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Andre Cartier - One of the best experts on this subject based on the ideXlab platform.
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The Role of Inhalant Food Allergens in Occupational Asthma
Current Allergy and Asthma Reports, 2010Co-Authors: Andre CartierAbstract:Workers handling food products and derivatives are at increased risk of developing Occupational Asthma. Exposure to food allergens occurs primarily through inhalation of dust, steam, vapors, and aerosolized proteins generated during cutting, scrubbing or cleaning, cooking or boiling, and drying activities. Suspicion of the diagnosis of Occupational Asthma should lead to proper investigation to confirm the diagnosis objectively. Most inhaled food allergy is IgE mediated, and skin prick tests or specific IgE tests are useful tools to support the diagnosis, but objective evidence of Asthma by monitoring of peak expiratory flows at and off work or specific inhalation challenges offers a better diagnostic value. This article provides a list of the various foods, food additives, and contaminants that have been associated with Occupational Asthma.
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New insights into Occupational Asthma.
Current Opinion in Allergy and Clinical Immunology, 2007Co-Authors: Louis-philippe Boulet, Denyse Gautrin, Catherine Lemière, Andre CartierAbstract:Purpose of review To examine recent publications on the types of agents involved in Occupational Asthma, the mechanisms by which they induce Asthma, and how best to evaluate and treat workers suspected of this respiratory condition. Recent findings High rates of Occupational Asthma and inhalation accidents were found in workers in crafts and related occupations in the manufacturing industries, and in plant and machine operatives; cleaners and construction workers may also be at risk. Further data support a role for CD4+ T cells in low-molecular-weight agent-induced Asthma, such as with isocyanates, and neurogenic mechanisms may also be involved. The use of noninvasive measures of airway inflammation in the diagnosis and management of Occupational Asthma such as sputum eosinophils monitoring is promising, although this is less obvious for exhaled nitric oxide. Finally, the persistence of troublesome Asthma even after withdrawal from relevant exposure has been re-emphasized and surveillance programs have been proposed. Summary Further data have been gathered on the prevalence of Occupational Asthma in various working populations, its mechanisms of development, the contribution of noninvasive measures of airway inflammation in the diagnosis and management of this condition, and its management and prevention.
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Prevalence and intensity of rhinoconjunctivitis in subjects with Occupational Asthma
European Respiratory Journal, 1997Co-Authors: J L Malo, Catherine Lemière, A Desjardins, Andre CartierAbstract:Subjects with Occupational Asthma may also report symptoms of rhinoconjunctivitis. The aims of this study were: 1) to assess the prevalence of rhinoconjunctivitis in association with Occupational Asthma, and the severity of rhinoconjunctivitis according to the type of agent (high (HMW) and low (LMW) molecular weight agents) causing Occupational Asthma; and 2) to evaluate the timing of occurrence of symptoms of rhinoconjunctivitis in relation to those of Occupational Asthma. A questionnaire on symptoms of rhinoconjunctivitis and its timing in relation to the development of chest symptoms was prospectively addressed to 143 subjects consecutively referred to an Occupational Asthma clinic. Objective testing through specific inhalation challenges confirmed the diagnosis of Occupational Asthma in 40 subjects. Symptoms of rhinitis were reported at some time by 37 of the 40 subjects (92%), and of conjunctivitis by 29 of the 40 subjects (72%). The prevalence of symptoms was not different for HMW and LMW agents, although rhinitis was more intense for HMW (19 out of 24 subjects with three or more of the following symptoms: runny nose, itchy nose, nasal blockage, and sneezing) than for LMW (5 out of 14 subjects) (p
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Occupational Asthma caused by dry metabisulphite.
Thorax, 1995Co-Authors: J L Malo, Andre Cartier, A DesjardinsAbstract:A case is described of Occupational Asthma in a worker with no previous history of Asthma who sprinkled dried metabisulphite powder onto potatoes and developed work-related symptoms. Occupational Asthma was confirmed by specific inhalation challenges.
A Cartier - One of the best experts on this subject based on the ideXlab platform.
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prevalence and intensity of rhinoconjunctivitis in subjects with Occupational Asthma
European Respiratory Journal, 1997Co-Authors: J L Malo, Catherine Lemière, A Desjardins, A CartierAbstract:Subjects with Occupational Asthma may also report symptoms of rhinoconjunctivitis. The aims of this study were: 1) to assess the prevalence of rhinoconjunctivitis in association with Occupational Asthma, and the severity of rhinoconjunctivitis according to the type of agent (high (HMW) and low (LMW) molecular weight agents) causing Occupational Asthma; and 2) to evaluate the timing of occurrence of symptoms of rhinoconjunctivitis in relation to those of Occupational Asthma. A questionnaire on symptoms of rhinoconjunctivitis and its timing in relation to the development of chest symptoms was prospectively addressed to 143 subjects consecutively referred to an Occupational Asthma clinic. Objective testing through specific inhalation challenges confirmed the diagnosis of Occupational Asthma in 40 subjects. Symptoms of rhinitis were reported at some time by 37 of the 40 subjects (92%), and of conjunctivitis by 29 of the 40 subjects (72%). The prevalence of symptoms was not different for HMW and LMW agents, although rhinitis was more intense for HMW (19 out of 24 subjects with three or more of the following symptoms: runny nose, itchy nose, nasal blockage, and sneezing) than for LMW (5 out of 14 subjects) (p<0.01). There were significantly fewer subjects with Occupational Asthma due to LMW agents, with rhinitis appearing before Asthma (p=0.03). Figures for conjunctivitis showed a similar trend, but did not reach statistical significance. In conclusion, symptoms of rhinoconjunctivitis are often associated with Occupational Asthma. Rhinitis is less pronounced in the case of low molecular weight agents, but more often appears before Occupational Asthma in the case of high molecular weight agents.
P S Burge - One of the best experts on this subject based on the ideXlab platform.
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Recent developments in Occupational Asthma.
Swiss medical weekly, 2010Co-Authors: P S BurgeAbstract:Occupational exposures now account for 20% of adult onset Asthma. Overall incidence has not declined, but recognition of the problem and substitutions have resulted in dramatic reductions in some causes of Occupational Asthma, particularly latex and glutaraldehyde in healthcare workers. Newer at risk workers include cleaners and those exposed to metal-working fluid. Standards of care have now been published, supported by evidence- based reviews of the literature, which are likely to require referral to centres specialising in Occupational Asthma for compliance. The spectrum of Occupational Asthma is expanding, with low-dose irritant mechanisms likely to account for some Occupational Asthma with latency. Eosinophilic and non-eosinophilic phenotypes are also seen, the non-eosinophilic variant having more normal non-specific responsiveness than the eosinophilic subgroup. Physiological confirmation of Occupational Asthma is required but remains challenging. Specific challenges may be negative in workers confirmed as having Occupational Asthma from workplace challenges. Serial measurements of peak expiratory flow or FEV1 are feasible in the Occupational health and general respiratory clinic settings and provide a method of validation of Occupational Asthma in those without ready access to specific challenge testing, while minimum data quantity standards are now established which need to be achieved for optimal sensitivity/specificity. New developments in the analysis of serial mea-surements of peak expiratory flow comparing the mean hourly values on work and rest days have shown good specificity and sensitivity from shorter records (but more frequent readings) than needed for the standard Oasys score.
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standards of care for Occupational Asthma
Thorax, 2008Co-Authors: David Fishwick, P S Burge, Lisa Bradshaw, J G Ayres, C M Barber, J Harrisroberts, Mandy Francis, S Naylor, Jonathan M Corne, Paul CullinanAbstract:Occupational Asthma remains a common disease in the UK with up to 3000 new cases diagnosed each year. The Health and Safety Executive (HSE) estimates the cost to our society to be over £1.1 billion for each 10-year period.1 In October 2001 the Health and Safety Commission agreed a package of measures aimed at reducing the incidence of Asthma caused by exposure to substances in the workplace by 30% by 2010. Key to this aim are primary prevention by proper risk assessment and exposure control, together with secondary prevention to ensure reduction in the delay between the development of allergic symptoms at work (normally nasal or respiratory) and appropriate advice to the affected worker and workplace. Conservative estimates suggest that one in 10 cases of adult onset Asthma relate directly to sensitisation in the workplace,2 with a smaller subset of workers with acute irritant induced Asthma. The latter—formerly termed reactive airway dysfunction syndrome (RADS)—relates to Asthma caused by exposure to high levels of airborne irritants. The prognosis of individuals with Occupational Asthma is better if they are removed from exposure quickly, particularly within a year of first symptoms.3–5 However, removing individuals often leads to unemployment. If the diagnosis of Occupational Asthma is incorrect, advising individuals whose Asthma is not caused by work to be removed from exposure may have unnecessary financial and social consequences. The intent of this article is not to document the entire current evidence base related to Occupational Asthma, as the British Occupational Health Research Foundation (BOHRF) recently completed such an evidence review.7 The key points of this article are summarised in box …
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fev1 decline in Occupational Asthma
Thorax, 2006Co-Authors: W Anees, Vicky Moore, P S BurgeAbstract:Background: In Occupational Asthma continued workplace exposure to the causative agent is associated with a poor prognosis. However, there is little information available on how rapidly lung function declines in those who continue to be exposed, nor how removal from exposure affects lung function. Methods: Forced expiratory volume in 1 second (FEV 1 ) was studied in 156 consecutive subjects with Occupational Asthma (87% due to low molecular weight agents) using simple regression analyses to provide estimates of the decline in FEV 1 before and after removal from exposure. Results: In 90 subjects in whom FEV 1 measurements had been performed for at least 1 year before removal from exposure (median 2.9 years), the mean (SE) rate of decline in FEV 1 was 100.9 (17.7) ml/year. One year after removal from exposure FEV 1 had improved by a mean (SE) of 12.3 (31.6) ml. The mean (SE) decline in FEV 1 was 26.6 (18.0) ml/year in 86 subjects in whom measurements were made for at least 1 year (median 2.6 years) following removal from exposure. The decline in FEV 1 was not significantly worse in current smokers than in never smokers, nor was it affected by the use of inhaled corticosteroids. Conclusion: FEV 1 declines rapidly in exposed workers with Occupational Asthma. Following removal from exposure, FEV 1 continued to decline but at a slower rate, similar to the rate of decline in healthy adults.
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BOHRF guidelines for Occupational Asthma
Thorax, 2005Co-Authors: A J Newman Taylor, Paul Cullinan, P S Burge, Paul J Nicholson, C BoyleAbstract:Publication of the first evidence based guidelines for Occupational Asthma New guidelines for the identification, management, and prevention of Occupational Asthma are published this month in Occupational and Environmental Medicine .1 The first evidence based guidelines for Occupational Asthma, they were prepared by a working group that included clinicians, patients, Occupational hygienists, and representatives of the Health and Safety Executive. The work was supported by a grant from the British Occupational Health Research Foundation (BOHRF). The guidelines will be supplemented by an abbreviated version for primary care practitioners, Occupational health practitioners, employers, employees, and workplace safety representatives. These guidelines are intended to increase awareness and improve the management of Occupational Asthma by all practitioners who encounter such patients, and to stimulate the means to reduce its incidence by those able to effect this. The important issues in Occupational Asthma concern its aetiology, diagnosis, outcome and prevention. Questions about these are not readily answered by randomised controlled trials (RCTs) and, arguably, conventional hierarchies with the RCT at the apex are not appropriate for assessing the strength of evidence used in the generation of guidelines.2 Although not having the high internal validity of the RCT, strong inferences can be drawn from observational studies (whose external validity can be greater than that of an RCT) when these are well designed and their findings consistent and plausible. The guidelines address several questions that are of key importance to respiratory physicians: Asthma can be …
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A comparison of some of the characteristics of patients with Occupational and non-Occupational Asthma
Occupational Medicine, 1995Co-Authors: E. J. Axon, J. R. Beach, P S BurgeAbstract:: Occupational Asthma is the most frequently diagnosed Occupational lung disease reported to the SWORD (Surveillance of Work-related and Occupational Respiratory Disease) scheme. However, diagnosing Occupational Asthma is not straightforward, and establishing a link with work may be difficult. This study was undertaken to determine the differences between patients with Occupational Asthma and those with non-Occupational Asthma which might help in their diagnosis. Information was collected using a self-completed questionnaire. Questionnaires were distributed to 30 subjects aged 18-65 years at each of two clinics--one for patients with Occupational Asthma and one for those with cryptogenic and environmental Asthma. Replies were received from 26 patients with Occupational Asthma (87%) and 29 patients with non-Occupational Asthma (97%). The age of onset was significantly higher for those with Occupational Asthma (42.6 vs 20.7 years). Significantly more subjects with Occupational Asthma reported improvement on holiday, whereas no significant difference was found in the numbers reporting worsening of symptoms on work days. Those with Occupational Asthma were less likely to report seasonal variation in symptoms, exacerbation by allergies, pets and stress, or a family history of Asthma. Subjects with Occupational Asthma were more likely to become unemployed (50% vs 3%). Recognition of some of these features in a patient's history may help in the difficult task of differentiating Occupational from non-Occupational Asthma, potentially avoiding the need for exhaustive investigations in some patients. The high prevalence of holiday improvement among subjects with non-Occupational Asthma suggested that domestic or environmental allergies arising outside the workplace may have been making an important contribution to ongoing symptoms in these subjects.
J L Malo - One of the best experts on this subject based on the ideXlab platform.
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prevalence and intensity of rhinoconjunctivitis in subjects with Occupational Asthma
European Respiratory Journal, 1997Co-Authors: J L Malo, Catherine Lemière, A Desjardins, A CartierAbstract:Subjects with Occupational Asthma may also report symptoms of rhinoconjunctivitis. The aims of this study were: 1) to assess the prevalence of rhinoconjunctivitis in association with Occupational Asthma, and the severity of rhinoconjunctivitis according to the type of agent (high (HMW) and low (LMW) molecular weight agents) causing Occupational Asthma; and 2) to evaluate the timing of occurrence of symptoms of rhinoconjunctivitis in relation to those of Occupational Asthma. A questionnaire on symptoms of rhinoconjunctivitis and its timing in relation to the development of chest symptoms was prospectively addressed to 143 subjects consecutively referred to an Occupational Asthma clinic. Objective testing through specific inhalation challenges confirmed the diagnosis of Occupational Asthma in 40 subjects. Symptoms of rhinitis were reported at some time by 37 of the 40 subjects (92%), and of conjunctivitis by 29 of the 40 subjects (72%). The prevalence of symptoms was not different for HMW and LMW agents, although rhinitis was more intense for HMW (19 out of 24 subjects with three or more of the following symptoms: runny nose, itchy nose, nasal blockage, and sneezing) than for LMW (5 out of 14 subjects) (p<0.01). There were significantly fewer subjects with Occupational Asthma due to LMW agents, with rhinitis appearing before Asthma (p=0.03). Figures for conjunctivitis showed a similar trend, but did not reach statistical significance. In conclusion, symptoms of rhinoconjunctivitis are often associated with Occupational Asthma. Rhinitis is less pronounced in the case of low molecular weight agents, but more often appears before Occupational Asthma in the case of high molecular weight agents.
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Prevalence and intensity of rhinoconjunctivitis in subjects with Occupational Asthma
European Respiratory Journal, 1997Co-Authors: J L Malo, Catherine Lemière, A Desjardins, Andre CartierAbstract:Subjects with Occupational Asthma may also report symptoms of rhinoconjunctivitis. The aims of this study were: 1) to assess the prevalence of rhinoconjunctivitis in association with Occupational Asthma, and the severity of rhinoconjunctivitis according to the type of agent (high (HMW) and low (LMW) molecular weight agents) causing Occupational Asthma; and 2) to evaluate the timing of occurrence of symptoms of rhinoconjunctivitis in relation to those of Occupational Asthma. A questionnaire on symptoms of rhinoconjunctivitis and its timing in relation to the development of chest symptoms was prospectively addressed to 143 subjects consecutively referred to an Occupational Asthma clinic. Objective testing through specific inhalation challenges confirmed the diagnosis of Occupational Asthma in 40 subjects. Symptoms of rhinitis were reported at some time by 37 of the 40 subjects (92%), and of conjunctivitis by 29 of the 40 subjects (72%). The prevalence of symptoms was not different for HMW and LMW agents, although rhinitis was more intense for HMW (19 out of 24 subjects with three or more of the following symptoms: runny nose, itchy nose, nasal blockage, and sneezing) than for LMW (5 out of 14 subjects) (p
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Occupational Asthma caused by dry metabisulphite.
Thorax, 1995Co-Authors: J L Malo, Andre Cartier, A DesjardinsAbstract:A case is described of Occupational Asthma in a worker with no previous history of Asthma who sprinkled dried metabisulphite powder onto potatoes and developed work-related symptoms. Occupational Asthma was confirmed by specific inhalation challenges.
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Aetiological agents in Occupational Asthma
European Respiratory Journal, 1994Co-Authors: M Chan-yeung, J L MaloAbstract:Occupational Asthma has become the most prevalent Occupational lung disease in developed countries. At present, about 200 agents have been implicated in causing Occupational Asthma in the workplace. These agents can be divided into two categories by their mechanism of action: immunological and nonimmunological. Immunological causes can be further divided into those that induce Asthma through an immunoglobulin E (IgE)-dependent mechanism, and those that induce Asthma through a non-IgE-dependent mechanism. In the latter category, specific IgE antibodies are found only in a small percentage of the patients with proven disease, even though the clinical picture is compatible with an allergic reaction. The immunological mechanism(s) responsible for these agents has yet to be identified. The best known example of nonimmunological Asthma is Reactive Airways Dysfunction Syndrome (RADS) or irritant-induced Asthma. In this review, examples of types of agents causing Occupational Asthma are discussed and a compendium table of aetiological agents is given.
Santiago Quirce - One of the best experts on this subject based on the ideXlab platform.
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Occupational Asthma: clinical phenotypes, biomarkers, and management.
Current Opinion in Pulmonary Medicine, 2019Co-Authors: Santiago Quirce, Joaquín SastreAbstract:PURPOSE OF REVIEW This review focuses on new findings in the clinical and inflammatory aspects that can help to better identify the different phenotypes of work-related Asthma and the development of specific biomarkers useful in diagnosis and follow-up. RECENT FINDINGS Studies on phenotyping of Occupational Asthma, a subtype of work-related Asthma, have mainly compared the clinical, physiological, and inflammatory patterns associated with the type of agent causing Occupational Asthma, namely, high-molecular-weight and low-molecular-weight agents. Most of this research has found that patients with Occupational Asthma due to high-molecular-weight agents have an associated presence of rhinitis, conjunctivitis, atopy, and a pattern of early Asthmatic reactions during specific inhalation challenge. The inflammatory profile (blood eosinophils, sputum cell count, or exhaled nitric oxide) may be similar when Occupational Asthma is caused by either type of agent. In some studies, severity of Asthma and exacerbations have been associated with exposure to low-molecular-weight agents. The most reliable biomarkers in diagnosis and follow-up are eosinophilia in induced sputum and exhaled nitric oxide. SUMMARY There are several phenotypes, characterized by its pathogenesis and inflammatory profile. Avoidance of the causative agents does not warrant complete recovery of Occupational Asthma. Treatment with biologic agents may be considered in severe Occupational Asthma.
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New Eliciting Agents of Occupational Asthma
Current Treatment Options in Allergy, 2017Co-Authors: Javier Dominguez-ortega, Ignacio Pérez-camo, Santiago QuirceAbstract:Occupational Asthma is a type of Asthma that arises from exposures in the workplace. There are more than 400 known causes of Occupational Asthma and the list is growing. New causes of allergic Occupational Asthma involving high and low molecular weight agents are continuously being reported. Their knowledge is important for physicians and Occupational health and safety professionals to maintain a high level of suspicion in exposed workers to these substances. The majority of new causes of allergic Occupational Asthma between 2011 and mid-2016 were seen with high-molecular-weight agents. Most new cases are observed in food and agro-alimentary industry, but also in the cosmetic industry, and frequently are associated with other IgE-mediated manifestations, especially allergic rhinoconjunctivitis and contact urticaria. Among the low-molecular weight agents, new acrylate and aldehyde compounds have been identified as eliciting agents of Occupational Asthma, as well as drugs, biocides, and other chemicals recently introduced in industry.
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Biomarkers in Occupational Asthma
Current Allergy and Asthma Reports, 2016Co-Authors: Javier Dominguez-ortega, Pilar Barranco, Rosa Rodríguez-pérez, Santiago QuirceAbstract:Purpose of Review Work-related Asthma is a common disorder among adult Asthma patients, and in the case of Occupational Asthma, it is induced by workplace exposures.
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Occupational rhinitis affects Occupational Asthma severity
Journal of Occupational Health, 2016Co-Authors: Gianna Moscato, Gianni Pala, Ilenia Folletti, Andrea Siracusa, Santiago QuirceAbstract:BACKGROUND The strong interactions between Asthma and rhinitis, and the influence of rhinitis in the severity and/or control of Asthma, have clearly been demonstrated. Nevertheless, no specific study has been conducted in the Occupational setting. OBJECTIVE The aim of the study was to assess the severity of Occupational Asthma and rhinitis and evaluate whether rhinitis is a predictor for increased Asthma severity. METHODS We retrospectively reviewed the clinical charts of 72 patients who received a diagnosis of allergic Occupational Asthma, with or without associated Occupational rhinitis. RESULTS Our findings suggested that persistent Asthma tended to be more common in subjects with associated Occupational Asthma and rhinitis, and Occupational Asthma severity was associated with Occupational rhinitis severity. Moderate-severe persistent Occupational rhinitis is a risk factor for persistent Occupational Asthma. CONCLUSIONS We demonstrated, for the first time in the Occupational setting, a significant association between Occupational rhinitis and Asthma severity.
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New causes of Occupational Asthma.
Current Opinion in Allergy and Clinical Immunology, 2011Co-Authors: Santiago Quirce, Joaquín SastreAbstract:Purpose of reviewThis review focuses on new causative agents of Occupational Asthma published in 2009 and 2010. The recent developments in the diagnostic tools employed in Occupational Asthma caused by new agents are summarized.Recent findingsWork exposures are a significant contributor to the burde
