95% CI 1.42-3.65). The presence of other smokers in the home was not quite significant (OR = 1.82, 95% CI 0.98-3.38). A history of pneumonia, the absence of breast feeding, and a family history of asthma were also significant risk factors. In a separate unmatched multivariate analysis of subjects who had worn the nitrogen dioxide badge, there was a dose-response relation between nitrogen dioxide (in parts per billion) and asthma. These results confirm the role of susceptibility factors in asthma and show that indoor environmental factors contribute to the incidence of asthma AU - InfanteRivard C LA - PT - DEP - TA - Am J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 147 IP - DP - 1993 Jan 01 TI - Response to isocyanates: effect of concentration, duration of exposure, and dose PG - 1287-1290 AB - There is no information on the relative role of dose, concentration, and duration of exposure in determining the magnitude of the bronchial response in subjects with isocyanate-induced asthma. Four subjects with asthma induced by toluene diisocyanate (TDI) were challenged using a recently described closed-circuit exposure chamber in which stable concentrations of TDI monomer can be generated. Each subject was challenged using various concentrations and durations of exposure on separate days. They were all exposed on three to four occasions to the same dose that had been shown to cause a 20% fall in FEV1 at a concentration of 15 ppb (DR15ppb) by varying the concentration (5, 10, 15, and 20 ppb) and durations (1 to 90 min), making sure that the total dose (concentration x duration) remained constant. They were also exposed to lower total doses by modifying the concentration and the duration on the remaining visits. Exposing subjects to the same DR15 ppb by modifying the concentration or the duration resulted in falls in FEV1 : or = 20%, except in one instance. Exposing subjects to doses lower than DR15 ppb, even at higher concentrations or for longer periods than in the challenges used for obtaining the DR15 ppb always caused falls in FEV1 : 20%. We conclude that the main determinant of bronchial responsiveness to TDI is not concentration nor duration of exposure per se but the product of both factors, that is, total dose AU - Vandenplas O AU - Cartier A AU - Ghezzo H AU - Cloutier Y AU - Malo JL LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 42 IP - DP - 1993 Jan 01 TI - Results of 29-year study of hoya (sea-squirt) asthma in Hatsukaichi, Hiroshima prefecture. PG - 214-218 AB - As remarkable improvements have been made to the working environment and working methods of oyster shucking workers during the past 30 years, a study was made on the effects of these improvements on hoya (sea-squirt) asthma and the following results were obtained. 1) The prevalence of hoya (sea-squirt) asthma among oyster shucking workers was 36.0%, 30.1%, 21.7%, 22.0%, 18.0%, and 26.6% in 1963, 1968, 1976, 1984, 1988, and 1992, respectively. Accompanying the improvements made to the working environment and working methods, asthmatic symptoms failed to develop in some of the patients through engaged in oyster shucking work. Thus, those with symptoms actually accounted for 36.0%, 18.7%, 15/8%, 7.4%, 8.4%, and 8.0% of the workers, respectively. 2) The proportion of serious cases among the patients rapidly decreased from 29.2% in 1963 to 0% after 1984. On the other hand the proportion of slight cases was 35.4% in 1963, but after 1988 all the cases were slight cases. 3) During the period from 1984 to 1992, the number of those newly engaged in oyster shucking work was 74. The number of those who developed hoya (sea-squirt) asthma during this period was 8 or 10.1%. All the cases were asthma of the rhinitis type. 4) The number of workers who did not develop asthmatic symptoms though engaged in oyster shucking work was 53 in 1984, 40 in 1988, and 49 in 1992. Of this number, 31% are now under hyposensitization therapy, 57.0% have received this therapy in the past, and 12.0% have not received any therapy AU - Ohtsuka T AU - Tsuboi S AU - Katsutani T AU - Jyo T AU - Kuwahara M AU - Kodomari Y AU - Tanemori N AU - Satoh H AU - Ono K AU - Oka S LA - PT - DEP - TA - Arerugi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 42 IP - DP - 1993 Jan 01 TI - Toluene 2,4-diisocyanate induced late asthmatic response and dual asthmatic response in guinea pigs. PG - 177-185 AB - Late asthmatic reaction (LAR) and dual asthmatic reaction (DAR) were developed in guinea pigs by repetitive treatment with toluene 2,4-diisocyanate (TDI). Development of LAR or DAR seemed to dependent on the TDI-treatment period. IgG was demonstrated in both the LAR and DAR models, whereas IgE was only in the DAR model. Increased numbers of eosinophils and goblet cells were observed in the epithelial mucosa of the bronchioles in addition to mast cells with decreased numbers of specific granules. Both LAR and DAR were inhibited in those model animals pretreated with dexamethasone. Serum corticosteroid and adrenal cytochrome P-450 levels in guinea pigs during TDI-treatment period were similar to those in untreated animals. Also, hepatic cytochrome P-450 levels and drug metabolizing activities were similar to those in untreated animals AU - Sugawara Y AU - Okamoto Y AU - Sawahate T AU - Tanaka K LA - PT - DEP - TA - Arerugi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 64 IP - DP - 1993 Jan 01 TI - Respiratory function in greenhouse workers PG - 521-526 AB - Respiratory findings were studied in a group of 135 female and 32 male workers employed in greenhouses. In addition 51 women and 30 men were studied as a control group. Exposed women had significantly higher prevalences of chronic cough, dyspnea, chest tightness, and rhinitis (P : 0.01) than the controls. Among the men, only rhinitis was more prevalent in greenhouse workers (P : 0.01) than in controls. Smokers had higher prevalences of all chronic respiratory symptoms than nonsmokers, but the differences were statistically significant only for chronic cough and rhinitis in women and for chronic phlegm in men. There was a high prevalence of acute symptoms during work. A large number of greenhouse workers complained of skin reactions to plants and pesticides (women: 37.8%; men: 34.4%). Workers had significantly lower mean ventilatory capacity measurements (except in the case of forced vital capacity) when compared to standard predicted values. Smokers and nonsmokers had similar values of lung function expressed as percentages of the predicted values. Greenhouse workers exposed for more than 10 years had a significantly lower FEF25, measured as a percentage of the predicted value, than workers exposed for less than 10 years. Our data indicate that occupational exposure to greenhouses may be associated with the development of acute and chronic respiratory symptoms and impairment of ventilatory capacity AU - Zuskin E AU - Schachter EN AU - Mustajbegovic J LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 91 IP - DP - 1993 Jan 01 TI - Occupational asthma in a technologist exposed to glutaraldehyde PG - 974-978 AB - BACKGROUND Occupational asthma can be caused by several sterilizing agents, including glutaraldehyde, which has been shown to cause irritation of the eyes and upper respiratory tract and skin rash. We report a case of occupational asthma that was caused by exposure to glutaraldehyde. METHODS To document the diagnosis of occupational asthma in a respiratory technologist, the following tests were performed: preshift and postshift spirometry, serial measurements of peak expiratory flow rate and nonspecific bronchial hyperresponsiveness, and workplace challenge test. RESULTS Monitoring of peak expiratory flow rate showed improvement when the subject was away from the workplace. Improvements in forced expiratory volume in 1 second (FEV1) and provocative concentration causing a 20% fall in FEV1 were also observed. A workplace challenge test showed a progressive fall in FEV1 when the subject was exposed to glutaraldehyde in a sterilizing agent used to clean bronchoscopes at her workplace. After the diagnosis of occupational asthma was confirmed, the subject continued to assist with bronchoscopy but no longer cleaned the bronchoscopes. CONCLUSIONS This case study illustrates the usefulness of a workplace challenge test in confirming the diagnosis of occupational asthma. It also indicates the importance of preventing or reducing exposure to sterilizing agents such as glutaraldehyde by means of effective ventilation and proper storage and enclosure during use AU - ChanYeung M AU - McMurren T AU - CatonioBegley F AU - Lam S LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 124 IP - DP - 1993 Jan 01 TI - Latex glove reactions found in a dental school PG - 67-71 AB - When a survey was distributed to students, faculty and staff of a dental school to determine the incidence of latex glove reactions, 15 percent reported adverse reactions to glove use. The most frequently reported symptom was dermatitis, followed by urticaria, sweating, conjunctivitis and rhinitis AU - Rankin KV AU - Jones DL AU - Rees TD LA - PT - DEP - TA - J Am Dent Assoc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 90 IP - DP - 1993 Jan 01 TI - Does competitive skiing cause asthma? Cold air is suspected to be the primary cause (interview by Birgit Wilhelmson). [Swedish] PG - 1764-1765 AU - Larsson K LA - PT - DEP - TA - Lakartidningen JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 75 IP - DP - 1993 Jan 01 TI - Tooth enamel dust as an asthma stimulus. A case report PG - 599-601 AB - A case report of a first-year dental student with asthma, who experienced exacerbation of symptoms and a severe asthmatic crisis in the course of her preclinical dental training, is presented. Dust generated as a result of preparing natural teeth triggered the bronchoconstrictive response. Her subsequent medical and preventive measures are cited. This case identifies, for the first time, enamel dust as an asthma stimulus, thus serving as a precaution to prospective dental students and personnel afflicted with the disease and emphasizing the importance of effective face masks in dental laboratories during dust-generating procedures AU - Housholder GT AU - Chan JT LA - PT - DEP - TA - Oral Surg Oral Med Oral Pathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 47 IP - DP - 1993 Jan 01 TI - Toluene diisocyanate-induced bronchial hyperreactivity in an animal model of occupationally-induced lung diseases. [German] PG - 215-222 AB - Diisocyanates, widely used in industry for the production of polyurethanes, paints and adhesives represent a growing problem in occupational medicine. Beside toxic responses, isocyanates induce sensitization of exposed workers and may cause asthmatic reactions. To study the pathomechanisms of acute isocyanate induced lung injury, we developed an animal model using anaesthetised rabbits. Inhalation of toluene diisocyanate (TDI) in the range of threshold limit value (TLV) of 10 ppb (as well as 5 and 30 ppb) four times for a period of one hour, performed in 3 groups of 8 rabbits, did not significantly alter airway resistance (R), dynamic elastance (Edyn), slope of inspiratory pressure generation (dPoes/TI), arterial pressure (Pa) or arterial blood-gas tensions (PaO2, Pa-CO2) within time of exposure. In these experiments, before and after each TDI inhalation, unspecific airway responsiveness to 2% Acetylcholine (ACH) aerosol, inhaled for 1 minute, was measured. After 4 hours of TDI-inhalation, the amplitude of the bronchoconstrictory responses to ACH rose significantly (p : 0.005) to 3.6 times of the control value. Similar changes in the amplitude of airway resistance were measured. After inhalation of 5 ppb TDI no significant changes in airway reactivity were noticed, whereas the responses were further enhanced with 30 ppb TDI. In a control group of 8 animals, not undergoing TDI inhalation, the responses of Edyn, R and delta Poes/TI to ACH aerosol inhalation did not significantly alter from one challenge to another. Conclusion: Diisocyanate atmospheres of threshold limit value of 10 ppb cause bronchial hyperreactivity within 4 hours of exposure in our rabbit model of occupational lung disease AU - Marek W AU - Potthast J AU - Marczynski B AU - Baur X LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 103 IP - DP - 1993 Jan 01 TI - Etiologic factors of chronic bronchitis in dairy farmers. Case control study in the Doubs region of France PG - 417-421 AB - Relationships were investigated between chronic bronchitis and plant dust exposure assessed by quantification of barn threshing and cattle foddering and chronic bronchitis and acute respiratory syndromes after plant mold dust exposure. Two groups of male dairy farmers were studied in the Doubs region, France: 197 with chronic bronchitis and 163 control subjects without chronic bronchitis. There was no relationship between chronic bronchitis and exposure. Thirty-three chronic bronchitis patients had semidelayed respiratory syndromes (SDRS) vs two control subjects. Twenty-seven times out of 33 (16 of 17 in the nonsmokers), the SDRS preceded chronic bronchitis. Past history of acute respiratory syndromes during barn threshing (RSBT) was more frequent in chronic bronchitis; RSBT always preceded chronic bronchitis. It is concluded that host factors are important in chronic bronchitis and that acute effects after exposure may be predisposing factors to chronic bronchitis AU - Dalphin JC AU - Pernet D AU - Dubiez A AU - Debieuvre D AU - Allemand H AU - Depierre A LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 87 IP - DP - 1993 Jan 01 TI - A large Q fever outbreak in the West Midlands: clinical aspects PG - 509-516 AB - In the spring of 1989 the largest outbreak of acute Q fever recorded in the United Kingdom occurred in Solihull and surrounding areas of the West Midlands. The diagnosis was confirmed in 147 people, mainly males of working age. Windborne spread from farmland to the south of the urban area was the most likely route of infection. Fever was the commonest symptom, seen in 101/102 (99%) cases, followed by weight loss reported by 83/101 (82%). Headache, often severe, was experienced by 69/101 (68%). The commonest respiratory symptom was breathlessness, 65/102 (64%), followed by cough, 52/102 (51%), and chest pain, 46/102 (45%). Neurological features, seen in 23% of cases, were more prominent in this outbreak than is commonly recognized. Persisting ill health 6 months following the acute episode not due to chronic Q fever was also a prominent feature of this largely urban outbreak AU - Smith DL AU - Ayres JG AU - Blair I AU - Burge PS AU - Carpenter MJ AU - Caul EO AU - Coupland B AU - Desselberger U AU - Evans M AU - Farrell ID AU - et al LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 8 IP - DP - 1993 Jan 01 TI - Use of serial measurements of peak flow in the diagnosis of occupational asthma. [Review] PG - 279-294 AB - Occupational asthma is best verified by physiological measures, including (1) measurement of lung function on a single occasion with bronchodilator response, (2) measurement of lung function before and after a workshift, and (3) repeated measurement of PEF over long periods of time, including readings at and away from work. The author describes a qualitative method for distinguishing patterns of PEF change at and away from work which has been effective in the diagnosis of work-related asthma. AU - Burge PS LA - PT - DEP - TA - Occupational Medicine: state of the art reviews JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 87 IP - DP - 1993 Jan 01 TI - A prospective audit of the value of fibre optic bronchoscopy in adults admitted with community acquired pneumonia PG - 105-109 AB - We audited our practice of bronchoscoping patients admitted with community acquired pneumonia to detect latent underlying abnormalities. Fifty-five bronchoscopies were performed immediately after clinical recovery in 64 sequential patients without obvious underlying carcinoma. Five (9.1%) showed abnormalities (four carcinomas and one mild tracheal stenosis). The detection rate of abnormalities and the number of unnecessary bronchoscopies would be improved if only those patients aged 50 years or over who were current or ex-smokers were bronchoscoped. In this group 13.9% (5/36) had an underlying abnormality. The cost implications of such a policy of early bronchoscopy are discussed and compared with traditional follow-up AU - Gibson SP AU - Weir DC AU - Burge PS LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - IP - DP - 1993 Jan 01 TI - Prevalence of occupational asthma in the electroplating industry PG - - AU - Boran AM LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 109 IP - DP - 1993 Jan 01 TI - Triplochiton scleroxylon-induced asthma in a sauna maker [Finnish] PG - 231-234 AU - Kujala V AU - Reijula K AU - Latvala J LA - PT - DEP - TA - Duodecim JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 109 IP - DP - 1993 Jan 01 TI - Allergy to aziridine paint hardener [Finnish] PG - 125-130 AU - Autio P AU - Estlander T AU - Jolanki R AU - Keskinen H AU - Kanerva L LA - PT - DEP - TA - Duodecim JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 103 IP - DP - 1993 Jan 01 TI - Exposure to microorganisms associated with allergic alveolitis and febrile reactions to mold dust in farmers PG - 1202-1209 AB - STUDY OBJECTIVE To compare exposure to microorganisms associated with allergic alveolitis (AA) and with febrile reactions to inhaled mold dust (organic dust toxic syndrome [ODTS]) in farmers and in normal subjects. DESIGN A prospective study in which exposure was evaluated within two weeks of medical consultation for AA or ODTS. Samples were collected during normal farming (background) and during the handling of materials associated with disease or causing maximal exposure in reference farms (worst case). SETTING Swedish farms PARTICIPANTS Eleven farmers with a confirmed diagnosis of AA from ten farms, 16 subjects with symptoms of ODTS from 12 farms, and 17 reference farmers. MEASUREMENTS AND RESULTS Worst-case samples representative of the exposure preceding disease were obtained on four farms where five farmers had had AA; the samples contained on average 2.6 +/- 1.8 x 10(9) (SD) spores/m3 of air. On six farms where nine farmers had had ODTS, representative samples averaged 13 +/- 13 x 10(9) spores/m3, and on reference farms this figure was 0.12 +/- 0.20 x 10(9) spores/m3. The daily spore dose associated with allergic alveolitis was 2 x 10(9) spores/d, which was ten times higher than on reference farms. The average dose associated with ODTS was 2 x 10(10) spores. Worst-case samples, collected during 10 to 30 min, contributed to more than 90 percent of the day exposure on farms where AA or ODTS had occurred. CONCLUSION Allergic alveolitis was associated with high exposure levels on most weekdays for weeks, and ODTS was associated with extreme exposure occurring on a single day. There was no correlation with individual spore types and disease and the present results are compatible with a hypothesis that common cell wall components of microorganisms may cause "toxic" symptoms and stimulate immune reactions AU - Malmberg P AU - RaskAndersen A AU - Rosenhall L LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 103 IP - DP - 1993 Jan 01 TI - Bronchial hyperresponsiveness and toluene diisocyanate. Long-term change in sensitized asthmatic subjects PG - 1123-1128 AB - Long-term change in nonspecific and specific bronchial hyperresponsiveness was studied in 16 subjects with asthma induced by toluene diisocyanate (TDI). A significant positive correlation between months of follow-up and provocative dose inducing a 20 percent fall in FEV1 (PD20FEV1) methacholine was observed in 5 of 16 subjects. In 4 of these 5 subjects, a PD20FEV1 > 1 mg of methacholine was observed 30 to 48 months after the end of TDI exposure. In most subjects, nonspecific bronchial hyperresponsiveness did not change. Nine of 16 subjects became nonresponsive to TDI at follow-up examination, but only 3 of these showed a significant increase in PD20FEV1 methacholine. Seven subjects were still responsive to TDI. Recovery from TDI-induced asthma can occur and only after long-term work cessation. Nonspecific bronchial hyperresponsiveness to methacholine can persist even in the absence of bronchial hyperresponsiveness to TDI, suggesting permanent chronic damage to mechanisms controlling airway tone AU - Paggiaro PL AU - Vagaggini B AU - Dente FL AU - Bacci E AU - Bancalari L AU - Carrara M AU - Di Franco A AU - Giannini D AU - Giuntini C LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 10 IP - DP - 1993 Jan 01 TI - Diagnostic criteria for chronic beryllium disease (CBD) based on the UK registry 1945-1991 PG - 41-43 AU - Williams WJ LA - PT - DEP - TA - Sarcoidosis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 47 IP - DP - 1993 Jan 01 TI - Extreme self-medication: a case report [German] PG - 686-688 AB - On the background of insufficient allergological diagnostic a case of serious cowhair asthma was misinterpreted as intrinsic asthma which led to an extreme form of selfmedication. The excessive daily intravenous selfapplication of 2000 mg theophylline and 24 mg fenoterol per inhalationem for about 4 years was tolerated without any serious side effects. The continues smoking of 40 cigarettes per day may have protected the patient from a toxic dose of theophylline. This case report demonstrates the importance of basic diagnostic as well as the continuous control of the proposed medication AU - Rauls G AU - Bergmann KC LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 22 Suppl 2 IP - DP - 1993 Jan 01 TI - Retrospective assessment of asbestos exposure--II. At the job level: complementarity of job-specific questionnaire and job exposure matrices PG - S96-105 AB - Retrospective assessment of asbestos exposure--II. At the job level: Complementarity of job-specific questionnaire and job exposure matrices. International Journal of Epidemiology 1993; 22 (Suppl. 2): S96-S105. The assessments of asbestos exposure by two a priori job exposure matrices (JEM) and by a job-specific questionnaire (SQ) are compared at job level. The data used for the comparison were generated by an ongoing case-control study on lung cancer in a region of northern Germany with a relatively high past prevalence of asbestos exposure. Among job periods assessed as unexposed by either JEM, 96% are recognized as such by the SQ. Discrepancies between the SQ and JEM were observed in jobs rated potentially exposed by the JEM. Despite varying estimates, the JEM and SQ were consistent as regards the relative classification of job periods by probability of exposure. The concordance of the methods, estimated by Kappa statistics, was stronger for the two JEM than for either of the JEM and the SQ. The identification of specific occupation/industry combinations in which discrepancies were most frequent and the comparison with expert ratings in some jobs yield insights into the sources of the disagreement between the methods. The misclassification of exposure by the JEM usually results in an overestimation of exposure. This is essentially related to loss of information due to the use of job codes as surrogates for job task descriptions and to the insufficiency of published data on asbestos exposure in different industries. As regards the SQ, two main sources of potential loss of sensitivity were identified: 1) possible omission of indirect sources of exposure by this method, 2) possible incompleteness of the SQ. The present comparison of methods of asbestos exposure assessment does not allow any one approach to be considered superior to another. Indeed, as proposed by Ahrens et al. in Part I of the study, both should be used to ensure optimal epidemiological performance AU - Orlowski E AU - Pohlabeln H AU - Berrino F AU - Ahrens W AU - BolmAudorff U AU - Grossgarten K AU - Iwatsubo Y AU - Jockel KH AU - Brochard P LA - PT - DEP - TA - Int J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 35 IP - DP - 1993 Jan 01 TI - Occupational asthma to the slime mold Dictyostelium discoideum PG - 1231-1235 AB - Dictyostelium discoideum is a slime mold that exists in a unicellular amoeboid form under certain nutritional conditions. In this form, it produces unique lysosomal enzymes that are valuable in studying cell-to-cell signaling systems. We report on a research microbiologist who developed rhinoconjunctivitis and asthma after release of D. discoideum from a pressurized canister. Immediate skin test reactivity was demonstrated to whole and lysed organisms. Enzyme-linked immunosorbent assay results revealed IgE antibody against D. discoideum whole organism, lysed organism, and lysosomal enzymes with the strongest response being directed toward lysosomal enzymes. Pulmonary function testing showed a decline in forced expiratory volume in 1 second and forced expiratory flow after modified laboratory exposure to D. discoideum. This case represents the first report of occupational rhinoconjunctivitis and asthma from slime mild AU - Gottlieb SJ AU - Garibaldi E AU - Hutcheson PS AU - Slavin RG LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 47 IP - DP - 1993 Jan 01 TI - Reported incidence of occupational asthma in the United Kingdom, 1989-90 PG - 459-463 AB - STUDY OBJECTIVE To estimate the incidence of occupational asthma seen by respiratory and occupational physicians in the UK in 1989 and 1990. DESIGN New cases of occupational asthma were taken from a national reporting scheme, the Surveillance of Work-related and Occupational Respiratory Disease Project (SWORD). Estimates of the working population from the Labour Force Survey were used to calculate reported incidence by age group, sex, occupation, and region. SETTING The SWORD project is a scheme for the reporting of new cases of work-related respiratory disease by thoracic and occupational physicians from throughout the UK which began in 1989. PATIENTS In 1989 and 1990, of 4229 cases reported, 1085 (26%) were in patients with occupational asthma. MAIN RESULTS Only half the reported cases were attributed to agents prescribed under the Industrial Injuries Scheme. There was considerable diversity in risk by occupation, with highest annual rates in welders, solderers, and electronic assemblers (175/million), laboratory workers (188/million), metal treaters (267/million), bakers (334/million), plastics workers (337/million), chemical processors (364/million), and spray painters (658/million). Crude rates in men were higher than in women, but rates within occupations were similar in both sexes. Rates of disease rose with age; adjustment for occupation increased the gradient. Regional differences were only partly explained by diversity of industry and were probably mainly due to variation in levels of ascertainment and reporting. CONCLUSIONS Asthma is the most commonly reported occupational lung disease in the UK. The incidence in the general population is unknown, but it was estimated that the incidence of new cases seen by respiratory and occupational physicians was about three times that reported. High relative risks were found in a number of occupations in which effective control of the work environment is urgently required AU - Meredith SK LA - PT - DEP - TA - Journal of Epidemiology & Community Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 115 IP - DP - 1993 Jan 01 TI - Respiratory symptoms and pulmonary ventilatory function in greenhouse workers [SerboCroatian (Roman)] PG - 199-203 AB - Respiratory symptoms and ventilatory capacity were studied in a group of 135 women employed in greenhouses. In addition, a control group of 51 unexposed women were studied. Greenhouse workers had significantly higher prevalence of chronic cough, dyspnea, chest tightness and rhinitis (p < 0.01) than the controls. Smokers had significantly higher prevalence of chronic cough (p < 0.01) and rhinitis (p < 0.05) than nonsmokers. There was a high prevalence of acute symptoms during work shift. In greenhouse workers there was a statistically significant decrease of measured ventilatory capacity tests (except FVC) as compared to the predicted normal values, especially for FEF25. Smokers and nonsmokers had similar changes of ventilatory capacity as percentage of the predicted normals. Greenhouse workers exposed for more than 10 years had considerably lower FEF50 and FEF25 as percentage of the predicted values than those exposed for less than 10 years. Our data indicate that longer exposure in greenhouses may be associated with the development of acute and chronic respiratory impairment AU - Zuskin E AU - Mustajbegovic J AU - Vidovic Z AU - Kern J AU - Vuletic S LA - PT - DEP - TA - Lijec Vjesn JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 3 IP - DP - 1993 Jan 01 TI - Effects of a furniture-integrated breathing-zone filtration system on indoor air quality, sick building syndrome, and productivity PG - 328-336 AU - Hedge A AU - Mitchell GE AU - McCarthy JF AU - Ludwig J LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 3 IP - DP - 1993 Jan 01 TI - Volatile organic compounds in ventilating air at different sampling points in the building and their relationship with the prevalence of occupant symptoms PG - 382-390 AU - Sundell J AU - Andersson B AU - Andersson K AU - Lindvall T LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 3 IP - DP - 1993 Jan 01 TI - Indoor air humidity and the sensation of dryness as risk factors of SBS PG - 382-390 AU - Sundell J AU - Lindvall T LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Asthma following occupational exposure to Lycopodium clavatum in condom manufacturers PG - 774-775 AB - Occupational asthma in two women employed in the manufacture of condoms is reported. The spores of Lycopodium clavatum, used as a rubber dusting agent, were identified as the causative agent AU - Cullinan P AU - Cannon J AU - Sheril D AU - Newman Taylor AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Association of silicosis, lung dysfunction, and emphysema in gold miners PG - 746-749 AB - BACKGROUND In an earlier study of gold miners men with silicosis were found to have abnormal lung function, including airflow obstruction and reduced diffusing capacity. In a follow up study a sample of these men was examined by computed tomography to determine whether emphysema accounted for these abnormalities, which are associated with silicosis in this working population. METHODS A sample of 70 men from a cohort of older gold miners with and without silicosis who had worked underground for a mean period of 29 years was examined by computed tomography to determine whether each man had emphysema. In addition, each man had lung function tests and routine chest radiography (125 kV). RESULTS A total of 48 men had emphysema on examination by computed tomography. On the basis of the results in a chest radiograph 55 of the men had silicosis. Emphysema was related to silicosis, being present in five of the 15 men without silicosis and in 43 of the 55 with silicosis. Diffuse emphysema was apparent in two men without silicosis (14%) and in 25 men with silicosis (45%). The proportion of men with diffuse emphysema increased from 14% in those with International Labour Organisation category 0 nodule profusion to 46% in those with category 1, 48% in those with category 2, and 67% in those with category 3. Emphysema was also related to smoking: eight of the 18 who had never smoked and 40 of the 52 smokers had emphysema. All of those who had never smoked and had emphysema had silicosis with category 2/2 or greater nodule profusion. Lung function tests showed changes associated with silicosis that could be explained by the associated emphysema. CONCLUSIONS In this population emphysema occurred in association with silicosis and accounted for the abnormalities in lung function associated with silicosis AU - Cowie RL AU - Hay M AU - Thomas RG LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 34 IP - DP - 1993 Jan 01 TI - Burnisher's asthma--a case due to ammonia from silverware polishing PG - 565-566 AB - A 39-year-old man with no past or family history of asthma developed asthmatic symptoms five months after working as a burnisher in a hotel. He polished brass or silverware using "brasso" or "silvo" respectively. He noticed symptoms only when using "silvo". Specific bronchial provocation testing (BPT) to "brasso" was negative. Specific BPT to "silvo" produced a dual asthmatic reaction. Ammonia was present in both polishes. The ammonia-in-air levels during polishing was 8-15 ppm with "silvo" and less than 1 ppm with "brasso". A specific BPT to 12 ppm of ammonia produced an immediate asthmatic reaction. Our opinion is that he had occupational asthma from the ammonia liberated while polishing silverware with "silvo". Ammonia has been reported to cause asthma. However, there have been no previous reports of occupational asthma among burnishers doing silver polishing AU - Lee HS AU - Chan CC AU - Tan KT AU - Cheong TH AU - Chee CB AU - Wang YT LA - PT - DEP - TA - Singapore Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 65 IP - DP - 1993 Jan 01 TI - Biological monitoring and possible health effects in workers occupationally exposed to methyl methacrylate PG - 227-232 AB - Monitoring by means of blood and urine analysis for methanol was successfully applied in 32 male workers who were exposed to methyl methacrylate (MMA) monomer at 6 ppm as a geometric mean and at 112 ppm as the maximum. Measurement of time-weighted average (TWA) intensity of the vapor exposure was successfully conducted with a diffusive sampler with activated carbon cloth as an adsorbent. Methanol concentrations in whole blood, serum, and urine samples were measured by headspace gas chromatography. The methanol concentrations in the three biological samples collected at the end of 8-h workshifts related linearly with the TWA MMA vapor concentrations, with correlation coefficients of 0.8-0.9. Quantitative evaluation of MMA in vapor and of methanol in urine suggests that only 1.5% of MMA inhaled will be excreted in urine as methanol. There were no significant clinical symptoms or abnormal hematological or serum biochemical findings at this exposure level, except that some workers complained throat irritation and frequent cough and sputa. The results indicate that biological monitoring by analysis for methanol is sensitive enough to detect MMA exposure at levels at which no serious health effects are to be expected AU - Mizunuma K AU - Kawai T AU - Yasugi T AU - Horiguchi S AU - Takeda S AU - Miyashita K AU - Taniuchi T AU - Moon CS AU - Ikeda M LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 21 IP - DP - 1993 Jan 01 TI - Bronchial asthma caused by occupational sulfite exposure PG - 221-224 AB - A case is reported of a patient with episodes of bronchospasm requiring hospital admission after handling sodium bisulfite on the job. The patient had a 15-year history of bronchial asthma and concomitant rhinoconjunctivitis and a 6-year history of asthma induced by moderate exercise. His family history included a father with sensitization to mites. Skin tests, measurement of specific IgI, and nasal provocation were positive for domestic dust mites and grass pollen. Skin tests for sodium metasulfite at a concentration of 10 mg/ml were negative. A simple blind oral provocation test of sodium metasulfite (1, 5, 20, and 50 mg) in acid medium was positive at the 50-mg dose, eliciting bronchial and nasal symptoms, and a decrease in CVF, FEV1, and PEF of more than 20% over baseline values. The episode of bronchospasm has not recurred in the workplace since exposure to sodium bisulfite was eliminated. Oral provocation with metasulfite in acid medium is considered a good technique for confirming the diagnosis of these cases AU - Valero AL AU - Bescos M AU - Amat P AU - Malet A LA - PT - DEP - TA - Allergol Immunopathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 60 IP - DP - 1993 Jan 01 TI - Acute noncardiogenic pulmonary edema due to polymer fume fever PG - 479-482 AB - BACKGROUND Certain fluorocarbon polymers can produce a clinical syndrome called polymer fume fever when the products of pyrolysis are inhaled. SUMMARY A previously healthy 21-year-old white man presented with severe chest tightness, difficulty in breathing, pyrexia, nausea, vomiting, and a dry irritating cough. These symptoms occurred suddenly while smoking a cigarette 2 hours after leaving his place of work, where he is a plastics machinist. A chest roentgenogram revealed a bilateral patchy alveolar air space filling pattern involving the mid and lower lung fields. The diagnosis of polymer fume fever was established on the basis of the symptom complex, the association with cigarette smoking, and the occupational exposure to micronized polytetrafluoroethylene. CONCLUSIONS A thorough occupational and smoking history is necessary to recognize polymer fume disease, which may resemble influenza AU - Silver MJ AU - Young DK LA - PT - DEP - TA - Cleve Clin J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 17 IP - DP - 1993 Jan 01 TI - Asthma and bronchospasm during preparation for colonoscopy with an aromatized solution of polyethylene glycol [French] PG - 762-762 AU - Halphen M AU - Masmejean J LA - PT - DEP - TA - Gastroenterol Clin Biol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 6 IP - DP - 1993 Jan 01 TI - Bronchoalveolar lavage in extrinsic allergic alveolitis: effect of time elapsed since antigen exposure PG - 1276-1281 AB - The aim of the present study was to investigate whether bronchoalveolar lavage (BAL) cell profile and immunoglobulin levels from patients with extrinsic allergic alveolitis (EAA) were related to the time elapsed between last antigen exposure and BAL. For this purpose, an analysis was performed of BAL fluid (BALF) obtained from 59 nonsmoking EAA patients at various time-points after termination of antigen exposure and BAL. BALF early after antigen provocation (group 1: < 24 h) contained high absolute and relative numbers of lymphocytes, neutrophils, eosinophils and mast cells, and a low relative number of alveolar macrophages. When obtained after recent antigen exposure (group 2: 2-7 days), BALF showed high numbers of lymphocytes, plasma cells and mast cells, and high levels of immunoglobulins M, G and A (IgM, IgG and IgA). In BAL obtained one week or more after the final antigen exposure, (Group 3: 8-30 days; Group 4: 1-12 months) the distribution of all constituents showed a tendency to return to normal values, with the exception of the lymphocytes. These results demonstrate that BAL cell profile and immunoglobulin levels in EAA are highly dependent on the time-point at which the material is obtained in relation to the last exposure to the causative antigen AU - Drent M AU - van VelzenBlad H AU - Diamant M AU - Wagenaar SS AU - Hoogsteden HC AU - van den Bosch JM LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 87 IP - DP - 1993 Jan 01 TI - Compensating occupational asthma [editorial] PG - 569-570 AU - Malo JL LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - Toluene diisocyanate induced asthma: outcome according to persistence or cessation of exposure [letter; comment] PG - 1055-1055 AU - Liss GM AU - Tarlo SM LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 65 IP - DP - 1993 Jan 01 TI - Bronchial carcinoma mortality in the German chromate-producing industry: the effects of process modification PG - 171-178 AB - This study updates a 1982 report on mortality at two German chromate-producing factories. The main objective of the study was to establish whether the change-over to a production process using lime-free conversion of chromite ore, thus eliminating the formation of calcium chromate, had resulted in a distinct reduction in bronchial carcinoma mortality among workers exposed for the first time after the change-over (completed in 1958 in Leverkusen and 1964 in Uerdingen). A total of 1417 workers with at least 1 year of exposure were enrolled in the study. The observation period ended on 31 December 1988. The expected number of deaths was calculated using population statistics for North Rhine-Westphalia. The risk was determined in the form of a standardised mortality ratio (SMR), i.e. the ratio of observed deaths to expected deaths. In the group of 739 workers exposed before the process change-over was completed, 432 died during the observation period, 66 of them from bronchial carcinoma. This significant excess produced an SMR of 2.27 (95% confidence interval: 1.78-2.85). Where the cause of death was unknown, cases were allocated to a cause of death on the basis of the percentage occurrence of various causes of death in the specific subcohort. The cohort of 678 workers first exposed after the process modification had been completed had a slightly increased SMR for lung cancer of 1.26 (95% confidence interval: 0.58-2.38) based on nine cases.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Korallus U AU - Ulm K AU - SteinmannSteinerHaldenstaett W LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 3 IP - DP - 1993 Jan 01 TI - Library fungi at the University of Sao Paulo and their relationship with respiratory allergy PG - 45-50 AB - In this study, we investigated the fungi most frequently found in the air and the books of 28 libraries at the University of Sao Paulo, Brazil. In a second phase, 314 librarians were questioned about the presence of asthmatic or rhinitic symptoms, and the relationship with the site of work. Forty-nine percent of them reported this type of symptoms and 80% related them to the place of work. In the third stage, librarians underwent intracutaneous tests against the 20 fungi most frequently isolated in libraries. Eighteen librarians presented positive tests, 12 of whom reported rhinitis and 6 of whom were asymptomatic. In 19.5% of symptomatic patients wheals > 15 mm were observed after 6 h, while 9% of the asymptomatic patients presented similar wheals. Fourteen librarians with positive tests underwent tests with each of the 20 fungi constituting the pool. The airborne fungi isolated in libraries are likely to be found anywhere in the city of Sao Paulo, but they are likely to be present in higher concentrations in libraries, subsequently producing respiratory allergies AU - Gambale W AU - Croce J AU - CostaManso E AU - Croce M AU - Sales M LA - PT - DEP - TA - Journal of Investigative Allergology & Clinica JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - Respiratory health effects of carbon black: a survey of European carbon black workers PG - 1082-1096 AB - A study population of 3086 employees was identified in 18 carbon black production plants in seven European countries. Respiratory health questionnaires, spirometry, and chest radiographs were used to estimate effects on health and personal monitoring procedures were employed to measure current exposure to inspirable and respirable dust along with sulphur and carbon monoxide. The low concentrations of gaseous contaminants made the generation of their current and cumulative exposure indices impossible. Low responses from some plants restricted the final analysis to 1742 employees in 15 plants (81% response rate) for respiratory symptoms and spirometry, and 1096 chest radiographs from 10 plants (74% response rate). In total, 1298 respirable and 1317 inspirable dust samples, as well as 1301 sulphur dioxide and 1322 carbon monoxide samples were collected. This study is the first to include a comprehensive and concurrent assessment of occupational exposure to carbon black dust and its associated gaseous contaminants. Cough, sputum, and the symptoms of chronic bronchitis were found to be associated with increasing indices of current exposure. Lung function tests also showed small decreases in relation to increasing dust exposure in both smokers and non-smokers. Nearly 25% of the chest radiographs showed small opacities of category 0/1 or greater. These were strongly associated with indices of cumulative dust exposure. The findings are consistent with a non-irritant effect of carbon black dust on the airways combined with dust retention in the lungs. Further cross sectional studies are planned to investigate whether long term exposure to carbon black dust causes damage to the lung parenchyma AU - Gardiner K AU - Trethowan NW AU - Harrington JM AU - Rossiter CE AU - Calvert IA LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - The 1891-1920 birth cohort of Quebec chrysotile miners and millers: mortality 1976-88 PG - 1073-1081 AB - A cohort of some 11,000 men born 1891-1920 and employed for at least one month in the chrysotile mines and mills of Quebec, was established in 1966 and has been followed ever since. Of the 5351 men surviving into 1976, only 16 could not be traced; 2508 were still alive in 1989, and 2827 had died; by the end of 1992 a further 698 were known to have died, giving an overall mortality of almost 80%. This paper presents the results of analysis of mortality for the period 1976 to 1988 inclusive, obtained by the subject-years method, with Quebec mortality for reference. In many respects the standardised mortality ratios (SMRs) 20 years or more after first employment were similar to those for the period 1951-75--namely, all causes 1.07 (1951-75, 1.09); heart disease 1.02 (1.04); cerebrovascular disease 1.06 (1.07); external causes 1.17 (1.17). The SMR for lung cancer, however, rose from 1.25 to 1.39 and deaths from mesothelioma increased from eight (10 before review) to 25; deaths from respiratory tuberculosis fell from 57 to five. Among men whose exposure by age 55 was at least 300 million particles per cubic foot x years (mpcf.y), the SMR (all causes) was elevated in the two main mining regions, Asbestos and Thetford Mines, and for the small factory in Asbestos; so were the SMRs for lung cancer, ischaemic heart disease, cerebrovascular disease, and respiratory disease other than pneumoconiosis. Except for lung cancer, however, there was little convincing evidence of gradients over four classes of exposure, divided at 30, 100, and 300 mpcf.y.(ABSTRACT TRUNCATED AT 250 WORDS) AU - McDonald JC AU - Liddell FD AU - Dufresne A AU - McDonald AD LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - Dust exposure and mortality in chrysotile mining, 1910-75. 1980 [classical article] PG - 1058-1072 AU - McDonald JC AU - Liddell FD AU - Gibbs GW AU - Eyssen GE AU - McDonald AD LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 42 IP - DP - 1993 Jan 01 TI - Airway inflammatory cell dynamics during late asthmatic reactions induced by toluene diisocyanate in guinea pigs. II. Histological study [Japanese] PG - 1692-1700 AB - We investigated airway inflammatory cell dynamics during late asthmatic reactions (LAR) induced by toluene diisocyanate (TDI) in a guinea pig model developed by K. Tanaka et al. (Bull. Chest Dis. Res. Inst. Kyoto Univ. 1983: 16: 1-9). For sensitization, 10% TDI solution was applied once daily to the bilateral nasal mucosa of 41 guinea pigs for 7 consecutive days. One week after the sensitization, the animals were challenged with 5% TDI solution once a week. In addition, metyrapone (50 mg/kg) was injected intraperitoneally 24 h, and 30 min before the challenge, respectively. Airway tissue specimens (large bronchi and bronchioles) were obtained from the 41 guinea pigs at each time point (30 min, 3, 6, 24 and 168 h) after the challenge. Airway inflammatory cell dynamics were evaluated with regard to the onset and persistence of LAR. As a control, 7 guinea pigs were only exposed to ethyl acetate (a solvent for TDI) and sacrificed 6 h afterward. A histological examination of the airways revealed remarkable infiltration of eosinophils but failed to demonstrate infiltration of other inflammatory cells, including neutrophils, in the mucosal tissues of the bronchi and bronchioles during LAR at any time point (3, 6 and 24 h) after the challenge. Therefore, we conclude that eosinophils, but not neutrophils, play an important role in LAR in our model, a contrast to previous reports on human TDI-induced LAR in which neutrophils were also involved AU - Yamada K AU - Niimi A AU - Amitani R AU - Kawai M AU - Tanaka K AU - Kuze F LA - PT - DEP - TA - Arerugi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 38 Suppl 2 IP - DP - 1993 Jan 01 TI - Occupational asthma due to isocyanates: current research orientation in occupational hygiene [French] PG - S128-S130 AB - The replacement of the HDI monomer by less volatile prepolymers is not accompanied by a decrease of the incidence of occupational asthma in Switzerland. Field measurements show that the prepolymer concentration levels may be high although the monomer is hardly detectable or complies with the norm. Our researches are focused on the improvement of generation and measurement techniques (international quality control), on the characterization of the prepolymers to study their transformation in biological media. Field surveys will be conducted to establish the prepolymer concentration profiles. We recommend for the introduction in Switzerland of threshold limit values for HDI-biuret and isocyanurate AU - Huynh CK AU - VuDuc T AU - Savolainen H LA - PT - DEP - TA - Soz Praventivmed JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 38 Suppl 2 IP - DP - 1993 Jan 01 TI - Occupational exposure to isocyanates and individual susceptibility [French] PG - S125-S127 AB - Patients with organic diisocyanate-induced pulmonary disease may be specially susceptible to the toxic effects of agent. Among 11 cases diagnosed in one year, the majority (10/11) were slow acetylators. The same patients were different from the control population in terms of alpha-1-antitrypsin phenotypes. Heterozygous combinations were more frequent than among controls. It seems that the combination of low N-acetylation capacity and a heterozygous alpha-1-antitrypsin predisposes to the disease AU - Berode M AU - Savolainen H LA - PT - DEP - TA - Soz Praventivmed JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 35 IP - DP - 1993 Jan 01 TI - Occupational dust exposure and prevalence of respiratory symptoms among conduit repair workers [Japanese] PG - 540-549 AB - The amount of water supply in Japan was 16 billion ton as of 1989. Water from rivers and other sources is purified, sterilized and then supplied to the residents through conduits. When conduits are accidentally damaged, they must be repaired by the workers of the Waterworks Bureau of the local government. In this task, the workers are exposed to airborne dust which develops while digging and filling the ground and cutting the conduit and the concrete covering the road. The purpose of the present study was to estimate the airborne dust exposure level among the workers and to investigate its effect on their respiratory organs. First, we measured the total dust exposure concentration of 20 conduit repair workers and the total dust concentration in 10 office rooms. Second, we conducted a self-administered questionnaire survey to estimate the prevalence of respiratory symptoms among the employees of 119 Waterworks Bureaus. The subjects of the analysis were 322 conduit repair workers and as their controls 345 clerical/engineering workers. The results can be summarized as follows: 1) The average daily total dust exposure while repairing conduits ranged from 0.27 to 5.05 mg/m3 (mean = 0.91 mg/m3), while that while exchanging water meters from 0.23 to 0.52 mg/m3 (mean 0.41 mg/m3). These values were 4.6 and 2.1 fold higher than the total dust concentration in office rooms (mean = 0.20 mg/m3). 2) With the use of fluorescent X-ray method, iron and aluminum were detected in all samples collected while repairing conduits and the intensity of X-ray increased with increase in weight of collected dust. Iron exposure concentration ranged from 0.006 to 0.095 mg/m3, which is much higher than the levels in the air in urban areas. Iron and aluminum could not be detected by fluorescent X-ray method in most of the samples collected in office rooms. These findings indicate that the main element in the dust collected while repairing conduits is soil, while that in office rooms is tobacco smoke. 3) Among the smokers, the prevalence of cough and phlegm was significantly higher in conduit repair workers than in clerical/engineering workers. A similar tendency was observed among ex-smokers and non-smokers, but the difference was not significant AU - Kumagai S AU - Kurumatani N AU - Nakachi S AU - Nakagiri S AU - Hara K LA - PT - DEP - TA - Sangyo Igaku JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 31 IP - DP - 1993 Jan 01 TI - A case of hypersensitivity pneumonitis induced by toluene diisocyanate presenting with transient bronchoconstriction [Japanese] PG - 1297-1302 AB - A 50-year-old male spray paint worker was admitted with non-productive cough and dyspnea on exertion. Chest X-ray and chest CT showed diffuse interstitial shadows in the bilateral lung fields. After admission, the symptoms and chest X-ray findings improved over several days, and he was followed as an outpatient. He then developed nocturnal dyspnea with wheezing and dry cough every day. About two months later, chest X-ray showed more severe diffuse interstitial shadows which did not disappear after admission. Bronchoalveolar lavage and transbronchial lung biopsy revealed allergic exudative interstitial pneumonia, and he was treated with steroid therapy. Paint contains toluene diisocyanate, and challenge test to toluene diisocyanate was positive. In the early course, this case presented with bronchoconstriction; bronchial reversibility and bronchial hyperresponsiveness to methacholine were positive. Bronchoconstriction may cause worsening of respiratory symptoms in patients with hypersensitivity pneumonitis induced by isocyanates AU - Bando T AU - Noda Y AU - Hirose J AU - Ohta G AU - Shibata K AU - Fujimura M AU - Matsuda T LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 24 IP - DP - 1993 Jan 01 TI - Cross-sectional epidemiological study of respiratory disease in turkey farmers PG - 713-722 AB - This study was a cross-sectional epidemiological investigation of respiratory disease in farmers involved in the turkey growing industry. Pulmonary function tests and health history questionnaires were administered to a total of 95 turkey farmers throughout Minnesota. Respiratory symptoms were greatest during the winter months when exposure to environmental agents was highest. Prevalence of symptoms was higher for smokers, personnel who worked in hen barns, and for persons who had worked in the turkey growing industry for more than 10 years. Pulmonary function was found to decrease during the work day. Also, pulmonary function was lowest for personnel working in hen bars, and for persons who had been employed in the industry for more than 10 years. These data support the association between respiratory disease and exposure to the environment in confinement farm buildings AU - Reynolds SJ AU - Parker D AU - Vesley D AU - Smith D AU - Woellner R LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 49 IP - DP - 1993 Jan 01 TI - Occupational asthma: an experimental asthma. Apropos of isocyanate-induced asthma [French] PG - 115-119 AB - Isocyanate-induced occupational asthma is a model of experimental asthma related to the environment. Many of its features are identical with those of allergic asthma by sensitization to air-borne allergens. Exposure to isocyanate before the first symptoms of asthma varies from a few weeks to several years. The prevalence of isocyanate-induced asthma has been estimated at 5 to 25%. Atopy is found in less than 30% of the cases. A significant increase of HRBNS can be demonstrated in most patients, but it may be absent. It may also fluctuate with the working periods or after a bronchial provocation test with isocyanate. Elimination of this compound reduces the HRBNS level in only one quarter of the cases. Delayed or biphasic reactions are frequent: 30 to 60% depending of the authors. An early diagnosis followed by total elimination may result in complete cure, but more than 50% of the patients remain symptomatic and with HRBNS. An IgE-dependent mechanism can be demonstrated in about 20% of the cases. The course of isocyanate-induced asthma is interesting in that the same phenomena are probably observed in chronic asthma resulting from repeated exposures to environmental allergens AU - Pauli G AU - Kopferschmitt MC AU - Dietemann A AU - Blaumeiser M AU - Bessot JC LA - PT - DEP - TA - Rev Pneumol Clin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 92 IP - DP - 1993 Jan 01 TI - Analysis of rat urine proteins and allergens by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting PG - 298-305 AB - BACKGROUND: In rats, urine has been identified as a major source of the allergens that cause laboratory animal allergy, an important occupational health problem. METHODS AND RESULTS: Urinary proteins and allergens of Wistar rats were studied by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting. Proteins excreted by male and female rats during puberty were similar and of low molecular weight. In adulthood, moderate increases in diffuse staining of 26 and 21 kd occurred in female urine. In males the 17 kd protein increased dramatically and the 23 and 21 kd proteins moderately. The urine excretion of high-molecular-weight proteins (75 to 63 kd) increased with age in males (females not studied). Immunoblot studies with six sera showed allergens in urine of male and female rats of all ages, three of which were present in all urine (75, 68, and 21 kd). Three allergens (17, 16, and 15 kd) in female urine may be allergenically similar to the 17 kd allergen in adult male urine. Adult male urine allergens were studied further with sera from 83 rat-hypersensitive subjects. Major allergens were identified at 23, 21, and 17 kd, and all sera had IgE to one or more of these proteins. Twenty-seven percent had IgE to 68 and 63 kd allergens. Minor allergens were identified at 75, 51, and 44 kd. CONCLUSIONS: Rat urine is an important source of the major allergens associated with rat hypersensitivity. Age and sex markedly influence the protein and allergenic constituents of rat urine AU - Gordon S AU - Tee RD AU - Taylor AJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - Investigation of possible adverse allergic reactions to mycoprotein ('Quorn') PG - 257-260 AB - Mycoprotein ('Quorn') is a food produced for human consumption from Fusarium graminearum. Crossreactivity studies showed that mycoprotein shared multiple common allergenic determinants with Aspergillus fumigatus and Cladosporium herbarum and some with Alternaria alternata. There is, therefore, a potential for mould allergic patients to react adversely to inhaled or ingested mycoprotein. Mycoprotein RAST screening of mycoprotein production workers was made during a 2 year period. Two of the production workers had specific RAST binding > or = 2% but none reported symptoms. Two of 10 patients referred to hospital following vomiting and diarrhoea after ingestion of mycoprotein had a mycoprotein skin-prick test weal > or = 2 mm but none had a significantly raised RAST. These largely negative results are important and reassuring because consumption of the product in the U.K. is now widespread and increasing AU - Tee RD AU - Gordon DJ AU - Welch JA AU - Newman Taylor AJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 148 IP - DP - 1993 Jan 01 TI - Reversible pulmonary responses to formaldehyde. A study of clinical anatomy students PG - Pt 1):1509-15 AB - Epidemiologic studies of irritants are difficult to perform using standard epidemiologic methods for several reasons, including the reversible nature of the health outcomes, the selection of sensitive individuals from the study population, and the wide heterogeneity in normal responses to irritants. This study examined the feasibility of using repeated measurements of peak expiratory flow (PEF) and reported symptoms to study respiratory irritants and their effects in students exposed to formaldehyde during a laboratory course. We studied 24 physical therapy students dissecting cadavers for 3 h per week over a 10-wk period. Formaldehyde exposures in the breathing zone ranged from 0.49 to 0.93 ppm (geometric mean +/- geometric SD, 0.73 +/-1.22). Irritant symptoms increased strongly over the course of the average laboratory period, but this effect was stronger at the beginning than at the end of the semester. PEF measured before each laboratory session declined over the semester by an average of about 10 L/min (2% of baseline), a trend that was statistically significant in random-effects regression models. After 14 wk away from the laboratory, the group's mean baseline PEF had returned to its preexposure level. Mean PEF also declined over each laboratory period, although this effect was attenuated over the course of the semester. Other important predictors of cross-laboratory PEF decrements were asthma and reporting throat irritation during the laboratory. It appears that mild irritant effects can be detected in naive subjects using a repeated monitoring design and relatively simple instrumentation AU - Kriebel D AU - Sama SR AU - Cocanour B LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 148 IP - DP - 1993 Jan 01 TI - Long-term variability of bronchial responsiveness to histamine in a random population sample of adults PG - Pt 1):944-9 AB - Long-term variability of bronchial responsiveness has been studied in a random population sample of adults. During a follow-up period of 18 yr, 2,216 subjects contributed 5,012 observations to the analyses. Each subject could have as many as seven observations. Bronchial responsiveness was assessed with a histamine challenge test. The threshold value was defined as the concentration of histamine that caused a decrease in FEV1 of 10% of more (PC10). After a 3-yr interval, a change of the threshold value with two or more doubling concentrations occurred in 21% of the subjects. This proportion increased to 43% if the time between two measurements increased to 18 yr. Of all subjects with multiple observations, 41% were always nonresponders (PC10 > or = 32 mg/ml), 11% were always responders (PC10 < or = 16 mg/ml), and 48% changed responder status. Of the subjects with greater than three observations, 65% changed responder status. Regression analyses, stratified by symptom status, sex, and smoking habit, were used to estimate intraclass correlation coefficients (ICC) as a measure of variability of responsiveness. On average, ICC values were low (0.40), also indicating considerable variability. With adjustment for FEV1, age, area of residence, and eosinophil count, the ICC values decreased slightly. This indicated that with adjustment, the total variability decreased more than the within-subject variability. ICC values did not differ significantly between asymptomatic and symptomatic subjects. Analyses of responsiveness as a binary variable revealed similar results AU - Rijcken B AU - Schouten JP AU - Weiss ST AU - Rosner B AU - de Vries K AU - Van der Lende R LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 15 IP - DP - 1993 Jan 01 TI - Development of an accurate portable recording peak-flow meter for the diagnosis of asthma PG - 188-192 AB - This article describes the systematic design of an electronic recording peak expiratory flow (PEF) meter to provide accurate data for the diagnosis of occupational asthma. Traditional diagnosis of asthma relies on accurate data of PEF tests performed by the patients in their own homes and places of work. Unfortunately there are high error rates in data produced and recorded by the patient, most of these are transcription errors and some patients falsify their records. The PEF measurement itself is not effort independent, the data produced depending on the way in which the patient performs the test. Patients are taught how to perform the test giving maximal effort to the expiration being measured. If the measurement is performed incorrectly then errors will occur. Accurate data can be produced if an electronically recording PEF instrument is developed, thus freeing the patient from the task of recording the test data. It should also be capable of determining whether the PEF measurement has been correctly performed. A requirement specification for a recording PEF meter was produced. A commercially available electronic PEF meter was modified to provide the functions required for accurate serial recording of the measurements produced by the patients. This is now being used in three hospitals in the West Midlands for investigations into the diagnosis of occupational asthma. In investigating current methods of measuring PEF and other pulmonary quantities a greater understanding was obtained of the limitations of current methods of measurement, and quantities being measured.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Hitchings DJ AU - Dickinson SA AU - Miller MR AU - Fairfax AJ LA - PT - DEP - TA - J Biomed Eng JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 8 IP - DP - 1993 Jan 01 TI - Reproducibility of peak expiratory flow measurements. [Review] PG - 295-302 AB - The ease of PEF measurement and the availability of inexpensive, portable instruments have led to its increasing use. However, relatively little literature exists addressing the testing procedure, optimal frequency, instrument precision, and virtually no epidemiologic literature exists describing the variability of repeated PEF tests within a single test session (reproducibility). A summary of data from one of the authors' own worker population studies is presented which addresses precision of PEF measurement. AU - Dahlqvist M AU - Eisen EA AU - Wegman DH AU - Kriebel D LA - PT - DEP - TA - Occupational Medicine: state of the art reviews JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 49 IP - DP - 1993 Jan 01 TI - Transient syndrome of acute irritation of the bronchi induced by single and massive inhalation of phthalic anhydride [Review] [French] PG - 247-251 AB - As an evaluation, we report the case of a 38-year-old female tanker driver suffering from "Reactive Airway Dysfunction Syndrome" (RADS). Forty-two months before, she accidentally inhaled a high concentration of gaseous phthalic anhydride. She had never transported this kind of substance before. After her accident, she was forbidden to transport any volatile substances that might harm her airways. She immediately felt a burning of the upper airways and started coughing. Three months later, she complained of wheezing, dyspnea at rest as well as chest tightness. She was diagnosed a bronchial asthmatic by her G.P. and was prescribed low doses of Salbutamol and Dipropionate Beclomethasone. At the time of the evaluation, she was asymptomatic except for coughing. All functional tests were normal except for a PD20 of 0.097 mg/ml for histamine, which clearly reveals bronchial hyperreactivity. We diagnosed "Reactive Airways Dysfunction Syndrome" and suggested she increased the intake of the medicine prescribed. When she came back a year later, she was totally asymptomatic and no longer suffered from bronchial hyperreactivity. This favorable evolution may be observed for these kinds of syndromes, usually helped by medication. Nonetheless, she suffered prejudice as she may no longer transport this kind of volatile and irritating substance. [References: 39] AU - Frans A AU - Pahulycz C LA - PT - DEP - TA - Rev Pneumol Clin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 1 IP - DP - 1993 Jan 01 TI - Clinical-epidemiological investigation of health effects caused by Stachybotrys atra building contamination PG - 225-230 AU - Johanning E AU - Morey PR AU - Jarvis BB LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - IP - DP - 1993 Jan 01 TI - Why do females report sick building symptoms more often than males? PG - 399-404 AU - Stenberg B AU - Wall S LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 1 IP - DP - 1993 Jan 01 TI - Effects of restrictive smoking polocies on indoor air quality and sick building syndrome: a study of 27 air-conditioned offices PG - 517-522 AU - Hedge A AU - Erickson WA AU - Rubin G LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 1 IP - DP - 1993 Jan 01 TI - Psychological correlates of sick building syndrome PG - 345-350 AU - Hedge A AU - Erickson WA AU - Rubin G LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 5 IP - DP - 1993 Jan 01 TI - Effects of a furniture-integrated breathing-zone filtration system on indoor air quality, sick building syndrome, productivity and absenteeism PG - 383-388 AU - Hedge A AU - Mitchell GE AU - McCarthy JF AU - Ludwig J LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 1 IP - DP - 1993 Jan 01 TI - Estimated reduction in exposure to environmental tobacco smoke through removing smoking in the workplace PG - 639-643 AU - Raynal A AU - Burge PS AU - Robertson AS AU - Jarvis M AU - Archibald M AU - Hawkin D LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 1 IP - DP - 1993 Jan 01 TI - The development of a questionnaire suitable for the surveillance of office buildings to assess the building symptom index, a measure of the sick building syndrome PG - 731-736 AU - Burge PS AU - Robertson AS AU - Hedge A LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 1 IP - DP - 1993 Jan 01 TI - Surveillance of office buildings using the workforce to measure the building symptom index, a measure of the sick building syndrome PG - 569-574 AU - Burge PS AU - Robertson AS LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 147 IP - DP - 1993 Jan 01 TI - Factors associated with bronchial responsiveness to histamine in a population sample of adults PG - Pt 1):1447-53 AB - The association of age, gender, number of eosinophils, area of residence, cigarette smoking, respiratory symptom prevalence, and FEV1 with the level of bronchial responsiveness was studied in a random sample of 2,216 subjects aged 15 to 72 yr. Subjects participated in the Dutch longitudinal study on chronic obstructive pulmonary disease. In 18 yr of follow-up, 5,012 observations were collected. Interviewers used a standardized questionnaire to assess the presence of respiratory symptoms. Bronchial responsiveness was measured by a histamine challenge test. Because multiple measurements within a subject are correlated, multivariate regression methods for correlated outcome were used. A greater number of eosinophils, skin test positivity, and living in a rural area (Vlagtwedde) were associated with increased responsiveness, independently of the level of FEV1 and the presence of respiratory symptoms. Older age was associated with increased responsiveness, and this was even more so in subjects with symptoms. Cigarette smokers were more responsive than nonsmokers, but this association was not significant if the level of FEV1 was taken into account. Hyperresponsiveness was more likely to be present if the amount of cigarettes smoked per day was greater. The level of responsiveness did not differ significantly between males and females. For the same degree of obstruction, however, expressed as the FEV1/VC ratio, males tended to be less responsive than females. The analyses were repeated using the dose-response slope as a continuous measure of responsiveness and by applying a method to adjust for censoring the responsiveness data. These analyses yielded identical results AU - Rijcken B AU - Schouten JP AU - Mensinga TT AU - Weiss ST AU - de Vries K AU - Van der Lende R LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 6 IP - DP - 1993 Jan 01 TI - Influence of in vivo prednisolone on increased in vitro O2- generation by neutrophils in emphysema PG - 90-95 AB - Evidence is accumulating that neutrophil-derived oxidants substantially contribute to the development of emphysema, especially in smoking individuals. It is not clear, however, why not all smokers develop emphysema. We tested the hypothesis that an abnormality in the oxidative metabolism of polymorphonuclear leucocytes (PMNs) might contribute to the development of emphysema. We investigated in vitro O2- production by peripheral PMNs in patients with stable emphysema and in healthy controls. In addition, we investigated whether in vivo prednisolone may modulate in vitro O2- production by PMNs in patients with emphysema during a stable phase of the disease. Spontaneous O2-production by PMNs was not significantly different in patients and controls. After stimulation with submaximal concentrations of calcium ionophore A23187 and phorbol myristate acetate, however, PMNs from patients with stable emphysema produced more O2- than those from healthy controls, especially in smoking subjects. Moreover, in vitro O2- generation by PMNs significantly decreased after in vivo prednisolone treatment in patients with emphysema. We suggest that our findings reflect an abnormality of PMNs, acting as one of the factors that contribute to the development of emphysema. This abnormality may, at least partially, be dampened by in vivo prednisolone treatment. These findings may provide new insights into the pathogenesis and treatment of pulmonary emphysema. Further studies on pulmonary PMNs are necessary to extend our findings AU - Renkema TE AU - Postma DS AU - Noordhoek JA AU - Sluiter HJ AU - Kauffman HF LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 61 IP - DP - 1993 Jan 01 TI - The upsurge of tuberculosis and its implication for anesthesia practice PG - 113-115 AU - Van Wormer LM LA - PT - DEP - TA - AANA Journal JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 269 IP - DP - 1993 Jan 01 TI - From the Centers for Disease Control and Prevention. Probable transmission of multidrug-resistant tuberculosis in correctional facility--California PG - 978-979 AU - Anonymous LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 64 IP - DP - 1993 Jan 01 TI - A retrospective cohort study on the incidence of hand dermatitis in nurses PG - 541-544 AB - Data on the incidence and induction time of hand dermatitis are not available from the literature. To assist the planning of a prospective study on risk factors for hand dermatitis, a retrospective cohort study was performed in nurses and office employees to obtain a rough estimate of the incidence and induction time of hand dermatitis in these occupational groups. Data were collected by means of a self-administered questionnaire with validated questions on symptoms of hand dermatitis. The cohort consisted of 371 nurses and 111 office employees who were newly employed by a University Hospital between 1 January 1987 and 31 December 1988. Follow-up ended on 30 September 1989. Subjects who reported that symptoms had already occurred before entering the study were excluded for analysis on the incidence, leaving 298 nurses and 101 office employees for further analysis. Due to limitations of the retrospective study design, only half of the cases were able to report the exact month of occurrence of symptoms. Therefore only a rough estimate could be made of the incidence and induction period, assuming that the distribution of person-months of observation in cases with a known incidence date was equal to that of cases with unknown incidence dates. Thus, it was estimated that the overall incidence was 6.5 cases/1000 person-months in nurses and 1 case/1000 person-months in office employees. In nurses, 72% of the cases occurred within 3 months of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Smit HA AU - Coenraads PJ LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 22 IP - DP - 1993 Jan 01 TI - Prevalence of hand dermatitis in different occupations PG - 288-293 AB - The prevalence of hand dermatitis in different occupational groups was estimated using a standardized questionnaire in a series of surveys among workers of a chemical company, a municipal electricity company, municipal public works, nurses and surgical assistants. A survey in a sample of the general population was performed to obtain a reference estimate of the prevalence. The prevalence of hand dermatitis in the general population was 5.2% in men and 10.6% in women. The prevalence of hand dermatitis among the occupational groups ranged from 2.9% in office workers to approximately 30% in nurses. The age-adjusted prevalence ratio (PR) of hand dermatitis in office workers was not significantly elevated compared with the general population. In nurses, the age-adjusted PR was 9.3 among men (95% confidence interval [CI]: 3.6-23.9) and 2.2 among women (95% CI: 1.5-3.5). The PR in surgical assistants was not significantly elevated (PR = 1.4, 95% CI: 0.7-2.6). This suggests that exposure in nurses (frequent washing of the hands), is more harmful to the skin than the less frequent but more intensive exposure in surgical assistants. The age-adjusted PR were also significantly elevated in male manual workers of the chemical company, the electricity company and public works and varied from 2.4 to 2.8. Occasional or regular occupational exposure to a variety of irritants in combination with mechanical stress (as occurs frequently in manual work) may be responsible for this observation.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Smit HA AU - Burdorf A AU - Coenraads PJ LA - PT - DEP - TA - Int J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Quality of self recorded peak expiratory flow PG - 1062-1062 AU - Gannon PFG AU - Dickinson S AU - Hitchings D AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 104 IP - DP - 1993 Jan 01 TI - Improving inhaler adherence in a clinical trial through the use of the nebulizer chronolog PG - 501-507 AU - Nides MA AU - Tashkin DP AU - Simmons MS AU - Wise RA AU - Li VC AU - Rand CS LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 16 IP - DP - 1993 Jan 01 TI - Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society PG - 5-40 AU - Quanjer PH AU - Tammeling GJ AU - Cotes JE AU - Pedersen OF AU - Peslin R AU - Yernault JC LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 6 IP - DP - 1993 Jan 01 TI - Expired air temperature at the mouth during a maximal forced expiratory manoeuvre PG - 1556-1562 AB - We have studied the temperature of expired air during a maximal forced expiratory manoeuvre, because this has not previously been fully investigated and it will influence how flow and volume recording devices should be calibrated and used. Temperature was recorded with a fine thermocouple, the response time of which was determined at various gas velocities and for which a correction was made. Recordings during maximal forced expiratory manoeuvres were made on 12 normal subjects and 12 subjects with chronic airflow limitation. The thermocouple was placed in the mouthpiece, so that it was at the level of the lips during a blow. In the normal subjects, the effect of differing inhalation protocols was also determined. In the normal subjects, the mean temperature was 33.6 degrees C at peak expiratory flow (PEF), and 34.4 degrees C at 75% forced vital capacity (FVC), but fell to 33.4 degrees C at FVC. In the subjects with chronic airflow limitation, the temperature was constant at 35.0 degrees C from PEF up to 50% FVC, being significantly higher than in the normals, and fell to 33.5 degrees C at FVC. Expired air temperature up to 50% FVC was significantly negatively correlated with absolute PEF, forced expiratory volume in one second (FEV1) and FVC. In the normals, a slow inhalation through the nose raised the expired temperature by almost 1 degree C throughout the blow, whereas inhaling air at 6 degrees C did not affect expired air temperature. The expired air temperature can vary by up to 3 degrees C between individual subjects, and it is influenced by the route of inhalation and the inspired volume.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Madan I AU - Bright P AU - Miller MR LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Respiratory symptoms questionnaire for asthma epidemiology: validity and reproducibility PG - 214-219 AB - BACKGROUND: There is a need for a new respiratory symptoms questionnaire for use in epidemiological research in asthma. METHOD: A questionnaire was designed following a pilot study in 78 subjects. It contains nine questions on symptoms such as wheeze and difficulty with breathing in defined circumstances such as exercise and sleep. It was completed by 211 adults and validated by comparison with a self reported history of asthma and with bronchial hyperresponsiveness to histamine. Its short term reproducibility was measured by three repeat administrations over two weeks. RESULTS: Subjects with asthma (n = 33), particularly those having had an asthma attack in the last year (n = 23), were more likely to report any symptom and to report a greater number of symptoms than those without asthma. The same relationship was found for bronchial hyperresponsiveness and symptoms. Either two or more, or three or more, symptoms appeared to be good indices of self reported asthma and bronchial hyperresponsiveness, or both, with a high sensitivity (65-91%) and specificity (85-96%). Reproducibility was good, with few subjects changing the number of symptoms reported by more than one symptom and none by more than four symptoms. The results compared favourably with those from questions on phlegm production from the MRC questionnaire and were better than those reported for the MRC wheeze questions. CONCLUSIONS: The questionnaire will be useful for epidemiological research on asthma and could form part of a new standardised questionnaire with wide applications AU - Venables KM AU - Farrer N AU - Sharp L AU - Graneek BJ AU - Newman Taylor AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Variability of bronchodilator response and effects of inhaled corticosteroid treatment in obstructive airways disease. Dutch CNSLD Study Group PG - 722-729 AB - BACKGROUND--In the day to day care of obstructive airways diseases (asthma and chronic obstructive pulmonary disease) important decisions such as disease classification and choice of therapy are based on assessment of the bronchodilator response. However, surprisingly little is known of the long term course of the bronchodilator response in patients with obstructive airways disease. METHODS--Data from a multicentre trial were used in which 274 patients aged 18-60 years with airways obstruction were selected with PC20 < 8 mg/ml and FEV1 < 95% CI of predicted. FEV1 was measured before and 20 minutes after 1000 micrograms terbutaline and 40 minutes after an additional 80 micrograms ipratropium bromide. Data were analysed from 185 patients who were followed up for 21 months (five measurements). Four different expressions of bronchodilator response (BDR) were examined for change under long term therapy, long term variability, and prognostic value in predicting response to inhaled corticosteroids. RESULTS--There was a significant reduction in BDR of 117 ml after three months of treatment with a beta 2 agonist plus a corticosteroid (BA + CS), but not after bronchodilators only. Significant reductions with BA + CS were also found in BDR as a percentage of initial FEV1, and in BDR as a percentage of predicted FEV1. Bronchodilator tests were quite variable (SD 186 ml or 11% of initial value) and less than half of the patients could consistently be classified as "irreversible" with recommended cutoff levels. The bronchodilator response at the start of the study proved to be a poor predictor of improvement in FEV1 under BA + CS treatment (correct prediction 60%). CONCLUSIONS--Bronchodilator responses decrease substantially with inhaled corticosteroid therapy, and within subject variability is considerable both in asthma and chronic obstructive pulmonary disease. Dichotomous decisions on whether patients are "irreversible" according to any single bronchodilator measurement should therefore be made with great caution. The bronchodilator response cannot be used accurately as a predictor of response to inhaled corticosteroids in obstructive airways disease AU - Kerstjens HA AU - Brand PL AU - Quanjer PH AU - van der BruggenBogaarts BA AU - Koeter GH AU - Postma DS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 75 IP - DP - 1993 Jan 01 TI - Growth of airways and air spaces in teenagers is related to sex but not to symptoms PG - 2045-2053 AB - To determine growth patterns of the lung and airways in adolescents, we analyzed maximal expiratory flow-volume curves, closing capacity, and residual volume. They were obtained every 6 mo for up to 7 yr in 430 boys and 125 girls (11-19 yr), of whom 143 boys and 36 girls were classified as symptomatic; symptoms were most often minor and limited to childhood. Development of flows vs. volumes was used to investigate growth of the airways relative to lung size. A model of isotropic growth of the airways and air spaces (J. Appl. Physiol. 65: 822-828, 1988) was modified for increasing elastic recoil pressure with growth. Growth of airways relative to volume occurred faster in teenage boys than in teenage girls and was compatible with isotropic growth in 92% of asymptomatic boys and in 44% of asymptomatic girls: dysanaptic growth in teenage girls seems to be a normal phenomenon and not a unique characteristic of symptomatic subjects. Subjects with respiratory symptoms in childhood and/or adolescence have lower flows for a given lung size and airway closure at a greater lung volume when they enter adulthood. However, no difference in patterns of lung growth was observed in association with the presence of respiratory symptoms AU - Merkus PJ AU - Borsboom GJ AU - van Pelt W AU - Schrader PC AU - Van Houwelingen HC AU - Kerrebijn KF AU - Quanjer PH LA - PT - DEP - TA - Journal of Applied Physiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 148 IP - DP - 1993 Jan 01 TI - Large lungs after childhood asthma. A case-control study PG - Pt 1):1484-9 AB - Several studies have suggested that the TLC after childhood asthma is increased compared wtih that in healthy subjects. The aim of this study was to assess whether TLC is increased after childhood asthma and whether this is associated with an increased growth of the lung during adolescence. During a mean period of 29 months we studied 53 patients and 106 healthy control subjects who were matched for sex, age, and standing height. The patients had had asthma for a mean period of 10 yr. We found that in asthmatics TLC was increased in both sexes by about 7% predicted compared with that in the matched control subjects. The growth of TLC in ml/yr during adolescence was less in patients; this can be accounted for by a delay in pubertal development. When corrected for the delay in growth of stature, growth of TLC in ml/cm in asthmatics was similar to that found in control subjects. These findings support the hypothesis of a developmental change of enhanced lung growth during childhood asthma; they do not support a mechanism with progressive loss of elastic recoil of the lung AU - Merkus PJ AU - van EssenZandvliet EE AU - Kouwenberg JM AU - Duiverman EJ AU - Van Houwelingen HC AU - Kerrebijn KF AU - Quanjer PH LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 6 IP - DP - 1993 Jan 01 TI - Assessment of bronchodilator response in children with asthma. Dutch CNSLD Study Group PG - 645-651 AB - The bronchodilator response (BDR) in forced expiratory volume in one second (FEV1) is routinely assessed to estimate the reversibility of airways obstruction. However, there is no consensus on how the BDR should be expressed, and recommendations applying to children are lacking. Similarly, the relationship between BDR and nonspecific bronchial hyperresponsiveness to histamine (BHR) has not been elucidated. These questions were addressed in 116 children, 7-16 yrs of age, with stable asthma after withdrawal of all pulmonary maintenance medication. Inclusion criteria were an initial FEV1 between 55-90% predicted, and/or FEV1/forced vital capacity (FVC) between 50-75%, as well as a fall in FEV1 of 20% or more when challenged with up to 150 micrograms histamine. The change in FEV1 (delta FEV1) 20 min after inhalation of 800 micrograms salbutamol was expressed in four ways: as an absolute difference (delta FEV1(l)), as a percentage of predicted FEV1 (delta FEV1%pred) or initial FEV1 (delta FEV1%init), and as a percentage of the deficit in FEV1 (delta FEV1%(pred-init)). delta FEV1%init and delta FEV1%pred were not related to age and stature of the children; delta FEV1%(pred-init) was related to stature, whilst delta FEV1(l) was related to both age and stature. All indices correlated with initial FEV1. However, this is an artefact introduced by relating change to initial value, rather than to the mean of initial and final value. In fact, BDR, expressed as delta FEV1%pred, was only slightly greater in children with the lowest initial airway calibre (p = 0.08), unlike delta FEV1%init. BDR was weakly related to BHR.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Waalkens HJ AU - Merkus PJ AU - van EssenZandvliet EE AU - Brand PL AU - Gerritsen J AU - Duiverman EJ AU - Kerrebijn KF AU - Knol KK AU - Quanjer PH LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 91 IP - DP - 1993 Jan 01 TI - Long-term effect of inhaled corticosteroids on growth rate in adolescents with asthma PG - 1121-1126 AB - BACKGROUND. Growth in stature in asthmatic adolescents may be delayed compared to normals as a result of treatment with inhaled corticosteroids (CS) or because of a delay in puberty. However, growth rates in asthmatic children have never been studied when treatment with CS was randomized and when growth was compared with that of matched healthy control subjects. OBJECTIVE. To assess the long-term effect of CS treatment on growth rates in asthmatic adolescents. METHODS. Participants were 40 asthmatic teenagers (mean age 12.8 years) who received randomized treatment with 0.2 mg of albuterol (salbutamol) with either placebo three times a day (BA + PL) or 0.2 mg of budesonide three times a day (BA + CS) for a median period of 22 months in a double-blind controlled study. Growth rates were compared with those of 80 control subjects who were matched for sex, age, height, and duration of follow-up. RESULTS. Growth rates in male patients, but not in female patients, were significantly less than in control subjects (P < .05), a finding consistent with a delay of puberty due to asthma. The mean difference (95% confidence interval) in growth rates between patients treated with BA+PL and their controls was -0.70 (-1.62, 0.22) cm/y; that between patients treated with BA + CS and their controls was -0.44 (-1.25, 0.37) cm/y. The observed mean (SEM) case-control difference between treatment groups was +0.27 (0.58) cm/y in favor of BA + CS. CONCLUSION. Growth retardation observed in adolescents with asthma may be due to a delay in puberty but not to the prescription of 0.6 mg of budesonide daily AU - Merkus PJ AU - van EssenZandvliet EE AU - Duiverman EJ AU - Van Houwelingen HC AU - Kerrebijn KF AU - Quanjer PH LA - PT - DEP - TA - Pediatrics JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 16 IP - DP - 1993 Jan 01 TI - Standardization of the measurement of transfer factor (diffusing capacity). Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society [see comments]. [Review] PG - 41-52 AU - Cotes JE AU - Chinn DJ AU - Quanjer PH AU - Roca J AU - Yernault JC LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 147 IP - DP - 1993 Jan 01 TI - Pubertal growth curves of ventilatory function: relationship with childhood respiratory symptoms PG - 372-378 AB - This study describes longitudinal growth patterns of ventilatory function in relation to the growth of standing height and weight of boys and girls aged 12.5 to 18 yr with or without a positive history of prepubertal respiratory symptoms. Ventilatory function was characterized by FVC, FEV1, peak expiratory flow (PEF) and maximal expiratory flow at 50% of the FVC (MEF50), derived from maximum expiratory flow volume (MEFV) curves. Data on respiratory symptoms and MEFV curves were obtained in a longitudinal survey of 404 children from a Dutch secondary school. Measurements were made at 6-month intervals between 1978 and 1985. The subjects selected for analysis comprised 151 boys and 118 girls for whom between nine and 14 measurements were available. In asymptomatic boys, the average peak growth rate of standing height occurred at about 14 yr, whereas the growth rates of the ventilatory function indices peaked about 0.8 (FVC) to 1.5 (MEF50) yr later. Weight growth paralleled that of FVC and FEV1. In girls, growth rates of all indices decreased over the whole age range. Adolescents with a positive history of prepubertal respiratory symptoms exhibited lung growth parallel to asymptomatic subjects, but at a lower level. In symptomatic boys, and to a lesser extent in girls, we found consistently lower levels of FVC, FEV1, and MEF50. We conclude that adolescents with a positive history of prepubertal respiratory symptoms, even if they lose their symptoms, remain at a disadvantage with respect to their ventilatory function when they reach adulthood AU - Borsboom GJ AU - van Pelt W AU - Quanjer PH LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 307 IP - DP - 1993 Jan 01 TI - Tuberculosis and poverty PG - 759-761 AB - OBJECTIVE--To examine whether the historical link between tuberculosis and poverty still exists. DESIGN--Retrospective study examining the notifications of all forms of tuberculosis by council ward over a six year period and correlating this with four indices of poverty; council housing, free school meals, the Townsend overall deprivation index, and the Jarman index. SETTING--The 33 electoral wards of the city of Liverpool. SUBJECTS--344 residents of Liverpool with tuberculosis. RESULTS--The rate of tuberculosis was correlated with all measures of poverty, the strongest correlation being with the Jarman index (r = 0.73, p < 0.0001). This link was independent of the high rates of tuberculosis seen in ethnic minorities. CONCLUSION--Tuberculosis remains strongly associated with poverty AU - Spence DP AU - Hotchkiss J AU - Williams CS AU - Davies PD LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 68 IP - DP - 1993 Jan 01 TI - Control of tuberculosis transmission in health care settings. A joint statement of the WHO Tuberculosis Programme and the International Union Against Tuberculosis and Lung Disease (IUATLD) PG - 369-371 AU - Anonymous LA - PT - DEP - TA - Weekly Epidemiological Record JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 306 IP - DP - 1993 Jan 01 TI - Pre-employment chest radiography for health service staff: who needs it? PG - 1041-1042 AU - Madan I LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 270 IP - DP - 1993 Jan 01 TI - From the Centers for Disease Control and Prevention. Initial therapy for tuberculosis in the era of multidrug resistance: recommendations of the Advisory Council for the Elimination of Tuberculosis PG - 694-698 AB - These recommendations update previous CDC/American Thoracic Society (ATS) recommendations for the treatment of tuberculosis (TB) among adults and children. The most notable changes are in response to the increasing prevalence of drug-resistant TB in the United States. These recommendations include the need for a) in vitro drug susceptibility testing of Mycobacterium tuberculosis isolates from all patients and reporting of these results to the health department, b) initial four-drug regimens for the treatment of TB, and c) initial directly observed therapy for persons with TB. Adherence to these recommendations will help prevent the occurrence of more cases of drug-resistant TB, reduce the occurrence of treatment failure, and reduce the transmission of TB in the United States AU - Anonymous LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 46 IP - DP - 1993 Jan 01 TI - Treatment of Legionnaires' disease. Current recommendations. PG - 63-79 AB - Legionnaires' disease is a relatively common cause of community-acquired pneumonia and of some outbreaks of hospital-acquired pneumonia. Moreover, Legionella pneumophila is frequently involved in the aetiology of the subset of pneumonias that is characterised by severe clinical course and high mortality. No sure clinical, radiographical or analytical features are useful in differentiating Legionella infection from other aetiologies of pneumonia. On the basis of these data, a rational initial therapeutic approach to community-acquired pneumonia, as well as to nosocomial pneumonia in certain circumstances, has to include an antimicrobial agent that is clinically effective against Legionella spp. Clinical studies have provided evidence that erythromycin is the first-line treatment. An intravenous dosage of 1g every 6 hours as initial therapy will be effective in most cases. Parenteral treatment may be switched to oral administration only after clinical response is observed. In vitro susceptibilities and preliminary experimental and clinical results suggest that clarithromycin will most likely become the preferred treatment once an intravenous preparation is available worldwide. However, orally administered clarithromycin at the dosage of 500 mg every 12 hours may be recommended in those developing countries in which health systems cannot afford the costs of intravenous therapy. In the case of clinically severe illness or in seriously immunosuppressed hosts with confirmed legionellosis, a combined therapeutic approach is warranted. Rifampicin 600 mg every 12 hours intravenously or orally has to be added to the usual dosage of erythromycin. Other alternative therapies, but with less distinct clinical efficacy, that can be combined with erythromycin are doxycycline 100 mg every 12 hours intravenously or orally, and intravenous ciprofloxacin 200 mg every 6 hours. AU - Roig J AU - Carreres A AU - Domingo C LA - PT - DEP - TA - Drugs JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 278 IP - DP - 1993 Jan 01 TI - Analysis of virulence factors of Legionella pneumophila. [Review] PG - 348-358 AB - Legionella pneumophila, the causative agent of Legionnaires' disease is a facultative intracellular bacterium, which in the course of human infection multiplies in lung macrophages predominantly manifesting as pneumonia. The natural habitat of Legionella is found in sweet water reservoirs and man-made water systems. Virulent L. pneumophila spontaneously convert to an avirulent status at a high frequency. Genetic approaches have led to the identification of various L. pneumophila genes. The mip (macrophage infectivity potentiator) determinant remains at present the sole established virulence factor. The Mip protein exhibits activity of a peptidyl prolyl cis trans isomerase (PPIase), an enzyme which is able to bind the immunosuppressant FK506 and is involved in protein folding. The recently cloned major outer membrane protein (MOMP) could play a role in the uptake of legionellae by macrophages. Cellular models are useful in studying the intracellular replication of legionellae in eukaryotic cells. Human cell lines and protozoan models are appropriate for this purpose. By using U 937 macrophage-like cells and Acanthamoeba castellanii as hosts, we could discriminate virulent and avirulent L. pneumophila variants since only the virulent strain was capable of intracellular growth at 37 degrees C. By using these systems we further demonstrated that a hemolytic factor cloned and characterized in our laboratory, legiolysin (lly), had no influence on the intracellular growth of L. pneumophila. AU - Hacker J AU - Ott M AU - Wintermeyer E AU - Ludwig B AU - Fischer G LA - PT - DEP - TA - Zentralblatt fur Bakteriologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - IP - DP - 1993 Jan 01 TI - The control of legionellosis including legionnaires' disease PG - - AU - Health and safety executive LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - CS gas--implications for the anaesthetist PG - 896-897 AB - Although the use of CS gas is illegal in the UK, an occasional patient exposed to its effects may be seen. We report the problems experienced with the anaesthetic management of such a patient AU - Bhattacharya ST AU - Hayward AW LA - PT - DEP - TA - Anaesthesia JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 92 IP - DP - 1993 Jan 01 TI - Duration and magnitude of action of 50 and 100 micrograms of inhaled salmeterol in protecting against bronchoconstriction induced by hyperventilation of dry cold air in subjects with asthma PG - 488-492 AU - Cartier A AU - Ghezzo H AU - L'Archeveque J AU - Trudeau C AU - Malo JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 91 IP - DP - 1993 Jan 01 TI - Exposure to domestic animals and risk of immunologic sensitization in subjects with asthma PG - 979-986 AB - BACKGROUND: The objective of the study was to determine whether exposure to domestic animals plays a significant role, beyond atopy, in the development of immediate sensitization to animal-derived antigens. METHODS: To test this hypothesis, 200 subjects with asthma (85 male subjects and 115 female subjects; mean age, 37 +/- 16 years) seen consecutively in an asthma clinic were enrolled in a cross-sectional survey. Each subject answered a questionnaire about allergy symptoms and past and current exposure to domestic animals. Skin prick testing with extracts of common inhalant allergens including antigens from eight species of animal (cat, dog, horse, rabbit, rat, mouse, guinea pig, and hamster) were also carried out. RESULTS: Seventy-nine percent of subjects were atopic, and 91% had kept animals at home at some point (figures were 80% for dogs, 68% for cats, 23% for rabbits, and 20% for rodents). Using two-by-two tables, we showed that skin reactivity to at least one animal antigen was strongly linked to atopy (86% of atopic subjects had skin reactions as compared with 34% of nonatopic subjects: p < 0.001) but not to previous and current exposure to domestic animals (78% of both exposed and never exposed subjects). However, with the use of logistic regression, the determinants of skin reactivity to animals were atopy (p < 0.001), followed by cumulative duration of exposure to domestic animals (p < 0.01). The number of animals times the number of species times the duration of exposure was also a significant determinant of skin reactivity (p = 0.05). CONCLUSIONS: We conclude that beyond the predominant role of atopy, cumulative duration of exposure to domestic animals is a significant determinant for immediate sensitization to animal-derived antigens in subjects with asthma AU - Desjardins A AU - Benoit C AU - Ghezzo H AU - L'Archeveque J AU - Leblanc C AU - Paquette L AU - Cartier A AU - Malo JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 15 IP - DP - 1993 Jan 01 TI - A cross-sectional epidemiological study of symptoms and respiratory physiology in a sample of workers in shoe manufacture [Italian] PG - 13-19 AB - The prevalence of respiratory symptoms and functional abnormalities has been evaluated in a sample of 350 workers (186 males and 164 females, mean age: 35.1 and 36.6 years respectively) employed in 24 factories of the shoes industry in the area of Pisa, exposed to airway irritants (solvent vapours, leather dusts and fumes). Each subject performed C.N.R. questionnaire of respiratory symptoms and diseases, and measurement of Forced Vital Capacity and derived indices. A mild prevalence of respiratory symptoms (chronic cough: 9.3% and 8.5% in males and females respectively; chronic phlegm: 14.6% and 6.8%; persistent wheeze: 2.1% and 1.7%; dyspnea of 1st degree: 23.3% and 39.0%) was reported, more frequently in smokers than in non smokers. Subjects with longer job duration in the shoe industry showed a trend to have a higher prevalence of chronic phlegm than subjects with shorter job duration; on the contrary, the last ones had a higher prevalence of rhino-conjunctivitis. A higher prevalence of attacks of shortness of breath and dyspnea of 2nd degree in males, and dyspnea of 1st degree in females was observed in workers to high risk job (to shear, to use adhesive, etc.) with respect to workers employed in low risk job (to assembly, to store etc). Mean spirometric values where in the normal range. Subdividing the subjects in groups with different smoking habit and job duration, a mild effect of the occupational exposure in groups with the same smoking habit could be observed for FEV1 and MEF50 particularly.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Paggiaro PL AU - Carrara M AU - Petrozzino M AU - Battaglia A AU - di Pede F AU - Bacci E AU - Talini D AU - Vellutini M AU - Viegi G AU - Giuntini C LA - PT - DEP - TA - Giornale Italiano di Medicina del Lavoro JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 3 IP - DP - 1993 Jan 01 TI - The Italian working group on the use of peak expiratory flow rate (PEFR) in asthma PG - 438-443 AU - Paggiaro PL AU - Moscato G AU - Giannini D AU - di Pede F AU - Bertoletti R AU - Bacci E AU - Bancalari L AU - Dente FL AU - Di Franco A AU - Vagaggini B LA - PT - DEP - TA - Eur Respir Rev JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 64 IP - DP - 1993 Jan 01 TI - Changes in nasal lavage fluid due to formaldehyde inhalation PG - 515-519 AU - Pazdrak K AU - Gorski P AU - Krakowiak A AU - Ruta U LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 21 IP - DP - 1993 Jan 01 TI - Occupational asthma caused by Papaver somniferum PG - 145-148 AU - Moneo I AU - Alday E AU - Ramos C AU - Curiel G LA - PT - DEP - TA - Allergol Immunopathol (Madr) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 103 IP - DP - 1993 Jan 01 TI - Effects of a bronchoprovocation challenge test with cigarette sidestream smoke on sensitive and healthy adults PG - 330-331 AB - In order to study the acute effects of environmental tobacco smoke on lung function, a cigarette sidestream smoke provocation test (analogous to a nonspecific bronchial provocation test) was performed. Ten persons with airways hyperreactive to methacholine and ten normoreactive persons were tested. A dose-response relationship was found for symptoms. The lung function of the normoreactive persons was not altered by short-time inhalation of sidestream smoke. The hyperreactive subjects, however, experienced significant decreases in FEV1, FVC, and MEF50. The decrease was most pronounced after the lowest dose of 2 ppm smoke-induced CO, leading to a mean fall of 6.3 percent in FEV1. Five of ten subjects with hyperreactive airways showed a decrease in FEV1 of more than 10 percent during the sidestream smoke provocation, one of them a decrease of over 20 percent after inhalation of 16 ppm CO sidestream smoke. We conclude that even short exposure to low concentrations of cigarette sidestream smoke causes significant impairment of lung function in sensitive persons. AU - Danuser B AU - Weber A AU - Hartmann AL AU - Krueger H LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Effect of bumetanide on toluene di-isocyanate induced contractions in guines-pig airways PG - 63-67 AU - Mapp CE AU - Boniotti A AU - Papi A AU - Maggi CA AU - Di Stephano A AU - Saetta M AU - Ciaccia A AU - Fabbri LM LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - Sensitisation to a weed pollen in a non-atopic subject during a clinical study. A case report PG - 276-278 AU - GarciaOrtega P AU - Martinez A AU - Martinez J LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 2 IP - DP - 1993 Jan 01 TI - Prevalence of impaired lung function in rubber manufacturing factory workers exposed to benzo(a)pyrene and respirable particulate matter PG - 26-31 AU - Gupta P AU - Banerjee DK AU - Bhargava SK AU - Kaul R AU - Shankar VR LA - PT - DEP - TA - Indoor Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 4 IP - DP - 1993 Jan 01 TI - Epidemic asthma in Cartagena, Spain, and its association with soybean sensitivity PG - 76-79 AB - We conducted a matched case-control study to assess the association between epidemic asthma and soybean sensitivity in Cartagena, Spain. In skin tests, 81% of the cases and no control subjects were positive to the commercial soybean allergen; 87% of the cases and 12% of the controls were positive to the prepared soybean allergen; and 69% of the cases and 6% of the controls showed high levels of specific immunoglobulin E antibodies (odds ratio = 10; 95% confidence interval = 1.4-433). The association remained strong after adjustment for total immunoglobulin E and for 28 other allergens. The results indicate that soybean sensitivity may be causing asthma epidemics in Cartagena AU - Navarro C AU - Marquez M AU - Hernando L AU - Galvan F AU - Zapatero L AU - Caravaca F LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 83 IP - DP - 1993 Jan 01 TI - Building-related asthma in Denver office workers PG - 89-93 AB - OBJECTIVES Reported cases of building-related asthma and hypersensitivity pneumonitis among workers in a Denver office building prompted an epidemiologic investigation. METHODS A cross-sectional, self-administered survey of employees in the office building of the reported cases was compared with that of employees in a comparison building. RESULTS A significant excess of respiratory disease existed among 512 Denver workers (case building) compared with 281 office workers in a suburban agency (control building). Denver employees had a higher prevalence of respiratory symptoms, and the prevalence of physician-diagnosed asthma with onset or exacerbation since building occupancy was 4.9 times greater for Denver employees than for suburban employees. Asthma was not associated with any particular ventilation system in the building. Water incursion from a below-grade wall may have contributed to the problem, but the etiology is unknown. CONCLUSIONS This investigation provided evidence of office building-related asthma. Individual cases may be sentinel events for other cases of work-related asthma or hypersensitivity pneumonitis and may indicate a need for public health investigation of remediable causes AU - Hoffman RE AU - Wood RC AU - Kreiss K LA - PT - DEP - TA - Am J Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - Immediate and delayed allergy to nickel with contact urticaria, rhinitis, asthma and contact dermatitis PG - 306-310 AU - Estlander T AU - Kanerva L AU - Tupasela O AU - Keskinen H AU - Jolanki R LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 103 IP - DP - 1993 Jan 01 TI - Hypersensitivity pneumonitis and airways hyperreactivity induced by occupational exposure to penicillin PG - 303-304 AB - A patient with penicillin-induced hyperreactive airways in association with hypersensitivity pneumonitis is described. Patch tests and intradermal tests to penicillin were positive. Bronchoalveolar lavage demonstrated a relative lymphocytosis and mild neutrophilia. Symptoms and physiologic abnormalities of pulmonary function and gas exchange resolved on cessation of exposure to penicillin AU - de Hoyos A AU - Holness DL AU - Tarlo SM LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 103 IP - DP - 1993 Jan 01 TI - Occupational asthma in a pesticides manufacturing worker PG - 295-296 AB - A 34-year-old chemical manufacturing worker had new onset of work-related asthma after several years of exposure to the fungicide, captafol. On specific bronchial challenge testing, he demonstrated a marked and persistent fall in FEV1. Cessation of exposure resulted in improved symptoms and pulmonary function. The delay in symptoms after several years of workplace exposure and the dual reaction demonstrated on specific bronchial challenge testing suggest sensitization to some component of technical-grade captafol, but an IgE response was not detected AU - Royce S AU - Wald P AU - Sheppard D AU - Balmes J LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 103 IP - DP - 1993 Jan 01 TI - Occupational asthma caused by pectin inhalation during the manufacture of jam PG - 309-311 AB - We report a case of pectin-induced occupational asthma in a 35-year-old man. His job involved mixing powdered pectin into a fruit puree during the manufacture of jam. Within minutes of adding pectin, he developed coryza, rhinorrhea, coughing, and wheezing. His symptoms cleared during weekends while away from work and improved with the use of a protective face mask at work. Peak flow rates were significantly lower while at work compared with those at home, and a prick skin test with the pectin powder was positive. We conclude that pectin should be added to the list of the substances known to induce occupational asthma AU - Cohen AJ AU - Forse MS AU - Tarlo SM LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 147 IP - DP - 1993 Jan 01 TI - Hypersensitivity pneumonitis-like reaction among workers exposed to diphenylmethane [correction to piphenylmethane] diisocyanate (MDI) PG - 338-346 AB - Isocyanates are well documented as a cause of occupational asthma. A hypersensitivity pneumonitis type of reaction has also been reported but only in a few isolated cases. We investigated nine subjects who complained of respiratory and general symptoms related to workplace exposure. All the subjects had worked in a plant where a resin based on diphenylmethane diisocyanate (MDI) is used in the manufacture of woodchip boards. They underwent inhalation challenges using the MDI resin for progressively increasing periods of time on separate days. In eight subjects, exposure to subirritant amounts of MDI induced a pattern of reaction consistent with hypersensitivity pneumonitis, i.e., significant falls in both FEV1 and FVC associated with a rise in body temperature (: 38 degrees C) and an increase in blood neutrophils (: +2,500/mm3). Bronchoalveolar lavage, performed in two subjects 24 h after the end of challenge exposure, revealed an increase in lymphocytes and neutrophils. Specific immunoglobulin G (IgG) and IgE antibodies to MDI human serum albumin (HSA) conjugates were present in all subjects. We conclude that the MDI resin caused an hypersensitivity pneumonitis type of reaction in at least eight (4.7%) of the 167 potentially exposed workers employed in the plant. These findings indicate that in some workplaces, a hypersensitivity pneumonitis type of reaction may be a more frequent consequence of isocyanate exposure than is usually thought AU - Vandenplas O AU - Malo JL AU - Dugas M AU - Cartier A AU - Desjardins A AU - Levesque J AU - Shaughnessy MA AU - Grammer LC LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 147 IP - DP - 1993 Jan 01 TI - Inhaled aeroallergen and storage mite reactivity in a Wisconsin farmer nested case-control study PG - 354-358 AB - A nested case-control study was undertaken to assess the role of antibody (Ab) to a panel of antigens associated with hypersensitivity pneumonitis in the development of lung disease among Wisconsin dairy farmers. Immunologic reactivity to a panel of inhaled allergens was assessed in the Ab+ cases and compared to the Ab+ control, Ab- control, and Ab- blue-collar control subjects by skin tests, RAST assays, and a modified American Thoracic Society questionnaire. The most prevalent allergens among the cases as determined by either skin test or RAST assays were the house dust mites (HDM) (21.6%), storage mites (11.2%), grain smuts (11.2%), Cladosporium (7.5%), Aspergillus (6.0%), and cattle (5.2%). No other allergens appeared to be different from in nonfarming populations. Of the storage mite reactors, IgE to Lepidoglyphus destructor (7 of 8) was the most frequently found, followed by Tyrophagus putrescentiae (6 of 8), Glycyphagus domesticus (5 of 8), Chortoglyphus arcuatus (5 of 8), and Acarus siro (2 of 8). L. destructor was also isolated from the farm of one of the cases. There was no difference in the total IgE levels among the groups. Reactions to HDM, storage mites, and grain smuts were significantly more frequent among the cases (p : 0.05). We conclude from this study that there is a significant increase in reactivity to certain inhaled allergens among those dairy farmers reporting barn-associated respiratory symptoms that is unrelated to past exposure to the causative agents of farmer's lung disease AU - Marx JJ Jr AU - Twiggs JT AU - Ault BJ AU - Merchant JA AU - FernandezCaldas E LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - Asthma, rhinitis, and dermatitis in workers exposed to reactive dyes PG - 65-70 AB - A survey was conducted at 15 textile plants with dyehouses in western Sweden. Employees with a history of work related rhinitis, asthma, or skin symptoms were offered a clinical and immunological investigation including skin prick tests, skin patch tests, and radioallergosorbent tests (RASTs) to detect specific allergy to reactive dyes. Among the 1142 employees, 162 were exposed to reactive dyes and 10 of these (6%) reported work related respiratory or nasal symptoms. An allergy to reactive dyes could be confirmed in five (3%, 95% confidence interval 1-7%). All but one had been exposed to reactive dyes for one year or less before the onset of symptoms. Positive RASTs could be detected in four of the five patients. All of the RAST positive patients were positive to remazol black B, but six out of eight additional remazol dyes also elicited positive results. RAST and RAST inhibition showed a cross reactivity between some of the dyes. Seven persons with work related dermatitis and three with urticaria or Quincke oedema were found. In one patient contact dermatitis to a monoazo dye was shown, but no positive patch test reactions to reactive dyes. IgE-mediated allergy to reactive dyes seems to be an important cause of respiratory and nasal symptoms among dyehouse employees exposed to dust from reactive dyes AU - Nilsson R AU - Nordlinder R AU - Wass U AU - Meding B AU - Belin L LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - Toluene diisocyanate induced asthma: outcome according to persistence or cessation of exposure PG - 60-64 AB - Sixty patients with occupational asthma due to exposure to toluene diisocyanate (TDI) were re-evaluated, five years after the initial diagnosis had been confirmed by a specific bronchial provocation challenge. During both examinations the severity of asthmatic symptoms and the need for antiasthma treatment were graded and lung function tests, measurement of airway responsiveness to methacholine (PD15), and skin tests with common inhalant allergens were carried out. The evolution of the disease was established on the basis of the increase or decrease in asthmatic symptoms, requirements for medication, and FEV1 and PD15 methacholine between the two examinations. At follow up 17 patients (group A, 28.3%) had carried on working in the same environment after relocation to jobs with only occasional exposure to TDI; 15 of them used protective respiratory devices. The remaining 43 (group B, 71.7%) avoided further inhalation of TDI by moving to another sector. Group A showed a significant decrease in FEV1 and PD15 methacholine and significant increases in the severity of symptom score and requirement for medication; 13 subjects (76.5%) were worse, four (23.5%) were stable, and no one had recovered or improved. Group B showed significantly less severe symptoms and a threefold increase in PD15 methacholine; 12 subjects (28.2%) totally recovered, 10 (23.2%) improved, 16 (37.2%) were stable, and five (11.6%) were worse. In group B the duration of exposure to TDI and of symptoms before the initial diagnosis delineated the patients who recovered from those who did not improve; intermediate values in these features characterised the subjects who improved but did not recover.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Pisati G AU - Baruffini A AU - Zedda S LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - Haemolytic anaemia in a case of occupational asthma due to maleic anhydride PG - 191-192 AU - Jackson J AU - Jones AH LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 103 IP - DP - 1993 Jan 01 TI - Farmer's fever. Systemic manifestation of farmer's lung without lung involvement PG - 632-634 AB - A 35-year-old dairy farmer presented with recurrent febrile episodes over more than three years. Fever up to 39 degrees C occurred only if he was in contact with the dairy barn and typically appeared at 4 to 8 h after an otherwise usual barn exposure. He had no dyspnea and throughout this period repeated physical examinations, chest roentgenograms, and lung functions remained normal. He was bronchoscoped and lavaged on three occasions, a lymphocytic alveolitis was always present and once, immediately after an acute episode, an important increase in lavage neutrophils was also found (47 percent). Transbronchial lung biopsy specimens showed a moderate cellular infiltrate but no granuloma or fibrosis. Three other persons who worked at the same farm had no similar manifestations or respiratory illnesses. The patient therefore had typical systemic manifestations of acute farmer's lung, but without the lung involvement required to confirm that diagnosis. Furthermore, his disease does not fit the entities known as grain fever and organic dust toxic syndrome. We believe that this patient presented a different entity that we coined "farmer's fever." AU - Cormier Y AU - Fournier M AU - Laviolette M LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 103 IP - DP - 1993 Jan 01 TI - Occupational asthma induced by inhaled egg lysozyme PG - 532-535 AB - A 26-year-old man employed in a company which manufactured hen egg white derived lysozyme for use in the pharmaceutical industry was evaluated for occupational asthma. The worker began to experience immediate-onset asthmatic symptoms two months after starting to work with egg lysozyme powder. The work process involved the production of approximately 1,000 kg of purified dried lysozyme powder per week. Prick skin testing was positive to egg lysozyme (50 mg/ml) and other egg protein components, but negative to whole egg white and egg yolk reagents. Serum specific IgE to egg lysozyme was documented. Decrements in serial peak expiratory flow rates were associated with lysozyme exposure at work. A specific bronchoprovocation challenge to lysozyme powder was positive demonstrating an isolated immediate asthmatic response (48 percent decrease from baseline FEV1). This is the first reported case of lysozyme-induced asthma specifically caused by inhalational exposure to egg lysozyme AU - Bernstein JA AU - Kraut A AU - Bernstein DI AU - Warrington R AU - Bolin T AU - Warren CP AU - Bernstein IL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 87 IP - DP - 1993 Jan 01 TI - Prescribed respiratory diseases in the 1990s [letter] PG - 79-79 AU - Gannon PF AU - Burge PS LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - Allergenicity of the cat flea (Ctenocephalides felis felis) PG - 377-383 AU - Trudeau WL AU - FernandezCaldas E AU - Fox RW AU - Brenner R AU - Bucholtz GA AU - Lockey RF LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - In vivo allergenic activities of eleven purified members of a major allergen family from wheat and barley flour PG - 410-415 AU - Armentia A AU - SanchezMonge R AU - Gomez L AU - Barber D AU - Salcedo G LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - Occupational respiratory disease caused by acrylates PG - 416-424 AB - Acrylates are compounds used in a variety of industrial fields and their use is increasing. They have many features which make them superior to formerly used chemicals, regarding both their industrial use and their possible health effects. Contact sensitization is, however, one of their well known adverse health effects but they may also cause respiratory symptoms. We report on 18 cases of respiratory disease, mainly asthma, caused by different acrylates, 10 cases caused by cyanoacrylates, four by methacrylates and two cases by other acrylates. AU - Savonius B AU - Keskinen H AU - Tuppurainen M AU - Kanerva L LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 35 IP - DP - 1993 Jan 01 TI - Diesel asthma. Reactive airways disease following overexposure to locomotive exhaust PG - 149-154 AB - While some of the gaseous and particulate components of diesel exhaust can cause pulmonary irritation and bronchial hyperreactivity, diesel exhaust exposure has not been shown to cause asthma. Three railroad workers developed asthma following excessive exposure to locomotive emissions while riding immediately behind the lead engines of caboose-less trains. Asthma diagnosis was based on symptoms, pulmonary function tests, and measurement of airways hyperreactivity to methacholine or exercise. One individual's peak expiratory flow rates fell in a work-related pattern when riding immediately behind the lead diesel engine. None had a previous history of asthma or other respiratory disease and none were current smokers. All three developed persistent asthma. In two cases, physiologic abnormalities suggesting reversible restriction were observed. This is the first report implicating diesel exhaust as a cause of reactive airways disease AU - Wade JF AU - Newman LS LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 341 IP - DP - 1993 Jan 01 TI - Exposure to methylene diphenyl diisocyanate in coal mines [letter] PG - 318-318 AB - The authors report an important application of (MDI) that does not seem to be widely known. The authors have been involved in a compensation dispute concerning a surface worker from a coal mine. This atopic patient had claimed compensation from the Belgian Fund for Occupational Diseases for bronchial asthma which his physician had regarded as occupational, essentially on the basis of a convincing temporal relation between the disease and periods of work. The claim was rejected, because no substantial exposure to a known asthma-causing agent has been identified. At the time of appeal, the patient has quit his work at the coal mine for 2 years. He gave a list of the products that he had frequently loaded on wagons for transportation underground. The source of exposure for the patient, was probably the handling of half-empty and leaking MDI drums coming back from the mine. No precautions seemed to have been taken and the worker's description, corroborated by others, suggested that exposure was at times considerable. On the basis of this information the occupational nature of the patient`s asthma was accepted. AU - Nemery B AU - Lenaerts L LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 41 IP - DP - 1993 Jan 01 TI - Byssinosis in the cotton waste industry PG - 129-132 AB - A cross-sectional survey was carried out on 772 workers in 27 mills in the North of England involved in the processing of cotton  waste. The overall prevalence of byssinosis as defined by  Schilling's criteria was 9.8 per cent with 5.4 per cent having  grades 2 and 3. The prevalence in workers who had  only ever had cotton waste exposure (5 per cent) was significantly less than for those who had mixed waste and raw cotton exposure. There was no clear relationship between prevalence of byssinosis and years of exposure or dust levels AU - Docker A AU - Jones RD AU - Thomas PG AU - Benn T LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 68 IP - DP - 1993 Jan 01 TI - Occupational lung cancer PG - 183-188 AB - Exposure to certain industrial agents has been thought to have carcinogenic potential, both for employees who work closely with such agents and for the general population that comes in contact with them. Although case reports, laboratory studies, and epidemiologic analyses help to determine the carcinogenicity of implicated agents, each of these types of investigation has limitations and deficiencies in distinguishing causal from noncausal associations. Asbestos has been linked with bronchogenic carcinoma, but several controversial factors--the degree of risk relative to exposure dose, the synergistic effect of cocarcinogens, and the question of existence of a threshold dose--complicate the understanding of the magnitude of the risk for exposed persons. Several other physical and chemical agents (such as chromium, nickel, and radon) have also been associated with an increased incidence of lung cancer in epidemiologic and animal studies. As with asbestos, the specific type of the agent and exposure conditions are important in determining the degree of carcinogenicity. In studies of exposure to man-made mineral fibers, formaldehyde, and silica, the findings have been inconsistent. Because the degree of health hazard attributable to asbestos and other known and suspected lung carcinogens is controversial, a wide range of opinions exists about the importance of occupational exposures to the overall incidence of lung cancers. Nevertheless, attempting to prevent lung cancers by minimizing or eliminating exposure to carcinogens is preferable to treating existent cases AU - Whitesell PL AU - Drage CW LA - PT - DEP - TA - Mayo Clin Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 43 IP - DP - 1993 Jan 01 TI - Developments in the darkroom: a cross-sectional study of sickness absence, work-related symptoms and environmental monitoring of darkroom technicians in a hospital in Glasgow PG - 27-31 AB - Nine female technicians using both manual and automatic processing methods were matched by age, sex and smoking habits with controls from the occupational therapy department. All were interviewed using a questionnaire about symptoms experienced during the day in question and the preceding month. Sickness absence information for 1987 was obtained, and the working environment was assessed by standard occupational hygiene methods. The technicians and controls had similar numbers of episodes of sickness absence (23 versus 24, respectively) but aggregated substantially more days absence attributed to sickness (204 versus 41). The total number of 'monthly' symptoms experienced by the technicians was greater than the controls (44 versus 30) as was the number of 'daily' complaints (26 versus 6). In all cases, respiratory symptoms were responsible for about one-third of problems, but statistical analysis (Wilcoxon matched pairs signed ranks tests) showed that the differences were not statistically significant. Occupational hygiene results were all within normal limits AU - Ide CW LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Comparison of fluticasone propionate with beclomethasone dipropionate in moderate to severe asthma treated for one year. International Study Group [see comments] PG - 817-823 AB - BACKGROUND High dose inhaled glucocorticosteroids are increasingly used in the management of patients with moderate to severe asthma. Although effective, they may cause systemic side effects. Fluticasone propionate is a topically active inhaled glucocorticosteroid which has few systemic effects at high doses. METHODS Fluticasone propionate, 1.5 mg per day, was compared with beclomethasone dipropionate at the same dose for one year in patients with symptomatic moderate to severe asthma; 142 patients received fluticasone propionate and 132 received beclomethasone dipropionate. The study was multicentre, double blind and of a parallel design. For the first three months patients attended the clinic every four weeks and completed daily diary cards. For the next nine months they were only seen at three monthly intervals in the clinic. RESULTS During the first three months diary card peak expiratory flow (PEF) rate and lung function measurements in the clinic showed significantly greater improvement in patients receiving fluticasone propionate (difference in morning PEF 15 l/min (95% CI 6 to 25)), and these differences were apparent at the end of the first week. The improved lung function was maintained throughout the 12 month period and the number of severe exacerbations in patients receiving fluticasone propionate was reduced by 8% compared with those receiving beclomethasone dipropionate. No significant differences between the two groups were observed in morning plasma cortisol levels, urinary free cortisol levels, or response to synthetic ACTH stimulation. In addition, both the rates of withdrawal and of adverse events were low, and there were fewer exacerbations of asthma with fluticasone propionate than beclomethasone dipropionate. CONCLUSIONS This study shows that fluticasone propionate in a daily dose of 1.5 mg results in a significantly greater increase in PEF and asthma control than the same dose of beclomethasone dipropionate, with no increase in systemic or other side effects AU - Fabbri L AU - Burge PS AU - Croonenborgh L AU - Warlies F AU - Weeke B AU - Ciaccia A AU - Parker C LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - IP - DP - 1993 Jan 01 TI - HIV infected healthcare workers with multidrug-resistant tuberculosis, 1990-1992 PG - 231- AU - Valway S AU - Pearson ML AU - Ikeda R AU - Edlin BR LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 248 IP - DP - 1993 Jan 01 TI - The effect of compound 48/80 on contractions induced by toluene diisocyanate in isolated guinea-pig bronchus PG - 67-73 AB - We have investigated the ability of compound 48/80 and of histamine H1 and H2 receptor antagonists to inhibit toluene diisocyanate-induced contractions in isolated guinea-pig bronchi. Compound 48/80 (100 micrograms/ml) significantly inhibited toluene diisocyanate-induced contractions. By contrast, the two histamine H1 and H2 receptor antagonists, chlorpheniramine (10 microM) and cimetidine, (10 microM) did not affect toluene diisocyanate-induced contractions, but significantly inhibited contractions induced by exogenously applied histamine (100 microM) and by 48/80. We investigated which mechanisms 48/80 used to inhibit toluene diisocyanate-induced contractions, paying particular attention to the possible involvement of capsaicin-sensitive primary afferents. In vitro capsaicin desensitization (10 microM for 30 min followed by washing) significantly reduced compound 48/80-induced contractions. A capsaicin-resistant component of contraction was also evident. Ruthenium red (3 microM), an inorganic dye which acts as a selective functional antagonist of capsaicin, did not affect 48/80-induced contraction. MEN 10,207 (Tyr5,D-Trp6,8,9,Arg10)-neurokinin A (4-10) (3 microM) a selective antagonist of NK2-tachykinin receptors significantly reduced 48/80-induced contractions. These results show that compound 48/80 inhibits toluene diisocyanate-induced contractions in isolated guinea-pig bronchi. It is likely that two mechanisms are involved in the inhibition: (1) the release of mediators other than histamine by mast cells, (2) an effect of 48/80 on sensory nerves AU - Mapp CE AU - Boniotti A AU - Papi A AU - Chitano P AU - Coser E AU - Di Stefano A AU - Saetta M AU - Ciaccia A AU - Fabbri LM LA - PT - DEP - TA - Eur J Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 147 IP - DP - 1993 Jan 01 TI - Chronic beryllium disease in a dental laboratory technician PG - 205-207 AB - Workers involved in the manufacture of dental prostheses are exposed to a number of potentially harmful substances capable of inducing lung disease. In this report, we describe a dental laboratory technician who developed chronic beryllium disease as a result of exposure in the workplace. The diagnosis of chronic beryllium disease was suspected from the clinical, radiographic, and histologic features and confirmed by the in vitro proliferation of lung lymphocytes to beryllium salts. The potential risks of beryllium use in the dental industry have been recognized for some time, but this is the first documentation of chronic beryllium disease in this population of workers. Since chronic beryllium disease may be easily confused with sarcoidosis, awareness of this occupational association is essential in preventing misdiagnosis and in providing appropriate management AU - Kotloff RM AU - Richman PS AU - Greenacre JK AU - Rossman MD LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - Occupational asthma and extrinsic alveolitis due to isocyanates: current status and perspectives PG - 213-228 AU - Vandenplas O AU - Malo JL AU - Saetta M AU - Mapp CE AU - Fabbri LM LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 248 IP - DP - 1993 Jan 01 TI - Toluene diisocyanate-stimulated release of arachidonic acid metabolites in the organ bath from guinea-pig airways PG - 277-280 AB - This study was designed to evaluate whether metabolites of arachidonic acid play a role in the contractile response to toluene diisocyanate in isolated guinea pig airways. In control experiments we collected the supernatant from an organ bath over a time period of 2 h, after the addition of toluene diisocyanate (100 and 300 microM), and after the addition of toluene diisocyanate (300 microM) in the presence of indomethacin (5 microM). We measured prostaglandin E2, 6-keto-prostaglandin F1 alpha, prostaglandin F2 alpha, thromboxane B2, leukotriene B4, leukotriene C4/D4/E4/F4 by radioimmunoassays. Levels of prostaglandin F2 alpha and 6-keto-prostaglandin F1 alpha increased significantly after addition of toluene diisocyanate in the absence of indomethacin. These results suggest that prostaglandins are involved in toluene diisocyanate-induced contractions in guinea-pig airways AU - Mapp CE AU - Boniotti A AU - Masiero M AU - Plebani M AU - Burlina A AU - Papi A AU - Maestrelli P AU - Saetta M AU - Ciaccia A AU - Fabbri L LA - PT - DEP - TA - Eur J Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - Toluene Di-isocyanate Induced Asthma: Outcome According To Persistence Or Cessation Of Exposure PG - 60-64 AU - Pisati G AU - Baruffini A AU - Zedda S LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 103 IP - DP - 1993 Jan 01 TI - Bronchial hyper-responsiveness and toluene di-isocyanate. Long-term change in sensitized asthmatic subjects PG - 1123-1128 AB - Long-term change in nonspecific and specific bronchial hyperresponsiveness was studied in 16 subjects with asthma induced by toluene diisocyanate (TDI). A significant positive correlation between months of follow-up and provocative dose inducing a 20 percent fall in FEV1 (PD20FEV1) methacholine was observed in 5 of 16 subjects. In 4 of these 5 subjects, a PD20FEV1 > 1 mg of methacholine was observed 30 to 48 months after the end of TDI exposure. In most subjects, nonspecific bronchial hyperresponsiveness did not change. Nine of 16 subjects became nonresponsive to TDI at follow-up examination, but only 3 of these showed a significant increase in PD20FEV1 methacholine. Seven subjects were still responsive to TDI. Recovery from TDI-induced asthma can occur and only after long-term work cessation. Nonspecific bronchial hyperresponsiveness to methacholine can persist even in the absence of bronchial hyperresponsiveness to TDI, suggesting permanent chronic damage to mechanisms controlling airway tone. AU - Paggiaro PL AU - Vagaggini B AU - Dente FL et al LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 43 IP - DP - 1993 Jan 01 TI - The value of questionnaires and spirometry in asthma surveillance programmes in the workplace PG - 203-206 AB - Shipyard workers and job applicants (n=1126) completed an asthma questionnaire, and underwent measurements of ventilatory lung function (FEV1, FEV1/FVC and PEER) and airway responsiveness. Airway responsiveness (to inhaled methacholine) was expressed as the dose calculated to provoke a 20 per cent fall in FEV1, ie the PD20. Results were categorized into four levels: high (PD20<200µg), medium (200–1000µg), low (1001–6400µg) and unquantifiable (>6400µg), which correspond with definite, possible, doubtful and no asthmatic activity. These categories agreed closely with diagnoses of asthma by general practitioners and the use of bronchodilator medication. The sensitivity and specificity of the questionnaire and the measurements of ventilatory function for detecting asthmatic activity were then determined. The questionnaire symptoms (wheeze, chest tightness, undue coughing or abnormal breathlessness) had a low (28 per cent) sensitivity for detecting definite or possible asthmatic activity and a specificity of only 73 per cent. The sensitivity of the ventilatory function tests (any one abnormal) was also low at 21 per cent with a specificity of 92 per cent. When the FEV1 <80 per cent predicted criterion was considered separately, its sensitivity was 11 per cent and its specificity was 98 per cent. These results illustrate that caution is needed when interpreting the results of questionnaires and measurements of ventilatory lung function in the diagnosis of asthma among working populations. AU - Stenton S AU - Beach JR AU - Avery AJ et al LA - PT - DEP - TA - Occup Med (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 24 IP - DP - 1993 Jan 01 TI - A follow-up study of laboratory animal exposed workers: the influence of atopy for the development of occupational asthma PG - 459-469 AB - In a 5-year follow-up study of 88 animal exposed laboratory technicians, the incidence of laboratory animal allergy (LAA), lung function, and the development of allergy test reactivity were investigated. Only two individuals developed test positive LAA rhinitis during the follow-up period. Furthermore, one subject who had previously had LAA rhinitis developed LAA asthma. In the remaining subjects the results of skin prick tests against laboratory animals and environmental allergens, total serum IgE levels, and lung function were unchanged. Atopy defined as parental and childhood allergy, raised total serum IgE levels, and positive skin prick tests against nonanimal environmental allergens and nonlaboratory animals (dog and horse) were risk indicators for development of test positive LAA asthma. The low incidence of LAA during the 5-year follow-up is interpreted as a result of an early LAA development in atopic subjects. AU - Sjostedt L AU - Willers S AU - Orbaek P LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 104 IP - DP - 1993 Jan 01 TI - Clinical and socioeconomic features of subjects with red cedar asthma. A follow-up study PG - 821-824 AB - A follow-up study of 128 subjects with red cedar asthma was conducted to evaluate the clinical and socioeconomic impact of the disease in determining the working status of the subjects after the diagnosis was made. The results suggest that the severity of asthma is not the main determinant of working status. Comparing the data at diagnosis and at follow-up examination, we found that the persistence of exposure resulted in a deterioration in the asthma despite the use of more medications. Subjects who were working were younger and had a larger number of dependents than the subjects who were not working at the time of the follow-up examination. We conclude that the socioeconomic factors are important in determining the working status of subjects with red cedar asthma. To prevent severe impairment and disability, there should be more economic incentives for these subjects to choose other jobs. AU - Marabini A AU - DimichWard H AU - Kwan SY et al LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - How Many Times Per Day Should Peak Expiratory Flow Rates Be Assessed When Investigating Occupational Asthma? PG - 1211-1217 AB - BACKGROUND Serial peak expiratory flow rate (PEF) recording has been advocated as a sensitive and specific means of confirming work related asthma. The optimum number of recordings per day to achieve the best between-reader and within-reader reproducibility and sensitivity/specificity ratio compared with the final diagnosis determined by specific inhalation challenges is unknown. METHODS PEF recording was carried out every two hours in 74 subjects referred for possible occupational asthma. Specific inhalation challenges performed in a hospital laboratory or at the workplace (positive in 33 subjects and negative in 41) were considered the gold standard. The duration of monitoring at work and away from work was at least two weeks each. Graphs of PEF recordings were generated in four different ways: every two hours, four times/day, three times/day, and every morning and evening. The graphs were assessed by three readers in three different centres in a blind manner. Furthermore, one third of each type of graph was read blind by the same reader one week after the initial interpretation. RESULTS Agreement between the three readers was a little more frequent (82%) in the case of the every two hour readings than for the other types of readings (70% v 77%). Agreement between at least two of the three readers occurred in 73% of positive challenges (sensitivity) and in 78% of negative challenges (specificity) for every two hour readings. The figures varied from 61% to 70% for positive challenges and from 78% to 88% for negative challenges for the other types of readings. Within-subject reproducibility from one reading to the next (one week apart) was excellent (83% to 100%). CONCLUSIONS Recording PEF every two hours results in a slightly more satisfactory agreement between readers and in concordance in terms of sensitivity/specificity than less frequent PEF readings, although the four times a day assessment is almost as satisfactory AU - Malo JL AU - Cote J AU - Cartier A AU - Boulet LP AU - L'Archeveque J AU - ChanYeung M LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 10 IP - DP - 1993 Jan 01 TI - The Quebec system of indemnification for occupational asthma. Description, efficacy, and costs PG - 313-323 AB - This study describes the Quebec system of compensation for occupational asthma, assessing the functional and social outcome of claimants and estimating the efficiency and cost. Information was obtained on the clinical, functional and social outcome as well as the estimated costs for 134/211 subjects (participation rate of 64%), who received compensation between 1986 and 1988. At the time of assessment (2 years and more after the diagnosis), 93% of participants still demonstrated significant bronchial hyperresponsiveness and 84% required anti-asthma medication. None of the participants remained exposed to the offending agent: 67% were working for the same or another employer, 16% were retired, 8% were retraining for a new job and 8% were still unemployed. Quality of life was mildly affected, more so than for a control group of subjects. The mean interval between the time claims were addressed and the first medicolegal decision was 8.1 months. The mean total cost (including temporary and permanent disability indemnities, medical and technical costs) was $CAN 49,200 (minimum and maximum values of $2,100 and $330,900). We conclude that for subjects with occupational asthma in Quebec: 1) the mean interval for a medicolegal decision to be made is eight months: 2) a minority is still unemployed two to four years after being assessed; 3) the quality of life is more affected than in a control group; 4) the mean cost is close to $CAN 50,000. AU - Malo JL AU - Dewitte JD AU - Cartier A et al LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 92 IP - DP - 1993 Jan 01 TI - Assessment of risk factors for IgE-mediated sensitisation to tetrachlorophthalic anhydride PG - 237-247 AB - Two groups of workers with occupational asthma caused by tetrachlorophthalic anhydride (TCPA) have been reported on; in only one report was specific anti-TCPA antibody demonstrated. We received a request to investigate respiratory problems among workers at a plant where solenoid coils are manufactured with the use of epoxy resin and where a new TCPA hardener had been introduced in 1988. In response, we conducted a cross-sectional evaluation of 52 current workers and assayed serum samples from 49 workers for TCPA-human serum albumin-specific IgE and IgG by ELISA. Mean airborne TCPA concentrations ranged from 0.21 to 0.39 mg/m3 in 1989 and May 1990 but were considerably lower (less than 0.009 to 0.13 mg/m3) by July 1990 when ventilation was introduced. Workers were classified in four departments as molders (most directly working with TCPA), those intermittently exposed to TCPA, coil assemblers, and office workers. There was a high prevalence of reported work-related respiratory symptoms (from 27% to 39%). The mean decline in FEV1 over the shift in the molders (down 4.1%) was significantly different from the change in the office group (increased 2.5%). Intrashift change in FEV1 was inversely correlated with log personal TCPA concentration (r = -0.47). Of 49 current workers, 15 (31%) had elevated serum TCPA-human serum albumin-specific IgE antibody levels and 19 (39%) had elevated specific IgG levels. The prevalence of specific IgE was highest in the mold and intermittent groups (54%), in comparison with the coil assembly (25%) and office (0%) groups. Those workers who were IgE positive were significantly less likely to be current smokers and had worked significantly longer since 1988. Of those hired in 1988 or after, the proportion of workers who were IgE positive increased with duration of employment category (p value for trend 0.022). Since ventilation was installed and TCPA exposures reduced to less than 0.1 mg/m3, there has been a marked decrease in symptoms and no new cases of occupational asthma among newly hired workers at the plant. AU - Liss GM AU - Bernstein D AU - Genesove L et al LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 92 IP - DP - 1993 Jan 01 TI - The low prevalence of occupational asthma and antibody-dependent sensitisation to diphenylmethane di-isocyanate in a plant engineered for minimal exposure to di-isocyanates PG - 387-396 AB - BACKGROUND Diisocyanate chemicals are leading causes of occupational asthma (OA). METHODS We conducted a cross-sectional study of 243 workers exposed to diphenylmethane diisocyanate (MDI) in a urethane mold plant that had been designed to minimize MDI exposure (levels were maintained below 0.005 ppm and were continuously monitored). All participants were screened by questionnaire and tests for serum antibodies to MDI-human serum albumin (HSA). On the basis of questionnaire responses, diagnoses were derived that included OA; non-OA; work-related and non-work-related rhinitis; and lower respiratory irritant responses. Serial peak expiratory flow rate studies were performed for 2 weeks in 43 workers with and in 23 workers without lower respiratory symptoms. RESULTS Results of serial peak expiratory flow rate studies were abnormal in 3 (33%) of 9 workers with OA, in 2 (50%) of 4 with non-OA, and in 2 (9%) of 23 case control subjects. A significant association was found between peak flow rate variability and a questionnaire asthma diagnosis (chi 2 p : 0.002). Physicians confirmed three cases of OA, one of which occurred in a control worker who was free of symptoms. In all three cases asthma symptoms remitted after the worker left the workplace. Serum specific IgE and IgG levels were elevated in 2 of 243 workers, one of whom was prick test positive to MDI-HSA and had had cutaneous anaphylaxis after MDI exposure. CONCLUSIONS On the basis of these cases, specific work activities associated with exposure to MDI were identified and corrective measures were instituted. Strict control and monitoring of ambient MDI exposure was associated with a low prevalence of specific sensitization to MDI and a lower than expected prevalence of OA AU - Bernstein DI AU - Korbee L AU - Stauder T AU - Bernstein JA AU - Scinto J AU - Herd ZL AU - Bernstein IL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Quantitative Versus Qualitative Analysis Of Peak Expiratory Flow In Occupational Asthma PG - 48-51 AB - BACKGROUND Peak expiratory flow rates (PEF) are often used to confirm the diagnosis of occupational asthma. The records are usually analysed qualitatively, and this may lead to interobserver disagreement. In this study the diagnostic value of a qualitative assessment of change in PEF was compared with objective measures of change in PEF and the results of a specific inhalation challenge test with plicatic acid. METHODS Twenty five patients with possible red cedar asthma recorded PEF six times a day for three weeks at work and for two weeks away from work and underwent a challenge test with plicatic acid at the end of the recording period. Patients were considered to have cedar asthma if the FEV1 after inhalation of plicatic acid was 15% or more below that on the control day. PEF was plotted against time and assessed qualitatively by three physicians. The graph was considered positive for cedar asthma if two of the three physicians agreed that PEF was lower at work than away from work. The 95% confidence interval for variation in PEF between periods at work and away from work was also obtained from 15 asthmatic patients without occupational asthma. Differences in PEF between periods at work and away from work were considered positive for occupational asthma in the patients exposed to cedar when they were outside the 95% confidence interval for variations in PEF in the 15 patients whose asthma was nonoccupational. RESULTS Of the 25 men studied, 15 had a positive response to plicatic acid. The qualitative PEF analysis had a sensitivity of 87% and a specificity of 90% in confirming red cedar asthma as diagnosed by the specific challenge test. Among the objective methods tested, only the difference in mean PEF between the maximum PEF at weekends and the minimum PEF on working days had a sensitivity (93%) greater than that of the qualitative method and a similar specificity. CONCLUSIONS The qualitative assessment of PEF is a good diagnostic test for cedar asthma. Only one objective method of PEF analysis proved to be slightly more sensitive than the qualitative method and similar in specificity. AU - Cote J AU - Kennedy S AU - ChanYeung M LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - The SHIELD scheme in the West Midlands Region, United Kingdom PG - 791-796 AB - OBJECTIVE--To study the general and specific incidence of occupational asthma within a defined geographic area; to audit the diagnosis of occupational asthma; to determine proposed mechanisms of asthma; and to determine the employment state of workers at diagnosis. DESIGN--A surveillance scheme of physicians likely to see cases of occupational asthma. SETTING--The West Midlands Region of the United Kingdom. SUBJECTS--Workers with occupational asthma diagnosed within the boundaries of the West Midlands Region. MAIN MEASURES--Demographic data, employer, agent to which exposed, date of diagnosis, method of diagnosis, proposed mechanism of asthma, and employment state. RESULTS--A recognised incidence of 43 (95% confidence interval CI 35-52) new cases per million general workers per year was detected. Specific occupational incidences varied from 1833 (95% CI 511-2990) per million paint sprayers to eight per million clerks. Specific incidence by District Health Authority varied from 103 in Solihull to 14 per million general workers in South Warwickshire. Agents to which workers were exposed at the time of diagnosis were generally well recognised (isocyanates 20.4%, flour 8.5%, colophony 8.3%). The most commonly used method of diagnosis was serial peak expiratory flow (PEF) measurement. Its use varied (specialist unit 72%, general chest physicians 50%, compensation board 48%). Workers were still exposed and therefore could have usefully performed PEF readings in 4% of cases where they were omitted from the specialist centre, 16% seen by chest physicians, and 2% seen by the Compensation Board. Other methods of diagnosis were used only infrequently outside the specialist unit. Fifty six per cent of reporting physicians considered that the mechanism of asthma was allergy compared with 18% who believed that it was irritation. Twenty eight per cent of workers were exposed to the suspected causative agent at the time of diagnosis, 38% were either on long term sickness absence, had retired, or had become unemployed. More workers (38%) who were exposed to agents recognised for statutory compensation before the 1991 changes seen at the specialist centre reach compensation and were reported to the scheme by the Compensation Board than those seen by chest physicians (9%). CONCLUSIONS--These recognised incidences are likely to be an underestimate of the true incidence. They highlight at risk occupations and suggest underdiagnosis in some District Health Authorities. They suggest that diagnostic methods are underused outside specialist centres and that the mechanism of asthma is generally considered to be allergic AU - Gannon PFG AU - Burge PS LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - Health, employment, and financial outcomes in workers with occupational asthma. PG - 491-496 AB - OBJECTIVE--To study the health, employment, and financial outcome of occupational asthma. DESIGN--A follow study of workers with confirmed occupational asthma. SETTING--A specialist occupational lung disease clinic. SUBJECTS--All workers had a diagnosis of occupational asthma made at least one year earlier. Diagnosis was confirmed by serial peak expiratory flow measurement, specific bronchial provocation testing, or specific immunology. MAIN OUTCOME MEASURES--Respiratory symptoms, medication, pulmonary function, employment state, and financial position. RESULTS--112 of a total of 140 eligible workers were followed up. 32% of patients remained exposed to the causative agent. These workers had more symptoms at follow up than those removed and a greater number were taking inhaled steroids. Continued exposure was also associated with a fall in % predicted forced expiratory volume in one second (FEV1) of 3% compared with that at presentation. Their median loss of annual income due to occupational asthma was 35%. Those removed from exposure were worse off financially (median loss 54% of annual income), had fewer respiratory symptoms than the group who remained exposed, and their % predicted FEV1 had improved by 4.6%. Statutory compensation and that obtained by common law suits did not match the loss of earnings due to the development of occupational asthma. Of the workers removed from exposure, those who no longer complained of breathlessness had been diagnosed significantly earlier after the onset of their first symptom (48 v 66 months, p = 0.001) and had a significantly higher FEV1 at presentation (90% v 73% predicted, p = 0.008) compared with those who were still breathless. They had developed symptoms earlier after first exposure (48 v 66 months, p > 0.05) and had been removed from exposure sooner (eight v 12 months, p > 0.05). CONCLUSION--Removal from exposure after diagnosis of occupational asthma is beneficial in terms of symptoms and lung function, but is associated with a loss of income. Early diagnosis is important for symptomatic improvement after removal from exposure. Inadequate compensation may contribute to the workers' decision to remain exposed after diagnosis AU - Gannon PF AU - Weir DC AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 15 IP - DP - 1993 Jan 01 TI - Occupational asthma: fate and management after the diagnosis PG - 27-31 AU - Moscato G AU - Bertoletti R AU - Biscaldi G AU - Dellabianca A AU - Niniano R AU - Colli MC LA - PT - DEP - TA - G Ital Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 148 IP - DP - 1993 Jan 01 TI - Effects of inhaled beclomethasone on airway responsiveness in occupational asthma. Placebo-controlled study of subjects sensitized to toluene diisocyanate PG - 407-412 AB - We investigated the effect of 5 months of treatment with inhaled beclomethasone dipropionate (BDP) on the airway responsiveness to methacholine (PD20 FEV1) and to toluene diisocyanate (TDI) in 15 sensitized asthmatic subjects who had been removed from occupational exposure to TDI. After the diagnosis was established by a positive inhalation challenge with TDI, each subject was removed from occupational exposure to isocyanates and treated with either BDP (1 mg twice per day, n = 7) or placebo (n = 8) for 5 months. The study was double blind for parallel groups. P20 FEV1 methacholine was measured before and three times during treatment and then at 6 months, that is, 4 wk after cessation of treatment. Airway sensitivity to TDI was assessed with specific inhalation challenge before treatment and at 6 months. Beclomethasone reduced the airway hyperresponsiveness to methacholine but did not affect the response to TDI. In fact, in the subjects on BDP, P20 FEV1 increased from 0.145 to 0.485 mg (p : 0.05) after 2 months of treatment. A further increase was observed at 4 and 5 months (0.548 and 0.629 mg, respectively, p : 0.01), and the improvement in nonspecific airway responsiveness was maintained after a 1-month washout period (0.637 mg, p : 0.01). In contrast, in the subjects on placebo, P20 FEV1 did not change significantly. At the end of the study, the severity of asthmatic reactions induced by bronchial challenge with TDI was significantly reduced in both groups, but no differences were observed between placebo and BDP.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Maestrelli P AU - DeMarzo N AU - Saetta M AU - Boscaro M AU - Fabbri LM AU - Mapp CE LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 28 IP - DP - 1993 Jan 01 TI - BAKERS' ASTHMA. FOLLOW-UP INVESTIGATIONS PG - 373-376 AU - Ulmer WTG AU - Kerz G LA - PT - DEP - TA - Arbeitsmedizin Sozialmedizin Praeventivmedizin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 91 IP - DP - 1993 Jan 01 TI - Quality of life of subjects with occupational asthma PG - 1121-1127 AB - BACKGROUND The aim of the study was to assess the quality of life in subjects with occupational asthma after removal from exposure to the offending agent by comparison with a group of subjects paired for clinical and functional indices in order to show the separation between the two groups of subjects with a hypothesized different quality of life and relate the impairment in quality of life to anthropometric, clinical, and functional variables. METHODS A previously described asthma quality of life questionnaire (Juniper EF, et al. Thorax 1992;47:76-83) was administered to two groups of subjects in a prospective manner. Information on the clinical and functional severity of asthma was obtained from each subject. Two groups of subjects were assessed: group 1, 134 subjects with occupational asthma who were seen more than 2 years after the diagnosis was confirmed, and group 2, 91 subjects who were seen in specialized asthma clinics of tertiary care hospitals for treatment of nonoccupational asthma and matched with 91 of the 134 subjects with occupational asthma from group 1 according to need for medication and (when available), baseline forced expiratory volume in 1 second (FEV1), and level of bronchial responsiveness. RESULTS A statistically significant difference was seen in the four domains (asthma symptoms, limitation of activities, emotional dysfunction, environmental stimuli) and in the total score of the quality of life questionnaire between the two groups of matched subjects; the mean difference in the total score was 0.6 on a scale of 1 (no limitation or none of the time) to 7 (severe limitation or all the time). A weak but statistically significant correlation between the total score and several indices (FEV1, bronchial responsiveness and asthma severity) was generally obtained. CONCLUSION The quality of life of subjects with occupational asthma is slightly less satisfactory than that of subjects paired for clinical and functional indices, although the magnitude of the difference is small; and quality of life is weakly correlated with clinical and functional indices. AU - Malo JL AU - Boulet LP AU - Dewitte JD AU - Cartier A AU - L'Archeveque J AU - Cote J AU - Bedard G AU - Boucher S AU - Champagne F AU - Tessier G etal LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - Grass pollen, thunderstorms and asthma PG - 354-359 AU - Knox RB LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 23 IP - DP - 1993 Jan 01 TI - Allergenicity of the cat flea PG - 347-349 AU - Baldo BA LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 48 IP - DP - 1993 Jan 01 TI - Discriminant analysis of symptom pattern and serum antibody titres in humidifier related disease PG - 496-500 AB - IgG related to humidifier fever but not sbs, little relation to smoking, but exposure related. Volunteer study with few normals affects stats AU - McSharry CP AU - Anderson K AU - Speekenbrink A AU - Lewis C AU - Boyd G LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 50 IP - DP - 1993 Jan 01 TI - An epidemiological study of the health of Sri Lankan tea plantation workers associated with long term exposure to paraquat. case control PG - 257-263 AB - Pulmonary function tests (FVC, FEV1, FEV1/FVC%, TLCO, single breath CO diffusion), chest x ray film, renal function (serum creatinine and blood urea nitrogen), liver function (serum alanine aminotransferase, aspartate transferase, and alkaline phosphatase, bilirubin, total protein, and albumin), a haematological screen (haemoglobin and packed cell volume), and a general clinical examination were performed on 85 paraquat spraymen (mean spraying time 12 years) and on two control groups (76 factory workers and 79 general workers) frequency matched for age and years of occupational service. All the subjects were men. There were no clinically important differences in any of the measurements made between the study group and the two control groups. In particular the results of the lung function tests, appropriate for paraquat toxicity of the study group, were similar to those of the control groups. The same was true of blood tests for liver and kidney function. The incidence of skin damage, nose bleeds, and nail damage in the study group was slightly higher than in the control groups but lower than the incidence reported for paraquat workers in previous studies. The results of this study confirmed that long term spraying of paraquat, at the concentrations used, produced no adverse health effects, in particular no lung damage, attributable to the occupational use of the herbicide. AU - Senanayake N AU - Gurunathan G AU - Hart TB AU - Amerasinghe P AU - Babapulle M AU - Ellapola SB AU - Udupihille M AU - Basanayake V LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 91 IP - DP - 1993 Jan 01 TI - Hypersensitivity Pneumonitis and Exposure to Acid-Fast Bacilli in Coolant Aerosols PG - 311- AB - Water-based coolants are routinely colonized with microorganisms which form a part of the coolant mist. Dominant microbes in water-based coolants are usually Gram negative (GM-) bacilli, and reported health effects have been restricted to relatively small cross-shift changes in pulmonary function. After i0 workers exposed to coolant mist developed hypersensitivity pneumonitis (HP), we studied microbes in two coolant sumps (A associated with cases and B as a control). Fluids were cultured on R2A and malt extract agars for 5-7 days at 30°C & 25°C respectively, colonies counted, fungi identified, and bacteria Gram stained, and acid-fast stained using the auramine fluorochrome procedure. Sump A contained 10(6)-10(7) Gram-positive, acidfast bacilli (AFB) per ml of fluid, and no yeasts or fungi. Biocldes were added, the fluid removed, the system cleaned with dilute bleach, and a new brand of fluid introduced. Levels of AFB rose to 5000 after 5 days, and to 7x10(5) after 2 weeks. A different fluid in Sump B co~tained 10(7)-10(9) GM- bacteria, 10(5) yeasts, and I0(4)Fusarium/ml. One of the workers with HP had strong precipitin hands against the sump A fluid, and an atypical "Mycobacterium" infection. This is the first report of a possible connection between exposure to AFB bacilli and HP, and emphasizes the need to monitor the kinds of organisms in reservoirs that contribute to aerosols and human exposure. AU - Muilenberg ML AU - Burge HA AU - Sweet T LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19930101 IS - IS - VI - 24 IP - DP - 1993 Jan 01 TI - Organic dust exposures from compost handling: Case presentation and respiratory exposure assessment PG - 365-374 AB - Inhalation of dust from contaminated organic materials may result in acute respiratory tract illness. Possible mechanisms include toxic and cellular reactions to microbial and other organic products or immunologic responses after prior sensitization to an antigen. A case is presented of a 52 year old male who developed fever, myalgia, and marked dyspnea 12 hr after shoveling composted wood chips and leaves. Inspiratory crackles, hypoxemia, and bilateral patchy pulmonary infiltrates were seen. Precipitating antibody tests for the usual antigens were inconclusive. He improved over 3 days. In order to assess the environmental conditions the patient had experienced, we returned to the site to reproduce and measure respiratory exposures during hand loading of the compost. Visible clouds of fine particulate were easily generated during handling activities. Microscopic examination of these dusts indicated a predominance of spores. Endotoxin concentrations from inspirable and respirable dust samples ranged from 636 to 16,300 endotoxin units/m3. Levels of contaminants found were consistent with those associated with respiratory illness in other agricultural settings. Two respiratory disorders, hypersensitivity pneumonitis (HP) and organic dust toxic syndrome (ODTS), may occur after exposure to organic dusts containing fungal spores and endotoxins. Despite extensive clinical and environmental investigations, we were unable to differentiate these two disorders, and suggest they may represent parts of a spectrum of responses to complex organic dusts, rather than completely distinct clinical entities. AU - Weber S AU - Kullman G AU - Petsonk AU - E AU - Jones G W AU - Olenchock S AU - Sorenson W AU - Parker J AU - Marcelo-Baciu R AU - Frazer D AU - Castranova V LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 89 IP - DP - 1992 Jan 01 TI - Evaluation of cutaneous responses and lung function from exposure to opiate compounds among ethical narcotics-manufacturing workers PG - 108-118 AB - We recently demonstrated morphine-6-hemisuccinate-human serum albumin conjugate (M-6-HS-HSA)—specific IgG in serum from ethic narcotics-manufacturing workers. In this article, we present results of epicutaneous tests to opiate compounds and lung-function studies in these same workers. Thirty-nine workers, exposed to opiates, were evaluated for possible work-related changes in lung function and were administered a questionnaire concerning opiate exposure and health history in February 1988. In December 1988, 33 employees with occupational exposure to opiates, six other workers (New Jersey referent) employed at the same factory with minimal exposure to opiate compounds, and 17 nonexposed individuals from Cincinnati, Ohio, were subjected to epicutaneous threshold testing with a panel of six opiate compounds and nine common aeroallergens. In opiate-exposed workers, significantly lower epicutaneous threshold concentrations were detected (compared to New Jersey referent and Cincinnati control subjects) for dihydrocodeine (p<0.01), hydrocodone (p<0.05), codeine (p<0.01), and morphine (p<0.05). Significant associates existed among epicutaneous threshold concentrations between the agents tested; that is, individuals with a positive morphine skin test would generally have a positive codeine skin test, etc. Atopic status (positive cutaneous test results to two or more of nine common aeroallergens) was not significantly associated (p>0.05) with positive opiate skin sensitivity. Although the mean cross-shift decrements in FEV1 for all workers were nonsignificant, five opiate-exposed individuals demonstated cross-shift decrements in FEV1 of >10%. Daily maximum-minus-minimum changes in workweek PEFR (PEFRmax-min) were significantly reduced for Monday through Thursday (p<0.05) compared to PEFRmax-min changes during a nonwork, nonexposure 3-day weekend. Ten exposed workers demonstrated daily PEFRmax-min changes of >20%, suggesting acute airway obstruction. Increased cutaneous reactivity to opiate compounds among opiate-exposed workers may reflect development of pharmacologic hyperresponsiveness to opiate compounds. Keywords: Hypersensitivity; asthma; morphine; codeine; dihydrocodeine; oxycodone; hydrocodone; antibodies; lung function AU - Biagini RE AU - Bernstein DM AU - Klincewicz SL AU - Mittman R AU - Bernstein IL AU - Henningsen GM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 305 IP - DP - 1992 Jan 01 TI - Breathing" coal mines and surface asphyxiation from stythe (black damp). PG - 509-510 AB - That disused coal mines "breathe" is well recognised within the mining industry, though the surprisingly close parallel with mammalian breathing may not be so widely appreciated. By contrast, the effect on surface communities living in the path of the expired mine air seems to have attracted scant attention. Though access shafts are often sealed when a coal mine is abandoned, the airways within the mine may remain patent, depending on the degree of subsidence, and a substantial volume of alveolar air (potentially as much as 500 million litres per km2 of shallow mined seam) may retain immediate contact with exposed coal faces, tunnel walls, and pit props. This allows metabolic oxidative processes to continue, thereby removing oxygen and replacing it (partially) with carbon dioxide. The process would be self limiting in the absence of ventilation, but some mines are connected by geological pores of Kohn to a natural positive pressure respirator-the earth's atmosphere. At times of stable weather and high atmospheric pressure fresh air is forced into these mines with a tidal volume which may reach several million litres per kM2, thereby allowing tissue respiration to continue. As atmospheric pressure returns (fairly quickly) to normal the mine expires a similar volume, which consists of its alveolar air mixed with the recently inspired fresh air. Such a mixture may pose little hazard, but when weeks or months later there is a storm and a rapid and profound fall in atmospheric pressure the mine may expire undiluted alveolar air with a dangerously low oxygen content at a forced expiratory volume in one second of several hundred litres per km2. This alveolar air is known locally in north east England as stythe or stythe gas but is more generally called black damp or choke damp-a reflection on the occupational threat it has posed to generations of coal miners. Far less commonly it may threaten overlying communities if it accumulates under impervious layers of rock or clay and then finds access to a limited area on the surface through fissures or faults. Such an event occurred recently in Newcastle upon Tyne. AU - Hendrick DJ AU - Sizer KE LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Effect of Cigarette Smoking on Prevalence of Summer-type Hypersensitivity Pneumonitis Caused by Trichosporon Cutaneum PG - 274-278 AB - We investigated the effect of cigarette smoking on the prevalence of summer-type hypersensitivity pneumonitis (SHP) caused by Trichosporon cutaneum. In the adult family members of SHP patients, we found that 27 of 41 (65.9%) nonsmokers were SHP patients, compared with 3 of 11 (27.3%) smokers (p < .05). Also, the prevalence of anti-T. cutaneum antibody was significantly lower in the smokers (p < .05). A questionnaire provided to 209 SHP patients revealed that the smoking rates of male and female SHP patients were significantly lower (p < .01) than rates in the normal Japanese population. However, no difference was found in serum anti-T. cutaneum antibody activities or the bron-choalveolar lavage lymphocyte phenotypes for smoking and nonsmoking SHP patients. It was concluded that cigarette smoking had a suppressive effect on the outbreak of SHP, but smoking caused no further suppression after the disease was established. AU - Arimaa K AU - Andoa M AU - Itoa K AU - Sakataa T AU - Yamaguchia T AU - Arakia S AU - Futatsukab M LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 97 IP - DP - 1992 Jan 01 TI - Sequential Respiratory, Psychologic, and Immunologic Studies in Relation to Methyl Isocyanate Exposure over Two Years with Model Development PG - 241-253 AB - Sequential Respiratory, Psychologic, and Immunologic Studies in Relation to Methyl Isocyanate Exposure over Two Years with Model Development Of 113 methyl isocyanate (MIC)-exposed subjects studied initially at Bhopal, India, 79, 56, 68, and 87 were followed with clinical, lung function, radiographic, and immunologic tests at 3, 6, 12, 18, and 24 months. Though our cohort consisted of subjects at all ages showing a varied severity of initial illness, fewer females and young subjects were seen. Initially all had eye problems, but dominant symptoms were exertional dyspnoea, cough, chest pain, sputum, and muscle weakness. A large number showed persistent depression mixed with anxiety with disturbances of personality parameters The early radiographic changes were lung oedema, overinflation, enlarged heart, pleural scars, and consolidation. The persistent changes seen were interstitial deposits. Lung functions showed mainly restive changes with small airway obstruction; there was impairment of oxygen exchange. Oxygen exchange improved at 3-6 months, and spirometry improved at 12 months, only to decline later. The expiratory flow rates pertaining to large and medium airway function improved, but those for small airways remained low. There were changes of alveolitis in bronchoalveolar lavage fluid on fibre optic bronchoscopy, and in 11 cases positive MIC-specific antibodies to IgM, IgG, and IgE were demonstrated. On follow up, only 48% of the subjects were clinically stable, while 50% showed fluctuations. Thirty-two percent of the subjects had lung function fluctuations. Detailed sequential behaviour over 24 years was predicted for dyspnoea, forced vital capacity, maximum expiratory flow rate (Q25-475), peak expiratory flow rate, Vo2, and depression score. A model for clinical behaviour explained a total variance of52A% by using the factors of cough, Pco2 and X-ray zones in addition to above five parameters. The behaviour of the railway colony group (1640 patients) revealed a similar pattern of illness. When this observed pattern of changes was transferred to the affected Bhopal city sections (with an equitable age-sex distribution), our model results were again validated. Thus the picture of MIC-induced disease seems similar despite the differences for age-sex and initial severity of illness in our cohort and in the population of Bhopal city as predicted by our model. AU - Kamat SR AU - Patel MH AU - Pradhan PV AU - Taskar SP AU - Vaidya PR AU - Kolhatkar VP AU - Gopalani JP AU - Chandarana JP AU - DalaI N AU - Naik M LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Occupational asthma due to EPO 60 PG - 294-295 AB - We report a case of asthma caused by exposure at work to EPO 60, an epoxy resin hardening agent. Inhalation tests with the hardening agent and resin reproducibly provoked an isolated late asthmatic response without change in airway responsiveness to inhaled histamine. AU - Lambourn EM AU - Hayes JP AU - McAllister WAC AU - Newman Taylor AJ LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Purification and characterisation of major inhalent allergens from soybean hulls PG - 748-755 AU - Gonzalez R AU - Polo F AU - Zapatero L AU - Caravaca F AU - Carreira J LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 21 IP - DP - 1992 Jan 01 TI - Compensating byssinosis [editorial] PG - 293-294 AU - White NW AU - Cheadle H LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Oilseed rape- a new allergen? PG - 501-505 AU - Fell PJ AU - Soulsby S AU - Blight MM AU - Brostoff J LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Allergens and storage mites PG - 429-431 AU - van HageHamsten M LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 89 IP - DP - 1992 Jan 01 TI - Latex antigens PG - 673-678 AU - Slater JE AU - Chhabra SK LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 90 IP - DP - 1992 Jan 01 TI - Natural history of occupational asthma: relevance of type of agent and other factors in the rate of development of symptoms in affected subjects PG - 937-944 AB - It is unknown whether factors such as the nature of the agent, gender, age, atopy, smoking habits, continuous or noncontinuous exposure, and pattern of asthmatic reaction can influence the rate of development of symptoms in subjects with occupational asthma. We compared several clinical and functional parameters among three groups of subjects with occupational asthma caused by Western red cedar (group 1, n = 433), isocyanates (group 2, n = 107), and high molecular weight agents acting through an IgE-mediated mechanism (group 3, n = 121). Survival analysis showed that the three curves relating years of exposure before onset of symptoms to the proportion of subjects without symptoms were significantly different in two respects: (1) almost 40% of subjects in groups 1 and 2 as compared with 20% of subjects in group 3 became symptomatic within 1 year of exposure; (2) after 5 years of exposure, the rate of sensitization was slower for subjects in groups 2 and 3 as compared with those in group 1. Having a nonimmediate reaction at the time of specific inhalation challenges, being continuously exposed and being younger slightly increased the risk at each time point on the curve of developing symptoms in subjects with occupational asthma. These data suggest that the natural history for onset of occupational asthma is different depending on the sensitizing agent. Factors such as age, type of exposure, and pattern of reaction on exposure to the agent also modulate the rate of development of this condition AU - Malo JL AU - Ghezzo H AU - D'Aquino C AU - L'Archeveque J AU - Cartier A AU - ChanYeung M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 43 IP - DP - 1992 Jan 01 TI - The objective evaluation of pulmonary ventilation at workplaces using PEFR PG - 1-5 AU - Gorski P AU - Bilewicz P LA - PT - DEP - TA - Med Pr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 83 IP - DP - 1992 Jan 01 TI - Monitoring Of Peak Expiratory Flow Rates During Occupational Asthma Treatment PG - 157-166 AB - The purpose of this study was to evaluate the effect of anti-inflammatory drug treatment on respiratory symptoms and lung function in twelve subjects with occupational asthma while at work. PEFR was monitored for four weeks and antiasthmatic drugs (salbutamol, chromolyn sodium and beclomethasone dipropionate) were administered for three weeks, starting after the first week of PEFR monitoring, in an unchanged working environment. After treatment five subjects became asymptomatic, six improved and one continued to have unchanged work-related asthmatic symptoms. There were only minor increases in forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and mean forced expiratory flow during the middle half of FVC (FEF25-75). Bronchial reactivity was studied in eleven subjects: six worsened and five improved. PEFR at 0600 h increased by 9.4% in nine responders and decreased by 5.8% in three non-responders. After treatment diurnal variation (DV) in PEFR decreased by 28.4% in responders and 30.8% in non-responders, even if at the fourth week it was 1.75 higher in non-responders compared to responders. In conclusion, in this study a continuous treatment of occupational asthma with anti-inflammatory drugs minimized respiratory symptoms, slightly increased PEFR and greatly reduced DV in PEFR. AU - Siracusa A AU - Forcina A LA - PT - DEP - TA - Med Del Lavoro JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 21 IP - DP - 1992 Jan 01 TI - A new case of occupational asthma from reactive dyes with severe anaphylactic response to the specific challenge PG - 209-216 AB - A case of occupational asthma in a wool and cotton dyer handling reactive dyes is described. The patient was skin positive, but asymptomatic to house dust mites. A bromoacrilamidic dye (Lanasol Yellow 4G) has been identified through chamber inhalation challenge as being responsible for the sensitization. A very short (4-minute) exposure produced a severe immediate obstructive ventilatory defect followed by arterial hypotension and urticaria. Bronchial hyperresponsiveness as tested through metacholine challenge was absent both in basal conditions and after the dye challenge. Both prick and patch test for the dye were positive in the absence of any sign of contact dermatitis AU - Romano C AU - Sulotto F AU - Pavan I AU - Chiesa A AU - Scansetti G LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - Effect of cessation of exposure to toluene diisocyanate (TDI) on bronchial mucosa of subjects with TDI-induced asthma PG - 169-174 AB - The effect of cessation of exposure to toluene diisocyanate (TDI) was studied in six patients with TDI-induced asthma, proved by a positive inhalation challenge with TDI. Bronchial challenges with TDI and methacholine were performed, and lobar bronchial biopsies were taken at diagnosis and 6 months later, after cessation of exposure. Biopsies from four nonasthmatic control subjects were also examined. At diagnosis, asthmatic subjects had thickened reticular basement membrane (p less than 0.05) and increased numbers of mononuclear cells (p less than 0.05) and eosinophils (p less than 0.05) in the lamina propria when compared with control subjects. Electron microscopy showed degranulation of eosinophils and mast cells in asthmatics. Six months after cessation of exposure, the thickness of reticular basement membrane was significantly reduced compared with that at diagnosis (p less than 0.05), and it decreased to values similar to those of control biopsies. Inflammatory cell numbers in bronchial mucosa of asthmatic subjects did not change significantly 6 months after removal from exposure, and degranulation of eosinophils and mast cells was still present. At the end of the study, airway hyperresponsiveness to methacholine and/or sensitivity to TDI persisted in most of the asthmatic patients despite the cessation of exposure and the disappearance of asthmatic symptoms. In conclusion, in patients with occupational asthma induced by TDI, the avoidance of exposure to the sensitizing agent for 6 months is able to reverse the reticular basement membrane thickening in the bronchial mucosa, but the inflammatory cell infiltrate, the specific sensitivity to TDI, and the nonspecific airway hyperreactivity may persist AU - Saetta M AU - Maestrelli P AU - Di Stefano A AU - De Marzo N AU - Milani GF AU - Pivirotto F AU - Mapp CE AU - Fabbri LM LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Guidelines for the diagnosis of occupational asthma. Subcommittee on 'Occupational Allergy' of the European Academy of Allergology and Clinical Immunology PG - 103-108 AB - The 'Guidelines for the diagnosis of Occupational Asthma' have been written by the Subcommittee on Occupational Allergy of the European Academy of Allergology and Clinical Immunology to give common diagnostic criteria in the evaluation of individual patients with suspected occupational asthma. The suggested diagnostic procedure includes five steps. 1. History suggestive of occupational asthma. 2. Confirmation of bronchial asthma, with demonstration of reversibility of bronchial obstruction, of non-specific bronchial hyperreactivity and of increased diurnal variability of peak expiratory flow rates (PEFR). 3. Confirmation of work-related bronchoconstriction with serial measurements of PEFR and of non-specific bronchial reactivity. 4. Confirmation of sensitization to occupational agents with skin tests and/or in vitro tests to detect specific immunoglobulins. 5. Confirmation of causal role of occupational agent with specific bronchial challenges. Requirements, advantages and limitations are discussed for each of the suggested techniques AU - Anonymous LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Serial measurements of peak expiratory flow and responsiveness to methacholine in the diagnosis of aluminium potroom asthma PG - 292-297 AB - Background Obstructive airways disease in aluminium potroom workers has been recognised for over 50 years. There is still controversy about whether this is true occupational asthma. Methods A cross-sectional survey of 379 potroom workers identified 26 subjects with symptoms suggestive of occupational asthma. Of these 26, 14 were considered by the plant physician to have occupational asthma and have a measurable PC20 methacholine. These 14 were further investigated by serial measurements of PEF at home and work, symptom diaries and measurements of methacholine reactivity before and after a three-week holiday. Results There was a good correlation between daily symptom scores and minimum PEF measurements; these showed changes characteristic of occupational asthma in 10 workers, with increased diurnal variation in PEF and consistent deterioration in relation to work exposure. One further record showed probable occupational asthma and two showed consistent small changes in PEF related to work exposure more in keeping with an irritant effect. Only one record was inadequate. Methacholine reactivity on a work-day was within the normal range in 13 subjects. A doubling of PC20 methacholine occurred in five of nine subjects with occupational asthma in whom repeated measurements were possible. Conclusion This study confirms the existence of aluminium potroom asthma. The lack of correlation with measurements of non-specific responsiveness suggests that the primary mechanism is one of hypersensitivity, perhaps enhanced by the bronchial irritants also present in the potroom. AU - Kongerud J AU - Soyseth V AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 89 IP - DP - 1992 Jan 01 TI - Activated T-lymphocytes and eosinophils in the bronchial mucosa in isocyanate-induced asthma PG - 821-829 AB - We have studied the phenotype and activation status of leukocytes in the bronchial mucosa in patients with isocyanate-induced asthma. Fiberoptic bronchial biopsy specimens were obtained from nine subjects with occupational (five toluene- and four methylene diisocyanate-sensitive) asthma, 10 subjects with extrinsic asthma, and 12 nonatopic healthy control subjects. Bronchial biopsy specimens were examined by immunohistology with a panel of monoclonal antibodies and the alkaline phosphatase-antialkaline phosphatase method. There was a significant increase in the number of CD25+ cells (interleukin-2 receptor-bearing cells, presumed "activated" T-lymphocytes; p less than 0.01) in isocyanate-induced asthma compared with that of control subjects. There were also significant increases in major basic protein (BMK-13)-positive (p less than 0.02) and EG2-positive (p less than 0.01) cells that represent total and "activated" eosinophil cationic protein-secreting eosinophils, respectively. In agreement with our previous findings, CD25+ (p less than 0.01), BMK-13 (p less than 0.03), and EG2+ (p less than 0.01) cells were also elevated in extrinsic asthma. No significant differences were observed in the numbers of T-lymphocyte phenotypic markers (CD3, CD4, and CD8) between subjects with asthma (isocyanate-induced and extrinsic) and control subjects. Similarly, no significant differences in immunostaining for neutrophil elastase (neutrophils) or CD68 (macrophages) were observed. The results suggest that isocyanate-induced occupational asthma and atopic (extrinsic) asthma have a similar pattern of inflammatory cell infiltrate. The results support the view that T-lymphocyte activation and eosinophil recruitment may be important in asthma of diverse etiology AU - Bentley AM AU - Maestrelli P AU - Saetta M AU - Fabbri LM AU - Robinson DS AU - Bradley BL AU - Jeffery PK AU - Durham SR AU - Kay AB LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 60 IP - DP - 1992 Jan 01 TI - DNA damage in human white blood cells after inhalative exposure to methylenediphenyl diisocyanate (MDI)--case report PG - 131-138 AB - A workplace-related inhalative exposure test in a challenge chamber was performed on an industrial worker in a methylenediphenyl diisocyanate (MDI) atmosphere from 5 to 20 ppb and the isolated white blood cell DNA was analysed by electrophoresis, anion-exchange chromatography and melting behaviour. The results of electrophoresis indicate that inhaled MDI induces double-strand breaks of DNA. Some of the DNA fragments were estimated to be in the region of 100-500 bp. Anion-exchange chromatography confirmed this finding. Following denaturation and rapid renaturation the results demonstrated that some DNA fragments are cross-linked by MDI. Comparing the melting curves before and after inhalative exposure in the challenge test chamber, genomic DNA revealed differences in the shape of the melting curve (hyperchromic effect). The results suggest that occupational MDI exposure could be associated with white blood cell DNA damage AU - Marczynski B AU - Czuppon AB AU - Hoffarth HP AU - Marek W AU - Baur X LA - PT - DEP - TA - Toxicol Lett JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 89 IP - DP - 1992 Jan 01 TI - Latex hypersensitivity after natural delivery PG - 779-780 AU - Laurent J AU - Malet R AU - Smiejan JM AU - Madelenat P AU - Herman D LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 101 IP - DP - 1992 Jan 01 TI - A raised level of soluble CD8 in bronchoalveolar lavage fluid in summer-type hypersensitivity pneumonitis in Japan PG - 1044-1049 AB - We used ELISA to measure soluble CD8 (sCD8) in the bronchoalveolar lavage fluid (BALF) and serum of patients with summer-type hypersensitivity pneumonitis (HP). The sCD8 levels in BALF were significantly higher in the patients with summer-type HP, surpassing those found in sarcoidosis and the other pulmonary diseases studied; however, the sCD8 levels in the serum of patients with summer-type HP did not differ from the levels of the healthy controls. The numbers of CD8+ T cells were increased in the BALF of the patients with summer-type HP, and there was a correlation between the sCD8 levels and the concentrations of CD8+ T cells. Gel filtration and polyacrylamide gel electrophoresis of the fluid revealed that the anti-CD8 monoclonal antibody-reactive components in the BALF of patients with pneumonitis corresponded to a protein with a molecular weight of between 52 and 54 kDa. Soluble CD8-rich fraction purified from the BALF of patients with summer-type HP augmented in vitro lymphocytes' proliferative responses stimulated with Cryptococcus neoformans, one of the causative agents for summer-type HP. Our result suggests that soluble CD8 in the BALF may play an important role in the pathogenesis of summer-type HP AU - Hamagami S AU - Miyagawa T AU - Ochi T AU - Tsuyuguchi I AU - Kishimoto S LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 86 IP - DP - 1992 Jan 01 TI - An investigation of the relationship between microbial and particulate air pollution and the sick building syndrome PG - 225-235 AB - The sick building syndrome has been the subject of research for approximately 10 years. Although it is often suggested that symptoms in office workers are due to circulating micro-organisms or particles, epidemiological studies investigating the relationship between them have been lacking. This cross-sectional study has combined medical and aerobiological assessments of offices in Great Britain and has found that, although airborne particulates and micro-organisms are unlikely to be the sole cause of the sick building syndrome, positive associations between symptom prevalence rates and levels of airborne viable bacteria and fungi within groups of buildings with similar ventilation systems, suggest a possible causal link that should be explored. AU - Harrison J AU - Pickering CAC AU - Faragher EB AU - Austwick PKC AU - Little SA AU - Lawton L LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 5 IP - DP - 1992 Jan 01 TI - Occupational Asthma: Validity Of Monitoring Of Peak Expiratory Flow Rates And Non-Allergic Bronchial Responsiveness As Compared To Specific Inhalation Challenge PG - 40-8 AB - The sensitivity and specificity of monitoring peak expiratory flow rates (PEFR) and bronchial responsiveness to the provocative concentration of histamine or methacholine (PC20) has been determined as compared to specific inhalation challenges in the diagnosis of occupational asthma. A prospective study of 61 subjects referred for occupational asthma to various agents was performed. PEFR was assessed every 2 h during a period away from work for at least 2 weeks. The period at work was 2 weeks, or less if there was increased symptomatology or marked changes in PEFR. At least one PC20 assessment was obtained at work and away from work. Graphs of PEFR and PC20 values were interpreted in blind fashion by three experienced readers. There was complete agreement among the three in 54 out of 61 instances (78%). Twenty five out of 61 subjects (41%) had positive specific inhalation challenges. The best index for comparing results of PEFR with specific inhalation challenges was the visual analysis of PEFR with sensitivity and specificity of 81% and 74%. All of the numerical indices were significantly less satisfactory. We conclude that visual analysis of PEFR is an interesting tool for investigating occupational asthma, although sensitivity and specificity values do not seem satisfactory enough to warrant using it alone AU - Perrin B AU - Lagier F AU - L'Archeveque J AU - Cartier A AU - Boulet LP AU - Cote J AU - Malo JL LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 8 IP - DP - 1992 Jan 01 TI - Reactive Airways Syndromes PG - 215-220 AU - Brooks SM LA - PT - DEP - TA - J Occup Health Safety Aust New Z JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 7 IP - DP - 1992 Jan 01 TI - Preventing potroom asthma in the aluminium industry PG - 16 AU - LA - PT - DEP - TA - Worksafe Aus JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 34 IP - DP - 1992 Jan 01 TI - Atopy and airways reactivity in animal health technicians PG - 53-60 AB - Smoking, response to allergen skin testing, and nonspecific airways reactivity in students entering a career program for animal health technicians (AHT) were studied at their entrance and 7 months into the program to determine whether such persons provide a suitable cohort to overcome the selection biases accompanying investigations of occupational asthma. Previous occupational exposure to animals (65%) was associated positively with allergic symptoms but negatively with skin response to animal allergens and to airway hyperreactivity (AR). AHTs remaining in the program were more likely than those dropping out to have (1) worked with animals, (2) positive skin responsiveness to animal allergens, and (3) AR; the latter was significantly associated with positive skin-test responses to animal allergen testing. This study demonstrates that significant exposure to animals may have occurred among workers entering animal-handling careers. Additionally, competing "healthy" and "resistant" worker effects operate among AHTs to influence the prevalence of occupational asthma in this population AU - Das R AU - Tager IB AU - Gamsky T AU - Schenker MB AU - Royce S AU - Balmes JR LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 83 IP - DP - 1992 Jan 01 TI - Histamine provocation test: an effective pre-employment selection method for aluminium workers PG - 422-427 AU - Looff AJA De AU - Dijkmans APG AU - Sorgdrager B LA - PT - DEP - TA - Med del Lavoro JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Haemolytic anaemia in a case of occupational asthma due to maleic anhydride PG - 142-143 AU - Gannon PFG AU - Burge PS AU - Hewlett C AU - Tee RD LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 68 IP - DP - 1992 Jan 01 TI - Occupational asthma caused by exposure to cooking lobster in the work environment: a case report PG - 360-361 AB - A 25-year-old male chef developed symptoms of cough, wheezing, and dyspnea following repeated exposure to cooking lobster in his work environment. Skin prick tests to lobster, mixed shellfish, haddock, cod, oysters, and clams were strongly positive. Skin prick tests to other routine antigens were negative except for Alternaria fungal spores. Bronchial inhalation of aqueous lobster extract resulted in an isolated early asthmatic response AU - Patel PC AU - Cockcroft DW LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - Occupational asthma caused by a hardener containing an aliphatic and a cycloaliphatic diamine PG - 1217-1218 AB - An otherwise healthy 44-yr-old man experienced a serious attack of bronchial obstruction after working with resins and hardeners, releasing fumes of a mixture of an alipathic and a cycloaliphatic diamine hardener. Eight hours after deliberate challenge with the hardener a large increase of airway resistance was found. Seventy-two hours after challenge, eosinophilia in the bronchoalveolar lavage (BAL) fluid together with a decrease of peripheral eosinophils was seen. After cessation of contact with this hardener, no more acute episodes occurred, although maintenance treatment with a topical corticosteroid and a beta 2-agonist remained necessary. A BAL performed 1 yr later showed a normal cell distribution. The results suggest that these aliphatic and cycloaliphatic diamine hardeners may be occupational hazards. Eosinophil inflammation may play a causal role AU - Aleva RM AU - Aalbers R AU - Koeter GH AU - De Monchy JG LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 21 IP - DP - 1992 Jan 01 TI - Allergic asthma to Bacillus subtilis enzyme: a model for the effects of inhalable proteins PG - 587-593 AB - The passage of 24 years since the diagnosis of allergic asthma in heavily exposed workers and in a few consumers due to dusty enzyme preparations of Bacillus subtilis compounded with laundry powder makes it possible to review objectively the many problems it raised. It emphasizes the lessons to be learned, relevant to inhalable enzyme products and to other inhalable proteins in general. Occupational allergic respiratory diseases were little studied at the time and the enzyme problems stimulated interest in what has now become a well-established and important field of medicine involving not only protein allergens but low molecular weight chemicals as well AU - Pepys J LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 21 IP - DP - 1992 Jan 01 TI - Hard metal interstitial pulmonary disease associated with a form of welding in a metal parts coating plant PG - 363-373 AB - We describe two cases of hard metal pulmonary disease (one fatal) in workers employed in the same area of a metal coating plant using the detonation gun process for applying a durable metal surface to metal parts. In this form of welding, a mixture of powdered metals, including tungsten carbide and cobalt, is heated by ignition of a flammable gas and propelled from the end of the "gun" at high temperature and velocity to form a welded metal coating. This process is done in an enclosed chamber and with each application, large volumes of fine aerosols are created. Inhalation exposure to hard metal may occur during the mounting and removal of the metal parts between applications, in spite of engineering controls and industrial hygiene surveillance. One of the cases presented with minimal chest x-ray abnormalities and an obstructive pattern on pulmonary function testing, although subsequent open lung biopsy showed diffuse interstitial pulmonary fibrosis. The fact that two cases of hard metal pulmonary interstitial disease occurred where thorough exposure control procedures and a surveillance program for cobalt were in place may indicate the need for revisions of the current technology used when hard metal is applied in the detonation gun process AU - Figueroa S AU - Gerstenhaber B AU - Welch L AU - Klimstra D AU - Smith GJ AU - Beckett W LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Pulmonary function and symptoms in workers exposed to wood dust PG - 84-87 AB - mean reduction of pft with exposure AU - Shamassain MH LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Bronchial allergen challenge: dose versus concentration PG - 219-225 AU - Frolund L AU - Madsen F AU - Scharling B AU - Heinig JH AU - Svendsen UG LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 118 IP - DP - 1992 Jan 01 TI - The hoarse obstetrician--an occupational hazard PG - 343-344 AU - Dowaliby JM LA - PT - DEP - TA - Archives of Otolaryngology -- Head & Neck Surg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 228 IP - DP - 1992 Jan 01 TI - The products of the reaction between toluene diisocyanate and water contract isolated guinea pig bronchi PG - 103-106 AB - We have investigated the ability of the products of the reaction between toluene diisocyanate (TDI) and water to contract bronchial smooth muscle. The experiments were performed in isolated guinea pig bronchi. TDI, both 2,4- and 2,6-toluenediamine (TDA) and mixtures of 2,4- and 2,6-TDA (ratio 80: 20 and 20:80) caused concentration-dependent contraction in the isolated bronchi. The mixture of disubstituted urea and biuret also contracted the bronchi, but not in a concentration-dependent fashion. Our results provide evidence that all products of the reaction between toluene diisocyanate and water have the ability to contract isolated bronchial smooth muscle in guinea pigs. Whatever the role of toluenediamine in the adverse respiratory effects induced by exposure to isocyanates, our findings reveal the necessity of in vivo studies on the metabolism of inhaled toluene diisocyanate in humans to improve our understanding of the mechanism of action of isocyanates AU - Mapp CE AU - Boniotti A AU - Papi A AU - Chitano P AU - Fabbri LM AU - Ciaccia A LA - PT - DEP - TA - Eur J Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - A nested case-control study of lung cancer among silica exposed workers in China PG - 167-171 AB - In an attempt to assess whether silica induces lung cancer, a nested case-control study of 316 male lung cancer cases and 1352 controls was carried out among pottery workers and tungsten, copper-iron, and tin miners from five provinces in south central China. Exposure to dust and silica for each study subject was evaluated quantitatively by cumulative exposure measures based on historical industrial hygiene records. Measurements on confounders such as inorganic arsenic, polycyclic aromatic hydrocarbons (PAHs), and radon were also collected from the worksites. Information on cigarette smoking was obtained by interviews of the subjects or their next of kin. A significant trend of increasing risk of lung cancer with exposure to silica was found for tin miners, but not for miners working in tungsten or copper-iron mines. Concomitant and highly correlated exposures to arsenic and PAHs among tin miners were also found. Risk of lung cancer among pottery workers was related to exposure to silica, although the dose-response gradient was not significant. Risks of lung cancer were significantly increased among silicotic subjects in iron-copper and tin mines, but not in pottery factories or tungsten mines. The results of this study provide only limited support for an aetiological association between silica and lung cancer AU - McLaughlin JK AU - Chen JQ AU - Dosemeci M AU - Chen RA AU - Rexing SH AU - Wu Z AU - Hearl FJ AU - McCawley MA AU - Blot WJ LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 1 IP - DP - 1992 Jan 01 TI - No difference in rates of absenteeism between workers in air-conditioned offices and naturally ventilated ones: a data base study PG - 279-284 AU - Gibert I AU - Chevalier A AU - Lambrozo J LA - PT - DEP - TA - Indoor Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Specific IgE antibodies to nickel in workers with known reactivity to cobalt PG - 213-218 AB - Twenty-one workers with hard metal asthma, including eight atopics, diagnosed on the basis of peak flow diaries and positive reaction to cobalt chloride (CoCl2) and/or nickel sulphate (NiSO4) in skin and provocation tests were studied for sensitization by detection of specific antibodies to nickel-conjugated human serum albumin (Ni-HSA), and nickel-conjugated exchange resin (Ni-resin). Their results were compared with those of sera obtained from control sera from 60 asthmatic patients and pair-matched asymptomatic control workers in the hard metal plant. In the RASTs (radioallergosorbent tests), sera from the same six subjects developed positive reactions both to Ni-HSA (RAST index greater than 2.0, P less than 0.01) and Ni-resin (RAST index greater than 2.0, P less than 0.01), while the counts measured for the others of the 15 subjects (RAST index less than 1.52) were about the same as those for control groups (RAST index less than 1.58). Subject HSA RAST and resin RAST results (378 +/-52 c.p.m. in HSA RAST and 324 +/- 56 in the resin RAST) were about the same as those of the control sera (388 +/- 65 c.p.m. and 398 +/- 59 c.p.m., respectively). There was no difference in the prevalence of smoking habit and high IgE between Ni-RAST positive and negative subjects. However, subjects with simultaneous sensitivity to nickel and/or cobalt still developed asthmatic attacks following medications, while those without sensitivity to these metals were almost symptom free. The positive sera had simultaneous sensitivity to both cobalt and nickel, suggesting the presence in them of specific IgE antibodies to nickel playing some role in the aetiology of hard metal asthma AU - Shirakawa T AU - Kusaka Y AU - Morimoto K LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - IgG and IgE antibody responses to cow dander and urine in farmers with cow-induced asthma PG - 83-90 AU - Ylonen J AU - Mantyjarvi R AU - Taivainen A AU - Virtanen T LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - IP - DP - 1992 Jan 01 TI - Medical management in cases of building-related illnesses PG - 99-105 AU - Robertson AS LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 21 IP - DP - 1992 Jan 01 TI - Hospital records as a data source for occupational disease surveillance: a feasibility study PG - 341-351 AB - To assess the feasibility of using hospital records for occupational disease surveillance and to evaluate the quality of the industry/occupation (I/O) information available in these records, the computer file of all discharge diagnoses from a large health maintenance organization during 1985 was reviewed. The frequencies of discharge diagnoses previously listed as Sentinel Health Events (Occupational), or SHE (O), were calculated and three possible SHE(O) diagnoses--lung cancer, bladder cancer, and toxic hepatitis--were selected for further review. Outpatient charts of patients discharged for each diagnosis were abstracted with regard to I/O information and the discharged patients were interviewed by telephone to obtain a lifetime occupational history. The accuracy of the I/O information obtained from the hospital chart was compared to that obtained by patient interview by number of digits matched on standard classification codes. The frequencies of matches for occupation and industry were greater for "usual" than for "last" categories with both cancer diagnoses, but were similar for "usual" and "last" categories with toxic hepatitis. To assess the proportion of each possible SHE(O) diagnosis that was related to workplace exposures, the I/O information obtained by interview was rated in a blinded fashion by an experienced occupational medicine physician. The highest probability ratings for work-relatedness were noted for lung cancer, primarily due to asbestos exposure. The results of this study suggest that hospital records can be used to identify possible SHE(O); if adequate I/O information is available, then work-relatedness can be assessed. However, the accuracy of I/O obtained from hospital charts is relatively low. The efficient and accurate collection of I/O information from hospital records will require the use of a simple, easily coded instrument to be routinely administered on admission AU - Balmes J AU - Rempel D AU - Alexander M AU - Reiter R AU - Harrison R AU - Bernard B AU - Benner D AU - Cone J LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 30 IP - DP - 1992 Jan 01 TI - A case of hypersensitivity pneumonitis due to isocyanate exposure showing progression even two months after removal of the antigen [Jpn] PG - 458-463 AB - A 68-year-old male developed dry cough and exertional dyspnea after handling paint spray containing isocyanates (TDI, MDI) for three months. Initially, the symptoms fluctuated according to whether he was at work or not. He was admitted to our hospital on February 7, 1990, because of progressive worsening of symptoms. In spite of admission to hospital and cessation of exposure to isocyanates, there was no improvement of symptoms. His chest X-ray film showed diffuse small nodular and reticular shadows. Transbronchial lung biopsy revealed thickening of the alveolar walls and formation of Masson's bodies associated with mononuclear cell infiltration in alveolar spaces. High titers of TDI-HSA and MDI-HSA specific IgG antibodies were detected by ELISA, and a high level of serum soluble IL2 receptor was also detected. From these results, we diagnosed hypersensitivity pneumonitis due to exposure to isocyanates. One week administration of prednisolone caused dramatic improvement of his symptoms, chest X-ray findings, and laboratory data. His clinical course and response to prednisolone therapy indicated that long-term steroid administration could not be avoided. The prolonged symptoms and the necessity for long-term steroid therapy are discussed AU - Akimoto T AU - Tamura N AU - Uchida K AU - Dambara T AU - Nukiwa T AU - Kira S LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 21 IP - DP - 1992 Jan 01 TI - Accelerated loss of lung function and alveolitis in a longitudinal study of non-smoking individuals with occupational exposure to asbestos PG - 835-844 AB - Long-term asbestos workers who insulate pipes and boilers may develop interstitial lung disease associated with loss of lung function. To quantitate annual loss of lung function, 77 individuals with chest X-rays greater than or equal to 1/0 ILO category who were life-long non-smokers or ex-smokers for greater than 5 years were evaluated. Study parameters included pulmonary function tests and bronchoalveolar lavage for a mean of 3 visits over 30 +/- 2 months. The study participants were 56 +/- 1 years old and had 31 +/- 1 years' occupational exposure to asbestos. At the first visit, multiple regression analysis revealed significant associations between rales or radiographic opacities and VC, FEV1, and total lung capacity; significant associations were also found between neutrophils/ml lavage fluid with FEV1 and diffusing capacity (all p less than 0.05). Annual declines for the asbestos-exposed were VC -92 +/- 28 ml/yr and FEV1 -66 +/- 21 ml/yr. Declines in VC and FEV1 were less in those with reduced lung function at the initial visit. There were no significant associations between any of the annual declines and cells recovered by bronchoalveolar lavage. Compared to other asbestos-exposed cohorts followed longitudinally, asbestos insulators with radiographs greater than or equal to 1/0 and exposure greater than or equal to 20 years have larger rates of FVC and FEV1 decline for both non-smokers and ex-smokers AU - Rom WN LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Immune response to flour and dust mites in a United Kingdom bakery PG - 581-587 AU - Tee RD AU - Gordon DJ AU - Gordon S AU - Crook B AU - Nunn AJ AU - Musk AW AU - Venables KM AU - Newman Taylor AJ LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 3 IP - DP - 1992 Jan 01 TI - Synergism between occupational arsenic exposure and smoking in the induction of lung cancer PG - 23-31 AB - We assembled data from numerous studies to examine whether active smoking and occupational exposure to arsenic act synergistically (more than additively) to increase the risk of lung cancer. Although several smaller studies lacked the power to reject simple additive relations, the joint effect from both exposures consistently exceeded the sum of the separate effects by about 70 to 130%. The only study not showing a greater than additive effect appeared to have inadequate data to address this question. We calculated the excess fractions for the synergism; these showed that a minimum of between 30% and 54% of lung cancer cases among those with both exposures could not be attributed to either one or the other exposure alone. Previous authors addressing the synergism between arsenic exposure and smoking have evaluated deviations from a multiplicative model, which is inappropriate for this purpose. Reports of no interaction or "negative" interaction have therefore been misleading. Taken as a whole, the evidence is compelling that arsenic and smoking act in a synergistic manner to produce lung cancer. Substantial reductions in the lung cancer burden of smokers occupationally exposed to arsenic could be achieved by reductions in either exposure. The mechanism for the synergism is unclear AU - HertzPicciotto I AU - Smith AH AU - Holtzman D AU - Lipsett M AU - Alexeeff G LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Type 1 allergy induced by Limulus Amoebocyte Lysate PG - 417-419 AU - Ebner C AU - Kraft D AU - Prasch F AU - Steiner R AU - Ebner H LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - Lung function, bronchial reactivity, atopic status, and dust exposure in Lancashire cotton mill operatives._ PG - 1103-1108 AB - A total of 645 cotton mill operatives were administered a respiratory questionnaire. Of these, 85 (13.2%) complained of one or more work-related respiratory symptoms: 23 (3.6%) had byssinosis and the remaining 62 had symptoms not conforming to byssinosis (nonbyssinotic symptomatics, NBS). All byssinotic, 56 NBS, and 84 matched asymptomatic operatives underwent pulmonary function testing (FEV1 and FVC), skin testing to common allergens, and histamine bronchial challenge. Work area and personal breathing zone cotton dust concentrations were assessed, and a cumulative cotton dust exposure index was calculated for each individual. Byssinotic, NBS, and asymptomatic operatives all had reduced FEV1; observed mean liters (95% CI); predicted mean: byssinosis, 2.36 (2.09 to 2.63), 3.02; NBS, 2.94 (2.71 to 3.17), 3.29; and asymptomatic, 3.12 (2.95 to 3.29), 3.31. Only byssinotic subjects had evidence of impaired FVC: 3.31 (2.97 to 3.65), 3.69. The majority of byssinotic operatives (18 of 23) had bronchial hyperreactivity (BHR) in comparison with 21 of 56 NBS and 14 of 84 asymptomatic operatives. Mean log PD20 (95% CI) values were significantly lower in the byssinotic group -0.72 (-1.42, -0.02) than in NBS 0.57 (0.08, 1.06) and asymptomatic subjects 0.57 (-0.26, 1.39). The distribution of atopy did not differ significantly between groups, and lung function did not differ significantly between atopic and nonatopic subjects. The cumulative cotton dust exposure index was the only dust parameter to be significantly greater in those with BHR (mean mg-yr/m3 [95% CI] 14.13 [13.1 to 15.1]) than those with normal reactivity [5.35 (3.9 to 6.8)] AU - Fishwick D AU - Fletcher AM AU - Pickering CAC AU - Niven RM AU - Faragher EB LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 21 IP - DP - 1992 Jan 01 TI - Immunological status and respiratory findings in furriers. PG - 433-441 AB - We studied 42 women occupationally exposed in the fur manufacturing industry (mean age: 34 years, mean duration of exposure: 11 years). The highest prevalence of positive immediate skin reactions to antigen of animal hair was found for marten (10%), followed by fox and lamb (7%), mink (5%), and Chinese lamb, domestic fox, and Chinese calf (2%). Precipitating antibodies were demonstrated for lamb (17%), astrakhan (14%), mink, domestic fox and skunk (12%), Chinese lamb (10%), and Chinese calf (7%). Increased total IgE was found in 9.5% of subjects. Chronic symptoms were consistently more prevalent among workers with positive skin tests and positive precipitins than among workers with negative tests. A high prevalence of acute symptoms during the work shift was found among furriers. The prevalence of these symptoms was higher among workers with positive precipitating antibodies than among those with negative studies but not for workers with positive skin tests. Mean acute reductions in ventilatory capacity over the work shift were recorded for most ventilatory parameters. In general, greater drops in respiratory parameters occurred in individuals with positive precipitins (e.g., FEV1: -6.5% vs. -2.8%; positive vs. negative precipitins) but not in those with positive skin tests. Our study suggests that workers in the fur manufacturing industry develop acute and chronic respiratory problems often associated with specific indicators of atopy AU - Zuskin E AU - Kanceljak B AU - Stilinovic L AU - Schachter EN AU - Kopjar B LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Obstructive airways disease associated with occupational sodium hydroxide inhalation PG - 213-214 AU - Rubin AE AU - Bentur L AU - Bentur Y LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 68 IP - DP - 1992 Jan 01 TI - Sensitization to the storage mite Lepidoglyphus destructor in wheat flour respiratory allergy PG - 398-403 AB - Occupational allergy due to hypersensitivity to cereal flours is relatively common among bakers and grain-store workers. Storage mites can contaminate wheat flour and could be an important cause of allergic symptoms due to inhalation. Forty-three patients with criteria for allergic sensitization to wheat flour (skin tests, specific IgE to wheat flour and positive challenge tests) were included in a study to investigate the prevalence of cosensitization to Lepidoglyphus destructor (Ld). This mite was the predominant species in the wheat flour samples supplied by our patients. We found that 30% of the patients had IgE-mediated hypersensitivity of Ld. Of these, 23% did not have a relationship with any bakery or agriculture. We conclude that the prevalence of sensitization to Ld in patients sensitized to wheat flour is important AU - Armentia A AU - Tapias J AU - Barber D AU - Martin J AU - de la Fuente R AU - Sanchez P AU - Salcedo G AU - Carreira J LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - New aeroallergens in agricultural and related practice PG - 423-426 AU - McSharry CP LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 42 IP - DP - 1992 Jan 01 TI - Extrinsic allergic alveolitis in agricultural environment. PG - 1790-1796 AB - The term extrinsic allergic alveolitis involves a group of interstitial and alveolar lung diseases with an immunoallergic mechanism. These diseases are associated with chronic inhalation of usually organic particles and therefore encountered almost exclusively in an agricultural environment. The most frequent and best known of them is the farmer's lung disease and therefore is largely described by the authors. Specific points concerning pigeon breeder's disease and cheese worker's disease, are also reviewed since they are quite frequently observed in France. The diagnosis is difficult because the radiological and functional abnormalities are transient and the signs of immunization in serum and alveoles are unspecific. This problem is developed here, and a practical diagnostic approach is suggested. Treatment is essentially preventive and includes modifications of the working tools and work conditions in order to reduce exposure to airborne pathogenic antigens AU - Dalphin JC LA - PT - DEP - TA - Rev Prat JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 61 IP - DP - 1992 Jan 01 TI - Studies support safety of fiberglass [news] PG - 7-8 AU - Johnson J LA - PT - DEP - TA - Occup Health Saf JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - A case-control study of occupational risk factors for laryngeal cancer PG - 837-844 AB - To determine whether specific jobs and occupational exposures are associated with laryngeal cancer lifetime occupational histories from a population-based case-control study in western Washington were examined. The study included 235 cases diagnosed between September 1983 and February 1987, and 547 controls identified by random digit dialing. After controlling for alcohol use, cigarette smoking, age and education, significantly increased risks were found for painters in construction (odds ratio (OR)) = 2.8, (95% confidence interval (95% CI) 1.1-6.9), supervisors and miscellaneous mechanics (OR = 2.3, 95% CI 1.1-4.8), construction workers (OR = 3.4, 95% CI 1.4-8.1), metalworking and plastic working machine operators (OR = 2.6, 95% CI 1.3-4.9) and handlers, and equipment cleaners and labourers (OR = 1.5, 95% CI 1.0-2.2). Allowing for a 10 year induction and latent period did not have a consistent effect on the associations. Potential exposures to asbestos, chromium, nickel, formaldehyde, diesel fumes, and cutting oils were assessed by using a job exposure matrix developed for this study. Three measures of exposure were examined--namely, peak, duration, and an intensity weighted exposure score. No significantly raised risks were seen, although increased risk was suggested among those exposed long term to formaldehyde in jobs with the highest exposures AU - Wortley P AU - Vaughan TL AU - Davis S AU - Morgan MS AU - Thomas DB LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Preventing occupational asthma [editorial] PG - 817-819 AU - Venables KM LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 5 IP - DP - 1992 Jan 01 TI - Lung dysfunction in animal confinement workers-chairman's report to the Scientific Committee of the Third International Symposium: issues in health, safety and agriculture, held in Saskatoon, Saskatchewan, Canada, May 10-15, 1992 PG - 277-279 AB - The session traced the course of health hazards in livestock confinement from anticipation of an emerging health hazard in 1974 to its full recognition as a significant health hazard in 1992. The session documented the major health hazards including hydrogen sulfide toxicity, bronchitis, non-allergic asthma, organic dust toxic syndrome, and mucus membrane irritation. In regard to exposures, bioaerosols seem to be the most significant hazard, with endotoxin evident as at least one of the major specific atiologic agents. Other agents were suspected, as newly recognized agents, specifically 1,3 beta-glucan. Previous epidemiological studies have revealed mild decrements in pulmonary function, however symptoms have always been excessively prevalent relative to controls. Recent results of a longitudinal observation showed a 12% drop out of workers with profound decrement in pulmonary function. In summary, the health hazard of livestock confinement workers is now well substantiated in North America and Europe and further work regarding prevention is highly indicated AU - Donham KJ AU - Zejda JE LA - PT - DEP - TA - Pol J Occup Med Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 37 IP - DP - 1992 Jan 01 TI - Salami and extrinsic allergic alveolitis: a new occupational disease in Switzerland PG - 263-267 AB - The authors report a case of extrinsic allergic alveolitis in a patient working in an industrial butchery where she is involved in the preparation of dry sausages. The molds proliferating at the surface of these sausages, molds from the Penicillium family, are responsible for the disease. The respective value of laboratory tests such as the presence of precipitating antibodies and the analysis of the cellularity of the bronchoalveolar lavage are discussed. Whenever a patient presents with clinical symptoms suggestive of extrinsic allergic alveolitis a detailed search for any type of exposure linked to the professional milieu is required, so as to propose adequate modifications in work conditions or work place AU - Reynaud C AU - Vodoz JF AU - Bernstein M AU - Nerbollier G AU - Richardet C AU - Polla BS LA - PT - DEP - TA - Soz Praventivmed JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Immune responses to colophony, an agent causing occupational asthma PG - 1050-1055 AB - BACKGROUND: Inhalation of fumes from heated colophony (pine resin) is a recognised cause of occupational asthma, although the mechanisms by which colophony produces symptoms are unclear and specific immune responses to colophony have not been reported in sensitised workers. A study was carried out to determine whether colophony is antigenic. METHODS: The immune responses to colophony were studied in C57BL/6 mice and Dunkin Hartley guinea pigs after intraperitoneal injection of colophony conjugated to bovine serum albumin (BSA) or human IgG by a mixed anhydride procedure. Colophony and dinitrofluorobenzene were also compared in an assay of dermal sensitisation. RESULTS: Mice immunised with the colophony conjugates produced antibodies which recognised conjugates of both BSA and human IgG irrespective of which had been used as the immunogen. Solutions of unconjugated colophony inhibited the binding of antibodies to the BSA-colophony and BSA-abietic acid conjugates, confirming that the antibodies recognised one or more components in the colophony. Portuguese colophony also abrogated the antigen binding of serum from guinea pigs immunised with the BSA-colophony conjugate. Spleen cells from immunised mice proliferated in the presence of the conjugates. Although there was some cross reactivity in these responses, it was not as marked as in the antibody assays. Unconjugated colophony failed to induce an immune response when injected intraperitoneally with adjuvant. Skin sensitisation could not be induced in mice by topical application, or by subcutaneous or intradermal injection of unconjugated colophony. CONCLUSIONS: Colophony components have the potential to act as haptens and an immune component could be involved in the pathogenesis of occupational asthma in workers exposed to colophony. Colophony is not readily immunogenic unless conjugated ex vivo to proteins AU - Cullen RT AU - Cherrie B AU - Soutar CA LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 31 IP - DP - 1992 Jan 01 TI - Hypersensitivity pneumonitis induced by Shiitake mushroom spores PG - 1204-1206 AB - Hypersensitivity pneumonitis due to the inhalation of Shiitake mushroom spores was demonstrated in a 38-year-old woman. Symptoms of cough, nausea and malaise, and clinical findings of cyanosis, bibasilar crackles, reduced lung volumes, hypoxemia, leukocytosis, elevated ESR, positive C-reactive protein, and bilateral diffuse reticulonodular shadows on chest roentgenogram improved after the patient was removed from exposure. Alveolitis was demonstrated by transbronchial lung biopsy, as well as an increase in lymphocytes in bronchoalveolar lavage. Serum precipitins and specific IgG antibodies to an extract of Shiitake mushroom spores, but not to other common molds or mushroom body, were detected in serum. Provocative inhalation test with the extract of mushroom spores caused the same clinical symptoms and signs as experienced in the workroom. This is the first report of typical hypersensitivity pneumonitis induced by Shiitake mushroom spores. Mushroom spores as well as thermophilic actinomycetes must be considered a causative agents for mushroom worker's lung AU - Matsui S AU - Nakazawa T AU - Umegae Y AU - Mori M LA - PT - DEP - TA - Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 102 IP - DP - 1992 Jan 01 TI - Reactive airway disease after chlorine gas exposure PG - 984-984 AU - Demeter SL AU - Cordasco EW LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Respiratory allergies (bronchial asthma and rhinitis) due to sensitization of type I allergy to red spider mite (Panonychus ulmi KOCH) PG - 958-962 AB - The inhabitants of a fruit growing area often report spontaneously of sensitization to the red spider mite (RSM) (Panonychus ulmi KOCH). These are for the most part sensitizations with low clinical symptoms (rhinitis, conjunctivitis and erythema). Severe clinical developments with bronchial asthma have been observed. We investigated six patients working in a fruit growing area sensitized by RSM. The sensitizations corresponded to a Type I allergy. Skin tests and provocation tests (nasal as well as bronchial) with RSM showed immediate reactions and RAST positive results were obtained using RSM allergen disks. RAST measurements of sera from nine house-dust mite Dermatophagoides pteronyssinus allergic patients using RSM allergen disks showed RAST-class : 1 for eight patients. RAST inhibition and immunoprint suggest a possible cross-reaction between RSM and D. pteronyssinus AU - Kroidl R AU - Maasch HJ AU - Wahl R LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 102 IP - DP - 1992 Jan 01 TI - Christmas candy maker's asthma. IgG4-mediated pectin allergy PG - 1605-1607 AB - We evaluated a 29-year-old candy maker with no history of asthma who developed asthma after exposure to pectin, a compound manufactured from fruits and fruit rinds. Following eight years of employment during which he added pectin to a recipe for Christmas candies, the candymaker developed acute respiratory symptoms. Challenge testing with the pectin mixture caused a 40 percent decrease in FEV1. Skin prick testing was positive to the pectin extract. Total IgE was normal and pectin-specific IgE antibodies were not detected. A strongly positive pectin-specific IgG4 antibody response was present that was not detected in a control serum and could be inhibited by the addition of pectin. Antigen-specific IgG4 should be sought in IgE negative cases of occupational asthma AU - Kraut A AU - Peng Z AU - Becker AB AU - Warren CP LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Hard metal pneumoconiosis and the association of tumor necrosis factor-alpha PG - 1600-1602 AB - Hard metal pneumoconiosis is a recently recognized occupational lung disease associated with the exposure to cobalt fumes in the workplace. Chronic exposure in susceptible individuals results in interstitial lung disease histopathologically manifested as interstitial fibrosis with an associated mononuclear cell infiltrate and the presence of "cannibalistic" multinucleated giant cells in the alveolar airspaces. The majority of patients present with symptoms of chronic cough and dyspnea. Interestingly, in addition, patients uniformly report significant weight loss out of proportion to their degree of respiratory impairment. In this case report we demonstrate the association of tumor necrosis factor-alpha (TNF) and hard metal (cobalt) pneumoconiosis and suggest that TNF may have a potential role in the etiology of the constitutional symptoms and the pathogenesis of interstitial lung disease AU - Rolfe MW AU - Paine R AU - Davenport RB AU - Strieter RM LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Abnormal lung function in polyurethane foam producers. Weak relationship to toluene diisocyanate exposures PG - 871-877 AB - Exposures to toluene diisocyanate (TDI) were studied for effects on respiratory health of workers in two plants manufacturing polyurethane foams. Intensive personal monitoring was used to characterize job exposures. Of 4,845 12-min personal samples, 9% exceeded 5 ppb and 1% exceeded 20 ppb. Initial questionnaire and spirometry were obtained in 386 workers (88.7% of target population). Current smoking was associated with lower mean FEV1 and FEF25-75, but percent predicted (% pred) means were normal in all smoking categories. Multiple regression showed significant adverse effects of cumulative TDI exposure on initial level of FVC and FEV1 of current smokers, and an effect at borderline significance (p less than 0.063) on FEF25-75 over all smoking categories. Logistic regression showed that chronic bronchitis was more prevalent among those with higher cumulative exposures, after controlling for smoking, age, and sex. Methacholine (MCh) reactivity was associated with reduced airway function, -8.5% pred for FEV1 and -20.0% pred for FEF25-75. In 227 with adequate follow-up, the slopes of annual change were abnormal, for example, FEV1 of -67 ml/yr in current and -53 ml/yr in never smokers. Men had worse FEV1 declines than did women, -71 ml/yr versus -43 ml/yr. TDI exposure, lifetime or concurrent, had no significant effect on slopes, despite its demonstrated effects on initial level of lung function and on prevalence of chronic bronchitis AU - Jones RN AU - Rando RJ AU - Glindmeyer HW AU - Foster TA AU - Hughes JM AU - O'Neil CE AU - Weill H LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Bronchial hyperresponsiveness and level of exposure in occupational asthma due to western red cedar (Thuja plicata). Serial observations before and after development of symptoms PG - 1606-1609 AB - Four workers from a cedar sawmill who developed red cedar asthma are described. They had serial measurements of lung function and nonspecific bronchial hyperresponsiveness (NSBH) several years before and after the development of chest symptoms. Measurements of dust concentration and specific IgE antibodies to plicatic acid-human serum albumin (PA-HSA) conjugate were also carried out before the onset of disease. NSBH developed in parallel with the development of asthma and was not present in any of the workers beforehand, indicating that it is not a predisposing host factor. Nasal symptoms preceded chest symptoms in three workers, suggesting that this may be an early marker of the disease. Although dust concentrations for jobs located both inside and outside the sawmill were low, jobs associated with somewhat higher exposures were associated with the initiation of asthma symptoms AU - ChanYeung M AU - Desjardins A LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Association of asthma with use of pesticides. Results of a cross-sectional survey of farmers PG - 884-887 AB - We investigated the association of self-reported asthma and pesticide use in 1,939 male farmers. Regardless of age, smoking pack-years, and nasal allergic reactions, the prevalence of asthma was significantly associated with the use of carbamate insecticides (prevalence odds ratio = 1.8, 95% confidence interval: 1.1 to 3.1, p = 0.02). Self-reported asthmatics, in comparison with nonasthmatics, had significantly lower mean values for lung function test variables after adjusting for age and height and a higher prevalence of respiratory symptoms. These findings raise the possibility that exposure to agriculture chemicals could be related to lung dysfunction in exposed farmers AU - Senthilselvan A AU - McDuffie HH AU - Dosman JA LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Bronchial hyperreactivity after inhalation of trimellitic anhydride dust in guinea pigs after intradermal sensitization to the free hapten PG - 1311-1314 AB - We have developed in the guinea pig, an animal model of bronchial hyperreactivity provoked by inhalation of trimellitic anhydride (TMA) dust, a known cause of occupational asthma in humans, after intradermal sensitization to the free hapten. Male Dunkin-Hartley guinea pigs (n = 6) were injected intradermally with 0.1 ml of 30% TMA in corn oil. Control animals (n = 7) were injected with 0.1 ml corn oil alone. On Days 21 to 28 after sensitization, guinea pigs were challenged (nose only) to 12 mg/m3 of inhalable TMA dust for 30 min. Bronchial reactivity was measured in sensitized animals and in control animals at 8 h after exposure to the dust. We also measured bronchial reactivity in sensitized exposed guinea pigs at 2 h (n = 5) and at 24 h (n = 5). Pulmonary inflation pressure (PIP) was used to assess bronchopulmonary response. Blood samples were taken for assessment of IgG-1 antibodies to TMA conjugated to guinea-pig albumin. The concentration of acetylcholine required to induce a 100% increase in PIP was used to assess bronchial reactivity. The lungs were eviscerated for histologic examination. All guinea pigs injected intradermally with TMA had high titers of specific IgG-1 antibodies to TMA conjugated to guinea-pig albumin. There was a significant increase in bronchial reactivity in sensitized guinea pigs 8 h after exposure to the TMA dust compared with that in the control animals. There was also a significant eosinophilic inflammatory influx in the subepithelium of the sensitized groups.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Hayes JP AU - Daniel R AU - Tee RD AU - Barnes PJ AU - Newman Taylor AJ AU - Chung KF LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Risk factors for increased airway responsiveness to methacholine challenge among laboratory animal workers PG - 1494-1500 AB - As a first step in a prospective study of the incidence of asthma to laboratory animals, a group of 364 adults 18 to 48 yr of age who were beginning employment with laboratory animals were evaluated in terms of their past history, health status, allergy, and airway responsiveness to methacholine. At entry to the study, 269 had previous occupational contact with animals, 109 had chest symptoms in the previous year, 168 had a history of allergic symptoms to laboratory animals (any with asthmatic responses were systematically excluded), and 118 had positive immediate skin tests (29 had positive skin tests to laboratory animals). When defined as a PD20FEV1 of 80 breath units or less, 18.4% of these young adults had methacholine hyperresponsiveness (HRA). Significant risk factors for HRA were found to be younger age, female sex, lower educational level, a history of allergic symptoms to laboratory animals, and a history of chest symptoms. Positive skin tests to laboratory animals were present in 8% of workers; this was not a significant risk factor for HRA although positive skin tests to pollen and household allergens were. Previous work experience was a risk factor, especially among those with allergic symptoms, and a trend toward self-selection was suggested in that the rate of HRA was lowest in workers with more than 2 yr of experience or with two or more previous jobs with laboratory animals AU - Newill CA AU - Prenger VL AU - Fish JE AU - Evans R AU - Diamond EL AU - Wei Q AU - Eggleston PA LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Guinea pig model of immunologic asthma induced by inhalation of trimellitic anhydride PG - 1553-1558 AB - We established a model of asthma induced by trimellitic anhydride (TMA) in guinea pigs and assessed the role of sensitization in the development of their bronchial hyperresponsiveness, and relationship between bronchial responsiveness and bronchial inflammation. Fourteen guinea pigs (sensitized group) were administered 1 mg/0.5 ml of trimellity 36-bovine serum albumin intramuscularly and 0.5 ml of complete Freund adjuvant on Day 1 as the priming dose. Booster doses were repeated on Day 15. By Day 28, all of the sensitized animals showed a high passive hemagglutination titer against trimellityl 14-ovalbumin. On Day 29, they were challenged by an inhalation of TMA (150 mg/m3) for 30 min, and respiratory resistance (Rrs) was monitored by the oscillation method. In all sensitized animals, Rrs increased immediately upon challenge and returned to baseline within 6 h. The bronchial reactivity to acetylcholine (Ach), measured 6 h after TMA challenge in the sensitized animals, increased significantly (p : 0.01) compared with that measured 24 h before challenge; that measured 24 h later was not different from that before challenge. There was also a significant difference (p : 0.01) in the number of eosinophils in the lamina propria and the epithelium 6 and 24 h after the challenge inhalation in the sensitized group. The increased airway responsiveness to Ach in the sensitized animals was correlated with an increase in the number of eosinophils in the lamina propria and the epithelium. These observations suggest that humoral antibody and eosinophils are involved in the pathogenesis of TMA-induced asthma AU - Obata H AU - Tao Y AU - Kido M AU - Nagata N AU - Tanaka I AU - Kuroiwa A LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Methacholine responsiveness, smoking, and atopy as risk factors for accelerated FEV1 decline in male working populations PG - 878-883 AB - Longitudinal lung function data from four occupational health surveys was used to explore the relationship between nonspecific bronchial responsiveness (NSBR) and the rate of decline of FEV1 (RDFEV) and to address other factors that may predict or influence RDFEV. Of the 1,203 subjects with baseline methacholine and lung function data, follow-up data were available for 733 individuals (61%). The data-available and data-unavailable groups were well matched with respect to baseline lung function, atopy, and smoking status. Compared with the unavailable group, those available for follow-up were younger (42.5 versus 37.7 yr; p less than 0.0001) and slightly less responsive to methacholine (p less than 0.01). Somewhat unexpectedly, RDFEV was lower in the 30 asthmatic subjects than in the nonasthmatics. Among the nonasthmatic subgroup (96% of those available for follow-up), age, occupational group, and baseline FEV1 (% predicted) were independent predictive factors for RDFEV. When these factors were included in the model, RDFEV was found to be increased among current smokers compared with never-smokers or ex-smokers. In the final regression model, a relationship was found between methacholine sensitivity (calculated as a dose-response slope) and RDFEV in nonasthmatics (p less than 0.05). Stratification by smoking status revealed that the relationship between RDFEV and bronchial responsiveness was confined to current smokers and that atopy was an additional risk factor in this subgroup only. This relationship was valid among current smokers in each of the three occupational groups studies. However, reinclusion of the 30 asthmatic subjects in the study population obscured the relationship between NSBR and RDFEV.There are some difficulties in generalising from studies of lung health in working populations, but this prospective analysis confirms that in smokers increased NSBR is associated with accelerated RDFEV as has been suggested by previous retrospective surveys. However among nonasthmatic nonsmokers, NSBR does not appear to influence RDFEV.The grain and sawmill workers had a lower RDFEV than the office workers, possibly due to a healthy worker effect*** WORDS) AU - Frew AJ AU - Kennedy SM AU - ChanYeung M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Changes in interleukin-1 and tumor necrosis factor production by peripheral blood monocytes after specific bronchoprovocation test in occupational asthma PG - 408-412 AB - The pathogenetic mechanisms of occupational asthma (OA) due to low-molecular-weight compounds have been poorly defined, and further studies are required to clarify the role of immunologic mechanisms in OA. Until now cellular mechanisms have been less investigated than humoral ones. We have evaluated interleukin-1 (IL-1) and tumor necrosis factor (TNF) production by peripheral blood monocytes (PBM), and peripheral T-cell subpopulations in 22 subjects with possible OA before and after specific bronchoprovocation test (SBPT). After SBPT, three subjects had an immediate reaction, seven a late reaction, and two a dual reaction. Ten subjects had no asthmatic reaction to SBPT. Spontaneous release of IL-1 from PBM did not change significantly after SBPT. TNF activity was increased 48 h after SBPT in immediate reactions and 72 h after SBPT in late-dual reactions. These results suggest that exposure to occupational agents may induce activation of PBM with increased spontaneous release of cytokines, such as TNF AU - Siracusa A AU - Vecchiarelli A AU - Brugnami G AU - Marabini A AU - Felicioni D AU - Severini C LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Exposure-response relationships between occupational exposures and chronic respiratory illness: a community-based study PG - 413-418 AB - Data from a random sample of 3,606 adults 40 to 69 yr of age residing in Beijing, China, were analyzed to investigate the association of reported occupational exposures to dusts and gases/fumes with the prevalence of chronic respiratory symptoms and level of pulmonary function. The prevalence of occupational dust exposure was 32%, and gas or fume exposure, 19%. After we adjusted for age, sex, area of residence, smoking status, coal stove heating, and education, an increased prevalence of chronic phlegm and breathlessness was significantly related to both types of exposures. Chronic cough was significantly related only to dust exposure, and persistent wheeze only to fume exposure. The global estimates of the relative odds of the four symptoms were 1.30 (95% CI [confidence interval] 1.09 to 1.48) and 1.27 (95% CI 1.09 to 1.48), respectively, for dusts and for gases/fumes. These two occupational exposures are associated with chronic respiratory symptoms independent of smoking, gender, and each other. There was an increasing prevalence of each symptom with increasing dust and fume exposure, represented by the index of cumulative exposure duration and exposure intensity. Linear trends for increased prevalence of chronic bronchitis and breathlessness were significant for both exposures, while the linear trend for wheeze was only significant for gases/fumes. Among subjects who did not report using coal stove heating, dust exposure was a significant predictor for FEV1, FEV1/FVC, FEF25-75, and peak expiratory flow rate (PEFR). There was also a significant decrease for FEV1 and FVC with increase of gas/fume exposure levels. Both current and former smokers appeared to be more susceptible to the effect of dusts than the never smokers.There was a significant interaction between dust exposure and smoking on pefr and fev1/fvc. AU - Xu X AU - Christiani DC AU - Dockery DW AU - Wang L LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 69 IP - DP - 1992 Jan 01 TI - Evaluation of immune complexes after immunotherapy with wheat flour in bakers' asthma PG - 441-444 AB - Inhalant food allergy has been described many times in literature, but double-blind clinical trials to support successful hyposensitization to these allergens has seldom been reported. Some authors have suspected that certain adverse reactions after immunotherapy may be mediated by immune complexes. Furthermore, the FDA does not recommend injection therapy with food extracts. We present a study on the detection of adverse effects after immunotherapy with an inhalant food (wheat flour) in a double-blind clinical trial in 26 patients with bakers' asthma. We investigated the presence of circulating immune complexes (CICs) after 2 years of treatment with hyposensitization to wheat flour AU - Armentia A AU - Arranz M AU - Martin JM AU - de la Fuente R AU - Sanchez P AU - Barber D AU - Salcedo G AU - Blanco A LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Allergy to methyltetrahydrophthalic anhydride in epoxy resin workers PG - 769-775 AB - One hundred and forty four current and 26 former workers in a plant producing barrels for rocket guns from an epoxy resin containing methyltetrahydrophthalic anhydride (MTHPA; time weighted average air concentration up to 150 micrograms/m3) were studied. They showed higher frequencies of work related symptoms from the eyes (31 v 0%; p : 0.001), nose (53 v 9%; p : 0.001), pharynx (26 v 6%; p : 0.01), and asthma (11 v 0%; p : 0.05) than 33 controls. Also they had higher rates of positive skin prick test to a conjugate of MTHPA and human serum albumin (16 v 0%; p : 0.01), and more had specific IgE and IgG serum antibodies (18 v 0%; p : 0.01 and 12 v 0%; p : 0.05 respectively). There were statistically significant exposure-response relations between exposure and symptoms from eyes and upper airways, dry cough, positive skin prick test, and specific IgE and IgG antibodies. There was a non-significant difference in reaction to metacholine between exposed workers and non-smoking controls. In workers with and without specific IgE antibodies, differences existed in frequency of nasal secretion (54 v 23%; p : 0.05) and dry cough (38 v 12%; p : 0.05). Workers with specific IgG had more dry cough (38 v 12%; p : 0.05), but less symptoms of non-specific bronchial hyperreactivity (0 v 26%; p : 0.05). Atopic workers sneezed more than non-atopic workers (65 v 30%; p : 0.01). In a prospective study five sensitised workers who left the factory became less reactive to metacholine, and became symptom free. In 41 workers who stayed, there was no improvement, despite a 10-fold reduction in exposure. The results show the extreme sensitising properties of MTHPA AU - Nielsen J AU - Welinder H AU - Horstmann V AU - Skerfving S LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Health hazard of poorly regulated exposure during manufacture of cemented tungsten carbides and cobalt PG - 832-836 AB - Forty two of 125 former workers in a factory in Syracuse, New York, which manufactured hard metal parts from tungsten carbide and cobalt, were studied by chest radiographs, spirometry, and plethysmographically determined lung volumes. The plant was closed in 1982 and the studies were performed in 1983-5. Recorded measurements of carbide dust concentrations were only mildly excessive by modern standards, but deceitful efforts to reduce the apparent concentration of dust were known to have occurred during an inspection by the Occupational Safety and Health Administration. Lung biopsies in four cases in the study and necropsy in one of the 83 cases not studied during life showed giant cell interstitial pneumonia and appreciable concentrations of tungsten carbide. This information indicates that exposure was substantial. Four workers had evidence of pulmonary fibrosis by chest radiographs; two of these workers had normal pulmonary function. Fourteen had abnormal pulmonary function, five of whom had a restrictive pattern, eight a pattern of air trapping, and one a combined pattern. Thus radiographic, or functional abnormalities, or both occurred in 16 of the 42 cases studied. No correlation with duration of exposure was established. Progressive clinically important disease (one fatal) has been found in four ex-workers, two in each of the restrictive and air trapping groups. These findings suggest that poorly regulated dust concentrations in a hard metals factory possibly cause pulmonary abnormalities and sometimes severe illness AU - Auchincloss JH AU - Abraham JL AU - Gilbert R AU - Lax M AU - Henneberger PK AU - Heitzman ER AU - Peppi DJ LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - IP - DP - 1992 Jan 01 TI - A case of extrinsic allergic alveolitis in a shoe factory worker. PG - 38-40 AB - The article describes one case of exogenic allergic alveolitis (EAA) developed in female engaged into shoe-making during 20 years and exposed to high concentrations of industrial multicomponent aerosols. Having pneumonia-like exacerbations, the disease demonstrated growing dyspnea and intercurrent pulmonary infiltrations. Such diagnoses as pneumonia, pulmonary tuberculosis, Loeffler syndrome, pulmonary sarcoidosis and EAA were discussed. The diagnosis of "shoe-maker's" EAA was based on the features of anamnesis, occupational life and manifestations confirmed by immunologic and morphologic data. Endobronchial lavage with hydrocortisone administration was proved to be effective. The importance of clinical and immunologic criteria, examination of ability to work in people suffering from EAA was stressed AU - Poliakova IN LA - PT - DEP - TA - Gig Tr Prof Zabol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 11 IP - DP - 1992 Jan 01 TI - Respiratory symptoms and ventilatory capacity in metal polishers PG - 466-472 AB - To evaluate the long-term effects of metal dusts on the bronchopulmonary system and the synergistic effect of cigarette smoke, a comparative study of spirometric measurements in 104 polishers and 90 unexposed controls was carried out in 25 brass and steelware polishing industries at Moradabad in northern India. The two groups were comparable in terms of age, height, smoking habit and socio-economic status. A total of 58.6% of the polishers had one or more respiratory symptoms, compared to only 25.5% of the controls (P : 0.05). Chronic cough was present in 21 polishers (20.2%) as compared to 11.1% of the controls. However, this difference was insignificant. Chronic phlegm was nearly three times as frequent among the polishers as among the controls (17.5% vs 4.4%) (P : 0.005). The prevalence of dyspnoea of varying grades was also significantly higher (16.3% as opposed to 4.4%) among the exposed groups. Chronic bronchitis (6.7%) and occupational asthma (4.8%) were found to be confined to polishers. The polishers also experienced acute respiratory symptoms during the work shift. The prevalence of acute respiratory symptoms was recorded for cough in 19 workers (44.1%) followed by dyspnoea in 14 workers (32.5%) and throat irritation in 11 workers (25.5%). Comparison of the mean values of pulmonary function parameters in the polishers and the controls showed significant differences in the smoking and non-smoking groups (P : 0.001). The polishers exhibited significantly greater acute reductions in various lung functions over the work shift, particularly for forced expiratory flow over the 25-75% portion of the spirogram (FEF25-75%) FEF25% and FEF50%, than did the controls.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Rastogi SK AU - Gupta BN AU - Husain T AU - Mathur N AU - Pangtey BS AU - Garg N LA - PT - DEP - TA - Hum Exp Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 31 IP - DP - 1992 Jan 01 TI - Hypersensitivity pneumonitis induced by hexamethylene diisocyanate PG - 912-916 AB - A case of hypersensitivity pneumonitis (HP) induced by hexamethylene diisocyanate (HDI) is described. Serial determinations of the lymphocyte surface phenotypes by two-color assay revealed the following: 1) increased activated cytotoxic T lymphocytes in the bronchoalveolar lavage fluid (BALF), and 2) increased percentage and absolute number of non-major histocompatibility complex (MHC)-restricted natural killer (NK) cells in the peripheral blood (PB) during the recovery phase of the disease. These findings were considered to be related to the activity of the disease AU - Usui Y AU - Aida H AU - Kimula Y AU - Miura H AU - Takayama S AU - Nakayama M LA - PT - DEP - TA - Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 99 IP - DP - 1992 Jan 01 TI - Comparison of the antigenic and allergenic properties of three types of bovine epithelial material PG - 112-117 AB - The antigenic and allergenic characteristics of three bovine epithelial extracts, dander, skin scrapings and whole skin, were compared using IgE-ELISA inhibition and SDS-PAGE with immunoblotting. Cow dander extract was shown to contain more allergenic activity than skin scrapings or whole skin extracts which were needed in about three times higher amounts than cow dander extract to induce the same degree of inhibition in ELISA. Skin scrapings and whole skin extracts contained more high-molecular weight components than dander extract. These components were at least partly serum-derived and reacted often with the IgG but not with the IgE of both the cow-asthmatics and their control subjects. The antigenic characteristics of the low-molecular weight components as well as the allergenic qualities of these three epithelial preparations were generally similar. Using the sera of 49 cow-asthmatic farmers, two major allergens were detected at 20 and 22 kD in all three extracts. Our results show that the highest amount of allergenic material and all the essential allergens are present in cow dander extract. In addition, the normally non-allergenic high molecular weight components are detected in low concentrations in dander extract. Therefore it is concluded that cow dander extract is the best alternative for allergen purification and allergen extract preparation AU - Ylonen J AU - Mantyjarvi R AU - Taivainen A AU - Virtanen T LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 64 IP - DP - 1992 Jan 01 TI - Prevalence of respiratory allergy in a platinum refinery PG - 257-260 AB - In a cross-sectional study, 65 workers in the chemical industry with exposure to platinum salts were investigated with regard to the prevalence to allergic respiratory tract diseases. A respiratory questionnaire, a skin-prick test with K2PtCl6 and environmental allergens, determination of total IgE, platinum-specific IgE and histamine release in basophilic granulocytes and lung function tests were applied before and after a Monday shift and after a Friday shift. Work-related symptoms of respiratory allergy were present in 23% of all workers, but were significantly more frequent in the most exposed group in the platinum refinery (52.4%). Of all workers, 18.7% had a positive skin-prick test with platinum salt. As compared to the other workers, the workers with work-related symptoms of respiratory allergy had significantly more positive skin-prick tests (64.3%) and a higher total IgE and platinum-specific IgE; they did not, however, show higher histamine release. In the course of the week, a significant fall in lung function, namely in FEV1 and FEF25, was recorded in the group of workers with work-related symptoms AU - BolmAudorff U AU - Bienfait HG AU - Burkhard J AU - Bury AH AU - Merget R AU - Pressel G AU - SchultzeWerninghaus G LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 90 IP - DP - 1992 Jan 01 TI - Rhinitis and asthma caused by occupational exposure to carob bean flour PG - 1008-1010 AU - van der Brempt X AU - Ledent C AU - Mairesse M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 90 IP - DP - 1992 Jan 01 TI - Respiratory allergy to Aspergillus-derived enzymes in bakers' asthma PG - 970-978 AB - Baking and food industry workers are exposed to several powdered Aspergillus-derived enzymes with carbohydrate-cleaving activity that are commonly used to enhance baked products. We describe a retrospective study of sensitization to fungal alpha-amylase and cellulase on bakers. Five bakers in whom respiratory allergy symptoms developed when they were exposed to bread "improvers" that contained fungal alpha-amylase and cellulase were investigated by in vivo and in vitro tests. Type I hypersensitivity to these enzymes was demonstrated in the five patients by means of skin testing, histamine release test, positive reverse enzyme-immunoassay for specific IgE antibodies, and bronchial provocation test response to alpha-amylase or cellulase or both. Isolated immediate and dual responses to the bronchial challenge tests with these enzymes were observed. Immunoblot analysis with use of a pooled serum identified IgE-binding components in both enzymes. In the reverse-enzyme immunoassay-inhibition assays cross-reactivity between alpha-amylase and cellulase was not found, but some degree of cross-reactivity between alpha-amylase and A. oryzae, and between cellulase and A. niger was demonstrated. Four of the patients were also sensitized to cereal flour. Aspergillus-derived enzymes used as flour additives can elicit IgE-mediated respiratory allergy, and this fact has to be considered in the diagnosis and clinical management of bakers' asthma AU - Quirce S AU - Cuevas M AU - DiezGomez M AU - FernandezRivas M AU - Hinojosa M AU - Gonzalez R AU - Losada E LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 41 IP - DP - 1992 Jan 01 TI - Medical students' exposure to formaldehyde in a gross anatomy dissection laboratory PG - 115-119 AB - The authors studied 150 first-year medical students exposed to formaldehyde during the dissection of cadavers in a gross anatomy laboratory. As a reference group, they used 189 third- and fourth-year medical students matched for sex, ethnic group, and age. Environmental and personal samples were collected to determine the exposure to formaldehyde among the first-year students. The mean concentration of formaldehyde in parts per million (ppm) in the area was 0.50 ppm (range = 0.40-0.60 ppm) and the personal sample was 0.74 ppm (range = 0.41-1.20 ppm). No significant differences were noted in the pre- and post-exposure mean FEV1 (forced expiratory volume in 1 second) and FVC (forced vital capacity) among the 22 randomly selected exposed male and female subjects. Significant differences, however, were observed in the exposed group for symptoms of decreased ability to smell, eye irritation, throat irritation, and dry mouth in comparison with the reference group. These symptoms were also significantly related to the time and place of occurrence. Medical schools should take more concrete measures to reduce students' exposure to formaldehyde. Meanwhile, although it is not now the practice in most medical schools, students should have ready access to goggles and respirators when working in dissection laboratories AU - Chia SE AU - Ong CN AU - Foo SC AU - Lee HP LA - PT - DEP - TA - J Am Coll Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 34 IP - DP - 1992 Jan 01 TI - Mushroom worker's lung. Detection of antibodies against Shii-take (Lentinus edodes) spore antigens in Shii-take workers PG - 1097-1101 AB - Indoor cultivation of the edible mushroom Shii-take (Lentinus edodes) regularly leads to symptoms of mushroom worker's lung (MWL) in workers. An immunologic test is described allowing detection of IgG type antibodies against Shii-take spore antigens. It was found that MWL patients employed in Shii-take picking (n = 5) have significantly increased antibody titres against Shii-take spore antigens. Different control groups, viz, MWL patients employed in the cultivation of the white button mushroom Agaricus bisporus (n = 14) and of the oyster mushroom Pleurotus spp (n = 3), patients with Bechterew's syndrome (n = 7), sarcoidosis (n = 7), rheumatoid arthritis (n = 9), and healthy controls were found in the same range of low titres. The use of protective masks during picking reduced complaints of the workers (n = 14). However, their antibody titres increased with duration of employment despite the protection AU - Van Loon PC AU - Cox AL AU - Wuisman OP AU - Burgers SL AU - Van Griensven LJ LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 34 IP - DP - 1992 Jan 01 TI - IgG subclass antibody against trimellitic anhydride in workers with and without immunologic lung diseases PG - 989-992 AB - In a retrospective comparison of two worker cohorts with elevated total antibody against trimellitic anhydride (TMA) conjugated to human serum albumin (TM-HSA), IgG subclass antibodies against TMA were studied in 19 workers with and 12 workers without TMA-induced immunologic lung disease. The main outcome measures were ELISA index of IgG1, IgG2, IgG3, and IgG4 against TM-HSA. There were no statistically significant differences in levels of any IgG subclass between these two groups. Neither were there any statistically significant differences when workers without lung disease were compared with subgroups of workers with lung disease, such as late respiratory systemic syndrome (n = 8), asthma/rhinitis (n = 6), or both (n = 5). In TMA workers with elevated total antibody against TM-HSA, IgG subclasses against TM-HSA in workers with TMA-induced immunologic lung disease were not different from workers without disease AU - Gerhardsson L AU - Grammer LC AU - Shaughnessy MA AU - Patterson R LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 70 IP - DP - 1992 Jan 01 TI - A case of toxic fibrosing alveolitis caused by ammonia vapors PG - 47-48 AU - Panova EI AU - Shershnev VN AU - Khavin PP LA - PT - DEP - TA - Klin Med (Mosk) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 340 IP - DP - 1992 Jan 01 TI - Occupational asthma in radiographers PG - 1477-1477 AU - Cullinan P AU - Hayes J AU - Cannon J AU - Madan I AU - Heap D AU - Newman Taylor AJ LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 67 IP - DP - 1992 Jan 01 TI - Allergic reactions to latex among health-care workers PG - 1075-1079 AB - With the emergence of the acquired immunodeficiency syndrome (AIDS) epidemic and the practice of protecting health-care workers from all body fluids, the use of rubber gloves has increased, as has occupational allergy to latex among health-care workers. During 1991, 49 Mayo Medical Center employees sought assessment and treatment of rhinitis, conjunctivitis, contact urticaria, contact dermatitis, asthma, or eczema thought to be related to exposure to latex. Most of these persons had a history of atopy and worked in areas where rubber gloves were used and changed frequently. Of the 49 subjects, 34 had positive results of skin tests to latex products, and the sera from 19 of 35 persons tested contained increased latex-specific IgE antibodies. Employees with sensitivity to latex (and co-workers in the immediate areas) should use vinyl gloves and should notify their own health-care providers of their sensitization. Changes in job assignment may be necessary for some persons AU - Bubak ME AU - Reed CE AU - Fransway AF AU - Yunginger JW AU - Jones RT AU - Carlson CA AU - Hunt LW LA - PT - DEP - TA - Mayo Clin Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 30 IP - DP - 1992 Jan 01 TI - Clinical study of bronchial inhalation challenge in summer-type hypersensitivity pneumonitis induced by Trichosporon cutaneum. PG - 1931-1936 AB - To evaluate the methods and criteria of judgement for the bronchial antigen inhalation challenge test, the test was performed with culture filtrate antigen of serotype I and II of Trichosporon cutaneum in 18 patients with summer-type hypersensitivity pneumonitis from 15 families. The quantity of 15 mg of culture filtrate antigen was adequate, and had no side effects. In the tests, 17 of 18 patients showed a positive reaction to both or either, serotype of antigen. In 36 performances of inhalation, there were 21 positive reactions and 15 negative reactions. According to the criteria of judgment for inhalation challenge test, the positive response rates of observation items were 75% for symptoms and signs, and 51% for laboratory data. Items with a high positive rate were cough, crepitant rales, and decrease of PaO2. On the other hand, low positive rates were observed for decrease of DLco, VC and positive CRP. Items with both high sensitivity and high specificity were cough, crepitant rales and decrease of PaO2. The low positive rate of decreased DLco was due to insufficient improvement before inhalation challenge. It was concluded that our methods and criteria of judgment for bronchial inhalation challenge test are useful AU - Sakata T AU - Sakata K AU - Yamasaki H AU - Yoshida K AU - Soda K AU - Mizobe T AU - Ito K AU - Ando M LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 30 IP - DP - 1992 Jan 01 TI - A case of hypersensitivity pneumonitis caused by a humidifier. PG - 1864-1868 AB - A 58-year-old woman was admitted complaining of dry cough and exertional dyspnea. Physical findings, chest X-ray films, chest CT scan and respiratory function tests were suggestive of interstitial pneumonia. Transbronchial lung biopsy showed specific findings of hypersensitivity pneumonitis. As a result of positive provocation test using her home humidifier, a diagnosis of humidifier lung was made. Many microorganisms including Flavobacterium meningosepticum were cultured from the water left in the humidifier for one week. As both complement fixation test and precipitation test were positive to humidifier water and to extract of Flavobacterium meningosepticum, the humidifier and Flavobacterium meningosepticum were suggested to be causative in this case AU - Tsujino I AU - Betsuyaku T AU - Inaba S AU - Yoshikawa T AU - Terai T LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 133 IP - DP - 1992 Jan 01 TI - Cobalt-induced asthma in workers exposed to hard metal dust PG - 2771-2772 AB - A case of 39 years old woman with asthma bronchiale associated with cobalt exposure is reported. Specific bronchial provocation tests in these patients supported the diagnosis of hard-metal-induced asthma and implicated cobalt as the agent responsible. The relevant literature data are reviewed AU - Lantos A AU - Galambos E AU - Tarjan E AU - Zsiray M AU - Wollak A LA - PT - DEP - TA - Orv Hetil JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 20 IP - DP - 1992 Jan 01 TI - A major barley allergen associated with baker's asthma disease is a glycosylated monomeric inhibitor of insect alpha-amylase: cDNA cloning and chromosomal location of the gene PG - 451-458 AB - A 14.5 kDa barley endosperm protein that is a major allergen in baker's asthma disease, as previously shown by both in vitro (IgE binding) and in vivo tests, has been identified as a glycosylated monomeric member of the multigene family of inhibitors of alpha-amylase/trypsin from cereals. A cDNA encoding this allergen (renamed BMAI-1) has been isolated and characterized. The deduced sequence for the mature protein, which is 132 residues long, is identical in its N-terminal end to the 20 amino acid partial sequence previously determined from the purified allergen, and fully confirms that it is a member of the multigene family of cereal inhibitors. Southern-blot analysis of wheat/barley addition lines using the insert in the BMAI-1 cDNA clone as a probe, has led to the location of the allergen gene (Iam1) in barley chromosome 2, while another related member of this protein family, the barley dimeric alpha-amylase inhibitor BDAI-1 gene (Iad1) has been located in chromosome 6. Iam1 is the first member of this inhibitor family in cereals to be assigned to chromosome group 2, thus extending the dispersion of genes in the family to five out of the seven homology groups of chromosomes in wheat and barley (chromosomes 2, 3, 4, 6 and 7) AU - Mena M AU - SanchezMonge R AU - Gomez L AU - Salcedo G AU - Carbonero P LA - PT - DEP - TA - Plant Mol Biol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 9 IP - DP - 1992 Jan 01 TI - Acute pneumopathy caused by exposure to zinc oxide. PG - 632-633 AB - The authors report the case of an acute lung reaction due to an accidental exposition to zinc oxide. This episode showed features of metal fume fever. The bronchoalveolar lavage showed an increased cellularity (1,300 cells/mm3) with 28% neutrophils and 25% eosinophils. The characteristics of pulmonary disease associated with fever associated to exposure to zinc, as well as its pathogenic mechanism are discussed AU - Castet D AU - Bouillard J LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 30 IP - DP - 1992 Jan 01 TI - Nasal sensitization of dairy farmers to bovine epithelial and urinary antigens PG - 121-127 AB - Nineteen dairy farmers with nasal symptoms associated with working in cowhouses participated in the study. Nasal challenge with bovine epithelial antigen (BEA) and bovine urinary antigen (BUA) was made before and after the indoor feeding season. Nasal challenge made before the indoor feeding season with BEA was positive in five patients and three of them showed positive reaction in nasal challenge also with BUA. After the indoor feeding season the results in nasal challenge with BEA were approximately equal to BEA and four of them showed positive response in nasal challenge to BUA. However, we did not find any significant increase in sensitivity in nasal challenge to BEA or BUA after the indoor feeding season. In addition to these patients, two patients who were excluded from nasal challenge before the indoor feeding season showed positive results in nasal challenge after the indoor feeding season with both BEA and BUA. Our results suggest that BUA in addition to BEA may have significance to nasal symptoms AU - Rautiainen M AU - Ruoppi P AU - Jagerroos H AU - Nuutinen J AU - Mantyjarvi R AU - Virtanen T LA - PT - DEP - TA - Rhinology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 18 IP - DP - 1992 Jan 01 TI - Occupational exposure to sulfuric acid in southern Ontario, Canada, in association with laryngeal cancer PG - 225-232 AB - A case-referent study, designed to test associations between asbestos, nickel, and the development of laryngeal cancer, was conducted in southern Ontario in 1977-1979. The cases were individually matched to neighborhood referents for gender and age. This constituted the primary study. Personal interviews had secured tobacco, alcohol, and detailed work histories. To 183 of the male pairs was added retrospective assessments of sulfuric acid exposure for each job, blind of disease status; this constituted the data base for an augmented secondary analysis. Logistic regression revealed statistically significant odds ratios when tobacco and alcohol were controlled. Exposure-response gradients were strongly positive with odds ratios in the range of 1.97 [95% confidence interval (95% CI) 0.63-6.13] for short duration-low level exposure through 6.91 [95% CI 2.20-21.74] for long duration-higher level exposure employing progressively more specific definitions of exposure. Asbestos as a confounder and the interaction terms examined were nonsignificant. These findings are corroborative of those of other studies AU - Soskolne CL AU - Jhangri GS AU - Siemiatycki J AU - Lakhani R AU - Dewar R AU - Burch JD AU - Howe GR AU - Miller AB LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 18 IP - DP - 1992 Jan 01 TI - Severe farmer's lung following a workplace challenge PG - 327-328 AB - A severe attack of farmer's lung developed in a dairy farmer after a workplace challenge. The patient showed full recovery after corticosteroid therapy. If a workplace challenge is considered necessary in the diagnosis of farmer's lung, care should be taken to avoid unnecessarily heavy exposure to the offending antigens AU - Kokkarinen J AU - Tukiainen H AU - Terho EO LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Acute and long term respiratory damage following inhalation of ammonia PG - 755-757 AB - A lifelong non-smoker who was the victim of a massive accidental exposure to anhydrous ammonia gas was followed up for 10 years. In the acute phase the patient presented with severe tracheobronchitis and respiratory failure, caused by very severe burns of the respiratory mucosa. After some improvement he was left with severe and fixed airways obstruction. Isotope studies of mucociliary clearance, computed tomography, and bronchography showed mild bronchiectasis. It is concluded that acute exposure to high concentrations of ammonia may lead to acute respiratory injury but also to long term impairment of respiratory function AU - Leduc D AU - Gris P AU - Lheureux P AU - Gevenois PA AU - De Vuyst P AU - Yernault JC LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Occupational asthma due to polyethylene shrink wrapping (paper wrapper's asthma) PG - 759-759 AB - Occupational asthma due to the pyrolysis products of polyvinyl chloride (PVC) produced by shrink wrapping processes has previously been reported. The first case of occupational asthma in a shrink wrap worker using a different plastic, polyethylene, is reported; the association was confirmed by specific bronchial provocation testing AU - Gannon PFG AU - Burge PS AU - Benfield GF LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 112 IP - DP - 1992 Jan 01 TI - Nasal peak flow rate records in work related nasal blockage PG - 839-844 AB - Eleven patients, who had symptoms of blocking nose in relation to exposure to airway irritants in their work environment, and 11 control subjects recorded nasal and bronchial peak expiratory flow rates (PEFRN and PEFRB) during a working week. In contrast to the control subjects the patients demonstrated a pattern of gradual decrease in PEFRN during the working week with restitution during the subsequent weekend and a different day rhythm in PEFRN during working days from days off. The changes in PEFRB were similar but less pronounced. The results indicate that the symptoms of nasal blockage can be visualized by following the PEFRN during a working week and that the changes in PEFRN may have a relationship to different environmental exposures AU - Ahman M LA - PT - DEP - TA - Acta Otolaryngol (Stockh) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 24 IP - DP - 1992 Jan 01 TI - Occupational asthma caused by isocyanates. PG - 295-297 AB - The aim of our study is to find whether the percentage of RAST positives to isocyanates within a company is a reflection of the exposure of the workers. Specific IgE was sought in 199 workers from ten companies where isocyanates were used. Twenty of them were followed for some time (june 87 to september 90). A non-exposed reference group was used for comparison. Measurements were made by the Pharmacia RAST-ELISA Method. In some cases, controls were made by RAST-RIA and CAPS ELISA/RIA. Results show that the proportion of positive RAST varies from one organisation to another and is probably a measure of the type and intensity of the exposure; the improvement of the working conditions to reduce the ambient concentration reduces, in time, the proportion of positive RAST; there were no positive RAST in the reference group; the conditions of taking and storage of blood samples before analysis influences the result. In conclusion, measurement of specific IgE may be an useful alternative to measurement of ambient concentration for following workers exposed to isocyanates 40/199 workers rast positive (not defined) Pharmacia tests rasts used for surveillance AU - Lauwers D AU - Pierard P AU - Thiriaux J AU - Vandeweyer R LA - PT - DEP - TA - Allerg Immunol (Paris) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 20 IP - DP - 1992 Jan 01 TI - Occupational hypersensitivity to spiramycin. Report of a case. PG - 127-130 AB - A case report of occupational hypersensitivity to Spiramycin. Rhinoconjunctivitis and spasmodic cough are reported in a 34 year-old female handling spiramycin powder in a pharmaceutical factory. The symptoms appeared within the first few hours of coming into contact with the drug and continued for several hours after leaving her place of work. The patient had no personal case history of atopy. Results for prick-test with extracts using a concentration of 1/100 (w/v) were positive, as were results por intradermical tests with a solution using a concentration of 1/10.000 (w/v). The diagnostic was confirmed with the application of a nasal provocation test. Our criteria to determine positivity to this test was according to Bachman (1) and the European Committee of Rhinomanometry. On our suggestion the patient was transferred to another section of the pharmaceutical company whereupon all symptoms disappeared immediately and no further allergic reactions to drugs were registered. This case suggest that reactions to a chemical product may involve immunological mechanisms AU - Malet A AU - Amat P AU - Valero A AU - Bescos M AU - Merola E AU - Lluch M LA - PT - DEP - TA - Allergol Immunopathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 20 IP - DP - 1992 Jan 01 TI - Asthma caused by culinary spices. PG - 85-86 AU - OlivePerez A AU - Tena CG LA - PT - DEP - TA - Allergol Immunopathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Occupational pharyngitis associated with allergic patch test reactions from acrylics PG - 571-573 AB - A female dentist specialized in orthodontics repeatedly developed symptoms of pharyngitis at work. A chamber provocation test indicated that her symptoms were caused by acrylics. Prick tests with acrylics were negative, while patch tests were strongly positive although the patient had no skin symptoms. The relationship between the symptoms and the patch test results is discussed. It is suggested that type IV allergic reactions may be involved in symptoms of the upper respiratory tract AU - Kanerva L AU - Estlander T AU - Jolanki R AU - Pekkarinen E LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - A case of fallow deer allergy. Cross-reactivity between fallow deer and horse allergy PG - 574-575 AB - We report the case of a 25-year-old housewife, a native of Mexico City, with rhinitis and asthma induced by exposure to fallow deer in an animal park close to her home. In the literature, we could find only one previous case. The patient presented a polyvalent IgE sensitization in prick skin tests and RAST to several animals' dander and epithelia, but RAST inhibition experiments showed a cross-reactivity only between fallow deer and horse allergen extracts AU - Huwyler T AU - Wuthrich B LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 136 IP - DP - 1992 Jan 01 TI - Five cross-sectional studies of grain elevator workers PG - 1269-1279 AB - Five cross-sectional studies were conducted on grain workers in all the terminal elevators in British Columbia, Canada, at 3-year intervals from 1976 to 1988. Civic workers were studied in the same manner as a referent group. The studies consisted of questionnaires, spirometry using the same spirometers, allergy skin tests, and measurement of dust concentration by personal sampling. Although the dust concentration in the elevators was reduced progressively over the years, grain workers had more respiratory symptoms and lower lung function compared with the civic workers in each of the five cross-sectional studies. Exposure to grain dust was associated with significant reduction in forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) but not in maximal midexpiratory flow rate or FEV1/FVC, suggesting reduction in volume which may be due to lesions in the lung parenchyma or in the small airways. Cigarette smoking was associated with significant reduction in FEV1, maximal midexpiratory flow rate, and FEV1/FVC due to airflow obstruction, but had no influence on FVC. Workers who took part in all five surveys tended to be a "healthier" selected group, but the grain workers still had lower lung function compared with the civic workers. This study confirmed previous findings that grain dust has adverse effects on the lungs. Cross-sectional study of the grain elevator workers proved to be a consistent and useful method to evaluate occupational health hazards Survivor population at end whose ld reduced with years of exposure, grain less than office workers AU - ChanYeung M AU - DimichWard H AU - Enarson DA AU - Kennedy SM LA - PT - DEP - TA - Am J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Outbreak of hypersensitivity pneumonitis among mushroom farm workers PG - 859-872 AB - Between April 1982 and August 1985, seven cases of mushroom worker's lung (MWL), a form of hypersensitivity pneumonitis, were diagnosed among workers at one mushroom farm in Florida. The cases suffered from episodic shortness of breath, cough, fever and chills, myalgia, malaise, and difficulty breathing. Pulmonary function testing revealed restrictive ventilatory impairment and reduced diffusing capacity; chest radiographs exhibited diffuse interstitial pulmonary infiltrates. The seven cases occurred among workers from different farm operations, suggesting that workers throughout the farm were exposed to the disease causing agent(s). Six of the affected workers left employment at the farm in order to remain free of symptoms. The other affected worker was able to continue working at the farm, but only by remaining in a maintenance shop which was physically separated from the rest of the farm facilities. An industrial hygiene survey demonstrated that farm workers from every work area were exposed to organic dust constituents suspected of causing MWL, but no specific antigens were identified as the cause of the cases. Of the remaining workers who participated in a cross-sectional respiratory morbidity survey at the farm, approximately 20% of the more heavily exposed workers reported occasionally experiencing symptoms consistent with MWL. Approximately 10% of the workers had below normal spirometry test results, but interpretation was hampered by the diverse racial makeup of the population and lack of an adequate comparison group. No abnormalities consistent with either acute or chronic MWL were seen on the chest radiographs. Serologic tests demonstrated that almost all workers had been exposed to antigens capable of causing MWL, but the results were not associated with health status. At the time of the cross-sectional survey, no workers were found to be suffering acute respiratory problems consistent with MWL AU - Sanderson W AU - Kullman G AU - Sastre J AU - Olenchock S AU - O'Campo A AU - Musgrave K AU - Green F LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 89 IP - DP - 1992 Jan 01 TI - Mercurialis annua pollen; a new source of allergenic sensitisation and respiratory disease PG - 987-993 AU - GarciaOrtega P AU - Martinez J AU - Martinez A AU - Palacios R AU - Belmonte J AU - Richart C LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 72 IP - DP - 1992 Jan 01 TI - Microbial contamination of ambient air by ultrasonic humidifier and preventive measures PG - 161-166 AB - The microbially contaminated ultrasonic humidifier (UH) causes humidifier fever. The number of airborne viable bacteria was determined when the UH was operating, and other methods to humidify the air of hospital wards were also examined. A UH contaminated with 10(5) bacteria ml(-1), a level common in hospitals, increased the bacterial count in the air from 860 m(-3) to 88,000 m(-3) at a distance of 3 m from the humidifier. Thus UH in hospitals may contaminate the air and be a potential hazard to patients. Contamination was slight when a washable and disinfectable ultrasonic nebulizer was used with disinfection at 24 h intervals. In tracheostomy patients requiring a high degree of air humidification, ultrasonic nebulizers which are readily washed and disinfected are recommended AU - Oie S AU - Masumoto N AU - Hironaga K AU - Koshiro A AU - Kamiya A LA - PT - DEP - TA - Microbios JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 59 IP - DP - 1992 Jan 01 TI - Increased prevalence of IgG-induced sensitization and hypersensitivity pneumonitis (humidifier lung) in nonsmokers exposed to aerosols of a contaminated air conditioner PG - 211-214 AB - Specific IgG antibodies against antigens of a contaminated air conditioner were estimated in serum of 134 workers of a printing company. Altogether 64% of the workers investigated revealed significantly elevated levels (: 3 U/ml) of IgG antibodies specific to these antigens as compared to a nonexposed control group. The occurrence of IgG antibodies for microbial extracts were 25% for Fusarium, 23% for Penicillium notatum, 13% for Alternaria tenuis, 12% for Aureobasidium pullulans, 9% for Sphaeropsidales species, 3% for Micropolyspora faeni, 2% for Aspergillus fumigatus and 2% for Thermoactionomyces vulgaris. Out of the 86 workers with elevated IgG antibodies for air conditioner antigens, 59 were nonsmokers. Considering a cut-off level of 10 U/ml IgG for high values, the proportion of smokers to nonsmokers becomes even more pronounced (6 to 36 respectively, binominal test p : 0.001). This is despite the fact that the distribution of smokers and nonsmokers among the 134 workers is approximately equal (60 to 74). All 3 workers with clinical diagnosis of humidifier lung or humidifier fever belonged to the nonsmoker group. Our findings indicate that crude water extracts of contaminated air conditioners are the best choice as antigen source for the diagnosis of humidifier lung in exposed workers. Nonsmokers are shown to have a high risk for immunological sensitization AU - Baur X AU - Richter G AU - Pethran A AU - Czuppon AB AU - Schwaiblmair M LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 5 suppl 15 IP - DP - 1992 Jan 01 TI - Effect of the number of peak expiratory flow readings per day on diurnal variation PG - 200s- AU - Gannon PFG AU - Newton DT AU - Pantin CFA AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 5 suppl 15 IP - DP - 1992 Jan 01 TI - An evaluation of a computer based system to divide peak expiatory flow records PG - 403s- AU - Newton DT AU - Gannon PFG AU - Burge PS AU - Pantin CFA AU - Middleton J LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 5 suppl 15 IP - DP - 1992 Jan 01 TI - Interpretation of serial peak expiratory flow records for workers in an electroplating factory PG - 403s- AU - Gannon PFG AU - Newton DT AU - Burgess DCL AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 2 IP - DP - 1992 Jan 01 TI - Health and indoor climate complaints of 7043 office workers in 61 buildings in the Netherlands PG - 127-136 AU - Zweers T AU - Preller L AU - Brunekreef B AU - Boleij JSM LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 1 IP - DP - 1992 Jan 01 TI - Sick building syndrome, working environments and hospital staff PG - 335-340 AU - Kelland P LA - PT - DEP - TA - Indoor Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 70 IP - DP - 1992 Jan 01 TI - Pollution keratoconjunctivitis. A review PG - 269-273 AU - Norn M LA - PT - DEP - TA - Acta Ophthalmol (Copenh) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 21 IP - DP - 1992 Jan 01 TI - Wittenoom, Western Australia: a modern industrial disaster PG - 735-747 AU - Musk AW AU - de Klerk NH AU - Eccles JL AU - Hobbs MS AU - Armstrong BK AU - Layman L AU - McNulty JC LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 21 IP - DP - 1992 Jan 01 TI - Metal fume fever PG - 872-875 AB - Metal fume fever is an ancient occupational disease still encountered among metal workers. The delay between exposure and onset of non-specific symptoms makes this an elusive diagnosis. We present the case of a patient who developed symptoms several hours after welding. The historical background, pathogenesis, clinical presentation, and self-limited course of this common, yet frequently unrecognized illness are discussed AU - Offermann PV AU - Finley CJ LA - PT - DEP - TA - Ann Emerg Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Class specific antibodies in serodiagnosis of farmer's lung PG - 332-336 AB - The aim of the present study was to determine which microbes and which immunoglobulin (Ig) classes should be included in tests to discriminate between patients with farmer's lung and reference persons. The sera of a group of farmer's lung patients and their spouses were measured for IgG, IgA, IgM, and IgE antibodies against a panel of farmer's lung microbes. The concentrations of IgG, IgA, and IgE antibodies were higher in patients compared with their spouses. The patients were generally positive for antibodies of several Ig classes whereas the spouses had only either IgG or IgA antibodies. A test comprising the determinations of IgG antibodies against T vulgaris and IgA antibodies against A fumigatus would correctly group 94% of the cases in the Finnish farming population. The selection of microbes for other environments needs to be determined locally AU - Ojanen T LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Reduction of airborne allergenic urinary proteins from laboratory rats PG - 416-422 AB - Allergy and asthma caused by proteins of laboratory animals, particularly rats and mice, are the most important occupational health hazards for the scientists and technicians who work with such animals. The influence of different cage litters, cage design, and stock density on measured rat urinary aeroallergen (RUA) concentrations has been examined in a room housing male rats, to determine practical means to reduce allergen concentration in animal laboratories. Eight hour static air samples were taken at 2 1/min and the RUA concentrations measured by radioallergosorbent test (RAST) inhibition. High RUA concentrations occurred when the animals were housed on wood based, contact litter (geometric mean (GM) sawdust 7.79 micrograms/m3; woodchip 6.16 micrograms/m3). The use of noncontact absorbent pads was associated with a significant decrease in RUA concentrations (GM 2.47 micrograms/m3; p less than 0.0001). Rat urinary aeroallergen concentrations fell more than fourfold when the animals were housed on woodbased, contact litter in filter top cages rather than conventional open top cages (GM filter top 0.33 micrograms/m3; open top 1.43 micrograms/m3; p less than 0.0001). The number of rats (stock density) strongly influenced the RUA concentration and a linear relation was found between the log(e) allergen concentration and stock density under these study conditions. The measurement of airborne particle size on cleaning out days showed that all litter types generated similar sized particles: more than 80% of the RUA was carried on particles larger than 8 microns in diameter for all litter types.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Gordon S AU - Tee RD AU - Lowson D AU - Wallace J AU - Newman Taylor AJ LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Signs of alveolar inflammation in non-smoking Swedish wood trimmers PG - 428-434 AB - Wood trimmers are periodically exposed to mould and may develop extrinsic allergic alveolitis (EAA). To investigate if there were any signs of EAA in wood trimmers with low exposure, 19 non-smoking wood trimmers underwent bronchoalveolar lavage (BAL), spirometry, and measurement of diffusion capacity (TLCO). The group was subdivided into those with (n = 9) and without serological antibodies against mould. In 14 workers the TLCO was measured both at the beginning and at the end of a week at work. Twenty five healthy non-smokers served as BAL controls and 19 healthy non-smokers as lung function controls. The median exposure of total dust was well below the Swedish threshold value, and the exposure of mould and bacteria was also low. The cell concentrations and the proportions of the various alveolar cells did not differ between the groups. The concentrations of the soluble components albumin, fibronectin, and hyaluronan were, however, significantly increased (p less than 0.001 for all) in the workers. No difference was found in lung function between the workers and the controls, and the TLCO was not impaired during a week at work. The groups of seropositive and seronegative workers did not differ in any of these parameters. The results are interpreted as a low intensity alveolar inflammation. The presence of precipitating antibodies against mould did not predict any greater risk of developing a more intense inflammation. Analysis of soluble non-cellular BAL components seems to reflect a discrete ongoing alveolar inflammation better than cell counts only AU - Johard U AU - Eklund A AU - Dahlqvist M AU - Ahlander A AU - Alexandersson R AU - Ekholm U AU - Tornling G AU - Ulfvarsson U LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Respiratory symptoms and ventilatory capacity in swine confinement workers PG - 435-440 AB - A group of 59 workers (41 men and 18 women) employed in swine confinement areas was studied to assess the presence of acute and chronic respiratory symptoms and the prevalence of abnormalities in ventilatory function. A control group of 46 (31 men and 15 women) unexposed workers was studied for the prevalence of chronic respiratory symptoms. For both male and female swine confinement workers complaints of chronic cough, dyspnoea, and chest tightness were significantly more frequent than among control workers. Male workers also complained more of chronic phlegm. Male swine confinement workers who were smokers had significantly higher prevalences of chronic cough, chronic phlegm, and chronic bronchitis than male non-smoking swine confinement workers. The frequency of acute symptoms associated with the workshift was high among the swine confinement workers with more than half of the workers complaining of cough and dyspnoea associated with work. Significant acute across shift reductions in lung function occurred in swine confinement workers, being largest for FEF25. All Monday preshift ventilatory capacity measurements in male confinement workers were significantly lower than predicted values; FVC and FEV1 were found to be lower than predicted values for women. The data indicate that exposure in swine confinement buildings is associated with the development of acute and chronic respiratory symptoms and impairment of lung function. Smoking appears to aggravate these changes AU - Zuskin E AU - Zagar Z AU - Schachter EN AU - Mustajbegovic J AU - Kern J LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 101 IP - DP - 1992 Jan 01 TI - Combined effect of smoking habits and occupational exposure to hard metal on total IgE antibodies PG - 1569-1576 AB - A survey was made within a population of workers (n = 706) exposed to hard metal dust (an alloy including cobalt), an agent known to cause occupational allergy. Twenty-seven (4 percent) of 733 workers were eliminated from consideration in this study because of atopic status identified prior to starting work in the plant. Using a Phadebas PRIST, the subjects' total IgE levels were determined and related to their smoking and exposure status. Nonexposed male smokers (n = 135) had a higher geometric mean IgE level (39.7 IU/ml) than did nonexposed subjects who had never smoked (33.1 IU/ml; n = 99); those with a higher Brinkman index (greater than 300), a smoking index obtained by multiplying the number of cigarettes per day by the duration of smoking in years, had significantly (p less than 0.05) decreased IgE levels. Although ex-smokers (n = 72) had a higher geometric mean IgE level (73.3 IU/ml) than did those who had never smoked, their serum IgE level declined with age since the time they quit smoking, regardless of their hard metal exposure status. Hard metal (cobalt) exposure may play a significant role as an adjuvant in the production of total IgE. A multivariate analysis demonstrated that hard metal exposure and a smoking habit together arithmetically (p less than 0.05) increased total IgE levels. These two factors may be preventable risk factors for occupational allergy in hard metal workers AU - Shirakawa T AU - Kusaka Y AU - Morimoto K LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 89 IP - DP - 1992 Jan 01 TI - Occupational asthma caused by a prepolymer but not the monomer of toluene diisocyanate (TDI) PG - 1183-1188 AB - Isocyanates are the most common cause of occupational asthma. Isocyanate monomers and prepolymers are widely used in the manufacture of polyurethane compounds. However, prepolymers are generating increasing interest because of their lower volatility. No distinction has yet been made between asthmatic reactions caused by the monomers and the prepolymers of isocyanates, and asthmatic reactions caused by one type of isocyanate but not the other type have not been reported. We describe two wood-roof maintenance workers who developed asthma after being exposed to a varnish containing a prepolymer of toluene diisocyanate (TDI) with only small amounts of the monomer. Specific inhalation-challenge tests with the TDI monomer did not elicit significant airway obstruction, whereas exposure to the varnish and to the purified TDI prepolymer induced late asthmatic reactions. Specific antibodies against TDI monomer human serum albumin and TDI prepolymer human serum albumin conjugates could not be demonstrated. These observations demonstrate that isocyanate prepolymers can cause occupational asthma and that asthmatic reactions caused by isocyanate prepolymers, but not to the corresponding monomer, can occur in some exposed workers AU - Vandenplas O AU - Cartier A AU - Lesage J AU - Perrault G AU - Grammer LC AU - Malo JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 45 IP - DP - 1992 Jan 01 TI - The feasibility of using a double blind experimental cross-over design to study interventions for sick building syndrome PG - 603-612 AB - Methodological problems have limited scientific investigation of the causes of and solutions for sick building syndrome. The feasibility of using an experimental double blind cross-over study to resolve many of these methodological problems was assessed in a pilot study. The experimental intervention was to vary the amount of outdoor air from 10 cubic feet per minute per person (cfmpp) to 20 cfmpp or 50 cfmpp by central manipulation of the building heating, ventilation and air-conditioning (HVAC) system. Over 6 consecutive study weeks, 2 trials of rates were administered in random order. Study subjects and investigators of the study were blinded to intervention sequence. Unblinding, office environment rating and symptom occurrence were measured weekly. Of 305 eligible workers, 254 participated. Problems were encountered in delivering the lowest dose of ventilation due to building leakage. The prevalence of symptoms diminished steadily over the 6 study weeks, time trends which could be controlled by recommended design modifications. Blinding to the intervention was successfully maintained. Weekly non-response did not introduce a response bias but reduced the number of subjects available for analysis by one-third for each trial. We conclude that this design, with certain modifications, is feasible to evaluate many proposed interventions for sick building syndrome AU - Tamblyn RM AU - Menzies RI AU - Tamblyn RT AU - Farant JP AU - Hanley J LA - PT - DEP - TA - J Clin Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 60 IP - DP - 1992 Jan 01 TI - Dysfunctional buildings or dysfunctional people: an examination of the sick building syndrome and allied disorders PG - 220-224 AB - As Bauer et al. (1992) have indicated, psychological variables may play a prominent role in workplace-related disorders, like sick building syndrome. To place their work in a broader context, a spectrum of workplace disorders is described that encompasses sick building syndrome, building-related illness, neurotoxic disorders, and mass psychogenic illness. For each disorder, the authors identify both the building- (or exposure-) related variables and the psychological variables believed to trigger or maintain the unique pattern of somatic and neuropsychiatric symptoms. Strategies to aid in diagnostically differentiating the four syndromes are also discussed AU - Ryan CM AU - Morrow LA LA - PT - DEP - TA - Journal of Consulting & Clinical Psychology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 60 IP - DP - 1992 Jan 01 TI - The role of psychological factors in the report of building-related symptoms in sick building syndrome PG - 213-219 AB - Sick building syndrome (SBS) is an increasingly common problem, although continued skepticism exists regarding its validity. Because of this, the attribution of complaints to psychogenic causes or mas hysteria persists. In this study (N = 111), self-report measures of psychopathology (Minnesota Multiphasic Personality Inventory [Hathaway & McKinley, 1983] and SCL-90-R [Derogatis, 1983]) and physical symptom reports failed to discriminate symptomatic from nonsymptomatic workers in an affected building but could more generally differentiate workers in the target building from control subjects. These results suggest that SBS cannot be justifiably attributed to psychological factors alone, although working in a contaminated environment appeared to have deleterious psychological consequences for some workers. Smoking history (in pack/years [packs per day x number of years smoked]) was reliably associated with the development of symptoms in exposed workers. Issues related to the assessment of psychological complaints in SBS are discussed AU - Bauer RM AU - Greve KW AU - Besch EL AU - Schramke CJ AU - Crouch J AU - Hicks A AU - Ware MR AU - Lyles WB LA - PT - DEP - TA - Journal of Consulting & Clinical Psychology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 34 IP - DP - 1992 Jan 01 TI - Assessing occupational disability from asthma PG - 120-128 AB - Asthma is receiving increased attention as a cause of occupational disability, both by virtue of occupational causation and by interactions between work and pre-existing asthma. Reasons for the failure of pneumoconiosis-related disability evaluation systems to be applicable to asthma are discussed, including the inherent variability of asthma, its responsiveness to treatment, and its variable time course with respect to occupational exacerbation. A distinction is made between the trait of airway hyperresponsiveness and the disease of asthma. A scheme for organizing reports about asthma-related disability clearly specifies the questions that need to be addressed AU - Harber P LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 34 IP - DP - 1992 Jan 01 TI - Spirometry in the occupational setting. Notes for guidance PG - 559-561 AU - Anonymous LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 156 IP - DP - 1992 Jan 01 TI - Two consecutive thunderstorm associated epidemics of asthma in the city of Melbourne. The possible role of rye grass pollen PG - 834-837 AB - OBJECTIVE: To document the clinical impact and identify the meteorological and environmental circumstances surrounding two epidemics of asthma exacerbations associated with thunderstorms in the city of Melbourne and to find a possible aetiology for these events. DESIGN: Collection of meteorological and environmental data from the Victorian Bureau of Meteorology and the Environment Protection Authority; collection of clinical data from metropolitan emergency departments and the Victorian Ambulance Service; and study of a cohort of affected patients with asthma and a control group of asthmatics who were not affected by the storms. SETTING: Tertiary institution. PATIENTS: Twelve storm-affected patients with asthma and 16 asthmatics not affected by the storms. INTERVENTION: Administration of a questionnaire, medical interview, pulmonary function tests and skin prick tests with common allergens. MAIN OUTCOME AND RESULTS: Both epidemics caused a major increase in the number of hospital attendances and admissions because of asthma exacerbation (five to ten fold rise). These events could not be related to atmospheric pollution or specific meteorological features of the storms. Patients affected by the second storm were significantly more likely to suffer from hay fever (P less than 0.05), rye grass pollen allergy (P less than 0.05) and allergy to rainfall released rye grass starch granules (P less than 0.025). CONCLUSIONS: Late spring thunderstorms in the city of Melbourne can trigger epidemics of asthma attacks. The seasonal nature of the phenomenon and the pattern of allergic responses found in affected patients suggest a possible aetiological role for rye grass pollen AU - Bellomo R AU - Gigliotti P AU - Treloar A AU - Holmes P AU - Suphioglu C AU - Singh MB AU - Knox B LA - PT - DEP - TA - Med J Aust JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 42 IP - DP - 1992 Jan 01 TI - Health and lifestyle characteristics of professional singers and instrumentalists PG - 89-92 AB - Ninety-one instrumentalists and 51 opera singers of the Royal Theatre in Copenhagen, Denmark, were examined, in order to study the frequency of symptoms from the musculoskeletal system and upper airways. The response rate was 91 per cent. Estimates of odds ratios (OR) with 95 per cent confidence interval were calculated, using multiple logistic regression equations, adjusting for age and gender. The frequency of musculoskeletal complaints was the same in singers and instrumentalists. Musculoskeletal problems were however not identical. Instrumentalists had statistically significantly more symptoms from the arm region than singers, OR = 3.1 (1.02-9.5), P less than 0.05. In contrast, instrumentalists had significantly fewer complaints from hip-, knee- and foot joints than singers, OR = 0.2 (0.07-0.61), P less than 0.001. Singers had significantly more symptoms from mouth, lips or throat than instrumentalists, OR = 4.5 (1.7-11.5), P = 0.002. Both male and female instrumentalists had a higher blood pressure. This difference seemed at least in part to be explained by a higher alcohol intake among instrumentalists. We suggest these differences in life style and health characteristics are likely to be caused by professional, ie occupational, work loads AU - Eller N AU - Skylv G AU - Ostri B AU - Dahlin E AU - Suadicani P AU - Gyntelberg F LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 89 IP - DP - 1992 Jan 01 TI - Increased incidence of asthma in children of smoking mothers PG - 21-26 AB - The relationship between parental smoking and both subsequent development of asthma and subsequent lung function (before age 12) was studied in more than 700 children enrolled before age 5. Children of mothers with 12 or fewer years of education and who smoked 10 or more cigarettes per day were 2.5 times more likely (95% confidence interval 1.42 to 4.59; P = .0018) to develop asthma and had 15.7% lower maximal midexpiratory flow (P less than .001) than children of mothers with the same education level who did not smoke or smoked fewer than 10 cigarettes per day. These relationships were independent of self-reported respiratory symptoms in parents. There was no association between maternal smoking and subsequent incidence of asthma or maximal midexpiratory flow among children of mothers with more than 12 years of education. It is concluded that children of lower socioeconomic status may be at considerable risk of developing asthma if their mothers smoke 10 or more cigarettes per day. It is speculated that recently reported increases in prevalence of childhood asthma may be in part related to the increased prevalence of smoking among less educated women AU - Martinez FD AU - Cline M AU - Burrows B LA - PT - DEP - TA - Pediatrics JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Comparison of allergic responses to dust mites in U.K. bakery workers and Swedish farmers PG - 233-240 AU - Tee RD AU - Gordon DJ AU - van HageHamsten M AU - Gordon S AU - Nunn AJ AU - Johansson SGO AU - Newman Taylor AJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Purification and characterisation of Lep d1, a major allergen from the mite Lepidoglyphus destructor PG - 454-460 AU - Ventas P AU - Carreira J AU - Polo F LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Divergent immune responses to respiratory and contact chemical allergens; antibody elicited to phthalic anhydride and oxozolone PG - 241-250 AU - Dearman RJ AU - Kimber I LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Increased sensitivity to toluene diisocyanate in airways previously exposed to low doses of TDI PG - 854-862 AU - Erjefalt I AU - Persson CGA LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Occupational asthma induced by the fungicide tetrachloroisothalonitrile PG - 760-761 AU - Honda I AU - Kohrogi H AU - Ando M AU - Araki S AU - Ueno T AU - Futatsuka M AU - Ueda A LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 21 IP - DP - 1992 Jan 01 TI - Occupational asthma induced by latex in a hospital nurse (letter). PG - 821-822 AU - Chatte M AU - Grange F AU - Prost G LA - PT - DEP - TA - Presse Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 34 IP - DP - 1992 Jan 01 TI - Two cases of occupational asthma probably caused by pyromellitic anhydride. PG - 150-151 AU - Tanaka K LA - PT - DEP - TA - Sangyo Igaku JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 5 suppl 15 IP - DP - 1992 Jan 01 TI - The accuracy of self recorded peak expiratory flow PG - 170s- AU - Gannon PFG AU - Belcher J AU - Pantin CFA AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - The accuracy of portable peak flow meters PG - 904-909 AU - Miller MR AU - Dickinson SA AU - Hitchings DJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 42 IP - DP - 1992 Jan 01 TI - Causes of hypersensitivity reactions in flour mill workers in Sudan PG - 149-154 AB - A study of 237 male workers at two flour mills and 71 controls was carried out in Sudan in order to investigate the main possible causes of hypersensitivity reactions to flour dust. Statistical analysis was carried out for the skin test results of wheat, mixed moulds (A13), grain dust, and mixed moulds (group MH) allergen extracts. The results showed that there was no statistical significance between the two exposed groups namely allergy complaining vs. allergy non-complaining except for wheat results in one of the two flour mills which was very slightly significant. But there were highly significant differences between the exposed compared with the control group in all allergens tested. There was no significant correlation, between allergic symptoms and precipitins to wheat or grain dust, nor between precipitins and positive skin tests. The results of respirable flour dust concentrations at different work locations had exceeded the threshold limit values which were taken as 10 mg/m3. Aspergillus supp. and Rhizopus niger were the predominant fungi in the wheat grains and products which were collected from the two mills. AU - Fakhri ZI LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 86 IP - DP - 1992 Jan 01 TI - A radiographer's asthma PG - 167-169 AU - Trigg CJ AU - Heap DC AU - Herdman MJ AU - Davies RJ LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 1 IP - DP - 1992 Jan 01 TI - The sick building syndrome: where are we in 1992 PG - 199-203 AU - Burge PS LA - PT - DEP - TA - Indoor Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 5 IP - DP - 1992 Jan 01 TI - The effect of phosphoramidon and epithelium removal on toluene diisocyanate-induced contractions in guinea-pig bronchi PG - 331-333 AU - Mapp CE AU - Boniotti A AU - Papi A AU - Chitano P AU - Saetta M AU - Di Stefano A AU - Ciaccia A AU - Fabbri LM LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - IP - DP - 1992 Jan 01 TI - Medical and clinical investigation of the sick building syndrome and building-related illnesses PG - 66-69 AU - Burge PS LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 36 IP - DP - 1992 Jan 01 TI - Determination of exposure to cobalt and nickel in the atmosphere in the hard metal industry PG - 497-507 AU - Kusaka Y AU - Kumagai S AU - Kyono H AU - Kohyama N AU - Shirakawa T LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Environmental chemicals and differential stimulation of immune response PG - 183-186 AU - Agius RM LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 81 IP - DP - 1992 Jan 01 TI - Occupational asthma [letter] PG - 434-435 AU - Ehrlich RI AU - Donson H AU - Bruning A LA - PT - DEP - TA - S Afr Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 304 IP - DP - 1992 Jan 01 TI - Pinpointing clusters of apparently sporadic cases of Legionnaires disease PG - 1022-1027 AU - Bhopal RS AU - Diggle P AU - Rowlingson B LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Occupational asthma induced by tall oil in the rubber tyre industry PG - 99-101 AB - A worker in the rubber tyre industry is described with occupational asthma from exposure to a solution of tall oil, a pine resin, confirmed by specific inhalation challenge. This supports studies of contact dermatitis which have suggested abietic and dehydroabietic acid oxidants to be the cause of colophony induced allergic reactions AU - Tarlo SM LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Occupational asthma due to EPO 60 PG - 294-295 AU - Lambourn EM AU - Hayes JP AU - McAllister WAC AU - Newman Taylor AJ LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Asthma and contact urticaria from latex gloves in a hospital nurse PG - 596-598 AU - De Zotti R AU - Larese F AU - Fiorito A LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Small airways dysfunction among non-smoking shipyard arc welders. PG - 441-444 AB - Increased volume of trapped gas (VTG), indicating small airways dysfunction, was found among 14 never smoking non-atopic welders who had worked for 10-31 (mean 22) years in their occupation. Spirometry and nitrogen wash out data were compared with those from a reference group of 14 never smoking men not exposed to welding. A methacholine provocation test was carried out. The effect was measured by change in forced expiratory volume in one second (FEV1) and VTG. The maximum decrease in FEV1 after inhalation of methacholine was 6% in welders and 2% among referents. Before provocation VTG and VTG total lung capacity (TLC) was higher among welders (127 ml v 98 ml and 1.76% v 1.38%). The increase in VTG and VTG/TLC was higher in welders after inhalation of methacholine at concentrations of 0.001% to 2% and remained increased after inhalation of salbutamol. The differences indicate small airways disease among shipyard welders. AU - Hjortsberg U AU - Orbaek P AU - Arborelius M LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 98 IP - DP - 1992 Jan 01 TI - Common Pathogenetic Pathways in Allergic and Irritant Contact Dermatitis PG - 166-170 AB - Despite their different pathogeneses, allergic and irritant contact dermatitis show a remarkable similarity with respect to clinical appearance, histology, and immunohistology. To further analyze this apparent contradiction, our study was designed to meticulously compare cellular infiltrates in irritant and allergic patch-test reactions by immunostaining with a broad panel of monoclonal antibodies. For this purpose, skin biopsies from allergic and irritant patch-test reactions of similar inflammatory degree were obtained from the same probands. We found that after 72 h both types of reaction were characterized by an identical dermal infiltrate consisting mainly of memory T cells, many of which were activated, and macrophages. Dermal and epidermal Langerhans cell density and HLA–DR expression of keratinocytes were also virtually identical. Our results show that antigen recognition by specific memory T cells as well as irritants can finally induce the same pattern of inflammation, including activation of T cells obviously independent of exogenous antigen. AU - Brasch J AU - Burgard J AU - Sterry W LA - PT - DEP - TA - Journal of Investigative Dermatology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 20 IP - DP - 1992 Jan 01 TI - Allergic skin reactivity in 232 patients over 50 years PG - 197-200 AB - We examined two hundred and thirty-two out-patients, ranging in age from 50 to 75 yrs. All patients were submitted to skin-tests: prick and, if it was necessary, intradermal reactions and/or RAST. Allergens employed were Gramineae, Parietaria, Olea, dermatophagoides Farinae, dermatophagoides Pteronyssinus, house dust, cat and dog skin scales. One hundred and twenty-eight subjects had positive responses to one or more aeroallergens. Asthma was the most frequent condition both in skin-positives and in skin-negatives. For 58% of skin-positives and 51% of skin-negatives the symptoms' onset was more than 10 yrs before our check. In 58.6% of patients we found positive reaction to dermatophagoides Farinae, in 51.5% to house dust, in 47.6% to dermatophagoides Pteronyssinus, in 34.3% to Gramineae, in 28.9% to parietaria and in 14.8% to olea. Fifty-four skin-positives subjects carried out lung function tests; in twenty-eight of them we found a bronchial obstruction. In more than 50% of the subjects, which had shown a reactivity to aeroallergens, we prescribed a specific hyposensitization. These data suggest that skin tests results in elderly patients can have a relevant role in preventive and pharmacological treatment, improving life quality AU - Mariotta S AU - Mannino F AU - Masullo M AU - Adani O AU - di Venanzio S AU - Boschi A LA - PT - DEP - TA - Allergol Immunopathol (Madr) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 305 IP - DP - 1992 Jan 01 TI - Asthma and open cast mining PG - 396-397 AU - Temple JM AU - Sykes AM LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Asthma from birth to age 23: incidence and relation to prior and concurrent atopic disease PG - 537-542 AB - BACKGROUND: Few studies present prospective data on the incidence of asthma. Its associations with sex and with prior and concurrent hay fever and eczema were examined in a nationally representative sample followed from birth to 23 years of age (British 1958 birth cohort). METHODS: Reports of asthma or wheezy bronchitis, hay fever and eczema were obtained by interview of parents of children at ages 7, 11, and 16 years, and of cohort members at age 23 years. Linked data from all four interviews were available on 7225 subjects (43% of the original birth cohort). RESULTS: The cumulative incidence of asthma or wheezy bronchitis was 18.2%, 21.8%, 24.5%, and 28.6% by the ages of 7, 11, 16, and 23 years respectively. Over the four incidence periods examined (0 to 7 years, 8 to 11 years, 12 to 16 years, 17 to 23 years) the average annual incidence of new cases was 2.6%, 1.1%, 0.71%, and 0.76% respectively. The male:female incidence ratio rose from 1.23 in the 0 to 7 year period to 1.48 at 12 to 16 years but had reversed to 0.59 at 17 to 23 years. A prior report of hay fever or eczema each increased the subsequent incidence of asthma or wheezy bronchitis by a factor of 1.7 to 2.0 independently of sex. This effect of prior atopic illness, however, was largely explained by the strong independent association of incidence of asthma and wheezy bronchitis with atopic disease at the end of each incidence period (odds ratios 2.0 to 2.5 per atopic condition, p < 0.01). CONCLUSIONS: Gender differences in the incidence of asthma or wheezy bronchitis vary with age and are not explained by atopy. The incidence of asthma or wheezy bronchitis can be predicted from a clinical history of hay fever or eczema but is more strongly associated with the presence of atopic disease at the time of onset AU - Anderson HR AU - Pottier AC AU - Strachan DP LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 327 IP - DP - 1992 Jan 01 TI - A comparison of salmeterol with albuterol in the treatment of mild-to-moderate asthma PG - 1420-1425 AU - Pearlman DS AU - Chervinsky P AU - LaForce C AU - Seltzer JM AU - Southern DL AU - Kemp JP AU - Dockhorn RJ AU - Grossman J AU - Liddle RF AU - Yancey SW AU - Cocchetto DM AU - Alexander WJ AU - van As A LA - PT - DEP - TA - NEJM JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 2225 IP - DP - 1992 Jan 01 TI - The notification of cooling towers and evaporative condensers regulations 1992 PG - - AU - LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 9 IP - DP - 1992 Jan 01 TI - Duration of bronchial protective effect of salmeterol in asthma induced by hyperventilation with dry cold air PG - Suppl 1:R19-21 AB - The duration of the blocking effect of salmeterol (50 micrograms), albuterol (200 micrograms) and placebo was compared in a double-blind study carried out in 12 adult asthmatic subjects who underwent hyperventilation tests with cold dry air on 4 study days. On the first day, the hyperventilation test was carried out at various time intervals with spontaneous functional recovery between each test. The response was assessed by interpolating the dose of cold dry air causing a 20% fall in FEV1 (PD20). On the three other days, the active or placebo medications were administered. Spirometry was assessed 15 minutes and 1 hour later. The hyperventilation test was then performed and repeated at various time intervals after administering the drug. The mean duration of the blocking effect was 0.25 hour for placebo, 3.5 hours for albuterol, and of 15.9 hours for salmeterol. Eight of the 12 subjects still showed some blocking effect eight hours after salmeterol by comparison with only one subject after albuterol. The authors conclude that salmeterol has a significantly longer effect than albuterol on bronchoconstriction induced by hyperventilation AU - Malo JL AU - Cartier A AU - Ghezzo H AU - Trudeau C AU - L'Archeveque J LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 112 IP - DP - 1992 Jan 01 TI - Occupational asthma. Occurrence, diagnosis, course and prevention [Norwegian] PG - 892-896 AB - Occupational asthma is defined as variable air flow obstruction caused by inhalation of agents at work. The condition is increasingly recognized as a cause of work-related respiratory disease, and in Norway is estimated to account for approximately 20% of the cases of asthma among adults exposed to dust or gases. These figures are likely to increase when more inhalable reactive chemicals are introduced at places of work. A careful and detailed history, immunological tests, serial measurements of peak expiratory flow (PEF) and demonstration of increased non-specific bronchial reactivity are useful tools for diagnosing occupational asthma. Accurate diagnosis is important because of the economic consequences of the label "occupational disease", and because early recognition and relocation to work not involving exposure to such chemicals might improve the prognosis of the disease AU - Kongerud J AU - Naalsund A LA - PT - DEP - TA - Tidsskr Nor Laegeforen JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Prevalence of respiratory disorders among aluminium potroom workers in relation to exposure to fluoride PG - 125-130 AB - In a survey of 370 aluminium potroom workers in western Norway, bronchial responsiveness, lung function, and respiratory symptoms were studied in relation to occupational exposure to air contaminants in the potroom. Increased prevalences of respiratory symptoms, work related asthmatic symptoms, and abnormal lung function were found in subjects exposed to total fluorides above 0.5 mg/m3 when compared with workers exposed to total fluorides at concentrations of less than 0.5 mg/m3. No significant association between bronchial responsiveness and exposure to fluoride was found and the prevalence of respiratory symptoms was independent of the degree of dust exposure. These findings indicate that work related asthmatic symptoms in potroom workers may be related to exposure to fluorides AU - Soyseth V AU - Kongerud J LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - IP - DP - 1992 Jan 01 TI - Management of health and safety at work regulations PG - - AU - LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 26 IP - DP - 1992 Jan 01 TI - Allergic contact dermatitis from resin hardeners during the manufacture of thermosetting coating paints PG - 87-90 AU - Foulds IS AU - Koh D LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 26 IP - DP - 1992 Jan 01 TI - Occupational contact dermatitis from triglycidyl isocyanurate in a powder paint factory PG - 59- AU - Munro CS AU - Lawrence CM LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 73 IP - DP - 1992 Jan 01 TI - The humoral immune response after BCG vaccination: an immunoblotting study using two purified antigens PG - 137-140 AB - The specific IgG response induced by BCG vaccination was investigated in 27 adults using two purified BCG antigens in a dot immunoblotting assay. The reflectance values increased significantly after vaccination when P64 but not when P32 was used as the antigen. The values measured after vaccination were compared with those obtained when testing sera from patients with tuberculosis. We observed that the level of anti-P64 IgG reached after BCG immunization was high enough to preclude a serological differential diagnosis with tuberculosis AU - Drowart A AU - Selleslaghs J AU - Yernault JC AU - Valcke C AU - De Bruyn J AU - Huygen K AU - Farber CM AU - Van Vooren JP LA - PT - DEP - TA - Tubercle & Lung Disease JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Control of tuberculosis in the United States. American Thoracic Society PG - 1623-1633 AB - TB continues to be a major public health problem in many areas of the United States. Elimination of this disease will require coordinated efforts of public health agencies, voluntary health associations, health-care providers, and community groups. TB controls is comprised of a variety of activities. Identification and treatment of patients with clinically active disease should be the highest priority for all TB control programs. Identification and preventive treatment of infected contacts and persons with tuberculous infection at greatest risk for developing disease (eg, HIV-infected, young children) should also receive high priority. Attention should then be given to identifying other high-risk groups and administering preventive therapy to those infected. While TB control occurs in many different settings, the health department TB control program plays a pivotal role in providing clinical services, and performing contact investigations, tuberculin-testing and prevention activities, surveillance, and evaluation of the community's overall progress in TB elimination. Health departments should receive strong and continuing support from medical care providers, voluntary health organizations, and community groups if TB elimination is to be achieved AU - Anonymous LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - Tuberculosis among National Health Service employees PG - A103- AU - Loughrey C AU - Riley M AU - Varghese G LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 117 IP - DP - 1992 Jan 01 TI - Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis. A risk to patients and health care workers PG - 191-196 AB - OBJECTIVE: To determine the factors associated with the development of multidrug-resistant tuberculosis among patients at a New York City Hospital and to investigate possible nosocomial transmission. DESIGN: A retrospective case-control study and tuberculin skin test survey. PATIENTS: Twenty-three patients with tuberculosis whose isolates were resistant to at least isoniazid and rifampin (case patients) were compared with patients with tuberculosis whose isolates were susceptible to all agents tested (controls). Tuberculin skin test conversion rates were compared among health care workers assigned to wards where patients with tuberculosis were frequently or rarely admitted. SETTING: A large, teaching hospital in New York City. MEASUREMENTS: Mycobacterium tuberculosis isolates from case patients and controls were typed by restriction fragment length polymorphism analysis. RESULTS: Case patients were younger (median age, 34 compared with 42 years; P = 0.006), more likely to be seropositive for HIV (21 of 23 compared with 11 of 23 patients; odds ratio, 11.5; 95% CI, 1.9 to 117), and more likely to have had a previous hospital admission within 7 months before the onset of tuberculosis (19 of 23 compared with 5 of 23 patients; odds ratio, 17.1; CI, 3.3 to 97), particularly on one ward (12 of 23 compared with 0 of 23 patients; odds ratio, undefined; P = 0.002). Health care workers assigned to wards housing case patients were more likely to have tuberculin skin test conversions than were health care workers assigned to other wards (11 of 32 compared with 1 of 47 health care workers; P less than 0.001). Few (6 of 23) case patients were placed in acid-fast bacilli isolation, and no rooms tested had negative pressure. Of 16 available multidrug-resistant isolates obtained from case patients, 14 had identical banding patterns by restriction fragment length polymorphism analysis. In contrast, M. tuberculosis isolates from controls with drug-susceptible tuberculosis had patterns distinct from each other and from those of case patients. CONCLUSIONS: These data suggest nosocomial transmission of multidrug-resistant tuberculosis occurred from patient to patient and from patient to health care worker and underscore the need for effective acid-fast bacilli isolation facilities and adherence to published infection control guidelines in health care institutions AU - Pearson ML AU - Jereb JA AU - Frieden TR AU - Crawford JT AU - Davis BJ AU - Dooley SW AU - Jarvis WR LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 268 IP - DP - 1992 Jan 01 TI - Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients PG - 1280-1286 AB - OBJECTIVE To describe transmission of multidrug-resistant (MDR) Mycobacterium tuberculosis infection among patients and health care workers (HCWs) in a ward and clinic for human immunodeficiency virus (HIV)-infected patients in a hospital, four studies were conducted. METHODS Case patients and control patients were persons who had been treated in the HIV ward or clinic, whose clinical course was consistent with tuberculosis and who had at least one positive culture for M tuberculosis between January 1, 1988, and January 31, 1990, resistant to at least isoniazid and rifampin (case patients), or whose isolates were susceptible to all drugs tested (control patients). In the first study, case patients and control patients were compared to identify risk factors for MDR tuberculosis. In the second study, inpatient and outpatient days of MDR tuberculosis case patients were compared to determine whether acid-fast bacillus (AFB) smear-positivity or aerosolized pentamidine use was associated with higher numbers of subsequent MDR tuberculosis cases among exposed patients. In the third study, restriction fragment length polymorphism analysis was performed on available MDR and sensitive M tuberculosis isolates. In the fourth study, skin test conversion rates among HCWs in the HIV ward and clinic were compared with those of HCWs in another ward, and the strength of the associations between skin test conversions among HCWs on the HIV ward and the number of person-days that AFB smear-positive case patients and control patients were on this ward was estimated. RESULTS Case patients were more likely than control patients to have been exposed on the HIV ward or clinic to an AFB smear-positive case patient (P less than .001). Inpatient and outpatient days of MDR tuberculosis case patients were associated with more subsequent cases of MDR tuberculosis if exposing case patients were smear-positive or if they received aerosolized pentamidine (P less than or equal to .01). Of 13 MDR isolates, all had one of two restriction fragment length polymorphism patterns; 10 sensitive isolates had restriction fragment length polymorphism patterns that were different from each other. The HCW skin test conversion rate was higher on the HIV ward and clinic than on the comparison ward (P less than .01). The risk of occupational acquisition of infection increased in direct proportion to the number of person-days that AFB smear-positive case patients were on the HIV ward (r = .75; P = .005), but did not increase in proportion to the number of person-days that AFB smear-positive control patients were there (r = -.36; P = NS). After isolation measures for AFB smear-positive tuberculosis patients were improved, MDR tuberculosis cases decreased to seven of 214 tuberculosis patients. CONCLUSIONS Nosocomial transmission of MDR M tuberculosis infection to patients and HCWs occurred on the HIV ward and clinic. Infectiousness of MDR tuberculosis case patients was associated with AFB sputum-smear positivity. Case patients with MDR tuberculosis created a greater risk of skin test conversion for HCWs on the HIV ward than drug-susceptible control patients AU - BeckSague C AU - Dooley SW AU - Hutton MD AU - Otten J AU - Breeden A AU - Crawford JT AU - Pitchenik AE AU - Woodley C AU - Cauthen G AU - Jarvis WR LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 42 IP - DP - 1992 Jan 01 TI - Tuberculosis screening in health service employees: who needs chest X-rays? PG - 179-182 AU - Chaturvedi N AU - Cockcroft A LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 48 IP - DP - 1992 Jan 01 TI - Control of tuberculosis in NHS staff; West Midlands PG - 463- AU - Burge A AU - Kumar S AU - Skinner C LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - A 10 year follow up of 180 adults with bronchial asthma: factors important for the decline in lung function [letter; comment] PG - 484-484 AU - Quanjer PH LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Interpretation of bronchodilator response in patients with obstructive airways disease. The Dutch Chronic Non-Specific Lung Disease (CNSLD) Study Group PG - 429-436 AB - BACKGROUND: There is no agreement on how a bronchodilator response should be expressed. Ideally, the index used should be able to distinguish asthma from chronic obstructive lung disease and be independent of initial FEV1. METHODS: Two hundred and seventy four adults (aged 18-60 years) outpatients with obstructive airways disease were studied. Patients were divided into syndrome groups on the basis of a standardised history: asthma (n = 99), asthmatic bronchitis (n = 88), and chronic obstructive lung disease (n = 51); 36 subjects could not be attributed to any subgroup. FEV1 was measured before and 20 minutes after inhalation of 1000 micrograms terbutaline. Different expressions of bronchodilator response (delta FEV1) were compared with respect to their dependence on initial FEV1 and their efficacy in separating subjects with asthma from those with chronic obstructive lung disease. delta FEV1 was expressed as a percentage of initial FEV1 (delta FEV1%init), absolute value (delta FEV1[1]), percentage of predicted FEV1 (delta FEV1%pred), standardised residual (delta SR-FEV1), and percentage of maximal possible increase (delta FEV1%[pred-init]). RESULTS: delta FEV1%init was more dependent on initial FEV1 (p = -0.405) than delta FEV1[1] (r = -0.145), delta FEV1%pred (r = -0.166), and delta SR-FEV1 (r = -0.127). delta FEV1%[pred-init] reached infinity when initial FEV1 approached predicted levels. delta FEV1%pred had a higher likelihood ratio (1.71) for separating patients with asthma from those with chronic obstructive lung disease than other expressions of bronchodilator response. Asthmatic patients had larger mean bronchodilator responses than patients in other subgroups; this difference was largest for delta SR-FEV1 (F = 9.19) and delta FEV1%pred (F = 9.03); it was much smaller for delta FEV1%init (F = 5.89). Despite significant differences in mean response, there was a large overlap of individual responses between diagnostic subgroups. The bronchodilator response was continuously and unimodally distributed for all expressions. CONCLUSIONS: delta FEV1%pred appears to be the most useful method of expressing bronchodilator response, both for clinical and for research purposes. Reversibility of airways obstruction in response to a bronchodilator is a continuous variable and not a dichotomous triat. Any cut off level of a "positive" bronchodilator response is therefore arbitrary AU - Brand PL AU - Quanjer PH AU - Postma DS AU - Kerstjens HA AU - Koeter GH AU - Dekhuijzen PN AU - Sluiter HJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - The lung health study: airway responsiveness to inhaled methacholine in smokers with mild to moderate airflow limitation. The Lung Health Study Research Group PG - 301-310 AB - As part of a multicenter clinical trial (Lung Health Study), methacholine inhalation challenge testing was performed in 5,877 current cigarette smokers, ages 35 to 59 yr (mean 48.5 +/- 6.8 yr), with borderline to moderate airflow limitation (FEV1/FVC ratio 63.0 +/- 5.5). The test was successfully completed in 96.4% of subjects, of whom 63% were male and 95.9% were white. Symptomatic reactions to methacholine were rarely severe enough to require evaluation by a trial physician. Nonspecific airways hyperresponsiveness (AHR) was defined as a greater than or equal to 20% decline in FEV1 from the post-diluent control value after inhalation of less than or equal to 25 mg/ml methacholine. AHR was noted in a significantly higher percentage of women (85.1%) than men (58.9%). Moreover, nearly twice as many women as men (46.6 and 23.9%, respectively) responded to less than or equal to 5 mg/ml of methacholine. In both men and women, baseline degree of airways obstruction and clinical center were strongly associated with AHR (p less than 0.001), whereas age was not. Additional associations with AHR were analyzed in men and women separately using logistic regression after adjustment for baseline lung function, age, and center-to-center differences. In men, AHR was significantly related to symptoms of wheeze, chronic cough and/or sputum, and a history of asthma or hay fever (p less than 0.004), but not to current or lifetime tobacco use. By contrast, among women, AHR was not significantly associated with chronic cough and/or phlegm (p greater than 0.05) or a past history of asthma or hay fever (p greater than 0.1) and was only weakly related to wheeze and current asthma (p = 0.04), as well as to cigarette pack-years (p = 0.044). These results indicate that most continuing smokers with functional evidence of early chronic obstructive pulmonary disease have nonspecific AHR that is strongly related to gender and baseline lung function and, to a lesser extent, to respiratory symptoms. The reason for the striking effect of gender on AHR in early chronic obstructive pulmonary disease is unclear but cannot be attributed to male-female differences in age, cigarette use, presence of asthma, or baseline degree of airflow obstruction AU - Tashkin DP AU - Altose MD AU - Bleecker ER AU - Connett JE AU - Kanner RE AU - Lee WW AU - Wise R LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 340 IP - DP - 1992 Jan 01 TI - Seasonal cryptogenic organising pneumonia with biochemical cholestasis: a new clinical entity PG - 281-284 AB - The term cryptogenic organising pneumonia has been used for the combination of dyspnoea, cough, pleuritic pain, widespread shadows on chest radiographs, and histological evidence of intra-alveolar organisation with buds of granulation tissue within the alveoli. We report 12 patients with seasonal recurrence of this disorder for between 3 and 11 years. In all 12 patients, symptoms recurred between late February and early May every year, tending to increase in severity each year, and resolved between June and January. Chest radiography and computed tomography showed bilateral consolidation. Lung biopsy samples showed intra-alveolar buds of granulation tissue. There were many neutrophils within the lumina of medium-sized airways and terminal bronchioles showed evidence of obstruction by granulation tissue. Functionally, the predominant defect was restrictive and only 2 patients (life-long non-smokers) had airflow limitation. All 12 patients had very high activities of liver enzymes, suggesting intrahepatic cholestasis, but no other evidence of liver disease. Cultures of blood, sputum, lung tissue, and bronchoalveolar lavage fluid, viral screening, and complement fixation tests were consistently negative. In all patients all abnormalities responded rapidly to oral steroid therapy. These findings suggest a seasonal syndrome of organising pneumonia and biochemical abnormalities indicative of intrahepatic cholestasis. No aetiological factor has been identified, but the nature and periodicity of the illness point to an inhaled agent present in the environment for a limited period every year AU - Spiteri MA AU - Klenerman P AU - Sheppard MN AU - Padley S AU - Clark TJ AU - Newman Taylor AJ LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 5 IP - DP - 1992 Jan 01 TI - Spectral analysis of peak expiratory flow from workers with suspected occupational asthma PG - 403s- AU - Belcher J AU - Gannon PFG AU - Pantin CFA AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 26 IP - DP - 1992 Jan 01 TI - Visual display units and facial rashes PG - 63-64 AU - Carmichael AJ AU - Roberts DL LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 40 IP - DP - 1992 Jan 01 TI - An outbreak of influenza A (H3N2) in a well immunized nursing home population PG - 589-592 AB - OBJECTIVE: To describe the epidemiologic features of an outbreak of influenza A that occurred in a skilled nursing home although over 90 percent of the resident population had previously received influenza vaccine. DESIGN: Retrospective cohort study. SETTING: Skilled nursing home facility in western New York State. PATIENTS: Nursing home residents and patient-care staff. MAIN OUTCOME MEASURE: Incidence of influenza-like illness among vaccinated versus unvaccinated nursing home residents and staff. RESULTS: Thirty-seven of 124 residents (attack rate = 30%) and 18 of 146 staff (attack rate = 12%) had an influenza-like illness. Staff illness began 16 days prior to onset among residents. Six cases of pneumonia and three influenza-related deaths occurred, all among the vaccinated residents. Ninety percent of the nursing home residents and 10% of the staff received the influenza vaccine prior to the outbreak. The calculated vaccine efficacies were minus 21% and plus 45% for residents and staff, respectively. CONCLUSION: While antigenic drift of the circulating influenza virus was the major factor in the apparent vaccine failure, the observed poor staff immunization rate (10%) and absence of surveillance which precluded the use of amantadine chemoprophylaxis suggest that the use of these strategies may be of importance in controlling influenza outbreaks in nursing homes. AU - Coles FB AU - Balzano GJ AU - Morse DL LA - PT - DEP - TA - J Am Geriatr Soc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 87 IP - DP - 1992 Jan 01 TI - High antibody levels to the mycobacterial fibronectin-binding antigen of 30-31 kD in tuberculosis and lepromatous leprosy PG - 362-367 AB - Immunoblot assays showed that mycobacterial fibronectin-binding antigens are important targets of the humoral immune response in tuberculosis and leprosy. Using culture filtrate antigens of Mycobacterium tuberculosis, strong reactivity with the fibronectin-binding of 30-31 kD (Fn 30-31) was demonstrated in 55.9% of tuberculosis sera and in 56.5% of lepromatous leprosy sera. Sera from patients with tuberculoid leprosy and control sera gave very weak binding. Reactivity of tuberculosis and lepromatous leprosy sera with the fibronectin-binding antigen of 58-60 kD (Fn 58-60) was less conspicuous. The ability to react with fibronectin of the antigens of 58-60 and 30-31 kD was demonstrated by parallel labelling with a fibronectin-biotin conjugate. Fn 30-31 was purified to homogeneity by a two-step procedure and used for ELISA. Positive titres were found in 63% out of 65 tuberculosis sera and in 60.5% out of 43 lepromatous leprosy sera. Antibody titres in lepromatous leprosy sera were higher than in tuberculosis sera. Our observations indicate indirectly that M. leprae possess a highly immunogenic molecule homologous to M. tuberculosis Fn 30-31, which elicits a high antibody response in lepromatous leprosy but not in tuberculoid leprosy. In this investigation, direct evidence for the presence of this antigen in M. leprae was obtained by immunochemistry of lepromatous leprosy lesions with a monospecific antibody raised against M. tuberculosis Fn 30-31 AU - Espitia C AU - Sciutto E AU - Bottasso O AU - GonzalezAmaro R AU - HernandezPando R AU - Mancilla R LA - PT - DEP - TA - Clin Exp Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - The impact of grain dust on respiratory health PG - 476-487 AU - ChanYeung M AU - Enarson DA AU - Kennedy SM LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 4 IP - DP - 1992 Jan 01 TI - Genetic and environmental factors in systemic sclerosis. [Review] PG - 857-861 AB - The occurrence of autoantibodies in patients with systemic sclerosis has suggested a role for immune dysregulation in this disease. Recent genetic studies have concentrated on the major histocompatibility complex-encoded antigens and found an association of particular HLA-DQ alleles with anticentromere antibodies. Although the role of major histocompatibility complex antigens and autoantibodies in the pathogenesis of systemic sclerosis remains unclear, determination of major histocompatibility complex alleles may have clinical value in identifying patients who are at increased risk for development of pulmonary fibrosis or rapidly advancing skin disease. A variety of environmental factors have been associated with systemic sclerosis-like skin diseases, including silica, vinyl chloride, paraffin, adulterated L-tryptophan, and "toxic" rapeseed oil. It has been suggested that silicone used during breast augmentation may be a risk factor for development of systemic sclerosis, but ascertainment bias in case reporting makes interpretation of these studies difficult. The heterogeneity of clinical features, major histocompatibility complex status, and autoantibody profiles in systemic sclerosis suggest that this disorder may actually be a group of distinct disorders, each of which has its own characteristic genetic and environmental predisposing risk factors. [References: 43] AU - Fox RI AU - Kang HI LA - PT - DEP - TA - Curr Opin Rheumatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 17 IP - DP - 1992 Jan 01 TI - Atypical systemic sclerosis following exposure to vinyl chloride monomer. A case report and review of the cutaneous aspects of vinyl chloride disease PG - 208-210 AB - An unusual case of systemic sclerosis occurring in a patient exposed to the vinyl chloride monomer (VCM) is presented. The dermatological aspects of vinyl chloride disease (VCD) are outlined and the mechanisms of pathogenesis discussed AU - Ostlere LS AU - Harris D AU - Buckley C AU - Black C AU - Rustin MH LA - PT - DEP - TA - Clin Exp Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - National survey of notifications of tuberculosis in England and Wales in 1988 PG - 770-775 AU - Medical Research Council LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 114 IP - DP - 1992 Jan 01 TI - Respiratory function in female workers occupationally exposed to acid air pollution [SerboCroatian (Roman)] PG - 96-100 AB - Prevalence of respiratory symptoms and ventilatory capacity were studied in 117 female workers exposed to acid fumes and aerosols in pickling industry. Similar prevalence of respiratory symptoms was recorded in three working groups: a) pickling; b) mustard making; c) packing. Significantly higher prevalences of chronic cough (p < 0.05), chest tightness, nasal catarrh and sinusitis (p < 0.01) were found in pickling workers in relation to controls. In all three exposed groups there was a high prevalence of acute symptoms during work shift. Measured FEV1, FEF50 and FEF25 were significantly decreased in comparison to predicted normal values. Pickling workers exposed for more than one year demonstrated significantly larger acute reductions during work shift than those with shorter exposure. Our data suggest that long term exposure to acid fumes and aerosols in industrial environment may cause the development of acute and/or chronic respiratory symptoms and lung function changes AU - Zuskin E AU - Mustajbegovic J AU - LatinLapaine K AU - MajskiCesarec S LA - PT - DEP - TA - Lijec Vjesn JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 2 IP - DP - 1992 Jan 01 TI - Bronchial asthma due to sensitization to chloramine T PG - 167-170 AB - Chloramine T, an organic, highly reactive derivative of chlorine with potent bactericidal properties, is used as a disinfectant in the food industry. Described as an occupational sensitizer in 1945 for the first time, it produces late or dual asthma, occasionally accompanied by fever and leukocytosis, which is mediated by IgE. We present the case of a male dairy worker who, after 4 years of exposure to the product, developed rhinitis and asthma. Skin tests with chloramine T were positive at a concentration of 10 mg/ml, while all other allergens tested negative. RAST detected specific IgE at 12 PRU and bronchial provocation induced immediate and late bronchoconstriction AU - Blasco A AU - Joral A AU - Fuente R AU - Rodriguez M AU - Garcia A AU - Dominguez A LA - PT - DEP - TA - Journal of Investigative Allergology & Clinica JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 9 IP - DP - 1992 Jan 01 TI - Multi-element follow up in biological specimens of hard metal pneumoconiosis PG - 104-117 AB - The movement of Co and the other components of the hard metal in the body fluids, their solubility, their links to the cells and proteins of the body, and their clearance are largely unknown. The first aim of this work is to evaluate whether Neutron Activation Analysis (NAA), a new analytical technique based on the radiochemical separation of samples irradiated in a Nuclear Reactor, may be suitable for studying the movement of elements in tissues or body fluids of workers over time. We have investigated seven hard metal workers, all employed in the grinding process, with NAA studies (single study in two, follow-up in five) of 29 elements on lung tissue, BAL fluid, blood, urine, pubic hair, toenails and sperm. In three, the diagnosis of hard metal pneumoconiosis was easy; in the other four, due to evident bilateral hilar lymphadenopathy, it was difficult to distinguish between pneumoconiosis and sarcoidosis stage II, and the final diagnosis, after pulmonary biopsy, was hard metal pneumoconiosis in three, and sarcoidosis in one. In spite of high potential, NAA gives a number of unexpected results, with apparent controversies and no clear relationship in the evolution of levels of Co, W and Ta: there is no simple explanation for such apparent inconsistencies at present, so that the study of the movement of elements in body fluid sometimes appears disappointing with this technique. Other observations were noted from the data available: 1) the concentration of elements (Co, Ta, W) in lung tissue is far higher than in BAL fluid, but the factor is so variable that BAL fluid cannot be taken as representative of the concentration of elements in lung tissue. 2) High concentrations in tissues or body fluids are indicative for exposure, but not for disease. In the light of available data, there are no levels above which development of disease is inevitable. 3) When the problem is to distinguish between sarcoidosis and pneumoconiosis in exposed subjects, the concentration of elements is of no value, and the pulmonary biopsy is still necessary. However a NAA study may be helpful to confirm the presence of the offending agent, and to avoid pulmonary biopsy in cases where the occupational history is unclear AU - Rizzato G AU - Fraioli P AU - Sabbioni E AU - Pietra R AU - Barberis M LA - PT - DEP - TA - Sarcoidosis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 99 IP - DP - 1992 Jan 01 TI - Interactions between aeroallergens and airborne particle matter PG - 425-428 AU - Behrendt H AU - Becker WM AU - Friedrichs KH AU - Darsow U AU - Tomingas R LA - PT - DEP - TA - Int Arch Allergy Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Peak flow measurement [editorial] PG - 903-903 AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 48 IP - DP - 1992 Jan 01 TI - New developments in occupational asthma. [Review] PG - 221-230 AB - Recent developments in occupational asthma are reviewed. There are now three independent estimates of the incidence of occupational asthma in the general working population, which all identify the same high risk occupational groups (particularly those exposed to isocyanates and flour or wheat). The incidence of occupational asthma principally depends on the agent and level of exposure. The property of a small molecular weight chemical to bind to and alter the structure of body proteins seems important. Smoking both increases the number of workers developing specific IgE to occupational agents, and the number developing occupational asthma. The relation between increased non-specific bronchial responsiveness and occupational asthma is reviewed. Occupational sensitisation may be the cause of hyperresponsiveness, or develop in those with pre-existing hyperresponsiveness. Around 20% of workers with occupational asthma have measurements within the normal range. Once occupational asthma develops, removal from exposure, particularly if delayed, often results in continuing asthma. Finally the prevention of occupational asthma is discussed. [References: 30] AU - Burge PS LA - PT - DEP - TA - Brit Med Bull JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 107 IP - DP - 1992 Jan 01 TI - Allergic diseases in Norway. Operative definition, occurrence and risk factors PG - 108-9, 111 AB - Cross-sectional surveys of Norwegian populations indicate that 14-17 per cent of the children below the age of 15 years have had an allergic disease. The corresponding figure in adults is 37 per cent. Among children allergic diseases tend to be more frequent in boys than in girls. In adults there is no significant sex-difference regarding the prevalences of hay fever and obstructive lung disease, while eczema and urticaria are more frequent in women than in men. There is an association of smoking, occupational airborne exposure and degree of industrialization to the prevalences of allergic diseases. There are indications of an increase in occurrence of allergic diseases. The need for standardized operative definitions of these diseases is emphasized AU - Bakke P AU - Gulsvik A LA - PT - DEP - TA - Nord Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 21 IP - DP - 1992 Jan 01 TI - An epidemiological survey of respiratory morbidity among granite quarry workers in Singapore: chronic bronchitis and lung function impairment PG - 312-317 AB - Respiratory symptoms of chronic bronchitis and measurements of lung function were studied in an epidemiological survey of the total population of workers currently employed in granite quarries in Singapore. There were 85 rock drilling and crushing workers with current exposure in high levels of silica dust. Their respiratory parameters were studied with reference to an internal comparison group of 154 quarry maintenance and transport workers with low dust exposure, and an external comparison group of 148 Telecoms postal delivery workers with no granite dust exposure. The highly exposed workers showed greater prevalences of chronic cough and phlegm, a mean reduction of 5% in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). The increased respiratory morbidity were independent of other factors such as age and smoking. Similar results were also noted after excluding those with silicosis (defined radiologically as profusion greater than 1/1 as read by at least two of three readers). This study strongly indicates a demonstrable risk of "occupational" bronchitis (mucus hypersecretion) and obstructive and restrictive lung function impairment, apart from the "classical" risk of silicosis. Measures taken to protect the health of workers exposed to silica dust should also be based on considerations taken to protect against the risk of these respiratory disorders as well AU - Ng TP AU - Phoon WH AU - Lee HS AU - Ng YL AU - Tan KT LA - PT - DEP - TA - Ann Acad Med Singapore JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 83 IP - DP - 1992 Jan 01 TI - Longitudinal study of workers of an aluminium die casting factory PG - 466-469 AB - We conducted a 5-year longitudinal study on 76 workers of a high and medium aluminium alloy die-casting factory. As in a previous cross-sectional study conducted in 1986 and in accordance with the data in the literature, the 1990 follow-up study showed: a low prevalence of chronic bronchitis (as defined by the ECSC questionnaire on respiratory symptoms); normal mean functional values of FVC, FEV1, FEV1/FVC%. We did not find any significant difference in the levels of lung function over the period of 1986-90. These results show that workers in the secondary aluminium industry are not exposed to a significant risk of chronic pulmonary disease AU - Discalzi GL AU - Capellaro F AU - Baracco A LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 83 IP - DP - 1992 Jan 01 TI - Respiratory symptoms and pulmonary function in the Italy primary aluminum industry. PG - 438-444 AB - The paper reports the results of a longitudinal study of 1478 workers in the primary aluminium industry in Italy (aluminium reduction with the pre-baked anode process) covering the prevalence and incidence of chronic obstructive lung disease, chronic bronchitis and bronchial asthma, and analysis of lung function deterioration over time (annual decline in FEV1) in relation to occupational exposure and individual non-occupational features. The incidence of respiratory symptoms of chronic cough and expectoration was significantly higher among electrolytic shop workers, in whom the annual decline in FEV1 was also significantly greater. In this group the incidence and prevalence of asthmatic manifestations was particularly high compared to casting and workshop workers. Asthmatic symptoms showed a short latency period related to exposure in potrooms and seems to be characterized by a marked deterioration in lung function over time even after withdrawal from exposure AU - Carta P AU - Boscaro G AU - Mantovano S AU - Papi G AU - D'Ambrosio P AU - Cherchi P LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 83 IP - DP - 1992 Jan 01 TI - Chronic bronchitis and respiratory function in those employed in primary aluminum production. [Italian] PG - 445-450 AB - A study was carried out on a group of 323 workers of a primary aluminium production plant located in Porto Marghera (Italy) in order to assess the prevalence of chronic bronchitis and respiratory function alterations, compared with the general working population of the same industrial area. The results showed a higher prevalence of chronic bronchitis (5.6% compared with 2.6%) and a greater reduction in vital capacity but only in the non-smokers (5.4% compared with 1.7%). The highest prevalence of chronic bronchitis (20%) and reduced vital capacity (27%) was observed in the rodding section. The frequency of bronchial obstruction was similar to that observed in potroom and casting workers AU - Alessandri MV AU - Baretta L AU - Magarotto G LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 83 IP - DP - 1992 Jan 01 TI - A retrospective assessment of 19 subjects compensated for the inhalation of aluminum powders (item 48, D.P.R. 482/75). [Italian] PG - 451-455 AB - A study was made of 19 male subjects, mean age 54.7, S.D. 7.5 years, exposed to risk of aluminium dust inhalation for 16, S.D. 9.7 years, awarded compensation by the local provincial branch of INAIL (National Institute for Insurance against Occupational Accidents) in the period 1975-1988, as prescribed by item 48 of Presidential Decree 482/1975. The workers were divided into two groups on the basis of radiological signs of lung fibrosis (3 1/1 cases and 7 1/0 cases according to the ILO classification) or of COPD (Chronic Obstructive Pulmonary Disease) (9 cases). Careful examination of the work histories confirmed the previous observations of aluminium pneumoconiosis with moderate functional alterations in alumina production, potroom and casting workers AU - Lorusso A AU - Sama B AU - Giacomazzi G AU - Magarotto G LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 83 IP - DP - 1992 Jan 01 TI - Follow-up of airway reactivity in potroom workers in relation to exposure PG - 418-421 AB - Two groups of workers were studied: a) 24 workers with respiratory complaints--7 of whom were light and 4 borderline hyper-reactors--who continued to work on the electrolytic reduction of aluminium for up to two years; b) 30 workers with increased bronchial reactivity who ceased to work in potrooms for 3.7 years on average (range 2-11 years) because of respiratory complaints. Subjective respiratory complaints were recorded and a non specific bronchial reactivity test was performed one or two times during the follow-up period. A sustained level of airway reactivity was recorded in both groups of workers regardless of exposure conditions. In workers with dyspnoea and airway obstruction, bronchial reactivity did not worsen in spite of continued exposure. On the other hand cessation of exposure was not followed by normalization of bronchial reactivity. The potential role of atopy, smoking habits and length of previous exposure was analyzed. It appears that increased bronchial reactivity, once induced, has a tendency to persist. An improvement in subjective complaints may be expected after cessation of exposure AU - Saric M AU - GodnicCvar J AU - Marelja J LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 83 IP - DP - 1992 Jan 01 TI - Respiratory disorders in aluminium potroom workers PG - 414-417 AB - Epidemiological studies of aluminum potroom workers have been in progress in Norway since 1986. The occurrence of work-related asthmatic symptoms and their determinants were studied. Work-related asthmatic symptoms and airflow limitation were closely associated with duration of potroom employment. A significant relationship between current fluoride exposure and work-related asthmatic symptoms was observed in a smaller, cross-sectional population where a detailed exposure classification was carried out. A similar association and also a dose-response gradient was found in a longitudinal study of new employees. The existence of occupational asthma in aluminium potroom workers was confirmed by characteristic patterns of repeated peak flow measurements supported by changes in methacholine responsiveness in workers with suspected work-related asthma. Current smoking as a risk factor for work-related asthmatic symptoms was observed both in cross-sectional and in longitudinal investigations. Similarly to current fluoride exposure, a dose-response gradient was demonstrated in the association between work-related asthmatic symptoms and current amount of tobacco smoked. Allergy was not shown to be a determinant of work-related asthmatic symptoms in any part of the investigation. A family history of asthma and previous occupational exposure may have had some influence on the risk of developing symptoms but the findings were inconsistent and probably of minor importance. Methacholine challenge seemed inappropriate for the screening of aluminium potroom workers in order to detect work-related asthmatic symptoms, but was closely correlated to the severity of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Kongerud J LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 83 IP - DP - 1992 Jan 01 TI - Eosinophil-related respiratory disease in aluminium workers PG - 435-437 AB - We carried out a nested case-control study in an aluminium producing plant, using the results of pre-employment examination to identify workers with an increased risk of developing work-related obstructive respiratory symptoms. Cases (n=49) are those who had become unable to work because of work-related respiratory disease. They were compared with 49 matched controls. Pre-employment eosinophil count was strongly related to the occurrence of work-related obstructive respiratory disease. This finding is interesting in the light of a possible pathogenesis AU - Sorgdrager B AU - Pal TM AU - De Monchy JG AU - Togtema HR AU - Kolk JJ LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Aerosolized beclomethasone in chronic bronchitis PG - 389-395 AU - Thompson AB AU - Mueller MB AU - Heires AJ AU - Bohling TL AU - Daughton D AU - Yancey SW AU - Sykes RS AU - Rennard SI LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Occupational asthma in a hairdresser caused by persulphate salts PG - 656-660 AB - Persulphate salts, which are common constituents of hair bleaches, have occasionally been reported to cause occupational asthma in hairdressers. We describe the clinical and immunological studies carried out in a hairdresser who developed cutaneous and respiratory symptoms, about 1 year after being employed in a hairdressing salon. Skin prick tests with 1:5 w/v potassium and sodium persulphate extracts were positive in our patient at 15 min and negative in control subjects. The European standard contactans (ECDRG) and a battery of hairdressing agents were patch tested with positive result to KATHON CG (isothiazolinone). The methacholine-inhalation test showed airway hyperresponsiveness. Bronchial provocation test with a 1:50 w/v potassium persulphate extract elicited a nonimmediate asthmatic reaction, followed by recurrent nocturnal fall in FEV1 lasting up to 3 days after the test. Plethysmography results revealed air trapping caused by a marked increase of airway resistance 3 h after the specific bronchial challenge. Histamine release test was not conclusive, and the determinations of specific IgA, IgM, IgG and IgG subclasses by EIA and IgE by RAST against persulphate salts were negative reason for isothiazolinone patch test positive not discussed, challenges with persulphates AU - Parra FM AU - Igea JM AU - Quirce S AU - Ferrando MC AU - Martin JA AU - Losada E LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 12 IP - DP - 1992 Jan 01 TI - Occupational asthma in a mechanic after a single exposure to isocyanates during handyman work. PG - 297-299 AU - Bergeret A AU - Normand JC AU - Prost G LA - PT - DEP - TA - J Toxicol Clin Exp JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Allergy to laboratory animals: an epidemiological study PG - 41-47 AB - A large cross sectional survey was carried out using a self administered questionnaire to examine the prevalence of laboratory animal allergy (LAA) and the factors associated with its development. Out of 5641 workers who were exposed to animals at 137 laboratory animal facilities in Japan, 23.1% had one or more allergic symptoms related to laboratory animals. The commonest symptom as rhinitis. About 70% of LAA subjects developed symptoms during their first three years of exposure. Atopy (past and family history), the number of animal species handled, and the time spent in handling correlated significantly with the development of LAA as did some types of job. A close relation between nasal symptoms and exposure to rabbits and between skin symptoms and exposure to rats were found. LAA subjects developed symptoms most quickly to rabbits AU - Aoyama K AU - Ueda A AU - Manda F AU - Matsushita T AU - Ueda T AU - Yamauchi C LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Clinical findings among hard metal workers PG - 17-24 AB - In 1940, the first report appeared describing a pulmonary disorder associated with occupational exposures in the cemented tungsten carbide industry. The disease, known as "hard metal disease," has subsequently been characterised in detail and comprises a wide range of clinical signs and symptoms. In this report, clinical findings in a group of 41 hard metal workers employed until recently are described. A high prevalence of respiratory symptoms was found. Thirteen workers (31%) had abnormal chest radiographs indicative of interstitial lung disease. Fifty per cent of these had been employed in hard metal manufacturing for less than 10 years. Abnormalities of pulmonary function were also frequent and included a restrictive pattern of impairment and decrease in diffusing capacity (27%). Associations were found between diffusing capacity, chest radiographic abnormalities and right ventricular ejection fraction at exercise indicating cardiopulmonary effects. The findings show the continuous need to control excessive occupational exposures to prevent hard metal disease, the history of which now enters its sixth decade AU - Fischbein A AU - Luo JC AU - Solomon SJ AU - Horowitz S AU - Hailoo W AU - Miller A LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 106 IP - DP - 1992 Jan 01 TI - Involvement of inflammatory mediators in the airway responses to trimellitic anhydride in sensitized guinea-pigs PG - 828-832 AB - 1. We examined the effect of various pharmacological agents on the acute bronchoconstrictor response and airway microvascular leakage in a model of guinea-pig sensitization to trimellitic anhydride (TMA) a cause of low molecular weight occupational asthma in man. 2. Guinea-pigs were given intradermal injections of 0.1 ml of 0.3% TMA in corn oil; 21-28 days later, anaesthetized guinea-pigs were challenged with TMA conjugated to guinea-pig albumin by tracheal instillation. Changes in lung resistance were measured and airway microvascular leakage was quantified by measuring the extravasation of Evans blue dye into the airway tissue. 3. Sensitized guinea-pig (n = 9 in each group) were pretreated with chlorpheniramine (2.5 mg kg-1, i.v.), WEB 2086 (10 micrograms kg-1, i.v.), BW 4AC (50 mg kg-1, i.p.), nedocromil sodium (2% aerosol for 60 s) or vehicle alone. 4. Pretreatment with chlorpheniramine inhibited both the acute bronchoconstrictor response and the increase in airway microvascular leakage. WEB 2086 and nedocromil sodium partially inhibited the bronchoconstrictor response but had no significant effect on airway microvascular leakage. BW 4AC caused a non-significant reduction of the bronchoconstrictor response and airway microvascular leakage. 5. These results indicate that both the bronchoconstrictor response and the airway microvascular response in this model of sensitization is mediated to a large extent by histamine. PAF but not 5-lipoxygenase products also partially mediates the bronchoconstrictor response but not the airway microvascular leakage. Nedocromil sodium partially inhibits the bronchoconstrictor response only AU - Hayes JP AU - Lotvall JO AU - Barnes PJ AU - Newman Taylor AJ AU - Chung KF LA - PT - DEP - TA - Br J Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 69 IP - DP - 1992 Jan 01 TI - Tobacco, alcohol, asbestos, and occupational risk factors for laryngeal cancer PG - 2244-2251 AB - Data from a hospital-based case-control study between 1985-1990 were used to examine the effects of tobacco, alcohol, asbestos, and other occupational exposures on laryngeal cancer risk in 194 white men with primary cancer of the larynx and 184 age-matched control subjects. A dose-dependent effect for current cigarette smoking was observed, with higher relative risks (RR) for supraglottic cancer (RR, 21.6 to 68) than for cancer of the glottis (RR, 5.5 to 20.7). Elevated RR for ex-smokers (RR, 4.8) and pipe and cigar smokers (RR, 4.3) did not vary by subsite. The effects of alcohol also showed dose-dependent effects, with higher RR for cancer of the supraglottis than glottis for heavy drinkers (207 ml or more/daily; RR, 9.6 versus 2.5) and binge drinkers (RR, 28.4 versus 8.3). A slightly elevated but not significant association was seen for asbestos exposure and glottic cancer (RR, 1.3). The RR did not increase linearly with the number of years employed in asbestos-related occupations. No relationship was observed between asbestos and cancer of the supraglottis. When examining the data for a synergistic effect of cigarette smoking and asbestos exposure, no excess risk was found. A significantly elevated risk was found for men exposed to diesel fumes (RR, 5.2). Elevated but not significant RR were seen for men chronically exposed to rubber (RR, 6.4) and wood dust or employed as construction laborers, auto mechanics, and other jobs. A significant inverse trend with body mass was observed for cancer of the supraglottis AU - Muscat JE AU - Wynder EL LA - PT - DEP - TA - Cancer JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 102 IP - DP - 1992 Jan 01 TI - Validation of an exposure system to particles for the diagnosis of occupational asthma PG - 402-407 AB - STUDY OBJECTIVE We previously described a closed-circuit system for exposure to particles in humans. This system has three components: a particle generator, an exposure chamber connected to an orofacial mask, and monitors. We describe results of challenges in 56 subjects who underwent challenges with the apparatus using occupational sensitizers in particles. SUBJECTS Fifty-six consecutive subjects referred for the investigation of occupational asthma to occupational sensitizers in particles were included. The agents were the following: flour and grains (n = 19), cedar (n = 10), psyllium (n = 9), guar gum (n = 9), drugs (n = 3), persulfate (n = 2), and miscellaneous (n = 4). INTERVENTION The duration of exposure was progressive and varied from one breath to a maximum of 180 min depending on the reaction. When no significant fall in FEV1 occurred after exposure with the aerosolization device, the standard approach of tipping particles from one tray to another was used. RESULTS Twenty-nine subjects (52 percent) had a significant (greater than or equal to 20 percent) fall in FEV1 after exposure. This includes 18 subjects with isolated immediate reactions, four with dual asthmatic reactions, and two with atypical reactions. In 20/24 instances (83 percent), the percentage of fall in FEV1 did not exceed 30 percent, thus showing that dose-response curves can generally be obtained in a safe way. In all instances except one (26/27 cases), subsequent exposures using the traditional method did not result in significant falls in FEV1. CONCLUSION This new procedure results in safe tests in terms of the percentage of changes in FEV1 during the immediate reactions and very rare false-negative challenges AU - Cloutier Y AU - Lagier F AU - Cartier A AU - Malo JL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 102 IP - DP - 1992 Jan 01 TI - Prevention of occupational lung disease. Task Force on Research and Education for the Prevention and Control of Respiratory Diseases PG - 257S-276S AU - Bates DV AU - Gotsch AR AU - Brooks S AU - Landrigan PJ AU - Hankinson JL AU - Merchant JA LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 101 IP - DP - 1992 Jan 01 TI - Occupational asthma in a beet sugar processing plant PG - 1720-1722 AB - A patient with occupational asthma in the beet sugar processing industry is described. Symptomatology, skin testing, immunologic testing, and specific bronchoprovocation testing indicate exposure to moldy sugar beet pulp was the cause of the patient's occupational asthma. Cooperation between the treating physician and public health authorities is encouraged. Probably due to A Niger, ppn pos. IgE to beet juice neg AU - Rosenman KD AU - Hart M AU - Ownby DR LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 101 IP - DP - 1992 Jan 01 TI - Occupational hypersensitivity pneumonitis in a smelter exposed to zinc fumes PG - 862-863 AB - A smelter exposed to zinc fumes reported severe recurrent episodes of cough, dyspnea and fever. Bronchoalveolar lavage showed a marked increase in lymphocytes count with predominance of CD8 T-lymphocytes. Presence of zinc in alveolar macrophages was assessed by analytic transmission electron microscopy. This is the first case of recurrent bronchoalveolitis related to zinc exposure in which the clinical picture and BAL results indicate a probable hypersensitivity pneumonitis AU - Ameille J AU - Brechot JM AU - Brochard P AU - Capron F AU - Dore MF LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 101 IP - DP - 1992 Jan 01 TI - Alterations in bronchoalveolar lavage fluid but not in lung function and bronchial responsiveness in swine confinement workers PG - 767-774 AB - Testing of lung function and bronchial reactivity, bronchoalveolar lavage (BAL), and a skin prick test with a standard panel and six "swine" extracts obtained from swine and swine environment were performed in 20 randomly selected nonsmoking swine confinement workers. In addition, blood samples for detection of antibodies by the diffusion in gel-enzyme-linked immunosorbent assay (DIG-ELISA) technique and precipitating antibodies were drawn. Air samples for measurement of dust and endotoxin levels were collected. All the farmers regarded themselves as healthy. The results were compared with reference groups consisting of urban nonsmoking subjects who had not been exposed to pig farming environment. The pig farmers had normal lung function and the bronchial reactivity was not different from the reference group. In the BAL fluid of the farmers, the concentration of total cells and granulocytes was increased while the concentrations of lymphocytes and macrophages were normal. The BAL fluid concentrations of albumin, fibronectin, and hyaluronan were elevated in the farmers. Skin prick tests with swine extracts were negative in all farmers. Antibodies (assessed by DIG-ELISA) against swine dander, swine dust, and pig feed were increased and precipitating antibodies against swine dander were found in 14, against pig food in five, and against swine confinement dust in three of the 20 pig farmers. The concentration of airborne total dust was 7.4 mg/cu mm and the endotoxin concentration was 37 (22 to 60) ng/cu mm during tending the pigs and increased, during feeding, to 13.8 mg/cu mm and 315 (194 to 716) ng/cu mm, respectively. There was no correlation between exposure and lung function or lavage findings. In conclusion, randomly selected pig farmers had signs of airway inflammatory reaction and activation of the immune system withoutX XXv$XXXF7XXXXXXXXXXXXXXXXXXXX XXXŠ alteration in lung function and bronchial reactivity AU - Larsson K AU - Eklund A AU - Malmberg P AU - Belin L LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 101 IP - DP - 1992 Jan 01 TI - Hyaluronic acid (hyaluronan) in BAL fluid distinguishes farmers with allergic alveolitis from farmers with asymptomatic alveolitis PG - 109-114 AB - Pulmonary function measurements, bronchoalveolar lavage (BAL), and analyses of precipitating antibodies in blood were performed in 12 farmers wtih no symptoms from the airways and 12 farmers who were admitted to the hospital due to acute symptoms of alveolitis (all nonsmokers). In addition, a bronchial methacholine provocation test was performed in the asymptomatic farmers. In 11 of the 12 symptomatic farmers but in none of the asymptomatic farmers, precipitating antibodies against one or more of the microorganisms which usually occur in a farmer's environment were found. In the farmers with symptomatic alveolitis, a restrictive impairment of pulmonary function was found, while pulmonary function was normal in all asymptomatic farmers. Findings in the BAL fluid showed increased concentrations of total cells, lymphocytes, and neutrophils and elevated levels of albumin, fibronectin, and angiotensin-converting enzyme in asymptomatic farmers compared with our own reference group. The same analyses in BAL fluid from the symptomatic farmers revealed a further increase in all parameters compared with the asymptomatic farmers. The BAL fluid from asymptomatic farmers had normal levels of hyaluronic acid (hyaluronan) and procollagen 3 N-terminal peptide, while these levels were significantly increased in the symptomatic group. We conclude that inflammation in the alveolar space and signs of activation of alveolar macrophages are present in farmers regardless of respiratory symptoms, although these findings are more pronounced in the presence of symptoms of acute alveolitis; however, the findings of impaired pulmonary function and the occurrence of precipitins and elevated levels of hyaluronic acid and procollagen 3 N-terminal peptide in BAL fluid were exclusively found in the farmers with airways symptoms. We postulate the hyaluronic acid, due to its pronounced ability to immobilize water, may be of importance in the development of the pulmonary function impairment observed in farmer's lung disease AU - Larsson K AU - Eklund A AU - Malmberg P AU - Bjermer L AU - Lundgren R AU - Belin L LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 101 IP - DP - 1992 Jan 01 TI - Penicillium decumbens. A new cause of fungus ball PG - 1152-1153 AU - Yoshida K AU - Hiraoka T AU - Ando M AU - Uchida K AU - Mohsenin V LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Comparison of a video questionnaire with the IUATLD written questionnaire for measuring asthma prevalence PG - 561-568 AB - A video questionnaire (VQ) for measuring asthma prevalence in adolescents was assessed for repeatability and validity in relation to bronchial hyperresponsiveness (BHR) (PD20 less than or equal to 7.8 mumol methacholine). Comparison was also made with a standard, self completed written questionnaire (SQ), based on the IUATLD Bronchial Symptoms Questionnaire, which included five questions seeking comparable data to those in the VQ. Both the VQ and SQ were administered to 707 schoolchildren (13-16 years), in whom English was the primary language. One hundred and six randomly selected children subsequently underwent bronchial challenge to methacholine. Both the sensitivity and specificity for BHR were higher for a combination of three or more positive responses to the VQ (0.73 and 0.88), than to the SQ (0.63 and 0.82), although these differences were not statistically significant (P = 0.24). When administered again after a two week interval, the VQ had a significantly higher (P = 0.03) coefficient of repeatability (0.79) than the SQ (0.50). We conclude that the VQ is a valid and reliable method of determining asthma prevalence, and propose that by providing data relatively free from biases due to language, culture, literacy or interviewing techniques it may be particularly useful when comparing asthma prevalence and severity in different populations AU - Shaw RA AU - Crane J AU - Pearce N AU - Burgess CD AU - Bremner P AU - Woodman K AU - Beasley R LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Diagnosing asthma by questionnaire in epidemiological surveys [editorial] PG - 509-510 AU - Burr ML LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Heterogeneity of IgE antibody response to reactive dye in sera from four different sensitized workers PG - 606-610 AB - We studied RAST and RAST inhibition tests to black GR, the most frequent sensitizer among several reactive dyes in our previous study, in order to evaluate the specificity of IgE antibodies to hapten or new antigenic determinants and the crossreactivity between two reactive dyes, black GR and orange 3R, in sera from four different sensitized workers. RAST inhibition studies with black GR-human serum albumin (HSA) conjugate discs demonstrated that black GR-HSA conjugates were the most effective inhibitors. Orange 3R-HSA conjugates, unconjugated forms of black GR and orange 3R were weak inhibitors in two patients and non-inhibitory in one patient, whereas they caused strong dose-dependent inhibitions in one patient. These results suggested that the IgE response to black GR-HSA conjugates might be heterogenous and the crossreactivity between two reactive dyes differed from one patient to another AU - Hong CS AU - Park HS LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Specific immunological and bronchopulmonary responses following intradermal sensitization to free trimellitic anhydride in guinea pigs [see comments] PG - 694-700 AB - We have developed a guinea pig model of trimellitic anhydride-induced airway hypersensitivity responses. In one group of guinea pigs, injected intradermally with 0.1 ml 30% trimellitic anhydride (TMA), we examined the specificity of the bronchopulmonary response to TMA comparing the effect of intravenous TMA conjugated to guinea pig serum albumin (GPSA) with a control hapten (procion dye) protein conjugate (PD-GPSA). A significant increase in pulmonary inflation pressure (PIP) was provoked in sensitized animals following intravenous injection with TMA-GPSA (20%; 0-400, median; range) as compared to intravenous injection of PD-GPSA. In the second group we compared three different methods of sensitization: single injection of 0.1 ml of 0.3% TMA; four injections of 0.1 ml of 0.1% TMA; and a single high dose injection of 30% TMA. Following intravenous TMA-GPSA guinea pigs sensitized with a single injection 0.3% TMA had an increase in PIP of 395%; 220-600, while those given four repeat injections of 0.1% TMA had an increase in PIP of 343%; 315-490. These results were significantly higher than the increase in PIP (160%; 0-220) which occurred in guinea pigs sensitized with a single dose of 30% TMA. Four of 11 guinea pigs given low dose injections of TMA had bronchopulmonary responses to inhaled TMA-GPSA. All sensitized guinea pigs had specific IgG1 antibodies demonstrated by enzyme linked immunosorbent assay (ELISA) and confirmed by ELISA inhibition. Four guinea pigs sensitized by low dose injections of TMA had IgE antibodies demonstrated by passive cutaneous anaphylaxis.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Hayes JP AU - Daniel R AU - Tee RD AU - Barnes PJ AU - Chung KF AU - Newman Taylor AJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 17 IP - DP - 1992 Jan 01 TI - Nasal disease in chrome workers PG - 287-288 AU - Dingle AF LA - PT - DEP - TA - Clin Otolaryngol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 101 IP - DP - 1992 Jan 01 TI - Acute silicosis responding to corticosteroid therapy PG - 366-370 AB - The course of acute silicosis usually is relentlessly progressive. Death results from cor pulmonale and respiratory failure, with mycobacterial infection a frequent serious complication. Attempts to treat the illness generally have been unavailing. We report an unusual case of acute silicosis in which improvement in clinical status, chest x-ray film findings and pulmonary function occurred following therapy with corticosteroids. To our knowledge, this is the first such case reported in the medical literature AU - Goodman GB AU - Kaplan PD AU - Stachura I AU - Castranova V AU - Pailes WH AU - Lapp NL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - A critical review of the toxicology of glutaraldehyde PG - 143-174 AB - Glutaraldehyde, a low molecular weight aldehyde, has been investigated for toxicity in humans and animals. Examination of this dialdehyde was indicated from previous studies with other aldehydes in which carcinogenicity of formaldehyde and toxicity of acetaldehyde and malonaldehyde have been disclosed. Information gaps concerning the actions of glutaraldehyde have been identified in this review and recommendations are suggested for additional short- and long-term studies. In particular, information regarding irritation of the respiratory tract, potential neurotoxicity, and developmental effects would assist in a complete hazard evaluation of glutaraldehyde. Further study related to disposition, metabolism, and reactions of glutaraldehyde may elucidate the mechanism of action AU - Beauchamp RO Jr AU - StClair MB AU - Fennell TR AU - Clarke DO AU - Morgan KT LA - PT - DEP - TA - Crit Rev Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 117 IP - DP - 1992 Jan 01 TI - Latex proteins as the trigger of respiratory and systemic allergies PG - 1269-1273 AB - 56 patients (52 members of the hospital's staff, four with other employment) who had hypersensitivity reactions to latex articles and developed an immediate-type response to latex extract with the skin-prick test were studied. Specific IgE antibodies were present in the enzyme-allergo-sorbent test of 50 of the subjects. Latex-containing surgical and household gloves were the main cause of allergies. Patients with isolated contact urticaria (n = 8) had a tendency towards lower antibody concentrations than those with additional respiratory and/or systemic symptoms (n = 48). Occupation-related provocation tests triggered rhinitis in 19, conjunctivitis in ten, and bronchial obstruction in six. The main allergen was found to be a protein with a relative molecular mass of 58,000, originating from the latex milk and passing from the latex glove into the glove powder. In the course of usual activities considerable allergen inhalation can occur. Even small amounts (e.g. 400 ng/ml) can precipitate significant allergic reactions. The results show that the main latex allergen, a glycine-rich protein molecule, can cause cutaneous, inhalant and systemic hypersensitivity reactions AU - Baur X AU - Jager D AU - Engelke T AU - Rennert S AU - Czuppon AB LA - PT - DEP - TA - Deutsche Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 117 IP - DP - 1992 Jan 01 TI - The accidental aspiration and ingestion of petroleum in a "fire eater". [German] PG - 1594-1598 AB - A 26-year-old man, practicing for a variety performance as "fire-eater", accidentally inhaled and ingested about 10 ml petroleum. Soon afterwards he developed dyspnoea, an urge to cough, fever up to 39 degrees C and loss of retentiveness. He was treated as an out-patient with doxycycline, 100 mg daily, and aspirin, 500 mg three times daily. While this reduced the dyspnoea, the elevated temperature persisted and he had haemoptysis. Chest x-ray and computed tomography 12 days after the aspiration revealed areas of atelectasis and of liquefaction necroses. Bronchoscopic and cytological examinations showed eosinophilic alveolitis and mucosal necrosis in both main bronchi. The symptoms were improved by two inhalations of beclomethasone four times daily, and systemic treatment with prednisolone, 50 mg daily, together with parenteral antibiotic administration (cefotaxime, 1.0 g twice daily). The focal lung lesions regressed completely within a few weeks. Five months after the aspiration computed tomography merely demonstrated discrete scarring of the previously necrotic lesions. This case illustrates that, even with extensive necrotic lung changes after petroleum aspiration, conservative treatment is justified and likely to be effective AU - Ewert R AU - Lindemann I AU - Romberg B AU - Petri F AU - Witt C LA - PT - DEP - TA - Deutsche Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 228 IP - DP - 1992 Jan 01 TI - Theophylline inhibits late asthmatic reactions induced by toluene diisocyanate in sensitised subjects PG - 45-50 AB - Toluene diisocyanate (TDI)-induced asthma is a frequent occupational airway disease. To determine whether a calibrated dosage of oral slow-release theophylline inhibits asthmatic reactions and the associated increase of airway responsiveness to methacholine induced by TDI, we examined six asthmatic subjects who developed a late or a dual asthmatic reaction after TDI inhalation challenge. We administered oral slow-release theophylline or placebo to each subject for 7 days according to a double-blind, randomized, cross-over study design. When the subjects received a placebo, TDI caused a late or a dual asthmatic reaction. When the subjects received theophylline. TDI caused significantly reduced late asthmatic reactions. Mean serum theophylline concentrations were within the therapeutic range. Theophylline neither modified the baseline airway responsiveness to methacholine, nor the increase of airway responsiveness to methacholine induced by TDI. These results suggest that slow-release theophylline may improve TDI-induced late asthmatic reactions, but it does not change the baseline airway responsiveness to methacholine and the increase of airway responsiveness to methacholine induced by TDI AU - Crescioli S AU - De Marzo N AU - Boschetto P AU - Spinazzi A AU - Plebani M AU - Mapp CE AU - Fabbri LM AU - Ciaccia A LA - PT - DEP - TA - Eur J Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 5 IP - DP - 1992 Jan 01 TI - Bronchial responsiveness and work-related asthma in aluminium potroom workers: effect of removal from exposure PG - 829-833 AB - Twelve subjects relocated from aluminium potrooms due to work-related asthma were followed up for 2-27 months (median 23 months). Repeated post-relocation examinations (numbering 3-7, median 6) of methacholine challenge, forced expiratory volume in one second (FEV1), eosinophil cell count and respiratory symptoms were carried out at regular intervals. At the time of relocation, bronchial hyperresponsiveness (provoking concentration producing a 20% fall in FEV1 (PC20) less than or equal to 8.0 mg.ml-1) was found in eight of the subjects. During the follow-up period a twofold increase in PC20 was found in 7 of the 8 subjects who had PC20 less than 8.0 mg.ml-1 at the time of relocation. There was an improvement of symptoms but no improvement in FEV1 or decrease of eosinophils during the follow-up examinations AU - Soyseth V AU - Kongerud J AU - Boe J AU - Fonneland T LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 5 IP - DP - 1992 Jan 01 TI - Update on an exposure system for particles in the diagnosis of occupational asthma PG - 887-890 AB - We have previously designed a system for exposure to particles and described the preliminary results in 20 subjects exposed to occupational sensitizers in powder form (Cloutier Y, et al. - Eur Respir J, 1989; 2: 769). Modifications have been made to the particles generator, exposure chamber and sampling ports. Furthermore, in order to improve the stability of concentrations in the exposure chamber and to make the system easy to operate by a technician, it has been completely automated using closed-loop feedback regulated by a computer program AU - Cloutier Y AU - Malo JL LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 5 IP - DP - 1992 Jan 01 TI - Fire-eater's lung PG - 112-114 AB - Acute pneumonitis following aspiration of petroleum products is usually related to accidental poisonings in children. We describe here two cases of hydrocarbon pneumonitis in fire-eaters, caused by accidental aspiration of petroleum during the performance of fire-eating. Both patients had cough, dyspnoea, chest pain and fever. Chest X-rays showed basal lung infiltrates and, 2 weeks later, pneumatocele formations. Reversible bronchial hyperresponsiveness and restrictive ventilatory limitation were demonstrated in one of the patients. The bronchoalveolar lavage specimen showed cytoplasmic vacuolation of the macrophages and neutrophilia. After treatment with antibiotics and corticosteroids the symptoms disappeared and the lung function values returned to normal within 2-3 weeks. Radiological resolution of the pneumatoceles occurred within 2-12 months AU - Brander PE AU - Taskinen E AU - SteniusAarniala B LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 64 IP - DP - 1992 Jan 01 TI - Clinical studies in workers engaged in maintenance of watermark moulds in a paper mill PG - 141-145 AB - Thirty subjects engaged in maintenance and repair of moulds used for producing watermarks on paper were studied, along with 27 control subjects from the same paper mill. The workers were simultaneously exposed to copper, chromium, zinc, xylol, and fumes of sulphuric acid in the course of their work. The study subjects were investigated for clinical, occupational, radiological haematological and psychological details. The aforementioned combined exposure was found to be responsible for a high prevalence of symptoms pertaining to the respiratory system and higher nervous functions. Breathlessness (26.7%), expectoration (10.0%) and emphysema (10.0%) were significantly higher among the exposed subjects. The exposed subjects also showed lowered visuomotor coordination and delayed reaction to light and sound stimuli AU - Srivastava AK AU - Gupta BN AU - Bihari V AU - Mathur N AU - Gaur JS AU - Mahendra PN AU - Kumar P AU - Bharti RS LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 89 IP - DP - 1992 Jan 01 TI - Latex-specific proteins causing immediate-type cutaneous, nasal, bronchial, and systemic reactions PG - 759-768 AB - We examined 70 patients reporting hypersensitivity reactions caused by latex articles. All patients suffered from urticaria, 36 from rhinitis, 31 from conjunctivitis, 22 from dyspnea, and 17 from systemic reactions, and four patients developed severe systemic complications during surgery. By means of inhalative challenge tests with powdered latex gloves, it could be demonstrated that the glove powder (cornstarch) obviously functions as a carrier for latex allergens, which then become airborne. Five of 18 patients undergoing such challenge tests demonstrated a significant increase of specific airway resistance; 17, acute rhinitis and/or conjunctivitis; and two, a systemic reaction. Sixty-two percent of the patients demonstrated specific IgE antibodies to natural latex, 58% to an irradiatively cross- linked, so-called, "hypoallergenic" latex preparation, and 46% to commercial-latex RAST disks (Pharmacia). No specific antibodies to cornstarch or a mixture of rubber chemicals were found. A good correlation (82%) exists between latex IgE RAST and latex skin prick test, as revealed in a subgroup of 45 subjects. By means of sodium dodecyl sulfate- polyacrylamide gel electrophoresis, the latex allergen appears to be a mixture of proteins in a molecular weight range from 10 to 67 kd AU - Jaeger D AU - Kleinhans D AU - Czuppon AB AU - Baur X LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 90 IP - DP - 1992 Jan 01 TI - Occupational asthma induced by a carpet fungicide--tributyl tin oxide PG - 274-275 AU - Shelton D AU - Urch B AU - Tarlo SM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 89 IP - DP - 1992 Jan 01 TI - Occupational asthma caused by alpha-amylase inhalation: clinical and immunologic findings and bronchial response patterns PG - 118-125 AB - Inhalation of dust from different enzymes can be the cause of occupational asthma in exposed workers. alpha-Amylase, derived from Aspergillus oryzae, is one of these enzymes, although there are few studies in the medical literature that refer to its allergologic properties and to clinical studies in sensitized patients. The results obtained in a study performed in 83 pharmaceutical-industry workers exposed to powdered alpha-amylase are described in this article. The existence of sensitization to this enzyme was demonstrated in 26 of the workers by positive skin tests. Specific IgE values were significantly higher in workers with positive skin tests than in workers with negative skin tests (p less than 0.001). The bronchial provocation test with alpha-amylase was positive in six of the 14 patients challenged, and only immediate bronchial responses were observed; the same type of response was obtained by nasal provocation. One of the workers had a positive response to oral provocation with this enzyme, presenting abdominal, skin, and respiratory symptoms a few minutes after ingestion. Consequently, we consider that the bronchial asthma presented by the workers was due to an immediate-type, IgE-dependent, immunologic mechanism AU - Losada E AU - Hinojosa M AU - Quirce S AU - SanchezCano M AU - Moneo I LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 232 IP - DP - 1992 Jan 01 TI - Extrinsic allergic alveolitis due to exposure to esparto dust PG - 177-179 AB - We here describe the case of a patient with a history of exposure to esparto grass for two and a half years, who presented with clinical symptoms, radiological signs, pulmonary function test and histological findings consistent with the diagnosis of hypersensitivity pneumonitis. Signs and symptoms reappeared after re-exposure. There are few reports of stipatosis in the world literature AU - del Campo F AU - Paredes C LA - PT - DEP - TA - J Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 7 IP - DP - 1992 Jan 01 TI - Clinical and immunological evaluation of isocyanate-exposed workers PG - 122-127 AB - Isocyanates are the most significant cause of occupational asthma in our country. To evaluate the prevalence of work-related respiratory symptoms and immunologic sensitization to it, we performed a questionnaire survey, allergy skin test, radioallergosorbent test (RAST) to toluene diisocyanate (TDI)-human serum albumin (HSA) conjugate and methacholine bronchial challenge test on 23 isocyanate-exposed employees and 9 unexposed controls working in a zipper factory. Six employees (26.1%) complained of work-related respiratory symptoms and three symptomatic workers showed significant bronchoconstrictions on TDI-bronchoprovocation test. Three (13%) asymptomatic workers had high specific IgE antibodies to TDI-HSA and none of the TDI-sensitive asthmatic workers had specific IgE antibody. One of the TDI-sensitive asthmatic workers showed a negative result on the initial methacholine bronchial challenge test, but bronchial hyperresponsiveness developed after the TDI challenge. It was suggested that TDI-sensitive asthma was noted in three (13%) of 23 exposed workers and that asymptomatic workers could have high specific IgE antibody. Measurement of the changes in bronchial hyperresponsiveness after the TDI challenge could be helpful to diagnose TDI-sensitive asthma AU - Park HS AU - Park JN AU - Kim JW AU - Kim SK LA - PT - DEP - TA - J Kor Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 34 IP - DP - 1992 Jan 01 TI - Factors in job decisions [letter] PG - 593-594 AU - Musk AW AU - Ryan G AU - James A AU - Cookson W LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 43 IP - DP - 1992 Jan 01 TI - Does formaldehyde-induced asthma exist? PG - 187-190 AB - Formaldehyde is a ubiquitous airborne pollutant in our modern environment. There are many potential sources of formaldehyde in the industrial setting. Ambient formaldehyde affects primarily the upper airways and eyes. Lower airway and pulmonary effects occur at exposure levels between 6-38 mg/m3. It is so soluble and rapidly metabolized that it seldom reaches the lower respiratory tract to inflict damage. There is no consistent evidence indicating that formaldehyde can be a respiratory sensitizer. It may, on rare occasions, induce bronchial asthma at relatively high exposure doses. There are no conclusive studies that would prove the development of de novo-IgE-mediated respiratory tract symptoms as resulting from inhalation of formaldehyde AU - Gorski P AU - Krakowiak A LA - PT - DEP - TA - Med Pr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 43 IP - DP - 1992 Jan 01 TI - Objective evaluation of respiratory ventilation at work by measuring peak expiratory flow rate (PEFR) PG - 1-5 AU - Gorski P AU - Bilewicz P AU - Krakowiak A LA - PT - DEP - TA - Med Pr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 30 IP - DP - 1992 Jan 01 TI - A case of occupational asthma caused by arrowhead scale in mandarin orange-worker. PG - 868-872 AB - A 50-year-old woman with occupational asthma, whose attacks were provoked by inhalation of Arrowhead scale (Unapsis Yanonensis Kuwana) attached to the leaves of mandarin oranges is reported. She experienced asthmatic attacks while picking leaves and harvesting mandarin oranges. Because Arrowhead scale-dust stuck to the leaves was suspected to be the allergen, tests of allergy were performed using an extract of the allergen prepared by Unger's method in our laboratory. Asthmatic attack was provoked 90 minutes after inhalation of the extract of cocoon. Histamine was not released, but leukotriene D4 production was induced by the addition of the extract to whole blood. Basophils were activated by addition of anti-IgG anti-sera as well as the extract. These data indicate that LT released from target cells in response to the worm elements, as well as histamine, is important as a chemical mediator AU - Takahashi K AU - Soda R AU - Matsuoka T AU - Tsutsui E AU - Shimizu I AU - Nakato K AU - Namba K AU - Isoshima K AU - Kamisaka K LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 44 IP - DP - 1992 Jan 01 TI - Surveillance and management PG - 139, 141,-139, 141, AB - Recognising the early signs of occupational asthma can prevent the onset of this debilitating disease. Consultant occupational health physician, Dr Bernard Graneek, suggests methods of surveillance and management to control its development AU - Graneek B LA - PT - DEP - TA - Occup Health (Lond) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 46 IP - DP - 1992 Jan 01 TI - Exogenous allergic alveolitis caused by mouldy hazel nut leaves. PG - 32-35 AB - A 62-year old farmer woman from the northeastern, very rainy part of Turkey has been collecting large amounts of green and brown involucral hazel-nut leaves for subsequent use as fuel. For the last 20 years she had been complaining of cough, respiratory distress and intermittent fever. In the course of years of continual antigen exposure she developed the clinical and x-ray signs of fibrosis of the lung. Bronchoalveolar lavage produced the typical cell pattern of chronic exogenous allergic alveolitis with predominant CD8 cells. Serum analysis yielded high titres of IgG antibodies against mould fungi partly obtained from hazel-nut husk cultures, as well as thermophilic actinomycetes AU - Erkan F AU - Baur X AU - Kili:caslan Z AU - Tabak L AU - Arseven O AU - Erelel M AU - Jaeger D AU - Cavdar T LA - PT - DEP - TA - Pneumologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 86 IP - DP - 1992 Jan 01 TI - 'Smoke-bomb' pneumonitis PG - 165-166 AU - Allen MB AU - Crisp A AU - Snook N AU - Page RL LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 9 IP - DP - 1992 Jan 01 TI - Detergent enzymes: has the risk of occupational sensitization disappeared?. PG - 443-448 AB - Occupational allergy to enzyme detergents had almost disappeared by the use of preventive measures, both individually and in industries. The occurrence of 8 new cases of asthma in a detergent factory has led to a prospective clinical and aetiological enquiry. Although there was no documentation using the specific provocation test or by measuring respiratory function whilst at work, the occupational character of this asthma seemed possible after taking a history. Sensitization to the enzymes used (Savinase, Maxatase and Biozym P 300 S) was shown by skin tests (8 positive to all the enzymes) and the level of specific IgE to Rast (8 times greater than class 3 for Savinase and Maxitase) and for HBDT for Maxatase and Biozym P 300 S (greater than 50% in 8 patients). From another stand point the incomplete application of preventive measures within the factory did not seem to totally explain the origin of this sensitization. In fact, it was the study of the morphology of the enzyme grains, which had been introduced into the factory which helped us toX XXÖX:XXXF7XXXXXXXXXXXXXXXXXXXX XXXŠ explain the mechanism. In effect it was the capsules of the grain which were fissured and thus allowed allergen contact. The replacement of these grains whose envelope was intact, led to the disappearance of the symptoms and confirmed our hypothesis. There remains a continuing risk from occupational sensitization to asthma and it is suggested that there is continued collaboration between the medical profession and industry AU - Perdu D AU - Lavaud F AU - Cossart C AU - Legrele S AU - Passemard F AU - Deltour G AU - Dubois de Montreynaud JM LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 9 IP - DP - 1992 Jan 01 TI - Allergic alveolitis due to colophony. PG - 472-473 AB - We report the observation of a 37 year-old female worker exposed for 5 years to heated colophony fumes. The patient used a soldering iron with colophony flux-cored solder. She presented with chronic cough and dyspnoea on exertion without any wheezing. Clinical evidence associated with chest X-ray, lung function tests, lymphocytic alveolitis in bronchoalveolar lavage led to hypothesize the diagnosis of an occupational alveolitis linked to colophony exposure. This was eventually confirmed by coupling repeated lung function tests and bronchoalveolar lavages with on-off periods of occupational exposure AU - Maria Y AU - Filliard E AU - Henninger JF LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 9 IP - DP - 1992 Jan 01 TI - Occupational asthma caused by ebony wood. [French] PG - 470-471 AB - A case of occupational asthma to ebony wood dust is described in a violin and stringed instrument maker, who was sanding and filing ebony to make the finger boards of violins and cellos. The diagnosis was confirmed using a realistic provocation test; after sanding and smoothing the ebony for 20 minutes the patient developed bronchial spasm with fall of the force expired volume in one second (VMS) of 45% which was reversible following the inhalation of beta 2 agonists. A delayed reaction was seen at 3 hours and 6 hours and at 20 hours after the test. The observations of occupational asthma or rhinitis to ebony wood are very rare. To our knowledge there are two publications at the present time. It has been recognised as an occupational disease (see table 47 of occupational diseases) and an exclusion order has been effected AU - KopferschmittKubler MC AU - Bachez P AU - Bessot JC AU - Pauli G LA - PT - DEP - TA - Rev Mal Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 122 IP - DP - 1992 Jan 01 TI - Peak flow profile and expert testimony. The significance of peakflow self assessment for pneumological expert testimony. [German] PG - 1070-1078 AB - Quantitative assessment of pulmonary obstructive diseases, such as asthma, may be difficult because of variability of obstruction. This is particularly true with regard to expert evidence pulmonary physicians deliver to insurances. Severity of obstruction, degree of impairment by an obstructive ventilatory defect, and temporal relationship of bronchial obstruction to exposure, may not be detected by physiological measurements in the pulmonary function laboratory. Much of the expert's opinion on these matters will depend on the credibility he assigns to the insured individual. The insured individual, in the other hand, has no other proof available than the description of his complaints, which puts him at a disadvantage. Serial peak flow measurements can be instrumental in clarifying such issues. They add an objective dimension to the case history. Six cases in which expert evidence was commissioned by insurances are described in detail, to exemplify how the thinking of the experts was modified by peak flow profiles. The greater usefulness of serial peak flow measurements in occupational asthma is emphasized and problems that may arise with peak flow measurements are discussed AU - Waldburger R AU - Hofmann M AU - Ruegger M LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 105 IP - DP - 1992 Jan 01 TI - A study of New Zealand wood workers: exposure to wood dust, respiratory symptoms, and suspected cases of occupational asthma PG - 185-187 AB - A randomly selected group of 50 New Zealand wood workers was studied. The level of airborne wood dust to which they were exposed ranged from 1.0-24.5 mg/m3. The wood workers reported experiencing higher rates of both lower and upper respiratory tract symptoms than a control group of office workers. Inhaled wood dust, in particular from rimu (Dacrydium cupressinum), was frequently cited by workers as being associated with respiratory tract symptoms. The wood workers' responses to the respiratory symptom questionnaire, and serial recordings of peak expiratory flow rate were used to screen the group for suspected cases of occupational asthma. Five cases fulfilled the study's criteria for suspected occupational asthma. In four of these, further evidence was found to support this diagnosis. We conclude that exposure to wood dust may cause occupational asthma in the woodworking industry in New Zealand AU - Norrish AE AU - Beasley R AU - Hodgkinson EJ AU - Pearce N LA - PT - DEP - TA - N Z Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 13 IP - DP - 1992 Jan 01 TI - Latex allergy: its importance in clinical practice PG - 67-69 AB - Latex has been identified as a potent and significant allergen. Atopic medical and dental personnel who regularly use latex gloves and patients with chronic latex exposure are at increased risk of latex allergy. If this allergy is unrecognized, anaphylactic shock can occur as a result of mucosal latex absorption at the time of surgery or procedure. Use of a nonlatex glove can prevent this potentially fatal event. Latex anaphylaxis also can occur from absorption through disrupted skin in occupationally exposed patients. Further prospective studies are needed to look at the significance of a positive latex skin test, particularly in the history-negative population. Only then can we define appropriate screening procedures AU - Sussman GL LA - PT - DEP - TA - Allergy Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 13 IP - DP - 1992 Jan 01 TI - A cross-sectional survey of 46 employees exposed to trimellitic anhydride PG - 139-142 AB - This is a report of 46 employees exposed to trimellitic anhydride (TMA). The evaluation consisted primarily of periodic serum antibody studies and a questionnaire that identified symptoms compatible with allergic asthma and/or rhinitis, late respiratory systemic syndrome (LRSS), or pulmonary disease anemia (PDA) syndrome. Industrial hygiene data from the plant in 1989 reported exposures that were lower than levels in 1979. Seven employees had positive IgE antibody against trimellityl-human serum albumin (TM-HSA); one had TMA rhinitis, and another possibly had TMA asthma/rhinitis. Fourteen employees had positive IgG antibody against TM-HSA of whom only three had titers high enough to cause disease, and none of them had symptoms compatible with LRSS or PDA. At most, two workers had asthma or rhinitis during the 1990 evaluation. In summary, in this employee population with low level TMA exposure there is a low incidence of immunologically mediated disease due to TMA AU - Grammer LC AU - Harris KE AU - Sonenthal KR AU - Ley C AU - Roach DE LA - PT - DEP - TA - Allergy Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 53 IP - DP - 1992 Jan 01 TI - Pulmonary effects of inhaled zinc oxide in human subjects, guinea pigs, rats, and rabbits PG - 503-509 AB - Occupational exposure to freshly formed zinc oxide (ZnO) particles (less than 1.0 micron aerodynamic diameter) produces a well-characterized response known as metal fume fever. An 8-hr threshold limit value (TLV) of 5 mg/m3 has been established to prevent adverse health effects because of exposure to ZnO fumes. Because animal toxicity studies have demonstrated pulmonary effects near the current TLV, the present study examined the time course and dose-response of the pulmonary injury produced by inhaled ZnO in guinea pigs, rats, rabbits, and human volunteers. The test animals were exposed to 0, 2.5, or 5.0 mg/m3 ZnO for up to 3 hr and their lungs lavaged. Both the lavage fluid and recovered cells were examined for evidence of inflammation or altered cell function. The lavage fluid from guinea pigs and rats exposed to 5 mg/m3 had significant increases in total cells, lactate dehydrogenase, beta-glucuronidase, and protein content. These changes were greatest 24 hr after exposure. Guinea pig alveolar macrophage function was depressed as evidenced by in vitro phagocytosis of opsonized latex beads. Significant changes in lavage fluid parameters were also observed in guinea pigs and rats exposed to 2.5 mg/m3 ZnO. In contrast, rabbits showed no increase in biochemical or cellular parameters following a 2-hr exposure to 5 mg/m3 ZnO. Differences in total lung burden of ZnO, as determined in additional animals by atomic absorption spectroscopy, appeared to account for the observed differences in species responses. Although the lungs of guinea pigs and rats retained approximately 20% and 12% of the inhaled dose, respectively, rabbits retained only 5%.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Gordon T AU - Chen LC AU - Fine JM AU - Schlesinger RB AU - Su WY AU - Kimmel TA AU - Amdur MO LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 21 IP - DP - 1992 Jan 01 TI - Irregular opacities in the lung, occupational asthma, and airways dysfunction in aluminum workers PG - 845-853 AB - We examined chest X-rays, measured expiratory flows and FVC by spirometry and TLC by projected lung area, ascertained respiratory data by questionnaires, and performed chest examinations in 670 Southeastern aluminum workers and 659 unexposed regional controls. Both groups were asbestos exposed. More aluminum workers had irregular opacities and fewer had pleural abnormalities than did regional pipefitter referents. The pulmonary function tests were expressed as percentage of predicted to adjust for height, age and duration of smoking based on a randomly selected U.S. reference population. Data from aluminum workers were compared to regional controls with students "t" tests run for unequal size groups. Aluminum workers had significant reductions in FEV1 of 3.2% predicted (p less than .003), FEF25-75 of 11.3% predicted (p less than .0001), FEF75-85 of 22.5% predicted (p less than .0001), and an increased TLC of 2.0% predicted (p less than .005). The 145 who had never smoked (NS) were compared with 124 NS controls and showed this same pattern of differences; but in smokers, the differences were significant for mid and terminal flows, but not for FEV1. In aluminum workers who never smoked, asthma prevalence by history was 7.6% vs. 4.0% in controls, and wheezes were heard in 21.4% vs. 2.4% in controls. In aluminum workers who were current smokers, asthma prevalence was 16.4% vs. 9.4% in controls, and wheezes were heard in 43.7% vs. 21.1% in controls. Aluminum workers had significantly more asthma, wheezing, airways obstruction, and pulmonary parenchymal abnormalities similar to asbestosis than did regional blue collar controls not melting and casting aluminum AU - Kilburn KH AU - Warshaw RH LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 21 IP - DP - 1992 Jan 01 TI - Immunological and respiratory changes in animal food processing workers PG - 177-191 AB - A group of 35 men employed in the processing of animal food was studied to assess the relation between respiratory findings and immunological status. The most frequent positive skin prick reactions to occupational allergens were to fish flour (82.9%), followed by carotene (77.1%), corn (65.7%), four-leaf clover (62.9%), sunflower (54.3%), chicken meat (31.4%), soy (28.6%), and yeast (22.7%). Increased total IgE serum levels were found in 14/35 (40.0%) animal food workers compared to 1/39 (2.6%) in a healthy population (p less than 0.01). A significantly higher prevalence of chronic respiratory symptoms was found among the exposed workers compared to control workers. There was however, no significant difference in the prevalence of chronic respiratory symptoms between animal food workers with positive and negative skin tests to house dust or to fish flour or among those with increased or normal IgE (except for dyspnea). The frequency of acute symptoms associated with the work shift was high among the animal food workers but similar by immunological status. There were significant mean across-shift reductions for all ventilatory capacity tests, being particularly pronounced for FEF25. Workers with positive skin tests to fish flour antigen had significantly larger across-shift reductions in FEF25 than workers with negative skin reactions. An aqueous extract of animal food dust caused a dose-related contractile response of isolated guinea pig tracheal muscle in vitro. Our data suggest that, in addition to any immunological response animal food dust may produce in vivo, it probably also causes direct irritant or pharmacological reactions on the airways as suggested by our in vitro data AU - Zuskin E AU - Kanceljak B AU - Schachter EN AU - Witek TJ AU - Maayani S AU - Goswami S AU - Marom Z AU - Rienzi N LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Silo filler's disease in New York State PG - 650-653 AB - Twenty new cases of Silo filler's disease (SFD) have been collected, documenting the incidence and clinical features of exposure to nitrogen oxides present in freshly filled silos. Cases of SFD were identified using a statewide computerized discharge diagnosis system. Fifteen of these were identified in the index period, allowing us to calculate an approximate annual incidence of 5.0 cases/100,000 silo-associated farm workers/yr in New York State. All cases occurred during harvest periods, with 80% in September and October. Corn silage was the gas source in 18 (90%). All cases involved young white men (mean age, 31.5 yr). The most common presenting feature was dyspnea. All victims entered a silo during the peak danger period, and only one used recommended ventilation techniques. Four cases ended in death (20% mortality). Silo filler's disease, although rare, is a potentially devastating disease involving otherwise young, healthy farm workers. It is readily prevented AU - Zwemer FL Jr AU - Pratt DS AU - May JJ LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Serum angiotensin converting enzyme activity in chronic beryllium disease PG - 39-42 AB - Serum angiotensin converting enzyme (SACE) activity is used as a marker of sarcoidosis activity and severity, but in chronic beryllium disease (CBD) the studies of SACE give conflicting results. We examined SACE activity in 23 CBD patients, five patients with beryllium sensitization, and 25 beryllium-exposed control subjects. CBD patients underwent complete clinical evaluation, including physical examination, pulmonary function testing, exercise physiology testing, chest radiography, and bronchoscopy with bronchoalveolar lavage and biopsy. CBD SACE activity was systematically compared with these clinical markers of disease severity. Of CBD patients, 22% had elevated SACE activity. The test did not discriminate CBD patients from those in the beryllium-sensitized or beryllium-exposed groups. However, SACE activity in CBD correlated with the extent of pulmonary granulomatous inflammation as reflected by the symptom of breathlessness, the number of white cells in bronchoalveolar lavage (r = 0.44), the number of lavage lymphocytes (r = 0.58), the lavage lymphocyte percentage (r = 0.55), and the profusion of small opacities on chest radiograph (r = 0.41). The test-retest reliability of the assay was high (r = 0.84), as was the agreement between fresh and -70 degrees C frozen sera (r = 0.93). We conclude that SACE activity levels may reflect the extent of pulmonary granulomatous inflammation in CBD but that the test does not help discriminate disease from nondisease AU - Newman LS AU - Orton R AU - Kreiss K LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Peak expiratory flow variability and bronchial responsiveness to methacholine. An epidemiologic study in 117 workers PG - 71-75 AB - We studied the relationships between peak expiratory flow (PEF) variability and bronchial responsiveness to methacholine in 117 workers attending the annual compulsory examination (mean age, 38.7 yr +/- 9.5; men, 86.3%). Subjects recorded their highest PEF out of three, every 3 waking hours (i.e., five times a day) for 7 days, each using a newly purchased Vitalograph peak flow meter, and underwent methacholine challenge tests with a maximal cumulative dose of 1,200 micrograms. Those with a FEV1 fall of 15% or more were considered as reactors. The variability of PEF was expressed as the amplitude percent mean, calculated from daily amplitude (highest-lowest reading/mean reading of the day x 100), averaged over 6 days, from the second to the seventh. This index had a continuous distribution, skewed towards the greatest amplitudes, and correlated negatively with FEV1 (r = -0.25, p = 0.01). Subjects with asthma (n = 8) had greater variations. In the 109 nonasthmatics, greater variability was observed in subjects with wheeze apart from colds, breathlessness, or hay fever; the average amplitude was greater in reactors than in nonreactors to methacholine (16.9% versus 9.3%, p less than 0.001). The subjects with excessive PEF variability were all methacholine reactors, but they were only a subgroup of the reactors. These results provide evidence that excessive PEF variability is an indicator of bronchial hyperresponsiveness to methacholine in a population sample AU - Neukirch F AU - Liard R AU - Segala C AU - Korobaeff M AU - Henry C AU - Cooreman J LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - Comparison of bronchial reactivity and peak expiratory flow variability measurements for epidemiologic studies PG - 588-593 AB - Inclusion of a standardized measurement of airway function is important in epidemiologic studies of asthma to facilitate comparison between different studies. Bronchial reactivity is widely used in such studies, but measurement of peak expiratory flow (PEF) variability has a number of potential advantages. We compared PEF variability with methacholine challenge tests in a community population sample. Subjects selected at random (n = 95) and on the basis of having experienced wheeze in the last 12 months (n = 130) performed a challenge test with methacholine to a maximum dose of 12.25 mumol and made serial PEF recordings every 2 h for a week. PEF variability was expressed as mean daily maximum amplitude as a percentage of the mean (amplitude % mean). Increased bronchial reactivity and PEF variability were arbitrarily defined as values above the 10th or below the 90th percentiles in the random sample. A measurement of amplitude % mean was available from all 225 subjects, whereas only 115 (51%) had a measurable PD20 methacholine. PD20 measurements correlated weakly but significantly with amplitude % mean (r = -0.44, p less than 0.001). Increased values of both bronchial reactivity and PEF variability were related to the presence of respiratory symptoms in the week before testing. Asthma was more strongly related to increased bronchial reactivity than to PEF variability. Both measurements showed a strong association with atopy and the intraclass correlation coefficients (ratio of between-subject to total variance) were similar for both.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Higgins BG AU - Britton JR AU - Chinn S AU - Cooper S AU - Burney PG AU - Tattersfield AE LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - Closed-circuit methodology for inhalation challenge tests with isocyanates PG - 582-587 AB - The diagnosis of isocyanate-induced occupational asthma can be made by exposing subjects to isocyanates in small challenge rooms. There are, however, several pitfalls inherent in this procedure. Isocyanate concentrations may not remain stable throughout the exposure and may exceed the recommended TLV ceiling of 20 ppb. This can induce irritant or unduly severe bronchial reactions. To overcome these problems, a closed-circuit apparatus for generating isocyanates in a gaseous form was developed; it was assessed in 20 subjects suspected of having isocyanate-induced asthma. Subjects were tested using both the small challenge room method and the new closed-circuit method in a randomized sequential way. Isocyanate concentrations were more stable with the closed-circuit apparatus than with the challenge room method (mean of individual variance of 6.3 and 61.8, respectively; p less than 0.001). The percentage of the total exposure time during which concentrations were above 20 ppb was reduced from 11.3 to 4.5% (p less than 0.001). The two methods yielded the same number of positive and negative responses, except for one subject who did not have a positive reaction when tested with the challenge room method. The pattern and magnitude of asthmatic reactions were similar for both methods. However, the duration of exposure was shorter with the challenge room method than with the closed-circuit methods (p = 0.04) AU - Vandenplas O AU - Malo JL AU - Cartier A AU - Perreault G AU - Cloutier Y LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - Reduced FVC among California grape workers PG - 257-262 AB - Pulmonary disease due to organic and inorganic dust inhalation represents a significant health problem in the agricultural community. In response to concern over the potential adverse health effects of agricultural exposures, and to address the question of whether the specific crop worked was associated with decreased lung function, we conducted a cross-sectional survey of pulmonary function in a population of 238 grape workers, 355 tomato workers, and 166 citrus workers in California's Central Valley. In addition, 92 workers (66 males and 26 females) performed spirometry before and after an 8-h work shift. Multiple regression analysis of pulmonary function in all 759 workers revealed that age, height, and smoking-adjusted mean preshift FVC was lower in grape workers than in citrus workers in each of three sex and age groups studied: decreased 314 ml for males greater than or equal to 25 yr of age p less than 0.05, 82 ml for males less than 25 yr, and 83 ml for females greater than or equal to 20 yr. Mean adjusted preshift FVC was also lower in grape workers than tomato workers (decreased 249 ml in males greater than or equal to 25 yr [p less than 0.05], 51 ml for males less than 25 yr, and 46 ml for females greater than or equal to 20 yr). Adjusted mean FEV1 was not different by crop, but FEV1/FVC and forced-expiratory flow from 25 to 75% of the FVC (FEF25-75) were significantly elevated in grape workers of the three age and sex groups compared with citrus or tomato workers.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Gamsky TE AU - McCurdy SA AU - Samuels SJ AU - Schenker MB LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - Relationship of pulmonary function to radiographic interstitial fibrosis in 2,611 long-term asbestos insulators. An assessment of the International Labour Office profusion score PG - 263-270 AB - Radiographic evidence of interstitial fibrosis (IF) secondary to asbestos inhalation (using the International Labour Office [ILO] profusion of small irregular opacities) was compared with FVC as an independent indicator of IF. In addition, spirometric indices of airflow (FEV1/FVC and FET25-75%) were correlated with the radiographic profusion score. A study of 2,611 long-term insulators was well designed for these analyses since all subjects were from the same trade, there were sufficient (n = 515) nonsmokers to assess the effects of asbestos exposure in the absence of smoking, most (60%, n = 1,557) of the workers had parenchymal abnormalities (scores greater than or equal to 1/0), and there was a greater prevalence of high scores than in other published series (347 workers or 13.3% had scores greater than or equal to 2/1). Looking at all subjects, the FVC decreased as profusion score increased. The FVC was abnormal (88.0% of predicted) even when the profusion score was clearly normal (0/0). The FVC was lower at any score in smokers and in workers with pleural thickening (more so with diffuse thickening). There was, however, no difference in FVC between intermediate scores 0/1 versus 1/0 and 1/2 versus 2/1. Airflow increased with greater profusion, tending to overcome a decrease seen at lesser profusion scores. These results provide a greater understanding of the relationships among profusion scores, smoking, pleural diseases, and pulmonary function AU - Miller A AU - Lilis R AU - Godbold J AU - Chan E AU - Selikoff IJ LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - Survey of cobalt exposure and respiratory health in diamond polishers PG - 610-616 AB - This cross-sectional study was undertaken after the discovery of cobalt-related fibrosing alveolitis and bronchial asthma in diamond polishers occupationally exposed to cobalt. A total of 194 workers from 10 diamond polishing workshops and 59 workers from three other workshops from the diamond industry (control subjects) were studied; a questionnaire was administered and spirometry was performed. Cobalt exposure was assessed by environmental air sampling using both area and personal sampling and by measuring urinary cobalt concentration. When considered on a workshop basis, these environmental and biologic indices of exposure correlated well with each other. These measurements led to the definition of three cobalt exposure categories: a no exposure group, a low exposure group, and a high exposure group. The high exposure was, however, still below the present threshold limit value for cobalt (50 micrograms/m3). Spirometry showed that indices of ventilatory function (FVC and FEV1) were significantly (p less than 0.05) lower in the group with the highest exposure to cobalt. These differences were not due to differences in smoking habits. The results were confirmed when the data were analyzed by covariance analysis of lung function indices against smoking status, taking mean cobalt exposure in each workshop as a covariate, and when the data were analyzed by multiple regression analysis. This analysis showed that cobalt exposure correlated with decreased pulmonary function. Our results suggest that, during diamond polishing, exposure to cobalt at levels below the current threshold limit value is associated, on a group basis, with measurable effects on lung function parameters. The relationship between these cross-sectional epidemiologic findings and the occurrence of overt lung disease in diamond polishers remains to be established AU - Nemery B AU - Casier P AU - Roosels D AU - Lahaye D AU - Demedts M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - Airway mucosal inflammation in occupational asthma induced by toluene diisocyanate PG - 160-168 AB - We examined the light and electron microscopic structure of lobar bronchial biopsies of nine subjects with occupational asthma induced by toluene diisocyanate (TDI) and of four control nonasthmatic subjects who had never been exposed to TDI. Inflammatory cell numbers were separately assessed in the intact epithelium, in the more superficial layer of the submucosa, and in the total submucosa. Asthmatic subjects had an increased number of inflammatory cells in the airway mucosa compared with control subjects. Eosinophils were significantly increased in all compartments, CD45-positive cells were significantly increased in the epithelium and in the more superficial layer of the submucosa, and mast cells were significantly increased only in epithelium. By electron microscopy eosinophils and mast cells appeared degranulated only in asthmatic patients. In the areas of epithelium that appeared intact by light microscopy, electron microscopy showed that, although the intercellular spaces between columnar cells were similar in asthmatic and control groups, the intercellular spaces between basal cells were significantly wider in patients with asthma. Patients with TDI-induced asthma also had a thicker subepithelial reticular layer, where immunohistochemistry showed the presence of collagen III. In conclusion, in patients with asthma induced by TDI, the airway mucosa shows pathologic features, such as inflammatory cell infiltrate and thickening of subepithelial collagen, similar to those described in atopic asthma AU - Saetta M AU - Di Stefano A AU - Maestrelli P AU - De Marzo N AU - Milani GF AU - Pivirotto F AU - Mapp CE AU - Fabbri LM LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - Nonoccupational beryllium disease masquerading as sarcoidosis: identification by blood lymphocyte proliferative response to beryllium PG - 1212-1214 AB - Chronic granulomatous lung disease caused by industrial exposure to beryllium continues to occur, but no community cases have been reported in more than 30 yr. With the advent of a blood screening test that detects beryllium sensitization, physicians can discriminate chronic beryllium disease from sarcoidosis. A 56-yr-old woman in whom sarcoidosis was diagnosed had an unremarkable occupational history, but her husband was a beryllium production worker. Blood and bronchoalveolar lavage lymphocyte transformation tests, measuring the beryllium-specific cellular immune response, were abnormal, confirming a diagnosis of chronic beryllium disease. Chronic beryllium disease continues to occur in the nonoccupational setting and among bystanders in industry, masquerading as sarcoidosis. Because even transient or possibly low levels of exposure may cause disease, this case has important implications for how clinicians, industry, and government agencies define the populations at risk of chronic beryllium disease AU - Newman LS AU - Kreiss K LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 159 IP - DP - 1992 Jan 01 TI - Hypersensitivity pneumonitis: sensitivity of high-resolution CT in a population-based study PG - 469-472 AB - OBJECTIVE Hypersensitivity pneumonitis refers to a group of pulmonary disorders caused by inhalation of organic or inorganic particulates by sensitized persons. The diagnosis relies on a constellation of findings: exposure to an offending antigen, characteristic signs and symptoms, abnormal chest findings on physical examination, and abnormalities on pulmonary function tests and radiographic evaluation. In population-based studies, the sensitivity of chest radiography for detection of this disease is relatively low. The aim of this study was to determine the sensitivity of high-resolution CT (HRCT) for detection of hypersensitivity pneumonitis diagnosed in a population of swimming-pool employees. SUBJECTS AND METHODS Thirty-one symptomatic employees of a recreation center who were referred because of possible hypersensitivity pneumonitis were examined by using chest radiography, HRCT, and fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. Hypersensitivity pneumonitis was diagnosed in subjects who had two or more work-related signs or symptoms, abnormal results on transbronchial biopsies, and abnormal lymphocytosis as shown by examination of bronchoalveolar lavage fluid. The chest radiographs and HRCT scans were interpreted by consensus by two observers who were unaware of the clinical diagnosis. RESULTS Only one of 11 subjects with a diagnosis of hypersensitivity pneumonitis had abnormal findings on a chest radiograph. Five had abnormal HRCT findings. The abnormality in each case consisted of small, poorly defined centrilobular nodules with variable profusion. No subject without the disease had abnormal HRCT findings. Those who had granulomas shown by lung biopsy were more likely to have abnormal HRCT findings than were those who had more subtle histologic abnormalities. CONCLUSION The sensitivity of HRCT for the detection of hypersensitivity pneumonitis in a population-based study is greater than that of chest radiography. The finding of poorly defined centrilobular nodules on HRCT scans should prompt consideration of this disease AU - Lynch DA AU - Rose CS AU - Way D AU - King TE Jr LA - PT - DEP - TA - Amm J Roentgenol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Bronchial asthma induced by chick pea and lentil PG - 185-187 AB - Allergic reactions to legumes through inhalation have rarely been described. We report the case of a 20-year-old man who experienced asthmatic attacks when exposed to the steam from cooking either chick pea or lentil. Type I hypersensitivity to the antigens in these legumes was demonstrated by means of immediate skin reactivity, histamine release tests, RAST and RAST inhibition. Specific bronchial challenges with the heated (75 degrees for 30 min) extracts of chick pea and lentil elicited isolated immediate responses AU - Martin JA AU - Compaired JA AU - de la Hoz B AU - Quirce S AU - Alonso MD AU - Igea JM AU - Losada E LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Detection of airborne reindeer epithelial antigen by enzyme-linked immunosorbent assay inhibition PG - 203-206 AB - Hypersensitivity reactions to reindeer epithelial (RE) allergens have been recently demonstrated among reindeer herders. To determine the concentration of airborne RE antigens a method based on inhibition of the enzyme-linked immunosorbent assay (ELISA) was developed. Dust samples were collected in workshops where reindeer leather was processed and the workers had inhaled dry epithelial dust during their working shifts. Specific IgE to RE allergen could be detected in one of 5 workers. RE antigen concentrations varied from 0.01 microgram to 3.9 micrograms/m3 in the air of the workshop. All workers except one claimed work-associated respiratory symptoms AU - Reijula K AU - Virtanen T AU - Halmepuro L AU - Anttonen H AU - Mantyjarvi R AU - Hassi J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Development of increased airway responsiveness in two nurses performing methacholine and histamine challenge tests PG - 188-189 AB - Two nurses who frequently examined patients with methacholine or histamine challenge tests developed increased airway responsiveness and symptoms of asthma. It is important to use a good system for evacuating the test aerosol during challenge tests AU - Lundgren R AU - Soderberg M AU - Rosenhall L AU - Norrman E LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Immunotherapy in patients allergic to cat and dog dander. I. Clinical results PG - 249-254 AB - Twenty-four asthmatics allergic to cat and/or dog dander were included in a study to examine the efficacy and safety of immunotherapy (IT) with partially purified, standardized extracts of cat or dog dander. In the first placebo controlled, double-blind part of the study, 10 patients were treated with extracts of both cat and dog, 12 with cat extracts and 2 with dog extracts. Fifteen patients received active IT and 9 placebo injections. Patients treated with both extracts received active extracts only, or placebo only. Bronchial allergen challenge after 5 months demonstrated a significant fall in sensitivity to cat (P = 0.04) in patients treated with cat extracts. No significant changes were found in sensitivity to dog after treatment with dog dander extract or in the placebo groups. During this period, bronchial sensitivity to histamine did not change significantly in any of the groups. To examine the effect of more prolonged IT, 19 patients allergic to cat (17) and/or dog (9) were treated for 12 months. Bronchial sensitivity to cat decreased further (P = 0.003), while no significant change was found in dog extract-treated patients. In cat extract-treated patients a significant decrease in bronchial histamine sensitivity developed (P = 0.02). Systemic side effects were few, but in some cases, local side effects were a dose-limiting factor. This study demonstrated that IT with cat extract may benefit cat-allergic asthmatics, whereas no influence of IT with dog extract was detected in dog-sensitive asthmatics AU - Haugaard L AU - Dahl R LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Occupational asthma in the confectionary industry caused by sensitivity to egg PG - 190-191 AB - We report on a patient with asthma induced by occupational exposure to egg used to spray cakes before baking. A type I hypersensitivity to egg white was demonstrated by means of skin test, immunoassay for specific IgE, and immediate bronchial provocation test response to an egg white extract AU - Carmona JGB AU - Picon SJ AU - Sotillos MG AU - Gaston PG LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - Risk factors of soybean epidemic asthma. The role of smoking and atopy PG - 1098-1102 AB - Epidemics of emergency room admissions for asthma occurring in Barcelona during the period 1981 to 1987 were caused by inhalation of soybean dust. To investigate the risk factors that determined why some asthma patients became reactive to soybean and were consequently affected by the asthma epidemics of Barcelona but others did not do so, a case-control study was conducted during 1989, 2 yr after the cessation of asthma epidemics. Patients with asthma admitted in emergency room services during epidemic asthma days (n = 169) were compared with asthma patients admitted in the same services during nonepidemic days and who were never admitted during the epidemics (n = 147). Risk factors other than soybean exposure, namely skin reactivity against at least one common allergen (odds ratio [OR] 3.0, 1.7 to 5.3), age over 64 yr (OR 2.8, 1.4 to 6.0), cigarette smoking at the time of the epidemics (OR 2.3, 1.2 to 2.4), past smoking (OR 1.8, 0.9 to 3.7), and total immunoglobulin E (IgE) higher than 100 IU/ml (OR 1.7, 1.0 to 3.0), were found independently related to epidemic asthma. The role of smoking was especially important for those who had a positive skin reaction and were exposed to soybean dust (OR 7.9, 1.8 to 36.0). In this group, a dose-response pattern with pack-years was observed (p less than 0.01). The present findings suggest a multifactorial process for epidemic asthma, in which atopy and cigarette smoking played an important synergistic role. This has a preventive potential for IgE-related asthma AU - Sunyer J AU - Anto JM AU - Sabria J AU - Rodrigo MJ AU - Roca J AU - Morell F AU - RodriguezRoisin R AU - Codina R LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 145 IP - DP - 1992 Jan 01 TI - Effect of corticosteroid treatment on the recovery of pulmonary function in farmer's lung PG - 3-5 AB - The effect of corticosteroid treatment on the course of farmer's lung (FL) was studied in 36 patients randomly allocated in a double-blind placebo-controlled study. All patients were in the acute stage of the disease and had had the first diagnosed attack of FL. Twenty patients were given prednisolone treatment for 8 wk. Sixteen patients received an 8-wk placebo treatment. One patient was withdrawn from the analysis when she terminated corticosteroid treatment because of side effects. After 1 month of treatment there was a significant difference (p = 0.03) in DLCO between the treatment groups. After a follow-up of 5 yr no statistically significant differences were found between the treatment groups in FVC, FEV1, or DLCO. FL recurred in six patients during the follow-up in the corticosteroid group and in one patient in the placebo group, but the difference was not statistically significant. In conclusion, in the corticosteroid group the improvement of pulmonary function was more rapid than in the placebo group, but no influence on the long-term result was found. The possibility that corticosteroid treatment may favor the occurrence of recurrent attacks of FL needs attention AU - Kokkarinen JI AU - Tukiainen HO AU - Terho EO LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 116 IP - DP - 1992 Jan 01 TI - Airway injury in swine confinement workers PG - 630-635 AB - OBJECTIVE To determine whether work-related respiratory symptoms are indicative of underlying lung disease among swine confinement workers and, if so, to identify whether respiratory changes were more indicative of airway or of interstitial lung injury. DESIGN: Nested case-control study within a population-based longitudinal study. SETTING University hospital. PARTICIPANTS Study participants were randomly selected from a group of 207 swine confinement workers followed longitudinally. Of these, 43 workers with respiratory symptoms were identified, and 31 were randomly selected for inclusion in this study. Three control groups (swine confinement workers, neighbor farmers, and blue collar workers) without work-related respiratory symptoms were frequency-matched by age, sex, and smoking status to the symptomatic swine confinement workers. MEASUREMENTS Spirometry and lung volumes, diffusing capacity of carbon monoxide, chest radiograph, methacholine airway challenge, and bronchoalveolar lavage were done. An endobronchial biopsy was done in the last 27 participants evaluated. RESULTS: Although spirometric measures of airflow were similar between the symptomatic swine confinement workers and the three control groups, swine confinement cases were found to have significant elevations in residual volume (126.5 +/- 28.2 L) when compared to swine confinement controls (115.4 +/- 38.4 L; P less than or equal to 0.05), neighborhood farmer controls (101.1 +/- 29.4 L; P less than or equal to 0.005), and blue collar controls (106.4 +/- 30.4 L; P less than or equal to 0.05). Swine confinement cases also had an enhanced airway response to inhaled methacholine and had thickening of the epithelial basement membrane of the lobar bronchi. No parenchymal injury was observed in the swine confinement cases. CONCLUSIONS Our findings suggest that swine confinement workers who have work-related respiratory symptoms are at risk for airway, but not parenchymal, lung injury, and that spirometry may not accurately reflect the extent of airway injury AU - Schwartz DA AU - Landas SK AU - Lassise DL AU - Burmeister LF AU - Hunninghake GW AU - Merchant JA LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 36 IP - DP - 1992 Jan 01 TI - A survey of chronic bronchitis among brassware workers PG - 283-294 AB - A stratified random sample of 580 workers aged between 18 and 50 years representing each sub-occupation in the brassware industry was studied for the prevalence of chronic bronchitis in relation to occupational and environmental factors. The findings were compared with those obtained in a reference group (N = 131) belonging to similar socio-economic status and unexposed to a dusty environment. Although the exposed group showed higher prevalence of chronic bronchitis in comparison to that observed in the controls (10.5 vs 5.3%), the difference was not significant at the 5% level. It was observed that the workers engaged in non-dusty occupations such as brass sheet cutting and engraving showed the lowest prevalence of the disease (5.0%) while those engaged in the dusty occupations viz., casting, soldering, electroplating and polishing showed the highest prevalence (12.0%). The smoking adjusted odds ratios calculated in various sub-occupations showed the highest risk of developing chronic bronchitis among the polishers (2.74). Though the risk in other occupational sub-groups was double, it did not attain a level of significance. The smoking adjusted odds ratios in relation to length of exposure showed that the risk was significantly higher among the workers exposed for over 10 years compared to those who worked for less than 10 years in the grinding, soldering and brass ingot making operations. The study thus showed a dose-response relationship between length of exposure and chronic bronchitis while effect of age on the disease was not discernible probably due to the small number of cases and the young age of the study group. The concentration of various metals in the air samples drawn from the work environment where main processes were in operation, was low compared to the prescribed level by ACGIH AU - Rastogi SK AU - Gupta BN AU - Mathur N AU - Husain T AU - Mahendra PN AU - Pangtey BS AU - Srivastava S LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 152 IP - DP - 1992 Jan 01 TI - Severity of pulmonary asbestosis as classified by International Labour Organisation profusion of irregular opacities in 8749 asbestos-exposed American workers. Those who never smoked compared with those who ever smoked PG - 325-327 AB - The profusion of irregular opacities on chest roentgenograms by International Labour Organisation pneumoconiosis criteria was used to assess the severity of asbestosis in 8749 asbestos-exposed active and retired American workers. Seventy-eight percent had no asbestosis (category 0/0 or 0/1), 18.6% had slight asbestosis (1/0 to 1/2), 3% had moderate asbestosis (2/1 to 2/3), and 0.3% had advanced disease (3/2 or greater). Significantly more current smokers had asbestosis than did those who had never smoked, and their average profusion of opacities was higher. The mean age of current smokers with asbestosis was 60 years, whereas subjects with the disease who had never smoked had a mean age of 64 years, a significant difference. Cigarette smoking and asbestosis appear to act synergistically to produce irregular opacities on chest roentgenograms of asbestos-exposed American workers AU - Kilburn KH AU - Warshaw RH LA - PT - DEP - TA - Arch Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 43 IP - DP - 1992 Jan 01 TI - The effect of occupational noxae in the tobacco industry on pulmonary function in exposed workers. [SerboCroation (Roman)] PG - 37-45 AB - A study was carried out to determine respiratory hazards to workers in tobacco manufacture. The investigations at the workplace included analysis of the work technology and measurements of chemical pollutants and dust concentrations in the work rooms. Ventilatory lung function tests were performed in 95 workers exposed to tobacco dust and in 129 control workers. Results of workplace analysis showed the presence of tobacco dust levels exceeding the maximum permissible concentrations. The values of some lung function tests for exposed workers non-smokers were significantly lower than for control workers non-smokers. They could be attributed to the effect of occupational noxae on the respiratory system AU - Popovic V AU - Arandelovic M AU - Jovanovic J AU - Momcilovic O AU - Veselic E AU - Dordevic D AU - Popovic A AU - Todorovska D LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 281 IP - DP - 1992 Jan 01 TI - Wheat and barley allergens associated with baker's asthma. Glycosylated subunits of the alpha-amylase-inhibitor family have enhanced IgE-binding capacity PG - 401-405 AB - A 16 kDa protein, designated CM16*, which strongly binds IgE from baker's-asthma patients has been identified as a glycosylated form of the previously reported WTAI-CM16, which is a subunit of the wheat tetrameric alpha-amylase inhibitor. A glycosylated form (CMb*) of BTAI-CMb, the equivalent inhibitor subunit from barley, has been also found to have significantly enhanced IgE-binding capacity. In all, 14 purified members of the alpha-amylase/trypsin-inhibitor family showed very different IgE-binding capacities when tested by a dot-blot assay. The glycosylated components CM16*, CMb* and the previously described non-glycosylated 14.5 kDa allergen from barley (renamed BMAI-1) were found to be the strongest allergens AU - SanchezMonge R AU - Gomez L AU - Barber D AU - LopezOtin C AU - Armentia A AU - Salcedo G LA - PT - DEP - TA - Biochem J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Persistent asthma after accidental exposure to ethylene oxide PG - 523-525 AU - Deschamps D AU - Rosenberg N AU - Soler P AU - Maillard G AU - Fournier E AU - Salson D AU - Gervais P LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Recent trends in bagassosis in Japan PG - 499-506 AB - The only workers presently exposed to bagasse dust in Japan are the employees of sugar refineries and lacquerware factories. A follow up study of six former cases of bagassosis from among the retired employees of a paper board factory, closed since 1973, showed that none of the subjects still had bagassosis. Examinations of 70 employees of a sugar refinery for allergic reactions also showed no case of bagassosis. Seven cases with suspicious shadows of bagassosis on chest radiographs and four cases with positive serum precipitin to stored bagasse were, however, found among those 70 subjects. The results show the disappearance of a past episode of bagassosis and the possibility of a new occurrence of bagassosis among the employees of sugar refineries and lacquerware factories in the near future in Japan AU - Ueda A AU - Aoyama K AU - Ueda T AU - Obama K AU - Ueno T AU - Hokama S AU - Nomura S LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Loss of lung function associated with exposure to silica dust and with smoking and its relation to disability and mortality in South African gold miners PG - 472-479 AB - The data from a lung function study on 2209 white 45-54 year old South African gold miners in 1968-71 and at a five year follow up examination, were analysed to establish the actual loss of lung function associated with exposure to silica dust and with smoking. Ex-smokers were excluded from the analysis. Of the remaining 1625 subjects, 1249 had the five year follow up test of lung function. The estimated excess loss of lung function for a 50 year old gold miner, associated with 24 years of underground dust exposure of an average respirable dust concentration of 0.30 mg m-3 (14.4 ghm-3) was 236 ml of FEV1 (95% confidence interval (95% CI 134-337) and 217 ml of FVC (95% CI 110-324). By comparison, the effect of smoking one packet of cigarettes a day over 30 years was associated with an estimated loss of 552 ml of FEV1 (95% CI 461-644) and 335 ml of FVC (95% CI 170-500). The cumulative dust exposure was not associated with the longitudinal loss of FEV1 or FVC when the initial FEV1 and FVC were adjusted in the models. According to the predicted values, however, gold miners appear to have a greater loss of lung function from 50 to 55 years of age than that predicted for a general population AU - Hnizdo E LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Lung function and radiographic signs of pulmonary fibrosis in oil exposed workers in a cable manufacturing company: a follow up study PG - 309-315 AB - Thirty seven workers employed for at least three years in oil impregnation of cables during 1963-83 were followed up in 1990 to study the development of pulmonary fibrosis and consequences for lung function. They had been exposed to concentrations of mineral oil vapours of 50-100 mg/m3, and concentrations of oil mist of 0.5-1.5 mg/m3. All 29 living persons were traced. For each person one control matched for age, height, and smoking habits was selected. Among 25 workers followed up with radiographic studies, 10 cases of pulmonary fibrosis were found, by contrast with one case in the control group (p less than 0.01). Chest radiographs from 1979-80 and 1989-90 were reviewed. The profusion of small opacities increased in seven of 16 persons during 10 years without exposure. Seventeen workers had lung function tests. The bellows function (VC, FEV1, MVV) and lung volumes (TLC, RV) did not differ from those in the matched controls (p greater than 0.05), but the carbon monoxide transfer factor (TLCO) was decreased. The largest reduction of TLCO (1.5 mmol/kPa/min) was found among workers exposed for 10 years or more (p less than 0.05). Arterial blood gases were not affected at rest, but during maximum tread mill exercise, PO2 and HbO2 were reduced in exposed workers compared with controls, particularly among those exposed for at least 10 years (p less than 0.05). Exposure to low viscosity oil mist and vapour is the most plausible cause of the fibrosis. Unaffected bellows function, reduced TLCO, and decreased arterial blood oxygen during exercise is compatible with peribronchiolar fibrosis AU - Skyberg K AU - Ronneberg A AU - Christensen CC AU - NaessAndresen CF AU - Borgersen A AU - Refsum HE LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 60 Suppl 2 IP - DP - 1992 Jan 01 TI - The influence of environmental factors (antibiotics) on workers in the pharmaceutical industry PG - 147-152 AU - Samolinski B AU - Tarchalska B AU - Zawisza E LA - PT - DEP - TA - Pneumonol Alergol Pol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 81 IP - DP - 1992 Jan 01 TI - Health risks among white South African goldminers--dust, smoking and chronic obstructive pulmonary disease PG - 512-517 AB - The South African goldmining industry employs a large labour force exposed to several health hazards, of which one of the most important is underground dust, containing a high level of free crystalline silica (30%). Inhalation of silica dust can cause chronic obstructive pulmonary disease (COPD). The present paper reviews the epidemiological evidence on COPD in white South African goldminers. COPD emerges as a major cause of disability and increased mortality. The associated risk factors are smoking and combined exposure to dust and smoking. In conclusion, decreased tobacco consumption in white goldminers would in most cases prevent serious lung function impairment and the premature deaths associated with it AU - Hnizdo E LA - PT - DEP - TA - S Afr Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - IP - DP - 1992 Jan 01 TI - Occupational exposure to cadmium and lung function PG - 205-210 AB - A total of 69 male subjects occupationally exposed to cadmium fumes in a factory producing silver-cadmium-copper alloys for brazing, were subjected to lung function tests, including ventilation (FVC and FEV1), residual volume (RV) and alveolar-capillary diffusion capacity (TLCO and KCO). For each subject, the cumulative exposure to cadmium was calculated as the product of the number of years in the job and the average atmospheric concentration of cadmium (expressed in micrograms/m3) encountered each year. Cadmium-exposed subjects had moderately higher mean values of RV (+ 8%) as compared with the control group; the increase was greater (+ 10%) in the subgroup of workers with greater cumulative exposure to cadmium. No significant differences were observed in FVC, FEV1, TLCO and KCO AU - Cortona G AU - Apostoli P AU - Toffoletto F AU - Baldasseroni A AU - Ghezzi I AU - Goggi E AU - Fornari S AU - Alessio L LA - PT - DEP - TA - Iarc Scientific Publications - Lyon JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 53 IP - DP - 1992 Jan 01 TI - Exposure to dust, endotoxins, and fungi in the animal feed industry PG - 362-368 AB - In the Dutch animal feed industry, approximately 6000 workers are exposed to organic dust, originating mainly from raw materials such as grain, pulses (peas and beans), and waste products from the vegetable oil and starch industries. In this study, 79 stationary dust samples and 530 personal dust samples from eight animal feed production facilities were analyzed. The stationary total dust samples showed gravimetric concentrations ranging from 0.2 to 25 mg/m3 (geometric mean [GM] 1.3 mg/m3). Concentrations of smaller particle fractions (respirable, thoracic, and inspirable dust) were considerably lower. Personal inspirable dust concentrations were considerably higher than stationary concentrations and were strongly related to job titles. Pooled personal inspirable dust concentrations ranged from 0.2 to 450 mg/m3 (GM = 2.4 mg/m3). After adjusting for differences between inspirable and total dust, 25% of the measurements exceeded the Dutch maximum allowed concentration (MAC) for total nuisance dust (10 mg/m3) and 42% exceeded the American Conference of Governmental Industrial Hygienists' threshold limit value for grain dust (4 mg/m3). Endotoxin concentrations ranged from 0.2 to 1870 ng/m3 inspirable dust (GM = 5.1 ng/m3). Endotoxin appeared to be less prevalent in respirable dust than in larger dust fractions. Concentrations in dust appeared to be related to stages in the production process. Colony-forming units (cfu) of fungi ranged from 130 to 15,300 cfu/m3 (GM = 2300 cfu/m3) and were in parallel measurements more strongly related to endotoxin concentrations than to dust concentrations. Clearly, workers in the Dutch animal feed industry are frequently exposed to dust levels above recommended Dutch and American levels. Exposure levels to endotoxin and to fungi are quantified.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Smid T AU - Heederik D AU - Mensink G AU - Houba R AU - Boleij JS LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 136 IP - DP - 1992 Jan 01 TI - Performance of two general job-exposure matrices in a study of lung cancer morbidity in the Zutphen cohort PG - 698-711 AB - Data from a general population cohort of 878 men from the town of Zutphen, The Netherlands, were used to evaluate the performance of two general job-exposure matrices. Exposures generated by the job-exposure matrices on the basis of job histories were compared. The validity of those exposures was measured against exposures reported by the participants in 1977/1978. The performance of the different exposure measures was assessed in proportional hazards analyses of lung cancer morbidity incidence. The two general job-exposure matrices generally disagreed with regard to exposure classification because of differences in exposure assessment and level of detail of the job axis. When compared with self-reported exposures, the sensitivity of both job-exposure matrices was low (on average, below 0.51), while the specificity was generally high (on average, above 0.90). Self-reported exposures to asbestos, pesticides, and welding fumes showed elevated risk ratios for lung cancer which were absent for exposures generated by the two job-exposure matrices. Thus, a population-specific job-exposure matrix is proposed as an alternative to general job-exposure matrices developed elsewhere. Such a matrix can be constructed from the results of in-depth interviews of a job-stratified sample of cohort members. Sound validation and documentation of exposure assessment methods used in job-exposure matrices are recommended AU - Kromhout H AU - Heederik D AU - Dalderup LM AU - Kromhout D LA - PT - DEP - TA - Am J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - Dust- and endotoxin-related respiratory effects in the animal feed industry PG - 1474-1479 AB - A cross-sectional study of 315 animal feed workers was undertaken in 14 animal feed mills in the Netherlands. Primary aims were to explore relationships between exposure to organic dust and respiratory symptoms and chronic lung function changes. The study comprised monitoring dust and endotoxin exposure, spirometric lung function measurements (FVC, FEV1, mean midexpiratory flow, and flow-volume parameters) and a questionnaire for respiratory symptoms. The exposure was measured in two periods, during spring and autumn. The average 8-h personal inspirable dust exposure was 9 mg/m3 grain dust (range, 0.2 to 150 mg/m3) and 25 ng/m3 endotoxin (range, 0.2 to 470 ng/m3) based on 530 personal dust measurements. On the basis of these measurements and the occupational history of the workers, the number of years "worked in dust" and an estimate of the cumulative dust and endotoxin exposure were calculated. The prevalence of most chronic respiratory symptoms tended to decrease with increasing years of exposure. The "healthy worker effect" is probably responsible for this finding. In general, a strong negative association between most of the exposure variables and lung function was found. The endotoxin exposure was more strongly related to decreases in lung function than the dust exposure. The estimated effects of an average (cumulative) endotoxin exposure on lung function were greater, with a higher statistical significance, than for an exposure to dust. These results suggest that endotoxin exposure is an important factor in the development of respiratory impairment. The lung function changes occur at endotoxin levels ranging from 0.2 to 470 ng/m3 AU - Smid T AU - Heederik D AU - Houba R AU - Quanjer PH LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Relations between occupation, smoking, lung function, and incidence and mortality of chronic non-specific lung disease: the Zutphen Study PG - 299-308 AB - Information gathered in the "Zutphen study", the Dutch contribution to the Seven Countries Study was used for the present study. Follow up data from 1965 to 1 July 1985 were used. During this follow up, the morbidity state of the participants was verified at regular intervals. In 1965 lung function was measured by spirometry and the vital capacity (VC) and forced expiratory volume in one second (FEV1) were available. A complete set of data was available for 668 men. The occurrence of chronic non-specific lung disease (CNSLD) at a specific time was coded by one physician, using strict criteria. Information about the cause of death was obtained and coded by one physician in 1985. Occupation was coded and a distinction between blue and white collar workers was made. For the analysis of the relation between age, lung function, smoking habits, and occupational state with CNSLD incidence and mortality, proportional hazard models were used. Blue collar workers had a significantly raised risk for incidence of CNSLD only. The hazard ratio for blue v white collar workers with CNSLD mortality was 1.4 but not statistically significant. It was concluded that occupation is clearly related to incidence of CNSLD. There were indications that occupation is related to mortality from CNSLD. A reduced FEV1 was a strong predictor of both CNSLD incidence and mortality. It is noteworthy that small differences in age and height standardised lung function were significantly related to incidence of CNSLD, mortality from CNSLD, and total mortality. Although these differences in lung function have no direct clinical importance for the individual subject, they indicate a raised morbidity and mortality risk for the population AU - Heederik D AU - Kromhout H AU - Kromhout D AU - Burema J AU - Biersteker K LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 63 IP - DP - 1992 Jan 01 TI - Lung function in silicosis PG - 387-391 AB - In order to assess the effect of silicosis on lung function, 61 gold miners with radiological silicosis were compared with 61 controls. Each pair was matched for age, dust exposure, and smoking habits. A full range of lung function tests was performed, and with two exceptions the results showed no significant differences between the two groups. The exceptions are the slope of the alveolar plateau (phase 3) and the closing volume, for which the silicotic cases had significantly higher values. The reason for the higher readings in the silicotic patients remains unexplained AU - Wiles FJ AU - Baskind E AU - Hessel PA AU - Bezuidenhout B AU - Hnizdo E LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 47 IP - DP - 1992 Jan 01 TI - Effects of the home environment on respiratory symptoms of a general population sample in middle Italy PG - 64-70 AB - The effects of home environment characteristics were evaluated in a multistage, stratified, cluster sample (N = 3,866) of the general population who lived in the district of Pisa (middle Italy). Each subject completed a standardized interviewer-administered questionnaire that contained questions about respiratory symptoms/diseases and risk factors (e.g., type of heating, fuels used for cooking and heating). Cough and asthma were significantly more frequent in men who did not smoke and who did not use natural gas for cooking and heating. Attacks of shortness of breath accompanied by wheeze, dyspnea, and cardiovascular conditions in female nonsmokers were associated with use of a stove or forced-air circulation for heating; the type of fuel used did not affect this result. Multiple logistic models, which accounted for independent effects of age, smoking status, pack-years, childhood respiratory illness, education, zone of residence, and work exposure to dusts, chemicals, or fumes, showed significantly increased odds ratios for (a) cough and phlegm in males (associated with bottled gas for cooking), (b) wheeze and shortness of breath with wheeze in females (associated with the use of a stove or forced-air circulation). These results, which confirm our previous observations in an unpolluted rural area of north Italy, indicate that characteristics of the home environment, as assessed by questionnaire, may be linked to mild adverse health effects, i.e., respiratory symptoms, in the general population. The results also identify the need to better characterize the dose-response relationship in indoor air pollution monitoring studies that include subsamples of this population AU - Viegi G AU - Carrozzi L AU - Paoletti P AU - Vellutini M AU - Diviggiano E AU - Baldacci S AU - Modena P AU - Pedreschi M AU - Mammini U AU - di Pede C AU - et al LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 18 IP - DP - 1992 Jan 01 TI - Occupational airborne exposure of the general population of a Norwegian county PG - 44-51 AB - Occupational airborne exposure was examined for a stratified sample (N = 1275) of the general population aged 18-73 years in Hordaland County, Norway. The subjects identified all jobs of more than six months since leaving school and stated whether they had been occupationally exposed to specific agents and work processes potentially harmful to the lungs. The prevalence in the population ever having been exposed was 18% for asbestos, 9% for quartz, 5% for aluminum dust, 6% for wood dust, 12% for metal gases, 12% for welding, 9% for soldering, and 1% for hairdressing. According to occupational title (last job), 3% of the population had held a job with a high degree of airborne exposure, 26% a job with moderate exposure, and 70% a job with no airborne exposure. During their worklife both the men and the women tended to leave polluted jobs more often than unpolluted jobs. Occupational exposure to airborne pollutants potentially harmful to the lungs is widespread in this Norwegian general population AU - Bakke P AU - Baste V AU - Hanoa R AU - Gulsvik A LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 112 IP - DP - 1992 Jan 01 TI - Obstructive lung disease in a Norwegian population group--risk factors and occurrence. [Norwegian] PG - 2836-2840 AB - In an ordinary Norwegian population which we studied, one in 13 persons suffered from an obstructive lung disease--bronchial asthma or chronic obstructive lung disease. The prevalence of the disease was the same in both sexes, but increased with age. There was a strong association between smoking and the disease. Occupational airborne pollution was an important risk factor. Taking the longest job held as a basis for the study, the adjusted odds ratio for obstructive lung disease in those exposed to a high degree of airborne pollution was 2.5 relative to those not so exposed. There was no difference between urban and rural areas in the frequency of the disease. Allergy and bronchial hypersensitivity were both associated with obstructive lung disease. Greater efforts should be put than at present into preventing obstructive lung disease AU - Bakke P AU - Hanoa R AU - Gulsvik A LA - PT - DEP - TA - Tidsskr Nor Laegeforen JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 21 IP - DP - 1992 Jan 01 TI - Measuring exposure for the epidemiologic study of acute effects PG - 77-89 AB - This report explores the importance of characterizing short-term (peak) exposures for successful epidemiologic study of acute reversible effects. By selecting upper respiratory tract irritation, which is time-limited, reversible, and not critically affected by host factor sensitivities, the illustrated approach (directed at an acute respiratory irritant) provides insights on issues important in the general study of acute effects. The fundamental concern in a study of acute irritant effects is that such events occur in response to abrupt increases in exposure. This calls for a closer examination of how to distinguish bursts, or peaks, of exposure from continuous exposures measured simply as time weighted averages. Three parameters of peak exposures are discussed: duration, magnitude, and frequency. The importance of duration is illustrated by contrasting exposure patterns relevant for the study of acute vs. chronic health effects. The minimum magnitude of a peak relevant to the study of a specific physiologic response requires knowledge of the threshold below which no detectable response occurs. For any identified threshold level, only exposures exceeding that level are defined as relevant peaks for an exposure-response analysis. Finally, the issue of frequency, the minimum length of time between successive exposures necessary for the subject to return to baseline risk, is explored. A study of respiratory irritation associated with sodium borates is used to illustrate these issues AU - Wegman DH AU - Eisen EA AU - Woskie SR AU - Hu XH LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 22 IP - DP - 1992 Jan 01 TI - Mortality studies of machining fluid exposure in the automobile industry I: A standardized mortality ratio analysis PG - 809-824 AB - Machining fluids are widely used in a variety of common industrial metalworking operations to lubricate and cool both the tool and the working surfaces. Previous studies have suggested elevated respiratory, digestive, and skin cancers in exposed populations. This cohort study was initiated to assess whether long-term exposure to machining fluids in the course of machining, grinding, and other cutting operations is associated with excess cancer mortality. The cohort includes more than 45,000 automobile production workers from 3 plants, almost 1 million years of follow-up, over 10,000 deaths, and an extensive exposure assessment component. Standardized mortality ratios (SMRs) have been estimated for each of the 3 plants, using both U.S. as well as local populations as reference. Relative risks of 1.2-3.1 have been observed for several specific respiratory and digestive cancers of a priori interest, including cancer of the stomach, large intestine, pancreas, lung, and larynx. In addition, elevated risks for leukemia and asthma were noted. Future exposure-response analyses will provide the opportunity to identify relatively modest excesses in cause-specific mortality risk associated with exposure to specific types (straight, soluble, or synthetic), additives, or components of machining fluids AU - Eisen EA AU - Tolbert PE AU - Monson RR AU - Smith TJ LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 49 IP - DP - 1992 Jan 01 TI - Dose related acute irritant symptom responses to occupational exposure to sodium borate dusts PG - 706-713 AB - A repeated measurement design was employed in the study of acute symptoms of eye and respiratory tract irritation resulting from occupational exposure to sodium borate dusts. The symptom assessment of the 79 exposed and 27 unexposed subjects comprised interviews before the shift began and then at regular hourly intervals for the next six hours of the shift, four days in a row. Exposures were monitored concurrently with a personal real time aerosol monitor. Two different exposure profiles, a daily average and short term (15 minute) average, were used in the analysis. Exposure-response relations were evaluated by linking incidence rates for each symptom with categories of exposure. Acute incidence rates for nasal, eye, and throat irritation, and coughing and breathlessness were found to be associated with increased exposure levels of both exposure indices. Steeper exposure-response slopes were seen when short term exposure concentrations were used. Results from multivariate logistic regression analysis suggest that current smokers tended to be less sensitive to the exposure to airborne sodium borate dust. There was no indication that anhydrous sodium borate was more potent than the other sodium borates in this work environment AU - Hu X AU - Wegman DH AU - Eisen EA AU - Woskie SR AU - Smith RG LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 60 Suppl 2 IP - DP - 1992 Jan 01 TI - Bacteria and their products as occupational allergens PG - 14-21 AU - Dutkiewicz J LA - PT - DEP - TA - Pneumonol Alergol Pol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 13 IP - DP - 1992 Jan 01 TI - Immediate allergy to natural latex: clinical and immunological studies PG - 115-120 AB - Since 1979 several reports of contact urticaria due to natural latex have been documented. In recent years cases of anaphylaxis, rhinitis, and asthma due to latex have appeared. Nine patients, studied in our clinic between 1986-1991, suffered immediate allergic reactions caused by rubber products. All showed an immediate skin reaction to latex extract. Rub testing with surgical gloves was positive in eight patients. Immunological techniques (RAST, ELISA, HRT) demonstrated specific IgE against latex. Specific bronchial provocation testing was performed in one patient who presented with asthma when she used latex surgical gloves. Patch testing to common rubber additives were negative in our patients. These results suggest that natural latex antigens present in rubber objects can cause hypersensitivity reactions probably due to IgE-mediated mechanisms AU - Losada E AU - Lazaro M AU - Marcos C AU - Quirce S AU - Fraj J AU - Davila I AU - Igea JM AU - SanchezCano M LA - PT - DEP - TA - Allergy Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - IP - DP - 1992 Jan 01 TI - Health disorders in workers of the fish processing industry. [RUSSIAN] PG - 34-35 AB - The contributors propose a study of the labour conditions (microclimate, work load and intensity) in processing of dried yellowfin fish, describe results of the psycho-physiological and clinical studies, including medical examinations, epicutaneous testing, ventilation capacity of the lungs and peripheral blood laboratory studies. It was established that the technological processes of drying yellowfin fish exhibited exposure to the biological factors causing irritations and sensibilization of the skin fraught with occupational diseases (dermatitis) and respiratory disorders (allergic rhinopathy and the pre-asthma syndrome) AU - Artiunina GP AU - Bykov VR AU - Baikova IS AU - Nikolenko VS AU - Akimov AA LA - PT - DEP - TA - Gig Tr Prof Zabol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 27 IP - DP - 1992 Jan 01 TI - Contact dermatitis from natural latex PG - 334-335 AU - Lezaun A AU - Marcos C AU - Martin JA AU - Quirce S AU - Diez Gomez ML LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19920101 IS - IS - VI - 146 IP - DP - 1992 Jan 01 TI - The effect of smoke inhalation on lung function and airways responsiveness in wildland fire fighters PG - 1469-1473 AU - Liu D AU - Tager IB AU - Balmes JR AU - Harrison RJ LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 67 IP - DP - 1991 Jan 01 TI - Swiss chard hypersensitivity: clinical and immunologic study PG - 487-492 AB - Allergy to vegetables and fruits seems to be more prevalent in atopics, especially in birch pollen-sensitized individuals. We report a case of a grass pollen-sensitized woman, in whom the inhalation of vapor from boiling Swiss chard precipitated rhinoconjunctivitis and asthma. Type I hypersensitivity to Swiss chard was demonstrated by means of immediate skin test reactivity, specific IgE determination by RAST, basophil degranulation, histamine release test, and an immediate bronchial provocation test response to Swiss chard extract. The controls did not react to any of these tests. RAST inhibition assays suggest the presence of some cross-reactivity among Swiss chard and grass pollen antigens, as well as cross-reactivity between vegetables and weed pollens of the chenopod family AU - de la Hoz B AU - FernandezRivas M AU - Quirce S AU - Cuevas M AU - Fraj J AU - Davila I AU - Igea JM AU - Losada E LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 20 IP - DP - 1991 Jan 01 TI - Respiratory disease in a textile factory in Nicaragua PG - 195-208 AB - This is the first epidemiologic study conducted in a textile mill in Nicaragua using techniques and diagnostic criteria similar to those used in the United States and England. The prevalence of byssinosis and nonspecific respiratory symptoms were studied in 194 workers in a cotton mill in Managua. Limited environmental sampling, performed using a vertical elutriator in yarn preparation and weaving areas, indicated that exposures were similar to those reported in other parts of the developing world. A modified translated version of the Medical Research Council respiratory questionnaire was administered. Pulmonary function tests were performed before and after the Monday workshift to measure across-shift change in ventilatory function. The prevalence of byssinosis was 5.9% and all the cases occurred among exposed women. Nonspecific respiratory symptoms were also more prevalent among exposed workers. After adjusting for age, gender, smoking habit, and work tenure, the exposure odds ratios for usual cough and usual phlegm were 3.3 and 2.2, respectively. The association between exposure and across-shift decrement in FEV1 was not significant. Byssinotic workers, however, had greater decrements in FEV1% than those without byssinosis: 5.5% versus 1.8%. A consistent gender effect was observed in which both exposed and unexposed women were found to have greater across-shift decrements in FEV1 than men. The gender difference existed among long-term workers as well as workers who had been employed less than 2 years. Results are related to cotton dust exposure, as has been documented elsewhere. The poorer health status of the women in this study population deserves follow-up AU - Velazquez AM AU - Christiani DC AU - McConnell R AU - Eisen EA AU - Wilcox M LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 144 IP - DP - 1991 Jan 01 TI - Exposure-related declines in the lung function of cotton textile workers. Relationship to current workplace standards PG - 675-683 AB - To evaluate the effectiveness of the current workplace standards in preventing chronic health effects from cotton dust exposure, a 5-yr longitudinal study of a large multimill population of cotton textile and synthetic process workers, employed at a major U.S. textile company, was conducted. To control for and assess the effect of type of work area on annual change in lung function, we limited the analysis to those 1,817 subjects who, throughout their textile work history at the company, worked exclusively in cotton yarn manufacturing or slashing and weaving, or in synthetic textile mills. The expected effect of smoking on average annual change in lung function was demonstrated for both cotton and synthetic workers. Despite lower overall dust exposure, cotton yarn workers exhibited steeper annual declines in lung function than did workers in slashing and weaving; this difference persisted within each smoking category, indicating a dust potency effect. There were mill differences in annual change in lung function among cotton workers, potentially masking an exposure effect. A smoking-work area interaction persisted after adjusting for mill differences, with the largest annual declines observed in cotton yarn workers who smoke. A significant dose-response relationship was seen in cotton yarn manufacturing between annual declines in FEV1, FVC, and FEF25-75 and average exposure by mill, and the larger declines were found in mills using the highest percentage and lowest grade of cotton. Synthetic textile workers had larger declines than did cotton textile workers, which were not explained by smoking or duration of employment. Unrecognized and unmeasured causative exposures or selection bias could explain this result.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Glindmeyer HW AU - Lefante JJ AU - Jones RN AU - Rando RJ AU - Abdel Kader HM AU - Weill H LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 143 IP - DP - 1991 Jan 01 TI - A ten-year follow-up study of cotton textile workers PG - 301-305 AB - A follow-up study of respiratory function in cotton textile workers was performed 10 yr after the original cross-sectional study (1975 to 1985). There were 35 nonsmoking female and 31 smoking male textile workers restudied from the original group of 116. The majority of those lost to follow-up had left the industry. The prevalence of byssinosis among the female workers at the time of follow-up was 15/35 (42.9%) compared with 8/35 (22.9%) at the time of the initial study (p = 0.063). For men the byssinosis prevalence at follow-up was 16/31 (51.6%) compared with 8/31 (22.9%) at the time of the initial study (p = 0.03). Similarly, the prevalence of almost all other respiratory symptoms was significantly higher at the follow-up than at the time of the initial study. Significant across-shift decrements in FEV1 and FVC were documented at both surveys. The mean annual decline in ventilatory capacity was greater than expected for both female (FVC: -0.036 +/- 0.005 L/yr; FEV1: -0.059 +/- 0.009 L/yr) and male workers (FVC: -0.059 +/- 0.008 L/yr; FEV1: -0.068 +/- 0.006 L/yr) (Mean +/- SE). The mean total airborne dust concentration measured at the time of the follow-up study was 3.95 mg/m3 with an average respirable dust concentration of 0.97 mg/m3. We conclude that continued exposure to high dust concentrations in the cotton textile industry is associated with an increasing prevalence of respiratory symptoms and progressive impairment of lung function. The increase in respiratory impairment was seen both in smokers and nonsmokers AU - Zuskin E AU - Ivankovic D AU - Schachter EN AU - Witek TJ Jr LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 66 IP - DP - 1991 Jan 01 TI - Acute ventilatory response to green coffee dust extract PG - 219-224 AB - The lung function response to inhalation of an extract of green coffee was studied in ten healthy subjects who were prescreened for airway hyperresponsiveness to an aerosol of green coffee extract. The effects of this provocation were evaluated at rest and following moderate exercise as well as with and without pretreatment with 80 mg of disodium cromoglycate (DSCG). There was a statistically significant decrement in lung function over time (P less than .001) following coffee provocation both at rest and following exercise. No significant protection against this response was observed with DSCG pretreatment. While the majority of these "healthy" coffee reactors exhibited baseline nonspecific airway hyperresponsiveness to methacholine (PC20 FEV1 less than 25 mg/mL in 7/10), there was no correlation in these ten subjects between baseline responsiveness to methacholine and the degree of lung function decrement following coffee (P greater than .05). Also, no correlation was observed between skin prick and lung function response to coffee extract. We conclude that inhalation of green coffee extract causes significant bronchoconstriction in selected healthy volunteers and that this response is not prevented by pretreatment with DSCG AU - Zuskin E AU - Kanceljak B AU - Witek TJ Jr AU - Schachter EN LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 17 IP - DP - 1991 Jan 01 TI - Respiratory health of workers exposed to swine confinement buildings only or to both swine confinement buildings and dairy barns PG - 269-275 AB - Swine building workers (N = 488) and nonfarming neighborhood referents (N = 216) were enrolled in this study. There was a slight but significant increase in the prevalence of chronic bronchitis (17.49 versus 11.57%) and more evidence of airflow obstruction (forced expiratory volume in 1 s/forced vital capacity 0.75 versus 0.78) among the swine workers when they were compared with the referents. The subjects who spent more than 3 h/d in the swine buildings had a higher prevalence of chronic bronchitis (21.94 versus 13.25%) and airflow obstruction (forced expiratory volume in 1 s/forced vital capacity 0.75 versus 0.76) than those with shorter daily contact. Swine building only workers had no precipitins to antigens found in their environment and no clinical evidence of extrinsic allergic alveolitis. The number of years on the farm, dual exposure with dairy cattle, positive skin prick tests, type of piggery, and type of feeding did not add to the respiratory health impact of swine buildings AU - Cormier Y AU - Boulet LP AU - Bedard G AU - Tremblay G LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 62 IP - DP - 1991 Jan 01 TI - Relationship of airborne endotoxin and bacteria levels in pig farms with the lung function and respiratory symptoms of farmers PG - 595-601 AB - Previous studies have demonstrated a high prevalence of respiratory and other symptoms and a decrement in lung function among pig farm workers, although the relationships with specific agents present in the work environment remain obscure. This study was therefore undertaken to investigate the relationship between symptoms, lung function and airborne endotoxin, ammonia and dust levels in piggeries. Information on symptoms, lung function, endotoxin, ammonia and dust levels was available for 183 pig farmers who worked in 136 farms. For 62 farms information was present on the levels of bacteria and gram-negative bacteria. For these 62 farms, endotoxin exposure measurements were taken in more than one stable. In general, no significant correlations were found between lung function and chronic respiratory symptoms, or dust and ammonia levels. The endotoxin concentration in stables was negatively related to most lung function variables, but only for the subgroup of 62 farmers was a statistically significant relationship found between endoxtoxin exposure and FEV1. A borderline statistically significant and negative relationship was found between the endotoxin concentration and the FVC. Symptoms experienced during or shortly after work showed odds ratios larger than one with the levels of bacteria, gram-negative bacteria and endotoxin, indicating a positive relationship. No consistency in the relationship between symptoms and dust levels was found. The results suggest that endotoxins and (gram-negative) bacteria probably play an important role in the development of symptoms and lung function changes among pig farmers AU - Heederik D AU - Brouwer R AU - Biersteker K AU - Boleij JS LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 85 IP - DP - 1991 Jan 01 TI - Relevance of airflow obstruction and mucus hypersecretion to mortality PG - 27-35 AB - A group of 2,065 gold miners surveyed between 1968 and 1970 was followed to 31 December 1986, at which date 859 were known to be dead. The relationship between airways obstruction and mucus hypersecretion to causes of mortality was analyzed. Airways obstruction was strongly related to mortality from chronic obstructive pulmonary disease (COPD), lung cancer, coronary heart disease and other causes. After standardization for airways obstruction, mucus hypersecretion was not related to mortality from COPD but remained related to mortality from ischaemic heart disease (IDH) and other causes, even after adjustment for tobacco smoking and dust exposure. Mucus hypersecretion was not related to mortality from lung cancer when standardized for airways obstruction AU - Wiles FJ AU - Hnizdo E LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 143 IP - DP - 1991 Jan 01 TI - The normal range of diurnal changes in peak expiratory flow rates. Relationship to symptoms and respiratory disease PG - 323-330 AB - Measuring peak expiratory flow rates (PEFR) several times a day can provide an objective assessment of functional changes relative to environmental or occupational exposures. This report describes the pattern of diurnal changes in PEFR in a reference population, and defines ranges of "normal" between- and within-day variability. An index of diurnal changes was defined as the ratio between maximal and minimal values, where the maximal value was restricted to PEFR measured at noon or in the evening (N, E) and the minimal value was restricted to the morning or at bedtime (M, B). A ratio greater than normal represented an exaggeration of the normal diurnal pattern in PEFR. Normal limits, based on the ninety-fifth percentile in the reference population, were larger for children (130%) than for adults 15 to 35 yr of age (117%) and those older than 35 yr of age (118%). The meaningfulness of excessive diurnal changes in PEFR was examined by relating this ratio (Max/Min), and a similar measure (the amplitude percent mean) to chronic respiratory symptoms and diseases in 938 adults and children who recorded PEFR values 2 to 4 times per day for as long as 14 days. There was a strong relationship of diurnal changes in PEFR that exceed normal limits with physician-confirmed asthma (relative risk of 2.99 with Max/Min), with exertional dyspnea (Grade 2+), and with more frequent reporting of acute symptoms of wheeze, attacks of wheezing dyspnea, cough, and chest colds. In addition, those exceeding the normal limits had about 2.9 times greater risk of having a FEV1 below 80% of predicted, and nearly 7 times greater risk of being below 70%.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Quackenboss JJ AU - Lebowitz MD AU - Krzyzanowski M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 143 IP - DP - 1991 Jan 01 TI - Emphysema type in relation to silica dust exposure in South African gold miners [published erratum appears in Am Rev Respir Dis 1991 Nov;144(5):1223] PG - 1241-1247 AB - The relationship between silica dust exposure in gold mines and the type of emphysema was studied in a group of 1,553 white gold miners who had undergone autopsy examination between 1974 and 1987. Of particular interest was the contrast between centriacinar and panacinar emphysema as they relate to silica exposure and the presence of silicosis. Subjects with significant emphysema, that is, with an emphysema score of 30% or more, were classified as having predominantly panacinar or predominantly centriacinar emphysema, and compared to those without emphysema (emphysema score less than or equal to 10%). Of those who had significant emphysema (greater than or equal to 30%), 24% had predominantly panacinar, 43% predominantly centriacinar, and 33% were classified as mixed. The odds ratios (OR) for the association between each emphysema type and dust exposure (one unit of the cumulative dust index) were found to be statistically significant and of equal magnitude [1.019, with a 95% confidence interval (CI) of 1.005 to 1.033 for panacinar and 1.019 with a 95% CI of 1.007 to 1.031 for centriacinar emphysema]. In 163 nonsmokers insignificant panacinar emphysema was more common than centriacinar emphysema. The results indicate that a miner with 20 yr in high-dust occupations has a 3.5 (1.7;6.6) times higher odds of having a significant degree of emphysema at autopsy than a miner not in a dusty occupation. This is likely to be true of smoking miners only because there were only four nonsmokers with an emphysema score between 30 and 40%.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Hnizdo E AU - SluisCremer GK AU - Abramowitz JA LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Silica exposure, silicosis, and lung cancer: a mortality study of South African gold miners PG - 53-60 AB - The effects of exposure to gold mining dust with a high concentration of free silica and tobacco smoking on mortality from lung cancer was assessed in a sample of 2209 white South African gold miners who started mining exposure during 1936-43, and were selected for a study of respiratory disorders in 1968-71 when they were aged 45-54. The mortality follow up was from 1968-71 to 30 December 1986. The relative risk for the effect of dust cumulated to the start of the follow up period was estimated as 1.023 (95% confidence interval (CI) 1.005-1.042) for a unit of 1000 particle-years. The combined effect of dust and tobacco smoking was better fitted by the multiplicative model than the additive model, suggesting that the two exposures act synergistically. No association between lung cancer and silicosis of the parenchyma or pleura was found, but a positive association existed between silicosis of the hilar glands and lung cancer AU - Hnizdo E AU - SluisCremer GK LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 46 IP - DP - 1991 Jan 01 TI - Prevalence of obstructive lung disease in a general population: relation to occupational title and exposure to some airborne agents PG - 863-870 AB - BACKGROUND The importance of occupational exposure to airborne agents in the development of obstructive disease is uncertain. Studying the relation in a community population has the benefit of reducing the healthy worker effect seen in studies of working populations. METHODS The prevalence of obstructive lung disease was examined in a Norwegian general population aged 18-73 in a two phased cross sectional survey. In the second phase a stratified sample (n = 1512) of those responding in the first phase was invited for clinical and spirometric examination (attendance rate 84%). Attenders were asked to state all jobs lasting greater than 6 months since leaving school and to say whether they had been exposed to any of seven specific agents and work processes potentially harmful to the lungs. RESULTS The prevalence of asthma and chronic obstructive lung disease was 2.4% and 5.4%, respectively; spirometric airflow limitation (FEV1/FVC less than 0.7 and FEV1 less than 80% of predicted values) was observed in 4.5% of the population. All jobs were categorised into three groups according to the degree of potential airborne exposure. Having a job with a high degree of airborne exposure increased the sex, age, and smoking adjusted odds ratio for obstructive lung disease (asthma and chronic obstructive lung disease) by 3.6 (95% confidence interval 1.3 to 9.9) compared with having a job without airborne exposure; the association with spirometric airflow limitation was 1.4 (0.3 to 5.2). Occupational exposures to quartz, metal gases, aluminium production and processing, and welding were significantly associated with obstructive lung disease after adjusting for sex, age, and smoking habit, the adjusted odds ratios varying between 2.3 and 2.7. Occupational exposure to quartz and asbestos was significantly related to spirometric airflow limitation in people older than 50. CONCLUSION Occupational title and exposure to specific agents and work processes may be independent markers of obstructive lung disease in the general population AU - Bakke S AU - Baste V AU - Hanoa R AU - Gulsvik A LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 6 IP - DP - 1991 Jan 01 TI - The prevalence of specific IgE and IgG to reactive dye-human serum albumin conjugate in workers of a dye factory and neighbouring factories PG - 63-68 AU - Park HS AU - Kim JW AU - Hong CS LA - PT - DEP - TA - J Kor Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 59 IP - DP - 1991 Jan 01 TI - Symptoms and functional disorders of the respiratory system caused by exposure to tea dust. [Polish] PG - 210-217 AB - A case report is presented of a female worker of a tee packing factory, with a 5 years history of tea dust exposition and symptoms of reversible airway obstruction and early allergic alveolitis. The results of spirometric and lung mechanics demonstrated reversible airway obstruction with co-existent restrictive changes, lowering of CO diffusing capacity (DLc0). Bronchial provocation tests with tea dust were carried out thrice and all were positive. The authors believe that the etiological factor of above mentioned changes were Aspergillus niger spores found in tea dust. Tea dust and the patient's sputum cultured for fungi revealed massive growth of A. niger. Serological tests revealed additionally, antibodies to A. niger and tea dust extracts. The authors discuss the possible mechanisms of airway disturbances in this patient AU - Muller J AU - Halweg H AU - Podsiadlo B AU - Radwan L LA - PT - DEP - TA - Pneumonol Alergol Pol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 143 IP - DP - 1991 Jan 01 TI - Bronchial responsiveness in a Norwegian community PG - 317-322 AB - Bronchial responsiveness to methacholine was examined in a Norwegian general population sample (n = 490) 18 to 73 yr of age. Altogether, 20 and 6% of the sample had PC20 less than or equal to 32 mg/ml and PC20 less than or equal to 8 mg/ml, respectively. The relationship of bronchial responsiveness to the following potential predictors were examined: sex, age, smoking habits, airway caliber (FEV1), FEV1 percent predicted (%FEV1), urban-rural area of residence, occupational airborne exposure in present job, and total serum IgE. After adjusting for age and FEV1, the odds ratio for PC20 less than or equal to 32 mg/ml was higher for men than for women in smokers and in ex-smokers, but did not vary by sex in nonsmokers, the adjusted odds ratio for PC20 less than or equal to 32 mg/ml in male compared with female smokers being 8.4 (95% Cl: 2.5-37.4). Irrespective of smoking status the sex- and FEV1-adjusted odds ratio for PC20 less than or equal to 32 mg/ml fell with increasing age. For every 10-yr increase in age the adjusted odds ratio for PC20 less than or equal to 32 mg/ml methacholine in nonsmokers decreased by 2.0 (95% Cl: 1.3-3.3). Also FEV1 and %FEV1 were predictors of PC20 less than or equal to 32 mg/ml after adjusting for sex and age irrespective of smoking status. Bronchial responsiveness (PC20 less than or equal to 8 mg/ml) was more prevalent in rural than in urban areas, the adjusted odds ratio being 2.5 (95% Cl: 1.1-5.9) for bronchial responsiveness in rural compared with urban residents after adjusting for sex, age, smoking habits, and FEV1.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Bakke PS AU - Baste V AU - Gulsvik A LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 143 IP - DP - 1991 Jan 01 TI - Silicosis, chronic airflow limitation, and chronic bronchitis in South African gold miners PG - 80-84 AB - In a cross-sectional study of a working population of black South African gold miners, 1,197 men were studied with respiratory and occupational questionnaires, lung function tests, and chest radiographs. The study was designed to examine the effects of silicosis on respiratory symptoms and lung function. A total of 857 men with chronic, simple silicosis and 340 men without silicosis were included in the sample. Other determinants of lung disease including the duration and intensity of underground dust exposure and tobacco smoking were also examined. Three distinct pulmonary disorders could be discerned: silicosis-associated pulmonary dysfunction with dyspnea on effort; chronic airflow limitation, which was related to the duration of underground exposure; and a chronic bronchitic symptom complex, which reflected the intensity of dust exposure in the workplace. Chronic, uncomplicated silicosis was found to be associated with significant loss of lung function, and all of the measured indices, FVC, FEV1, FEV1/FVC%, maximal midexpiratory flow rate (MMEF), and lung diffusion for carbon monoxide measured by the single-breath method (DLCO) were reduced. When comparing men with Category 3/3 nodule profusion with men without silicosis, reductions of FVC of 351 ml, FEV1 of 447 ml, MMEF of 1.04 L/s, and DLCO of 4.7 ml/min/mm Hg (p = 0.0001) were detected after controlling for age, height, the direct effects of the underground environment, and tobacco smoking. Dyspnea on effort was more common in the men with silicosis (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS) AU - Cowie RL AU - Mabena SK LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 4 IP - DP - 1991 Jan 01 TI - Occupational dust or gas exposure and prevalences of respiratory symptoms and asthma in a general population PG - 273-278 AB - The relationship of occupational airborne, exposure to respiratory symptoms and asthma was examined using a self-administered questionnaire in a cross-sectional survey of a random sample (n = 4,992 subjects) of the general population aged 15-70 yrs of Hordaland county, Norway. The response rate was 90%. Twenty nine percent of the population had a history of occupational dust or gas exposure, 5% reported having been exposed to asbestos at work, and 4% reported quartz exposure. A history of occupational dust or gas exposure was associated with morning cough, chronic cough, phlegm when coughing, breathlessness on exercise, occasional wheezing and a physician's diagnosis of asthma after adjusting for sex, age, smoking habits and urban-rural area of residence. The adjusted relative odds ratios for the respiratory disorders in subjects exposed to dust or gas ranged from 1.6-1.9. The population attributable risk of occupational dust or gas exposure for the respiratory disorders ranged from 11-19%. The study indicates that respiratory disorders are independently associated with occupational airborne exposure in a Norwegian general population sample AU - Bakke P AU - Eide GE AU - Hanoa R AU - Gulsvik A LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 20 IP - DP - 1991 Jan 01 TI - Combined effect of grain farming and smoking on lung function and the prevalence of chronic bronchitis PG - 416-423 AB - The combined effect of grain farming and smoking on lung function and the prevalence of chronic bronchitis was examined in 1633 residents 20 to 65 years of age from the town of Humboldt, Saskatchewan. Multiple multivariate analysis indicated that in women grain farming and smoking had a significant synergistic effect on the values of forced expired volume in one second/forced vital capacity (FEV1/FVC), mid-expiratory flow rate (MMFR), flow rate at 50% and 25% of total volume (Vmax50 and Vmax25) after adjustment for covariates including age and height. No other factors were found to change the results. The combined effect of grain farming and smoking on lung function was not statistically significant in men. The data also show that female non-smoking grain farmers had an identical prevalence of chronic bronchitis compared with non-smoking female non-farmers, 2.0% versus 2.1%. But in women with a positive smoking history, the prevalence was 13.2% and 5.9% respectively, giving an adjusted odds ratio in grain farmers compared to non-farmers of 3.55 (95% confidence interval (Cl): 1.06-11.30). It was found that the prevalence of chronic bronchitis increased more rapidly with increasing cigarette consumption in grain farmers than in non-farmers in women. It was estimated that 85%, 72% and 66% of the prevalence of chronic bronchitis was attributed to the joint effects of grain farming and ex-smoking, light smoking (1-19 cigarettes/day) or heavy smoking (20+ cigarettes/day) status, respectively. In contrast to women, the effect of grain farming on the prevalence of chronic bronchitis was similar in men with and without a positive smoking history. Our data suggest that there is a positive interactive effect of grain farming exposure and smoking on lung function and the prevalence of chronic bronchitis in women. The difference in the interaction between men and women requires further study AU - Chen Y AU - Horne SL AU - McDuffie HH AU - Dosman JA LA - PT - DEP - TA - Int J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 64 IP - DP - 1991 Jan 01 TI - The chest X ray in Q-fever: a report on 69 cases from the 1989 West Midlands outbreak PG - 1101-1108 AB - Acute and serial chest radiographic appearances of Q-fever in a large UK outbreak in the West Midlands are described. In 69 acute films (taken within 20 days of onset of illness), 10% of films were normal. Appearances in 62 abnormal films were varied and, in contrast to some previous reports, showed no features that might distinguish Q-fever pneumonia from pneumonias of other origins. Analysis of serial films in 47 cases showed that complete radiographic resolution frequently took up to 6 months, longer than has been described previously. Initial appearances deteriorated over the first 2 weeks of radiographic surveillance in 20% of cases. No relationship was found between the extent of radiographic change and the age of the patient or the presence or absence of respiratory symptoms. Age did not affect time to resolution AU - Smith DL AU - Wellings R AU - Walker C AU - Ayres JG AU - Burge PS LA - PT - DEP - TA - Brit J Radiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - IP - DP - 1991 Jan 01 TI - Guidelines on the use of Colophony (rosin) solder fluxes in the electronics industry PG - - AU - Electronics Industry Joint Working Group to consider Colophony LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 67 IP - DP - 1991 Jan 01 TI - Relationships of total IgE level, skin prick test response, and smoking habits PG - 355-358 AB - Epidemiologic observations on 331 men showed that increased serum IgE concentration was associated with a wheal response to skin prick testing, but also to an erythema response in the absence of any wheal, and to heavy smoking. The association between IgE and the various skin prick test responses remained after taking into account smoking and asthma AU - Oryszczyn MP AU - Annesi I AU - Neukirch F AU - Dore MF AU - Kauffmann F LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 143 IP - DP - 1991 Jan 01 TI - Blood eosinophilia and FEV1. Cross-sectional and longitudinal analyses PG - Pt 1):987-92 AB - A previous cross-sectional analysis of 1980 data from a population of working men in the Paris area has shown a significant relationship of blood eosinophilia to a reduced FEV1 among nonsmokers, remaining after excluding men with a history of asthma. In the present report, we reexamine this relationship, after taking into account asthma, bronchial hyperresponsiveness, and positive skin prick tests, using data collected in 1985 in a subsample of 363 men from the initial population. Blood eosinophilia, defined by 5% or more eosinophils or by 250 or more eosinophils per cubic millimeter appeared to be associated with a lower FEV1, primarily in nonsmokers. A difference of approximately 0.40 L was observed in never-smokers with eosinophilia (greater than or equal to 5% of eosinophils) compared with those without. This association persisted after exclusion of subjects with atopy, asthma, and bronchial hyperresponsiveness. Longitudinally, no significant association was observed between 1980 eosinophilia and the annual FEV1 decline between 1980 and 1985, even in nonsmokers. The results of our cross-sectional analyses suggest that asthma or asthma-like disorder does not explain the association between eosinophilia and FEV1. The role of eosinophil in respiratory disorders may go beyond its intervention in allergy. Further longitudinal studies are needed to better understand discrepancies between cross-sectional and longitudinal data and whether eosinophilia is a risk factor for chronic air-flow limitation AU - Frette C AU - Annesi I AU - Korobaeff M AU - Neukirch F AU - Dore MF AU - Kauffmann F LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 21 IP - DP - 1991 Jan 01 TI - The significance of specific IgG and IgG4 antibodies to a reactive dye in exposed workers PG - 357-362 AB - To evaluate the significance of specific IgG and specific IgG4 in the development of work-related respiratory symptoms, specific IgG and specific IgG4 to Black GR-human serum albumin (HSA) conjugate were measured by ELISA in 309 dye-exposed workers and 63 unexposed patients as negative controls. A survey revealed that 78 (25.2%) had work-related lower respiratory symptoms with or without nasal, skin or eye symptoms. Specific IgG and specific IgG4 were detected in 23% and 14% of the exposed workers, respectively. The prevalence of specific IgG and specific IgG4 was significantly higher in smokers and workers with specific IgE or those with lower respiratory symptoms (P less than 0.05), but was not associated with work station, duration of dye exposure or atopy. These results suggested that the existence of specific IgG to Black GR-HSA might represent a response to Black GR exposure and be closely related with work-related respiratory symptoms AU - Park HS AU - Hong CS LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 200 IP - DP - 1991 Jan 01 TI - Bronchial smooth muscle responses evoked by toluene diisocyanate are inhibited by ruthenium red and by indomethacin PG - 73-76 AB - We have investigated the ability of ruthenium red, an inorganic dye with Ca2+ entry-blocking properties and a selective antagonist of capsaicin, and of indomethacin, a cyclooxygenase inhibitor, to inhibit bronchial smooth muscle responses evoked by toluene diisocyanate in guinea pigs. Previous exposure of isolated guinea pig bronchi to ruthenium red significantly decreased the response produced by toluene diisocyanate. Further, the response to toluene diisocyanate was significantly decreased by pretreatment with indomethacin. These findings provide evidence that toluene diisocyanate-induced contractions of guinea pig bronchi are produced indirectly by generation of a prostanoid that activates capsaicin-sensitive afferents via a ruthenium red-sensitive mechanism AU - Mapp CE AU - Boniotti A AU - Graf PD AU - Chitano P AU - Fabbri LM AU - Nadel JA LA - PT - DEP - TA - Eur J Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 337 IP - DP - 1991 Jan 01 TI - Experience with mustard gas casualties [letter] PG - 242-242 AU - Newman Taylor AJ AU - Morris AJ LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Industrial injuries compensation [editorial] PG - 577-578 AU - Harrington JM AU - Newman Taylor AJ AU - Coggan D LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - The effect of smoking on the development of allergic disease and specific immunological responses in a factory workforce exposed to humidifier contaminants PG - 30-33 AB - The effects of smoking on the development of work related asthma and on the production of specific IgE and IgG antibodies to antigen from a contaminated humidifier are described for a sample of 258 workers from a printing factory. Current smoking was associated with low production of IgG antibody but with higher production of IgE antibody. No dose response for either antibody was found when numbers of cigarettes or pack-years smoked were considered. Work related asthma was detected in 12 workers by peak flow recordings. Six were current smokers and one was an ex-smoker. One subject with work related asthma had a high (and one a marginal) concentration of specific IgE to humidifier antigen AU - Finnegan MJ AU - Little S AU - Gordon DJ AU - Austwick PK AU - Tee RD AU - Nunn AJ AU - Newman Taylor AJ LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 63 IP - DP - 1991 Jan 01 TI - Atopic allergy to chloramine-T and the demonstration of specific IgE antibodies by the radioallergosorbent test PG - 363-365 AU - Blomquist AM AU - Axelsson IGK AU - Danielson D AU - Kiviloog J AU - Ulander A AU - Zetterstrom O LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 81 IP - DP - 1991 Jan 01 TI - The UCLA population studies of CORD: X. A cohort study of changes in respiratory function associated with chronic exposure to SOx, NOx, and hydrocarbons PG - 350-359 AB - Two never-smoking cohorts in Southern California, one in Lancaster (N = 2340) exposed only to moderate levels of oxidants and the other in Long Beach (N = 1326) exposed to high levels of SOx, NO2, hydrocarbons and particulates completed spirometry and the single-breath nitrogen test five to six years apart. Forty-seven percent and 45 percent of the participants were retested. Mean results at baseline for those tested and not retested were similar. Loss to follow-up was primarily due to moving (39 percent and 47 percent). Every difference of consequence indicated greater deterioration in lung function in Long Beach. The level of significance of the difference was greatest, even in the youngest age groups, for delta N2(750-1250), suggesting that the earliest site of impairment may occur in the small airways. Greater deterioration in spirometric parameters was observed in every age group in Long Beach females above seven years of age at baseline and in Long Beach males above 15 years of age, suggesting that chronic exposure to the pollutant mix occurring in Long Beach ultimately adversely affects the large airways as well as small airways AU - Detels R AU - Tashkin DP AU - Sayre JW AU - Rokaw SN AU - Massey FJ Jr AU - Coulson AH AU - Wegman DH LA - PT - DEP - TA - Am J Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 44 IP - DP - 1991 Jan 01 TI - Infections in British clinical laboratories, 1988-1989 PG - 667-669 AB - During 1988-89 this continuing survey showed 18 infections in the staff of laboratories reporting from 166 centres, representing 21,756 person-years of exposure. Shigella and other bowel infections (one caused by S typhi) predominated, affecting 11 microbiology medical laboratory scientific officers. Three shigella infections originated from quality control samples. Pulmonary tuberculosis affected four workers, including two mortuary technicians, but without detected occupational exposure to Mycobacterium tuberculosis. Other infections included one caused by Brucella melitensis. Hepatitis was not reported. The sustained low level of hepatitis is encouraging and suggests a low risk to staff of bloodborne infections such as human immunodeficiency virus AU - Grist NR AU - Emslie JA LA - PT - DEP - TA - Journal of Clinical Pathology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 3 IP - DP - 1991 Jan 01 TI - Social classifications and coding methodology PG - - AU - Office of Population Censuses and Surveys LA - PT - DEP - TA - Standard Occupational Classification JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 104 IP - DP - 1991 Jan 01 TI - Tuberculosis among long term hospital residents: report of a recent outbreak PG - 421-422 AB - Following the diagnosis of a case of miliary tuberculosis in a ward of 30 psychogeriatric patients, a further seven patients required treatment for active tuberculosis, and an additional four received prophylactic therapy. Tuberculosis contributed significantly to the deaths of three patients during the outbreak. This report highlights the particular risks of both reactivation and primary tuberculosis among geriatric patients receiving long term residential care. Late diagnosis contributed to the extent of the outbreak. Previous studies indicate that occult transmission of tuberculosis is relatively common in this group. An active policy of screening and prophylactic treatment is advised AU - Taylor DR AU - Allison G AU - Phillips DE LA - PT - DEP - TA - N Z Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 143 IP - DP - 1991 Jan 01 TI - An outbreak of tuberculosis in a shelter for homeless men. A description of its evolution and control PG - 257-261 AB - of tuberculosis in this setting. The shelter provides evening accommodations for men aged 50 yr and older. The capacity is approximately 200 clients, and the client pool is approximately 1,000 men/yr. During a 6-wk period in December 1986 and January 1987, seven cases of tuberculosis were diagnosed in shelter clients. Nine cases were reported in clients during the preceding 12 months, and four cases in the year previous to that. The majority of outbreak cases were pulmonary tuberculosis, sputum smear positive. Drug resistance was rare. Phage typing of 15 Mycobacterium tuberculosis isolates revealed one predominant type and four other types. The goals of the control plan (and the steps taken to achieve them) were to render known infectious cases noninfectious (directly observed therapy); to find undiagnosed infectious cases (repetitive mass screenings); to protect exposed clients (repetitive tuberculin skin testing and isoniazid preventive therapy); and to make the shelter environment safe (exclude infectious, noncompliant clients and improve the shelter's ventilation system). Implementation of this plan rapidly terminated the outbreak; following the first mass screening in January 1987, at which six asymptomatic cases were detected, only five additional cases occurred in shelter clients during a 2-yr period of follow-up. The investigation suggested that the outbreak evolved during 1986 as a result of the presence at the shelter of an increasing number of men with undiagnosed infectious pulmonary tuberculosis.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Nolan CM AU - Elarth AM AU - Barr H AU - Saeed AM AU - Risser DR LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 100 IP - DP - 1991 Jan 01 TI - Tuberculosis diagnosed at death in the United States PG - 678-681 AB - From 1985 through 1988, 5.1 percent of TB cases reported in the United States were diagnosed at death. Differences in the proportions diagnosed at death by race/ethnicity, sex, and place of birth (United States vs foreign-born) were relatively small. The proportion of cases diagnosed at death increased with age, from 0.7 percent in patients less than 5 years old to 18.6 percent among patients 85 years and older. Only 26.0 percent of cases diagnosed alive were among those 65 years and older, but 60.3 percent of those diagnosed at death were in this age group. Eighteen percent of cases with miliary, meningeal and peritoneal TB were diagnosed at death, compared with 4.8 percent among those with pulmonary TB. These data indicate that TB too often remains unrecognized and that, to prevent continuing deaths from this curable disease, a high index of suspicion of TB remains important, particularly among the elderly and among persons with extrapulmonary sites of disease AU - Rieder HL AU - Kelly GD AU - Bloch AB AU - Cauthen GM AU - Snider DE Jr LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 143 IP - DP - 1991 Jan 01 TI - Tuberculosis in house staff. A decision analysis comparing the tuberculin screening strategy with the BCG vaccination PG - 490-495 AB - The BCG vaccination is not recommended for health-care workers in the United States. The current strategy against tuberculosis in tuberculin-negative house staff is an annual tuberculin screening test followed by chemoprophylaxis with isoniazid for a positive result. We performed a decision analysis that unequivocally concluded that the BCG vaccination leads to fewer cases of tuberculosis in this population over a 10-yr period. The BCG vaccine requires only an efficacy rate of at least 13.1% to prevent more cases of tuberculosis than the current strategy. This threshold value is independent of the annual tuberculin conversion rate. This study provides a framework, based on the best information in the literature, on which a well-informed decision regarding tuberculosis prevention can be made. Therefore, this analysis demonstrates that the BCG vaccine should be considered for tuberculin-negative house officers and medical students working in high risk areas of the United States AU - Greenberg PD AU - Lax KG AU - Schechter CB LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 1 IP - DP - 1991 Jan 01 TI - Tuberculosis notification rates in the elderly PG - R149-50 AB - The highest rate of tuberculosis notification in England and Wales during the 1980s occurred in males aged 65 years and over. This is explained on the basis of reactivation rather than recent infection: a trend which is likely to continue until the end of the century AU - Springett VH LA - PT - DEP - TA - CDR (Lond Engl Rev) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 72 IP - DP - 1991 Jan 01 TI - Screening for tuberculosis: current practices and attitudes of hospital workers PG - 265-267 AB - To examine the current practices and attitudes of health workers to the prevention of tuberculosis in our 55-bed chest unit, we investigated the tuberculin reactor status, reviewed pre-employment screening and reviewed the action taken after contact with tuberculosis by staff members. We assessed all 61 staff members, including 44 nurses, 1 physiotherapist, 11 doctors and 5 domestic workers. 47/61 staff members had had BCG vaccination. Heaf testing revealed 3 Heaf-negative subjects and, of the remainder, 52 had grade 3 or stronger reactions. Only 3/11 doctors, 36/44 nurses and 4/5 domestic workers had had any pre-employment screening. No action was taken by any doctor after their last contact with tuberculosis, whereas 10/44 nurses and 3/5 domestic workers had had chest X-rays. This study shows the low importance with which the risk of tuberculosis is perceived, particularly by doctors and demonstrates the need for stricter supervision and improved quality of pre-employment screening AU - Clague JE AU - Fields P AU - Graham DR AU - Davies PD LA - PT - DEP - TA - Tubercle JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 46 IP - DP - 1991 Jan 01 TI - Current trends in tuberculosis mortality in England and Wales PG - 438-440 AB - To determine current trends in mortality from tuberculosis according to age the published data on notification and deaths from tuberculosis from 1974 to 1987 have been analysed. The ratio of deaths to notifications per year was assessed over this period as a measure of case fatality from tuberculosis. The mean annual decline in the ratio for each age group was as follows: 0-14 years 6.7% (95% confidence interval 4.00 to 9.6%), 15-34 years 1.4% (-0.2 to 3.0%), 35-54 years 4.5% (2.2 to 6.9%), 55-74 years 2.8% (1.8 to 3.7%), and 75+ years 3.2% (2.1 to 4.2%). Because the incidence of disease in the 75+ group has declined much more slowly than in the rest of the population and because the size of this age group has increased in relation to the other groups, the overall annual mortality from tuberculosis has declined by only 0.13% (95% CI -1.3 to 1.3%). The total number of deaths from tuberculosis declined from 996 in 1974 to 430 in 1987, whereas deaths in the 75+ age group remained relatively constant at around 200 a year AU - Nisar M AU - Davies PD LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 29 IP - DP - 1991 Jan 01 TI - Humoral immune response of tuberculous patients against the three components of the Mycobacterium bovis BCG 85 complex separated by isoelectric focusing PG - 2348-2350 AB - An isoelectric-focusing technique followed by Western blot (immunoblot) analysis was used to investigate the immunoglobulin G response of tuberculous patients against each of the three components of the Mycobacterium bovis BCG antigen 85 complex. The 85A component was stained by the tuberculous as well as the non-tuberculous sera. In contrast, the 85B and the 85C proteins of the complex were not stained by the control sera but were stained by 20 of 28 tuberculous serum samples AU - Van Vooren JP AU - Drowart A AU - De Cock M AU - Van Onckelen A AU - D'Hoop MH AU - Yernault JC AU - Valcke C AU - Huygen K LA - PT - DEP - TA - Journal of Clinical Microbiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 100 IP - DP - 1991 Jan 01 TI - Properties of the mycobacterial antigen complex A60 and its applications to the diagnosis and prognosis of tuberculosis. PG - 1687-1693 AU - Cocito CG LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 18 IP - DP - 1991 Jan 01 TI - Legionella in hospitals: a review. PG - Suppl A:481-9 AB - Although epidemics of nosocomial Legionnaires' disease attract great attention, up to 30% of sporadic cases of hospital-acquired pneumonia are caused by legionellae. Legionellae are ubiquitous contaminants of potable water and can achieve high numbers in the hot-water systems of large buildings such as hospitals. They are present in the mains water supply in small numbers but are amplified considerably in the hospital's hot-water system. This is encouraged by water temperatures below 50 degrees C, areas of stagnation and sludge formation, the presence of amoebae and other bacteria and the materials used in the piping. Formation of aerosols from contaminated water is a major mode of spread of legionellae, but there is evidence to suggest that aspiration is also a mode of entry. Safe levels of legionellae in cooling towers have been defined, but not for hot-water systems. A combination of culture and antigen detection by immunofluorescence offer the best method for enumerating legionellae in environmental samples. Control involves a mixture of physical (heat, UV irradiation, sanitation) and chemical (hypochlorite, ozone) methods combined with good plumbing practice (e.g. arrangement of pumps and calorifiers, elimination of dead-legs). Adequate control can be costly and requires considerable attention to detail. AU - Hart CA AU - Makin T LA - PT - DEP - TA - J Hosp Infect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 13 IP - DP - 1991 Jan 01 TI - Advances in the epidemiology and control of Legionella infections. PG - 329-340 AU - Hoge CW AU - Brieman RF LA - PT - DEP - TA - Epidemiologic Reviews JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 5 IP - DP - 1991 Jan 01 TI - Legionellosis. PG - 561-584 AB - Legionella is a common cause of community- and hospital-acquired pneumonia. New information on the pathogenesis of infection and the host immune response is reviewed. Specialized laboratory tests, especially culture, are necessary for diagnosis since the clinical presentation is nonspecific. New antimicrobial agents and innovative approaches to disinfection of water distribution systems are presented. AU - Nguyen MH AU - Stout JE AU - Yu VL LA - PT - DEP - TA - Infect Dis Clin North Am JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 20 IP - DP - 1991 Jan 01 TI - Survival and growth of Legionella species in the environment. PG - 121S-129S AU - Lee JV AU - West AA LA - PT - DEP - TA - Society for Applied Bacteriology Symposium Series JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 21 IP - DP - 1991 Jan 01 TI - Epidemiological characteristics of Legionella infection in South Australia: implications for disease control. PG - 65-70 AB - About one third of adults surveyed in South Australia have shown evidence of past silent infection with Legionella pneumophila serogroup 1. However, the annual notification rate for symptomatic disease is only about 0.5 per 100,000 residents in non-epidemic years. The male to female ratio is 2.5 to one and approximately 50% of the cases are at least 60 years of age. Cases have presented more in summer and in the metropolitan areas. Twenty cases of Legionnaires' disease occurred during the summer of 1985-86. A cooling tower was held to be the principal source with aerosols being dispersed up to three kilometers away during an atmospheric thermal inversion. A subsequent outbreak of 22 L. longbeachae serogroup 1 infections had no marked geographic clustering. The outbreak commenced in spring and cases were distinguished as active gardeners. L. longbeachae was found in garden soil and it is hypothesised that this soil inhabitant can become aerosolised and inhaled during gardening. The potential for primary prevention of Legionnaires' disease is discussed in relation to water-handling equipment and the need for early precautionary treatment of all community-acquired pneumonia as suspect Legionnaires' disease is emphasised. AU - Cameron S AU - Roder D AU - Walker C AU - Feldheim J LA - PT - DEP - TA - Aust N Z J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 30 IP - DP - 1991 Jan 01 TI - Tear gas dermatitis. Allergic contact sensitization due to CS PG - 576-577 AU - Ro YS AU - Lee CW LA - PT - DEP - TA - Int J Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 52 IP - DP - 1991 Jan 01 TI - The influence of the helmet respirator on peak flow rate in aluminum potroom PG - 243-248 AB - The efficiency of the Racal Airstream helmet respirator in improving peak expiratory flow rates (PEFR) and symptoms (dyspnea, wheezing, and cough) in aluminum potroom workers with respiratory complaints was assessed in 19 workers. Peak expiratory flow readings and symptom recording from a 2-week working period with use of the respirator were compared with a period when the 3M 9906 disposable mask was used. The study was designed as a randomized, parallel, cross-over study with five or six daily measurements of PEFR and daily symptom recording. A significant number of workers (15) had a higher mean peak flow in the helmet period than in the nonhelmet period (p less than 0.01); symptoms did not improve significantly in the helmet period. Objective evidence of respiratory protection was observed for the group of workers as a whole, but the effect on symptoms as well as individual effect on peak flow was minor in the majority of the workers AU - Kongerud J AU - Rambjor O LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 144 IP - DP - 1991 Jan 01 TI - A longitudinal study of respiratory symptoms in aluminum potroom workers PG - 10-16 AB - The influence of occupational work exposure and host factors on the incidence of dyspnea and wheezing as reported in questionnaires was examined in 1,301 new employees in aluminum electrolytic potrooms. The incidence appeared to decrease after 2 yr of exposure, and the estimated probability of development of symptoms was nearly 20% after 4 yr. A total of 105 subjects developed dyspnea and wheezing. Of 78 symptomatic subjects who were interviewed, 76% experienced improvement or absence of symptoms when off work. In 523 subjects who were assigned to specific levels of exposure at the end of follow-up, a dose-response gradient was found between the development of symptoms and fluoride exposure. Increased risk with increasing amounts of tobacco was also observed, but childhood allergy and a family history of asthma were not significantly related to the outcome variable. We conclude that both total fluoride exposure and smoking are related to asthmatic symptoms in potroom workers, and the suggestion of a dose-response gradient was found for both variables. However, a causal relationship between fluorides and symptoms should be investigated further by specific bronchial provocation testing and by research for specific antibodies and other immunologic markers AU - Kongerud J AU - Samuelsen SO LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 4 IP - DP - 1991 Jan 01 TI - Methacholine responsiveness, respiratory symptoms and pulmonary function in aluminum potroom workers PG - 159-166 AB - The relationship between nonspecific bronchial reactivity and work-related asthmatic symptoms was examined in a cross-sectional study of 337 aluminium potroom workers by a shortened method of continuous methacholine nebulization. The provocative concentration producing a 20% fall in forced expiratory volume in one second (FEV1) (PC20) was less than or equal to 8 mg.ml-1 (hyperresponsiveness) in 17 workers (5%), whilst minor responsiveness (8 mg.ml-1 less than PC20 less than 32 mg.ml-1) was present in 24 subjects (7%). The prevalence of work-related asthmatic symptoms was 9%. Female sex, ex-smoker and airflow limitation were significant predictors of methacholine responsiveness (p less than 0.05). In a multiple logistic regression analysis the odds ratios (OR) for work-related asthmatic symptoms was 10.8 (95% confidence interval: 2.9-40.6) for hyperresponsiveness and 4.4 (95% confidence interval: 1.2-16.4) for minor responsiveness. The sensitivity, specificity and predictivity of PC20 less than 32 mg.ml-1 for work-related asthmatic symptoms were 35, 92 and 35%, respectively, whilst the agreement, when adjusted for the by chance expectation, was 0.27 (95% confidence interval: 0.10-0.54). Although a significant association was found between bronchial reactivity and work-related asthmatic symptoms, the usefulness of the methacholine test as a tool for detection of work-related asthmatic symptoms appears to be of limited value due to its low sensitivity AU - Kongerud J AU - Soyseth V LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 116 IP - DP - 1991 Jan 01 TI - Comparison of the measurement of serum cotinine levels by gas chromatography and radioimmunoassay PG - 691-693 AB - Standard cotinine solutions, controls and human serum samples containing cotinine have been measured by both radioimmunoassay (RIA) and gas chromatographic (GC) techniques. Cross-checks on standards and controls showed good agreement. However, for samples containing greater than 50 ng ml-1 of cotinine, RIA gave results on average 60% higher than GC. Determinations by using RIA and GC on samples containing less than 7 ng ml-1 of cotinine gave no significant correlation. The importance of the age of the serum sample has been investigated, and it is suggested that the age may affect the determination when dealing with low levels of cotinine AU - Anderson IG AU - Proctor CJ AU - Husager L LA - PT - DEP - TA - Analyst JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 144 IP - DP - 1991 Jan 01 TI - Smoking and symptom effects on the curves of lung function growth and decline PG - 17-22 AU - Sherrill DL AU - Lebowitz MD AU - Knudson RJ AU - Burrows B LA - PT - DEP - TA - Am J Respir Crit Care Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Bronchiolitis in a patient with talcosis PG - 140-142 AU - Reijula K AU - Paakko P AU - Kerttula R AU - TaikinaAho O AU - Tuuponen T AU - Hassi J LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 99 IP - DP - 1991 Jan 01 TI - An evaluation of the accuracy of Assess and Mini-Wright peak flowmeters PG - 358-362 AB - With the advent of small inexpensive peak flowmeters, the at-home monitoring of peak flow rates has become an invaluable aid in the treatment of asthmatic patients. In this study, we evaluated the performance of the MiniWright and Assess peak flowmeters for accuracy and reproducibility. Measurements were made at varying peak flow rates and compared with those obtained simultaneously by a calibrated pneumotachograph. When this segment of the study was completed, the peak flow devices were subjected to 200 uses and were then retested. Four MiniWright peak flowmeters that had been extensively used in our clinic were tested as well. The Assess peak flowmeter was more accurate than the MiniWright at low flow rates (less than 300 L/min), while the MiniWright meter was more accurate at high flow rates (greater than 400 L/min). We also found that the accuracy of the MiniWright meter deteriorated after 200 uses and worsened further after extensive use, while the Assess meter retained its accuracy after 200 uses AU - Shapiro SM AU - Hendler JM AU - Ogirala RG AU - Aldrich TK AU - Shapiro MB LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 1 IP - DP - 1991 Jan 01 TI - Evaluation of Dermestid sensitivity in museum personel PG - - AU - Siegel S AU - Lee N AU - Rohr A AU - et al LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 17 IP - DP - 1991 Jan 01 TI - Symptoms, airway physiology and histology of workers exposed to medium-density fiber board PG - 409-413 AB - Medium density fiber (MDF) board was recently introduced in the furniture industry. In this pilot study health complaints, physiology, and histology of the upper airways were evaluated for two groups of workers, one handling MDF board for at least one-third of their work week (MDF group) and another handling traditional fiber board. Civil servants served as a reference group. The frequency of health complaints concerning the airways was higher, the sense of smell was poorer, and the frequency of nasal obstruction measured with rhinomanometry was higher for the MDF group, while mucociliary activity was lower in the group handling traditional board. In both groups forced vital capacity was low when compared with expected values. Histological specimens from the middle turbinate of the nose showed, in a few cases, nasal epithelial dysplasia in the traditional board group, but histological changes in terms of scoring did not differ significantly between the groups. AU - HOLMSTROM M AU - ROSEN 0 AU - WILHELMSSON B. LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 325 IP - DP - 1991 Jan 01 TI - Relation between Airway Responsiveness and Serum IgE in Children with Asthma and in Apparently Normal Children PG - 1067-1071 AB - Background. Although asthma diagnosed by a physician is known to be related to serum IgE levels, it is not known whether there is a relation between the level of IgE and airway hyperresponsiveness to a methacholine challenge. The characteristics of asymptomatic persons that predispose them to airway hyperresponsiveness are also unknown. Methods. We studied the relation between the serum total IgE level and airway hyperresponsiveness in the presence or absence of asthma and other atopic diseases in a birth cohort of children. Data from a questionnaire regarding respiratory symptoms, plus measurements of the serum total IgE level and airway responsiveness to inhaled methacholine, were obtained for 562 11-year-olds in New Zealand. Results. The boys had a higher prevalence than the girls of current diagnosed asthma (13 percent vs. 6 percent), current symptoms of wheezing (22 percent vs. 15 percent), and airflow obstruction at base line (6 percent vs. 1 percent) and had a wider distribution of IgE levels, although mean IgE levels (120.8 IU per milliliter in the boys and 98.1 IU per milliliter in the girls) did not differ significantly between the sexes. The prevalence of diagnosed asthma was strongly related to the serum IgE level (P for trend <0.0001). No asthma was reported in children with IgE levels <32 IU per milliliter, whereas 36 percent of those with IgE levels =1000 IU per milliliter were reported to have asthma. This relation with the serum IgE level was not explained by a concomitant diagnosis of allergic rhinitis or eczema. Airway hyperresponsiveness to a methacholine challenge also correlated very highly (P<0.0001) with the serum IgE level. This relation remained significant even after the exclusion of children with diagnosed asthma (P<0.0001) and of all children with a history of wheezing, allergic rhinitis, or eczema (P<0.0001). Conclusions. Even in children who have been asymptomatic throughout their lives and have no history of atopic disease, airway hyperresponsiveness appears to be closely linked to an allergic diathesis, as reflected by the serum total IgE level. AU - Sears MR AU - Burrows B AU - Flannery EM AU - Herbison GP AU - Hewitt CJ AU - and Holdaway MD LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 46 IP - DP - 1991 Jan 01 TI - Measures of reversibility in response to bronchodilators in chronic airflow obstruction: relation to airway calibre. PG - 43-45 AB - A study was carried out to examine the independence from starting prebronchodilator FEV1 of four indices commonly used to express airflow (FEV1) reversibility in response to bronchodilators. In 121 patients with chronic airflow obstruction with a mean prebronchodilator FEV1 of 1.81 (43.9% of predicted values) the change in FEV1 expressed as a percentage of the patient's predicted FEV1 was the least dependent on starting FEV1. Reversibility, expressed as a percentage of the prebronchodilator value or as a percentage of the maximal possible increase (predicted minus starting FEV1) was correlated with starting FEV1. AU - Weir DC AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 1 IP - DP - 1991 Jan 01 TI - Aquarium allergy: A case of isolated conjunctivitis from Artemia adulta and Chironomus thummi PG - 141-145 AB - Case report with positive skin prick test. No asthma, probable not occupational (avvocato) AU - Moscato G AU - Vinci G AU - Radaelli C AU - Rossi GL AU - Dellabianca A AU - Biale C LA - PT - DEP - TA - Giornale Italiano di Allergologia e Immunologia Clinica JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 153 IP - DP - 1991 Jan 01 TI - Occupational asthma caused by scented gravel in cat litter boxes PG - 939-940 AB - Perfumes are now added to articles in everyday use to an increasing extent. One example of this is addition of perfume to gravel in cat toilets. It is recognized that perfumes may cause toxic and allergic skin reactions while perfume as the cause of asthma is not so well recognized. In the case described here, exposure to industrial perfume resulted in asthma on account of irritation. AU - Jensen OC AU - Petersen I. LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 144 IP - DP - 1991 Jan 01 TI - Outbreak of the reactive airways dysfunction syndrome after a spill of glacial acetic acid. PG - 1058-1064 AB - The reactive airways dysfunction syndrome (RADS) defines a chronic asthmalike illness with airway hyperresponsiveness that develops within 24 hours of a single, brief, highly irritating inhalation exposure. Support for the syndrome has been limited to case reports. A chemical spill, exposing hospital employees to 100% acetic acid, offered an opportunity to more convincingly establish the existence of RADS. All 56 exposed subjects were asked both to complete a questionnaire focusing on their preexposure health status, potential for exposure, and symptom development after the accident, 8 months after the spill, and to undergo methacholine challenge testing to detect airway hyperresponsiveness. An industrial hygienist, blinded to clinical data, estimated each subject's exposure. Preemployment health history forms were reviewed to assess recall bias. The study questionnaire was returned by 51 (91%) subjects; 24 (47%) consented to methacholine challenge, including 7 of the 8 with RADS-consistent symptoms. Diagnostic criteria for RADS were satisfied by none of 7 (0%) subjects with low exposure, 1 of 30 (3.3%) with medium exposure, and 3 of 14 (21.4%) with high exposure (test of trend p value = 0.021). The odds ratio estimate of the relative risk of RADS in subjects with high exposure was 9.8 (95% Cl, 0.902 to 264.6). Neither stratified analysis nor review of the preemployment health history forms revealed evidence of confounding or recall bias, respectively. The reactive airways dysfunction syndrome appears to be a valid clinical entity. Further study of RADS is especially appropriate given increasing evidence that airway inflammation may be etiologically important in all asthma. AU - Kern DG LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Bronchial hyperreactivity in potroom workers and prognosis after stopping exposure PG - 653-655 AB - A group of 30 potroom workers who developed an asthma-like syndrome during their work in the electrolytic extraction of aluminium (Alu-Swiss process with prebacked anodes) was followed up after stopping exposure. Subjective respiratory complaints were registered and a non-specific bronchial reactivity test using methacholine was performed once or twice during the follow up period (1984-9). After transfer to other work most workers either had an improvement in respiratory symptoms (60%) or even normalisation (27%); only 13% did not show changes. Bronchial hyperreactivity remained unchanged in 67% of workers, was less pronounced in 13%, normalised in 13%, and deteriorated in 7%. Smoking habits, atopy, and duration of exposure did not seem to have influenced the results obtained. No significant correlation was found between duration of exposure and the speed of onset of respiratory symptoms and the later prognosis of the syndrome. Based on the information collected during the period of observation it appears that reactive airway dysfunction syndrome, once induced, has a tendency to persist. An improvement in subjective complaints may be expected, however, after stopping exposure. AU - Saric M AU - Marelja J LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - * IP - DP - 1991 Jan 01 TI - Insoluble and soluble allergens from wheat grain and wheat dust: detection of IgE binding in inhalant and ingestion allergy PG - 27-33 AU - Walsh BJ AU - Baldo BA AU - Clancy R AU - Musk AW AU - Bass DJ AU - Wrigley CW LA - PT - DEP - TA - NER Allergy Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 84 IP - DP - 1991 Jan 01 TI - Fume fever and reactive dysfunction syndrome in a welder PG - 1034-1036 AU - Langley RL LA - PT - DEP - TA - Southern Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 23 IP - DP - 1991 Jan 01 TI - Latex allergy PG - 448-449 AU - LamatheHillion G LA - PT - DEP - TA - Allerg Immunol (Paris) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 58 S1 IP - DP - 1991 Jan 01 TI - Late asthmatic reactions, airway inflammation and chronic asthma in toluene-diisocyanate-sensitized subjects PG - 18-21 AB - To determine the importance of airway inflammation for exacerbation and prognosis of asthma induced by toluene diisocyanate (TDI), we first examined sensitized subjects during asthmatic reactions induced by exposure to TDI in the laboratory. We observed that late and dual, but not early, asthmatic reactions induced by TDI are accompanied by a transient increase of airway responsiveness, bronchoalveolar neutrophilia followed by eosinophilia and by an increase of LTB4 and albumin in bronchoalveolar lavage fluid. All these effects were prevented by pretreatment with prednisone. In addition, we examined the lung pathology of 1 sensitized subject who died after exposure at work. The pathologic features of fatal asthma induced by TDI and of chronic asthma induced by TDI suggest the importance of inflammation for the exacerbation and prognosis of the disease AU - Fabbri LM AU - Saetta M AU - Picotti G AU - Mapp CE LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 4 IP - DP - 1991 Jan 01 TI - Symptoms and perceived indoor air quality among occupants of houses and appartments with different ventilation systems PG - 428-438 AU - Ruotsalainen R AU - Jaakkola JJK AU - Ronnberg R AU - Majanen A AU - Seppanen O LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - IP - DP - 1991 Jan 01 TI - Frequency of lung function disturbances of industrial poultry farmers PG - - AU - Wuthe H AU - Bergman KC AU - Gehlmann B AU - Pippig I AU - Heintze R AU - Luther P AU - Vogel J LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 99 IP - DP - 1991 Jan 01 TI - Increased airways responsiveness in swine farmers PG - 941-944 AB - small diferences AU - Zhou C AU - Hurst TS AU - Cockcroft DW AU - Dosman JA LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 87 IP - DP - 1991 Jan 01 TI - Source of the aeroallergen of soybean dust: a low mollecular mass glycoprotein from the soybean tela PG - 783-788 AU - Swanson MC AU - Li JTC AU - WentzMurtha PE AU - Trudeau WL AU - FerandezCaldas E AU - Griefe A AU - Rodrigo MAJ AU - Morell F AU - Reed CE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 97 IP - DP - 1991 Jan 01 TI - Reactive chemicals in industrial asthma PG - 755-761 AU - Zeiss CR LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 87 IP - DP - 1991 Jan 01 TI - Occupational allergy to pancreatic powder: characterisation of IgE-binding antigens in pancreatic extract by immunoblotting PG - 650-654 AU - van Toorenenbergen AW AU - HuijskesHeins MIE AU - Dieges PH AU - Leijnse B LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 87 IP - DP - 1991 Jan 01 TI - Clinical and immunologic evaluations of reactive dye-exposed workers PG - 839-849 AB - To evaluate type I hypersensitivity to reactive dyes, its prevalence, and its relationship to respiratory dysfunction, we studied clinical and immunologic features, including skin prick tests, RAST, and bronchoprovocation tests, of 309 employees working in a reactive-dye industry. Our survey revealed that 78 (25.2%) employees had work-related lower respiratory symptoms associated with or without nasal, skin, or eye symptoms. Among these employees, 38 (48.7%) had nonspecific bronchial reactivity. Thirteen demonstrated immediate (6) dual (6), or late only (1) asthmatic responses after inhalation of four kinds of reactive-dye solutions. Twenty-five employees demonstrated immediate skin responses to black GR dye, and 21 reacted to orange 3R. Fifty-three employees (17%) had spectfic serum IgE antibody against black GR and orange 3R-human serum albumin conjugate. Specific IgE was detected more frequently in symptomatic employees (30%) and smokers (100%). No association was found between atopy and specific IgE binding. The RAST-inhibition tests of black GR revealed significant inhibitions by black GR-human serum albumin conjugate and minimal inhibitions by unconjugated black GR. Orange 3R RAST-inhibition tests revealed significant inhibitions by conjugated forms of black GR and orange 3R and some inhibitions by two unconjugated dyes, suggesting an immunologic cross-reactivity between these dyes. These findings suggested that reactive dyes could induce immunologic responses, most likely IgE-mediated. AU - Park HS AU - Lee AU - Kim BO AU - Lee KJ AU - Roh JH AU - Moon YH AU - Hong CS LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 66 IP - DP - 1991 Jan 01 TI - Pollen allergy to mimosa (Acacia floribunda) in a Mediterranean area: an occupational disease PG - 253-255 AU - Ariano R AU - Panzani RC AU - Amedeo J LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 33 IP - DP - 1991 Jan 01 TI - Prolonged asthma after smoke inhalation: a report of three cases and a review of previous reports PG - 458-461 AU - Moisan TC LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 80 IP - DP - 1991 Jan 01 TI - Riding school lung? Allergic alveolitis in an 11 year old girl PG - 386-388 AU - Kristiansen JD AU - Lahoz AX LA - PT - DEP - TA - Acta Paediatr Scand JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 33 IP - DP - 1991 Jan 01 TI - Carbonless copy paper: a review of published epidemiologic studies PG - 486-495 AU - Buring JE AU - Hennekens CH LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 4 suppl 14 IP - DP - 1991 Jan 01 TI - Occupational asthma causes by Brazil ginseng dust PG - 507- AU - Subiza J AU - Subiza JL AU - Martin Escribano P AU - Hinojosa M AU - Garcia R AU - Jerez M AU - Subiza E LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 41 IP - DP - 1991 Jan 01 TI - Absence and labour turnover in a foundry attributable to respiratory disease PG - 185-187 AU - Low I AU - Mitchell C LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 151 IP - DP - 1991 Jan 01 TI - Pharmacogenetics in the detection of the hypersusceptible worker PG - 968-976 AU - Stikinger HE AU - Mountain JT AU - Scheel LD LA - PT - DEP - TA - Ann N Y Acad Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 144 IP - DP - 1991 Jan 01 TI - Grain dust and lung function PG - 1314-1321 AU - Huy T AU - de Schipper K AU - ChanYeung M AU - Kennedy SM LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 302 IP - DP - 1991 Jan 01 TI - Proximity of the home to a cooling tower and risk of non-outbreak legionnaires' disease PG - 378-383 AU - Bhopal RS AU - Fallon RJ AU - Buist EC AU - Black RJ AU - Urquhart JD LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 63 IP - DP - 1991 Jan 01 TI - Isocyanate-induced asthma: results of inhalation tests with TDI, MDI and methacholine PG - 9-13 AU - Vogelmeier C AU - Baur X AU - Fruhmann G LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 4 IP - DP - 1991 Jan 01 TI - Comparison of self administered questionnaire with physician diagnosis in the diagnosis of the sick building syndrome PG - 422-427 AU - Burge PS AU - Robertson AS AU - Hedge A LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 63 IP - DP - 1991 Jan 01 TI - Alterations in lung function due to mixtures of organic solvents used in floor laying PG - 43-50 AU - Angerer P AU - Marstaller H AU - BahemannHoffmeister A AU - Rommelt H AU - Hoppe P AU - Kessel R LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 59 IP - DP - 1991 Jan 01 TI - Occurrence and significance of precipitating antibodies against thermophilic actinomycetes in the sera of dairy herd workers, Nangali, Delhi PG - 167-175 AB - The study was prompted by the lack of information on the role of thermophilic actinomycetes in hypersensitivity pneumonitis in India. It reports the occurrence of precipitating antibodies against clinically important thermophilic actinomycetes in the sera of a population sample of dairy herd workers, Nangali, Delhi. Of 112 workers investigated, 28 (25%) showed precipitins against Faenia rectivirgula, 4 (3.2%) against Saccharomonospora viridis, 2 against Thermoactinomyces thalpophilus and one each against T. vulgaris and T. sacchari. The results of enzyme-linked immunosorbent assay (ELISA) indicated that IgG antibody activity against F. rectivirgula was significantly higher in the symptomatic group than in the asymptomatic group (p less than 0.05) of workers and the controls (p less than 0.01). Significant difference in F. rectivirgula IgG activity was also obtained between the precipitin-positive symptomatic group and the precipitin-positive asymptomatic group (p less than 0.05). In strong contrast, the IgG antibody activity against T. thalpophilus was found to be uniformly low. A limited aeromicrobiological sampling of the dairy farm revealed S. viridis (55.8%) to be the commonest species followed by T. vulgaris (19.2%), T. thalpophilus (18.5%), F. rectivirgula (5%) and T. sacchari (1.5%). On the basis of suggestive clinical and laboratory findings, farmer's lung disease was suspected in four dairy herd workers. A comprehensive clinical evaluation including pulmonary function studies on the dairy herd workers and their long-term follow-up is indicated to determine the extent of respiratory morbidity caused by F. rectivirgula, S. viridis, T. thalpophilus, T. sacchari and T. vulgaris in India AU - Gangwar M AU - Khan ZU AU - Gaur SN AU - Randhawa HS LA - PT - DEP - TA - Antonie Van Leeuwenhoek JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 21 IP - DP - 1991 Jan 01 TI - Wheat dust-associated respiratory disease in a farming community PG - 222-226 AB - Sixty-six volunteers who considered themselves to have wheat dust-related respiratory disease, were reviewed from a farming community. A spectrum of disease was described ranging from a mild allergic rhinitis limited to periods of wheat dust exposure through to perennial asthma in which wheat dust was but one of several precipitating factors. Approximately half of those with asthma had symptoms limited to times of wheat dust exposure. Results of a limited survey of farmers showed patterns of symptoms similar to those in the volunteer group. Most subjects were atopic with elevated IgE levels, and had positive skin prick tests to environmental allergens. All but one of 65 subjects tested had a positive RAST test to wheat dust antigen. It is concluded that wheat dust associated respiratory tract disease is a significant problem in Australian farming communities, that a particular pattern of asthma can be described, and that IgE mediated reactions contribute to this disease pattern AU - Clancy RL AU - Ruhno J AU - Scicchitano R AU - Cripps AW AU - Hensley MJ AU - Saunders NA AU - Wrigley C AU - Walsh B AU - Sutherland DC LA - PT - DEP - TA - Aust N Z J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 21 IP - DP - 1991 Jan 01 TI - Olive pollen induces asthmatic response PG - 329-332 AB - We provide evidence that olive pollen extract can induce asthmatic response. The pattern of airway response to olive pollen is investigated. Nineteen patients with seasonal allergic rhinitis and asthma, suspected to be due to olive pollen, all of whom had positive skin-prick test, were investigated. Bronchial challenge with olive pollen extract were performed and the peak flow rate was followed for 20 hr. Eight patients developed dual asthmatic response (DAR), six patients developed early asthmatic response (EAR) and five patients had no asthmatic response. The early maximal fall in FEV1 and the PD15 were not different between the group with DAR and the group with EAR only. We conclude that olive pollen can induce dual asthmatic response AU - Tamir R AU - Pick AI AU - Topilsky M AU - Kivity S LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 33 IP - DP - 1991 Jan 01 TI - Toluene diisocyanate-induced asthma: clinical findings and bronchial responsiveness studies in 113 exposed subjects with work-related respiratory symptoms PG - 720-725 AB - We report the clinical findings and the results of inhalation challenge with toluene diisocyanate (TDI) and methacholine in 113 subjects with a history of exposure to TDI and work-related respiratory symptoms. Only some of the subjects (40.7%) had isocyanate asthma, diagnosed by a positive TDI inhalation challenge. Most reactors had a dual (30.4%) or a late (41.3%) response. The interval between the last occupational exposure and the specific challenge was significantly shorter in reactors, and among this group the number of immediate reactions to TDI decreased progressively with an increasing interval. The reactors had a significantly higher proportion of positive responses to methacholine and a significantly lower mean PD15 FEV-1 (provocative dose of methacholine which provoke a 15% decrease in forced expiratory volume in 1 second) (reactors: 557 micrograms, SEM 92.3; nonreactors: 1346 micrograms, SEM 128, P less than .01). Methacholine challenge could not identify subjects with isocyanate asthma AU - Moscato G AU - Dellabianca A AU - Vinci G AU - Candura SM AU - Bossi MC LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 338 IP - DP - 1991 Jan 01 TI - Extrinsic allergic alveolitis secondary to carmine [letter] PG - 460-460 AU - DietemannMolard A AU - Braun JJ AU - Sohier B AU - Pauli G LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 21 IP - DP - 1991 Jan 01 TI - Allergy from cellulase and xylanase enzymes PG - 609-615 AU - Tarvainen K AU - Kanerva L AU - Tupasela O AU - GrenquistNorden B AU - Jolanki R AU - Estlander T AU - Keskinen H LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 17 IP - DP - 1991 Jan 01 TI - Immediate and delayed allergy from epoxy resins based on diglycidyl ether of bisphenol A PG - 208-215 AU - Kanerva L AU - Jolanki R AU - Tupasela O AU - Halmepuro L AU - Keskinen H AU - Estlander T AU - Sysilampi M LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Environmental, occupational, and personal factors related to the prevalence of sick building syndrome in the general population PG - 451-462 AU - Norback D AU - Edling C LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 2 IP - DP - 1991 Jan 01 TI - Mechanical ventilation in office buildings and the sick building syndrome. An experimental and epidemiogical study PG - 111-121 AU - Jaakkola JJK AU - Heinonen OP AU - Seppanen O LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 46 IP - DP - 1991 Jan 01 TI - Prolonged lethargy in hospital staff after legionella infection PG - 285P-285P AU - Lloyd RS AU - Guest D AU - Fairfax AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - IP - DP - 1991 Jan 01 TI - Relationship between occupational and personal factors and sick building syndrome symptoms in air-conditioned offices PG - - AU - Hedge A AU - Erickson WA AU - Rubin G LA - PT - DEP - TA - Am J Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 1988 IP - DP - 1991 Jan 01 TI - The relationship between passive cigarette smoke exposure in office workers and the symptoms of building sickness PG - 320-326 AU - Robertson AS AU - Burge PS AU - Hedge A AU - Wilson S AU - HarrisBass J LA - PT - DEP - TA - Indoor and Ambient Air Quality JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 1 IP - DP - 1991 Jan 01 TI - Evaluation of two different questionnaires used for diagnosing ocular manifestations in the sick building syndrome on the basis of an objective test PG - 5-11 AU - Franck C AU - Skov P LA - PT - DEP - TA - Indoor Air JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 33 IP - DP - 1991 Jan 01 TI - A review of medical surveillance records of employees exposed to ethyleneamines PG - 148-154 AU - Lewinsohn HC AU - Ott MG LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Respiratory symptoms in children at schools near a foundry PG - 588-591 AU - Symington P AU - Coggon D AU - Holgate S LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Clinical and immunological responses to occupational exposure to alpha-amylase in the baking industry PG - 604-608 AU - Brisman J AU - Belin L LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Characterisation of respiratory health and exposures at a sintered permanent magnet manufacturer PG - 609-615 AU - Deng J AU - Sinks T AU - Elliott L AU - Smith D AU - Singal M AU - Fine L LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Biological monitoring of occupational exposure to tetrahydrofuran PG - 616-621 AU - Ong CN AU - Chia SE AU - Phoon WH AU - Tan KT LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Occupational asthma due to hexahydrophthalic anhydride: a case report PG - 643-645 AU - Chee CBE AU - Lee HS AU - Cheong TH AU - Wang YT AU - Poh SC LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 46 IP - DP - 1991 Jan 01 TI - Occupational wood-dust sensitivity from Euonymus europaeus (spindle tree) and investigation of cross reactivity between E.e. wood and Artemesia vulgaris pollen (mugwort) PG - 186-190 AU - Herold DA AU - Wahl R AU - Maasch HJ AU - Hausen BM AU - Kunkel G LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 21 IP - DP - 1991 Jan 01 TI - A case of occupational asthma, rhinitis and urticaria due to sesame seed PG - 623-624 AU - Lowenstein H LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 4 IP - DP - 1991 Jan 01 TI - Occupational asthma to spores of Pleurotus cornucopiae PG - 1143-1147 AU - Michils A AU - De Vuyst P AU - Nolard N AU - Servais G AU - Duchateau J AU - Yernault JC LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 21 IP - DP - 1991 Jan 01 TI - Quantifying serum antibody class and subclass responses by enzyme immunoassay in humidifier-related disease PG - 601-607 AU - Lewis C AU - McSharry CP AU - Anderson K AU - Speekenbrink A AU - Kemeny DM AU - Durnin S AU - Feyerabend C AU - Sinclair D AU - Watt AD AU - Boyd G LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 6 IP - DP - 1991 Jan 01 TI - Surveillance for occupational asthma PG - 107-110 AU - Balmes JR LA - PT - DEP - TA - Occupational Medicine: state of the art reviews JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 19 IP - DP - 1991 Jan 01 TI - Respiratory symptoms and pulmonary function in chicken catchers in poultry confinement units PG - 195-204 AU - Morris PD AU - Lenhart SW AU - Service WS LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 66 IP - DP - 1991 Jan 01 TI - Occupational asthma and rhinoconjunctivitis from inhalation of crystalline bovine serum albumin powder PG - 301-304 AU - Joliat TL AU - Weber RW LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 52 IP - DP - 1991 Jan 01 TI - Occupational exposure of forrest workers to Glyphosate during brush saw spraying work PG - 61-64 AU - Jauhiainen A AU - Rasanen K AU - Sarantila R AU - Nuutinen J AU - Kangas J LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 99 IP - DP - 1991 Jan 01 TI - Occupational asthma in a developing country PG - 528-528 AU - Syabbalo N LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 52 IP - DP - 1991 Jan 01 TI - A study of respiratory morbidity and pulmonary function among solderers in the electronics industry PG - 45-51 AU - Gupta BN AU - Rastogi SK AU - Husain T AU - Mathur N AU - Pangtey BS LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 33 IP - DP - 1991 Jan 01 TI - Screening for occupational asthma: a word of caution PG - 19-22 AU - McNutt GM AU - Schlueter DP AU - Fink JN LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 87 IP - DP - 1991 Jan 01 TI - Reassessment of the temporal patterns of bronchial obstruction after exposure to occupational sensitizing agents PG - 630-639 AB - Typical asthmatic reactions after exposure to common or occupational allergens have been classified as isolated immediate, early late, late, and dual (Pepys and Hutchcroft, 1975). Atypical reactions can also occur, but their temporal behavior and frequency are unknown. We analyzed 69 bronchospastic reactions after exposure to three types of occupational sensitizers in the laboratory: isocyanates, western red cedar, and IgE sensitizing agents. Graphs of the reactions were presented to three observers in a blind, randomized way. Reactions were defined as follows: (1) typical patterns, that is, isolated immediate, early late, late, and dual, as put forward by Pepys and Hutchcroft, and (2) atypical patterns including progressive (onset, during, or minutes after exposure, progressing to a maximum reaction 5 to 6 hours later) and square waved (similar to a dual reaction but with only partial recovery [less than 10%] between the immediate and late falls in FEV1). Some curves were also analyzed by polynomial regression. The three observers agreed in 59/69 cases (86%), and a consensus was reached after discussion for the remaining subjects. Fifteen of 63 (22%) reactions were atypical. IgE-mediated reactions and reactions to red cedar were, respectively, mainly of the immediate and late types. The distribution of reactions to isocyanates, however, was significantly different (chi-square, 6.1; p = 0.01), the "progressive" pattern occurring in 7/23 instances (30%). There was a satisfactory concordance between visual assessment and polynomial fit analysis in distinguishing dual from square-waved reactions. We conclude that isocyanates frequently cause atypical progressive bronchospastic reactions that are rarely observed after exposure to IgE agents and western red cedar. AU - Perrin B AU - Cartier A AU - Ghezzo H AU - Grammer L AU - Harris K AU - Chan H AU - ChanYeung M AU - Malo JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 114 IP - DP - 1991 Jan 01 TI - An experimental human model of metal fume fever PG - 930-936 AU - Blanc P AU - Wong H AU - Bernstein MS AU - Homer A AU - Boushey A LA - PT - DEP - TA - Ann Int Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 88 IP - DP - 1991 Jan 01 TI - Identification of soybean dust as an epidemic asthma agent in urban areas by molecular marker and RAST analysis of aerosols PG - 124-134 AB - From 1981 to 1987, 26 outbreaks of asthma have occurred in the city of Barcelona, Spain, affecting a total of 687 subjects and causing 1155 emergency room admissions. Assays of urban aerosols collected with high-volume samplers between October 1986 and May 1989 have indicated that soybean dust originating from harbor activities (and not traffic or industrial pollution) is the causal agent for these epidemics. Soybean particulates in the filters have been characterized from the composition of the alcohol fraction, namely, campesterol, stigmasterol, beta-sitosterol, n-triacontan-1-ol, and n-dotriacontan-1-ol, constituting a series of aerosol components correlated with the epidemiologic data. This result has also been confirmed by immunochemical assay of specific soybean allergens. The concentration of these sterols in the air corresponds to a 24-hour average level of soybean dust in the order of 25 micrograms/m3 on epidemic days. These results suggest the advisability of monitoring soybean dust in air particulates of populated areas surrounding soybean storage or processing plants. The techniques presented here afford a simple way for the recognition of soybean dust in aerosols containing high concentrations of organic pollutants of traffic or industrial origin. AU - Aceves M AU - Grimalt JO AU - Sunyer J AU - Anto JM AU - Reed JE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 88 IP - DP - 1991 Jan 01 TI - Occupational asthma caused by vetch (Vicia sativa) PG - 135-136 AU - Picon SJ AU - Carmona JGB AU - Sotillos MMG LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - IP - DP - 1991 Jan 01 TI - Patterns of asthma in the workplace PG - 283-290 AU - Burge PS LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 35 IP - DP - 1991 Jan 01 TI - Structure activity hypotheses in occupational asthma caused by low molecular weight substances PG - 129-137 AB - Many substances with a low molecular weight (less than 1000 molecular weight) but of different chemical classes are recognized as causative agents of occupational asthma. Some of their major chemical properties are highlighted in relation to their putative interactions with human macromolecules. Thus, certain transition metals which form co-ordination complexes may chelate human proteins. Several organic substances have marked basic properties which are responsible for their chemical reactivity. Some of these, such as the bifunctional bases ethylene diamine, piperazine and para-phenylene diamine are known causative agents of asthma while their monofunctional counterparts, in spite of wide industrial application, are not similarly recognized causes. This suggests that the presence of multiple reactive groups is of importance in the molecular interactions with human macromolecules that eventually lead to occupational asthma. Reference is also made to other substances to exemplify hypothetical mechanisms of these interactions. Such generation of hypotheses is a prelude to quantitative studies of structure activity relationships (QSARs) where the hypotheses can be tested and revised. Structure activity hypotheses in isolation might not be adequate predictors of the risk of occupational asthma. However, if applied to novel chemical entities they might eventually prove useful in contributing to the development of policies for prospective health surveillance and in establishing priorities for epidemiological research. AU - Agius RM AU - Nee J AU - McGovern B AU - Robertson A LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - IP - DP - 1991 Jan 01 TI - Advances in asthmology,1990 PG - 277-282 AU - Nakazawa T LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 41 IP - DP - 1991 Jan 01 TI - Asthma in silk workers PG - 140-142 AU - Uragoda CG AU - Wijekoon PNB LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - IP - DP - 1991 Jan 01 TI - Indoor pollution PG - - AU - Department of the Environment LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 1 IP - DP - 1991 Jan 01 TI - Environment Committee, Sixth report; Indoor Pollution PG - - AU - Rossi H LA - PT - DEP - TA - HMSO 61-1 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 40 suppl 1 IP - DP - 1991 Jan 01 TI - IgE mediated occupational respiratory and skin allergy (ORSA) to a spider mite PG - 66- AU - Astarita C AU - Franzise A AU - Sproviero S AU - Altucci P LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 4 IP - DP - 1991 Jan 01 TI - Formaldehyde--induced bronchial asthma--does it really exist? PG - 317-320 AB - These studies try to explain if there is a correlation between exposure to formaldehyde (FM) and bronchospastic reactions. 367 workers were examined in our study. They were aged 23 to 52. They had been exposed occupationally to FM at concentration not exceeding 0.5 mg/m3. All subjects suffered from respiratory symptoms; 14 had chronic bronchitis, 2 bronchial asthma. A history was taken and spirometry performed (peak expiratory flow (PEF)) with use of a single blind crossover method, in a three-day clinical observation. All subjects were provoked with histamine (PC20). Skin prick tests with common allergens, a patch test with FM and formaldehyde-specific IgE antibodies assay were performed. There were no significant differences in the respiratory parameters during the three-day clinical observation. Two subjects were supposed to have bronchial asthma induced by FM, but for lack of differences in respiratory parameters the occupational background of their asthma was excluded. None of the subjects complained of significant irritant symptoms. On the basis of our results one may doubt that FM is capable of acting as a respiratory sensitizer AU - Gorski P AU - Krakowiak A LA - PT - DEP - TA - Pol J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 25 IP - DP - 1991 Jan 01 TI - An experimental etiological study of toluene diisocyanate (TDI) induced occupational asthma. PG - 347-350 AB - Thirteen guinea pigs were immunized with TDI-BSA conjugates employing CFA or AHG adjuvant or only adjuvant as a control via intraperitoneal route. After 5-8 weeks, 30.8% of the sensitized animals experienced asthma attacks after a TDI-HSA challenge. The dynamic airway pulmonary ventilation imaging with Tc-99m-DTPA showed an accumulation of radioactivity. The radioactivity ratio of trachea or bronchus/lung was increased 6.46-29 times in contrast with before challenge. A specific IgE and IgG type antibodies were developed in 87.5% of TDI-BSA/CFA sensitized animals and 40% of TDI-BSA/AHG sensitized animals by passive cutaneous anaphylaxis (PCA). Results of these suggested that allergic response play an important role in the mechanism of TDI-induced asthma AU - Liu JY LA - PT - DEP - TA - Chung Hua Yu Fang I Hsueh Tsa Chih JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 46 IP - DP - 1991 Jan 01 TI - Studies on the pneumoconiosis risk of dental laboratory technicians due to palladium particles in dust. PG - 519-522 AU - Augthun M AU - Kirkpatrick CJ AU - Schyma S LA - PT - DEP - TA - Dtsch Zahnarztl Z JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - - IP - DP - 1991 Jan 01 TI - Medical aspects of occupational asthma MS25 PG - - AU - Health and safety executive LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 111 IP - DP - 1991 Jan 01 TI - Allergic alveolitis. Humidifier fever. PG - 1853-1854 AB - Among predisposed persons the use of home humidifiers may induce febrile conditions named humidifier fever. The disease is considered to be an extrinsic allergic alveolitis. It may also be induced by modern ultrasound humidifiers. A case is described where an ultrasound humidifier was found to be the cause of humidifier fever AU - Johnsen B LA - PT - DEP - TA - Tidsskr Nor Laegeforen JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 14 IP - DP - 1991 Jan 01 TI - Cobalt particles, identified by energy-dispersive X-ray microanalysis, in diamond polisher's lung PG - 92-95 AU - Dinsdale D AU - Verbeken EK AU - Demedts M AU - Nemery B LA - PT - DEP - TA - Archives of Toxicology - Supplement - Archiv Fur T JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 30 IP - DP - 1991 Jan 01 TI - Bacterially contaminated oil mists in engineering works: a possible respiratory hazard PG - 404-406 AU - TraversGlass SA AU - Griffin P AU - Crook B LA - PT - DEP - TA - Grana JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 12 IP - DP - 1991 Jan 01 TI - Insect allergy: biochemical and immunological analysis of the allergens PG - 246-24* AU - Shulman S LA - PT - DEP - TA - Progr Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 20 IP - DP - 1991 Jan 01 TI - First-aid reports of acute chlorine gassing among pulpmill workers as predictors of lung health consequences PG - 71-81 AB - 8 Workers in pulpmills can be exposed to a multitude of gases hazardous to respiratory function, the most common of which is chlorine gas. First-aid reports of acute gas overexposure incidents ("gassings") over an 8 year period were used to generate exposure data on a group of pulpmill workers whose respiratory function had been studied cross-sectionally in 1981 and 1988. Three hundred forty-eight incidents representing 174 workers were identified, 78% of these being treated solely by the first-aid attendant with the administration of O2 and cough suppression medication. Among 316 workers tested during a 1988 respiratory health survey, 78 had at least one chlorine or chlorine dioxide "gassing" incident. There was a significant decrease in the FEV1/FVC ratio (p less than .05) as well as increased risk for workplace associated chest symptoms in this group with at least one "gassing" incident. In an age- and smoking-matched analysis, among workers tested both in 1981 and 1988, there was a greater decline in FEV2/FVC ratio and MMF (p less than .05) in the "gassed" group than in the nonexposed group over the 7 year period of observation. These results emphasize the need for worker protection against accidental chlorine gas exposures AU - Salisbury DA AU - Enarson DA AU - ChanYeung M AU - Kennedy SM LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 46 IP - DP - 1991 Jan 01 TI - RAST-detection of specific IgE in diphenylmethane diisocyanate exposed workers: considerations in performance of the test PG - 166-172 AU - Spiazzi A AU - Boccagni P AU - Germano P AU - Pezzini A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Quantitive skin prick and bronchial provocation tests with platinum salt PG - 830-837 AU - Merget R AU - SchultzeWerninghaus G AU - Bode F AU - Bergmann E AU - Zachgo W AU - MeierSydow J LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - * IP - DP - 1991 Jan 01 TI - Occupational allergic reactions among workers in a penicillin-manufacturing plant PG - 340-346 AU - Roberts EA LA - PT - DEP - TA - Industr Hyg Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 82 IP - DP - 1991 Jan 01 TI - Isocyanates: adverse effects on health [Italian] PG - 328-335 AU - Mapp CE LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 4 suppl 13 IP - DP - 1991 Jan 01 TI - Late asthmatic reactions, airway inflammation and chronic asthma in TDI sensitized subjects PG - 136s-138s AB - Sensitized subjects may develop symptoms of asthma after exposure to isocyanates in their place of work. After challenge with isocyanates in the laboratory, sensitized subjects develop immediate, late and dual asthmatic reactions. We speculated that toluene diisocyanate (TDI) might cause late asthmatic reactions and increase bronchial responsiveness by causing an acute inflammatory reaction in the airways, and that airway inflammation may be responsible for persistence of occupational asthma induced by isocyanates. To test these hypotheses, we examined sensitized subjects during asthmatic reactions induced by exposure to toluene diisocyanate in the laboratory. We observed that late and dual, but not early, asthmatic reactions are associated with a transient increase of bronchial responsiveness which is associated with an acute inflammatory reaction of the airways characterized by an increase of neutrophils followed by eosinophils, by an increase of leukotriene B4 and albumin in bronchoalveolar lavage fluid, and that all these effects are inhibited by steroids. Longitudinal studies suggest that the majority of subjects with occupational asthma continue to have persistent asthma months and years after the cessation of exposure, and the results of our studies combined with the results of studies performed by others suggest that the persistence of asthma may be related to the persistence of airway inflammation. [References: 25] AU - Fabbri LM AU - Picotti G AU - Mapp CE LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - * IP - DP - 1991 Jan 01 TI - Bakers rhinoconjunctivitis: a case report PG - 37-38 AU - Rosen JP LA - PT - DEP - TA - NER Allergy Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - * IP - DP - 1991 Jan 01 TI - Laboratory investigations with the bakery workers in Djakova PG - *-* AU - Rosic D AU - Bozovic N AU - Despotovic N AU - Rosic J AU - Bojovic M AU - Vidanovic M LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Inhalation of hydrogen sulphide: a case of subacute manifestations and long term sequelae PG - 286-287 AU - Parra O AU - Monso E AU - Gallego M AU - Morera J LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Occupational asthma due to maleic anhydride PG - 283-285 AU - Lee HS AU - Wang YT AU - Cheong TH AU - Tan KT AU - Chee BE AU - Narendran K LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Diurnal variation in peak expiratory flow rate among polyvinylchloride compounding workers PG - 275-278 AU - Lee HS AU - Ng TP AU - Phoon WH LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 67 IP - DP - 1991 Jan 01 TI - Occupational asthma due to latex surgical gloves PG - 319-323 AU - Marcos C AU - Lazaro M AU - Fraj J AU - Quirce S AU - de la Hoz B AU - FernandezRivas M AU - Losada E LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - * IP - DP - 1991 Jan 01 TI - Occupational asthma in a home pieceworker PG - *-* AU - Liss GM AU - Halperin WE AU - Landrigan PJ LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - The characteristics of respiratory ill health of wool textile workers PG - 221-228 AU - Love RG AU - Muirhead M AU - Collins HPR AU - Soutar CA LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Dimethylethylamine in mould core manufacturing: exposure, metabolism, and biological monitoring PG - 203-207 AU - Lundh T AU - Stahlbom B AU - Akesson B LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 43 IP - DP - 1991 Jan 01 TI - Extrinsic allergic alveolitis in a cold storage worker PG - 221-222 AU - Mader I AU - Liebetrau G AU - Treutler D LA - PT - DEP - TA - Z Gesamte Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - * IP - DP - 1991 Jan 01 TI - Rezoni allergiche alla penicillina nei lavatori addetti alla produzione dell'antibiotico PG - *-* AU - Maffei R AU - Napolitano L LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 115 IP - DP - 1991 Jan 01 TI - Prevalence of atopy and hypersensitivity to formaldehyde in pathologists PG - 614-616 AU - Salkie ML LA - PT - DEP - TA - Arch Pathol Lab Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - * IP - DP - 1991 Jan 01 TI - Smallpox handlers lung PG - 274-275 AU - Morris Evans WH AU - Foreman HM LA - PT - DEP - TA - Proc R Soc Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 82 IP - DP - 1991 Jan 01 TI - Asthma and systemic toxic reaction due to cabreuva (Myrocarpus fastigiatus Fr. All.) wood dust PG - 446-450 AB - A 48-year-old parquet floor layer suffered from an attack of asthma at work and systemic toxic reaction after exposure to cabreuva wood dust (Myrocarpus fastigiatus Fr. All.). Exposure to the same dust in hospital produced a late asthmatic reaction with fever, vomiting and myalgia. Leucocytosis with neutrophilia was present after a bronchial provocation test but no radiological changes were observed. A control bronchial provocation test with fir wood dust was negative. It was not possible to study the systemic toxic reaction further due to non-collaboration of the patient; nevertheless, these findings show that systemic reactions to wood dust should always be investigated even though their occurrence is fortunately rare AU - Innocenti A AU - Romeo R AU - Mariano A LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Computed tomography of the thorax in workers exposed to hard metals PG - 208-210 AU - Menselson DS AU - Gendal ES AU - Janus CL AU - Fischbein A LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 143 IP - DP - 1991 Jan 01 TI - Respiratory effects of occupational exposure in a general population sample in north Italy PG - 510-515 AB - We assessed the effects of occupational exposure in a general population sample living in an unpolluted rural area of North Italy. In the age range of 18 to 64 yr, there were 417 participants who reported any exposure to dusts, chemicals, or gases and 1,218 who reported no exposure. Each subject completed a standardized interviewer-administered questionnaire (CNR-questionnaire). A variable proportion of participants succeeded in performing flow-volume curves, diffusing capacity of carbon monoxide, and slope of alveolar plateau of nitrogen. There was no significant difference for symptom prevalence rates between exposed and nonexposed in men and women who smoke. In nonsmoking women, those exposed showed significantly higher prevalence rates for exertional dyspnea and asthma. Regarding lung function, in exposed male smokers there was a significantly higher slope of the alveolar plateau. In exposed female nonsmokers, FEV1 and forced expiratory flows were significantly lower. Multiple logistic models in the overall group, accounting for age, smoking, and pack-years, showed that work exposure was associated significantly with higher risks for all symptoms in men (e.g., odds ratio: 2.76 for dyspnea, 2.31 for asthma, 1.69 for cough, and 1.64 for phlegm); in females, the association was significant for dyspnea (OR = 3.74) and asthma (OR = 3.29). Exposed men also had a significantly higher risk for %FEV1 or FEV1/FVC% below 70 (OR = 1.45). Our findings confirm those of the other few epidemiologic surveys in general population samples and contribute to the suggestion of a causal association between occupational exposure and chronic obstructive pulmonary disease AU - Viegi G AU - Prediletto R AU - Paoletti P AU - Carrozzi L AU - di Pede F AU - Vellutini M AU - di Pede C AU - Giuntini C AU - Lebowitz MD LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - * IP - DP - 1991 Jan 01 TI - Variations on respiratory disease morbidity among pulp and paper town residents PG - *-* AU - Deprez RD AU - Oliver C AU - Halteman W LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 60 IP - DP - 1991 Jan 01 TI - The in vitro effect of toluene diisocyanate on lymphocyte cyclic adenosine monophosphate production by isoproterenol, prostaglandin and histamine PG - 223-229 AU - Davies RJ AU - Butcher BT AU - O'Neil CE AU - Salvaggio JE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 56 IP - DP - 1991 Jan 01 TI - Recurrent asthma following a single exposure to grain in a farmer PG - 245-246 AU - Davies RJ AU - Green M AU - Schofield NMC LA - PT - DEP - TA - Tubercle JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 67 IP - DP - 1991 Jan 01 TI - Late asthma caused by inhalation of Lepidoglyphus destructor PG - 126-128 AU - Sotillos MMG AU - Carmona JGB AU - Picon SJ LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - * IP - DP - 1991 Jan 01 TI - Radioallergosorbent testing of toluene diisocyanate-reactive individuals using a p-tolyl isocyanate antigen PG - *-* AU - Butcher BT AU - O'Neil CE AU - Reed MA AU - Salvaggio JE LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Injurious effects of wool and grain dust on alveolar epithelial cells and macrophages in vitro PG - 196-202 AU - Brown DM AU - Donaldson K LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 66 IP - DP - 1991 Jan 01 TI - Asthma caused by occupational exposure to a furan-based binder system PG - 458-463 AB - A 50-yr-old mold maker developed severe asthma a few weeks after commencing work with a furan binder. Asthma recurred within hours of subsequent exposure and was confirmed by measurements every 2 hr of peak flow rate. The molds were prepared by mixing sand with a resin (containing furfuryl alcohol, paraformaldehyde, and xylene) and a catalyst (containing sulfuric acid, phosphoric acid, and butyl alcohol). Occupation-type exposure in the laboratory to the resin mixed with catalyst, and to pure furfuryl alcohol mixed with sulfuric acid or butyl alcohol, provoked late asthmatic responses and heightened nonallergic bronchial responsiveness to inhaled histamine. No changes were produced by the same exposures in an asthmatic volunteer with a similar degree of histamine bronchial responsiveness, or in the worker after exposure to resin alone and catalyst alone. Avoidance of exposure was followed by clearing of symptoms and return of histamine bronchial responsiveness towards normal. The findings identify the occurrence of specific bronchial responsiveness to volatile reaction product(s) of furfuryl alcohol following reaction with sulfuric acid or with butyl alcohol. The incidence of this problem needs investigation, especially since furan-based binder systems are replacing traditional methods. AU - Cockcroft DW AU - Cartier A AU - Jones G AU - Tarlo SM AU - Dolovich J AU - Hargreave FE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Occupational asthma caused by exposure to neurospora in a plywood factory worker PG - 279-282 AU - Cote J AU - Chan H AU - Brochu G AU - ChanYeung M LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 63 IP - DP - 1991 Jan 01 TI - Hexahydrophthalic acid in urine as an index of exposure to hexahydrophthalic anhydride PG - 77-79 AU - Jonsson B AU - Welinder H AU - Skarping G LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - * IP - DP - 1991 Jan 01 TI - Comparison of chironomid midge with other allergens in asthmatic patients PG - *-* AU - Ito K AU - Yamashita N AU - Nakada S AU - Miyamoto T AU - Shibuya T AU - Kamei K AU - Sasa M LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - * IP - DP - 1991 Jan 01 TI - Mites (Acaridida) as possible causes of allergy among elevator workers PG - *-* AU - Humiczewska M LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - * IP - DP - 1991 Jan 01 TI - Skin tests and blood leucocyte histamine release of patients with allergies to labatory animals PG - *-* AU - Hook WA AU - Powers K AU - Siraganian RP LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - * IP - DP - 1991 Jan 01 TI - Pulmonary function in PiM and MZ grainworkers PG - *-* AU - Horne SL AU - Cockcroft DW AU - Dosman JA LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 23 IP - DP - 1991 Jan 01 TI - TDI and lung function PG - 411-413 AU - Kay S LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 143 IP - DP - 1991 Jan 01 TI - Lung health consequences of reported accidental chlorine gas exposure among pulpmill workers PG - 74-79 AU - Kennedy SM AU - Enarson DA AU - Janssen RG AU - ChanYeung M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - IP - DP - 1991 Jan 01 TI - Contact dermatitis and respiratory symptoms from Narcissus pseudonarcissus PG - - AU - Gon‡alo S AU - Freitas JD AU - Sousa I LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 29 IP - DP - 1991 Jan 01 TI - Lymphocyte transformation test with nickel in hard metal asthma: another sensitizing component of hard metal PG - 153-160 AB - To determine cell-mediated immunity to nickel, another matrix in hard metal besides cobalt, lymphocyte transformation tests (LTT) with nickel were carried out in seven hard metal asthma patients all of who had reacted to cobalt chloride in the bronchial provocation tests (BPT). Immunoallergic studies prior to the present study revealed that three of the seven generated a simultaneous positive reaction in the BPT with nickel and the allergosorbent test with nickel-conjugated human serum albumin (Ni-HSA). A stimulation index in LTT indicating a positive response was defined on the basis of results from the studies in the controls. Data revealed that two of the three who showed a combination of positive bronchial and immunological reactions with nickel had a positive LTT with nickel. In the other five, peripheral lymphocytes did not proliferate in response to nickel. Thus it is suggested that cell-mediated immunity to nickel as well as cobalt is implicated in some cases associated with hard metal asthma AU - Kusaka Y AU - Nakano Y AU - Shirakawa T AU - Fujimura N AU - Kato M AU - Heki S LA - PT - DEP - TA - Ind Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Increase in the numbers of CD8 positive lymphocytes and eosinophils in peripheral blood of subjects with late asthmatic reactions induced by toluene diisocyanate PG - 116-121 AU - Finotto S AU - Fabbri LM AU - Rado V AU - Mapp CE AU - Maestrelli P LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 46 IP - DP - 1991 Jan 01 TI - Occupational asthma due to styrene PG - 396-397 AB - In a patient with asthma who was exposed to styrene serial self recorded measurements of peak expiratory flow showed the asthma to be work related, and inhalation tests with styrene reproducibly provoked a dual asthmatic response and increased responsiveness to inhaled histamine. AU - Hayes JP AU - Lambourn L AU - Hopkirk JAC AU - Durham SR AU - Newman Taylor AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Bronchial asthma in a paediatric nurse caused by inhaled pancreatic extracts PG - 355-356 AU - Hayes JP AU - Newman Taylor AJ LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 41 IP - DP - 1991 Jan 01 TI - Obstructive lung injury after treating wood with sodium hydroxide PG - 45-46 AU - Hansen KS AU - Isager H LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 144 IP - DP - 1991 Jan 01 TI - Asthma and allergy associated with occupational exposure to ispaghula and senna products in a pharmaceutical work force PG - 1065-1069 AB - A cross-sectional study of 125 pharmaceutical workers engaged in the manufacture of bulk laxatives based on ispaghula husks (psyllium) and senna pods was conducted. Skin prick tests with extracts of these components revealed that 7.6% were allergic to ispaghula and 15.3% were allergic to senna. Four (3.2%) cases of occupational asthma were identified. The overall prevalence of asthma (6.4%) was less than in a comparable nonexposed Australian population (odds ration, 0.44). Symptoms referrable to the upper airways, eyes, and skin were more prevalent (52.0%) than in the reference population (odds ratio, 1.53). Smokers and nonatopic subjects were more likely to complain of these symptoms if they were sensitized to senna and/or ispaghula than if they were not sensitized (relative risks, 1.9 and 2.6, respectively). Sensitization to ispaghula and/or senna was not a risk factor for asthma. An IgE-mediated allergic mechanism is probably responsible for the allergic symptoms in many of these subjects. Smoking seems to be a cofactor in this process. AU - Marks GB AU - Salome CM AU - Woolcock AJ LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 33 IP - DP - 1991 Jan 01 TI - Toluene Di-isocyanate-Induced Asthma : Clinical Findings And Bronchial Responsiveness Studies In 113 Exposed Subjects With Work-Related Respiratory Symptoms PG - 720-725 AU - Moscato G AU - Dellabianca A AU - Vinci G et al LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 100 IP - DP - 1991 Jan 01 TI - Outcome of assessment for occupational asthma PG - 329-335 AB - Among 154 referrals to a university hospital clinic for assessment of possible occupational asthma, the feasibility and results of different investigations were assessed using a consistent approach to all patients. A positive skin test to a workplace allergen (14 percent of all subjects), positive peak flow workplace changes (12 percent), improvement in methacholine response on holiday (9 percent), and/or positive specific challenge testing (14 percent) supported the diagnosis of occupational asthma in 61 subjects (39 percent of the total referrals). Fifty-one of these were related to a workplace sensitizer and ten to a presumed irritant. Occupational asthma was excluded in 48 subjects (31 percent) who had normal methacholine responsiveness within 24 hours of work (22 percent of the 154 subjects), peak flow readings no worse at work than on holidays (14 percent of the total referrals) and/or negative specific challenge testing (10 percent of the total referrals). Insufficient information could be obtained for a diagnosis in the remaining 45 subjects (28 percent). No single investigation was considered diagnostic in this study, as each could be positive or negative for other reasons AU - Tarlo SM AU - Broder I LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 100 IP - DP - 1991 Jan 01 TI - Peak expiratory flow rates in possible occupational asthma PG - 63-69 AB - Objective criteria for interpretation of peak expiratory flow rate readings were assessed in 50 patients evaluated for suspected occupational asthma who had at least two weeks of PEFR readings and an objective diagnosis based on other investigations. The prevalence of OA was 36 percent. Peak flows were interpreted by two observers blinded to other results. Criteria for a PEFR interpretation of OA were as follow: diurnal variation greater than or equal to 20 percent relatively more frequently or with greater variation on working days than days off work. With the objective diagnoses as the gold standard, the sensitivity of the PEFR interpretations was 72 percent for OA; specificity for no asthma was 53 percent. Excluding those with greater than or equal to 20 percent variation on only one day sensitivity improved to 93 percent for OA, and specificity to 77 percent. There was an acceptable level of interobserver variation (kappa 62 to 83 percent). We conclude that simple objective criteria for PEFR interpretation can be developed with acceptable interobserver variation. AU - Liss GM and Tarlo SM LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 143 IP - DP - 1991 Jan 01 TI - Is The Clinical History A Satisfactory Means Of Diagnosing Occupational Asthma? PG - 528-532 AB - In some countries a diagnosis of occupational asthma for medicolegal purposes is made when a questionnaire is suggestive and the individual is exposed to a product known to be a sensitizer. The value of an open questionnaire administered by physicians with experience in occupational asthma is unknown, however. We prospectively assessed all subjects (162) referred to our clinic because their physicians thought their asthma might be work related. The medical questionnaire included questions about the nature of the symptoms (dyspnea, wheezing, cough, and chest tightness) and the timing (worse at work or after a shift at work or improved during weekends or holidays). An initial clinical assessment was set by the physician on a scale that ranged from highly probable to probable, uncertain, unlikely, or absent. Subjects then underwent objective assessment with specific inhalation challenges (n = 72), serial monitoring of peak expiratory flow rates for periods at work and away from work (n = 29), or both (n = 61), to confirm or rule out the diagnosis of occupational asthma. A total of 75 subjects (46%) were shown to have occupational asthma. Symptoms alone (type and timing) did not provide a satisfactory differentiation between those subjects with and those without occupational asthma. For example, 66 of 75 (88%) subjects with occupational asthma said that their symptoms improved during holidays, but 66 of 87 (76%) subjects without occupational asthma experienced a similar improvement.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Malo JL AU - Ghezzo H AU - L'Archeveque J et al LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Occupational respiratory disease in the United Kingdom 1989: a report to the British Thoracic Society and the Society of Occupational Medicine by the SWORD project group PG - 292-298 AB - A voluntary scheme for the surveillance of work related and occupational respiratory disease (SWORD) was established in January 1989 with help from the British Thoracic Society and the Society of Occupational Medicine and support from the Health and Safety Executive. Three hundred and fifty four chest physicians representing 90% of the chest clinics in the United Kingdom and 361 occupational physicians submit reports regularly of newly diagnosed cases of work related respiratory illness with information on age, sex, residence, occupation, and suspected causal agent. In 1989 2101 cases were notified, of which frequent diagnoses were asthma (26%), mesothelioma (16%), pneumoconiosis (15%), benign pleural disease (11%), and allergic alveolitis (6%). Incidence rates calculated against denominators from the Labour Force Survey showed very large differences between occupational groups, especially for asthma and asbestos related diseases. Substantial regional variation in the incidence of asthma was not explained by the geographical distribution of high risk industries and was probably due to differing levels of ascertainment. The results imply that the true frequency of acute occupational respiratory disease in the United Kingdom may have been three times greater than that reported. AU - Meredith SK AU - Taylor VM AU - McDonald JC LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Quantitative Skin Prick And Bronchial Provocation Tests With Platinum Salt PG - 830-837 AB - Occupational asthma due to platinum salts is a frequent disease in platinum refineries. The diagnosis is based upon a history of work related symptoms and a positive skin prick test with platinum salts. Bronchial provocation tests have not been performed in epidemiological studies because the skin test is believed to be highly specific and sensitive. As no reliable data about this issue currently exist, this study assesses the use of skin prick and bronchial provocation tests with methacholine and platinum salt in platinum refinery workers. Twenty seven of 35 workers, who were referred to our clinic with work related symptoms and nine control subjects with bronchial hyperreactivity underwent a skin prick test and bronchial provocation with methacholine and platinum salt. For skin prick and bronchial provocation tests with platinum salt a 10(-2)-10(-8) mol/l hexachloroplatinic acid solution, in 10-fold dilutions was used. Four of the 27 subjects and all controls showed neither a bronchial reaction nor a skin reaction. Twenty three subjects were considered allergic to platinum salt; 22 of these showed a fall of 50% or more in specific airway conductance after inhalation of the platinum salt solution. Four workers experienced a positive bronchial reaction despite a negative skin prick test. No correlation of responsiveness to methacholine with responsiveness to platinum salt was found, but the skin prick test correlated with the bronchial reaction to platinum salt (rs = 0.50, p less than 0.023, n = 22). One dual reaction was seen in bronchial provocation tests. Side effects of both skin tests and bronchial provocation tests with platinum salt were rare and were not encountered in workers without a skin reaction to platinum salt. It is concluded that bronchial provocation tests with platinum salts should be performed on workers with work related symptoms but negative skin tests with platinum salts. AU - Merget R AU - SchultzeWerninghams G AU - Bode F et al LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 100 IP - DP - 1991 Jan 01 TI - The use of portable peak flowmeters in the surveillance of occupational asthma PG - 1515-1521 AB - The purpose of this study was to identify the strengths and limitations of using portable peak flowmeters to document suspected cases of occupational asthma that were reported to a statewide surveillance project. The New Jersey Department of Health conducts surveillance for occupational asthma as part of the federally sponsored Sentinel Event Notification System for Occupational Risks (SENSOR). Between May 1988 and January 1990, 70 cases were reported voluntarily by physicians. Subjects who were still employed in suspected work sites were requested to test themselves for at least 15 days, using portable peak flowmeters to generate serial measurements of their peak expiratory flow rate (PEFR). For each of the 14 subjects who were successfully tested, the PEFR data provided valuable information about their asthma-work association. However, a large number of subjects whose cases were reported (56) either could not be tested or were not successfully tested. The proportion of subjects completing the test would probably improve if it were conducted when their conditions were first diagnosed. Accordingly, the collection of serial peak flow measurements to document occupational asthma would best be initiated by the treating physician when the patient first sought care, rather than waiting until after the case was reported to the state health department. AU - Henneberger PK AU - Stanbury MJ AU - Trimbath LS AU - Kipen HM LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 63 IP - DP - 1991 Jan 01 TI - Immunological and respiratory changes in soy bean workers PG - 15-20 AU - Zuskin E AU - Kanceljak B AU - Schachter EN AU - Witek TJ AU - Marom Z AU - Goswami S AU - Maayani S LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - A preliminary report of a surveillance scheme of occupational asthma in the West Midlands PG - 579-582 AB - The results from the first year of a notification scheme for occupational asthma in the West Midlands Region are presented. The scheme includes recognised new and old cases of occupational asthma. Thirty new cases were recognised per million general working population in the first year. Cases recognised in different occupational groups ranged from 154 per million painters and assembly workers to three per million clerical staff. Analysis of the agents to which workers with recognised occupational asthma were exposed identified commonly recognised agents such as isocyanates, colophony, and flour and generally less well recognised ones such as oil mists. The distribution of new and old reported cases, including those receiving compensation from the Department of Social Security, were calculated by health authority using estimated working population as the denominator. The number of reported cases varied from 303 per million in a semi-urban health authority that has a respiratory physician with a special interest in occupational asthma to less than 30 cases per million in eight health authorities. The most likely cause for these differences is lack of ascertainment. AU - Gannon PFG AU - Burge PS LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 46 IP - DP - 1991 Jan 01 TI - Abnormal lung function associated with asbestos disease of the pleura, the lung, and both: a comparative analysis PG - 33-38 AB - The impairment of lung function associated with different types of asbestos related disease was examined in 1298 men. The 310 men with circumscribed pleural lesions (plaques) or diffuse pleural thickening without asbestosis were compared with 596 men with asbestosis only and with 322 men with pleural abnormalities and asbestosis, as classified from chest radiographs by ILO pneumoconiosis criteria. Spirometric indices and total lung capacity (TLC; determined by planimetry) were measured and expressed as percentages of predicted values. Non-smoking men with pleural disease only had reduced values of mid and terminal expiratory flows (80.6 and 69.9% predicted) and a reduced FEV1 (89% predicted) with a forced vital capacity (FVC) of 94% predicted. TLC was 104% predicted. Thus they had airways obstruction with-out restriction. Non-smoking men with pulmonary asbestosis (ILO profusion of opacities mostly 1/0 and 1/1) had pulmonary function similar to that of men with pleural disease. FEV1 and FVC and flow rates at other lung volumes were lower in smokers with asbestosis (after adjustment for duration of smoking) than in the non-smokers with asbestosis. Airflow limitation was worse in the men with both pleural abnormalities and pulmonary asbestosis with lower values for mid expiratory flow, FEV1 and FVC (but not TLC) than those with either abnormality alone, in both non-smokers and current smokers. Men with diffuse pleural thickening that included the costophrenic angles had more airways obstruction and air trapping and lower FVC values than those with circumscribed pleural disease AU - Kilburn KH AU - Warshaw RH LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 72 IP - DP - 1991 Jan 01 TI - Mealworm asthma: clinical and immunologic studies PG - 475-480 AU - Bernstein DI AU - Gallagher JS AU - Bernstein IL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48, No. 5, IP - DP - 1991 Jan 01 TI - Mortality from respiratory cancer and other causes in united kingdom chromate production workers PG - -313, AU - Davies JM AU - Easton DF AU - Bidstrup PL LA - PT - DEP - TA - Brit J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - IP - DP - 1991 Jan 01 TI - Asbestos exposure and airway responses in Occupational lung diseases PG - 1984-1984 AU - Becklake MR AU - Ernst P LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 64 s1 IP - DP - 1991 Jan 01 TI - Hyperreactivity in clinical practice- induction by occupational factors PG - 285-302 AU - Belin L LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 256 IP - DP - 1991 Jan 01 TI - Toluene diisocyanate contracts guinea pig bronchial smooth muscle by activating capsaicin-sensitive sensory nerves PG - 1082-1085 AB - This study was designed to evaluate the mechanism of action of toluene diisocyanate (TDI) and the role of endogenous neutral endopeptidase in modulating in vitro contractile responses to TDI in guinea pigs. TDI (0.01-1 mM) produced a concentration-dependent contraction of the guinea pig main bronchi. Sensory nerve desensitization with capsaicin greatly reduced and in some cases almost abolished TDI-induced contractions. The neutral endopeptidase inhibitor phosphoramidon significantly increased the contractile response to TDI. Pretreatment with the substance P antagonist (D-Arg1,D-Pro2,D-Trp7,9,Leu11)-substance P greatly reduced TDI-induced contractions. These results suggest that TDI activates the "efferent" function of capsaicin-sensitive sensory nerves and that neutral endopeptidase may play a role in modulating the response in guinea pigs AU - Mapp CE AU - Graf PD AU - Boniotti A AU - Nadel JA LA - PT - DEP - TA - Journal of Pharmacology & Experimental Therape JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 143 IP - DP - 1991 Jan 01 TI - Airway inflammation during late asthmatic reactions induced by toluene diisocyanate PG - S37-8 AB - To determine the importance of airway inflammation for the development of late asthmatic reactions, we examined sensitized subjects during late asthmatic reactions induced by exposure to toluene diisocyanate (TDI) in the laboratory. Late asthmatic reactions are associated with a transient increase of bronchial responsiveness and, at the same time, with an increase of neutrophils followed by eosinophils, and of LTB4 and albumin in bronchoalveolar lavage fluid. Late asthmatic reactions, increased bronchial responsiveness, and increase of neutrophils, eosinophils, LTB4, and albumin concentration in bronchoalveolar lavage induced by exposure to TDI are all prevented by pretreatment with prednisone but not with the nonsteroidal anti-inflammatory agent indomethacin. Aerosolized steroids (beclomethasone and dexamethasone isonicotinate) completely inhibit late asthmatic reactions induced by TDI, whereas theophylline has a partial, and verapamil, ketotifen, and cromolyn have no protective effect. These results suggest that late asthmatic reactions induced by TDI may be caused by airway inflammation, and that anti-inflammatory steroids should be recommended in the prophylaxis of TDI asthma AU - Fabbri LM AU - Maestrelli P AU - Saetta M AU - Mapp CE LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 99 IP - DP - 1991 Jan 01 PG - 831-836 AU - Berube D AU - Cartier A AU - L'Archeveque J AU - Ghezzo H AU - Malo JL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 48 IP - DP - 1991 Jan 01 TI - Factors relating to the development of respiratory symptoms in coffee process workers PG - 314-322 AU - Thomas KE AU - Trigg CJ AU - Baxter PJ AU - Topping MD AU - Lacey J AU - Crook B AU - Whitehead P AU - Bennett JB AU - Davies RJ LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 99 IP - DP - 1991 Jan 01 TI - Cough in hot pepper workers PG - 27-32 AB - Study objective To determine whether there is an effect on the prevalence of respiratory symptoms, an alteration in lung function, or an increase in the cough threshold to capsaicin among workers chronically exposed to hot chili (Capsicum) peppers. Design Cross-sectional study of responses to a structured questionnaire, lung function assessed by spirometry and cough threshold to inhalation of capsaicin aerosol in a group of occupationally-exposed Capsicum workers as compared to non-exposed employees of the same work site. Setting Spice manufacturing facility. Participants Twenty-two Capsicum-exposed and 19 nonexposed workers. Measurements and main results When evaluated by questionnaire, 13 (59 percent) of the Capsicum-exposed workers reported cough as compared to 4 (21 percent) of the nonexposed workers (p<0.05). Baseline FEV1 and FVC did not differ between the two groups. Cough threshold, as assessed by the lowest concentration of inhaled capsaicin eliciting cough, was related to workplace exposure (p=0.05), displaying a bimodal pattern of higher and lower cough thresholds among the Capsicum workers as compared to a unimodal distribution among the nonexposed workers. Within the exposed group, a higher cough threshold was significantly related to male gender (p=0.03) and was associated to a lesser extent with dietary preference for hot food (p=0.09) and cumulative cigarette smoking (p=0.07). Conclusion Chronic occupational exposure to chili peppers is associated with complaints of cough but does not alone lead to decreased responsiveness of capsaicin-sensitive nerves when assessed by cough threshold. The cough response to capsaicin inhalation may be modified by the effects of multiple, potentially interactive factors. (Chest 1991; 99:27–32) AU - Blanc P AU - Liu D AU - Juarez C AU - Boushey HA LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 46 IP - DP - 1991 Jan 01 TI - Long term effects of smoke inhalation in survivors of the King's Cross underground station fire PG - 914-918 AB - Background In most accidents causing smoke inhalation only a few victims actually inhale the smoke. The fire at King's Cross provided an opportunity to assess the long term effects of smoke inhalation in a larger number of patients. Methods Fourteen survivors from the King's Cross underground station fire were assessed for respiratory disability six months after the disaster and 10 were reassessed at two years. All had inhaled substantial quantities of smoke and 10 had skin burns of differing severity. Results Six months after the fire nine survivors admitted to one or more symptoms, which included hoarseness (two cases), cough (five cases), and breathlessness (six cases); and a survivor with asthma noted a worsening of his symptoms. The remaining five denied new symptoms. Peak expiratory flow, spirometric indices, and transfer factor for carbon monoxide were within the predicted normal ranges. The mean residual volume, however, was greater than the predicted value and the mean maximum expiratory flow at 25% of vital capacity (V25) less than predicted, with no significant difference between smokers (n = 7) and non-smokers (n = 7). At least one of these ventilatory defects, suggesting small airways obstruction, was present in 11 survivors at six months and they had persisted in the seven patients who were reassessed at two years. Conclusion Smoke inhalation may be associated with injury to the small airways. AU - Fogarty PW AU - George PJM AU - Solomon M AU - Spiro SG AU - Armstrong RF LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 46 IP - DP - 1991 Jan 01 TI - Bronchial asthma due to Cannabis sativa seed. PG - 647-649 AB - A 51-year-old man with asthmatic attacks due to Cannabis sativa seed inhalation was studied. Specific IgE against this seed was demonstrated by in vivo (skin and bronchial challenge tests) and in vitro methods (reverse enzyme immunoassay and histamine release from basophils), suggesting a Type I immunologic reaction. AU - Vidal C1 AU - Fuente R AU - Iglesias A AU - Sáez A. LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 87 IP - DP - 1991 Jan 01 TI - Difference in the phenotypes of bronchoalveolar lavage lymphocytes in patients with summer-type hypersensitivity pneumonitis, farmer's lung, ventilation pneumonitis, and bird fancier's lung: Report of a nationwide epidemiologic study in Japan PG - 1002-1009 AB - We performed a nationwide epidemiologic study of hypersensitivity pneumonitis (HP) in Japan by questionnaire and found that 835 cases of HP were recognized during the 1980s; 74.4% were summer-type HP, 8.1% farmer's lung, 4.3% ventilation pneumonitis, 4.1% bird fancier's lung, 2.3% other types, such as chemical worker's lung, and 6.8% of unknown causative agent. It was found that the ratios of bronchoalveolar lavage (BAL) lymphocytes were significantly different with the type of disease. The ratio was 0.6 ± 0.1 (mean ± SEM) in summer-type HP (N = 271), 4.4 ± 0.7 in farmer's lung (N = 22), 1.6 ± 0.3 in ventilation pneumonitis (N = 19), and 2.0 ± 0.5 in bird fancier's lung (N = 19). In farmer's lung, the ratio in smokers was 6.2 ± 1.9 (N = 6) in contrast with 3.4 ± 0.7 for nonsmokers (N = 16) (p < 0.05). It has been generally considered that the phenotypes of BAL lymphocytes in patients with HP are predominately CD8 cells. Our present results, however, indicate that the phenotypes of BAL lymphocytes vary with the type of HP, probably depending on factors such as causative agent, smoking, or staging of the disease. AU - Ando M AU - Konishi K AU - Yoneda R AU - Tamura M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19910101 IS - IS - VI - 338 IP - DP - 1991 Jan 01 TI - Effect of low concentrations of ozone on inhaled allergen responses in asthmatic subjects PG - 199-203 AB - The relation between inhalation of ambient concentrations of ozone and airway reactivity to inhaled allergens may be important in asthma, since both agents can produce inflammatory changes in the airways. Seven asthmatic patients (mean age 40 [SD 13] years), with seasonal symptoms of asthma and positive skin tests for ragweed or grass, took part in a study to investigate whether exposure to low concentrations of ozone potentiates the airway allergic response. The patients were studied during 4 separate weeks in the winter. In each week there were 3 study days: on days 1 and 3 methacholine challenges were carried out; and on day 2 the subject received one of four combined challenges in a single-blind design—air breathing followed by inhalation of allergen diluent (placebo); ozone followed by inhalation of allergen diluent; air followed by allergen; or ozone followed by allergen. The ozone concentration was 0·12 ppm during 1 h of tidal breathing at rest, and allergens were inhaled until the forced expiratory volume in 1 s (FEV1) had fallen by 15% (PC15). There were no significant differences in baseline FEV1 after exposure to ozone but PC15 was significantly reduced when allergen was preceded by ozone inhalation: the mean PC15 after air was 0·013 (SD 0·017) mg/ml compared with 0·0056 (0·0062) mg/ml after ozone (p = 0·042). Thus, low ozone concentrations, similar to those commonly occurring in urban areas, can increase the bronchial responsiveness to allergen in atopic asthmatic subjects. This effect does not seem to be the result of changes in baseline airway function. AU - Molfino NA AU - Wright SC AU - Katz I AU - Tarlo S AU - Silverman F AU - McClean PA AU - Slutsky AS AU - Zamel N AU - Szalai JP AU - Raizenne M LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 47 IP - DP - 1990 Jan 01 TI - Delayed eye and other consequences from exposure to methyl isocyanate: 930 follow up of exposed and unexposed cohorts in Bhopal PG - 553-558 AB - A follow up study three years after exposure to methyl isocyanate in 93% of exposed survivors and "control" residents in 10 Bhopali communities showed an excess of eye irritation, eyelid infection, cataract, and a decrease in visual acuity among the exposed people. Breathlessness was twice as common in the heavily exposed clusters as those with lower exposure, a trend that could not be explained by different age or smoking patterns (OR 2 05, 95% CI 1-363-08). Case referent analysis of outpatient attendances at Bhopal Eye Hospital, considering patients with severe refractive errors and astigmatism as "controls," showed a 40% increased risk of trachoma, 36% increased risk of other lid infections, and 45% increased risk of irritant symptoms among previously exposed people. "Bhopal eye syndrome" may thus include full resolution of the initial interpalpebral superficial erosion, a subsequent increased risk of eye infections, hyperresponsive phenomena (irritation, watering, and phlyctens), and possibly cataracts. It remains to be confirmed whether this reflects a more generalised disease as a consequence of previous exposure to methyl isocyanate or whether it is only the eye that is affected. AU - Andersson N AU - Ajwani MK AU - Mahashabde S AU - Tiwari MK AU - Kerr Muir M AU - Mehra V AU - Ashiru K AU - Mackenzie CD LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 264 IP - DP - 1990 Jan 01 TI - Bhopal Tragedy's Health EffectsA Review of Methyl Isocyanate Toxicity PG - 2781-2787 AB - SIX YEARS AGO, on December 3, 1984, a toxic gas leak at a Union Carbide pesticide plant in Bhopal, India, released methyl isocyanate (MIC) and its reaction products. The number of persons "exposed" and "injured" remains uncertain. Official estimates from the Indian government place the dead at around 1800. Others estimate mortality to have been between 2500 and 5000 and the number of injured to have been up to 200 000. Until the Bhopal incident, neither deaths nor cases of toxic effects from MIC exposure had been recorded in Index Medicus.51 We have extensively surveyed the medical literature concerning effects of MIC exposure on the victims of the disaster and laboratory studies in animals. A great deal has been learned, but many questions still remain unanswered. 1 Weill H. Disaster at Bhopal. Bull Eur Physiopathol Respir. 1988;23:587-590. 2 Bogard W. The Bhopal Tragedy . Boulder, Colo: Westview Press Inc; 1989. 3 Lepkowski W. Bhopal: Indian city begins to heal, but conflicts remain . Chem Eng News . (December 2) , 1985;63:18-32. 4 Jasanoff S. The Bhopal disaster and the right to know . Soc Sci Med. 1988;27:1113-1123. 5 Calamity at Bhopal . Lancet . 1984;2:1378-1379. Editorial. 6 Morehouse W, Subramaniam AM, eds. The Bhopal Tragedy . New York, NY: Council on International and Public Affairs; 1986. 7 Everest L, ed. Behind the Poison Cloud . Chicago, Ill: Banner Press; 1985. 8 Union Carbide Corporation. Bhopal Methyl Isocyanates Incident: Investigation Team Report . Danbury, Conn: Union Carbide Corp; (March) 1985. 9 Smith AB, Zenz C. Methyl isocyanate . In: Zenz C, ed. Occupational Medicine Principles and Practical Applications . Chicago, Ill: Year Book Medical Publishers Inc; 1988:745-746. 10 Occupational Health Guidelines for Methyl Isocyanate . Washington, DC: US Dept of Health and Human Services; (September) 1978:1-4. NIOSH publication 81-123. 11 Union Carbide Corporation. Methyl Isocyanate Technical Report F-41443A . New York, NY: Union Carbide Corp; 1976. 12 Kimmerle G, Eben A. Toxicity of methyl isocyanate and how to determine its quantity in air . Arch Toxicol. 1964;20:235-241. 13 Bucher JR, Schwetz BA, Shelby MD, McConnell EE. Introduction: the toxicity of methyl isocyanate . Environ Health Perspect. 1987;72:73. 14 Bucher JR. Methyl isocyanate: a review of health effects research since Bhopal . Fundam Appl Toxicol. 1987;9:367-379. 15 Bhopal Working Group. The public health implication of the Bhopal disaster: APHA technical report . Am J Public Health . 1987;77:230-236. 16 Lorin HG, Kulling PE. The Bhopal tragedy: what has Swedish disaster medicine planning learned from it? J Emerg Med. 1986;4:311-316. 17 Tachakra SS. The Bhopal disaster . J R Soc Health. 1987;107:1-2. 18 Shrivastava P, ed. Bhopal: Anatomy of a Crisis . Cambridge, Mass: Ballinger Publishing Co; 1987:57. 19 Bucher JR. The toxicity of methyl isocyanate: where do we stand? Environ Health Perspect. 1987;72:197-198. 20 Marwick C. Bhopal tragedy's repercussions may reach American physicians . JAMA . 1985;253: 2001-2003. 21 Zaidi SH. Bhopal and after . Am J Ind Med. 1986;9:215-216. 22 Correspondents, India: long-term effects of MIC . Lancet . (April 29) , 1989;1:952. 23 Blake PG, Ijadi-Maghsoodi S. Kinetics and mechanism of thermal decomposition of MIC . Int J Chem Kinet. 1982;14:945-952. 24 Bhattacharya BK, Malhotra RC, Chattopadhyay DP. Inhibition of rat brain cytochrome oxidase activity by pyrolysed products of methyl isocyanate . Toxicol Lett. 1987;37:131-134. 25 Acharya VN, Naik SR, Potnis AV, et al. Sequential study of thiocyanate levels in Bhopal water following methyl isocyanate gas leakage . J Postgrad Med. 1986;32:192-194. 26 Sainani GS, Joshi VR, Mehta PJ, Abraham P. Bhopal tragedy: a year later . J Assoc Physicians India . 1985;33:755-756. 27 Salmon AG. Bright red blood of Bhopal victims: cyanide or MIC? Br J Ind Med. 1986;43:502-504. 28 Anderson N. Long-term effects of methyl isocyanate . Lancet . 1989;1:1259. 29 Nemery B, Sparrow S, Dinsdale D. Methyl isocyanate: thiosulphate does not protect . Lancet . 1985;2:1245-1246. 30 Hayes WJ Jr, ed. Pesticides Studied in Man . Baltimore, Md: Williams & Wilkins; 1982:125-127. 31 Hamilton A, Hardy HL. Cyanides . In: Industrial Toxicology . Acton, Mass: Publishing Sciences Group Inc; 1974:221-228. 32 Bucher JR, Gupta BN, Adkins B Jr, et al. Toxicity of inhaled methyl isocyanate in F344/N rats and B6C3F1 mice, I . Environ Health Perspect . 1987;72:53-61. 33 Fowler EH, Dodd DE, Troup CM. Biological effects of short-term, high-concentration exposure to methyl isocyanate, V: morphologic evaluation of rat and guinea pig lungs . Environ Health Perspect. 1987;72:39-44. 34 Dodd DE, Frank FR, Fowler EH, Troup CM, Milton RM. Biological effects of short-term, high-concentration exposure to methyl isocyanate, I: study objectives and inhalation exposure design . Environ Health Perspect. 1987;72:13-19. 35 Fowler EH, Dodd DE. Respiratory tract changes in guinea pigs, rats, and mice following a single six-hour exposure to methyl isocyanate vapor . Environ Health Perspect. 1987;72:109-116. 36 Misra NP, Pathak R, Gaur KJBS, et al. Clinical profile of gas leak victims in acute phase after Bhopal episode . 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Indian J Exp Biol. 1988;26:149-160. 42 Rastogi SK, Gupta BN, Husain T, Kumar A, Chandra S, Ray PK. Effects of exposure to toxic gas on the population of Bhopal, II: respiratory impairment . Indian J Exp Biol. 1988;26:161-164. 43 Naik SR, Acharya VN, Bhalerao RA, et al. Medical survey of methyl isocyanate gas affected population of Bhopal: part II . J Postgrad Med. 1986;32:185-191. 44 Pant SC, Srivastava RK, Vijayaraghavan R. Histomorphologic changes induced by methyl isocyanate in lungs of rats and rabbits . Bull Environ Contam Toxicol. 1987;38:876-881. 45 Amber L. Methyl isocyanate tests: new evidence of lasting lung damage . Chem Eng News . (March 3) , 1986;64:4. News of the Week. Editorial. 46 Dutta KK, Gupta GSD, Mishra A, Joshi A, Tandon GS, Ray PK. Inhalation toxicity studies of methyl isocyanate (MIC) in rats: part I—pulmonary pathology and genotoxicity evaluation . Indian J Exp Biol. 1988;26:177-182. 47 Alarie Y, Ferguson JS, Stock MF, Weyel DA, Schaper M. Sensory and pulmonary irritation of methyl isocyanate in mice and pulmonary irritation and possible cyanide-like effects of methyl isocyanate in guinea pigs . Environ Health Perspect. 1987;72:159-167. 48 Nemery B, Dinsdale D, Sparrow S. Toxicity of inhaled methyl isocyanate in experimental animals . Bull Eur Physiopathol Resp. (July) -August 1987;23:315-322. 49 Boorman GA, Uraih LC, Gupta BN, Bucher JR. Two-hour methyl isocyanate inhalation and 90-day recovery study in B6C3F1 mice . Environ Health Perspect. 1987;72:63-69. 50 Boorman GA, Brown R, Gupta BN. Pathologic changes following acute methyl isocyanate inhalation and recovery in B6C3F1 mice . Toxicol Appl Pharmacol. 1987;87:446-456. 51 Uraih LC, Talley FA, Mitsumori K, Gupta BN, Bucher JR, Boorman GA. Ultrastructural changes in the nasal mucosa of Fisher 344 rats and B6C3F1 mice following an acute exposure to methyl isocyanate . Environ Health Perspect. 1987;72:77-88. 52 Tepper JS, Wiester MJ, Costa DL, Watkinson WP, Weber MF. Cardiopulmonary effects in awake rats four and six months after exposure to methyl isocyanate . Environ Health Perspect. 1987;72: 95-103. 53 Srivastava RK, Vijayaraghavan R, Kumar P, et al. Effects of inhaled sublethal concentration of methyl isocyanate on lung mechanics in rats . Indian J Exp Biol. 1987;25:535-538. 54 Dinsdale D, Nemery B, Sparrow S. Ultrastructure changes in the respiratory tract of rats following methyl isocyanate inhalation . Arch Toxicol. 1987;59:385-390. 55 Andersson N, Kerr Muir M, Mehra V, Salmon AG. Exposure and response to methyl isocyanate: results of community-based survey in Bhopal. Br J Ind Med. 1988;45:469-475. 56 Dwivedi PC, Raizada JK, Saini VK, et al. Ocular lesions following methyl isocyanate contamination: the Bhopal experience . Arch Ophthalmol. 1985;103:1627. 57 Maskati QB. Ophthalmic survey of Bhopal victims 104 days after the tragedy . J Postgrad Med. 1986;32:199-202. 58 Raizada JK, Dwivedi PC. Chronic ocular lesions in Bhopal gas tragedy . Indian J Ophthalmol. 1987;35:453-545. 59 Khurrum MA, Ahmad SH. Long-term follow-up of ocular lesion of methyl isocyanate gas disaster in Bhopal . Indian J Ophthalmol. 1987;35:136-137. 60 Pozzani UC, Kinkead ER. Animal and human response to methyl isocyanate . Presented at the Annual Meeting of the American Industrial Hygiene Association; May 16-20,1966; Pittsburgh, Pa . 61 Gassert T, Mackenzie C, Muir MK, Anderson N, Salomon AG. Long-term pathology of lung, eye, and other organs following acute exposure of rats to methyl isocyanate . Lancet . 1986;2:1403. 62 Rye WA. Human response to isocyanate exposure . J Occup Med. 1973;15:306-307. 63 Harding JJ, Rixon KC. Lens opacities induced in rat lenses by methyl isocyanate . Lancet . 1985;1:762. 64 Gupta BN, Stefanski SA, Bucher JR, Hall LB. Effect of methyl isocyanate (MIC) gas on the eyes of Fischer 344 rats . Environ Health Perspect. 1987;72:105-108. 65 Varma DR. Epidemiological and experimental studies on the effects of methyl isocyanate on the course of pregnancy . Environ Health Perspect. 1987;72:153-157. 66 Shilotri NP, Raval MY, Hinduja IN. Gynecological and obstetrical survey of Bhopal women following exposure to methyl isocyanate . J Postgrad Med. 1986;32:203-205. 67 Deo MG, Gangal S, Bhisey AN. Immunological, mutagenic, and genotoxic investigations in gasexposed population of Bhopal . Indian J Med Res. 1987;86( (suppl) ):63-76. 68 Kanhere S, Darbari BS, Shrivastava AK. Morphological study of placentae of expectant mothers exposed to gas leak at Bhopal . Indian J Med Res. 1987;86( (suppl) ):77-82. 69 Naik SR, Acharya VN, Bhalerao RA, et al. Medical survey of methyl isocyanate gas affected population of Bhopal . J Postgrad Med. 1986;32:175-184. 70 Taylor ES. On maternal-fetal transfer of thyroxine in congenital hypothyroidism due to a total organification defect or thyroid agenesis . Obstet Gynecol Surv. 1990;45:115-116. 71 Goswami HK. Cytogenetic effects of methyl isocyanate exposure in Bhopal . Hum Genet. 1986; 74:81-84. 72 Varma DR, Ferguson JS, Alarie Y. Reproductive toxicity of methyl isocyanate in mice . J Toxicol Environ Health. 1987;21:265-275. 73 Schwetz BA, Adkin B Jr, Harris M, Moorman M, Sloane R. Methyl isocyanate: reproductive and developmental toxicology studies in Swiss mice . Environ Health Perspect. 1987;72:149-152. 74 Bhattacharya BK, Sharma SK, Jaiswal DK. In vivo binding of [1-14C] methyl isocyanate to various tissue proteins . Biochem Pharmacol. 1988;37: 2489-2493. 75 Ferguson JS, Kennedy AL, Stock MF, Brown WE, Alarie Y. Uptake and distribution of 14C during and following exposure to (14C) methyl isocyanate . Toxicol Appl Pharmacol. 1988;94:104-117. 76 Mason JM, Zeiger E, Haworth S, Ivett J, Valencia R. Genotoxicity studies of methyl isocyanate in Salmonella, Drosophila, and cultured Chinese hamster ovary cells . Environ Mutagen. 1987;9:19-28. 77 Kligerman AD, Campbell JA, Erexson GL, Allen JW, Shelby MD. Sister chromatid exchange analysis in lung and peripheral blood lymphocytes of mice exposed to methyl isocyanate by inhalation . Environ Mutagen. 1987;9:29-36. 78 Tice RR, Luke CA, Shelby MD. Methyl isocyanate: an evaluation of in vivo cytogenetic activity . Environ Mutagen. 1987;9:37-58. 79 Shelby MD, Allen JW, Caspary WJ, et al. Results of in vitro and in vivo genetic toxicity tests on methyl isocyanate . Environ Health Perspect. 1987;72:183-187. 80 Sutcliffe M. An eyewitness in Bhopal . BMJ . 1985;290:1883-1884. 81 Bharucha EP, Bharucha NE. Neurological manifestations among those exposed to toxic gas at Bhopal . Indian J Med Res. 1987;86 ( (suppl) ):59-62. 82 Irani SF, Mahashur AA. A survey of Bhopal children affected by methyl isocyanate gas . J Postgrad Med. 1986;32:195-198. 83 Saxena AK, Singh KP, Nagle SL, et al. Effect of exposure to toxic gas on the population of Bhopal, IV: immunological and chromosomal studies . Indian J Exp Biol. 1988;26:173-176. 84 Karol MH, Taskar S, Gangal S, Rubanoff BF, Kamat SR. The antibody response to methyl isocyanate . Environ Health Perspect. 1987;72:169-175. 85 Karol MH, Kamat SR. The antibody response to methyl isocyanate: experimental and clinical findings . Bull Eur Physiopathol. 1988;23:591-597. 86 Dwivedi PD, Mishra A, Gupta GSD, Dutta KK, Das SN, Ray PK. Inhalation toxicity studies of methyl isocyanate (MIC) in rats, IV: immunologic response of rats one week after exposure . Indian J Exp Biol. 1988;26:191-194. 87 Tucker AN, Bucher JR, Germolec DR, Silver MT, Vore SJ, Luster MI. Immunological studies on mice exposed subacutely to methyl isocyanate . Environ Health Perspect. 1987;72:139-141. 88 Hong HL, Bucher JR, Canipe J, Boorman GA. Myelotoxicity induced in female B6C3F1 mice by inhalation of methyl isocyanate . 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AU - Mehta PS AU - Mehta AS AU - Mehta SJ AU - Makhijani AB LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 373 IP - DP - 1990 Jan 01 TI - Occupational fatalities associated with exposure to epoxy resin paint in an underground tank--Makati, Republic of the Philippines PG - 379-380 AB - On October 31, 1988, three men who were plugging leaks in and waterproofing an underground water tank at a building in Salcedo Village, Makati, Republic of the Philippines, were overcome by paint fumes and died in the tank. The incident was investigated by the Philippines Department of Health Field Epidemiology Training Program. The underground water storage tank measured 20 meters (66 feet) long by 6 meters (19.8 feet) wide by 3 meters (9.9 feet) high and was divided into three communicating compartments; entry and exit were through one access hole. Because of typhoon rains on the evening of October 30, the tank contained approximately 60 centimeters (2 feet) of water when the five-person crew began work at 8 a.m., although company procedures required that such tanks be dry before any waterproofing materials were applied. By 9 p.m., when the crew started to apply an epoxeal waterproofing paint, the water was 10.2 centimeters (4 inches) deep. Two 60-centimeter (2-foot) diameter electrically powered exhaust fans were provided to ventilate the tank, but the workers did not use them because of concern for a possible electrocution hazard from the standing water. At approximately 10 p.m., one worker left the tank because he had become drowsy and nauseated and was vomiting. At 10:30 p.m., a second worker left the tank to obtain coffee. When these two workers returned to the tank at approximately 11:30 p.m., they found the three other crewmembers dead. Autopsy reports attributed the cause of death to asphyxia. A toxicology report from the Philippines National Bureau of Investigation indicated that blood specimens from the three men who died were negative for alcohol, sulfur, cyanide, and phosphorus. Analysis of samples of the paint by the Philippines Department of Science and Technology confirmed the presence of an epoxy resin. Reported by: RR Gavino, MD, ES Salva, MD, SP Gregorio, MD, NB Bautista, MD, MM Dayrit, MD, Field Epidemiology Training Program, CN Reodica, MD, National Capital Region, Philippines Dept of Health; E Luis, MD, V Diaz, MD, Dept of Science and Technology; B Vitasa, MD, Coll of Public Health, Univ of the Philippines; R Garcia, MD, Philippines National Bureau of Investigation. Global EIS Program, Div of Field Svcs, Epidemiology Program Office; Div of Safety Research, National Institute for Occupational Safety and Health, CDC. Editorial Note Editorial Note: Epoxy-based waterproofing paints contain several types of toxic chemicals, and precautionary measures are required when these paints are used in a confined space. Constituents of epoxy resins will displace oxygen in a confined space and may have an independent narcotic effect on exposed workers. In this episode, the epoxy paint contained glycidyl ether, a reactive dilutent used to decrease viscosity (1). Uncured glycidyl ether vapors are more dense than air and will settle to the bottom of a confined space, such as the water storage tank, thereby displacing oxygen. For this reason, in the United States, CDC's National Institute for Occupational Safety and Health (NIOSH) recommends use of appropriate personal protective equipment (i.e., a positive pressure-supplied air respirator and clothing) and adequate ventilation when persons work with (or assess the presence of) glycidyl ether in confined spaces. In the United States, acute traumatic occupational deaths are monitored by NIOSH through the National Traumatic Occupational Fatalities (NTOF) data file (2). The NTOF data file uses death certificates as the source of information for work-related fatalities resulting from external causes of injury and poisoning (International Classification of Diseases, Ninth Revision (ICD-9), rubrics E800-E899). From 1980 through 1985, the NTOF data file included 286 deaths (an average of 48 work-related deaths per year) that involved workers in confined spaces with cause of death directly attributable to asphyxiation, explosion, or drowning. This figure probably underestimates the number of such confined-space-related fatalities in the United States because of misclassification and the lack of a specific ICD-9 code for "confined spaces" on the death certificate. NIOSH defines a confined space as one that "by design has limited openings for entry and exit, unfavorable natural ventilation which could contain or produce dangerous air contaminants, and which is not intended for continuous employee occupancy" (3). The water storage tank in the incident reported here not only met these criteria, but also contained dangerous air contaminants introduced by the workers through the use of epoxeal waterproofing paint. Companies, municipalities, and other organizations who assign workers to perform tasks within confined spaces should develop and implement a comprehensive program for working in confined spaces (3,4). Important considerations for such recommendations are whether 1) entry is necessary or the assigned task can be completed from the outside; 2) a confined space safe entry permit has been issued by the company; 3) warning signs are posted where they will be noticed by employees; 4) air quality in the confined space has been tested for safety according to basic criteria*; 5) employees and supervisors have been trained in the proper selection and use of appropriate respiratory protection (6,7), protective clothing, lifelines, and emergency rescue equipment; 6) employees have been trained to work in confined spaces and in confined space rescue procedures; and 7) ventilation equipment is available and/or used and air quality is tested when the ventilation system is operating. In addition, confined space procedures for work performed inside tanks should specifically incorporate use of explosion-proof lighting and fixtures in and near flammable atmospheres** and use of nonflammable paints (when possible) for coating the interior of tanks. AU - Gavino RR AU - Salva ES AU - Gregorio SP AU - Bautista NB AU - Dayrit MM LA - PT - DEP - TA - MMWR CDC Surveill Summ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 4 IP - DP - 1990 Jan 01 TI - Epidemiological study of mortality from cancer among chromium platers PG - 2-3 AU - Horiguchi S AU - Morinaga K AU - Endo G LA - PT - DEP - TA - Asia Pacific J Pub Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 169 IP - DP - 1990 Jan 01 TI - A severe asthmatic reaction to poly(methyl methacrylate) denture base resin PG - 250-251 AU - Basker RM AU - Hunter AM AU - Highet AS LA - PT - DEP - TA - Brit Dental J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 168 suppl IP - DP - 1990 Jan 01 TI - New aspects of isocyanate asthma PG - 606-613 AU - Baur X LA - PT - DEP - TA - Lung JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 suppl 1 IP - DP - 1990 Jan 01 TI - Occupational rhinoconjunctivitis and asthma from cow's milk proteins (lactalbumin) inhalation PG - 43-43 AU - Bernaola G AU - Fernandez E AU - Echechipia S AU - Munoz D LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 336 IP - DP - 1990 Jan 01 TI - Oilseed rape is not a potent allergen PG - 808- AU - Ninian TK AU - Milne V AU - Russell G LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 142 IP - DP - 1990 Jan 01 TI - Respiratory responses of young asthmatic volunteers in controlled exposures to supfuric acid aerosols PG - 343-348 AU - Avol EL AU - Linn WS AU - Shamoo DA AU - Anderson KR AU - Peng RC AU - Hackney JD LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 85 IP - DP - 1990 Jan 01 TI - Serotype-related antigen of Trichosporon cutaneum in the induction of summer-type hypersensitivity pneumonitis: correlation between serotype of inhalation challenge-positive antigen and that of isolates from the patients' homes PG - 36-44 AU - Ando M AU - Sakata T AU - Yoshida K AU - Yamasaki H AU - Araki S AU - Onoue K AU - Shinoda T LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 65 IP - DP - 1990 Jan 01 TI - Bakers' asthma: prevalence and evaluation of immunotherapy with wheat flour extract PG - 265-272 AU - Armentia A AU - MartinSantos JM AU - Quintero A AU - Fernandez A AU - Barber D AU - Alonso E AU - Gil I LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 98 IP - DP - 1990 Jan 01 TI - Clinical surveillance and management of occupational asthma. Tertiary prevention by the primary practitioner PG - S196-201 AU - Cullen MR LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 97 IP - DP - 1990 Jan 01 TI - Persistence of toluene diisocyanate-induced asthma despite negligible workplace exposures PG - 121-125 AU - Banks DE AU - Rando RJ AU - Barkman HW Jr LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 85 IP - DP - 1990 Jan 01 TI - Sensitivity And Specificity Of PC20 And Peak Expiratory Flow Rate In Cedar Asthma PG - 592-598 AB - The diagnosis of red cedar asthma is usually confirmed by a specific challenge with plicatic acid, the compound responsible for the disease. We performed this study to determine the sensitivity and specificity of two other diagnostic tests, prolonged recording expiratory flow rate (PEFR) and measurement of bronchial responsiveness (provocative dose of methacholine causing a 20% fall in FEV1 [PC20 methacholine]). Twenty-three patients with suspected cedar asthma participated in the study. The patients recorded PEFR during 2 weeks away from work and 3 weeks at work. PC20 was measured both at the end of the nonworking and working period. An obvious decrease in PEFR in 2 of 3 working weeks, when PEFRs of weekends or holidays were compared (by visual inspection of the PEFR recording), and a decrease in PC20 by more than a twofold dilution, when the patient returned to work, were considered as positive tests for cedar asthma. Plicatic acid challenge test was performed at the end of the study; 14 patients reacted, whereas nine patients did not. With the results of the plicatic acid challenge test as the gold standard, the sensitivity and specificity of PEFR recordings were 86% and 89%; changes in PC20, 62% and 78%; and 93% and 45% for a positive clinical history. The combination of PEFR and clinical history revealed a 100% sensitivity with a 45% specificity. Combination of PEFR and PC20 did not improve the diagnostic accuracy.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Cote J AU - Kennedy S AU - ChanYeung M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 18 IP - DP - 1990 Jan 01 TI - Cross-sectional study of platinum salts sensitisation among precious metals refinery workers PG - 653-664 AU - Baker DB AU - Gann PH AU - Brooks SM AU - Gallagher J AU - Bernstein IL LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 85 IP - DP - 1990 Jan 01 TI - Exposure-response relationships in asthma caused by tetrachlorophthalic anhydride PG - 55-58 AU - Venables KM AU - NewmanTaylor AJ AU - LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 62 IP - DP - 1990 Jan 01 TI - Health effects of exposure to endotoxins and organic dust in poultry slaughter-house workers PG - 159-164 AU - Hagmar L AU - Schutz A AU - Hallberg T AU - Sjoholm A LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 97 IP - DP - 1990 Jan 01 TI - Fatal pulmonary edema due to nitric acid fume inhalation in three pulp-mill workers PG - 487-489 AU - Hajela R AU - Janigan DT AU - Landrigan PL AU - Boudreau SF AU - Sebastian S LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 68 IP - DP - 1990 Jan 01 TI - Forms of humidifier lung PG - 512-517 AU - Hauck R AU - Baur X LA - PT - DEP - TA - Klin Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 IP - DP - 1990 Jan 01 TI - Ecology of house dust mites in Oxfordshire PG - 203-209 AU - Hart BJ AU - Whitehead L LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 3 suppl 10 IP - DP - 1990 Jan 01 TI - Occupational asthma due to operating theatre wear PG - 173s-173s AU - Gannon PFG AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 suppl 1 IP - DP - 1990 Jan 01 TI - Asthma and contact dermatitis from epoxy resin PG - 43-43 AU - Kanerva L AU - Halmepuro L AU - Jolanki R AU - Keskinen H AU - Estlander T LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 suppl 1 IP - DP - 1990 Jan 01 TI - Hypersensitivity pneumonitis in plaster of Paris workers caused by esparto grass (Stipa tenasissima): stapatosis PG - 45-45 AU - Hinojosa M AU - Fraj J AU - de la Hoz B AU - Cuevas M AU - Fogue L AU - Alcazar R AU - Sueiro A LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 16 IP - DP - 1990 Jan 01 TI - Mortality of workers in the British cotton industry in 1968-1984 PG - 113-120 AU - Hodgson JT AU - Jones RD LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 IP - DP - 1990 Jan 01 TI - Mite allergy and exposure to storage mites and house dust mites in farmers PG - 211-219 AU - Iversen M AU - Korsgaard J AU - Hallas T AU - Dahl R LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 47 IP - DP - 1990 Jan 01 TI - Exposure to grain dust and changes in lung function PG - 466-472 AU - James AL AU - Zimmerman MJ AU - Ryan HE AU - Musk AW LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 19 IP - DP - 1990 Jan 01 TI - Baker's asthma, a case report PG - 407-409 AU - Chia KS AU - Tan WC AU - Jeyaratnam J LA - PT - DEP - TA - Ann Acad Med Singapore JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 47 IP - DP - 1990 Jan 01 TI - Airway responsiveness of firefighters after smoke exposure PG - 524-527 AU - Chia KS AU - Jeyaratnam J AU - Chan TB AU - Lim TK LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 45 IP - DP - 1990 Jan 01 TI - Occupational asthma due to tea dust PG - 203-206 AB - Three patients are described who had developed asthma after working as tea packers. In two cases the diagnosis was confirmed by serial monitoring of peak expiratory flow rates, bronchial responsiveness to histamine, and specific inhalation challenges in the laboratory. The third patient experienced isolated changes in bronchial responsiveness to histamine after periods of exposure at work and after specific inhalation challenges in the laboratory without showing spirometric changes. Two of the three subjects were non-atopic; none had an immediate reaction to skin prick testing with a tea solution. AU - Cartier A AU - Malo JL LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 40 IP - DP - 1990 Jan 01 TI - Health problems among spice grinders PG - 111-115 AU - Chan OY AU - Lee CS AU - Tan KT AU - Thirumoorthy T LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 IP - DP - 1990 Jan 01 TI - Evidence for mucosal inflamation in occupational asthma PG - 1-5 AU - ChanYeung M AU - Lam S LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 64 IP - DP - 1990 Jan 01 TI - Silk-induced asthma in children: a report of 64 cases PG - 375-378 AU - Chaoming W AU - Shitai Y AU - Lixin Z AU - Yan Y LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 152 IP - DP - 1990 Jan 01 TI - The respiratory health of Victorian broiler growers PG - 521-524 AU - Brown AM LA - PT - DEP - TA - Med J Aust JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 97 IP - DP - 1990 Jan 01 TI - Cold air challenge and platinum skin reactivity in platinum refinery workers PG - 1401-1407 AU - Brooks SM AU - Baker DM AU - Gann PH AU - Jarabek AM AU - Hertzberg V AU - Gallagher J AU - Biagini RE AU - Bernstein IL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - May IP - DP - 1990 Jan 01 TI - Sensibilizing effect of industrial aerosol on the body of gas cutters PG - 99-101 AU - Budanova LF AU - Khaimovich ML AU - Cherniavsky VP LA - PT - DEP - TA - Vrach Delo JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 141 IP - DP - 1990 Jan 01 TI - Objective versus qualative analysis of PEFR in the diagnosis of Occupational asthma PG - A82-A82 AU - Cote J AU - Kennedy SM AU - ChanYeung M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 17 IP - DP - 1990 Jan 01 TI - Health effects from work in swine confinement buildings PG - 17-25 AU - Donham KJ LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 86 IP - DP - 1990 Jan 01 TI - Occupational challenge studies with laboratory workers allergic to rats PG - 63-72 AU - Eggleston PA AU - Ansari AA AU - Ziemann B AU - Adkinson NF AU - Corn M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 34 IP - DP - 1990 Jan 01 TI - A review of exposure conditions and possible health effects associated with aerosol and vapour from low-aromatic oil-based drilling fluids PG - 149-157 AU - Eide I LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 22 IP - DP - 1990 Jan 01 TI - Mercury is a respiratory allergen PG - 81-88 AU - Drouet M AU - Le Sellin J AU - Bonneau JC AU - Sabbah A LA - PT - DEP - TA - Allerg Immunol (Paris) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 336 IP - DP - 1990 Jan 01 TI - Outbreak of Pontiac fever due to Legionella anisa PG - 35-37 AU - Fenstersheib MD AU - Miller M AU - Diggins C AU - Liska S AU - Detwiler L AU - Werner SB AU - Lindquist D AU - Thacker WL AU - Benson RF LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 9 IP - DP - 1990 Jan 01 TI - Bronchial provocation testing of sodium iso-nonanoyl oxybenzene sulphonate PG - 83-89 AU - Ferguson H AU - Thomas KE AU - Ollier S AU - Davies RJ LA - PT - DEP - TA - Hum Exp Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 3 IP - DP - 1990 Jan 01 TI - Characteristics of patients with soybean dust-induced acute severe asthma requiring mechanical ventilation PG - 429-433 AB - Patients presenting with acute severe asthma during the Barcelona's outbreaks caused by soybean dust inhalation from August, 1981, through September, 1987, characteristically showed an abrupt severe onset of each attack followed by a rapid relief of symptoms after treatment. To throw further light on clinical findings, pathophysiology and outcome in the most life-threatening episodes, we reviewed records of acute severe asthma patients treated by mechanical ventilation in one of the four main hospitals of the city. Twelve such patients (15 episodes) were compared to 24 non-epidemic asthmatic patients (25 episodes) also treated by mechanical ventilation in the same institution during the same period of time. There was a male predominance during outbreaks (p less than 0.03) and epidemic patients were ventilated fewer hours (12 +/- 8 h) (mean +/- SD), admitted fewer days to intensive care (1.6 +/- 0.7 days), and hospitalized fewer days (7.1 +/- 4.4 days) than non-epidemic patients (65 +/- 84 h, 4.6 +/- 3.8 days (p less than 0.001, each), and 16.0 +/- 13.2 days (p less than 0.004), respectively). These differences together with both the fulminant presentation of the episodes of epidemic asthma and the point-source origin of the asthma outbreaks previously shown are consistent with the unusual nature of the aetiologic agent, soybean dust. AU - Ferrer A AU - Torres A AU - Roca J AU - Sunyer J AU - Anto JM AU - RodriguezRoisin R LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 17 IP - DP - 1990 Jan 01 TI - Characterization of health effects of wood dust exposures PG - 33-38 AU - Enarson DA AU - ChanYeung M LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 97 IP - DP - 1990 Jan 01 TI - The pulmonary sequalae associated with accidental inhalation of chlorine gas PG - 820-825 AU - Schwartz DA AU - Smith DD AU - Lakshminarayan S LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 103 IP - DP - 1990 Jan 01 TI - Asthma and the employment experience PG - 399-401 AU - McClellan VE AU - Garrett JE LA - PT - DEP - TA - N Z Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 IP - DP - 1990 Jan 01 TI - Ispaghula sensitisation in workers manufacturing a bulk laxative PG - 199-202 AB - Exposure to ispaghula dust in a pharmaceutical factory resulted in chest tightness/wheeze, nasal, and ocular or skin symptoms in 48 of 92 exposed workers. Whilst symptoms were not incapacitating in the majority (44) of these, one worker required antihistamines and three others experienced severe respiratory symptoms when exposed to the dust. These three were atopic, had a positive RAST and skin test to ispaghula; a combination unique to them. There was a significant relationship between work-related symptoms and atopic status, however, smoking did not influence symptoms, total serum IgE and specific anti-ispaghula IgE. We conclude that handling ispaghula produces an irritant effect in most exposed people, however, sensitization to the dust can occur with severe respiratory symptoms. AU - McConnochie K AU - Edwards JH AU - Fifield R LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 suppl 1 IP - DP - 1990 Jan 01 TI - Occupational asthma and rhinitis due to styrene PG - 45-45 AU - Moscato G AU - Marraccini P AU - Dellabianca A AU - Vinci G LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 141 IP - DP - 1990 Jan 01 TI - Rapidly fatal progression of cobalt lung in a diamond polisher PG - 1373-1378 AB - Interstitial lung disease was diagnosed in a 52-yr-old male diamond polisher, who worked with polishing disks containing cobalt. After a further 7 months of probably high occupational exposure without any specific treatment, he had to quit work because of dyspnea. Despite treatment with systemic corticosteroids and continuous oxygen administration, he died 3 months later in respiratory distress. Postmortem examination of the lung tissue showed a typical giant-cell interstitial fibrosis, with active inflammatory cell infiltration superimposed on an established centrilobular fibrosis. The lung tissue contained 2.1 micrograms cobalt/g wet weight (more than 100-fold the normal concentration); cobalt particles, mainly localized in macrophages, were identified by transmission electron microscopy and energy-dispersive X-ray analysis. We speculate that the rapid deterioration and fatal outcome resulted from the continued exposure to cobalt, leading to a high pulmonary concentration of cobalt, and from the oxygen treatment because cobalt promotes the formation of hydroxyl free radicals. AU - Nemery B AU - Nagels J AU - Verbeken E AU - Dinsdale D AU - Demedts M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 45 IP - DP - 1990 Jan 01 TI - Sericulturist's lung: hypersensitivity pneumonitis related to silk production PG - 233-234 AU - Nakazawa T AU - Umegae Y LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 32 IP - DP - 1990 Jan 01 TI - Occupational asthma due to alkyl cyanoacrylate PG - 709-710 AU - Nakazawa T LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 45 IP - DP - 1990 Jan 01 TI - Respiratory health of plywood workers occupationally exposed to formaldehyde PG - 288-294 AU - Malaka T AU - Kodama AM LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 32 IP - DP - 1990 Jan 01 TI - An immunologic and genetic study of asthma in workers in an aluminium smelter PG - 1022-1026 AU - Mackay IR AU - Oliphant RC AU - Laby B AU - Smith MM AU - Fisher JN AU - Mitchell RJ AU - Propert DN AU - Tait BD LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 142 IP - DP - 1990 Jan 01 TI - Prevalence of occupational asthma and immunologic sensitization to psyllium among health personnel in chronic care hospitals PG - 1359-1366 AB - Psyllium is a high molecular weight laxative that can cause occupational asthma among health care workers who prepare this product for chronically ill patients. The prevalence of immunologic sensitization and occupational asthma to psyllium is unknown. We investigated the personnel of four chronic care hospitals, including two where four cases of occupational asthma had been confirmed the year preceding the trial. A questionnaire and skin prick tests with psyllium and various inhalants were administered to 193 of 248 (78%) of the workers who agreed to participate. Seventy-five subjects (39%) had a history of respiratory symptoms in normal life and/or respiratory symptoms and/or rhinoconjunctivitis after handling psyllium. Six (3%) showed skin reactivity to psyllium. Increased specific IgE antibodies were found in 20 of 162 of the sera that were tested (12%). In the second part of the study, a histamine inhalation challenge was performed on 70 of 75 (93%) of the subjects with a history suggestive of asthma and/or occupational asthma and/or skin reactivity to psyllium. Twenty (29%) had significant bronchial hyperresponsiveness. The six subjects with a history suggestive of occupational asthma (n = 3) and/or asthma (n = 6) and/or positive skin test results to psyllium (n = 6) had significant bronchial hyperresponsiveness and increased specific IgE levels. They all underwent specific inhalation challenges with psyllium in the laboratory. Four developed bronchospastic reactions (two immediate and two dual reactions). We conclude that by including the initial four cases reported in the year preceding the initiation of this trial, the prevalence of IgE sensitization to psyllium was between 5 (skin testing) and 12% (increased specific IgE levels).(ABSTRACT TRUNCATED AT 250 WORDS) AU - Malo JL AU - Cartier A AU - L'Archeveque J AU - Ghezzo H AU - Lagier F AU - Trudeau C AU - Dolovich J LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 3 IP - DP - 1990 Jan 01 TI - Acute lung reaction due to zinc inhalation PG - 111-114 AB - A 27-yr-old man began work at a company that produces concrete pipes in April 1987. The pipes are linked with rings covered with zinc. In September 1987, he was transferred to a new job in the same plant where he had to heat zinc wires and shoot the heated zinc in powder form onto the iron rings. He had no past personal nor family atopic history. Two weeks after he began in his new job, he experienced an episode of chills with muscle aches and dyspnoea at the end of a working day. The fever persisted until the next day, at which time he saw a physician. A chest radiograph revealed diffuse interstitial shadows. He was off work for 10 days. His symptomatology disappeared and his chest radiograph cleared. He went back to work and experienced a similar episode. He remained away from work for one month, after which specific inhalation challenges were performed. On a control day, there were no significant changes in forced expiratory volume in one second (FEV1), forced vital capacity (FVC), or buccal temperature. Two white blood counts (WBC) showed 8,400 and 8,500 white cells. He was exposed to his usual work environment for one hour on two consecutive days. On both occasions, there were significant falls in FEV1 (16% and 20%) and FVC (10% and 11%), occurring 4-6 h after exposure. Buccal temperature reached 38.1 and 38.7 degrees C on the two occasions, and WBC were 17,000 and 15,900 at the end of each day. Precipitins were negative and specific IgG antibodies could not be detected.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Malo JL AU - Malo J AU - Cartier A AU - Dolovich J LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 86 IP - DP - 1990 Jan 01 TI - Prevalence of occupational asthma and immunologic sensitisation to guar gum among employees at a carpet-manufacturing plant PG - 562-569 AB - Guar gum is a high-molecular-weight agent that can cause occupational rhinitis and asthma. We surveyed the employees at a carpet-manufacturing plant in which guar gum is used to adhere the dye to the fiber; 162/177 of the employees (92%) participated in the first part of the survey that included a questionnaire and skin prick tests with common allergens and guar gum (1 mg/ml). IgE and IgG antibodies to guar gum were also measured in those subjects (133/162 or 82%) who agreed to blood tests. Thirty-seven subjects (23%) had a history suggestive of occupational asthma and 59 (36%), of occupational rhinitis. Eight subjects (5%) demonstrated immediate skin reactivity to guar gum. Eleven subjects (8.3%) had serum IgE antibodies to guar gum. All subjects, except one subject who had a history suggestive of occupational asthma (n = 37) or positive skin tests (n = 4), participated in the second part of the study. A methacholine-inhalation test was performed during a workshift or in the 3 to 4 hours after the workshift. Five subjects had a concentration of methacholine causing a 20% fall in FEV1 of less than 16 mg/ml (significant bronchial hyperresponsiveness) and positive skin reactions to guar gum. Four of these subjects underwent specific inhalation challenges. The remaining subject had a history of severe bronchospastic reaction on exposure to guar gum, and his FEV1 of 1.6 L made specific challenges impossible. Two subjects had typical isolated immediate reactions.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Malo JL AU - Cartier A AU - L'Archeveque J AU - Ghezzo H AU - Soucy F AU - Somers J AU - Dolovich J LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 47 IP - DP - 1990 Jan 01 TI - Persistent reactive airway dysfunction syndrome after exposure to toluene diisocyanate PG - 239-241 AU - Luo JC AU - Nelsen KG AU - Fischbein A LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 85 IP - DP - 1990 Jan 01 TI - Occupational asthma and specific IgE to a diazonium salt intermediate used in the polymer industry PG - 1076-1082 AU - Luczynska CM AU - Hutchcroft BJ AU - Harrison MA AU - Doran JD AU - Topping MD LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 IP - DP - 1990 Jan 01 TI - Prevalence of specific IgE to storage mites (A.siro, L.destructor and T.longior) in an urban population and crossreactivity with the house dust mite (D.pteronyssinus) PG - 403-406 AU - Luczynska CM AU - Griffin P AU - Davies RJ AU - Topping MD LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 85 IP - DP - 1990 Jan 01 TI - Characterization of water-soluble shrimp allergens released during boiling PG - 1005-1013 AU - Lehrer SB AU - Ibanez MD AU - McCants ML AU - Daul CB AU - Morgan JE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 85 IP - DP - 1990 Jan 01 TI - Rose hips: a new occupational allergen PG - 704-708 AU - Kwaselow A AU - Rowe M AU - SearsEwald D AU - Ownby D LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 85 IP - DP - 1990 Jan 01 TI - Occupational asthma caused by guar gum PG - 785-790 AB - Some vegetable gums have been reported to cause asthma. We describe three subjects who were exposed at work to guar gum, which is derived from the outer part of Cyanopsis tetragonolobus, a vegetable that grows in India. The first subject worked for a pharmaceutical company; the second and third subjects worked at a carpet-manufacturing plant. All three subjects developed symptoms of rhinitis and asthma after the onset of exposure to guar gum. All subjects were atopic and demonstrated mild bronchial hyperresponsiveness to inhaled histamine at the time they were observed. Skin prick tests demonstrated an immediate skin reaction to guar gum. All three subjects had high levels of serum IgE antibodies to guar gum. Specific inhalation challenges in which the three subjects were exposed for short intervals (less than or equal to 4 minutes) to powder of guar gum elicited isolated immediate bronchospastic reactions in two subjects and a dual reaction in the other subject. AU - Lagier F AU - Cartier A AU - Somer J AU - Dolovich J AU - Malo JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 335 IP - DP - 1990 Jan 01 TI - Oilseed rape as a potent antigen PG - 121-121 AU - Parratt D AU - Thomson G AU - Saunders C AU - McSharry CP AU - Cobb S LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 141 IP - DP - 1990 Jan 01 TI - Immulogic hemorrhagic pneumonia caused by isocyanates PG - 226-230 AU - Patterson R AU - Nugent KM AU - Harris KE AU - Eberle ME LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 45 IP - DP - 1990 Jan 01 TI - Occupational asthma caused by inhalation of casein PG - 306-308 AU - Olaguibel JM AU - Hernandez D AU - Morales P AU - Peris A AU - Basomba A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 47 IP - DP - 1990 Jan 01 TI - Six year follow up of lung function in men occupationally exposed to formaldehyde PG - 747-752 AU - Nunn AJ AU - Craigen AA AU - Darbyshire JH AU - Venables KM AU - Newman Taylor AJ LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 141 IP - DP - 1990 Jan 01 TI - Airbourne concentrations and particle size distribution of allergen derived from domestic cats (Felis domesticus) PG - 361-367 AU - Luczynska CM AU - Li Y AU - Chapman MD AU - PlattsMills TAE LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 141 IP - DP - 1990 Jan 01 TI - Comparison of monitoring of peak expiratory flow rates and bronchial responsiveness with specific inhalation challenges in occupational asthma PG - A79-A79 AU - Perrin B AU - Malo JL AU - L'Archeveque J AU - Ghezzo H AU - Lagier F AU - Cartier A LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 85 IP - DP - 1990 Jan 01 TI - Identification and partial characterisation of the soybean-dust allergens involved in the Barcelona asthma epidemic PG - 778-784 AU - Rodrigo MJ AU - Morell F AU - Helm RM AU - Swanson M AU - Greife A AU - Anto JM AU - Sunyer J AU - Reed CE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 suppl 1 IP - DP - 1990 Jan 01 TI - Occupational asthma due to inhaled carminic acid PG - 43-43 AU - Rodriguez A AU - de la Cuesta CG AU - Olaguibel JM AU - Tabar A AU - Santos F LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 3 suppl 10 IP - DP - 1990 Jan 01 TI - Occupational asthma and rhinitis due to dust from oil-fired boilers PG - 173s-173s AB - Asthma and rhinitis in boiler operators AS ROBERTSON, PS BURGE Institute of Occupational Health, University of Birmingham, and East Birmingham Hospital, Birmingham Four boiler operators and one boiler chemist (mean age 47-4, range 35-54 y) from a Birmingham engineering company were referred to outpatients with work related symptoms. All workers complained of acute and chronic respiratory and nasal symptoms. Respiratory symptoms consisted of chest tightness, wheeze, cough and breathlessness and nasal symptoms including blocked or runny nose with pain, crusting and bleeding. Their job with the engineering company involved operating and occasionally cleaning oil, coal and gas fired boilers; four were still employed, one having left one year previously. They had been employed for a mean of 10-6 (range 5-19) years. All had previously been well while working as boiler operators elsewhere (mean 13-8 y). In November 1984 4/5 of the workers entered the boiler house after the oil fired boilers had been cleaned by contractors. All were systematically unwell in association with symptoms of asthma and profound nasal irritation that lasted approximately one week. Subsequent to this exposure all workers had variable work related nasal and respiratory symptoms. One worker gave a past history of pneumonia related to boiler cleaning. On examination three had inflamed nasal mucosae and one had a nasal perforation. The mean lung function of those currently working was reduced (% predicted): FEV, 75% (SD 18%), FVC 88% (SD 11%). Chest radiographs were normal in all five. Only one had a positive skin prick test response to a common allergen. Serial peak flow recordings in those engaged in routine boiler operations showed occupational asthma in one, small consistent declines in mean peak flow in two, and a normal record in the remaining worker. Although the acute irritant effects of the vanadium contained within oil fired boiler dust is well recognised, the recurrent nasal and respiratory symptoms associated with low level exposure described here have not previously been described. AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 49 IP - DP - 1990 Jan 01 TI - Respiratory symptoms and respiratory function among Finnish Reindeer herders PG - 74-80 AU - Reijula K AU - Larmi E AU - Hassi J AU - Hannuksela M LA - PT - DEP - TA - Arct Med Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 98 IP - DP - 1990 Jan 01 TI - Reactive airways dysfunction syndrome in three police officers following a roadside chemical spill PG - 928-929 AU - Promisloff RA AU - Lenchner GS AU - Cichelli AV LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 IP - DP - 1990 Jan 01 TI - Allergy to mice. II. Further characterisation of two major mouse allergens (Ag 1 and Ag 3) and immunohistochemical investigations of their sources PG - 71-77 AU - Price JA AU - Longbottom JL LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 45 IP - DP - 1990 Jan 01 TI - Hard metal asthma: cross immunological and respiratory reactivity between cobalt and nickel? PG - 267-271 AB - Eight asthmatic patients with hard metal asthma due to cobalt underwent bronchial provocation challenge with nickel sulphate. Seven patients developed a fall in FEV1 of 20% or more after inhaling nickel sulphate, four showing an immediate response and three a late response. Eight control subjects, including six asthmatic patients, with no history of hard metal exposure, showed no bronchoconstriction in response to a provocation challenge with nickel sulphate. Specific antibodies to nickel conjugated human serum albumin were present in four of the eight patients with sensitivity to cobalt conjugated human serum albumin but were absent from the serum of 60 unexposed asthmatic patients and 25 exposed symptom free workers. These results suggest that nickel as well as cobalt sensitivity plays a part in hard metal asthma. AU - Shirakawa T AU - Kusaka Y AU - Fujimura N AU - Kato M AU - Heki S AU - Morimoto K LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 90 IP - DP - 1990 Jan 01 TI - Hypersensitivity pneumonitis associated with the use of ultrasonic humidifiers PG - 263-265 AU - Shiue ST AU - Scherzer HH AU - DeGraff AC AU - Cole SR LA - PT - DEP - TA - N Y State J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 79 IP - DP - 1990 Jan 01 TI - Humidifier lung: an occupational disease PG - 87-88 AU - Schutz R LA - PT - DEP - TA - Schweiz Rundschau Med (Praxis) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 176 IP - DP - 1990 Jan 01 TI - Pollinosis, an occupational disease in gardners PG - 97-104 AU - Schubert H AU - Prater E LA - PT - DEP - TA - Dermatol Mon schr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 32 IP - DP - 1990 Jan 01 TI - Occupational allergic rhinitis in the hair care industry: reactions to permanent wave solutions PG - 473-475 AU - Schwartz HJ AU - Arnold JL AU - Strohl KP LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 116 IP - DP - 1990 Jan 01 TI - Epiglotic dysfunction after isocyanate inhalation exposure PG - 725-727 AU - Sales JH AU - Kennedy KS LA - PT - DEP - TA - Arch Otolaryngol Head Neck Surg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 suppl 1 IP - DP - 1990 Jan 01 TI - Identification of major allergenic flour proteins in order to develop assays to measure flour aeroallergens PG - 3-3 AU - Sandiford CP AU - Tee RD AU - Newman Taylor AJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 150 IP - DP - 1990 Jan 01 TI - Clubbing in hypersensitivity pneumonitis PG - 1849-1851 AU - Sansores R AU - Salas J AU - Chapela R AU - Barquin N AU - Selman M LA - PT - DEP - TA - Arch Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 32 IP - DP - 1990 Jan 01 TI - Evaluation of flu-like symptoms in workers handing xanthan gum powder PG - 625-630 AU - Sargent EV AU - Adolph J AU - Clemmons MK AU - Kirk GD AU - Pena BM AU - Fedoruk MJ LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 IP - DP - 1990 Jan 01 TI - Respiratory and immunological reactions among Shiitake (Lentinus edodes) mushroom workers PG - 13-19 AU - Sastre J AU - Ibanez MD AU - Lopez M AU - Lehrer SB LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 174 IP - DP - 1990 Jan 01 TI - Bronchial hyperreactivity in pig farmers and cattle breeders PG - 131-136 AU - Scheefeldt M AU - Wilfert A AU - Lehnigk B AU - Wosnitzka H LA - PT - DEP - TA - Z Erkrank Atm Org JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 174 IP - DP - 1990 Jan 01 TI - Pig-breeders lung - a form of extrinsic allergic alveolitis PG - 143-148 AU - Schlegel V AU - Liebetrau G AU - Pohl WD LA - PT - DEP - TA - Z Erkrank Atm Org JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 86 IP - DP - 1990 Jan 01 TI - Allergens involved in occupational asthma caused by baby's breath (Gypsophila paniculata) PG - 189-193 AU - Schroeckenstein DC AU - MeierDavis S AU - Yunginger JW AU - Bush RK LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 81 IP - DP - 1990 Jan 01 TI - Asma de collanti cianoacrilici PG - 142-146 AU - De Zotti R AU - Larese F LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 IP - DP - 1990 Jan 01 TI - Asthme professionnel au methyl-methacrylate PG - 386- AU - ReymaudGaubert M AU - PhilipJoet F AU - Arnaud A LA - PT - DEP - TA - Presse Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - IP - DP - 1990 Jan 01 TI - Occupational asthma PG - - AU - Department of Social Security LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 85 IP - DP - 1990 Jan 01 TI - An optimized assay of specific IgE antibodies to reactive dyes and studies of immunologic responses in exposed workers PG - 642-648 AB - Methods of assaying reactive dye-specific IgE antibodies were investigated with a RAST. Sera from three patients, occupationally exposed to a reactive dye, Remazol black B (Chemical Abstract registry number 17095-24-8), were used. Directly dyed disks, that is, disks without any carrier protein, resulted in poor and unreliable measures of specific IgE. In contrast, optimized preparation of conjugates between the dye and human serum albumin resulted in efficient binding of specific IgE. The patients' RAST results were strongly positive, whereas sera from 36 exposed workers but without symptoms and sera from unexposed subjects with high levels of total IgE were negative. The hapten and carrier specificity of the IgE antibodies was studied by direct RAST and RAST inhibition. In one patient, the antibodies were principally hapten specific, whereas another patient was found to have antibodies with a high degree of specificity to the carrier. The third patient's antibodies were intermediate between the other two patients' antibodies in this respect, suggesting that antibody specificity is dependent not only on the nature of the hapten but also on individual immune response factors. The study demonstrates that it is important to use an optimized preparation of dye-protein conjugates to elicit reliable results and a high degree of specific IgE binding in the RAST AU - Wass U AU - Nilsson R AU - Nordlinder R AU - Belin L LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 16 IP - DP - 1990 Jan 01 TI - An in vitro method for predicting sensitizing properties of inhaled chemicals PG - 208-214 AB - A method for monitoring chemical reactivity in aqueous solutions, at neutral pH and 37 degrees C, was developed. The chemical was allowed to react with a lysine-containing peptide, and the reaction was monitored with high-performance liquid chromatography. Simple acids, bases, and solvents did not react with the peptide, whereas isocyanates, anhydrides, and chloramine-T, substances well known for their sensitizing and asthma inducing properties, did. Thus a positive test strongly suggested that the chemical had the potential to act as a hapten and cause sensitization when inhaled. Prepolymers of diphenylmethane diisocyanate were considerably more reactive than prepolymers of toluene diisocyanate or hexamethylene diisocyanate. Isocyanates blocked with caprolactam, butanone oxime, malonic acid diethylester, or isononyl phenol showed no reactivity. This result suggested a significantly reduced risk of respiratory reactions when such blocked isocyanates are handled at room temperature. One blocked isocyanate showed, however, considerable reactivity AU - Wass U AU - Belin L LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 141 IP - DP - 1990 Jan 01 TI - Effects of inhaled preservatives on asthmatic subjects ii. Benzalkonium chloride PG - 1405-1408 AU - Zhang YG AU - Wright WJ AU - Tam WK AU - HguyenDang TH AU - Salome CM AU - Woolcock AJ LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 62 IP - DP - 1990 Jan 01 TI - Long-term exposure to cement dust and later hospitalisation due to respiratory disease PG - 217-220 AU - Vestbo J AU - Rasmussen FV LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 16 IP - DP - 1990 Jan 01 TI - Relationship of airborne microorganisms with the lung function and leucocyte levels of workers with a history of humidifier fever PG - 428-433 AB - An influenza-like illness appeared recently among workers in a plant processing synthetic yarn. A humidifier, a cold-water spraying system, was the suspected cause. Lung function changes over the day and week and changes in blood leucocytes were studied among the workers from the suspected department and two reference populations. Exposure to colony-forming units of bacteria and fungi and to endotoxins was also monitored. The workers from the suspected department had statistically significantly lower lung functions on the first workday of the week than the referents. Their blood leucocytes were also raised statistically significantly. The exposure to fungi, bacteria, and endotoxins differed significantly between the various departments, but the measured levels were low. It was concluded that the observed effects were suggestive of a "Monday morning fever" type of reaction and that adverse effects occurred at exposure levels lower than those found to date in the literature AU - Kateman E AU - Heederik D AU - Pal TM AU - Smeets M AU - Smid T AU - Spitteler M LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 79 IP - DP - 1990 Jan 01 TI - Humidifier syndrome as occupational disease in Switzerland. PG - 797-803 AB - Control of humidity may be necessary in various industrial processes. Contamination of humidifiers by algae and bacteria may lead in exposed workers to two distinct syndromes: extrinsic allergic alveolitis and humidifier fever. In Switzerland 18 cases of humidifier syndrome were accepted by SUVA as occupational disease. 13 of the 18 cases occurred in the printing industry. In 13 out of 18 cases contaminated humidifiers were the cause of the syndrome and in five cases contaminated air-conditioning systems. Due to the often uncharacteristic clinical signs and symptoms and variable clinical features diagnosis of humidifier syndrome was missed by the general practitioner. Once humidifier fever was clearly diagnosed most workers had to change their working place. Despite the avoidance of exposure respiratory problems, radiographic changes and pulmonary function changes often persisted. Major pulmonary function decreases resulting in pulmonary invalidity were observed in five of the 18 cases (28%). Technical measures to prevent humidifier syndrome are described AU - Jost M AU - Lehmann M LA - PT - DEP - TA - Schweiz Rundsch Med Prax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 7 IP - DP - 1990 Jan 01 TI - Statistiques medicolegales sur l'asthma professionnel au Quebec de 1986 a 1988 PG - 337-341 AU - Lagier F AU - Cartier A AU - Malo JL LA - PT - DEP - TA - Rev Mal Resp JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 86 IP - DP - 1990 Jan 01 TI - The use of an immunoassay index for antibodies against isocyanate human protein conjugates and application to human isocyanate disease PG - 94-98 AB - Serum IgG and IgE to isocyanate haptenized human serum albumin (HSA) were estimated by ELISA in 55 isocyanate workers who underwent isocyanate inhalation challenge studies in Montreal, Canada. The challenges were negative in 29 workers and positive in 26 workers. Isocyanate antibodies were estimated by ELISA index. The mean IgG indices were found to be significantly higher in the challenge-positive workers, and there was a similar trend for the IgE indices. Antibody specificities for toluene diisocyanate-HSA, diphenylmethane diisocyanate-HSA, and hexamethylene diisocyanate-HSA were determined by inhibition studies with a variety of isocyanate haptenized carriers. The other isocyanate substituted carriers were either noninhibitory or caused only partial inhibition as contrasted with the complete inhibition achieved by HSA conjugated to the isocyanate to which the worker was exposed. We interpret these specificity studies as indicating that the inhalation of isocyanates results in production of antibody that recognizes new antigenic determinants that develop from the coupling of isocyanates to homologous proteins. AU - Grammer LC AU - Harris KE AU - Malo JL AU - Cartier A AU - Patterson R LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 5 (suppl) IP - DP - 1990 Jan 01 TI - Compensation of occupational asthma in Quebec PG - 236S- AU - Malo JL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - IP - DP - 1990 Jan 01 TI - Further findings from the office environment study: productivity PG - 231-236 AU - Raw GJ AU - Leaman A LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 9 IP - DP - 1990 Jan 01 TI - Ventilatory function of workers at Okpella cement factory in Nigeria PG - 187-192 AU - Alakija W AU - Iyawe VI AU - Jarikre LN AU - Chiwuzie JC LA - PT - DEP - TA - W Afri J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 80 IP - DP - 1990 Jan 01 TI - Consistent pattern of elevated symptoms in air-conditioned office buildings: a reanalysis of epidemiologic studies PG - 1193-1199 AU - Mendell MJ AU - Smith AH LA - PT - DEP - TA - Am J Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 3/90 IP - DP - 1990 Jan 01 TI - Air-conditioning plants- a health problem PG - 117-121 AU - Rosskamp E LA - PT - DEP - TA - Bundesgesundhblad JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 28 IP - DP - 1990 Jan 01 TI - Hazardous health effects of occupational exposure to wood dust PG - 107-119 AU - Flechsig R AU - Nedo G LA - PT - DEP - TA - Industr Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 1 IP - DP - 1990 Jan 01 TI - An investigation of the relationship between microbial and particulate indoor air pollution and the sick building syndrome PG - 149-154 AU - Harrison J AU - Pickering CAC AU - Faragher EB AU - Austwick PKC LA - PT - DEP - TA - Indoor air 90 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - ed Lunau, IP - DP - 1990 Jan 01 TI - Hair nicotine as a marker for ETS exposure PG - 437-446 AU - Nilsen OG AU - Zahlsen K LA - PT - DEP - TA - Indoor air quality and ventilation JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - S 83 IP - DP - 1990 Jan 01 TI - Gezondheidsklachten en klachten over het binnenklimaat in kantoorgebouwen PG - 1-62 AU - Preller L AU - Zweers T AU - Boleij JSM AU - Brunekreef B LA - PT - DEP - TA - Directoraat-Generaal van de Arbeid JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 1 IP - DP - 1990 Jan 01 TI - Sick building syndrome: the effect of changes in ventilation rates on symptom prevalence: the evaluation of a double blind experimental approach PG - 519-524 AU - Menzies RI AU - Tamblyn RM AU - Tamblyn RT AU - Farant JP AU - Hanley J AU - Spitzer WO LA - PT - DEP - TA - Indoor air 90 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 159 IP - DP - 1990 Jan 01 TI - Reactive airways disfunction syndrome (RADS) due to chlorine gas exposure PG - 275-277 AU - Donnelly SC AU - FitzGerald MX LA - PT - DEP - TA - Ir J Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 1 IP - DP - 1990 Jan 01 TI - Sick Building Syndrome; environmental comparisons of sick and healthy buildings PG - 479-483 AU - Burge PS AU - Jones P AU - Robertson AS LA - PT - DEP - TA - Indoor air 90 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 1 IP - DP - 1990 Jan 01 TI - Validation of self-administered questionnaire in the diagnosis of sick building syndrome PG - 575-580 AU - Burge PS AU - Robertson AS AU - Hedge A LA - PT - DEP - TA - Proceedings of the fifth Internation Conference in JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 4 IP - DP - 1990 Jan 01 TI - The office illness project in northern Sweden. Part 1: a prevalence study of sick building syndrome related to demographic data, work characteristics and building factors PG - 627-632 AU - Stenberg B AU - Mild KH AU - Sandstrom M AU - Lonnberg G AU - Wall S AU - Sundell J AU - Zingmark PA LA - PT - DEP - TA - Indoor air 90 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 4 IP - DP - 1990 Jan 01 TI - The office illness project in Northern Sweden part 3: a case-referent study of SBS in relation to building characteristics and ventilation PG - 633-638 AU - Sundell J AU - Lonnberg G AU - Wall S AU - Stenberg B AU - Zingmank PA LA - PT - DEP - TA - Indoor air 90 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 45 IP - DP - 1990 Jan 01 TI - Immune activation and autoantibodies in humans with longterm inhalation exposure to formaldehyde PG - 217-223 AU - Trasher JD AU - Broughton A AU - Madison R LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 45 IP - DP - 1990 Jan 01 TI - Hypersensitivity pneumonitis of a mushroom worker due to Aspergillus glaucus PG - 245-247 AU - Yoshida K AU - Ando M AU - Ito K AU - Sakata T AU - Arima K AU - Araki S AU - Uchida K LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 52 IP - DP - 1990 Jan 01 TI - Chronic respiratory effects of indoor formaldehyde exposure PG - 117-125 AU - Krzyzanowski M AU - Quackenboss JJ AU - Lebowitz MD LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 44 IP - DP - 1990 Jan 01 TI - a case of occupational allergic bronchopulmonary aspergillosis unique to Japan PG - 482-489 AU - Kurosawa M AU - Kobayashi S AU - Yanagihara Y AU - Shida T LA - PT - DEP - TA - BJCP JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 27 IP - DP - 1990 Jan 01 TI - Ethylenediamine-induced late asthmatic responses PG - 207-212 AU - Nakazawa T AU - Matsui S LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 45 IP - DP - 1990 Jan 01 TI - Clinical significane of IgG subclass antibodies to wheat flour antigens in bakers PG - 497-504 AU - Tiikkainen U AU - Klockars M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 18 IP - DP - 1990 Jan 01 TI - Case report of occupational asthma due to Palisander wood dust and bronchoprovocation challenge by inhalation of pure wood dust from a capsule PG - 541-545 AU - GodnicCvar J AU - Gomzi M LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 52 IP - DP - 1990 Jan 01 TI - Air conditioning- assessment of humidification units PG - 168-173 AU - Nagorka R AU - Rosskamp E AU - Seidel K LA - PT - DEP - TA - Off Gesundh-Wes JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 34 IP - DP - 1990 Jan 01 TI - Exposure of diamond polishers to cobalt PG - 609-614 AU - van den Oever R AU - Roosels D AU - Douwen M AU - Vanderkeel J AU - Lahaye D LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 74 IP - DP - 1990 Jan 01 TI - A clinician's approach to determine the diagnosis, prognosis and therapy of occupational asthma PG - 811-822 AU - ChanYeung M LA - PT - DEP - TA - Med Clin North Am JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 28 IP - DP - 1990 Jan 01 TI - Analysis of maximal expiratory flow-volume patterns in Sea-squirt asthma patients PG - 133-138 AU - Meguro T AU - Ogata M LA - PT - DEP - TA - Industr Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 4 IP - DP - 1990 Jan 01 TI - Library of congress indoor air quality and work environment study: health symptoms and comfort concerns PG - 603-608 AU - Fidler AT AU - Wilcox TG AU - Leaderer BP AU - Selfridge OJ AU - Hornung RW LA - PT - DEP - TA - Indoor air 90 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 1 IP - DP - 1990 Jan 01 TI - The effect of change in building ventilation category on sickness absence rates and the prevalence of sick building syndrome PG - 237-242 AU - Robertson AS AU - Roberts KT AU - Burge PS AU - Raw GJ LA - PT - DEP - TA - Indoor air 90 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 1 IP - DP - 1990 Jan 01 TI - Headache in office workers PG - 243-247 AU - Robertson AS AU - Roberts KT AU - Burge PS LA - PT - DEP - TA - Indoor air 90 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - IP - DP - 1990 Jan 01 TI - Indoor climate and air quality problems; investigation and remedy PG - 24-26 AU - Valbjorn O AU - Hagen H AU - Kukkonen E AU - Sundell J LA - PT - DEP - TA - SBI report 212 Danish Building Research Institute JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 180 IP - DP - 1990 Jan 01 TI - Evidence that toluene diisocyanate activates the efferent function of capsaicin-sensitive primary afferents PG - 113-118 AB - Isocyanates are an important cause of occupational asthma. The mechanism of isocyanate-induced asthma is still unknown. To determine whether toluene diisocyanate stimulates the 'efferent' function of peripheral endings of capsaicin-sensitive sensory nerves, we investigated the effect of toluene diisocyanate in the rat isolated urinary bladder, a preparation in which the action of capsaicin has been well characterized. Toluene diisocyanate (0.03-3 mM) produced a concentration-dependent contraction of the bladder strips. Its maximal effect was about 50% of the response to capsaicin (1 microM). Previous exposure of the strips to capsaicin followed by washing out produced complete unresponsiveness, both to the first exposure to toluene diisocyanate and to a second exposure of capsaicin. Further, the response to both toluene diisocyanate and capsaicin was completely prevented by extrinsic bladder denervation, achieved by bilateral removal of pelvic ganglia (72 h before). Repeated exposure of the rat bladder to toluene diisocyanate reduced the capsaicin-evoked release of calcitonin gene-related peptide-like immunoreactivity (CGRP-LI), taken as biochemical marker of activation of these sensory nerves. These experiments provide the first evidence that toluene diisocyanate activates directly or indirectly the efferent function of capsaicin-sensitive primary sensory nerves AU - Mapp CE AU - Chitano P AU - Fabbri LM AU - Patacchini R AU - Santicioli P AU - Geppetti P AU - Maggi CA LA - PT - DEP - TA - Eur J Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 1 IP - DP - 1990 Jan 01 TI - Questionnaire design guidelines for investigation of "sick" buildings PG - 605-610 AU - Hedge A LA - PT - DEP - TA - Indoor air 90 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 1 IP - DP - 1990 Jan 01 TI - A modular longitudinal approach to the investigation of sick building syndrome PG - 287-292 AU - Leinster P AU - Raw GJ AU - Thomson N AU - Leaman A AU - Whitehead C AU - Pickering CAC AU - Burge PS LA - PT - DEP - TA - Indoor air 90 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 1 IP - DP - 1990 Jan 01 TI - The effect of air humidification on symptoms and environmental complaints in office workers. A six period cross-over study PG - 775-780 AU - Reinikainen LM AU - Jaakkola JJK AU - Helenius T AU - Seppanen O LA - PT - DEP - TA - Indoor air 90 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - European s IP - DP - 1990 Jan 01 TI - Indoor air quality: biological contaminants PG - 1-54 AU - WHO LA - PT - DEP - TA - WHO regional publications JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - IP - DP - 1990 Jan 01 TI - Raumlufttechnische Anlagen - ein gesundheitliches Problem PG - 117-121 AU - von Rosskamp E LA - PT - DEP - TA - Bundesgesundhblad JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 16 IP - DP - 1990 Jan 01 TI - Influence of indoor climate on the sick building syndrome in an office environment PG - 363-371 AU - Skov P AU - Valbjorn O AU - Pedersen BV LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 104 IP - DP - 1990 Jan 01 TI - The Stafford outbreak of legionnaires' disease PG - 361-380 AU - O'Mahony MC AU - StanwellSmith RE AU - Tillett HE AU - Harper D AU - Hutchison JGP AU - Farrell ID AU - Hutchinson DN AU - Lee JV AU - Dennis PJ AU - Duggal HV AU - Scully JA AU - Denne C LA - PT - DEP - TA - Epidemiol Infect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - IP - DP - 1990 Jan 01 TI - Humidifier fever PG - 1114-1116 AU - Burge PS LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 47 IP - DP - 1990 Jan 01 TI - Asmagenic properties of a newly developed detergent ingredient: sodium iso-nonanoyl oxybenzene sulphonate PG - 405-410 AU - Stenton SC AU - Dennis JH AU - Walters EH AU - Hendrick DJ LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 98 IP - DP - 1990 Jan 01 TI - Medical-legal definition of occupational asthma PG - 1007-1011 AU - Smith DD LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 98 IP - DP - 1990 Jan 01 TI - Evaluation of occupational asthma from airborne egg protein exposure in multiple settings PG - 398-404 AU - Smith AB AU - Bernstein DI AU - London MA AU - Gallagher J AU - Ornella GA AU - Gelletly SK AU - Wallingford K AU - Newman MA LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 68 IP - DP - 1990 Jan 01 TI - Leukotriene B4 and late asthmatic reactions induced by toluene diisocyanate PG - 1576-1580 AB - We investigated whether leukotriene B4 (LTB4) is released from the lungs of sensitized subjects during asthmatic reactions induced by toluene diisocyanate (TDI). We examined three groups of TDI-sensitized subjects, one after no exposure to TDI, the second 8 h after an exposure to TDI that caused an early asthmatic reaction, and the third 8 h after an exposure to TDI that caused a late asthmatic reaction. We analyzed bronchoalveolar lavage (BAL) fluid by reverse-phase high-performance liquid chromatography and by specific radioimmunoassay. The mean concentration of LTB4 was higher [0.31 +/- 0.09 (SE) ng/ml, range 0.15-0.51] in BAL fluid of sensitized subjects who developed a late asthmatic reaction than in BAL fluid of subjects who developed an early asthmatic reaction (0.05 +/- 0.04 ng/ml, range 0-0.224), and no LTB4 was detectable in the control subjects. We also performed BAL 8 h after TDI exposure on four TDI-sensitized late-dual reactors who were on steroid treatment. In this group of subjects no LTB4 was detectable. These results suggest that LTB4 may be involved in late asthmatic reactions induced by TDI AU - Zocca E AU - Fabbri LM AU - Boschetto P AU - Plebani M AU - Masiero M AU - Milani GF AU - Pivirotto F AU - Mapp CE LA - PT - DEP - TA - J Appl Physiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 134 IP - DP - 1990 Jan 01 TI - Intoxication with ammonium tetraformiate, a silage additive PG - 1267-1268 AU - van de Meer YG AU - Haasbroek WM AU - Bax GM LA - PT - DEP - TA - Ned Tijdschr Geneeskd JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 45 IP - DP - 1990 Jan 01 TI - Ipecacuanha asthma: an old lesson PG - 974-974 AU - Seaton A LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 45 IP - DP - 1990 Jan 01 TI - Occupational asthma in a pharmaceutical worker exposed to hydralazine PG - 980-981 AB - A pharmaceutical worker developed asthma when exposed to hydralazine, an antihypertensive drug. The diagnosis of occupational asthma was supported by specific inhalation challenges, which produced a late asthmatic reaction and an increase in bronchial responsiveness. No evidence of an IgE or an IgG dependent mechanism could be found. AU - Perrin B AU - Malo JL AU - Cartier A AU - Evans S AU - Dolovich J LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 85 IP - DP - 1990 Jan 01 TI - Late asthmatic reactions to occupational sensitizing agents: frequency of changes in nonspecific bronchial responsiveness and of response to inhaled beta2-adrenergic agent PG - 834-842 AU - Malo JL AU - Ghezzo H AU - L'Archeveque J AU - Cartier A LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 100 IP - DP - 1990 Jan 01 TI - Pharmacological modulation of the contractile response to toluene diisocyanate in the rat isolated urinary bladder PG - 886-888 AB - 1. Toluene diisocyanate produced concentration-dependent contractions of the rat isolated urinary bladder. 2. The contractions were tetrodotoxin-resistant and were abolished by previous exposure of the strips to capsaicin. 3. Indomethacin (5 microM) and ruthenium red (30 microM) inhibited toluene diisocyanate-induced contractions. Responses expressed as a percentage of the response obtained with substance P, 30 nM, were respectively 141.6 +/- 24.8% and 20.1 +/- 5.1% in control and indomethacin-treated strips (P less than 0.005); 123.0 +/- 30.2% and 14.0 +/- 6.5% in control and ruthenium red-treated strips (0.01 less than P less than 0.05). 4. These results suggest that toluene diisocyanate-induced contractions of the rat isolated bladder are the result of the release of cyclo-oxygenase products which may act by activating the capsaicin receptor AU - Mapp CE AU - Chitano P AU - Fabbri LM AU - Patacchini R AU - Maggi CA LA - PT - DEP - TA - Br J Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 98 IP - DP - 1990 Jan 01 TI - Occupational asthma in the egg processing industry PG - 261-262 AU - Reed CE LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 120 IP - DP - 1990 Jan 01 TI - Bachmittel, insbesondere Alpha-amylase, als berufliche Inhalations-allergene in der bachwarenindustrie PG - 446-450 AU - Wutrich B AU - Baur X LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 11 IP - DP - 1990 Jan 01 TI - A twelve-year clinical and immunologic evaluation of workers involved in the manufacture of trimellitic anhydride PG - 71-77 AU - Zeiss CR AU - Mitchell JH AU - Van Peenen PFD AU - Harris J AU - Levitz D LA - PT - DEP - TA - Allergy Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 20 IP - DP - 1990 Jan 01 TI - Specific antibodies to methyltetrahydrophalic anhydride in exposed workers PG - 639-645 AU - Welinder H AU - Nielsen J AU - Gustavsson C AU - Bensryd I AU - Skerfving S LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 301 IP - DP - 1990 Jan 01 TI - Evaluation of peak flow and symptoms only self management plans for control of asthma in general practice PG - 1355-1359 AU - Charlton I AU - Charlton G AU - Broomfield J AU - Mullee MA LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 45 IP - DP - 1990 Jan 01 TI - Concentrations of specific dusts in swineries and humoral response of swinery workers PG - 354-362 AU - Virtanen T AU - Kalliokoski P AU - Vilhunen P AU - Taivainen A AU - Mantyjarvi R LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 28 IP - DP - 1990 Jan 01 TI - Organic dust toxic syndrome: an acute febrile reaction to organic dust exposure distinct from hypersensitivity pneumonitis PG - 389-420 AU - Von Essen S AU - Robbins RA AU - Thompson AB AU - Rennard SI LA - PT - DEP - TA - Clin Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 142 IP - DP - 1990 Jan 01 TI - Pulmonary fibrosis in aluminum oxide workers. Investigation of nine workers, with pathologic examination and microanalysis in three of them PG - 1179-1184 AB - Epidemiologic surveys have indicated an excess of nonmalignant respiratory disease in workers exposed to aluminum oxide (Al2O3) during abrasives production. However, clinical, roentgenographic, histologic, and microanalytic description of these workers are lacking. This is a report of nine Al2O3-exposed workers with abnormal chest roentgenograms (profusion greater than or equal to 1/0, ILO/UC) from a plant engaged in the production of Al2O3 abrasives from alundum ore. Mean duration of exposure was 25 yr, and time since first exposure was 28 yr. in a subgroup of three, the severity of symptoms, reduction in the forced vital capacity (67% predicted) and diffusing capacity (51% predicted), and progressive roentgenographic changes (profusion greater than or equal to 2/2) prompted open lung biopsy. Lung tissue was analyzed by scanning electron microscopy and electron microprobe analysis. In each of the three biopsies, interstitial fibrosis with honeycombing was seen on routine section. In one biopsy, silica and asbestos fiber counts were at the low end of the range seen with silicosis and asbestosis; however, the absence of asbestos bodies and silicotic nodules suggested that the fibrosis was due to another cause. Metals occurred in amounts several orders of magnitude above background, and the majority was aluminum as Al2O3 and aluminum alloys. The findings in these nine workers suggests a common exposure as the possible cause. The nonspecific pathologic findings, absence of asbestos bodies and silicotic nodules, and the striking number of aluminum-containing particles suggest that Al2O3 is that common exposure. The possibility of "mixed dust" fibrosis should also be considered. AU - Jederlinic PJ AU - Abraham JL AU - Churg A AU - Himmelstein JS AU - Epler GR AU - Gaensler EA LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 6 IP - DP - 1990 Jan 01 TI - A longitudinal study of risk factors in asthma and chronic bronchitis in childhood PG - 341-347 AB - The prevalence, persistence, incidence and remission rates of reported diagnosed asthma and chronic bronchitis has been studied longitudinally over ten years in a representative community sample of children and adolescents. The objectives are to evaluate the rates of change over time, the role of family history of disease, and the social risk factors in the longitudinal course of disease. The relationship between the two reported diagnoses is very high, about half of each group having the other diagnosis. Each diagnosis has specific symptoms with which it is associated. Remission of clinical disease is associated with continuing symptoms in about half of such cases. The incidence rates and remissions of cases as they have occurred over time were associated with different symptoms and risk factors. A family history of lung disease and family social characteristics are significant risk factors affecting the presence of these diseases, and how they change. Discussion suggests these factors may affect possible precursors, such as lower respiratory tract illnesses, as well as personal habits (such as smoking), which are related to both diagnoses. Further, the interactions of these risk factors appear to significantly influence impairments of lung function at the beginning of adult life, and potential subsequent disease AU - Lebowitz MD AU - Holberg CJ AU - Martinez FD LA - PT - DEP - TA - Eur J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 85 IP - DP - 1990 Jan 01 TI - Occupational asthma caused by latex in a surgical glove manufacturing plant. PG - 626-631 AB - A 33-year-old latex glove inspector was diagnosed as having occupational asthma on the basis of peak flow and methacholine-responsiveness changes related to workplace exposure. She had latex sensitivity by skin prick testing. This finding led to a survey of her workplace. Of the 81 workers, 84% completed a questionnaire to assess work-related respiratory symptoms, 79% underwent skin prick testing to latex and six other workplace chemicals, and 62% performed workshift spirometry. Seven workers had spirometric changes consistent with asthma, of whom five had greater than or equal to 15% fall in FEV1 during the workshift. Six of these workers underwent methacholine-challenge testing, and three were found to have a significant improvement in responsiveness to methacholine away from work, suggestive of occupational asthma. Two of these workers had positive skin test responses to latex. Including the index case, 6% of workers who had pulmonary function testing had findings of latex-related occupational asthma. Skin test responses to latex occurred in 11% of workers tested. Our findings suggest that latex should be considered among the causes of occupational asthma. AU - Tarlo SM AU - Wong L AU - Roos J AU - Booth N LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - IP - DP - 1990 Jan 01 TI - The health benefits of smoking cessation PG - - AU - Surgeon General LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 84 IP - DP - 1990 Jan 01 TI - Cotinine analytical workshop report: consideration of analytical methods for determining cotinine in human body fluids as a measure of passive exposure to tobacco smoke. PG - 173-182 AB - A two-day technical workshop was convened November 10-11, 1986, to discuss analytical approaches for determining trace amounts of cotinine in human body fluids resulting from passive exposure to environmental tobacco smoke (ETS). The workshop, jointly sponsored by the U.S. Environmental Protection Agency and Centers for Disease Control, was attended by scientists with expertise in cotinine analytical methodology and/or conduct of human monitoring studies related to ETS. The workshop format included technical presentations, separate panel discussions on chromatography and immunoassay analytical approaches, and group discussions related to the quality assurance/quality control aspects of future monitoring programs. This report presents a consensus of opinion on general issues before the workshop panel participants and also a detailed comparison of several analytical approaches being used by the various represented laboratories. The salient features of the chromatography and immunoassay analytical methods are discussed separately. AU - Watts RR AU - Langone JJ AU - Knight GJ AU - Lewtas J LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - IP - DP - 1990 Jan 01 TI - The measurement of ETS through adsorption/desorption procedures PG - 82-89 AU - Proctor CJ AU - Dymond HF LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 16 IP - DP - 1990 Jan 01 TI - Respiratory symptoms and lung function of aluminum potroom workers PG - 270-277 AB - The association of occupational exposure with respiratory disease and lung function was examined in a cross-sectional study of 1805 aluminum potroom workers. Work-related asthmatic symptoms occurred in 15% of the workers with an exposure of 10 years or more and in 8% of the workers who had been employed less than five years. In a multiple logistic regression analysis an odds ratio (OR) of 3.4 [95% confidence interval (95% CI) 2.1-5.8] for work-related asthmatic symptoms was estimated for long versus short duration of employment. Airflow limitation was also significantly related to years of exposure (OR 2.6, 95% CI 1.7-3.9). Current occupational exposure and the occurrence of respiratory symptoms were not significantly associated. The results suggest that exposure to air pollutants in the primary aluminum industry may lead to the development of asthmatic symptoms, as well as to reduced respiratory function AU - Kongerud J AU - Gronnesby JK AU - Magnus P LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 65 IP - DP - 1990 Jan 01 TI - Contact allergies to CN and CS ("tear gas") in participants in demonstrations PG - 288-292 AB - 56 occasional demonstrators were interviewed with regard to former skin contact with omega-chloroacetophenone (CN) or ortho-chlorobenzylidene malononitrile (CS). 33 persons (59%) reported skin reactions of various kinds. Patch testing with CN, the structurally related preservative chloroacetamide, and CS revealed clinically relevant reactions to CN in 3 cases and questionable positive reaction to CS in one case. 8 further patients showed mild reactions to CN and CS. We did not find any indication of cross reactions between CN and chloroacetamide AU - Fuchs T AU - in der Wiesche M LA - PT - DEP - TA - Zeitschrift fur Hautkrankheiten JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 68 IP - DP - 1990 Jan 01 TI - Epidemiology, prevention and control of legionellosis: memorandum from a WHO meeting. PG - 155-164 AB - This Memorandum describes the following aspects of legionellosis: clinical presentations of legionella infection, general epidemiology (including nosocomial outbreaks and travel-associated legionnaires' disease), surveillance and reporting of cases, the organism and its environment, and measures for prevention and control. These topics were discussed by experts at a meeting in Geneva on 27-29 November 1989. This article also includes their conclusions and recommendations for research in critical areas including surveillance and preventive activities that have been found to be effective. AU - Anonymous LA - PT - DEP - TA - Bull World Health Organ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 11 IP - DP - 1990 Jan 01 TI - Disinfection of water distribution systems for legionella: a review of application procedures and methodologies. PG - 79-88 AB - Hospital-acquired legionella pneumonia is emerging as a major problem; potable water distribution systems have been shown to be the primary reservoirs for the legionella organisms. As a result, disinfection measures have been developed to eradicate the organism from the hospital water supply. Each disinfection modality differs in its design and application such that choosing an appropriate cost-effective control measure requires careful analysis and planning. We assess in comparative fashion the disinfection modalities of thermal eradication ("heat-and-flush"), instantaneous steam-heating system, chlorination, ultraviolet light irradiation, ozonation and metal ionization. The theoretical bases, the actual procedure or system, the logistics of implementation, the costs and personnel requirements and the advantages and disadvantages are presented for each modality. Criteria for selection of a method, the use of combinations of methods, parameters for installation, pitfalls in implementation and a plan for subsequent environmental surveillance are discussed in detail. AU - Muraca PW AU - Yu VL AU - Goetz A LA - PT - DEP - TA - Infect Control Hosp Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 336 IP - DP - 1990 Jan 01 TI - Potential value of serology for diagnosis of extrapulmonary tuberculosis PG - 641-644 AB - The possible benefits for improved diagnosis of extrapulmonary tuberculosis were evaluated by means of a modified serological competition assay. Antibodies to the 38 kD Mycobacterium tuberculosis antigen were detected in 73% of cases of extrapulmonary tuberculosis and 70% of smear-negative cases of pulmonary tuberculosis at a chosen specificity of 98%. Of 55 patients (45%) whose diagnosis of tuberculosis was not made until 7 days or longer after admission, 76% were positive for the antibody. In this group the serological test would have allowed chemotherapy to be started on average 12.5 days earlier and would have obviated the need for 80% of diagnostic biopsies AU - Wilkins EG AU - Ivanyi J LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 28 IP - DP - 1990 Jan 01 TI - Evaluation of lipoarabinomannan for the serological diagnosis of tuberculosis PG - 2587-2590 AB - The availability of highly purified lipoarabinomannan from Mycobacterium tuberculosis in its native acylated, highly antigenic state allowed its application to the serodiagnosis of tuberculosis in patients from the Republic of Mexico. Antilipoarabinomannan immunoglobulin G antibodies in sera from 66 patients with pulmonary, miliary, and pleural tuberculosis and tuberculosis lymphadenities were measured by using the enzyme-linked immunosorbent assay against sera from a control population of healthy individuals, people with histoplasmosis, and people with lung diseases not caused by mycobacteria. The results pointed to an unexpectedly high degree of specificity of 91% and a sensitivity of 72%, comparable to figures from previous studies with other purified antigens; most of the false-positive results were for patients with histoplasmosis. Thus, lipoarabinomannan of M. tuberculosis is a potentially useful antigen for the serodiagnosis of tuberculosis AU - Sada E AU - Brennan PJ AU - Herrera T AU - Torres M LA - PT - DEP - TA - Journal of Clinical Microbiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 142 IP - DP - 1990 Jan 01 TI - Serodiagnosis of tuberculosis using an ELISA with antigen 5 and a hemagglutination assay with glycolipid antigens. Results in patients with newly diagnosed pulmonary tuberculosis ranging in extent of disease from minimal to extensive PG - 385-389 AB - Hemagglutination tests with three glycolipid antigens, A1, B1, and C, and ELISA with antigen 5 were done on serum from Chinese patients with pulmonary tuberculosis and from normal subjects in Hong Kong. Tests with all four antigens were of similar efficiency, giving positive results in 30 to 52% of 88 smear-positive patients, in 16 to 22% of 37 smear-negative, culture-positive patients, in 5 to 13% of 76 culture-negative patients with radiologically active disease, in 5 to 11% of 217 culture-negative patients with inactive disease, and in 1 to 4% of 140 normal subjects. If tests were combined so that an overall positive was scored when all tests were positive, there was worse discrimination between patients and normal subjects; however, as suggested by the poor correlation between the results with pairs of the tests, better discrimination was obtained if an overall positive was scored when any of the tests was positive. A positive result in any of the four tests was found in 22% of all cases, including 58% of smear-positive patients, 32% of smear-negative, culture-positive patients, and 0.7% of normal subjects AU - Chan SL AU - Reggiardo Z AU - Daniel TM AU - Girling DJ AU - Mitchison DA LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 40 IP - DP - 1990 Jan 01 TI - Pulmonary tuberculosis. An occupational hazard for pathologists and pathology technicians in Japan PG - 116-127 AB - The incidence of pulmonary tuberculosis among pathology workers in Japan is elevated, presumably due to frequent exposure to tubercle bacilli in the work place. To demonstrate the etiological significance of the association between this disease and occupation epidemiologically, a questionnaire survey was performed to assess the incidence of pulmonary tuberculosis among 1,201 pathologists and 1,187 pathology technicians throughout Japan. Pathology department workers other than pathologists and technicians, such as secretaries (n = 207), and workers in university departments of preventive medicine and public health (n = 732) served as control groups. While non-occupation-related tuberculosis was found in both departmental groups with nearly equal incidence, the incidence of pulmonary tuberculosis among pathologists and pathology technicians after engagement in their current specialist work was significantly higher than that in the control groups (odds ratio = 6.08-10.98). The incidence of disease among pathology technicians who assisted in autopsies was markedly higher than among those not involved in autopsies (odds ratio = 6.65). This elevated incidence was significantly related to the duration of work in pathology activities, and showed little change over the last decade. These findings indicate that specific environmental conditions in pathology departments, particularly autopsy of cadavers harboring active tuberculosis, constitute a serious occupational hazard AU - Sugita M AU - Tsutsumi Y AU - Suchi M AU - Kasuga H AU - Ishiko T LA - PT - DEP - TA - Acta Pathologica Japonica JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 39 IP - DP - 1990 Jan 01 TI - Nosocomial transmission of multidrug-resistant tuberculosis to health-care workers and HIV-infected patients in an urban hospital--Florida PG - 718-722 AU - Anonymous LA - PT - DEP - TA - MMWR JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 155 IP - DP - 1990 Jan 01 TI - The investigation of a tuberculosis outbreak in the closed environment of a U.S. Navy ship, 1987 PG - 347-351 AB - A sailor on a U.S. Navy ship had smear-positive, cavitary, pulmonary tuberculosis. Contact investigation of the entire ship's crew found 216 new reactors to tuberculin skin test (24.5%) among 881 previously tuberculin-negative sailors. The risk for new infection was highest among sailors in the patient's department (relative risk, 4.4; 95% confidence interval 3.7, 5.3); 95% (15/16) of sailors in his division were new reactors. While crewmembers in all departments were at risk for a new tuberculosis infection, working and berthing in compartments that were distant from those of the index case were protective. The ship's closed ventilation system contributed to the outbreak AU - DiStasio AJ 2d AU - Trump DH LA - PT - DEP - TA - Mil Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 161 IP - DP - 1990 Jan 01 TI - Nosocomial transmission of tuberculosis associated with a draining abscess PG - 286-295 AB - Nine secondary cases of tuberculosis and 59 tuberculin skin test conversions occurred after exposure to a hospitalized patient with a large tuberculous abscess of the hip and thigh. Among 442 tuberculin-negative hospital employees, the relative risk of skin test conversion associated with recalled exposure to the patient was 14.0 (95% confidence limits, 6.8, 28.7). Four of 5 surgical suite employees who assisted with incision and debridement of the abscess had skin test conversions, as did 85% of 33 employees on a general medical floor who recalled exposure to the patient and 30% of 20 intensive care unit employees who recalled exposure. The prevalence of tuberculin reactivity in visitors and other patients on two floors also showed a strong association with exposure to the patient. A high concentration of Mycobacterium tuberculosis in the abscessed tissue, disturbance of the surface of liquid drainage from the abscess by irrigations and by the agitated behavior of the patient, and positive air pressure in the patient's room are factors that appear to have contributed to the high risk of tuberculosis transmission AU - Hutton MD AU - Stead WW AU - Cauthen GM AU - Bloch AB AU - Ewing WM LA - PT - DEP - TA - Journal of Infectious Diseases JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 113 IP - DP - 1990 Jan 01 TI - Tuberculosis control and the AIDS epidemic in developing countries PG - 89-91 AU - Pitchenik AE LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 300 IP - DP - 1990 Jan 01 TI - Control and prevention of tuberculosis in Britain: an updated code of practice. Subcommittee of the Joint Tuberculosis Committee of the British Thoracic Society PG - 995-999 AB - A subcommitte was appointed by the Joint Tuberculosis Committee of the British Thoracic Society to review and bring up to date guidelines on control measures for tuberculosis. The updated code of practice emphasises that all cases of tuberculosis must be notified. A minority of patients need admission, and those with positive sputum smears should be regarded as infectious until they have received two weeks of chemotherapy. NHS staff at risk should be protected, and evidence of infectious tuberculosis should be sought as routine among certain prospective NHS employees, schoolteachers, and others. Contact tracing should be vigorously pursued, and all entrants to Britain from countries where tuberculosis is common should be screened. BCG vaccination should be offered in selected instances, and local organisation of tuberculosis services should be extended AU - Joint Tuberculosis Committee of the British Thoracic Society LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 46 IP - DP - 1990 Jan 01 TI - Prevalence of building sickness syndrome in hospital outpatient departments PG - 313-313 AU - Fletcher AM AU - Niven RM AU - Pickering CAC LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 22 IP - DP - 1990 Jan 01 TI - Facial skin complaints and work on video display units; an epidemiological study of office employees PG - 621-625 AU - Berg M AU - Liden C AU - Axelson O LA - PT - DEP - TA - J Am Acad Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 5 IP - DP - 1990 Jan 01 TI - Significant changes of bronchial responsiveness to methacholine after early asthmatic reaction to toluene diisocyanate (TDI) in a TDI-sensitive asthmatic worker PG - 185-188 AB - Current asthma is often diagnostically excluded by the presence of normal bronchial responsiveness. We report on a TDI-induced occupational asthma patient with normal bronchial responsiveness. He had suffered from shortness of breath during and after TDI exposure for several months. His initial methacholine bronchial challenge test showed a negative response. The bronchoprovacation test with TDI showed an isolated immediate bronchoconstriction. The following methacholine bronchial challenge tests revealed that the bronchial hyperresponsiveness developed seven hours after the TDI challenge (methacholine PC20:5.1 mg/ml), progressed up until 24 hours, and returned to normal on the seventh day. This case provides evidence that the response of the airway to TDI may not always be accompanied by bronchial hyperresponsiveness to methacholine. Screening programs utilizing methacholine challenges may not always identify TDI-sensitized asthmatic workers AU - Park HS AU - Cho YS AU - Park JN AU - Baik JH AU - Rhu NS AU - Cho DI AU - Kim JW LA - PT - DEP - TA - J Kor Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 31 IP - DP - 1990 Jan 01 TI - Reactive dye induced occupational asthma without nonspecific bronchial hyperreactivity PG - 98-102 AB - Current asthma is often excluded by the presence of normal bronchial hyperresponsiveness. We report two asthmatic patients with normal bronchial hyperresponsiveness and one asthmatic patient with mild bronchial hyperresponsiveness (methacholine PC20; 24 mg/ml) which was presumed to be caused by sensitization and exposure to Black GR, the most frequent sensitizer among reactive dyes. They all complained of lower respiratory symptoms after work as well as at the workstation. The bronchoprovocation test with Black GR revealed isolated immediate bronchoconstrictions in all 3 patients and all had high specific IgE antibodies to Black GR-human serum albumin conjugate. After one worker continued at work for 3 days, he experienced a marked drop of methacholine PC20, and it returned to the pre-exposure level during 1 week. The other patient whose initial methacholine challenge was negative developed bronchial hyperresponsiveness on the first day after the dye bronchoprovocation, and returned to normal bronchial hyperresponsiveness on the third day. These findings suggested that patients with occupational asthma caused by reactive dye may not always have bronchial hyperresponsiveness to methacholine, and the screening program utilizing methacholine challenges may not always identify these patients AU - Park HS AU - Lee MK AU - Hong CS LA - PT - DEP - TA - Yonsei Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 141 IP - DP - 1990 Jan 01 TI - Outcome of patients with cedar asthma with continuous exposure PG - 373-376 AB - After an average follow-up of 6.5 yr (range 1 to 13), 48 of 48 patients with cedar asthma, who were still working in the same industry, were re-examined. In all of them, the diagnosis of cedar asthma had been confirmed with a specific challenge inhalation test with plicatic acid. We graded the severity of asthma symptoms and the requirement for antiasthma medications at the time of diagnosis and at the time of follow-up visit. Spirometry and measurement of airway responsiveness to methacholine (PC20 methacholine) were also done on both visits. The increase or decrease in asthma symptoms, medications requirement, FEV1 and PC20 methacholine between the follow-up and the diagnostic visit were used to determine the outcome of the patients. Using these parameters, 10.4% of patients improved, 62.5% remained stable, 37.5% deteriorated, and none recovered. Among the characteristics of the patients observed at the time of diagnosis, the age of the patient, the atopic status, smoking habit, and the presence of specific IgE to plicatic acid were not useful in predicting the eventual outcome. Reduction of exposure by transfer to a less dusty job and the use of an airstream helmet did not prevent deterioration of asthma. Only the use of the twin-cartridge respirator was associated with a favorable outcome. We conclude that among cedar asthmatics who remained exposed to cedar dust for an average of 6.5 yr, over one-third showed marked deterioration of their asthma symptoms. There is also no way to predict who will deteriorate. A decrease in the amount of exposure to cedar dust does not prevent deterioration of asthma. This suggests that the ideal management of cedar asthma is removal from exposure AU - Cote J AU - Kennedy S AU - ChanYeung M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 98 IP - DP - 1990 Jan 01 TI - Environmental and occupational asthma. Exposure assessment. [Review] PG - 209S-211S AU - Newman Taylor AJ AU - Tee RD LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 84 IP - DP - 1990 Jan 01 TI - The twenty-metre shuttle-running test: a combined test for maximal oxygen uptake and exercise-induced asthma? PG - 31-35 AB - A maximal multistage 'twenty-metre shuttle-running test' has already been developed to estimate maximal oxygen uptake (VO2 max). This field test requires little equipment or expertise, can be performed simultaneously by several subjects, and is widely used in physical education lessons. The present study assessed the potential for this test to provoke exercise-induced asthma in 73 schoolboys, aged 15-16 years. Measurements of the forced expiratory volume in one second (FEV1) were made at rest and 10 min after the twenty-metre shuttle-running test; exercise-induced asthma was defined as greater than a 10% fall in FEV1 after exercise. The pupils achieved 73 +/- 19 shuttles (mean +/- SD) giving a VO2 max of 47.0 +/- 5.3 ml kg-1 min-1. Exercise-induced asthma was documented in eight pupils (11%); two were known asthmatics who, despite taking pre-exercise B2 agonist treatment, had sharp falls in FEV1 (-25.4 and -25.6%); two had previously experienced occasional chest tightness or wheeze with exercise (-16.5 and -13.2% fall FEV1); but four were asymptomatic, with no previous asthmatic symptoms (-20.0, -18.2, -15.3 and -11.4% fall FEV1). This study has demonstrated the potential of the twenty-metre shuttle-running test to provoke exercise induced-asthma, and may therefore be a useful clinical test to assess for exercise-induced asthma when an estimate of VO2 max would also be helpful. Furthermore, physical education teachers should take basic precautions when using this test.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Freeman W AU - Weir DC AU - Sapiano SB AU - Whitehead JE AU - Burge PS AU - Cayton RM LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 106 IP - DP - 1990 Jan 01 TI - The lung of a fire-eater [Finnish] PG - 889-893 AU - Brander PE AU - Taskinen E AU - SteniusAarniala B LA - PT - DEP - TA - Duodecim JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 44 IP - DP - 1990 Jan 01 TI - Postal survey on airborne occupational exposure and respiratory disorders in Norway: causes and consequences of non-response PG - 316-320 AB - STUDY OBJECTIVE The aim was to examine causes for non-response in a community survey, and how non-response influences prevalence estimates of some exposure and disease variables, and associations between the variables. DESIGN This was a cross sectional questionnaire study with two reminder letters. The questionnaire asked for information on smoking habits, occupational airborne exposure and respiratory disorders. SETTING A random sample of 4992 subjects from the general population aged 15-70 years of Hordaland County, Norway. MAIN RESULTS The overall response rate was 90%, with a 63% response to the initial letter. The response rates to the first and second reminder letters were 56% and 36% respectively. In 20% of the non-respondents an uncompleted questionnaire was returned with cause for non-response; in two thirds of these the cause for non-response was that the subject was not resident at the mailing address. A home visit to a random sample of 50 urban non-respondents provided further information on 29 subjects. A wrong address at the Central Population Registry and the subject's feeling of lack of personal benefit from a postal survey were the major reasons for non-response. Smokers were late respondents and subjects with respiratory disorders tended to be early respondents. CONCLUSION The main reasons for non-response were a wrong mailing address and a feeling of lack of personal benefit from responding. Using only the initial letter would have changed the estimated prevalence of smokers from 39% to 35%. Otherwise, the estimated prevalence of the exposure and disease variables as well as the associations between them were only slightly changed after including the respondents to the first and second reminder letters AU - Bakke P AU - Gulsvik A AU - Lilleng P AU - Overa O AU - Hanoa R AU - Eide GE LA - PT - DEP - TA - Journal of Epidemiology & Community Health - L JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 44 IP - DP - 1990 Jan 01 TI - Exogenous allergic asthma following exposure to pectin - a new occupational allergy PG - 337-338 AU - Westphal W AU - Muller E AU - Becker WM AU - Fasske E AU - Schlaak M LA - PT - DEP - TA - Pneumonologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 44 IP - DP - 1990 Jan 01 TI - Disease of the airways in oyster mushroom cultivators PG - 339-340 AU - Betz B LA - PT - DEP - TA - Pneumonologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 1 IP - DP - 1990 Jan 01 TI - Reactive airways dysfunction syndrome: a subset of occupational asthma PG - 23-29 AU - Demeter SL AU - Cordasco EM LA - PT - DEP - TA - J Disability JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 45 IP - DP - 1990 Jan 01 TI - Hay fever, eczema and urticaria in southwest Norway. Lifetime prevalences and association with sex, age, smoking habits, occupational airborne exposures and respiratory symptoms PG - 515-522 AB - Information on hay fever, eczema, urticaria, respiratory symptoms, smoking habits and occupational dust or gas exposure was obtained by a self-administered questionnaire from a random sample of 4992 subjects of the general population aged 15-70 years of the Hordaland county, Norway. The response rate was 90% of the sample. The lifetime prevalences of hay fever, eczema and urticaria were 10%, 25% and 9% of the respondents, respectively. Eczema and urticaria were more often reported by women than by men. The lifetime prevalence of hay fever decreased substantially by age in both sexes. A history of hay fever was inversely related to cigarette smoking. The lifetime prevalences of eczema and urticaria were associated with occupational dust or gas exposure after adjusting for sex, age, smoking habits and area of residence. Adjusted odds ratios of respiratory symptoms in subjects with hay fever were almost 2.0 compared with those without AU - Bakke P AU - Gulsvik A AU - Eide GE LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 17 IP - DP - 1990 Jan 01 TI - IgG4 antibodies against pig-derived antigens PG - 96-98 AU - Brouwer R AU - Heederik D AU - van Swieten P LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 17 IP - DP - 1990 Jan 01 TI - Across-shift lung function changes among pig farmers PG - 57-58 AU - Heederik D AU - van Zwieten R AU - Brouwer R LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 16 IP - DP - 1990 Jan 01 TI - Combined effect of silica dust exposure and tobacco smoking on the prevalence of respiratory impairments among gold miners PG - 411-422 AB - The combined effect of underground gold mining dust with a high content of free silica and tobacco smoking on the prevalence of respiratory impairment was examined among 2209 South African gold miners and 483 nonminers. The subjects were grouped as having normal function; minimal, moderate or marked obstruction; marked obstruction with restriction; or pure restriction on the basis of their lung function profiles. Each profile group was compared with the normal group for exposure prevalences, and additive and multiplicative relative risk models were applied to test for departure from the additivity of individual effects. Departure from additivity was found to increase progressively with the severity of obstructive impairment. The results indicated that approximately 94% of the cases with the most severe respiratory impairment (N = 191) could have been prevented through the elimination of tobacco smoking. In conclusion, tobacco smoking was found to potentiate the effect of dust on respiratory impairments AU - Hnizdo E AU - Baskind E AU - SluisCremer GK LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 19 IP - DP - 1990 Jan 01 TI - Occupational exposure and 25-year incidence rate of non-specific lung disease: the Zutphen Study PG - 945-952 AB - Information gathered in the Zutphen Study, the Dutch contribution to the Seven Countries Study that started in the 1960s, was used for the present study. In 1960 878 men participated in the physical examination and they were followed for 25 years until 1 July 1985. During this follow-up, their morbidity status was verified regularly. With this information the occurrence of chronic non-specific lung disease (CNSLD) at a specific time was coded by one physician, using strict criteria. The CNSLD diagnosis was based on the following criteria: episodes of respiratory symptoms such as regular cough and phlegm for longer than three months or episodes of wheezing and shortness of breath reported to the survey physician, or: diagnosis of CNSLD, including chronic bronchitis or emphysema by a clinical specialist. Occupation in 1960 was coded and used to generate specific occupational exposures with a Job Exposure Matrix. Because the exact time of diagnosis of CNSLD was known, incidence densities could be calculated. For 804 men a complete set of data was available. A Poisson regression analysis was used to analyse the relationships between the incidence density and independent variables like age, calendar period, occupation and specific occupational exposures. Blue collar workers had a significantly elevated incidence density ratio (IDR) compared to white collar workers (1.82, 95% confidence limits (CL): 1.35, 2.46). Subgroups of blue collar workers, wood and paper workers, textile workers, and tailors, construction workers and transport workers had significantly elevated IDRs also. Of the specific exposures heavy metals, mineral dust and adhesives had a significantly elevated IDR.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Heederik D AU - Kromhout H AU - Burema J AU - Biersteker K AU - Kromhout D LA - PT - DEP - TA - Int J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 47 IP - DP - 1990 Jan 01 TI - Combined effect of silica dust and tobacco smoking on mortality from chronic obstructive lung disease in gold miners PG - 656-664 AB - A sample of 2209 white South African gold miners aged 45-54 between 1968-71, who started mining exposure during 1936-43, was investigated from 1968-71 to 30 December 1986. The effect of silica dust and tobacco smoking on mortality from chronic obstructive lung disease (COLD) was assessed. The relative risk (RR) for dust exposure before 1950 was estimated as 2.5 (95% confidence interval (CI) 1.5-4.2), for 10 units of 1000 particle-years. The combined effect of dust exposure before 1950 and years of cigarette smoking on mortality from COLD was best estimated by the multiplicative model, indicating that the two exposures act synergistically. All those that died of the disease were smokers. According to the estimates of attributable risk about 5% of the deaths from COLD were from the effect of dust, 34% were from smoking, and 59% were from the combined effect of dust and smoking. In conclusion, the results indicate that workers exposed to silica dust who smoke are at higher risk of dying from COLD than smokers not exposed to silica dust, as the two exposures act synergistically in causing COLD AU - Hnizdo E LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 47 IP - DP - 1990 Jan 01 TI - Silica exposure, silicosis, and lung cancer: a necropsy study PG - 4-9 AB - Recent studies of the association between lung cancer and silicosis and silica dust have been inconclusive; some showing positive association and some showing none. The present study matched 231 cases of lung cancer with 318 controls by year of birth. Subjects were selected from the necropsy records of the National Centre for Occupational Health. Data on intensity and duration of exposure to silica dust were obtained from personnel records. Presence or absence of lung cancer and the presence and severity of silicosis of the parenchyma, pleura, and hilar glands were documented from necropsy reports. Smoking data were abstracted from records of routine examinations. No case-control differences were noted for any of the exposure indicators including cumulative dust exposure, total dusty shifts, weighted average intensity of exposure, total underground shifts, and shifts in high dust. Similarly, no association was found between lung cancer and the presence or severity of silicosis and any site. Stratified analyses showed neither significant nor suggestive trends when case-control comparisons for silicosis were examined by level of dust exposure or smoking. Reasons for disparity between these results and those of some other studies may include concomitant exposures to radon daughters, asbestos, diesel emissions, and cigarette smoking; idiosyncracies of the compensation process; and the possibility of a threshold in the relation(s) AU - Hessel PA AU - SluisCremer GK AU - Hnizdo E LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 34 IP - DP - 1990 Jan 01 TI - Evidence for an amphibole asbestos threshold exposure for asbestosis assessed by autopsy in South African asbestos miners PG - 443-451 AB - In an attempt to determine whether there exists a threshold asbestos dose below which asbestosis does not occur, data on 807 men who had worked on amphibole asbestos mines and undergone autopsy were analysed. When exposure was expressed as fibre-years no asbestosis was found at autopsy when exposure was up to 2 fibre-years, even after 31-45 years of residence time. In the group exposed to greater than 2-5 fibre-years asbestosis was found. When exposure was expressed as average fibre concentration asbestosis occurred below 2 fibres per ml (f ml-1) and the prevalence increased with residence time. In conclusion, if a threshold dose for asbestosis does exist it is at approximately 2 fibre-years if off-shift exposure is ignored AU - SluisCremer GK AU - Hnizdo E AU - du Toit RS LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 16 IP - DP - 1990 Jan 01 TI - Smoking habits and lifetime occupational exposure to gases or dusts, including asbestos and quartz, in a Norwegian community PG - 195-202 AB - Past or present occupational airborne exposure was recorded with a self-administered questionnaire sent to a random sample (N = 4992) of the 15- to 70-year-old population of Hordaland County, Norway. Completed questionnaires were returned by 90% of the sample. The respondents comprised 39% smokers, 20% ex-smokers, and 41% nonsmokers. Altogether 46% of the men and 12% of the women had a history of occupational gas or dust exposure. Occupational asbestos exposure was reported by 10% of the men and 0.4% of the women, and quartz exposure had been experienced by 8% of the men and 0.4% of the women. Smokers with a history of asbestos exposure represented 5% of the male population. Thirty percent of the smokers reported having been advised to stop smoking by a physician. The asbestos-exposed smokers had not received such advice more often than the smokers not exposed to asbestos. The findings indicate that airborne occupational exposure is widespread in the Norwegian County of Hordaland AU - Bakke P AU - Gulsvik A AU - Eide GE AU - Hanoa R LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 152 IP - DP - 1990 Jan 01 TI - Accumulation of respiratory diseases among employees at a recently established refuse sorting plant. [Danish] PG - 2485-2488 AB - An increasing number of plants for re-use of refuse have been constructed in Denmark in recent years. The Kaastrup Plant near Skive was opened in spring 1986. The plant accepts household rubbish and industrial refuse separately. The refuse is sorted by machine (industrial refuse is sorted partially manually) and in a large partially open machine plant, refuse is converted into fuel pellets. During a period of eight months, eight out of 15 employees developed respiratory symptoms. In seven, bronchial asthma was diagnosed and chronic bronchitis in one person. Four had initial symptoms of the organic dust toxic syndrome. After further six months, another case of occupationally-conditioned asthma occurred in the plant. Only two out of nine had previously had asthma or atopic disease. The investigation did not reveal any evidence of type-I allergy. Six out of nine had specific precipitating antibodies to refuse while all had negative RAST tests to this. In spring 1989, from six to eighteen months after the onset of the symptoms, six had still dyspnoea on exertion and three had positive histamine-provocation tests and seven out of nine had left the plant. Occupational medical measurements revealed dust concentrations of 8.1 mg/cubic millimeter in September 1986 and total germs of up to 3 x 10(9) cfu/cubic meter. Construction of the plant involved considerable contact with the refuse on account of the cleansing processes and open systems and it was reconstructed in the course of 1987/1988 so that the hygienic conditions are now acceptable.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Sigsgaard TI AU - Bach B AU - Taudorf E AU - Malmros P AU - Gravesen S LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 98 IP - DP - 1990 Jan 01 TI - Bronchoalveolar lavage and morphology of the airways after cessation of exposure in asthmatic subjects sensitized to toluene diisocyanate PG - 536-542 AB - To evaluate the morphologic basis of the different outcomes of toluene diisocyanate (TDI) asthma after quitting occupational exposure, we examined ten patients with TDI asthma who showed, at diagnosis, a positive TDI challenge test and nonspecific bronchial hyperresponsiveness (NSBH) to methacholine. After diagnosis, all patients ceased work and a 4- to 40-month follow-up was obtained with three to eight determinations of the cumulative dose producing a 15 percent fall in FEV1 (PD15FEV1) methacholine in each patient. Bronchoalveolar lavage (BAL) and biopsy of bronchial muscosa were performed 3 to 39 months after cessation of work, in the absence of acute exacerbations of the disease. Total cell count in BAL fluid was moderately increased in four of ten patients, eosinophils were increased in five of ten patients, and neutrophils were increased in eight of ten patients. Mucosal biopsy specimens of main or lobar bronchi were available in eight of ten patients; epithelial damage and thickening of basement membrane was observed in almost all patients, as well as a mild-to-moderate inflammatory reaction in the submucosa, mainly represented by lymphocytes, eosinophils, and neutrophils. No relationship was observed between the cellularity of BAL and the degree of NSBH at the time of BAL; mean values of total cells and differential count were not different between patients with presence or absence of the different histologic findings. Mucosal biopsy and BAL were performed also in four subjects exposed to dusts without respiratory symptoms or NSBH; similar findings were obtained except for the absence of eosinophils in BAL and a lesser degree of basement membrane thickening and inflammatory reaction in the submucosa. The study of the changes in NSBH after quitting exposure showed that five of ten patients had a significant improvement in NSBH to methacholine, as evaluated by a positive significant linear regression between months of work cessation and PD15FEV1 methacholine; only one of these five patients had an increased number of eosinophils in BAL fluid. By contrast, four of the five patients with persistent NSBH after quitting exposure had an increased number of eosinophils in BAL. We suggest that persistent NSBH in TDI asthma after cessation of work may be related to an inflammatory reaction in which eosinophil infiltration seems to be a major determinant AU - Paggiaro P AU - Bacci E AU - Paoletti P AU - Bernard P AU - Dente FL AU - Marchetti G AU - Talini D AU - Menconi GF AU - Giuntini C LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 47 IP - DP - 1990 Jan 01 TI - Respiratory symptoms and lung function in hemp workers PG - 627-632 AB - Respiratory symptoms and abnormalities of lung function were studied in 84 female and 27 male hemp workers employed in two textile mills (A and B) processing soft hemp (C sativa). In mill A 46 women and 27 men were investigated and 38 female workers were studied in mill B. Forty nine women and 30 men from a non-dusty industry served as controls. A significantly higher prevalence of almost all chronic respiratory symptoms was found in female hemp workers when compared to control workers. Among the men these differences were significant for nasal catarrh and sinusitis. A high prevalence of byssinosis was found among female hemp workers in both mills (group A, 47.8%; group B, 57.9%) as well as in the male workers (66.7%). Statistically significant across shift reductions in lung function were found for all ventilatory capacity measurements in female and male hemp workers varying from 7.1% for forced expiratory volume in one second (FEV1) to 15.1% for flow rates at 50% vital capacity (FEF50). Measured Monday baseline values before the work shift were significantly lower than expected for hemp workers, being particularly reduced for FEF25 and FEF50. The data suggest that occupational exposure to hemp dust is a significant risk factor for the development of acute and chronic lung disease in workers employed in this textile industry AU - Zuskin E AU - Kanceljak B AU - Pokrajac D AU - Schachter EN AU - Witek TJ Jr LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 141 IP - DP - 1990 Jan 01 TI - Carbon monoxide diffusing capacity, other indices of lung function, and respiratory symptoms in a general population sample PG - 1033-1039 AB - To assess the relationships among single-breath diffusing capacity for CO (DLCOsb) (13), respiratory symptoms, and cigarette smoking in a general population sample, the data of 718 men and 894 women 20 yr of age or older were analyzed, and comparisons were performed with flow-volume curve (MEFV) variables and the slope of the alveolar plateau (DN2%/L) as well. Percent predicted DLCOsb and its correction for alveolar volume (DL/VA) were significantly lower in smokers than in nonsmokers. The relationship of presence/absence of respiratory symptoms and cigarette smoking with DLCOsb and DL/VA was significant. DLCO indices were almost always selected as discriminant variables in multivariate analysis between asymptomatic and symptomatic subjects. Poor concordance among lung function tests was evident: in men, 30% with abnormal (i.e., lower than 97.5% percentile) and 21% with normal DLCO indices also had abnormal MEFV parameters and/or DN2%/L. In women, the corresponding figures were 24 and 10%, respectively. In men, when considering only DLCO indices, the percentage of symptomatic subjects with abnormal lung function tests ranged from 33% in those with at least one symptom to 45% in those complaining of dyspnea. When the proportion of symptomatic subjects with DN2%/L and MEFV abnormalities were added, it increased to 56 and 66%, respectively. However, in women the proportion of symptomatic subjects with abnormal lung function indices was very small. These results indicate the usefulness of including CO diffusing capacity in epidemiologic surveys in the detection of abnormalities AU - Viegi G AU - Paoletti P AU - Prediletto R AU - di Pede F AU - Carrozzi L AU - Carmignani G AU - Mammini U AU - Lebowitz MD AU - Giuntini C LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19900101 IS - IS - VI - 45 IP - DP - 1990 Jan 01 TI - Effects of chronic organic dust exposure on respiratory function and airway responsiveness in peat moss factory workers PG - 20-23 AB - Fifty-two males and 1 female, who were 19 to 62 y of age (median = 26), were employed at an eastern Quebec peat moss plant and were included in this study. Of these 53 workers, 29 were smokers, 5 were ex-smokers, and 19 had never smoked. The workers were divided by level of exposure into 4 groups: (1) group 1--minimal exposure (N = 7); (2) group 2--light exposure (N = 7); (3) group 3--moderate exposure (N = 17); and (4) group 4--heavy exposure (N = 22). Chest radiographs and physical examinations were normal for all subjects. Only 1 subject had precipitins to Penicillium and Monocillium species isolated from the peat moss plant. Pulmonary function tests were normal and similar in all groups. Thirty-three subjects (20 smokers, 4 ex-smokers, and 9 nonsmokers) had chronic bronchitis; these symptoms were related to work exposure for 28 subjects. Bronchial responsiveness to methacholine was measured in 14 subjects who had persistent cough and sputum. No subject had evidence of airway hyper-responsiveness, i.e., PC20 metacholine less than 8 mg/ml. We concluded that the peat moss workers in our study showed no evidence of extrinsic allergic alveolitis; however, chronic exposure to organic dust leads to chronic cough and sputum production, which is not associated with significant lung impairment nor increase in nonspecific airway responsiveness AU - Cormier Y AU - Boulet LP AU - BerubeGenest F LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 15 IP - DP - 1989 Jan 01 TI - Acute pulmonary responses among automobile workers exposed to aerosols of machining fluids PG - 627-641 AB - Previous investigations of workers exposed to machining fluids have shown increased rates of cough and phlegm and have shown that these exposures may cause occupational asthma. To examine acute responses to these agents, cross-shift lung function changes related to machining fluid aerosols among 89 machine operators at two factories producing automobile parts were measured and compared with the findings for 42 unexposed assembly workers studied similarly at the same factories. Workers wore a personal air-sampling device on a Monday and Friday of a working week, and spirometry was performed before and after the work shifts on both days. On Mondays, a 5% or greater decrease in the forced expiratory volume in 1-second (FEV1), regarded as an "FEV1-response," occurred in 23.6% of the machinists and in only 9.5% of the assembly workers (relative risk = 2.5, p less than .05). After adjusting statistically for a history of childhood asthma, for smoking prior to lung function testing, and for race, odds ratios for an FEV1-response of 4.4 among workers exposed to aerosols of straight mineral oils, 5.8 for oil emulsions, and 6.9 for synthetic fluids were found. The FEV1-responses on Fridays were similar to those on Mondays. There was no progressive decline in FEV1 over the work week. Personal air samples, collected with a two-stage impactor, allowed aerosol masses to be measured in three size fractions: less than 3.5 microns, 3.5-9.8 microns, and greater than 9.8 microns aerodynamic diameter. Exposure levels to each type of machining fluid were remarkably similar within each size fraction and for total aerosol levels. Total aerosol concentrations for assembly workers ranged from 0.07 to 0.44 mg/M3, and for machinists from 0.16 to 2.03 mg/m3. Inhalable particle (less than or equal to 9.8 microns) levels were derived from the sum of the air concentrations in the two smallest-size fractions, and significant cross-shift decrements in FEV1 on Mondays and Fridays were associated with inhalable aerosol levels greater than 0.20 mg/m3. These findings show that acute airflow obstruction is associated with exposures to aerosols of various machining fluids and that airway responses occur well below current recommended exposure limits AU - Kennedy SM AU - Greaves IA AU - Kriebel D AU - Eisen EA AU - Smith TJ AU - Woskie SR LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 46 IP - DP - 1989 Jan 01 TI - Pulmonary function among pulp and paper workers in Berlin, New Hampshire PG - 765-772 AB - Pulmonary function was studied among pulp and paper workers from a production facility in New Hampshire. Subjects were first tested in the 1960s and then surveyed at regular intervals up to 1985. The current study examined results for the 339 subjects who participated in at least one of the two most recent follow up surveys in 1979 and 1985. For the 171 subjects who were tested in both surveys, the pulmonary function values were higher and the effect of pulp mill work was diminished compared with the findings for the 168 subjects who were tested in just one of the two surveys. To avoid the loss of less healthy subjects and the subsequent bias in effect estimate, the 1985 data were analysed cross sectionally with the inclusion of data from 1979 for those subjects who had not been followed up in the last survey. The subjects with work experience in the pulp mill had mean levels of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) lower than those of unexposed subjects who had never worked in the pulp or paper production areas. Based on parameter estimates from regression analysis, each year of employment in the pulp operation was associated with a -5.8 ml change in FEV1 (p = 0.08) and a -7.2 ml change in FVC (p = 0.04). Ninety one per cent of the subjects with pulp mill experience had terminated employment in that area of the company, so the association with decreased lung function appears to be a non-reversible effect that persisted after the cessation of exposure AU - Henneberger PK AU - Eisen EA AU - Ferris BG Jr LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 16 IP - DP - 1989 Jan 01 TI - Respiratory function in animal food processing workers PG - 179-187 AB - A group of 71 men employed in animal food processing was studied to assess the prevalence of acute and chronic respiratory symptoms and the presence of lung function abnormalities. In addition, a control group of 55 unexposed men was studied for the prevalence of chronic respiratory symptoms. A significantly higher prevalence for most of the chronic respiratory symptoms was found among the exposed workers compared to the control workers. Those workers who smoked had a significantly higher prevalence of chronic cough, chronic phlegm, chronic bronchitis, and chest tightness than the smokers in the control group. For nonsmokers, the differences between exposed and control workers were significant for chronic phlegm and chest tightness. The frequency of acute symptoms associated with the work shift was high among the animal food workers. There were significantly lower measured values for FVC, FEV1, and FEF50 in the exposed group (smokers and nonsmokers) compared to predicted lung function values. In smokers, all measured parameters of ventilatory capacity were significantly less than predicted; for nonsmokers, the FVC and FEV1 were less than normal. Our data indicate that exposure to dust in the animal food industry may be associated with the development of acute and chronic respiratory symptoms and the impairment of lung function. Smoking, in this setting, appears to aggravate these changes AU - Zuskin E AU - Mataija M AU - Pokrajac D AU - Schachter EN AU - Witek TJ Jr LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 50 IP - DP - 1989 Jan 01 TI - A diffusive sampler for personal monitoring of toluene diisocyanate (TDI) exposure; Part I: Design of the dosimeter PG - 1-7 AB - A passive dosimeter for monitoring occupational exposure to toluene diisocyanate (TDI) was developed. The device is constructed from a 37-mm aerosol cassette. The collection medium used in the dosimeter is 0.5% sulfuric acid (H2SO4). Membranes of both the permeation and diffusion types were evaluated for use in the dosimeter. Microporous Teflon diffusion membranes exhibited superior performance in terms of surface effects and residual TDI and were chosen for use. Collected TDI is determined as toluenediamine by either colorimetry using a modification of the Marcali technique or fluorometry using fluorescamine reagent. A significant dependence on wind speed was minimized by use of a second microporous membrane as a wind screen. The mass transfer rate of TDI was found to be approximately 0.0152 micrograms/ppb.hr and was equivalent for the 2,4 and 2,6 isomers of TDI AU - Rando RJ AU - Hammad YY AU - Chang SN LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 50 IP - DP - 1989 Jan 01 TI - A diffusive sampler for personal monitoring of toluene diisocyanate (TDI) exposure; Part II: Laboratory and field evaluation of the dosimeter PG - 8-14 AB - A passive monitor for TDI which utilizes microporous Teflon diffusion membranes and a 0.5% sulfuric acid (H2SO4) absorbing medium was evaluated. The collection rate of TDI is proportional to exposure dose from 10 to at least 300 ppb.hr, and response is equivalent for 2,4- and 2,6-TDI. Collection rate is independent of humidity and normal atmospheric pressure variations, while temperature causes a decrease of 1.0% per degree centigrade. Negative interference caused by ambient nitrogen dioxide (NO2) is eliminated by addition of sulfamic acid (HSO3 NH2) to the collecting medium. N-ethylmorpholine is a positive interferent. Field testing of the sampler against a reference impinger technique indicated a positive bias when TDI is aerosolized AU - Rando RJ AU - Hammad YY AU - Chang SN LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 95 IP - DP - 1989 Jan 01 TI - Role of inhalation challenge testing in the diagnosis of isocyanate-induced asthma PG - 414-423 AB - Results of isocyanate challenge tests performed on 63 workers referred with a diagnosis of probable isocyanate asthma between 1974 and 1988 were reviewed. Thirty (48 percent) had an acute episode of asthma with a greater than 20 percent decline in FEV1 following subirritant exposure to isocyanates. No difference in the frequency or type of respiratory complaints between isocyanate reactors and nonreactors was found. No differences in lung function results were present when comparing smoking and ex-smoking reactors and nonreactors. In never-smokers with complaints consistent with isocyanate-induced asthma, the presence of obstructive lung disease increased the likelihood that isocyanate-induced asthma was present. Bronchial responsiveness to methacholine occurred in nearly all isocyanate reactors but predicted isocyanate-induced asthma in only 68 percent of the workers. In nearly all cases of challenge-confirmed toluene diisocyanate (TDI)-induced asthma, a 15-min exposure to 20 ppb of the commercial TDI mixture (80:20 2,4:2,6) provoked asthma. Conversely, in the absence of an asthmatic response following exposure to this dose for this duration, a second exposure at this concentration for a longer time would be reasonable to confirm the absence of isocyanate-induced asthma. Among workers employed in the production of polyurethane foam and confirmed to have TDI-induced asthma by inhalation challenge to the different TDI isomers, there appeared to be increased airway reactivity to the 2,6 isomer. This may have relevance to the frequency and intensity of respiratory symptoms that workers with TDI-induced asthma develop in differing industrial settings AU - Banks DE AU - Sastre J AU - Butcher BT AU - Ellis E AU - Rando RJ AU - Barkman HW Jr AU - Hammad YY AU - Glindmeyer HW AU - Weill H LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 95 IP - DP - 1989 Jan 01 TI - Smoking and cotton dust effects in cotton textile workers PG - 997-1003 AB - Cotton textile workers have an increased prevalence of both obstructive and restrictive lung function patterns compared with control subjects. Similar abnormal patterns may occur with respiratory diseases of other etiologies, notably those associated with cigarette smoking. The shape of the maximum expiratory flow volume (MEFV) curve has been used to characterize patterns of lung function abnormality. To better evaluate the respiratory effects of cotton dust exposure and to contrast them with those of cigarette smoking, we defined a new functional parameter (angle beta) related to the shape of the MEFV curve. We compared 477 cotton textile workers, both current smokers and never smokers, 45 years and older, with 932 similarly aged control subjects from three communities. Smokers, regardless of their occupational exposure or sex, have smaller beta values than nonsmokers. Cotton textile workers, despite a greater prevalence of abnormal lung function, have beta values that do not differ from those of persons without occupational exposure to cotton dust. We suggest that morphologic patterns of flow volume curves reflect separate effects of cotton dust exposure and smoking and may be related to different sites of airway injury AU - Schachter EN AU - Kapp MC AU - Beck GJ AU - Maunder LR AU - Witek TJ LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 96 IP - DP - 1989 Jan 01 TI - Acute effects of herbal tea dust extracts on lung function PG - 1327-1331 AB - The acute effect of herbal tea dust extracts on lung function was studied in 15 of 25 healthy subjects responding to the inhalation of these extracts. Bronchial inhalation challenge was performed with tea extracts (sage, dog rose and gruzyan) and with normal saline solution as a control substance to assess their baseline airway reactivity to an isotonic aerosol. Lung function testing was performed before exposure and at 0, 15, 30, and 60 minutes after the cessation of exposure. The same subjects were also tested by challenge with methacholine. Lung function was measured by recording FVC, FEV1, FEF50, FEF25, SGaw, and Raw. Subjects were skin tested by the skin prick method and serum IgE levels were determined. The findings suggested that neither baseline nonspecific airway reactivity nor specific markers of immediate sensitivity to tea predict airway responses to tea extracts. Further evaluation of immunologic markers may help to explain the onset and progression of airway disease in workers AU - Zuskin E AU - Kanceljak B AU - Witek TJ Jr AU - Schachter EN LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 44 IP - DP - 1989 Jan 01 TI - Housewives with raw potato-induced bronchial asthma PG - 532-536 AB - Allergy to white potato has rarely been described. We report two cases of atopic patients, housewives, in whom peeling raw potatoes precipitated rhinoconjunctivitis and asthmatic attacks, and, in one of them, contact urticaria. Type I hypersensitivity to raw potato antigens was demonstrated by means of immediate skin test reactivity, specific IgE determination by RAST, basophil degranulation, histamine release test and an immediate bronchial provocation test response to raw potato extract. The controls did not react to any of these tests. Potato allergenic constituent is currently being investigated but, as far as we know, it is heat-labile and has an MW of more than 10 Kd AU - Quirce S AU - Diez Gomez ML AU - Hinojosa M AU - Cuevas M AU - Urena V AU - Rivas MF AU - Puyana J AU - Cuesta J AU - Losada E LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 6 IP - DP - 1989 Jan 01 TI - Prevalence of asthma and asthma symptoms in a general population sample of north Italy PG - 527s-531s AB - The prevalence rates of asthma and asthma symptoms were investigated in a general population sample (n = 3,289) living in a rural area of northern Italy. The subjects received a standard questionnaire and performed lung function tests with automated equipment. The overall prevalence rate of reported diagnosis of asthma was 5%. In young nonsmokers of both sexes the prevalence rates of reported diagnoses were higher than those of symptoms whilst the reverse occurred in older age groups. The prevalence rates decreased from childhood to young adults and increased again in older age groups. In smokers, reported diagnoses and symptoms increased with age and the prevalence rates of symptoms were always higher than those of diagnoses. Smokers with symptoms and reported diagnoses had lower lung function parameters than those with only symptoms. The distribution of asthma symptoms in our population indicates the importance of cigarette smoke and other environmental factors in the expression of the disease AU - Paoletti P AU - Carmignani G AU - Viegi G AU - Carrozzi L AU - Bertieri C AU - di Pede F AU - Mammini U AU - Giuntini C LA - PT - DEP - TA - Eur Respir J Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 39 IP - DP - 1989 Jan 01 TI - Potentially allergenic airborne particles in the vicinity of a yeast and penicillin production plant PG - 1094-1097 AB - Potential health risks of exposure to emissions of a yeast and penicillin production plant were investigated by measuring viable particles and protein contents of particles in ambient air. The results showed a clear decrease of the downwind number of yeast colony-forming units with increasing distance from the source. Upwind the number of yeast colony-forming units was zero. Identification showed that nearly all yeast were of the species Saccharomices cerevisiae. Such a trend could not be found for the total number of colony-forming units (yeasts, molds, and bacteria) although the upwind concentration was slightly lower than the downwind concentration. The downwind protein concentration was significantly elevated compared to the upwind concentration AU - Preller L AU - Hollander A AU - Heederik D AU - Brunekreef B LA - PT - DEP - TA - Air Pollution Control Association JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 172 IP - DP - 1989 Jan 01 TI - Epidemiologic cross-sectional study of the prevalence of chronic bronchitis and lung function disorders in swine breeders and milkers. [German] PG - 143-149 AB - In an epidemiological cross-sectional study the influence of occupation in swine production confinements on development of chronic bronchitis and lung function impairments was investigated. The study population comprised 307 swine confinement workers and 165 cattle workers without significant differences in age distribution and smoking habits. For evaluation of respiratory symptoms a standardized questionnaire was used. The following lung function tests were carried out: FVC, FEV1, RV, MEF25, MEF50, PEF and Raw. Regarding the prevalence of chronic bronchitis and lung function impairments no statistically significant differences were found between the two groups. Indeed swine confinement workers indicated a distinct trend to a higher prevalence of chronic bronchitis in correlation to the duration of employment. Workers in swine confinement buildings with more than 10 y exposure showed significantly worse mean values of the measured lung function parameters and significantly more frequent pathological lung function values than the control group of cattle workers AU - Barthel E AU - Krecklow K LA - PT - DEP - TA - Z Erkr Atmungsorgane JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 15 IP - DP - 1989 Jan 01 TI - Respiratory symptoms among Swedish swine producers PG - 311-318 AB - Two hundred nine male farmers engaged in swine production, born in 1913 or later, and alive in 1985 received mailed questionnaires on respiratory symptoms, medical history, and exposure to contaminated air in swine confinement buildings. The response rate was 76%. The prevalence of three or more symptoms of bronchitis was higher than that in welders who had completed the same questionnaire--Mantel-Haenszel odds ratio 5.26 (1.9-14.8) for smoking subjects. The number of reported symptoms was strongly influenced by smoking habits (p less than .01) and by exposure (p less than .01), and by a positive interaction between these (p less than .01, two-way analysis of covariance). Air in swine confinement buildings is contaminated with bacterial endotoxins and organic dust, and it is concluded that it may pose a risk for airways diseases such as chronic bronchitis AU - Wilhelmsson J AU - Bryngelsson IL AU - Ohlson CG LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 16 IP - DP - 1989 Jan 01 TI - Lung function of welders of zinc-coated mild steel: cross-sectional analysis and changes over five consecutive work shifts PG - 289-296 AB - Spirometric lung-function measurements were conducted 5 days before and after the work shift of 11 welders of zinc-coated steel, ten nonwelders who were indirectly exposed to welding fumes, and 17 controls. The exposure to dust and zinc of all participants was monitored personally using PAS-6 samplers. Geometric mean concentrations for welders were 0.91 mg/m3 (dust) and 34.0 micrograms/m3 (zinc). Cross-sectional analysis of Monday morning values showed no differences in lung-function parameters between groups. However, the number of years the participants were engaged in welding was of borderline statistical significance and correlated negatively with values of FEV1 and FEV1/FVC. Changes in lung function over a work shift or a working week were not related to the exposure level AU - Marquart H AU - Smid T AU - Heederik D AU - Visschers M LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 11 IP - DP - 1989 Jan 01 TI - Allergic contact dermatitis and oculorhinitis due to tulips. [Italian] PG - 241-242 AB - A case of occupational allergic contact dermatitis with conjunctivitis and rhinitis due to tulips bulbs is described. The patient, aged 23, was employed in a florist storehouse. The dermatitis, affecting his hands, face, armpits, knees, elbows and ears, was accompanied by a rhinoconjunctivitis. Patch tests made with a tulip thin slice outcome positive results. The appearance, the way of arising and the results of the patch tests suggest the existence of an immediate type immunologic reaction (type I or IgE-dependent hypersensibility) AU - Cassina G AU - Valsecchi R AU - Leghissa P AU - Ferrari MT AU - Piazzolla S LA - PT - DEP - TA - G Ital Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 46 IP - DP - 1989 Jan 01 TI - Natural history of pleural thickening after exposure to crocidolite PG - 461-467 AB - Serial plain che AU - de Klerk NH AU - Cookson WO AU - Musk AW AU - Armstrong BK AU - Glancy JJ LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 31 IP - DP - 1989 Jan 01 TI - Respiratory allergy and specific immunoglobulin E and immunoglobulin G antibodies to reactive dyes used in the wool industry PG - 857-862 AU - Topping MD AU - Forster HW AU - Ide CW AU - Kennedy FM AU - Leach AM AU - Sorkin S LA - PT - DEP - TA - JOM JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - i IP - DP - 1989 Jan 01 TI - Asthma and rhinitis associated with Lycopodium spores in condoms PG - 563- AU - Juhlin L LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 80 IP - DP - 1989 Jan 01 TI - Chronic bronchitis in the iron and steel industry: prevalence study PG - 123-131 AB - The paper reports the results of a prevalence study on functional impairment and chronic bronchitis in 733 foundry workers and in a control group of 1041 workers not exposed to the specific risks of the iron and steel industry. This study is the first part of a longitudinal study lasting 5 years within the framework of the Fourth Research Programme of the European Coal and Steel Community. Data on microclimate and particulate pollution for the various departments showed uniformly cold and damp conditions. Concentrations of pollutants were generally below the current T.L.V.'s. The subjects were subdivided into groups according to age, smoking and length of exposure. All the subjects were administered the "E.C.S.C. Questionnaire for the study of chronic bronchitis and pulmonary emphysema" and underwent a chest X-ray and spirometry to measure FVC, FEV1 and Vmax 50. The prevalence of functional impairment and chronic bronchitis was higher in the foundry workers than in the group of non-exposed workers. A statistical standardization was made of the effect of age and smoking thus accentuating the effect of exposure. The results are compared with the data obtained by other epidemiologic studies on working populations exposed to a similar risk AU - Scotti PG AU - Arossa W AU - Bugiani M AU - Nicoli E LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 15 IP - DP - 1989 Jan 01 TI - Effects of exposure to dust in swine confinement buildings--a working group report PG - 309-312 AB - Pulmonary and other symptoms among workers in swine confinement buildings were evaluated by an international working group. In several studies in five different countries a total of about 2000 workers has been studied in clinical and epidemiologic investigations. Symptoms indicative of acute and chronic airway inflammation were widespread, as were systemic reactions of organic dust toxic syndrome. The base-line, and across workshift, pulmonary function changes were moderate. There was no evidence that antigen-antibody reactions are important in the pathogenesis. Longitudinal studies are recommended to establish the relationship between acute and chronic symptoms and end stage disease AU - Rylander R AU - Donham KJ AU - Hjort C AU - Brouwer R AU - Heederik D LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 46 IP - DP - 1989 Jan 01 TI - Respiratory symptoms and impairment in shipyard welders and caulker/burners PG - 292-301 AB - All 607 men, aged 17 to 69, comprising a stratified sample of workers from one shipyard completed a respiratory questionnaire, clinical examination, and detailed spirometry. Chest radiographs were available on 332 men. Among the men aged 50-69 the prevalence of persistent cough and phlegm (chronic bronchitis) was 40%, of wheeze on most days 25%, and undue breathlessness on exertion 25%. After allowing for age the relative risk of welders and caulker/burners having these symptoms were respectively 2.8, 2.2, and 3.1 compared with other shipyard tradesmen. The effects were of comparable magnitude to and interacted with those of current smoking. Among the welders and caulker/burners who smoked, the relative risk of developing chronic bronchitis or undue breathlessness was related to the average fume exposure; the relative risk of wheeze was related to the average fume exposure in all smoking categories, with the strongest association in the ex-smokers. The occurrence of wheeze was also associated with a history of previous metal fume fever. A history of pleurisy but not of pneumonia was related to the fume exposure in the welders. After allowing for age and stature, forced expiratory volume (FEV1) was on average higher in young welders (age less than 30) than other tradesmen. In welders and caulker/burners who were current or ex-smokers, FEV1 and PEF were reduced in relation to the average fume exposure (mean reductions respectively 0.25 l and 0.99 l s-1). The FEV1% (of forced vital capacity), the flow rates at small lung volumes (MEF50%FVC and MEF25%FVC), the mean transit time, and its standard deviation were also reduced by fume exposure or the declines with age were increased, or both. No impairment was demonstrable in the non-smokers and many men had given up smoking with apparently beneficial results. The occupational component of the respiratory impairment related mainly to exposures in the past; information was needed on the effects of present conditions in the industry AU - Cotes JE AU - Feinmann EL AU - Male VJ AU - Rennie FS AU - Wickham CA LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 46 IP - DP - 1989 Jan 01 TI - Pulmonary dysfunction in gold miners with reactive airways PG - 873-876 AB - In a cross sectional study of a working population of black South African gold miners a sample of 1197 older miners was examined. Airway reactivity determined by a greater than 10% response of the forced expiratory volume in one second (FEV1) to inhaled salbutamol was detected in 139 (12%) of the men. No relation was found between the extent of exposure to the underground environment and the frequency of airway reactivity. There was evidence of increased chronic airflow limitation in the men with reactive airways. This increase persisted after controlling for age, tobacco smoking, and for the presence and degree of silicosis. On average, the presence of reactive airways was associated with reduced (after bronchodilator) forced vital capacity (FVC) of 118 ml, 95% confidence interval (CI) 16 to 220 ml, FEV1 of 168 ml (95% CI 74-262 ml), FEV1/FVC% of 3% (95% CI 2.3-3.7%), and maximal mid-expiratory flow of 300 ml/s (95% CI 86-514 ml/s). Although there was no evidence that airway reactivity was induced by this occupational exposure, those with reactive airways appeared to be more susceptible to the adverse effects of the underground environment on the bronchial tree AU - Cowie RL LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 95 IP - DP - 1989 Jan 01 TI - Prevalence of chronic bronchitis and respiratory function in a group of dairy farmers in the French Doubs province PG - 1244-1247 AB - We used a questionnaire combined with medical history and spirometric studies to compare symptoms and respiratory function in two groups of subjects living in the French province of Doubs. A group of 250 dairy farmers was compared with 250 control subjects, matched with regard to sex, age, height, and smoking habits. The prevalence of acute bronchial infections and dyspnea was identical in the two groups. Among dairy farmers, 30 (12 percent) had chronic bronchitis vs 15 (6 percent) in the control group (p less than 0.05). Chronic bronchitis was more common in patients aged over 40 years (p less than 0.001) and in nonsmokers (p less than 0.001). All respiratory function parameters measured (expressed as a mean percentage of values measured in comparison with theoretic values) were lower in the dairy farmer group than in the control group. With regard to degree of bronchial obstruction, the difference between the two groups was more marked in patients aged 40 years and over and in nonsmokers. Dairy farmers' occupation is a risk factor of chronic bronchitis and bronchial obstruction, in particular in patients aged 40 years and over and in nonsmokers AU - Dalphin JC AU - Bildstein F AU - Pernet D AU - Dubiez A AU - Depierre A LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 44 IP - DP - 1989 Jan 01 TI - Nedocromil sodium in adults with asthma dependent on inhaled corticosteroids: a double blind, placebo controlled study PG - 654-659 AB - Eighty nine adults with asthma who were receiving inhaled corticosteroid and bronchodilator treatment took part in a double blind, randomised, placebo controlled trial of nedocromil sodium, 4 mg four times daily by inhalation. During a run in period of two to four weeks corticosteroid treatment was reduced when possible to produce a comparable level of symptoms across the trial population. The test treatment was then taken for four weeks, with the severity of asthma recorded daily by patients and assessed at two weekly hospital visits. There was an improvement in symptoms in the patients taking nedocromil sodium by comparison with those having the placebo, the differences being significant for diary card PEF readings, asthma symptom scores, and bronchodilator usage at night. The mean difference between the two groups was 18 l/min for PEF, 0.42 for daytime asthma score, and 1.73 puffs in 24 hours for bronchodilator usage. These results suggest that asthmatic patients who require inhaled steroids show better control of their asthma with the addition of nedocromil sodium than of placebo over a four week period after reduction of the dosage of their inhaled steroids AU - Bone MF AU - Kubik MM AU - Keaney NP AU - Summers GD AU - Connolly CK AU - Burge PS AU - Dent RG AU - Allan GW LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 262 IP - DP - 1989 Jan 01 TI - An outreak of nitrogen dioxide-induced respiratory illness among ice hockey players PG - 3014-3017 AU - Hedberg K AU - Hedberg CW AU - Iber C AU - White KE AU - Osterholm MT AU - Jones DBW AU - Fink JR AU - MacDonald KL LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - suppl 150 IP - DP - 1989 Jan 01 TI - Facial skin complaints and work at visual display units PG - - AU - Berg M LA - PT - DEP - TA - Acta Dermato-Veneriologica JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 19 IP - DP - 1989 Jan 01 TI - Diagnosis of occupational asthma PG - 649-652 AB - Accurate diagnosis of occupational asthma takes time, enthusiasm and a particular knowledge of the work situation, as well as expertise in the use of diagnostic procedures. The prognosis of patients with occupational asthma is probably improved by removing them from the responsible agent as soon as possible after sensitization occurs. However, it is much easier to make the diagnosis while the worker is still exposed to the cause of the problem. Early referral for expert investigation is therefore important AU - Burge PS LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 33 IP - DP - 1989 Jan 01 TI - Building sickness, are symptoms related to the office lighting? PG - 47-59 AB - Office lighting has been suggested as one of the possible factors in producing 'building sickness'. Health questionnaires were completed by 106 out of 109 (97%) workers in six randomly sampled multi-occupied offices in each of two buildings, one air-conditioned and one naturally ventilated. There was a significantly higher prevalence of work-related headache and work-related lethargy in the air-conditioned building than in the naturally ventilated one. There was also less daylight in the air-conditioned building and lower mean luminance and illuminance of the work positions despite there being more lights on (p less than 0.01). The workers had a greater dislike of fluorescent lighting (p less than 0.01) and overall found the lighting to be less comfortable (p less than 0.01) and glare readings were higher. The workers perceived their control of lighting as poorer (p less than 0.001) and consequently there was less agreement about it (p less than 0.001). Those with work-related headache found the lighting less comfortable (p = 0.059) and perceived more glare (p less than 0.05). This study suggests the need to maximize the use of natural light from untinted windows, to reduce the impingement of fluorescent tubes on the line of sight and to return the control of levels of lighting to each individual worker AU - Robertson AS AU - McInnes M AU - Glass D AU - Dalton G AU - Burge PS LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 44 IP - DP - 1989 Jan 01 TI - Occupational asthma due to soft corrosive soldering fluxes containing zinc chloride and ammonium chloride PG - 220-223 AB - Two cases of occupational asthma due to soft corrosive soldering fluxes used in metal jointing are described in which the diagnosis was based on work related deterioration in daily peak expiratory flow rate and positive responses in bronchial provocation tests. Both fluxes contained ammonium chloride and zinc chloride. Occupational asthma provoked by these agents has not previously been reported AU - Weir DC AU - Robertson AS AU - Jones S AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 39 IP - DP - 1989 Jan 01 TI - Incidence of pulmonary tuberculosis by occupation of hospital employees in the National Health service in England and wales 1980-1984 PG - 30-32 AU - Lunn JA AU - Mayho V LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 10 IP - DP - 1989 Jan 01 TI - Tuberculosis epidemic among hospital personnel PG - 204-210 AB - Six employees of the emergency department at Parkland Memorial Hospital developed active tuberculosis in 1983-1984. Five of the cases occurred four to 12 months after exposure to the index case, a patient with severe cavitary tuberculosis seen in the emergency department in April 1983. One resident physician developed cavitary disease after exposure to this patient. An additional employee case may have resulted from transmission from one of the initial employee cases. One immunocompromised patient may have acquired tuberculosis as a result of exposure to the index case. In addition, the tuberculin skin tests of at least 47 employees exposed to the index case converted from negative to positive. Of 112 previously tuberculin-negative emergency department employees who were tested in October 1983, 16 developed positive skin tests, including the 5 employees with active disease. Fifteen of these new positives had worked on April 7, 1983, while the index case was in the emergency department (X2 = 20.6, P less than 0.001). Factors related to the genesis of the epidemic included the disease characteristics in the index case and the recirculation of air in the emergency department. This investigation indicates that city-county hospital emergency department employees should be screened at least twice a year for evidence of tuberculosis and that the employee health services of such hospitals should regard the surveillance of tuberculosis infection among personnel at a high-priority level AU - Haley CE AU - McDonald RC AU - Rossi L AU - Jones WD Jr AU - Haley RW AU - Luby JP LA - PT - DEP - TA - Infect Control Hosp Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 10 IP - DP - 1989 Jan 01 TI - Annual tuberculin skin testing of employees at a university hospital: a cost-benefit analysis PG - 465-469 AB - The usefulness of routine annual tuberculin skin testing (purified protein derivative [PPD]) of hospital employees has been questioned. Between 1984 and the end of 1987 the PPD conversion rates of hospital employees at a university and psychiatric hospital in North Florida were compared. The number of employees in both hospitals were almost equal and compliance with the annual testing was more than 95%. In the psychiatric hospital tuberculosis screening of patients was practiced on admission and annually thereafter. Although no unsuspected smear-positive tuberculosis patients were diagnosed in the psychiatric hospital as compared to four in the university hospital, the annual conversion rates of employees were 0.42% and 0.13%, respectively (p greater than 0.001). However, the ratios of these conversion rates to the incidence of tuberculosis in the counties where these hospitals are located respectively were similar (20.0 vs 24.3, p = 0.7). The community seems be the major source of the PPD conversion. At the university hospital more than +70,000 was spent on the annual PPD testing to discover 15 converters; nine had no or minimal contact with patients and only two complied with isoniazid (INH) prophylaxis. Annual PPD testing is not cost effective in hospitals with a low annual conversion rate among its employees and with low tuberculosis case rates in the hospital and the surrounding community AU - Raad I AU - Cusick J AU - Sherertz RJ AU - Sabbagh M AU - Howell N LA - PT - DEP - TA - Infect Control Hosp Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 14 IP - DP - 1989 Jan 01 TI - High incidence of pulmonary tuberculosis in pathologists at Tokai University Hospital: an epidemiological study PG - 55-59 AB - Between 1935 and 1950 tuberculosis was the most common cause of death in Japan. Subsequently, the mortality rate, incidence, and prevalence of tuberculosis have decreased remarkably due to socioeconomic improvements and development of specific chemotherapy. It has been suspected that the incidence and prevalence of pulmonary tuberculosis in hospital workers, particularly those employed in pathology divisions, may be higher than those for other health care workers. However, there have been no reports on this subject. We conducted a questionnaire survey to assess and compare the incidence of pulmonary tuberculosis in pathologists at Tokai University Hospital with that in other employees of the University. Data on history of treatment for tuberculosis were obtained. The incidence of pulmonary tuberculosis in pathologists was significantly higher than that in other university employees, including clinical doctors who see patients with tuberculosis. These findings suggest that specific environmental conditions in the Pathology Division represent an occupational hazard although the infection might be contracted from other hospital staff AU - Sugita M AU - Tsutsumi Y AU - Suchi M AU - Kasuga H LA - PT - DEP - TA - Tidsskr Nor Laegeforen JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 39 IP - DP - 1989 Jan 01 TI - Occupational hazard in hospital staff exposed to 2% glutaraldehyde in an endoscopy unit PG - 69-71 AB - The occupational hazards associated with exposure to 2 per cent glutaraldehyde have been assessed in medical and nursing staff working in an endoscopy unit. Eight of the nine staff were affected and the clinical manifestations included watering of eyes, rhinitis, dermatitis, respiratory difficulties, nausea and headache. The atmospheric concentrations of glutaraldehyde were assessed and the effect on clinical manifestations is discussed. Glutaraldehyde is an irritant and sensitiser. Guidelines for those exposed to the compound are discussed to prevent, monitor and manage any health hazard AU - Jachuck SJ AU - Bound CL AU - Steel J AU - Blain PG LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 39 IP - DP - 1989 Jan 01 TI - Control of tuberculosis in health service workers: the role of the chest radiograph PG - 128-130 AB - Chest radiograph reports were reviewed retrospectively in 1994 new employees in the Leicestershire Health Authority to assess the use of this examination in detecting and preventing tuberculosis. No evidence suggestive of active tuberculosis was found in the cases reviewed indicating that the chest radiograph is of limited value. A discussion of these findings and a review of previous work suggests that a change in screening policy with the pre-employment chest radiograph performed only on selected groups would have no significant effect on the incidence of tuberculosis in staff or patients. The savings both in radiation exposure and financially would be considerable AU - Krarup KC AU - Scarisbrick DA LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 83 IP - DP - 1989 Jan 01 TI - The slowing of the decline in tuberculosis notifications and HIV infection PG - 321-322 AB - Rates of tuberculosis in England and Wales increased slightly in 1986. Evidence is put forward to suggest that this is due to disease in older patients, particularly females. It is very unlikely, therefore, that the arrest in the decline in tuberculosis rates in the UK is related to HIV infection. Infection incurred during World War II is a more probable cause AU - Davies PD LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 68 IP - DP - 1989 Jan 01 TI - Disease due to the Legionellaceae (other than Legionella pneumophila). Historical, microbiological, clinical, and epidemiological review PG - 116-132 AB - More than 20 species of the Legionellaceae family of bacteria have been discovered since the discovery of Legionella pneumophila. Thirteen have been implicated as causative agents of pneumonia including the Pittsburgh pneumonia agent (Tatlockia micdadei, Legionella micdadei). Although outbreaks of nosocomial pneumonia in immunosuppressed hosts have been well-described, most cases have occurred sporadically in the community. The spectrum of disease ranges from severe life-threatening pneumonia to a self-limiting febrile illness (Pontiac fever). Isolation from the natural aquatic environment has preceded its discovery as agents of human disease in 6 species, while environmental isolation has not yet been obtained for 3 species implicated in disease. The mode of transmission is uncertain, but cases of dual infection by L. pneumophila and the newer species suggests that the epidemiology of these new organisms will be similar to that of L. pneumophila. The antibiotic of choice appears to be erythromycin. The historical background, epidemiology, microbiology, and clinical manifestations of these newly-discovered organisms are reviewed in comparative fashion. AU - Fang GD AU - Yu VL AU - Vickers RM LA - PT - DEP - TA - Medicine (Baltimore) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 21 IP - DP - 1989 Jan 01 TI - Airborne contact dermatitis due to triglycidyl isocyanurate PG - 202-203 AU - DoomsGoossens A AU - Bedert R AU - Vandaele M AU - Degreef H LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 18 IP - DP - 1989 Jan 01 TI - A toxicity study of parenteral thiamine hydrochloride PG - 867-870 AB - Thiamine deficiency is not uncommon in certain populations and clinical disease states such as Wernicke's encephalopathy or beriberi. Rapid parenteral repletion may be required, yet questions about the safety of IV thiamine have been raised because of reports of anaphylaxis. Our study was a prospective evaluation of the safety of thiamine hydrochloride given as a 100-mg IV bolus in 989 consecutive patients (1,070 doses). A total of 12 adverse reactions (1.1%) were reported. Minor reactions consisting of transient local irritation were seen in 11 patients (1.02%), and there was only one major reaction (0.093%) consisting of generalized pruritus. Thiamine hydrochloride may be administered intravenously without undue concern. Intradermal test doses before administration are not warranted unless patients have had previous allergic reactions AU - Wrenn KD AU - Murphy F AU - Slovis CM LA - PT - DEP - TA - Ann Emerg Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 11 IP - DP - 1989 Jan 01 TI - The BCG story: lessons from the past and implications for the future. [Review] PG - Suppl 2:S353-9 AB - BCG (bacille Calmette-Guerin) vaccines are at once among the least satisfactory and yet the most widely used of all vaccines today. Their variable efficacy against tuberculosis and leprosy is still not understood and points to a fundamental unsolved problem in vaccine immunology. The extensive use of BCG vaccines means that there are few BCG-free populations in the world that would be suitable for trials of future antimycobacterial vaccines. These facts have implications with regard to strategies for the development and testing of new vaccines against mycobacterial diseases. AU - Fine PE LA - PT - DEP - TA - Reviews of Infectious Diseases JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 67 IP - DP - 1989 Jan 01 TI - The distribution and implications of BCG scars in northern Malawi PG - 35-42 AB - Reported are data on the BCG scar status of more than 112,000 individuals who were surveyed in Karonga District, northern Malawi, between 1979 and 1984. The age and sex patterns of apparent BCG scars reflect the history of BCG vaccination activities in the district. Repeated independent examinations of large numbers of people revealed that the proportions remaining with the same observed scar status among those initially classified as being scar "positive" or scar "negative" were each approximately 90%. The repeatability of positive scar reading was lower among children and older adults than among young adults aged 15-24 years, and blind follow-up of children known to have been vaccinated as infants in child health clinics indicated that less than 60% had a detectable scar 3 years after receiving the vaccine. "Negative" repeatability increased consistently with age. The implications of these findings for estimating BCG vaccine uptake and for assessing its efficacy in case-control and cohort studies are discussed. The finding that BCG scars may be difficult to read suggests there is a danger of observer bias that could lead to distortion--in particular, to overestimates of vaccine efficacy AU - Fine PE AU - Ponnighaus JM AU - Maine N LA - PT - DEP - TA - Bull World Health Organ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 76 IP - DP - 1989 Jan 01 TI - Tear gas--its toxicology and suggestions for management of its acute effects in man [editorial] PG - 295-295 AU - Folb PI AU - Talmud J LA - PT - DEP - TA - S Afr Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 262 IP - DP - 1989 Jan 01 TI - Tear gas--harassing agent or toxic chemical weapon? PG - 660-663 AB - Tear gas has gained widespread acceptance as a means of controlling civilian crowds and subduing barricaded criminals. The most widely used forms of tear gas have been o-chlorobenzylidenemalononitrile and omega-chloroacetophenone. Proponents of their use claim that, if used correctly, the noxious effects of exposure are transient and of no long-term consequences. The use of tear gas in recent situations of civil unrest, however, demonstrates that exposure to the weapon is difficult to control and indiscriminate, and the weapon is often not used correctly. Severe traumatic injury from exploding tear gas bombs as well as lethal toxic injury have been documented. Moreover, available toxicological data are deficient as to the potential of tear gas agents to cause long-term pulmonary, carcinogenic, and reproductive effects. Published and recent unpublished in vitro tests have shown o-chlorobenzylidenemalononitrile to be both clastogenic and mutagenic. Sadly, the nature of its use renders analytic epidemiologic investigation of exposed persons difficult. In 1969, eighty countries voted to include tear gas agents among chemical weapons banned under the Geneva Protocol. There is an ongoing need for investigation into the full toxicological potential of tear gas chemicals and renewed debate on whether their use can be condoned under any circumstances. AU - Hu H AU - Fine J AU - Epstein P AU - Kelsey K AU - Reynolds P AU - Walker B LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 15 IP - DP - 1989 Jan 01 TI - Questionnaire reliability and validity for aluminum potroom workers PG - 364-370 AB - As a part of a study on the respiratory symptoms of aluminum potroom workers, the reliability of a self-administered questionnaire and an interview questionnaire was studied with the use of 261 and 49 employees, respectively. The validity of the self-administered questionnaire (134 persons examined) and the interview questionnaire (90 persons examined) was assessed in a comparison of the statements with the case histories. The reliability of the self-administered questionnaire was fairly high, the kappa coefficient ranging from 0.58 to 0.83, while the reliability of the interview questionnaire varied from -0.03 to 0.45. The same pattern was present with regard to validity, as the self-administered questionnaire showed the highest mean sensitivity, specificity, and agreement in a comparison with the case histories. The self-administered questionnaire seemed to discriminate well between symptomatic and asymptomatic individuals, whereas supplemental information about symptoms, as obtained by a standardized interview questionnaire, appeared to be less valid AU - Kongerud J AU - Vale JR AU - Aalen OO LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 2 IP - DP - 1989 Jan 01 TI - Room temperature influences output from the Wright jet nebulizer PG - 681-684 AB - Standardization of the solute output from the Wright nebulizer is necessary in nonspecific bronchial challenge to obtain reproducible results. Airflow and driving pressure are known determinants of the output. In an epidemiological study, in which day-to-day variations in room temperature occurred, we found the reproducibility of the output from a Wright nebulizer to be outside the range of acceptance. We have, therefore, examined to what extent ambient temperature and humidity might influence the output from three Wright nebulizers. The solute output was linearly correlated not only to flow (r = 0.98) and driving pressure (r = 0.90) but also to room temperature (r = 0.96). The mean output increased approximately 23% when room temperature was increased from 19 to 24 degrees C. This is equivalent to an increase in airflow of more than one litre. Ambient humidity did not influence the nebulizer output. When temperature was included in the calibration procedure, the coefficient of variation of the output decreased from 5 to 2%. This emphasizes the need for calibration of the Wright nebulizer with regard to ambient temperature as well as to airflow and pressure, especially in epidemiological field studies in which large variations of temperature are likely to occur AU - Kongerud J AU - Soyseth V AU - Johansen B LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 37 IP - DP - 1989 Jan 01 TI - Considerations of the chemical complexity of ETS with regard to inhalation studies. [Review] PG - 164-169 AB - Any inhalation study that investigates environmental tobacco smoke, ETS, is considering a very complex entity. ETS contains numerous chemicals that are continuously changing both in their absolute concentration, in the ratio of concentration between one and another, and even in their particulate to vapour phase distribution. Moreover, when considering ETS in real-life situations, many of the chemical components of ETS will be present as a result of sources other than tobacco smoking. This paper emphasises that the chemical and physical nature of ETS must be considered in the design and interpretation of any inhalation study on ETS, and illustrates the difficulty in defining precisely what constitutes ETS in such studies. AU - Proctor CJ AU - Smith G LA - PT - DEP - TA - Experimental Pathology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 139 IP - DP - 1989 Jan 01 TI - Spirometric abnormalities in young smokers correlate with increased chemiluminescence responses of activated blood phagocytes PG - 181-187 AB - Spirometric values determined from the flow-volume loops of 60 healthy young smokers (mean age, 28 +/- 0.6 yr) were correlated with measurements of the release of extracellular and intracellular reactive oxidants (RO) as determined by luminol-enhanced chemiluminescence (LECL) from peripheral blood activated with the synthetic chemotactic tripeptide FMLP combined with cytochalasin B (CB). Fractionation and reconstitution experiments revealed that LECL originated predominantly from polymorphonuclear leukocytes (PMNL). Circulating total leukocyte counts and serum thiocyanate levels were also determined. The data were analyzed using Spearman's correlation coefficient and by multiple regression analysis. Cigarette smoking was associated with elevated intracellular and especially extracellular LECL responses, the latter being strongly correlated (p less than 0.0001) with cigarettes smoked per day, serum thiocyanate levels, circulating leukocytes, and PMNL counts. Abnormalities of the spirometric parameters FEV1/FVC, FEF50/FVC, FEF25, FEF25-75, and FEF75-85 correlated best with extracellular LECL (p less than 0.0002 to p less than 0.0001), but also with pack-years (p less than 0.006 to p less than 0.0001), cigarettes smoked per day (p less than 0.008 to p less than 0.0002), thiocyanate levels (p less than 0.04 to p less than 0.002) and leukocyte counts (p less than 0.03 to p less than 0.002). According to stepwise multiple regression analysis of the data the combination of the independent variables extracellular LECL, pack-years, and numbers of circulating PMNL accounts for 35.6% of the variation in lung function in the group of cigarette smokers, with LECL being the most important contributor (26%).(ABSTRACT TRUNCATED AT 250 WORDS) AU - Richards GA AU - Theron AJ AU - Van der Merwe CA AU - Anderson R LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 30 IP - DP - 1989 Jan 01 TI - Occupational asthma due to ozone PG - 485-487 AB - Ozone increases bronchial reactivity in normal and atopic subjects. Ozone is produced by high voltage electric discharge. Persons with pre-existent bronchial hyperreactivity should be excluded from work where significant exposure to ozone can occur. We describe a case of occupational asthma due to ozone. The levels of ozone were about 0.04 ppm. AU - Lee HS AU - Wang YT AU - Tan KT LA - PT - DEP - TA - Singapore Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 44 IP - DP - 1989 Jan 01 TI - Occupationally related respiratory symptoms in trout-processing workers PG - 336-341 AB - All eight production workers from a small trout-processing factory were studied because of respiratory or rhinitis symptoms when working next to the automatic gutting machine. Seven of the eight had positive histamine provocation tests. Four patients had elevated total IgE levels while one had a slightly elevated eosinophil count. All workers had either weakly or moderately positive RAST against contaminated water from the outlet drain of the gutting machine. This water contained 1 microgram endotoxin/ml. We concluded that five of the workers had probably developed occupationally related asthma from inhalation of contaminated aerosol from the gutting machine. Inhalation of endotoxin from gram-negative bacteria may be the cause of this disorder. An alternative explanation is a Type I allergy caused by fish or bacterial protein with or without a simultaneous effect of endotoxin. AU - Sherson D AU - Hansen I AU - Sigsgaard T LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 233 IP - DP - 1989 Jan 01 TI - Asthma related to occupation of spouse PG - 809-810 AB - Two spouses are described whose asthma was precipitated by meeting their partner after they had returned from work. One is likely to have been sensitised by platinum salts carried from work on her husbands clothes. The second may have been sensitised to rat urine from a rat previously at home, but reacted to kissing his wife when she came home from her work as a small animal scientist. Both were much better after their spouses showered and changed clothes before coming home. AU - Venables KM AU - Newman Taylor AJ LA - PT - DEP - TA - Practitioner JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 333 IP - DP - 1989 Jan 01 TI - ASPERGILLUS, ASTHMA, AND AMOEBAE PG - 893-894 AB - AU - Seaton A AU - Robertson MD LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 125 IP - DP - 1989 Jan 01 TI - Anaphylactic Symptoms due to Chlorhexidine Gluconate PG - 50-52 AB - Six patients who developed urticaria, dyspnea, and anaphylactic shock due to topical application of chlorhexidine gluconate solution are described. Chlorhexidine gluconate was confirmed as the causative agent of type I hypersensitivity by intradermal, scratch, and epicutaneous tests. To prevent life-threatening adverse reactions, it seems important to use chlorhexidine gluconate on wound surfaces at a concentration of 0.05%, as recommended by the manufacturer; chlorhexidine gluconate may not be suitable for application to mucous membranes. AU - Okano M AU - Nomura M AU - Hata S AU - Okada N AU - Sato K AU - Kitano Y AU - Tashiro M AU - Yoshimoto Y AU - Hama R AU - Aoki T LA - PT - DEP - TA - Acta Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 39 IP - DP - 1989 Jan 01 TI - Mean wheal diameter in skin tests for castor bean extracts in castor bean allergic workers of eastern Sudan. PG - 144-146 AB - The mean wheal diameter by prick test for castor bean (Ricinus communis, Euphorbiaceae) extracts was measured in a castor bean allergic population. Three types of castor bean extracts namely Cimmaron, Pacific and dust (a mixture of Cimmaron, Pacific and hull), were applied at 1/10,000 dilutions with a control solution. The subjects comprised 318 male workers who were divided into four groups with a fifth control group of 63 male workers. The solutions were tested on three subject groups with Cimmaron in the first, Pacific in the second, and dust in the third. All three extracts were applied in the fourth and the control groups. The results have shown that the Cimmaron type gives a larger wheal diameter than Pacific or dust at the same concentration. There were statistically significant differences between the wheal diameters caused by different extracts in the same subjects. The possibility of producing a type of seed containing less amount of allergen could be considered and experimented on by the agricultural research bodies. AU - Fakhri ZI LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 298 IP - DP - 1989 Jan 01 TI - Occupational asthma in nurses due to chlorhexidine and alcohol aerosols PG - 929-930 AB - Chlorhexidine is known to sensitise skin' and has been associated with severe allergic reactions.2 We are not aware of any previous report of an association between asthma and the use of chlorhexidine and alcohol aerosols. We describe two cases. Case reports Case I-A 54 year old nursing auxiliary presented with a three month history of increasingly frequent attacks of cough and wheezing. These episodes occurred within minutes after she used a chlorhexidine and alcohol aerosol (Dispray 2 Hard Surface Disinfectant, Stuart Pharmaceuticals, Wilmslow, Cheshire) to disinfect incubators. She had been a cigarette smoker previously but did not have a history of asthma and was not receiving treatment for asthma. Spirometric testing gave normal results, with the ratio of forced expiratory volume in one second to forced vital capacity being 3-4:4 2 litres (81%). The concentration of histamine causing a 20% fall in the forced expiratory volume in one second was 9-2 g/l, indicating borderline hyperresponsiveness of the airways.3 A bronchial provocation test that mimicked the woman's normal use of the aerosol was performed, during which she cleaned the work surfaces in a small ventilated laboratory with this agent for 30 minutes. Spirometric values were recorded over the next eight hours and compared with those taken over eight hours on a control day. The forced expiratory volume in one second fell by 13% 10 minutes after the challenge, and this was associated with cough and chest tightness. No late response was observed. Case 2-A 43 year old midwife presented with a six month history of chest tightness after exposure to a chlorhexidine and alcohol aerosol (Dispray 2). She was a non-smoker and did not have a history of asthma, but she had recently been prescribed a salbutamol inhaler. Spirometric tests gave normal results, with the ratio of forced expiratory volume in one second to forced vital capacity being 3A49:4 05 litres (86%). A histamine challenge test indicated normal airways responsiveness, the concentration of histamine causing a 20% fall in the forced expiratory volume in one second being >16 g/l.3 The patient recorded peak expiratory flow rates five times daily. At work there was a 43-48% variation between maximum and minimum values compared with less than 10% variation away from work (figure). A bronchial provocation test with the aerosol showed a maximum fall in forced expiratory volume in one second of 22% two minutes after exposure to the spray. No late response was observed. AU - Waclawski ER AU - McAlpine LG AU - Thomson NC LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 31 IP - DP - 1989 Jan 01 TI - Baker's asthma: report of an unusual case PG - 439-43* AU - Walker CL AU - Grammer LC AU - Shaughnessy MA AU - Patterson R LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 31 IP - DP - 1989 Jan 01 TI - Diphenylmethane diisocyanate hypersensitivity pneumonitis: a serologic evaluation PG - 315-31* AU - Walker CL AU - Grammer LC AU - Shaughnessy MA AU - Duffy M AU - Stoltzfus VD AU - Patterson R LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 34 IP - DP - 1989 Jan 01 TI - Tea dust- an occupational hazard PG - 45-47 AU - Wikramanayake TW LA - PT - DEP - TA - Ceylon Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 83 IP - DP - 1989 Jan 01 TI - Immunolic specificity of isocyanate-induced IgE antibodies in serum from 10 sensitised workers PG - 126-135 AU - Wass U AU - Belin L LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 110 IP - DP - 1989 Jan 01 TI - Hypersensitivity pneumonitis induced by toluene diisocyanate: sequalae of continuous exposure PG - 31-34 AU - Yoshizawa Y AU - Ohtsuka M AU - Noguchi K AU - Uchida Y AU - Suko M AU - Hasegawa S LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 83 IP - DP - 1989 Jan 01 TI - Recent experience in the control and management of tuberculosis in a mental handicap hospital PG - 315-319 AU - Wiggins J AU - Hearn G AU - Skinner C LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 44 IP - DP - 1989 Jan 01 TI - Local invasive pulmonary aspergillosis occuring in a gardener: an occupational hazard? PG - 678-679 AU - Zuk JA AU - King D AU - Zakhour HD AU - Delaney JC LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 40 IP - DP - 1989 Jan 01 TI - Ventilatory capacity in animal food workers PG - 205-213 AU - Zuskin E AU - Mataija M AU - Tepsic E AU - Ivankovic D AU - Kanceljak B AU - GodnicCvar J LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - Helsinki IP - DP - 1989 Jan 01 TI - Ammattitaudit 1988 PG - - AU - Vaarenen V AU - Vasama M AU - Jolanki R AU - Toikkanen J LA - PT - DEP - TA - Tyoterveyslaitos JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 62 IP - DP - 1989 Jan 01 TI - Dermato-respiratory allergy induced by a marine worm (Marphysa sanguinea) used a fishing bait PG - 514-517 AU - Valero A AU - Huguet J AU - Sanosa J AU - Malet A AU - GarciaCalderon PA LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 101 IP - DP - 1989 Jan 01 TI - Specific IgE responses in isocyanate-induced asthma PG - 709-715 AB - BACKGROUND Isocyanates are the most frequent cause of occupational asthma in industrialized countries. OBJECTIVE We sought to investigate the utility of specific IgE measurement in the diagnosis of isocyanate-induced asthma. METHODS Fifty-eight of 101 patients referred for investigation were diagnosed as having isocyanate-induced occupational asthma by means of history, serial peak flow records, and bronchial provocation tests. Specific IgE antibodies to toluene diisocyanate:human serum albumin (HSA), diphenylmethane diisocyanate:HSA, and hexamethylene diisocyanate: HSA were measured in all patients by Phadebas RAST. RESULTS Twenty patients had a RAST ratio of 2 or greater to at least one isocyanate. Thirteen (28%) of the 46 patients with a positive provocation test response had a RAST ratio of 2 or greater, and nine (20%) had a RAST ratio of 3 or greater. Raising the RAST cut-off from 2 or greater to 3 or greater reduced its sensitivity but increased the specificity of the test to 100%. RAST measurement was most likely to be positive within 30 days of exposure. Serial measurements suggested that the half-life of the IgE antibodies was approximately 6 months. Evidence of cross-reactivity between isocyanate RAST responses was found in eight subjects. CONCLUSION Specific IgE to isocyanates is a more specific than sensitive index of occupational asthma. With a RAST score of 3 or greater, it is wholly specific and therefore diagnostic of isocyanate-induced asthma. The sensitivity of specific IgE measurement is highest when blood is taken less than 30 days from last exposure, which is consistent with the observed half-life. AU - Tee RD AU - Graneek BJ AU - Burge PS AU - Newman Taylor AJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 19 IP - DP - 1989 Jan 01 TI - Nasal hyperreactivity to newspapers PG - 57-58 AU - Theander C AU - Bende M LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 39 IP - DP - 1989 Jan 01 TI - Occupational asthma due to a repair process for polyethylene-coated electrical cables PG - 33-34 AU - Stenton SC AU - Kelly CA AU - Walters EH AU - Hendrick DJ LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - i IP - DP - 1989 Jan 01 TI - Case control study of serum immunoglobulin E antibodies reactive with soybean in epidemic asthma PG - 179-182 AU - Sunyer J AU - Anto LM AU - Rodrigo MJ AU - The clinical and toxicoepidemiological committee LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 96 IP - DP - 1989 Jan 01 TI - Irritant-induced occupational asthma PG - 297-300 AB - A retrospective review was performed on the files of 154 consecutive workers assessed for occupational asthma to clarify the relative frequency of asthma induced by irritants in the workplace and to determine whether such asthma was clearly distinguishable from other forms of occupational asthma. Fifty-nine workers were considered to have occupational asthma. A subset of ten had a history consistent with asthma initiated by exposure to high concentrations of an irritant, had persistent symptoms for an average of five years when seen, demonstrated increased reactivity to methacholine, and gave no prior history of pulmonary complaints. These ten had a lower incidence of atopy (20 percent vs 58 percent) and a more frequent history of smoking (80 percent vs 38 percent) than the other subjects with occupational asthma but did not differ in average latency (5.9 years vs 5.7 years). Our findings suggest that irritant-induced asthma is not uncommon, and those affected may have different baseline characteristics from others with occupational asthma. AU - Tarlo SM AU - Broder I LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 15 IP - DP - 1989 Jan 01 TI - Work related illness in offices: a proposed model of the sick building syndrome PG - 143-158 AU - Hedge A AU - Burge PS AU - Robertson AS AU - Wilson S AU - HarrisBass J LA - PT - DEP - TA - Environ Int JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 15 IP - DP - 1989 Jan 01 TI - Influence of personal characteristics, job-related factors and psychological factors on the sick building syndrome PG - 286-295 AU - Skov P AU - Valbjorn O AU - Pedersen BV LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 15 IP - DP - 1989 Jan 01 TI - Sick building syndrome, sensation of dryness and thermal comfort in relation to room temperature in an office building: need for individual control of temperature PG - 163-168 AU - Jaakkola JJK AU - Heinonen OP AU - Seppanen O LA - PT - DEP - TA - Environ Int JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 67 IP - DP - 1989 Jan 01 TI - Foam at inner eye canthus in office workers, compared with an average Danish population as control group PG - 61-68 AU - Franck C AU - Skov P LA - PT - DEP - TA - Acta Ophthalmol (Copenh) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 15 IP - DP - 1989 Jan 01 TI - Indoor air quality and health in two office buildings with different ventilation systems PG - 115-128 AU - Hedge A AU - Sterling TD AU - Sterling EM AU - Collett CW AU - Nie V LA - PT - DEP - TA - Environ Int JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - American S IP - DP - 1989 Jan 01 TI - The NIOSH approach to conducting indoor air quality investigations in office buildings PG - 63-72 AU - Gorman RW AU - Wallingford KM LA - PT - DEP - TA - Design and protocol for monitoring indoor air qual JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 46 IP - DP - 1989 Jan 01 TI - Climate, intermittent humidification, and humidifier fever PG - 671-674 AB - Two summer outbreaks of humidifier fever (HF) are described in a microprocessor factory (factory A) and a printing factory (factory B). The air in each factory was humidified intermittently and controlled by present humidistats operating to maintain a relative humidity of 45% by an air handler incorporating a spray humidifier in factory A and two ceiling mounted spray humidifiers in factory B. Questionnaire data from each workforce suggested that although symptoms apparently occurred most commonly in both factories on return from holiday (41/57, 71.9%), many subjects (24/40, 60%) in factory A also had intermittent symptoms of ill defined periodicity for some time before the disorder was recognised. Similar intermittent symptoms with no discernible pattern occurred in factory B in a smaller number of subjects (4/17, 23.5%), all of whom were night or rotating shift workers. Both episodes of humidifier fever after return from summer holiday developed when nocturnal air temperatures were unseasonably low; not on the day of return to work but two days later (factory A) and one day later (factory B). Symptoms were most common in most workers who had circulating serum IgG antibody measured by ELISA to humidifier sludge in factory B (14/17, 82.9%) but were most common in IgG antibody negative subjects in factory A (27/40, 67.5%). A more classic form of humidifier fever redeveloped in factory B during winter when meteorological recordings suggested that humidification of intake air was more continuous. Humidifier fever in winter may have been the major influence on the formulation of the symptom pattern thought to be relevant for recognition of the disorder.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Anderson K AU - Watt AD AU - Sinclair D AU - Lewis C AU - McSharry CP AU - Boyd G LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 15 IP - DP - 1989 Jan 01 TI - Isocyanate exposure and hypersensitivity pneumonitis--report of a probable case and prevalence of specific immunoglobulin G antibodies among exposed individuals PG - 234-237 AB - A car painter experienced three episodes of a hypersensitivity pneumonitis-like disease after exposure to two-component acrylic lacquers with hexamethylene diisocyanate (HDI) as the curing agent. High titers of HDI-specific immunoglobulin (Ig) G antibodies were found in the patient's serum by means of enzyme-linked immunosorbent assay (ELISA). In the ELISA, 5 to 10% of the sera from 455 isocyanate-exposed but asymptomatic workers were positive, depending on the criterion used for a positive test, whereas 0% of the sera from 157 unexposed referents was found to be positive. Among 10 subjects with isocyanate-induced asthma and isocyanate-specific IgE antibodies, 50% had specific IgG. It was concluded that the presence of isocyanate-specific IgG antibodies in serum is correlated with isocyanate exposure rather than with symptoms of isocyanate-induced disease AU - Selden AI AU - Belin L AU - Wass U LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 83 IP - DP - 1989 Jan 01 TI - Immunologic specificity of isocyanate-induced IgE antibodies in serum from 10 sensitized workers PG - 126-135 AB - A procedure for the preparation of RAST disks used to assay isocyanate-specific IgE antibodies was developed. The outcome of the RAST was found to be strongly dependent on how the isocyanate test antigen was synthesized. Specific IgE from selected workers with isocyanate asthma reacted optimally to conjugates with less than or equal to 10 isocyanate molecules bound per molecule of human serum albumin. Further haptenization resulted in decreased specific binding and increased nonspecific binding because of high levels of total IgE. The hapten and carrier specificity of isocyanate-induced IgE antibodies were studied by direct RAST and RAST inhibition. The existence of new antigenic determinants related to both the isocyanate hapten and the carrier could be demonstrated. It was important to use a test antigen prepared from the same isocyanate as that to which the worker had been exposed, since the cross-reactivity between different isocyanate haptens was partial and varied from one patient to another. It was confirmed that isocyanate-specific IgE antibodies can be demonstrated only in a subgroup of workers with isocyanate-related bronchial asthma AU - Belin L LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 19 IP - DP - 1989 Jan 01 TI - Immunological specificity of chloramine-T-induced IgE antibodies in serum from a sensitized worker PG - 463-471 AB - A procedure for the preparation of chloramine-T (CT) conjugates used to assay IgE antibodies was developed using response surface methodology and serum from a subject occupationally exposed to the substance. The conjugates, synthesized by reacting CT with human serum albumin (HSA) and other protein carriers, were used as antigens in a radio-allergosorbent test (RAST). Human serum albumin was found to be a suitable carrier, although other protein carriers also gave specific IgE-binding of a similar extent. The CT-HSA conjugates used in the RAST were characterized by high performance liquid chromatography, electrophoresis, immunodiffusion and ammonium sulphate precipitation. However, no strong correlation was seen between the ability of the conjugates to bind IgE and their physical or immuno-chemical properties. The hapten and carrier specificity of CT-induced IgE antibodies in khe subject's serum were studied by direct RAST and RAST inhibition. No existence of new antigenic determinants related to the carrier could be demonstrated. Although HSA as a carrier was altered immunochemically by CT, the IgE antibodies were found to be specific to hapten only. Chloramine-T-specific IgG antibodies could not be demonstrated in the subject's serum AU - Wass U AU - Belin L AU - Eriksson NE LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 10 IP - DP - 1989 Jan 01 TI - Possible asthma and rhinitis associated with exposure to ethyl-2-cyanoacrylate PG - 191-197 AU - Roy ML AU - Siu SR AU - Wong R LA - PT - DEP - TA - Occupational Health in Ontario JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 17 IP - DP - 1989 Jan 01 TI - Angiooedema, rhinitis and asthma provoked by fishing bait (Eisenia foetida) PG - 331-335 AU - Santiago AV AU - Casals JH AU - Valls JS AU - Casajuana AM AU - Calderon PAG LA - PT - DEP - TA - Allergol Immunopathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 139 IP - DP - 1989 Jan 01 TI - The pulmonary sequalae of accidental chlorine inhalation PG - A393-A393 AU - Schwartz DA AU - Smith DD AU - Lakshminarayan S LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 31 IP - DP - 1989 Jan 01 TI - Effect of chronic chromolyn sodium therapy in a beautician with occupatinal asthma PG - 112-113 AU - Schwartz HJ LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 62 IP - DP - 1989 Jan 01 TI - Hypersensitivity pneumonitis in an orchid grower associated with sensitivity to the fungus Cryptostroma corticale PG - 522-525 AU - Shepherd GM AU - Michelis MA AU - Macris NT AU - Smith JP LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 95 IP - DP - 1989 Jan 01 TI - Occupational asthma from cobalt sensitivity in workers exposed to hard metal dust PG - 29-37 AU - Shirakawa T AU - Kusaka Y AU - Fujimura N AU - Goto S AU - Kata M AU - Heki S AU - Morimoto K LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 84 IP - DP - 1989 Jan 01 TI - IgG antibodies in relation to exposure to laboratory-animal allergens PG - 520-528 AU - Price JA AU - Longbottom JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 32 IP - DP - 1989 Jan 01 TI - Specific IgE, IgG, and IgG4 to black GR in asthmatic patients exposed to reactive dye PG - 1197-1205 AU - Park HS AU - Lee MK AU - Hong CS LA - PT - DEP - TA - J Korean Med Assoc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 43 IP - DP - 1989 Jan 01 TI - Asthma in hairdressers induced by persulphate PG - 173-175 AU - Pankow W AU - Hein H AU - Bittner K AU - Wichert P LA - PT - DEP - TA - Pneumonologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 44 IP - DP - 1989 Jan 01 TI - Occupational asthma in a pharmaceutical worker exposed to penicillamine PG - 157-158 AU - Lagier F AU - Cartier A AU - Dolovich J AU - Malo JL LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 19 IP - DP - 1989 Jan 01 TI - Measurement of specific IgE antibodies in individuals exposed to formaldehyde PG - 509-514 AU - Kramps AU - Peltenburg LTC AU - Kerklaan PRM AU - Spieksma FTM AU - Valentijn RM AU - Dijkman JH LA - PT - DEP - TA - Clin Exp Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 19 IP - DP - 1989 Jan 01 TI - The incidence of IgE and IgG antibodies to chlorhexidine PG - 307-314 AB - The incidence of IgE and IgG antibodies to chlorhexidine AU - Layton GT AU - Stanworth DR AU - Amos HE LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 44 IP - DP - 1989 Jan 01 TI - A self management plan in the treatment of adult asthma PG - 200-204 AU - Beasley R AU - Cushley M AU - Holgate ST LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 2 IP - DP - 1989 Jan 01 TI - Occupational asthma caused by exposure to ash wood dust (Fraxinus americana) PG - 385-387 AB - A 63 year old man reported rhinitis and asthma, which occurred only at work where he was exposed to ash wood dust. Monitoring of peak expiratory flow rates (PEFR) and bronchial responsiveness to histamine when off work and at work showed increased variation of PEFR at work but no significant changes in nonspecific bronchial responsiveness assessed by the provocation concentration producing a 20% fall in FEV1 (PC20). Specific inhalation challenges were carried out in a special challenge room with ash wood dust. During the exposure for only 3 minutes, the mean concentration of particles was 3 mg-m3 and about 50% of particles had a diameter less than 10 mu. An immediate bronchospastic reaction was documented. Antibodies to a human serum albumin (HSA) ash wood conjugate were not significantly increased. AU - Malo JL AU - Cartier A LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 83 IP - DP - 1989 Jan 01 TI - Significant changes in nonspecific bronchial responsiveness after isolated immediate bronchospastic reactions caused by isocyanates but not after a late reaction caused by plicatic acid PG - 159-165 AB - Although late bronchospastic reactions after exposure to antigenic and sensitizing agents usually significantly alter bronchial responsiveness to histamine or methacholine, presumably by causing bronchial inflammation, isolated immediate bronchospastic reactions do not induce such changes. We studied three subjects who demonstrated different patterns of reaction. The first individual was diagnosed as having occupational asthma to red cedar. This was confirmed by specific inhalation challenges that resulted in late bronchospastic reaction. No significant changes in the provocative concentration of histamine causing a 20% fall in FEV1 (PC20) were found 1 day after this reaction. Two weeks later, serial assessments (five and six, respectively) of PC20 histamine were recorded on control days and up to 48 hours after exposure to plicatic acid, which caused a late bronchospastic reaction with a maximum fall of 37% in FEV1. No significant changes in PC20 were found; the maximum variations on control days were 0.36 to 0.74 mg/ml, and on active days, from 0.37 to 0.59 mg/ml. By contrast, two other subjects, who demonstrated isolated immediate reactions after exposure to diphenylmethane diisocyanate, had significant changes in PC20 histamine and methacholine, in one subject from 3.1 mg/ml to 0.6 mg/ml 8 hours after exposure, and in the other subject, from 61.0 to 7.4 mg/ml 7 hours after exposure, with recovery during the next few days. These examples demonstrate that the pattern of nonspecific bronchial responsiveness after immediate and late bronchospastic reactions can be different from what has previously been described. Immediate bronchospastic reactions may lead to bronchial hyperresponsiveness, whereas late asthmatic reactions do not always induce changes in bronchial responsiveness.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Malo JL AU - Archeveque JL AU - Cartier A LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - i IP - DP - 1989 Jan 01 TI - Occupational asthma in a chicory grower PG - 672-672 AU - Nemery B AU - Dements M LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 15 IP - DP - 1989 Jan 01 TI - Allergic airways disease caused by methyl tetrahydophthalic anhydride in epoxy resin PG - 154-155 AU - Nielsen J AU - Welinder H AU - Skerfving S LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 19 IP - DP - 1989 Jan 01 TI - Food specific skin-test reactivity in atopic subjects PG - 431-435 AU - Morgan JE AU - Daul CB AU - Hughes J AU - McCants M AU - Lehrer SB LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 19 IP - DP - 1989 Jan 01 TI - Anaphylaxis produced by rubber glove contact. Case reports and immunological identification of the antigens involved PG - 425-430 AU - Morales C AU - Basomba A AU - Carreira J AU - Sastre A LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 17 IP - DP - 1989 Jan 01 TI - Occupational asthma induced by chromium salts PG - 173-176 AU - Olaguibel JM AU - Basomba A LA - PT - DEP - TA - Allergol Immunopathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 34 IP - DP - 1989 Jan 01 TI - Tea dust, an occupational hazard PG - 45-47 AU - de Alwis WR LA - PT - DEP - TA - Ceylon Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 299 IP - DP - 1989 Jan 01 TI - Occupational risks of glutaraldehyde PG - 342-342 AU - Burge PS LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 84 IP - DP - 1989 Jan 01 TI - Histamine and leucotriene release in bronchoalveolar fluid during plicatic acid-induced bronchoconstriction PG - 762-768 AU - ChanYeung M AU - Chan H AU - Tse KS AU - Salari H AU - Lam S LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 2 IP - DP - 1989 Jan 01 TI - New methodology for specific inhalation challenges with occupational agents in powder form PG - 769-777 AB - Numerous agents in powder form (wood dust, flour, antibiotics, drugs, etc.) can cause occupational asthma. The diagnosis is generally confirmed by specific inhalation challenges in a special challenge room. There are several pitfalls to the procedure: 1) subjects may be exposed to high concentrations of particles; the concentrations of particles may be higher than the threshold limit value-short term exposure level (TLV-STEL), possibly resulting in severe or irritant reactions; 2) the exposure is erratic. To overcome these problems, a new device for aerosolization of powders has been developed. This apparatus consists of three parts: a particles generator, an aerosol delivery system connected to an orofacial mask, and monitors - a photometer and a cascade impactor. Information on the concentration and size distribution of inhaled particles can therefore be obtained. We performed specific inhalation challenges with this apparatus on 20 subjects suspected of having occupational asthma. The concentration of particles was generally below or close to the TLV-STEL and information was obtained on the proportion of particles with a diameter less than 10 mu. Falls in forced expiratory volume in one second (FEV1) were progressive with each increase in the duration of exposure. The five subjects who had negative reactions to exposure were asked to tip the relevant product from one tray to another in the traditional realistic way. All had negative responses. We conclude that this new procedure offers advantages over the traditional method as it gives information on the concentration and size distribution of inhaled particles and makes the drawing of a dose-response curve possible, both of which may improve the safety and accuracy of the test. AU - Cloutier Y AU - Lagier F AU - Lemieux R AU - Blais MC AU - StArnaud C AU - Cartier A AU - Malo JL LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 110 IP - DP - 1989 Jan 01 TI - Hypersensitivity pneumonitis treated with an electrostatic dust filter PG - 115-118 AU - Jacobs RL AU - Andrews CP AU - Jacobs FO LA - PT - DEP - TA - Ann Int Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 39 IP - DP - 1989 Jan 01 TI - Oilseed rape and asthma PG - 168- AU - Meyer TC LA - PT - DEP - TA - J Roy Coll Gen Pract JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 83 IP - DP - 1989 Jan 01 TI - Therapeutic effect and titres of specific IgE and IgG antibodies in patients with sea squirt allergy (Hoya asthma) under long-term hyposensitisation with three sea squirt antigens PG - 386-393 AU - Jyo T AU - Kodomari N AU - Kuwabara W AU - Katsutani T AU - Oysuka T AU - Tsuobi S AU - Oka S AU - Shigeta S AU - Ono K LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 84 IP - DP - 1989 Jan 01 TI - Guidelines for the immunologic evaluation of occupational lung disease PG - 805-814 AU - Grammer LC AU - Patterson R AU - Zeiss CR LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - i IP - DP - 1989 Jan 01 TI - Lochgoilhead fever outbreak in non-pneumonic legionellosis due to Legionella micdadei PG - 316-318 AU - Goldberg DJ AU - Wrench JG AU - Collier PW LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 31 IP - DP - 1989 Jan 01 TI - A health hazard evaluation of pheasant handlers PG - 473-47* AU - Goldstein MD AU - Schwartz BS AU - Maccarillo B AU - Borbi M AU - Tuccillo R LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 44 IP - DP - 1989 Jan 01 TI - Asthma: epidemics and epidemiology PG - 609-613 AU - Hendrick DJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 9 suppl 2 IP - DP - 1989 Jan 01 TI - Follow-up of respiratory function of 23 patients with occupational asthma PG - 25-29 AU - Grange F AU - Chapoulet MT AU - Prost G LA - PT - DEP - TA - J Toxicol Clin Exp JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 17 IP - DP - 1989 Jan 01 TI - Respiratory symptoms in Danish welders PG - 271-276 AU - Groth M AU - Lyngenbo O LA - PT - DEP - TA - Scand J Soc Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 19 IP - DP - 1989 Jan 01 TI - A prospective study of bronchial hyperresponsiveness and respiratory symptoms in a population of Australian schoolchildren PG - 299-306 AU - Peat JK AU - Salome CM AU - Sedgwick CS AU - Kerrebijn J AU - Woolcock AJ LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 61 IP - DP - 1989 Jan 01 TI - Small airways function in workers processing polyvinylchloride PG - 427-430 AU - Nielsen J. Fahraeus C. Bensryd I. Akesson B. Welinder H. Linden K. Skerfving S LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 299 IP - DP - 1989 Jan 01 TI - Smoking and occupational allergy in workers in a platinum refinery PG - 939-942 AB - OBJECTIVE To test the hypothesis that smoking increases the risk of sensitisation by occupational allergens. DESIGN Historical prospective cohort study. SETTING Platinum refinery. SUBJECTS 91 Workers (86 men) who started work between 1 January 1973 and 31 December 1974 and whose smoking habit and atopic state (on skin prick testing with common allergens) had been noted at joining. MAIN OUTCOME MEASURES Results of skin prick tests with platinum salts carried out routinely every three to six months and records of any respiratory symptoms noted by the refinery's occupational health service. Follow up was until 1980 or until leaving refinery work, whichever was earlier. RESULTS 57 Workers smoked and 29 were atopic; 22 developed a positive result on skin testing with platinum salts and 49 developed symptoms, including all 22 whose skin test result was positive. Smoking was the only significant predictor of a positive result on skin testing with platinum salts and its effect was greater than that of atopy; the estimated relative risks (95% confidence interval) when both were included in the regression model were: smokers versus non-smokers 5.05 (1.68 to 15.2) and atopic versus non-atopic 2.29 (0.88 to 5.99). Number of cigarettes smoked per day was the only significant predictor of respiratory symptoms. CONCLUSION Smokers are at increased risk of sensitisation by platinum salts. AU - Venables KM AU - Dally MB AU - Nunn AJ et al LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 83 IP - DP - 1989 Jan 01 TI - Consequences of occupational asthma PG - 437-440 AB - Seventy-nine patients attending hospital for follow-up of occupational asthma were interviewed, on average 6 years after asthma developed. Although 90% thought their symptoms had improved, 10% had required a hospital admission (apart from for investigation), 72% still took medication and most reported symptoms in the last 3 months. One-third were currently unemployed and 40-73% reported limitation in everyday activities, such as housework or shopping. Symptoms on waking were used as an index of troublesome asthma. Those 31 in whom this occurred at least once a week reported limitation in everyday activities significantly more commonly than others. This relation was more marked in men than women. Limitation in everyday activities was, however, more frequently reported by women than men, who were also more likely than men to be unemployed, suggesting that factors other than impairment of function also contribute to handicap in occupational asthma. AU - Venables KM AU - Davison AG AU - NewmanTaylor AJ LA - PT - DEP - TA - Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 16 IP - DP - 1989 Jan 01 TI - Predisposing factors in laboratory animal allergy: a study of atopy and environmental factors PG - 199-208 AB - A population of 101 laboratory technicians handling laboratory animals was studied with regard to predisposing factors for allergy. Twenty-seven had symptoms indicating laboratory animal allergy (LAA); of these, nine had asthma and were skin prick test positive for animal allergens. The LAA asthmatics had an increased frequency of a family history of allergy (relative risk, RR = 3.8); the predictive value was 0.27. There was also an increase of skin prick positivity against common nonanimal allergens (RR = 15); the predictive value was 0.60. All persons with marked positive skin prick tests (greater than or equal to +2) to environmental allergens had developed animal-test-positive LAA asthma. In 56% of the LAA asthma cases the serum IgE levels were elevated (greater than 100kU/L). In preemployment screening of susceptible individuals two important selection criteria emerged, viz., family history of allergy and positive skin prick reactions against environmental allergens. AU - Sjostedt L AU - Willers S LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 46 IP - DP - 1989 Jan 01 TI - Respiratory symptoms, lung function, and sensitisation to flour in a British bakery PG - 636-642 AB - A survey of dust exposure, respiratory symptoms, lung function, and response to skin prick tests was conducted in a modern British bakery. Of the 318 bakery employees, 279 (88%) took part. Jobs were ranked from 0 to 10 by perceived dustiness and this ranking correlated well with total dust concentration measured in 79 personal dust samples. Nine samples had concentrations greater than 10 mg/m3, the exposure limit for nuisance dust. All participants completed a self administered questionnaire on symptoms and their relation to work. FEV1 and FVC were measured by a dry wedge spirometer and bronchial reactivity to methacholine was estimated. Skin prick tests were performed with three common allergens and with 11 allergens likely to be found in bakery dust, including mites and moulds. Of the participants in the main exposure group, 35% reported chest symptoms which in 13% were work related. The corresponding figures for nasal symptoms were 38% and 19%. Symptoms, lung function, bronchial reactivity, and response to skin prick tests were related to current or past exposure to dust using logistic or linear regression analysis as appropriate. Exposure rank was significantly associated with most of the response variables studied. The study shows that respiratory symptoms and sensitisation are common, even in a modern bakery. AU - Musk AW AU - Venables KM AU - Crook B et al LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 15 IP - DP - 1989 Jan 01 TI - Potroom asthma: New Zealand experience and follow-up PG - 43-49 AB - Occupational asthma related to work in potlines in an aluminum smelter has been diagnosed on clinical criteria in 57 workers. About half were regular tobacco smokers but atopy was uncommon. There was a wide range in the time for which each had been employed prior to development of symptoms, but the average was about 20 months. Thirty-four showed nonspecific bronchial hyperreactivity to methacholine. At annual reviews over a period of 5 years following transfer to other work at the smelter, the majority improved in symptoms in 1-2 years and bronchial hyperreactivity returned to normal. However, over the subsequent 3 years, deterioration, not limited to tobacco smokers or atopic subjects, has occurred in some subjects. AU - O'Donnell TV AU - Welford B AU - Coleman ED LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 30 IP - DP - 1989 Jan 01 TI - Occupational asthma and IgE antibodies to reactive dyes PG - 298-304 AB - Reactive dyes have been widely used in recent years. This paper reports nine cases of immediate type occupational asthma to reactive dyes in one dye industry. All patients had had asthmatic symptoms, four had had rhinitis and they had worked for 6 to 25 months. Skin prick tests with reactive dyes were positive and bronchoprovocation tests also produced immediate or dual types of bronchoconstriction. We used the radioallergosorbent test (RAST) technique with nitrocellulose filter paper as a solid phase to detect specific IgE to four reactive dye-human serum albumin conjugates. High specific IgE binding was found in eight asthmatic workers compared with 13 negative controls. The RAST inhibition test revealed that there was no immunological cross-reactivity between 4 reactive dyes. These results suggested that the mechanism of their asthmatic symptoms was immunological, mostly an IgE-mediate reaction. AU - Park HS AU - Kim YJ AU - Lee MK et al LA - PT - DEP - TA - Yonsei Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 46 IP - DP - 1989 Jan 01 TI - Diurnal Variation In Peak Expiratory Flow Rate Among Grain Elevator Workers PG - 566-569 AB - The diurnal variation (DV) in peak expiratory flow rate (PEFR) has been studied among 132 grain elevator workers who accomplished three daily measurements of PEFR during three weeks. DV was calculated as the difference between the highest and the lowest PEFR as a percentage of the mean PEFR on each day. For the whole group the median was 5.9%. DV was higher among smokers and among workers with work related pulmonary symptoms. Analysis of variance showed that only age (p = 0.012) and smoking (p = 0.016) had a significant effect on DV. Pulmonary symptoms, total IgE, and duration of occupation had no independent impact on DV, whereas the exposure level of grain dust tended (p = 0.082) to have an independent effect. Twelve workers had an abnormally high DV (greater than 20%), of whom seven showed no signs of obstructive respiratory disease by spirometry. If only a single spirometric test had been performed the tentative diagnosis of bronchial asthma could have been missed in these seven workers. AU - Revsbech P AU - Anderson G LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 96 IP - DP - 1989 Jan 01 TI - Occupational asthma due to various agents: Absence of clinical and functional improvement at an interval of four or more years after cessation of exposure PG - 1046-1049 AB - We have previously shown that in some subjects with occupational asthma caused by various agents, there is no improvement approximately two years after exposure ended. These results could be explained by the short interval between diagnosis and follow-up. In the current study, we saw 28 subjects with occupational asthma at two intervals, 2.3 years (range, three months to 5.7 years) and 5.8 years (range, 4.3 to 10.9 years) after the cessation of exposure. Various causes of occupational asthma were included. The diagnosis was confirmed in 26 of the cases by specific inhalation challenges in the laboratory, and in the remaining two cases by combined monitoring of peak expiratory flow rates and bronchial responsiveness. All subjects had symptoms of asthma at both follow-up assessments. There were no changes in the need for medication, spirometry, or bronchial hyperresponsiveness. Depending on the interval of the follow-up, four to six subjects required inhaled steroid agents in addition to the usual bronchodilators, 11 had FEV1 less than 80 percent of predicted, and 26 or 27 had an abnormal PC 20 histamine. Only two subjects demonstrated sustained improvement in PC 20 at the first and second follow-ups, and one other showed changes during the second follow-up assessment which were not present at the first. We conclude that except for three subjects, the need for medication did not diminish, nor did airway obstruction and hyperresponsiveness improve in this group of subjects with occupational asthma long after exposure ended. These results differ from other studies, which demonstrated that some recovery takes place in a greater proportion of individuals. AU - Allard C AU - Cartier A AU - Ghezzo H AU - Malo JL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 84 IP - DP - 1989 Jan 01 TI - Specific Serum Antibodies Against Isocyanates: Association With Occupational Asthma PG - 507-514 AB - Although increased levels of specific IgE and/or IgG antibodies have been documented in individual cases of occupational asthma caused by common types of isocyanates (hexamethylene diisocyanate [HDI] and diphenylmethane diisocyanate [MDI]), the frequency among workers with occupational asthma is still unknown. The sera of 62/65 workers referred for specific inhalation challenges with isocyanates were analyzed for the presence of specific antibodies to the relevant isocyanate. Most workers (39, 63%) were exposed to HDI, some to MDI (17, 27%), and a few to toluene diisocyanate (six, 10%). Specific inhalation challenges were positive in 29 subjects, eliciting either immediate (seven), early late (two), late (13), or dual (seven) reactions. Specific inhalation challenges were more often positive in those subjects with increased nonspecific bronchial responsiveness. Twenty-nine subjects demonstrated increased levels of specific IgE and/or IgG antibodies to isocyanates in the absence of antibodies against human serum albumin (increased IgE only, no subject; IgG only, 20; both IgE and IgG, nine subjects). Although there was a loose association between the results of specific inhalation challenges and levels of specific IgE, the association was much better with the level of specific IgG. Indeed, 21 of the 29 subjects (72%) with positive challenges had increased levels of specific IgG, whereas 25 of the 33 subjects (76%) with negative challenges had normal levels of antibodies. The association was significant with both HDI and MDI. The levels of antibodies were not significantly associated with the type of temporal reaction.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Cartier A AU - Grammer L AU - Malo JL et al LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 80 IP - DP - 1989 Jan 01 TI - EFFECTS OF LONG-TERM THERAPY WITH INHALED CORTICOSTEROIDS (BECLOMETHASONE DIPROPRIONATE) IN OCCUPATIONAL ASTHMA PATIENTS NO LONGER EXPOSED PG - 498-505 AU - Sulotto F AU - Romano C LA - PT - DEP - TA - Med Del Lavoro JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 84 IP - DP - 1989 Jan 01 TI - Guidelines for the clinical evaluation of occupational asthma due to high molecular weight (HMW) allergens. Report of the Subcommittee on the Clinical Evaluation of Occupational Asthma due to HMW Allergens PG - 829-833 AU - Novey HS AU - Bernstein IL AU - Mihalas LS AU - Terr AI AU - Yunginger JW LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 44 IP - DP - 1989 Jan 01 TI - Pseudo-occupational asthma PG - 760-761 AU - Venables KM AU - Davison AG LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 84 IP - DP - 1989 Jan 01 TI - Guidelines for the clinical evaluation of occupational asthma due to small molecular weight chemicals. Report of the Subcommittee on the Clinical Evaluation of Occupational Asthma due to Small Molecular Weight Chemicals PG - 934-938 AU - Butcher BT AU - Bernstein IL AU - Schwartz HJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 84 IP - DP - 1989 Jan 01 TI - Guidelines for bronchoprovocation on the investigation of occupational asthma. Report of the Subcommittee on Bronchoprovocation for Occupational Asthma PG - 823-829 AB - Asthma can be induced or exacerbated at work by several means. Four work-related disorders, characterized by airflow obstruction and airway hyperresponsiveness, have been described. These include occupational asthma, byssinosis, the reactive airways dysfunction syndrome, and variable airflow obstruction caused by irritant substances. This committee has elected to focus only on the topic of occupational asthma, which is defined as asthma that is either induced or exacerbated by exposure to a specific (as opposed to an irritant) agent found at work. The Committee has decided to exclude discussion of other causes of asthmatic exacerbations at work, which does not mean that these conditions are not important. It may also, as discussed in other sections of this report, be quite difficult to distinguish an irritant effect from a specific bronchospastic response. A preexisting history of asthma before exposure to the offending agent does not preclude the diagnosis of occupational asthma. AU - Cartier A AU - Bernstein IL AU - Burge PS AU - Cohn JR AU - Fabbri LM AU - Hargreave FE AU - Malo JL AU - McKay RT AU - Salvaggio JE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 320 IP - DP - 1989 Jan 01 TI - Community outbreaks of asthma associated with inhalation of soybean dust PG - 1097-1102 AB - Since 1981, 26 outbreaks of asthma have been detected in the city of Barcelona. The geographic clustering of cases close to the harbor led us to consider the harbor as the probable source of the outbreaks. We therefore studied the association between the unloading of 26 products from ships in the harbor and outbreaks of asthma in 1985 and 1986. All 13 asthma-epidemic days in these two years coincided with the unloading of soybeans (lower 95 percent confidence limit of the risk ratio, 7.2). Of the remaining 25 products, only the unloading of wheat was related to the epidemics of asthma, although when adjusted for the unloading of soybeans the relation was not statistically significant. High-pressure areas and mild southeasterly to southwesterly winds, which favored the movement of air from the harbor to the city, were registered on all epidemic days. Particles of starch and episperm cells that were recovered from air samplers placed in the city had morphologic characteristics identical to those of soybean particles. Furthermore, the lack of bag filters at the top of one of the harbor silos into which soybeans were unloaded allowed the release of soybean dust into the air. We conclude that these outbreaks of asthma in Barcelona were caused by the inhalation of soybean dust released during the unloading of soybeans at the city harbor. AU - Anto JM AU - Sunyer J AU - RodriguezRoisin R AU - SuarezCervera M AU - Vazquez L AU - The toxicoepidemiological committee LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 185 IP - DP - 1989 Jan 01 TI - Interstitial lung disease in plaster workers PG - 136-140 AU - Arellano JLP AU - Sanchez RS AU - Guzman FJL AU - Buitrago JMG AU - Matos AO AU - Villaron LG LA - PT - DEP - TA - Rev Clin Esp JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 83 IP - DP - 1989 Jan 01 TI - The toxicity of constituents of cedar and pine woods to pulmonary epithelium PG - 610-618 AU - Ayars GH AU - Altman LC AU - Frazier CE AU - Chi EY LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 44 IP - DP - 1989 Jan 01 TI - Occupational asthma caused by iroko wood PG - 156-158 AU - Azofra J AU - Olaguibel JM LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 19 IP - DP - 1989 Jan 01 TI - Occupational allergy in an entomological research centre. II. Identification of IgE-binding proteins from developmental stages of the blowfly Lucilia cuprina and other species of adult flies PG - 411-417 AU - Baldo BA AU - Bellas TE AU - Tovey ER AU - Kaufman GL LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 55 IP - DP - 1989 Jan 01 TI - Improved medium for recovery and enumeration of the farmer's lung organism, Saccharomonospora viridis PG - 2669-2674 AU - Amner W AU - Edwards C AU - McCarthy AJ LA - PT - DEP - TA - Appl Environ Microbiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 139 IP - DP - 1989 Jan 01 TI - Does Aluminium smelting cause lung disease? PG - 1042-1057 AU - Abramson MJ AU - Wlodarczyk JH AU - Saunders NA AU - Hensley MJ LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 80 IP - DP - 1989 Jan 01 TI - Occupational asthma due to cuttle fish bone dust PG - 425-428 AU - Beltrami V AU - Innocenti A AU - Pieroni MG AU - Civai R AU - Nesi D AU - Bianco S LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 248 IP - DP - 1989 Jan 01 TI - A barley flour inhibitor of insect alpha-amylase is a major allergen associated with baker's asthma disease PG - 119-122 AU - Barber D AU - SanchezMonge R AU - Gomez L AU - Carpizo J AU - Armentia A AU - LopezOtin C AU - Juan F AU - Salcedo G LA - PT - DEP - TA - FEBS Lett JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 84 IP - DP - 1989 Jan 01 TI - Allergic respiratory disease in grain workers: the role of storage mites PG - 296-303 AU - Blainey AD AU - Topping MD AU - Ollier S AU - Davies RJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 18 IP - DP - 1989 Jan 01 TI - A new cause of occupational asthma in a pharmacist PG - 433-433 AU - Breton JL AU - Leneutre F AU - Esculpavit G LA - PT - DEP - TA - Presse Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 19 IP - DP - 1989 Jan 01 TI - The relationship between exposure to rats and antibody production in man: IgG antibody levels to rat urinary protein PG - 437-441 AU - Botham JW AU - McCall JC AU - Teasdale EL AU - Botham PA LA - PT - DEP - TA - Clin Exp Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 298 IP - DP - 1989 Jan 01 TI - Lake Nyos disaster, Cameroon, 1986: the medical effects of large scale emission of carbon dioxide? PG - 1437-1441 AB - 1700 people in Cameroon, west Africa, in 1986 when a massive release of gas occurred from Lake Nyos, a volcanic crater lake. The clinical findings in 845 survivors seen at or admitted to hospital were compatible with exposure to an asphyxiant gas. Rescuers noted cutaneous erythema and bullae on an unknown proportion of corpses and 161 (19%) survivors treated in hospital; though these lesions were initially believed to be burns from acidic gases, further investigation suggested that they were associated with coma states caused by exposure to carbon dioxide in air. The disaster at Lake Nyos and a similar event at Lake Monoun, Cameroon, two years previously provide new information on the possible medical effects of large scale emissions of carbon dioxide, though the presence of other toxic factors in these gas releases cannot be excluded. AU - Baxter PJ AU - Kapila M AU - Mfonfu D LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 63 IP - DP - 1989 Jan 01 TI - Monoamine oxidase inhibition as a sequel of hydrogen sulfide intoxication: increases in brain catecholamine and 5-hydroxytryptamine levels PG - 131-136 AB - Administration of sodium hydrosulfide (NaHS), an alkali salt of hydrogen sulfide (H2S) at doses of 10 and 30 mg/kg, corresponding to sublethal and lethal doses (0.66 and 2.0 X LD50) resulted in significant increases in regional catecholamine levels of the rat brain only after the dose of 2.0 × LD50 of NaHS. Whereas the cortex and the cerebellum showed little or no change in catecholamine content, the hippocampus, striatum and brainstem all showed increases in noradrenaline and adrenaline. Additional analysis also showed that brainstem dopamine and 5-hydroxytryptamine levels (5-HT) increased as well. In vitro testing of sulfide for inhibition of monoamine oxidase (MAO) activity showed the anion to be inhibitory with an IC50 of 39.1±3.6 µM. Inhibition of MAO activity ex vivo could be demonstrated at a dose of 100 mg/kg but not at the lower dose of 30 mg/kg NaHS. Inhibition of enzyme activity could not be demonstrated at this lower dose, possibly due to the well known rapid intramitochondrial metabolism of sulfide. Correlation of synaptosomal and mitochondrial sulfide levels with enzyme inhibition data suggests that inhibition of MAO may be an important contributing factor to the mechanism(s) underlying loss of central respiratory drive after fatal intoxication with H2S. AU - Warenycia MW AU - Smith KA AU - Blashko CS AU - Kombian SB AU - Reiffenstein RJ LA - PT - DEP - TA - Archives of Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 44 IP - DP - 1989 Jan 01 TI - Anaphylaxis to latex during surgery PG - 547-550 AB - Five young women, all of whom had anaphylactic responses in operating units, are described. Three of them worked in a hospital, three showed immediate hypersensitivity to fruit and all had known urticaria to latex. Anaphylaxis appeared progressively 15 to 30 minutes after injection of anaesthetic drugs. Skin tests with these drugs were negative. Skin prick tests through gloves and with four different allergen preparations (saline which had been incubated with gloves and three kinds of latex) were positive. Human basophil degranulation tests with all four allergens were positive and radio allergo sorbent tests to latex were also positive. IgE dependent allergy to latex may be investigated by questionnaire and if necessary by prick tests before each operation to prevent anaphylaxis due to surgical gloves. AU - LEYNADIER F AU - PECQUET C AU - DRY J LA - PT - DEP - TA - Anaesthesia JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19890101 IS - IS - VI - 44 IP - DP - 1989 Jan 01 TI - Longitudinal course of extrinsic allergic alveolitis in pigeon breeders. PG - 415-418 AB - The purpose of this study was to assess the longitudinal course of pigeon breeders' disease by evaluating 24 patients with the acute form of the disease 10 years after their original diagnosis. Twenty one patients attended for clinical assessment, pulmonary function studies, chest radiography, and antibody measurement. Eighteen had continued to keep pigeons, emphasising their commitment to the hobby. Despite continued antigen exposure pigeon related symptoms had improved in most patients and only five still had troublesome symptoms. Four patients had residual abnormalities of pulmonary function or chest radiographs and three had chronic bronchitis. Fanciers had attempted to regulate their exposure to the birds by use of masks and by spending less time in their lofts but this is an unlikely explanation for the benign course of their disease, as levels of antibody to pigeon gammaglobulin remained high, suggesting that appreciable antigen exposure was still occurring. In most cases a state of equilibrium between host and antigen appeared to have developed. This observation has implications for the clinical management and understanding of the nature of the disease. AU - Bourke SJ AU - Banham SW AU - Carter R AU - Lynch P AU - Boyd G LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 9 IP - DP - 1988 Jan 01 TI - Effects of acute intoxication with hydrogen sulfide on central amino acid transmitter systems. PG - 587-595 AB - The acute effects of hydrogen sulfide (H2S) on brain amino acid levels were examined in five regions of the rat brain following administration of either saline (controls), or 10 or 30 mg/kg i.p. of sodium hydrosulfide (NaHS). These doses represented sublethal (0.66 x LD50) as well as lethal (2 x LD50) amounts. No significant changes in amino acid levels were found in the cerebral cortex, striatum or hippocampus. In the cerebellum, aspartate and glycine levels declined at 10 mg/kg NaHS. The region showing the greatest change was the brainstem where aspartate, glutamate, glutamine, GABA, glycine and taurine and alanine all increased. It would appear then, that acute intoxication results in substantial changes in brainstem amino acid levels. As some of these amino acids have been implicated in the neuronal control of breathing, one of the underlying causes of death following H2S may be the alteration of amino acid neurotransmitter levels and metabolism resulting in the arrest of central respiratory drive. AU - Kombian SB AU - Warenycia MW AU - Mele FG AU - Reiffenstein RJ LA - PT - DEP - TA - Neurotoxicity JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 45 IP - DP - 1988 Jan 01 TI - Exposure and response to methyl isocyanate: results of a community based survey in Bhopal PG - 469-475 AB - In the two weeks immediately after the Bhopal disaster a community based survey was carried out in a series of eight exposed and two non-exposed clusters of households. The primary concern was the effect of the gas (subsequently identified as methyl isocyanate) on the eyes of the victims but data were also sought on respiratory status and the first symptoms of the exposure. No case of blindness was encountered that could be attributed to the gas. The most frequent symptoms reported were burning of the eyes, coughing, watering of the eyes, and vomiting. Among these, the frequency of cough most closely followed the rate of death in the different clusters. Although much rarer overall, the frequency of reported diarrhoea appeared to bear a stronger relation to death rates. Reports of photophobia and the clinical finding of superficial interpalpebral erosion of the cornea were more frequent where the death rates were lower. This clinical and epidemiological picture is consistent with different effects of the gas at different doses (as estimated from distance from the factory). AU - ANDERSSON N AU - MUIR MK AU - MEHRA V AU - SALMON AG LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 10 IP - DP - 1988 Jan 01 TI - Styrene-induced occupational asthma and rhinitis PG - 253-259 AB - Styrene is an aromatic compound widely used in the production of plastic polymers and rubbers. Studies of the effect of styrene on the respiratory tract are scarce. We describe three cases of occupational asthma and one case of occupational rhinitis due to styrene, which have been recently observed in our center. There is evidence that styrene can be a primary cause of occupational asthma and rhinitis. The mechanisms of action are unknown. Our findings suggest the need for preventive strategies for styrene exposed workers. AU - Moscato G AU - Marraccini P AU - Dellabianca A AU - Vinci G AU - Candura SM LA - PT - DEP - TA - Giornale Italiano di Medicina del Lavoro JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 139 IP - DP - 1988 Jan 01 TI - Replicated Dose-Response Study of Sulfur Dioxide Effects in Normal, Atopic, and Asthmatic Volunteers PG - 77-79 AB - To help assess respiratory health risks from sulfur dioxide (SO2) air pollution, we studied 24 normal, 21 atopic, 16 minimal/mild asthmatic, and 24 moderate/severe, medication-dependent asthmatic subjects classified according to history, lung function, allergy skin tests, serum IgE level, and airway reactivity to methacholine. All were exposed in a chamber (21° C, 50% humidity) to 0.0, 0.2, 0.4, and 0.6 ppm SO2 in random order at 1-wk intervals; then exposures were repeated to test consistency of response. The 1-h exposures included three 10-min exercise periods (ventilation ~ 40 L/min). Physiologic response was measured early (~ 15 min) and late (~ 55 min) in exposure. Symptoms were evaluated during exposure and for 1 wk afterward. Normal and most atopic subjects showed little response at these SO2 levels. A few atopic subjects and many asthmatics developed bronchoconstriction and respiratory symptoms, but most were able to maintain their exercise. Effects were not markedly different between early and late measurements, nor between the first and second round of studies; however, late and second-round responses appeared slightly more favorable. No statistically significant effect of SO2 on symptoms was found 1 day or 1 wk after exposure. Minimal/mild asthmatics showed, on the average, slight responses at 0.0 ppm (attributable to exercise) and increasing responses at increasing SO2 concentrations. Moderate/severe asthmatics reacted more at 0.0 ppm, but their increments in response with increasing SO2 concentration were roughly similar to those of minimal/mild asthmatics. Thus, responses to SO2 per se were not strongly dependent on clinical severity of asthma, nor on SO2 exposure history during previous weeks. AU - Linn WS AU - Avol EL AU - Peng R AU - Shamoo DA AU - Hackney JD LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 11 IP - DP - 1988 Jan 01 TI - Occupational sensitisation by inhalation of enzymes diaphorase and lipase PG - 179-181 AU - Bossert J AU - Fuchs E AU - Wahl R AU - Maasch HJ LA - PT - DEP - TA - Allergologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 94 IP - DP - 1988 Jan 01 TI - Increases in airway responsiveness following acute exposure to respiratory irritants PG - 476-481 AU - Boulet LP LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Respiratory symptoms in arable farmworkers: role of storage mites PG - 697-702 AU - Blainey AD AU - Topping MD AU - Ollier S AU - Davies RJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 5 IP - DP - 1988 Jan 01 TI - Role of alpha-amylase in bakers asthma PG - 519-521 AU - Birnbaum J AU - Latil F AU - Vervloet D AU - Senft M AU - Charpin J LA - PT - DEP - TA - Rev Franc Resp JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Recurrent asthma induced by toluene diisocyanate PG - 660-662 AU - Banks DE AU - Rando RJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 38 IP - DP - 1988 Jan 01 TI - A survey of aerosol-related symptoms in dental hygienists PG - 23-25 AU - Basu MK AU - Browne RM AU - Potts AJC AU - Harrington JM LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 54 IP - DP - 1988 Jan 01 TI - Baking additives as new allergens in bakers asthma PG - 70-72 AU - Baur X AU - Sauer W AU - Weiss W LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 166 IP - DP - 1988 Jan 01 TI - Humidifier lung and humidifier fever PG - 113-124 AU - Baur X AU - Behr J AU - Dewair W AU - Ehret W AU - Fruhmann G AU - Vogelmeier C AU - Weiss W AU - Zinkernagel V LA - PT - DEP - TA - Lung JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 1 IP - DP - 1988 Jan 01 TI - Acquired progressive asthma in a fire-fighter PG - 469-470 AU - Bergstrom CE AU - Tornling G AU - Unge G LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 48 IP - DP - 1988 Jan 01 TI - Occupational risk factors for laryngeal cancer on the texas gulf coast PG - -1964, AU - Brown LM AU - Mason TJ AU - Pickle LW AU - Stewart PA AU - Buffler PA AU - Burau K AU - Ziegler RG AU - Fraumeni JF LA - PT - DEP - TA - Cancer Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Asthma induced by ivory dust: a new occupational cause PG - 737-738 AU - Armstrong RA AU - Neill P AU - Mossop RT LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 18 IP - DP - 1988 Jan 01 TI - IgG antibodies against polyisocyanates in car painters PG - 85-93 AU - Welinder H AU - Nielsen J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 18 IP - DP - 1988 Jan 01 TI - Asthma Due To The Complex Salts Of Platinum: A Cross-Sectional Survey Of Workers In A Platinum Refinery PG - 569-580 AB - Anamnestic and immunological data of workers of a platinum refinery (group A: workers with work-related symptoms, n = 8; group B: workers with symptoms not clearly work-related, n = 9; group C: asymptomatic workers, n = 13) and controls (group D: atopics, n = 10; group E: non-atopics, n = 16) were compared. Exposure to platinum salt was higher in group A than in groups B or C. In group A, symptoms developed 4 months (median) after the onset of exposure. All subjects of group A and three workers of group B, but none of the workers of the other groups, showed a positive cutaneous reaction to (PtCl6)2-. Total serum IgE was higher in groups A and D than in groups B, C or E. (PtCl6)2(-)-specific IgE was higher in group A, but there was non-specific binding of (PtCl6)2- to IgE. Histamine release with (PtCl6)2- was found in all groups and was highest in atopic controls. Histamine release with (PtCl6)2- and histamine release with anti-IgE showed an excellent correlation, suggesting a similar release mechanism of (PtCl6)2- and anti-IgE. In skin-test positive subjects, high cutaneous (PtCl6)2(-)-sensitivity is linked to high histamine release with (PtCl6)2- or anti-IgE, supporting the concept of a role of cell surface IgE or IgE-Fc-receptor in the release process with platinum salts. However, high specificity of cutaneous reactions contrasts with low specificity of in-vitro tests with (PtCl6)2-. A different reaction of basophils and mast cells, when challenged with free platinum salts, is hypothesized. We conclude that neither histamine release from basophils with (PtCl6)2- nor RAST for the detection of (PtCl6)2- -specific IgE are helpful in the diagnosis of platinum salt allergy. AU - Merget R AU - SchultzeWerninghaus G AU - Muthorst T et al LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 137 IP - DP - 1988 Jan 01 TI - Persistent asthma due to isocyanates : A follow-up study of subjects with occupational asthma due to toluene di-isocyanate (TDI) PG - 1326-1329 AB - Thirty-five subjects with occupational asthma due to toluene diisocyanate (TDI) exposure were examined. All the subjects were studied with inhalation challenges with TDI and with methacholine. TDI asthma was documented by a positive inhalation challenge to low levels of TDI. Airway responsiveness to methacholine was in the range of asthmatic patients at the time of diagnosis. After an average follow-up interval of 10 months, all the subjects were re-examined. Of the 35 subjects examined, 30 subjects (85.7%) left the workplace, and 5 remained in the same job. Twenty-seven subjects (77.1%) continued to have asthmatic attacks requiring medication for relief of symptoms. At follow-up examination, TDI asthma was documented by a positive inhalation challenge to TDI in 27 subjects. Of these 27 TDI reactors, 22 subjects were removed from occupational exposure to TDI. The TDI reactors had persistent respiratory symptoms and airway hyperresponsiveness to methacholine. At follow-up visit, 8 subjects (22.9%) lost sensitization to TDI; 5 subjects (62.5%) in this group had also normal airway responsiveness to methacholine after removal from exposure. Only 1 subject among the TDI nonreactors complained of mild respiratory symptoms. At diagnosis, there were no significant differences between subjects who recovered and those who did not with regard to age, smoking habits, atopy, duration of exposure to isocyanates, duration of symptoms, baseline FEV1 (% pred), and baseline airway responsiveness to methacholine.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Mapp CE AU - Beghe B AU - Balboni A et al LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 45 IP - DP - 1988 Jan 01 TI - Laboratory animal allergy in a pharmaceutical company PG - 660-666 AB - A cross sectional survey was carried out on 138 workers exposed to laboratory animals. Sixty (44%) had symptoms in a self completed questionnaire that were consistent with laboratory animal allergy (LAA) of whom 15 (11%) had chest symptoms. There was a positive skin prick test to one or more animal urine extracts (rat, mouse, guinea pig, rabbit) in 13% and 38% had a positive radioallergosorbent test to urine extract. LAA chest symptoms were almost five times more common in atopic than non-atopic subjects (who were distinguished by skin test response to common, non-animal aeroallergens). A positive skin test to animal urine was associated with LAA chest symptoms and with atopy. Nose, eye, or skin symptoms without chest symptoms were not associated with atopy. There was an inverse relation between duration of employment at the firm and LAA chest symptoms, suggesting selection of affected people out of employment with animals. AU - Venables KM AU - Tee RD AU - Hawkins ER et al LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 45 IP - DP - 1988 Jan 01 TI - Smoking, atopy, and laboratory animal allergy PG - 667-671 AB - This study examined data from three cross sectional surveys of 296 laboratory workers exposed to small mammals. Four indices of laboratory animal allergy were studied: symptoms suggestive of occupational asthma, symptoms suggestive of any occupational allergy, skin weals to animal urine extracts, and serum binding in radioallergosorbent tests with urine extracts. Pooled data from the three surveys showed an association between smoking and all indices except radioallergosorbent tests; the association was significant for symptoms of occupational asthma. One of the three surveys consistently showed a stronger association of allergy indices with smoking than with atopy (defined on skin tests with non-animal aeroallergens). Associations with smoking persisted after stratifying by atopic status, suggesting that smoking may be a risk factor for laboratory animal allergy. AU - Venables KM AU - Upton JL AU - Hawkins ER et al LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Increased Risk Of Occupational Allergy In Smokers Working In A Platinum Refinery PG - 264 AU - Venables KM; Stevens J LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 5 IP - DP - 1988 Jan 01 TI - Occupational asthma to an exotic wood: Nesorgordonia papaverifera (danta or kotibe) PG - 71-73 AU - Gozalo F AU - Fernandez RP LA - PT - DEP - TA - Rev Mal Resp JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Bronchial provocation studies in farmers with positive RAST to the storage mite Lepidoglyphus destructor PG - 541-551 AU - van HageHamsten M AU - Zetterstrom O AU - Johansson SGO LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Occupational asthma due to sodium iso-nonanoyl oxybenzene sulphonate, a newly developed detergent ingredient PG - 501-502 AB - Research with sodium iso-nonanoyl oxybenzene sulphonate (SINOS) for use in a detergent product was complicated by the development of asthma in an atopic 38 year old laboratory technician. Inhalation challenge tests with nebulised SINOS solutions over a dose range of 0.01-32 micrograms gave reproducible late asthmatic reactions after the higher doses and an increase in bronchial responsiveness to methacholine. The magnitude of the late reaction was related to the challenge dose. Research with sodium iso-nonanoyl oxybenzene sulphonate (SINOS) for use in a detergent product was complicated by the development of asthma in an atopic 38 year old laboratory technician. Inhalation challenge tests with nebulised SINOS solutions over a dose range of 0.01-32 micrograms gave reproducible late asthmatic reactions after the higher doses and an increase in bronchial responsiveness to methacholine. The magnitude of the late reaction was related to the challenge dose. AU - Hendrick DJ AU - Connolly MJ AU - Stenton SC AU - Bird AG AU - Winterton IS AU - Walters EH LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 30 IP - DP - 1988 Jan 01 TI - An epidemiologic study of respiratory health effects in a group of North Carolina furniture workers PG - 959-95* AB - Goldsmith DF, Shy CM AU - Goldsmith DF AU - Shy CM LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 14 IP - DP - 1988 Jan 01 TI - Respiratory health effects from occupational exposure to wood dusts PG - 1-15 AU - Goldsmith DF AU - Shy CM LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 82 IP - DP - 1988 Jan 01 TI - Prospective immunologic and clinical study of a population exposed to hexamethylene diisocyanate PG - 627-633 AU - Grammer LC AU - Eggum P AU - Silverstein M AU - Shaughnessy MA AU - Liotta JL AU - Patterson R LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 39 IP - DP - 1988 Jan 01 TI - Ventilatory function in aluminium extraction workers: a four-year follow-up PG - 289-296 AU - Gomzi M LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 18 IP - DP - 1988 Jan 01 TI - Asthma caused by bromelain: an occupational allergy PG - 445-450 AU - Gailhofer G AU - WildersTruschnig M AU - Smolle J AU - Ludvan M LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 18 IP - DP - 1988 Jan 01 TI - Occupational allergic rhinitis from guar gum PG - 245-252 AU - Kanerva L AU - Tupasela O AU - Jolanki R AU - Vaheri E AU - Estlander T AU - Keskinen H LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 18 IP - DP - 1988 Jan 01 TI - Experiences of specific IgE in asthma due to diisocyanates PG - 597-604 AU - Keskinen H AU - Tupasela O AU - Tiikkainen U AU - Nordman H LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Respiratory symptoms in Danish farmers: an epidemiological study of risk factors PG - 872-877 AU - Iversen M AU - Dahl R AU - Korsgaard J AU - Hallas T AU - Jensen EJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 18 IP - DP - 1988 Jan 01 TI - Cross-reaction between aromatic isocyanates (TDI and MDI): a specific bronchial provocation test study PG - 323-329 AU - Innocenti A AU - Cirla AM AU - Pisati G AU - Mariano A LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 45 IP - DP - 1988 Jan 01 TI - Respiratory symptoms in West Sussex firemen PG - 251-255 AU - Horsfield K AU - Cooper FM AU - Buckman MP AU - Guyatt AR AU - Cumming G LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 14 IP - DP - 1988 Jan 01 TI - Respiratory symptoms and pathophysiological effects of occupational exposure to formaldehyde and wood dust PG - 306-311 AU - Holmstrom M AU - Wilhelmsson B LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 45 IP - DP - 1988 Jan 01 TI - Recent trends in the prevalence of byssinotic symptoms in the Lancashire textile industry PG - 782-789 AU - Cinkotai FF AU - Rigby A AU - Pickering CAC AU - Seaborn D AU - Faragher E LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 45 IP - DP - 1988 Jan 01 TI - Allergy to occupational exposure to hydroquinone and to methionine PG - 376-380 AU - Choudat D AU - Neukirch F AU - Brochard P AU - Barrat G AU - Marsac J AU - Conso F AU - Philbert M LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 18 IP - DP - 1988 Jan 01 TI - Comparison of cellular and protein changes in bronchial lavage fluid of symptomatic and asymptomatic patients with red cedar asthma on follow-up examination PG - 359-365 AU - ChanYeung M AU - Leriche J AU - MacLean L AU - Lam S LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 82 IP - DP - 1988 Jan 01 TI - Soybean flour asthma: detection of allergens by immunoblotting PG - 251-255 AU - Bush RK AU - Schroekenstein D AU - MeierDavis S AU - Balmes J AU - Rempel D LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Bronchial asthma caused by Lathyrus sativus flour PG - 536-539 AU - Valdivieso R AU - Quirce S AU - Sainz T LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 1 IP - DP - 1988 Jan 01 TI - Extrinsic allergic alveolitis caused by spores of the oyster mushroom Pleurotus ostreatus PG - 466-468 AU - Cox A AU - Folgering HTM AU - van Griensven LJLD LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 38 IP - DP - 1988 Jan 01 TI - Occupational asthma in tomato growers following an outbreak of the fungus verticillium albo-atrum in the crop PG - 13-17 AU - Davies PDO AU - Jacobs R AU - Mullins J AU - Davies BH LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 5 IP - DP - 1988 Jan 01 TI - A case of semi-delayed hypersensitivity to dry sausage dust PG - 633-635 AU - Dalphin JC AU - Francois J AU - Saugier B AU - Picard L AU - Bourgeois M AU - Depierre A LA - PT - DEP - TA - Rev Mal Resp JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 60 IP - DP - 1988 Jan 01 TI - Respiratory symptoms and lung function following exposure in workers exposed to soft paper tissue dust PG - 341-345 AU - Ericsson J AU - Jarvholm B AU - Norin F LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 14 IP - DP - 1988 Jan 01 TI - Obstructive and restrictive ventilatory impairment in polyvinylchloride fabrication workers PG - 273-279 AU - Ernst P AU - De Guire L AU - Armstrong B AU - Theriault G LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 18 IP - DP - 1988 Jan 01 TI - Allergic dermatoses and respiratory diseases from reactive dyes PG - 290-297 AU - Estlander T LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 38 IP - DP - 1988 Jan 01 TI - Skin test survey of castor bean allergic working population in eastern Sudan, with frequency response of first dilutions giving skin reactions PG - 128-133 AB - The mean wheal diameter by prick test for castor bean (Ricinus communis, Euphorbiaceae) extracts was measured in a castor bean allergic population. Three types of castor bean extracts namely Cimmaron, Pacific and dust (a mixture of Cimmaron, Pacific and hull), were applied at 1/10,000 dilutions with a control solution. The subjects comprised 318 male workers who were divided into four groups with a fifth control group of 63 male workers. The solutions were tested on three subject groups with Cimmaron in the first, Pacific in the second, and dust in the third. All three extracts were applied in the fourth and the control groups. The results have shown that the Cimmaron type gives a larger wheal diameter than Pacific or dust at the same concentration. There were statistically significant differences between the wheal diameters caused by different extracts in the same subjects. The possibility of producing a type of seed containing less amount of allergen could be considered and experimented on by the agricultural research bodies. AU - Fakhri ZI AU - Erwa HH LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 16 IP - DP - 1988 Jan 01 TI - A prospective and immunologic study of factory workers exposed to TDI PG - 139-144 AU - Duce F AU - de Gregorio MA AU - Perez J AU - Portillo JR AU - Pascual G AU - Alfonso ER LA - PT - DEP - TA - Allergy et Immunopathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 28 IP - DP - 1988 Jan 01 TI - Occupational asthma from shrimps PG - 17-18 AU - Dugue P AU - Lachaussee R AU - Garcia G LA - PT - DEP - TA - Rev Fr Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 138 IP - DP - 1988 Jan 01 TI - Acidity potentiates bronchoconstriction induced by hypoosmolar aerosols PG - 35-39 AU - Balmes JR AU - Fine JM AU - Christian D AU - Gordon T AU - Sheppard D LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 81 IP - DP - 1988 Jan 01 TI - Woodman's disease: hypersensitivity pneumonitis from cutting live trees PG - 455-460 AU - Dykewicz MS AU - Laufer P AU - Patterson R AU - Roberts M AU - Sommers HM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 11 IP - DP - 1988 Jan 01 TI - Fate of grainhandlers with bronchial hyperreactivity PG - 193-197 AU - Enarson DA AU - Vedal S AU - ChanYeung M LA - PT - DEP - TA - Clin Invest Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 45 IP - DP - 1988 Jan 01 TI - Occupational asthma in a mineral analysis laboratory PG - 381-386 AU - Musk AW AU - Peach S AU - Ryan G LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 13 IP - DP - 1988 Jan 01 TI - Isocyanates and respiratory disease: current status PG - 331-349 AU - Musk AW AU - Peters JM AU - Wegman DH LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 14 IP - DP - 1988 Jan 01 TI - Skin and respiratory symptoms from exposure to alkaline glutaraldehyde in medical services PG - 366-371 AU - Norback D LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 82 IP - DP - 1988 Jan 01 TI - Specific serum antibodies against phthalic anhydride in occupationally exposed subjects PG - 126-133 AU - Nielsen J AU - Welinder H AU - Schutz A AU - Skerfving S LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 49 IP - DP - 1988 Jan 01 TI - Health status of a group of sewage treatment workers in Toronto, Canada PG - 346-350 AU - Nethercott JR AU - Holness DL LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 18 IP - DP - 1988 Jan 01 TI - Evidence of allergic hypersensitivity to chironomid midges in an English village PG - 275-285 AU - McHugh SM AU - Credland PF AU - Tee RD AU - Cranston PS LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 1 IP - DP - 1988 Jan 01 TI - Occupational asthma due to isocyanates PG - 273-279 AU - Mapp CE AU - Boschetto P AU - Vecchio LD AU - Maestrelli P AU - Fabbri LM LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 138 IP - DP - 1988 Jan 01 TI - Patterns of improvement in spirometry,bronchial hyperresponsiveness, and specific IgE antibody levels after cessation of exposure in occupational asthma caused by snow-crab processing PG - 807-812 AB - Thirty-one workers with occupational asthma caused by snow-crab processing were assessed by a long-term follow-up on three occasions at mean +/- SD intervals of 12.8 +/- 5.4, 31.4 +/- 6.3, and 64.4 +/- 6.3 months after leaving work. The diagnosis of work-related asthma was initially confirmed in all of them by specific inhalation challenges at the workplace or by laboratory inhalation of snow-crab boiling water (n = 24) or by serial monitoring of airway caliber and bronchial responsiveness to histamine at work and off work (n = 7). Total duration of work-related exposure was 12.8 +/- 5.6 months (range, 3 to 21 months), and the duration of symptoms after onset was 6.8 +/- 4.2 months (range, 1 to 18 months). At the time of diagnosis, all 31 subjects required medication for asthma, 11 had a FEV1 less than or equal to 85% predicted, and all subjects had a PC20 less than or equal to 16 mg/ml. Twelve of 25 serum samples assessed showed high levels of specific immunoglobulin E (IgE) antibodies to crab meat and/or boiling water. At the time of the first follow-up, there was a reduction in the number of subjects still requiring medication, with a significant reduction in FEV1, and a PC20 less than or equal to 16 mg/ml. However, no further change was observed afterwards. Similarly, the mean FEV1 and FEV1/FVC improved significantly from the time of diagnosis to the first follow-up (p less than 0.01), with a plateau thereafter.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Malo JL AU - Cartier A AU - Ghezzo H AU - Lafrance M AU - McCants M AU - Lehrer SB LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Occupational asthma in workers of a pharmaceutical company processing spiramycin PG - 371-377 AB - After investigation of one worker with occupational asthma, all 51 employees of a pharmaceutical company processing the macrolide antibiotic spiramycin were investigated to determine the frequency of the condition and the risk factors. The antibiotic was produced for short periods four to five times a year. The first part of the investigation, conducted before a production period, consisted of the following: questionnaire, skinprick tests, blood sample, spirometry, assessment of bronchial responsiveness to methacholine, and monitoring of peak expiratory flow rates (PEF). The second part of the survey was carried out in 48 of the 51 workers during the production period, and included the same assessments except for skin testing. No FEV1 values had changed by more than 9% or PEF by more than 19%. Inhalation challenge with spiramycin was performed in 12 of the 14 individuals who had a history of occupational asthma, a provocative concentration of methacholine (PC20) of 16 mg/ml or less, or a PC20 that fell by 2.5 fold or more during the production period (or a combination of these). Three subjects experienced immediate bronchoconstriction. All reported symptoms, and all had a fall in PC20 methacholine during the production period. It is concluded that the minimum frequency of occupational asthma in this company processing spiramycin is 4/51 (7.8%). The combination of a positive response to the questionnaire and a change in bronchial hyperresponsiveness during the production period appeared to be the best detector of individuals with occupational asthma, as confirmed by inhalation challenge with spiramycin. AU - Malo JL AU - Cartier A LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 82 IP - DP - 1988 Jan 01 TI - Pulmonary and immunologic evaluation of foundry workers exposed to methylene diphenyldiisocyanate (MDI) PG - 55-61 AU - Liss GM AU - Bernstein DI AU - Moller DR AU - Gallagher JS AU - Stephenson RL AU - Bernstein IL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - * IP - DP - 1988 Jan 01 TI - Immune response of humans to exposure to protein-producing microorganisms PG - 71-75 AU - Litovskaya AV LA - PT - DEP - TA - Z Mik Epi Imm (Moscow) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 45 IP - DP - 1988 Jan 01 TI - Respiratory and allergic symptoms in wool textile workers PG - 727-741 AU - Love RG AU - Smith TA AU - Gurr D AU - Soutar CA AU - Scarisbrick DA AU - Seaton A LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Allergic alveolitis and late asthmatic reaction due to molds in the tobacco industry PG - 74-76 AU - Lander F AU - Jepsen JR AU - Gravesen S LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 45 IP - DP - 1988 Jan 01 TI - Respiratory disorder among tobacco workers PG - 500-502 AU - Lander F AU - Gravesen S LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 150 IP - DP - 1988 Jan 01 TI - Chronic obstructive lung disease in pig breeders. Employment of a filtering helmet respirator (Airstream helmet) for diagnosis and secondary prophylaxis PG - 1663-1664 AU - Larsen AI AU - Jepsen JR AU - Praest LP AU - Pedersen IM AU - Christensen KM LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 38 IP - DP - 1988 Jan 01 TI - Reactive airways dysfunction syndrome PG - 135-138 AU - Lerman S AU - Kipen H LA - PT - DEP - TA - Am Family Physician JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 32 IP - DP - 1988 Jan 01 TI - Fungal and actinomycete spores as pollutants of the workplace and occupational allergens PG - 515-533 AB - Spores of fungi and actinomycetes are almost always present in air but their numbers and types differ with time of day, weather, season and location (especially if this is dominated by large nearby spore sources). Without a source of spores in a building, numbers indoors are usually smaller than outdoors but the types found are similar. Heaviest exposure to airborne spores is often found in the workplace. Important sources are agricultural crops, especially during harvesting or during handling and processing after storage. mushrooms, wood for timber or pulping, composts, food processing and, increasingly, biotechnological processes. Many of the spores concerned are 1–5 µm in diameter and they may number up to 1010 spores m-3 air. Many of the organisms found are well-known allergens and have been implicated in occupational asthma or extrinsic allergic alveolitis. Some may also cause infection, e.g. Aspergillus fumigatus, or carry mycotoxins, e.g. Aspergillus flavus, while very intense exposure may cause ‘organic dust toxic syndrome’. Important factors in the development of occupational asthma and allergic alveolitis are predisposition and the nature, intensity and duration of exposure. Examples of exposure to fungal and actinomycete spores in different occupational environments are described. AU - Lacey J AU - Crook B LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 81 IP - DP - 1988 Jan 01 TI - Occupational asthma from reactivity to an alkaline hydrolysis derivative of gluten PG - 385-390 AB - A 29-year-old female subject had been working for 13 years in a company producing biscuits. She was exposed intermittently to an alkaline hydrolysis wheat gluten derivative (AHGD) that was incorporated into marshmallows. Five years before being referred, she started reporting rhinoconjunctivitis and asthmatic symptoms immediately after handling AHGD. When she was first assessed, she had avoided contact with AHGD for 1 year, and she was asymptomatic. Normal spirometry and bronchial responsiveness to histamine (provocative concentration causing a 20% fall in FEV1, 22 mg/ml) were obtained. There was a positive allergy skin test to ragweed pollen and to AHGD at 0.01 mg/ml. Skin tests with individual extracts of cereals, including wheat, were negative. Inhalation challenge with AHGD for 15 seconds caused immediate rhinoconjunctivitis and bronchoconstriction (maximum fall of 40% in FEV1 30 minutes after the exposure) with complete recovery 2 hours later. There was no reaction thereafter, and the provocative concentration of histamine causing a 20% fall in FEV1 was not significantly changed (13.1 mg/ml) 9 hours after the challenge. Inhalation challenge with wheat flour containing native gluten for 30 minutes did not cause any symptoms or significant change in FEV1. IgE RAST counts were greater with the AHGD than with gluten and the whole wheat extract; the opposite was generally found with sera from individuals with baker's asthma and wheat food allergy. With the serum of the affected worker, AHGD completely inhibited the corresponding RAST, but gluten did not. With wheat food allergy, AHGD was relatively inactive inhibition of the wheat and gluten RAST, but gluten was effective.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Lachance P AU - Cartier A AU - Dolovich J AU - Malo JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 260 IP - DP - 1988 Jan 01 TI - Acute systemic reactions to carbonless copy paper associated with histamine release PG - 242-243 AU - LaMarte FP AU - Merchant JA AU - Casale TB LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - Suppl 2 IP - DP - 1988 Jan 01 TI - Proteinas de la soja con capacidad para unirse a IgE expecifica humana PG - 24- AU - Gonzalez R AU - Zapatero L AU - Caravaca F AU - Carreira J LA - PT - DEP - TA - Rev Esp Alergol Immunol Clin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 23 IP - DP - 1988 Jan 01 TI - Prognosis of occupational asthma induced by isocyanates PG - 565-569 AU - Paggiaro PL AU - Bacci E AU - Dente FL AU - Talini D AU - Giuntini C LA - PT - DEP - TA - Bull Eupopean Physiopath Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 86 IP - DP - 1988 Jan 01 TI - Short-term sensitising antibodies in bakers asthma PG - 215-219 AU - Popp W AU - Zwick H AU - Rauscher H LA - PT - DEP - TA - Int Arch Allergy Appl Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 23 IP - DP - 1988 Jan 01 TI - Effects of chronic exposure to diisocyanates PG - 561-564 AU - Pham QT AU - Teculescu D AU - MeyerBisch C AU - Mur JM LA - PT - DEP - TA - Bull Eupopean Physiopath Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 18 IP - DP - 1988 Jan 01 TI - ELISA method for measurement of airborne levels of major laboratory animal allergens PG - 95-107 AU - Price JA AU - Longbottom JL LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 14 IP - DP - 1988 Jan 01 TI - Health effects due to occupational exposure to cobalt blue dye among plate printers in a porcelain factory in Denmark PG - 378-384 AU - Raffn E AU - Mikkelsen S AU - Altman DG AU - Christensen JM AU - Groth S LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 79 IP - DP - 1988 Jan 01 TI - Asthma induced by sodium tosylchloramide PG - 237-240 AU - Romeo L AU - Gobbi M AU - Pezzini A AU - Caruso B AU - Costa G LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 1 IP - DP - 1988 Jan 01 TI - Tea-dust induced asthma PG - 769-770 AU - Roberts JA AU - Thomson NC LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 26 IP - DP - 1988 Jan 01 TI - Summer-type hypersensitivity pneumonitis induced by trichosporon cutaneum in terms of the role of serotype on the antigen PG - 123-128 AU - Sakata T AU - Ando M AU - Yoshida K AU - Soda K AU - Akaki S AU - Shinoda T AU - Ikeda R AU - Kojima N AU - Sakai H LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 18 IP - DP - 1988 Jan 01 TI - The existance of specific antibodies to cobalt in hard metal asthma PG - 451-460 AU - Shirakawa T AU - Kusaka Y AU - Fujimura N AU - Goto S AU - Morimoto K LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 82 IP - DP - 1988 Jan 01 TI - Occupational sensitivity to Aliphitobius diaperinus (Panzer) (lesser mealworm) PG - 1081-1088 AU - Schroeckenstein DC AU - MeierDavis S AU - Graziano FM AU - Falomo A AU - Bush RK LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 92 IP - DP - 1988 Jan 01 TI - Respiratory illness in the construction industry PG - 135-13* AU - Schwartz DA AU - Baker EL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 16 IP - DP - 1988 Jan 01 TI - Hypersensitivity to wheat flour in bakers PG - 309-314 AU - Santiago AV AU - Par PA AU - Valls JS AU - Martinez PS AU - Casajuana AM AU - Calderon PAG LA - PT - DEP - TA - Allergol Immunopathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 1 IP - DP - 1988 Jan 01 TI - Acute exposure to sawdust does not alter airway caliber and responsiveness to histamine in asthmatic subjects PG - 540-546 AU - De Luca S AU - Caire N AU - Cloutier Y AU - Cartier A AU - Ghezzo H AU - Malo JL LA - PT - DEP - TA - Eur Respir J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 49 IP - DP - 1988 Jan 01 TI - A search for discomfort-inducing factors in carbonless copying paper PG - 117-120 AB - Connections between various types of carbonless copying paper and the occurrence of work-related symptoms of the skin and mucous membranes were studied. The analysis started from the exposure factor, i.e., from the carbonless copying papers and not from the exposed persons. In total, 276 paper samples were investigated. One hundred ninety samples were carbonless copying papers for which information was obtained concerning both the handling of the papers and the symptoms occurring among those handling the papers. To distinguish between carbonless copying papers of different makes, gas chromatography of paper extracts was performed, sometimes combined with thin-layer chromatography of the color formers. By coding the paper samples, the analyses of the papers and the interviews of the exposed persons could be performed "blindly." In the carbonless copying paper most frequently associated with complaints, mono-iso-propylbiphenyl (MIPB) was used as solvent for the color formers. It is probable, however, that the symptoms connected to this paper were induced by some component of the paper other than MIPB. A covariation between papers associated with skin symptoms and mucous membrane symptoms was observed. Exposure to carbonless copying papers treated with desensitizing ink (D-ink) covariated statistically with work-related skin irritation. The causative factor was probably two specific D-inks available on the Swedish market at the period of the investigation AU - Norback D AU - Wieslander G AU - Gothe CJ LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 11 IP - DP - 1988 Jan 01 TI - Health and wellbeing disorders in air conditioned buildings; comparitive investigations of the building illness syndrome PG - 277-282 AU - Kroling P LA - PT - DEP - TA - Energy and Buildings JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Diffused interstitial pulmonary fibrosis in "tabachine" PG - 233-241 AU - Lorenzo R LA - PT - DEP - TA - Arch Monaldi Mal Torace JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 77 IP - DP - 1988 Jan 01 TI - Anaphylaxis and angioaodema due to rubber allergy in children PG - 314-316 AU - Axelsson IGK AU - Eriksson M AU - Wrangsjo K LA - PT - DEP - TA - Acta Paediatr Scand JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - IP - DP - 1988 Jan 01 TI - Control of substances hazardous to health regulations 1988: approved codes of practice PG - - AU - Anonymous LA - PT - DEP - TA - HMSO London JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - IP - DP - 1988 Jan 01 TI - Broadcasting house legionnaires' disease; report of the Westminster action committee PG - - AU - Cunningham D LA - PT - DEP - TA - Pub Environment Committee Westminster City Council JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 49 IP - DP - 1988 Jan 01 TI - Occupational asthma due to lycopodium powder PG - 143-148 AU - Catilina P AU - Chamoux A AU - Gabrillargues D AU - Catilina MJ AU - Royfe MH AU - Wahl D LA - PT - DEP - TA - Arch Mal Prof JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 12 IP - DP - 1988 Jan 01 TI - Air pollution sources in offices and assembly halls, quantified by the olf unit PG - 7-19 AU - Fanger PO AU - Lauridsen J AU - Bluyssen P AU - Clausen G LA - PT - DEP - TA - Energy and Buildings JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 12 IP - DP - 1988 Jan 01 TI - Introduction of the Olf and Decipol units to quantify air pollution perceived by humans indoors and outdoors PG - 1-6 AU - Fanger PO LA - PT - DEP - TA - Energy and Buildings JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 93 IP - DP - 1988 Jan 01 TI - Total lung capacity. An insensitive measure of impairment in patients with asbestosis and chronic obstructive pulmonary disease? PG - 299-302 AB - The total lung capacity (TLC) is frequently used as a measure of respiratory impairment in patients with asbestosis. Because asbestosis and chronic obstructive pulmonary disease (COPD) exert opposite effects on the TLC, it may be an insensitive measure of impairment in patients with both abnormalities. To assess this, we compared asbestos-exposed patients with functional evidence of COPD and radiographic evidence of interstitial fibrosis (group 1) to those with interstitial fibrosis alone (group 2). Despite the two groups being comparable in degree of radiographic "fibrosis," no case of restrictive impairment (reduced TLC) was identified among those with both interstitial fibrosis and COPD (group 1), compared to 33 percent of those with interstitial fibrosis alone (group 2). In addition, those patients with both interstitial fibrosis and COPD, compared to those with interstitial fibrosis alone, were found to have greater impairment as measured by alveolar-arterial oxygen difference and diffusing capacity. We conclude that the TLC is an insensitive measure of impairment due to asbestosis in patients with the common setting of coexistent asbestosis and COPD AU - Barnhart S AU - Hudson LD AU - Mason SE AU - Pierson DJ AU - Rosenstock L LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 259 IP - DP - 1988 Jan 01 TI - Building-associated risk of febrile acute respiratory disease in army trainees PG - 2108-2112 AU - Brundage JF AU - Scott RMN AU - Lednar WM AU - Smith DW AU - Miller RN LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 138 IP - DP - 1988 Jan 01 TI - Cobalt exposure and lung disease in tungsten carbide production PG - 1220-1226 AU - Sprince NL AU - Oliver LC AU - Eisen EA AU - Greene RE AU - Chamberlin RI LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 38 IP - DP - 1988 Jan 01 TI - Pollen allergy due to artificial pollination of Japanese pear PG - 18-22 AU - Teranishi H AU - Kasuya M AU - Yoshida M AU - Ikarashi T LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 4 IP - DP - 1988 Jan 01 TI - Respiratory function in flour-mill workers PG - 104-109 AU - Taytard A AU - Tessier JF AU - Vergeret J AU - Pellet F AU - Faugere JG AU - Gachie JP AU - Beziau F AU - Kombou L AU - Fontan J AU - Redon S AU - Rio P AU - Freour P LA - PT - DEP - TA - Eur J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 81 IP - DP - 1988 Jan 01 TI - Occupational allergy to locusts: an investigation of the sources of the allergen PG - 517-525 AU - Tee RD AU - Gordon DJ AU - Hawkins ER AU - Nunn AJ AU - Lacey J AU - Venables KM AU - Cooter RJ AU - McCaffery AR AU - Newman Taylor AJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 82 IP - DP - 1988 Jan 01 TI - Allergy to castor bean 2. Identification of the major allergens in castor bean seeds PG - 67-72 AB - Castor bean proteins were separated and identified by isoelectric focusing and sodium dodecyl sulfate-polyacrylamide gel electrophoresis and blotted onto nitrocellulose paper. The capacity of the castor bean proteins to bind human IgE was probed with sera from castor bean-sensitive patients and radiolabeled anti-IgE. It proved difficult to identify allergens with isoelectric focusing. However, three allergens were identified when proteins were first separated on sodium dodecyl sulfate-polyacrylamide gel electrophoresis: the 2S storage albumin, the 11S crystalloid proteins, and a third protein doublet with molecular weights of 47 and 51 kd. Specific IgE antibody to the 2S storage albumin, measured by RAST, was detected in most (96%) castor bean-sensitive patients, confirming it as the major allergen. We would like to suggest that the 2S albumin be named Ric c I, that the crystalloid proteins be named Ric c II, and that the 47/51 kd doublet be named allergen 3. AU - Thorpe SC AU - Kenemy DM AU - Panzani RC AU - McGurl B AU - Lord M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 82 IP - DP - 1988 Jan 01 TI - Allergy to castor bean. I. Its relationship to sensitization to common inhalant allergens (atopy). PG - 62-66 AB - The IgE response to castor bean (Ricinus communis) was studied in 96 castor bean-allergic patients from Marseilles, France. All had positive skin tests to castor bean. The IgE response to grass, cat, dust mite, olive, and Parietaria was also measured, and a positive RAST to one or more of these allergens was taken to indicate atopic status. Castor bean-specific IgE antibodies, measured by RAST, were found in 87 (91%) of the castor bean-allergic patients, in two of 13 atopic Marseilles residents living close to the castor bean mills, in three of 42 allergic subjects who had no known contact with castor bean, and in none of a control group of 111 Marseilles blood donors. Very high levels of castor bean-specific IgE (maximum class 4 readings on the Phadebas RAST score) were found in 54 (56%) of the castor bean-allergic patients, but the level of IgE antibody to castor bean was not significantly different in atopic and nonatopic subjects. The frequency of a positive serological test (RAST) for atopy in castor bean-allergic subjects (32%) was very similar to that found in the local population (36%). These data indicate that castor bean is an extremely potent sensitizer for both atopic and nonatopic individuals. The magnitude of the specific IgE antibody response is not related to the atopic status of the patient and may be a function of the physiochemical characteristics of the allergen itself. AU - Thorpe SC AU - Kenemy DM AU - Panzani R AU - Lessof MH LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 1 IP - DP - 1988 Jan 01 TI - Allergic reactions to cuttlefish in deep-sea fishermen PG - 1116-1116 AU - Tomaszunas S AU - Weclawik Z AU - Lewinski M LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Farm animal feeders: another group affected by cereal flour asthma PG - 406-410 AU - Valdivieso R AU - Pola J AU - Zapata C AU - Puyana J AU - Cuesta J AU - Martin C AU - Losada E LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 91 IP - DP - 1988 Jan 01 TI - Acute symptoms in coffee workers PG - 169-172 AU - Urogoda CG LA - PT - DEP - TA - J Tropical Med and Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 297 IP - DP - 1988 Jan 01 TI - Allergy to latex gloves: unusual complication during delivery PG - 1029-1029 AU - Turjanmaa K AU - Reunala T AU - Tuimala R AU - Karkkainen T LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 44 IP - DP - 1988 Jan 01 TI - Occupational bronchopulmonary pathology caused by woodwork: diagnostic approach PG - 83-93 AU - Underner M AU - CazenaveRoblot F AU - Patte F LA - PT - DEP - TA - Rev Pneumol Clin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 5 IP - DP - 1988 Jan 01 TI - The pulmonary pathology produced by cobalt and hard metals PG - 201-207 AU - van den Eckhout A AU - Verbeken E AU - Demedts M LA - PT - DEP - TA - Rev Mal Resp JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 82 IP - DP - 1988 Jan 01 TI - Immunotherapy for cat asthma PG - 1055-1068 AU - Van Metre TE AU - Marsh DG AU - Adkinson NF AU - KageySobotka A AU - Khattignavong A AU - Norman PS AU - Rosenberg GL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 47 IP - DP - 1988 Jan 01 TI - Immunological and respiratory findings in spice-factory workers PG - 95-108 AU - Zuskin E AU - Kanceljak B AU - Skuric Z AU - Pokrajak D AU - Schachter EN AU - Witek TJ AU - Maayani S LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 39 IP - DP - 1988 Jan 01 TI - Ventilatory capacity in soy bean workers PG - 195-202 AU - Zuskin E AU - Skuric Z AU - Kanceljak B AU - Pokrajak D AU - Zrilic I AU - TonkovicLojovic M AU - Mataija M LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Respiratory findings in spice factory workers PG - 335-339 AU - Zuskin E AU - Skuric Z AU - Kanceljak B AU - Pokrajak D AU - Schachter EN AU - Witek TJ LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 14 IP - DP - 1988 Jan 01 TI - Respiratory symptoms and lung function in furriers PG - 189-196 AU - Zuskin E AU - Skuric Z AU - Kanceljak B AU - Pokrajak D AU - Schachter EN AU - Witek TJ LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 14 IP - DP - 1988 Jan 01 TI - Respiratory symptoms and ventilatory capacity in soy bean workers PG - 157-165 AU - Zuskin E AU - Skuric Z AU - Kanceljak B AU - Pokrajak D AU - Schachter EN AU - Witek TJ LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 81 IP - DP - 1988 Jan 01 TI - Environmental mycological studies on the causative agent of summer-type hypersensitivity pneumonitis PG - 475-483 AU - Yoshida K AU - Ando M AU - Sakata T AU - Akaki S LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 259 IP - DP - 1988 Jan 01 TI - Outbreak of hypersensitivity pneumonitis in an industrial setting PG - 1965-1969 AU - Woodard ED AU - Friedlander B AU - Lesher RJ AU - Font W AU - Kinsey R AU - Hearne FT LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Functional similarities of asbestosis and cryptogenic fibrosing alveolitis PG - 708-714 AB - The pathological features in the lung in asbestosis and cryptogenic fibrosing alveolitis are similar. Patients with asbestosis, however, appear to have less severe impairment of transfer factor (TLCO) than those with fibrosing alveolitis for a given level of radiographic abnormality when assessed on the basis of the International Labour Organisation (ILO) profusion score. The impairment of lung function in the two disorders has been compared in more detail in 29 patients with asbestosis and 25 with fibrosing alveolitis, arterial oxygen desaturation during exercise being used to define the severity of the disorders. Arterial oxygen saturation (ear oximeter) and oxygen uptake were measured during incremental exercise on a cycle ergometer. TLCO (single breath technique) and total lung capacity (TLC, plethysmograph) were measured. Chest radiographs were graded for profusion according to the ILO international classification. Patients with asbestosis had significantly higher mean values for TLCO and TLC and lower mean profusion scores than those with fibrosing alveolitis. When stratified for the degree of arterial oxygen desaturation, however, no significant differences were found in TLCO, TLC, or profusion score between the two disorders. To the extent that arterial oxygen desaturation with exercise reflects the morphological severity of the disease, these results suggest that, for a given degree of interstitial lung disease, asbestosis and cryptogenic fibrosing alveolitis are functionally and radiologically similar AU - Markos J AU - Musk AW AU - Finucane KE LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 82 IP - DP - 1988 Jan 01 TI - Immunochemical quantitation, size distribution, and cross-reactivity of Lepidoptera (moth) aeroallergens in southeastern Minnesota PG - 47-54 AU - Wynn SR AU - Swanson MC AU - Reed CE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 14 IP - DP - 1988 Jan 01 TI - Health and socioeconomic consequences of occupational respiratory allergies: a pilot study using workers' compensation data PG - 291-298 AU - Yassi A LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 14 IP - DP - 1988 Jan 01 TI - Occupational asthma due to toluene diisocyanate among Velcro-like tape manufacturers PG - 73-78 AU - Wang JD AU - Huang PH AU - Lin JM AU - Su SY AU - Wu MC LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 137 IP - DP - 1988 Jan 01 TI - A longitudinal study of the occurence of bronchial hyperresponsiveness in western red cedar workers PG - 651-655 AU - Vedal S AU - Enarson DA AU - Chan H AU - Ochnio J AU - Tse KS AU - ChanYeung M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 8 IP - DP - 1988 Jan 01 TI - A longitudinal epidemiological survey in workers of a furniture plant PG - 453-454 AU - Vellutin M LA - PT - DEP - TA - Medicina Riv JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 11 IP - DP - 1988 Jan 01 TI - Inhalation of spices: alveolitis and asthma PG - 165-168 AU - Vetter N AU - Berger E AU - Freisleben R AU - Pokieser L AU - Kremser M LA - PT - DEP - TA - Allergologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 94 IP - DP - 1988 Jan 01 TI - Increases in airway responsiveness following acute exposure to respiratory irritants. Reactive airway dysfunction syndrome or occupational asthma? PG - 476-81 AB - We describe a persistent increase in nonspecific bronchial responsiveness following acute exposure to strong respiratory irritants in four subjects with no past history of asthma or atopy and in a subject with mild asthma. They were exposed either to a bleaching agent, sulfuric acid, hydrochloric acid, perchloroethylene, or toluene diisocyanate fumes. In all cases the inhalation of high concentrations of irritant fumes was brief (less than one hour) and induced acute symptoms of cough and dyspnea. The asthmatic subject developed a severe bronchospasm which required mechanical ventilation. In all subjects the exposure led to prolonged (more than one year) symptoms of variable airflow obstruction induced on contact with common respiratory irritants. In the previously normal subjects, a mild hyperresponsiveness to methacholine could be observed. The asthmatic subject became dependent on steroids. No change in the forced expiratory volume in one second was observed when the subject exposed to sulfuric acid was rechallenged in the laboratory, but her nonspecific bronchial responsiveness was then back to normal at this time. When those exposed to perchloroethylene or toluene diisocyanate fumes were reexposed to these agents, a late asthmatic response occurred, suggesting that the subjects developed occupational asthma after an intense short-term exposure to perchloroethylene or toluene diisocyanate. We conclude that airway hyperresponsiveness can develop or increase after the inhalation of high concentrations of irritants and that these changes may be prolonged. Occupational asthma following intense short-term exposure to sensitizing agents should be differentiated from airway hyperresponsiveness which results from a nonsensitizing mechanism, as in the reactive airway dysfunction syndrome. AU - Boulet LP LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 33 IP - DP - 1988 Jan 01 TI - Lung function and symptoms in employees of poultry farms PG - 286-291 AB - Environmental measurements were made in different types of poultry confinement buildings. Levels of total dust 1.6 meters above the ground averaged 5.0 mg/m3. Ammonia levels averaged about 13 ppm with peak values of about 50 ppm. To study possible respiratory problems of the people working in these confinement buildings, the ventilatory lung function was measured and an interrogation concerning respiratory symptoms was carried out by 26 (7 females, 19 males) poultry farmers. A very high prevalence (10 of 26) of obstructive ventilatory lung function changes was found. The FEV1 values of the exposed men were significantly lower than the predicted normal values (ECCS). An association between duration of exposure and pulmonary function exists. AU - Danuser B AU - Wyss C AU - Hauser R AU - von PlantaU AU - Folsch D LA - PT - DEP - TA - Soz Praventivmed JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 4 IP - DP - 1988 Jan 01 TI - Respiratory symptoms and pulmonary function in 871 miners according to Pi phenotype: a longitudinal study PG - 39-44 AU - Pierre F AU - Pham QT AU - Mur JM AU - Chau N AU - Martin JP LA - PT - DEP - TA - Eur J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 137 IP - DP - 1988 Jan 01 TI - Clinically important respiratory effects of dust exposure and smoking in British coal miners PG - 106-112 AU - Marine WM AU - Gurr D AU - Jacobsen M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 113 IP - DP - 1988 Jan 01 TI - Evaluation of an apparatus designed for the collection of sidestream tobacco smoke PG - 1509-1513 AU - Proctor CJ AU - Martin C AU - Beven JL AU - Dymond HF LA - PT - DEP - TA - Analyst JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 44 IP - DP - 1988 Jan 01 TI - BCG vaccination against tuberculosis and leprosy. [Review] PG - 691-703 AU - Fine PE LA - PT - DEP - TA - British Medical Bulletin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 19 IP - DP - 1988 Jan 01 TI - Allergic contact dermatitis from triglycidyl isocyanurate in polyester paint pigments PG - 67-68 AU - Mathias CGT LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 42 IP - DP - 1988 Jan 01 TI - Changes in tuberculosis notification rates in the white ethnic group in England and Wales between 1953 and 1983 PG - 370-376 AB - Since the early 1960s notification rates for tuberculosis in England and Wales for the whole population have been influenced by high rates in certain ethnic groups. Using data based on country of birth from the British (Thoracic and) Tuberculosis Association surveys of 1965 and 1971, and based on ethnic origin from the Medical Research Council surveys in 1978/79 and 1983, rates for the white ethnic group have been estimated at those four times, and compared with the published rates for the whole population in 1953, when only a very small proportion was of non-white ethnic origin. Between 1953 and 1983 the notification rate for the white ethnic group fell from 122.2 to 11.3 per 100,000 for males, an annual decline of 7.7%, the corresponding rates for females being 90.1 and 5.8, an annual decline of 8.8%. The greatest annual declines occurred between 1953 and 1965, 9.4% for males and 11.2% for females. The annual declines in the most recent period, 1978/79 to 1983, were 6.9% for males and 7.3% for females. In both sexes the decline was greatest in the 15-24 year age group and least in the oldest age group, and this has led to a change in the age pattern of annual notification rates. The highest rates in both sexes occurred in young adults in 1953 but in the oldest age groups in 1983. There is however no evidence of any cohort experiencing an increase in notification rate with increasing age AU - Springett VH AU - Darbyshire JH AU - Nunn AJ AU - Sutherland I LA - PT - DEP - TA - Journal of Epidemiology & Community Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 22 IP - DP - 1988 Jan 01 TI - Tuberculosis among the central London single homeless. A four-year retrospective study PG - 16-17 AU - Ramsden SS AU - Baur S AU - el Kabir DJ LA - PT - DEP - TA - Journal of the Royal College of Physicians of Lond JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 38 IP - DP - 1988 Jan 01 TI - The value of routine chest radiography in offshore workers PG - 58-60 AU - Gann M LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - IP - DP - 1988 Jan 01 TI - Guidelines for the control of tuberculosis in NHS employees PG - - AU - Burge A LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 183 IP - DP - 1988 Jan 01 TI - Sudden outbreaks of tuberculosis: apropos of 10 school epidemics in Barcelona and its province PG - 24-29 AU - de March Ayuela P AU - Boque Genovard MA LA - PT - DEP - TA - Revista Clinica Espanola JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 69 IP - DP - 1988 Jan 01 TI - Pulmonary tuberculosis in health service staff-is it still a problem? PG - 113-118 AB - Twenty-three new cases of pulmonary tuberculosis were notified among 21,951 National Health Service staff working in the Lothian area during the 6 years 1978-1983. Eight of the 23 cases were detected by pre-employment screening. Five further cases were detected during employment by voluntary chest X-ray screening. During the same period a further 10 cases presented with symptoms, suggesting that voluntary screening during employment was relative unproductive in the detection of new cases. There was no evidence of an increased risk of pulmonary tuberculosis in most occupational groups of Health Service staff; the average annual incidence during employment was 11/10(5) overall with 9/10(5) in nurses and 23/10(5) in doctors, rates very similar to the local population of working age. However two cases occurred in 300 medical laboratory technicians giving a much higher incidence of 111/10(5) (p less than 0.005) AU - Capewell S AU - Leaker AR AU - Leitch AG LA - PT - DEP - TA - Tubercle JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 3 IP - DP - 1988 Jan 01 TI - TGIC toxicity update PG - 1-2 AU - Harris S LA - PT - DEP - TA - Powder Coating Bulletin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 34 IP - DP - 1988 Jan 01 TI - The effects of ketotifen on beta-adrenergic activity in asthmatics PG - 585-589 AB - In order to examine a possible mechanism of action of ketotifen in asthma, a double-blind study was undertaken to determine whether ketotifen showed any effects on the beta-adrenergic system in asthmatic patients. The effects of ketotifen 1 mg b.i.d. for one month on the changes in spirometry, plasma potassium and serum glucose nebulized salbutamol was compared with placebo. In addition the degree of inhibition caused by local salbutamol on the wheal volume due to intradermal prostaglandin E and bradykinin, was compared following ketotifen and placebo. Nebulized salbutamol produced consistent improvements in spirometry and changes in potassium and glucose levels. Local salbutamol significantly decreased the wheal volume induced by intradermal prostaglandin E and bradykinin. However, none of these salbutamol-induced effects were altered following ketotifen or placebo. Ketotifen, in the doses used, has no demonstrable effect on the beta-adrenergic system in asthmatic patients AU - Gove RI AU - Burge PS AU - Stableforth DE AU - Skinner C LA - PT - DEP - TA - Eur J Clin Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Transfer factor for carbon monoxide in patients with diabetes with and without microangiopathy PG - 725-726 AB - The transfer coefficient (KCO) was significantly lower in diabetic patients with microangiopathy than in a matched group without this complication. This may reflect microangiopathy in the pulmonary circulation AU - Weir DC AU - Jennings PE AU - Hendy MS AU - Barnett AH AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 43 IP - DP - 1988 Jan 01 TI - Occupational asthma due to oil mists PG - 200-205 AB - Twenty five patients who were exposed to oil mists at their place of work were investigated for possible work related asthma. Serial peak expiratory flow recordings showed 13 to have definite work related asthma, seven equivocal work related asthma, and three asthma unrelated to work; two had normal recordings. Subjects with work related asthma often produced different patterns of peak flow response during the working week; patterns also varied between patients. Six of these patients had bronchial tests with oil from their place of work. Three had asthma induced by exposure to unused (clean) soluble oil and one reacted to used but not to clean oil. The challenge tests in the remaining two gave inconclusive results. It is concluded that occupational asthma due to oil mists is common, the peak flow response is heterogeneous, and the provoking agent within the oil may vary from worker to worker AU - Robertson AS AU - Weir DC AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 81 IP - DP - 1988 Jan 01 TI - Occupational asthma--does it exist? PG - 252-254 AU - Burge PS LA - PT - DEP - TA - J R Soc Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 85 IP - DP - 1988 Jan 01 TI - Systemic sclerosis secondary to occupational exposure PG - 114-116 AU - Owens GR AU - Medsger TA LA - PT - DEP - TA - Am J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 18 IP - DP - 1988 Jan 01 TI - Asthma due to the complex salts of platinum--a cross-sectional survey of workers in a platinum refinery PG - 569-580 AB - Anamnestic and immunological data of workers of a platinum refinery (group A: workers with work-related symptoms, n = 8; group B: workers with symptoms not clearly work-related, n = 9; group C: asymptomatic workers, n = 13) and controls (group D: atopics, n = 10; group E: non-atopics, n = 16) were compared. Exposure to platinum salt was higher in group A than in groups B or C. In group A, symptoms developed 4 months (median) after the onset of exposure. All subjects of group A and three workers of group B, but none of the workers of the other groups, showed a positive cutaneous reaction to (PtCl6)2-. Total serum IgE was higher in groups A and D than in groups B, C or E. (PtCl6)2(-)-specific IgE was higher in group A, but there was non-specific binding of (PtCl6)2- to IgE. Histamine release with (PtCl6)2- was found in all groups and was highest in atopic controls. Histamine release with (PtCl6)2- and histamine release with anti-IgE showed an excellent correlation, suggesting a similar release mechanism of (PtCl6)2- and anti-IgE. In skin-test positive subjects, high cutaneous (PtCl6)2(-)-sensitivity is linked to high histamine release with (PtCl6)2- or anti-IgE, supporting the concept of a role of cell surface IgE or IgE-Fc-receptor in the release process with platinum salts. However, high specificity of cutaneous reactions contrasts with low specificity of in-vitro tests with (PtCl6)2-. A different reaction of basophils and mast cells, when challenged with free platinum salts, is hypothesized. We conclude that neither histamine release from basophils with (PtCl6)2- nor RAST for the detection of (PtCl6)2- -specific IgE are helpful in the diagnosis of platinum salt allergy AU - Merget R AU - SchultzeWerninghaus G AU - Muthorst T AU - Friedrich W AU - MeierSydow J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 61 IP - DP - 1988 Jan 01 TI - Mortality and cancer morbidity in workers exposed to sulphur dioxide in a sulphuric acid plant PG - 157-162 AB - To evaluate the risk of non-malignant respiratory disease and tumours at exposure to sulphur dioxide, a retrospective cohort study was performed on a group of 400 male workers, employed for at least six months during the period 1961-1981, in a sulphuric acid factory. Since 1969, fairly extensive measurements have been performed in the respiratory zone of the workers. The median level of total dust, over the years, was 2.2 mg/m3 (time-weighted average), of respirable dust 0.6 mg/m3, of sulphur dioxide 3.6 mg/m3, and of arsenic 11 micrograms/m3. There was a significantly increased total mortality in the period 1961-1985. Applying greater than or equal to 5 years latency period there were 47 observed deaths, giving a standardized mortality rate (SMR) of 1.57 (P = 0.002). The increased mortality was due to violence and intoxication (observed 9, SMR = 2.83; P = 0.006) and cardiovascular disease (SMR = 1.51, P = 0.05). The total tumour morbidity was not increased (observed 17, SMR = 1.17, P greater than 0.5) and there was no rise of either non-malignant or malignant lung diseases. However, there was an increase of bladder cancer (observed 5, SMR = 4.36, P = 0.006) AU - Englander V AU - Sjoberg A AU - Hagmar L AU - Attewell R AU - Schutz A AU - Moller T AU - Skerfving S LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 45 IP - DP - 1988 Jan 01 TI - Occupational exposures and changes in pulmonary function over 13 years among residents of Cracow PG - 747-754 AB - In a 13 year follow up study conducted among residents of Cracow the relation of annual rate of decline in FEV1 to occupational exposures was analysed. The study group consisted of 696 men and 983 women aged 19-60 at the start of the study in 1968. They were interviewed three times, in 1968, 1973, and 1981, and decline in FEV1 was estimated for each subject from spirometric measurements in 1968 and 1981. The interviews provided data on exposure at the workplace to dusts, variable temperature, and chemicals or irritating gases, which established duration and time of the exposure. The FEV1 mean level, height, and smoking habits were considered as confounders in the analysis. The study indicated that the most pronounced influence on decline in FEV1 was prolonged and continuing exposure to variable temperature. The effects of dusts, independent of exposure to variable temperature, were much smaller but analysis in occupational subgroups suggest that dust may be important in some, such as workers in the building materials and pottery industry. Relatively immediate effects of exposure to chemicals were detected independently of effects of other exposures. The estimated effects of occupational exposures were of a similar magnitude as those of tobacco smoking though related to much smaller groups. Both effects were additive in accelerating decline in lung function. These results, obtained in the general population and less biased by selection than studies performed in industrial settings, show the importance of occupational factors in the natural history of limitation of airflow AU - Krzyzanowski M AU - Jedrychowski W AU - Wysocki M LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 17 IP - DP - 1988 Jan 01 TI - The relation of respiratory symptoms and ventilatory function to moderate occupational exposure in a general population. Results from the French PAARC study of 16,000 adults PG - 397-406 AB - Data from the French PAARC (Pollution Atmospherique et Affections Respiratoires Chroniques) study were used to assess the effect of a priori moderate occupational exposure to dust, gases or chemical fumes on the prevalence of respiratory symptoms and ventilatory function. In this community-based population, without households 'headed' by manual workers, 34% of the 8692 men and 23% of the 7772 women, 25-59 years of age, ever occupationally active, reported some exposure. The studied relationships were adjusted for age, height, smoking habits, socio-occupational class, education and air pollution by logistic or linear regression methods. For men and women, some 50% increase (p less than 0.01) in chronic cough, chronic bronchitis, dyspnoea grade 2 and wheezing prevalence was observed in the exposed group compared to the never exposed, with the strongest association for wheezing. FEV1 and FEF25-75% were not associated with occupational exposure. Among men, FEV1/FVC and FEF25-75%/FVC were significantly lower (p less than 0.001 and p less than 0.05) among the exposed compared to never exposed, but FVC was significantly greater (p less than 0.05). Among women, occupational exposure was significantly related to a lower FEV1/FVC in the subgroup with a history of asthma or wheezing. Results suggest that occupational exposures of relatively low intensity, encountered in the non-industrial work places may constitute a non-negligible risk for respiratory health AU - Krzyzanowski M AU - Kauffmann F LA - PT - DEP - TA - Int J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 1 IP - DP - 1988 Jan 01 TI - Cadmium fume inhalation and emphysema PG - 663-667 AB - Lung function and chest radiographs of 101 men who had worked for 1 or more years manufacturing copper-cadmium alloy were compared with those of a referent group matched for age, sex, and employment status. Cigarette consumption was similar in the two groups. The cadmium workers had an excess of abnormalities of lung function and of radiographic changes consistent with emphysema. Classification of the cadmium workers by exposure categories based on either estimated cumulative cadmium exposure or liver cadmium measured by neutron activation analysis showed that abnormalities of lung function were greatest in those with the highest cumulative cadmium exposure or liver cadmium. The difference in the transfer coefficient (KCO) between cadmium workers and referents increased linearly with increasing cumulative exposure without evidence for a threshold. The estimated mean decrement in KCO for a cadmium worker employed 5 or more years with a cumulative exposure of 2000 yr.microgram.m-3 (exposure to the current UK control limit of 50 micrograms.m-3 for a working lifetime of 40 yr) lies between 0.05 and 0.3 mmol.min-1.kPa-1.l-1 (95% confidence interval). This decrement is consistent with the functional and radiological changes of emphysema observed in this group of workers AU - Davison AG AU - Fayers PM AU - Newman Taylor AJ AU - Venables KM AU - Darbyshire J AU - Pickering CAC AU - Chettle DR AU - Franklin D AU - Guthrie CJ AU - Scott MC AU - O'Malley D AU - Holden H AU - Mason HJ AU - Wright AL AU - Gompertz D AU - Taylor AJ AU - et al LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19880101 IS - IS - VI - 45 IP - DP - 1988 Jan 01 TI - Relations between liver cadmium, cumulative exposure, and renal function in cadmium alloy workers PG - 793-802 AB - Detailed biochemical investigations of renal function were made on 75 male workers exposed to cadmium and an equal number of referents matched for age, sex, and employment status. The exposed group consisted of current and retired workers who had been employed in the manufacture of copper-cadmium alloy at a single factory in the United Kingdom for periods of up to 39 years and for whom cumulative cadmium exposure indices could be calculated. In vivo measurements of liver and kidney cadmium burden were made on exposed and referent workers using a transportable neutron activation analysis facility. Significant increases in the urinary excretion of albumin, retinol binding protein, beta 2 microglobulin, N-acetylglucosaminidase (NAG), alkaline phosphatase, gamma-glutamyl transferase and significant decreases in the renal reabsorption of calcium, urate, and phosphate were found in the exposed group compared with the referent group. Measures of glomerular filtration rate (GFR) (creatinine clearance, serum creatinine, and beta 2 microglobulin) indicated a reduction in GFR in the exposed population. Many of these tubular and glomerular function indicators were significantly correlated with both cumulative exposure index and liver cadmium burden. Using cumulative exposure index and liver cadmium as estimates of dose, a two phase linear regression model was applied to identify an inflection point signifying a threshold level above which changes in renal function occur. Many biochemical variables fitted this model; urinary total protein, retinol binding protein, albumin, and beta 2 microglobulin gave similar inflection points at cumulative exposure levels of about 1100 y.micrograms/m3 whereas changes in the tubular reabsorption of urate and phosphate occurred at higher cumulative exposure indices. Measures of GFR, although fitting the threshold model did not give well defined inflection points. Fewer variables fitted the two phase model using liver cadmium; those that did gave threshold levels in the range 20.3-55.1 ppm. When cadmium workers with cumulative exposure indices of less than 1100 y.micrograms/m3 were compared with their respective referents only serum beta 2 microglobulin and urinary NAG were significantly increased in the exposed group and these differences were not related to the degree of cadmium exposure.(ABSTRACT TRUNCATED AT 400 WORDS) AU - Mason HJ AU - Davison AG AU - Wright AL AU - Guthrie CJ AU - Fayers PM AU - Venables KM AU - Smith NJ AU - Chettle DR AU - Franklin DM AU - Scott MC AU - et al LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 136 IP - DP - 1987 Jan 01 TI - Occupational exposures and chronic respiratory symptoms. A population-based study PG - 298-304 AB - Data from a random sample of 8,515 white adults residing in 6 cities in the eastern and midwestern United States were used to examine the relationships between occupational exposures to dust or to gases and fumes and chronic respiratory symptoms; 31% of the population had a history of occupational dust exposure and 30% reported exposure to gas or fumes. After adjusting for smoking habits, age, gender, and city of residence, subjects with either occupational exposure had significantly elevated prevalences of chronic cough, chronic phlegm, persistent wheeze, and breathlessness. The adjusted relative odds of chronic respiratory symptoms for subjects exposed to dust ranged from 1.32 to 1.60. Subjects with gas or fume exposure had relative odds of symptoms between 1.27 and 1.43 when compared with unexposed subjects. Occupational dust exposure was associated with a higher prevalence of chronic obstructive pulmonary disease as defined by an FEV1/FVC ratio of less than 0.6, when comparing exposed and unexposed participants (OR = 1.53, 95% Cl = 1.17-2.08). Gas or fume exposure was associated with a small, but not significant, increase in COPD prevalence. Significant trends were noted for wheeze and phlegm with increasing duration of dust exposure. Although 36% of exposed subjects reported exposure to both dust and fumes, there was no evidence of a multiplicative interaction between the effects of the individual exposures. Smoking was a significant independent predictor of symptoms, but did not appear to modify the effect of dust or fumes on symptom reporting. These data, obtained in random samples of general populations, demonstrate that chronic respiratory symptoms and disease can be independently associated with occupational exposures AU - Korn RJ AU - Dockery DW AU - Speizer FE AU - Ware JH AU - Ferris BG Jr LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 81 IP - DP - 1987 Jan 01 TI - Problems in the diagnosis of occupational asthma. PG - 105-115 AU - Burge PS LA - PT - DEP - TA - Br J Dis Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 31 IP - DP - 1987 Jan 01 TI - Sick building syndrome: a study of 4373 office workers PG - 493-504 AU - Burge PS AU - Hedge A AU - Wilson S AU - Bass JH AU - Robertson A LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 42 IP - DP - 1987 Jan 01 TI - Extrinsic allergic alveolitis caused by a cold water humidifier PG - 32-37 AB - Three workers developed classical extrinsic allergic alveolitis while working in a printing works that had a contaminated cold water humidifier. All had nodular shadows on their chest radiographs, reduced gas transfer measurements, and lung biopsy specimens that showed an alveolitis with giant cells and cholesterol clefts. In two subjects bronchoalveolar lavage was performed and the lavage fluid contained more than 70% lymphocytes in each case. Bronchial provocation tests with the humidifier antigen in these two workers reproduced their symptoms. Unlike previously reported cases, where exposure was to humidifiers working at generally higher temperatures, challenge with thermophilic actinomycetes in our two patients produced no reaction. Tests for precipitins to the humidifier antigen gave strongly positive reactions in the three workers but no single organism isolated from the humidifier produced a significantly positive reaction AU - Robertson AS AU - Burge PS AU - Wieland GA AU - Carmalt MH LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 44 IP - DP - 1987 Jan 01 TI - A study of serum thiocyanate concentrations in office workers as a means of validating smoking histories and assessing passive exposure to cigarette smoke PG - 351-354 AB - Patients in clinical practice often falsely report their smoking status. To see if this was so in occupational surveys we have validated smoking histories (using a serum thiocyanate assay) in 206 randomly sampled office workers who completed a smoking questionnaire administered by a doctor. Past and present cigarette consumption was determined with an assessment of exposure to passive cigarette smoke at home and at work in the non-smokers. Serum thiocyanate concentrations were measured by the ferric nitrate method. All smoking groups showed mean thiocyanate concentrations greater than non-smokers except those smoking five or fewer cigarettes a day. There was a significant increase in plasma thiocyanate with increasing smoking (p less than 0.01). Non-smokers with and without exposure to passive smoke could not be separated by thiocyanate concentration. In our hands serum thiocyanate concentrations identified moderate and heavy smokers but could not distinguish between non-smokers, light smokers, and passive smokers. Fourteen non-smokers had serum thiocyanate concentrations higher than 70 mumol/l which were still raised on a repeat sample. On a further questionnaire two admitted to smoking. To help confirm non-smoking status, expired carbon monoxide levels were also checked in this group. One person had a level of 22 ppm and subsequently admitted to smoking. In the others the levels were less than or equal to 10 ppm. Using a combination of serum thiocyanate assay and exhaled breath carbon monoxide levels, non-smoking was confirmed in 98% of those stating that they were non-smokers. In non-smokers exposure to passive cigarette smoke was much more likely to occur at work than at home AU - Robertson AS AU - Burge PS AU - Cockrill BL LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 42 IP - DP - 1987 Jan 01 TI - Epidemiological-environmental study of diesel bus garage workers: acute effects of NO2 and respirable particulate on the respiratory system PG - 201-214 AB - Two hundred and eighty-three (283) male diesel bus garage workers from four garages in two cities were examined to determine if there was excess chronic respiratory morbidity related to diesel exposure. The dependent variables were respiratory symptoms, radiographic interpretation for pneumoconiosis, and pulmonary function (FVC, FEV1, and flow rates). Independent variables included race, age, smoking, drinking, height, and tenure (as surrogate measure of exposure). Exposure-effect relationships within the study population showed no detectable associations of symptoms with tenure. There was an apparent association of pulmonary function and tenure. Seven workers (2.5%) had category 1 pneumoconiosis (three rounded opacities, two irregular opacities, and one with both rounded and irregular). The study population was also compared to a nonexposed "blue-collar" population. After indirect adjustment for age, race, and smoking, the study population had elevated prevalences of cough, phlegm, and wheezing, but there was no association with tenure. Dyspnea showed a dose-response trend but no apparent increase in prevalence. Mean percent predicted pulmonary function of the study population was greater than 100%, i.e., elevated above the comparison population. These data show there is an apparent effect of diesel exhaust on pulmonary function but not chest radiographs. Respiratory symptoms are high compared to "blue-collar" workers, but there is no relationship with tenure. AU - Gamble J AU - Jones W AU - Minshall S LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 31 IP - DP - 1987 Jan 01 TI - Long-term health effects in hamsters and rats exposed chronically to man-made vitreous fibres PG - 731-754 AU - Smith DM AU - Ortiz LW AU - Archuleta RF AU - Johnson NF LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 135 IP - DP - 1987 Jan 01 TI - The predictors of emphysema in South African gold miners PG - 1234-1241 AB - Environmental and host factors have been implicated in the pathogenesis of emphysema. To assess the role of gold mining exposure (an environmental factor) and of various clinical features recorded early in a miner's career (host factors), a case control study was carried out as follows. From whole lung sections made routinely at all full autopsy examinations on South African gold miners, we selected 44 cases of emphysema and 42 controls without emphysema from among men 51 to 71 yr of age who died during 1980 and 1981. Exposure information was gathered and clinical records were reviewed for smoking history, symptoms, and the presence of rhonchi by decade before death. The presence and grade of silicosis (abstracted from the routine autopsy reports) was similar in both groups; so was bronchitis in the 49 cases and controls with histologic material adequate for review. However, cases were on average older, had worked more shifts in high dust, and had smoked more than controls; they had also exhibited symptoms and rhonchi more frequently before 1950, i.e., 30 yr before death. When these factors were examined in a multiple logistic regression analysis, shifts worked in high dust, smoking, and age were all shown to be strong and independent predictors of emphysema at autopsy; prediction, however, was not improved by addition of any of the clinical features examined. These findings agree with previous cross-sectional studies in South African gold miners showing an exposure response relationship between mining service and air-flow limitation measured by lung function tests in life.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Becklake MR AU - Irwig L AU - Kielkowski D AU - Webster I AU - de Beer M AU - Landau S LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 152 IP - DP - 1987 Jan 01 TI - Tuberculosis control in the military population: apathy revisited PG - 421-423 AU - Smith LS AU - Schillaci RF LA - PT - DEP - TA - Mil Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 80 IP - DP - 1987 Jan 01 TI - A school outbreak of tuberculosis PG - 415-415 AU - Connolly K AU - Murphy C LA - PT - DEP - TA - Ir Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 8 IP - DP - 1987 Jan 01 TI - Tuberculosis in hospital personnel PG - 97-101 AB - Tuberculosis (TB) skin testing practices and the prevalence and inherent risk of TB infection among hospital employees in 167 North Carolina (NC) hospitals were determined from a 79% (132/167) response to a tuberculosis screening questionnaire. Preemployment TB skin testing was performed by 98% of responding hospitals, primarily (87%) by the Mantoux method. TB skin test reactions of greater than or equal to 10 mm were interpreted as significant by 72% and at the appropriate time interval of 48 to 72 hours after administration by 80%. The booster test was routinely performed in 12% of the hospitals. TB infection prevalence among new employees during 1983 was 6.3% (260/4137) in 30 hospitals supplying these data. A positive correlation was noted between employee infection prevalence and county TB case rates (P = .014). Skin test conversion data from 56 hospitals across the state revealed a five year mean conversion rate of 1.14% among 71,253 personnel. There was an association between the incidence of TB in the general population and the frequency of conversions among hospital employees in corresponding geographical regions. Similarly, the incidence of TB among approximately 100,000 NC hospital employees in 1983 and 1984 was less than the incidence in the general population. These associations suggest that the incidence of TB infection among hospital personnel may reflect the prevalence of tuberculosis in the community rather than an occupational hazard. Annual TB skin testing of hospital employees may be justified in eastern North Carolina where the incidence of tuberculosis (22-30 cases/100, 000) is greater than the national average and where the risk of new TB infection among hospital employees is relatively common (greater than or equal to 1.5%) AU - Price LE AU - Rutala WA AU - Samsa GP LA - PT - DEP - TA - Infection Control JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 135 IP - DP - 1987 Jan 01 TI - Tuberculosis in physicians. Compliance with preventive measures PG - 3-9 AB - Compliance with public health recommendations for tuberculosis control was evaluated by a survey of 4,417 physicians who had not contracted tuberculosis during medical school nor during the 4 decades after graduation through 1981. Thirty-one percent of the cohort had been vaccinated with bacille Calmette-Guerin (BCG) and 47% considered themselves tuberculin-positive. Thirty-two percent of 1,088 physicians who graduated after 1974 had been exposed to 3 or more patients with infectious tuberculosis in the previous year. Fifty-eight percent of 738 unimmunized, tuberculin-negative physicians who had been exposed to one or more patients with infectious tuberculosis in the previous year had tuberculin tests every 1 to 2 yr. Forty-nine percent of 597 unimmunized tuberculin reactors with similar occupational exposure had chest roentgenograms every 1 to 2 yr. The BCG-vaccinated physicians were less likely to have frequent tuberculin tests but no different frequency of chest roentgenograms. Eight percent of 1, 460 unimmunized tuberculin reactors received isoniazid chemoprophylaxis, including 39% of 128 tuberculin reactors who graduated after 1974 (the majority of the latter were younger than 35 yr of age). Of 66 physicians who had active tuberculosis during medical school or after graduation, 20 (30%) had not received any antituberculosis chemotherapy, whereas 2 of 46 who did, received chemotherapy only after a second episode of tuberculosis. In summary, our study documents poor compliance by physicians with recommended policies for the prevention of tuberculosis in health care workers AU - Geiseler PJ AU - Nelson KE AU - Crispen RG LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 68 IP - DP - 1987 Jan 01 TI - Effectiveness of BCG vaccination in England and Wales in 1983 PG - 81-92 AB - The effectiveness of BCG vaccination, at about age 13 years, in the prevention of tuberculosis at ages 15-24 years in England and Wales in 1983, has been determined by the same method as in two previous surveys in 1973 and 1978. In 1983, the tuberculosis notification rate among those vaccinated in the schools' scheme was 3.30 per 100,000, compared with an estimated rate of 13.20 per 100,000 among those who were tuberculin negative and not vaccinated in the scheme. The protective effectiveness of BCG vaccination at ages 15-24 years in England and Wales in 1983 is thus estimated as 75%; the estimated efficacy in the white ethnic group is closely similar, namely 76%. The estimated efficacy of BCG at ages 15-19 and 20-24 years in the three surveys, both in the white ethnic group and in the entire cohort, has been compared with that found in the Medical Research Council's controlled trial of tuberculosis vaccines which began in 1950. There is no evidence of any decrease in the protective efficacy of BCG vaccination between the four cohorts of young adults, which span a total period of 29 years. However, there were steep decreases between the cohorts in the annual notification rates for the white ethnic group; these decreases occurred in the BCG vaccinated and in the tuberculin negative unvaccinated groups, as well as among those found tuberculin positive (and not vaccinated) in the schools' scheme. It is concluded that the level of protective efficacy of BCG vaccination at ages 15-24 years is high, and has remained unchanged since the start of the BCG in schools' scheme. However, as the tuberculosis notification rate in young adults has decreased steeply throughout this period, and is continuing to decrease, the benefits to be expected from the BCG in schools' scheme will decrease equally rapidly AU - Sutherland I AU - Springett VH LA - PT - DEP - TA - Tubercle JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 2 IP - DP - 1987 Jan 01 TI - The epidemiology of Legionella pneumophila infections. PG - 206-221 AB - The study of outbreaks of Legionella pneumophila has been essential in understanding the organism, the disease, and its pathogenesis. Early epidemics defined the clinical spectrum: Pontiac fever is an acute, self-limited, febrile illness with an attack rate of 95% to 100% and an incubation period of 36 hours. In contrast, legionnaires' disease is a life-threatening bronchopneumonia with an attack rate of 2% to 7% and an incubation period of two to ten days. Three times as many males as females are affected with legionnaires' disease, and age, cigarette smoking, and chronic medical disease (particularly immunosuppression) appear to be separate risk factors. Furthermore, L pneumophila is responsible for approximately 1% to 3% of community-acquired pneumonias, 13% of those acquired in the hospital and as many as 26% of atypical pneumonias. Diverse environmental reservoirs have been identified, including cooling systems, potable or domestic water systems, respiratory therapy devices, industrial coolants, and whirlpool spas. Hot water temperature, stagnant water, sediment, and the presence of other microorganisms are important factors in the amplification of the Legionellaceae. Although airborne transmission has been widely suggested, aspiration may be an important mode in certain patients. Regional and national surveillance may identify common sources and allow the introduction of early control measures. The latter have included primarily pulse and continuous hyperchlorination and super-heating hot water systems to 50 to 60 degrees C. Experimental data suggest that ozone and UV light may be useful in the future. Additionally, cooling towers and evaporative condensers have been decontaminated and maintained with a variety of biocides. The prevention of outbreaks requires thoughtful planning, redesign, and good engineering practices. AU - Doebbeling BN AU - Wenzel RP LA - PT - DEP - TA - Seminars in Respiratory Infections JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 2 IP - DP - 1987 Jan 01 TI - Legionella species as hospital-acquired respiratory pathogens. PG - 34-47 AB - Nosocomial pneumonia caused by legionella is an increasingly recognized entity. Legionella sp responsible for documented nosocomial disease include Legionella pneumophila, Tatlockia micdadei, Legionella bozemanii, Legionella dumoffi and Legionella oakridgensis. The clinical presentation is nonspecific although diarrhea occurs frequently. Hyponatremia occurs significantly more frequently in legionnaires' disease than pneumonias caused by other agents. Chest roentgenographic findings are nonspecific, although cavitation can be seen in immunosuppressed patients. Laboratory methods require the use of direct fluorescent antibody (DFA) stains, culture using selective media, serologic testing, and detection of antigen in urine. The DFA test is not sensitive; however, it does correlate with the severity of disease. Culture from sputa is now feasible. Bronchoalveolar lavage is a promising technique for obtaining specimens. The ideal specimen for culture is that obtained by transtracheal aspiration, which bypasses oropharyngeal contamination. Combination therapy of erythromycin and rifampin is recommended for selected patients. Because the source of the organism is the hospital water distribution system, we recommend routine environmental surveillance, especially in hospitals in which organ transplants are performed. The role of cooling towers as a vector for dissemination of the organism is disputed. Disinfection of the water supply can be accomplished by using heat eradication. Chlorination has generally proven unsatisfactory because of organism persistence as well as corrosive damage to the plumbing system from the chlorine. Both physician awareness and availability of specialized laboratory testing are necessary for the detection of cases. AU - Korvick JA AU - Yu VL AU - Fang GD LA - PT - DEP - TA - Seminars in Respiratory Infections JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 8 IP - DP - 1987 Jan 01 TI - Legionnaires' disease: respiratory infections caused by Legionella bacteria. PG - 419-439 AB - This article provides a review of Legionnaire's Disease, a bacterial pneumonia caused by Legionella species, and of Pontiac Fever, the flu-like illness caused by these microorganisms. The authors draw on their personal experience with major human outbreaks of Legionnaire's Disease and with animal models of Legionella pneumonia. Emphasis is placed on the sources in nature from which legionellosis is acquired, the means of dissemination of bacteria, the epidemiology of human infections, the pathogenetic mechanisms of disease and host defense, the clinical manifestations, and the treatment. AU - Davis GS AU - Winn WC Jr LA - PT - DEP - TA - Clin Chest Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 135 IP - DP - 1987 Jan 01 TI - The serodiagnosis of tuberculosis and other mycobacterial diseases by enzyme-linked immunosorbent assay. PG - 1137-1151 AU - Daniel TM AU - Debanne SM LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - IP - DP - 1987 Jan 01 TI - Legionnaires' disease PG - - AU - Health and safety executive LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 35 IP - DP - 1987 Jan 01 TI - Determination of nicotine and cotinine in human serum and urine: an interlaboratory study PG - 45-52 AB - An interlaboratory study aimed at determining nicotine and cotinine in human serum and urine was carried out. 11 laboratories from 6 countries, all experienced in performing nicotine and cotinine determinations in biological fluids by radioimmunoassay (RIA) and/or gas chromatography (GC) were involved. Each of them received 18 serum and 18 urine samples. The specimens were obtained from 8 smokers and 10 non-smokers; 2 samples from non-smokers were spiked with defined amounts of nicotine and cotinine. All the laboratories distinguished perfectly between the smokers and the non-smokers and according to cotinine levels in serum the laboratories ranked the samples with good agreement. There were systematic differences in the absolute values between the laboratories. The ratios of urinary cotinine concentrations between active and passive smokers differed widely from laboratory to laboratory. The reasons for this are not yet known and necessitate further investigation AU - Biber A AU - Scherer G AU - Hoepfner I AU - Adlkofer F AU - Heller WD AU - Haddow JE AU - Knight GJ LA - PT - DEP - TA - Toxicology Letters JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 35 IP - DP - 1987 Jan 01 TI - Measuring problems in estimating the exposure to passive smoking using the excretion of cotinine PG - 35-44 AB - Quality control studies on cotinine measurements following low level environmental tobacco smoke (ETS) exposure are rare. The exposure to ETS was controlled and systematically changed in a series of experiments in a climatic chamber. Healthy nonsmoking volunteers were exposed to ETS simultaneously. The duration and level of exposure varied using high (8, 17 and 25 ppm CO), and low (2 and 5 ppm CO) exposure levels. The variation between radioimmunoassay (RIA) and gas chromatography (GC) was high as was the variation between the results of RIA laboratories. There was also a high within-laboratory-variation. A 1:10 dilution seems to be preferable over a 1:3 dilution. Freezing the urine samples immediately after collection led to the detection of higher cotinine values than freezing the samples 24 h after collection. Highly reliable data for cotinine were obtained when the urine samples were kept frozen immediately after collection and fractionated sampling over 48-72 h was used. Our data show that estimating low-level ETS exposure by measuring urinary cotinine is highly susceptible to uncontrolled variation and errors. Sufficiently reliable estimates of low-level ETS exposure can be made only when fractionated sampling over 48-72 h is used and when the urine samples are kept frozen just after collection AU - Letzel H AU - FischerBrandies A AU - Johnson LC AU - Uberla K AU - Biber A LA - PT - DEP - TA - Toxicology Letters JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 44 IP - DP - 1987 Jan 01 TI - A study of respiratory effects from exposure to 2ppm formaldehyde in occupationally exposed workers PG - 188-205 AU - Schachter EN AU - Witek TJ AU - Brody DJ AU - Tosun T AU - Beck GJ AU - Leaderer BP LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 23 IP - DP - 1987 Jan 01 TI - Late asthmatic reactions and changes in histamine responsiveness provoked by occupational agents. PG - 577-581 AB - The temporal and quantitative relationship between increases in airway responsiveness and late asthmatic reactions provoked by inhalation challenge with occupational agents was studied in nine individuals who underwent a total of thirteen active inhalation challenge tests with one of the following agents: toluene diisocyanate (TDI), maleic anhydride (MA), trimellitic anhydride (TMA), carmine, or colophony (pine wood resin). Airway responsiveness to inhaled histamine (histamine PC20) was measured before and at approximately 3 and 24 h after control and active challenge exposure, when, on all but four occasions, FEV1 was within 10% of pre-challenge values. Significant increases (p less than 0.02) in histamine responsiveness were present at 3 h following challenge exposures which subsequently provoked a definite late asthmatic reaction (FEV1 decrease greater than 15% 3-11 h post challenge). These increases in histamine responsiveness were significantly greater than those at 3 h following the challenges which provoked an isolated early (FEV1 decrease less than 6% 3-11 h post-challenge) or equivocal late asthmatic reaction (FEV1 decrease 6-15% 3-11 h post-challenge) (p less than 0.03). Although histamine responsiveness remained high at 24 h after challenges provoking late asthmatic reactions (p less than 0.05), this was less than the increase at 3 h and not significantly different from the PC20 at 24 h after challenges provoking either single early or equivocal late asthmatic reactions AU - Graneek BJ AU - Durham SR AU - Newman Taylor AJ. LA - PT - DEP - TA - Bull Eur Physiopath Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 32 IP - DP - 1987 Jan 01 TI - Passive smoking. Acute effects on the lung function of sensitive persons PG - 299-302 AB - From the relationship between the degree of air pollution due to tobacco and its acute effects on healthy persons it is possible to estimate the still tolerable level of air pollution for healthy adults. The results and conclusions of the studies published by now on acute effects of passive smoking on patients with bronchial asthma are partially contradictory and do not allow a reliable estimation of the upper limit of tobacco smoke exposure for this particularly sensitive group. Because of methodological problems in studies with symptomatic asthmatics, further studies should be conducted which investigate patients with hayfever and asthma out of the pollen season, clinically healthy subjects with nonspecific bronchial hyperreactivity upon pharmacological challenge, and subjects who claim sensitivity to tobacco smoke. AU - Hartmann A AU - Weber A AU - Danuser B LA - PT - DEP - TA - Soz Praventivmed JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 135 IP - DP - 1987 Jan 01 TI - Sarcoidlike lung granulomatosis induced by aluminum dusts PG - 493-497 AB - Interstitial lung disease developed in a 32-yr-old chemist after working 8 yr in a dusty atmosphere containing aluminum powders. Bronchoalveolar lavage disclosed a helper T-lymphocyte alveolitis, and transbronchial lung biopsies showed sarcoidlike epithelioid granulomas. These granulomas contained dust identified by mineralogic analyses as consisting mainly of aluminum particles. Nasal and liver biopsies and a Kveim test did not reveal extrapulmonary granulomatous infiltration. An extensive immunologic work-up showed none of the abnormalities classically seen in sarcoidosis, but peripheral blood lymphocytes exhibited blastic transformation in the presence of soluble aluminum compounds. About 1 yr after cessation of exposure, a chest radiograph and lung function tests remained essentially unchanged, but signs of alveolitis disappeared. This observation suggests that aluminum may cause granulomatous lung disease accompanied by a helper T-lymphocyte alveolitis, similar to that of berylliosis and sarcoidosis. Further observations would be necessary to show if this constitutes an early stage of aluminum-induced fibrosis (aluminum lung). AU - De Vuyst P AU - Dumortier P AU - Schandene L AU - Estenne M AU - Verhest A AU - Yernault JC LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 136 IP - DP - 1987 Jan 01 TI - Aluminum-induced pulmonary fibrosis: do fibers play a role? PG - 176-179 AB - A 50-yr-old man with a history of 19 yr of work in the aluminum smelting industry, including 14 years in the potrooms, was found to have diffuse interstitial fibrosis, slightly more severe in the upper zones. He died of respiratory insufficiency 5 yr after initial presentation. Analysis of lung by electron optical techniques revealed 15,000,000,000 nonfibrous particles and 1,300,000,000 fibrous particles of aluminum oxide/g dry lung, values representing approximately a 1,000-fold increase over background exposure. The nonfibrous particles had a geometric mean diameter of 0.4 mu, and the fibers had a geometric mean length of 1.0 mu, a width of 0.06 mu, and an aspect ratio of 16. X-ray diffraction demonstrated alpha but not gamma aluminum oxide. These studies indicate that previous suggestions relating aluminum-induced fibrosis to the presence of gamma aluminum oxide are not correct. Although pulmonary fibrosis in this case may be a response to a very high total aluminum particle burden, the presence of large numbers of fibers raises the possibility that fibers play a role in aluminum fibrosis AU - Gilks B AU - Churg A LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 92 IP - DP - 1987 Jan 01 TI - Pulmonary involvement in zinc fume fever PG - 946-948 AU - Vogelmeier C AU - Konig G AU - Bencze K AU - Fruhmann G LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 33 IP - DP - 1987 Jan 01 TI - Results of a cross-sectional study of the effects of soldering fumes with particular reference to the respiratory tract PG - 44-47 AU - Wallenstein G AU - Schulz P AU - Sprecher D AU - Dietz E LA - PT - DEP - TA - Z Gesamte Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 42 IP - DP - 1987 Jan 01 TI - The economic consequences of developing occupational asthma PG - 209-209 AU - Weir DC AU - Robertson AS AU - Jones S AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 13 IP - DP - 1987 Jan 01 TI - Respiratory effects of work in retail food stores II. Pulmonary function findings PG - 213-217 AU - Wegman DH AU - Eisen EA AU - Smith TJ AU - Greaves IA AU - Fine LJ LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 13 IP - DP - 1987 Jan 01 TI - Respiratory effects of work in retail food stores II. Respiratory symptoms PG - 209-212 AU - Wegman DH AU - Eisen EA AU - Smith TJ AU - Greaves IA AU - Fine LJ LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 11 IP - DP - 1987 Jan 01 TI - respiratory symptoms associated with the use of azodicarbonamide foaming agent in a plastics injection moulding facility PG - 83-92 AU - Whitehead LW AU - Robins TG AU - Fine LJ AU - Hansen DJ LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 11 IP - DP - 1987 Jan 01 TI - Respiratory dysfunction after potroom asthma PG - 627-636 AU - Wergeland E AU - Lund E AU - Waage JE LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 91 IP - DP - 1987 Jan 01 TI - Antigens of powdered pearl-oyster shell causing hypersensitivity pneumonitis PG - 146-149 AU - Weiss W AU - Baur X LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - ii IP - DP - 1987 Jan 01 TI - Positive formaldehyde-rast after prolonged formaldehyde exposure by inhalation PG - July 18-July 18 AU - Wilhelmsson B AU - Holmstrom M LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 79 IP - DP - 1987 Jan 01 TI - A model of immunologic lung injury induced by trimellitic anhydride inhalation: antibody response PG - 59-63 AU - Zeiss CR AU - Levitz D AU - Leach CL AU - Hatoum NS AU - Ratajcak HV AU - Chandler MJ AU - Roger JC AU - Garvin PJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 17 IP - DP - 1987 Jan 01 TI - Predominance of mite allergy over allergy to pollens and animal danders in a farming population PG - 417-423 AU - van HageHamsten M AU - Johansson SGO AU - Zetterstrom O LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 70 IP - DP - 1987 Jan 01 TI - Combined asthma and alveolitis induced by cobalt in a diamond polisher PG - 54-61 AU - van Cutsem EJ AU - Ceuppens JL AU - Lacquet LM AU - Demedts M LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 42 IP - DP - 1987 Jan 01 TI - Further characterisation of allergens associated with hypersensitivity to the "green nimitti" midge (Cladotanytarsus lewisi, Diptera: Chironomidae) PG - 12-19 AU - Tee RD AU - Cranston PS AU - Kay AB LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 48 IP - DP - 1987 Jan 01 TI - Occupational asthma to cochineal carmine PG - 569-571 AU - Tenabene A AU - Bessot JC AU - Lenz D AU - KofferschmittKubler MC AU - Pauli G LA - PT - DEP - TA - Arch Mal Prof JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 25 IP - DP - 1987 Jan 01 TI - Two cases of hypersensitivity pneumonitis due to isocyanate in foundry castworkers PG - 924-928 AU - Takazakura E AU - Tsuji H AU - Makino H AU - Terada Y AU - Sugiura H AU - Kitagawa S LA - PT - DEP - TA - Jap J Thoracic Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 12 IP - DP - 1987 Jan 01 TI - Occupational asthma from inhaled egg protein PG - 205-218 AU - Smith AB AU - Bernstein DI AU - Aw TC AU - Gallagher JS AU - London M AU - Kopp S AU - Carson GA LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 8 IP - DP - 1987 Jan 01 TI - Achieved objectives in laboratory animal allergy research: their significance for policy and practice PG - 189-194 AU - Slovak AJM LA - PT - DEP - TA - NER Allergy Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 79 IP - DP - 1987 Jan 01 TI - Occupational asthma caused by Voacanga africana seed dust PG - 574-578 AU - Hinojosa M AU - Moneo I AU - Cuevas M AU - DiazMateo P AU - Subiza J AU - Losada E LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - * IP - DP - 1987 Jan 01 TI - Legionella experience PG - 130-131 AU - Brodie E LA - PT - DEP - TA - Occup Health (Lond) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - IP - DP - 1987 Jan 01 TI - Second report of the committee of enquiry into the outbreak of legionnaires' disease in Stafford in April 1985 PG - - AU - Badenoch J LA - PT - DEP - TA - HMSO Cm 256 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 294 IP - DP - 1987 Jan 01 TI - Effect of negative ion generators in a sick building PG - 1195-1196 AU - Finnegan MJ AU - Pickering CAC AU - Gill FS AU - Ashton I AU - Froese D LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - IP - DP - 1987 Jan 01 TI - Commercially available spirometers; a performance evaluation PG - - AU - Nelson SB LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 42 IP - DP - 1987 Jan 01 TI - IgE-mediated anaphylactoid reaction to rubber PG - 46-50 AU - Axelsson JGK AU - Johansson SGO AU - Wrangsjo K LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 13 IP - DP - 1987 Jan 01 TI - The sick building syndrome in the office environment; the Danish town hall study PG - 339-349 AU - Skov P AU - Valbjorn O LA - PT - DEP - TA - Environ Int JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 2 IP - DP - 1987 Jan 01 TI - The sick building syndrome, further prevalence studies and investigation of possible causes PG - 487-491 AU - Harrison J AU - Pickering CAC AU - Finnegan MJ AU - Austwick PKC LA - PT - DEP - TA - Indoor Air 87 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 37 IP - DP - 1987 Jan 01 TI - Risk of isothiazolinones PG - 30-31 AB - The past 5 years has seen an increase in the awareness of problems connected with the growth of organisms in water cooling towers and air conditioning plants. To overcome these a wide variety of biocide formulations have been developed. Some of these biocide concentrates are highly irritant. Two incidents are reported in this paper of men accidentally exposed to concentrated biocides containing isothiazolinones. AU - Clark EG LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 108 IP - DP - 1987 Jan 01 TI - Gesunderheits Haustechnik Bauphysik Umwelttechnik PG - 121-131 AU - Kroling P LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 17 IP - DP - 1987 Jan 01 TI - Allergic contact dermatitis to crystal violet lactone [corrected] in carbonless copy paper PG - 310-311 AU - Shehade SA AU - Beck MH AU - Chalmers RJ LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 42 IP - DP - 1987 Jan 01 TI - The role of preservatives in atrovent-induced bronchoconstriction PG - 230-231 AU - Beasley CRW AU - Rafferty P AU - Holgate ST LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 17 IP - DP - 1987 Jan 01 TI - Occupational asthma in nurses handling psyllium PG - 1-6 AB - Five nurses aged 31–55 years old had a history of asthmatic symptoms after being exposed to psyllium that they prepared and distributed to patients. They had been nurses for 9–20 years and had reported asthmatic symptoms related to work in the past 3–12 months. They reported symptoms of rhinoconjunctivitis and all were atopic but only one had a previous history of asthma. Four of the five tested subjects had an immediate skin reaction to a commercial psyllium extract. All had IgE antibodies to psyllium. At the time that they were investigated, four out of the five had a significant increase in bronchial responsiveness to methacholine (PC 20 <8 mg/ml). Inhalation challenges with psyllium caused isolated immediate (one subject) and dual reactions (three subjects). One subject exposed for only 1 min to the psyllium powder experienced a severe immediate bronchospastic reaction, which required intubation for 3 h with complete functional recovery thereafter. This experience illustrates the precautions necessary, with the inclusion of a cautious dose-response approach, even with an'occupation-type'challenge in the laboratory. AU - Cartier A AU - Malo JL AU - Dolovich J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 29 IP - DP - 1987 Jan 01 TI - Prevalence of occupational asthma in spray painters exposed to several types of isocyanates, including polymethylene polyphenylisocyanate PG - 340-344 AB - The prevalence of occupational asthma was assessed in four paint shops of a large assembly plant where 51 employees were exposed to several types of isocyanates, including polymethylene polyphenylisocyanate (PPI). Three employees were first referred by their physician for asthma symptoms. A questionnaire was administered to the other 48 employees. Seven of these were suspected of having work-related asthma. Airway hyperexcitability to inhaled histamine was demonstrated in these ten subjects (three referred and seven screened). The diagnosis of occupational asthma was confirmed in six subjects (three referred and three screened) through specific inhalation challenges in the laboratory to a paint system component containing PPI. Thus, the prevalence of occupational asthma was 11.8% in these paint shops using several types of isocyanates, including PPI. AU - Seguin P AU - Allard A AU - Cartier A AU - Malo JL LA - PT - DEP - TA - JOM JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 59 IP - DP - 1987 Jan 01 TI - Platinum group metal sensitivity: reactivity to platinum group metal salts in platinum halide salt-sensitive workers PG - 464-469 AB - The ability of closely related platinum group metal salts (PGMS) to cross-react with the principal sensitising agent ammonium hexachloroplatinate IV was investigated in refinery workers. Selected subjects were screened by skin prick test, specific RAST, RAST inhibition, and primate PCA tests. These showed--but only in platinum-sensitive subjects--a low prevalence of skin and RAST sensitivity to the other PGMS and limited evidence of hapten specific cross-reactivity AU - Murdoch RD AU - Pepys J LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 79 IP - DP - 1987 Jan 01 TI - Respiratory effects of indoor air polution PG - 685-700 AU - Samet JM AU - Marbury MC AU - Spengler JD LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 82 IP - DP - 1987 Jan 01 TI - Psyllium-induced asthma PG - 160-16* AU - Scott D LA - PT - DEP - TA - Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 15 IP - DP - 1987 Jan 01 TI - Late asthmatic reactions due to larvae of Calliphora erythrocephala used as fishing bait PG - 25-28 AU - Sestini P AU - Innocenti A LA - PT - DEP - TA - Allergol Immunopathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - IP - DP - 1987 Jan 01 TI - Premorbid states among workers of the polyethylenepolyamine production PG - - AU - Shpak BY LA - PT - DEP - TA - Russian JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - * IP - DP - 1987 Jan 01 TI - Sensitizations against Tribolium confusum Du Val in patients with occupational and non-occupational exposure PG - *-* AU - Rudolph R AU - Stressmann E AU - Stressmann B AU - Haupthof M LA - PT - DEP - TA - Adv Aerobiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 13 IP - DP - 1987 Jan 01 TI - Occupational asthma caused by himic anhydride PG - 150-154 AU - Rosenman KD AU - Bernstein DI AU - O'Leary K AU - Gallagher JS AU - D'Souza L AU - Bernstein IL LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 17 IP - DP - 1987 Jan 01 TI - Allergy to mice. 1. Identification of two major mouse allergens (Ag 1 and Ag 3) and investigation of their possible origin PG - 43-53 AU - Price JA AU - Longbottom JL LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 42 IP - DP - 1987 Jan 01 TI - Storage mite allergy among grain elevator workers PG - 423-429 AU - Revsbech P AU - Andersen G LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 71 IP - DP - 1987 Jan 01 TI - Immunodetection by enzyme-linked immuno-filtration assay (ELIFA) of IgG,IgM,IgA, and IgE antibodies in bird breeder's disease PG - 164-169 AU - Pinon JM AU - geers R AU - Lepan H AU - Pailler S LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 80 IP - DP - 1987 Jan 01 TI - Mushrooms and the lung PG - 667-66* AU - Pickering CAC LA - PT - DEP - TA - Proc R Soc Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 41 IP - DP - 1987 Jan 01 TI - Winegrowers lung caused by fungae on choice late vintage grapes-an alveolitis of exogenous allergic origin triggered by Botrytis cinerea spores PG - 165-169 AU - Popp W AU - Ritschka L AU - Zwick H AU - Rauscher H LA - PT - DEP - TA - Prax Klin Pneumol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 8 IP - DP - 1987 Jan 01 TI - Asthma and rhinitis related to laboratory rats: use of purified rat urinary allergen to study exposure in laboratories and the human immune response PG - 245-251 AU - PlattsMills TAE AU - Longbottom J AU - Heymann PW AU - Edwards J LA - PT - DEP - TA - NER Allergy Proc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 17 IP - DP - 1987 Jan 01 TI - Pattern of specific airway response in asthma due to western red cedar (Thuja plicata): relationship with length of exposure and lung function measurements PG - 333-339 AU - Paggiaro PL AU - ChanYeung M LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 136 IP - DP - 1987 Jan 01 TI - Atropine does not inhibit late asthmatic responses induced by toluene-diisocyanate in sensitized subjects PG - 1237-1241 AU - Paggiaro PL AU - Bacci E AU - Talini D AU - Dente FL AU - Rossi O AU - Pulera N AU - Fabbri LM AU - Giuntini C LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 79 IP - DP - 1987 Jan 01 TI - Formaldehyde reactions and the burden of proof PG - 705-706 AU - Patterson R AU - Dykewicz MS AU - Grammer LC AU - Pruzansky JJ AU - Zeiss CR AU - Harris KE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 128 IP - DP - 1987 Jan 01 TI - Occupational asthma due to formaldehyde PG - 28?-28* AU - Orosz M AU - Nagy L AU - Galambos E LA - PT - DEP - TA - Orv Hetil JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 136 IP - DP - 1987 Jan 01 TI - Clinical significance of an isolated reduction in residual volume PG - 1377-1380 AU - Owens MW AU - Kinasewitz GT AU - Anderson WM LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - * IP - DP - 1987 Jan 01 TI - Tremorgenic mycotoxins from Aspergillus fumigatus as a possible occupational health problem in sawmills PG - 787-790 AU - Land CJ AU - Hult K AU - Fuchs R AU - Hagelberg S AU - Lundstrom H LA - PT - DEP - TA - Appl Environ Microbiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 80 IP - DP - 1987 Jan 01 TI - Cellular and protein changes in bronchial lavage fluid after late asthmatic reaction in patients with red cedar asthma PG - 44-50 AU - Lam S AU - Leriche J AU - Phillips D AU - ChanYeung M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 12 IP - DP - 1987 Jan 01 TI - Trimellitic anhydride exposure in a 55-gallon drum manufacturing plant: immunologic, and industrial hygiene evaluation PG - 407-417 AU - Letz G AU - Wugofski L AU - Cone JE AU - Patterson R AU - Harris KE AU - Grammer LC LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - i IP - DP - 1987 Jan 01 TI - Allergy in cystic fibrosis nurses to pancreatic extract PG - AU - Lipkin GW AU - Vickers DW LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 55 IP - DP - 1987 Jan 01 TI - Nonspecific bronchial hypereactivity and degree of allergization to occupational factors in carpet factory workers PG - 147-14* AU - Liedhart J AU - Malolepszy J AU - Wryzszcz M AU - Krasnowska M AU - Liebhart E AU - Kuliczkowska D AU - Panaszek B AU - Machaj Z AU - Szeliga W LA - PT - DEP - TA - Pneum Pol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 149 IP - DP - 1987 Jan 01 TI - Cobalt asthma PG - 3563-3565 AU - Lander F LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 147 IP - DP - 1987 Jan 01 TI - Asthma and urticaria after hepatitis B vaccination PG - 3-3 AU - Lohiya G LA - PT - DEP - TA - Western J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 80 IP - DP - 1987 Jan 01 TI - Allergy to rats: quantitative immunoelectrophoretic studies on rat dust as a source of inhalant allergen PG - 243-251 AU - Longbottom JL AU - Austwick PKC LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 92 IP - DP - 1987 Jan 01 TI - Occupational asthma due to fumes of galvanized metal PG - 375-377 AB - Two solderers exposed to fumes of galvanized metal reported a history of shortness of breath and fever which occurred during the evening and night of days spent at work. Specific inhalation challenges performed by asking subjects to do soldering on galvanized iron revealed a late bronchospastic reaction. One subject also demonstrated a significant increase in oral temperature and peripheral neutrophils. Environmental measurements revealed the presence of zinc after soldering on galvanized metal. This contaminant was not present after a control exposure while soldering on iron. Although metal fume fever has been described in workers exposed to fumes of galvanized metal, this is the first account of occupational asthma due to this agent. AU - Malo JL AU - Cartier A LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 57 IP - DP - 1987 Jan 01 TI - Occupational asthma due to ebony wood (Diospyros crassiflora) dust PG - 247-349 AU - Maestrelli P AU - Marcer G AU - Dal vecchio L LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 23 IP - DP - 1987 Jan 01 TI - Pathogenesis of late asthmatic reactions induced by exposure to isocyanates PG - 583-586 AU - Mapp CE AU - Boschetto P AU - Zocca E AU - Milani GF AU - Pivorotto F AU - Tagazzin V AU - Fabbri LM LA - PT - DEP - TA - Clin Respir Physiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 25 IP - DP - 1987 Jan 01 TI - Hypersensitivity pneumonitis caused by home humidifier, a case report PG - *-* AU - Matsumoto H AU - Nakano H AU - Fujikane T AU - Akaishi T AU - Sasaki N AU - Shimizu T AU - Onodera S LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 43 IP - DP - 1987 Jan 01 TI - The prevalence of asthma among inhabitants in the vicinity of a polyurethane factory in Finland PG - 308-316 AU - Nuorteva P AU - Assmuth T AU - Haahtela T AU - Ahti J AU - Kurvonen E AU - Nieminen T AU - Saarainen T AU - Seppala K AU - Veide P AU - Viholainen S LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 82 IP - DP - 1987 Jan 01 TI - Acid anhydrides and asthma PG - 435-439 AU - Newman Taylor AJ AU - Venables KM AU - Durham SR AU - Graneek BJ AU - Topping MD LA - PT - DEP - TA - Int Archs appl Immun JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 29 IP - DP - 1987 Jan 01 TI - Occupational asthma due to styrene, two case reports PG - *-* AU - Moscato G AU - Biscaldi G AU - Cottica D AU - Pugiese F AU - Candura S AU - Candura F LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 36 IP - DP - 1987 Jan 01 TI - Occupational asthma from inhaled egg protein PG - 23-25 AU - MMWR LA - PT - DEP - TA - MMWR JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 136 IP - DP - 1987 Jan 01 TI - Standardization of spirometry- 1987 update PG - 1285-1298 AU - American Thoracic Society LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - i IP - DP - 1987 Jan 01 TI - Respiratory allergy to inhaled bat guano PG - 316-318 AB - In the Sudan many asthmatic patients attribute their symptoms to inhalation of bat droppings. Design of the roofs of many Sudanese buildings allows black bats to roost; guano drops through cracks in the ceiling into the rooms below where it can be inhaled and cause allergic respiratory disorders. Seven atopic patients seen at Sennar Hospital with bat-related case-histories were investigated. Six had bronchial asthma and allergic rhinitis and one had asthma alone. Extracts of yellow hairy bat, black bat, and bat droppings were made. All seven patients had a positive skin prick test and specific IgE antibodies (RAST) to bat droppings. Three patients also had a positive RAST to both yellow and black bats and one patient to yellow bat. Droppings are probably the major allergen source in bat-related respiratory allergy. AU - ElAnsary EH AU - Tee RD AU - Gordon DJ AU - Newman Taylor AJ LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 99 IP - DP - 1987 Jan 01 TI - Wild silk-induced bronchial asthma. A contribution to the knowledge of allergies caused by bed quilts filled with silk waste PG - 15-1* AU - Ebner H AU - Kraft D LA - PT - DEP - TA - Wiener Klin Wochenschift JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 79 IP - DP - 1987 Jan 01 TI - The temporal relationship between increases in airway responsiveness to histamine and late asthmatic responses induced by occupational agents PG - 398-406 AU - Durham SR AU - Graneek BJ AU - Hawkins R AU - Newman Taylor AJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 35 IP - DP - 1987 Jan 01 TI - Immunoglobulin E-mediated contact urticaria and bronchial asthma caused by household rubber gloves containing latex. 3 case reports [Ger] PG - 137-139 AB - During a period of a few months we observed 3 female patients suffering from contact urticaria by use of rubber gloves. In one case the local urticarial reaction at the fore arms was followed by asthma. In all 3 cases we could prove type I allergy against latex by radio allergo sorbent test (RAST) AU - Seifert HU AU - Seifert B AU - Wahl R AU - Vocks E AU - Borelli S AU - Maasch HJ LA - PT - DEP - TA - Derm Beruf Umwelt JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 136 IP - DP - 1987 Jan 01 TI - Bronchoalveolar neutrophilia during late asthmatic reactions induced by toluene diisocyanate PG - 36-42 AU - Fabbri LM AU - Boschetto P AU - Zocca E AU - Milani G AU - Pivirotto F AU - Plebani M AU - Burlina A AU - Licata B AU - Mapp CE LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 42 IP - DP - 1987 Jan 01 TI - Changes in bronchial responsiveness to histamine at intervals after allergen exposure PG - 302-308 AU - Cockcroft DW AU - Murdock KY LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 78 IP - DP - 1987 Jan 01 TI - A fatal case of asthma due to toluene diisocyanate PG - 501-502 AU - Corona PC LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 43 IP - DP - 1987 Jan 01 TI - Occupational asthma due to formaldehyde in a hospital setting PG - 91-94 AU - DegorgeHecquet I AU - Gacouin JC AU - Sauvaget J LA - PT - DEP - TA - Rev Pneumol Clin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 38 IP - DP - 1987 Jan 01 TI - Aquarium allergy: asthma from multiple sensitisations to fishfood constituents PG - 160-161 AU - Dietschi R AU - Wuthrich B LA - PT - DEP - TA - Hautarzt JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 43 IP - DP - 1987 Jan 01 TI - Occupational asthma among farmers PG - 26-35 AU - Underner M AU - Cazenave F AU - Patte F LA - PT - DEP - TA - Rev Pneumol Clin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 29 IP - DP - 1987 Jan 01 TI - Thermal degredation products from an ethylene methacrylic acid copolymer-partial metal salt as the cause of industrial bronchitis PG - 752-753 AU - Burgess KR LA - PT - DEP - TA - J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 80 IP - DP - 1987 Jan 01 TI - Grain-dust extract induced direct release of mediators from human lung tissue PG - 279-284 AU - ChanYeung M AU - Chan H AU - Salari H AU - Wall R AU - Tse KS LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 80 IP - DP - 1987 Jan 01 TI - Levels of specific antibody in bronchoalveolar lavage (BAL) and serum in an animal model of trimellitic anhydride-induced lung injury PG - 223-229 AU - Chandler MJ AU - Zeiss CR AU - Leach CL AU - Hutoum NS AU - Levitz D AU - Garvin PJ AU - Patterson R LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 79 IP - DP - 1987 Jan 01 TI - A rabbit model of hypersensitivity to plicatic acid, the agent responsible for red cedar asthma PG - 762-767 AU - Chan H AU - Tse KS AU - van Oostdam J AU - Moreno R AU - Pare PD AU - ChanYeung M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 11 IP - DP - 1987 Jan 01 TI - Respiratory effects and dust exposures in hog confinement farming PG - 571-580 AU - Holness DL AU - O'Blenis EL AU - SaasKortsak A AU - Pilger C AU - Nethercott JR LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 44 IP - DP - 1987 Jan 01 TI - Small airway hyperreactivity among lifelong non-atopic non-smokers exposed to isocyanates PG - 824-828 AU - Hjortsberg U AU - Orbaek P AU - Arborelius M LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 76 IP - DP - 1987 Jan 01 TI - Multidisciplinary approach to bakers asthma PG - 954-957 AU - Huguenot C AU - Zellweger JP AU - Pecoud A AU - Droz PO AU - Boillat MA LA - PT - DEP - TA - Schweiz Rundschau Med (Praxis) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 149? IP - DP - 1987 Jan 01 TI - Obstructive pulmonary disease of farmers PG - *-* AU - Iverson M AU - Dahl R AU - Hallas T LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 42 IP - DP - 1987 Jan 01 TI - Chip pile workers and mould exposure PG - 545-548 AU - Jappinen P AU - Haahtela T AU - Liira J LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - * IP - DP - 1987 Jan 01 TI - Metal fume fever and asthma PG - 1116-1116 AU - Kawane H AU - Soejima R AU - Umeki S AU - Niki Y LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 92 IP - DP - 1987 Jan 01 TI - Hypersensitivity pneumonitis in a hairdresser PG - 577-578 AU - Kawane H AU - Soejima R LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 149 IP - DP - 1987 Jan 01 TI - Asthma on handling green coffee beans PG - 2853-285* AU - Johansen JP AU - Viskum S LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - * IP - DP - 1987 Jan 01 TI - Gibbium psylloides (mite beetle) as an inhalative allergen PG - 183-187 AU - Fuchs E AU - Bossert J AU - Honomichl K AU - Maasch HJ AU - Risler H AU - Wahl R LA - PT - DEP - TA - Adv Aerobiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 149 IP - DP - 1987 Jan 01 TI - Health consequences of the employment of suction machinery in the unloading of grain, Symptoms, pulmonary function and sperm quality PG - 1764-1767 AU - Foldspang A AU - Handberg S AU - Kappel B AU - Petersen R LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 17 IP - DP - 1987 Jan 01 TI - Amoebae and humidifier fever PG - 235-242 AU - Finnegan MJ AU - Pickering CAC AU - Davies PS AU - Austwick PKC AU - Warhurst DC LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 11 IP - DP - 1987 Jan 01 TI - Pulmonary function and intradermal tests in workers exposed to soft-paper dust PG - 637-645 AU - Heederik D AU - Burdorf L AU - Boleij J AU - Willems H AU - van Bilsen J LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 29 IP - DP - 1987 Jan 01 TI - Occupational exposure and lung function measurements among workers in swine confinement buildings PG - 904-907 AU - Haglind P AU - Rylander R LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 80 IP - DP - 1987 Jan 01 TI - Immunologic and functional consequences of chemical (tetrachlorophthalic anhydride)-induced asthma after four years of avoidance of exposure PG - 212-218 AB - Seven patients with occupational asthma caused by a chemical, tetrachlorophthalic anhydride (TCPA), left their work in 1980. They have subsequently avoided TCPA exposure and have been followed until 1985. One patient died in 1981. The six living patients reported continuing symptoms suggestive of asthma, and five who were studied in 1985 demonstrated mild bronchial hyperresponsiveness (histamine concentration provoking a 20% fall in FEV1 range 2.7 to 12.5 mg/ml). Specific IgE antibody to TCPA conjugated with human serum albumin was measured by a radioallergosorbent test and detected in all patients. After avoidance of exposure, specific IgE fell exponentially with a half-life of 1 year. Specific IgE was still detectable in 1985, and throughout the follow-up period, prick tests with the conjugate elicited immediate skin responses. In 1981 four patients had inhalation tests with TCPA, and specific IgE rose afterward and then fell again AU - Venables KM AU - Topping MD AU - Nunn AJ AU - Howe W AU - Newman Taylor AJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 84 IP - DP - 1987 Jan 01 TI - Toluene diisocyanate respiratory reactions PG - 93-100 AU - Patterson R. Hargreave FE. Grammer LC. et al. LA - PT - DEP - TA - Int Arch Allergy Appl Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 82 IP - DP - 1987 Jan 01 TI - The relationship between total serum IgE and castor bean-specific IgE antibodies in castor bean-sensitive patients from Marseilles PG - 456-460 AB - The relationship between serum IgE and castor bean (Ricinus communis)-specific IgE was studied in a group of dockworkers and other residents of Marseilles who were diagnosed as having castor bean allergy. The diagnosis was made because they had asthma or other allergic symptoms together with a positive skin test to castor bean. Total serum IgE was found to be higher in castor-bean-allergic patients (mean = 174 IU/ml) than in a control group of local blood donors (mean = 66 IU/ml). IgE levels were not as high as those found in the sera of a previously identified group of castor-bean-allergic dockworkers from Port Sudan (mean = 902 IU/ml). Castor-bean-specific IgE was demonstrated in the serum of 91% of the allergic group and there was some correlation with total IgE (r = 0.53, p less than 0.01). The proportion of IgE antibody specific for castor bean was determined in 20 castor-bean-sensitive patients using the radioallergosorbent test and was found to vary between 9 and 64% (mean = 38% or 265 ng/ml). No castor-bean-specific IgE antibody was detected in the control group. AU - Thorpe SC. Kemeny DM. Panzani R. Lessof MH LA - PT - DEP - TA - Int Arch Allergy Appl Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 79 IP - DP - 1987 Jan 01 TI - Occupational asthma and rhinitis related to laboratory rats: serum IgG and IgE antibodies to the rat urinary allergen PG - 505-515 AB - Allergic reactions to rat urinary proteins are an important cause of occupational asthma and rhinitis among laboratory workers. We have measured IgG and IgE antibodies to a purified rat urinary allergen in sera from 179 laboratory workers of whom 30 reported symptoms on exposure to rats. There was a very good correlation between IgE antibodies and positive skin tests. In addition, there was a close correlation between reported asthmatic reactions and serum IgE antibody to rat allergen: IgE ab was present in 12/18 of workers with asthmatic reactions but in only 2/135 of workers without symptoms (p less than 0.001). Serum IgG antibodies to rat allergen were present in all sera with IgE antibody but were also present in 30% of asymptomatic individuals. The incidence and quantity of IgG antibody correlated with the degree of exposure to animals (i.e., hours per day) but not with the length of exposure in years. Our results on rat allergy confirm that there is an increased incidence of asthma among individuals who were atopic as judged by positive skin tests to other allergens. However, this relationship did not apply to individuals with rhinitis alone, and excluding atopic individuals from employment would have been a very inefficient method of reducing asthma or rhinitis in this group. Our results confirm that IgE antibody responses to rat urinary allergen are an important cause of occupational disease. The results for IgG antibody suggest that their prevalence represents a marker for the degree of exposure to rat proteins. AU - PlattsMills TAE AU - Longbottom J AU - Edwards J AU - Cockcroft A AU - Wilkins S LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 17 IP - DP - 1987 Jan 01 TI - Clinical and socio-professional fate of isocyanate-induced asthma PG - 55-61 AB - Thirty-one patients with isocyanate-induced asthma were studied 6–54 months after diagnosis. Four had the same work conditions and unchanged or worse respiratory symptoms; seven had an alternative job or safer work conditions at the same workplace and suffered from mild to severe symptoms. The remaining twenty subjects were definitely removed from exposure; of these, ten (50%) remained symptomatic after being removed from exposure for an average of 19 months. Asymptomatic patients appeared to be younger and to have shorter durations of total and symptomatic exposures, while symptomatic patients were more reactive to acetylcholine at diagnosis. For patients removed from isocyanate exposure and for those re-employed at the same work-place, quality of the new work site seems to play a role in the evolution of isocyanate-induced asthma. AU - Rosenberg N AU - Garnier R AU - Rousselin X et al LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 1 IP - DP - 1987 Jan 01 TI - Outcome of asthma induced by isocyanates PG - 14-22 AB - Isocyanates are widely used in industry for the manufacture of polyurethanes. Although they are recognized as an important cause of occupational asthma, it is unclear whether asthma persists after avoidance of exposure. We have followed up 50 cases, all of whom had avoided exposure for at least 4 years. At follow-up, 82% continued to have respiratory symptoms and approximately half of these required treatment at least once per week. These results indicate that a significant proportion of those with isocyanate-induced asthma are likely to have persisting symptoms for at least several years after exposure is avoided. AU - Lozewicz S AU - Assoufi BK AU - Hawkins R et al LA - PT - DEP - TA - Br J Dis Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 79 IP - DP - 1987 Jan 01 TI - Follow-up study of 232 patients with occupational asthma caused by western red cedar (Thuja plicata) PG - 792-796 AB - A total of 232 patients with red cedar asthma diagnosed by inhalation provocation tests were observed an average of 4 years after the initial diagnosis. The status during the follow-up examination was as follows: 96 patients continued to work with red cedar, and 136 left the industry and had no further exposure to red cedar in their jobs or hobbies. Of the 136 patients who left the industry, only 55 (40.4%) recovered completely, whereas the remaining 81 (59.6%) continued to experience attacks of asthma of varying severity. The initial pulmonary function tests were significantly higher among the asymptomatic group compared to the symptomatic group (FEV1 99.3 +/- 2.7% versus 90.5 +/- 2.2% predicted, respectively). Methacholine PC20 during the initial examination was higher among the asymptomatic group than in the symptomatic group (1.46 +/- 3.96 mg/ml versus 0.77 +/- 4.52 mg/ml, respectively). These findings indicate that the patients in the asymptomatic group were diagnosed at an earlier stage of the disease. This observation was confirmed by the significantly shorter duration of symptoms before diagnosis among the asymptomatic patients compared to the symptomatic patients (1.6 +/- 1.9 versus 2.6 +/- 4.3 years). Race, smoking status, immediate skin reactivity, and presence of plicatic acid-specific IgE antibodies did not influence the outcome of these patients. Of the 96 patients who continued to work with red cedar, 47 were exposed daily, whereas 41 were exposed intermittently.(ABSTRACT TRUNCATED AT 250 WORDS) AU - ChanYeung M AU - Maclean L AU - Paggiaro PL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 44 IP - DP - 1987 Jan 01 TI - Clinical and immunological investigations of respiratory disease in workers using reactive dyes PG - 534-541 AU - Docker A AU - Wattie JM AU - Topping MD AU - Luczynska CM AU - Newman Taylor AJ AU - Pickering CAC AU - Thomas P AU - Gompertz DTI LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 44 IP - DP - 1987 Jan 01 TI - Allergy to laboratory animals: a prospective study of its incidence and of the influence of atopy on its development PG - 627-632 AB - The pattern of incidence of allergy to laboratory animals (ALA) has been studied prospectively in 383 individuals occupationally exposed to rodents and to rabbits. The incidence of the disease after one year of exposure to animals fell from 37% in 1980 and 1981 to 20% in 1982, 10% in 1983, and 12% in 1984. A similar reduction was noted after two and three years of exposure in the 1982 and 1983 cohorts. The reduction in incidence coincided with the introduction of a site order and code of practice for working with animals and an education programme designed to focus awareness on the problem. Although rats were believed to be the major cause of the disease, objective measurements of IgE antibody against rat urine allergen were positive in only half the symptomatic individuals. Antibodies to different animal derived allergens were, however, found in several other personnel. Symptoms were generally of mild or moderate intensity and affected mainly the nose, eyes, and skin; chest symptoms were found in only 1.6% of the exposed population. A study of the influence of atopy on the development of ALA showed that after one year of exposure to animals a significantly greater proportion of atopic individuals became symptomatic (19-43% compared with 3-6%). After two and three years of exposure, however, this discrepancy was not maintained, with more non-atopic individuals developing the disease. AU - Botham PA AU - Davies GE AU - Teasdale EL LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 29 IP - DP - 1987 Jan 01 TI - Establishing clinical and immunologic criteria for diagnosis of occupational immunologic lung disease with phthalic anhydride and tetrachlorophthalic anhydride exposures as a model PG - 806-811 AU - Grammer LC AU - Harris KE AU - Chandler MJ AU - Flaherty D AU - Patterson R LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 154 IP - DP - 1987 Jan 01 TI - Atopy and pre-employment screening PG - 102-110 AU - Nordman H LA - PT - DEP - TA - Eur J Respir Dis Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 91 IP - DP - 1987 Jan 01 TI - Airway hyperresponsiveness in allergic rhinitis. A risk factor for asthma PG - 671-674 AU - Braman SS AU - Barrows AA AU - DeCotiis BA AU - Settipane GA AU - Corrao WM LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 80 IP - DP - 1987 Jan 01 TI - Occupational asthma caused by isonicotinic acid hydride (INH) inhalation PG - 578-582 AU - Asai S AU - Shimoda T AU - Hara K AU - Fujiwara K LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 42 IP - DP - 1987 Jan 01 TI - Occupational allergy to weeping fig in plant keepers PG - 161-167 AU - Axelsson IGK AU - Johansson SGO AU - Zetterstrom O LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 42 IP - DP - 1987 Jan 01 TI - A new indoor allergen from a common non-flowering plant PG - 604-611 AU - Axelsson IGK AU - Johansson SGO AU - Zetterstrom O LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 4 IP - DP - 1987 Jan 01 TI - Field Study of Circadian Rhythm in PEF of Electronics Workers Suffering from Colophony-induced Asthma PG - 263-267 AB - Twenty-two British electronics workers suffering from occupationally-induced asthma due to their exposure to colophony fumes self-recorded their peak expiratory flow (PEF) every 1-2 hr throughout the waking span for at least two weeks, both during work and vacation periods. Data were analyzed by a two-step procedure using the statistical techniques of Single and Population Mean Cosinor analyses. The objective endpoints of mesor (24-hr mean), amplitude (measure of 24-hr rhythmic variation) and acrophase (peak time along the scale of 24 hr) for the time-spans of the work-week (Monday-Friday), weekend after work (Saturday-Sunday) and vacation weekdays and vacation weekends were compared. The PEF data of four workers who participated in the study for nearly one year also were evaluated for seasonal variation. A statistically significant difference (P less than 0.04) was detected in the PEF amplitude between work and vacation weeks; the difference in the PEF mesor and acrophase between work-weekdays and work-weekends achieved near or statistical significance (P = 0.07 and 0.05, respectively). The at-work amplitude was higher and the acrophase earlier timed. There was no statistically significant difference between work-week and weekend-after-work PEF mesors. Winter PEF mesors were significantly lower than summer ones in the four subjects self-measuring their bronchial patency over the year. Overall, the findings indicate that data obtained through employee surveys, using lightweight portable and inexpensive PEF Wright meters and analyzed by statistical analyses used in the field of biological rhythm research, yield objective evidence of occupationally associated decrements in pulmonary function resulting from colophony fume exposure. AU - Randem B AU - Smolensky MH AU - Hsi B AU - Albright D AU - Burge PS LA - PT - DEP - TA - Chronobiol Int JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 91 IP - DP - 1987 Jan 01 TI - Allergic bronchopulmonary aspergillosis due to Aspergillus oryzae PG - 285-28* AU - Akiyama K AU - Takizawa H AU - Suzuki M AU - Miyachi S AU - Ichinohe M AU - Yanagihara Y LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 29 IP - DP - 1987 Jan 01 TI - Smoking and ethylene diamine sensitisation in an industrial population PG - 311-314 AU - Aldrich FD AU - Strange AW AU - Geesaman RE LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 82 IP - DP - 1987 Jan 01 TI - Sawmill alveolitis in Sweden PG - 440-443 AU - Belin L LA - PT - DEP - TA - Int Arch Allergy Appl Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 41 IP - DP - 1987 Jan 01 TI - Bronchial asthma caused by the preservative addition of phenylhydrargum boras in eye drops: identification by a specific bronchial inhalation test PG - 974-976 AU - Baumann UA LA - PT - DEP - TA - Prax Klin Pneumol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 135 IP - DP - 1987 Jan 01 TI - Occupational asthma and IgE sensitisation in a pharmaceutical company processing psyllium, ispaghula PG - 1033-1038 AB - We assessed the prevalence of occupational asthma and IgE sensitization to psyllium in a pharmaceutical company producing psyllium hydrophilic mucilloid, which is used as a laxative. Workers were intermittently exposed, approximately 5 times/yr, for periods of less than 10 days. Of the 140 employees, 130 (93%) were studied before a processing period via a questionnaire spirometry (n = 125), blood sampling (n = 118), and skin prick tests (n = 120) with 7 common inhaled allergens as well as plantain and psyllium. Thirty-nine workers had a history suggestive of occupational asthma. Twenty-three of 120 (19%) showed a skin wheal diameter greater than or equal to 3 mm to psyllium and 31 of 118 (26%) had increased specific IgE antibodies; 39 (32%) workers had at least 1 of these 2 features. Subjects with a questionnaire suggestive of asthma or occupational asthma were further investigated by serial monitoring of peak expiratory flow rates and PC20 methacholine before and during the psyllium processing period. All workers had spirometry repeated during the processing period. Twenty-one subjects who had a PC20 less than or equal to 16 mg/ml (n = 10) and/or decreased their PC20 by a greater than or equal to 3.2-fold difference (n = 4) and/or changed their FEV1 by greater than or equal to 10% (n = 13) during the processing period were referred for inhalation challenges to psyllium in the laboratory. Five of the 18 workers for whom these tests were feasible gave an immediate bronchoconstrictive reaction.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Bardy JD AU - Malo JL AU - Seguin P AU - Ghezzo H AU - Desjardins J AU - Dolovich J AU - Cartier A LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 17 IP - DP - 1987 Jan 01 TI - Antibodies to bird serum proteins in confectionary workers exposed to egg spray PG - 405-408 AB - In an extended study of a group of confectionery workers sensitized by exposure to egg spray, it was found that their blood serum contained antibodies to avian serum proteins. Comparison of the ratio of IgG antibodies determined by ELISA to egg yolk ‘livetins’ and pigeon serum in these patients and in pigeon breeders showed that the phenomenon is entirely due to immunological cross-reactivity among avian blood serum proteins. These avian serum proteins in hens' eggs, not ovalbumin, were identified as the major sensitizing antigens. AU - Berrens L AU - Edwards JH LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 92 IP - DP - 1987 Jan 01 TI - Occupational asthma in a national disability survey PG - 613-61* AU - Blanc P LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - * IP - DP - 1987 Jan 01 TI - Allergy to laboratory animals in health care personnel PG - 525-546 AU - Bland SM AU - Evans R AU - Rivera JC LA - PT - DEP - TA - Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 17 IP - DP - 1987 Jan 01 TI - Enzyme-linked immunosorbent-assay (ELISA) for IgG in bagasse workers' sera: comparison with counter-immunoelectrophoresis PG - 355-363 AU - Boiron P AU - Drouhet E AU - Dupont B LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 17 IP - DP - 1987 Jan 01 TI - Importance of airway inflammation for late asthmatic reactions induced by toluene diisocyanate in sensitized subjects PG - *-* AU - Boschetto P AU - Zocca E AU - Bruchi O AU - Cappellazzo G AU - Milani GF AU - Pivirotto F AU - Mapp CE AU - Fabbri LM LA - PT - DEP - TA - Advances in prostaglandin thromboxane and leucotri JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 80 IP - DP - 1987 Jan 01 TI - Prednisone inhibits late asthmatic reactions and airway inflammation induced by toluene diisocyanate in sensitized subjects PG - 261-267 AU - Boschetto P AU - Fabbri LM AU - Zocca E AU - Milani G AU - Pivirotto F AU - Vecchio AD AU - Plebani M AU - Mapp CE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 80 IP - DP - 1987 Jan 01 TI - Six-year clinical and immunologic follow-up of workers exposed to trimellitic anhydride PG - 147-152 AU - Boxer MB AU - Grammer LC AU - Harris KE AU - Roach DE AU - Patterson R LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 23 IP - DP - 1987 Jan 01 TI - Disaster at Bhopal: the accident, early findings and respiratory health outlook in those injured. PG - 587-590 AB - In December, 1984, in Bhopal, India, a massive leak of methyl isocyanate (MIC) resulted from operational and equipment malfunctions in a pesticide plant. Many thousands of residents of the city, most in proximity to the plant, suffered sublethal and lethal respiratory injuries, the expected consequences of high-level exposure to this type of potent irritant chemical vapour. Animal toxicologic information was limited prior to the accident, but has since confirmed that the lung is the major target of these lethal injuries, invariably with pulmonary oedema. Early concerns regarding acute cyanide intoxication were not supported by subsequent scientific inquiry. Superficial corneal erosions did not result in permanent eye injury. The primary medical (and, presumably, legal) issue which is unresolved, and perhaps unresolvable, is the incidence and determinants of long-term respiratory injury in the survivors. Available evidence, which is limited, suggests that chronic damage, when present, is, or resembles, fibrosing bronchiolitis obliterans, the expected consequence when permanent injury results from acute, high-level irritant gas exposure. Definition of the follow-up population is uncertain, and exposure information is lacking. Dose-response relationships are not likely to emerge from follow-up studies. Back to Results Formats Abstract Full Text PDF Search by Subject Accidents, Occupational Chemical Industry Cyanates Cyanides Disasters Follow-Up Studies Gas Poisoning Humans AU - Weill H LA - PT - DEP - TA - Bull Eupopean Physiopath Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 42 IP - DP - 1987 Jan 01 TI - Short term variability in FEV1 and bronchodilator responsiveness in patients with obstructive ventilatory defects PG - 487-490 AB - Short term variability in FEV1 and responsiveness to inhaled bronchodilator were measured in 150 patients with obstructive ventilatory defects. The range of initial FEV1 was 0 5-4 71 and the natural variability over a 20 minute period when expressed in absolute terms was similar over the entire range, and differed insignificantly from that found in normal subjects. The increase in FEV1 and vital capacity (VC) required to exclude natural variability with 95% confidence in these patients was 160 ml and 330 ml respectively. Natural variability when expressed in percentage terms was negatively correlated with the level of FEV1 recorded. The analysis of changes in FEV1 and VC after administration of bronchodilator used absolute and percentage criteria for response. The number of responders differed considerably according to the criterion used. In those defined by the absolute criterion as responders there was no evidence that size of response was related to level of FEV1. Percentage criteria have traditionally been used to identify responses to bronchodilator that may be clinically useful, while absolute criteria, although statistically valid, have not been favoured. Reappraisal of the criteria used and their limitations and implications is required. AU - TWEEDDALE PM AU - ALEXANDER F AU - McHARDY GJR LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 81 IP - DP - 1987 Jan 01 TI - Variability and reversibility of the slow and forced vital capacity in chronic airflow obstruction. PG - 182-185 AB - The variability of the forced (FVC) and slow vital capacity (SVC) manoeuvres were compared in 33 adult patients with chronic airflow obstruction. The reversibility of the two manoeuvres to nebulized salbutamol were compared in 18 of the patients. Both manoeuvres had equally small variances both before and after bronchodilator. The degree of reversibility of the FVC was however significantly greater (P<0.05) than the SVC. Although both measurements are equally variable, the FVC has a greater capacity for reversibility, which may have clinical significance. AU - Gove RI AU - Shepherd J AU - Burge PS LA - PT - DEP - TA - Br J Dis Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19870101 IS - IS - VI - 287 IP - DP - 1987 Jan 01 TI - Manchester air disaster PG - 1663-1667 AB - On 22 August 1985 a fire occurred on a Boeing 737 jet airliner at take off at Manchester Airport. One hundred and thirty seven passengers and crew were on board. Fiftytwo passengers died on the aircraft, 85 escaped. Most survivors had minor physical injuries, but 15 required admission to hospital because ofsmoke inhalation and two of these had severe burns. At presentation only one survivor required ventilation but within 12 hours a further five required ventilation. Although initially patients suffering from smoke inhalation may seem relatively well, lung function may deteriorate rapidly in the first 24 hours. Careful organisation andregularpractice ofprocedures to deal with a major accident are essential to be able to respond adequately to such an event. AU - O'HICKEY SP AU - PICKERING CAC AU - JONE PE LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 158 IP - DP - 1986 Jan 01 TI - Pulmonary asbestosis: CT study of subpleural curvilinear shadow. Work in progress. PG - 653-658 AB - High-resolution computed tomographic scans of 19 patients with pulmonary asbestosis revealed a subpleural curvilinear shadow (SCLS) parallel to the inner chest wall in the lungs of 15 (78.9%) patients. Most (46.7%) SCLS measured greater than 5 cm but less than 10 cm in length and occurred less than 1 cm from the inner chest wall in all cases. SCLS was distributed mainly in the lower lobe in patients with mild pulmonary fibrosis and in segments where fibrosis was mild in patients with honeycomb shadows. This may reflect initiation of pulmonary fibrosis leading to the formation of a honeycomb shadow. Radiologic-pathologic correlation, achieved in one postmortem specimen, seemed to indicate that SCLS was associated with the initial change of fibrosing bronchioloalveolitis, which is characteristic of pulmonary asbestosis. AU - Yoshimura H AU - Hatakeyama M AU - Otsuji H AU - Maeda M AU - Ohishi H AU - Uchida H AU - Kasuga H AU - Katada H AU - Narita N AU - Mikami R LA - PT - DEP - TA - Radiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 32 IP - DP - 1986 Jan 01 TI - Medical survey of methyl isocyanate gas affected population of Bhopal. Part II. Pulmonary effects in Bhopal victims as seen 15 weeks after M.I.C. exposure PG - 185-191 AB - Introduction A large amount (40 tonnes) of MIC gas leaked from the storage tank of the factory of Union Carbide Co. Ltd., Bhopal, into the atmosphere on the night of 2/3 December 1984, killing a few thousand people and leaving several thousand disabled. In the absence of adequate literature it was difficult to predict and prevent long-term effects of MI.C gas on human beings. In order to assess the extent and nature of lung damage a study was undertaken. This article describes in detail the effects on the respiratory system at the end of three and half months. Material and methods The material consisted of two groups [Group I (n = 446) and group It (n = 123)]. The selection of these two groups has been described earlier.[9] Each individual was assessed for his/her lung function. Pulmonary function tests consisted of forced expiratory spirography with the help of a Vitalograph (UK) and peak expiratory flow rates (PEFR) measured with the help of Wright's Mini Peak Flowmeter. After explaining the procedure, each subject was made to blow in the vitalograph and a forced expiratory spirogram was recorded. Each subject repeated the performance thrice and the best graph was selected.[6] From this graph, the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio and mid expiratory flow rates (MEFR) were calculated. On the basis of these tests, the pulmonary function disability was classified as restrictive or obstructive in nature. Subjects with FVC of 80% below the predicted values6 were labelled as having restrictive disability, they were further, classified into mild (FVC 60-80% of predicted), moderate (FVC 40-60% of predicted) and severe (FVC< 40% of predicted). Similarly, obstruction was further classified on the basis of FEV1/FVC ratio.[6] In those subjects showed airway obstruction, the tests were repeated after giving a bronchodilator aerosol. Pulmonary function tests could not be done in children below the age of seven years because of lack of cooperation. Routine chest films were taken in subjects with respiratory symptoms and signs, and in those who had abnormal pulmonary functions. Precaution was taken to maintain the consistency of technique to achieve a good comparative standard. Radiographs were reviewed by three independent observers who looked for certain predetermined findings which were noted in accordance with the earlier study from this institute. The zones affected were noted as per the criteria followed by Tuberculosis Chemotherapy Centre.[13] Results Demographic patterns in both the groups have already been discussed earlier.[9] Clinical features. In Group I, all subjects who were interrogated gave a history of burning of nose and throat and dry cough on the night of 2-3 December immediately after exposure to MIC gas. The symptoms gradually improved with the treatment they received. [Table 1] shows residual symptoms and signs in both the groups at the time of the survey (104-109 days later). In Group I, the cough was dry in 107 (23.8%) and productive in 217. In 202 subjects (45%), the sputum was small in quantity and the patients had a lot of difficulty to bring it out. The chest pain was continuous and dull-aching in nature and used to be aggravated by coughing and deep breathing. In this group, 52 (11.6%) subjects were smoking more than 5-10 bidees/cigarettes per day. In Group 41, the cough was dry, in 13 and productive in 8 subjects. In this group, 28 (22.8%) subjects were smokers smoking more than 10 cigarettes/bidees per day. Pulmonary function tests Group I [Table 2] Pulmonary function tests could be done in only 326 subjects of Group I. Restrictive disability was present in 160. The details regarding severity of restriction and/or obstruction are presented in [Table 2] and [Table 3] which are self-explanatory. Chest radiography Chest radiography was done in 306 of Group I and 81 of Group II subjects. The details are given in [Table 4]. AU - Naik S R AU - Acharya V N AU - Bhalerao R A AU - Kowli S S AU - Nazareth H H AU - Mahashur A A AU - Shah S S AU - Potnis A V AU - Mehta A C. LA - PT - DEP - TA - J Postgrad Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 15 IP - DP - 1986 Jan 01 TI - Discomfort from rubber gloves indicating contact urticaria PG - 79-84 AB - Rubber glove intolerance is a common dermatological problem and hypersensitivity of both delayed and immediate types occur. In order to study immediate skin reactions induced by rubber gloves, 15 patients with discomfort and itch produced by rubber gloves were examined The patients were provoked K wearing rubber gloves, scratch tested with gloves, rubber chemicals and powders, RAST-tests were performed using an extract from the rubber tree (Hevea brasiliensis). In 6/15 patients, contact urticaria was confirmed, in 3 of whom IgE antibodies to latex were demonstrated. AU - Wrangsjö K AU - Mellström G AU - Axelsson G LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 148 IP - DP - 1986 Jan 01 TI - Poisoning with Hexite smoke ammunition PG - 454-455 AU - Blom L AU - Hven PE LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 41 IP - DP - 1986 Jan 01 TI - Occupational asthma in a hairdressing salon PG - 42-50 AB - Occupational asthma among hairdressers has been recognised for some years and cases of work related asthma due to hair bleaches containing persulphates and hair dyes have been reported. The extent of the disease among hairdressers remains unknown. An investigation was carried out on an entire hairdressing salon, which specialised in hair bleaching and colouring and which employed 23 staff. On the basis of history and specific and non-specific bronchial provocation testing, four out of 23 staff were found to have occupational asthma due to the persulphate salts contained in hair bleaches. Only one of these had a positive skinprick test response to persulphate salts. Tests for non-specific bronchial reactivity to histamine in this work force were more sensitive for the diagnosis of asthma than simple lung function tests or recordings of peak flow rates performed four times daily for three weeks. The response to these agents was studied in greater detail by specific bronchial provocation tests in 14 members of the salon as well as one hairdresser from elsewhere with occupational asthma, three individuals with non-occupational asthma, and four normal subjects. Only those with a history of work related asthma and bronchial hyperreactivity responded positively, confirming that the response to bleach powders was specific. Studies of pulmonary mechanics after challenge showed that the response arose from changes in airway calibre not lung volumes. Measurement of neutrophil chemotactic activity after challenge showed significant rises in those affected, suggesting that mast cells may play a part in the pathogenesis of occupational asthma due to persulphates AU - Blainey AD AU - Ollier S AU - Cundell D AU - Smith RE AU - Davies RJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 40 IP - DP - 1986 Jan 01 TI - On the physical and thermodynamic stability of solid sodium tetrafluoraluminate PG - 566-571 AU - Bjorseth O AU - Herstad O AU - Holm JL LA - PT - DEP - TA - Acta Chem Scand [A] JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 89 IP - DP - 1986 Jan 01 TI - Respiratory symptoms and occupational bronchitis in chromite ore miners, Sudan PG - 223-228 AB - Prevalence of respiratory symptoms and chronic bronchitis was determined in a group of 122 subjects (77 exposed miners, 18 partially exposed, 27 controls) working at chromite ore mines in Sudan. The mean ages (+/- s.d.) of the three groups were 36.4 (+/- 7.8), 35.2 (+/- 6.8) and 34.6 (+/- 7.5) years respectively. Methods included a respiratory symptoms questionnaire based on the British Medical Research Council (MRC 1976) questionnaire on respiratory symptoms, determination of FEV1, FVC and FEV1/FVC%. The majority (66%) of the exposed subjects were non-smokers (NS) and 20 (77%) of the 'ever-smokers' (current and ex-smokers) were smokers of less than 15 cigarettes day-1. Respiratory symptoms (cough, phlegm, dyspnoea) were more frequent among the miners and so was chronic bronchitis. The prevalence of the latter was 26% among the miners compared to 11% and 7% among the partially exposed and the controls respectively. These differences could not be accounted for by cigarette smoking. Sixty-five per cent of the miners diagnosed as having asthma, chronic bronchitis or both were non-smokers. Although the values for the FEV1/FVC% remained normal or near the lower limits of the normal range, the mean value was significantly lower among the miners. It was concluded that the mine dust was the prime cause of the respiratory symptoms and chronic bronchitis among the miners. AU - Ballal SG LA - PT - DEP - TA - J Trop Med Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - i IP - DP - 1986 Jan 01 TI - Role of Aspergillus amylase in bakers asthma PG - 43-43 AU - Baur X AU - Fruhmann G AU - Haug B AU - Rasche B AU - Reiher W AU - Weiss W LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 41 IP - DP - 1986 Jan 01 TI - Exposure to naphthalene diisocyanate in a rubber plant: symptoms and lung function PG - 85-89 AU - Alexandersson R AU - Gustafsson P AU - Hedenstierna G AU - Rosen G LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 77 IP - DP - 1986 Jan 01 TI - Occupational asthma from work with synthetic resins PG - 1807-1812 AU - Avolio G AU - Cacciabue M AU - Galietti F AU - Giorgis GE AU - Iorio M AU - Oliaro A AU - Scappaticci E LA - PT - DEP - TA - Min Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 41 IP - DP - 1986 Jan 01 TI - Lung disease after exposure to polyvinyl chloride dust PG - 566-567 AU - AnttiPoika M AU - Nordman H AU - Nickels J AU - Keskinen H AU - Viljanen A LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 78 IP - DP - 1986 Jan 01 TI - Occupational asthma in sawmills of eastern Canada and United States PG - 392-398 AB - Eleven individuals with a history of work-related asthma are described. They were employed in 10 different sawmills of northwestern and southeastern Quebec and Maine where coniferous trees (spruces, firs, and pines) are cut into boards. Duration of exposure and symptomatology varied from 1.5 to 40 years and 0.5 to 10 years, respectively. Ten subjects were atopic and seven demonstrated immediate skin reactivity to mixed tree pollens. The diagnosis of occupational asthma was confirmed by significant and sustained changes in serial peak expiratory flow rates at work as compared with a period off work in every individual and significant changes in bronchial responsiveness to histamine at work as compared with a period off work in eight individuals or significant changes in FEV1 at work in the three other subjects. Specific inhalation tests by exposing four workers to sawdust in our laboratory were negative. We conclude that working in this specific type of sawmills of eastern Canada and northeastern United States can cause occupational asthma. Although the causative agent is unknown, the presence of atopy and/or immediate skin reactivity to tree pollens and/or bronchial hyperresponsiveness might be risk factors. AU - Malo JL AU - Cartier A AU - Boulet LP LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 41 IP - DP - 1986 Jan 01 TI - Occupational asthma caused by maleic anhydride : bronchial provocation testing and immunological data PG - 251 AU - Graneek BJ AU - Durham SR LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 137 IP - DP - 1986 Jan 01 TI - FATAL ASTHMA IN A SUBJECT SENSITIZED TO TOLUENE DIISOCYANATE PG - 1494-1498 AU - Fabbri LM AU - Danieli D AU - Crescioli S AU - Bevilacqua P AU - Meli S AU - Saetta M AU - Mapp CE LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 43 IP - DP - 1986 Jan 01 TI - Allergy to laboratory animals in laboratory technicians and animal keepers PG - 192-198 AB - The prevalence of allergy to laboratory animals (LAA) was investigated in laboratory technicians and animal keepers. In a questionnaire 41 of 101 technicians reported symptoms provoked by work with laboratory animals. On clinical investigation 30 were found to have symptoms and signs related to contact with animals, and allergy was confirmed by radioallergosorbent tests (RAST) and skin tests in 19. All had rhinitis and 10 also had bronchial asthma. Forty seven other technicians who had stopped working with laboratory animals showed the same relative numbers of respiratory tract symptoms and of confirmed allergy to laboratory animals as did those currently handling animals. Seven of 23 animal keepers had work related symptoms. LAA symptoms were found in four and confirmed animal allergy in two. All four animal keepers with animal related symptoms had rhinitis, none had bronchial asthma. Positive animal RAST and skin tests were found only among people with animal related symptoms. A history of atopic disease was commoner among those with positive animal test results than among those with negative test results. No relation between smoking and the development of allergy to laboratory animals emerged. Simple prophylactic measures often sufficed to help technicians with animal related symptoms to remain at work. AU - Agrup G AU - Belin L AU - Sjostedt L et al LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 90 IP - DP - 1986 Jan 01 TI - Chronic asthma due to toluene di-isocyanate PG - 494-499 AB - Twelve subjects were studied with inhalation challenge testing to toluene diisocyanate (TDI) because of suspected TDI asthma based on a consistent clinical and occupational history. In seven cases, TDI asthma was documented by a positive inhalation challenge to low levels of TDI. Six of the seven TDI reactors had persistent respiratory symptoms and required daily treatment even though they had been removed from isocyanate exposure for intervals as long as 12 years (mean 4.5 years). These six TDI reactors had either dual (four cases) or late bronchospasm (two cases) to less than 20 ppb TDI, and all had a positive methacholine or cold air challenge prior to study. The one TDI reactor with a negative methacholine challenge had a positive (immediate) bronchospastic response to a TDI challenge performed one week after removal from isocyanate exposure. Five workers had a negative TDI challenge, two of whom had persistent respiratory symptoms and positive methacholine challenges at the time of TDI inhalation testing. We conclude that respiratory symptoms may persist following long-term removal from occupational exposure to TDI and are associated with nonspecific bronchial hyperreactivity. The TDI sensitivity may also persist for a long time even in the absence of any additional occupational exposure. Long-term prospective studies of symptomatic isocyanate workers are needed to fully define the extent of this problem. AU - Moller DR AU - Brooks SM AU - McKay RT AU - Cassedy K AU - Kopp S AU - Bernstein IL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 78 IP - DP - 1986 Jan 01 TI - Plicatic Acid-Specific Ige And Nonspecific Bronchial Hyper-responsiveness In Western Red-Cedar Workers PG - 1103-1109 AB - In a cross-sectional survey of 652 workers in a western red-cedar sawmill, we obtained data on symptoms, pulmonary function, immediate skin reactivity to common allergens, nonspecific bronchial responsiveness, total IgE level, and sensitization to plicatic acid conjugated with human serum albumin as measured by RAST. Dust exposure was estimated by personal and area sampling for total dust during a work shift and cumulative exposure by duration of employment. Seven percent of the workers had an elevated RAST, and 20% had nonspecific bronchial hyperresponsiveness. Elevation in RAST was associated with bronchial hyperresponsiveness. Almost half (46%) of the workers with RAST elevation had bronchial hyperresponsiveness compared to 18% in workers with no RAST elevation. The association was unaffected by total IgE level or by limiting the analysis to workers without respiratory symptoms and was most apparent in younger workers. Bronchial hyperresponsiveness was associated with increased prevalence of respiratory symptoms as well as with lower levels of pulmonary function. The likelihood of bronchial hyperresponsiveness increased with increasing age but was unrelated to the dust-exposure concentration. RAST elevation was unrelated to employment duration or dust exposure and was not associated with an increased prevalence of symptoms or lower levels of pulmonary function independent of bronchial hyperresponsiveness. We conclude that plicatic acid-specific IgE and nonspecific bronchial hyperresponsiveness are associated in western red-cedar workers and that this association may reflect a causal connection. AU - Vedal S AU - ChanYeung M AU - Enarson DA et al LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 28 IP - DP - 1986 Jan 01 TI - Pre-employment screening for allergy to laboratory animals: epidemiologic evaluation of its potential usefulness PG - 1158-1164 AB - Employers at laboratory animal facilities have begun to use selection criteria which proscribe employment of persons thought to be at increased risk of developing allergy to laboratory animals. Some of these criteria are: a personal history of allergy, chronic rhinitis, or asthma, positive direct skin tests, elevated serum immunoglobulin E, abnormal forced expiratory volume in 1 second, and a family history of allergy. The usefulness of these criteria were examined in preemployment screening when applied to job applicants who will be handling laboratory animals, by calculating the sensitivity, specificity, and positive predictive value (PPV) of each criterion. Results illustrated that the primary goal of the screening program must be determined before an evaluation can be made of the usefulness of potential screening criteria in meeting the goal, ie, to identify persons who are themselves at high risk (high PPV), to identify a large proportion of low-risk job applicants (specificity), or to screen out a large proportion of occupational disease (high sensitivity), because it is not possible to maximize these parameters simultaneously. Results indicate that, currently, the use of these screening criteria as determinants for hiring persons to work with laboratory animals is unwarranted. AU - Newill CA AU - Evans R AU - KhouryMJ LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 79 IP - DP - 1986 Jan 01 TI - Phthalic anhydride-induced occupational asthma PG - 77-82 AB - Out of 118 workers exposed to phthalic anhydride (PA) dust for 2 months or more in four plants producing alkyd and/or polyunsaturated polyester resins, 28 (24%) suffered from work-related rhinitis, 13 (11%) from chronic productive bronchitis, and 21 (28%) from work-associated asthma. Asthma was generally preceded by rhinitis and was mostly of late type. 3 out of 11 asthmatics had a PA-positive skin test. In 2 subjects the presence of antibodies was demonstrated by the Prausnitz-Kustner test. 4 out of 25 heavily exposed subjects without asthma had a nonspecific bronchial hyperreactivity. The results did not indicate any significant 'healthy worker selection' as regarding rhinits and asthma. Chronic productive bronchitis was common and was more prevalent among former workers than among present employees, indicating a selection of nonreacting subjects in the plant. The time-weighted average breathing zone PA levels in two plants were between 3 and 13 mg/m3 during different direct PA handling operations and less than 0.3 mg/m3 at other kinds of work. In 2 subjects, positive bronchial provocation was obtained by short-term exposure to 0.5 and 6 mg PA/m3, respectively. AU - Wernfors M AU - Nielsen J AU - Schutz A et al LA - PT - DEP - TA - Int Arch Allergy Appl Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 61 IP - DP - 1986 Jan 01 TI - Preschool wheezing and prognosis at 10 PG - 642-646 AU - Park ES AU - Golding J AU - Carswell F AU - StewartBrown S LA - PT - DEP - TA - Arch Dis Child JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 292 IP - DP - 1986 Jan 01 TI - Isocyanate in a paint spraying workshop PG - 313 AU - Lee WR AU - ScottAR LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 41 IP - DP - 1986 Jan 01 TI - Nitrocellulose-based RAST to detect IgE antibodies in workers hypersensitive to diphenylmethane-4,4'-diisocyanate PG - 203-209 AU - Grunewalder E AU - Karol MH LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - * IP - DP - 1986 Jan 01 TI - Lung function and rhizopus antibodied in wood trimmers PG - 167-177 AU - Hedenstierna G AU - Alexandersson R AU - Belin L AU - Wimander K AU - Rosen G LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 293 IP - DP - 1986 Jan 01 TI - Low concentrations of formaldehyde in bronchial asthma: a study of exposure under controlled conditions PG - 310-31* AU - Harving H AU - Korsgaard J AU - Dahl R LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 77 IP - DP - 1986 Jan 01 TI - Occupational disease of hairdressers PG - 109-113 AU - Heacock HJ AU - Rivers JK LA - PT - DEP - TA - Can J Pub Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 37 IP - DP - 1986 Jan 01 TI - Bronchial reactivity in workers from an aluminium plant using alu-swiss technology PG - 311-317 AU - GodnicCvar J LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 37 IP - DP - 1986 Jan 01 TI - Chronic cardiovascular and respiratory symptoms in aluminium workers PG - 319-327 AU - Gomzi M AU - Pisl Z LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 16 IP - DP - 1986 Jan 01 TI - Enzyme linked immunofiltration (ELIFA) for the detection of specific antibodies (IgG, IgM, IgA, IgE) in farmer's lung disease PG - 553-562 AU - Gari M AU - Pinon JM AU - Poirriez JM AU - Boulant J AU - geers R AU - Thoannes H LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 28 IP - DP - 1986 Jan 01 TI - Respiratory effects of mesquite broiling PG - Nov-No* AU - Johns RE AU - Lee JS AU - Gibbons HL AU - Reading JC AU - Agahian B LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 35 IP - DP - 1986 Jan 01 TI - Clinical and immunologic studies on patients with bakers asthma PG - 47-59 AU - Kamidaira T AU - Suetsugu S AU - Umeda H LA - PT - DEP - TA - Arerugi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 66 IP - DP - 1986 Jan 01 TI - Sisal hemp occupational asthma PG - 282-28* AU - Kaizhang C LA - PT - DEP - TA - Natl Med J China JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 35 IP - DP - 1986 Jan 01 TI - Effects of improvements in working conditions on occupational asthma PG - 1003-1010 AU - Jyo T AU - Kuwabara M AU - Kodomari Y AU - Katsutani T AU - Otsuka T AU - Tsuboi S AU - Oka S AU - Shigeta S LA - PT - DEP - TA - Arerugi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 24 IP - DP - 1986 Jan 01 TI - A case of hypersensitivity pneumonitis probally due to isocyanate in a polyurethane paint sprayer PG - 1013-1017 AU - Kato S AU - Kirii K AU - Osanai K AU - Sato S AU - Takahashi K LA - PT - DEP - TA - Jap J Thoracic Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 16 IP - DP - 1986 Jan 01 TI - Inhalant allergy following occupational exposure to blowflies PG - 65-71 AU - Kaufman GL AU - Baldo BA AU - Tovey ER LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 43 IP - DP - 1986 Jan 01 TI - Ventilatory impairment from pre-harvest retted flax PG - 809-813 AU - Jamison JP AU - Langlands JHM AU - Lowry RC LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 148 IP - DP - 1986 Jan 01 TI - Hard metal lung. A case of cobalt-conditioned pneumoconiosis PG - 1311-1312 AU - Jerpsen JR AU - Egede F LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 43 IP - DP - 1986 Jan 01 TI - Symptoms and longitudinal changes in lung function in young seasonal grain handlers PG - 587-591 AU - James AL AU - Cookson WOCM AU - Buters B AU - Lewis S AU - Ryan G AU - Hockey R AU - Musk AW LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 105 IP - DP - 1986 Jan 01 TI - Hypersensitivity pneumonitis caused by Cladosporium in enclosed hot-tub area PG - 204-206 AB - A 48-year-old woman had an 18-month history of malaise and chronic cough with intermittent episodes of fever, chills, and pneumonic infiltrates. Transbronchial biopsy findings were consistent with hypersensitivity pneumonitis. Cultures of fungus from a hot-tub room in her home were positive for Cladosporium species. Serum precipitins were weakly positive for Cladosporium cladosporioides. Removal of the patient from the home environment led to a resolution of symptoms within 1 week. Within 4 hours of re-exposure to the hot-tub room, symptoms and signs and changes in leukocyte count and spirometric values again occurred. Bronchial provocation with a commercial extract of C. cladosporioides led to a similar pattern 5 hours after the initial challenge. This case identifies a previously unreported etiologic agent and environmental site for hypersensitivity pneumonitis. AU - Jacobs RL AU - Thorner RE AU - Holcomb JR AU - Schwietz LA AU - Jacobs FO LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 77 IP - DP - 1986 Jan 01 TI - Occupational hexamethylene diisocyanate asthma PG - 181-194 AU - Innocenti A AU - Mariano A AU - Valiani M LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - IP - DP - 1986 Jan 01 TI - Occupational asthma PG - - AU - HMSO LA - PT - DEP - TA - HMSO cmnd 9717 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 16 IP - DP - 1986 Jan 01 TI - Occupational asthma caused by African maple (Obeche) and Ramin: evidence of cross reactivity between these two woods PG - 145-153 AU - Hinojosa M AU - Losada E AU - Moneo I LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 12 IP - DP - 1986 Jan 01 TI - Bronchial asthma due to exposure to potassium aluminiumtetrafluoride PG - 223-22* AU - Hjortsberg U AU - Nise G AU - Orbaek P AU - SoesPeterson U AU - Arborelius M LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 14th Int C IP - DP - 1986 Jan 01 TI - Bronchial asthma due to exposure to aluminium fluoride salt PG - 395-400 AU - Hjortsberg U AU - Nise G AU - Orbaec P AU - Piitulainen E AU - Arborelius M LA - PT - DEP - TA - Medichem JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 77 IP - DP - 1986 Jan 01 TI - Occupational asthma caused by eastern white cedar (Thuja orientalis) with demonstration that plicatic acid is present in this wood dust and is the causal agent PG - 639-645 AU - Cartier A AU - Chan H AU - Malo JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 78 IP - DP - 1986 Jan 01 TI - IgE sensitization in snow crab-processing workers PG - 344-348 AB - Occupational asthma is a highly prevalent disease among snow crab-processing workers, but its immunologic mechanism has not been identified. Prick skin tests with snow crab-meat extract, commercial extracts from other crab genera, and snow crab cooking water collected in 1984 were performed on 119 workers. Crab-specific IgE was assessed by RAST in sera from 115 workers with meat and water extracts. Both skin and RAST tests were performed in 58 individuals. Diagnosis of occupational asthma had previously been confirmed in 54 individuals. A highly significant relationship was demonstrated between the presence of immediate skin reactivity or increased serum levels of specific IgE to crab extracts and the occurrence of occupational asthma. There was good agreement between the results of skin and RAST tests with extracts of either meat or snow crab cooking water. Cooking water and snow crab-meat extracts were more sensitive than commercial preparations. Water extract was more potent and more sensitive than meat extract. We conclude that there is evidence that occupational asthma in snow crab-processing workers is mediated through an IgE mechanism. AU - Cartier A AU - Malo JL AU - Ghezzo H AU - McCants M AU - Lehrer SB LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 133 IP - DP - 1986 Jan 01 TI - Occupational asthma PG - 686-703 AU - ChanYeung M AU - Lam S LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 77 IP - DP - 1986 Jan 01 TI - TDI induced airway hypersensitivity and pathology in the guinea pig PG - 828-834 AU - Cibulas W AU - Murias CG AU - Miller ML LA - PT - DEP - TA - Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 43 IP - DP - 1986 Jan 01 TI - Occupational asthma due to unheated colophony PG - 559-560 AB - Occupational asthma due to colophony is well recognised in the electronics industry where colophony forms part of the soldering flux. The colophony heated at soldering temperature (350-450'C) undergoes some decomposition, raising the possibility that the occupational asthma may be due to colophony breakdown products rather than to the colophony resin acids themselves. In the United Kingdom this has resulted in occupational asthma due to colophony being recognised as a prescribed disease only after exposure to electronic soldering flux. There have been isolated case reports of occupational asthma when the colophony was heated to lower temperatures; in particular a machine tool setter developed occupational asthma reproduced by heating colophony at 180'C and a chemical worker developed occupational asthma when making colophony derivatives heated to 90°C. We report the first case in which asthma has been induced by exposure to colophony at room temperature. AU - Burge PS AU - Wieland A AU - Robertson AS AU - Weir D LA - PT - DEP - TA - Brit J Industr Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 10 IP - DP - 1986 Jan 01 TI - Respiratory symptoms, lung function, and IgG4 levels against pig antigens in a sample of Dutch pig farmers PG - 283-285 AU - Brouwer R AU - Biersteker K AU - Bongers P AU - Remijn B AU - Houthuijs D LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 292 IP - DP - 1986 Jan 01 TI - Asthma caused by pulverised fuel ash PG - 1561-1561 AB - Pulverised fuel ash is the residue that remains when pulverised coal is burnt in power stations. Low grade coal, ground to a particle size of 0- 1-100 tm, is blown into boilers in jets of airborne coal particles, and the residual ash is collected in electrostatic precipitators. Pulverised fuel ash is an important byproduct ofthe power industry: it is used for land filling and, because it sets hard in the presence of lime and water, is widely used as a building material in breeze blocks. It has not previously been reported as causing asthma. We report a case of asthma in a worker at a power station that was caused by inhalation of pulverised fuel ash. Case report Nine months after staring work as a plant attendant at a power station a 27 yearold man developed episodes of shortness of breath with wheezing, which improved at weekends and during holidays. His work included cleaning the filters of the bags. On two occasions he was admitted to hospital with acute severe asthma. He had suffered from hay fever since childhood,and skin prick tests with etrmacts of grass pollen and housedust elicited immediate reactions. He recorded his peak expiratory flow rate every two hours for 28 days. This deteriorated during work and improved when he was away from work. He underwent single blind occupational type inhalation tests.Tipping of 250 g of lactose and 2-5 g of charcoal (producing dust that looked like pulverised fuel ash) for 30 minutes elicted no change in his forced expiratory volume in one second, but tipping of 250 g of lactose with 2g of pulveriused fuel ash provroked a late asthmatic ration. this late reation was reproduced by a second inhalation test with the ash. The concentration of histamine required to cause a 20% fall in FEV1 decreased from 12 mg/ml one day before the inhalation test with pulverised fuel ash to 2-5 mg/ml 24 hours after the test. Serum neutrophil chemotacic activity increased by 120% during the late asthmatic reaction. After these results he was relocated at work to prevent him being exposed to pulverised fuel ash any longer. He remained free of symptoms and required no treatment. Serial measurements of PEF after he Was relocated showed no evidence of asthma. This patient's symptoms suggested that he had developed asthma related to his work, and this was confirmed by the results of serial measurements of his peak expiratory flow rate. Inhalation testing with pulverised fuel ash, to which he was exposed at work, provoked a reproducible asthmatic reaction. This late response was associated with a rise in serum neutrophil chemotactic activity (measured during the second inhalation test). The interval of nine months before the onset of his symptoms, the late asthmatic reaction provoked by the inihalation test with pulverised fuel ash, the associated increase in airway reactivity, and the resolution of asthma after relocation at work suggest that pulverised fuel ash was the primary cause of this man's asthma. Pulverised fuel ash is a complex material: 60-80%h of its weight is made up of water insoluble aluminosilicates, 15-30% of crystals (the main species being mullite, magnetite, carbon, and quartz), and the remainin 24% of water soluble sulphaes of calcium, sodium, and potassium with trace quantities of arsenic, boron, copper, molybdenum, and selenium. We did not identify which ofthese materials, either alone or in combination, caused our patient's asthma. Some 12 milion tons of pulverised fuel ash are produced each year in the United Kingdom and 50 million tonnes each year in the United States. The greatest risk of developing asthma due to inhaled pulverised fuel ash is run by those working in the power and construction industries. AU - Davison AG AU - Durham S AU - Newman Taylor AJ LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 5 IP - DP - 1986 Jan 01 TI - Asthma and rhinitis after exposure to glutaraldehyde in endoscopy units PG - 325-327 AU - Corrado OJ AU - Osman J AU - Davies RJ LA - PT - DEP - TA - Hum Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 22 IP - DP - 1986 Jan 01 TI - A diagnostic study of five cases of allergic asthma due to sensitivity to silk allergens in textile workers of the Prato area PG - 433-440 AU - Cosmi F AU - Schiatti R AU - Ignesti C LA - PT - DEP - TA - Quad Sclavo Diagn JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 43 IP - DP - 1986 Jan 01 TI - Atopy, non-allergic bronchial reactivity and past history as determinants of work related symptoms in seasonal grain handlers PG - 396-400 AU - Cookson WOCM AU - Ryan G AU - MacDonald S AU - Musk AW LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 41 IP - DP - 1986 Jan 01 TI - Relationships between radiographic change, pulmonary function, and brochoalveolar lavage fluid lymohocytes in farmer's lung disease PG - 28-33 AB - Ninety four dairy farmers were investigated by chest radiography, pulmonary function tests, and bronchoalveolar lavage. They were divided into five groups--1: 11 subjects with acute farmer's lung; 2: 25 subjects with previously diagnosed farmer's lung who had stayed on their farm; 3: 15 farmers with previously diagnosed farmer's lung who had left the farm; 4: 23 precipitin positive symptomless farmers; 5: 20 precipitin negative symptomless farmers. The study evaluated the relationships between radiographic changes measured with a scoring system derived from the International Labour Office (ILO) classification, the results of pulmonary function tests, and bronchoalveolar lavage fluid. Thirty eight subjects had radiographic evidence of interstitial pulmonary infiltrates. Group 1 had the highest percentage of lymphocytes recovered by bronchoalveolar lavage (mean 66.3 (SD 19.2]. For all subjects carbon monoxide transfer factor (TLCO) and total lung capacity were negatively correlated with radiographic changes (r = -0.45 and -0.30; p less than 0.001 and less than 0.01 respectively). TLCO was also negatively correlated with radiographic change in group 2 (r = -0.59, p less than 0.005). The percentage of lavage lymphocytes was correlated with radiographic changes for all subjects (r = 0.36, p less than 0.001), but this correlation was not seen within groups. This study shows good correlation between radiographic abnormalities, pulmonary function changes and the cellular composition of bronchoalveolar lavage fluid. AU - Cormier Y AU - Belanger J AU - Tardif A LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 36 IP - DP - 1986 Jan 01 TI - Occupational asthma caused by nickel salts PG - 29-31 AU - Davies JE LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 77 IP - DP - 1986 Jan 01 TI - Respiratory dysfunction in farmers versus non-farming rural community control subjects PG - 136-139 AU - Dosman JA AU - Graham BL AU - Hall D AU - Loon P LA - PT - DEP - TA - Can J Publ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 41 IP - DP - 1986 Jan 01 TI - Respiratory and allergic disorders in workers exposed to grain and flour dust PG - 297-300 AU - el Karim MAA AU - el Rab MOG AU - Omer AAA AU - el Haimi YAA LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - IP - DP - 1986 Jan 01 TI - respiratory disability in ex-cotton workers PG - - AU - Elwood PC AU - Bevan C AU - Saunders MJ LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 8 IP - DP - 1986 Jan 01 TI - Occupational exposure to phthalic anhydride, study on respiratory impairment in a group of exposed workers PG - 57-64 AU - Moscato G AU - Gherson G AU - Salvaterra A AU - Vidi I LA - PT - DEP - TA - G Ital Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 69 IP - DP - 1986 Jan 01 TI - Late, but not early, asthmatic reactions induced by toluene-diisocyanate are associated with increased airway responsiveness to methacholine PG - 276-284 AU - Mapp CE AU - Di Giacomo GR AU - Omini C AU - Broseghini C AU - Fabbri LM LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 68 IP - DP - 1986 Jan 01 TI - Toluene diisocyanate-induced asthma without airway hyperresponsiveness PG - 89-95 AU - Mapp CE AU - Dal vecchio L AU - Boschetto P AU - De Marzo N AU - Fabbri LM LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 24 IP - DP - 1986 Jan 01 TI - A case of hypersensitivity pneumonitis caused by a humidifier PG - 1288-1291 AU - Mikasa K AU - Mikami R AU - Sawaki M AU - Ito S AU - Katada H AU - Kasuga H AU - Shioya N AU - Narita N LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 7 IP - DP - 1986 Jan 01 TI - Cigarette smoking and the antibody response to inhaled antigens PG - 98-98 AU - McSharry CP AU - Wilkinson PC LA - PT - DEP - TA - Immunol Today JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 69 IP - DP - 1986 Jan 01 TI - Respiratory disease in animal house workers PG - 29-35 AU - Lutsky II AU - Baum GI AU - Teichtahl H LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 66 IP - DP - 1986 Jan 01 TI - Acute symptoms following exposure to graindust in farming PG - 73-80 AU - Manfreda J AU - HolfordStevens V AU - Cheang M AU - Warren CPW LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 77 IP - DP - 1986 Jan 01 TI - Occupational asthma caused by cellulase PG - 635-639 AU - Losada E AU - Hinojosa M AU - Moneo I LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 9 IP - DP - 1986 Jan 01 TI - Respiratory disease in a photographer PG - 349-354 AU - Hodgson MJ AU - Parkinson DK LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 95 IP - DP - 1986 Jan 01 TI - Specific IgE antibodies to reactive dye-albumin conjugates PG - 177-186 AU - Luczynska CM AU - Topping MD LA - PT - DEP - TA - J Immunol Methods JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 66 IP - DP - 1986 Jan 01 TI - Prevalence of IGE antibodies to grain and grain dust in grain elevator workers PG - 149-153 AU - Lewis DM AU - Romeo PA AU - Olenchock SA LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 148 IP - DP - 1986 Jan 01 TI - The incidence of acute and chronic pulmonary disease in the tobacco industry PG - 1697-1700 AU - Lander F LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 43 IP - DP - 1986 Jan 01 TI - Respiratory diseases in hard metal workers: an occupational hygiene study in a factory PG - 474-485 AU - Kusaka Y AU - Yokoyama K AU - Sera Y AU - Yamamota S AU - Sone S AU - Kyono H AU - Shirakawa T AU - Goto S LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 43 IP - DP - 1986 Jan 01 TI - Effects of hard metal dust on ventilatory function PG - 486-489 AU - Kusaka Y AU - Ichikawa Y AU - Shirakawa T AU - Goto S LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 77 IP - DP - 1986 Jan 01 TI - Occupational asthma to honeybee-body dust in a honey processing plant PG - 736-740 AU - Ostrom NK AU - Swanson MC AU - Agerwal MK AU - Yunginger JW LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 127 IP - DP - 1986 Jan 01 TI - Bronchial hyperreactivity in occupational asthma- a longitudinal study PG - 819-821 AU - Orosz M AU - Nagy L AU - Galambos EE LA - PT - DEP - TA - Orovosi Hetilap JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 127 IP - DP - 1986 Jan 01 TI - Laboratory animal allergy PG - 1395-1397 AU - Orosz M AU - Nagy L AU - Galambos EE LA - PT - DEP - TA - Orovosi Hetilap JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 66 IP - DP - 1986 Jan 01 TI - In vitro and in vivo changes in human complement caused by silage PG - 91-96 AU - Olenchock SA AU - May JJ AU - Pratt DS LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 77 IP - DP - 1986 Jan 01 TI - Fusarium solani: prevalence of skin reactivity and antigenic analysis PG - 842-849 AU - O'Neil CE AU - McCants ML AU - Salvaggio JE AU - Lehrer SB LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 37 IP - DP - 1986 Jan 01 TI - Bronchial hyperractivity testing with methacholine in aluminium potroom workers PG - 301-309 AU - Ofner B AU - Marelja J LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 16 IP - DP - 1986 Jan 01 TI - IgE antibody-mediated reaction caused by topical application of chlorhexidine PG - 155-161 AB - IgE antibody-mediated reaction caused by topical application of chlorhexidine AU - Ohtoshi T AU - Yamauchi N AU - Tadokoro K AU - Miyachi S AU - Suzuki S AU - Miyamoto T AU - Muranaka M LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 77 IP - DP - 1986 Jan 01 TI - Use of haptenising ELISA to evaluate respiratory disease in a worker exposed to capacitor-coating powder PG - 597-603 AU - Paterson B AU - Grammer LC AU - Ekberg NL AU - Patterson R LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 8 IP - DP - 1986 Jan 01 TI - Cross sectional epidemiological study of symptoms and respiratory function in furniture manufacturers PG - 145-148 AU - Paggiaro PL AU - Vellutini M AU - Viegi G AU - Zoi D AU - di Pede F AU - Gregori G AU - Diviggiano E AU - di Pede C AU - Sbrana C AU - Pistelli G LA - PT - DEP - TA - G Ital Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 41 IP - DP - 1986 Jan 01 TI - Specific bronchial reactivity to TDI: relationship with baseline clinical findings PG - 279-282 AB - large series AU - Paggiaro PL AU - Innocenti A AU - Bacci E AU - Rossi O AU - Talini D LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 16 IP - DP - 1986 Jan 01 TI - Results of skin test and RAST in allergy to a clinically potent allergen (castor bean) PG - 259-266 AB - In order to investigate once more the usefulness of the RAST procedure in the diagnosis of reaginic hypersensitivity, we studied a series of patients showing a well known sensitivity to castor bean, which is a potent antigen, and compared the results with those given by patients with no clinical allergy to this antigen as confirmed by negative skin testing. The latter group included patients with no contact, a remote contact or a close contact with castor bean. Castor bean allergy seems to be a good model in the testing of human reaginic hypersensitivity. We observed in the castor bean positive group of forty-one patients a 95% correlation between RAST positivity and skin test positivity with only two negative RAST scores, and in the castor bean negative group of ninety-four patients, a 97% correlation, with three RAST positive scores. For its specificity and its good sensibility (although lesser than skin testing), RAST can thus be recommended as a diagnostic tool as a complement to skin testing. Moreover, for potent allergens, RAST offers a risk-free diagnostic alternative. AU - Panzani R AU - Johansson SGO LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 77 IP - DP - 1986 Jan 01 TI - A bronchial challenge test for cobalt in the diagnosis of asthma due to inhalation of hard metal dust PG - 538-546 AU - Pisati G AU - Bernabeo F AU - Cirla AM LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 292 IP - DP - 1986 Jan 01 TI - Occupational asthma due to methyl methacrylate in an orthopaedic theatre sister PG - 1362-1363 AU - Pickering CAC AU - Brainbridge D AU - Birtwhistle IH AU - Griffiths DL LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - * IP - DP - 1986 Jan 01 TI - Occupational allergic lung disease caused by organic agents PG - 1058-1062 AU - Pepys J LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 22 IP - DP - 1986 Jan 01 TI - Occupational asthma: investigations and aetiological factors PG - 399-425 AU - Pauli G AU - Bessot JC AU - DietemannMolard A LA - PT - DEP - TA - Bull Eupopean Physiopath Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 6 IP - DP - 1986 Jan 01 TI - Adrenoreceptor system in platinum induced asthma PG - 8-12 AU - Rapoport Z AU - Shestovitsky VA AU - Rogavaya OF AU - Rubanovitch VM LA - PT - DEP - TA - Gig Tr Prof Zabol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 8 IP - DP - 1986 Jan 01 TI - Clinical study on wheat flour induced respiratory disease PG - 69-73 AU - Rossi O AU - Bacci E AU - Dente F AU - Talini D AU - Ambrosino N AU - Paggiaro PL LA - PT - DEP - TA - G Ital Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - * IP - DP - 1986 Jan 01 TI - Prevention of occupational allergic diseases PG - 1053-1057 AU - Salvaggio JE AU - Butcher BT AU - O'Neil CE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 9 IP - DP - 1986 Jan 01 TI - The role of atopy in potroom workers' asthma PG - 239-242 AU - Saric M AU - GodnicCvar J AU - Gomzi M AU - Stilinovic L LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 9 IP - DP - 1986 Jan 01 TI - Bronchial hyperreactivity and occupational asthma PG - 217-219 AU - Saric M LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 37 IP - DP - 1986 Jan 01 TI - Asthma in aluminium electrolysis workers PG - 297-300 AU - Saric M LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 43 IP - DP - 1986 Jan 01 TI - IgE antibody responses to platinum group metals: a large scale refinery survey PG - 37-43 AB - All 306 South African platinum refinery workers (116 white, 190 coloured) accepted for employment on grounds of absence of evidence of atopy were investigated using the skin prick test and RAST to detect sensitivity to platinum, palladium, and rhodium salts. RAST studies were made for these, together with HSA and DNP-HSA RAST. Of the 306 workers, 38 had a positive skin prick test to the platinum halide salts; of these, one gave a positive reaction to the palladium salt and six to the rhodium salt. There were no isolated positives to the rhodium and palladium halide salts. Total IgE levels were raised in 24 of the 38 (63%) platinum salt prick test positive workers compared with only 43 of the 268 (16%) prick test negative group (p less than 0.001). Positive RASTs were obtained in 62% of those with positive skin tests to the platinum salts. Four of the six giving positive rhodium salt skin tests gave a positive RAST to rhodium salt. Of these, two gave positive RASTS to HSA and all four to DNP-HSA. The palladium salt RAST was negative in the single skin test reactor. In the platinum salt skin test positive group a raised HSA RAST was obtained in 10.5% compared with only 2.5% in the skin negative group. Twenty one per cent of the platinum salt skin positive group had a raised RAST score to DNP-HSA with only 3.5% (4/116) in the skin test negative group, of whom three also had a raised HSA RAST. The latter findings are suggestive of IgE antibody production to new antigenic determinants in HSA produced by conjugation with the platinum salts AU - Murdoch RD AU - Pepys J AU - Hughes EG LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 41 IP - DP - 1986 Jan 01 TI - Syaaniakrylaattiliima ja asthma PG - 834-836 AU - Poppius E AU - AnttiPolka M AU - Keskinen H LA - PT - DEP - TA - Suom Laakaril JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - ii IP - DP - 1986 Jan 01 TI - Benzalkonium chloride and bronchoconstriction PG - 1227-1227 AU - Beasley R AU - Rafferty P AU - Holgate S LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 28 IP - DP - 1986 Jan 01 TI - Upper respiratory irritation from controlled exposure to vapor from carbonless copy forms PG - 415-419 AB - Exposure to carbonless copy forms has been associated with subjective reports of respiratory and skin irritation, but objective measurements of human reactions to exposure are lacking. Thirty workers with complaints of prior sensitivity to the forms were given brief, controlled exposure to vapors from carbonless forms and from bond paper in random, single-blind fashion. Nasal impedance increased 34% after exposure to carbonless forms (P less than .025) and rose 8% after exposure to plain paper (P greater than .10). However, frequency of symptoms did not differ between the two exposure modes, and was not correlated with the nasal measurements. Quantitation of nasal congestion by this technique may be a sensitive measure of short-term reaction to inhalation of irritants AU - Morgan MS AU - Camp JE LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 11 IP - DP - 1986 Jan 01 PG - 99-107 AU - Gleeson MJ AU - Youlton LJF AU - Shelton DM AU - Siodlak MZ AU - Eiser NM AU - Wengraf CL LA - PT - DEP - TA - Clin Otolaryngol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 30 IP - DP - 1986 Jan 01 TI - The percutaneous absorption of triarylmethane and phenoxazine type colour former components of carbonless copy papers PG - 115-122 AU - Cameron BD AU - Dunsire JP AU - Draffan GH AU - Bruce JC LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 64 IP - DP - 1986 Jan 01 TI - Eye symptoms and signs in buildings with indoor climate problems PG - 306-311 AU - Franc C LA - PT - DEP - TA - Acta Ophthalmol (Copenh) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 12 IP - DP - 1986 Jan 01 TI - Human reactions to low concentrations of volatile organic compounds PG - 167-175 AU - Molhave L AU - Bach B AU - Pedersen OF LA - PT - DEP - TA - Environ Int JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - i IP - DP - 1986 Jan 01 TI - Outbreak of pulmonary tuberculosis in children PG - 1141-1143 AU - Bosley ARJ AU - George G AU - George M LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 12 IP - DP - 1986 Jan 01 TI - Ventilation requirements for the control of body odour in spaces occupied by women PG - 195-199 AU - BergMunch B AU - Clausen G AU - Fanger PO LA - PT - DEP - TA - Environ Int JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 1 IP - DP - 1986 Jan 01 TI - Statistical methods for assessing agreement between two methods of clinical measurement PG - 307-310 AU - Bland JM AU - Altman DG LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 97 IP - DP - 1986 Jan 01 TI - Outbreak of legionnaires' disease in Glasgow Royal Infirmery: micobiological aspects PG - 393-403 AU - Timbury MC AU - Donaldson JR AU - McCartney AC LA - PT - DEP - TA - J Hygiene (Cambridge) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 30 IP - DP - 1986 Jan 01 TI - Workplace exposure and reported health in New Zealand diagnostic radiographers PG - 281-286 AU - Spicer J AU - Hay DM AU - Gordon M LA - PT - DEP - TA - Australas Radiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - ii IP - DP - 1986 Jan 01 TI - Effect of rubbers and their constituents on proliferation of Legionella pneumophila in naturally contaminated hot water PG - 180-183 AU - Niedeveld CJ AU - Pet FM AU - Meenhorst PL LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 1 IP - DP - 1986 Jan 01 TI - First report of the committee of enquiry into the outbreak of legionnaires' disease in Stafford in April 1985 PG - - AU - Badenoch J LA - PT - DEP - TA - HMSO cmd 9772 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 77 IP - DP - 1986 Jan 01 TI - Respiratory symptoms and lung function in farmers: a cross-sectional study PG - 184-190 AU - Siracusa A AU - Pannelli F AU - Volpi R AU - Cresci A LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 133 IP - DP - 1986 Jan 01 TI - Different classes of antibody activities to Trichosporon cutaneum antigen in summer-type hypersensitivity pneumonitis by enzyme-linked immunosorbent assay PG - 83-87 AU - Soda K AU - Ando M AU - Shimazu K AU - Sakata T AU - Yoshida T AU - Akaki S LA - PT - DEP - TA - Am Rev Respir Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 77 IP - DP - 1986 Jan 01 TI - Respiratory allergy to laboratory fruit flies (Drosophila melanogaster) PG - 108-113 AU - Spieksma FTM AU - Vooren PH AU - Cramps JA AU - Dijkman JH LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 24 IP - DP - 1986 Jan 01 TI - A community survey and pathogenesis of occupational asthma in sawing and wood workers PG - 447-453 AU - Takahashi K AU - Maeda M AU - Matsumoto T AU - Tanabe K LA - PT - DEP - TA - Nippon Kyobu Shikkan Gakkai Zasshi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 78 IP - DP - 1986 Jan 01 TI - Immunologic response to aerosols of affinity-purified antigen in hypersensitivity pneumonitis PG - 411-416 AU - Stricker WE AU - Layton JE AU - Homburger HA AU - Katzmann JA AU - Swanson MC AU - Hyatt RE AU - Reed CE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 15 IP - DP - 1986 Jan 01 TI - Contact dermatitis and asthma from reactive dyes PG - 186-193 AU - Thoren K AU - Meding B AU - Nordlinder R AU - Belin L LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 41 IP - DP - 1986 Jan 01 TI - Symptoms and pulmonary function in Western Red Cedar workers related to duration of employment and dust exposure PG - 179-183 AU - Vedal S AU - ChanYeung M AU - Enarson D AU - Fera T AU - MacLean L AU - Tse KS AU - Langille R LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - * IP - DP - 1986 Jan 01 TI - Alveolitis after use of a leather impregnation spray PG - 727-728 AU - Wright GM LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 37 IP - DP - 1986 Jan 01 TI - Ventilatory capacity in workers processing food spices PG - 19-28 AU - Zuskin E AU - Skuric Z AU - Kanceljak B AU - Pokrajac D AU - Bradic V LA - PT - DEP - TA - Arh Hig Rada Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 32 IP - DP - 1986 Jan 01 TI - The effects of soldering fume under special conditions of the respiratory tract- survey of the literature PG - 521-524 AU - Wallenstein G AU - Werner L LA - PT - DEP - TA - Z Gesamte Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 43 IP - DP - 1986 Jan 01 TI - Respiratory effects of occupational exposure to tobacco dust PG - 802-808 AB - Few investigations of the respiratory effects of occupational exposure to tobacco dust have been carried out and the threshold limit value has not well been established. A cross sectional survey on a sample of 223 male and female workers at a cigar and cigarette factory in Lucca (Tuscany) showed a significantly higher prevalence of wheezing, attacks of shortness of breath with wheezing, dyspnoea, and rhinitis than in a reference population. A trend towards a decrease in forced end expiratory flows according to smoking habit and work duration was evident. Positive skin prick tests were observed in 26% of men and 23% of women and were positively associated with duration of work and negatively with cigarette smoking. Thin interstitial space involvement was observed on chest x ray examination in almost half the female workers with more than 35 years exposure. These findings suggest that prolonged exposure to tobacco dust may have negative health effects and that it is advisable to establish a threshold limit value for tobacco dust different from that of inert dust. AU - Viegi G AU - Paggiaro PL AU - Begliomini E AU - Vaghetti E AU - Paoletti P AU - Giuntini C LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 27 IP - DP - 1986 Jan 01 TI - Combined asthma and alveolitis from haydust exposure PG - 799-801 AU - Vogelmeier C AU - Baur X AU - Dewair M AU - Konig G AU - Fruhmann G LA - PT - DEP - TA - Internist JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 68 IP - DP - 1986 Jan 01 TI - Occupational lung fibrosis in an aluminium polisher PG - 131-140 AB - An aluminium polisher developed severe lung fibrosis complicated by bronchial carcinoma. Although he was not submitted to the exposure risks usually described in aluminium lung (bauxite smelting, use of aluminium powders, aluminium welding), he worked in a high concentration of aluminium dust. This was demonstrated by mineralogical analyses which revealed large amounts of small metallic aluminium particles (0.5 micron - 5 micron) in bronchoalveolar lavage, lung tissue and lymph nodes 5 years after the end of exposure. Aluminium polishing seems to be a potential cause of aluminium lung. AU - De Vuyst P AU - Dumortier P AU - Rickaert R AU - Van de Weyer R AU - Lenclud C AU - Yernault JC LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 1 IP - DP - 1986 Jan 01 TI - Occupational asthma caused by nickel and zinc PG - 259-262 AB - A 28-year-old man developed asthma 10 years after working in a metal-plating factory. Recordings of peak expiratory flow rates showed increased variations after exposure at work. Allergy prick skin tests elicited an immediate reaction with nickel sulfate at a concentration of 1 and 10 mg/ml, and with zinc sulfate at a concentration of 10 mg/ml. Inhalation challenges with nickel sulfate and zinc sulfate produced bronchial obstructions. Thus, we concluded that this was a case of asthma caused by nickel sulfate and zinc sulfate AU - Hong CS AU - Oh SE AU - Lee HC AU - Huh KB AU - Lee SY LA - PT - DEP - TA - Korean J Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 8 IP - DP - 1986 Jan 01 TI - Occupational asthma caused by glutaraldehyde exposure PG - 272-278 AU - Nicewicz JT AU - Murphy DMF AU - Welsh JP AU - Sirolli H LA - PT - DEP - TA - Immunology and Allergy Practice JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 40 IP - DP - 1986 Jan 01 TI - Changes in annual tuberculosis notification rates between 1978/79 and 1983 for the population of Indian subcontinent ethnic origin resident in England PG - 357-363 AB - In two national surveys of tuberculosis notifications in England conducted in 1978/79 and 1983 the estimated annual notification rates for the Indian subcontinent (Indian, Pakistani, and Bangladeshi) ethnic groups were considerably higher than the rate for the white ethnic group. The mean annual decline in rates between the surveys appeared to be greater for the Indian and the Pakistani and Bangladeshi ethnic groups, 15% and 16% respectively, than for the white ethnic group (7%). Data from two small sample population surveys, the National Dwelling and Housing Survey in 1978 and the Labour Force Survey in 1983, were used to calculate the rates. However, comparison of the estimates for the population of Indian subcontinent ethnic origin in England from these surveys revealed discrepancies between them. Additional information from the Labour Force Survey on the year of first entry to the United Kingdom (UK) permitted the calculation of new estimates for the 1978 population, and based on these estimates the annual notification rates for 1978/79 were 287 per 100,000 for the Indian and 286 per 100,000 for the Pakistani and Bangladeshi ethnic groups. The rates for 1983 were 178 and 169 respectively, and the mean annual decline between the surveys was 11% for the Indian and 12% for the Pakistani and Bangladeshi ethnic groups. There were important changes in the characteristics of the population of Indian subcontinent ethnic origin in England between 1978 and 1983, and therefore the rates for both surveys have been standardised by the method of direct standardisation to a common reference population.(ABSTRACT TRUNCATED AT 250 WORDS) AU - Nunn AJ AU - Darbyshire JH AU - Fox W AU - Johnson DA AU - Springett VH LA - PT - DEP - TA - Journal of Epidemiology & Community Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 67 IP - DP - 1986 Jan 01 TI - The diagnosis and management of tuberculosis in common hostel dwellers PG - 125-131 AB - Edinburgh hostel dwellers have been regularly screened for pulmonary tuberculosis since 1957. Sixty-eight cases were notified during the 7 years 1976-1982: 42 (65%) were detected by 4687 hostel survey X-rays, and a further 26 presented with symptoms. Disease was more advanced in the symptomatic hostellers both by radiological and bacteriological criteria with twice as many being sputum smear positive (58% vs. 26%). Full clinical details were available for 65 of the 68. Four were diagnosed at post mortem examination and two had chemotherapy stopped because the disease was considered inactive. Of the remaining 59 eligible for treatment, 47 (80%) received a complete course of adequate chemotherapy; 16 as hospital in-patients, 26 first in hospital and then under out-patient supervision and five simply as supervised out-patients; none relapsed. Twelve (20%) of the 59 defaulted from supervision after a mean follow-up period of 2.4 months AU - Capewell S AU - France AJ AU - Anderson M AU - Leitch AG LA - PT - DEP - TA - Tubercle JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 8 IP - DP - 1986 Jan 01 TI - An outbreak of tuberculosis in a children's hospital PG - 129-142 AB - A 3-year-old girl was admitted to a children's hospital; subsequently her mother was found to have pulmonary tuberculosis with smear-positive sputum. Of over 400 patients, their families and staff at risk in the hospital, 30 inpatients, three outpatients, two sibling visitors and one staff member became infected. A retrospective cohort study of exposed inpatients identified exposure duration, exposure proximity and primary diagnosis as independent predictors of infection risk. Children with neoplastic disease who were being treated with cytotoxic and immunosuppressive therapy with clotting factors were at a greater risk of developing clinical disease including disseminated infection. Altogether three generations of infected children and adults were diagnosed amongst community and hospital contacts in this extended outbreak. These findings support current recommendations for the follow-up of highly susceptible casual contacts of cases of pulmonary tuberculosis with smear-positive sputa AU - George RH AU - Gully PR AU - Gill ON AU - Innes JA AU - Bakhshi SS AU - Connolly M LA - PT - DEP - TA - J Hosp Infect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 133 IP - DP - 1986 Jan 01 TI - Tuberculosis in physicians: a continuing problem PG - 773-778 AB - We evaluated the occurrence of active tuberculosis in 4,575 physicians who graduated between 1938 and 1981 from the same medical school. There were 66 cases. Fifteen (23%) cases were detected after 1970 including 4 diagnosed in 1981. For most years, the incidence of tuberculosis was higher in physicians than in the general population. Forty-eight (73%) patients were between 25 and 34 yr of age at the time of diagnosis. Two thirds of all cases occurred within 6 yr of graduation, even in graduates since 1970. The risk of tuberculosis was 140 per 100,000 persons-years within 6 yr of graduation. Sixty-three percent of initially tuberculin-negative medical students who subsequently had active tuberculosis converted their tuberculin reaction during medical school or clinical training. Recipients of BCG vaccine had 40% less tuberculosis than unimmunized, initially tuberculin-negative, physicians. Health authorities should be cognizant of the continuing risk of tuberculosis in medical students and physicians AU - Geiseler PJ AU - Nelson KE AU - Crispen RG AU - Moses VK LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 134 IP - DP - 1986 Jan 01 TI - Delayed tuberculin boosting in the older population [editorial] PG - 857-858 AU - Cauthen GM AU - Snider DE Jr LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 30 IP - DP - 1986 Jan 01 TI - A new personal sampler for airbourne total dust in workplaces PG - 89-102 AU - Mark D AU - Vincent JH LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 77 IP - DP - 1986 Jan 01 TI - Delayed anaphylactoid reaction in a worker exposed to chromium PG - 451-456 AU - Moller DR AU - Brooks SM AU - Bernstein DI AU - Cassedy K AU - Enrione M AU - Bernstein IL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 49 IP - DP - 1986 Jan 01 TI - Effect of ketotifen on the bronchodilating action of aminophylline PG - 296-299 AB - The use of methyl xanthine derivatives for the treatment of bronchospasm is limited by unwanted side-effects which are frequently dose related. Potentiation of the bronchodilating effects of these derivatives would therefore have obvious clinical advantages. This paper reports the results of a trial designed to elucidate whether potentiation occurs between aminophylline and ketotifen AU - Hendy MS AU - Burge PS AU - Stableforth DE LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 1 IP - DP - 1986 Jan 01 TI - Limitations of simple spirometry [letter] PG - 676-676 AU - Gove RI AU - Burge PS AU - Robertson AS LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 146 IP - DP - 1986 Jan 01 TI - A double-blind comparison of oral prednisolone 40 mg/day with inhaled beclomethasone dipropionate 1500 ug/day in patients with adult onset chronic obstructive airways disease PG - 565-569 AB - A double-blind cross-over trial was carried out on 83 sequential out-patients presenting with adult onset chronic airflow obstruction who were not clearly asthmatic. The study consisted of three treatment phases each lasting two weeks with a two week interval between each phase. The treatment phases were prednisolone 40 mg daily, beclomethasone dipropionate 500 ug three times a day and placebo, administered in a random order. FEV1 and FVC were measured at the end of each of the treatment phases and peak expiratory flow rate five times a day throughout. Over the study period 25 (30%) patients responded with an improvement of greater than or equal to 20% in at least one of the parameters measured as compared with the best of either baseline or placebo measurements. A further eight patients were classified as partial responders with an improvement of greater than 15% in any single parameter or greater than 10% in any two parameters. A similar number responded to beclomethasone [15] as responded to prednisolone [16]. Only six patients, however, responded fully to both forms of steroid therapy. A number of patients responded to one form of steroid treatment only which was also comparable between the two groups (prednisolone 10, beclomethasone 9). For full and partial responders mean improvement in FEV1, FVC and PEFR was greater during the prednisolone phase than during the beclomethasone phase, however, the difference did not achieve statistical significance AU - Robertson AS AU - Gove RI AU - Wieland GA AU - Burge PS LA - PT - DEP - TA - European Journal of Respiratory Diseases - Supplem JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 38 IP - DP - 1986 Jan 01 TI - Asthma, humidifiers and 'office worker's lung' PG - 82-85 AU - Burge PS AU - Robertson A LA - PT - DEP - TA - Occup Health (Lond) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 38 IP - DP - 1986 Jan 01 TI - Building sickness--all in the mind? PG - 78-81 AU - Robertson A AU - Burge PS LA - PT - DEP - TA - Occup Health (Lond) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 20 IP - DP - 1986 Jan 01 TI - Airborne outbreak of trichothecene toxicosis PG - 549-552 AU - Croft WA AU - Jarvis BB AU - Yatawara CS LA - PT - DEP - TA - Atmos Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 134 IP - DP - 1986 Jan 01 TI - Factors associated with the change in ventilatory function and the development of chronic obstructive pulmonary disease in a 13-year follow-up of the Cracow Study. Risk of chronic obstructive pulmonary disease PG - 1011-1019 AB - In a longitudinal, epidemiologic study, we investigated the relation of a number of factors to the loss of ventilatory lung function over time and to the incidence of chronic obstructive pulmonary disease (COPD). Data on 759 men and 1,065 women 19 to 70 yr of age examined twice during a 13-yr period were analyzed. The decline rate in FEV1 was related to age and was greater in persons with lower FEV1 values and in taller persons. The clear relation to smoking was confirmed. Occupational exposure to dusts in men and to variable temperatures in women significantly increased the FEV1 decline rate. In men in blood group A, the loss of FEV1 was smaller than in men in the other blood groups. In women who had had 4 or more children, we observed a faster decline in FEV1. In the analysis of COPD incidence, we confirmed that age, baseline FEV1 value, and, in men, smoking habit are the most important predictors of disease. Among women, also, attacks of breathlessness were demonstrated to increase disease risk twofold (p less than 0.10), even after adjustment for other factors in the logistic regression model. We estimated the index of risk for COPD and predicted 63% of male and 67% of female cases in the top 20% of risk distribution AU - Krzyzanowski M AU - Jedrychowski W AU - Wysocki M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 12 IP - DP - 1986 Jan 01 TI - Immunoglobulin E antibodies against a reactive dye - a case report PG - 221-222 AU - Hagmar L AU - Welinder H AU - Dahlquist I LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 41 IP - DP - 1986 Jan 01 TI - Physiological evidence that emphysema is not a feature of byssinosis PG - 6-11 AB - A group of women with byssinosis of grades 2 and 3 were seen consecutively over three years in an occupational outpatient clinic. Detailed lung function tests were performed and the results for smokers and non-smokers compared. One hundred and fifty three patients were seen and 50 of these were life time non-smokers, 35 smoked one to nine cigarettes a day, and 68 smoked 10 or more cigarettes a day. After correction for age the mean FEV1 was found to be significantly lower (p less than 0.01) in heavy smokers than in non-smokers. In a subgroup of 89 subjects who were able to perform the carbon monoxide gas transfer test significantly lower values were obtained for the carbon monoxide transfer factor (TLCO), (p less than 0.001), TLCO % predicted (p less than 0.001), and the transfer coefficient (KCO) (p less than 0.001) in the heavy smokers than in the non-smokers, despite the fact that the non-smokers had worked longer in the cotton mills (p less than 0.02). The mean TLCO was significantly lower than predicted in the heavy smokers (p less than 0.001) but not in the non-smokers. A significant negative correlation was found between the number of cigarettes smoked per day and the TLCO (p less than 0.01), TLCO % predicted (p less than 0.001), and KCO (p = 0.005), but not with the number of years spent in the carding area. These results provide evidence supporting recent pathological observations that emphysema is probably due to concomitant cigarette smoking and is not itself a feature of byssinosis AU - Honeybourne D AU - Pickering CAC LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19860101 IS - IS - VI - 80 IP - DP - 1986 Jan 01 TI - Enhancement of antibody production by mercury and platinum group metal halide salts. Kinetics of total and ovalbumin-specific IgE synthesis PG - 405-411 AB - The effects of halide salts of mercury, platinum and palladium on the synthesis of total and specific serum IgE and of total IgG were studied in groups of Hooded Lister rats immunised with antigen (ovalbumin) in the presence and absence of an adjuvant (Bordetella pertussis vaccine or aluminium hydroxide). Repeated intraperitoneal injections of mercuric chloride alone rapidly enhanced total IgE levels in control rats, independent of adjuvant. Injections of the platinum salt, however, elevated total IgE levels more slowly and then only in the B. pertussis-treated group. The halide salt of palladium was ineffective. In rats immunised with antigen and adjuvant, mercury treatment rapidly produced enhancement of the titre-specific IgE antibodies, whereas treatment with platinum again raised these levels more slowly. The palladium salt had no such effect AU - Murdoch RD AU - Pepys J LA - PT - DEP - TA - Int Archs Allergy Appl Immun JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 77 IP - DP - 1985 Jan 01 TI - Cross reactivity studies with platinum group metal salts in platinum-sensitised rats PG - 456-458 AB - Hooded Lister rats were sensitised to the halide salt of platinum ammonium tetrachloroplatinate(II)[(NH4)2PtCl4] in its conjugated form with ovalbumin. Sensitisation was achieved by intraperitoneal injection with Bordetella pertussis vaccine as adjuvant, followed 21 days later by a further injection in saline. The presence of specific anti-platinum IgE antibody was determined by passive cutaneous anaphylaxis (PCA) and radioallergosorbent test (RAST) using the platinum halide salt conjugated to a heterologous carrier. Sera exhibiting positive reactions were pooled and PCA tests performed on the titrated pooled sera with 3 conjugated platinum group metal salts, 5 platinum group metals in their free salt form and 6 platinum salts with differing ligands. PCA challenges with these compounds resulted in significant cross reactivity between ammonium tetrachloroplatinate(II), ammonium hexachloroplatinate(IV) and the conjugated tetrachloroplatinate. There was very limited cross reactivity with other platinum or platinum group metal salts in either free or conjugated forms. Furthermore, these results were confirmed by RAST inhibition studies AU - Murdoch RD AU - Pepys J LA - PT - DEP - TA - Int Archs Allergy Appl Immun JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 133 IP - DP - 1985 Jan 01 TI - Grain dust and respiratory health PG - 969-973 AB - Exposure to grain dust gives rise to many respiratory problems. Since the growing, transporting and processing of grain are major Canadian industries, the number of individuals who might be affected by such exposure is sizeable. This paper describes clinical syndromes related to grain dust exposure, together with predisposing host factors, in an attempt to determine what levels of exposure are "safe" for workers and what areas still require extensive research AU - ChanYeung M AU - Enarson D AU - Grzybowski S LA - PT - DEP - TA - Can Med Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 87 IP - DP - 1985 Jan 01 TI - Predictors of bronchial hyperexcitability in grainhandlers PG - 452-455 AB - We have studied bronchial hyperexcitability to methacholine (defined as a fall of at least 20 percent in FEV1 at 8 mg/ml or lower) in 504 white male grainhandlers working in terminal elevators in the Port of Vancouver. There was a significant association between bronchial hyperexcitability and level of FEV1; for a 10 percent decrease in percent of predicted FEV1, bronchial hyperexcitability was twice as common. Among those with bronchial hyperexcitability, the PC20 was significantly related to the FEV1. Grainhandlers with immediate skin reactivity to common allergens were twice as likely to have bronchial hyperexcitability. There was a significant increase in the prevalence of bronchial hyperexcitability with increasing duration of employment. Grainhandlers with chest tightness and breathlessness were over twice as likely to have bronchial hyperexcitability. We did not observe an increased prevalence of bronchial hyperexcitability in smokers, and there was no difference between age groups. We conclude that the determinants of bronchial hyperexcitability in this population include baseline FEV1, immediate skin reactivity to common allergens, some respiratory symptoms, and cumulative exposure to grain dust AU - Enarson DA AU - ChanYeung M AU - Tabona M AU - Kus J AU - Vedal S AU - Lam S LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - A study of serum antibody activity in workers with occupational exposure to diphenylmethane diisocyanate PG - 314-320 AB - The prevalence of sensitization was studied in a group of 76 foundry workers with occupational exposure to diphenylmethane diisocyanate (MDI). Ten workers had clinical evidence of asthma, 40 had non-asthmatic respiratory symptoms, and 26 were asymptomatic. Specific IgE antibodies to MDI were found in two workers (2.6%) and specific IgG antibodies, in five workers (6.6%). The prevalence of IgE and IgG antibodies was higher in the 10 subjects with asthma than in the non-asthmatic group. The prevalence of anti-paratolyl-monoisocyanate antibodies was not significantly different from that of anti-MDI antibodies, and both haptenic determinants displayed a high degree of cross-reactivity in the RAST inhibition test. The role of humoral immunological mechanisms in MDI-induced asthma is unclear in view of the rather low prevalence of these serum antibodies in this group of workers AU - Tse KS AU - Johnson A AU - Chan H AU - ChanYeung M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 132 IP - DP - 1985 Jan 01 TI - Rapid decline in FEV1 in grain handlers. Relation to level of dust exposure PG - 814-817 AB - We have prospectively studied the respiratory health of a cohort of grain elevator workers in the Canadian west coast terminal elevators, beginning in 1975 and following them for 6 yr. We have used a "nested" case-control model to identify determinants of the worst trend in FEV1 over this period. The 10% of participants in this category had a mean decline of greater than 100 ml/yr. They were significantly more likely to have had a decline in FEV1 over a work week and to have nonspecific bronchial hyperreactivity. There was a significant relationship between the odds ratio of being a case and the mean level of dust exposure associated with the job and location at the work site; cases were associated with mean total dust levels greater than 5 mg/m3. We found no relationship between the odds ratio of being a case and a number of host factors, such as immediate skin reactivity to common allergens, history of asthma, bronchitis, or hay fever, or presence of respiratory symptoms. We conclude that exposure to grain dust at levels greater than 5 mg/m3 is associated with a serious adverse trend in FEV1 AU - Enarson DA AU - Vedal S AU - ChanYeung M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - Immediate skin reactivity and its relationship to age, sex, smoking, and occupational exposure PG - 53-57 AB - To evaluate potential predictors of atopy, 3353 workers from various occupations were classified according to airborne exposures into three groups: (1) 1213 control workers with no measurable exposures, (2) 815 workers with gas and fume exposure, and (3) 1325 workers with organic dust exposure. Atopic status was determined by prick skin testing with common allergens. Workers exposed to organic dusts had a lower prevalence of skin test reactivity than either controls or gas- and fume-exposed workers. Skin test reactivity also decreased with age and was higher in nonwhite workers compared to white workers. No difference in skin test reactivity was seen between female and male workers, nor between smoking and nonsmoking workers. A logistic regression analysis that controlled for the correlation between the predictive factors confirmed the results of the crude analyses. It is suggested that atopic workers exposed to organic dusts might selectively leave the industry AU - ChanYeung M AU - Vedal S AU - Lam S AU - Enarson D LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - Occupational asthma due to methyl methacrylate and cyanoacrylates PG - 836-839 AB - Five patients had asthma provoked by cyanoacrylates and one by methyl methacrylate, possibly because of the development of a specific hypersensitivity response. Acrylates have wide domestic as well as industrial uses, and inhalation of vapour emitted during their use can cause asthma AU - Lozewicz S AU - Davison AG AU - Hopkirk A AU - Burge PS AU - Boldy DA AU - Riordan JF AU - McGivern DV AU - Platts BW AU - Davies D AU - Newman Taylor AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 25 IP - DP - 1985 Jan 01 TI - Hemangiosarcoma of the liver in workers of the PVC industry and other VC-induced diseases with angiologic-dermatologic, hepatologic, radiologic and neurologic symptoms. [German] PG - 22-29 AB - Occupational diseases resulting from exposure to vinyl chloride (VC) include angiosarcoma of the liver and other neoplasms. Among workers exposed to VC we have found capillary abnormalities in the extremities, with scleroderma and Raynaud syndrome, acro-osteolysis, neurological and psychiatric diseases and chromosome abnormalities, as well as abnormal liver metabolism and haematological findings AU - Halama J AU - BeckerStone S AU - Halama JM LA - PT - DEP - TA - Radiologe JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 291 IP - DP - 1985 Jan 01 TI - Comparison of health problems related to work and environmental measurements in two office buildings with different ventilation systems PG - 373-376 AB - A cross sectional survey investigating "building sickness" was carried out in two buildings with similar populations of office workers but differing ventilation systems, one being fully air conditioned with humidification and the other naturally ventilated. The prevalence of symptoms related to work was assessed by a questionnaire administered by a doctor. A stratified, randomly selected sample of workers was seen (84% response). Building sickness includes several distinct syndromes related to work, most of which were significantly more common in the air conditioned building than the naturally ventilated building--namely, rhinitis (28% v 5%), nasal blockage and dry throat (35% v 9%), lethargy (36% v 13%), and headache (31% v 15%). The prevalence of work related asthma and humidifier fever was low and did not differ significantly between the two buildings. An environmental assessment of the offices was performed to attempt to identify possible factors responsible for the differences in the prevalence of disease. Globe temperature, dry bulb temperature, relative humidity, moisture content, air velocity, positive and negative ions, and carbon monoxide, ozone, and formaldehyde concentrations were all measured. None of these factors differed between the buildings, suggesting that building sickness is caused by other factors AU - Robertson AS AU - Burge PS AU - Hedge A AU - Sims J AU - Gill FS AU - Finnegan M AU - Pickering CAC AU - Dalton G LA - PT - DEP - TA - Br Med J (Clin Res Ed) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 35 IP - DP - 1985 Jan 01 TI - Occupational asthma in a fibre glass works PG - 121-127 AB - Seven cases of work related asthma occurring in a continuous filament glass fibre plant are described. All but one had no past history of asthma. Bronchial challenge testing with several agents has failed to identify the cause. The work related rhinitis complained of by 20 per cent of the workforce appears to be due to airborne glass fibre fly, since this symptom was reproduced by challenge with fly. Occupational asthma in association with continuous filament glass fibre production has not previously been reported AU - Finnegan MJ AU - Pickering CAC AU - Burge PS AU - Goffe TR AU - Austwick PK AU - Davies PS LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 20 IP - DP - 1985 Jan 01 TI - Bronchial and cardiovascular responses to inhaled reproterol in asthmatics: a double-blind placebo controlled dose-response study PG - 349-353 AB - Reproterol is a synthetic selective beta-adrenoceptor agonist with a xanthine side chain. The bronchial and cardiovascular responses to inhaled reproterol were studied in 14 asthmatics. The study was placebo controlled and double-blind, comparing doubling doses of reproterol from 500 micrograms-8 mg. The peak improvement in FEV1 showed a non-linear dose-response, with an initial plateau at the 1 mg dose producing a mean increase in FEV1 of 17%, but significant further improvement at the 8 mg dose, producing a mean improvement of 29% in FEV1. The time taken for improvement in airways obstruction to start shortened with increasing doses. The duration of bronchodilation was dose-dependent, with the 8 mg dose showing a significantly longer duration of action than the lower doses. The time to drop below 75% of the maximum achieved bronchodilation was 125 min, and was independent of the dose. There were no significant changes in pulse or blood pressure at any dose. The study shows that reproterol is a well tolerated selective beta 2-adrenoceptor agonist whose duration of action and peak effect can be significantly increased by increasing the dose to 8 mg, without producing more unwanted effects AU - Patchett P AU - Patchett SM AU - Burge PS LA - PT - DEP - TA - Br J Clin Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 7 IP - DP - 1985 Jan 01 TI - The effects of naloxone infusion and stellate ganglion blockade on hot flushes in the human male PG - 169-174 AB - A 77-yr-old man presented with severe episodes of hypotension, flushing and sweating starting immediately after infarcting his only remaining functioning testis. The attacks were shown to be mediated by the cervical sympathetic chain, the reaction on the face and neck being abolished by a stellate ganglion block. The severity and frequency of sweating was also considerably reduced with naloxone as may be seen in female climacteric flushing. Injection of testosterone significantly reduced the frequency and severity of the attacks, which were unaltered by oestrogen treatment AU - Hendy MS AU - Cockrill B AU - Burge PS LA - PT - DEP - TA - Maturitas JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - Occupational asthma in a factory with a contaminated humidifier PG - 248-254 AB - Thirty five printers who had work related wheeze, chest tightness, or breathlessness kept two hourly records of their peak expiratory flow for at least two weeks. They all worked in a factory supplied by air from contaminated humidifiers. The peak flow records showed consistent work related deterioration in 15 workers, nine of whom had a diurnal variation in peak flow exceeding 20%. Ten workers kept further records after the humidifiers had been cleaned, other work practices remaining unchanged. There was substantial improvement in all 10 workers, implying that material from the contaminated humidifier was the cause of the work related changes in peak flow. The patterns of work related changes in peak flow fell into four groups: falls maximal on the first work day, falls maximal midweek, falls equivalent each work day, and falls progressive throughout the working week. Three quarters of this last group had immediate prick test responses to humidifier antigen, which were negative in all the others with work related changes in peak flow. This suggests that the progressive daily deterioration pattern alone is due to an IgE mediated response to humidifier antigens. A large range of microorganisms was identified in the humidifiers. No single microorganism appeared to be the antigen responsible for the precipitating antibody seen in 75% of the study population AU - Burge PS AU - Finnegan M AU - Horsfield N AU - Emery D AU - Austwick P AU - Davies PS AU - Pickering CAC LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 42 IP - DP - 1985 Jan 01 TI - Occupational asthma due to an emulsified oil mist PG - 51-54 AB - A toolsetter developed occupational asthma due to the oil mist generated by his lathe on which it was used as a coolant. The diagnosis was confirmed by serial measurements of peak expiratory flow at home and work, including a prolonged period away from work. Occupational type bronchial provocation tests were performed using the whole emulsified oil and its components separately. He reacted specifically to the whole emulsified oil and to the reodorant, a pine oil preparation. He also reacted to colophony, a constituent of the emulsifier AU - Hendy MS AU - Beattie BE AU - Burge PS LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - IP - DP - 1985 Jan 01 TI - National survey of notifications in England and Wales 1983 PG - 658-661 AU - Medical Research Council LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - EH14 IP - DP - 1985 Jan 01 TI - Reference method for monitoring and evaluating airborne man-made mineral fibres PG - - AU - WHO/EURO Technical Committe for monitoring and evaluating airborne MMMF LA - PT - DEP - TA - WHO Environmental Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - IP - DP - 1985 Jan 01 TI - Particle size selective sampling in the workplace PG - - AU - ACGIH LA - PT - DEP - TA - Report of the ACGIH technical committee on air sam JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 78 IP - DP - 1985 Jan 01 TI - Risk of tuberculous infection among house staff in an urban teaching hospital PG - 1061-1064 AB - Physicians in training in our medical center were found to have a higher risk of tuberculous infection than other hospital employees. Their annual tuberculin conversion rate was 3.96%; in two of the 15 recent converters, active disease developed. There is a significant linear relationship between the acquisition of tuberculous infection and the duration of training in an urban teaching hospital. Their compliance rate to annual tuberculin testing and chemoprophylaxis is less than 50% AU - Chan JC AU - Tabak JI LA - PT - DEP - TA - Southern Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 79 IP - DP - 1985 Jan 01 TI - Pulmonary tuberculosis in residents of lodging houses, night shelters and common hostels in Glasgow: a 5-year prospective survey PG - 60-66 AB - Despite a high prevalence of pulmonary tuberculosis in the vagrant population in large cities, this group is reluctant to accept chest radiograph screening and outpatient chemotherapy. In order to improve the response rate, inducements were given for chest radiographic examinations between 1978 and 1982 to residents in lodging houses, night shelters, common hostels in Glasgow. The response rate improved and 133 cases of active pulmonary tuberculosis were found. Of these, 63% had positive sputum for Mycobacterium tuberculosis. The clinical details were available in 105 cases; 40 residents completed adequate chemotherapy and there were 15 deaths. Six deaths could be attributed directly or indirectly to pulmonary tuberculosis. Procedures for case tracing should be improved if this reservoir of pulmonary tuberculosis is to be reduced AU - Patel KR LA - PT - DEP - TA - Br J Dis Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 132 IP - DP - 1985 Jan 01 TI - Tuberculosis in female nurses in British Columbia: implications for control programs PG - 137-140 AB - All 57 cases of active tuberculosis in women in nursing and related assisting occupations (henceforth called nurses) notified in British Columbia between 1969 and 1979 were reviewed. This represented a mean annual incidence of active tuberculosis of 2.6/10 000, similar to that in other women, adjusted for age and birthplace. The rate varied according to birthplace: among nurses born in Canada the rate was 2.0, almost twice that of other women born in Canada, and among those born in Asia it was 24.8, less than half that of other women born in Asia. The nurses born in Canada who had received BCG (bacille Calmette-Guerin) during their training were least likely to contract tuberculosis, the incidence rate being comparable to that among other women. Those whose results of tuberculin testing were negative but who were not vaccinated were twice as likely to contract tuberculosis, whereas those whose results were positive at the start of training were four times as likely to contract tuberculosis. The feasibility and implications of a tuberculosis screening and surveillance program are discussed AU - Burrill D AU - Enarson DA AU - Allen EA AU - Grzybowski S LA - PT - DEP - TA - Can Med Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 1 IP - DP - 1985 Jan 01 TI - Tuberculosis outbreak among Rastafarians in Birmingham PG - 627-628 AU - Packe GE AU - Patchett PA AU - Innes JA LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 13 IP - DP - 1985 Jan 01 TI - Infections and infection risk in residents of long-term care facilities: a review of the literature, 1970-1984. [Review] PG - 63-77 AB - We reviewed the English-language peer-reviewed journals and the Centers for Disease Control's Morbidity and Mortality Weekly Reports between 1970 and 1984 presenting information about infections and infection risk in residents of long-term care facilities. More than 50 articles met review criteria. Approximately one third of the articles were reports of outbreaks, primarily of respiratory and gastrointestinal infections. Seven articles reported rates for several infection sites, but most rates were not directly comparable to one another because numerators and/or denominators were different. Many of the studies have been done in Veterans Administration hospitals with largely male populations, which may limit their applicability to freestanding long-term care facilities with largely female clients. This review establishes the need for high-quality observational studies of infections in long-term care facilities. Such studies are needed before intervention studies can be done to measure the effect of manipulation of risk factors on infection outcome. AU - Jackson MM AU - Fierer J LA - PT - DEP - TA - American Journal of Infection Control JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 8 IP - DP - 1985 Jan 01 TI - Acute toxicity and primary irritancy of 2-amino-3,5-dicyano-4-o-chlorophenyl-6-ethoxypyridine PG - 171-182 AB - 2-Amino-3,5-dicyano-4-o-chlorophenyl-6-ethoxypyridine (ACCPE) is a water soluble compound formed during the alkaline treatment of the alcoholic liquor in the production of 2-chlorobenzylidene malononitrile (CS). The acute toxicity and primary irritancy of ACCPE and CS were investigated and compared. Both perorally and intravenously, ACCPE was significantly less acutely toxic than CS. Also, whilst CS was a moderate dermal and eye irritant, ACCPE was not a primary skin irritant and only marginally irritating to the eye. ACCPE presents a significantly lower acute handling hazard than does CS AU - Ballantyne B LA - PT - DEP - TA - Drug & Chemical Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 131 IP - DP - 1985 Jan 01 TI - Effect of cigarette smoking on the pulmonary function of children and adolescents PG - 752-759 AB - The effect of personal cigarette smoking on the growth of lung function in children and adolescents has been assessed in a longitudinal study of a group of 669 subjects 5 to 19 yr of age at initial examination. Subjects were seen annually and assessed with standard questionnaires and measurements of forced expiratory volume in one second (FEV1) and forced expiratory flow during the middle half of the forced vital capacity (FEF25-75). Multiple regression analysis revealed that after correction for previous FEV1 or FEF25-75, age, sex, height, change in height, interactions of age and change in height, and sex and height, and mother's smoking, the personal smoking by the children led to a significant decrease in the rate of growth of FEV1 (p less than 0.001) and FEF25-75 (p = 0.033). On the basis of this analysis, it is estimated that, on average, children who begin to smoke at 15 yr of age and continue to smoke would achieve only 92% (95% confidence limit, 87 to 96%) of their expected FEV1 and 90% (95% confidence limit, 81 to 99%), of their expected FEF25-75 at 20 yr of age. These data suggest that relatively small amounts of cigarette use (median total consumption of 7,300 cigarettes in this study) by adolescents can lead to significant effects on the growth of lung function AU - Tager IB AU - Munoz A AU - Rosner B AU - Weiss ST AU - Carey V AU - Speizer FE LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 76 IP - DP - 1985 Jan 01 TI - Occupational allergy to the common house fly. (Musca domestica): use of immunologic response to identify atmospheric allergen PG - 826-831 AB - A 48-year-old scientific worker developed rhinitis that occurred when she entered the housefly (Musca domestica) rearing room where she worked. She was found to have specific IgE antibody to M. domestica in her serum by RAST. She was relocated at work and avoided further occupational exposure to M. domestica. The level of specific IgE decreased in serial samples but subsequently increased after her inadvertent reexposure at work. Extracts of fly-cage dust and of high volume atmospheric samples from the fly-rearing room inhibited the M. domestica RAST in a dose-dependent fashion. After logit transformation the lines of inhibition of the fly cage dust and of the atmospheric samples were parallel and steeper than the self-inhibition by M. domestica, implying the cage dust and atmospheric samples shared antigens not present in the M. domestica extract. This method of monitoring atmospheric antigen has considerable potential for evaluating the effectiveness of environmental change in the workplace AU - Tee RD AU - Gordon DJ AU - Lacey J AU - Nunn AJ AU - Brown M AU - Newman Taylor AJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 76 IP - DP - 1985 Jan 01 TI - Shrimp-meal asthma in the aquaculture industry PG - 471-475 AB - Technician in a research farm producing fish food developed artemia related rhinitis and asthma in shrimpmeal for aquaculture AU - Carino M AU - Elia G AU - Molinini R AU - Nuzzaco A AU - Ambrosi L LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 76 IP - DP - 1985 Jan 01 TI - A comparison of the binding of IgE in the sera of patients with bakers' asthma to soluble and insoluble wheat-grain proteins PG - 23-28 AU - Walsh BJ AU - Wrigley CW AU - Musk AW AU - Baldo BA LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 15 IP - DP - 1985 Jan 01 TI - Allergy to guinea pigs: 1. Allergenic activities of extracts derived from the pelt,saliva, urine and other sources PG - 241-251 AU - Walls AF AU - Newman Taylor AJ AU - Longbottom JL LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 15 IP - DP - 1985 Jan 01 TI - Allergy to guinea pigs: II Identification of specific allergens in guinea pig dust by crossed radio-immunophoresis and investigation of the possible origin PG - 535-546 AU - Walls AF AU - Newman Taylor AJ AU - Longbottom JL LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 66 IP - DP - 1985 Jan 01 TI - Occupational lung disease following long-term inhalation of pancreatic extracts PG - 13-20 AU - Wiessmann KJ AU - Baur X LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 35 IP - DP - 1985 Jan 01 TI - Cross-sectional study of respiratory effects of arc welding PG - 79-84 AU - Zober A AU - Weltle D LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 115 IP - DP - 1985 Jan 01 TI - Das sogenannte 'Wildseiden' asthma eine noch immer aktuelle inhalationsallergie auf seidenabfalle PG - 1387-1388 AU - Wuthrich B AU - Dietschii R AU - Keter A AU - ZorteaCaflisch C LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 131 IP - DP - 1985 Jan 01 TI - A respiratory epidemiologic survey of grain mill workers in Cape Town, South Africa PG - 505-510 AU - Yach D AU - Myers J AU - Bradshaw D AU - Benatar SR LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 76 IP - DP - 1985 Jan 01 TI - Immunoglobin E antibodies against coriander and other spices PG - 477-481 AU - van Toorenbergen AW AU - Dieges PH LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 15 IP - DP - 1985 Jan 01 TI - Storage mite allergy is common in a farming population PG - 555-564 AU - van HageHamsten M AU - Johansson SGO AU - Hoglund S AU - Tull P AU - Wiren A AU - Zetterstrom O LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 87 IP - DP - 1985 Jan 01 TI - Fuel chip-induced pneumonitis caused by Penicillium species PG - 394-396 AB - Two cases of Penicillium-induced hypersensitivity pneumonitis in farmers handling fuel chips are presented. Attention should be paid to safe handling of all types of solid fuel (wood, chips, and peat) and other materials in which mold may grow. AU - van Assendelft AHW AU - Raitio M AU - Turkia V LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 13 IP - DP - 1985 Jan 01 TI - Immediate hypersensitivity to mustard and rape PG - 121-122 AU - Meding B LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 7 IP - DP - 1985 Jan 01 TI - Occupational asthma from azodicarbonamide: case report PG - 97-99 AU - Valentino M AU - Comai M LA - PT - DEP - TA - G Ital Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - Allergy to storage mites or cow dander as a cause of rhinitis among Finish dairy farmers PG - 23-26 AB - Acarus siro negative AU - Terho EO AU - Husman K AU - Vohlonen I AU - Rautalahti M AU - Tukiainen H LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 32 IP - DP - 1985 Jan 01 TI - Study of the allergens in bakers asthma and rhinitis PG - 69-73 AU - Tena CG AU - Bahima AC AU - Perez AO LA - PT - DEP - TA - Alergia JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 42 IP - DP - 1985 Jan 01 TI - Clinical and immunological reactions to Aspergillus niger among workers at a biotechnology plant PG - 312-318 AU - Topping MD AU - Scarisbrick DA AU - Luczynska CM AU - Clarke EC AU - Seaton A LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - A study of serum antibody activity in workers with occupational exposure to MDI PG - 314-320 AU - Tse KS AU - Johnson A AU - Chan H AU - ChanYeung M LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 76 IP - DP - 1985 Jan 01 TI - Chronic tracheo-bronchitis due to occupational exposure to alabaster and polyester resin dust: two case reports PG - 166-169 AU - Talini D AU - Trifoglio M AU - Bacci E AU - di Pede C AU - Paggiaro PL LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 76 IP - DP - 1985 Jan 01 TI - An immunological approach to indoor aeroallergen quantification with a new volumetric air sampler: studies with mite, roach, cat, mouse and guinea pig antigens PG - 724-729 AU - Swanson MC AU - Agarwal MK AU - Reed CE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 11 IP - DP - 1985 Jan 01 TI - Respiratory symptoms and pulmonary function among welders working with aluminium, stainless steel and railroad tracks PG - 27-32 AB - Sixty-four aluminum welders, 46 stainless steel welders,and 149railroad track welders were investigated regarding respiratory symptoms and pulmonary function (forced vital capacity and forced expiratory volume in 1 s). Referents consisted of nonwelding industrial workers and raiload workers. All groups of welders showed a higher frequency of chronic bronchitis symptoms than their respective referents. Respiratory symptoms were related to ozone concentrations in welders working with aluminum. In stainless steel and railroad track welders respiratory symptoms were related to chromium exposure rather than to total particle exposure. The pulmonary function was not affected in any of the welding groups studied AU - Sjogren B AU - Ulfvarson U LA - PT - DEP - TA - Scand J Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 42 IP - DP - 1985 Jan 01 TI - Respiratory impairment in coffee factory workers in the Asaro valley of Papua New Guinea PG - 496-498 AU - Smith D AU - Brott K AU - Koki G LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 10 IP - DP - 1985 Jan 01 TI - Indoor infection in a modern building PG - 407-413 AU - Shigematsu I AU - Minowa M LA - PT - DEP - TA - Tokai J Exp Clin Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 229 IP - DP - 1985 Jan 01 TI - Building sickness PG - 531-534 AU - Robertson AS AU - Burge PS LA - PT - DEP - TA - Practitioner JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 8 IP - DP - 1985 Jan 01 TI - Low humidity and microtrauma PG - 371-373 AU - Rycroft RJG LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 291 IP - DP - 1985 Jan 01 TI - Tuberculosis in a primary school: the Uppingham outbreak PG - 1039-1040 AU - Wales JM AU - Buchan AR AU - Cookson JB AU - Jones DA AU - Marshall BSM LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 8 IP - DP - 1985 Jan 01 TI - Frictional contact dermatitis PG - 401-402 AB - Frictional trauma to the palms and fingertips can provoke a dermatitis. Cases of frictional dermatitis have been recognized in workers handling large quantities of pressure-sensitive carbonless paper. Elimination of the trauma led to healing within 2-3 weeks AU - Menne T AU - Hjorth N LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 103 IP - DP - 1985 Jan 01 TI - Psyllium hypersensitivity, nurses and gerriatric units PG - 642-642 AU - Schoenwetter WF AU - Steinberg P LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - * IP - DP - 1985 Jan 01 TI - The prevalence of respiratory symptoms among farmers and ranchers in south eastern South Dakota PG - 5-9 AU - Schlenker EH AU - Leonardson GR AU - McClain C AU - Barnes E AU - Parry RR LA - PT - DEP - TA - Univ S Dakota Sch Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 37 IP - DP - 1985 Jan 01 TI - Hyperresponsiveness and inflamation in asthma due to TDI PG - 59-63 AU - Scaglione V AU - Arivella I AU - Giacomini A LA - PT - DEP - TA - Pluc Bol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 66 IP - DP - 1985 Jan 01 TI - Acute and long term airway hyperreactivity in aluminium-salt exposed workers with nocturnal asthma PG - 105-118 AU - Simonsson BG AU - Sloberg A AU - Rolf C AU - HaegerAronsen B LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - * IP - DP - 1985 Jan 01 TI - Dichloroacetyl chloride exposure PG - 116-119 AU - Ross DS LA - PT - DEP - TA - Occup Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - Ed Allegra IP - DP - 1985 Jan 01 TI - A follow up study on the incidence and development of bronchial hyperreactivity and allergy in baker's apprentices PG - *-* AU - Rozniecki D AU - Kuna P AU - Gorski P LA - PT - DEP - TA - Bronchitis and emphysema 4th congress of SEP proce JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 76 IP - DP - 1985 Jan 01 TI - Evaluation of papain/chymopapain cross allergenicity PG - 776-781 AU - Sagona MA AU - Bruszer GV AU - Lawrence MS LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 15 IP - DP - 1985 Jan 01 TI - Skin test and RAST responses to wheat and common allergens and respiratory disease in bakers PG - 203-210 AU - Prichard MG AU - Ryan G AU - Walsh BJ AU - Musk AW LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 15 IP - DP - 1985 Jan 01 TI - A longitudinal study of possible allergy to enzyme detergents PG - 101-115 AU - Pepys J AU - Mitchell J AU - Hawkins R AU - Malo JL LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 75 IP - DP - 1985 Jan 01 TI - Monkey dander asthma PG - 268-271 AU - Petry RW AU - Voss MJ AU - Kroutil LA AU - Crowley W AU - Bush RK AU - Busse WW LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 37 IP - DP - 1985 Jan 01 TI - Chronic bronchitis and bronchial asthma in workers employed in lacquerings of furniture industry PG - 197-210 AU - Pirsic B LA - PT - DEP - TA - Pluc Bol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 27 IP - DP - 1985 Jan 01 TI - TDI-induced occulorhinitis and bronchial asthma PG - 51-52 AU - Paggiaro PL AU - Rossi O AU - Lastrucci L AU - Pardi F AU - Pezzini A AU - Baschieri L LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - suppl IP - DP - 1985 Jan 01 TI - Specific bronchial provocation test in MDI bronchial asthma PG - *-* AB - TDI, no cross reaction AU - Paggiaro PL AU - Pardi F AU - Rossi O AU - Lastrucci L AU - Bacci E AU - Talini D LA - PT - DEP - TA - Italian J Dis Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 42 IP - DP - 1985 Jan 01 TI - Byssinosis in Hong Kong PG - 499-502 AU - Ong SG AU - Lam TH AU - Wong CM AU - Ma PL AU - Lam SK AU - Kelly FJO LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 7 IP - DP - 1985 Jan 01 TI - Epidemiologic and immunologic studies in processors of the king crab PG - 155-169 AU - Orford RR AU - Wilson JT LA - PT - DEP - TA - Am J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 42 IP - DP - 1985 Jan 01 TI - Bronchial reactivity in green coffee exposure PG - 415-420 AU - Kuskin E AU - Kanceljak B AU - Skuric Z AU - Butkovic D LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 147 IP - DP - 1985 Jan 01 TI - Late asthmatic reaction caused by micro fungae in the tobacco industry PG - 2918-2919 AU - Lander F AU - Jepsen JR AU - Graveson S LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 132 IP - DP - 1985 Jan 01 TI - Pulmonary effects of acute vanadium pentoxide inhalation in monkeys PG - 1181-1185 AU - Knecht EA AU - Moorman WJ AU - Clark JC AU - Lynch DW AU - Lewis TR LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 102 IP - DP - 1985 Jan 01 TI - Asthma and rhinitis due to ethylcyanoacrylate instant glue PG - 613-615 AU - Kopp SK AU - McKay RT AU - Mooler DR AU - Cassedy K AU - Brooks SM LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 19 IP - DP - 1985 Jan 01 TI - TDI induced asthma PG - 209-211 AU - Lingyu L LA - PT - DEP - TA - Chung Hua Yu Fang I Hsueh Tsa Chih JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 6 IP - DP - 1985 Jan 01 TI - Vanadium PG - 177-185 AU - Lees REM LA - PT - DEP - TA - Occ Health in Ontario JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 42 IP - DP - 1985 Jan 01 TI - Respiratory disease in foundry workers PG - 101-105 AU - Low I AU - Mitchell C LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 26 IP - DP - 1985 Jan 01 TI - Properties and toxicity of airborne wood dust in wood working establishments PG - 43-52 AU - Liu WK AU - Wong MH AU - Tam NFY AU - Choy ACK LA - PT - DEP - TA - Toxicol Lett JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 78 IP - DP - 1985 Jan 01 TI - Respiratory allergy to cement PG - 47-50 AU - Lob M LA - PT - DEP - TA - Z Unfallchir Vers Med Berufskr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 11 IP - DP - 1985 Jan 01 TI - Exposure to microorganisms, febrile and airway-obstructive symptoms, immune status and lung function of Swedish farmers PG - 287-293 AU - Malmberg P AU - RaskAnderson A AU - Palmgren U LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 15 IP - DP - 1985 Jan 01 TI - Isolated late asthmatic reaction due to nickel sulphate without antibodies to nickel PG - 95-99 AB - A worker with occupational exposure to nickel developed asthma a few months after starting work. Skin prick tests to nickel sulphate were negative. Inhalation challenge with nickel sulphate, at a concentration of 10 mg/ml for 30 min induced a late asthmatic reaction, starting 3 hr after the end of exposure leading to severe nocturnal attack. Tests for antibodies with nickel reactivity were negative. AU - Malo JL AU - Cartier A AU - Gagnon G AU - Evans S AU - Dolovich J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 15 IP - DP - 1985 Jan 01 TI - Occupational asthma due to azobisformamide PG - 261-264 AB - Azobisformamide is a low molecular weight agent used in the plastic industry as a foaming product. Two subjects with a history of work-related asthma in association with exposure to azobisformamide underwent specific inhalation tests. One subject developed an isolated late asthmatic response, whereas in the other a dual reaction was observed. AU - Malo JL AU - Pineau L AU - Cartier A LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 76 IP - DP - 1985 Jan 01 TI - Occupational asthma due to colophony PG - 371-378 AU - Maestrelli P AU - Alessandri MV AU - Dal Vaccio L AU - Barolucci GB AU - Cocheo V LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 37 IP - DP - 1985 Jan 01 TI - Acute toxic effect irritative syndrome of the upper respiratory tract due to diisocyanates PG - 217-220 AU - MadelcGrom M AU - Modic S LA - PT - DEP - TA - Pluc Bol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 42 IP - DP - 1985 Jan 01 TI - Lung function after exposure to barley dust PG - 106-110 AU - McCarthy PE AU - Cockroft AE AU - McDermott M LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 75 IP - DP - 1985 Jan 01 TI - Time course of the increase in airway responsiveness associated with late asthmatic reactions to toluene diisocyanate in sensitised subjects PG - 568-572 AU - Mapp CE AU - Polato R AU - Maestrelli P AU - Hendrick DJ AU - Fabbri LM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 54 IP - DP - 1985 Jan 01 TI - Combined asthma and alveolitis due to diphenylmethane diisocyanate (MDI) with demonstration of no cross respiratory reactivity to toluene diisocyanate (TDI) PG - 424-429 AU - Mapp CE AU - Vecchio LD AU - Boschetto P AU - Fabbri LM LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 75 IP - DP - 1985 Jan 01 TI - Reactions during haemodialysis caused by allergy to ethylene oxide gas sterilisation PG - 563-567 AU - Marshall CP AU - Pearson FC AU - Sagona MA AU - Lee W AU - Wathen RL AU - Ward RA AU - Dolovich J LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 35 IP - DP - 1985 Jan 01 TI - Late asthmatic responses induced by ethylenediamine PG - 40-45 AU - Matsui S AU - Nakazawa T AU - Umegae Y AU - Kanatani K LA - PT - DEP - TA - Arerugi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - Bagassosis, a case report PG - 233-236 AU - Morcelli J LA - PT - DEP - TA - Rev Hosp Clinic Fac Med S Paulo JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 75 IP - DP - 1985 Jan 01 TI - Detection of IgE mediated respiratory sensitisation in workers exposed to hexahydrophthalic anhydride PG - 663-672 AU - Moller DR AU - Gallagher JS AU - Bernstein DI AU - Wilcox TG AU - Burroughs HE AU - Bernstein IL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 75 IP - DP - 1985 Jan 01 TI - Formaldehyde asthma - rare or overlooked PG - 91-99 AU - Nordman H AU - Keskinen H AU - Tuppurainen M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 11 IP - DP - 1985 Jan 01 TI - Systemic reaction associated with polyisocyanate exposure PG - 51-54 AU - Nielsen J AU - Sango C AU - Winroth G AU - Hallberg T AU - Skerfving S LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 11 IP - DP - 1985 Jan 01 TI - Across-shift changes in the pulmonary function of meat-wrappers and other workers in the retail food industry PG - 21-26 AU - Eisen EA AU - Wegman DH AU - Smith TJ LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 15 IP - DP - 1985 Jan 01 TI - Skin-test reactivity to egg protein-exposure by inhalation compared with ingestion PG - 147-150 AB - Of two hundred and sixty-seven subjects exposed to egg by ingestion only, forty-eight were skin (prick)-test positive to egg material. All forty-eight subjects also reacted to other allergens on skin testing, forty-seven (98%) to allergens associated with respiratory allergy. Of thirteen subjects exposed to egg by inhalation in their workplace (and ingestion) two were skin-test-positive to egg, both also reacting to respirable allergens. Thus, inhalation of egg antigen does not greatly influence skin-test reactivity to eggs as determined by comparing the ratio of egg skin-test-positives to total skin-test-positives in the egg groups ingesting and inhaling egg antigen, i.e. 48:218 vs 2:6. In terms of the pulmonary response to inhaled eggs there were equal numbers of symptomatics with positive skin tests to common allergens as there were symptomatics with negative skin tests. Thus, an allergic predisposition shown by a positive skin test to common allergens does not predict nor preclude development of a pulmonary reaction to inhaled egg material. AU - Edwards J AU - McConnochie K AU - Davies BH LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 54 IP - DP - 1985 Jan 01 TI - Hypersensitivity pneumonitis in grain farmers due to sensitisation to Erwinia herbicola PG - 65-68 AU - Dutkiewicz J AU - Kus L AU - Dutiewicz E AU - Warren CPW LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 132 IP - DP - 1985 Jan 01 TI - Prednisone inhibits late asthmatic reactions and the associated increase in airways responsiveness induced by TDI in sensitised subjects PG - 1010-1014 AU - Fabbri LM AU - ChiesuraCorona P AU - Dal Veccio L AU - Di Giacomo GR AU - Zocca E AU - Marzo AU - Maestrelli P AU - Mapp CE LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 21 IP - DP - 1985 Jan 01 TI - Prednisone, Indomethacin and airway responsiveness in Toluene diisocyanate sensitised subjects PG - 421-426 AU - Fabbri LM AU - Di Giacomo R AU - Dal vecchio L LA - PT - DEP - TA - Bull Eur Physiopath Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - Cmnd 9717 IP - DP - 1985 Jan 01 TI - Occupational asthma PG - 5-13 AU - Department of Health and Social Security LA - PT - DEP - TA - HMSO JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 76 IP - DP - 1985 Jan 01 TI - Use of immunoblot technique for detection of human IgE and IgG antibodies to individual silk proteins PG - 537-542 AU - Dewair M AU - Baur X AU - Ziegler K LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - Occupational asthma due to formaldehyde PG - 255-260 AB - Bronchial provocation studies on 15 workers occupationally exposed to formaldehyde are described. The results show that formaldehyde exposure can cause asthmatic reactions, and suggest that these are sometimes due to hypersensitivity and sometimes to a direct irritant effect. Three workers had classical occupational asthma caused by formaldehyde fumes, which was likely to be due to hypersensitivity, with late asthmatic reactions following formaldehyde exposure. Six workers developed immediate asthmatic reactions, which were likely to be due to a direct irritant effect as the reactions were shorter in duration than those seen after soluble allergen exposure and were closely related to histamine reactivity. The breathing zone concentrations of formaldehyde required to elicit these irritant reactions (mean 4.8 mg/m3) were higher than those encountered in buildings recently insulated with urea formaldehyde foam, but within levels sometimes found in industry. AU - Burge PS AU - Harries MG AU - Lam WK AU - O'Brien IM AU - Patchett P LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - Pulmonary disease associated with cafeteria flooding PG - 96-101 AU - Hodgson MJ AU - Morey PR AU - Attfield M AU - Sorenson W AU - Fink JN AU - Rhodes WW AU - Visvesvara GS LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 55 IP - DP - 1985 Jan 01 TI - Severe acute "occupational asthma" caused by accidental allergen exposure in an allergen challenge laboratory PG - 36-37 AU - Hoeppner VH AU - Murdock KY AU - Kooner S AU - Cockcroft DW LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 76 IP - DP - 1985 Jan 01 TI - Clinical evaluation of patients with complaints related to formaldehyde exposure PG - 831-840 AU - Imbus HR LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 165 IP - DP - 1985 Jan 01 TI - Wood dust as inhalative noxious agent PG - 235-241 AU - Kirsten D AU - Liebetrau G AU - Meister W LA - PT - DEP - TA - Z Erkrank Atm Org JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - Neurobehavioral and respiratory symptoms of formaldehyde and xylene exposure in histology technicians PG - 229-233 AU - Kilburn KH AU - Seidman BC AU - Warshaw R LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - Pulmonary and neurobehavioural effects of formaldehyde exposure PG - 254-260 AU - Kilburn KH AU - Warshaw R AU - Boylen CT LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 27 IP - DP - 1985 Jan 01 TI - Respiratory symptoms and pulmonary function in men exposed to toluene diisocyanate (TDI) in a foam factory PG - 35-39 AU - Kalra S AU - Kashyap S AU - Behera D AU - Malik SK LA - PT - DEP - TA - Indian J Chest Dis & All Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 42 IP - DP - 1985 Jan 01 TI - Respiratory abnormalities among workers in an iron and steel foundry PG - 94-100 AU - Johanson A AU - ChanYeung M AU - MacLean L AU - Atkins E AU - Dybuncio A AU - Cheng F AU - Enarson D LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 19 IP - DP - 1985 Jan 01 TI - Study of aetiology of low fever among female silk-weaving workers: extrinsic allergic alveolitis due to mulberry silk dust exposure PG - 354-357 AU - Jingdong L LA - PT - DEP - TA - Chung Hua Fang I Hsuehtsa Chuh JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 65 IP - DP - 1985 Jan 01 TI - Phthalic anhydride induced asthma and its etio-diagnostic study PG - 393-39* AU - Jingyu L LA - PT - DEP - TA - Natl Med J China JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - Workplace allergenicity of a psyllium-containing bulk laxative PG - 73-76 AB - IgE antibodies specific to psyllium were demonstrated by RAST in a patient with work-place-related asthmatic and dermatological reactions. Antibodies were not cross-reactive with the related plant, English plantain. AU - Gauss WF AU - Alarie JP AU - Karol MH LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 27 IP - DP - 1985 Jan 01 TI - A 10 year follow-up study of a group of workers exposed to isocyanates PG - 15-18 AU - Gee JB AU - Morgan WKC LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 88 IP - DP - 1985 Jan 01 TI - Cobalt-induced bronchial asthma in diamond polishers PG - 740-744 AB - Three diamond workers had occupational asthma attributed to the inhalation of cobalt powder. The exposure originated from high speed polishing disks with an abrasive consisting of microdiamonds cemented in extra fine cobalt not alloyed to tungsten carbide. The bronchoconstriction progressed towards the end of working-days; it was especially pronounced in the absence of an adequate exhaust ventilation; and it could be accompanied by rhinitis and chest tightness. Cobalt inhalation challenge tests were positive in all three patients, and exposure to cobalt temporarily increased nonspecific hyperreactivity. AU - Gheysens B AU - Auwerx J AU - van den Eekhout A AU - Demedts M LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - IP - DP - 1985 Jan 01 TI - The persulfates: a tripple threat PG - 520-525 AU - Fisher AA LA - PT - DEP - TA - Cutis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 15 IP - DP - 1985 Jan 01 TI - Factors affecting the development of precipitating antibodies in workers exposed to contaminated humidifiers PG - 281-292 AB - A total of 601 sera from groups of workers exposed to heavily and moderately contaminated humidifiers respectively were examined by the double diffusion test for precipitating antibodies to humidifier extracts. Clinical information was obtained using a standardized questionnaire. Skin-prick tests to control, to three common inhalant antigens and to an extract from the humidifier were performed in 103 subjects exposed to a heavily contaminated humidifier. In this environment a strong inverse relationship between current smoking and precipitins was detected (P < 0.001). Pack years smoked had no bearing on precipitin level. In the larger study there was a clear dose response effect of smoking on precipitins. The effect of smoking appeared to reverse within 3 years. Duration of exposure also had a major effect on the development of precipitins with a clear ‘dose response’ again being seen in the larger study. These relationships did not apply in the groups exposed to moderately contaminated humidifiers. Levels of airborne antigen were measured using a competitive ELISA inhibition assay and were found to be much lower in sites with moderately contaminated humidifiers than at sites with heavily contaminated humidifiers. Our results suggest that the airborne antigen level is crucial in determining the pattern and strength of precipitin response in smokers and non-smokers exposed to contaminated humidifiers. AU - Finnegan MJ AU - Pickering CAC AU - Davies PS AU - Austwick PKC LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 67 IP - DP - 1985 Jan 01 TI - Prevalence of bronchial asthma and chronic bronchitis in a community in Northern Sweden; relation to environmental and occupational exposure to sulphur dioxide PG - 41-49 AU - Stjernberg N AU - Eklund A AU - Nystrom L AU - Rosenhall L AU - Emmelin A AU - Stromqvist L LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 78 IP - DP - 1985 Jan 01 TI - Potato Riddler's lung PG - 282-284 AU - Greene B LA - PT - DEP - TA - Ir Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 76 IP - DP - 1985 Jan 01 TI - A familial occurrence of allergic bronchopulmonary aspergillosis: a probable environmental source PG - 55-59 AU - Halwig JM AU - Rurup VP AU - Greenberger PA AU - Patterson R LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - i IP - DP - 1985 Jan 01 TI - Didymella exitialis and late summer asthma PG - 1063-1066 AU - Harries MG AU - Lacey J AU - Tee TD AU - Cayley GR AU - Newman Taylor AJ LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 55 IP - DP - 1985 Jan 01 TI - Prevalence of occupational asthma in silk filatures PG - 511-515 AB - A clinical survey in two silk filatures revealed that 36.2% of the persons engaged in the processing of natural silk were suffering from bronchial asthma, while 16.9% of the total subjects had asthma of occupational origin. Skin prick tests using crude silkworm cocoon and pupal allergen extracts revealed that 28.8% of the subjects were sensitive to the silkworm-derived allergens. IgE antibodies specific to both cocoon and pupal allergens were demonstrable by RAST in the sera of patients with positive skin reactions and occupational asthma. AU - Harindranath N AU - Prakash O AU - Subba Rao PV LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 60 IP - DP - 1985 Jan 01 TI - Childhood asthma and puberty PG - 231-235 AU - BalfourLynn L LA - PT - DEP - TA - Arch Dis Child JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 290 IP - DP - 1985 Jan 01 TI - Interaction of smoking and atopy in producing specific IgE antibody against a hapten protein conjugate PG - 201-204 AU - Venables KM AU - Topping MD AU - Howe W AU - Luczynska CM AU - Hawkins R AU - Newman Taylor AJ LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 42 IP - DP - 1985 Jan 01 TI - Occupational asthma in a steel coating plant PG - 517-524 AB - An outbreak of occupational asthma, of unknown cause and extent, was detected in a steel coating plant. In 1979 a cross-sectional study which defined occupational asthma in terms of respiratory symptoms detected 21 people with suggestive symptoms among the 221 studied. They all worked in the coating shop, but the plastic coatings used at the plant contained many potential sensitising agents that might have caused the asthma. All 21 developed their symptoms after 1971, and it was found that in this year a supplier had modified a coating allowing, at the temperatures used in the process, toluene di-isocyanate to be liberated. Two of the symptomatic subjects were tested by inhalation of the isocyanate and showed asthmatic reactions and other subjects were found to have asthma related to periods spent at work by records of peak expiratory flow rate. Over half the 21 had a symptom free latent period after first exposure of three years or less, a pattern not seen in other subjects with respiratory symptoms. After the isocyanate had been removed from the process 17 of these subjects became asymptomatic or improved, a greater proportion than in other subjects with respiratory symptoms. AU - Venables KM AU - Dally MB AU - Burge PS et al LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 46 IP - DP - 1985 Jan 01 TI - Efficacy of the helmet respirator in occupational asthma due to laboratory animal allergy (LAA) PG - 411-415 AB - The efficacy of the Racal Airstream helmet respirator in preventing symptoms due to Laboratory Animal Allergy (LAA) was assessed in ten patients. Eight of these were established cases of asthma and two had severe rhinitis. Peak expiratory flow rate (PEFR) readings, recorded every two hours, were kept for seven weeks (six in exposure), together with a diary of subjective symptoms. Objective evidence of good protection was obtained in six out of the eight asthmatic patients; overt asthma was seen in the other two. The helmet respirator would appear to be a valuable adjunct in the management of occupational asthma in those who opt to remain in exposure. Those asthmatics who use a helmet respirator need to be monitored carefully and regularly to ensure that their respiratory function has not deteriorated. Persons with severe local symptoms of rhinitis and conjunctivitis also benefit subjectively from the use of the helmet although symptoms are not completely suppressed nor may progression towards asthma be prevented. The findings may well be applicable to the management of other types of occupational asthma but any inferences should be drawn with caution. AU - Slovak AJM AU - Orr RG AU - Teasdale EL LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 76 IP - DP - 1985 Jan 01 TI - Follow-up of occupational asthma caused by crab and various agents PG - 682-688 AB - Sixty-three subjects with occupational asthma caused by crab (n = 31) and various other agents (n = 32) were studied after cessation of exposure at work for mean +/- SD intervals of 12.3 +/- 5.5 and 24.5 +/- 18.7 months (greater than 6 months in every subject), respectively. Nineteen of the subjects with asthma caused by crab and 30 of the subjects with asthma caused by various agents were still symptomatic of asthma, nine subjects of the latter group requiring bronchodilators (with inhaled beclomethasone in five) regularly. No significant changes in baseline spirometry were observed at the time of follow-up as compared with initial assessment, nine subjects (all in the asthma group caused by various agents) demonstrating significant bronchial obstruction. Improvement in bronchial responsiveness to histamine was significant (p less than 0.01) in the group with asthma caused by crab but not in the other group. Forty-eight of 52 subjects still had significant airway hyperexcitability. Subjects with asthma caused by crab who were asymptomatic and those subjects with asthma caused by various agents who used bronchodilators only if they were needed had worked for shorter intervals after onset of symptoms (p less than 0.01 and p less than 0.05, respectively). It is concluded that subjects with occupational asthma caused by various agents can remain symptomatic of asthma and demonstrate a persistence of bronchial obstruction and hyperexcitability for prolonged intervals after cessation of exposure. AU - Hudson P AU - Cartier A AU - Pineau L AU - Lafrance M AU - St Aubin JJ AU - Dubois JV AU - Malo JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 42 IP - DP - 1985 Jan 01 TI - Lung function, atopy, specific hypersensitivity, and smoking of workers in the enzyme detergent industry over 11 years PG - 43-50 AB - A study of 2800 workers employed in three factories of the two major manufacturers of enzymatic products in the United Kingdom covering 11 years of operation from 1969 to 1980 showed that 2344 workers had sufficient lung function data to meet the operational criteria and these were analysed in three separate groups by factory locations. Spirometry and prick tests for specific skin reactions to standardised enzyme were performed at six monthly intervals for the first six years of the study and then annually. Factory enzyme dust and total dust measurements were made to determine the degree of dust exposure of the subjects. The lung function of the factory groups was analysed for the effects of working in the detergent industry, the degree of exposure to enzymes, skin prick test positivity to enzymes, atopicity, and smoking. The 4.5% of workers who had experienced respiratory effects from enzymes were analysed separately. Exposure to the enzyme allergen has had no significant long term effect on the lung function of the detergent workers. A higher proportion of atopics than non-atopics became skin test positive to the allergen and more smokers than non-smokers were sensitised. The overall lung function of detergent workers showed 39 ml/year loss in FEV1 on the 11 year longitudinal study and 51 ml/year loss on the lateral (cross sectional) analysis with better lung function in the south east than the north west of England. In the development of the methodology for the study several potential problems were discovered that could remain unrecognised in a cross sectional analysis performed in isolation. AU - Flood DF AU - Blofeld RE AU - Bruce CF et al LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - PROGNOSIS IN OCCUPATIONAL ASTHMA PG - 241-243 AU - Yeung M AU - Grzybowski S LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 75 IP - DP - 1985 Jan 01 TI - Epidemiologic evaluation of screening for risk factors: Application to genetic screening PG - 1204-1208 AU - Khoury MJ AU - Newill CA AU - Chase GA LA - PT - DEP - TA - Am J Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - Allergy to weeping fig, a new occupational disease PG - 461-464 AU - Axelsson G AU - Skedinger M AU - Zetterstrom O LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 40 IP - DP - 1985 Jan 01 TI - Radiographic changes in humidifier fever PG - 312-313 AU - Anderson K AU - McSharry CP AU - Boyd G LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 76 IP - DP - 1985 Jan 01 TI - A comparative study of the allergens of cat urine,serum,saliva and pelt PG - 563-569 AU - Anderson MC AU - Baer H AU - Ohman JL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 131 IP - DP - 1985 Jan 01 TI - Specific bronchoalveolar lavage IgE antibody in hypersensitivity pneumonitis from diphenylmethane diisocyanate PG - 463-465 AU - Bascom R AU - Kennedy TP AU - Levitz D AU - Zeiss CR LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 131 IP - DP - 1985 Jan 01 TI - Pulmonary function and respiratory symptoms in polyvinylchloride fabrication workers PG - 203-208 AU - Baser ME AU - Tockman MS AU - Kennedy TP LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 23 IP - DP - 1985 Jan 01 TI - Remission of Goodpastures syndrome after withdrawal of an unusual toxic PG - 312-317 AU - Bernis P AU - Hamels J AU - Quoidbach A AU - Mahieu P AU - Bouvy P LA - PT - DEP - TA - Clin Nephrol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - IP - DP - 1985 Jan 01 TI - The diversity of reaginic immune responses to platinum and palladium metallic salts PG - 794-802 AU - Biagini RE AU - Bernstein IL AU - Gallagher JS LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 78 IP - DP - 1985 Jan 01 TI - Pulmonary responsiveness to methacholine and disodium hexachloroplatinate (Na2PtCl6) aerosols in cynomolgus monkeys PG - 139-146 AU - Biagini RE AU - Moorman WJ AU - Lewis TR AU - Bernstein IL LA - PT - DEP - TA - Toxicol Appl Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 75 IP - DP - 1985 Jan 01 TI - Occupational asthma due to sunflower pollen PG - 70-74 AU - Bousquet J AU - Dhivert H AU - Clauzel AM AU - Hewitt B AU - Michel FB LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 76 IP - DP - 1985 Jan 01 TI - Exposure to formaldehyde: relationship to respiratory symptoms and function PG - 312-315 AU - Bracken MJ AU - Leasa DJ AU - Morgan WKC LA - PT - DEP - TA - Can J Pub Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 88 IP - DP - 1985 Jan 01 TI - Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposure PG - 376-384 AB - Ten individuals developed an asthma-like illness after a single exposure to high levels of an irritating vapor, fume, or smoke. In most instances, the high level exposure was the result of an accident occurring in the workplace or a situation where there was poor ventilation and limited air exchange in the area. In all cases, symptoms developed within a few hours and often minutes after exposure. We have designated the illness as reactive airway dysfunction syndrome (RADS) because a consistent physiologic accompaniment was airways hyperreactivity. When tested, all subjects showed positive methacholine challenge tests. No documented preexisting respiratory illness was identified nor did subjects relate past respiratory complaints. In two subjects, atopy was documented, but in all others, no evidence of allergy was identified. In the majority of the cases, there was persistence of respiratory symptoms and continuation of airways hyperreactivity for more than one year and often several years after the incident. The incriminated etiologic agent varied, but all shared a common characteristic of being irritant in nature. In two cases, bronchial biopsy specimens were available, and an airways inflammatory response was noted. This investigation suggests acute high level, uncontrolled irritant exposures may cause an asthma-like syndrome in some individuals which is different from typical occupational asthma. It can lead to long-term sequelae and chronic airways disease. Nonimmunologic mechanisms seem operative in the pathogenesis of this syndrome. AU - Brooks SM AU - Weiss MA AU - Bernstein IL LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 27 IP - DP - 1985 Jan 01 TI - Reactive airways dysfunction syndrome PG - 473-476 AU - Brooks SM AU - Weiss MA AU - Bernstein IL LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19850101 IS - IS - VI - 29 IP - DP - 1985 Jan 01 TI - EXPOSURE OF WELDERS TO FUMES, Cr, Ni, Cu AND GASES IN DUTCH INDUSTRIES PG - 377-389 AB - The exposure of welders in Dutch industries to total particulate, chromium, nickel and copper fume during the welding of unalloyed, stainless and high alloyed steels has been investigated. The exposure to the gases NO2 , NO and ozone is also discussed. The results are presented in tables and graphs. The correlation between the arc-time factor and the welding fume concentration in the breathing zone appeared to be bad. MMA-welding fumes of stainless steel contain mainly soluble hexavalent chromium. During MIG and TIG welding the fumes contain chromium which was insoluble in water and not hexavalent. The nickel was insoluble in water in all three processes. In comparison with the Dutch occupational health standards, it appears that the dust exposure is often higher than the limit value of 5 mg m -3 in MMA and gas-shielded arc welding. The exposure to chromium is usually higher than the standard of 0.05 mg m -3 for hexavalent chromium and the standard of 0.5 mg m -3 for total chromium in MMA welding of stainless steel, and the exposure to copper fumes during welding of copper is usually higher than the standard of 0.2 mg m -3 Among the gaseous contaminants NO2 . NO and ozone, only ozone with MIG welding of aluminum gives concentrations in the breathing-zone exceeding the standard of 0.2 mg m -3 (0.1 ppm). AU - van de WAL JF LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 13 IP - DP - 1984 Jan 01 TI - A Critical Review of the Literature on Hydrogen Sulfide Toxicity PG - 25-97 AB - For most disposition studies, H2S has been administered either parenterally or orally as H2S solutions or various sulfide salts. Since the pK, for dissociation of the first proton from H2S is 7.04 and 11.96 for the second proton (see section on Chemical Properties), under physiological conditions sulfide salts exist primarily as undissociated H2S and the hydrosulfide anion. Ig3 The quantitative disposition of H2S after inhalation exposure has not been determined. A qualitative disposition study using a histochemical procedure to identify AU - Beauchamp RO AU - Bus JS AU - Popp JA AU - Boreiko CJ AU - Andjelkovich DA AU - Leber P LA - PT - DEP - TA - Critical Reviews in Toxicology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 41 IP - DP - 1984 Jan 01 TI - Changes in respiratory variables of grain handlers and civic workers during their initial months of employment PG - 94-99 AU - Broder I AU - Hutcheon MA AU - Minty S AU - Davies G AU - Leznoff A AU - Thomas P AU - Corey P LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 24 IP - DP - 1984 Jan 01 TI - Severe asthma from inhalation of soya dust PG - 209-210 AU - Bourgeois M LA - PT - DEP - TA - Rev Franc Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 4 IP - DP - 1984 Jan 01 TI - Respiratory allergy to synthetic resins PG - 83-101 AU - Bernstein IL AU - Bernstein DI LA - PT - DEP - TA - Clin Immunol Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 14 IP - DP - 1984 Jan 01 TI - Baker's asthma PG - 177-185 AU - Block G AU - Tse KS AU - Chan KKH AU - ChanYeung M LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 74 IP - DP - 1984 Jan 01 TI - Heterogeneity of specific IgE responses in workers sensitised to acid anhydride compounds PG - 794-801 AU - Bernstein DI AU - Gallagher JS AU - D'Souza L AU - Bernstein IL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 34 IP - DP - 1984 Jan 01 TI - Case report- exposure to glutaraldehyde PG - 63-64 AU - Benson WG LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 75 IP - DP - 1984 Jan 01 TI - An investigation of the prevalence of byssinosis in three Greek spinning mills PG - 478-485 AU - Bazas T AU - Harrington JM AU - Bazas B LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 75 IP - DP - 1984 Jan 01 TI - TDI induced occupational asthma in the textile printing industry PG - 393-398 AU - Baruffini A AU - Cirla A AU - Pisati G AU - Sala C LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 94 IP - DP - 1984 Jan 01 TI - Some aspects of formaldehyde on the upper respiratory tract PG - 1411-1413 AU - Ballinger JJ LA - PT - DEP - TA - Laryngoscope JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 14 IP - DP - 1984 Jan 01 TI - Antibodies to hen and duck antigens in poultry workers PG - 421-428 AU - Anderson P AU - Schonheyder H LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 39 IP - DP - 1984 Jan 01 TI - Peak flow rate records in surveys: reproducibility of observers' reports PG - 828-832 AB - Peak expiratory flow rate (PEFR) has been measured hourly from waking to sleeping in 29 workers with respiratory symptoms exposed to the fumes of soft soldering fluxes containing colophony (pine resin). Thirty-nine records of mean length 33 days have been analysed, and the results compared with the occupational history and bronchial provocation testing in the same workers. From plots of daily mean, maximum, and minimum PEFR, recurring physiological patterns of asthma emerge. The most common pattern is for asthma to increase with each successive working day. Some workers have an equivalent deterioration each working day. Regular recovery patterns taking one, two, and three days are described. The combination of a three-day recovery pattern and a late asthmatic reaction on Monday results in Monday being the best day of each week. Assessment of these records has shown them to be specific and sensitive, provided the worker was not taking corticosteroids or sodium cromoglycate during the period of the record and that bronchodilator usage was kept constant on days at home and at work. The results of the PEFR records correlate well with bronchial provocation testing, and provide a suitable alternative to this for the diagnosis of mild to moderate occupational asthma. The records are of particular use for screening symptomatic workers whose symptoms appear unlikely to be related to work. AU - Venables KM AU - Burge PS AU - Davison AG AU - Newman Taylor AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 73 IP - DP - 1984 Jan 01 TI - Detection of immunologically sensitized isocyanate workers by RAST and intracutaneous skin tests PG - 610-618 AU - Baur X AU - Dewair M AU - Fruhmann G LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 288 IP - DP - 1984 Jan 01 TI - Respiratory symptoms related to work in a factory manufacturing cimetidine tablets PG - 1418 AU - Coutts IL AU - Lozewicz S AU - Dally MB AU - et al LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 73 IP - DP - 1984 Jan 01 TI - Occupational asthma in poultry workers PG - 271-275 AB - 16 poultry workers with poultry house realted rhinitis and/or asthma underwent clincial and laboratory evaluation that included history and physical examination, skin tests with common inhalant and PAg, total and specific IgE levels, and pulmonary-function studies. 16 age and sex matched atopic subjects who were not occupationally exposed to poultry and 12 asymptomatic veterinarians with occupational exposure to poultry served as controls. Rhinitis and asthma developed only in symptomatic poultry workers after exposure to poultry: only in these individuals could immediate wheal and flare reactions to poultry antigens be detected (p < 0.001). The elapsed time between the initial poultry exposure and the onset of poultry house related symptoms average 10 years. In the symptomatic poultry workers, immediate skin test reactivity and RAST reactions were most frequently associated with NFM. The association between respiratory symptoms temporally related to poultry house exposure and the demonstrable IgE antibody mediated reaction suggests a relationship between the two. AU - BarSela S AU - Teichtahl H AU - Lutsky I LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 74 IP - DP - 1984 Jan 01 TI - Occupational asthma in snow crab processing workers PG - 261-269 AB - The prevalence of occupational asthma was studied in two snow crab-processing industries in operation since 1980. Before the 1982 season, all except 10 of the 313 employees were investigated by a questionnaire, prick skin tests with common allergens, crab n and crab-boiling water extracts, and spirometry. The diagnosis was confirmed in 46 (15.6%) workers (including 33 of 64 subjects with a history highly suggestive of occupational asthma in the previous seasons) by (1) specific inhalation challenges in 33 subjects (one immediate, nine dual, and 23 late asthmatic responses) and/or (2) a combination of monitoring of peak expiratory flow rates (n = 12) and significant changes in bronchial responsiveness to histamine (n = 16) as well as in spirometry (n = 18) after reappearance of symptoms on return to work. Positive skin tests to crab (p less than 0.001) and, to a lesser degree, smoking history (p = 0.03) but not atopy (p greater than 0.05) were related to the presence of occupational asthma. A high prevalence of rhinoconjunctivitis (35 of 46) and urticaria (16 of 46) was also documented in the affected individuals. AU - Cartier A AU - Malo JL AU - Forest F et al LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 6 IP - DP - 1984 Jan 01 TI - Piperazine-induced airway symptoms: exposure-response relationships and selection in an occupational setting PG - 347-357 AB - The heterocyclic secondary amine piperazine is known to cause asthma. In a cohort of 602 workers, employed during the period 1942-1979, at a chemical industry where piperazine is handled, a study conducted by means of a mailed questionnaire showed a strong exposure-response relationship as to frequency of work-related airway symptoms indicating asthma. In the most exposed group about a third of the workers had experienced such symptoms. Age, length of employment, smoking habits, and previous work-related asthmatic symptoms, but not atopy, modified the response. Further, there was an association between piperazine exposure and chronic bronchitis. In the most exposed group every fourth subject had chronic bronchitis. The frequency was modified by smoking habits; atopy was a confounder. Although many subjects, especially high-exposed ones, left work because of airway symptoms, there was no difference in occurrence of airway symptoms between former and present employees, ie, no "healthy worker selection" ("survivor population effect"). AU - Hagmar L AU - Bellander T AU - Ranstam J AU - Skerfving S LA - PT - DEP - TA - Am J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 130 IP - DP - 1984 Jan 01 TI - Occupational Asthma Without Bronchial Hyper-responsiveness PG - 513-515 AB - Current asthma (variable air-flow obstruction) is often excluded by the presence of normal bronchial responsiveness. We report a patient with occupational asthma that was presumed to be caused by sensitization and exposure to toluene diisocyanate (TDI). Variable air-flow obstruction measured by peak flow rates (PFR), and symptoms of asthma reversed by salbutamol, occurred after natural exposure to TDI when methacholine bronchial responsiveness was well into the nonasthmatic range. The asthma occurred at the end of, or just after work, suggesting the occurrence of late asthmatic responses. While the patient continued at work, the late asthmatic responses became progressively more severe as methacholine responsiveness progressively increased into the asthmatic range. This suggests that, in individual subjects, the degree of bronchial responsiveness is a determinant of the severity of the late asthmatic response. When the patient stopped work, spontaneous symptoms of asthma and increased diurnal variation of PFR recurred spontaneously until methacholine responsiveness returned into the normal range. These observations indicate that asthma can occur at a time when methacholine bronchial responsiveness is normal, providing the stimulus is strong enough. They further demonstrate that the magnitude and ease of bronchoconstriction relates to the degree of methacholine responsiveness. AU - Hargreave FE AU - Ramsdale EH AU - Pugsley SO LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 34 IP - DP - 1984 Jan 01 TI - Enzyme asthma: fourteen years clinical experience of a recently prescribed disease PG - 126-132 AU - Juniper CP AU - Roberts DM LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 14 IP - DP - 1984 Jan 01 TI - Follow-up study of patients with respiratory disease due to toluene di-isocyanate (TDI) PG - 463-469 AB - The outcome of the respiratory symptoms, pulmonary function tests and bronchial hyperresponsiveness was studied in forty-seven workers with respiratory disease due to toluene diisocyanate (TDI) (twenty-seven asthmatic and twenty non-asthmatic subjects) after about 2 years from the first examination. Eight of twelve asthmatic subjects who left the industry after the first examination complained at the follow-up of dyspnoea and wheezing, but pulmonary function tests were unchanged; bronchial hyperresponsiveness decreased in three, but most were still positive to challenge test with bethanechol at the follow-up. Fifteen subjects who continued their exposure to TDI showed at the follow-up a significant decrease of the spirometric parameters and an increase of the bronchial hyperresponsiveness, and symptoms of chronic bronchitis were more frequent at the second examination. Non-asthmatic subjects, both exposed and non-exposed to TDI at the second examination, showed a significant decrease of the pulmonary function tests but no relevant changes in bronchial hyperresponsiveness. Our data suggest that stopping occupational exposure to TDI frequently did not produce an improvement of the TDI bronchial asthma, and persistence of the occupational exposure causes a more rapid decline in the respiratory function. AU - Paggiaro PL AU - Loi AM AU - Rossi O et al LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 41 IP - DP - 1984 Jan 01 TI - Wheat flour sensitisation and airways disease in urban bakers PG - 450-454 AU - Prichard MG AU - Ryan G AU - Musk AW LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 14 IP - DP - 1984 Jan 01 TI - Specific IgE antibodies in twenty-eight workers with di-isocyanate-induced bronchial asthma PG - 453-461 AB - A specific IgE-mediated response was evaluated in twenty-eight workers exposed to TDI or MDI, with diagnosis of occupational asthma and positive to bronchial provocative challenge. The presence of anti-diisocyanate IgE was observed in 27% of subjects exposed to TDI and 83% of those exposed to MDI, particularly in individuals who experienced an acute massive exposure. An immediate-type response to bronchial provocative test was found in 66% of individuals with specific antibodies. Specific IgE are prevalent (91%) in subjects who developed symptoms before 6 years of exposure to isocyanates. The results suggest an association between the presence of specific IgE, early asthmatic symptoms and heavy episodic exposure. AU - Pezzini A AU - Riviera A AU - Paggiaro PL AU - Spiazzi A AU - Gerosa F AU - Filieri M AU - Toma G AU - Tridente G LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 26 IP - DP - 1984 Jan 01 TI - Respiratory effects of two types of solder flux used in the electronics industry PG - 81-85 AB - Fumes from solder flux have been shown to cause asthma among solderers in a British electronics factory. In the present study, questionnaires and lung spirometry were administered to 104 U.S. electronics workers (93 women, 11 men) who soldered printed circuit boards. Two types of solder flux were used: 68 subjects had worked only with a rosin-core (colophony) solder; 36 had changed from rosin- to an aqua-core ("phosphorous hexate") solder 15 months before the study. Symptoms of eye, throat, and nose irritation occurred in nearly half of the total group. Lower respiratory tract symptoms, including cough, phlegm production, and wheezing, also occurred with increased frequency, compared with reported rates among a general population. Similar symptom rates were observed among the aqua- and rosin-core groups. That these symptoms were work related was indicated by the subject's improvement on weekends or during vacation periods. On average, lung spirometry performed before starting work on Monday mornings showed no impairment in lung function; over the course of the work day there were small decrements in the forced expiratory volume at 1 s (mean, -21 +/- 11 [SD] ml) and forced vital capacity (-30 +/- 145 ml), but these decrements were unrelated to the individual amounts of solder used during the same period. Among the white female workers (N=83), several multivariate analyses indicated that an increase in the amount of soldering had a beneficial effect on lung function, particularly among those who currently smoked. This paradox probably resulted from a "healthy worker effect" resulting from some individuals with lower than average lung function who left the industry early in the course of their employment. AU - Greaves IA AU - Wegman DH AU - Smith TJ AU - Spiegelman DL LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 29 IP - DP - 1984 Jan 01 TI - Pulmonary hypersensitivity in the alginate industry PG - 90-95 AU - Henderson AK AU - Ranger AF AU - Lloyd J AU - McSharry CP AU - Mills RJ AU - Moran F LA - PT - DEP - TA - Scot Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 4 IP - DP - 1984 Jan 01 TI - Occupational asthma due to allergens of organic origin PG - 37-54 AU - Hendrick DJ AU - Butcher BT AU - Connolly MJ LA - PT - DEP - TA - Clin Immunol Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 114 IP - DP - 1984 Jan 01 TI - Asthma due to enzymes PG - 916-917 AB - Hartmann AL, Wuthrich B, Baur X, Asthma due to enzymes, Schweiz Med Wochenschr, 1984; 114: 916-917 AU - Hartmann AL AU - Wuthrich B AU - Baur X LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 4 IP - DP - 1984 Jan 01 TI - Occupational asthma from inorganic chemicals PG - 125-129 AU - Fink JN LA - PT - DEP - TA - Clin Immunol Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - IP - DP - 1984 Jan 01 TI - Atlas of mortality from selected diseases in England and Wales PG - - AU - Gardner MJ AU - Winter PD AU - Barker DJ LA - PT - DEP - TA - Pub A Wiley JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 22 IP - DP - 1984 Jan 01 TI - Hypersensitivity pneumonitis in a polyurethane sprayer PG - 506-513 AU - Fujimura N AU - Kino T AU - Nagai S AU - Kitaichi S AU - Izumi T AU - Oshima S LA - PT - DEP - TA - Jap J Thor Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 41 IP - DP - 1984 Jan 01 TI - Extrinsic allergic alveolitis in the tobacco industry PG - 77-83 AU - Huuskonen MS AU - Husman K AU - Jarvisalo J LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 74 IP - DP - 1984 Jan 01 TI - Asthma caused by African maple (triplochiton scleroxylon) wood dust PG - 782-786 AU - Hinojosa M AU - Moneo I AU - Dominguez J AU - Delgado E AU - Losada E AU - Alcover R LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 26 IP - DP - 1984 Jan 01 TI - Respiratory variables and exposure-effect relationships in isocyanate exposed workers PG - 449-455 AU - Holness DL AU - Broder I AU - Corey PN LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 39 IP - DP - 1984 Jan 01 TI - Occupational asthma, rhinitis and dermatitis due to tetrazene in a detonator manufacturer PG - 470-471 AB - The detonation of sporting ammunition requires a guaranteed method of igniting a small quantity of percussion sensitive mix contained in a metal chamber known as a cap. This is struck externally by the firing pin. Mercury fulminate, used originally, is highly toxic and unstable. Manufacturers in modern times have therefore based the ignition mixture on the lead salt of trinitro resorcinol (styphnic acid). A typical mixture also contains oxidisers, fuel (to provide a good heat output), and tetrazene as a sensitiser. Percussion caps must fire with absolute reliability when struck by a blow of specified energy content but must not fire at lower energy inputs. To maintain fine control, tetrazene is used as a relatively weak percussion sensitive explosive in its own right. It is, however, indispensible in the industry as the only sensitiser known for lead styphnate. Its chemical name is 1-(5-tetrazoly)-4-guanyltetrazene hydrate and it is synthesised from organic salts of amino guanidine. The commercial product with which this paper is concerned is an off white fine powder of low bulk density in short needle crystals of a wide range of sizes. It is stable when submerged in water at ordinary temperatures but is rapidly destroyed by boiling water. The dry powder is a highly sensitive explosive but can be handled safely if sufficiently diluted in inert materials. It is practically insoluble in all common solvents but it can form salts with strong mineral acids. It is decomposed by strong bases such as sodium hydroxide. AU - Burge PS AU - Hendy M AU - Hodgson ES LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 4 IP - DP - 1984 Jan 01 TI - Occupational asthma, rhinitis and alveolitis due to colophony PG - 55-82 AU - Burge PS LA - PT - DEP - TA - Clin Immunol Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 41 IP - DP - 1984 Jan 01 TI - Do amines induce occupational asthma in workers manufacturing polyurethane foams PG - 552-553 AU - Candura F AU - Moscato G LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 75 IP - DP - 1984 Jan 01 TI - Bronchial asthma due to occupational exposure to DOP PG - 120-124 AU - Brunetti G AU - Moscato G LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 39 IP - DP - 1984 Jan 01 TI - Circadian rhythms in peak expiratory flow rate in workers exposed to cotton dust PG - 759-765 AU - Cinkotai FF AU - Sharpe TC AU - Gibbs ACC LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 14 IP - DP - 1984 Jan 01 TI - Recurrent nocturnal asthma after bronchoprovocation with western red cedar sawdust: association with acute increase in non-allergic bronchial responsiveness PG - 61-68 AU - Cockcroft DW AU - Hoeppner VH AU - Werner GD LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 51 IP - DP - 1984 Jan 01 TI - Hypersensitivity pneumonitis due to cotton dust in Indian children PG - 341-344 AU - Chetty A AU - Malviya AN LA - PT - DEP - TA - Indian J Pediat JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 130 IP - DP - 1984 Jan 01 TI - Symptoms, pulmonary function and bronchial reactivity in Western Red Cedar workers compared with those of office workers PG - 1038-1041 AU - ChanYeung M AU - Vedal S AU - Kus J AU - MacLean L AU - Enarson D AU - Tse KS LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 14 IP - DP - 1984 Jan 01 TI - Monitoring of maximum expiratory peak flow rates and histamine inhalation tests in the investigation of occupational asthma PG - 193-196 AB - A 49 year old carpenter developed asthma after he was employed in a new workshop. Specific inhalation tests carried out in a laboratory with presswood sawdust and the different glues used at work were negative. Monitoring peak expiratory flow rates (PEFR) at work revealed a progressive fall on consecutive days with recovery after periods off-work. Histamine inhalation tests showed a definite increase in bronchial hyperexcitability after working periods. Monitoring of PEFR in conjunction with histamine inhalation tests can thus help in confirming occupational asthma. AU - Cartier A AU - Pineau L AU - Malo JL LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 14 IP - DP - 1984 Jan 01 TI - MDI-induced asthma: evaluation of the immunologic responses and application of an animal model of isocyanate senitivity PG - 329-339 AU - Chan KC AU - Karol MH LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 22 IP - DP - 1984 Jan 01 TI - A case of pneumonitis possibly due to isocyanate in an automobile painter PG - 1040-1045 AU - Dosake H AU - Shida A AU - Morokuma M AU - Gocho T AU - Terai T AU - Honma Y AU - Hasegawa H AU - Kawakami Y LA - PT - DEP - TA - Jap J Thoracic Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 39 IP - DP - 1984 Jan 01 TI - Respiratory symptoms and lung function among workers in swine confinement buildings: a cross sectional epidemiological survey PG - 96-99 AU - Donham KJ AU - Zaval DC AU - Merchant JA LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 41 IP - DP - 1984 Jan 01 TI - Occupational asthma from nickel sensitivity: 1. human serum albumin in the antigenic determinant PG - 51-55 AU - Dolovich J AU - Evans SL AU - Nieboer LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 4 IP - DP - 1984 Jan 01 TI - Respiratory hypersensitivity to diisocyanates PG - 103-124 AU - Davies RJ LA - PT - DEP - TA - Clin Allergy & Immunology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 130 IP - DP - 1984 Jan 01 TI - Cobalt lung in diamond polishers PG - 130-135 AB - Five diamond polishers with interstitial lung disease attributed to cobalt not alloyed to carbides of hard metals are described. The exposure originated from high-speed grinding tools with a polishing surface of microdiamonds cemented in very fine cobalt. Mineralogic analysis of lung tissue, lavage fluid, filtered air, and exhaust dust in the work environment revealed cobalt as the only toxic agent. Complaints consisted of work-related rhinitis, cough, chest tightness, dyspnea, anorexia, and weight loss, and were intensified in the absence of an adequate exhaust ventilation. Three subjects were in a rather subacute stage, as documented by open lung biopsy in 2 of them, and had a severe restrictive defect and markedly decreased diffusing capacity. Two patients presented a more chronic histologic pattern and had a less decreased diffusing capacity. Open lung biopsies showed in these 4 a fibrosing alveolitis, mainly of the centrilobular zones. In the former 2 patients, subacute lesions consisting of a mural mononuclear cell infiltrate, marked intra-alveolar desquamation, and multinucleated giant cells were found, whereas in the latter 2, centrilobular fibrosis with some microcyst formation was also already seen. Multiple multinucleated giant cells were present in the bronchoalveolar lavage fluid. Interruption of the exposure, with or without corticotherapy, caused a rapid regression of the complaints and a partial improvement of lung function. AU - Demedts M AU - Gheysens B AU - Nagels J LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 41 IP - DP - 1984 Jan 01 TI - Respiratory symptoms and lung function in a group of solderers PG - 346-351 AU - Courtney D AU - Merrett JD LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 14 IP - DP - 1984 Jan 01 TI - Barn allergy among Scottish farmers PG - 197-206 AU - Cuthbert OD AU - Jeffrey IG AU - McNeill HB AU - Wood J AU - Topping MD LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 73 IP - DP - 1984 Jan 01 TI - Occupational asthma in professions with exposure to flour PG - 1103-1107 AU - Fankhouser J AU - Hartmann AL AU - Wuthrich B LA - PT - DEP - TA - Schweiz Rundschau Med (Praxis) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 39 IP - DP - 1984 Jan 01 TI - Pulmonary function in aluminium smelters PG - 743-751 AU - Field GB LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 39 IP - DP - 1984 Jan 01 TI - Penicillium allergic alveolitis: faulty installation of central heating PG - 294-298 AU - Fergusson RJ AU - Milne LJR AU - Crompton GK LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 41 IP - DP - 1984 Jan 01 TI - Occupational asthma from nickel sensitivity. ii Factors influencing the interaction of Ni++, HSA and serum antibodies with nickel related specificity PG - 56-63 AU - Nieboer E AU - Evans SL AU - Dolovich J LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 4 IP - DP - 1984 Jan 01 TI - Clinical and epidemiological methods in investigating occupational asthma PG - 3-17 AU - Newman Taylor AJ AU - Venables KM LA - PT - DEP - TA - Clin Immunol Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 65 suppl 1 IP - DP - 1984 Jan 01 TI - Clinical aspects of farmers lung PG - *-* AU - Monkare S LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 4 IP - DP - 1984 Jan 01 TI - Occupational extrinsic allergic alveolitis PG - 173-192 AU - Molina C LA - PT - DEP - TA - Clin Immunol Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 14 IP - DP - 1984 Jan 01 TI - Bronchial asthma due to spiramycin and adipic acid PG - 335-361 AB - Two cases of bronchial asthma due to spiramycin in workers of a pharmaceutical factory are reported. The subjects complained of cough, breathlessness and symptoms of asthma at work when coming into contact with spiramycin's powder. The symptoms cleared when away from work for more than 3 or 4 days. Inhalation challenge tests by aerosolization of solutions of spiramycin reproduced asthmatic reactions dual in type in both patients, the immediate component of the response has not been previously described for this antibiotic. Furthermore, one of the patients developed an immediate asthmatic reaction also after inhalation of a solution of adipic acid, and additive to bind spiramycin and diminish its irritant action. The reaction was obtained at a non-irritant concentration of the acid, was reproducible and inhibited by previous administration of sodium cromoglycate: this finding and the failure to elicit the reaction in the other patient suggest a hypersensitivity reaction to this substance. AU - Moscato G AU - Naldi L AU - Candura F LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 39 IP - DP - 1984 Jan 01 TI - Occupational asthma due to hexachlorophene PG - 630-631 AU - Nagy L AU - Orosz M LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 129 IP - DP - 1984 Jan 01 TI - Hyper-reactive airway smooth muscle responsiveness after inhalation of toluene diisocyanate vapors PG - 296-300 AU - McKay RT AU - Brooks SM LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 252 IP - DP - 1984 Jan 01 TI - Contact urticaria and airways obstruction from carbonless copy paper PG - 1038-1040 AU - Marks JG AU - Trautlein JJ AU - Zwillich CW AU - Demers LM LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 38 IP - DP - 1984 Jan 01 TI - Occupational causes of laryngeal cancer PG - -121 AU - Olsen J AU - Sabroe S LA - PT - DEP - TA - J Epidemiol Community Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 75 IP - DP - 1984 Jan 01 TI - Bronchial hyper-responsiveness induced by TDI PG - 115-119 AU - Mapp C AU - Ploato R AU - Maestrelli P AU - Fabbri LM LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 34 IP - DP - 1984 Jan 01 TI - A Clinical, radiological and pulmonary function case control study of 135 dockyard welders aged 45 years and over PG - 3-23 AU - McMillan GHG AU - Pethybridge RJ LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 65 IP - DP - 1984 Jan 01 TI - Antibody measurements in extrinsic allergic alveolitis PG - 259-265 AU - McSharry CP AU - Banham SW AU - Lynch PP AU - Boyd G LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 39 IP - DP - 1984 Jan 01 TI - Respiratory symptoms in Ispaghula-allergic nurses after oral challenge with Ispaghula suspension PG - 65-68 AU - Machado L AU - Stalenheim G LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 82 IP - DP - 1984 Jan 01 TI - Hypersensitivity pneumonitis in workers exposed to esparto grass PG - 214-217 AU - Macias MH AU - Cano MS AU - Mun$oz FM AU - Gomez MLD LA - PT - DEP - TA - Med Clin (Barc) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 39 IP - DP - 1984 Jan 01 TI - Occupational asthma due to heated freon PG - 628-629 AU - Malo JL AU - Gagnon G AU - Cartier A LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 41 IP - DP - 1984 Jan 01 TI - Epidemiological study of the lung function of workers at a factory manufacturing polyvinylchloride PG - 328-333 AU - LLoyd MH AU - Gauld S AU - Copland L AU - Soutar CA LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 4 IP - DP - 1984 Jan 01 TI - Occupational allergy due to animal allergens PG - 19-36 AU - Longbottom JL LA - PT - DEP - TA - Clin Immunol Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 14 IP - DP - 1984 Jan 01 TI - Occupational allergy due to inhalation of epecacuanha dust PG - 169-175 AU - Luczynska CM AU - Marshall PE AU - Scarisbrick DA AU - Topping MD LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 73 IP - DP - 1984 Jan 01 TI - Occupational asthma due to poultry mites PG - 56-60 AB - he possible role of the northern fowl mite (NFM) in occupation-related respiratory disease of poultry workers was examined. The study population included 16 poultry workers with workplace-associated asthma and rhinitis, 27 atopic individuals with similar symptoms but no occupational exposure to poultry, and 12 asymptomatic nonatopic poultry-exposed controls. Ten of the 16 atopic poultry workers had immediate wheal-and-flare reactions to NFM, as compared with two of 27 non—poultry-exposed controls (p <0.001). In cutaneous testing with five poultry-related antigens, the NFM was the most reactive. On skin tests, four atopic poultry workers were positive for NFM and negative for Dermatophagoides farinae; four workers were negative for NFM and positive for D. farinae. Radioallergosorbent test (RAST) showed specific IgE levels for NFM, with positive RAST scores in 60% of poultry workers having positive skin tests. A provocative bronchial test with NFM extract in a poultry worker having positive NFM skin test and RAST score resulted in an immediate 25% reduction in the FEV1 and a 62% fall in forced expiratory flow volume at 25% of vital capacity. Collectively, the established presence of NFM in the poultry workplace, associated clinical histories, positive cutaneous tests, positive specific-IgE assays, and positive bronchial challenge combine to estalbish a role for NFM in occupational allergic respiratory disease of poultry farmers. AU - Lutsky I AU - Teichtahl H AU - BarSela S LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 73 IP - DP - 1984 Jan 01 TI - Failure of enzyme encapsulation to prevent sensitisation of workers in the dry bleach industry PG - 348-355 AU - Liss GM AU - Kominsky JR AU - Gallagher JS AU - Melius J AU - Brooks SM AU - Bernstein IL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 48 IP - DP - 1984 Jan 01 TI - Isolation and characterization of a new Cytophaga species implicated in work-related lung disease PG - 936-943 AU - Liebert CA AU - Hood MA AU - Deck FH AU - Bishop K AU - Flaherty DK LA - PT - DEP - TA - Appl Environ Microbiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 41 IP - DP - 1984 Jan 01 TI - Rice meller's syndrome: a prelimonary report PG - 445-449 AU - Lim HH AU - Domala Z AU - Joginder S AU - Lee SH AU - Lim CS AU - AbuBakar CM LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 100 IP - DP - 1984 Jan 01 TI - Mushroom worker's lung PG - 682-685 AU - Kulmala T AU - Elo J AU - Kallioinen T AU - Liippo K AU - Palojoki A LA - PT - DEP - TA - Duodecim JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 311 IP - DP - 1984 Jan 01 TI - Respiratory allergies related to automobile air conditioners PG - 1619-1621 AU - Kumar P AU - Marier R AU - Leech SH LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 38 IP - DP - 1984 Jan 01 TI - Interstitial pneumonia through moulds in a fruit cold storage house PG - 434-437 AU - Kroidl RF AU - Amthor M AU - Durkes U AU - Freitag V AU - Hain E LA - PT - DEP - TA - Prax Klin Pneumol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 125 IP - DP - 1984 Jan 01 TI - Occupational asthma due to isocyanate (TDI) PG - 1931-1934 AU - Orosz M AU - Nagy L AU - Galambos E LA - PT - DEP - TA - Orovosi Hetilap JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 125 IP - DP - 1984 Jan 01 TI - Electronics-workers asthma due to colophony PG - 1395-1397 AU - Orosz M AU - Nagy L AU - Falus F LA - PT - DEP - TA - Orv Hetil JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 14 IP - DP - 1984 Jan 01 TI - Follow up study of patients with respiratory disease due to TDI PG - 463-469 AU - Paggiaro PL AU - Loi AM AU - Ferrante RB AU - Pardi F AU - Roselli MG AU - Baschieri L LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 4 IP - DP - 1984 Jan 01 TI - Immunological studies in experimental animals of occupational chemical allergens PG - 159-172 AU - Patterson R AU - Zeiss CR AU - Harris KE LA - PT - DEP - TA - Clin Immunol Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 35 IP - DP - 1984 Jan 01 TI - The effects of furfurol upon the respiratory system PG - 39-45 AU - Pawlowicz A AU - Droszcz W AU - Garlicki A AU - Kutyla J AU - Kowalczyk M LA - PT - DEP - TA - Med Pracy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 4 IP - DP - 1984 Jan 01 TI - Occupational allergy due to platinum complex salts PG - 131-158 AU - Pepys J LA - PT - DEP - TA - Clinics in Immunology and Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 35 IP - DP - 1984 Jan 01 TI - Evaluation of the health status of PVC processing workers PG - 97-104 AU - Przybylowski J AU - Podolecki A AU - Szczepanski Z AU - Biskupek K LA - PT - DEP - TA - Med Pracy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 14 IP - DP - 1984 Jan 01 TI - Airborne endotoxins and humidifier disease PG - 109-112 AU - Rylander R AU - Haglind P LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 52 IP - DP - 1984 Jan 01 TI - Asthmatic response to inhaled aminophylline: a report of two cases PG - 97-98 AU - Rosenberg M AU - Aaronson D AU - Evans C LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 26 IP - DP - 1984 Jan 01 TI - Bronchial asthma due to inhaled chloroplatinate PG - 500-509 AU - Shima S AU - Yoshida T AU - Tachikawa S AU - Kato Y AU - Miki T AU - Kidaka K AU - Taniwaki H AU - Ito T LA - PT - DEP - TA - Jpn J Ind Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 130 IP - DP - 1984 Jan 01 TI - Hypersensitivity pneumonitis induced by Trichosporon cutaneum PG - 407-411 AU - Shimazu K AU - Ando M AU - Sakata K AU - Araki S LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 22 IP - DP - 1984 Jan 01 TI - Hypersensitivity pneumonitis induced by Trichosporon cutaneum, approposal of of the aetiologic agent of the summer-type hypersensitivity pneumonitis PG - 491-500 AU - Shimazu K AU - Ando M AU - Sakata T AU - Yoshida K AU - Akaki S LA - PT - DEP - TA - Jap J Thoracic Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 45 IP - DP - 1984 Jan 01 TI - Complaints relating to the handling of carbonless copy paper in Sweden PG - B24, B26-B24, B27 AB - No specific relationship could be established between complaints and chemicals used in the brands of carbonless copy paper on the Swedish market. The symptoms were non-specific and very variable. Any office encountering these problems must have them analyzed separately to find the local explanation. Carbonless copy paper has been in widespread use for more than 20 years. Although several reports have been published about suspected health hazards from such papers, none has been able to prove any relationship between carbonless copy papers in general and health hazards (see bibliography). That all chemicals in a product are absolutely safe can never be proved, but if all efforts to prove them dangerous fail, the suspicions of their hazards must diminish. Investigations must concentrate on finding the local cause of the trouble AU - Jeansson K AU - Lofstrom A AU - Lidblom A LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - IP - DP - 1984 Jan 01 TI - Aerosol challenge in lung disease PG - 225- AU - Burge PS LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - Lewis publ IP - DP - 1984 Jan 01 TI - Indoor sources of indoor air microbes PG - - AU - Burge HA LA - PT - DEP - TA - Indoor air and human health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 14 IP - DP - 1984 Jan 01 TI - The diversity of allergens involved in bakers asthma PG - 93-107 AU - Sutton R AU - Skerritt JH AU - Baldo BA AU - Wrigley CW LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 33 IP - DP - 1984 Jan 01 TI - The correlation between sea-squirt crude and purified antigens and histamine release in sea squirt asthma PG - 78-82 AU - Tanifuji K AU - Daibo A AU - Sudo M AU - Tamura M LA - PT - DEP - TA - Arerugi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 33 IP - DP - 1984 Jan 01 TI - sea-squirt asthma PG - 357-363 AU - Tanifuji K LA - PT - DEP - TA - J Allergology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 85 IP - DP - 1984 Jan 01 TI - Host factors affecting longitudinal decline in lung function among grain elevator workers PG - 782-786 AU - Tabona M AU - ChanYeung M AU - Enarson D AU - MacLean L AU - Dorken E AU - Schulzer M LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 65 IP - DP - 1984 Jan 01 TI - Lung reactions during poultry handling related to dust and bacterial endotoxin levels PG - 266-271 AU - Thelin A AU - Tegler O AU - Rylander R LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 41 IP - DP - 1984 Jan 01 TI - Asthma and other symptoms in cinnamon workers PG - 224-227 AU - Uragoda CG LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 24 IP - DP - 1984 Jan 01 TI - Coexistance of rhinitis and allergic tracheobronchitis due to lycopodium powder,with positive RAST, and contact eczema with positive skin test PG - 215-215 AU - Wuthrich B AU - Helbling A LA - PT - DEP - TA - Rev Fr Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 41 IP - DP - 1984 Jan 01 TI - Respiratory function in tea workers PG - 88-93 AU - Zuskin E AU - Skuric Z LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 39 IP - DP - 1984 Jan 01 TI - Nasal hypersensitivity in wood furniture workers PG - 586-595 AU - Wilhelmsson B AU - Jernudd Y AU - Ripe E AU - Holmberg K LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 39 IP - DP - 1984 Jan 01 TI - Hypersensitivity pneumonitis due to Aspergillus fumigatus in compost PG - 74-75 AU - Vincken W AU - Roels P LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 45 IP - DP - 1984 Jan 01 TI - Monitoring of formic acid in urine of humans exposed to low levels of formaldehyde PG - 19-23 AB - This study documented the formaldehyde exposures of a group of veterinary medicine students. It also investigated the feasibility of biologically monitoring the exposures. The biological monitoring was based on the fact that the formaldehyde is metabolized in the body to formic acid, and may then be excreted in the urine. Therefore, exposures to formaldehyde could theoretically create a shift in the formic acid levels in the urine. Normal baseline levels of urinary formic acid were first established for each subject. The baselines of most students were quite variable. Very few exhibited a "tight variability" in their baseline. Next, three sets of pre- and post-exposure urine samples were taken. A series of paired t-tests were run on these "pre" and "post" sets. The results indicated that no significant formic acid shift was seen. A subset of the samples was "corrected" for specific gravity. However, this adjustment did not have an effect upon the relative formic acid levels. In addition, no significant formic acid shift was seen in the adjusted group. Exposure levels of the students were less than 0.5 ppm of formaldehyde. Therefore, the main conclusion of the study was that biological monitoring of formaldehyde exposures (via formic acid shifts) at these low levels was not a feasible technique. AU - Gottschling LM AU - Beaulieu HJ AU - Melvin WW. LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 130 IP - DP - 1984 Jan 01 TI - Pulmonary alveolar proteinosis and aluminum dust exposure PG - 312-315 AB - A 44-yr-old male presented with shortness of breath, diffuse X-ray infiltrates, and physiologic evidence of a restrictive lung disease. Biopsy revealed pulmonary alveolar proteinosis. The patient had worked for the previous 6 yr as an aluminum rail grinder in a very dusty environment. Analysis of his lung tissue revealed greater than 300 X 10(6) particles of aluminum/g dry lung; all of the particles appeared as spheres of less than 1 mu diameter. We believe that this case represents an example of pulmonary alveolar proteinosis induced by inhalation of aluminum particles; this finding confirms animal studies which suggest that proteinosis can be produced by very large doses of many types of finely divided mineral dust. AU - Miller RR AU - Churg AM AU - Hutcheon M AU - Lom S LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 41 IP - DP - 1984 Jan 01 TI - Comparison of radiographic appearances with associated pathology and lung dust content in a group of coalworkers PG - 459-467 AB - The pathology and dust content of lungs from 261 coalminers in relation to the appearances of their chest radiographs taken within four years of death were examined. Radiological opacities of coalworkers' pneumoconiosis were more profuse the more dust was retained in lungs. Among the men who had mined low rank coal--that is, with a relatively high proportion of ash--the increase in profusion was most closely related to the ash component of the dust, whereas in men who had mined high rank coal both coal and ash increased in the lungs in relation to radiological profusion. The fine p type of opacity was found to be associated with more dust and a higher proportion of coal and less ash than the nodular r opacity, and was also more likely to be associated with emphysema. The pathological basis of the different types of opacity found on the radiographs of coalminers related to the number, size, and nodularity of the dust lesions. Larger fibrotic lesions were likely to appear as r opacities, whereas fine reticular dust deposition was most likely to present as p opacities, q opacities showing a mixture of appearances. The study has shown that the composition of dust retained in the lung, as well as its amount, makes an important contribution to the radiographic appearances of pneumoconiosis. In particular, the r type of lesion on the radiograph of a low rank coalminer indicates the possibility of a silicotic like lesion AU - Ruckley VA AU - Fernie JM AU - Chapman JS AU - Collings P AU - Davis JM AU - Douglas AN AU - Lamb D AU - Seaton A LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 129 IP - DP - 1984 Jan 01 TI - Emphysema and dust exposure in a group of coal workers PG - 528-532 AB - The lungs of 450 coal miners who had been studied previously in a long-term epidemiologic project at 24 British mines have been examined post-mortem for signs of dust-related fibrosis and emphysema. Reliable estimates of cumulative (working-life) exposures to respirable mine dust were available for 342 of the men. The relative frequency of emphysema increased with age at death, and both panacinar and centriacinar emphysema occurred more frequently in smokers than in nonsmokers. The proportion of subjects with any emphysema was 47% in 92 men with no palpable dust lesions, 65% in 183 with small, simple pneumoconiotic lesions, and 83% in 175 miners with massive fibrosis (PMF). The chance of finding centriacinar emphysema in those with PMF increased significantly with increasing exposure to coal dust in life (p less than 0.025). A similar but less convincing relationship was found in those with simple pneumoconiosis (p less than 0.11), but in both groups, increasing amounts of ash with a given exposure to coal reduced the probability of finding centriacinar emphysema. The occurrence of centriacinar emphysema was associated also with increasing amounts of dust retained in the lungs. A preliminary exploration of this association did not support the hypothesis that emphysematous lungs clear dust less efficiently. We conclude that the association observed between exposure to respirable coal dust and emphysema in coal miners indicates a causal relationship. However, because it can be demonstrated only for men whose lungs show some dust-related fibrosis, it is suggested that the extent and nature of such fibrosis may be a crucial factor in determining the presence of centriacinar emphysema AU - Ruckley VA AU - Gauld SJ AU - Chapman JS AU - Davis JM AU - Douglas AN AU - Fernie JM AU - Jacobsen M AU - Lamb D LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 144 IP - DP - 1984 Jan 01 TI - The role of cell injury and the continuing inflammatory response in the generation of silicotic pulmonary fibrosis PG - 149-161 AB - The pathogenesis of silicosis involves interaction between pulmonary macrophages and fibroblasts. The consequences of direct injury to pulmonary cells and the role of inflammatory cells other than the macrophage have received little attention. These were studied over a 20 week period after instilling silica to mice by correlating the changing inflammatory response, as revealed by bronchoalveolar lavage and lung sections, with the cellular location of silica particles and the development and resolution of granulomatous lesions. Within 24 h, a massive concentration of particles and PMN was seen in centrilobular locations with acute focal necrosis of type 1 epithelial cells. Rapid epithelial repair occurred but PMN were recovered from the lung up to 20 weeks. In the alveoli, silica was ingested by PMN and AM, resulting in the death of some cells; free particles crossed the epithelium and were found predominantly in peribronchial macrophages. Silicotic granulomas formed within a week and consisted mainly of fibroblasts macrophages and some PMN. It is suggested that the necrosis of type 1 epithelium and the continuing efflux with serial destruction of PMN may be important factors in the generation of silicotic fibrosis AU - Bowden DH AU - Adamson IY LA - PT - DEP - TA - Journal of Pathology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 62 IP - DP - 1984 Jan 01 TI - Serodiagnosis of pulmonary tuberculosis in Argentina by enzyme-linked immunosorbent assay (ELISA) of IgG antibody to Mycobacterium tuberculosis antigen 5 and tuberculin purified protein derivative PG - 755-761 AU - Balestrino EA AU - Daniel TM AU - de Latini MD AU - Latini OA AU - Ma Y AU - Scocozza JB LA - PT - DEP - TA - Bull World Health Organ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 18 IP - DP - 1984 Jan 01 TI - Evaluation of mycobacterial antigens in an enzyme-linked immunosorbent assay (ELISA) for the serodiagnosis of tuberculosis PG - 309-318 AB - Five mycobacterial antigens were compared in an enzyme-linked immunosorbent assay (ELISA) for the serodiagnosis of tuberculosis. The antigens studied were an unheated sterile culture filtrate of Mycobacterium tuberculosis, tuberculin purified protein derivative (PPD) from M. tuberculosis (PPDa), purified cytoplasmic protein antigens 5 and 6 from M. tuberculosis, and a PPD prepared from M. kansasi (PPDk). Multivariate analysis of variance showed that geometric mean titres obtained with each of the antigens in ELISA were significantly different in tuberculosis patients and in control groups. The covariation of the ELISA results with the five antigens was highly interdependent. Analysis of receiver operating characteristics revealed that the most accurate test was obtained with antigen 5. M. tuberculosis PPD, M. tuberculosis antigen 6, and M. tuberculosis culture filtrate were, in descending order, less accurate AU - Benjamin RG AU - Debanne SM AU - Ma Y AU - Daniel TM LA - PT - DEP - TA - Journal of Medical Microbiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 78 IP - DP - 1984 Jan 01 TI - Asian immigrant tuberculosis--the effect of visiting Asia PG - 248-253 AB - The intervals between arrival or rearrival in the UK and notification of tuberculosis have been studied in four groups of Asian immigrants according to contact with known cases of tuberculosis in the UK and recent visits to Asia. It appears that about one-fifth of the Asian immigrants who developed tuberculosis in West Ham in a 5-year period did so as a result of a recent visit to Asia. About one-third appeared to have acquired their infection before leaving Asia and developed the disease soon after arrival in the UK. Nearly one-half apparently acquired their disease from known or unknown contacts in the UK AU - McCarthy OR LA - PT - DEP - TA - Br J Dis Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 5 IP - DP - 1984 Jan 01 TI - Tuberculosis in hospital PG - 109-117 AU - George RH LA - PT - DEP - TA - J Hosp Infect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 100 IP - DP - 1984 Jan 01 TI - A new Legionella species, Legionella feeleii species nova, causes Pontiac fever in an automobile plant PG - 333-338 AU - Herwald LA AU - Gorman GW AU - McGrath T AU - Toma S AU - Brake B AU - Hightower AW AU - Jones J AU - Reingold AL AU - Boxer PA AU - Tang P AU - Moss CW AU - Wilkinson HW AU - Brenner DJ AU - Steigerwald AG AU - Broome CV LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 41 IP - DP - 1984 Jan 01 TI - Exposure to oxides of nitrogen: respiratory symptoms and lung function in British coalminers PG - 214-219 AU - Robertson A AU - Dodgson J AU - Collings P AU - Seaton A LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 114 IP - DP - 1984 Jan 01 TI - Bronchial challenge with hypertonic KCl solution in the diagnosis of bronchial asthma. A comparison with the challenge performed by inhalation of distilled water PG - 910-913 AU - Magyar P AU - Dervaderics M AU - Toth A LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 289 IP - DP - 1984 Jan 01 TI - The sick building syndrome: prevalence studies PG - 1573-1575 AB - Random samples or the entire workforce in nine offices in which similar clerical work was being performed were studied using a doctor administered questionnaire that inquired into symptoms that have been linked with the "sick building syndrome." Five of the offices were fully air conditioned, one had recirculation of air and mechanical ventilation, and three were naturally ventilated. Workers in three air conditioned and three naturally ventilated buildings were interviewed blind. Seven of the buildings were studied at our request in the absence of any known problem. Comparison of prevalences of symptoms between the naturally ventilated and the other buildings showed a repeated pattern of nasal, eye, and mucous membrane symptoms with lethargy, dry skin, and headaches. There were highly significant excesses of these six symptoms in the air conditioned buildings when compared by chi 2 tests with the naturally ventilated buildings. It is suggested that these six symptoms represent the sick building syndrome and that the size of the problem is probably greater than is currently recognised. Possible causes are discussed AU - Finnegan MJ AU - Pickering CAC AU - Burge PS LA - PT - DEP - TA - Br Med J (Clin Res Ed) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 2 IP - DP - 1984 Jan 01 TI - Headache and mucous membrane irritation. An epidemiological study PG - 249-254 AU - Valbjorn O AU - Kousgaard N LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 33 IP - DP - 1984 Jan 01 TI - Pulmonary function and symptoms of Nigerian workers exposed to cement dust PG - 379-385 AU - Oleru UG LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 58 IP - DP - 1984 Jan 01 TI - Immunological responses to complex salts of platinum. II. Enhanced IgE antibody responses to ovalbumin with concurrent administration of platinum salts in the rat PG - 478-485 AB - The effect of platinum group metal salts on IgE antibody synthesis in an animal model was studied with respect to the magnitude and kinetics of the response. In outbred Hooded Lister Rats immunized with 10 micrograms ovalbumin with B. pertussis as adjuvant and boosted with 1 microgram in saline an enhanced secondary response to ovalbumin was obtained when certain halide platinum salts were given concurrently with primary immunization. This phenomenon was limited to ammonium tetrachloroplatinate II, ammonium hexachloroplatinate IV and to a lesser extent the cesium trichloronitroplatinate II. Platinum group metal salts not possessing this characteristic were cis-dichlorodiammine plantinum II, tetra-ammineplatinum II chloride, ammonium aquopentachlororhodate III and ammonium tetrachloropalladate II. Kinetic studies show that the time courses of the primary and secondary responses were not altered in the presence of the platinum salts. In rats immunized with ovalbumin without adjuvant there was no detectable antibody and concurrent administration of platinum salts also had no effects. Thus platinum salts whilst acting synergistically with adjuvant to enhance antibody synthesis do not act as adjuvants in their own right AU - Murdoch RD AU - Pepys J LA - PT - DEP - TA - Clin Exp Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19840101 IS - IS - VI - 57 IP - DP - 1984 Jan 01 TI - Immunological responses to complex salts of platinum. I. Specific IgE antibody production in the rat PG - 107-114 AB - Ammonium tetrachloroplatinate II ([NH4]2 PtCl4) was used in free and conjugated forms with ovalbumin in an attempt to elicit specific antibody directed against either the free platinum (Pt) salt or the platinum moiety of ovalbumin-Pt conjugates in the hooded Lister rat. Immunization with free Pt salt via intraperitoneal, intramuscular, intradermal, subcutaneous, intratracheal and footpad routes over a wide range of doses (1 microgram-1 mg) employing both B. pertussis and/or aluminium hydroxide gel as adjuvants failed to induce specific IgE antibody, either primary or secondary, as shown by direct skin, PCA test or RAST. Conjugation of (NH4)2 PtCl4 with ovalbumin produced conjugates, with between two and 10 haptenic Pt groups per ovalbumin molecule, capable of inducing IgE antibody directed against the Pt moiety as determined by heterologous PCA challenge, where carrier cross-reactivity was excluded, and by specific RAST, confirmed by RAST inhibition AU - Murdoch RD AU - Pepys J LA - PT - DEP - TA - Clin Exp Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 38 IP - DP - 1983 Jan 01 TI - Rapid method for measurement of bronchial responsiveness PG - 760-765 AB - A rapid, simple method for measuring bronchial responsiveness to inhaled histamine is described. The method was used to obtain dose response curves in 50 atopic subjects with varying respiratory and nasal symptoms. The cumulative dose of histamine which caused a 20% fall in the one second forced expiratory volume (PD2>FEV.) varied between 0*046 and greater than 39 umol and correlated with the severity of symptoms. The reproducibility of the PD2,FEv, determined from duplicate measurements in 15 subjects with varying degrees of bronchial responsiveness was found to be satisfactory. When the PD2OFEV, from this rapid method was compared with that obtained from the dosimeter method no significant difference was found. The dose delivered by this method was shown to be cumulative. AU - Yan K AU - Salome CM AU - Woolcock AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 38 IP - DP - 1983 Jan 01 TI - Clinical studies of workers exposed to polyvinylchloride dust PG - 834-839 AB - A previous study showed that exposure of workers to polyvinylchloride (PVC) dust was associated with the presence of small rounded opacities in the chest radiograph, and also with a small average reduction of the forced expiratory volume in one second (FEV1). Studies have now been carried out on selected men to determine the clinical importance of the presence of small rounded opacities and also to identify any clinical or physiological features associated with PVC dust exposure. Among 28 men with small rounded opacities, complaints of persistent bronchial mucous hypersecretion were more common (nine men) than amont 29 men of similar age, smoking habits, and dust exposures (one man, p less than 0.01), and there was a suggestion that the physical sign of late inspiratory crackles was more frequent among men with opacities (seven of 27 men) than the other men (two of 28 men, p less than 0.05). The average lung function of men with opacities was only trivially lower than that of the comparative group and the difference between the groups was not significant. In further studies 13 non-smokers with the highest PVC dust exposure and lowest FEV1 (adjusted for age, height, weight, and dust exposure) were examined. None had an observed FEV1 less than 80% of the predicted value for age and height, and these men did not differ in symptoms, signs, or lung function from non-smokers with low dust exposure and similarly low FEV1. In a similar study of 18 smokers with the highest PVC dust exposures and lowest adjusted FEV1, some men had an observed FEV1 well below 80% of predicted values for non-smokers, but with one exception no clinical or functional differences were found between then and 18 smokers with low dust exposure and similarly low FEV1. The exception was again the presence of end inspiratory crackles on auscultation, which were slightly more frequent among men with the highest dust exposures (seven men) than among those with low exposure (two men, p less than 0.06). We conclude that these findings are consistent with the suggestion that the radiographic abnormalities caused by PVC dust exposure are not associated with important functional effects or clinical illness. Further studies are desirable to examine the eventual outcome of the syndrome AU - Soutar CA AU - Gauld S LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 38 IP - DP - 1983 Jan 01 TI - Evaluation of ultrasonically nebulised solutions for provocation testing in patients with asthma PG - 284-291 AU - Anderson SD AU - Schoeffel RE AU - Finney M LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 9 IP - DP - 1983 Jan 01 TI - Prevalence of dichromate sensitivity PG - 190-194 AU - Peltonen L AU - Fraki J LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 9 IP - DP - 1983 Jan 01 TI - Allergic contact dermatitis from an organic di-isocyanate PG - 300-303 AB - Organic di-isocyanates are used widely in industry. The concomitant respiratory complications are well-known. Cutaneous problems precipitated by skin contact with these chemicals are less well recognised. Allergic contact dermatitis caused by exposure to di-cyclohexylmethane 4,4'-di-isocyanate has been demonstrated in a factory where it was used to form a surface-coating polyurethane. Attention to hygiene methods may have reduced the incidence of cases AU - White IR AU - Stewart JR AU - Rycroft RJ LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 128 IP - DP - 1983 Jan 01 TI - Respiratory health in workers exposed to man-made vitreous fibers PG - 104-112 AU - Weill H AU - Hughes JM AU - Hammad YY AU - Glindmeyer HW 3d AU - Sharon G AU - Jones RN LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 84 IP - DP - 1983 Jan 01 TI - Tuberculosis. A look at the world situation PG - 756-761 AU - Grzybowski S LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 32 IP - DP - 1983 Jan 01 TI - Interstate outbreak of drug-resistant tuberculosis involving children--California, Montana, Nevada, Utah PG - 516-518 AU - Anonymous LA - PT - DEP - TA - MMWR JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 127 IP - DP - 1983 Jan 01 TI - Transmission of tuberculosis by flexible fiberbronchoscopes PG - 97-100 AB - The development of flexible fiberoptic bronchoscopy was an important technologic advance in the diagnosis and management of patients with pulmonary disease. However, reliable decontamination and sterilization of these delicate instruments have been difficult. Many physicians routinely use a solution of povidone-iodine diluted in 70% ethyl alcohol and water to decontaminate fiberbronchoscopes, despite the fact that these iodophor compounds were developed as skin antiseptics and not as germicidal disinfectants for decontaminating instruments. We isolated a strain of Mycobacterium tuberculosis on a surveillance culture from a bronchoscope after it had been cleaned and disinfected with an iodophor solution. In another hospital, we documented the transmission of M. tuberculosis from one patient to another by a bronchoscope that had been disinfected with a commonly recommended iodophor solution. We then studied the tuberculocidal efficacy of various iodophor preparations used with exposure times from 10 to 30 min. In several experiments these iodophors failed to kill M. tuberculosis. Because iodophors do not reliably kill M. tuberculosis, they should not be used to disinfect fiberoptic bronchoscopes AU - Nelson KE AU - Larson PA AU - Schraufnagel DE AU - Jackson J LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 23 IP - DP - 1983 Jan 01 TI - Late inhalation toxicology and pathology produced by exposure to a single dose of 2-chlorobenzylidene malononitrile (CS) in rats and hamsters PG - 257-265 AU - Marrs TC AU - Clifford E AU - Colgrave HF LA - PT - DEP - TA - Medicine Science & the Law JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 2 IP - DP - 1983 Jan 01 TI - Chemical agents used in riot control and warfare PG - 247-256 AB - The development of riot control agents is reviewed with emphasis on the major factors influencing the selection and deployment of those agents in current use. Typical agents, irrespective of their chemical nature, cause unpleasant symptoms involving the eyes, skin, mouth, nose and respiratory tract. Ideally, these symptoms cause the sufferer to seek escape from exposure and resolve within 15-30 minutes after exposure has ceased. The medical management of casualties is discussed, with particular consideration of the problems likely to be referred to a Poison Control Centre AU - Beswick FW LA - PT - DEP - TA - Hum Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 128 IP - DP - 1983 Jan 01 TI - Cigarette smoking and lung destruction. Accumulation of neutrophils in the lungs of cigarette smokers PG - 833-838 AB - It has been hypothesized that lung destruction in persons with emphysema associated with cigarette smoking is mediated by elastase released by neutrophils that have migrated to the alveolar structures in response to cigarette smoke. To directly evaluate this hypothesis, cell suspensions, isolated from bronchoalveolar lavage fluid and from open lung biopsies of nonsmokers and cigarette smokers with normal lung parenchyma and from open lung biopsies of nonsmokers and cigarette smokers who have sarcoidosis were evaluated for the presence of neutrophils. A significantly increased number of neutrophils was present in the cell suspensions isolated from bronchoalveolar lavage fluid and from open lung biopsies of both normal and sarcoid cigarette smokers compared with that in the nonsmokers (p less than 0.01, each comparison). Evaluation of the alveolar macrophages present in lavage fluid suggested a mechanism by which neutrophils may be attracted to the lungs of cigarette smokers: alveolar macrophages of cigarette smokers release a chemotactic factor for neutrophils, whereas alveolar macrophages of nonsmokers do not. In addition, alveolar macrophages of nonsmokers, after exposure to cigarette smoke, in vitro, are stimulated to release this chemotactic factor. These studies demonstrate that an increased number of neutrophils are present in the lungs of cigarette smokers compared with that in nonsmokers and suggest that cigarette smoke may attract neutrophils to the lung by stimulating alveolar macrophages to release a potent chemotactic factor for neutrophils AU - Hunninghake GW AU - Crystal RG LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 44 IP - DP - 1983 Jan 01 TI - Acute inhalation toxicology of nitrogen trichloride PG - 145-146 AU - Barbee SJ AU - Thackara JW AU - Rinehart WE LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 19 IP - DP - 1983 Jan 01 TI - Standardized lung function testing. Report of working party PG - 1-95 AU - Anonymous LA - PT - DEP - TA - Bull Eupopean Physiopath Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 40 IP - DP - 1983 Jan 01 TI - Lung cancer associated with chloromethyl methyl ether manufacture: an investigation at two factories in the United Kingdom PG - 384-389 AB - The prevalence of deaths from lung cancer, other cancer, and all other causes was studied in workers and former workers at two factories (A and B) in the United Kingdom at which chloromethyl methyl ether has been manufactured, at one since about 1948 and at the other since 1956. At factory A in South Wales 571 men were traced and at factory B in the north east of England 1196. A statistically significant excess of observed deaths from lung cancer but not other cancer compared with the number expected was found in factory A when the death rates for the population of Glamorgan were applied. The deaths from lung cancer at factory A were related to risk in terms of total exposure time, and average exposure rate and dosage. The degree of exposure was more important than the duration of exposure. There has so far been no demonstrable excess of deaths from lung cancer in employees working at factory A since the process was changed in 1972. In factory B the risk was low over the whole period, and there was no excess of lung or other cancers compared with the rates for the Tyneside conurbation. Despite improvements in the process in both factories continued surveillance of the workers is needed for some years yet. AU - McCallum RI AU - Woolley V AU - Petrie A LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 38 IP - DP - 1983 Jan 01 TI - Chrome plating: symptoms, findings in the upper airways, and effects on lung function PG - 367-374 AB - Respiratory symptoms, lung function, and changes in the nasal septum were noted for 100 subjects exposed to chrome plating. The findings were compared with those of 119 nonexposed controls, studied with identical techniques, as well as with data in the literature. Complaints of nasal irritation were common among subjects exposed to a daily average that exceeded 1 microgram/m3 of chromic acid, while the frequency of chronic bronchitis was similar to that in different control series. Nasal septal ulceration and perforation were seen in two-thirds of the subjects exposed to peak levels of 20 micrograms/m3 or more. Both forced vital capacity and forced expired volume in 1 sec were reduced by 0.2 L. The forced midexpiratory flow diminished by 0.4 L/sec from Monday morning to Thursday afternoon in subjects exposed to a daily average of 2 micrograms/m3 or more chromic acid, but there was no clear correlation with short-term high exposure. Subjects exposed to lower levels showed no significant changes. Data collected on Monday morning (i.e., after 2 days without exposure) did not differ significantly from reference values. It is concluded that an 8-hr mean exposure exceeding 2 micrograms/m3 may cause a transient decrease in lung function, and that short-term exposure to at least 20 micrograms/m3 may cause septal ulceration and perforation. AU - Lindberg E AU - Hedenstierna G. LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 38 IP - DP - 1983 Jan 01 TI - Quantitative immunoelectrophoretic analysis of rat allergen extracts PG - 419-431 AU - Walls AF AU - Longbottom JL LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 13 IP - DP - 1983 Jan 01 TI - Asthma due to grinding epoxy resin cured with phthalic anhydride PG - 165-168 AU - Ward MJ AU - Davied D LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 50 IP - DP - 1983 Jan 01 TI - Sensitisation in a grain handler to the storage mite Lepidoglyphus destructor (Schrank) PG - 30-33 AU - Warren CPW AU - HolfordStevens V AU - Sinha RN LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - IP - DP - 1983 Jan 01 TI - Baker's asthma: Epidemiological and clinical findings- needs for prospective studies PG - 429-433 AU - Thiel H LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 98 IP - DP - 1983 Jan 01 TI - Syndromes in workers exposed to Trimellitic anhydride. A longitudinal clinical and immunologic study PG - 8-12 AU - Zeiss CR AU - Wolkonsky P AU - Chacon R AU - Tuntland PA AU - Levitz D AU - Pruzansky JJ AU - Patterson R LA - PT - DEP - TA - Ann Int Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 128 IP - DP - 1983 Jan 01 TI - Asthma caused by diphenylmethane diisocyanate in foundry workers PG - 226-230 AU - ZammitTabona M AU - Sherkin M AU - Kijek K AU - Chan H AU - ChanYeung M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 33 IP - DP - 1983 Jan 01 TI - A comparative study of chilli grinders with paprika splitters PG - 145-147 AU - Uragoda CG LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 13 IP - DP - 1983 Jan 01 TI - Diagnosis of pigeon breeders disease by indirect immunofluorescence on sections of pigeon oviduct PG - 57-60 AU - Smets P AU - Gari M AU - Pinon JM AU - Seguela JP LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - Ed Kerr , IP - DP - 1983 Jan 01 TI - Wood dust asthma PG - *-* AU - Sosman AJ LA - PT - DEP - TA - Proc XI International Congress of Allergology and JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 40 IP - DP - 1983 Jan 01 TI - Occurrence of lung cancer in workers producing chromium pigments PG - 1-74 AU - Langard S AU - Vigander T LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 128 IP - DP - 1983 Jan 01 TI - The effect of temperature on recording spirograms PG - 894-898 AU - Miller MR AU - Pincock AC LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 17 IP - DP - 1983 Jan 01 TI - The effect of reduced ventilation on indoor air quality in an office building PG - 51-64 AU - Turiel I AU - Hollowell CD AU - Mirksch RR AU - Rudy JV AU - Young RA LA - PT - DEP - TA - Atmos Environ JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 25 IP - DP - 1983 Jan 01 TI - Measurement of IgG antibody and airborne antigen to control an industrial outbreak of hypersensitivity pneumonitis PG - 207-210 AU - Reed CE AU - Swanson MC AU - Lopez M AU - Ford AM AU - Major J AU - Witmer WB AU - Valdes TB LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 13 IP - DP - 1983 Jan 01 TI - IgE-mediated occupational allergy to a spider mite PG - 383-388 AU - Reunala T AU - Bjorksten F AU - Forstrom L AU - Kanerva L LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 72 IP - DP - 1983 Jan 01 TI - Antibodies against TDI protein conjugates PG - 676-680 AU - Patterson R AU - Harris KE AU - Zeiss CR LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 13 IP - DP - 1983 Jan 01 TI - Absence of IgG antibodies to TDI-HSA in a radioimmunological study PG - 75-79 AU - Paggiaro PL AU - Filieri M AU - Loi AM AU - Roselli R AU - Cantalupi R AU - Parlanti A AU - Toma G AU - Baschieri L LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 124 IP - DP - 1983 Jan 01 TI - Investigations in occupational asthma due to hexachlorophene PG - 2793-2795 AU - Orosz M AU - Nagy L AU - Galambos E LA - PT - DEP - TA - Orovosi Hetilap JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 38 IP - DP - 1983 Jan 01 TI - Effictiveness of long term DSCG treatment in painters asthma PG - 157-164 AU - Orefice U AU - D'Ambrogio G AU - Colle B AU - Ferrazzano PL LA - PT - DEP - TA - Arch Monaldi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 50 IP - DP - 1983 Jan 01 TI - Acute symptoms secondary to formaldehyde exposure on a pathology resident PG - 326-328 AU - Kwong F AU - Kraske G AU - Nelson AM AU - Glaustermeyer WB LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 11 IP - DP - 1983 Jan 01 TI - Occupational asthma due to carmine of cochenille PG - 487-488 AU - Lenz D AU - Pelletier A AU - Pauli G AU - Roegel E AU - Aouizerate E AU - Enjalbert M AU - Bouvot JL AU - Courty G LA - PT - DEP - TA - Rev Franc Mal Resp JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 38 IP - DP - 1983 Jan 01 TI - Dust exposure challenge test as a measure of potential allergenicity and occupational disease risk in handling ispaghula products PG - 141-144 AB - It is known that workers in the pharmaceutical industry, and nurses, can become sensitized and develop allergic respiratory symptoms by handling bulk laxatives containing Ispaghula powder. Fifteen individuals allergic to Ispaghula were challenged with a commercially available Ispaghula product and three other products manufactured in a way to make them less dusty. The results show that the use of products with smaller amounts of airborne particles results in a lower incidence of symptoms and thus probably reduces the potential occupational risk of sensitization to the Ispaghula allergen. AU - Machado L AU - Olsson G AU - Stalenheim G AU - Zetterstrom O LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 161 IP - DP - 1983 Jan 01 TI - Pilot study of chronic bronchitis in varnished wire production PG - 283-285 AB - isocyanate possible AU - Maintz G LA - PT - DEP - TA - Z Erkrank Atm Org JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 33 IP - DP - 1983 Jan 01 TI - A study into the health and mortality of men exposed to cobalt and oxides PG - 181-186 AU - Morgal LG LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 74 IP - DP - 1983 Jan 01 TI - Occupational asthma in food workers: study of three cases PG - 302-307 AU - Nava C AU - Brambilla G AU - BriaticoVangosa G AU - Marchisio M AU - Talamo F LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 1 IP - DP - 1983 Jan 01 TI - Asthmatic reactions to a commonly used aerosol insect killer PG - 378-380 AU - Newton JG AU - Breslin ABX LA - PT - DEP - TA - Med J Aust JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 72 IP - DP - 1983 Jan 01 TI - Asthma and IgE antibodies induced by chromium and nickel salts PG - 407-412 AB - Metal plating with chromium and nickel has secured an occupational relation with asthma for which an allergic basis has been postulated but not confirmed. A worker who developed de novo asthma after plating with nickel and chromium but not other metals was subjected to inhalational challenge and immunoserologic tests to evaluate this association. He developed acute asthma to chromium sulfate and a biphasic asthma-like response to nickel sulfate. Radioimmunoassays incorporating the challenge materials revealed specific IgE antibodies to the provocative agents but not to another metal, gold, which he could tolerate. The findings support the postulates that bronchial reactivity can be specifically induced by fumes of metallic salts, even in a previously nonallergic individual, and that an IgE type I immunopathogenic mechanism is involved. AU - Novey HS AU - Habib M AU - Wells ID LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 13 IP - DP - 1983 Jan 01 TI - Allergy to inhaled egg material PG - 427-432 AB - The use of a spray system to coat meat rolls with egg solution resulted in the development of asthmatic type symptoms in eight of thirteen workers exposed to the spray. Symptoms were severe in five workers, less severe in two, and one worker experienced vague symptoms. Even though precipitins were present in nine of the workers there were no pyrexial episodes nor influenza-like symptoms occurring some hours after inhaling the egg material to suggest extrinsic allergic alveolitis. All sera with precipitins reacted against an antigen in egg yolk, two sera only to this antigen but no precipitins to ovalbumin were detected. Lung function, X-ray and haematology provided no evidence that the inhalation of egg had lasting detrimental effects. There was no correlation between clinical response, skin testing, IgE levels and precipitins, hence, for each individual none of these parameters is predictive. However, collectively the results show sensitization and this has been confirmed by lack of symptoms when a different method of coating the pastry was adopted. AU - Edwards JH AU - McConnochie K AU - Trotman DM AU - Collins G AU - Saunders MJ AU - Latham SM LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 40 IP - DP - 1983 Jan 01 TI - Single cell protein as an occupational hazard PG - 212-215 AU - Ekenvall L AU - Dolling B AU - Gothe CJ AU - Ebbinghaus L AU - von Stedingk LV AU - Wasserman J LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 9, No. 4, IP - DP - 1983 Jan 01 TI - Nasal and sinonasal cancer. connection with occupational exposures in denmark, finland and sweden PG - -326, AU - Hernberg S AU - Westerholm P AU - Schultz Larsen K AU - Degerth R AU - Kuosma E AU - Englund A AU - Engzell U AU - Hansen HS AU - Mutanen P LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 40 IP - DP - 1983 Jan 01 TI - Allergy to laboratory animals: a retrospective and a prospective study PG - 442-449 AU - Davies GE AU - Thompson AV AU - Niewola Z AU - Burrows GE AU - Teasdale EL AU - Bird DJ AU - Phillips DA LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 4 IP - DP - 1983 Jan 01 TI - Estimation of airborne rat derived antigens by ELISA PG - 113-126 AU - Davies GE AU - Thompson AV AU - Rackham M LA - PT - DEP - TA - J Immunoassay JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 38 IP - DP - 1983 Jan 01 TI - Interstitial lung disease and asthma in hard metal workers: bronchoalveolar lavage, ultrastructural and analytical findings and results of bronchial provocation tests PG - 119-128 AB - Five patients with respiratory disorders associated with hard metal exposure are described. In four patients electron microprobe analysis of bronchoalveolar lavage cells or lung tissue was used to show tungsten and other hard-metal components. Three patients had interstitial pneumonia and fibrosis with unusual multinucleate giant cells. Electron microscopy showed that the giant cells comprised both type II alveolar epithelial cells and alveolar macrophages. The multinucleate macrophages formed a distinctive feature of the bronchoalveolar lavage material but the multinucleate alveolar epithelial lining cells were evident only in lung tissue. The other two patients both suffered from work-related asthma, one of whom also had pulmonary opacities. Bronchial provocation tests in these patients supported the diagnosis of hard-metal-induced asthma and implicated cobalt as the agent responsible. AU - Davison AG AU - Haslam PL AU - Corrin B AU - Coutts II AU - Dewar A AU - Riding WD AU - Studdy PR AU - Newman Taylor AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 13 IP - DP - 1983 Jan 01 TI - Asthma in merchant seamen and laboratory workers caused by allergy to castor beans: analysis of allergens PG - 553-561 AB - Three merchant seamen and two laboratory workers who developed allergic symptoms following exposure to castor beans have been investigated. Bronchial-provocation testing with castor beans in the merchant seamen demonstrated a late reaction in two. Specific IgE against whole castor-bean extract and ricin, ricinus agglutinin and dericinated extracts of castor bean were found in the patients' sera using radioallergosorbent tests (RAST). RAST inhibition, toxocological and haemagglutination tests suggest that the ricin and dericinated extracts contain distinct allergens. AU - Davison AG AU - Britton MG AU - Forrester JA AU - Davies RJ AU - Hughes DTD LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 71 suppl IP - DP - 1983 Jan 01 TI - Respiratory effects of formaldehyde and UFFI off-gas following controlled exposure PG - 159-15* AU - Day JH AU - Lees REM AU - Clarke RH LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 128 IP - DP - 1983 Jan 01 TI - Acute effects of grain dust exposure during a work shift PG - 399-404 AU - do Pico GA AU - Reddan W AU - Anderson S AU - Flaherty D AU - Smally E LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 127 IP - DP - 1983 Jan 01 TI - Epidemiologic health study of workers in an aluminium smelter in British Colombia. Effects on the respiratory system PG - 465-469 AU - ChanYeung M AU - Wong R AU - MacLean L AU - Tan F AU - Schulzer M AU - Enarson D AU - Martin A AU - Dennis R AU - Gryzbowski S LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 74 IP - DP - 1983 Jan 01 TI - Allergic pathology in a pre-prepared pizza production department PG - 272-276 AU - Campiglio R AU - Bonazzina R AU - Cortona G AU - Nava C LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 13 IP - DP - 1983 Jan 01 TI - Radioallergosorbent testing with p-tolyl monoisocyanate in toluene diisocyanate workers PG - 31-34 AU - Butcher BT AU - O'Neil CE AU - Reed MA AU - Salvaggio JE LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 38 IP - DP - 1983 Jan 01 TI - Correlation between a respiratory questionnaire and peak flow measurements in printing workers exposed to a contaminated humidifier PG - 708-708 AU - Burge PS AU - Pickering CAC AU - Horsfield N LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 13 IP - DP - 1983 Jan 01 TI - Asthma due to Central American walnut (Juglans clanchana) PG - 389-394 AU - Bush RK AU - Clayton D LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 13 IP - DP - 1983 Jan 01 TI - Allergic properties of a feed protein of microfungal origin PG - 69-73 AU - Kauppinen K AU - Kuuliala O AU - Bjorksten F LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 44 IP - DP - 1983 Jan 01 TI - Asthme et soudure a l'etain. A propos de deux cas PG - 306-307 AU - Grange F LA - PT - DEP - TA - J Arch Mal Prof JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 38 IP - DP - 1983 Jan 01 TI - Resolution of pulmonary dysfunction following acute chlorine exposure PG - 76-80 AU - Hasan FM AU - Gehshan A AU - Fuleihan FJD LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 113 IP - DP - 1983 Jan 01 TI - Allergic asthma caused by occupational exposure to dust of the proteolytic enzyme pectinase PG - 265-267 AU - Hartmann AL AU - Wlater H AU - Wuthrich B LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 51 IP - DP - 1983 Jan 01 TI - Exposure to terpenes: effects on pulmonary function PG - 191-198 AU - Hedenstierna G AU - Alexandersson R AU - Wimander K AU - Rosen G LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 33 IP - DP - 1983 Jan 01 TI - Byssinosis: a cross-sectional study in an Australian textile factory PG - 119-125 AU - Gun RT AU - Janckewicz G AU - Esterman A AU - Roder D AU - Antic R AU - McEvoy RD AU - Thornton A LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 25 IP - DP - 1983 Jan 01 TI - Occupational allergy to laboratory animals: employer practices PG - 372-376 AU - Lutsky II AU - Kalbfleisch JH AU - FinkJN LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 71 IP - DP - 1983 Jan 01 TI - Tetrachlorophthalic anhydride asthma: evidence for specific IgE antibody PG - 5-11 AB - We describe seven women with asthma induced by occupational exposure to an acid anhydride, tetrachlorophthalic anhydride (TCPA), an epoxy resin hardening agent. Inhalation tests with TCPA at atmospheric concentrations of less than one tenth of a manufacturer's recommended exposure limit provoked asthmatic reactions in the four women tested. None had evidence of pretest bronchial hyperreactivity. Immediate skin prick test reactions were elicited in the seven subjects by a conjugate of TCPA with human serum albumin (TCPA-HSA) but not in others tested. Specific IgE antibody levels to TCPA-HSA, measured by radioallergosorbent test scores, were significantly elevated in the seven, but not in TCPA-exposed and unexposed comparison groups. These results imply that occupational asthma caused by TCPA is an allergic reaction mediated by specific IgE antibody. AU - Howe W AU - Topping MD AU - Hawkins R AU - Newman Taylor AJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 13 IP - DP - 1983 Jan 01 TI - Bakers Asthma PG - 359-370 AU - Block G et al LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 127 IP - DP - 1983 Jan 01 TI - Occupational asthma in crab processing workers PG - 155 AU - Carter A AU - Lafrance M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 13 IP - DP - 1983 Jan 01 TI - Some aspects of occupational asthma PG - 191-195 AU - Avilla R LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 29 IP - DP - 1983 Jan 01 TI - Irritative and allergic effects of pesticide aerosols on the respiratory tract PG - 678-681 AU - Barthel E LA - PT - DEP - TA - Z Gesamte Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 9, No. 2, IP - DP - 1983 Jan 01 TI - Nasal cancer and occupational exposure. preliminary report of a joint nordic case-referent study PG - -213, AU - Hernberg S AU - Collan Y AU - Degerth R AU - Englund A AU - Engzell U AU - E Kuosma; AU - Mutamen P AU - Nordlinder H AU - Hansen HS AU - Schultz Larsen K AU - Sogaard H AU - Westerholm P LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 13 IP - DP - 1983 Jan 01 TI - Prevalence and diagnosis of laboratory animal allergy PG - 433-442 AU - Beeson MF AU - Dewdnet JM AU - Edwards RG AU - Lee D AU - Orr RG LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 40 IP - DP - 1983 Jan 01 TI - Amines: possible causative agents in the development of bronchialreactivity in workers manufacturing polyurethanes from isocyanates PG - 251-257 AU - Belin L AU - Wass U AU - Audunsson G AU - Mathiasson L LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - IP - DP - 1983 Jan 01 TI - Occupational asthma induced by phthalic anhydride and related compounds PG - AU - Bernstein IL LA - PT - DEP - TA - Proc XI Int Cong Allergology Clin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 72 IP - DP - 1983 Jan 01 TI - The relationship of total serum IgE and blocking antibody in trimellitic anhydride-induced occupational asthma PG - 714-719 AU - Bernstein DI AU - Zeiss C AU - Wolonsky P AU - Levitz D AU - Roberts M AU - Patterson R LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 72 IP - DP - 1983 Jan 01 TI - The relationship of airborne trimellitic anhydride concentrations to trimellitic anhydride-induced symptoms and immunre responses PG - 709-713 AU - Bernstein DI AU - Roach DE AU - McGrath KG AU - Larsen RS AU - Zeiss CR AU - Patterson R LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 13 IP - DP - 1983 Jan 01 TI - Baker's asthma PG - 359-370 AU - Block G AU - Tse KS AU - Kijek K AU - Chan H AU - ChanYeung M LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - dissertati IP - DP - 1983 Jan 01 TI - Some hygiene aspects related to use of reacted dry scrubbing alumina in primary aluminium production PG - - AU - Bjorseth O LA - PT - DEP - TA - Norwegian Institute of Technology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 44 IP - DP - 1983 Jan 01 TI - Exposures to respirable, airborne Penicillium from a contaminated ventilation system: clinical, environmental and epidemiological aspects PG - 151-169 AU - Bernstein RS AU - Sorenson WG AU - Garabrant D AU - Reaux C AU - Treitman RD LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 51 IP - DP - 1983 Jan 01 TI - RAST with animal dander, urine, saliva and serum PG - 543-546 AU - Berrens L AU - van Dijk AG AU - BollebakkerBaars A AU - Huizinga M LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 72 IP - DP - 1983 Jan 01 TI - Sporobolomyces: a possible cause of extrinsic allergic alveolitis PG - 305-309 AB - A 28-year-old horseback rider presented with symptoms, chest radiograph, and pulmonary function tests suggestive of extrinsic allergic alveolitis related to exposure to a horse barn. Exposure to the barn produced symptoms, fever, and a fall in VC commencing 4 hr after exposure. Precipitins were positive against Sporobolomyces, suggesting this might be the causative agent; precipitins were negative against other fungi and horses. Lymphocyte stimulation to Sporobolomyces in vitro was positive in the patient and negative in two control subjects. Sporobolomyces was grown from straw in the barn. Cessation of exposure to this barn (but continued exposure to horses) has resulted in improvement in clinical condition. A survey for immunologic sensitivity to Sporobolomyces revealed that eight of 30 atopic subjects had positive wheal-and-flare prick skin tests to Sporobolomyces antigen, whereas none of 30 laboratory controls or 30 grain handlers had precipitins against Sporobolomyces. Sporobolomyces is a common fungus in cereal grain growing areas. Its spore size is less than 5 µm, consistent with other causative agents of this disorder. In this patient, positive precipitins and lymphocyte stimulation to Sporobolomyces and negative precipitins to other known causes of extrinsic allergic alveolitis provide circumstantial evidence that Sporobolomyces was the cause of the syndrome. Original article Sporobolomyces: a possible cause of extrinsic allergic alveolitis ? D.W. Cockcroft, M.D., F.R.C.P.(C.), a, b, B.A. Berscheid, B.A.a, b, I.A. Ramshaw, Ph.D.a, b, J. Dolovich, M.D., F.R.C.P.(C.)a, b AU - Cockcroft DW AU - Berscheid BA AU - Ramshaw IA AU - Dolovich J LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19830101 IS - IS - VI - 127 IP - DP - 1983 Jan 01 TI - Acute Effects of Volcanic Ash from Mount Saint Helens on Lung Function in Children PG - 714-719 AB - To evaluate the acute effects of volcanic ash from Mt. St. Helens on the lung function of children, we studied 101 children 8 to 13 yr of age who were attending a 2-wk summer camp for children with diabetes mellitus in an area where about 1.2 cm of ash had fallen after the June 12,1980, eruption. The outcome variables used were forced vital capacity, forced expiratory volume in one second, their ratio and mean transit time. Total and respirable dust levels were measured using personal sampling pumps. The children were tested on arrival and twice (early morning [A.M.] and late afternoon [P.M.]) every second or third day during the session. A within-day effect was measured by the P.M./A.M. ratio for the lung function variables; a between-day effect was measured by the change in the P.M. measurements over the 2 wk of camp. We found no strong evidence of either a within-day or a between-day effect on lung function, even in a subgroup of children who had preexisting lung disease or symptoms, despite daytime dust/ash levels that usually exceeded the Environmental Protection Agency’s significant harm level for particulate matter. AU - A. Sonia Buist AU - Larry R. Johnson AU - William M. Vollmer AU - Gary J. Sexton AU - Paula H. Kanarek LA - PT - DEP - TA - American Review of Respiratory Disease JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 70 IP - DP - 1982 Jan 01 TI - Isocyanate-induced pulmonary disease: a current perspective PG - 24-31 AU - Bernstein IL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 63 IP - DP - 1982 Jan 01 TI - Clinical and immunologic evaluation of trimellitic anhydride and phthalic anhydride-exposed workers using a questionnaire with comparitive analysis of enzyme-linked radioimmunoassay studies PG - 311-318 AU - Bernstein DI AU - Patterson R AU - Zeiss CR LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 69 IP - DP - 1982 Jan 01 TI - Hypersensitivity to chironomids (non biting midges): localisation of the antigenic sequences of haemoglobins (Erythrocruorins) of Chironomus thimmi thummi (Diptera) PG - 66-76 AU - Baur X AU - Dewair M AU - Fruhmann G AU - Ascheuer H AU - Pfetschinger J AU - Braunitzer G LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 12 IP - DP - 1982 Jan 01 TI - Clinical symptoms and results of skin test, RAST and bronchial provocation test in 33 papain workers PG - 9-17 AU - Baur X AU - Konig G AU - Bencze K AU - Fruhmann G LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 12 IP - DP - 1982 Jan 01 TI - IgE-mediated acute asthma following inhalation of a powdered marine sponge PG - 179-186 AU - Baldo BA AU - Krelis S AU - Taylor KM LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - IP - DP - 1982 Jan 01 TI - Some observations on occupational asthma PG - - AU - Barrat G AU - Choudat D AU - Brochard P AU - Marsac J AU - Philbert M LA - PT - DEP - TA - Unknown JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 63 IP - DP - 1982 Jan 01 TI - Single and serial measurements of lung function in the diagnosis of occupational asthma PG - 47-59 AB - Reports a different analysis of the Burge 1979 paper on 49 workers with a history of occupational asthma and 46 exposed controls. Sensitivity for expert interpretation against SIC showed a sensitivity of 77% for colophony sensitive electronics workers not taking prophylactic treatment and 100% for isocynate exposed printers. The colophony group had reduced sensitivity to 42% when taking prophylactic DSCG or beclomethasone. Specificity was 100% for colophony exposed workers and 83% for isocyanate exposed workers. FEV1, FVC and FEF75, FEF50 and FEF25 were measured before entry to the workplace and on leaving on a Monday, the next Friday and the following Monday after a 2 day absence from work. 22% of the cases and 11% of the controls had a fall in FEV1 after at least one of the 3 shifts. The coefficients of variation for FEF75, FEF50 and FEF25 were too high to allow meaningful pre-post shift comparisons. AU - Burge PS LA - PT - DEP - TA - Eur J Respir Dis Suppl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 37 IP - DP - 1982 Jan 01 TI - Exposure to formaldehyde: effects on pulmonary function PG - 279-284 AU - Alexandersson R AU - Hedenstierna G AU - KolmodinHedman B LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 37 IP - DP - 1982 Jan 01 TI - Occupational asthma in electronics workers caused by colophony fumes: Follow-up of affected workers PG - 348-353 AB - Thirty-nine electronics workers were investigated by bronchial provocation testing to soldering fluxes containing colophony and were followed up one to four years later. At presentation and on follow-up each worker had nonspecific bronchial reactivity measured with inhaled histamine, and also had detailed measurements of lung function and estimation of total immunoglobulin levels. They completed a questionnaire designed to detect residual disability. The workers were divided into three groups. Twenty had left work after their initial diagnosis, eight had been moved to alternative work within their original factories, and 11 were thought to have asthma unrelated to colophony exposure as they failed to react to colophony at presentation. Histamine reactivity had returned to normal in half the workers who had left their original factories, but in only one worker who had moved within her original factory. This suggested that the nonspecific bronchial reactivity to histamine was the result rather than the cause of the occupational asthma, and that indirect exposure at work was sufficient to delay recovery of histamine reactivity. However, only two of the 20 affected workers who had left their original factories were symptom free on follow-up, and most had a considerable reduction in their quality of life by continuing asthma, which was particularly provoked by exercise, respiratory infections, and nonspecific irritants. Continuing symptoms may have been caused by domestic sources of colophony, or possibly the failure to eliminate colophony from the lungs. AU - Burge PS LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 63 Sup 123 IP - DP - 1982 Jan 01 TI - Non-specific bronchial hyper-reactivity in workers exposed to toluene di-isocyanate, diphenyl methane di-isocyanate and colophony PG - 91-96 AB - Non-specific bronchial reactivity to histamine has been measured before specific occupational bronchial tests in the following groups: 51 workers exposed to toluene di-isocyanate (TDI); 40 workers exposed to diphenylmethane diisocyanate (MDI); 45 electronics workers exposed to colophony fumes and 13 unexposed controls. Finally 38 electronics workers had repeated measurements after moving their place of work. The results showed that histamine reactivity was an important, but not obligatory, factor in the development of occupational asthma, and that it appeared to be the result rather than the cause of occupational asthma, as it returned towards normal in workers removed from exposure. TDI and MDI were shown to be acting as specific causes of occupational asthma rather than nonspecific irritants at concentrations up to 0.02 ppm. There was evidence that some irritant reactions to colophony were occurring at exposure levels encountered at work, but that the majority of workers with colophony asthma were having specific reactions to the colophony fume AU - Burge PS LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 72 IP - DP - 1982 Jan 01 TI - Clinical features and natural history of occupational asthma due to western red Cedar (Thuja plicata) PG - 411-415 AB - After an average follow-up interval of three and a half years (range one to nine years), 125 patients with occupational asthma due to red cedar exposure were re-examined. Fifty patients remained in the same job. All of them continued to have asthmatic attacks requiring regular medication for relief of symptoms. They had worse lung function and ther bronchial reactivity to methacholine increased. Seventy-five patients left the industry; half of them became asymptomatic, whereas the remaining half continued to have recurrent attacks of asthma. Several factors were of prognostic significance. Those with a shorter duration of exposure as well as a shorter duration of symptoms prior to diagnosis and removal from exposure showed improvement. Those who remained symptomatic tended to be older; they had longer duration of exposure and a longer duration of symptoms prior to diagnosis. They tended to have more abnormal results of lung function studied and more marked bronchial hyper-reactivity to methacholine at the time of diagnosis. They also tended to have dual asthmatic reaction rather than late asthmatic reaction to inhalation challenge with red cedar extract. Smoking, race and degree of peripheral blood eosinophilia did not play a role in determining the outcome. Since none of these patients had symptomatic asthma before employment and since they reacted to inhalation challenge of red cedar, it could be assumed that persistent asthma in those who failed to recover is the result of their previous occupational exposure. Early diagnosis and removal from exposure were found to be associated with recovery. AU - ChanYeung M AU - Lam S AU - Koener S LA - PT - DEP - TA - Am J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 48 IP - DP - 1982 Jan 01 TI - Acquired persistent increase in nonspecific bronchial reactivity associated with isocyanate exposure PG - 93-95 AU - Cockcroft DW LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 70 IP - DP - 1982 Jan 01 TI - Immunologic and nonimmunologic mechanisms in asthma due to western red cedar (Thuja plicata) PG - 32-37 AU - ChanYeung M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 70 IP - DP - 1982 Jan 01 TI - Clinical and immunologic evaluation of trimellitic anhydride workers in multiple industrial settings PG - 15-18 AU - Zeiss CR. Wolkonsky P. Pruzansky JJ. Patterson R LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 37 IP - DP - 1982 Jan 01 TI - Coffee workers asthma PG - 313-322 AU - Osterman K AU - Zetterstrom O AU - Johansson SG LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 20 IP - DP - 1982 Jan 01 TI - A case of hypersensitivity pneumonitis caused by MDI exposure PG - 1236-1240 AU - Hanawa M AU - Mabuchi T AU - Oeda H LA - PT - DEP - TA - Jap J Thoracic Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 24 IP - DP - 1982 Jan 01 TI - Piperazine induced occupational asthma PG - 193-197 AU - Hagmar L AU - Bellander T AU - Bergoo B AU - Simonsson BG LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - i IP - DP - 1982 Jan 01 TI - Occupational asthma caused by allergy to pigs urine PG - 867-867 AU - Harries MG AU - Cromwell O LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 24 IP - DP - 1982 Jan 01 TI - Formaldehyde asthma; challenge exposure levels and fate after five years PG - 893-897 AU - Hendrick DJ AU - Rando RJ AU - Lane DJ AU - Morris MJ LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 4 IP - DP - 1982 Jan 01 TI - The use of RAST to monitor exposure to occupational allergens PG - 77-83 AU - Goodwin BFJ LA - PT - DEP - TA - Proc XI ICACI meeting JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 43 IP - DP - 1982 Jan 01 TI - Australian TDI workers' sera assayed for IgE against p-tolyl-isocyanate-human serum albumin conjugate PG - 759-763 AU - Game CJA LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 248 IP - DP - 1982 Jan 01 TI - Asthma induced by nickel PG - 1065-1066 AU - Fisher JR AU - Rosenblum GA AU - Thompson BD LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 26 IP - DP - 1982 Jan 01 TI - Variables affecting the outcome of inhalation of enzyme dusts PG - 647-655 AU - Flindt MLH LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 51 IP - DP - 1982 Jan 01 TI - Styrene and methylmethacrylate in the industrial environment as a risk factor of chronic obstructive lung disease PG - 151-157 AU - Jedrychowski W LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 37 IP - DP - 1982 Jan 01 TI - Mites living in hay: an important allergen source PG - 475-479 AU - Hillerdal G AU - Zetterstrom O AU - Johansson SGO AU - Engstrom B AU - Wiren A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 63 suppl 1 IP - DP - 1982 Jan 01 TI - Cutting oil mist and bronchitis PG - 79-83 AU - Jarvholm B LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 63 suppl 1 IP - DP - 1982 Jan 01 TI - The effects of corticosteroids on the immediate asthmatic reaction PG - 163-166 AU - Burge PS LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 70 IP - DP - 1982 Jan 01 TI - Development and loss of toluene diisocyanate reactivity: immunologic, pharmacologic and provocation challenge studies PG - 231-235 AU - Butcher BT AU - O'Neil CE AU - Reed MA AU - Salvaggio JE AU - Weill H LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 63 suppl 1 IP - DP - 1982 Jan 01 TI - Mechanisms of isocyanate induced asthma PG - 82-86 AU - Butcher BT LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 63 suppl 1 IP - DP - 1982 Jan 01 TI - Long-term respiratory effects of isocyanate exposure PG - 87-90 AU - Butcher BT LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 3 IP - DP - 1982 Jan 01 TI - Could you be overlooking occupational asthma? PG - 97-112 AU - Burge PS LA - PT - DEP - TA - J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 63 suppl 1 IP - DP - 1982 Jan 01 TI - Occupational asthma due to soft soldering fluxes containing colophony (rosin, pine resin) PG - 65-77 AU - Burge PS LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 63 suppl.1 IP - DP - 1982 Jan 01 TI - Non-specific hyperreactivity in workers exposed to toluene diisocyanate, diphenyl methane diisocyanate and colophony PG - 91-96 AU - Burge PS LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 33 IP - DP - 1982 Jan 01 TI - Hypersensitivity to D pteronyssinus in a librarian PG - 27-32 AU - Cernelc D LA - PT - DEP - TA - Arh Hig Rata Toksikol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 82 IP - DP - 1982 Jan 01 TI - Occupational asthma caused by cedar urea formaldehyde particle board PG - 49-53 AU - Cockcroft DW AU - Hoeppner VH AU - Dolovich J LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 69 IP - DP - 1982 Jan 01 TI - Grain fever syndrome induced by inhalation of airborne grain dust PG - 435-443 AU - do Pico GA AU - Flaherty D AU - Bhansali P AU - Chavaje N LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 81 IP - DP - 1982 Jan 01 TI - Pulmonary actions to Durham wheat- a constituent of grain dust PG - 55-61 AB - To identify constituents of grain dust responsible for grain handlers' respiratory symptoms, 11 volunteer grain elevator workers underwent inhalation provocation tests with extracts of durum wheat, durum wheat airborne dust, and grain insects and mites. Factors that might influence the host response to the challenge were assessed. Five of the 11 subjects showed a greater than 20 percent decrement in FEV1 after inhalation of durum wheat extracts (airways reaction). The bronchial reactions were immediate in 1/5 and late in 4/5. These airway reactions were blocked by sodium cromoglycate. Only one subject showed airway reaction to durum wheat dust extract, and none reacted to mites or insect extracts. There was no change in DLCO, temperature, or in total C3 complement blood levels, nor was there evidence of activation of complement by the alternate or classic pathway. The airway response was not always related to the atopic status of the individual. The reaction is more likely to occur in subjects with preexisting airway obstruction and nonspecific bronchial hyperreactivity. Durum wheat has been identified as an inducer of occupational asthma in grain handlers. This reaction is probably due to specific or nonspecific mediator release. There was no apparent parenchymal or systemic reaction or complement activation detectable in the subjects' sera after inhalation of durum wheat extracts. AU - do Pico GA AU - Jacobs S AU - Flaherty D AU - Rankin J LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 36 IP - DP - 1982 Jan 01 TI - Occupational flour allergy; bakers asthma and rhinitis PG - 389-397 AU - Debelic M AU - Sarvan B LA - PT - DEP - TA - Prax Klin Pneumol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 3* IP - DP - 1982 Jan 01 TI - Health and safety in soft soldering PG - 26-28 AU - Courtney D LA - PT - DEP - TA - Brazing and Soldering JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 102 IP - DP - 1982 Jan 01 TI - Humidifier fever PG - 7-8 AU - Edwards JH LA - PT - DEP - TA - Roy Soc Health J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 8 IP - DP - 1982 Jan 01 TI - Allergy to the complex salts of platinum. A review of the literature and three case reports PG - 141-145 AU - Orbaek P LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 63 suppl 1 IP - DP - 1982 Jan 01 TI - Laboratory animal allergy PG - 60-64 AU - Newman Taylor AJ LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 11 IP - DP - 1982 Jan 01 TI - Air-conditioner disease PG - 2325-2329 AU - Molina CL AU - Aiache JM AU - Bedu M AU - Menaut P AU - Wahl D AU - Brestowski J AU - Grall Y LA - PT - DEP - TA - Nouv Presse Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - i IP - DP - 1982 Jan 01 TI - Asthma caused by occupational exposure to vanadium compounds PG - 183-184 AU - Musk AW AU - Tees JG LA - PT - DEP - TA - Med J Aust JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 63 suppl 1 IP - DP - 1982 Jan 01 TI - An epidemic of bath water fever- endotoxin alveolitis? PG - 108-116 AU - Muittari A AU - Kuusisto P AU - Sovijarvi A LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 39 IP - DP - 1982 Jan 01 TI - Lack of allergic reactions in coffee workers exposed to pruteen (bacterial single-cell protein) PG - 183-186 AU - Mayes RW LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 69 IP - DP - 1982 Jan 01 TI - Occupational asthma induced by inhalation and ingestion of garlic PG - 448-454 AU - Lybarger JA AU - Gallagher JS AU - Pulver DW AU - Litwin A AU - Brooks S AU - Bernstein IL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 69 IP - DP - 1982 Jan 01 TI - Occupational asthma caused by nickel sulphate PG - 55-59 AB - A 28-yr-old man developed asthma shortly after being exposed to nickel sulfate (NiSO4) in a metal-plating factory. Recordings of peak expiratory flow rates at work and for an off-work period showed increased variations at work, with best values on weekends. Allergy prick skin tests elicited an immediate reaction with NiSO4 at a concentration of 10 mg/ml. Experimental inhalation challenges with NiSO4 at the same concentration of 10 mg/ml for 60 sec produced a bronchial obstruction typical of an early asthmatic response. A control asthmatic subject with a similar level of sensitivity to histamine failed to react after the same inhalation of NiSO4, which suggests a specific rather than irritant mechanism for the reaction. the patient had evidence of IgE antibody to a NiSO4-human serum albumin antigen. His serum selectively bound 63 Ni, and the test was selectively blocked by nonlabeled nickel sulfate. These results, evaluated together, suggest the development of occupational asthma caused by allergy to NiSO4 in this patient. AU - Malo JL AU - Cartier A AU - Doepner M AU - Nieboer E AU - Evans S AU - Dolovich J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - ii IP - DP - 1982 Jan 01 TI - Northern fowl mite (Ornithonyssus sylviarum) in occupational asthma in poultry workers PG - 874-875 AU - Lutsky I AU - BarSela S LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 24 IP - DP - 1982 Jan 01 TI - Bronchopulmonary diseases due to hard metal dust PG - 636-648 AU - Kusaka Y LA - PT - DEP - TA - Jpn J Ind Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 63 suppl 1 IP - DP - 1982 Jan 01 TI - Respiratory symptoms and ventilatory function in machine shop workers exposed to coolant lubricants PG - 85-89 AU - Oxhoj H AU - Andreasen H AU - Henius UM LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 69 IP - DP - 1982 Jan 01 TI - Antibody responses following immunotherapy with cat pelt extract PG - 320-326 AU - Ohman JL AU - Marsh DG AU - Goldman M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 70 IP - DP - 1982 Jan 01 TI - Immunology and immunopathology of trimellitic anhydride pulmonary reactions PG - 19-23 AU - Patterson R AU - Zeiss CR AU - Pruzansky JJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - ed J W Ker IP - DP - 1982 Jan 01 TI - Trimellitic anhydride and toluene diisocyanate respiratory reactions PG - *-* AU - Patterson R AU - Suhs EP AU - Zeiss CR LA - PT - DEP - TA - Proc XI concress allergology and clinical immunolo JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - ii IP - DP - 1982 Jan 01 TI - Reduction in bronchial hyperreactivity during prolonged allergen avoidance PG - 675-677 AU - PlattsMills TAE AU - Tovey ER AU - Mitchell EB AU - Moszoro H AU - Nock P AU - Wilkins S LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 63 suppl 1 IP - DP - 1982 Jan 01 TI - Humidifier Fever PG - 104-107 AU - Pickering CAC LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 81 IP - DP - 1982 Jan 01 TI - Chronic respiratory disease among workers in a pulp mill- a ten year follow-up study PG - 285-289 AU - Poukkula A AU - Huhti E AU - Makarainen M LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 10 IP - DP - 1982 Jan 01 TI - Case report of two Western Red Cedar workers with occupational asthma PG - 441-447 AU - Reques FG LA - PT - DEP - TA - Allergol Immunopathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 73 IP - DP - 1982 Jan 01 TI - Occupational asthma from fish feed (Echinodorus plamosus larva) PG - 234-236 AU - Resta O AU - FoschinoBarbaro MP AU - Carnimeo N AU - Di Napoli PL AU - Pavese I AU - Schino P LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 70 IP - DP - 1982 Jan 01 TI - Measurement of airborne antigens PG - 38-40 AU - Reed CE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 125 IP - DP - 1982 Jan 01 TI - The effects of occupational exposure on pulmonary function PG - 319-322 AU - Psarrow D AU - Bosse R AU - Rosner B AU - Weiss S LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 48 IP - DP - 1982 Jan 01 TI - Serum IgE antibodies to Psyllium in individuals allergic to Psyllium and English plantain PG - 294-298 AU - Rosenberg S AU - Landy R AU - Klotz SD AU - Fireman P LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 48 IP - DP - 1982 Jan 01 TI - Bronchial asthma following exposure to ECG ink PG - 351-352 AU - Rodenstein D AU - Stanescu DC LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 112 IP - DP - 1982 Jan 01 TI - Hardmetal lung disease PG - 198-207 AU - Scherrer M AU - Maillard JM LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 70 IP - DP - 1982 Jan 01 TI - Overview of occupational immunologic lung disease PG - 5-10 AU - Salvaggio JE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 8 IP - DP - 1982 Jan 01 TI - Facial rash in visual display unit operators PG - 25-28 AU - Nilsen A LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 34 IP - DP - 1982 Jan 01 TI - Colophony and the products of its pyrolysis as a cause of occupational allergies PG - 106-111 AU - Kalas D AU - Runstukova J LA - PT - DEP - TA - Pracovne Lekarstvi JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 247 IP - DP - 1982 Jan 01 TI - Asthma induced by nickel PG - 1600-1602 AB - NICKEL allergy manifest as contact dermatitis has long been recognized. In 1971 McConnell et al1 reported asthma due to nickel sulfate in a metal-plate worker; a bronchoprovocation challenge test with nickel sulfate duplicated the patient's symptoms, and circulating antibodies were found by hemagglutination tests. We report a second case study of asthma induced by nickel sulfate. Report of a Case A 60-year-old metal polisher with a history of contact dermatitis and recent episodes of shortness of breath was referred to our clinic in April 1980 for further evaluation. His medical history was unremarkable. He had stopped smoking at the age of 33 years. He had no history of allergies and knew of none in his family. The patient had been a metal polisher since the age of 24 years and had contact with gold, brass, and nickel. At 49 years he began polishing bumpers and continued this work until AU - Block JT AU - Young M LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 43 IP - DP - 1982 Jan 01 TI - Health complaints attributed to the use of carbonless copy paper (a preliminary report) PG - 432-435 AB - Persistent health complaints attributed to the use of carbonless copy paper by office workers on the campus of the University of Washington led to this preliminary study. The goals were to estimate the extent of the problem in a population of known carbonless copy paper users; to describe those health problems which the users attribute to the use of carbonless copy paper; and to make a preliminary determination of the chemical constituents of the paper. Participants were asked to complete a health questionnaire and to attach to it copies of the forms they used. A minimum estimate of 10.7 health complainants per 100 users was similar to that found by investigators in Denmark, but lower than that reported by other investigators and of anecdotal material reported to the study group. There was a statistically significant association between complainants and the amount of paper used. Reports of headaches and irritation of the skin, eye and respiratory tract were similar to those reported elsewhere. Concurrent factors such as poor ventilation, high temperature and/or low humidity need to be investigated for possible synergistic or additive effects AU - Kleinman GD AU - Horstman SW LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 126 IP - DP - 1982 Jan 01 TI - Immune reactions in the lungs of asymptomatic dairy farmers PG - 964-967 AU - SolalCeligny P AU - Laviolette M AU - Hebert J AU - Cormier Y LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 48 IP - DP - 1982 Jan 01 TI - Immediate type 1 asthmatic response to Henna following occupational exposure in hairdressers PG - 98-99 AU - Starr JC AU - Yunginger J AU - Brahser GW LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 32 IP - DP - 1982 Jan 01 TI - Wheat millers asthma in Sri-Lanka PG - 124-127 AU - Uragoda CG LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 12 IP - DP - 1982 Jan 01 TI - Specific IgE antibodies in workers with occupational asthma due to Western Red Cedar PG - 249-258 AU - Tse KS AU - Chan H AU - ChanYeung M LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 69 IP - DP - 1982 Jan 01 TI - Occupational asthma in a florist caused by the dried plant, Baby's breath PG - 474-477 AU - Twiggs JT AU - Yunginger JW AU - Mahendra K AU - Agarwal MK AU - Reed CE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 69 IP - DP - 1982 Jan 01 TI - Immuno-chemical measurements of airborne mouse allergens in a laboratory animal facility PG - 522-526 AU - Twiggs JT AU - Argarwal MK AU - Dahlberg MJE AU - Yunginger JW LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 30 IP - DP - 1982 Jan 01 TI - Evaluation of occupational risk and biological effects in a factory of polymethylmethacrylate sheets PG - 72-79 AU - Thorpe LD AU - Valsecchi F AU - Sala C AU - Cesna MA LA - PT - DEP - TA - Lav Um JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 16 IP - DP - 1982 Jan 01 TI - Bakers asthma (grain dust induced asthma) PG - 14-18 AU - Tse TCSE AU - Raghuprasad PK LA - PT - DEP - TA - Drug Intelligence and Clinical Pharmacology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 43 IP - DP - 1982 Jan 01 TI - Allergen specific histamine release from whole blood in flour-sensitive bakers PG - 208-220 AU - Thiel H AU - Zimmermann I AU - Rasche B AU - Ulmer WT LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 37 IP - DP - 1982 Jan 01 TI - Castor bean allergy among workers in the felt industry PG - 603-608 AB - We describe occupational allergy to castor bean in workers in a felt manufacturing plant. Twenty-six (37%) of the workers complained they were affected by the felt and were examined by us. Of these, 12 were considered to have occupational allergy. These 12 subjects had raised specific IgE levels to both felt and castor bean extracts. In addition, three subjects without occupational allergy had raised specific IgE. The presence of castor bean allergens in the felt was suggested by the correlation between the RAST scores to the felt and castor bean and confirmed by RAST inhibition experiments. The RAST results correlated well with the results of skin prick tests to felt and castor bean extracts. In addition it was found that atopy did not predispose the workers to castor bean allergy. AU - Topping MD AU - Henderson RTS AU - Luczynska M AU - Woodmass A LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 112 IP - DP - 1982 Jan 01 TI - Occupational asthma due to ampicillin PG - 1046-1048 AU - Wuthrich B AU - Hartmann AL LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 132 IP - DP - 1982 Jan 01 TI - Obstructive bronchitis in workers of chromium manufacturing plant PG - 59-62 AU - Weiser O AU - Grunbacher G AU - Prugger F AU - Raber A AU - Wawschinek O LA - PT - DEP - TA - Wiener Med Wochnsch JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 43 IP - DP - 1982 Jan 01 TI - Health effects of wood dust- relevance for an occupational standard PG - 674-678 AU - Whitehead LW LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 107 IP - DP - 1982 Jan 01 TI - Hard metal pulmonary fibrosis PG - 1396-1399 AB - A 20-year-old labourer, employed in the metal powder industry, developed increasing shortness of breath and serious urge to cough after 2 1/4 years of exposition to cobalt and tungsten carbide powder. On admission 9 months later pulmonary changes were demonstrated radiographically indicating hard-metal-dust lung. Detailed clinical assessment including transpleural biopsy and lingula resection as well as histochemical investigations and follow-up observations permitted access to the pathogenesis and morphology of the disease. By introduction of steroid treatment, before conclusion of diagnostic steps, limitation of the inflammatory primary reaction was possible inasmuch as loss of pulmonary function could be arrested despite massive, histologically verified, tendency for fibrosis. AU - Ott G AU - Mikuz G LA - PT - DEP - TA - Deutsche Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 81 IP - DP - 1982 Jan 01 TI - Pulmonary fibrosis in an aluminium arc welder PG - 372-374 AB - Case report of 35 year old smoker working for 18 years as an aluminium arc welder, making boats often in confined spaces. PFT mixed obstructive/restricticve. No mention of clubbing or crackles. Had left upper lobectomy. Dense accumulation of macrophages contain grey/browm material in nodules and interstitium, X-ray spectrometry showed that material was aluminium. No follow-up data included AU - Vallyathan V AU - Bergeron WN AU - Robichaux PA AU - Craighead JE LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 13 IP - DP - 1982 Jan 01 TI - Desquamative interstitial pneumonia in an aluminum welder PG - 694-699 AB - Case report o a 35 year old electric arc welder for 16 years. 20 year ex-smoker. Crackles but not clubbed.. FEV1/FVC 1.84/2.7 (predicted 3.86/4.79). DLCO 13.4 (32.8) Surgical lung biopsy DIP with refractile non-birefringent dust peribonchial containing large amounts of aluminium Stormy post-operative course, long term outcome not stated AU - Herbert A. Sterling G. Abraham J. Corrin B. LA - PT - DEP - TA - Human Pathology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 2 IP - DP - 1982 Jan 01 TI - Post-mortem study of emphysema in coalworkers and non-coalworkers PG - 600-603 AB - A post-mortem survey of emphysema in coalworkers and non-coalworkers was carried out in men aged 50-70 years dying of ischaemic heart disease (IHD). It was determined that in such men selection for necropsy was similar in coalworkers and non-coalworkers. All lungs were examined in a standard way and the amounts of centrilobular and panacinar emphysema were scored on numerical scales. Emphysema in men dying of IHD was significantly more frequent in coalworkers than in non-coalworkers even after age and smoking habits were accounted for by stratification. In the coalworkers, the severity of emphysema was related to the amount of dust in simple foci in the lungs. Because both groups were selected similarly from their parent populations the relative frequency of emphysema found in this study reflects that in the whole populations of coalworkers and non-coalworkers in the study area and confirms an excess of emphysema in coalworkers. This excess is likely to be due to occupational factors AU - Cockcroft A AU - Seal RM AU - Wagner JC AU - Lyons JP AU - Ryder R AU - Andersson N LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 126 IP - DP - 1982 Jan 01 TI - Serodiagnosis of tuberculosis using the enzyme-linked immunoabsorbent assay (ELISA) of antibody to Mycobacterium tuberculosis antigen 5 PG - 1013-1016 AB - The serologic response to purified mycobacterial antigen 5 was examined using an enzyme-linked immunoabsorbent assay in 75 patients with pulmonary tuberculosis and 150 control subjects. Two patient and 6 control groups were studied. The serums from the patient groups had significantly higher IgG antibody concentrations than infected control subjects with good specificity. In patients living in low prevalence areas where the results of skin tests in the majority of the population are negative, an antibody titer greater than or equal to 1:40 would have a 95.8% specificity for active disease. For patients living in a high prevalence area where the results of skin tests in the majority of the population are positive, then an antibody titer greater than or equal to 1:40 would have a 79.9% specificity for active disease. Serums from patients with active nontuberculous mycobacterial infection had intermediate mean titers AU - Benjamin RG AU - Daniel TM LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 125 IP - DP - 1982 Jan 01 TI - Nosocomial tuberculosis PG - 559-562 AB - Hospital employees are at risk of contracting tuberculosis from patients. The undiagnosed case with sputum-smear positive for acid-fast bacilli is the usual source case. However, even the smear-negative patient may pose a risk. This was documented by a high rate of skin test conversion in hospital staff exposed to a smear-negative, culture-positive patient in a respiratory intensive care unit. The patient required bronchoscopy, intubation, and assisted ventilation. Of susceptible hospital staff members who were exposed to the index case, 14 of 45 (31%) converted their PPD skin test. Ten of 13 (77%) susceptible hospital staff members present at the time of bronchoscopy converted, compared with 4 of 32 (12.5%) who were not present at bronchoscopy (Fischer's exact test p = 0.0006). Rough calculations suggest that during the bronchoscopy and intubation the index case generated at least 249 infectious units per hour. At the ventilation levels in this area, this resulted in 1 infectious unit of tuberculosis in each 68.9 cubic feet of air. Improved ventilation, high efficiency filters, and ultraviolet irradiation are effective recommended ways to clean the air of infectious particles AU - Catanzaro A LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 57 IP - DP - 1982 Jan 01 TI - Tuberculosis in children in a national survey of notifications in England and Wales, 1978-79. Report from the Medical Research Council Tuberculosis and Chest Diseases Unit PG - 734-741 AU - Anonymous LA - PT - DEP - TA - Arch Dis Child JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 1 IP - DP - 1982 Jan 01 TI - Intraoral and pulmonary tuberculosis following dental treatment PG - 842-844 AU - Smith WH AU - Davies D AU - Mason KD AU - Onions JP LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 25 IP - DP - 1982 Jan 01 TI - Ghosts, witches, sickness and death: the traditional interpretation of injury and disease in a rural area of Papua New Guinea PG - 108-115 AB - For many people in remote parts of Papua New Guinea (PNG) health and illness have their origin in the invisible realm of spirits, ghosts and sorcerers. For instance, death from malaria may be interpreted as witchcraft and other deaths are attributed to the agency of ghosts. An accident, such as a fall, may be regarded by the victim and his family as the result of sorcery. Even though health professionals know a great deal about the physical aspects of the diseases which afflict their communities, they may not understand the people's interpretation of them. Modern medicine has no satisfactory approach for dealing with some culture-bound syndromes AU - Sharp PT LA - PT - DEP - TA - Papua New Guinea Medical Journal JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 126 IP - DP - 1982 Jan 01 TI - Five-year longitudinal study of workers employed in a new toluene diisocyanate manufacturing plant PG - 420-428 AB - The respiratory health of 277 workers in a new toluene diisocyanate (TDI) manufacturing plant was studied prospectively during 5 yr of exposure. Personal TDI monitors were used to continuously measure peak and 8-h time-weighted average (TWA) concentrations in over 2,000 samples. Longitudinal change in pulmonary function was assessed in 223 men in whom 3 or more data points allowed construction of individual slopes of annual change. Regression of annual change on smoking (pack-years), atopic status, and cumulative TDI exposure dichotomized at 68.2 parts per billion (ppb) months into low and high exposure groups showed significant effects of smoking on spirometric tests and lung volumes. After adjusting for pack-years of smoking, the 74 men in the high cumulative TDI exposure category had significantly larger declines in FEV1, %FEV, and FEF25--75% than did the 149 men in the low category. Annual change in FEV1 was then examined in 6 smoking-exposure categories: in never smokers, average annual decline was 38 ml/yr greater in those with higher cumulative TDI exposure. Current and previous cigarette smokers did not show this effect of cumulative TDI exposure. Analysis of FEV1 change by time above 20 ppb TDI yielded a similar result in never smokers, a 24 ml/yr excess average decline attributable to longer time above 20 ppb. In current cigarette smokers, those with longer time above 20 ppb had excess decline of 18 ml/yr (42 versus 24 ml/yr). our low and high cumulative exposure groups spent 2 and 15%, respectively, of their working time above 5 ppb TDI. The different health effects observed in these groups supports the NIOSH-recommended standard of 5 ppb TDI as an 8-h TWA AU - Diem JE AU - Jones RN AU - Hendrick DJ AU - Glindmeyer HW AU - Dharmarajan V AU - Butcher BT AU - Salvaggio JE AU - Weill H LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 125 IP - DP - 1982 Jan 01 TI - Noncomparability of longitudinally and cross-sectionally determined annual change in spirometry PG - 544-548 AB - Annual decline in lung function determined longitudinally is often compared with predicted decline determined cross-sectionally. To test this comparison, spirometric data were collected 5 times over 5 yr from 52 adult male Caucasians. The age regression coefficient for FEV1 and FVC, determined cross-sectionally at each visit, was more than twice the longitudinal annual change computed from the same data as the mean of the slopes of each subject's regression lines. The discrepancy persisted even when the first visit was deleted to reduce learning effects on longitudinal estimates. This discrepancy may be partly explained by the sensitivity of cross-sectional analyses to past noxious influences, whereas longitudinal analyses are sensitive only to influences that continue to affect annual decline during the study period. We also found historical evidence of an increase in height-specific VC, which would artifactually steepen cross-sectionally determined regression lines. Thus, observed longitudinal changes of study cohorts should be compared with control longitudinal data AU - Glindmeyer HW AU - Diem JE AU - Jones RN AU - Weill H LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 125 IP - DP - 1982 Jan 01 TI - Lung function consequences of exposure and hypersensitivity in workers who process green coffee beans PG - 199-202 AB - Three hundred seventy-two workers were examined at two coffee processing plants in New Orleans. Workplace dust concentrations were relatively low, and respiratory symptom prevalences were not different in various areas of the plants. After controlling for other variables, men with lengthy employment and exposure to dust of green (unroasted) coffee had lower mean residual FEV1 values (regression coefficient, -0.011 L/yr employed, p less than 0.05). Similarly, workers with serum IgE antibodies to green coffee beans had lower mean residual FEV1 (-0.244 L, p less than 0.05). Each effect remained significant after controlling for the other. In a subset that included all workers exposed to green coffee, acute changes in expiratory flow rates were not related to differences in exposure. The finding of adverse impacts of exposure and sensitization, in a work force relatively free of overt asthma, has important implications for worker health protection AU - Jones RN AU - Hughes JM AU - Lehrer SB AU - Butcher BT AU - Glindmeyer HW AU - Diem JE AU - Hammad YY AU - Salvaggio J AU - Weill H LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - i IP - DP - 1982 Jan 01 TI - Pocket-sized device for measuring forced expiratory volume in one second and forced vital capacity PG - 15-17 AB - An inexpensive pocket-sized instrument--the turbine spirometer--has been developed that measures and gives a direct digital display of the forced expiratory volume in one second and forced vital capacity. The instrument is as accurate as and considerably cheaper than spirometers in general use. Condensation does not affect the calibration. The turbine spirometer will enable spirometry to be easily monitored in hospital wards and general practice and by patients at home AU - Chowienczyk PJ AU - Lawson CP LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 1 IP - DP - 1982 Jan 01 TI - A tuberculosis outbreak in Deal, Kent PG - 1060-1061 AB - 6 people associated with a rowing club had active tuberculosis and 2 of them died. Although an effort to follow standard contact-tracing procedures was made and the connection with the club was recognised when the 3rd case was diagnosed, none of the active cases was detected by contact tracing. Altogether more than 500 contacts were examined; 443 were tuberculin tested and 222 had chest X-rays, 1 death, of a man said to have been an alcoholic, was due to his refusal to seek medical advice. The other death, of a young tuberculin-positive contact, occurred after he missed his appointment for follow up AU - Jones JS LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 144 IP - DP - 1982 Jan 01 TI - Bronchial asthma and chromium allergy precipitated by steel welding. PG - 801-802 AU - Dahl R AU - Mikkelsen HB LA - PT - DEP - TA - Ugeskr Laeger JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 39 IP - DP - 1982 Jan 01 TI - Angiographic study of digital arteries in workers exposed to vinyl chloride PG - 169-172 AB - Five patients exposed to vinyl chloride were studied by hand angiography and other non-invasive methods, including photoplethysmography, rheography, and thermography. Raynaud's phenomenon was present in all five subjects, while acro-osteolysis affected only one. Organic vascular lesions, such as narrowing, segmentary occlusions of digital arteries and bridge collaterals, were found in angiographic studies. Only one patient did not show clear segmentary occlusions, but his vessels were crooked and diffusely narrowed. Angiographic results appear to correlate well with the changes shown by non-invasive techniques AU - Falappa P AU - Magnavita N AU - Bergamaschi A AU - Colavita N LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 12 IP - DP - 1982 Jan 01 TI - Double-blind trials of inhaled beclomethasone diproprionate and fluocortin butyl ester in allergen-induced immediate and late asthmatic reactions PG - 523-531 AB - The blocking effects of inhaled beclomethasone dipropionate (BDP) and fluocortin butyl ester (FCB) on the immediate and late asthmatic reactions induced by inhaled allergen were studied in two trials. In the first, a double-blind cross-over trial compared BDP (800 micrograms daily as powder) with FCB 8 mg daily (1:20 by wt.-Formulation 1). The second trial was identical in design and compared FCB 8 mg daily (1:20) with FCB 8 mg daily as Formulation 2 (1:40). Known BDP, 400 micrograms daily by pressurized aerosol was studied at the end of the second trial. Allergen provocation was performed before and after 7 days treatment with each drug, with a 2-week interval between each drug. Overall, a blocking index for the immediate reaction of greater than 50% was obtained in ten of twenty patients (50%) using BDP, and five of twenty-one (25%) using FCB (P less than 0.01). The late reaction was blocked in nine of eleven (82%) instances on BDP, and four of fourteen (33%) on FCB. Contrary to earlier reports, inhaled corticosteroid agents used for several days prior to bronchial challenge, were found to block both the immediate as well as the late reaction in many individuals AU - Burge PS AU - Efthimiou J AU - TurnerWarwick M AU - Nelmes PT LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 26 IP - DP - 1982 Jan 01 TI - Coal miners exposed to diesel exhaust emissions PG - 799-815 AU - Reger R AU - Hancock J AU - Hankinson J AU - Hearl F AU - Merchant J LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 125 IP - DP - 1982 Jan 01 TI - Acute respiratory effects of exposure to diesel emissions in coal miners PG - 39-42 AB - A study was conducted to determine if acute respiratory effects, measured in terms of changes in forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and maximal expiratory flow rate at 50% of forced vital capacity (Vmax50), were related to exposure to diesel emissions in coal miners. Sixty coal miners exposed to diesel emissions and 90 miners not exposed were tested before and after a work shift for ventilatory function changes. Significant work shift decrements in ventilatory function did occur in miners in both groups who smoked cigarettes, but there were no significant differences in the ventilatory function changes between those miners exposed to diesel emissions and those not exposed either in the aggregate or under control by smoking status AU - Ames RG AU - Attfield MD AU - Hankinson JL AU - Hearl FJ AU - Reger RB LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 126 IP - DP - 1982 Jan 01 TI - Respiratory abnormalities in employees of the hard rock mining industry PG - 629-634 AB - Respiratory symptoms, forced vital capacity, and the single breath N2 test were assessed in male employees (25 to 54 yr of age) who had been employed for more than 5 yr in the mining industry in Manitoba. The results were compared with those in a similar group of men selected from the general population. The prevalence of cough and/or phlegm in both nonsmoking and smoking mining employees was significantly greater than that in the sample of the general population (p less than 0.05). In both nonsmokers and ex-smokers amongst the mining employees, the parameters derived from the single breath N2 test tended to be lower and maximal expiratory flow rates tended to be higher than in comparable groups in the general population sample. In smokers, FVC, FEV1, FEV1/FVC, maximal expiratory flow rates, RV/TLC, and the slope of phase III were significantly worse in smelter workers than in underground workers. Alterations in lung function in those who worked underground, but not in those who worked in the smelter, was related to the duration of employment in the industry. The data suggest that exposure to mining irritants may result in disorders of lung function, and that this effect is greater in cigarette smokers AU - Manfreda J AU - Sidwall G AU - Maini K AU - West P AU - Cherniack RM LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19820101 IS - IS - VI - 39 IP - DP - 1982 Jan 01 TI - Occupational exposure and 12-year spirometric changes among Paris area workers PG - 221-232 AB - A follow-up study over 12 years was conducted among 556 men aged 30 to 54 in 1960 and working at that time in factories around Paris (France). Various occupational exposures were recorded at the time of the 1960 survey after a technical study of each workplace. The annual rate of decline of FEV1 during 12 years was estimated for each subject from the measurements in 1960 and 1972. This rate (the FEV1 slope) was related independently of FEV1 level (which reflects the loss since the beginning of adult life) and of smoking habits to occupational exposure to dust, gases, and heat. FEV1 slope was significantly related to inhalation of mineral dust (even in the absence of silica) as well as to grain dust, and the slope was steeper with increased intensity of exposure to dust. Analysis of job changes showed that among heavily exposed subjects, those who changed jobs had a less steep slope than those who did not. Our results support the hypothesis of a causal role of exposure to dust in the development of chronic airflow obstruction and of a benefit when exposure to dust ceases. Exposure to dust, gas, and heat usually occurred together so data on gas and heat were analysed after taking account of exposure to dust. The influence of heat on FEV1 decline showed a clear trend. Results suggest that exposure to gases associated with exposure to dust or heat or both had a deleterious effect. After adjusting for age, smoking, and FEV1 level (ASLA) the following average slopes were obtained: 44 ml/a (for exposure to none or to only a slight amount of dust, or to gases alone), 51 ml/a (heat), 53 ml/a (noticeable dust), 55 ml/a (noticeable dust and heat), 60 ml/a (noticeable dust, heat, and high concentration of gases). Independently of the occupational exposures, ASLA FEV1 slopes among manual workers were related to skill, being 44 ml/a for skilled and 51 ml/a for unskilled men. Independently of social class and occupational exposures recorded, there were differences in FEV1 slopes by factory, suggesting that one should not rely on using one factory as the control of studies of occupational exposure to another AU - Kauffmann F AU - Drouet D AU - Lellouch J AU - Brille D LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 124 IP - DP - 1981 Jan 01 TI - Distinguishing byssinosis from chronic obstructive pulmonary disease. Results of a prospective five-year study of cotton mill workers in India PG - 31-40 AB - This prospective 5-yr follow-up study of 1,241 textile workers from three mills was designed to determine the pattern and course of byssinosis in India and to distinguish this disease from chronic bronchitis. The initial prevalence of byssinosis was 14% in carding sections, 10% in spinning sections, and 11% in winding sections. In these dusty sections, the prevalences of both byssinosis and bronchitis increased with a longer service. Among workers with byssinosis; 56% had work-related and exertional dyspnea, 54% had chest tightness, 20% had wheezing, and 36% had cough. There was a history of Monday sickness in 22%. During follow-up it was confirmed that the atypical presentation of byssinosis with cough was more common in the carding department. The yearly decrease in pulmonary function was correlated with duration and degree of exposure to cotton dust. Thus, the decrease was larger in carding workers and in workers with byssinosis plus cough than in those with byssinosis or bronchitis. The yearly decrease in the one-second forced expiratory volume was different (p less than 0.05) for subjects with nonspecific chest symptoms (88 ml) and subjects with work-related chest symptoms (114 ml). The decreases in forced vital capacity and one-second forced expiratory volume were larger for increased dust loads. Fewer pulmonary infiltrates were seen in radiographs of workers with byssinosis than in those of workers with bronchitis. The immunoglobulins studied in 86 textiles workers and 17 control subjects showed higher IgG values among workers with work-related symptoms, especially cough, but not among those with bronchitic symptoms (p less than 0.01). Our results suggested that byssinosis is an entity distinct from chronic bronchitis AU - Kamat SR AU - Kamat GR AU - Salpekar VY AU - Lobo E LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 50 IP - DP - 1981 Jan 01 TI - An outbreak of Nocardia asteroides infection in a renal transplant unit PG - 123-135 AB - An outbreak of Nocardia asteroides infection occurred in the nephro-urological intensive care unit, St. Peter's Group of Hospitals, London in 1979. In is suggested that the outbreak has been due to patient-to-patient transmission. Five months before the outbreak. N. asteroides was first isolated from nephrostomy urine from an asymptomatic patient who had undergone several urological operations. Subsequently six of the seven patients admitted for renal transplant over a three month period developed proven infections. The first transplant patient had an abdominal abscess and the other five had only pulmonary disease with obvious radiological lesions. Bacteriological diagnosis was made in three patients by examination of sputum and in the other three from bronchoscopic specimen, pleural fluid and pus from an abscess respectively. Five of the six renal transplant patients were treated with amoxycillin and erythromycin. Clinical and radiological improvement was observed and no patient died as a result of the infection. In the intensive care unit air and dust samplings were positive for N. Asteroides. The unit was closed and fumigated with formaldehyde and when the air sampling continued to be negative the unit was then re-opened AU - Lovett IS AU - Houang ET AU - Burge PS AU - TurnerWarwick M AU - Thompson FD AU - Harrison AR AU - Joekes AM AU - Parkinson MC LA - PT - DEP - TA - Q J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 6 IP - DP - 1981 Jan 01 TI - Occupational asthma and dermatitis: points of contact PG - 235-241 AU - Burge PS LA - PT - DEP - TA - Clin Exp Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - IP - DP - 1981 Jan 01 TI - Chromium and inorganic compounds of chromium in air. Laboratory method using atomic absorbtion spectrometry PG - - AU - Health and safety executive LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 67 IP - DP - 1981 Jan 01 TI - Relation of particle dimension to carcinogenicity in amphibole asbestos and other fibrous minerals PG - 965- AU - Stanton MF AU - Layard M AU - Tegeris A AU - et al LA - PT - DEP - TA - J Natl Cancer Inst JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 6 IP - DP - 1981 Jan 01 TI - Soluble oil dermatitis PG - 229-234 AU - Rycroft RJ LA - PT - DEP - TA - Clin Exp Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 64 IP - DP - 1981 Jan 01 TI - Occupational asthma due to inhalation of chloramine-T PG - 428-438 AU - Kramps JA AU - van Toorenbergen AW AU - Vooren PH AU - Dijkman JH LA - PT - DEP - TA - Int Archs Allergy Appl Immun JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 64 IP - DP - 1981 Jan 01 TI - Occupational asthma due to inhalation of chloramine-T. 1. Clinical observations and inhalation-provocation studies PG - 422-427 AU - Dijkman JH AU - Vooren PH AU - Kramps JA LA - PT - DEP - TA - Int Archs Allergy Appl Immun JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 79 IP - DP - 1981 Jan 01 TI - Factors influencing the interpretation of FEV1 declines across the working shift PG - Suppl):71S-73S AB - An analysis of variability within individuals was conducted for FEV1, obtained from subjects employed in the cottonseed industry. Individual SDs ranged from .020 to .428 L. The within-subject SD of the preshift-postshift difference ranged from .014 to .302 L. When within-subject variability of FEV1 was analyzed in relation to symptoms, smoking history, and shift, the only statistical difference occurred in the 14 bronchitic subjects (.141 L) relative to the 179 without bronchitis (.099 L), and the three subjects with byssinosis (.192 L) relative to those without symptoms (.102 L). Changes over the working shift were significantly different for evening relative to morning and night shifts, even though there was no significant difference in smoking status, symptoms, exposure, race, age, years employed in the mill, and work area. In addition, baseline measurements were not significantly related to shift. Therefore, the effect of individual variability, symptoms, and shift should be considered if an accurate classification of reactors based on change in FEV1 across the shift is to be obtained AU - Glindmeyer H 3d AU - Diem J AU - Hughes J AU - Jones RN AU - Weill H LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 2 IP - DP - 1981 Jan 01 TI - Toxic-allergic syndrome caused by ingestion of rapeseed oil denatured with aniline PG - 567-568 AB - In the past four months a new syndrome has caused more than 100 deaths in Spain. The most striking feature is a toxic-allergic pneumonopathy with respiratory distress and radiological evidence of interstitial (occasionally alveolar) exudation. Other features are fever, headache, nausea, muscular and abdominal pains, rash, hepatosplenomegaly, and eosinophilia; later, thrombotic phenomena and neurological disorders may appear. The epidemic has been traced to ingestion of rapeseed oil, denatured with aniline and containing acetanilide. The syndrome does not resemble intoxication with aniline or acetanilide, and is provisionally ascribed to "oleoanilide", a product formed by reaction of acetanilide with fatty acids AU - Tabuenca JM LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 38 IP - DP - 1981 Jan 01 TI - An investigation of operating theatre staff exposed to humidifier fever antigens PG - 144-151 AB - Sixty staff working in a hospital operating theatre, where a case of humidifier fever had been identified, were studied together with 49 subjects working in other parts of the hospital. They each had a blood test for serology, a skin test, and a chest radiograph and completed a questionnaire. The theatre staff also had pulmonary function tests. The theatre humidifier was found to contain several organisms including amoebae and antigens cross-reacting highly with those implicated in previous outbreaks of humidifier fever. Of the 60 exposed subjects, 25 had developed antibodies, nine had probable symptoms of humidifier fever, and six possible symptoms. There was a strong association between symptoms and antibodies (p = 6 x 10-5 by Fisher's exact test). The development of antibodies was also related to duration of exposure in the theatre (p <001 by x2 test for trend) and inversely to smoking (p = 0 0073 by Fisher's exact test) but not to history of atopy. Because of the presence of antigens and because certain biocides added were ineffective in controlling antigenic build-up the humidifier was switched off. Eight months later specific IgG levels in the theatre staff sera, estimated by an enzyme-linked immunosorbent assay technique, had fallen on average by 25%. Inhalation challenge with humidifier water was performed in eight subjects. The inhalation of humidifier water produced reactions in four of the eight subjects. Neither of the non-exposed controls reacted, one of the exposed subjects without antibodies or symptoms reacted, one of the exposed subjects with antibodies but without previous symptoms reacted, and both of the exposed subjects with antibodies and with previous symptoms reacted. The reactions were mainly systemic with fever, chills, arthralgia, headache, and general malaise, maximal between 10 and 12 hours after challenge. AU - COCKCROFT A AU - EDWARDS J AU - BEVAN C AU - CAMPBELL I AU - COLLINS G AU - HOUSTON K AU - JENKINS D AU - LATHAM S AU - SAUNDERS M AU - TROTMAN D LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 42 IP - DP - 1981 Jan 01 TI - Pulmonary function status of workers exposed to hardwood or pine dust PG - 178-186 AU - Whitehead LW AU - Ashikaga T AU - Vacek P LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 47 IP - DP - 1981 Jan 01 TI - Anaphylactic reaction to fibreglass PG - 157-158 AB - This is a case report of 33 year old lady with an anaphylactic reaction with wheeze starting a few hours after exposure to fibreglass used to insulate a cathouse. No other evidence of cause and effect. AU - Zanjanian MH AU - Sahu A LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 36 IP - DP - 1981 Jan 01 TI - Detergent enzymes and occupational safety PG - 513-516 AU - Zachariae H AU - H0X/eghThomsen J AU - Witmeur O AU - Wide L LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 283 IP - DP - 1981 Jan 01 TI - Another smoking hazard: raised serum IgE concentration and increased risk of occupational allergy PG - 1215-1217 AU - Zetterstrom O AU - Osterman K AU - Machado L AU - Johansson SGO LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 38 IP - DP - 1981 Jan 01 TI - Castor bean allergy in the upholstery department of a furniture factory PG - 293-296 AB - In this study, undertaken to identify the cause of allergy in several upholstery workers in a furniture factory, the workers were handling several different materials, including glue, silicone spray, upholstery fabrics, and felt. Radio-allergo-sorbent test (RAST) assays showed that sera from sensitised workers contained specific IgE towards the felt; however, further investigations using RAST showed that the allergen was not the felt itself but a contaminant of the felt. The felt was manufactured from sacks, some of which had been used to store castor beans. The sera with raised IgE to the felt also had raised IgE to the castor bean extract. By means of RAST inhibition we confirmed that castor bean allergens in the felt were solely responsible for the raised IgE in the sera. The in-vitro RAST results were found to correlate well with the in-vivo pick tests and clinical symptoms. AU - Topping MD AU - Tyrer FH AU - Lowing RK LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 4 IP - DP - 1981 Jan 01 TI - Occurrence and detection of respiratory disorders in the primary aluminium industry PG - 295-300 AU - Vale JR LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 11 IP - DP - 1981 Jan 01 TI - Colophony-induced asthma in a poultry vender PG - 395-399 AU - So SY AU - Lam WK AU - YU D LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 11 IP - DP - 1981 Jan 01 TI - Type 1 allergy in mushroom soup processors PG - 43-47 AU - Symington IS AU - Kerr JW AU - McLean DA LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 38 IP - DP - 1981 Jan 01 TI - Laboratory animal allergy: a clinical survey of an exposed population PG - 38-41 AU - Slovak AJM AU - Hill RN LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - Cairo IP - DP - 1981 Jan 01 TI - Aluminium salt induced occupational asthma PG - *-* AU - Sjoberg A AU - Simonsson B AU - HaegerAronssen B LA - PT - DEP - TA - Proc Nineth International Conference of Occupation JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 7 IP - DP - 1981 Jan 01 TI - Carbonless copy paper PG - 218-222 AU - Anonymous LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 245 IP - DP - 1981 Jan 01 TI - Allergic contact dermatitis from carbonless copy paper PG - 2331-2332 AU - Marks JG LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 62 IP - DP - 1981 Jan 01 TI - American National Standard, Ventilation for Accceptible Indoor air Quality PG - - AU - American Society of Heating R LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 62 IP - DP - 1981 Jan 01 TI - Thermal environment conditions for human occupancy PG - - AU - American Conference of Heating R LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - ii IP - DP - 1981 Jan 01 TI - Bronchial hyperreactivity in response to inhalation of ultrasonically nebulised solutions of distilled water and saline PG - 1285-128* AB - To assess non-specific bronchial reactivity the effect of inhaling ultrasonically nebulised solutions of distilled water and hypotonic (0.3%), isotonic (0.9%), and hypertonic (2.7%, 3.6%) saline was investigated in 10 asthmatic patients and nine normal subjects. Expired ventilation and the maximum percentage fall in forced expiratory volume in one second (FEV1) were recorded. The sensitivity to the inhaled solutions was determined by measuring the ventilation required to induce a fall in FEV1 of 20% from the prechallenge value. Hypotonic and hypertonic but not isotonic solutions caused a significant fall in FEV1 in the asthmatic subjects. Normal subjects showed no response to either distilled water or 3.6% saline, the only solutions with which they were challenged. The method used for this challenge is rapid, simple, and inexpensive and provides a new means of diagnosing non-immunologically mediated bronchial hyperreactivity. AU - Schoeffel RE AU - Anderson SD AU - Altounyan RE LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 68 IP - DP - 1981 Jan 01 TI - Allergy to murine antigens in a biological research institute PG - 310-318 AU - Schumacher MJ AU - Tait BD AU - Holmes MC LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 68 IP - DP - 1981 Jan 01 TI - Clinical and immunological correlations in trimellitic anhydride airway syndromes PG - 188-193 AU - Sale SR AU - Roach DE AU - Zeiss CR AU - Patterson R LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 67 IP - DP - 1981 Jan 01 TI - Standardisation of inhalation provocation tests; influence of nebuliser output, particle size and method of inhalation PG - 156-161 AU - Ryan G AU - Dolovich MB AU - Obminski G AU - Cockcroft DW AU - Juniper E AU - Hargreave FE AU - Newhouse MT LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 123 IP - DP - 1981 Jan 01 TI - Standardisation of inhalation provocation tests; two techniques of aerosol generation and inhalation compared PG - 195-199 AU - Ryan G AU - Dolovich MB AU - Roberts RS AU - Frith PA AU - Juniper EF AU - Hargreave FE AU - Newhouse MT LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 141 IP - DP - 1981 Jan 01 TI - Trimellitic anhydride toxicity. A case of acute multisystem failure PG - 1071-1074 AU - Rivera M AU - Nicotra MB AU - Byron GE AU - Patterson R AU - Yawn DH AU - Franco M AU - Zeiss CR AU - Greenberg SD LA - PT - DEP - TA - Arch Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 9 IP - DP - 1981 Jan 01 TI - Atopic and non-atopic sensitivity in a large bakery PG - 307-312 AU - Popescu IG AU - Ulmeanu V AU - Murariu D LA - PT - DEP - TA - Allergol Immunopathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 68 IP - DP - 1981 Jan 01 TI - Hypersensitivity lung disease presumably due tp Cephalosporium in homes contaminated by sewage flooding or by humidifier water PG - 128-132 AU - Patterson R AU - Fink JN AU - Miles WB AU - Basich JE AU - Schleuter DB AU - Tinkelman DG AU - Roberts M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 11 IP - DP - 1981 Jan 01 TI - A pulmonary survey of grain handlers in the West Of Scotland PG - 121-129 AU - Patel KR AU - Symington IS AU - Pollock R AU - Shaw A LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 11 IP - DP - 1981 Jan 01 TI - Bronchial asthma due to inhaled wood dust, Tanganika aningre PG - 605-610 AU - Paggiaro PL AU - Cantalupi R AU - Filieri M AU - Loi AM AU - Parlanti A AU - Toma G AU - Baschieri L LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 103 IP - DP - 1981 Jan 01 TI - Solder's asthma PG - 143-145 AU - Kovac S AU - Beritec T AU - Pavicic F AU - Stilinovic L LA - PT - DEP - TA - Lijec Vjesn JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 11 IP - DP - 1981 Jan 01 TI - Analysis of green coffee bean and castor bean allergens using RAST inhibition PG - 357-366 AB - Coffee workers with occupational allergic symptoms and positive skin tests to green coffee bean and factor dust antigens have elevated serum IgE antibodies (by radioallergosorbent test–RAST) to green coffee and castor bean allergens. These antibodies were used in a RAST inhibition assay to analyse coffee and castor allergens. Bean allergens were extracted by homogenization in PBS, centrifugation and concentration of supernates by ultrafiltration. Green coffee bean allergens, fractionated by gel filtration and Pevikon block electrophoresis, were shown to be very heterogeneous with a molecular weight range of 50 000 to 500 000 daltons. Castor allergens were more homogeneous with a molecular weight of 14 000 daltons and were partially purified by Pevikon block electrophoresis, gel filtration and isoelectrofocusing. Chemical analysis showed that protein was the major component in both allergen extracts. However, proteolytic enzymes could only partially destroy allergenic activity. Such isolation and characterization of these allergens should result in better methods of diagnosis and treatment of coffee workers with occupational allergic disease. AU - Lehrer SB AU - Karr RM AU - Salvaggio JE LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 4 IP - DP - 1981 Jan 01 TI - Observations on 5 cases of fluoride asthma PG - 306-312 AU - Maestrelli P AU - Marcer G AU - Clonfer E LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 51 IP - DP - 1981 Jan 01 TI - Assessing the nature and clinical significance of psychological contributions to childhood asthma PG - 327-341 AU - Matus I LA - PT - DEP - TA - Am J Orthopsychiat JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - Cairo IP - DP - 1981 Jan 01 TI - Exposure to airborne fungae in workers handling old paper currency in a bank PG - 712-71* AU - El Batawi MA AU - El Batawi YA LA - PT - DEP - TA - proc XVI Int Cong Occup Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 49 IP - DP - 1981 Jan 01 TI - Allergy to fish in fish meal factory workers PG - 13-19 AU - Droxzcz W AU - Kowalski L AU - Piotrowska A AU - Pietruszewska E LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 11 IP - DP - 1981 Jan 01 TI - Inhalation challenge in humidifier fever PG - 227-235 AU - Edwards JH AU - Cockcroft A LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - i IP - DP - 1981 Jan 01 TI - The health hazards of formaldehyde PG - 926-927 AU - editorial LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 7 IP - DP - 1981 Jan 01 TI - Influence of fluoride recovery alumina on the work environment and the health of aluminium potroom workers PG - 214-222 AU - Eduard W AU - Lie A LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 68 IP - DP - 1981 Jan 01 TI - Occupational asthma secondary to inhalation of garlic dust PG - 156-160 AU - Falleroni AE AU - Zeiss R AU - Levitz BS LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 283 IP - DP - 1981 Jan 01 TI - Asthma in workers manufacturing cephalosporins PG - 950-95* AB - We report two cases of asthma caused by exposure to cephalosporins. CASE 1 A 35-year-old production research chemist had for two years had a dry irritating cough which improved when away from work. He had also had short-lived attacks of sneezing and chest tightness when weighing out small quantities of 7-aminocephalosporanic acid (7ACA) and its tosyalate dihydrate derivative (7CTD). He had no history of asthma, rhinitis, or eczema but skin-prick tests were positive to cat, housedust, and house-dust mite extracts. Bronchial provocation testing was carried out. The patient weighed 50 g amounts of 7ACA and 7CTD. This reproduced his symptoms and provoked immediate falls in forced expiratory volume in Is. No reactions were provoked by challenge with cephalexin powder or a control challenge with magnesium stearate. Skin-prick test results were positive to solutions of 7ACA and 7CTD at dilutions of 1 g/l but negative to cephalexin at 10 g/l. CASE 2 A 36-year-old production worker had been intermittently exposed to cephalexin over 10 years before starting work on a process in which cephalexin monohydrate powder was dried. An airline hood was provided for this work but he did not always wear it. After one month he developed tightness in the chest and breathlessness, which resolved spontaneously during a two-week absence from work but recurred shortly after his return while donning overalls contaminated with cephalexin. These symptoms also resolved spontaneously, but on returning to work 10 days later he had an anaphylactic reaction and was admitted to hospital. He returned to work only once, when he developed chest tightness after spending 20 minutes in the canteen. He had no history of asthma, rhinitis, or eczema but a skin-prick test result with grass pollen extract was positive. Immediate asthmatic reaction resulting from five minutes exposure to dust created by weighing 50 g of 7ACA and 7CTD. Bronchial provocation testing was carried out. Cephalexin disolvate 1 mg diluted in 250 g of lactose was tipped between trays for 30 minutes. On the first occasion this provoked a 16% immediate fall in forced expiratory volume in Is; a 30% fall occurred when the test was repeated. Challenge with cephalexin monohydrate 2 mg in 250 g of lactose for five minutes provoked a 30% immediate fall in forced expiratory volume in Is. He did not react to control challenge with lactose. Skin-prick tests to cephalexin disolvate and monohydrate at a dilution of 0-1 mg/l elicited immediate reactions. Atopic and non-atopic hospital staff unexposed to cephalosporins had negative skin-prick test results to solutions used in the above cases. AU - Coutts II AU - Dally MB AU - Newman Taylor AJ AU - Pickering CAC AU - Horsfield N LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 11 IP - DP - 1981 Jan 01 TI - Toluene diisocyanate induced asthma: evaluation od antibodies in the serum of affected workers against tolyl mono-isocyanate protein conjugates PG - 161-168 AU - Danks JM AU - Cromwell O AU - Buckingham JA AU - Newman Taylor AJ AU - Davies RJ LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 64 IP - DP - 1981 Jan 01 TI - Allergy to laboratory animals: a survey by questionnaire PG - 302-307 AU - Davies GE AU - McArdle LA LA - PT - DEP - TA - Int Arch Allergy Appl Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - Cmnd 8121 IP - DP - 1981 Jan 01 TI - Occupational asthma PG - - AU - Department of Health and Social Security LA - PT - DEP - TA - HMSO JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 74 IP - DP - 1981 Jan 01 TI - Allergy induced by exposure to animals PG - 928-932 AU - Dewdney JM LA - PT - DEP - TA - J Roy Soc Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 141 IP - DP - 1981 Jan 01 TI - Ethylenediamine-aminophylline hypersensitivity PG - *-* AU - DeShazo RD LA - PT - DEP - TA - Arch Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 24 IP - DP - 1981 Jan 01 TI - Immunological responses to in haled organic dusts and chemicals PG - 363-366 AU - Cambridge GW LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 72 IP - DP - 1981 Jan 01 TI - Longitudinal study of isocyanate asthma PG - 231-237 AU - Innocenti A AU - Franzinelli A AU - Sartorelli E LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 68 IP - DP - 1981 Jan 01 TI - Streptomyces albus; a new cause of hypersensitivity pneumonitis PG - 295-299 AU - Kagen SL AU - Fink JN AU - Schlueter DP AU - Karup VP AU - Fruchtman RB LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 41 IP - DP - 1981 Jan 01 TI - Microbial aerosols and Actinomycetes in etiological considerations of mushroom workers lung PG - 1454-1460 AU - Kleyn JG AU - Johnson W AU - Wetzler TF LA - PT - DEP - TA - Appl Environ Microbiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 36 IP - DP - 1981 Jan 01 TI - ECG ink as a cause of asthma PG - 275-276 AU - Keskinen H AU - Nordman H AU - Terho EO LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 23 IP - DP - 1981 Jan 01 TI - Survey of industrial workers for antibodies to toluene diisocyanate PG - 741-747 AU - Karol MH LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 38 IP - DP - 1981 Jan 01 TI - Sensitisation against environmental antigens and respiratory symptoms in swine workers PG - 334-338 AU - Katila ML AU - Mantyjarvi RA AU - Ojanen TH LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 11 IP - DP - 1981 Jan 01 TI - Asthma from plexiglas powders PG - 49-54 AU - Kennes B AU - garciaHerreros P AU - Dierckx P LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 79 IP - DP - 1981 Jan 01 TI - Asthma induced by dust from urea-formaldehyde foam insulating material PG - 706-707 AU - Frigas E AU - Filley WV AU - Reed CE LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 47 IP - DP - 1981 Jan 01 TI - Hypersensitivity pneumonitis due to Saccharomonospora viridis diagnosed by inhalation challenge PG - 449-452 AU - Green JG AU - Treuhaft MW AU - Arusell RM LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 36 IP - DP - 1981 Jan 01 TI - Occupational asthma after exposure to a diazonium salt PG - 950-951 AU - Granham V AU - Coe MJS AU - Davies RJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - ed Slovak IP - DP - 1981 Jan 01 TI - Occupational asthma in food workers PG - - AU - Harries PG LA - PT - DEP - TA - Proc SOM research panel symposium JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 317 IP - DP - 1981 Jan 01 TI - Role of irritant receptors in asthma PG - 5-6 AB - Sulphur dioxide inhaled at low concentration had no delectable effect on forced expiratory volume in one second in non-asthmatic atopic controls, but it induced asthma and increased bronchial reactivity in nine symptomless atopic and non-atopic asthmatic patients. This increased reactivity was inhibited by sodium cromoglycate (SCG) and partly inhibited by atropine. This suggests that SCG, in addition to its ability to stabilise mast cells, may also act on bronchial irritant receptors or directly on smooth muscle in asthmatic patients AU - Harries MG AU - Parkes PEG AU - Lessof ME AU - Orr TSC LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 36 IP - DP - 1981 Jan 01 TI - Occupational asthma caused by a plastics blowing agent, azodicarbonamide PG - 906-909 AB - A prevalence study of occupational asthma was carried out by questionnaire in 1980 among a group of 151 workers who had been exposed to azodicarbonamide dust in the process of its manufacture. Twenty- eight (18.5%) people without previous asthma gave a history of episodes of late onset asthma after exposure to azodicarbonamide. Re-exposure caused repetition and worsening of symptoms. Immediate removal from further exposure resulted in rapid cessation of symptoms without further recurrence. Seven of 13 sensitised individuals who were still exposed three months after the onset of disease developed prolonged airways hyperreactivity to common environmental irritants. Azodicarbonamide should be excluded as a causative agent in plastics and rubber industry workers complaining of occupational asthma. AU - Slovak AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 1 IP - DP - 1981 Jan 01 TI - Allergy in laboratory animal workers PG - 827-828 AB - 179 people working with small laboratory animals were studied by questionnaire, lung-function tests, skin tests with common allergen extracts and extracts of the serum and urine of five animal species, and serology. 49 people had symptoms related to animal contact, most commonly rhinitis but also asthma and skin rashes. Skin reactivity to animal extracts was related to symptoms, particularly asthma, but many people with rhinitis only had negative skin tests. Positive skin tests without symptoms were rare. 3 people had additional late skin reactions. Atopic individuals were no more likely than non-atopics to have animal-related symptoms but were more likely to have asthma. Gel diffusion revealed no precipitating antibodies, and no specific IgG was detected with the ELISA technique. Lung-function measurements were normal. Sensitisation to laboratory animals may involve heavy antigen exposure, so that relatively unreactive individuals can be affected. Exclusion of atopic individuals from work with laboratory animals will not eliminate the problem. AU - Cockcroft A AU - Edwards J AU - McCarthy P et al LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 36 IP - DP - 1981 Jan 01 TI - Occupational asthma in a factory making flux-cored solder containing colophony PG - 828-834 AB - The prevalence of work-related wheeze and breathlessness was measured in factory employees manufacturing flux-cored solder. The flux contained colophony which was heated in the production process, exposing the workers to colophony fumes. Measurement of colophony in the breathing zone defined three grades of exposure with median levels of 1.92 mg/m3 (six subjects), 0.02 mg/m3 (14 subjects), and less than 0.01 mg/m3 (68 subjects). All but two workers in the first two groups, and 90% of a random sample of the last group, were studied. Occupational asthma was present in 21% of the higher two exposure groups and 4% of the lowest exposure group. Mean values of FEV1 and FVC fell with increasing exposure. The prevalence of upper and lower respiratory symptoms was only one-third to a half that found in a previous study of shop floor electronics workers, whose work raised the flux to a higher temperature and produced higher concentrations of colophony fume. Total IgM levels were higher in the solder manufacturers than in unexposed controls, and were higher still in the electronics workers. The solder manufacturers were exposed to colophony fumes at 140 degrees C, below the temperature at which the resin acids decompose, supporting the hypothesis that it is the whole resin acids rather than decomposition products which cause occupational asthma. The threshold limit value should be based on the resin acid content of the fume, and not the aldehyde content as at present. The survey suggests that sensitisation will not be prevented unless exposure is kept well below the present threshold limit value. AU - Burge PS AU - Edge G AU - Hawkins R AU - White V AU - Newman Taylor AJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 80 IP - DP - 1981 Jan 01 TI - An epidemiologic study of workers exposed to western red cedar and other wood dusts PG - 30S-32S AU - Brooks SM AU - Edwards JJ AU - Apol A et al LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 38 IP - DP - 1981 Jan 01 TI - Ventilatory function in workers exposed to tea and wood dust PG - 339-345 AU - Al Zuhair YS AU - Whitaker CJ AU - Cinkotai FF LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 11 IP - DP - 1981 Jan 01 TI - Relationship between the results of skin, conjunctival and bronchial tests and RAST with Candida albicans in patients with asthma PG - 343-351 AU - Akiyama K AU - Yui Y AU - Shida T AU - Miyamoto T LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 114 IP - DP - 1981 Jan 01 TI - Pontiac fever; isolation of the etiologic agent (Legionella pneumophila) and demonstration of its mode of transmission PG - 337- AU - Kaufmann AF AU - McDade JE AU - Patton CM AU - et al LA - PT - DEP - TA - Am J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 38 IP - DP - 1981 Jan 01 TI - Lung function of office workers exposed to humidifier fever antigen PG - 34-37 AU - Ashton I AU - Axford AT AU - Bevan C AU - Cotes JE LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - ii IP - DP - 1981 Jan 01 TI - Formaldehyde in insulated houses PG - 375-375 AU - Bernadini P AU - Carelli G AU - Valentino R LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 7 IP - DP - 1981 Jan 01 TI - Life threatening pulmonary reaction from car paint containing prepolymerized isocyanate PG - 310-311 AU - Belin L AU - Hjortsberg U LA - PT - DEP - TA - Scand J Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 1 IP - DP - 1981 Jan 01 TI - Respiratory tract reactions to Western Red Cedar PG - 41-51 AU - Blainey AD AU - Graham VAL AU - Phillips MJ AU - Davies RJ LA - PT - DEP - TA - Hum Toxicol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 23 IP - DP - 1981 Jan 01 TI - Fibrous zeolites and endemic mesothelioma in Cappadocia, Turkey PG - 548-550 AU - Lilis R LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 72 IP - DP - 1981 Jan 01 TI - First report of clinical manifestations with suspicted immune pathogenesis caused by bromo-acetamide-2-chloro-5-benzophenone (BCB) PG - 228-230 AU - BriaticoVangosa G AU - Baroni M AU - Nava C LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19810101 IS - IS - VI - 68 IP - DP - 1981 Jan 01 TI - Bronchial responsiveness to histamine or methacholine in asthma: measurement and clinical significance PG - 347-355 AB - Bronchial responsiveness is the term used to de- scribe the tendency of the airways to bronchoconstrict to specific stimuli such as allergens and isocyanates, which select a limited population of apparently sen- sitized subjects, and to nonspecific (nonallergic) stim- uli, which affect most asthmatic persons. Specific bronchial responsiveness to allergic stimuli is difficult to quantitate because commonly available allergen ex- tracts are not well standardized for the number and concentration of components. Nonspecific respon- siveness can be quantitated by inhalation tests with histamine or methacholine, by exercise, or by iso- capnic hyperventilation of cold air, and may be in- creased in asthma and other conditions such as chronic obstructive bronchitis and cystic fibrosis. In this article we will discuss the measurement of nonspecific bron- chial responsiveness by inhalation tests with histamine or methacholine and its relationship to the occurrence and severity of asthma. METHODS AU - Hargreave FE AU - Ryan G AU - Thomson NC AU - OByrne PM AU - Latimer K AU - Juniper EF AU - Dolovich J LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 77 IP - DP - 1980 Jan 01 TI - Mass Ammonia Inhalation PG - 496-498 AB - The clinical, roentgenographic and laboratory findings, their relationship to each other and to the subsequent hospital course are reported for 14 victims of gaseous ammonia inhalation. Initial physical examination enabled differentiation of a mildly affected from a moderately affected group, but patients in both groups responded well to conservative medical management. Ammonia is an extremely noxious gas when inhaled and exposure to it, usually in the setting of an industrial accident, has long been recognized as a cause of both acute and chronic respiratory disease. None of the previous case reports, however, provide data which allow correlation of the clinical, roentgenographic, and blood gas findings with the subsequent course. Recently, we have managed 14 patients accidentally exposed to large concentrations of gaseous ammonia. The purpose of this report is to provide a correlative summary of their presentation and hospital course. In particular, analysis of the data reveals that physical examination of the chest in the first 24 hours postexposure allows the best prediction of subsequent hospital course. AU - Montaguea TJ AU - Macneil AR LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 6 IP - DP - 1980 Jan 01 TI - Contact urticaria and asthma from Denatonium benzoate (Bitrex) PG - 466-471 AB - A 30-year-old male developed asthma and pruritus after using an insecticidal spray (Pyrex®). The same symptoms appeared with an alcoholic skin disinfectant (M-sprit®) and other spirituous preparations denaturated with denatonium benzoate (Bitrex®). An open epicutaneous test (20 min) showed wheal and erythema to Pyrex, M-sprit and Bitrex diluted to 2 × 10-6 mg 1-1. It is deduced that the contact urticaria elicited from denatonium benzoate was caused by an immunologic mechanism of the immediate hypersensitivity type. AU - Bjorkner B LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - Academic p IP - DP - 1980 Jan 01 TI - Grain dust and health PG - - AU - Becklake MR LA - PT - DEP - TA - State of the art JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 107S IP - DP - 1980 Jan 01 TI - Prevalence of symptoms and immuno-response in relation to exposure to infected humidifiers PG - 155-162 AU - Belin L LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 61 S1 IP - DP - 1980 Jan 01 TI - Clinical and immunological data on wood trimmer's disease in Sweden PG - 169-176 AU - Belin L LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 2 IP - DP - 1980 Jan 01 TI - Formaldehyde: hypersensitivity and irritant reactions at work and in the home PG - 60-72 AU - Bardana EJ LA - PT - DEP - TA - Imm Allergy Pract JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 9 IP - DP - 1980 Jan 01 TI - Bathing fever epidemic of unknown aetiology in Finland PG - 215-218 AU - Aro S AU - Muittari A AU - Virtanen P LA - PT - DEP - TA - Int J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 65 IP - DP - 1980 Jan 01 TI - Inhalent allergy due to crickets PG - 71-74 AU - Bagentose AH AU - Mathews KP AU - Homburger HA AU - SaaveardDelgado AP LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 35 IP - DP - 1980 Jan 01 TI - Hypersensitivity to inhaled flour allergens PG - 45-56 AU - Baldo BA AU - Krelis S AU - Wrigley CW LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - IP - DP - 1980 Jan 01 TI - Clinical symptoms and dynamics of occupational bronchial asthma induced by exposure to hexavalent chromium in alumina industry workers PG - -46 AU - Budanova L LA - PT - DEP - TA - GigienaTruda i Professional'nye Zabolevaniya pag JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 78 IP - DP - 1980 Jan 01 TI - Bakers' asthma: development and possibility for treatment PG - 400-405 AU - Thiel H AU - Ulmer WT LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 74 IP - DP - 1980 Jan 01 TI - Asthma and atopy in workers with an epoxy adhesive PG - 149-154 AU - Meadway J LA - PT - DEP - TA - Br J Dis Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 36 IP - DP - 1980 Jan 01 TI - Two cases of asthma due to maleic anhydride PG - 393-395 AU - Guerin JC AU - Deschamps O AU - Guillot YL AU - Chavaillon JM AU - Kalb JC LA - PT - DEP - TA - Poumon-coeur JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 66 IP - DP - 1980 Jan 01 TI - Allergy to laboratory animals PG - 158-165 AU - Gross NJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 35 IP - DP - 1980 Jan 01 TI - Positive alveolar responses to inhalation provocation tests: their validity and recognition PG - 415-427 AB - The validity of inhalation tests in the investigation of extrinsic allergic alveolitis was assessed from the results of 144 antigen and control tests in 31 subjects. A definitive pattern of positive late responses was observed. Reactions to nebulised bird serum and droppings in subjects with bird fancier's lung were identical to reactions after "natural" exposures in aviaries or lofts, and to reactions after "occupational" challenges in subjects with farmer's lung and mushroom worker's lung. In general, positive tests were easily recognised subjectively from symptoms and signs appropriate to an influenza-like illness and undue respiratory effort on exercise. They were associated with significant changes in six readily available objective monitoring measurements--exercise minute ventilation (greater than or equal to +15%), body temperature (> 37.2 degrees C), circulating neutrophils (greater than or equal to +2500/mm3), exercise respiratory frequency (greater than or equal to +25%), circulating lymphocytes (greater than ore equal to -500/mm3 with lymphopenia), and forced vital capacity (greater than or equal to -15%). These confirmatory monitoring tests had specificities of approximately 95% and sensitivities of 85-48%. Measurement of diffusing capacity, lung volume subdivisions, or resting minute ventilation/respiratory frequency proved to be too insensitive to be useful, as did auscultation and chest radiography. We conclude that responses that do provoke significant changes in these less sensitive tests are unnecessarily distressing and, presumable, unnecessarily hazardous. AU - Hendrick DJ AU - Marshall R AU - Faux JA AU - Krall JM LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - ii IP - DP - 1980 Jan 01 TI - Pulmonary hypersensitivity in prawn workers PG - 1350-1353 AU - Gaddie J AU - Legge J AU - Friend JAR AU - Reid TMS LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 77 IP - DP - 1980 Jan 01 TI - Humidifier lung: an outbreak in office workers PG - 183-187 AU - Ganier M AU - Lieberman P AU - Fink J AU - Lockwood DG LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 29 IP - DP - 1980 Jan 01 TI - Studies on occupational health problems in agricultural tobacco workers PG - 113-117 AU - Ghosh SK AU - Parikh JR AU - Gokani VN AU - Rao MN AU - Kashyap SK AU - Chatterjee SK LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 302 IP - DP - 1980 Jan 01 TI - Allergy to tobacco: an occupational hazard PG - 617-619 AU - Gleich GJ AU - Welsh PW AU - Yunginger JW AU - Hyatt RE AU - Catlett JB LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 10 IP - DP - 1980 Jan 01 TI - Occupational asthma due to stainless steel welding fumes PG - 151-159 AB - Seven patients with respiratory symptoms after welding were examined. Five had occupational asthma caused by fumes from manual metal are stainless steel welding. The detailed clinical results of two patients with repeated challenge tests are reported. One patient was nonatopic and had earlier had contact dermatitis due to chromium. He experienced a non-immediate type of asthmatic reaction after welding stainless steel. The other patient was atopic and showed an immediate-type reaction. Both reactions were repeated in the second provocation lest after about 2 years. In addition both disodium cromoglycate and beclomethasone pretreatments inhibited the reaction of the two patients, but a placebo medication did not. A remarkable amount of chromium and nickel are detected in the fumes released during stainless steel welding but not in the fumes from mild steel welding, with which all provocation tests were negative. The chromium or the nickel in welding fumes might be the aetiological factor of the reaction. AU - Keskinen H AU - Kalliomaki PL AU - Alanko K LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 10 IP - DP - 1980 Jan 01 TI - Antigens which detect IgE antibodies in workers sensitive to toluene diisocyanate PG - 101-109 AU - Karol M AU - Alarie Y LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 122 IP - DP - 1980 Jan 01 TI - Familial hypersensitivity pneumonitis induced by Bacillus subtelis PG - *-* AU - Johnson CL AU - Bernstein IL AU - Gallagher JS AU - Bonventre PF AU - Brooks SM LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 71 IP - DP - 1980 Jan 01 TI - Occupational asthma due to Triplochiton scleroxylon (Samba, Obeche) PG - 251-254 AU - Innocenti A AU - Angotzi G LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 35 IP - DP - 1980 Jan 01 TI - Comparison of normal and asthmatic circadian rhythms in peak expiratory flow rate PG - 732-738 AB - A computer technique (cosinor analysis) has been used to evaluate circadian rhythms in airway calibre in normals and asthmatics. Two hundred and twenty-one normal subjects recorded peak expiratory flow rate (PEFR) at home four times a day for seven days. Rhythm detection was statistically significant in 145 of them (65-6%) who showed a mean amplitude of 8-3% of individual mean PEFR (± SD 5 2%). Amplitude was independent of age, sex, atopy, family history of asthma, and smoking habit. Fifteen of them were also studied three times a day for five days in the laboratory with flow-volume loops. Eleven showed significant PEFR rhythms at home. No single measurement from the flow-volume loop showed periodicity in as many of them but rhythms were now also detected in the other four normal subjects in some components of the loop. Fifty-six asthma patients were studied with a similar protocol of PEFR measurement and compared with the 145 rhythmic normal subjects. Mean phases of the normal and asthmatic rhythms were not significantly different with acrophases (peak of rhythm cycle) at 1557 and 1526 respectively. The mean asthmatic amplitude was, however, significantly greater at 50 9 %. Nocturnal asthma, therefore, probably represents an exaggeration of a normal circadian rhythm in airway calibre. The amplitude of the PEFR rhythm is an index of bronchial lability and is thus valuable in monitoring asthma patients. An amplitude of > 20 % should be a useful screening test for asthma. AU - Hetzel MR AU - Clark TJH LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 66 IP - DP - 1980 Jan 01 TI - Radioallergosorbent testing of toluene diisocyanate reactive individuals using p-tolyl isocyanate antigen PG - 213-216 AU - Butcher BT AU - O'Neil CE AU - Reed MA AU - Salvaggio JE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 10 IP - DP - 1980 Jan 01 TI - Occupational asthma in a research centre breeding locusts PG - 355-363 AB - The prevalence of work-related asthma, rhinitis and urticaria was measured in a scientific establishment working with locusts. Twenty-six percent of those handling the locust in the research centre had work-related wheeze or breathlessness, and one-third had work-related rhinitis and urticaria. Work-related symptoms were uncommon in scientists exposed to locusts in the field, and in other employees at the centre. Antigens were prepared from the locusts, Schistocerca gregaria and Locusta migratoria, as well as the moth, Chilo partellus, which was also bred at the centre. Skin prick testing with the locust antigens showed positive reactions in 55% of the atopic workers at the centre, but were also present in 43% of unexposed atopic workers. In this latter group there was a correlation between positive reaction to locust and dermatophagoides antigens. Atopic workers handling the locusts developed occupational asthma more often and more quickly than similarly exposed non-atopic workers. IgG and IgE antibodies to the locust antigens were found to correlate significantly with both the degree of exposure and the presence of disease. AU - Burge PS AU - Edge G AU - O'Brien IM AU - Harries MG AU - Hawkins R AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 10 IP - DP - 1980 Jan 01 TI - Bronchial provocation studies in workers exposed to the fumes of electronic soldering fluxes PG - 137-149 AB - Flux cored solder commonly used in the electronics industry is a metal alloy, based on tin and lead, and a flux consisting of colophony with a small concentration of an activator. Thirty-four electronics workers with occupational asthma and seventeen with respiratory symptoms, probably from other causes, have been investigated by occupational type bronchial provocation testing. All the sensitized workers had a significant fall in FEV1 after exposure to colophony fumes for 15 min or less. The non-sensitized workers had no significant reactivity to this test. There was little correlation between the reaction to colophony fumes and the non specific reactivity to histamine, suggesting that colophony fumes were causing specific sensitization. In sensitized workers Portuguese Y colophony was found to cause slightly larger reactions than similar exposures to American WW colophony. In the six workers tested reactions followed exposure to abietic acid alone, the principal resin acid in colophony. Methyhlation of the carboxyl group of colophony was associated with decreased reactivity. Workers with non-specific bronchial hyperreactivity also sometimes reacted after exposure to fumes from the flux activators alone, but even this reaction could show specificity for the specific activator to which the worker was exposed. Finally two non-colophony substitute materials were evaluated. AU - Burge PS AU - Harries MG AU - O'Brien IM AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 122 IP - DP - 1980 Jan 01 TI - Respiratory survey of workers in a pulp and paper mill in Powell River, British Colombia PG - 249-257 AB - A respiratory survey was carried out in 1,932 workers in the pulp and paper mill in Powell River, British Columbia. The survey included a medical-occupational questionnaire, spirometry, chest radiographs, and environmental monitoring. The results obtained in 1,826 white male workers were analyzed. The workers were divided into 6 groups according to the type of exposure at work: subjects in group 1 were mainly exposed to gases, vapors, and chemicals in the kraft mill; group 2, to wood dust; group 3, to paper dust; group 4, to CO; group 5, to all kinds of air contaminants; group 6 (control subjects), to much lower levels of various air contaminants at work. We were unable to demonstrate an increased prevalence of respiratory symptoms and pulmonary function abnormalities among workers exposed to gases and chemicals in the kraft mill. However, we found that workers exposed to wood dust had slightly but significantly lower pulmonary function compared to other groups. Although cigarette smoking had a significant deleterious effect on pulmonary function, as expected, alcohol consumption also affected pulmonary function. Among nonsmokers, those who admitted to having more than 3 drinks per day had significantly lower pulmonary function than those who had no drinks or fewer than 3 drinks per day during the previous week. Among current smokers and ex-smokers, the effect of alcohol consumption on pulmonary function was not significant. The concentrations of sulfur dioxide, hydrogen sulfide, and chlorine encountered in Powell River were low, well below the currently accepted threshold limit values, and this may account for the negative findings in this study. Similar studies should be carried out in other pulp and paper mills in British Columbia to establish whether the currently accepted threshold limit values for these gases are adequate. AU - ChanYeung M AU - Wong R AU - MacLean L AU - Tan F AU - Dorken E AU - Schulzer M AU - Dennis R AU - Grzybowski S LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 121 IP - DP - 1980 Jan 01 TI - Epidemiologic health survey of grain elevator workers in British Colombia PG - 329-338 AU - ChanYeung M AU - Schulzer M AU - Mclean L AU - Dorken E AU - Grzybowski S LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 121 IP - DP - 1980 Jan 01 TI - Hypersensitivity to platinum salts: a population study PG - 230-230 AU - Dally MB AU - Hunter JV AU - Stewart M AU - Newman Taylor AJ LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 20 IP - DP - 1980 Jan 01 TI - Allergy to garlic dust PG - 145-147 AU - Couturier P AU - Kreuter M AU - Loupi J LA - PT - DEP - TA - Rev Franc Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 20 IP - DP - 1980 Jan 01 TI - Five cases of occupational asthma in the pharmaceutical industry PG - 135-144 AU - Enjalbert M AU - Tessoer JF AU - Taytard A AU - Laylavoix F AU - Freour P LA - PT - DEP - TA - Rev Franc Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 61 suppl 1 IP - DP - 1980 Jan 01 TI - Frequency of illness and immuno-respomse related to infected humidifiers in a book-bindery PG - 151-153 AU - Ekstrom NA LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 77 IP - DP - 1980 Jan 01 TI - Increased bronchial reactivity to inhaled histamine in nonsmoking grain workers with normal lung function PG - 28-31 AU - Mink JT AU - Gerrard JW AU - Cockcroft DW AU - Cotton DJ AU - Dosman JA LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 10 IP - DP - 1980 Jan 01 TI - An epidemic of extrinsic allergic alveolitis caused by tap water PG - 77-90 AB - In an industrial community, Linnavuori, (population 1000) over 100 people developed fever, cough, and dyspnoea 3 to 6 hours after sauna or bathing. This epidemic began in August of 1978 and ended gradually in December. The water source of the community was a small (0.4 km2) lake; in November it was found that the water was contaminated with several bacteria, fungi, and algae. Precipitating antibodies to these bacterial and fungal antigens were not found in the sera of symptomatic patients. To show that tap water, purified by the local waterworks, had provoked the symptoms, four clinically typical patients were each twice challenged. Two of the patients visited their usual public sauna, the two others took a bath at home. Two patients inhaled home tap water aerosol, one inhaled lake water vapor and one home tap water vapor in hospital. Three to six hours after seven of the eight challenges the patients showed two or more of the following symptoms and signs: chills, fever, dry cough, dyspnoea, and inspiratory crepitant râles. Six provocations increased the amount of segmented neutrophils and in each case the lung diffusion capacity decreased significantly. Although the clinical picture resembles extrinsic allergic alveolitis, it is possible that bacterial endotoxins have induced alternative pathway complement activation and release of leukocyte pyrogens. AU - Muittari A AU - Kuusisto P AU - Virtanen P AU - Solijarvi A AU - Gronroos P AU - Marmoinen A AU - Antila P AU - Kellomaki L LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - ii IP - DP - 1980 Jan 01 TI - Endotoxin and bath water fever PG - 89-89 AU - Muittari A AU - Rylander R AU - SalkinojaSalonen M LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 66 IP - DP - 1980 Jan 01 TI - Induction of immunological tolerence to the trimellitic haptenic group in mice PG - 322-326 AU - Liu FT AU - Bargatze RF AU - Katz DH LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 10 IP - DP - 1980 Jan 01 TI - Detection of castor allergens in castor wax PG - 33-42 AU - Lehrer SB AU - Karr RM AU - Muller DJG AU - Salvaggio JE LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 37 IP - DP - 1980 Jan 01 TI - Changes in lung function after exposure to vanadium PG - 253-256 AU - Lees REM LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 121 IP - DP - 1980 Jan 01 TI - Ethylene-diamine induced asthma PG - 151-155 AU - Lam S AU - ChanYeung M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 30 IP - DP - 1980 Jan 01 TI - Another causal factor in the production of humidifier fever PG - 63-68 AU - Parrott WF AU - Blyth W LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 10 IP - DP - 1980 Jan 01 TI - Meat wrapper's asthma: identification of the causal agent PG - 263-269 AU - Pauli G AU - Bessot JC AU - Kofferschmitt MC AU - Lingot G AU - Wendling R AU - Ducos P AU - Limasset JC LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 61 suppl 1 IP - DP - 1980 Jan 01 TI - A 7 year survey of "allergic" occupational lung disease in the United Kingdom PG - 137-149 AU - Pickering CAC LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - Pergamon p IP - DP - 1980 Jan 01 TI - Humidifier fever PG - 357-360 AU - Pickering CAC LA - PT - DEP - TA - Advances in Allergy and Immunology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 65 IP - DP - 1980 Jan 01 TI - Quillaja bark (soapbark) induced asthma PG - 285-287 AU - Raguprasad PK AU - Brooks SM AU - Litwin A AU - Edwards JJ AU - Bernstein IL AU - Gallagher J LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 6 suppl 1 IP - DP - 1980 Jan 01 TI - Asthma, symptoms of chronic bronchitis and ventilatory capacity among cobalt workers and zinc production workers PG - 1-49 AU - Roto P LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - ii IP - DP - 1980 Jan 01 TI - Pontac fever explained? PG - 969-969 AU - Rowbotham TJ LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - i IP - DP - 1980 Jan 01 TI - Isocyanate-induced asthma in a car factory PG - 756-758 AU - White WG AU - Morris MJ AU - Sugden E AU - Zapata E LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - ii IP - DP - 1980 Jan 01 TI - Outbreak of tuberculosis after minimal exposure to infection PG - 187-189 AU - Rao VR AU - Joanes RF AU - Kilbane P AU - Galbraith NS LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 35 IP - DP - 1980 Jan 01 TI - Hard metal lung disease: importance of cobalt in coolants PG - 653-659 AB - Four patients were found to react to occupational exposure to grinding of hard metal (tungsten carbide). Three of the patients had symptoms and signs compatible with an allergic alveolitis, the symptoms disappearing and the chest radiograph clearing when they were absent from work for a few months. Re-exposure to the offending agent led to new signs and symptoms. The first patient was re-exposed twice and each time reacted a little more seriously. After the last episode her chest radiograph has not cleared completely, in contrast to the first two times. The fourth patient had more typical occupational asthma. All the cases occurred in the part of the factory where air concentrations of cobalt were the lowest. The cobalt there is dissolved in the coolant necessary for grinding the hard metal. It occurs mainly in the ionised form, which is known to react with proteins and therefore presumably acts as a hapten. Protective measures, including choosing a coolant with minimal ability to dissolve cobalt and an effective exhaust system, should minimise the risk of this occupational disease in the future. AU - Sjogren I AU - Hillerdal G AU - Andersson A AU - Zetterstrom O LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - i IP - DP - 1980 Jan 01 TI - Meat wrappers asthma caused by thermal degredation products of polyethylene PG - 211-211 AU - Skerfving S AU - Akesson B AU - Simonsson BG LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 65 IP - DP - 1980 Jan 01 TI - Hypersensitivity pneumonitis induced by Penicillium species PG - 65-70 AU - Solley GO AU - Hyatt RE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 35 IP - DP - 1980 Jan 01 TI - Epidemiological study of respiratory disease in workers exposed to polyvinylchloride dust PG - 644-652 AU - Soutar CA AU - Copland LH AU - Thornley PE AU - Hurley JF AU - Ottery J AU - Adams WGF AU - Bennett B LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 45 IP - DP - 1980 Jan 01 TI - Respiratory morbidity in workers exposed to dust containing phenolic resin PG - 221-229 AU - Sparks PJ AU - Peters JM LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 93 IP - DP - 1980 Jan 01 TI - Management of the pregnant asthmatic patient PG - 905-918 AU - Turner ES AU - Greenberger PA AU - Patterson R LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 78 IP - DP - 1980 Jan 01 TI - Bakers asthma, development and possibility for treatment PG - 400-405 AU - Thiel H AU - Ulmer WT LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - ii IP - DP - 1980 Jan 01 TI - Myopericarditis associated with farmers lung PG - 197-197 AU - Terho E AU - Valta R AU - Tukiainen H AU - Lansimes E LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 96 IP - DP - 1980 Jan 01 TI - Occupational asthma from psyllium laxatives PG - 1213-1216 AU - Terho EO AU - Torkko M LA - PT - DEP - TA - Duodecim JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 51 IP - DP - 1980 Jan 01 TI - Bronchial asthma due to sensitisation to the larva of Mosca carnaria PG - 287-28* AU - Zucchi J AU - Ingrosso W LA - PT - DEP - TA - Riv Pat Clin Tuberc Pneumol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - i IP - DP - 1980 Jan 01 TI - Chronic respiratory disease and respiratory function in a group of fire fighters PG - 654-658 AB - A sample of 193 subjects drawn from the New South Wales Fire Brigade was studied to examine the prevalence of chronic respiratory disease and impairment of respiratory function. The prevalence of respiratory disease was less than that reported in other groups of firemen and reflects the lower level of occupational exposure, and possibly a survivor effect, within the New South Wales Fire Brigade. Among recent recruits, the effects of cigarette smoking far outweighed any contribution from occupational exposure. Among firemen with 20 years or more service a twofold increase in the prevalence of chronic bronchitis is considered to result from the additive effects of cigarette smoking and the high occupational smoke exposures consequent to the availability of respiratory protection and earlier attitudes to its use. The increasingly toxic nature of combustion products at fires was not accompanied by a discernible increase in the prevalence of chronic respiratory disease or impairment of respiratory function. The major combustion products responsible for respiratory damage were self-administered, arising from burning tobacco rather than from burning buildings. AU - Young I AU - Jackson J AU - West S LA - PT - DEP - TA - Med J Aust JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 61 suppl 1 IP - DP - 1980 Jan 01 TI - Recognition of allergic alveolitis in the trimming department of a Swedish sawmill PG - 163-167 AU - Wimander K AU - Belin L LA - PT - DEP - TA - Eur J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 28 IP - DP - 1980 Jan 01 TI - Allergies to ethylenediamine PG - *-* AU - von Pevney VI AU - Schafer U LA - PT - DEP - TA - Dermatosen JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 242 IP - DP - 1980 Jan 01 TI - Karaya gum hypersensitivity in an enterostomal therapist PG - 432-432 AU - Wagner W LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 65 IP - DP - 1980 Jan 01 TI - Efficacy and specificity of immunotherapy with labatory animal allergen extracts PG - 413-421 AU - Wahn U AU - Siraganian RP LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 315 IP - DP - 1980 Jan 01 TI - DI-ISOCYANATE-INDUCED ASTHMA IN A CAR FACTORY PG - 756-760 AB - In a car factory employing 203 women machinists making seat covers more women complained of respiratory symptoms after the introduction of a new seat cover fabric, cropped nylon backed with flame-bonded polyurethane foam (CNPF). 68 women working in the trim shop were studied on the first day back at work after a week's holiday and then at the end of a working week; the incidence of wheezing and/or shortness of breath was greater than expected but there was no difference between peak flow rates. A second study of 192 of the 203 women working in the trim shop confirmed this recent increase in incidence of asthmatic symptoms and showed that significantly more machinists who had worked with this new fabric had a reduced peak flow rate than machinists who had not. Asthma developed in one subject when she was working in the factory sewing CNPF, when she was handling this fabric in the challenge cabinet in the laboratory, and on challenge with toluene di-isocyanate in the laboratory. Airways resistance increased in 3 other workers after exposure to CNPF in the laboratory. Low concentrations (between 0.0003 and 0.003 ppm) of toluene di-isocyanate were found in the air around this fabric. 4 of 9 women with symptoms had IgE antibodies to toluene di-isocyanate. AU - White WG AU - Sugden E AU - Morris MJ AU - Zapata E LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 93 IP - DP - 1980 Jan 01 TI - Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group PG - 391-398 AB - At six centers, 203 patients with hypoxemic chronic obstructive lung disease were randomly allocated to either continuous oxygen (O2) therapy or 12-hour nocturnal O2 therapy and followed for at least 12 months (mean, 19.3 months). The two groups were initially well matched in terms of physiological and neuropsychological function. Compliance with each oxygen regimen was good. Overall mortality in the nocturnal O2 therapy group was 1.94 times that in the continuous O2 therapy group (P = 0.01). This trend was striking in patients with carbon dioxide retention and also present in patients with relatively poor lung function, low mean nocturnal oxygen saturation, more severe brain dysfunction, and prominent mood disturbances. Continuous O2 therapy also appeared to benefit patients with low mean pulmonary artery pressure and pulmonary vascular resistance and those with relatively well-preserved exercise capacity. We conclude that in hypoxemic chronic obstructive lung disease, continuous O2 therapy is associated with a lower mortality than is nocturnal O2 therapy. The reason for this difference is not clear AU - Anonymous LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 37 IP - DP - 1980 Jan 01 TI - Interaction of atopy and exposure to cotton dust in the bronchoconstrictor response PG - 141-146 AB - A survey of 255 workers in four cottonseed crushing mills included a respiratory health questionnaire, allergy skin testing, and measurements of lung function over the Monday working shift. Atopy was defined as having two or more positive weal reactions to common inhalant antigens. Categories of exposure to dust were based on the stage of milling, and one category contained workers with continuous exposure to cotton dust derived from linters, the cotton fibres adherent to cottonseed. Atopy and exposure to dust were found to have significant interaction: large mean declines in FEV1 and FEF 25-75 occurred only in the workers exposed to linter dust who were also atopic. Skin-testing surveys in cotton textile mills have concentrated on specific cotton antigen reactivity and its first-order relations to symptoms. Our results indicate a need to identify atopic workers, and to search for interactions between atopy and other variables that may influence acute changes in expiratory flow rates AU - Jones RN AU - Butcher BT AU - Hammad YY AU - Diem JE AU - Glindmeyer HW 3d AU - Lehrer SB AU - Hughes JM AU - Weill H LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - IP - DP - 1980 Jan 01 TI - Progression of asbestos radiographic abnormalities: relationships to estimates of dust exposure and annual decline in lung function PG - 537-543 AB - The determinants of radiographic worsening were examined in a cohort of 244 asbestos-cement manufacturing workers. Progression of irregular small opacities was related to higher average and cumulative dust exposures. Progression of pleural thickening or pleural plaques was related to length of exposure and time since first exposure, but not to average or cumulative exposure. Larger declines in forced vital capacity and forced expiratory volume (one second) were related to larger cumulative dust exposures and to progression of irregular small opacities and pleural thickening. Progression of pleural calcification was not associated with significantly declines in lung function. Changes in lung diffusing capacity did not correlate with measures of dust exposure or with progression of radiographic abnormalities AU - Jones RN AU - Diem JE AU - Glindmeyer H AU - Weill H AU - Gilson JC LA - PT - DEP - TA - IARC Scientific Publications JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 281 IP - DP - 1980 Jan 01 TI - National survey of notifications in England and wales 1978-9 PG - 895-898 AU - Medical Research Council LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 6 IP - DP - 1980 Jan 01 TI - Bacteria and soluble oil dermatitis PG - 7-9 AB - Simultaneous investigation of the bacterial flora of a soluble oil in use as a metalworking fluid and of the skin of machine operatives exposed to that soluble oil did not support the hypothesis that bacteria in soluble oil emulsions colonise the skin and either initiate or maintain the dermatitis associated with soluble oil exposure AU - Rycroft RJ LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 280 IP - DP - 1980 Jan 01 TI - Reason for variable response to Tine test PG - 223- AU - Lunn JA LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 121 IP - DP - 1980 Jan 01 TI - The early bactericidal activity of drugs in patients with pulmonary tuberculosis PG - 939-949 AU - Jindani A AU - Aber VR AU - Edwards EA AU - Mitchison DA LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 74 IP - DP - 1980 Jan 01 TI - Comparison of atropine with ipratropium bromide in patients with reversible airways obstruction unresponsive to salbutamol PG - 259-262 AB - Dose-response curves for atropine and ipratropium bromide were made in nine asthmatics unresponsive to salbutamol. Conventional doses of ipratropium resulted in significantly less bronchodilatation than large doses of atropine, suggesting that larger doses of ipratropium should be used AU - Burge PS AU - Harries MG AU - l'Anson E LA - PT - DEP - TA - Br J Dis Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 37 IP - DP - 1980 Jan 01 TI - Occupational type bronchial provocation tests: testing with soluble antigens by inhalation PG - 248-252 AB - Thirty-seven patients with asthma or alveolitis thought to result from exposure to materials commonly encountered at their work were tested by inhalation of an aerosol of these materials. Twenty-four (65%) developed an immediate asthmatic reaction, which was followed by a non-immediate reaction in 10, of whom six developed the signs and symptoms of alveolitis. Eighteen (76%) patients with asthmatic reactions to test material were prick test positive to that material while only two our of 13 with a negative inhalation test were prick test positive (15%). Precipitating antibody to test material was measured in 23 and was present in nine (39%) of those with positive inhalation tests, and one (12%) of those with negative tests. It was present in five of the six with a reaction in the gas exchanging portions of the lung AU - Harries MG AU - Burge PS AU - O'Brien IM LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 78 IP - DP - 1980 Jan 01 TI - Pulmonary manifestations of vinyl and polyvinyl chloride (interstitial lung disease). Newer aspects PG - 828-834 AB - Newer varieties of occupational lung diseases primarily due to the vast increase in industrial technology have been reported recently. Preeminent among such newer agents are vinyl chloride (VC) and polyvinyl chloride. Very few cases have been reported, in Europe only, with descriptive histopathologic changes. To our knowledge, no pathologic studies of VC exposure have been described in the American literature. The biopsy abnormalities in our patients disclosed desquamation of alveolar macrophages into the alveolar lumina and minor interstitial and alveolar inflammatory changes. Pulmonary function abnormalities included restrictive insufficiency. Preventive therapy consists of the avoidance of further exposures, frequent industrial hygiene monitoring, and total avoidance of tobacco smoke, as well as associated atmospheric pollutants. Thus far, none of these patients has exhibited evidence of pulmonary neoplasms. All three patients survived their occupational injuries, and two are still disabled to varying degrees. Urine and blood levels of phthalic acid derivatives were elevated in two patients, the exact significance of which is not fully known. It probably represents a toxicologic response, but must be further pursued before conclusions can be reached AU - Cordasco EM AU - Demeter SL AU - Kerkay J AU - Van Ordstrand HS AU - Lucas EV AU - Chen T AU - Golish JA LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 92 IP - DP - 1980 Jan 01 TI - Controlled clinical trial of methylprednisolone in patients with chronic bronchitis and acute respiratory insufficiency PG - 753-758 AU - Albert RK AU - Martin TR AU - Lewis SW LA - PT - DEP - TA - Ann Int Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 122 IP - DP - 1980 Jan 01 TI - Respiratory symptoms in Manitoba farmers: association with grain and hay handling PG - 1259-1264 AB - Of a random sample of farmers in two crop districts of Manitoba mailed a respiratory questionnaire in 1976, 833 (82% of those currently farming in the area) replied. More than half were grain farmers and nearly half had never smoked cigarettes. The prevalence of chronic cough and phlegm production, wheezing and exertional dyspnea was positively related to the amount of smoking but was also higher than expected in nonsmokers. Acute dyspnea, sometimes of delayed onset and accompanied by fever, was most commonly related to handling old grain and was reported by 44% of the farmers. Current smokers were more susceptible than nonsmokers to this type of dyspnea. Farmers with history of acute dyspnea while handling grain were more likely to wear masks, but the overall rate of mask wearing, even among those at highest risk, was low AU - Warren CP AU - Manfreda J LA - PT - DEP - TA - Can Med Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19800101 IS - IS - VI - 32 IP - DP - 1980 Jan 01 PG - 103-109 AU - Kalas D AU - Runstukova J LA - PT - DEP - TA - Pracov Lec JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 8 IP - DP - 1979 Jan 01 TI - Twelve years spirometric changes among Paris area workers PG - 201-212 AB - The effects of smoking habits, socio-occupational factors and respiratory symptoms in the development of airflow obstruction have been studied in a working population of 575 men aged 30-54 in 1960 and surveyed in 1960 and 1972. On average, FEV1 decreased by 47 ml/annum. Apart from FEV1 level, which reflects loss since the beginning of adult life, three factors were independently related to FEV1 slope: tobacco consumption, occupational exposure and social class. The decrease of FEV1 with smoking was dose related and decelerated among those who stopped smoking. This follow-up study ruled against phlegm as a causal factor of early stage airflow obstruction, although its role is not excluded at later stages AU - Kauffmann F AU - Drouet D AU - Lellouch J AU - Brille D LA - PT - DEP - TA - Int J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 15 IP - DP - 1979 Jan 01 TI - Twelve year FEV1 changes and smoking habits among 556 workers in the Paris-area PG - 723-737 AB - The aim of the study was to analyse the effects of smoking, in particular to show its causal role in the development of airflow obstruction, and to look at changes in smoking habits. The study was conducted among 556 men, aged 30 to 54 in 1960, surveyed twice, in 1960 and 1972. The hypothesis of tobacco as a causal factor of airflow obstruction is strengthened, following this study, by three results: 1) FEV1 slope was related to tobacco consumption, even after adjustement for FEV1 level (42 ml/yrs for non-smokers, 51 ml/yrs for heavy smokers); 2) FEV1 loss with age increased with the amount of tobacco consumption: one pack a day smoked for 25 years was equivalent to an aging of 5 years; 3) FEV1 loss decelerated if the subject gave up smoking, thus preventing any further risk. What appeared to be a spontaneous regulation in smoking habits was observed. The men who stopped smoking were those with low respiratory status. In this population, men who were ex-smokers in 1960 and maintained this status until 1972 had a FEV1 slope similar to that of the non-smokers AU - Kauffmann F AU - Querleux E AU - Drouet D AU - Lellouch J AU - Brille D LA - PT - DEP - TA - Bull Eupopean Physiopath Respir JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 9 IP - DP - 1979 Jan 01 TI - Toluene di-isocyanate-induced asthma. I. Reactions to TDI, MDI, HDI and histamine PG - 1-6 AB - A group of twenty four workers handling di-isocyanates and with respiratory disease were investigated by occupational-type bronchial provocation tests for sensitivity to toluene di-isocyanate (TDI), to which all were exposed, and to diphenylmethane di-isocyanate (MDI) and hexamethylene di-isocyanate (HDI). Sixteen gave asthmatic reactions to TDI and eight of these also reacted to MDI. Four of the eight TDI and MDI reactors had histories of exposure only to TDI, and of them two reacted also to HDI. Of nine subjects tested with HDI, three gave asthmatic reactions, and all three also reacted to TDI and MDI. Thus reactions to MDI and HDI were elicited only in the TDI reactors. The possibility of specific sensitivity to these and other di-isocyanates requires tests in subjects exposed to them and not to TDI AU - O'Brien IM AU - Harries MG AU - Burge PS AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 9 IP - DP - 1979 Jan 01 TI - Blood histamine levels after exercise testing PG - 437-441 AB - Histamine has been measured in whole blood and in the plasma of twenty-three subjects following exercise testing of seventeen asthmatics and six normal controls. Whole blood histamine rose in both asthmatics and controls and was associated with a concomitant rise in the basophil count. Plasma histamine in the peripheral venous blood only rose in one patient who developed urticaria after exercise AU - Harries MG AU - Burge PS AU - O'Brien I AU - Cromwell O AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 34 IP - DP - 1979 Jan 01 TI - Isocyanate asthma: respiratory symptoms due to 1,5-naphthylene di-isocyanate PG - 762-766 AB - Occupationally related asthma developing in three patients due specifically to exposure to 1,5-naphthylene di-isocyanate (NDI), a hot curing agent used in manufacturing rubber, has been confirmed for the first time using bronchial provocation testing. This substance has been thought to be safer than toluene di-isocyanate (TDI) and diphenylmethane di-isocyanate (MDI) because of its relatively high melting point (120 degrees C). Each patient worked in the same factory and the circumstances of exposure were similar. Provocation testing was also performed with TDI in concentrations up to 0.018 parts per million (ppm) and MDI in concentrations up to 0.02 ppm, to which the patients had been exposed in the past, but no reactions were elicited. None of the patients had increased bronchial reactivity judged by histamine lability and exercise testing. Each patient was advised to give up his job, but two of the three could not find alternative employment and remained exposed. Three-year follow-up shows that airways narrowing has persisted in those who have remained exposed AU - Harries MG AU - Burge PS AU - Samson M AU - Taylor AJ AU - Pepys J LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 2 IP - DP - 1979 Jan 01 TI - Colophony and asthma [letter] PG - 591-591 AU - Burge PS LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 34 IP - DP - 1979 Jan 01 TI - Work-related respiratory disease in employees leaving an electronics factory PG - 19-22 AB - Examination of the records of employees leaving an electronics factory over three-and-a-half years showed that a significantly greater proportion left the shop floor (where soldering took place) because of ill health than left the stores and office areas. This difference was largely due to work-related respiratory disease in those whose job was soldering. Shop floor workers leaving for health reasons also had increased sickness certification due to respiratory illness compared to stores and office workers. These findings suggest that work-related respiratory illness is a significant cause of morbidity and loss of employment in solderers working at the factory and that this has been a longstanding problem with its onset before the first recorded cases of occupational asthma caused by solder flux containing colophony AU - Perks WH AU - Burge PS AU - Rehahn M AU - Green M LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 34 IP - DP - 1979 Jan 01 TI - Occupational asthma in an electronics factory PG - 13-18 AB - Workers in a modern electronics factory were surveyed by questionnaire and lung function testing to see if there was evidence of widespread work-related respiratory symptoms. Of the responding workers exposed to solder flux fumes on the shop floor, 22% had work-related breathlessness or wheeze or both. Exposed workers had a lower FEV1 and FVC than unexposed workers. Work-related rhinitis was also present in 22% of exposed workers. The most likely cause for these results is sensitivity to colophony fumes, released from solder flux during soldering. Levels of solder flux fume were below the threshold limit value in this factory during the survey AU - Burge PS AU - Perks W AU - O'Brien IM AU - Hawkins R AU - Green M LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 241 IP - DP - 1979 Jan 01 TI - The epidemiology of tuberculosis in physicians PG - 33-38 AU - BarrettConnor E LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 64 IP - DP - 1979 Jan 01 TI - Inhalation challenge and pharmacologic studies of toluene diisocyanate (TDI)-sensitive workers PG - 146-152 AB - Workers with "sensitivity" to toluene diisocyanate (TDI) studied in depth in an attempt to determine mechanisms of bronchial hyperreactivity. Tests included provocative inhalation challenge (PIC) with TDI and methacholine challenge. Blood samples obtained prior to and at various times after PIC were used to measure complement and split products of complement and plasma histamine levels and to determine dose-response slopes of lymphocyte cyclic adenosine monophosphate (cAMP) following stimulation with agonists. TDI-reactive individuals were all reactive to methacholine and responded to PIC with TDI by immediate, delayed, or dual bronchospastic reactions. No change in plasma histamine, total complement levels, or split products of complement were measurable. TDI reactors gave decreased lymphocyte cAMP dose response slopes to stimulation with isoproterenol, prostaglandin E1, and TDI, which suggests that impairment of adrenergic receptors may play an important role in TDI reactivity AU - Butcher BT AU - Karr RM AU - O'Neil CE AU - Wilson MR AU - Dharmarajan V AU - Salvaggio JE AU - Weill H LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 120 IP - DP - 1979 Jan 01 TI - Influence of dose and fiber type on respiratory malignancy risk in asbestos cement manufacturing PG - 345-354 AB - This investigation provides information concerning the risk or respiratory malignancy in relation to duration, degree, and fiber type of exposure to asbestos in a manufacturing cohort of 5,645 with long-term follow-up. Excess mortality for this cause was found in groups with moderate and high cumulative exposure (standard mortality ratios of 290 and 226). Analysis of the influence of components of total exposure dose (duration, average concentration) revealed no detectable excess risk in persons employed for less than 2 years or with low-degree average exposure. Exposure to corcidolite (blue) fiber in addition to the predominantly used chrysotile in pipe making appeared to be associated with higher risk than was exposure to chrysotile alone AU - Weill H AU - Hughes J AU - Waggenspack C LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 101 IP - DP - 1979 Jan 01 TI - Contact urticaria to rubber PG - 597-598 AU - Nutter AF LA - PT - DEP - TA - Br J Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 5 IP - DP - 1979 Jan 01 TI - Ispagula powder: an allergen in the work environment PG - 257-261 AB - Bulk laxatives based on ispagula powder have given no known allergic side effects when administered perorally. Twenty-seven out of 64 workers in a pharmaceutical factory developed rhinitis, conjunctivitis or asthma when engaged in the packing of ispagula husks, an operation which gives rise to dust. The symptoms are accounted for by a type 1 allergy acquired from ispagula husks. This allergy can be demonstrated by intracutaneous and provocation tests. Occupational health measures were taken which reduced the dust content to a minimum; thereafter only one new case of sensitization was recorded during the next 24 months of observation. Five similar cases were reported among nursing staff exposed to the dust of ispagula while administering doses of bulk laxative. AU - Goransson K AU - Michaelson NG LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 34 IP - DP - 1979 Jan 01 TI - Occupational asthma in an electronics factory: a case control study to evaluate aetiological factors PG - 300-307 AB - This is the final part of a study carried out to investigate occupational asthma due to sensitivity to colophony fumes (a component of soldering flux) in an electronics factory. Fifty-eight workers with occupational asthma employed on the main shop floor were investigated. In them the interval between first exposure and sensitisation varied widely with a group becoming sensitive within one to two years of first exposure, and another group whose sensitisation was delayed for three to 23 years. Once sensitised the interval between arriving at work and the onset of daily symptoms seemed to be bimodally distributed, resembling the immediate and late asthmatic symptoms seen on provocation testing. Twenty-three out of 58 had no definite daily deterioration at work but improved at the weekends. Wheeze and breathlessness occurred in the evenings at home in most, and one-third were woken by breathlessness at least on some nights. These 58 cases were compared with 48 controls without occupational asthma who had worked on the same shop floor for at least four years. Mean levels of FEV1 were significantly worse in the cases before exposure on Monday morning. The cases also had more than twice as much sickness absence as controls. FEV1 fell by more than 10% over a working shift in 33% of cases and 5% of controls. Atopy (a positive skin prick test to one or more common allergens) and a past history of allergic disease were weakly but significantly associated with being a case. The effects of smoking and a family history of allergic disease were trivial. Prick testing with an antigen derived from the colophony in the solder flux was completely negative, but cases and controls had significantly raised levels of total IgM compared with blood bank controls, perhaps suggesting some previously unrecognised immunological process. AU - BURGE PS AU - PERKS WH AU - OBRIEN IM AU - BURGE A AU - HAWKINS R AU - BROWN D LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 25 IP - DP - 1979 Jan 01 TI - Experiences with the provocation inhalation test in occupationally induced allergic diseases of the respiratory tract PG - 140-145 AU - Wallenstein G AU - Rebohle E AU - Bergmann I LA - PT - DEP - TA - Allergie Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 320 IP - DP - 1979 Jan 01 TI - Decrease in vital capacity in PCB-exposed workers in a capacitor manufacturing facility PG - 277-283 AU - Warshaw R AU - Fischbein A AU - Thornton J AU - Miller A AU - Selikoff IJ LA - PT - DEP - TA - Ann N Y Acad Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 36 IP - DP - 1979 Jan 01 TI - Respiratory function in coffee workers PG - 117-122 AU - Zuskin E AU - Valic F AU - Skuric Z LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 29 IP - DP - 1979 Jan 01 TI - Hazards of spraying with two-pack paints containing isocyanates PG - 22-24 AU - Tyrer FH LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 5 IP - DP - 1979 Jan 01 TI - Humidifier-associated extrinsic allergic alveolitis PG - 35-41 AU - van Assendelft A AU - Forsen KO AU - Keskinen H AU - Alanko K LA - PT - DEP - TA - Scand J Work Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - ed Hughes IP - DP - 1979 Jan 01 TI - The respiratory condition of potroom workers: Australian experience PG - 79-85 AU - Smith MM LA - PT - DEP - TA - Health protection in primary aluminium production JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 63 IP - DP - 1979 Jan 01 TI - Characterisation of mouse allergens PG - 435-442 AU - Siraganian RP AU - Sandberg AL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - IP - DP - 1979 Jan 01 TI - Occupational and environmental respiratory disease PG - - AU - Salvaggio J LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 64 IP - DP - 1979 Jan 01 TI - Occupational asthma- overview and mechanisms PG - 646-649 AU - Salvaggio JE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 42 IP - DP - 1979 Jan 01 TI - Respiratory impairment in the electrolytic extraction of aluminium PG - 217-221 AU - Saric M AU - Zuskin E AU - Gomzi M LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 36 IP - DP - 1979 Jan 01 TI - Bronchoconstriction in potroom workers PG - 211-215 AU - Saric M AU - Zuskin E AU - Gomzi M LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 36 IP - DP - 1979 Jan 01 TI - Bacterial contamination of cotton as an indicator of respiratory effects among card room workers PG - 299-304 AU - Rylander R AU - Imbus HR AU - Suh MW LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 115 IP - DP - 1979 Jan 01 TI - Allergic contact hypersensitivity to nickel, neomycin, ethylenediamine and benzocaine PG - 959-962 AU - Prystowsky SD AU - Allen AM AU - Smith RW AU - Nonomura AU - Odom RB AU - Akers WA LA - PT - DEP - TA - Arch Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 34 IP - DP - 1979 Jan 01 TI - "Coughing water", bronchial hyperreactivity induced by swimming in a chlorinated pool PG - 682-683 AU - Pickering CAC AU - Mustchin CP LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - IP - DP - 1979 Jan 01 TI - Carbon and carbonless copy paper PG - 27-32 AU - Calnan CD LA - PT - DEP - TA - Acta Dermatovener JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 9 IP - DP - 1979 Jan 01 TI - Passive transfer in man and the monkey of type 1 allergy due to heat labile and heat stable antibody to complex salts of platinum PG - 99-108 AU - Pepys J AU - Parish WE AU - Cromwell O AU - Hughes EG LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 29 IP - DP - 1979 Jan 01 TI - Humidifier fever in an industrial setting, results of three years control using precipitin measurements PG - 53-63 AU - Perdrix A AU - Lascaud D AU - Dell'Accio P AU - AmbroiseThomas P AU - Paramelle B LA - PT - DEP - TA - Bronches JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 21 IP - DP - 1979 Jan 01 TI - A study of health status and working conditions of phthalic anhydride workers PG - 61-67 AU - Ohta T AU - Ogawa T AU - Aoyama H AU - Hara I LA - PT - DEP - TA - Jap J Industr Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 34 IP - DP - 1979 Jan 01 TI - Effects of electric arc welding on ventilatory lung function PG - 211-217 AB - Respiratory symptoms, spirometry, forced expiratory flows, and the nitrogen closing volume test were studied in 119 welders and 90 controls, matched with respect to age, height, and smoking habits. Respiratory symptoms according to a questionnaire were more prevalent in the welders. No short-term changes of the measured variables during the day or week attributable to welding were found in twenty-one nonsmoking welders. Compared to the controls, closing volume and closing capacity (i. e., closing volume + residual volume) were significantly higher, and total lung capacity and the amplitude of the cardiogenic oscillations in the nitrogen curve were significantly lower in the welders who were nonsmokers or exsmokers, whereas there were no differences among smokers. These findings in welders may be attributable to deposition of welding fume particles in peripheral small airways or alveoli. AU - Oxhoj H AU - Bake B AU - Wedel H AU - Wilhemsen L LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 63 IP - DP - 1979 Jan 01 TI - Nonspecific bronchial reactivity in occupation asthma PG - 28-34 AU - Lam S AU - Wong R AU - ChanYeung M LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 119 IP - DP - 1979 Jan 01 TI - The search for expiratory obstruction in meat wrappers studied on the job PG - 611-618 AU - Krumpe PE AU - Finley TN AU - Martinez N LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 34 IP - DP - 1979 Jan 01 TI - Occupational allergy in nurses to a bulk laxative PG - 51-55 AU - Machado L AU - Zetterstrom O AU - Fagerberg E LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 36 IP - DP - 1979 Jan 01 TI - Pulmonary function in firefighters: acute changes in ventilatory capacity and their correlates PG - 29-34 AU - Musk AW AU - Smith TJ AU - Peters JM AU - McLaughlin E LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 63 IP - DP - 1979 Jan 01 TI - Papain-induced asthma- physiological and immunological features PG - 98-103 AU - Movey HS AU - Marchioli LE AU - Sokol WN AU - Wells ID LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 9 IP - DP - 1979 Jan 01 TI - Recurrent nocturnal asthmatic reactions to bronchial provocation tests PG - 213-219 AU - Newman Taylor AJ AU - Davies RJ AU - Hendrick DJ AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 70 IP - DP - 1979 Jan 01 TI - Toluene diisocyanate induced asthma: specific and non specific bronchial challenge tests PG - 203-214 AU - Mapp C AU - Moro G AU - Fabbri LM AU - Crepet M LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 9 IP - DP - 1979 Jan 01 TI - Specific IgE antibody to platinum salts in sensitised workers PG - 109-117 AU - Cromwell O AU - Pepys J AU - Parish WE AU - Hughes EG LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 9 IP - DP - 1979 Jan 01 TI - Barn allergy, asthma and rhinitis due to storage mites PG - 229-236 AU - Cuthbert OD AU - Brostoff J AU - Wraith DG AU - Brighton WD LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 75 IP - DP - 1979 Jan 01 TI - Respiratory abnormalities among grain elevator workers PG - 461-467 AU - ChanYeung M AU - Wong R AU - MacLean L LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 30 IP - DP - 1979 Jan 01 TI - Aspects of occupational hygiene and epidemiology in a pharmaceutical company manufacturing amoxacillin PG - 185-196 AU - Carlesi G AU - Ferrea E AU - Melino C AU - Messineo A AU - Pacelli E LA - PT - DEP - TA - Nuovi Ann Ig Microbiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 120 IP - DP - 1979 Jan 01 TI - Determinants of allergen induced asthma: dose of allergen, circulating IgE antibody concentration, and bronchial responsiveness to inhaled histamine PG - 1053-1058 AU - Cockcroft DW AU - Ruffin RE AU - Frith PA AU - Cartier A AU - Juniper EF AU - Dolovich J AU - Hargreave FE LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 75 suppl 2 IP - DP - 1979 Jan 01 TI - Patterns of airway reactivity to asthma produced by exposure to toluene diisocyanate PG - 229-231 AU - Chester EH AU - MartinezCatinchi FL AU - Schwartz HJ AU - Fleming GM AU - McDonald EW LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - ii IP - DP - 1979 Jan 01 TI - Asthma due to industrial use of chloramine PG - 334-334 AU - Charles TJ LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - IP - DP - 1979 Jan 01 TI - Evidence for specific hypersensitivity in occupational asthma due to small molecular weight chemicals and organic (locust) allergen PG - 301-308 AU - Burge PS AU - Harries MG AU - O'Brien MG AU - Pepys J LA - PT - DEP - TA - Pub Pitman JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 9 IP - DP - 1979 Jan 01 TI - Occupational asthma due to inhaled carmine PG - 185-189 AB - Two patients are described with occupational asthma due to carmine, a natural dye extracted from the insect Coccus cactus. Both had dual asthmatic reactons after carmine inhalation. Oral challenge provoked gastrointestinal symptoms in one patient, and asthma in them both, perhaps accounting for their continuing symptoms. One patient worked extracting carmine from the insects and the other used carmine as a cosmetic colouring agent. AU - Burge PS AU - O'Brien IM AU - Harries MG AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 2 IP - DP - 1979 Jan 01 TI - Occupational type bronchial provocation testing PG - 7-12 AU - Burge PS AU - Pepys J LA - PT - DEP - TA - Allergologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 21 IP - DP - 1979 Jan 01 TI - Evaluation and control of a respiratory exposure to 3-(dimethylamino)propylamine PG - 688-690 AU - Brubaker RE AU - Muranko HJ AU - Smith DB AU - Beck GJ LA - PT - DEP - TA - JOM JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 64 IP - DP - 1979 Jan 01 TI - Inhalation challenge testing with toluene diisocyanate PG - 655-657 AU - Butcher BT LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - ii IP - DP - 1979 Jan 01 TI - Bronchial provocation studies in farmers allergic to storage mites PG - 1330-1332 AU - Ingram CG AU - Jeffrey IG AU - Symington IS AU - Cuthbert OD LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 33 IP - DP - 1979 Jan 01 TI - A consideration of risk factors and development of chronic bronchitis in a five year follow up study of an industrial population PG - 210-214 AU - Jedrychowski W LA - PT - DEP - TA - J Epedemiol Pub Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 36 IP - DP - 1979 Jan 01 TI - Mill effect and dose-response relationships in byssinosis PG - 305-313 AU - Jones RN AU - Diem JE AU - Glindmeyer H AU - Dharmarajan V AU - Hammad YY AU - Carr J AU - Weill H LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 21 IP - DP - 1979 Jan 01 TI - Longitudinal study of tolyl-reactive IgE antibodies in workers hypersensitive to TDI PG - 354-358 AU - Karol MH AU - Sandberg T AU - Riley EJ AU - Alarie Y LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 13 IP - DP - 1979 Jan 01 TI - Presence of tolyl-specific IgE and absence of IgG antibodies in workers exposed to toluene diisocyanate PG - 221-232 AU - Karol MH AU - Riley J AU - Alarie Y LA - PT - DEP - TA - J Environ Sci Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 63 IP - DP - 1979 Jan 01 TI - Occupational asthma to clam's liver extract PG - 197-19* AU - Karlin JM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 64 IP - DP - 1979 Jan 01 TI - Bronchoprovocation studies in coffee workers asthma PG - 650-654 AU - Karr RM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 64 IP - DP - 1979 Jan 01 TI - A proposed standardised method for bronchoprovocation tests in toluene diisocyanate induced asthma PG - 658-661 AU - Gerblich AA AU - Horowitz J AU - Chester EH AU - Schwartz HJ AU - Fleming GM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 21 IP - DP - 1979 Jan 01 TI - Non-smoking grain handlers in Saskatchewan: airways reactivity and allergic status PG - 352-346* AU - Gerrard JW AU - Mink J AU - Cheung SS AU - Tan LKT AU - Dosman JA LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 120 IP - DP - 1979 Jan 01 TI - Comparison of three standardised questionnaires on respiratory symptoms PG - 1221-1231 AU - Helsing KJ AU - Comstock GW AU - Speizer FE AU - Ferris BG AU - Lebowitz MD AU - Tockman MS AU - Burrows B LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 37 IP - DP - 1979 Jan 01 TI - Farmers lung disease in Vermont PG - 52-60 AU - Gump DW AU - Babbott FL AU - Holly C AU - Sylwester DL LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - i IP - DP - 1979 Jan 01 TI - Bronchial asthma due to alpha methyl dopa PG - 1461-1461 AU - Harries MG AU - Newman Taylor AJ AU - Wooden J AU - Mac Auslan A LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 42 IP - DP - 1979 Jan 01 TI - Unsuitability of bakery work for a person with atopy: a study of 234 bakery workers PG - 192-195 AU - Jarvinen K AU - Pirila V AU - Bjorksten F LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 9 IP - DP - 1979 Jan 01 TI - Toluene di-isocyanate-induced asthma. II. Inhalation challenge tests and bronchial reactivity studies PG - 7-15 AB - In sixty-three workers exposed to toluene di-isocyanate (TDI), no overall differences in bronchial reactivity to histamine inhalation and to exercise testing were found between the total groups of positive and negative TDI reactors to provocation tests. A subgroup of TDI highly sensitive subjects reacting to very low concentrations (less than or equal to 0.001 p.p.m.) were more sensitive to both histamine and exercise than the group who were less sensitive to TDI, and who reacted to higher concentrations (0.002--0.02 p.p.m.) than the group of non-reactors. There were, however, in the last group a number of subjects with high degrees of histamine reactivity who did not react to the TDI. These findings suggest that, on the one hand, the asthmatic reactions to TDI cannot be attributed solely to non-specific mechanisms and, on the other, that in subjects with high degrees of specific sensitivity non-specific mechanisms may also be playing a part AU - O'Brien IM AU - NewmanTaylor AJ AU - Burge PS AU - Harries MG AU - Fawcett IW AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 34 IP - DP - 1979 Jan 01 TI - Peak Flow Rate Records In The Diagnosis Of Occupational Asthma Due To Colophony PG - 308-316 AB - Peak expiratory flow (PEF) has been measured hourly from waking to sleeping in 29 workers with respiratory symptoms exposed to the fumes of soft soldering fluxes containing colophony (pine resin). Thirty-nine records of mean length 33 days have been analysed, and the results compared with the occupational history and bronchial provocation testing in the same workers. From plots of daily mean, maximum and minimum PEF, recurring physiological patterns of asthma emerge. The most common pattern is for asthma to increase with each successive working day. Some workers had equivalent deterioration each working day. Regular recovery patterns taking one, two and three days are described. The combination of a three day recovery pattern and a late asthmatic reaction on Monday results in Monday being the best day each week. Assessment of these records has shown them to be specific and sensitive, provided that the worker was not taking corticosteroids or cromoglycate during the period of the record and that bronchodilator usage was kept constant on days at home and at work. The results of the PEF records correlate well with bronchial provocation testing, and provide a suitable alternative to this for the diagnosis of mild to moderate occupational asthma. The records are of particular use for screening symptomatic workers whose symptoms appear unlikely to be related to work. AU - Burge PS AU - O'Brien IM AU - Harries MG LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 34 IP - DP - 1979 Jan 01 TI - Peak flow rate records in the diagnosis of occupational asthma due to isocyanates PG - 317-323 AB - Peak expiratory flow rate (PEFR) has been recorded hourly or two-hourly from waking to sleeping in workers with respiratory symptoms who were exposed to isocyanate fumes at work. Twenty-three recordings averaging 33 days duration were recorded in 20 workers. Each worker was also admitted for bronchial provocation testing to toluene di-isocyanate (TDI) or diphenylmethane di-isocyanate (MDI) fumes or both. A final assessment of work-related asthma made from subsequent work exposure was compared with the results of bronchial provocation testing and a subjective assessment of the peak flow records. Both techniques were specific and sensitive. Physiological patterns of occupational asthma were defined from the records of PEFR. The most striking finding was the slow recovery from work-induced asthma. This commonly took several days to start and in one worker took 70 days to complete after leaving work. Several workers developed a pattern resembling fixed airways obstruction after repeated exposure at work. The consequences of these findings for the recording of symptoms of occupational asthma are discussed and recommendations are made for the recording of PEFR in workers in general. AU - Burge PS AU - O'Brien IM AU - Harries MG LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - ii IP - DP - 1979 Jan 01 TI - Pulmonary haemorrhage and haemolytic anaemia due to trimellitic anhydride PG - 328-330 AU - Ahmad D AU - Morgan WKC AU - Patterson R AU - Williams T AU - Zeiss CR LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 21 IP - DP - 1979 Jan 01 TI - Prevalence of respiratory disease in a cotton compress and warehouse PG - 273-275 AU - Barman ML LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 9 IP - DP - 1979 Jan 01 TI - Allergic reactions, including asthma, to the pineapple protease bromelain following occupational exposure PG - 443-450 AU - Baur X AU - Fruhmann G LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 38 IP - DP - 1979 Jan 01 TI - Occupational asthma and dermatitis after exposure to dusts of persulphate salts in two industrial workers PG - 144-150 AU - Baur X AU - Fruhmann G AU - Lieber V LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 9 IP - DP - 1979 Jan 01 TI - Studies on the specificity of human IgE antibodies to the plant proteases papain and bromelain PG - 451-457 AU - Baur X LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 9 IP - DP - 1979 Jan 01 TI - Papain-induced asthma: diagnosis by skin test, RAST and bronchial provocation test PG - 75-81 AU - Baur X AU - Fruhmann G LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 121 IP - DP - 1979 Jan 01 TI - Isocyanate-induced asthma in an automobile spray painter PG - 602-604 AU - Cockcroft DW AU - Mink JT LA - PT - DEP - TA - Can Med Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - 21 IP - DP - 1979 Jan 01 TI - Pulmonary abnormalities in art glassblowers PG - 487-489 AU - Braun SR AU - Tsiatis A LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19790101 IS - IS - VI - ii IP - DP - 1979 Jan 01 TI - Asthma due to industrial use of chloramine PG - 10-12 AU - Bourne MS AU - Flindt MLH AU - Walker JM LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 23 IP - DP - 1978 Jan 01 TI - Clinical and immunological studies in pulmonary extrinsic allergic alveolitis PG - 267-276 AU - Boyd G LA - PT - DEP - TA - Scot Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 5 IP - DP - 1978 Jan 01 TI - A respiratory survey of cedar mill workers PG - 328-332 AU - Ashley MJ AU - Corey P AU - ChanYeung M AU - MacLean L AU - Maledy H AU - Grzybowski S LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 8 IP - DP - 1978 Jan 01 TI - Immediate-type hypersensitivity to reactive dyes PG - 25-31 AU - Alanko et al LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 7 IP - DP - 1978 Jan 01 TI - Asthme des coiffeurs: danger des decolorants capillaires des persulfates alcalins PG - 4151-4151 AU - Hardel PJ AU - ReybetDegat O AU - Jeannin L AU - Paqueron MJ LA - PT - DEP - TA - Nouv Presse Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 7 IP - DP - 1978 Jan 01 TI - Hairdressers asthma: dangers from bleaches containing alkaline persulphates PG - 4151-4151 AU - Hardel PJ AU - ReybetDegat O AU - Jeannin L AU - Paqueron MJ LA - PT - DEP - TA - Nouv Presse Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 8 IP - DP - 1978 Jan 01 TI - Asthma caused by bromelin inhalation PG - 21-24 AU - Galleguillos F AU - Rodriguez JC LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - ii IP - DP - 1978 Jan 01 TI - Respiratory hazards from proteolytic enzymes PG - 524-525 AU - Forsbeck M AU - Ekenvall L LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 74 IP - DP - 1978 Jan 01 TI - Hypersensitivity pneumonitis and extrinsic asthma PG - 98-101 AU - Karr RM AU - Konler PF AU - Salvaggio JE LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 62 IP - DP - 1978 Jan 01 TI - Coffee worker's asthma: a clinical appraisal using the radioallergosorbent test PG - 143-148 AU - Karr RM AU - Lehrer SB AU - Butcher BT AU - Salvaggio JE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 8 IP - DP - 1978 Jan 01 TI - Occupational asthma in Finland PG - 569-579 AU - Keskinen H AU - Alanko K AU - Saarinen L LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 61 IP - DP - 1978 Jan 01 TI - Allergy to insects in Japan PG - 10-16 AU - Kino T AU - Oshima S LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 150 IP - DP - 1978 Jan 01 TI - Clinical and cytological examinations on industrial workers exposed to mineral-oil aerosols PG - 171-176 AU - Kandt D AU - Eckert H LA - PT - DEP - TA - Z Erkrank Atm Org JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 39 IP - DP - 1978 Jan 01 TI - Tolyl specific IgE antibodies in workers with hypersensitivity to toluene diisocyanate PG - 454-458 AU - Karol MH AU - Ioset HH AU - Alarie YC LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 33 IP - DP - 1978 Jan 01 TI - Reproducibility and comparison of responses to inhaled histamine and methacholine PG - 705-710 AU - Juniper EF AU - Frith PA AU - Dunnett C AU - Cockcroft DW AU - Hargreave FE LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 29 IP - DP - 1978 Jan 01 TI - The influence of work environment on the occurrence of chronic non-specific respiratory tract disease among workers producing superphosphate PG - 521-526 AU - Jedrychowski W AU - Chlopek H LA - PT - DEP - TA - Med Pracy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 69 IP - DP - 1978 Jan 01 TI - Occupational asthma due to benzalkonium chloride PG - 713-715 AU - Innocenti A LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 69 IP - DP - 1978 Jan 01 TI - Occupational allergic asthma due to colophony PG - 720-722 AU - Innocenti A AU - Loi F LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 20 IP - DP - 1978 Jan 01 TI - A case study of bronchial asthma due to phthalic anhydride PG - 228-229 AU - Igaku S LA - PT - DEP - TA - Jap J Industr Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 8 IP - DP - 1978 Jan 01 TI - Comparitive serological and clinical findings in subjects exposed to environmental allergens PG - 347-360 AU - How MJ AU - Goodwin BFJ AU - Juniper CP AU - Kinshott AK LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 117 IP - DP - 1978 Jan 01 TI - Asthma due to African Zebrawood (Microberlinia) dust PG - 601-603 AU - Bush RK AU - Yunginger JW AU - Reed CE LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - i IP - DP - 1978 Jan 01 TI - Seasonal asthma in an angler PG - 668-668 AU - Buisseret P LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 8 IP - DP - 1978 Jan 01 TI - Respiratory disease in workers exposed to solder flux fumes containing colophony (pine resin) PG - 1-14 AB - Twenty-one patients are described who developed asthma, or evidence of a peripheral airways reaction, while working in the electronics industry and exposed to solder flux fumes containing colophony (pine resin). This selected group contained five patients with pre-existing asthma. Fourteen patients had never smoked. Prick-testing with common environmental antigens gave one or more positive reactions in nine patients. The diagnosis was confirmed by occupational-type provocation tests in all workers with colophony-based cored solder, and reproduced by exposure to the fumes of heated colophony alone. Control subjects did not react to the test with colophony. The clinical findings and provocation test reactions have features of a hypersensitivity reaction, although so far specific antibodies have not been found. AU - Burge PS AU - Harries MG AU - O'Brien IM AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 59 IP - DP - 1978 Jan 01 TI - Rape pollen allergy PG - 222-227 AU - Bucur I AU - Arner B LA - PT - DEP - TA - Scand J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 7 IP - DP - 1978 Jan 01 TI - Meat wrappers asthma; positive diagnosis and professional study PG - 203-205 AU - Pauli G AU - Bessot JC AU - Lenz D AU - Kopferschmitt C AU - Roegel E LA - PT - DEP - TA - Rev Fr Mal Resp JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - IP - DP - 1978 Jan 01 TI - Agriculture, Acarina and allergy PG - - AU - Cuthbert OD LA - PT - DEP - TA - Proc third Charles Blackley Symposium JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 118 IP - DP - 1978 Jan 01 TI - Bathtub refinishers lung: an unusual response to toluene diisocyanate PG - 955-959 AU - Fink JN AU - Schlueter DP LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 33 IP - DP - 1978 Jan 01 TI - Epidemiology of chronic bronchitis PG - 5-42 AU - Minette A LA - PT - DEP - TA - Rev Inst Hyg MInes JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 24 IP - DP - 1978 Jan 01 TI - Occupational asthma due to Daphnia allergy PG - 191-193 AU - Meister W LA - PT - DEP - TA - Allergie Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - ii IP - DP - 1978 Jan 01 TI - Respiratory allergy to a factory humidifier contaminant presenting as pyrexia of undetermined origin PG - 94-95 AB - We report a patient who had attacks of fever which were particularly acute upon return to work after a weekend or other absence, but which improved during the working week. They were probably attributable to a reaction to contaminants growing in the factory humidifier system. (The challenge was to freeze dried humidifier sludge at 10mg/ml) AU - Newman Taylor AJ AU - Pickering CAC AU - TurnerWarwick M AU - Pepys J LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 40 IP - DP - 1978 Jan 01 TI - Occupational asthma of bakers PG - 258-261 AU - Napolitano J AU - Weiss NS LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 8 IP - DP - 1978 Jan 01 TI - Asthma and extrinsic allergic alveolitis due to Merulius lacrymans PG - 535-542 AB - A teacher with breathlessness of insidious onset developed acute symptoms on return home following his discharge from hospital. His flat was found to have extensive dry rot (Merulius lacrymans). Precipitins and specific IgE and IgG antibody against M. lacrymans were present and intracutaneous testing gave a typical dual skin reaction. Pulmonary physiology demonstrated airflow obstruction with a low DLCO and KCO, and a chest X-ray showed diffuse micronodular shadowing, maximal in the mid-zones. Inhalation challenge testing provoked a combined asthmatic reaction without a change in DLCO. Rapid clinical recovery and more gradual radiographic and physiological improvement followed cessation of exposure to the antigen. AU - O'Brien IM AU - Bull J AU - Creamer B AU - Sepulveda R AU - Harries MG AU - Burge PS AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 41 IP - DP - 1978 Jan 01 TI - Natural and synthetic fibres as a cause of asthma and rhinitis PG - 48-50 AB - One hundred and thirty-six textile workers were tested with natural fibers; 97 were tested with synthetic fibers. By inhalation testing 20% were positive to both types of fibers; by nasal provocative testing 30% were positive. There was a close correlation between the size of the wheals in the prick tests and the percentage of fiber challenge tests. Fiber provocation tests and metacholine tests did not display any conformity with each other. The authors feel that synthetic fibers may act as haptens and cause Type I or IgE-mediated allergy and both natural and synthetic fibers should be considered important causes of occupational asthma among textile workers. AU - Muittari A AU - Veneskoski T LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 24 IP - DP - 1978 Jan 01 TI - Professional allergic disease in CSSR PG - 163-166 AU - Makesova D AU - Zavazac V AU - Sach J AU - Huzl F AU - Vryskock J LA - PT - DEP - TA - Allergie Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 69 IP - DP - 1978 Jan 01 TI - Lung changes among vinyl chloride and PVC workers PG - 151-162 AU - Mapp C AU - Fabbri LM AU - Rossi O AU - Moro G AU - Giovani C LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 28 IP - DP - 1978 Jan 01 TI - A review of allergic respiratory disease in labatory animal workers PG - 751-756 AU - Lutsky I AU - Toshner D LA - PT - DEP - TA - Lab Animal Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 8 IP - DP - 1978 Jan 01 TI - Extraction and analysis of coffee bean allergens PG - 217-226 AU - Lehrer SB AU - Karr RM AU - Salvaggio JE LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 20 IP - DP - 1978 Jan 01 TI - Meat wrappers asthma PG - 116-117 AU - Levy SA AU - Syorey J AU - Phashko BE LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 33 IP - DP - 1978 Jan 01 TI - Allergy to coffee bean dust PG - 350-350 AU - Osterman K AU - Johansson SGO AU - Zetterstrom O LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 24 IP - DP - 1978 Jan 01 TI - Silk asthma PG - 31-37 AU - Okumura E AU - Miyosh H AU - Hirota T AU - Kakimoto S LA - PT - DEP - TA - Bull Osaka Med Sch JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 62 IP - DP - 1978 Jan 01 TI - Human antihapten antibodies in trimellitic anhydride inhalation reactions PG - 971-978 AU - Patterson R AU - Zeiss CR AU - Roberts M AU - Pruzansky JJ AU - Wolkonsky P AU - Chacon R LA - PT - DEP - TA - J Clin Invest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 21 IP - DP - 1978 Jan 01 TI - Isocyanates at levels higher than MAC and their effect on respiratory function PG - 271-275 AU - Pham QT AU - Cavelier C AU - Mur JM AU - Mereau P LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 21 IP - DP - 1978 Jan 01 TI - Isocyanates and respiratory function: a study of workers producing polyurethane foam moulding PG - 121-129 AU - Pham QT AU - Cavelier C AU - Mereau P AU - Mur JM AU - Cicolella A LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - * IP - DP - 1978 Jan 01 TI - Toluene diisocyanate PG - 472-47* AU - Peters JM AU - Wegman DH LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - i IP - DP - 1978 Jan 01 TI - Respiratory hazards from proteolytic enzymes PG - 669-669 AU - Pauwels R AU - Devos M AU - Callens L AU - van der Straeten M LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 20 IP - DP - 1978 Jan 01 TI - Occupational asthma due to tetrachlorphthalic anhydride PG - 183-188 AU - Schleuter DP AU - Banaszak EF AU - Fink JN AU - Barboriak J LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 67 IP - DP - 1978 Jan 01 TI - Humidifier fever in a group of foundry workers PG - 1855-1861 AU - Scherrer M AU - Imhof K AU - Weickhardt U AU - Lebek G LA - PT - DEP - TA - Schweiz Rundschau Med (Praxis) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 8 IP - DP - 1978 Jan 01 TI - Recurrent nocturnal asthma due to toluene diisocyanate: a case report PG - 195-201 AU - Siracusa A AU - Curradi F AU - Abbritti G LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - ed Middlet IP - DP - 1978 Jan 01 TI - Aerobiology and inhalent allergens PG - 899-945 AU - Solomon WR AU - Mathews KP LA - PT - DEP - TA - Allergy Principles and Practice JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 8 IP - DP - 1978 Jan 01 TI - Papain induced allergic reactions PG - 207-215 AU - Tarlo SM AU - Shaikh W AU - Bell B AU - Cuff M AU - Davies GM AU - Dolovich J AU - Hargreave FE LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 8 IP - DP - 1978 Jan 01 TI - Dual skin test reactions and serum antibodies to subtilisin and Aspergillus fumigatus extracts PG - 77-91 AU - Zetterstrom O LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 108 IP - DP - 1978 Jan 01 TI - L'humidification de l'air des locaux previent-elle les maladies respiratoires pendant l'hiver PG - 827-831 AU - Guberan E AU - Dang VB AU - Sweetman PM LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 107 IP - DP - 1978 Jan 01 TI - Pontiac fever PG - 149-160 AU - Glick TH AU - Gregg MB AU - Berman B AU - Mallison G AU - Rhodes WW AU - Kassanoff IRA LA - PT - DEP - TA - Am J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - ii IP - DP - 1978 Jan 01 TI - 1974 outbreak of legionnaires' disease diagnosed in 1977 PG - 122-124 AU - Terranova W AU - Cohen ML AU - Fraser DW LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - - IP - DP - 1978 Jan 01 TI - Prolonged and frequent recordings of peak expiratory flow rate in workers with suspected occupational asthma due to colophony and isocyanate fumes. A study to define the physiological patterns of occupational asthma and to assess the use of these records for diagnosis. PG - - AU - Burge PS LA - PT - DEP - TA - MSc Thesis, University of London JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 9 IP - DP - 1978 Jan 01 TI - Aluminium induced pulmonary granulomatosis PG - 705-711 AB - Case report of 31 year old smoking welder of metals who worked in aircraft industry. No data on his exposure is given, but large amounts of aluminium found in the granulomas in a surgical lung biopsy. The disease appears to have come on after he left the welding job when he was working with fibreglass resins AU - Chen W-J AU - Monnat RJ AU - Chen M AU - Mottet NK LA - PT - DEP - TA - Human Pathology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 39 IP - DP - 1978 Jan 01 TI - Physical state of airborne p, p'-diphenylmethane diisocyanate (MDI) and its measurement PG - 737-744 AB - The current exposure standard of 0.02 ppm ceiling for MDI by definition refers to a gaseous species. The standard method, recommended by NIOSH, for measuring MDI in air, is also based on the the assumption that MDI is in the gas phase. Investigations in our Unit indicate that a major portion of airborne MDI, in working environments during spraying operations, is present as an aerosol. In view of this finding, the standard method would underestimate the MDI concentration and describing the airborne MDI concentration in "ppm" or "volume/volume unit" in invalid. A new method for calibration of the continuous reading monitors to measure airborne MDI concentration in mg/m3 unit is described AU - Dharmarajan V AU - Weill H LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - IP - DP - 1978 Jan 01 TI - Control of tuberculosis in NHS employees, limitation of X-ray examinations PG - - AU - Department of Health and Social Security LA - PT - DEP - TA - Health Circular HC(78)3 JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 23 IP - DP - 1978 Jan 01 TI - Death resulting from lacrimatory agents PG - 527-530 AU - Chapman AJ AU - White C LA - PT - DEP - TA - Journal of Forensic Sciences JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 2 IP - DP - 1978 Jan 01 TI - Toluene diisocyanate [letter] PG - 96-97 AU - Burge PS AU - Taylor AJ AU - Harries MG AU - O'Brien I LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 8 IP - DP - 1978 Jan 01 TI - Effects of orally administered sodium cromoglycate in asthma and urticaria due to foods PG - 423-427 AB - Out of twenty patients with a history of asthma or urticaria attributed to food substances, ten reacted on oral challenge: seven with asthma, one with asthma and urticaria and two with urticaria alone. In five of the eight asthmatic reactors, the symptoms developed within a few sec and there was no associated rise in free venous plasma histamine. In those remaining, two with asthma, two with urticaria and one with both, the symptoms developed only after 20-30 min. A rise in free plasma histamine occurred only in the two subjects with urticaria alone. The third with urticaria and asthma did not have blood estimations performed. Sodium cromoglycate in a dosage of 800 mg a day for 1 week, or a single dose of 1.0 g by mouth, did not block any of the reactions. By inhalation it blocked the asthmatic reactions which developed within a few sec of challenge AU - Harries MG AU - O'Brien IM AU - Burge PS AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 30 IP - DP - 1978 Jan 01 TI - Occupational asthma in the electronics industry PG - 411-417 AU - Burge PS LA - PT - DEP - TA - Occup Health (Lond) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 62 IP - DP - 1978 Jan 01 TI - Response to corticosterids in chronic bronchitis PG - 363-367 AU - Shim C AU - Stover DE AU - Williams MH LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 33 IP - DP - 1978 Jan 01 TI - Polyvinyl chloride pneumoconiosis PG - 19-25 AB - A 53-year-old man, who had been exposed for 23 years to polyvinyl chloride (PVC) in the bagging area of a vinyl chloride polymerisation plant, presented with a diffuse micronodular infiltrate on his chest radiograph. Light microscopy of lung obtained by drill biopsy showed a diffuse infiltration with histiocytes and multinucleated giant cells, with some collagen formation. Ultrastructural studies showed foreign particles in the macrophages, which were identical with PVC powder viewed under the electron microscope. Incubation of PVC powder with human lung macrophages in vitro showed that the macrophages englufed the powder to give a similar ultrastructural appearance AU - Arnaud A AU - Pommier de Santi PP AU - Garbe L AU - Payan H AU - Charpin J LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 117 IP - DP - 1978 Jan 01 TI - Lung function and respiratory symptoms in silicotic and nonsilicotic gold miners PG - 429-435 AB - In a cross-sectional sample of 1,973 white gold miners 45 to 54 years of age, symptoms of chronic bronchitis were equally common in men with radiologically diagnosed silicosis and those without silicosis; however, more silicotic miners complained of missing work during the previous 3 years because of chest illness. Whereas mean forced vital capacity did not differ between the 2 groups, both the 1-sec forced expiratory volume and the mean forced expiratory flow during the middle half of the forced vital capacity were significantly lower in those with silicosis. This difference was almost entirely accounted for by their higher exposure to dust in the mines. Men with silicosis, therefore, have the same or only slightly more airway obstruction than men without silicosis who have had similar total exposure to dust AU - Irwig LM AU - Rocks P LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 92 IP - DP - 1978 Jan 01 TI - The response to exercise in normal and asthmatic children PG - 718-721 AB - Twenty-five normal and 105 asthmatic children were exercised on a treadmill. Pulmonary function was assessed before and after exercise. The maximum fall from the resting value in normal subjects depended on the test used: PEFR 12.5%; FEV, 10%; MMEF 26%; V50 30%; V25 33%. Using these criteria, PEFR and FEV, detected 99% of those asthmatic children who had a positive exercise response. The largest fall from the resting value was seen with the MMEF, but this test detected only 70% of the positive responders. The pre-exercise function did not affect the severity of the response but did have an effect on the incidence of exercise-induced bronchospasm. AU - Kattan M AU - Keens TG AU - Mellis CM AU - Levison H. LA - PT - DEP - TA - J Paediatr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19780101 IS - IS - VI - 33 IP - DP - 1978 Jan 01 TI - Lung injury following a 50-metre fall into water PG - 175-180 AB - The pulmonary complications of a 50-metre fall to the water (a form of suicide attempt producing 87% mortality) were studied in 15 survivors. Presenting findings included crackles, haemoptysis, and hypotension. The alveolar-arterial oxygen difference was greater than 150 mmHg (20 kPa) in nine subjects on admission. Ventilatory failure developed in 10 of the patients, including all of those with massive haemoptysis. Radiographic findings included pneumothorax and diffuse pulmonary opacities adjacent to the area of impact. Pneumothorax developed within 12 hours of admission in 10 of 15 subjects but was associated with rib fractures in only four subjects. The clinical course of the condition is consistent with the hypothesis that the traumatic pulmonary tears produced interstitial emphysema, with subsequent development of pneumomediastinum, subcutaneous emphysema, and pneumothorax. Pneumothorax is a common complication of severe lung contusion even in the absence of penetrating pleural injury. AU - Robertson HT AU - Lakshminarayan S AU - Hudson LD LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 71 IP - DP - 1977 Jan 01 TI - Diurnal variation of asthma PG - 87-92 AB - We have studied possible aetiological factors in the large diurnal variation in peak expiratory flow rate seen in some asthmatics. This phenomenon occurred in both atopic and non-atopic patients. It could not be attributed to recumbency in bed at night or to allergy to the house dust mite in bedding. Circadian variation in asthmatic shift workers was intimately related to sleep and virtually independent of solar time. Treatment tends to lose its effect as it is discontinued during sleep and this increases the apparent diurnal variation in many patients. Excessive circadian variation may be an important factor in sudden asthma deaths. The importance of effective nocturnal medication is stressed AU - Clark TJH AU - Hetzel MR LA - PT - DEP - TA - Br J Dis Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 116 IP - DP - 1977 Jan 01 TI - Maximal expiratory flows in coal miners PG - 175-180 AU - Hankinson JL AU - Reger RB AU - Morgan WK LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 32 IP - DP - 1977 Jan 01 TI - Collagen breakdown and nitrogen dioxide inhalation PG - 33-36 AU - Hatton DV AU - Leach CS AU - Nicogossian AE LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 58 IP - DP - 1977 Jan 01 TI - Carcinogenicity of fibrous glass: pleural response in the rat in relation to fibre dimensions PG - 587-603 AU - Stanton MF AU - Layard M AU - Tegeris A AU - Miller E AU - May M AU - Kent E LA - PT - DEP - TA - J Natl Cancer Inst JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 62 IP - DP - 1977 Jan 01 TI - Ventilation, cardiac frequency and pattern of breathing during exercise in men exposed to O-chlorobenzylidene malononitrile (CS) and ammonia gas in low concentrations PG - 341-351 AB - Ventilation minute volume, tidal volume and cardiac frequency during submaximal exercise have been measured in healthy young soldier volunteers exposed to O-chlorobenzylidene malononitrile (CS) and ammonia gas in concentrations respectively of 0.16 to 4.4 mg.m(-3) and 50 to 344 mg.m(-3). The response of ventilation minute volume to the two gases is apparently similar; both gases cause a reduction of, on average 6%. With low doses this reflects a diminution in respiratory frequency whereas with higher doses it is due to a reduction in tidal volume which is accompanied by tachypnoea. The findings may result from stimulation successively of receptors in the larynx and of irritant receptors in the large airways of the lung. The pain which is a feature of exposure to CS but not to ammonia is due to stimulation of other so far unidentified receptors. Neither gas has a direct effect upon the exercise cardiac frequency AU - Cole TJ AU - Cotes JE AU - Johnson GR AU - Martin HD AU - Reed JW AU - Saunders JE LA - PT - DEP - TA - Q J Exp Physiol Cogn Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 7 IP - DP - 1977 Jan 01 TI - Fungal antigens as a source of sensitization and respiratory disease in Scottish maltworkers PG - 549-562 AB - Mycological and serological studies were carried out as part of a survey of respiratory disease in Scottish maltworkers. 70% of stained sputum smears from 574 workers showed the presence of higher plant cells and/or myclelia, and the spores of common environmental fungi. Penicillium spp. (90%), Rhizopus stolonifer (48%) and yeasts (53%) were the dominant fungi in 699 sputum cultures, and showed a similar proportional distribution in 327 samples of grain, malt, culms and dusts from fifty-six maltings. 57% of 711 men were serologically positive for fungi, 22% for Aspergillus fumigatus, 20% for A. clavatus, 10% for A. niger, 16% for Cladosporium herbarum and over 3% for Rhizopus stolonifer, 6% of 132 men were positive for Penicillium cyclopium. No precipitating antibodies to antigens from Alternaria tenuis, Aureobasidium pullulans, Candida albicans, Geotrichum candidum, Rhodotorula glutinis or Trichoderma viride were detected in tests of forty sera. Sera from the 5.2% of men with symptoms of extrinsic allergic alveolitis showed increased reactivity to mycelial antigens from Aspergillus clavatus. The fungus was cultured from 21% of maltings, 7% of all environmental samples and from the sputa of 8% of maltworkers AU - Blyth W AU - Grant IW AU - Blackadder ES AU - Greenberg M LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 34 IP - DP - 1977 Jan 01 TI - Farmer's lung in a group of Scottish dairy farms PG - 186-195 AU - Wardrop VE AU - Blyth W AU - Grant IW LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 2 IP - DP - 1977 Jan 01 TI - BCG and vole bacillus vaccines in the prevention of tuberculosis in adolescence and early adult life PG - 293-295 AU - Hart PD AU - Sutherland I LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 59 IP - DP - 1977 Jan 01 TI - Toluene diisocyanate pulmonary disease: immunopharmacologic and mecholyl challenge studies PG - 223-227 AB - Selected workers exhibiting clinical "sensitivity" to toluene diiosocyanate (TDI) (wheezing, cough, and dyspnea upon entering a TDI-containing area) were studied for : (1) in vitro TDI-induced leukocyte histamine release; (2) determination of cyclic 3',5' adenosine monophosphate (cAMP) levels of lymphocytes exposed to TDI; (3) effect of TDI on the isoproterenol-induced increase of lymphocyte cAMP levels: and (4) acetyl-beta-methylcholine (mecholyl) inhalation challenge. TDI did not induce histamine release from leukocytes of "sensitive" or "nonsensitive" individuals, nor were lymphocyte cAMP levels affected by in vitro TDI exposure, TDI did, however, diminish in vitro stimulation of cAMP by isoproterenol. This effect, seen with cells of "sensitive" and "nonsensitive" individuals, appeared to be dose-dependent; there were no significant differences between the two groups. When challenged with mecholyl, 7 of 10 "sensitive" but only 1 of 10 "nonsensitive" individuals showed a greater than 20% decrease in FEV1. These results suggest that TDI-induced obstructive airways disorders may be associated with altered beta-adrenergic function AU - Butcher BT AU - Salvaggio JE AU - O'Neil CE AU - Weill H AU - Garg O LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 71 IP - DP - 1977 Jan 01 TI - On observing patterns of airflow obstruction in chronic asthma PG - 73-86 AU - TurnerWarwick M LA - PT - DEP - TA - Brit J Dis Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 1 IP - DP - 1977 Jan 01 TI - Worker safety: how to establish site enzyme capability PG - 327-340 AB - A book chapter describing the hygiene and engineering controls in Proctor and Gamble. Descibes rates of sensitisation falling from 40% to 7.2% and disease (asthma and rhinitis) from 15% to nil. In Enzymes in Detergency ed van Ee JH, Misset O and Baas EJ, Marcel Dekker 1977 AU - Peters G AU - Mackenzie DP LA - PT - DEP - TA - Enzymes in Detergency JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 297 IP - DP - 1977 Jan 01 TI - Legionnaires' disease. Isolation of a bacterium and demonstration of its role in other respiratory disease PG - 1197-1197 AU - McDade JE AU - Shepard CC AU - Fraser DW AU - Tsai TF AU - Redus MA AU - Dowdle WR LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 297 IP - DP - 1977 Jan 01 TI - Legionnaires' disease: description of an epidemic of pneumonia PG - 1189-1189 AB - 180 cases, 29 deaths AU - Fraser DW AU - Tsai TR AU - Orenstein W AU - Parkin WE AU - Beecham JH AU - Sharrar RG AU - Harris J AU - Mallison GF AU - Martin SM AU - McDade JE AU - Shepard CC AU - Brachman PS LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 60 IP - DP - 1977 Jan 01 TI - Trimellitic anhydride-induced airway syndromes: clinical and immunologic studies PG - 96-103 AU - Zeiss CR AU - Patterson R AU - Pruzansky JJ AU - Miller MM AU - Rosenberg M AU - Levitz D LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 7 IP - DP - 1977 Jan 01 TI - Challenge and exposure test reactions to enzyme detergents in subjects sensitised to subtilisin PG - 355-363 AU - Zetterstrom O LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 107 IP - DP - 1977 Jan 01 TI - A bronchial allergy to vine pollen and precipitin lung disease PG - 195-197 AU - Zellweger P AU - Favez G LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 2 IP - DP - 1977 Jan 01 TI - Toluene diisocyanate PG - 177-181 AU - Wolf CR AU - Brugsch HG AU - Elkins HB AU - Trenchard HJ AU - Harris WC AU - Jennings GH AU - Gower ND LA - PT - DEP - TA - Clin Otolaryngol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 34 IP - DP - 1977 Jan 01 TI - Chronic pulmonary function loss from exposure to toluene diisocyanate PG - 196-200 AU - Wegman DH AU - Peters JM AU - Pagnotto L AU - Fine LJ LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 115 IP - DP - 1977 Jan 01 TI - Dimethyl ethanolamine induced asthma PG - 867-871 AU - Valleries M AU - Cockcroft DW AU - Taylor DM AU - Dolovich J AU - Hargreave FE LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 99 IP - DP - 1977 Jan 01 TI - Bronchial hyperexcitability in workers exposed to aluminium salts PG - 36-37 AU - Simonsson BG AU - HaegerAronsen B AU - Sjoberg A AU - Eklundh G LA - PT - DEP - TA - Scand J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 40 IP - DP - 1977 Jan 01 TI - Lung function and immunological changes in poultry breeders PG - 131-139 AU - StahuljakBeritic D AU - Dimov D AU - Buthovic L LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 23 IP - DP - 1977 Jan 01 TI - Metal fume fever in ferro-chrome workers PG - 25-28 AU - Stoke J LA - PT - DEP - TA - Central African J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 238 IP - DP - 1977 Jan 01 TI - Hypersensitivity pneumonitis following prolonged inhalation of hair spray PG - 888-889 AU - Stinger GC AU - Hunter SW AU - Bonnabeau RC LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 24 IP - DP - 1977 Jan 01 TI - Observations on a case of rhinitis and asthma due to Marphysa sanguinea PG - 588-58* AU - Rigo M AU - Falagiani P LA - PT - DEP - TA - Folia Allergol Immunol Clin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 32 IP - DP - 1977 Jan 01 TI - Chemical pneumonitis secondary to inhalation of epoxy pipe coating PG - 173-178 AU - Rice DL AU - Jenkins DE AU - Gray JM LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 6 IP - DP - 1977 Jan 01 TI - Occupational bronchial asthma due to the effects of manganese PG - 19-23 AU - Saakadze VP AU - Vasilov BG LA - PT - DEP - TA - Gig Tr Proc Zabol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 39 IP - DP - 1977 Jan 01 TI - A case report of pheasant hypersensitivity: another type of bird fanciers disease PG - 40-42 AU - Peters GA AU - Swedlund HA AU - Atlas E LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 38 IP - DP - 1977 Jan 01 TI - Are embalmers at risk PG - 61-62 AU - Plunkett ER AU - Barbela T LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 4 IP - DP - 1977 Jan 01 TI - Bronchial asthma in radio equiptment assemblers PG - 139-141 AU - Ozhiganova VN AU - Ivanova IS AU - Dueva LA LA - PT - DEP - TA - Sovetskaja Med Moscow JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - ii IP - DP - 1977 Jan 01 TI - Thermophilic actinomycetes in air of cotton mills PG - 45-46 AU - Lockwood MG AU - Attwell RW LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - ii IP - DP - 1977 Jan 01 TI - Respiratory allergy to urine proteins of rats and mice PG - 847-849 AU - Newman Taylor AJ AU - Longbottom JL AU - Pepys J LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 32 IP - DP - 1977 Jan 01 TI - Humidifier fever PG - 653-663 AU - Medical Research Council LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 7 IP - DP - 1977 Jan 01 TI - Tetracycline asthma PG - 285-290 AU - Menon MPS AU - Das AK LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 17 IP - DP - 1977 Jan 01 TI - Allergy to Panonychus ulmi (Koch) PG - 93-97 AU - Michel FB AU - Guin JJ AU - Seignalet C AU - Rambier A AU - Marty JC AU - Caula F AU - Laveil G LA - PT - DEP - TA - Rev Franc Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 119 IP - DP - 1977 Jan 01 TI - Prognosis of occupational bronchial asthma after change of occupation and elimination of antigen PG - 363-366 AU - Meyer WC LA - PT - DEP - TA - Mun Med Wschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 7 IP - DP - 1977 Jan 01 TI - Asthma due to inhaled chemical agents- epoxy resin systems containing phthalic acid anhydride, trimellitic acid anhydride and triethylene tetramine PG - 1-14 AU - Fawcett IW AU - Newman Taylor AJ AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 32 IP - DP - 1977 Jan 01 TI - Humidifier fever. MRC symposium (1977) PG - 653-663 AU - Edwards JH LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 70 IP - DP - 1977 Jan 01 TI - Pulmonary changes among titanium workers PG - 31-32 AU - Daum S AU - Anerson HA AU - Fischbein SA AU - Miller A AU - Selikoff IJ LA - PT - DEP - TA - Proc R Soc Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 19 IP - DP - 1977 Jan 01 TI - Potential health hazard to agricultural workers in swine confinement buildings PG - 383-387 AU - Donham KJ AU - Rubino M AU - Thedell TD AU - Kammermeyer J LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - IP - DP - 1977 Jan 01 TI - List of permitted additives to tobacco products PG - 12001-12003 AU - Department of Health and Social Security LA - PT - DEP - TA - London Gazette JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 60 IP - DP - 1977 Jan 01 TI - In vitro studies on the inhibitory action of toluene diisocyanate on lymphocyte cyclic adenosine monophosphate production by isoproterenol, prostaglandin and histamine PG - 223-229 AU - Davies RJ AU - Butcher BT AU - O'Neil CE AU - Salvaggio JE LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 7 IP - DP - 1977 Jan 01 TI - Phthalic anhydride asthma PG - 15-20 AU - Chester EH AU - Schwartz HJ AU - Payne CB AU - Greenstein S LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 7 IP - DP - 1977 Jan 01 TI - Bronchial reactivity to inhaled histamine: a method and clinical survey PG - 235-243 AU - Cockcroft DW AU - Killian DN AU - Mellon JJA AU - Hargreave FE LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 7 IP - DP - 1977 Jan 01 TI - Allergen-induced increase in non-allergic bronchial reactivity PG - 503-513 AU - Cockcroft DW AU - Ruffin RE AU - Dolovich J AU - Hargreave FE LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 116 IP - DP - 1977 Jan 01 TI - Fate of occupational asthma. A follow-up study of patients with occupational asthma due to Western Red Cesar (Thuja plicata) PG - 1023-1029 AU - ChanYeung M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 7 IP - DP - 1977 Jan 01 TI - Immediate and late onset asthma from occupational exposure to soybean dust PG - 369-373 AU - Bush RK AU - Cohen M LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 237 IP - DP - 1977 Jan 01 TI - Respiratory health and polyvinyl chloride fumes PG - 1826-1826 AU - Jones RN AU - Weill H LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 32 IP - DP - 1977 Jan 01 TI - respiratory health and dust levels in cottonseed mills PG - 281-286 AU - Jones RN AU - Carr J AU - Glindmeyer H AU - Diem J AU - Weill H LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 58 IP - DP - 1977 Jan 01 TI - Allergic bronchopulmonary aspergillosis in a cane sugar mill PG - 129-133 AU - Khan ZU AU - Sandhu RS AU - Randhawa HS AU - Parkash D LA - PT - DEP - TA - Scand J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 7 IP - DP - 1977 Jan 01 TI - Pulmonary hypersensitivity to Alternaria and Aspergillus in baker's asthma PG - 227-233 AU - Klaustermeyer WB AU - Bardana EJ AU - Hale FC LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 92 IP - DP - 1977 Jan 01 TI - Respiratory symptoms of employees of retail meat departments PG - 545-553 AU - Fleet SM AU - Barancik JI AU - Tuthill TM LA - PT - DEP - TA - Pub Health Reports JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - i IP - DP - 1977 Jan 01 TI - Extrinsic allergic alveolitis and contaminated cooling-water in a factory machine PG - 297-300 AB - Symptoms and signs typical of extrinsic allergic alveolitis occurred in 24 workers in a stationery factory. The illness was caused by inhalation of a water aerosol contaminated by microorganisms, and although no specific organism has been incriminated, affected workers had serum precipitins to the contaminated water, and the illness could be reproduced by inhalation challenge tests. AU - Friend JAR AU - Gaddie J AU - Palmer KNV AU - Pickering CAC AU - Pepys J LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 29 IP - DP - 1977 Jan 01 TI - Chromium exposure, biological indexes and clinical findings in chromium plating industry PG - 141-151 AU - Franchini I AU - Cavatorta A AU - Mutti A AU - Marcato M AU - Bottazzi D AU - Cigala F LA - PT - DEP - TA - Lav Um JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 34 IP - DP - 1977 Jan 01 TI - Occupational formalin asthma PG - 11-18 AB - Hypersensitivity to formalin used to sterilise artificial kidney machines was shown by inhalation provocation tests to be responsible for attacks of wheezing accompanied by productive cough in two members of the nursing staff of a haemodialysis unit. Three further members of the staff of 28 who were continually exposed to this substance occupationally had developed similar recurrent but less frequent episodes since joining the unit. Two underwent inhalation provocation tests with formalin which did not reproduce these symptoms.Single episodes of these symptoms had been noted by three additional staff members so that altogether eight (29%) had experienced attacks described as bronchitic since becoming exposed to formalin. We suggest that, while exposure to formalin did not seem to be directly responsible in all cases, it might have increased susceptibility to other provoking agents or induced a hyper-reactive responsiveness of the airways. The responses observed in the two nurses after inhalation provocation tests with fromalin were predominantly of airways obstruction. Wheezing began between two and three hours after exposure, and peak expiratory flow rates fell maximally by approximately 50%. Reactions persisted for 10 hours to 10 days depending on the exposure dose. A productive cough was a prominent feature. The sputum appeared to be mucopurulent, but culture produced a scanty growth of Haemophilus influenzae only, together with upper respiratory tract commensals. The cellular content was not homogeneous, neutrophil leucocytes and eosinophil leucocoytes variably dominating. Variable responses of neutrophil and eosinophil leucocytes were also seen in the peripheral blood. AU - Hendrick DJ AU - Lane DJ LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 19 IP - DP - 1977 Jan 01 TI - Polyvinylchloride film thermal decomposition products as an occupational illness PG - 192-196 AU - Brooks SM AU - Vandevort R LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 154 IP - DP - 1977 Jan 01 TI - Epidemiology of chronic lung disease in a cotton mill community PG - 167-186 AU - Bouhuys A AU - Schoenberg JB AU - Beck GJ AU - Schilling RSF LA - PT - DEP - TA - Lung JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 40 IP - DP - 1977 Jan 01 TI - Spirometric alterations in workers in the chromium electroplating industry PG - 25-32 AU - Bovet P AU - Lob M AU - Grandjean M LA - PT - DEP - TA - Int Arch Occup Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 7 IP - DP - 1977 Jan 01 TI - Immunoglobin E specific to wheat and rye flour proteins PG - 473-483 AU - Bjorksten F AU - Backman A AU - Jarvinen KAJ AU - Lehti H AU - Savilahti E AU - Syuanen P AU - Karkkainen T LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 121 IP - DP - 1977 Jan 01 TI - One case of allergy of the immediate type due to inhalation of sublimed benzophenone PG - 1023-1025 AU - Bettink JGHD LA - PT - DEP - TA - Ned Tyd Schr Geneesk JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 116 IP - DP - 1977 Jan 01 TI - Longitudinal study of workers employed in the manufacture of toluene di-isocyanate PG - 411-421 AB - Workers at a toluene-diisocyanate manufacturing plant were studied longitudinally to determine the effects of the chemical on their health. Studies included health questionnaire, pulmonary function, environmental monitoring, and immunologic testing. Workers reporting increased lower respiratory symptoms were from the nonsmoker group. Environmental monitoring showed frequent excursions of toluene-diisocyanate concentrations above the threshold limiting value. There was poor correlation between area and personal exposure levels. No exposure-related decline of pulmonary function was demonstrable. Immunologic studies showed development of a positive skin test to a toluene-diisocyanate-human serum albumin conjugate by some persons and an increasing incidence of toluene-diisocyanate-specific IgE antibodies as measured by a radioallergosorbent test. Toluene-diisocyanate did not induce histamine release from leukocytes in vitro but did diminish the in vitro stimulation of cyclic adenosine monophosphate by isoproterenol. Most of the clinically sensitive persons demonstrated adverse bronchial response when challenged by inhalation of toluene-diisocyanate. This response was dose dependent in some persons. When challenged with Mecholyl, clinically sensitive persons showed greater reactivity of airways than nonsensitive persons AU - Butcher BT AU - Jones RN AU - O'Neil CE AU - Glindmeyer HW AU - Diem JE AU - Dharmarajan V AU - Weill H AU - Salvaggio JE LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19770101 IS - IS - VI - 27 IP - DP - 1977 Jan 01 TI - Bacillus Subtilis Enzymes: a 7 year clinical, epidemiological and immunological study of an industrial allergen PG - 3-12 AU - Juniper CP AU - How MJ AU - Goodwin BFJ AU - Kinshott AK LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 57 IP - DP - 1976 Jan 01 TI - Wood dust hypersensitivity PG - 352-357 AU - Booth BH AU - LeFoldt RH AU - Moffitt EM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 18 IP - DP - 1976 Jan 01 TI - Variation of pulmonary function among workers in cotton mills PG - 551-555 AU - Barnes R AU - Simpson GR LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 84 IP - DP - 1976 Jan 01 TI - Immediate skin-test reactivity in a general population sample PG - 129-133 AU - Barbee RA AU - Lebowitz MD AU - Thompson HC AU - Burrows B LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 58 IP - DP - 1976 Jan 01 TI - Clinical and bronchial provocation studies in patients with meat wrappers asthma PG - 291-298 AU - Andrasch RH AU - Bardana EJ AU - Koster F AU - Pirofsky B LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 235 IP - DP - 1976 Jan 01 TI - Thermoactive price-label fume intolerence PG - 937-937 AU - Andrasch RH AU - Bardana EJ LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 308 IP - DP - 1976 Jan 01 TI - Isocyanates in the fire PG - 186 AU - Axford AT AU - McKerrow CB AU - Jones P AU - Le Quesne PM LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 33 IP - DP - 1976 Jan 01 TI - Accidental exposure to isocyanate fumes in a group of firemen PG - 65-71 AU - Axford AT AU - McKerrow CB AU - Jones AP AU - Le Quesne PM LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 6 IP - DP - 1976 Jan 01 TI - Bakers Asthma PG - 241-250 AU - Hendrick DJ AU - Davies RJ AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 101 IP - DP - 1976 Jan 01 TI - Occupational allergy due to inhalation of pollen from Euphorbia fulgens Karw PG - 567-570 AU - Hausen BM AU - KetelsHarken H AU - Schulz KH LA - PT - DEP - TA - Deutsche Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 6 IP - DP - 1976 Jan 01 TI - Asthma due to inhaled chemical agents: amprolium hydrochloride PG - 105-108 AU - Greene SA AU - Freedman S LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 18 IP - DP - 1976 Jan 01 TI - Effects of occupational and non-occupational factors on the respiratory symptoms of vinyl chloride and other workers PG - 659-670 AU - Gamble J AU - Shuguey L AU - McMichael AJ AU - Waxweiler RJ LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 37 IP - DP - 1976 Jan 01 TI - Respiratory function and symptoms: an environmental-epidemiological study of rubber workers exposed to a phenol formaldehyde type resin PG - 499-513 AU - Gamble JF AU - McMichael AJ AU - Williams T AU - Battigelli M LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 112 IP - DP - 1976 Jan 01 TI - Persulphate hair bleach reactions PG - 1407-1409 AU - Fisher AA AU - DoomsGoossens A LA - PT - DEP - TA - Acta Dermatol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 6 IP - DP - 1976 Jan 01 TI - Factors in allergen-induced asthma: relevance of the intensity of the airways allergic reaction and non-spicific reactivity PG - 219-225 AU - Killian D AU - Cockcroft DW AU - Hargreave FE AU - Dolovich J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 18 IP - DP - 1976 Jan 01 TI - meat-wrappers asthma: a case study PG - 102-104 AU - Johnson CJ AU - Anderson HW LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 31 IP - DP - 1976 Jan 01 TI - Pulmonary hypersensitivity to ramin (Gonystylus bancanus) PG - 585-587 AU - Howie AD AU - Boyd G AU - Moran F LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 33 IP - DP - 1976 Jan 01 TI - Sickness absence caused by chest disease in relation to smoking and chronic bronchitis symptoms PG - 243-24* AB - The relationship between sickness absence caused by chest diseases, smoking habit, and symptoms of chronic bronchitis among the workers of a fertilizer factory in Karaków is examined. The analysis of absence was based on the spells and days of absence registered during a period of six years. The results show that the group of workers with symptoms of chronic bronchitis had many more spells and days of absence caused by chest diseases than persons free from these symptoms. The activity and chronicity of bronchitis symptoms strongly influenced the level of absence, but the role of smoking was not so evident. From the results obtained it appears that analysis of absence can be a valid screening test in the detection of chronic chest diseases, the frequency of which can easily be estimated from absence data. AU - Jedrychowski W LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 58 IP - DP - 1976 Jan 01 TI - Toluene diisocyanate (TDI) pulmonary disease: immunologic and inhalation challenge studies PG - 89-100 AU - Butcher BT AU - Salvaggio JE AU - Weill H AU - Ziskind MM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 114 IP - DP - 1976 Jan 01 TI - Occupational asthma due to Californian Redwood (Sequoia semipervirens) dusts PG - 1027-1031 AU - ChanYeung M AU - Abboud R LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 31 IP - DP - 1976 Jan 01 TI - Hypersensitivity pneumonitis after exposure to isocyanates PG - 127-12* AU - Charles J AU - Bernstein A AU - Jones B AU - Jones DJ AU - Edwards JH AU - Seal RME AU - Seaton A LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 6 IP - DP - 1976 Jan 01 TI - Asthma due to non-occupational exposure to toluene (tolylene) diisocyanate PG - 99-104 AU - Carroll KB AU - Secombe JP AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 6 IP - DP - 1976 Jan 01 TI - Immediate (type 1) allergic responses to platinum compounds PG - 193-195 AU - Cleare MJ AU - Hughes EG AU - Jacoby B AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 18 IP - DP - 1976 Jan 01 TI - Prevalence of chronic pulmonary disease in aluminium potroom workers PG - 379-385 AU - Discher DP AU - Breitenstein BD LA - PT - DEP - TA - JOM JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 31 IP - DP - 1976 Jan 01 TI - Respiratory disease of workers harvesting grain PG - 294-302 AU - Darke CS AU - Knowelden J AU - Lacey J LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 114 IP - DP - 1976 Jan 01 TI - Recurrent nocturnal asthma after exposure to grain dust PG - 1011-1019 AU - Davies RJ AU - Green M AU - Schofield NMC LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 16 IP - DP - 1976 Jan 01 TI - Asthmatic manifestations in workers engaged in preparing nutritional proteins from oil (an allergy to candida tropicalis?) PG - 17-23 AU - Cornillon J AU - Touraine JP AU - Lesterlin P AU - Touraine R AU - Touraine F AU - Grimaud D AU - de Bouteiller O LA - PT - DEP - TA - Rev Franc Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 6 IP - DP - 1976 Jan 01 TI - Asthma due to inhaled chemical agents- fumes from Multicore soldering flux and colophony resin PG - 577-585 AU - Fawcett IW AU - Newman Taylor AJ AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 6 IP - DP - 1976 Jan 01 TI - Asthma due to "glycyl compound" powder: an intermediate in the production of salbutamol PG - 405-409 AU - Fawcett IW AU - Pepys J AU - Erooga MA LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 6 IP - DP - 1976 Jan 01 TI - Allergy to a tetracycline preparation PG - 301-303 AU - Fawcett IW AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 235 IP - DP - 1976 Jan 01 TI - Respiratory tract illness in meat wrappers PG - 915-917 AU - Falk H AU - Portnoy B LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 33 IP - DP - 1976 Jan 01 TI - Ispaghula as an occupational allergen PG - *-* AU - Michaelson G AU - Goransson K LA - PT - DEP - TA - Sven Lak Rik JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 4 IP - DP - 1976 Jan 01 TI - Maladie des humidificateurs PG - 537-544 AU - Michel FB AU - Aiache JM AU - Gayraud JP AU - Pierredon M LA - PT - DEP - TA - Rev Fr Mal Resp JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 31 IP - DP - 1976 Jan 01 TI - Biological effects of proteolytic enzyme detergents PG - 621-634 AU - Medical Research Council LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 18 IP - DP - 1976 Jan 01 TI - Byssinosis and other respiratory ailments, a survey of 6631 cotton textile employees PG - 455-462 AU - Martin CF AU - Higgins JE LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 7 IP - DP - 1976 Jan 01 TI - Bronchopulmonary reactions and asthma due to platinum. Occurrence in workers using platinum in the Paris area PG - 206-208 AU - Ruff F AU - Di Matteo G AU - Dupuis JP AU - Hebert R AU - Parrot J LA - PT - DEP - TA - Rev Fr Mal Resp JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 101 IP - DP - 1976 Jan 01 TI - Mushroom workers lung caused by inhalation of spores of the edible fungus Pleurotus florida (oyster mushroom) PG - 1241-1245 AU - Noster V AU - Hausen BM AU - Felten G AU - Schulz KH LA - PT - DEP - TA - Deutsche Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 33 IP - DP - 1976 Jan 01 TI - Loss of pulmonary elastic recoil in workers formerly exposed to proteolytic enzyme (alcalase) in the detergent industry PG - 158-165 AU - Musk AW AU - Gandevia B LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 17 IP - DP - 1976 Jan 01 TI - Clinical studies of styrene workers: initial findings PG - 171-181 AU - Lorimer WV AU - Lilis R AU - Nicholson WJ AU - Anderson H AU - Fischbein A AU - Daum S AU - Rom W AU - Rice C AU - Selikoff IJ LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 28 IP - DP - 1976 Jan 01 TI - Epidemiologic evaluation of isocyanate immediate irritative action "one day effect" control PG - 17-24 AU - Mapp C AU - Fabbri LM AU - Marcer G AU - Mastrangelo G AU - Sala B LA - PT - DEP - TA - Lav Um JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 113 IP - DP - 1976 Jan 01 TI - In vitro demonstration of specific IgE in phthalic anhydride hypersensitivity PG - 701-704 AU - Maccia CA AU - Bernstein IL AU - Emmett EA AU - Brooks SM LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 33 IP - DP - 1976 Jan 01 TI - Neurological complications after a single severe exposure to toluene diisocyanate PG - 72-78 AU - LeQuesne PM AU - Axford AT AU - McKerrow CB AU - Parry Jones A LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 11 IP - DP - 1976 Jan 01 TI - Clinical picture and diagnosis of occupational bronchial asthma due to the action of formaldehyde containg polymers PG - 17-20 AU - Ozhiganova VN AU - Dueva LA AU - Popova NG LA - PT - DEP - TA - Gig Tr Prof Zabol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 6 IP - DP - 1976 Jan 01 TI - Investigation of a respiratory disease associated with an air-conditioning system PG - 109-118 AU - Pickering CAC AU - Moore WKS AU - Lacey J AU - HolfordStevens VC AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 36 IP - DP - 1976 Jan 01 TI - Tossockosis: reactions to Douglas fir tusock moth PG - 302-307 AU - Perlman F AU - Press E AU - Googins JA AU - Malley A AU - Poarea H LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 6 IP - DP - 1976 Jan 01 TI - Asthma due to inhaled chemical agents- persulphate salts and henna in hairdressers PG - 399-404 AU - Pepys J AU - Hutchcroft BJ AU - Breslin ABX LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - * IP - DP - 1976 Jan 01 TI - Occupational disorders of the skin due to chemicals in processing polyurethane PG - *-* AU - Rothe A LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 36 IP - DP - 1976 Jan 01 TI - Immunological reactions in penicillin factory workers PG - 313-323 AU - Shmunes E AU - Taylor JS AU - Petz LD AU - Garratty G AU - Fudenberg HH LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 44 IP - DP - 1976 Jan 01 TI - Delayed asthmatic response following occupational exposure to enflurane PG - 166-169 AU - Schwettmann RS AU - Casterline CL LA - PT - DEP - TA - Anaesthiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 33 IP - DP - 1976 Jan 01 TI - Sickness absence in leas workers and controls PG - 236-23* AU - Shannon HS AU - Williams MK AU - King E LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 31 IP - DP - 1976 Jan 01 TI - Respiratory effects of occupational exposure to an epoxy resin system PG - 236-240 AU - Sargent EV AU - Mitchell CA AU - Brubaker RE LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 119 IP - DP - 1976 Jan 01 TI - Mushroom workers lung disease PG - 61-63 AU - Stolz JL AU - Arger PH AU - Benson JM LA - PT - DEP - TA - Radiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 36 IP - DP - 1976 Jan 01 TI - Asthma due to soldering flux: a polypropylene glycol mixture PG - 419-422 AU - Stevens JJ LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 113 IP - DP - 1976 Jan 01 TI - Respiratory response to tobacco dust exposure PG - 751-754 AU - Valic F AU - Berilic D AU - Butkovic D LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 33 IP - DP - 1976 Jan 01 TI - Occupational type test for the etiological diagnosis of asthma due to toluene diisocyanate PG - 14-21 AU - Zedda S AU - Cirla A AU - Aresin G AU - Sala C LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 114 IP - DP - 1976 Jan 01 TI - Effects of wool dust on respiratory function PG - 705-709 AU - Zuskin E AU - Valic F AU - Bouhuys A LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 31 IP - DP - 1976 Jan 01 TI - Gas-chromatographic analysis of air contaminated by rosin PG - 2205-2211 AU - Drugov YS AU - Murav'eva GV LA - PT - DEP - TA - Zhurnal Analiticheskoi Khimii JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - IP - DP - 1976 Jan 01 TI - CIBS guide: Environmental control PG - volume A-Section A1 AU - Chartered Institute of Building Services Engineers LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - IP - DP - 1976 Jan 01 TI - Ventilation and air conditioning requirements PG - Volume B-Section B2 AU - Chartered Institute of Building Services Engineers LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 6 IP - DP - 1976 Jan 01 TI - Bronchial histamine reactivity: its relationship to the reactivity of the bronchi to allergens PG - 523-532 AU - Bryant DH AU - Burns MW LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 6 IP - DP - 1976 Jan 01 TI - The relationship between bronchial histamine reactivity and atopic state PG - 373-381 AU - Bryant DH AU - Burns MW LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 91 IP - DP - 1976 Jan 01 TI - Tuberculosis studies in Moscogee country,Georgia. Twenty year evaluation of a community trial of BCG vaccination PG - 276-280 AU - Comstock GW AU - Woolpert SF AU - Livesay VT LA - PT - DEP - TA - Publ Hlth Rep JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - IP - DP - 1976 Jan 01 TI - A guide to the reporting of injuries, diseases and dangerous occurrences regulations 1995 PG - - AU - Health and safety executive LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - i IP - DP - 1976 Jan 01 TI - Incidence of tuberculosis, hepatitis, brucellosis and shigellosis in British medical laboratory workers PG - 759-762 AU - Harrington JM AU - Shannon HS LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - i IP - DP - 1976 Jan 01 TI - Tuberculous infection in a paediatric department PG - 30-32 AU - Stewart CJ LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 51 IP - DP - 1976 Jan 01 TI - Extrinsic allergic alveolitis in workers of malt manufacturing plants in Scotland PG - Pt 2):629-36 AU - Grant IW LA - PT - DEP - TA - Bulletin of the International Union Against Tuberc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 1 IP - DP - 1976 Jan 01 TI - Extrinsic allergic alveolitis in Scottish maltworkers PG - 490-493 AB - In a survey of respiratory disease in the Scottish malting industry 5.2% of employees were found to have symptoms of extrinsic allergic alveolitis. In most cases the disease was mild and not associated with any serious respiratory disability. It was significantly less common where modern mechanical methods of malting were used. Mycological and serological studies suggested that it was usually caused by a type 3 allergic reaction to Aspergillus clavatus AU - Grant IW AU - Blackadder ES AU - Greenberg M AU - Blyth W LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 16 IP - DP - 1976 Jan 01 TI - Effects on man of drenching with dilute solutions of o-chlorobenzylidene malononitrile (CS) and dibenz (b.f)-1:4-oxazepine (CR) PG - 159-170 AU - Ballantyne B AU - Gall D AU - Robson D LA - PT - DEP - TA - Medicine Science & the Law JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 1 IP - DP - 1976 Jan 01 TI - Immunological mechanisms in the pathogenesis of vinyl chloride disease PG - 936-938 AB - Vinyl chloride (VC) disease is a multisystem disorder incorporating Raynaud's phenomenon, acro-osteolysis, thrombocytopenia, portal fibrosis, and hepatic and pulmonary dysfunction. Immunological and immunochemical investigations showed the presence of circulating immune complexes in 19 out of 28 patients with the disease and in a further two out of 30 workers exposed to VC. The immunological data were reviewed in relation to the clinical picture of the disease and to the available evidence on the metabolism of VC. The results suggest that VC disease is an immune complex disorder and that the immune response is initiated by the adsorption of VC or a metabolite on to tissue or plasma protein AU - Ward AM AU - Udnoon S AU - Watkins J AU - Walker AE AU - Darke CS LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 19 IP - DP - 1976 Jan 01 TI - Resorption of the mandible in vinyl chloride acro-osteolysis (Letter) PG - 971-971 AU - Jayson MI AU - LloydJones K AU - Berry DC AU - Bromige M LA - PT - DEP - TA - Arthritis & Rheumatism JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 84 IP - DP - 1976 Jan 01 TI - Vinyl chloride-associated liver disease PG - 717-731 AB - Although polyvinyl chloride has been produced from vinyl chlride monomer for more than 40 years, recognition of toxicity among vinyl chloride polymerization workers is more recent. In the mid 1960s, workers involved in cleaning polymerization tanks were found to have acro-osteolysis. In 1974, the same population of workers was found to be at risk for an unusual type of hepatic fibrosis and angiosarcoma of the liver. We describe two cases of vinyl chloride-associated liver injury, one of hepatic fibrosis and one of angiosarcoma. Histologic features of these lesions are similar to the hepatic fibrosis and angiosarcomas resulting from chronic exposure to inorganic arsenicals. Preliminary studies suggest that the toxicity of vinyl chloride may result from formation, during high-dose exposure, of active metabolites by mixed function oxidases of the liver. Epidemiologic studies indicate an increased incidence not only of liver disease, but also of cancers of the brain, lung, and possibly other organs AU - Berk PD AU - Martin JF AU - Young RS AU - Creech J AU - Selikoff IJ AU - Falk H AU - Watanabe P AU - Popper H AU - Thomas L LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 69 IP - DP - 1976 Jan 01 TI - Clinical aspects of vinyl chloride disease: acro-osteolysis PG - 284-286 AU - Preston BJ AU - Jones KL AU - Grainger RG LA - PT - DEP - TA - Proc R Soc Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 1 IP - DP - 1976 Jan 01 TI - Survival in acute myeloid leukemia [Letter] PG - 85-85 AU - Burge PS AU - Frankerd TA AU - Richards JD LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 4 IP - DP - 1976 Jan 01 TI - Long-term effects of an amiloride/hydrochlorothiazide combination ('Moduretic') on electrolyte balance PG - 260-266 AB - A study was carried out of plasma electrolyte estimations made before and after long-term use of a combination of amiloride and hydrochlorothiazide in 23 patients. The mean duration of use was 20.3 months. No significant differences were found in plasma potassium, sodium, bicarbonate or urea from baseline levels AU - Burge PS AU - Montuschi E LA - PT - DEP - TA - Current Medical Research & Opinion JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 1 IP - DP - 1976 Jan 01 TI - Neutrophil pyruvate kinase deficiency with recurrent staphylococcal infections: first reported case PG - 742-745 AB - A woman with an intracellular killing defect in the neutrophils had neutrophil pyruvate kinase deficiency. She had had recurrent staphylococcal infections throughout her life. The enzyme present was unstable and its kinetics were abnormal AU - Burge PS AU - Johnson WS AU - Hayward AR LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19760101 IS - IS - VI - 1 IP - DP - 1976 Jan 01 TI - Successful treatment of myeloma kidney by diuresis and plasmaphoresis PG - 503-504 AU - Feest TG AU - Burge PS AU - Cohen SL LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 2 IP - DP - 1975 Jan 01 TI - Quality and quantity of survival in acute myeloid leukaemia PG - 621-624 AB - The quality of life in leukaemia is as important as its quantity. In fifty-one patients the quality and quantity of life were improved by less aggressive treatment than is usual. By not trying to induce complete remission at all costs, the mobidity and early mortality were reduced and at least an equivalence in survival was obtained AU - Burge PS AU - Prankerd TA AU - Richards JD AU - Sare M AU - Thompson DS AU - Wright P LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 1 IP - DP - 1975 Jan 01 TI - Morbidity and mortality in pseudopolycythaemia PG - 1266-1269 AB - A follow-up of 35 patients with pseudopolycythaemia showed that symptoms, high packed-cell volumes, and low plasma volumes persisted in most patients. The death-rate in these patients was six times greater than expected. Patients with pseudopolycythaemia are often regarded as having a good prognosis; however, this view should be revised in the light of these findings AU - Burge PS AU - Johnson WS AU - Prankerd TAJ LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 100 IP - DP - 1975 Jan 01 TI - Acro-osteolysis (acro-osteopathia ulcero-mutilans) in a worker exposed to vapours of synthetics (author's transl). [German] PG - 1001-1004 AB - The neuro-cutaneo-osseous syndrome of "sporadic" acrosteolysis (of Bureau-Barriere), localized to the ends of the feet, has occasionally been seen in workers engaged in the polymerization of vinyl chloride, A case of the disease is described in a 42-year-old worker exposed to different vapours during the manufacture of plastic products, but he had never worked with vinyl chloride. Outstanding signs were dysproteinaemia, moderate thrombocytopenia, while symptoms of Raynaud's disease as well as scleroderma-like changes in hands and feet (typical of vinyl chloride disease) were absent. The onset of the osteolytic and ulcerative process corresponded to prolonged exposure to cold on the job. It is, therefore, assumed that there was concealed chronic intoxication with synthetic vapours which, in connection with cold exposure and other individual factors, may have aided in the manifestation of the disease. It is possible that under certain conditions synthetics other than vinyl chloride may contribute to the occurrence of sporadic cases of acro-osteolysis AU - Kind R AU - Hornstein OP LA - PT - DEP - TA - Deutsche Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 1 IP - DP - 1975 Jan 01 TI - Difolatan dermatitis PG - 127-127 AU - Camarasa G LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 252 IP - DP - 1975 Jan 01 TI - Proceedings: Comparison of effects of ammonia and CS aerosol upon exercise ventilation and cardiac frequency in healthy men PG - 28P-29P AU - Cole TJ AU - Cotes JE AU - Johnson GR AU - Martin HV AU - Reed JW AU - Saunders MJ LA - PT - DEP - TA - Journal of Physiology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 30 IP - DP - 1975 Jan 01 TI - Source of infection for sporadic Legionnaires' disease: a review PG - 9-12 AU - Bhopal RS LA - PT - DEP - TA - J Infect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 112 IP - DP - 1975 Jan 01 TI - Changes in the respiratory response to coarse cotton dust over a ten-year period PG - 417-421 AU - Zuskin E AU - Valic F LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 14 IP - DP - 1975 Jan 01 TI - Occupational asthma from inhaling proteolytic enzymes PG - 131-137 AU - Zapeda AG AU - Procel EG AU - Quiroga EHG AU - Vargas MM AU - Torres LM LA - PT - DEP - TA - Rev Med Inst Mex Seg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 11 IP - DP - 1975 Jan 01 TI - Respiratory effects of toluene diisocyanate manufacture. A multidisciplinary approach PG - 101-108 AU - Weill H AU - Salvaggio J AU - Neilson A AU - Butcher B AU - Ziskind M LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 35 IP - DP - 1975 Jan 01 TI - Mechanism of respiratory injury by TDI (toluene diisocyanate) PG - 142-147 AU - van Ert M AU - Battigelli MC LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 67 IP - DP - 1975 Jan 01 TI - Hypersensitivity studies in Popple (Aspen tree) peelers PG - 405-407 AU - Thiede WH AU - Banaszak EF AU - Fink JN AU - Unger GF AU - Scanlon GT LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 1 IP - DP - 1975 Jan 01 TI - Clinicopathological comparisons in respiratory pathology in tobacco growers and in workers engaged in the tobacco industry PG - 25-2* AU - Truda IG LA - PT - DEP - TA - Gig Tr Prof Zabol (Moskva) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 33 IP - DP - 1975 Jan 01 TI - Occupational asthma from green coffee dust PG - 677-683 AU - Somazzi S AU - Wutrich B LA - PT - DEP - TA - Med et Hygiene JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 30 IP - DP - 1975 Jan 01 TI - Airways disease caused by phenolic (phenol formaldehyde) resin exposure PG - 574-577 AU - Schoenberg JB AU - Mitchell CA LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - ii IP - DP - 1975 Jan 01 TI - Formalin asthma in hospital laboratory staff PG - 816-816 AU - Sakula A LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 10, No. 1 IP - DP - 1975 Jan 01 TI - Toxicity of chromic acid in the chromium plating industry (2) PG - -163 AU - Royle H LA - PT - DEP - TA - Environ Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 112 IP - DP - 1975 Jan 01 TI - Bronchial provocation tests in etiologic diagnosis and analysis of asthma PG - 829-859 AU - Pepys J AU - Hutchcroft BJ LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - ii IP - DP - 1975 Jan 01 TI - Acute respiratory disease following formalin inhalation PG - 603-604 AU - Porter JAH LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 55 IP - DP - 1975 Jan 01 TI - Allergens of mamalian origin, characterisation of allergens extracted from rat, mouse, guinea pig and rabbit pelts PG - 16-24 AU - Ohman JL AU - Lowell FC AU - Bloch KJ LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 4 IP - DP - 1975 Jan 01 TI - Humidifier fever in an industrial setting PG - 667-667 AU - Paramelle B AU - Perdrix A AU - Lascaud D AU - AmbroseThomas P AU - Cau G AU - Aiache JM LA - PT - DEP - TA - Nouv Presse Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 8 IP - DP - 1975 Jan 01 TI - Action of oxygen and oxidisers on the lung and bronchioles PG - 91-106 AU - Pariente R LA - PT - DEP - TA - Prog Resp Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 34 IP - DP - 1975 Jan 01 TI - A study of Western red cedar induced asthma PG - 296-304 AU - Mue S AU - Ise T AU - Ono Y AU - Akasaka K LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 32 IP - DP - 1975 Jan 01 TI - Silo-fillers disease PG - 81-92 AU - Morrissey WL AU - Gould IA AU - Carrington CB AU - Gaensler EA LA - PT - DEP - TA - Respiration JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 33 IP - DP - 1975 Jan 01 TI - Release of histamine from lung tissue in vitro by dimethylhydrantoin-formaldehyde resin and polyvinylprrrolidone PG - 127-129 AU - Nicholls PJ LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 11 IP - DP - 1975 Jan 01 TI - Pulmonary function defects in nonsmoking vinyl chloride workers PG - 247-250 AU - Miller A LA - PT - DEP - TA - Environ Health Perspect JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 246 IP - DP - 1975 Jan 01 TI - Changes in pulmonary function in workers exposed to vinyl chloride and polyvinyl chloride PG - 42-52 AU - Miller A AU - Teirstein AS AU - Chuang M AU - Selikoff IJ AU - Warshaw R LA - PT - DEP - TA - Ann N Y Acad Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 32 IP - DP - 1975 Jan 01 TI - Occupational asthma after inhalation of dust of the proteolytic enzyme papain PG - 302-307 AU - Milne J AU - Brand S LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 67 IP - DP - 1975 Jan 01 TI - Pulmonary mycotoxicosis PG - 293-297 AU - Emanuel DE AU - Wenzel FJ AU - Lawton BR LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 5 IP - DP - 1975 Jan 01 TI - Occupational asthma in aluminium smelters PG - 475-483 AU - Field GB AU - Milne J LA - PT - DEP - TA - Aust N Z J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 25 IP - DP - 1975 Jan 01 TI - Nasal ulceration in workers exposed to ruthenium and platinum salts PG - 133-134 AU - Harris S LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 23 IP - DP - 1975 Jan 01 TI - Occupational sensitisation of the respiratory tract by hair and dust of animals PG - 87-96 AU - Czecholinski K AU - Veltman G AU - Scholzke KH LA - PT - DEP - TA - Berufsdermatosen JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 5 IP - DP - 1975 Jan 01 TI - Asthma due to inhaled chemical agents- the macrolide antibiotic spiramycin PG - 99-107 AU - Davies RJ AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 111 IP - DP - 1975 Jan 01 TI - Precipitating antibody in office workers and hospitalized patients directed towards antigens causing hypersensitivity pneumonitis PG - 201-205 AU - Chmelik F AU - Flaherty DK AU - Reed CE LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 5 IP - DP - 1975 Jan 01 TI - Extrinsic allergic alveolitis due to rat serum protein PG - 443-456 AU - Carroll KB AU - Pepys J AU - Longbottom JL AU - Hughes DTD AU - Benson HG LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 27 IP - DP - 1975 Jan 01 TI - Functional conditions of the respiratory system and work site pollution 2. Prevalence of respiratory function changes in workers employed in bichromate and chromic acid production PG - 175-187 AU - Capodaglio E AU - Catenacci G AU - Pezzagno G AU - Poggi G AU - Pozzoli L LA - PT - DEP - TA - Lav Um JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 56 IP - DP - 1975 Jan 01 TI - Standardisation of bronchial inhalation challenge procedures PG - 323-327 AU - Chai H AU - Farr RS AU - Froelich LA AU - Mathison DA AU - McLean JA AU - Rosenthal RR AU - Sheffer AL AU - Spector SL AU - Townley RG LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 83 IP - DP - 1975 Jan 01 TI - Asthma from Psyllium in laxative manufacture PG - 361-362 AB - Symptoms of asthma developed in three patients after exposure to psyllium powder, which was being used in the manufacture of a bulk laxative. All three had reaginic skin test sensitivity, and two had positive bronchial challenges with a psyllium extract. AU - Busse WW AU - Schoenwetter WF LA - PT - DEP - TA - Ann Int Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 5 IP - DP - 1975 Jan 01 TI - Immunological features of asthma (part ii) PG - 403-40* AU - British Thoracic and Tuberculosis Association LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - i IP - DP - 1975 Jan 01 TI - Formalin Asthma in hospital staff PG - 607-608 AU - Hendrick DJ AU - Lane DJ LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 32 IP - DP - 1975 Jan 01 TI - Long-term effects on the health of men engaged in the manufacture of tolylene di-isocyanate PG - 72-78 AU - Adams WGF LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 292 IP - DP - 1975 Jan 01 TI - Immediate hypersensitivity to hog trypsin resulting from industrial exposure PG - 1050-1053 AU - Colten HR AU - Polakoff PL AU - Weinstein SF AU - Strieder DJ LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19750101 IS - IS - VI - 9 IP - DP - 1975 Jan 01 TI - Nowy apamt do badania mikrobiologicznego zanieczyszczenia powietrza PG - 3742 AB - New apamt to test new apparatus for testing the microbiological pollution of air AU - Dutkicwicz J AU - Kwapistewski C LA - PT - DEP - TA - Ochr. POW JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - IP - DP - 1974 Jan 01 TI - The situation in animals: Responses of cattle and horses to inhaled antigens PG - 241-251 AB - Aspergillosis and farmer’s lung in man and animal. Proceedings of the 4th International Symposium, Davos, 7-9 October 1971 (ed. R. DeHaller & F. Suter), H. Huber Publishers, Bern. AU - Pauli B AU - Luginbiihl H AU - Gerber H LA - PT - DEP - TA - Aspergillosis and farmer’s lung in man and animal. Proceedings JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 4 IP - DP - 1974 Jan 01 TI - The role of Penicillium frequentens in suberosis (Respiratory disease in workers in the cork industry) PG - 109-117 AU - Avila R AU - Lacey J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 24 IP - DP - 1974 Jan 01 TI - Hard metal disease and tool room grinding PG - 11-16 AB - Hard Metal Disease and Tool Room Grinding AU - Bech AO LA - PT - DEP - TA - J Soc Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 109 IP - DP - 1974 Jan 01 TI - Hypersensitivity lung disease in the Turkey raising industry PG - 630-635 AU - Boyer RS AU - Klock LE AU - Schmidt CD AU - Hyland L AU - Maxwell K AU - Gardner RM AU - Renzetti AD LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - ed Yamamur IP - DP - 1974 Jan 01 TI - Rat asthma in laboratory workers PG - 123-12* AU - Frankland AW LA - PT - DEP - TA - Allergology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 221 IP - DP - 1974 Jan 01 TI - A comparative clinical and pulmonary function study of grain handlers and bakers PG - 86-96 AU - Kleinfield M LA - PT - DEP - TA - Ann N Y Acad Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 68 IP - DP - 1974 Jan 01 TI - Schock und exanthematische Hautveranderungen als allergische reaktion auf einen hexachlorophenhaltigen Deso-Spray PG - 141-142 AU - Kaunzner W LA - PT - DEP - TA - Z Arztl Forbild JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 26 IP - DP - 1974 Jan 01 TI - Functional state of the respiratory system and work environment pollution PG - 97-124 AU - Capodaglio E AU - Pezzagno G AU - Catenacci G AU - Pozzoli L AU - Ghittori S LA - PT - DEP - TA - Lav Um JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 16 IP - DP - 1974 Jan 01 TI - Occupational health case report no 3: ethyl acrylate PG - 199-200 AU - Cohen SR AU - Maier AA AU - Flesch JP LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 4 IP - DP - 1974 Jan 01 TI - Asthma due to inhaled chemical agents: ampicillin,benzyl penicillin, 6 amino penicillanic acid and related substances PG - 227-247 AB - Three out of four workers from an antibiotic-producing factory developed late asthma and eosinophilia on inhalation challenge testing with ampicillin and related substances. The chemicals to which each worker reacted varied, suggesting differences in the clinically important allergens for each individual. The taking by mouth of ampicillin in one patient, and benzyl penicillin in another in therapeutic doses led to the development of late asthma accompanied by skin and gastro-intestinal disturbances. The inhalation of 200 µg of beclomethasone dipropionate before in one case, and before and 3-hourly after provocation challenge in the other, blocked the late asthmatic reaction. 40 mg sodium cromoglycate similarly given failed to inhibit the reactions. In one patient, 04416–0.24 mg of isoprenaline sulphate inhaled 10 min before or 60 min after inhalation testing prevented the development of late asthma, and when given during the asthmatic reaction led to its rapid reversal. AU - Davies RJ AU - Hendrick DJ AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 68 IP - DP - 1974 Jan 01 TI - Budgerigar-fanciers lung: a report of a fatal case PG - 57-5* AU - Edwarsd C AU - Luntz G LA - PT - DEP - TA - Brit J Dis Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 54 IP - DP - 1974 Jan 01 TI - Anaphylaxis-like reactions to corticosteroid therapy PG - 125-131 AU - Mendelson LM AU - Meltzer EO AU - Hamburger RN LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 221 IP - DP - 1974 Jan 01 TI - Evaluation before and after exposure- the pattern of physiological response to cotton dust PG - 38-43 AU - Merchant JA AU - Halprin GM AU - Hudson AR AU - Kilburn KH AU - McKenzie WM AU - Bermanzohn P AU - Hurst DJ AU - Hamilton JD AU - Germino VH LA - PT - DEP - TA - Ann N Y Acad Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 3 IP - DP - 1974 Jan 01 TI - Respiratory disease in cheese workers. The pathological role of mites PG - 1603-1605 AU - Molina C AU - Aiache JM AU - Tourreau A AU - Jeanneret A LA - PT - DEP - TA - Nouv Presse Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 16 IP - DP - 1974 Jan 01 TI - Occupational allergy to animal dander and sera PG - 465-469 AU - Lincoln TA AU - Bolton NE AU - Garrett AS LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 33 IP - DP - 1974 Jan 01 TI - Mushroom workers' pneumonitis PG - 282-288 AU - Lockey SD LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 4 IP - DP - 1974 Jan 01 TI - The effects of inhaled beclomethasone diproprionate and sodium cromoglycate on asthmatic reactions to provocation tests PG - 13-24 AB - A comparison was made between the effects of prior inhalation of sodium cromogly-cate or beclomethasone dipropionate on immediate, late and dual asthmatic reactions to provocation challenge tests with a range of allergens. Whereas sodium cromoglycate inhibited immediate and dual asthmatic reactions, beclomethasone dipropionate had no effect on immediate asthmatic reactions, but consistently inhibited late asthmatic reactions. AU - Pepys J AU - Davies RJ AU - Breslin ABX AU - Hendrick DJ AU - Hutchcroft BJ LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 74 IP - DP - 1974 Jan 01 TI - Unusual cause of bronchial asthma: cacoon seed used for decorative purposes PG - 538-539 AU - Rubin JM AU - Duke MB LA - PT - DEP - TA - New York State J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 54 IP - DP - 1974 Jan 01 TI - Fungus aerosols arising from cold-mist vaporizers PG - 222-228 AU - Solomon WR LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 29 IP - DP - 1974 Jan 01 TI - Mushroom workers lung, two outbreaks PG - 252-257 AU - Stewart CJ LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 221 IP - DP - 1974 Jan 01 TI - Follow-up observations on workers exposed to enzyme detergents PG - 76-85 AU - Weill H AU - Waggenspack C AU - DeRouen T AU - Ziskind M LA - PT - DEP - TA - Ann N Y Acad Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 53 IP - DP - 1974 Jan 01 TI - Hypersensitivity reactions to grain dust PG - 139-149 AU - Warren P AU - Cherniack RM AU - Tse KS LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 109 IP - DP - 1974 Jan 01 TI - Extrinsic allergic alveolitis owing to hypersensitivity to chickens- significance of sputum precipitins PG - 672-677 AU - Warren CPW AU - Tse KS LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 49 IP - DP - 1974 Jan 01 TI - Bronchial asthma and skin sensitisation from handling isinicotinic acid anhydride for nebulisation PG - 803-809 AU - Wang I AU - Schmid GH LA - PT - DEP - TA - Z Hautkr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 110 IP - DP - 1974 Jan 01 TI - Vinyard sprayers lung PG - 545-555 AU - Villar TG LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 290 IP - DP - 1974 Jan 01 TI - Acute airway responses to hairspray preparations PG - 660-663 AU - Zuskin E AU - Bouhuys A LA - PT - DEP - TA - NEJM JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - IP - DP - 1974 Jan 01 TI - Occupational asthma due to inhalation of pharmacological dusts and other chemical agents with some reference to other occupational asthmas in Japan PG - 124-132 AU - Kobayashi S LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 16 IP - DP - 1974 Jan 01 TI - Glutaraldehyde and formaldehyde allergy PG - 518-518 AU - Neering H AU - Ketel V WG LA - PT - DEP - TA - Contact Dermatitis Newsletter JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 109 IP - DP - 1974 Jan 01 TI - Management of newborns after nursery exposure to tuberculosis PG - 415-419 AU - Light EJ AU - Saidleman M AU - Sutherland JM LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 55 IP - DP - 1974 Jan 01 TI - The tuberculosis morbidity among pathologists in Finland PG - 257-261 AU - Teppo L AU - Ojajarvi J AU - Brander E LA - PT - DEP - TA - Scand J Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 64 IP - DP - 1974 Jan 01 TI - Evaluation of BCG vaccination among Puerto Rican children PG - 283-291 AU - Comstock GW AU - Livesay VT AU - Woolpert SF LA - PT - DEP - TA - Am J Public Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 15 IP - DP - 1974 Jan 01 TI - Glutaraldehyde contact dermatitis PG - 442-443 AU - Gordon HH LA - PT - DEP - TA - Contact Dermatitis Newsletter JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 18 IP - DP - 1974 Jan 01 TI - Health condition of the workers of platinum catalyzer factory. [RUSSIAN] PG - 10-13 AU - Gladkova EV AU - Odintsova FP AU - Volkova ID AU - Vinogradova VK LA - PT - DEP - TA - Gig Tr Prof Zabol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 150 IP - DP - 1974 Jan 01 TI - Clinical signs in poisoning with fumes of zinc chloride PG - 161-169 AU - Schmahl K LA - PT - DEP - TA - Pneumonologie JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 101 IP - DP - 1974 Jan 01 TI - Sclerodermic aspects of occupational acro-osteolysis (polymerization of vinyl chloride). [French] PG - 33-44 AU - Moulin G AU - Rety J AU - Paliard P AU - Vouillon G AU - Guttin G LA - PT - DEP - TA - Ann Dermatol Syphiligr (Paris) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 65 IP - DP - 1974 Jan 01 TI - Experimental pulmonary lesions caused by prolonged inhalation of PVC dust in work areas. [Italian] PG - 321-342 AU - Frongia N AU - Spinazzola A AU - Bucarelli A LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19740101 IS - IS - VI - 1 IP - DP - 1974 Jan 01 TI - Disinfection of gastrointestinal fibre endoscopes PG - 656-658 AU - Axon ATR AU - Cotton PB AU - Phillips I AU - Avery SA LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 25 IP - DP - 1973 Jan 01 TI - Respiratory functional changes in subjects exposed to chromium. II. Steady-state CO transfer changes. PG - 56-59 AU - Reggiani A AU - Lotti M AU - De Rosa E AU - Saia B LA - PT - DEP - TA - Lav Um JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 25 IP - DP - 1973 Jan 01 TI - Respiratory functional changes in subjects exposed to chromium. I. Spirographic changes. PG - 23-27 AU - Reggiani A AU - Lotti M AU - De Rosa E AU - Saia B LA - PT - DEP - TA - Lav Um JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 108 IP - DP - 1973 Jan 01 TI - Prevalence of bronchitis and airway obstruction in American bituminous coal miners PG - 886-893 AU - Kibelstis JA AU - Morgan EJ AU - Reger R AU - Lapp NL AU - Seaton A AU - Morgan WK LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 48 IP - DP - 1973 Jan 01 TI - Observations on the protective effect of BCG in a South Indian rural population: fourth report PG - 40-49 AU - FrimodtMoller J AU - Acharyulu GS AU - Kesava Pillai K LA - PT - DEP - TA - Bull Int Union Tubercl JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 54 IP - DP - 1973 Jan 01 TI - A tuberculosis survey in England and wales in 1971; the influence of immigration and country of birth upon notifications PG - 249-260 AU - British Thoracic and Tuberculosis Association LA - PT - DEP - TA - Tubercle JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 26 IP - DP - 1973 Jan 01 TI - Ventilatory lung function in cement workers PG - 84-85 AU - Kalacic I LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 26 IP - DP - 1973 Jan 01 TI - Human perception of humidity under four controlled conditions PG - 22-27 AU - Anderson I AU - Lundquist GR AU - Proctor DF LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 79 IP - DP - 1973 Jan 01 TI - Asthma and metals PG - 761-762 AU - Williams CD LA - PT - DEP - TA - Ann Int Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 28 IP - DP - 1973 Jan 01 TI - Isocyanate asthma: respiratory symptoms caused by diphenyl-methane diisocyanate PG - 596-600 AU - Tanser AR AU - Bourke MP AU - Blandford AG LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 226 IP - DP - 1973 Jan 01 TI - meat wrappers asthma PG - 639-641 AU - Sokol WN AU - Aelony Y AU - Beall GN LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 27 IP - DP - 1973 Jan 01 TI - Respiratory abnormalities in workers exposed to grain dust PG - 74-77 AU - Tse KS AU - Warren P AU - Janusz M AU - McCarthy DS AU - Cherniack RM LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - * IP - DP - 1973 Jan 01 TI - Oil of Juniper as an allergenic substance for skin and respiratory tract PG - 11-16 AU - Rothe A AU - Heine A AU - Rebohle E LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - IP - DP - 1973 Jan 01 TI - Asthma caused by dust from pearl shell PG - 242-250 AU - Shioda K AU - Hamada A AU - Mitani K AU - Matsuda M LA - PT - DEP - TA - Occupational bronchial asthma ed Soc Occupational JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 3 IP - DP - 1973 Jan 01 TI - Clinical and immunological response to enzymes of Bacillus subtelis in factory and consumers PG - 143-160 AU - Pepys J AU - Wells ID AU - D'Souza MF AU - Greenberg M LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 28 IP - DP - 1973 Jan 01 TI - Respiratory disease in cork workers (suberosis) PG - 409-423 AU - Pimental JC AU - Avila R LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 51 IP - DP - 1973 Jan 01 TI - Hypersensitivity pneumonitis to chickens in horses PG - 103-10* AU - Mansmann RA AU - Osburn BI LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 22 IP - DP - 1973 Jan 01 TI - Studies on pollen allergy in workers of strawberry cultivation PG - 699-69* AU - Kobayashi T AU - Nakazawa T AU - Honma S AU - Inazawa M AU - Fukudu R AU - Ooseki H AU - Nagata S AU - Kobayashi S LA - PT - DEP - TA - Jap J Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 28 IP - DP - 1973 Jan 01 TI - The prevalence of acetylcholine reactivity in cotton mill workers PG - 141-146 AU - Navratal M AU - Roth Z LA - PT - DEP - TA - Rev Inst Hyg Mines (Hasselt) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 64 IP - DP - 1973 Jan 01 TI - Allergic sensitivity in workers producing a new myocardiotropic drug,Caebochromene PG - 296-301 AU - Nava C AU - BriaticoVangosa G AU - Marchisio M LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 78 IP - DP - 1973 Jan 01 TI - Asthma caused by nickel sensitivity PG - 888-890 AU - McConnell LH AU - Fink JN AU - Schlueter DP AU - Schmidt MG LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 3 IP - DP - 1973 Jan 01 TI - Respiratory allergy to exotic wood dust PG - 307-310 AU - Eaton KK LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 64 IP - DP - 1973 Jan 01 TI - Hypersensitivity bronchitis in tungsten carbide workers PG - 390-390 AU - Cotes EO AU - Sawyer HJ AU - Rebuch JW AU - Kvale PA AU - Sweet LW LA - PT - DEP - TA - Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - IP - DP - 1973 Jan 01 TI - The development of the threshold limit value of rosin smoke in air PG - - AU - Christy HR LA - PT - DEP - TA - Thesis Clarkson College of Technology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 26 IP - DP - 1973 Jan 01 TI - Diurnal variation of respiratory function independent of air quality PG - 144-152 AU - Kerr HD LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 52 IP - DP - 1973 Jan 01 TI - Hypersensitivity to phenylglycine acid chloride PG - 73-84 AU - Kammermeyer JK AU - Mathews KP LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 26 IP - DP - 1973 Jan 01 TI - Byssinosis- a study of 10,133 textile workers PG - 183-191 AU - Imbus HR AU - Suh MW LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 15 IP - DP - 1973 Jan 01 TI - Occupational asthma from Western Red Cedar dust (Thuja plicata) in furniture factory workers PG - 580-585 AU - Ishizaki T AU - Shida T AU - Miyamoto T AU - Matsumara Y AU - Mizuno K AU - Tomaru M LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 28 IP - DP - 1973 Jan 01 TI - The skin sensitivity to flour of bakers' apprentices PG - 42-49 AU - Herxheimer H LA - PT - DEP - TA - Acta Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 30 IP - DP - 1973 Jan 01 TI - A survey of respiratory disease in cotton operatives part 2. Symptoms, dust estimations, and the effect of smoking habit PG - 48-4* AU - Fox AJ AU - Tompleson JBL AU - watt A AU - Wilkie AG LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 30 IP - DP - 1973 Jan 01 TI - A survey of respiratory disease in cotton operatives Part 1. Symptoms and ventilation test results PG - 42-47 AU - Fox AJ AU - Tompleson JBL AU - watt A AU - Wilkie AG LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 26 IP - DP - 1973 Jan 01 TI - Differential aerosol challenge studies in byssinosis PG - 120-124 AU - Hamilton JD AU - Halprin GM AU - Kilburn KH AU - Merchant JA AU - Ujda JR AU - Durham NC LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 35 IP - DP - 1973 Jan 01 TI - A physiological study of byssinosis in colonial America PG - 537-546 AB - A physiological study of byssinosis in colonial America. AU - Bouhuys A AU - Mitchell CA AU - Schilling RSF AU - Zuskin E LA - PT - DEP - TA - Trans N Y Acad Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 30 IP - DP - 1973 Jan 01 TI - A study of the acute and chronic changes in the ventilatory capacity of workers in Lancashire cotton mills PG - 25-36 AU - Berry G AU - McKerrow CB AU - Molyneux MKB AU - Rossiter CE AU - Tompleson JBL LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 233 IP - DP - 1973 Jan 01 TI - On occupational sensitisation- a hazard to the coffee industry PG - 1146-114* AU - Bernton HS LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 108 IP - DP - 1973 Jan 01 TI - Occupational asthma and rhinitis due to Western red cedar (Thuja plicata) PG - 1094-1102 AU - ChanYeung M AU - Barton GM AU - MacLean L AU - Grzybowski S LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19730101 IS - IS - VI - 28 IP - DP - 1973 Jan 01 TI - Medical experience in enzyme production PG - 250-259 AU - Witmeur O AU - WolfJurgensen P AU - HoeghThomsen J et al LA - PT - DEP - TA - Acta Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 50 IP - DP - 1972 Jan 01 TI - Allergic respiratory reactions in bird fanciers provoked by allergen inhalation provocation tests PG - 157-15* AU - Hargreave FE AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 2 IP - DP - 1972 Jan 01 TI - respiratory symptoms following brief exposure to Cedar of Lebanon (Cedra lebani) dust PG - 219-224 AU - Greenberg M LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 21 IP - DP - 1972 Jan 01 TI - Studies on cement asthma PG - 665-66* AU - Fueki R AU - Kuramuti G AU - Togawa M AU - Kobayashi S AU - Shichijo K AU - Kikaki Y AU - Ookawa A LA - PT - DEP - TA - Jap J Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 25 IP - DP - 1972 Jan 01 TI - Pulmonary infiltration due to aerosol Thesaurosis PG - 101-108 AU - Gowdy JM AU - Wagstaff MJ LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 14 IP - DP - 1972 Jan 01 TI - Health survey of aluminium workers with special reference to fluoride exposure PG - 531-541 AU - Kaltreider NL AU - Elder MJ CLV AU - Colwell MO LA - PT - DEP - TA - JOM JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 105 IP - DP - 1972 Jan 01 TI - Mushroom workers lung PG - 819-822 AU - ChanYeung M AU - Grzybowski S AU - Schonell ME LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 21 IP - DP - 1972 Jan 01 TI - Sugar beet pollinosis as an occupational disease PG - 235-243 AU - Matsuyama R AU - Sato M AU - Miyata M AU - Wagatsuma Y AU - Ozaki H LA - PT - DEP - TA - Jap J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 10 IP - DP - 1972 Jan 01 TI - On occupational allergic asthma of different kinds newly found in our allergy clinic PG - 37-47 AB - The following four kinds of occupational allergic asthma newly found by the author and his associates are reported here 1) Inhalative asthma caused by mulberry lumber among the lumber processors, 2) Inhalative asthma caused by the spores of lycopodium clavatum (“sekishoshi”) among dental technicians, 3) Buckwheat allergose among the cooks of a buckwheat-noodle service shop, and 4) Pancreatin allergose among the pharmaceutists. Including the cases introduced by the author, new sorts of occupational asthma have been yearly discovered as the fruits of untiring researches by the members of the Research Group on Occupational Allergy in Japan. Nevertheless, various kinds of working circumstances exist in our surroundings, and occupational allergy of many kinds may still be unknown. Now the problem of occupational allergy comes into the limelight, likewise the question of public injury. We stand in need of looking at our surroundings again from this point of view. AU - Nakamura S LA - PT - DEP - TA - J Asthma Research JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 102 IP - DP - 1972 Jan 01 TI - Fever due to diphenylmethane diisocyanate (MDI) PG - 647-649 AU - Lob M LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 102 IP - DP - 1972 Jan 01 TI - Diphenylmethane diisocyanate fever (MDI) PG - 647-649 AU - Lon M LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 2 IP - DP - 1972 Jan 01 TI - Asthma due to inhaled wood dusts- western red cedar and iroko PG - 213-218 AB - Occupational type exposure tests with wood dusts provoked specific late asthmatic reactions to Iroko or cedar wood dust in two asthmatic woodworkers respectively. Aqueous extracts gave immediate reactions only to Iroko in the Iroko sensitive patient, who also had precipitins only to the Iroko extract. No skin or serological or inhalation test reactions were given in non-exposed subjects. AU - Pickering CAC AU - Batten JC AU - Pepys J LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 65 IP - DP - 1972 Jan 01 TI - Inhalation tests with chemical allergens: complex salts of platinum PG - 272-274 AU - Pickering CAC LA - PT - DEP - TA - Proc R Soc Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 2 IP - DP - 1972 Jan 01 TI - Asthma due to inhaled chemical agents- complex salts of platinum PG - 391-396 AB - Sixteen workers, from a platinum refinery, with respiratory disease were tested with solutions of complex salts of platinum and ten gave immediate prick test reactions to concentrations of 10-4-10-6and immediate nasal reactions in seven out of eleven tested to concentrations of 103-10-8. Occupational-type exposure inhalation tests to the dust from mixtures of 40 mg of the platinum salt with 1 kg of lactose gave immediate asthmatic reactions in eight and in one of these a late reaction, all also giving immediate prick test reactions. The asthmatic reactions were inhibited by disodium cromoglycate. In two with negative prick tests, late asthmatic reactions were elicited. The occupational-type exposure test provides a safe, acceptable procedure for etiological diagnosis. AU - Pepys J AU - Pickering CAC AU - Hughes EG LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 2 IP - DP - 1972 Jan 01 TI - Asthma due to inhaled chemical agents- tolylene di-isocyanate PG - 225-236 AB - Four patients with asthma due to tolylene di-isocyanate (TDI) were tested by occupational type exposure to a polyurethane varnish and its TDI activator'. Late asthmatic reactions were given in two patients, the third gave an immediate reaction and the fourth gave a dual, immediate followed by late asthmatic, reaction. The reactions in the last two patients were inhibited by disodium cromoglycate. Two patients encountered the TDI in fumes from soldering polyurethane coated wire. The possibility of sensitization in conditions of limited exposure requires more frequent consideration as none of the four subjects tested gave histories of heavy exposure. AU - Pepys J AU - Pickering CAC AU - Breslin ABX AU - Terry DJ LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 2 IP - DP - 1972 Jan 01 TI - Asthma due to inhaled chemical agents- piperazine dihydrochloride PG - 189-196 AB - An occupational type exposure to the dust from a mixture of piperazine dihydrochloride and lactose provoked late (3–4hr) asthmatic reactions in two sensitized subjects. These reactions were completely inhibited by disodium cromoglycate. AU - Pepys J AU - Pickering CAC AU - Loudon HWG LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 2 IP - DP - 1972 Jan 01 TI - Asthma due to inhaled chemical fumes- aminoethylethanolamine in aluminium soldering flux PG - 197-204 AB - Three patients with asthma due to the fumes of aluminium soldering flux containing amino-ethyl ethanolamine were tested by occupational type exposures to the fumes of the flux and the amino-ethyl ethanoiamine. Typical late asthmatic reactions not inhibited by disodium cromoglycate were produced, one patient also giving an immediate asthmatic reaction which was inhibited by disodium cromoglycate. AU - Pepys J AU - Pickering CAC LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 1 IP - DP - 1972 Jan 01 TI - Bronchial reactivity in occupational asthma PG - 522-524 AU - Pain MCF AU - Symonds HS LA - PT - DEP - TA - Med J Aust JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 77 IP - DP - 1972 Jan 01 TI - Wood-pulp workers disease: a hypersensitivity pneumonitis caused by Alternaria PG - 907-914 AU - Schleuter DP AU - Fink JN AU - Hensley GT LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 50 IP - DP - 1972 Jan 01 TI - The chemistry and behaviour of fluxes PG - 133-137 AU - Rubin W AU - Allen BM LA - PT - DEP - TA - Trans Inst Metal Finishing JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 49 IP - DP - 1972 Jan 01 TI - Hypersensitivity pneumonitis due to contamination of home humidifier PG - 245-251 AU - Tourville DR AU - Weiss WI AU - Wertlake PT AU - Leudemann GM LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 27 IP - DP - 1972 Jan 01 TI - Byssinosis: a follow up study of workers exposed to fine grade cotton dust PG - 459-462 AU - Valic F AU - Zuskin E LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 219 IP - DP - 1972 Jan 01 TI - Polymer fume fever PG - 1587-1589 AU - Williams N AU - Smith FK LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 81 IP - DP - 1972 Jan 01 TI - Respiratory allergy caused by mother-of-pearl PG - 630-630 AU - Tas J LA - PT - DEP - TA - Ir J Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 11 IP - DP - 1972 Jan 01 TI - Contact dermatitis due to sensitivity to Cidex (activated glutaraldehyde) PG - 279-280 AU - Harman RRM AU - O'Grady KJ LA - PT - DEP - TA - Contact Dermatitis Newsletter JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 12 IP - DP - 1972 Jan 01 TI - Turpentine in eyeglasses PG - 309- AU - Jordon WP LA - PT - DEP - TA - Contact Dermatitis Newsletter JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 29 IP - DP - 1972 Jan 01 TI - Mortality of gas workers, final report of a prospective study PG - 394- AU - Doll R AU - Vessey MP AU - Beasley RWR AU - et al LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 72 IP - DP - 1972 Jan 01 TI - Combined alveolitis and asthma due to hexamethylene diisocyanate (HDI) with demonstration of crossed respiratory and immunologic reactivities to diphenylmethane diisocyanate (MDI) PG - 413-419 AB - A worker exposed intermittently to hexamethylene diisocyanate (HDI) developed episodes of dyspnea, wheezing, and fever on working days. Complete lung function tests performed when the subject was asymptomatic were normal except for increased airway responsiveness to histamine, which significantly improved after a 3 wk period off work. At that time, specific inhalation challenges with HDI were carried out. After being exposed for 5 min, the subject developed general malaise, cough, fever, and leukocytosis, together with a mixed restrictive and obstructive breathing defect. We demonstrated a subsequent increase in airway hyperexcitability, which lasted for 2 mo. The subject was also challenged with diphenylmethane diisocyanate (MDI) for 15 min. A late obstructive reaction was documented. Increased levels of specific IgG antibodies against HDI-human serum albumin (HSA) and MDI-HSA were demonstrated. AU - Malo JL AU - Ouimet G AU - Cartier A AU - Levitz D AU - Zeiss CR LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19720101 IS - IS - VI - 29 IP - DP - 1972 Jan 01 TI - Respiratory disease in foundrymen PG - 341-343 AB - Concern for the health of foundry workers has a long history, perhaps almost as long as the craft itself. Hunter (1969) comments that 'the founding of metal is an ancient craft, so ancient that, under the weight of tradition, both employers and workers have regarded the hot, dusty, and dangerous conditionsas inevitable; and industrial countries made no campaigns for better working conditions until about1930'. Apart from the general provisions of the Factories Acts, legislation specifically affecting iron and steel foundries is comparatively recent. Conditions in foundries in the United Kingdom have been the subject of reports by a series of committees over the last 25 years-iron in 1947, non-ferrous in 1957, and steel in 1961. McLaughlin (1950) studied mainly the radiographic abnormalities found in the lungs of iron and steel foundry workers. Pneumoconiosis is still a problem in these men and the recently published figures (Digest of Pneumoconiosis Statistics, 1970) show that in 1969 there were 48 new diagnoses of pneumoconiosis in foundry workers (iron, 35 men; steel, 11 men; non-ferrous, 2 men). The most recent investigation of the health of foundry workers is reported by Dr. T. A. Lloyd Davies, at the time the Senior Medical Inspector of Factories, and his medical colleagues. The enquiry was made at the request of the Sub-Committee on Surveys and Statistics of the Industrial Health Advisory Committee as it had been suggested that foundry workers had more chronic bronchitis than other comparable workers in industrial areas. The study was called for in 1963, begun in 1964, and completed in the middle of 1965. The full report went to the Industrial Health Advisory Committee in May 1968 but was not published until 1971. Advantage was taken of three new developments since earlier studies of respiratory disease in foundry workers. These are the use of standardized questions in the Medical Research Council Short Questionnaire on Respiratory Symptoms; standard ventilatory function tests; and observers trained in interviewing techniques. Furthermore, the important role of cigarette smoking as a factor in lung disease, and, in particular, in dust diseases of the lung was well recognized by the time the survey was planned. The survey was based on a 1 in 40 sample of the 130 000 people known to be employed in foundries. A total sample of 1 997 men was drawn randomly from four size ranges of foundries of four types of iron, steel, non-ferrous, and mixed. Men over 35 years of age were chosen to ensure that any factors in the foundry atmosphere would have had time to operate. In the event, 1780 foundry workers, 93 % of the eligible sample of men aged 35 to 64, were matched for age, height, and weight with 1 730 factory workers as controls. The controls were from engineering works of the same occupier of the foundry surveyed, or a near one. The only significant differences between these two groups were that the controls had about 3 % more smokers which therefore had to be allowed for in the comparison, and they were slightly less well off socio-economically. Although the authors refer to bronchitis from time to time, they have coined two new terms for chronic bronchial disease-sputum-breathlessness syndrome and sputum-chest illness syndrome. The first of these is defined as production of sputum for at least three months together with breathlessness grade ii (i.e., dyspnoea when walking on the level with others at an ordinary pace) or more. The sputum-chest illness syndrome is a combination of disabling chronic bronchitis with loss of work in which there is sputum for at least three months of the year plus one or more chest illnesses. These are rather unwieldy terms but they have the advantage that they are more descriptive and specific than chronic bronchitis. The sputum-breathlessness syndrome was significantly more prevalent in foundry workers than in controls but the difference disappeared when a correction for smoking was applied. The prevalence of sputum-chest illness syndrome, on the other hand, increases with years of employment in foundry work, and this increase was nearly double that recorded in men in the control factories. It was found more frequently in foundrymen than in controls in all the regions studied except one. This exception was explicable by the presence of four former foundrymen who had been transferred to the control factory because of sputum-chest illness syndrome. Prevalence of this syndrome increased with smoking in all the men studied, and the combination of foundry work ana smoking gave a higher prevalence for all grades of smoking. Men not exposed to foundry or any other dust who smoke 25 cigarettes a day have as much sputum-chest illness syndrome as those who have never smoked but have worked in a foundry for 45 years. The rates of sputum-chest illness syndrome in the different smoking groups suggested an additive rather than a synergistic effect. It is interesting that obstructive airways disease, although much more frequent in men with sputum-chest illness syndrome, did not seem to be associated with occupation. An unexpected finding was that men without the sputum-chest illness syndrome had a higher forced expiratory volume in 1 second (FEV1.0) than controls and higher than the predicted values. Lung function in foundrymen declines more quickly with age than in controls but they have high lung function values at age 35 years. This is not explained by self-selection of men with better physique, and pneumoconiosis is unlikely to be involved. Only simple pneumoconiosis was seen and this was found in 143 foundry floor men (14 1 %) and 62 fettlers (34 6%). The most advanced form of this (category 3) was seen in only one fettler (0 6%) and three foundry floor workers (0-3 %). These prevalence rates were applied to the whole foundry industry and it was calculated that between 2524 and 7767 foundrymen were potentially eligible for industrial injury benefit for pneumoconiosis. The discrepancy between the estimated number of pproximately 5 000 men with pneumoconiosis category 2 and 3 and the numbers recorded under the National Insurance (Industrial Injuries) Act is noted but not adequately explained. Although this survey took place in 1964-65 it does not appear to have influenced boardings as the average number of foundry workers in whom pneumoconiosis was diagnosed between 1966 and 1970 is only 47 per annum. This survey shows that in spite of regulations introduced to suppress dust in foundries the foundry environment is frequently unsatisfactory. Work in foundries is still notoriously dirty. As the young intending foundry worker is told when he reads about thiscareer choice (TheFoundry Industry, 1965), 'by contrast with the pattern shop which is invariably light and clean and sometimes air conditioned, the foundry itself looks less attractive. The sand commonly used is black and the workers, particularly the moulders, are apt to get somewhat dirty'. He is reassured, however, that the dirt will easily wash off in the shower baths which must be provided. But there is also heat which may be excessive, unavoidable noise, dust, and vibration. 'In fact, dust, smoke and fumes are inevitable by-products of many foundry processes...' but dust suppression or extraction and air filtration alleviate these nuisances to a great extent. In a booklet published in the Safety Health and Welfare Series 'Improving the Foundry Environment' (1962), it is pointed out that although in the past it has often been thought that efforts to keep a foundry clean were a waste of time because of the nature of the work, this idea was rejected as long ago as 1947 by the Joint Advisory Committee on Conditions in Iron Foundries. The booklet underlines the importance of proper standards of cleanliness in foundries and gives a detailed account of how to attain them. Dust measurements and analysis and their interpretation are described, but in reference to methods of dust suppression it is remarked that it is unfortunate that so few foundries are in a position to estimate the efficiency of such methods. The additional hazards from gases such as carbon monoxide, sulphur dioxide, chlorine, and complex fumes from core binders are referred to as well as particulate matter containing oxides of iron, lead, zinc, selenium, tellurium, beryllium, and phosphoric acid. Fumes also arise from fluxes and degassing materials in non-ferrous foundries, from shell moulding, organic solvents, and other materials. This is a well planned and carefully executed survey and as it is clearly important that foundry conditions should be improved it is a pity that publication has been so long delayed. The survey raises questions about the nature and extent of occupational hygiene in foundries and the kind of medical advice available for their workers. One wonders what efforts are being made by the industries concerned to eliminate the essentially dirty and smoky nature of the work and to introduce techniques which are cleaner. References Central Youth Employment Executive (1965). The Foundry Industry. Choice of Careers No. 19, 2nd ed., p. 39. H.M.S.O., London. Department of Trade and Industry (1972e. Digest ofPneumoconiosis Statistics 1970. H.M.S.O., London. Hunter, D. (1969). The Diseases of Occupations, 5th ed., p. 987. English Universities Press, London. Ministry of Labour (1962). Improving the Foundr,' Environment. Safety, Health and Welfare. New Series No. 17. H.M.S.O., London. Lloyd Davies, T. A. (1971). Respiratory Disease in Foundrymen, Report of a Survey. H.M.S.O., London. McLaughlin, A. I. G. (1950). Industrial Lung Diseases of Iron and Steel Foundry Workers. Ministry of Labour and National Service. H.M.S.O., London. AU - McCallum RI LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 4 IP - DP - 1971 Jan 01 TI - Specificity of Exercise in Exercise-induced Asthma PG - 577-581 AB - Ventilatory function after three types of exercise running, cycling, and swimming-was studied in 10 control subjects and 40 asthmatic patients. All performed eight minutes of submaximal aerobic exercise during each of the programmes, which were conducted in a randomly selected order. Biotelemetric monitoring of heart rates was used to equate the intensity of the exertion undertaken during the three systems of exercise. No control subject showed any significant variation in ventilatory capacity after exercise, and the responses after the three forms of exercise did not differ. In asthmatics exercise-induced asthma was observed after 72-5% of running tests, 65% of cycling tests, and 35% of swimming tests. In addition, those patients who developed exercise-induced asthma after swimming were noted to have significantly smaller falls in FEV, levels than were recorded after running and cycling. These results were statistically significant (P <0-01). The unexplained aetiology of increased airways resistance after exercise in asthmatics is discussed. This study indicates that swimming should be recommended in preference to running or cycling as an exercise programme for adults and children with asthma. AU - FITCH KD AU - MORTON AR LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 112 IP - DP - 1971 Jan 01 TI - Pneumoconiosis caused by inhalation of polyvinylchloride. [Hungarian] PG - 85-86 AU - Szende B AU - Lapis K AU - Pinter A AU - Nemes A AU - Tarjan E LA - PT - DEP - TA - Orv Hetil JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - Cmnd 4775 IP - DP - 1971 Jan 01 TI - Report of the enquiry into the medical and toxicological aspects of CS (ortho-chlorobenzylidene malanonitrile). Part 2. Enquiry into the toxicological aspects of CS and its use for civil purposes PG - - AU - Himsworth H AU - Black DAK AU - Crawford T AU - et al LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 32 IP - DP - 1971 Jan 01 TI - Allergic contact dermatitis due to cidex PG - 895-898 AU - Lyon TC LA - PT - DEP - TA - Oral Surgery JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 104 IP - DP - 1971 Jan 01 TI - The epidemiology of active tuberculosis in hospital employees in Ontario 1966-1969 PG - 851-860 AU - Ashley MJ AU - Wigle WD LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 28 IP - DP - 1971 Jan 01 TI - Studies on the aetiology of byssinosis PG - 143-151 AU - Taylor G AU - Massoud AAE AU - Lucas F LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 48 IP - DP - 1971 Jan 01 TI - Hypersensitivity pneumonitis related to a home furnace humidifier PG - 171-178 AU - Sweet LC AU - Anderson JA AU - Callies QC AU - Coates EO LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 31 IP - DP - 1971 Jan 01 TI - Stimulation of lung irritant receptors by cigarette smoke, carbon dust and histamine aerosol PG - 15-19 AU - Sellick H AU - Widdicombe JG LA - PT - DEP - TA - J Appl Physiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 1041 IP - DP - 1971 Jan 01 TI - Hazards to health: do it yourself polyurethane foam PG - 432-433 AU - Peters JM AU - Murphy RLH LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 66 IP - DP - 1971 Jan 01 TI - Thermoactinomyces sacchari species, a thermophilic actinomycete causing bagassosis PG - 327-338 AU - Lacey J LA - PT - DEP - TA - J Gen Microbiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 1 IP - DP - 1971 Jan 01 TI - Platinum sensitivity: treatment by specific hyposensitisation PG - 75-82 AB - An analytical chemist developed respiratory tract and cutaneous allergy to complex salts of platinum in the course of his work. Specific hyposensitization was achieved by means of intradermal injections of allergen given in increasing doses. During the course of injections he developed symptoms and signs suggestive of a serum-sickness reaction. The immunological significance of these phenomena was investigated AU - Levene GM AU - Calnan CD LA - PT - DEP - TA - Clin Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 104 IP - DP - 1971 Jan 01 TI - Respiratory symptoms and skin reactivity in workers exposed to proteolytic enzymes in the detergent industry PG - 1-12 AU - Mitchell CA AU - Gandevia B LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 62 IP - DP - 1971 Jan 01 TI - A case of allergic rhinitis and asthma from inhaling castor seed dust PG - 281-28* AU - Nava C AU - Alessio L LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 105 IP - DP - 1971 Jan 01 TI - Bronchial reactions to Western Red Cedar (Thuja plicata) PG - 56-61 AU - Chan-Yeung M AU - Barton GM AU - MacLean L AU - Grzybowski S LA - PT - DEP - TA - Can Med Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 155 IP - DP - 1971 Jan 01 TI - Studies on fungal pollution in bakeries PG - 52-55 AU - Charpin J AU - LauriolMallea M AU - Renard M AU - Charpin H LA - PT - DEP - TA - Bull Acad Natl Med (Parris) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 11 IP - DP - 1971 Jan 01 TI - A study of precipitating antibodies in allergy to Ephestia kuehniella PG - 257-263 AU - Cabanieu G AU - Bezian JH AU - MorichauBeauchant G AU - Capbern A AU - Pautrizel R LA - PT - DEP - TA - Rev Franc Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 74 IP - DP - 1971 Jan 01 TI - Interstitial pneumonitis due to hypersensitivity to an organism contaminating a heating system PG - 80-83 AU - Fink JN AU - Banaszak EF AU - Thiede WH AU - Barboriak JJ LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 23 IP - DP - 1971 Jan 01 TI - Clinical, roentgenologic and physiologic effects of acute chlorine exposure PG - 29-34 AU - Kaufman J AU - Burkons D LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 26 IP - DP - 1971 Jan 01 TI - A study of workers exposed to detergent enzymes PG - 425-433 AU - Weill H AU - Waddell LC AU - Ziskind M LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 47 IP - DP - 1971 Jan 01 TI - Clinical, immunologic, and physiologic observations in factory workers exposed to B. subtilis enzyme dust PG - 170-180 AU - Franz T AU - McMurrain KD AU - Brooks S AU - Bernstein IL LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19710101 IS - IS - VI - 49 IP - DP - 1971 Jan 01 TI - Enzyme allergy in populations exposed to long-term, low level concentrations of household laundry products PG - 219-237 AU - Bernstein IL LA - PT - DEP - TA - J Allergy Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 283 IP - DP - 1970 Jan 01 TI - Hypersensitivity pneumonitis due to contamination of an air-conditioner PG - 271-276 AU - Banaszak EF AU - Thiede WH AU - Fink JN LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 39 IP - DP - 1970 Jan 01 TI - The allergenicity of psyllium seed PG - 313-317 AU - Bernton HS LA - PT - DEP - TA - Med Annals District Colombia JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 10 IP - DP - 1970 Jan 01 TI - Desensitisation in hairdressers (lacqueur and colouring) PG - 327-331 AU - Blandin G LA - PT - DEP - TA - Rev Franc Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 10 IP - DP - 1970 Jan 01 TI - Desensibilisation chez des coiffeurs (laque et decolorant) PG - 327-331 AU - Blandin G LA - PT - DEP - TA - Rev Franc Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 27 IP - DP - 1970 Jan 01 TI - Occupational asthma and rhinitis due to Western red cedar (Thuja plicata), with special reference to bronchial reactivity PG - 235-244 AU - Gandevia B AU - Milne J LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 45 IP - DP - 1970 Jan 01 TI - Bronchial provocation tests in asthma PG - 221-22* AU - Aas K LA - PT - DEP - TA - Arch Dis Child JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 63 IP - DP - 1970 Jan 01 TI - Lung function in men engaged in the manufacture of TDI PG - 378-379 AU - Adams WGF LA - PT - DEP - TA - Proc R Soc Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 1 IP - DP - 1970 Jan 01 TI - An epidemiological study of workers producing washing powder PG - 689-693 AU - Newhouse ML AU - Tagg B AU - Pocock SJ AU - McEwan AC LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 2 IP - DP - 1970 Jan 01 TI - Survey of workers exposed to dusts containing derivatives of Bacillus subtilis PG - 629-633 AU - Greenberg M AU - Milne JF AU - Watt A LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 63 IP - DP - 1970 Jan 01 TI - A controlled study of workers handling organic diisocyanates PG - 375-376 AU - Hill RN LA - PT - DEP - TA - Proc R Soc Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 63 IP - DP - 1970 Jan 01 TI - Isocyanates, symposium on PG - 365-382 AU - LA - PT - DEP - TA - Proc R Soc Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 25 IP - DP - 1970 Jan 01 TI - Mushroom workers lung PG - 25-30 AU - Jackson E AU - Welch KMA LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - ii IP - DP - 1970 Jan 01 TI - Occupational asthma, part 1 PG - 332-335 AU - Gandevia B LA - PT - DEP - TA - Med J Aust JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 12 IP - DP - 1970 Jan 01 TI - A study of mortality, symptoms and respiratory function in humans occupationally exposed to oil mist PG - 253-261 AU - Ely TS AU - Pedley SF AU - Hearne FT AU - Stille WT LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - IP - DP - 1970 Jan 01 TI - Mushroom workers lung PG - - AU - Craig DB AU - Donevan RE LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 63 IP - DP - 1970 Jan 01 TI - Symptoms and lung function following acute and chronic exposure to TDI PG - 18-20 AU - McKerrow CB AU - Davies HJ AU - Parry Jones A LA - PT - DEP - TA - Proc R Soc Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - ii IP - DP - 1970 Jan 01 TI - A case of platinosis PG - 1194-1195 AU - Milne JEH LA - PT - DEP - TA - Med J Aust JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - ii IP - DP - 1970 Jan 01 TI - Occupational asthma due to Western or Canadian red cedar (Thuja plicata) PG - 233-235 AU - Mitchell C LA - PT - DEP - TA - Med J Aust JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 2 IP - DP - 1970 Jan 01 TI - Studies on antigenic substances in sericulture PG - 447-44* AU - Kobayashi S LA - PT - DEP - TA - Clin Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 73 IP - DP - 1970 Jan 01 TI - Pulmonary toxicity of isocyanates PG - 654-655 AU - Peters JM AU - Murphy RLH LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 20 IP - DP - 1970 Jan 01 TI - Respiratory impairment in workers exposed to "safe" levels of toluene diisocyanate PG - 364-367 AU - Peters JM AU - Murphy LH AU - Pagnotto LD AU - Whittenberger JL LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 25 IP - DP - 1970 Jan 01 TI - Furriers lung PG - 387-398 AU - Pimental JC LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 25 IP - DP - 1970 Jan 01 TI - Occupational and non-occupational respiratory allergy in bakers PG - 159-177 AU - Popa V AU - George SAL AU - Gavanescu O LA - PT - DEP - TA - Acta Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 25 IP - DP - 1970 Jan 01 TI - Coffee workers lung PG - 399-405 AU - van Toorn DW LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 27 IP - DP - 1970 Jan 01 TI - Teamakers asthma PG - 181-182 AU - Uragoda CG LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 100 IP - DP - 1970 Jan 01 TI - Cheeze washers asthma PG - 1108-1111 AU - Wuthrich B AU - Keiser G LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 30 IP - DP - 1970 Jan 01 TI - The state of the upper respiratory tract in formaldehyde production employees PG - 11-15 AU - Yefremov GG LA - PT - DEP - TA - Zh Ushn Nos Gorl Bolezn JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 27 IP - DP - 1970 Jan 01 TI - Bronchitis in two integrated steel works. 3. Respiratory symptoms and ventilatory capacity related to atmospheric pollution PG - 121-129 AU - Lowe CR AU - Campbell H AU - Khosla T LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 61 IP - DP - 1970 Jan 01 TI - A case of occupational allergy to tamarind flour PG - 447-451 AB - The paper reports the case of a worker preparing condensing pastes for the textile industry, who, while manipulating one such product containing tamarind-seed meal, complained suddenly of itching, erythema, palpebral oedema, weeping. The characteristics and the antecedant facts of the accident seemed to be indicative of a progressive sensitisation. The intradermic test with the allergenic extract of the substance confirmed that the subject was sensitised to tamarind meal, and did not present sensitisation to other substances. The possible occurance of allergic manifestations (cutaneous in the case described) induced by tamarind seed meal must be kept in mind for preventive purposes, considering the fact that such sustance is becoming more and more used in the textile industry. AU - Cirla AM AU - Nava C AU - Limonta A LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19700101 IS - IS - VI - 48 IP - DP - 1970 Jan 01 TI - Occupational rhinitis and bronchial asthma due to morphine: evidence from inhalational and nasal challenges. Occupational asthma caused by Papaver somniferum. [Professional diseases of the skin and respiratory organs in persons working in the production of several drugs]. PG - 99-101 AB - Nofer Institute of Occupational Medicine, Department of Occupational Diseases, Lodz, Poland. A case of occupational bronchial asthma due to morphine in a nonatopic 46-year-old woman is presented. The following diagnostic tests were used: a workplace trial with bronchodilator and placebo, and single-blind, placebo-controlled nasal and bronchial challenge with 0.5% morphine HCl. For the nasal challenge, four asthmatic patients were selected as a control group. The nasal washings were done before and 30 min, 3 h, 24 h, and 48 h after all challenges. In the nasal lavage fluid, the total numbers of eosinophils, neutrophils, basophils, and mast cells were counted, and, after the nasal challenge, total protein and albumin levels were measured. During the workplace trial, the PEF variability ratio increased from 5% to 38%. After the challenges, a decrease in the spirometric parameters (VC and FEV1) of about 30-40% was observed, with minimums at 24 and 48 h. An influx of granulocytes with an increase in the relative number of eosinophils and basophils from 3 h until 48 h after the challenge was observed in the nasal lavage fluid. The protein level in the nasal lavage fluid increased from 190 to 1275 microg/ml 24 h after the challenge with an increase of relative albumin level from 24% to 40% at 24 h. In the control group, no changes in relative number of basophils and eosinophils and albumin/total protein ratio in the nasal lavage fluid or in the spirometric parameters were observed after the challenge. AU - Alenina AN AU - Nikonets IF AU - Ivanova IS AU - Makarenko I LA - PT - DEP - TA - Klin Med (Mosk) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 12 IP - DP - 1969 Jan 01 TI - Bronchitis in two integrated steelworks. II. Sulphur dioxide and particulate atmospheric pollution in and around the two works PG - 151-170 AU - Warner CG AU - Davies GM AU - Jones JG AU - Lowe CR LA - PT - DEP - TA - Ann Occup Hyg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 1 IP - DP - 1969 Jan 01 TI - Industrial bronchitis PG - 463-468 AU - Lowe CR LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 99 IP - DP - 1969 Jan 01 TI - Late evaluation of pulmonary function after acute exposure to chlorine gas PG - 374-379 AU - Weil H AU - George R AU - Schwarz M AU - Ziskind M LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 30 IP - DP - 1969 Jan 01 TI - Asthma related to chromium compounds PG - 482-491 AU - Williams CD LA - PT - DEP - TA - North Carolina Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 24 IP - DP - 1969 Jan 01 TI - Cheese washers lung PG - 872-876 AU - Weck AL AU - Gutersohn J AU - Butikofer E LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 281 IP - DP - 1969 Jan 01 TI - Hypersensitivity to wood dust PG - 977-980 AU - Sosman AJ AU - Schlueter DP AU - Fink JN AU - Barboriak JJ LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 56 IP - DP - 1969 Jan 01 TI - Bronchial asthma and asthmatic bronchitis determined by simple chemicals PG - 395-404 AU - Popa V AU - Tecelescu D AU - Stanescu D AU - Gavrilescu N LA - PT - DEP - TA - Dis Chest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 26 IP - DP - 1969 Jan 01 TI - Ventilatory function in workers exposed to low levels of toluene diisocyanate: a six month follow up PG - 115-120 AU - Peters JM AU - Murphy RLH AU - Ferris BG LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - i IP - DP - 1969 Jan 01 TI - Allergic reactions of the lungs to enzymes of bacillus subtelis PG - 1181-1184 AU - Pepys J AU - Hargreave FE AU - Longbottom JL AU - Faux J LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 26 IP - DP - 1969 Jan 01 TI - Isocyanate hazard from wire insulation; an old hazard in a new guise PG - 79-81 AU - Paisley DPG LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 19 IP - DP - 1969 Jan 01 TI - Platinum and platinosis PG - 685-691 AU - Parrot JL AU - Hebert R AU - Saindelle A AU - Ruff F LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 15 IP - DP - 1969 Jan 01 TI - Incidence of the allergic manifestations and phenomena of pulmonary spastic syndrome in the workers exposed to flour and floury dust PG - 364-373 AU - Odavic M AU - Cvetanova VL LA - PT - DEP - TA - Allergie Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 58 IP - DP - 1969 Jan 01 TI - A case of bronchial asthma caused by spores of Lentinus edotes (Berk) sing PG - 405-409 AU - Shichijo K AU - Kondo T AU - Yamada M AU - Aoki M AU - Shimoyama K AU - Taya T LA - PT - DEP - TA - J Jap Soc Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 35 IP - DP - 1969 Jan 01 TI - Histamine release by sodium chlorplatinate PG - 313-321 AU - Saindelle A AU - Ruff F LA - PT - DEP - TA - Br J Pharmacol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 18 IP - DP - 1969 Jan 01 TI - A case of Cortinellus shiitake spore asthma PG - 81-85 AU - Kondo O LA - PT - DEP - TA - Jap J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 19 IP - DP - 1969 Jan 01 TI - Asthma and urticaria in a hairdresser using a persulphate bleach PG - 75-79 AU - Meindl K AU - Meyer R LA - PT - DEP - TA - Zbl Arbeitsmed JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 19 IP - DP - 1969 Jan 01 TI - Exposure to dust in the cottonseed oil extraction industry PG - 99-103 AU - Noweir MH AU - ElSadek Y AU - ElDakhakhny AA LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 9 IP - DP - 1969 Jan 01 TI - Asthma in agricultural workers PG - 49-59 AU - MorichauBeauchant G AU - Beeson C AU - Dajean J LA - PT - DEP - TA - Rev Franc Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 18 IP - DP - 1969 Jan 01 TI - Studies on bronchial asthma observed in culture oyster workers PG - 141-184 AU - Nakashima T LA - PT - DEP - TA - Hiroshima J Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 38 IP - DP - 1969 Jan 01 TI - Allergic alveolitis in maltworkers PG - *-* AU - Channell S AU - Blyth W AU - Lloyd M AU - Weir DM AU - Amos WMG AU - Littlewood AP AU - Riddle HFV AU - Grant IWB LA - PT - DEP - TA - QJM JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 26 IP - DP - 1969 Jan 01 TI - Effects in man and rabbits of inhalation of cotton dust or extracts of purified endotoxins PG - 314-321 AU - Cavagna G AU - Foa V AU - Vigliani EC LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - i IP - DP - 1969 Jan 01 TI - Pulmonary disease due to inhalation of derivatives of Bacillus subtelis containing proteolytic enzymes PG - 1177-1181 AU - Flindt MLH LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 26 IP - DP - 1969 Jan 01 TI - Circadian variation of FEV in shift workers PG - 121-125 AU - Guberan E AU - Williams MK AU - Walford J AU - Smith MM LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 4th editio IP - DP - 1969 Jan 01 TI - Paprika splitters lung PG - 1081-1081 AU - Hunter D LA - PT - DEP - TA - Diseases of Occupations JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 4 IP - DP - 1969 Jan 01 TI - Immunological investigation of individuals with toluene diisocyanate asthma PG - 585-596 AU - Avery SB AU - Stetson DM AU - Pan PM AU - Mathews KP LA - PT - DEP - TA - Clin Exp Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19690101 IS - IS - VI - 2 IP - DP - 1969 Jan 01 TI - Occupational asthma and rhinitis due to western (Canadian) red cedar (Thuja plicata) PG - 741-744 AU - Milne J AU - Gandevia B LA - PT - DEP - TA - Med J Aust JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 59 IP - DP - 1968 Jan 01 TI - Bronchial asthma from a diazonium salt PG - 463-466 AU - Armeli G LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 16 IP - DP - 1968 Jan 01 TI - A clinical and physiologic study of grain handlers PG - 380-384 AU - Kleinfield M AU - Messite J AU - Swencicki RE AU - Shapiro J LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 25 IP - DP - 1968 Jan 01 TI - Immunological aspects of bagassosis PG - 283-292 AU - Hearn CED AU - HolfordStevens V LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 25 IP - DP - 1968 Jan 01 TI - Bagassosis: an epidemiological, environmental and clinical survey PG - 267-282 AU - Hearn CED LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 42 IP - DP - 1968 Jan 01 TI - Respiratory allergy caused by platinum salts PG - 233-237 AU - Freedman SO AU - Krupey J LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 16 IP - DP - 1968 Jan 01 TI - Clinical and immunological appraisal of workers exposed to diisocyanates PG - 619-625 AU - Bruckner HC AU - Avery SB AU - Stetson DM AU - Dodson VN LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 39 IP - DP - 1968 Jan 01 TI - Allergic problems in screwworm fly eradication program personel PG - 1116-1119 AU - Dillie JR AU - Gibbons HL AU - Spikes GA LA - PT - DEP - TA - Clin Aviation Aerospace Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - IP - DP - 1968 Jan 01 TI - Thermal decomposition products of gum rosin PG - - AU - Melvin WW AU - Gray EB AU - Frazier AP LA - PT - DEP - TA - Project 68-12 Merkins drive San Antonia Texas JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 23 IP - DP - 1968 Jan 01 TI - An annual cycle in the ventilatory capacity of men with pneumoconiosis and of normal subjects PG - 340-349 AU - McKerrow CB AU - Rossiter CE LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - ii IP - DP - 1968 Jan 01 TI - Diffuse pulmonary fibrosis and blackfat tobacco smoking in Guyana PG - 259-25* AU - Millar GJ AU - Beadnell HMSG AU - Ashcroft LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 44 IP - DP - 1968 Jan 01 TI - Immediate type hypersensitivity to phenylmercuric compounds PG - 310-318 AU - Mathews KP LA - PT - DEP - TA - Am J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 25 IP - DP - 1968 Jan 01 TI - Allergenicity of piperazine: a study in environmental aetiology PG - 319-325 AU - McCullagh SF LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - ii IP - DP - 1968 Jan 01 TI - Inhibitory effects of sodium cromoglycate on allergen-inhalation tests PG - 134-137 AU - Pepys J AU - Chan M AU - Hargreave FE AU - McCarthy DS LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 16 IP - DP - 1968 Jan 01 TI - Acute respiratory effects in workers exposed to low levels of toluene diisocyanate PG - 642-647 AU - Peters JM AU - Murphy RLH AU - Pagnotto LD AU - van Ganse WF LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 34 IP - DP - 1968 Jan 01 TI - Toluene diisocyanate asthma PG - 27-29 AU - Sweet LC LA - PT - DEP - TA - Univ Michegan med Centre Bull JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 25 IP - DP - 1968 Jan 01 TI - Byssinosis, chronic bronchitis, and ventilatory capacities in workeers exposed to soft hemp dust PG - 176-17* AU - Valic F AU - Walford J AU - Kersic W AU - Paukovic R LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 22 IP - DP - 1968 Jan 01 TI - Bronchitis in two integrated steel works. I. Ventilatory capacity, age, and physique of non-bronchitic men PG - 1-11 AU - Lowe CR AU - Pelmear PL AU - Campbell H AU - Hitchens RA AU - Khosla T AU - King TC LA - PT - DEP - TA - British Journal of Preventive & Social Medicin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 3 IP - DP - 1968 Jan 01 TI - Glutaraldehyde and contact dermatitis PG - 802- AU - Sanderson KV AU - Cronin E LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 4 IP - DP - 1968 Jan 01 TI - Sensitivity to glutaraldehyde PG - 79-79 AU - Skog E LA - PT - DEP - TA - Contact Dermatitis Newsletter JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 20 IP - DP - 1968 Jan 01 TI - Cooperation of patients in the therapeutic plan. (Evaluation on personal material) PG - 211-218 AU - Zoric M AU - Jarebica M LA - PT - DEP - TA - Tuberkuloza JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 203 IP - DP - 1968 Jan 01 TI - Large intravenous dosage of thiamine PG - 175- AU - Pollit NT LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19680101 IS - IS - VI - 25 IP - DP - 1968 Jan 01 TI - Pneumoconiosis in Chromite Miners in South Africa PG - 63-67 AB - Ten chromite miners in South Africa have been found to show radiological evidence of a fine nodulation; ive of these miners had worked only in chromite mines. These cases occurred in a labour force of some I,500 persons subjected to regular examination. Clinical evidence and the esults of intratracheal injection of chromite suspension into rats indicate that the radiological changes are due not to fibrosis but to a benign deposition of chromite (Cr2O3FeO) dust in the lungs. AU - Sluis-Cremer GK AU - Du Toit RSJ LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 24 IP - DP - 1967 Jan 01 TI - Ventilatory function in relation to mining experience and smoking in a random sample of miners and non-miners in a Witwatersrand Town PG - 13-25 AU - SluisCremer GK AU - Walters LG AU - Sichel HS LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 24 IP - DP - 1967 Jan 01 TI - Chronic bronchitis in miners and non-miners: an epidemiological survey of a community in the gold-mining area in the Transvaal PG - 1-12 AU - SluisCremer GK AU - Walters LG AU - Sichel HS LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 14 IP - DP - 1967 Jan 01 TI - Effects of chlorine gas apon respiratory function PG - 545-558 AU - Kowitz TA AU - Reba RC AU - Parker RT AU - Spicer WS LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 3 IP - DP - 1967 Jan 01 TI - Acro-osteolysis occurring in men engaged in the polymerization of vinyl chloride PG - 712-714 AU - Harris DK AU - Adams WG LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 66 IP - DP - 1967 Jan 01 TI - The association of progressive systemic sclerosis (scleroderma) with coal miners' pneumoconiosis and other forms of silicosis PG - 323-334 AU - Rodnan GP AU - Benedek TG AU - Medsger TA Jr AU - Cammarata RJ LA - PT - DEP - TA - Ann Intern Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 39 IP - DP - 1967 Jan 01 TI - Occupational asthma following inhalation of moth particles PG - 274-283 AU - Stevenson DD AU - Mathews KP LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 22 IP - DP - 1967 Jan 01 TI - Asthma due to aluminium soldering flux PG - 533-537 AU - Sterling GM LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 16 IP - DP - 1967 Jan 01 TI - Clinical observation of bronchial asthma in culture oyster workers PG - 255-266 AU - Wada S AU - Nishimoto Y AU - Nakashima T AU - Shigenobu T AU - Onari K AU - Awaya M LA - PT - DEP - TA - Hiroshima J Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 14 IP - DP - 1967 Jan 01 TI - Human responses to controlled vanadium pentoxide exposure PG - 709-712 AU - Zenz C AU - Berg BA LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 39 IP - DP - 1967 Jan 01 TI - Inhalation sensitisation to trypsin PG - 11-16 AU - Zweiman B AU - Green G AU - Mayock RL AU - Hildreth EA LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 7 IP - DP - 1967 Jan 01 TI - Occupational asthma from protein hormones in the pharmaceutical industry PG - 153-160 AU - Pilat L AU - Popa V AU - Tecoulesco D LA - PT - DEP - TA - Rev Franc Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 22 IP - DP - 1967 Jan 01 TI - Weavers asthma PG - 39-46 AU - Pilat L AU - Popa V AU - Stanescu D AU - Teculescu D LA - PT - DEP - TA - Acta Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - iii IP - DP - 1967 Jan 01 TI - Mushroom workers lung PG - 708-710 AU - Sakula A LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 22 IP - DP - 1967 Jan 01 TI - Allergic alveolitis in a maltworker PG - 478-478 AU - Riddle HFU AU - Grant IWB LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 7 IP - DP - 1967 Jan 01 TI - Sericin allergy in hairdressers PG - 193-202 AU - Sidi E AU - Gervais P AU - BourgeoisSpinasse J AU - Gervais A AU - Morault A AU - Planat P LA - PT - DEP - TA - Rev Franc Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 9 IP - DP - 1967 Jan 01 TI - Nickel, a review of its occupational health aspects PG - 127-136 AU - Mastromatteo E LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 12 IP - DP - 1967 Jan 01 TI - Schwartzman reaction in endotoxin-resistant rabbits induced by heterologous endotoxin PG - 445-453 AU - Kovats TG AU - Vegh P LA - PT - DEP - TA - Immunology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 24 IP - DP - 1967 Jan 01 TI - Pulmonary hypersensitivity to the grain weevil PG - 158-161 AU - Lunn JA AU - Hughes DTD LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 22 IP - DP - 1967 Jan 01 TI - Hypersensitivity to pituitary snuff with miliary shadowing in the lungs PG - 13-20 AU - Manon WE AU - Scott DJ AU - Ansell G AU - Manson GL AU - Fraser R LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 9 IP - DP - 1967 Jan 01 TI - Extrinsic asthma in a tungsten carbide worker PG - 518-519 AU - Bruckner HC LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 104 IP - DP - 1967 Jan 01 TI - Une cause nouvelle d'allergie professionnelle chez les coiffeuses: l'allergie a la sericine PG - 169-170 AU - Charpin J AU - Blanc M LA - PT - DEP - TA - Marseille Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 104 IP - DP - 1967 Jan 01 TI - A new cause of occupational asthma in a hairdresser, allergy to seracin PG - 169-170 AU - Charpin J AU - Blanc M LA - PT - DEP - TA - Marseille Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 97 IP - DP - 1967 Jan 01 TI - A study of pulmonary function among Indians and assessment of the Wright peak flow meter in relation to spirometry for field use PG - 707-716 AU - Kamat SR AU - Thiruvengadam KV AU - Rao TL LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19670101 IS - IS - VI - 13 IP - DP - 1967 Jan 01 TI - Peptone as as inhalation allergen PG - 185-186 AU - Bohm KH LA - PT - DEP - TA - Allergy Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - ii IP - DP - 1966 Jan 01 TI - Precipitins against extracts of thatched roofs in the sera of New Guinea natives with chronic lung disease PG - 1396-139* AU - Blackburn CRB AU - Green W LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - IP - DP - 1966 Jan 01 TI - Chromium PG - - AU - Hueper WC LA - PT - DEP - TA - Occ Env Cancers Resp JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 133 IP - DP - 1966 Jan 01 TI - Role of antibodies in reactions to gram negative bacterial endotoxins PG - 727-745 AU - Kim YB AU - Watson DW LA - PT - DEP - TA - Ann N Y Acad Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 15 IP - DP - 1966 Jan 01 TI - Inhalative asthma in the lumber processors PG - 60-6* AU - Katsutani T AU - Jyo T AU - Otsuka T LA - PT - DEP - TA - Jap J Allergology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 86 IP - DP - 1966 Jan 01 TI - L'asthma bronchiale allergica come malatta professionale PG - 176-181 AU - Introna F LA - PT - DEP - TA - Minerva Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 27 IP - DP - 1966 Jan 01 TI - Conditions provoked by platinum compounds PG - 877-886 AU - Hebert R LA - PT - DEP - TA - Arch Mal Prof JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 22 IP - DP - 1966 Jan 01 TI - Occupational asthma in the fat bodies industry PG - 513-521 AU - Charpin J AU - Zafiropoulo A AU - Luccioni R LA - PT - DEP - TA - Pneumon Coer JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 8 IP - DP - 1966 Jan 01 TI - Asthma in a precision casting worker PG - 326-328 AU - Dodson VN AU - Rosenblatt EC LA - PT - DEP - TA - J Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 23 IP - DP - 1966 Jan 01 TI - Millworkers asrhma: allergic responses to the grain weevil (Sitophilus granarius) PG - 149-152 AU - Lunn JA LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 27 IP - DP - 1966 Jan 01 TI - Human response to low concentrations of p p-diphenylmethane diisocyanate (MDI) PG - 121-127 AU - Konzen RB AU - Craft BF AU - Scheel LD AU - Gorski CH LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 4 IP - DP - 1966 Jan 01 TI - Four cases with asthma caused by silk inhalation PG - 159-162 AU - Matsumura T AU - Tateno K AU - Yugami S AU - Kimura T LA - PT - DEP - TA - J Asthma Res JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 1 IP - DP - 1966 Jan 01 TI - An iatrogenic autoantibody: immunological responses to pituitary snuff in patients with diabetes insipidus PG - 377-389 AU - Pepys J AU - Jenkins PA AU - Lachmann PJ AU - Mahon WE LA - PT - DEP - TA - Clin Exp Immunol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 15 IP - DP - 1966 Jan 01 TI - A case of bronchial asthma caused by dust of Ho (Mongolia hypoleuca sieb et zucc) tree under occupational exposure PG - 633-634 AU - Wada S AU - Nishimoto Y AU - Nakashima T AU - Yamakido M LA - PT - DEP - TA - Jap J Allergology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 22 IP - DP - 1966 Jan 01 TI - Occupational respiratory allergy to oleaginous seeds PG - 523-527 AU - Tabart J LA - PT - DEP - TA - Poumon Coeur JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 19 IP - DP - 1966 Jan 01 TI - Allergic manifestations in castor oil factory workers in Ljubljana PG - 65-71 AU - Spoujitch V AU - Stern P AU - Banic ST AU - Bonac I AU - Milosevic D AU - Cernelec D AU - Fetich J AU - Kartin P AU - Brnovic A AU - Janezic A AU - Kocijancic K AU - Cvoriscec B AU - Grom D LA - PT - DEP - TA - Glas Srp Akad Nauka (Med) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 24 IP - DP - 1966 Jan 01 TI - Symptoms among chilli grinders PG - 162-164 AU - Uragoda CG LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 47 IP - DP - 1966 Jan 01 TI - Tuberculosis among immigrants to England and wales; a national survey in 1965 PG - 145-156 AU - British Tuberculosis Association LA - PT - DEP - TA - Tubercle JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 57 IP - DP - 1966 Jan 01 TI - Sensitising effect of an extract of tamarind seeds used in sizing in weaving PG - 241-248 AB - The author reports the results of a study in the weaving department of a wool factory, where some case of bronchitis and asthma had occurred; these were related to the use of a size made of flour of tamarind seeds. It was possible to demonstrate that 9 workers (about 1% of the workers of the department) presented asthmatic attecks every time they went back to work. Out of these 9 workers, 8 presented intradermoreaction to extracts obtained both from the size and from the tamarind seed; this demonstrates an allergic reaction to substances present in the seeds. The sensitising substance seems to be contained in a polysaccharide fraction extractable by boiling. AU - Cavagna G LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 24 IP - DP - 1966 Jan 01 TI - The cocoa bean and the allergic child PG - 484-491 AU - Fries JH LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19660101 IS - IS - VI - 81 IP - DP - 1966 Jan 01 TI - Fatal Hydrogen Sulfide Intoxication. Report of Three Cases occurring in a Sewer PG - 375-380 AB - 3 fatal cases of H2S gassing in a sewer are described, 2 of the 3 occurring in men attempting to rescue the first. At autopsy an unusual greenish discoloration of the skin, blood and brain were noted. As it is known that neither sulphaemoglobin nor sulphmethaemoglobin is formed in the blood of the victims of H2S poisoning, it is conjectured that some loose combination of H2S and haemoglobin must have occurred to produce these findings AU - Adelson AU - L AU - Sunshine I LA - PT - DEP - TA - Arch. Pathol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19650101 IS - IS - VI - 58 IP - DP - 1965 Jan 01 TI - The Environment and Disease: Association or Causation? PG - 295-300 AB - Amongst the objects of this newly-founded Section of Occupational Medicine and firstly ‘to provide a means, not readily afforded elsewhere, whereby physicians and surgeons with a special knowledge of the relationship between sickness and injury and conditions of work may discuss their problems, not only with each other, but also with colleagues in other fields, by holding joint meetings with other Sections of the Society’; and secondly, ‘to make available information about the physical, chemical and psychological hazards of occupation, and in particular about those that are rare or not easily recognized’. At this first meeting of the Section and before, with however laudable intentions, we set about instructing our colleagues in other fields, it will be proper to consider a problem fundamental to our own. How in the first place do we detect these relationships between sickness, injury and conditions of work? How do we determine what are physical, chemical and psychological hazards of occupation, and in particular those that are rare and not easily recognized? There are, of course, instances in which we can reasonably answer these questions from the general body of medical knowledge. A particular, and perhaps extreme, physical environment cannot fail to be harmful; a particular chemical is known to be toxic to man and therefore suspect on the factory floor. Sometimes, alternatively, we may be able to consider what might a particular environment do to man, and then see whether such consequences are indeed to be found. But more often than not we have no such guidance, no such means of proceeding; more often than not we are dependent upon our observation and enumeration of defined events for which we then seek antecedents. In other words we see that the event B is associated with the environmental feature A, that, to take a specific example, some form of respiratory illness is associated with a dust in the environment. In what circumstances can we pass from this observed association to a verdict of causation? Upon what basis should be proceed to do so? I have no wish, nor the skill, to embark upon philosophical discussion of the meaning of ‘causation’. The ‘cause’ of illness may be immediate and direct; it may be remote and indirect underlying the observed association. But with the aims of occupational, and almost synonymous preventive, medicine in mind the decisive question is where the frequency of the undesirable event B will be influenced by a change in the environmental feature A. How such a change exerts that influence may call for a great deal of research, However, before deducing ‘causation’ and taking action we shall not invariably have to sit around awaiting the results of the research. The whole chain may have to be unraveled or a few links may suffice. It will depend upon circumstances. Disregarding then any such problem in semantics we have this situation. Our observations reveal an association between two variables, perfectly clear-cut and beyond what we would care to attribute to the play of chance. What aspects of that association should we especially consider before deciding that the most likely interpretation of it is causation? (1) Strength. First upon my list I would put the strength of the association. To take a very old example, by comparing the occupations of patients with scrotal cancer with the occupations of patients presenting with other diseases, Percival Pott could reach a correct conclusion because of the enormous increase of scrotal cancer in the chimney sweeps. ‘Even as late as the second decade of the twentieth century’, writes Richard Doll (1964), ‘the mortality of chimney sweeps from scrotal cancer was some 200 times that of workers who were not specially exposed to tar or mineral oils and in the eighteenth century the relative difference is likely to have been much greater.’ To take a more modern and more general example upon which I have now reflected for over fifteen years, prospective inquiries into smoking have shown that the death rate from cancer of the lung in cigarette smokers is nine to ten times the rate in non-smokers and the rate in heavy cigarette smokers is twenty to thirty times as great. On the other hand the death rate from coronary thrombosis in smokers is no more than twice, possibly less, the death rate in non-smokers. Though there is good evidence to support causation it is surely much easier in this case to think of some feature of life that may go hand-in-hand with smoking – features that might conceivably be the real underlying cause or, at the least, an important contributor, whether it be lack of exercise, nature of diet or other factors. But to explain the pronounced excess of cancer of the lung in any other environmental terms requires some feature of life so intimately linked with cigarette smoking and with the amount of smoking that such a feature should be easily detectable. If we cannot detect it or reasonably infer a specific one, then in such circumstances I think we are reasonably entitled to reject the vague contention of the armchair critic ‘you can’t prove it, there may be such a feature’. Certainly in this situation I would reject the argument sometimes advanced that what matters is the absolute difference between the death rates of our various groups and not the ratio of one to the other. That depends upon what we want to know. If we want to know how many extra deaths from cancer of the lung will take place through smoking (i.e. presuming causation), then obviously we must use the absolute differences between the death rates – 0.07 per 1,000 per year in nonsmoking doctors, 0.57 in those smoking 1-14 and 2.27 for 25 or more daily. But it does not follow here, or in more specifically occupational problems, that this best measure of the effect upon mortality is also the best measure in relation to etiology. In this respect the ratios of 8, 20 and 32 to 1 are far more informative. It does not, of course, follow that the differences revealed by ratios are of any practical importance. Maybe they are, maybe they are not; but that is another point altogether. We may recall John Snow’s classic analysis of the opening weeks of the cholera epidemic of 1854 (Snow 1855). The death rate that he recorded in the customs supplied with the grossly polluted water of the Southwark and Vauxhall Company was in truth quite low – 71 deaths in each 10,000 houses. What stands out vividly is the fact that the small rate is 14 times the figure of 5 deaths per 10,000 houses supplied with the sewage free water of the Lambeth Company. In thus putting emphasis upon the strength of an association we must, nevertheless, look at the obverse of the coin. We must not be too ready to dismiss a cause and effect hypothesis merely on the grounds that the observed association appears to be slight. There are many occasions in medicine when this is in truth so. Relatively few persons harboring the meningococcus fall sick of the meningococcal meningitis. Relatively few persons occupationally exposed to rat’s urine contract Weill’s disease. (2) Consistency: Next on my list of features to be specially considered I would place the consistency of the observed association. Has it been repeatedly observed by different persons, in different places, circumstances and times? This requirement may be of special importance for those rare hazards singled out in the section’s terms of reference. With many alert minds at work in the industry today many an environmental association may be thrown up. Some of them on the customary tests of statistical significance will appear to be unlikely to be due to chance. Nevertheless whether chance is the explanation or whether a true hazard has been revealed may sometimes be answered only by a repetition of the circumstances and the observations. Returning to my more general example, the Advisory Committee to the Surgeon-General of the United States Public Health Service found the association of smoking with cancer of the lung in 29 retrospective and 7 prospective inquiries (US Department of Health, Education and Welfare 1964). The lesson here is that broadly the same answer has been reached in quite a wide variety of situations and techniques. In other words, we can justifiably infer that the association is not due to some constant error or fallacy that permeates every inquiry. And we have indeed to be on our guards against that. Take, for instance, an example given by Heady (1958). Patients admitted to hospital for operation for peptic ulcer are questioned about recent domestic anxieties or crises that may have precipitated the acute illness. As controls, patients admitted for operation for a simple hernia are similarly quizzed. But, as Heady points out, the two groups may not be in pari materia. If your wife ran off with the lodger last week you still have to take your perforated ulcer to hospital without delay. But with a hernia you might prefer to stay at home for a while – to mourn (or celebrate) the event. No number of exact repetitions would remove or necessarily reveal that fallacy. We have, therefore, the somewhat paradoxical position that the different results of a different inquiry certainly cannot be held to refute the original evidence; yet the same results from precisely the same form of inquiry will not invariably greatly strengthen the original evidence. I would myself put a good deal of weight upon similar results reached in quite different ways, e.g. prospectively and retrospectively. Once again looking at the obverse of the coin there will be occasions when repetition is absent or impossible and yet we should not hesitate to draw conclusions. The experience of the nickel refiners of South Wales is an outstanding example. I quote from the Alfred Watson Memorial Lecture that I gave in 1962 to the Institute of Actuaries: ‘The population at risk, workers and pensioners, numbered about one thousand. During the ten years 1929 to 1938, sixteen of them had died from cancer of the nasal sinuses. At the age specific death rates of England and Wales at that time, one might have anticipated one death from cancer of the lung (to compare with the 16), and a fraction of a death from cancer of the nose (to compare with the 11). In all other bodily sites cancer had appeared on the death certificate 11 times and one would have expected it to do so 10 – 11 times. There had been 67 deaths from all other causes of mortality and over the ten years’ period 72 would have been expected at the national death rates. Finally division of the population at risk in relation to their jobs showed that the excess of cancer of the lung and nose had fallen wholly upon the workers employed in the chemical processes. ‘More recently my colleague, Dr. Richard Doll, has brought this story a stage further. In the nine years 1948 to 1956 there had been, he found, 48 deaths from cancer of the lung and 13 deaths from cancer of the nose. He assessed the numbers expected at normal rates of mortality as, respectively 10 to 0.1. ‘In 1923, long before any special hazard had been recognized, certain changes in the refinery took place. No case of cancer of the nose has been observed in any man who first entered the works after that year, and in these men there has been no excess of cancer of the lung. In other words, the excess in both sites is uniquely a feature in men who entered the refinery in, roughly, the first 23 years of the present century. ‘No causal agent of these neoplasms has been identified. Until recently no animal experimentation had given any clue or any support to this wholly statistical evidence. Yet I wonder if any of us would hesitate to accept it as proof of a grave industrial hazard?’ (Hill 1962). In relation to my present discussion I know of no parallel investigation. We have (or certainly had) to make up our minds on a unique event; and there is no difficulty in doing so. (3) Specificity: One reason, needless to say, is the specificity of the association, the third characteristic which invariably we must consider. If as here, the association is limited to specific workers and to particular sites and types of disease and there is no association between the work and other modes of dying, then clearly that is a strong argument in favor of causation. We must not, however, over-emphasize the importance of the characteristic. Even in my present example there is a cause and effect relationship with two different sites of cancer – the lung and the nose. Milk as a carrier of infection and, in that sense, the cause of disease can produce such a disparate galaxy as scarlet fever, diptheria, tuberculosis, undulant fever, sore throat, dysentary and typhoid fever. Before the discovery of the underlying factor, the bacterial origin of disease, harm would have been done by pushing too firmly the need for specificity as a necessary feature before convicting the dairy. Coming to modern time the prospective investigations of smoking and cancer of the lung have been criticized for not showing specificity – in other words the death rate of smokers is higher than the death rate of non-smokers from many causes of death (though in fact the results of Doll and Hill, 1964, do not show that). But here surely one must return to my first characteristics, the strength of the association. If other causes of death are raised 10, 20 or even 50% in smokers whereas cancer of the lung is raised 900 – 1000% we have specificity – a specificity in the magnitude of the association. We must also keep in mind that diseases may have more than one cause. It has always been possible to acquire a cancer of the scrotum without sweeping chimneys of taking to mulespinning in Lancashire. One-to-one relationships are not frequent. Indeed I believe that multi-causation is generally more likely than single causation though possibly if we knew all the answer we might get back to a single factor. In short, if specificity exists we may be able to draw conclusions without hesitation; if it is not apparent, we are not thereby necessarily left sitting irresolutely on the fence. (4) Temporality: My fourth characteristic is the temporal relationship of the association – which is the cart and which is the horse? This is a question which might be particularly relevant with diseases of slow development. Does a particular diet lead to disease or do the early stages of the disease lead to those particular dietetic habits? Does a particular occupation or occupational environment promote infection by the tubercle bacillus or are the men and women who select that kind of work more liable to contract tuberculosis whatever the environment – or, indeed, have they already contracted it? This temporal problem may not arise often, but it certainly needs to be remembered, particularly with selective factors at work in the industry. (5) Biological gradient: Fifthly, if the association is one which can reveal a biological gradient, or dose-response curve, then we should look most carefully for such evidence. For instance, the fact that the death rate from cancer of the lung rises linearly with the number of cigarettes smoked daily, adds a very great deal to the simpler evidence that cigarette smokers have a higher death rate than non-smokers. The comparison would be weakened, though not necessarily destroyed, if it depended upon, say, a much heavier death rate in light smokers and a lower rate in heavier smokers. We should then need to envisage some much more complex relationship to satisfy the cause and effect hypothesis. The clear dose-response curve admits of a simple explanation and obviously puts the case in a clearer light. The same would clearly be true of an alleged dust hazard in industry. The dustier the environment the greater the incidence of disease we would expect to see. Often the difficulty is to secure some satisfactory quantitative measures of the environment which will permit us to explore this dose-response. But we should invariably seek it. (6) Plausibility: It will be helpful if the causation we suspect is biologically plausible. But this is a feature I am convinced we cannot demand. What is biologically plausible depends upon the biological knowledge of the day. To quote again from my Alfred Watson Memorial Lecture (Hill 1962), there was ‘…no biological knowledge to support (or to refute) Pott’s observation in the 18th century of the excess of cancer in chimney sweeps. It was lack of biological knowledge in the 19th that led to a prize essayist writing on the value and the fallacy of statistics to conclude, amongst other “absurd” associations, that “it could be no more ridiculous for the strange who passed the night in the steerage of an emigrant ship to ascribe the typhus, which he there contracted, to the vermin with which bodies of the sick might be infected.” And coming to nearer times, in the 20th century there was no biological knowledge to support the evidence against rubella.’ In short, the association we observe may be one new to science or medicine and we must not dismiss it too light-heartedly as just too odd. As Sherlock Holmes advised Dr. Watson, ‘when you have eliminated the impossible, whatever remains, however improbable, must be the truth.’ (7) Coherence: On the other hand the cause-and-effect interpretation of our data should not seriously conflict with the generally known facts of the natural history and biology of the disease – in the expression of the Advisory Committee to the Surgeon-General it should have coherence. Thus in the discussion of lung cancer the Committee finds its association with cigarette smoking coherent with the temporal rise that has taken place in the two variables over the last generation and with the sex difference in mortality – features that might well apply in an occupational problem. The known urban/rural ratio of lung cancer mortality does not detract from coherence, nor the restriction of the effect to the lung. Personally, I regard as greatly contributing to coherence the histopathological evidence from the bronchial epithelium of smokers and the isolation from cigarette smoke of factors carcinogenic for the skin of laboratory animals. Nevertheless, while such laboratory evidence can enormously strengthen the hypothesis and, indeed, may determine the actual causative agents, the lack of such evidence cannot nullify the epidemiological associations in man. Arsenic can undoubtedly cause cancer of the skin in man but it has never been possible to demonstrate such an effect on any other animal. In a wider field John Snow’s epidemiological observations on the conveyance of cholera by water from the Broad Street Pump would have been put almost beyond dispute if Robert Koch had been then around to isolate the vibrio from the baby’s nappies, the well itself and the gentleman in delicate health from Brighton. Yet the fact that Koch’s work was to be awaited another thirty years did not really weaken the epidemiological case though it made it more difficult to establish against the criticisms of the day – both just and unjust. (8) Experiment: Occasionally it is possible to appeal to experimental, or semi-experimental, evidence. For example, because of an observed association some preventive action is taken. Does it in fact prevent? The dust in the workshop is reduced, lubricating oils are changed, persons stop smoking cigarettes. Is the frequency of the associated events affected? Here the strongest support for the causation hypothesis may be revealed. (9) Analogy: In some circumstances it would be fair to judge by analogy. With the effects of thalidomide and rubella before us we would surely be ready to accept slighter but similar evidence with another drug or another viral disease in pregnancy. Here then are nine different viewpoints from all of which we should study association before we cry causation. What I do not believe – and this has been suggested – that we can usefully lay down some hard-and-fast rules of evidence that must be obeyed before we can accept cause and effect. None of my nine viewpoints can bring indisputable evidence for or against the cause-and-effect hypothesis and none can be required as a sine qua non. What they can do, with greater or less strength, is to help us to make up our minds on the fundamental question – is there any other way of explaining the set of facts before us, is there any other answer equally, or more, likely than cause and effect? Tests of Significance No formal tests of significance can answer those questions. Such tests can, and should, remind us of the effects that the play of chance can create, and they will instruct us in the likely magnitude of those effects. Beyond that they contribute nothing to the ‘proof’ of our hypothesis. Nearly forty years ago, amongst the studies of occupational health that I made for the Industrial Health Research Board of the Medical Research Council was one that concerned the workers in the cotton-spinning mills of Lancashire (Hill 1930). The question that I had to answer, by the use of the National Health Insurance records of that time, was this: Do the workers in the cardroom of the spinning mill, who tend the machines that clean the raw cotton, have a sickness experience in any way different from that of the other operatives in the same mills who are relatively unexposed to the dust and fibre that were features of the card room? The answer was an unqualified ‘Yes’. From age 30 to age 60 the cardroom workers suffered over three times as much from respiratory causes of illness whereas from non-respiratory causes their experience was not different from that of the other workers. This pronounced difference with the respiratory causes was derived not from abnormally long periods of sickness but rather from an excessive number of repeated absences from work of the cardroom workers. All this has rightly passed into the limbo of forgotten things. What interests me today is this: My results were set out for men and women separately and for half a dozen age groups in 36 tables. So there were plenty of sums. Yet I cannot find that anywhere I thought it necessary to use a test of significance. The evidence was so clear cut, the differences between the groups were mainly so large, the contrast between respiratory and non-respiratory causes of illness so specific, that no formal tests could really contribute anything of value to the argument. So why use them? Would we think or act that way today? I rather doubt it. Between the two world wars there was a strong case for emphasizing to the clinician and other research workers the importance of not overlooking the effects of the play of chance upon their data. Perhaps too often generalities were based upon two men and a laboratory dog while the treatment of choice was deducted from a difference between two bedfuls of patients and might easily have no true meaning. It was therefore a useful corrective for statisticians to stress, and to teach the needs for, tests of significance merely to serve as guides to caution before drawing a conclusion, before inflating the particular to the general. I wonder whether the pendulum has not swung too far – not only with the attentive pupils but even with the statisticians themselves. To decline to draw conclusions without standard errors can surely be just as silly? Fortunately I believe we have not yet gone so far as our friends in the USA where, I am told, some editors of journals will return an article because tests of significance have not been applied. Yet there are innumerable situations in which they are totally unnecessary – because the difference is grotesquely obvious, because it is negligible, or because, whether it be formally significant or not, it is too small to be of any practical importance. What is worse the glitter of the t table diverts attention from the inadequacies of the fare. Only a tithe, and an unknown tithe, of the factory personnel volunteer for some procedure or interview, 20% of patients treated in some particular way are lost to sight, 30% of a randomly-drawn sample are never contracted. The sample may, indeed, be akin to that of the man who, according to Swift, ‘had a mind to sell his house and carried a piece of brick in his pocket, which he showed as a pattern to encourage purchasers.’ The writer, the editor and the reader are unmoved. The magic formulae are there. Of course I exaggerate. Yet too often I suspect we waste a deal of time, we grasp the shadow and lose the substance, we weaken our capacity to interpret the data and to take reasonable decisions whatever the value of P. And far too often we deduce ‘no difference’ from ‘no significant difference.’ Like fire, the chi-squared test is an excellent servant and a bad master. The Case for Action Finally, in passing from association to causation I believe in ‘real life’ we shall have to consider what flows from that decision. On scientific grounds we should do no such thing. The evidence is there to be judged on its merits and the judgment (in that sense) should be utterly independent of what hangs upon it – or who hangs because of it. But in another and more practical sense we may surely ask what is involved in our decision. In occupational medicine our object is usually to take action. If this be operative cause and that be deleterious effect, then we shall wish to intervene to abolish or reduce death or disease. While that is a commendable ambition, it almost inevitably leads us to introduce differential standards before we convict. Thus on relatively slight evidence we might decide to restrict the use of a drug for early-morning sickness in pregnant women. If we are wrong in deducing causation from association no great harm will be done. The good lady and the pharmaceutical industry will doubtless survive. On fair evidence we might take action on what appears to be an occupational hazard, e.g. we might change from a probably carcinogenic oil to a non-carcinogenic oil in a limited environment and without too much injustice if we are wrong. But we should need very strong evidence before we made people burn a fuel in their homes that they do not like or stop smoking the cigarettes and eating the fats and sugar that they do like. In asking for very strong evidence I would, however, repeat emphatically that this does not imply crossing every ‘t’, and swords with every critic, before we act. All scientific work is incomplete – whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us a freedom to ignore the knowledge we already have, or to postpone the action that it appears to demand at a given time. Who knows, asked Robert Browning, but the world may end tonight? True, but on available evidence most of us make ready to commute on 8:30 the next day. AU - Bradford Hill A LA - PT - DEP - TA - Proc R Soc Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19650101 IS - IS - VI - 20 IP - DP - 1965 Jan 01 TI - Penicillin hypersensitivity and haemagglutinating antibodies in workers at a penicillin factory PG - 206-214 AU - Rudski E AU - Lukasiak B AU - Leszczynski W LA - PT - DEP - TA - Acta Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19650101 IS - IS - VI - 20 IP - DP - 1965 Jan 01 TI - Mechanism of bronchoconstriction during inhalation of sulphur dioxide PG - 164-167 AB - Inhalation of SO2 (4–6 ppm) for 10 min decreased airway conductance (increased airway resistance) in seven healthy subjects. Subcutaneous injection of atropine prevented this effect. In anesthetized, paralyzed, artifically ventilated cats, SO2 increased pulmonary resistance, whether delivered to the upper or to the lower airways. This was prevented by complete cold block of the cervical vagosympathetic nerves or by injecting atropine intravenously before the SO2 was inhaled. These results establish the reflex nature of bronchoconstriction during inhalation of SO2. 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Specificity of pyrogenic tolerance and the role of hypersensitivity in pyrogenicity, lethality and skin reactivity PG - 425-446 AU - Watson DW AU - Kim YB LA - PT - DEP - TA - J Exp Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19630101 IS - IS - VI - i IP - DP - 1963 Jan 01 TI - Airway resistance and peak expiratory flow-rate in smokers and non-smokers PG - 1237-1238 AU - Zamel N AU - Youssef HH AU - Prime FJ LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19630101 IS - IS - VI - 9 IP - DP - 1963 Jan 01 TI - Asthma, bronchitis and rhinitis from working with lycopodium, allergy in the gum industry PG - 360-367 AU - Rebohle E LA - PT - DEP - TA - Allergie Asthma JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19630101 IS - IS - VI - 18 IP - DP - 1963 Jan 01 TI - Sensitivity to deer scurf PG - 168-169 AU - MunroAshman D AU - Frankland AW LA - PT - DEP - TA - Acta Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19630101 IS - IS - VI - 268 IP - DP - 1963 Jan 01 TI - TDI toxicity PG - 353-357 AU - Brugsch HG AU - Elkins HB LA - PT - DEP - TA - N Engl J Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19630101 IS - IS - VI - 20 IP - DP - 1963 Jan 01 TI - Studies on ventilatory capacity and histamine response during exposure to isocyanate vapour in polyurethane foam manufacture PG - 204-209 AU - Gandevia B LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19630101 IS - IS - VI - 34 IP - DP - 1963 Jan 01 TI - Respiratory allergy due to chemical compounds encountered in the rubber, lacquer, shellac and beauty culture industries PG - 374-381 AU - Gelfand HH LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19630101 IS - IS - VI - 18 IP - DP - 1963 Jan 01 TI - Allergy to ACTH of animal and human origin PG - 462-470 AU - Forssman O AU - Korsgren M AU - Nordh B AU - Paulsen F LA - PT - DEP - TA - Acta Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19630101 IS - IS - VI - 157 IP - DP - 1963 Jan 01 TI - Localisation et signification biologique de la substance provoquant des accidents allergiques chez les personnes exposees a un contact prolonge avec les grand Acridiens (Locusta migratoria) PG - 2299-2300 AU - Joly P LA - PT - DEP - TA - Comptes Rendus des Seances de la Societe de Biolog JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19630101 IS - IS - VI - 6 IP - DP - 1963 Jan 01 TI - A respiratory disease study of industrial groups PG - 9-* AU - Holland WW LA - PT - DEP - TA - Arch Environ Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19630101 IS - IS - VI - 88 IP - DP - 1963 Jan 01 TI - Response to a respiratory survey PG - 596-602 AU - Anderson DO AU - Zickmantel R AU - Ferris BG LA - PT - DEP - TA - Can Med Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19630101 IS - IS - VI - 20 IP - DP - 1963 Jan 01 TI - Byssinosis prevalence and flax processing PG - 320-323 AU - Bouhuys A AU - Hartogensis F AU - Korfage HJH LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19630101 IS - IS - VI - 20 IP - DP - 1963 Jan 01 TI - Aluminium pneumoconiosis. 1. in vitro comparison of stamped aluminium powders containing different lubricating agents and a granular aluminium powder PG - 264-267 AB - AU - Corrin B LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19630101 IS - IS - VI - 88 IP - DP - 1963 Jan 01 TI - Acute interstitial pulmonary fibrosis caused by a smoke bomb PG - 36-39 AU - Milliken JA AU - Waugh D AU - Kadish ME LA - PT - DEP - TA - Can Med Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19620101 IS - IS - VI - 86 IP - DP - 1962 Jan 01 TI - The prevalence of chronic bronchitis in an industrial population PG - 47-4* AU - Brinkman GL AU - Coates EO LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19620101 IS - IS - VI - 266 IP - DP - 1962 Jan 01 TI - Thesaurosis due to inhalation of hair spray PG - 750-750 AU - Bergmann M AU - Flance IJ AU - Cruz PT AU - Klam N AU - Aronson PR AU - Joshi RA AU - Blumenthal HT LA - PT - DEP - TA - NEJM JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19620101 IS - IS - VI - 19 IP - DP - 1962 Jan 01 TI - Hard metal disease PG - 239-252 AB - In Great Britain there have been no published reports of respiratory disease occurring amongst workers in the hard metal (tungsten carbide) industry. In this paper the clinical and radiological findings in six cases and the pathological findings in one are described. In two cases physiological studies indicated mild alveolar diffusion defects. Histological examination in a fatal case revealed diffuse pulmonary interstitial fibrosis with marked peribronchial and perivascular fibrosis and bronchial epithelial hyperplasia and metaplasia. Radiological surveys revealed the sporadic occurrence and low incidence of the disease. The alterations in respiratory mechanics which occurred in two workers following a day's exposure to dust are described. Airborne dust concentrations are given. The industrial process is outlined and the literature is reviewed. The toxicity of the metals is discussed, and our findings are compared with those reported from Europe and the United States. We are of the opinion that the changes which we would describe as hard metal disease are caused by the inhalation of dust at work and that the component responsible may be cobalt. AU - Bech AO AU - Kipling MD AU - Heather JC LA - PT - DEP - TA - Brit J Industr Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19620101 IS - IS - VI - 20 IP - DP - 1962 Jan 01 TI - Changes during 24 hours in the lung function and histamine hyperreactivity of the bronchial tree in asthmatics and bronchitic patients PG - 93-101 AU - de Vries K AU - Goei JT AU - BooijNoord H AU - Orie NGM LA - PT - DEP - TA - Int Arch Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19620101 IS - IS - VI - 19 IP - DP - 1962 Jan 01 TI - Some pharmacological actions of cotton dust and other vegetable dusts PG - 33-3* AU - Nicholls PJ LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19610101 IS - IS - VI - 18 IP - DP - 1961 Jan 01 TI - The role of bacterial endotoxins in occupational diseases caused by inhaling vegetable dusts PG - 120-129 AU - Pernis B AU - Vigliani EC AU - Cavagna C AU - Finulli M LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19610101 IS - IS - VI - 19 IP - DP - 1961 Jan 01 TI - Bronchial asthma due to organic phosphate insecticides PG - 397-401 AU - Weiner A LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19610101 IS - IS - VI - 84 IP - DP - 1961 Jan 01 TI - Allergy to raw coffee- an occupational disease PG - 469-471 AU - Kaye M AU - Freedman SO LA - PT - DEP - TA - Can Med Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19610101 IS - IS - VI - IP - DP - 1961 Jan 01 TI - The host factor in bronchitis PG - 43-59 AU - Orie NGM AU - Sluiter HJ AU - de Vries K AU - Tammeling GJ AU - Witkop J LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19610101 IS - IS - VI - 28 IP - DP - 1961 Jan 01 TI - BCG vaccination against tuberculosis in Chicago, a 20 year study statistically analyzed PG - 622-641 AU - Rosenthal SR AU - Loewinsohn E AU - Graham ML AU - et al LA - PT - DEP - TA - Paediatrics JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19610101 IS - IS - VI - 42 IP - DP - 1961 Jan 01 TI - Four cases of syringe-transmitted tuberculosis PG - 25-27 AU - Heycock JB AU - Noble TC LA - PT - DEP - TA - Tubercle JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19610101 IS - IS - VI - 18 IP - DP - 1961 Jan 01 TI - Pulmonary fibrosis in workers exposed to finely powdered aluminium PG - 10-23 AB - Of 30 workmen at risk 27 were examined and 6 found to have evidence of pulmonary fibrosis. In the two fatal cases the evidence for pulmonary fibrosis was conclusive and in three other cases it was sufficient; in one case it was suggestive. The clinical radiological and pathological features of these six cases are recorded. Results of respiratory function tests on the four non-fatal cases are given. The manufacturing process is described. An analysis of the powder is given, also the results of dust measurement in the contaminated atmosphere. The literarure is reviewed and our own experience compared with reports from Germany and Canada. We concluded that the pulmonary fibrosis was caused by the dust inhaled at work and that the component responsible was finely divbided aluminium. AU - MITCHELL J AU - MANNING GB AU - MOLYNEUX M AU - LANE RE LA - PT - DEP - TA - British Journal of Industrial Medicine JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19610101 IS - IS - VI - 18 IP - DP - 1961 Jan 01 TI - Chronic pulmonary berylliosis in a female chemist PG - 133-142 AB - A chronic progressive granulomatous disease of the lungs is described in a female chemist who worked for about two years with a beryllium compound in the manufacture of fluorescent lighting tubes. The level of beryllium in the laboratory atmosphere was found to be 2-7 ,ug. per cu.m. and in other parts of the factory up to 391 ,ug. per cu.m. were recorded. Symptoms began about two years after she left this work and she died three years later. A diagnosis of chronic pulmonary berylliosis was made, and confirmation was obtained by lung biopsy when early in the course of the disease a large cyst attached to the right middle lobe was removed by thoracotomy. Tests of lung function showed that there was a low arterial saturation at rest and a normal Pco2 in spite of marked hyperventilation. Both elastance and resistance of the lungs were greater than normal and total work of breathing was six times the normal. Pregnancy was associated with relief of symptoms which persisted for some months after a normal birth. Death occurred about seven years after exposure to beryllium ceased. At necropsy beryllium was detected in the lungs chemically and demonstrated in histological sections by special stains. Microscopic examination of the lung showed conchoidal bodies and doubly refractile crystals and the pathogenesis of these lesions is discussed. It is suggested that there is a sensitivity reaction to beryllium, which is probably combined with protein to form an antigen, and that the breakdown of necrotic foci provokes a further reaction in the lung with the repeated appearance of fresh lesions. AU - MCCALLUM RI AU - RANNIE E AU - VERITY C LA - PT - DEP - TA - Br J Ind Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19600101 IS - IS - VI - 80 IP - DP - 1960 Jan 01 TI - Asthma-like disease among Norwegian aluminium plant wotkers PG - 796-797 AU - Bruusgaard A LA - PT - DEP - TA - Tidsskr Nor Laegeforen JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19600101 IS - IS - VI - IP - DP - 1960 Jan 01 TI - Klinische Grundlagen der sechsundvierzig meldepflichtigen Berufskrankheiten PG - 197-202 AU - Baader EW LA - PT - DEP - TA - Pub Urban & Schwarzenberg (Munchen) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19600101 IS - IS - VI - 21 IP - DP - 1960 Jan 01 TI - Feather pluckers disease: duck fever PG - 67-69 AU - Plessner MM LA - PT - DEP - TA - Arch Mal Prof JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19600101 IS - IS - VI - 17 IP - DP - 1960 Jan 01 TI - A clinical and environmental study of byssinosis in the Lancashire cotton industry PG - 1-9 AU - Roach SA AU - Schilling RSF LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19600101 IS - IS - VI - 25 IP - DP - 1960 Jan 01 TI - Bronchial asthma in the aluminium industry PG - 208-221 AU - Midttun O LA - PT - DEP - TA - Acta Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19590101 IS - IS - VI - 42 IP - DP - 1959 Jan 01 TI - Oxidation of resin acids in wood chips PG - 867-869 AU - Lawrence RV LA - PT - DEP - TA - TAPPI JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19590101 IS - IS - VI - 30 IP - DP - 1959 Jan 01 TI - Allergy in fur workers with special reference to paraphenylenediamine PG - 11-18 AU - Silberman DE AU - Sorrell AH LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19590101 IS - IS - VI - 27 IP - DP - 1959 Jan 01 TI - Febrile gruppenerkrankungen in einer Modellschreinerei durch Inhalation von mit Schimmelpilzen kontaminierien Befeuchterwasser (Befeuchterfieber) PG - 710-713 AU - Pestalozzi C LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19590101 IS - IS - VI - 20 IP - DP - 1959 Jan 01 TI - Industrial hygiene experiences with toluene diisocyanate PG - 204-20* AU - Walworth HT AU - Virchow WE LA - PT - DEP - TA - Am Ind Hyg Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19590101 IS - IS - VI - ii IP - DP - 1959 Jan 01 TI - Maximum forced expiratory flow rate as a measure of ventilatory capacity with a description of a new portable instrument for measuring it PG - 1041-1047 AU - Wright BM AU - McKerrow CB LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19590101 IS - IS - VI - 171 IP - DP - 1959 Jan 01 TI - Respiratory disease in mushroom workers PG - 101-104 AU - Bringhurst LS AU - Byrne RN AU - GershonCohen J AU - Chester W LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19590101 IS - IS - VI - * IP - DP - 1959 Jan 01 TI - respiratory allergy to flax PG - 423-425 AU - Charpin J AU - Blanc M AU - Laspalles F LA - PT - DEP - TA - Unknown JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19590101 IS - IS - VI - 14 IP - DP - 1959 Jan 01 TI - Occupational diseases among workers in the bulb industries PG - 338-355 AU - Van der Werff PJ LA - PT - DEP - TA - Acta Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19590101 IS - IS - VI - 2 IP - DP - 1959 Jan 01 TI - BCG and Vole bacillus vaccines in the prevention of tuberculosis in adolescents PG - 379-396 AU - Medical Research Council LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19590101 IS - IS - VI - 14 IP - DP - 1959 Jan 01 TI - Ciba guest symposium. Terminology, definitions and classifications of chronic pulmonary emphysema and related conditions PG - 286-299 AU - Ciba guest symposium LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19580101 IS - IS - VI - 13 IP - DP - 1958 Jan 01 TI - BRONCHIOLITIS FROM NITROUS FUMES PG - 327-333 AB - Two patients are described who suffered from bronchiolitis following the inhalation of nitrous fumes. In one instance, death occurred 14 days after exposure from a generalized obliterative bronchiolitis. The other patient recovered completely after a period of intense dyspnoea and cyanosis. A brief account is given of some of the known occupational hazards. In view of the extensive use of nitric acid in industry, it seems likely that accidents will continue to occur. AU - DARKE CS AU - Warrack AJN LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19580101 IS - IS - VI - 149 IP - DP - 1958 Jan 01 TI - The appearances and histological structure of the cuticle of the desert locust- Schistocerca gregaria PG - 557-570 AU - Malek SRA LA - PT - DEP - TA - Proc R Soc Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19580101 IS - IS - VI - 15 IP - DP - 1958 Jan 01 TI - Respiratory function during the day in cotton workers- a study in byssinosis PG - 75-83 AU - McKerrow CB AU - McDermott M AU - Gilson JC AU - Schilling RSF LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19570101 IS - IS - VI - 18 IP - DP - 1957 Jan 01 TI - Irritation and respiratory allergy in spray painters using chrome yellow PG - 248-24* AU - Marechal MJ LA - PT - DEP - TA - Arch Mal Prof JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19570101 IS - IS - VI - 40 IP - DP - 1957 Jan 01 TI - Contributo allo studio delle alterazion dell' apparato respiratoria nel cromismo professiomale PG - 100-10* AB - deseo antecedentes sobre los efectos del cromo en las vias respiratorias de trabajadores de la galvanoplastia. AU - Lerza P LA - PT - DEP - TA - Folia Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19570101 IS - IS - VI - 28 IP - DP - 1957 Jan 01 TI - Bronchial asthma due to silk PG - 325-327 AU - Weiner A AU - Lawn F LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19570101 IS - IS - VI - 15 IP - DP - 1957 Jan 01 TI - Hazards of isocyanates in polyurethane foam plastic production PG - 324-330 AU - Zapp JA LA - PT - DEP - TA - A M A Arch Industr Health JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19570101 IS - IS - VI - 14 IP - DP - 1957 Jan 01 TI - An investigation into the acute respiratory reaction to the inhalation of tamarind seed preparations PG - 250-252 AU - Tuffnell PG AU - DingwallFordyce I LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19570101 IS - IS - VI - 11 IP - DP - 1957 Jan 01 TI - Allergy to coffee PG - 150-154 AU - Bruun E LA - PT - DEP - TA - Acta Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19570101 IS - IS - VI - ii IP - DP - 1957 Jan 01 TI - Respiratory symptoms, bronchitis and ventilatory capacity in a random sample of an agricultural population PG - 1198-1203 AU - Higgins ITT LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19570101 IS - IS - VI - 14 IP - DP - 1957 Jan 01 TI - An outbreak of weavers cough associated with tamarind seed powder PG - 105-110 AB - It has been established that an ususual and widespread outbreak of cough and dyspnoea occured among weavers of viscose yarn, in which tamarind seed kernal powder had been used as a sizing agent. The condition appeared to be a reaction to a constituent of the size. The preservatives (fungicides) are unlikely to have been responsible. They were originally suspected by the importers and were left out of subsequent deliveries, without any apparent change in effect. A fungus or other organism is also unlikely to have been the activating agent, as fungicides were present in the material which first produced symptoms and no undue concentration of fungae was detected in the atmosphere of the weaving shed. AU - Murray R AU - Dingwall-Fordyce I AU - Lane RE LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19570101 IS - IS - VI - 36 IP - DP - 1957 Jan 01 TI - A standardised breath holding technique for the clinical measurement of diffusing capacity of the lung for carbon monoxide PG - 1-17 AU - Ogilvie CM AU - Forster RE AU - Blakemore WS AU - Morton JW LA - PT - DEP - TA - J Clin Invest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19560101 IS - IS - VI - 25 IP - DP - 1956 Jan 01 TI - Asthmatic syndrome following exposure to tolylene diisocyanate PG - 540-543 AU - Woodbury JW LA - PT - DEP - TA - Ind Med Surg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19560101 IS - IS - VI - 27 IP - DP - 1956 Jan 01 TI - Asthma and rhinitis from insect antigens PG - 437-444 AU - Feinberg AR AU - Feinberg SM AU - BenaimPinto C LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19560101 IS - IS - VI - ii IP - DP - 1956 Jan 01 TI - Byssinosis in cotton and other textile workers PG - 261,319-261,319 AU - Schilling RSF LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19550101 IS - IS - VI - 12 IP - DP - 1955 Jan 01 TI - An epidemiological study of byssinosis among Lancashire cotton workers PG - 217-21* AU - Schilling RSF AU - Hughes JPW AU - DingwallFordyce I AU - Gilson JL LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19550101 IS - IS - VI - 80 IP - DP - 1955 Jan 01 TI - Gesundheitsschaden durch neuartige Lacke und Schaumstoffe PG - 1661-1663 AU - Schurmann D LA - PT - DEP - TA - Deutsche Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19550101 IS - IS - VI - 7 IP - DP - 1955 Jan 01 TI - An outbreak of bronchial asthma in South Africa affecting more than 200 persons caused by castor bean dust from an oil-processing factory PG - 10-24 AU - Ordman D LA - PT - DEP - TA - Int Arch Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19550101 IS - IS - VI - 12 IP - DP - 1955 Jan 01 TI - Injury to the respiratory tract by isocyanates used in making lacquers PG - 50-53 AU - Swensson A AU - Holmquist C AU - Lundgren K LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19550101 IS - IS - VI - 12 IP - DP - 1955 Jan 01 TI - Vanadium poisoning from gas turbines PG - 57-59 AU - Browne RC LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19550101 IS - IS - VI - 12 IP - DP - 1955 Jan 01 TI - Vanadium poisoning from gas turbines PG - 57-59 AU - Browne RC LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19550101 IS - IS - VI - 71 IP - DP - 1955 Jan 01 TI - Observations on an epidemic of cutaneous and lymphatic tuberculosis which followed the use of anti-typhoid vaccine PG - 465-472 AU - Masashi T AU - Ogawa G AU - Sagawa I AU - Amano S LA - PT - DEP - TA - Am Rev Respir Dis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19550101 IS - IS - VI - 9 IP - DP - 1955 Jan 01 TI - Uber die Inhaltssoffe von Makore und Peroba-Holz sofie ihre gesundheitsschadigende PG - 112-117 AU - Sandermann W AU - Barghoorn AW LA - PT - DEP - TA - Wirkung Holzforschung JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19540101 IS - IS - VI - 7 IP - DP - 1954 Jan 01 TI - Rape pollen allergen: report of a case PG - 367-369 AU - Colldahl H LA - PT - DEP - TA - Acta Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19540101 IS - IS - VI - 45 IP - DP - 1954 Jan 01 TI - Study of an epidemic of bronchial asthma in cotton weavers PG - 349-378 AU - Vigliani EC AU - Parmeggiani L AU - sassi C LA - PT - DEP - TA - Med Lav JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19530101 IS - IS - VI - 11 IP - DP - 1953 Jan 01 TI - Locust sensitivity PG - 445-453 AU - Frankland AW LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19530101 IS - IS - VI - 10 IP - DP - 1953 Jan 01 TI - Health problems in the manufacture and use of plastics PG - 255-267 AU - Harris DK LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19530101 IS - IS - VI - 248 IP - DP - 1953 Jan 01 TI - Tuberculosis: incidence among American medical students, prevention and control and the use of BCG PG - 722-729 AU - Abruzzi WA AU - Hummel RJ LA - PT - DEP - TA - NEJM JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19520101 IS - IS - VI - 66 IP - DP - 1952 Jan 01 TI - Incidence of pulmonary tuberculosis among employees of tuberculosis hospitals PG - 16-27 AU - Mikol EX AU - Horton R AU - Lincoln NS AU - Stokes AM LA - PT - DEP - TA - Am Rev Tuberc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19520101 IS - IS - VI - i IP - DP - 1952 Jan 01 TI - An interpretation of statistical trends in tuberculosis PG - 521-524 AU - Springett VH LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19520101 IS - IS - VI - ii IP - DP - 1952 Jan 01 TI - Printers asthma PG - 755-757 AU - Fowler PBS LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19520101 IS - IS - VI - 3 IP - DP - 1952 Jan 01 TI - The late bronchial reaction in induced asthma PG - 323-328 AU - Herxheimer H LA - PT - DEP - TA - Int Arch Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19520101 IS - IS - VI - 9 IP - DP - 1952 Jan 01 TI - Vanadium poisoning from cleaning oil-fired boilers PG - 50-55 AU - Williams N LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19520101 IS - IS - VI - 23 IP - DP - 1952 Jan 01 TI - Increasing castor bean allergy in Southern California due to fertiliser PG - 406-415 AU - Small WS LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19520101 IS - IS - VI - XIV, ch XX IP - DP - 1952 Jan 01 TI - Naturalis historica PG - 77-7* AU - Pliny LA - PT - DEP - TA - pub Heineman London JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19520101 IS - IS - VI - 86 IP - DP - 1952 Jan 01 TI - Palladium complexes part V. Reaction of palladium compounds with 2:2' dipyridyl PG - 32-37 AU - Livingstone SE LA - PT - DEP - TA - J Proc Roy Soc New South Wales JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19520101 IS - IS - VI - 26 IP - DP - 1952 Jan 01 TI - Asthma and dermatitis caused by chlorplatinic acid PG - 8-9 AU - Marshall J LA - PT - DEP - TA - S Afr Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19510101 IS - IS - VI - 1 IP - DP - 1951 Jan 01 TI - A report of asthma due to inhalation of Amorphophalus powder PG - 29-2* AU - Shichijo K AU - Tanaka S AU - Kotani A AU - Sako T AU - Hasegawa S AU - Takahashi K AU - Ogawa E AU - Matsushima T LA - PT - DEP - TA - Kitakanto Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19510101 IS - IS - VI - 4 IP - DP - 1951 Jan 01 TI - Platinosis PG - 549-559 AU - Roberts EA LA - PT - DEP - TA - Arch Industr Hyg Occup Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19510101 IS - IS - VI - 9 IP - DP - 1951 Jan 01 TI - The mushroom fly as a cause of bronchial asthma PG - 513-516 AU - Truitt GW LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19510101 IS - IS - VI - 20 IP - DP - 1951 Jan 01 TI - Occupational cancer and other health hazards in a chromate plant: a medical appraisal ii. clinical and toxicologic aspects PG - 393-407 AU - Mancuso TF LA - PT - DEP - TA - Ind Med Surg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19510101 IS - IS - VI - 4 IP - DP - 1951 Jan 01 TI - Lycopodium allergy PG - 308-319 AU - Salen E LA - PT - DEP - TA - Acta Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19510101 IS - IS - VI - 2 IP - DP - 1951 Jan 01 TI - Bronchial obstruction induced by allergen, histamine and acetyl-beta-methylcholine chloride PG - 27-39 AU - Herxheimer H LA - PT - DEP - TA - Int Arch Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19510101 IS - IS - VI - i IP - DP - 1951 Jan 01 TI - Induced asthma in man PG - 1337-1341 AU - Herxheimer H LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19510101 IS - IS - VI - 22 IP - DP - 1951 Jan 01 TI - Bronchial asthma, urticaria and allergic rhinitis from tannic acid PG - 494-499 AU - Johnston TG AU - Cazort AG AU - Marvin HN AU - Pringle RB AU - Sheldon JM LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19510101 IS - IS - VI - 12 IP - DP - 1951 Jan 01 TI - Clinical and experimental studies on cases of poisoning with Desmodur T (toluene diisocyanate 1-2-4 and 1-2-6) PG - 191-200 AU - Fuchs S AU - Valade P LA - PT - DEP - TA - Arch Mal Prof JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19510101 IS - IS - VI - ii IP - DP - 1951 Jan 01 TI - Polymer fume fever PG - 1008-1011 AU - Harris DK LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19510101 IS - IS - VI - 20 IP - DP - 1951 Jan 01 TI - Clinical experience with exposure to ethylene amines PG - 541-546 AU - Dernehl CU LA - PT - DEP - TA - Industr Med and Surg JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19510101 IS - IS - VI - 146 IP - DP - 1951 Jan 01 TI - Occupational tuberculosis in hospital and sanatorium personnel PG - 1188-1190 AU - Childress WG LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19510101 IS - IS - VI - 21 IP - DP - 1951 Jan 01 TI - The multiple puncture tuberculin test PG - 151-153 AU - Heaf F LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19500101 IS - IS - VI - 21 IP - DP - 1950 Jan 01 TI - Castor bean: an industrial hazard as a contaminant of green coffee dust and used hurlap bags PG - 545-54* AU - Figley KD AU - Rawling FA LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19500101 IS - IS - VI - 238 suppl IP - DP - 1950 Jan 01 TI - Vanadium pentoxide dust PG - 1-* AU - Sloberg SG LA - PT - DEP - TA - Acta Med Scand JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19500101 IS - IS - VI - 7 IP - DP - 1950 Jan 01 TI - Byssinosis PG - 52-56 AU - Schilling RSF LA - PT - DEP - TA - Brit Med Bulletin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19500101 IS - IS - VI - 7 IP - DP - 1950 Jan 01 TI - Skin cancer in the engineering industry from the use of mineral oil PG - 1-11 AB - 1. Examination of machine operators at their jobs in three factories has shown that their skins become grossly contaminated with cutting oils. As an early result 80 per cant. of the workers become afflicted with oil folliculitis. 2. In addition, those workers who have been exposed for long periods to cutting oils have on their arms multiple hyperkeratotic lesions, 60 per cent of those who have been exposed for more than 15 years being affected. 3. A case of scrotal carcinoma in a machine operator from one of the firms has been described. 4. An investigation of the records of the United Birmingham Hospitals has revealed that during the last 10 years, 34 cases of scrotal cancer occurred. Of these, 6 occurred in machine operators and 6 in other workers exposed to oil in the engineering industry; 13 occurred in workers exposed to tar, pitch, etc.; the remaining 9 could not be allocated to any definite category. 5. Biological tests showed that a sample of the cutting oil in use in one of the machine shops was capable of producing benign tumours on rabbits. 6. The significance of these findings is discussed, and the existence of a hazard of skin cancer for certain workers exposed to oil in the engineering industry is indicated. 7. Measures for the protection of machine operators are reviewed. AU - Cruickshank CND AU - Squire JR LA - PT - DEP - TA - Br J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19490101 IS - IS - VI - 7 IP - DP - 1949 Jan 01 TI - Bronchial asthma caused by the inhalation of wood dust PG - 492-496,505 AU - Ordman J LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19490101 IS - IS - VI - 23 IP - DP - 1949 Jan 01 TI - Wood dust as an inhalent allergen. Bronchial asthma caused by Kejaat wood (Pterocarpus anglolensis) PG - 973-975 AU - Ordman D LA - PT - DEP - TA - S Afr Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19490101 IS - IS - VI - 22 IP - DP - 1949 Jan 01 TI - Industrial fluorosis. A study of the hazard to man and animals near Fort William, Scotland PG - - AU - Medical Research Council LA - PT - DEP - TA - MRC Memorandum JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19490101 IS - IS - VI - 109 IP - DP - 1949 Jan 01 TI - Respiratory recording of asthmatic attacks induced and terminated artificially PG - 4P-5P AU - Herxheimer H LA - PT - DEP - TA - J Physiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19480101 IS - IS - VI - 1 IP - DP - 1948 Jan 01 TI - Allergic examination of bakers and millers PG - 283-296 AU - Castberg T LA - PT - DEP - TA - Acta Allergol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19480101 IS - IS - VI - 162 IP - DP - 1948 Jan 01 TI - Properties of ethylene diamine PG - 960-960 AU - BoasRraube SG AU - Dresel EM AU - Dryden ICC LA - PT - DEP - TA - Nature JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19480101 IS - IS - VI - IP - DP - 1948 Jan 01 TI - Tuberculosis in young adults - Report of the Prophit Tuberculosis survey 1935-1948 PG - - AU - Daniels M AU - Ridehalgh F AU - Springett VH LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19470101 IS - IS - VI - 37 IP - DP - 1947 Jan 01 TI - Air circulant et air captif dans l'exploration de la fonction ventilatrice pulmonaire PG - 624-628 AU - Tiffeneau R AU - Pinelli A LA - PT - DEP - TA - Paris Medical JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19470101 IS - IS - VI - 18 IP - DP - 1947 Jan 01 TI - Allergy (asthma) to ingested gum tragacanth PG - 214-216 AU - Brown EB AU - Crepea SB LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19470101 IS - IS - VI - 5 IP - DP - 1947 Jan 01 TI - The allergens in mill dust: asthma in millers, farmers and others PG - 519-525 AU - JimenezDiaz C AU - Lanoz C AU - Canto G LA - PT - DEP - TA - Ann Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19470101 IS - IS - VI - 4 IP - DP - 1947 Jan 01 TI - Byssinosis in the cotton trade PG - 48-55 AU - Gill CIC LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19470101 IS - IS - VI - 21 IP - DP - 1947 Jan 01 TI - Buckwheat allergy PG - 737-739 AU - Ordman D LA - PT - DEP - TA - S Afr Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19470101 IS - IS - VI - 18 IP - DP - 1947 Jan 01 TI - Flour allergy PG - 341-350 AU - Schwartz M LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19470101 IS - IS - VI - 4 IP - DP - 1947 Jan 01 TI - Health hazards of the pharmaceutical industry PG - 111-11* AU - Watrous RM LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19460101 IS - IS - VI - 3 IP - DP - 1946 Jan 01 TI - Some basic effects of vanadium pentoxide PG - 177-182 AU - Wyers H LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19460101 IS - IS - VI - 20 IP - DP - 1946 Jan 01 TI - Sewage filter flies (Psychoda) as a cause of bronchial asthma PG - 32-35 AU - Ordman D LA - PT - DEP - TA - S Afr Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19450101 IS - IS - VI - 2 IP - DP - 1945 Jan 01 TI - Asthma caused by the complex salts of platinum PG - 92-98 AB - A syndrome consisting of running of the nose, sneezing, tightness of the chest, shortness of breath, cyanosis, wheezing and cough is described. This syndrome occurred in 52 out of 91 men exposed to the dust or spray of the complex salts of platinum. Thirteen men complained of dermatitis. These syndromes did not arise in men exposed to much higher concentrations of metallic platinum in the atmosphere, or to men exposed to the complex salts of the other precious metals, including palladium. Prevention is by exhaust ventilation. AU - Hunter D AU - Milton R AU - Perry KMA LA - PT - DEP - TA - Brit J Industr Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19450101 IS - IS - VI - 16 IP - DP - 1945 Jan 01 TI - Atopy to simple chemical compounds- Sulfonechloramides PG - 209-220 AU - Feinberg SM AU - Watrous RM LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19450101 IS - IS - VI - ii IP - DP - 1945 Jan 01 TI - Casualties following exposure to zinc chloride smoke PG - 368-370 AU - Evans EH LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19440101 IS - IS - VI - 15 IP - DP - 1944 Jan 01 TI - Vitamin B1 hypersensitivity with desensitisation PG - 150-153 AU - Mitrani MM LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19430101 IS - IS - VI - 143 IP - DP - 1943 Jan 01 TI - Exploring the dangerous trades PG - 1-468 AU - Hamilton A LA - PT - DEP - TA - Pub Little Brown and Co, Boston JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19420101 IS - IS - VI - IP - DP - 1942 Jan 01 TI - The allergenic properties of the vegetable gums. A case of asthma due to tragacanth PG - 203-217 AU - Gelfand HH LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19420101 IS - IS - VI - 14 IP - DP - 1942 Jan 01 TI - - PG - 538-53* AU - Shilkret HH AU - Swartz HF LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19420101 IS - IS - VI - 47 IP - DP - 1942 Jan 01 TI - Bronchial asthma due to sensitivity to gum acacia PG - 253-253 AU - Sprague PH LA - PT - DEP - TA - Can Med Assoc J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19410101 IS - IS - VI - 12 IP - DP - 1941 Jan 01 TI - Hypersensitivity to beetles (Coleoptera) PG - 493-494 AU - Sheldon JM AU - Johnston JH LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19410101 IS - IS - VI - i IP - DP - 1941 Jan 01 TI - Toxic effects of iroko PG - 38-39 AU - Davidson JM LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19410101 IS - IS - VI - 12 IP - DP - 1941 Jan 01 TI - Sensitivity to gum acacia, with a report of ten cases of asthma in printers PG - 290-294 AU - Bohner CB LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19400101 IS - IS - VI - 114 IP - DP - 1940 Jan 01 TI - Karaya gum (Indian gum) hypersensitivity PG - 747-748 AU - Figley KD LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19400101 IS - IS - VI - 27 IP - DP - 1940 Jan 01 TI - Garlic: an occupational factor in the aetiology of bronchial asthma PG - 86-86 AU - Henson GE LA - PT - DEP - TA - J Florida Med Assoc JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19400101 IS - IS - VI - 12 IP - DP - 1940 Jan 01 TI - Allergic rhinitis and asthma due to sensitisation to the Mexican bean weevil (Zabrotes subfasciatus Boh) PG - 42-45 AU - Wittich FW LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19400101 IS - IS - VI - 8 IP - DP - 1940 Jan 01 TI - Powder metallurgy as a source of dust from the medical and technical standpoint PG - 142- AB - Study of 27 workers in one factory, nodular CXR changes in 8 AU - Jobs H AU - Ballhausen C. LA - PT - DEP - TA - Vertrauensartz Krankenkasse JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19390101 IS - IS - VI - - IP - DP - 1939 Jan 01 TI - The practice of Allergy PG - 677 AB - This book contains the first case of occupational asthma in a matchmaker. AU - Vaughan WT LA - PT - DEP - TA - St Louis: Mosby JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19390101 IS - IS - VI - 10 IP - DP - 1939 Jan 01 TI - Allergy to grain dusts and sputs PG - 327-336 AU - Harris LH LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19390101 IS - IS - VI - 10 IP - DP - 1939 Jan 01 TI - Asthma and allergic rhinitis due to sensitisation to phthalic anhydride PG - 164-165 AU - Kern RA LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19380101 IS - IS - VI - 19 IP - DP - 1938 Jan 01 TI - Investigation of Norwegian aluminium workers for prevalence of asthma,acute cryolite intoxication and fluorosis PG - 117-148 AU - Evang K LA - PT - DEP - TA - Tidsskr Nor Laegeforen JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19380101 IS - IS - VI - 3 IP - DP - 1938 Jan 01 TI - Chrome lung cancer PG - 1-114 AU - Alwens W AU - Jonas W LA - PT - DEP - TA - Acta Unio Internationalis contra Cancrum JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19380101 IS - IS - VI - 53 IP - DP - 1938 Jan 01 TI - Metal fume fever and its prevention PG - 1080-1086 AU - Sayers RR LA - PT - DEP - TA - Public Health Report (Washington) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19370101 IS - IS - VI - 8 IP - DP - 1937 Jan 01 TI - Paprika-splitters lung PG - 1-* AU - Kovats F LA - PT - DEP - TA - Acta Med Szeged Budapest JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19360101 IS - IS - VI - 212 IP - DP - 1936 Jan 01 TI - Investigations on respiratory dust disease in operatives in the cotton industry PG - *-* AU - Prausnity C LA - PT - DEP - TA - Med Res Counc Spec Rep Ser (Lond) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19360101 IS - IS - VI - 56 IP - DP - 1936 Jan 01 TI - Fluorine intoxication in Norwegian aluminium plant workers PG - 179-182 AU - Frostad AW LA - PT - DEP - TA - Tidsskr Nor Laegeforen JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19360101 IS - IS - VI - 18 IP - DP - 1936 Jan 01 TI - Tuberculosis in hospital nurses PG - 97-99 AU - Heimbeck J LA - PT - DEP - TA - Tubercle JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19350101 IS - IS - VI - 13 IP - DP - 1935 Jan 01 TI - L'eczema du bois PG - 313-329 AU - Malespine E LA - PT - DEP - TA - Annales d'hygiene publique industrielle et social JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19350101 IS - IS - VI - 229 IP - DP - 1935 Jan 01 TI - A case of asthma sensitivity to chromates PG - 1348-1349 AU - Card WI LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19350101 IS - IS - VI - IP - DP - 1935 Jan 01 TI - Annual report of the chief inspector of factories PG - 60-60 AU - Bridge JC LA - PT - DEP - TA - HMSO JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19350101 IS - IS - VI - * IP - DP - 1935 Jan 01 TI - Asthma provoked by locusts PG - 1025-102* AU - Ludmer N LA - PT - DEP - TA - Semana Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19340101 IS - IS - VI - 103 IP - DP - 1934 Jan 01 TI - Allergic response to dust of insect origin PG - 560-562 AU - Randolph H LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19340101 IS - IS - VI - 5 IP - DP - 1934 Jan 01 TI - Soybean as a possible important source of allergy PG - 300-302 AU - Duke WW LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19340101 IS - IS - VI - 63 IP - DP - 1934 Jan 01 TI - On a case of occupational asthma with allergy to a chemical substance PG - 987-989 AU - Bergmann A LA - PT - DEP - TA - Schweiz Med Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19330101 IS - IS - VI - 101 IP - DP - 1933 Jan 01 TI - Atopy to acacia (gum arabic) PG - 444-445 AU - Spielman AD AU - Baldwin HS LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19330101 IS - IS - VI - 22 IP - DP - 1933 Jan 01 TI - Geographical variation of Legionnaires' disease: a critique and guide to future research PG - 1127-1136 AU - Bhopal RS LA - PT - DEP - TA - Int J Epidemiol JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19320101 IS - IS - VI - 3 IP - DP - 1932 Jan 01 TI - Emanations of flies as exciting causes of allergic coryza and asthma PG - 459-468 AU - Parlato SJ LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19320101 IS - IS - VI - 99 IP - DP - 1932 Jan 01 TI - Sensitivity to acacia PG - 2251-2252 AU - Maytom CK AU - Magath TB LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19320101 IS - IS - VI - i IP - DP - 1932 Jan 01 TI - Asthma from sensitisation to chromium PG - 182-183 AU - Joules H LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19320101 IS - IS - VI - IP - DP - 1932 Jan 01 TI - Report of the depatment committee on dust in cardrooms in the cotton industry PG - - AU - Home office LA - PT - DEP - TA - HMSO JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19310101 IS - IS - VI - 97 IP - DP - 1931 Jan 01 TI - Chrome poisoning with manifestations of sensitisation PG - 95-98 AU - Smith AR LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19300101 IS - IS - VI - 1 IP - DP - 1930 Jan 01 TI - Boxwood sensitiveness PG - 346-349 AU - Markin LE LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19300101 IS - IS - VI - 1 IP - DP - 1930 Jan 01 TI - Sensitivity due to Christmas trees: a seasonal atopen in bronchial asthma PG - 442-445 AU - Cobe HM LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19290101 IS - IS - VI - 1 IP - DP - 1929 Jan 01 TI - Cedar asthma PG - 87-88 AU - Black JH LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19290101 IS - IS - VI - 1 IP - DP - 1929 Jan 01 TI - Cedar wood asthma PG - 88-8* AU - Stier RFE LA - PT - DEP - TA - J Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19280101 IS - IS - VI - 90 IP - DP - 1928 Jan 01 TI - Endemic asthma due to castor bean dust PG - 79-82 AB - For many years it has been known to Toledo physicians that an "asthma colony" existed in a certain district of East Toledo. Suspicion had long pointed to a linseed oil mill as being the cause of the trouble, for many of these asthmatic patients asserted that their attacks coincided with the odor of linseed oil from the mill when the wind was in the right direction. Complaints had been made at various times to the city health department, but nothing incriminating the oil mill could be found. The state department of health also made an investigation, but did not learn anything of value concerning the unusual number of asthma sufferers in this vicinity. Early in 1927, one of us was appointed health commissioner for the city of Toledo. One of the first problems presented was the demand from residents of this district that something be done to prove or disprove the connection of this oil mill with the asthma situation. On investigation, it was found that the oil mill not only manufactures linseed oil but also expresses castor oil from castor beans. After all the oil is removed from the beans, the resulting cake is finely ground to form what is known in the trade as castor bean "pomace." This pomace is sacked and sold as an ingredient of fertilizer, being valuable for this purpose because of its high nitrogen content. Most of the castor bean residue is recovered and sacked during the process of grinding the "cake" after the oil has been pressed out, but there is a considerable amount of fine dust which does not fall through the screen of the grinding-mill. This dust is blown out into the air through three good sized pipes projecting through the roof of the mill, and at all times when the mill is in operation a fine cloud of this dust can be seen issuing from these pipes. The dust is so fine that it will pass through a 200 mesh wire screen; from this it is apparent how readily it can be carried by the wind. Previous efforts to solve the relation of this oil mill to the asthma situation centered on linseed oil, because the sufferers had always noted the odor of linseed oil when the wind was in the right direction. However, we found that after the oil was expressed from the flaxseed there still remained about 9 per cent of oil in the flaxseed, making it too heavy to be wind-borne. Furthermore, there was no flax dust blown into the air on the linseed oil side of the mill. Our attention, then, was devoted to a study of the castor bean dust as being the possible cause of these numerous cases of asthma. No doubt the reason it was previously overlooked is that this castor bean dust is almost odorless as compared with linseed oil. The asthmatic sufferers and their families could easily smell the linseed oil fumes but were not aware of the invisible castor bean dust particles in the air. Across the street from this oil mill is located the Oakdale School. For some time the chief topic discussed at the Parent-Teachers Association meetings at this school had been this asthma problem. Several of the pupils had lost time from school because of asthmatic attacks coming on in school, and many of the parents were also affected for days at a time. The president of this association gave us a list of eighty-five names and addresses of persons living in this vicinity who ascribed their asthmatic attacks to the presence of this oil mill. These persons were asked to report to the office of the city health commissioner, and there the examinations were made. Of these eighty-five persons, we have had the opportunity of examining thirty-two. Two of these proved to have cases of seasonal hay-fever with pollen asthma, so that there were actually thirty patients seen who had asthma at all times of the year. The histories these patients gave were all quite similar. They all had lived within a mile of the plant and had no asthma before moving to this district, and the onset of the attacks varied from one to seventeen years after moving to this neighborhood. The attacks were nocturnal in the men who worked during the day at a distance from their homes, but occurred day or night in the housewives and children whose work did not take them away from the vicinity. Attacks were most frequent and most severe during the fall and spring months when the wind attained its highest velocity, and these patients invariably had attacks when the wind blew toward their homes from the direction of the mill. Thus, patients on the south side of the mill would have asthma when the wind was from the north, while those living on the north side would be free from attacks at this time. When the wind shifted to some other direction, conditions would be reversed. The mill is in operation day and night. The mill is in operation day and night but closed June-August when symptoms improved. The histories also showed that many of these patients found that they could obtain relief by leaving the neighborhood but that the asthma recurred when they returned to their homes ; if they went on vacations or moved away from the mile radius of the mill, their asthmatic attacks disappeared. The thirty patients seen were all tested cutaneously by the scratch method with 1: 100 extracts of castor bean dust and flaxseed dust made up with Coca's solution. At first we used the raw dust moistened with tenth-normal sodium hydroxide, but we soon found that extracts of the dusts were more convenient and were just as reliable for testing. Every one of these thirty patients gave positive reactions to the castor bean extract, and the wheals for the most part were remarkable for their size. We designated the reactions ++++ when the wheal measured 2.5 cm. in diameter, but some of the wheals attained a diameter of from 6 to 8 cm., and the pseudopodia extended outward several more centimeters. Only two cases exhibited a cutaneous reaction of less than 2.5 cm. Some of these reactions were delayed for a period of from one-half to four hours but they invariably appeared. We were well aware that castor bean dust contains a very irritating substance, ricin, so we made control skin tests on about forty persons, all with negative results. Many of these control patients belonged in the hyper- sensitive class as they were subject to hay-fever, asthma and perennial hay-fever. It would appear then that the positive reactions that we obtained in the cases of castor bean dust asthma were specific reactions and not due to the irritating effect of ricin in the extract. Plain text: For many years it has been known to Toledo physicians that an "asthma colony" existed in a certain district of East Toledo. Suspicion had long pointed to a linseed oil mill as being the cause of the trouble, for many of these asthmatic patients asserted that their attacks coincided with the odor of linseed oil from the mill when the wind was in the right direction. Complaints had been made at various times to the city health department, but nothing incriminating the oil mill could be found. The state department of health also made an investigation, but did not learn anything of value concerning the unusual number of asthma sufferers in this vicinity. Early in 1927, one of us was appointed health commissioner for the city of Toledo. One of the first problems presented was the demand from residents of this district that something be done to prove or disprove the connection of this oil mill with the asthma situation. On investigation, it was found that the oil mill not only manufactures linseed oil but also expresses castor oil from castor beans. After all the oil is removed from the beans, the resulting cake is finely ground to form what is known in the trade as castor bean "pomace." This pomace is sacked and sold as an ingredient of fertilizer, being valuable for this purpose because of its high nitrogen content. Most of the castor bean residue is recovered and sacked during the process of grinding the "cake" after the oil has been pressed out, but there is a considerable amount of fine dust which does not fall through the screen of the grinding-mill. This dust is blown out into the air through three good sized pipes projecting through the roof of the mill, and at all times when the mill is in operation a fine cloud of this dust can be seen issuing from these pipes. The dust is so fine that it will pass through a 200 mesh wire screen; from this it is apparent how readily it can be carried by the wind. Previous efforts to solve the relation of this oil mill to the asthma situation centered on linseed oil, because the sufferers had always noted the odor of linseed oil when the wind was in the right direction. However, we found that after the oil was expressed from the flaxseed there still remained about 9 per cent of oil in the flaxseed, making it too heavy to be wind-borne. Furthermore, there was no flax dust blown into the air on the linseed oil side of the mill. Our attention, then, was devoted to a study of the castor bean dust as being the possible cause of these numerous cases of asthma. No doubt the reason it was previously overlooked is that this castor bean dust is almost odorless as compared with linseed oil. The asthmatic sufferers and their families could easily smell the linseed oil fumes but were not aware of the invisible castor bean dust particles in the air. Across the street from this oil mill is located the Oakdale School. For some time the chief topic discussed at the Parent-Teachers Association meetings at this school had been this asthma problem. Several of the pupils had lost time from school because of asthmatic attacks coming on in school, and many of the parents were also affected for days at a time. The president of this association gave us a list of eighty-five names and addresses of persons living in this vicinity who ascribed their asthmatic attacks to the presence of this oil mill. These persons were asked to report to the office of the city health commissioner, and there the examinations were made. Of these eighty-five persons, we have had the opportunity of examining thirty-two. Two of these proved to have cases of seasonal hay-fever with pollen asthma, so that there were actually thirty patients seen who had asthma at all times of the year. The histories these patients gave were all quite similar. They all had lived within a mile of the plant and had no asthma before moving to this district, and the onset of the attacks varied from one to seventeen years after moving to this neighborhood. The attacks were nocturnal in the men who worked during the day at a distance from their homes, but occurred day or night in the housewives and children whose work did not take them away from the vicinity. Attacks were most frequent and most severe during the fall and spring months when the wind attained its highest velocity, and these patients invariably had attacks when the wind blew toward their homes from the direction of the mill. Thus, patients on the south side of the mill would have asthma when the wind was from the north, while those living on the north side would be free from attacks at this time. When the wind shifted to some other direction, conditions would be reversed. The mill is in operation day and night. The mill is in operation day and night but closed June-August when symptoms improved. The histories also showed that many of these patients found that they could obtain relief by leaving the neighborhood but that the asthma recurred when they returned to their homes ; if they went on vacations or moved away from the mile radius of the mill, their asthmatic attacks disappeared. The thirty patients seen were all tested cutaneously by the scratch method with 1: 100 extracts of castor bean dust and flaxseed dust made up with Coca's solution. At first we used the raw dust moistened with tenth-normal sodium hydroxide, but we soon found that extracts of the dusts were more convenient and were just as reliable for testing. Every one of these thirty patients gave positive reactions to the castor bean extract, and the wheals for the most part were remarkable for their size. We designated the reactions ++++ when the wheal measured 2.5 cm. in diameter, but some of the wheals attained a diameter of from 6 to 8 cm., and the pseudopodia extended outward several more centimeters. Only two cases exhibited a cutaneous reaction of less than 2.5 cm. Some of these reactions were delayed for a period of from one-half to four hours but they invariably appeared. We were well aware that castor bean dust contains a very irritating substance, ricin, so we made control skin tests on about forty persons, all with negative results. Many of these control patients belonged in the hyper- sensitive class as they were subject to hay-fever, asthma and perennial hay-fever. It would appear then that the positive reactions that we obtained in the cases of castor bean dust asthma were specific reactions and not due to the irritating effect of ricin in the extract. AU - Figley KD AU - Elrod RM LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19270101 IS - IS - VI - 6 IP - DP - 1927 Jan 01 TI - Uberempfindlichkeit gegen Kautschuk als Ursache von Urticaria und Quinckeschem Oden PG - 1096-1097 AU - Stern G LA - PT - DEP - TA - Klin Wochenschr JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19240101 IS - IS - VI - 82 IP - DP - 1924 Jan 01 TI - Bronchial asthma and other allergic manifestations in pharmacists PG - 1854-1855 AU - Peshkin M LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19240101 IS - IS - VI - 83 IP - DP - 1924 Jan 01 TI - Asthma due to grain dusts PG - 27-2* AU - Cadman FT LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19240101 IS - IS - VI - HMSO IP - DP - 1924 Jan 01 TI - Dust from feathers PG - *-* AU - Horner DR LA - PT - DEP - TA - Annual report of the chief inspector of factories JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19240101 IS - IS - VI - HMSO IP - DP - 1924 Jan 01 TI - Weavers Cough PG - - AU - Bridge JC LA - PT - DEP - TA - Annual report of the chief inspector of factories JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19230101 IS - IS - VI - 165 IP - DP - 1923 Jan 01 TI - On occupational sensitisation to the castor bean PG - 196-202 AU - Bernton HS LA - PT - DEP - TA - Am J Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19230101 IS - IS - VI - 30 IP - DP - 1923 Jan 01 TI - An epidemic of asthma due to Pediculoides ventricosus PG - 1-70 AU - Ancona G LA - PT - DEP - TA - il Policlinico JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19230101 IS - IS - VI - 80 IP - DP - 1923 Jan 01 TI - A case of hypersensitivity to silk PG - 11-12 AU - Clarke JA AU - Meyer GP LA - PT - DEP - TA - JAMA JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19220101 IS - IS - VI - 88 IP - DP - 1922 Jan 01 TI - Industrial injuries caused by beetles PG - 68-72 AU - Loir A AU - Legangneur H LA - PT - DEP - TA - Bull de l'academie de medicin JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19220101 IS - IS - VI - 88 IP - DP - 1922 Jan 01 TI - Accidents de travail occasionnes par des Coleopteraes PG - 68-72 AU - Loir A AU - Legangneur H LA - PT - DEP - TA - Bull Acad Med JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19220101 IS - IS - VI - 2 IP - DP - 1922 Jan 01 TI - Cancer of the scrotum: the etiology, clinical features, and treatment of the disease PG - 971-973 AB - AU - Southam AH AU - Wilson SR LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19200101 IS - IS - VI - 160 IP - DP - 1920 Jan 01 TI - Bronchial asthma (with cases due to green coffee beans, flour, boxwood,orangewood,horse hair) PG - 414-417 AU - Walker RJ LA - PT - DEP - TA - Am J Med Sci JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19180101 IS - IS - VI - 11 IP - DP - 1918 Jan 01 TI - Notes on the poisonous urticating spines of Hemileuca oliviae larvae PG - 363-367 AU - Caffrey DJ LA - PT - DEP - TA - J Economic Entomology JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19090101 IS - IS - VI - HMSO, Cd 4 IP - DP - 1909 Jan 01 TI - Investigation into the present health of cardroom strippers and grinders PG - 203-205 AU - Collis EL LA - PT - DEP - TA - Annual report of the chief inspector of factories JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19090101 IS - IS - VI - i IP - DP - 1909 Jan 01 TI - A lecture on the infection of consumption PG - 433-437 AU - Williams CT LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19070101 IS - IS - VI - HMSO, Lond IP - DP - 1907 Jan 01 TI - Conditions of the workers employed in the manufacture of shuttles from African boxwood PG - 266-268 AU - Hay J LA - PT - DEP - TA - Annual report of the chief inspector of factories JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19050101 IS - IS - VI - HMSO IP - DP - 1905 Jan 01 TI - Poisonous wood in shuttle making PG - 380-38* AU - Harvey Gibson RJ LA - PT - DEP - TA - Ann Report of Chief Inspector of Factories JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 19000101 IS - IS - VI - IP - DP - 1900 Jan 01 TI - Factories and Workshops. Annual report for 1899 PG - - AU - Legge TM LA - PT - DEP - TA - - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 18920101 IS - IS - VI - IP - DP - 1892 Jan 01 TI - Linen manufacture, in The hygiene diseases and mortality of occupations PG - 375-375 AU - Arlidge JT LA - PT - DEP - TA - Percival (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 18920101 IS - IS - VI - IP - DP - 1892 Jan 01 TI - Cloth manufacture, in The hygiene diseases and mortality of occupations PG - 407-407 AU - Arlidge JT LA - PT - DEP - TA - Percival (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 18820101 IS - IS - VI - i IP - DP - 1882 Jan 01 TI - The contagion of phthisis PG - 618-621 AU - Williams CT LA - PT - DEP - TA - Br Med J JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 18760101 IS - IS - VI - IP - DP - 1876 Jan 01 TI - Accidents found amongst workers: employees making chromates PG - 193-233 AU - Delpech MA AU - Hillairet M LA - PT - DEP - TA - Ann d'Hygiene Publique et de Medicine Legal JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 18630101 IS - IS - VI - ii IP - DP - 1863 Jan 01 TI - Surat cotton as it badly affects operatives in cotton mills PG - 648-649 AU - Leach J LA - PT - DEP - TA - Lancet JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 18620101 IS - IS - VI - 45 IP - DP - 1862 Jan 01 TI - On brassfounders ague PG - 177-187 AU - Greenhow EH LA - PT - DEP - TA - Medico-chirurlogical transactions (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 18460101 IS - IS - VI - 29 IP - DP - 1846 Jan 01 TI - On the capacity of the lungs, and on the respiratory functions, with a view to establishing a precise and easy method of detecting disease by the spirometer PG - 137-252 AU - Hutchinson J LA - PT - DEP - TA - Med Chir Trans (London) JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 17130101 IS - IS - VI - Tr Wilmer IP - DP - 1713 Jan 01 TI - Diseases of dressers of flax and hemp and carders of silk rolls PG - - AU - Ramazzini B LA - PT - DEP - TA - De morbus artificum diatriba JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 690101 IS - IS - VI - 694-702 IP - DP - 69 Jan 01 TI - A cluster of lung injury associated with home humidifier use: clinical, radiological and pathological description of a new syndrome PG - AB - Background Over a few months in the spring of 2011, a cluster of patients with severe respiratory distress were admitted to our intensive care unit (ICU). Household clustering was also observed. Extensive laboratory investigations failed to detect an infectious cause. Methods Clinical, radiological and pathological investigations were conducted and the Korean Center for Disease Control performed epidemiological studies. Results The case series consisted of 17 patients. Their median age was 35 (range 28–49) years. Six were pregnant at presentation and four had given birth 2 weeks previously. All presented with cough and dyspnoea. In the majority of patients (14/17), multifocal areas of patchy consolidation were identified in the lower lung zones on the initial CT. As the condition progressed, the patchy consolidation disappeared (10/13) and diffuse centrilobular ground-glass opacity nodules started to predominate and persist. Pathological specimens (11/17) showed a bronchiolocentric, temporally homogenous, acute lung injury pattern with sparing of the subpleural and peripheral alveolar areas. Ten patients required mechanical ventilation, eight of whom subsequently received extracorporeal life support. Four of the latter underwent lung transplantation. Five of the six patients in the ICU who did not receive lung transplantation died. An epidemiological investigation revealed that all patients had used humidifier disinfectants in their homes. Conclusions This case series report showed that lung injury and respiratory failure can occur as a result of inhaling humidifier disinfectants. This emphasises the need for more stringent safety regulations for potentially toxic inhalants that might be encountered in the home. AU - Hong S AU - Kim HJ AU - Huh JW AU - Do K AU - Jang SJ AU - Song JS AU - Choi S AU - Heo Y AU - Kim Y AU - Lim C AU - Chae EJ AU - Lee H AU - Jung M AU - Lee K AU - Lee M AU - Koh Y LA - PT - DEP - TA - Thorax JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 280101 IS - IS - VI - 63 IP - DP - 28 Jan 01 TI - Non-allergic occupational asthma because of almond shell dust PG - 1087-1088 AB - case report of a 37 year old sheller of hulled almonds. Developed rhinitis after one year and asthma after 3 years of exposure with late and nocturnal symptoms. No prior aasthma, no problem with eating almonds. Almond shell extract showed no specific IgE or prick test at 1;10. NSBR positive (methachoiline PC20 180ug) Specific challenge with almond shell dust at 5mg/m3 showed an immediate rection persisting for 24 hours AU - Foti C AU - Nettis E AU - Cassano N AU - Damiani E AU - Carino M AU - Vena GA LA - PT - DEP - TA - Allergy JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 00101 IS - IS - VI - IP - DP - 0 Jan 01 TI - Difolatan dermatitis in a welder; non-agricultural exposure PG - 104- AU - Groundwater JR LA - PT - DEP - TA - Contact Dermatitis JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 00101 IS - IS - VI - IP - DP - 0 Jan 01 PG - AU - Buendía-Roldán AU - I AU - Santiago-Ruiz AU - L AU - Pérez-Rubio AU - G AU - Mejía AU - M AU - Rojas-Serrano AU - J AU - Ambrocio-Ortiz AU - E AU - Benítez-Valdez AU - G AU - Selman AU - M AU - Ramcés AU - FV LA - PT - DEP - TA - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 00101 IS - IS - VI - 77(6) IP - DP - 0 Jan 01 PG - AU - Cummings AU - Kristin J AU - Stanton AU - Marcia L AU - Kreiss AU - Kathleen AU - Boylstein AU - Randy J AU - Park AU - Ju-Hyeong AU - Cox-Ganser AU - Jean M AU - Virji AU - M Abbas AU - Edwards AU - Nicole T AU - Segal AU - Leopoldo N AU - Blaser AU - Martin J AU - Weissman AU - David N AU - Nett AU - Randall J LA - PT - DEP - TA - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 00101 IS - IS - VI - 77(6) IP - DP - 0 Jan 01 PG - AU - Cummings AU - Kristin J AU - Stanton AU - Marcia L AU - Kreiss AU - Kathleen AU - Boylstein AU - Randy J AU - Park AU - Ju-Hyeong AU - Cox-Ganser AU - Jean M AU - Virji AU - M Abbas AU - Edwards AU - Nicole T AU - Segal AU - Leopoldo N AU - Blaser AU - Martin J AU - Weissman AU - David N AU - Nett AU - Randall J LA - PT - DEP - TA - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 00101 IS - IS - VI - IP - DP - 0 Jan 01 PG - AU - Laditka AU - James N AU - Laditka AU - Sarah B AU - Arif AU - Ahmed A AU - Hoyle AU - Jessica N LA - PT - DEP - TA - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO - PMID- OWN - STAT- DA - 00101 IS - IS - VI - ("0091-743 IP - DP - 0 Jan 01 TI - = "Trends in respiratory diagnoses and symptoms of firefighters exposed to the World Trade Center disaster: 2005–2010", PG - AB - ct = "Objectives AU - = "Jessica Weakley and Mayris P. Webber and Jackson Gustave and Kerry Kelly and Hillel W. Cohen and Charles B. Hall and David J. Prezant" AU - LA - PT - DEP - TA - JT - JID - EDAT- MHDA- CRDT- PHST- PHST- PHST- AID - AID - PST - SO -