Decorative flowers are known to be a cause of occupational allergy in the floral industry. The allergic manifestations induced by flowers include asthma, rhinoconjunctivitis and urticaria. We present a case of a 55-year-old woman, who has been working for the last 30 years as a gardener with various kinds of flowers, e.g., Limonium sinuatum (LS), chrysanthemum, sweet William (Dianthus barbatus) and Lilium. During the last 10 years she has developed nasal and eyes symptoms, dry cough, dyspnoea, chest tightness and wheezing. Clinical examination, routine laboratory testing, chest radiography, skin prick tests (SPT) involving common allergens, native plants pollens and leaves by the prick-prick technique, rest spirometry, methacholine challenge test and specific inhalation challenge test (SICT) were conducted. SPT results to common allergens were positive for grass pollens. SPT with native plants pollens and leaves showed a positive reaction only for LS. SICT induced an isolated early asthmatic reaction and significant increase in the number of eosinophils in the nasal lavage fluid. Additionally, significant increase in non-specific bronchial hyperreactivity was observed after SICT. To our knowledge, the presently described report is the first one of Limonium sinuatum induced occupational asthma and rhinitis in a Polish gardener.
Objectives: Several studies, mostly based on questionnaire-derived data, have shown an increased risk of allergic diseases, especially asthma, among cleaners. The risk factors and etiological mechanisms are still being investigated. Occupational exposure to various chemical and biological agents may induce specific sensitization and/or irritant effects. The aim of our study was to estimate the prevalence of work-related symptoms suggesting the presence of allergic disease reported by cleaners, and to relate them to the results of commercially available and standardized objective tests used for screening detection of occupational sensitization and chronic respiratory disorders. Material and Methods: A cross-sectional study was performed among 142 Polish workers of cleaning service in their workplaces. A detailed questionnaire, skin prick tests to common allergens and chemicals used by these workers for cleaning purposes (chloramine T, chlorhexidine, formaldehyde, glutaraldehyde, benzalconium chloride), total and specific serum IgE antibodies to disinfectants and rest spirometry were performed in all the subjects. Results: Fifty nine percent of all the subjects declared occurrence of at least 1 symptom suggesting allergic ailment during cleaning activities at work. Skin prick tests and specific serum IgE antibodies to disinfectants were negative in all the subjects. In 8 cases wheezing was detected during auscultation, but only in 5 of them obstructive pattern in rest spirometry was found. Conclusions: Occupational allergic causation of symptoms among cleaners could be less likely than work-related symptoms associated with exacerbations of new-onset or pre-existing respiratory diseases. Therefore, in this group of workers, mainly the non-specific irritant impact of chemicals on airways should be taken into consideration.
Objectives: The aim of this study was to evaluate the coexisting factors and usefulness of diagnostic methods in metal-induced asthma in Polish welders. Materials and Methods: Examination of 50 welders occupationally exposed to metals and with suspicion of metal-induced asthma (group A), 100 welders occupationally exposed to metals but without suspicion of metal-induced asthma (group B), and two control groups (10 patients with atopic asthma and 10 healthy subjects) was carried out. Questionnaire survey, clinical examination, skin prick tests to common aeroallergens and metal salts, rest spirometry tests, X-ray, metacholine challenge and a single-blind, placebo controlled specific inhalation challenge tests with metals (or work-like conditions challenge tests) were performed. Results: In group A – in 9 cases we obtained positive results of specific inhalation challenge tests with metals (in 3 cases with nickel, in 4 cases with chromium, in 1 case with cobalt and in 1 case with manganese). Nine cases of metal-induced occupational asthma were recognized. In group B – only in one case we obtained positive results of work-like conditions challenge test (clinical and spirometry changes, eosinophil influx in induced sputum), which confirmed the diagnosis of occupational asthma. In most of examined welders (62%), pulmonary changes in chest X-ray images were noted. The statistical analysis revealed that working as a welder for more than 10 years is the coexisting factor of presence of chest X-ray changes (p- or q-type nodular changes or interstitial changes). Positive results of skin prick tests with metal salts were the coexisting factors of occupational asthma due to metals among examined group of welders. Conclusions: Specific inhalation challenge plays the key role in diagnostics of metal-induced asthma in welders. Pulmonary changes in chest X-ray were found in a significant percentage of examined welders.
Objectives The aim of the study was to evaluate health effects of occupational exposure to diisocyanates (DIC) among polyurethane foam products factory workers. Material and Methods Thirty workers had a physical examination, skin prick tests with common allergens, allergen-specific immunoglobulin E (IgE) antibodies to diisocyanates and pulmonary function tests. Concentrations of selected isocyanates in the workplace air samples as well as concentration of their metabolites in the urine samples collected from the workers of the plant were determined. Results The most frequent work-related symptoms reported by the examined subjects were rhinitis and skin symptoms. Sensitization to at least 1 common allergen was noted in 26.7% of the subjects. Spirometry changes of bronchial obstruction of a mild degree was observed in 5 workers. The specific IgE antibodies to toluene diisocyanate (TDI) and 4,4’-methylenebis(phenyl isocyanate) (MDI) were not detected in any of the patients’ serum. Cellular profiles of the collected induced sputum (ISP) did not reveal any abnormalities. Air concentrations of TDI isomers ranged 0.2–58.9 μg/m³ and in 7 cases they exceeded the Combined Exposure Index (CEI) value for those compounds. Concentrations of TDI metabolites in post-shift urine samples were significantly higher than in the case of pre-shift urine samples and in 6 cases they exceeded the British Biological Monitoring Guidance Value (BMGV – 1 μmol amine/mol creatinine). We didn’t find a correlation between urinary concentrations of TDI, concentrations in the air and concentrations of toluenediamine (TDA) in the post shift urine samples. Lack of such a correlation may be an effect of the respiratory protective equipment use. Conclusions Determination of specific IgE in serum is not sensitive enough to serve as a biomarker. Estimation of concentrations of diisocyanate metabolites in urine samples and the presence of work-related allergic symptoms seem to be an adequate method for occupational exposure monitoring of DIC, which may help to determine workers at risk as well as to recognize hazardous workplaces.
Objectives About 5–10% of asthmatics do not respond well to standard treatment plan. Occupational exposure may be one of the factors that can be linked with treatment failure. The aim of the study was to assess the prevalence of work-related asthma (WRA) among adult asthmatics under follow up in an outpatient allergy clinic and to create a useful tool for detecting individuals with possible WRA. Material and Methods Preliminary 5-question questionnaire designed to recognize WRA was presented to 300 asthmatics. All patients with positive preliminary verification along with 50 subjects from control group were asked to fill up a detailed questionnaire. The WRA was diagnosed by positive match for asthma symptoms in combination with workplace exposure indicated in the detailed WRA questionnaire followed by confirmation of each WRA case by detailed exposure analysis. Results Work-related asthma was recognized in 63 subjects (21% of study group). The preliminary questionnaire has 76.9% sensitivity and 94% specificity in recognition of WRA. Occupational exposure to irritants is a risk factor of WRA recognition (relative risk (RR) = 2.09 (1.44:3.03)). Working in exposure-free environment is a factor against WRA recognition (RR = 0.38 (0.24:0.61)). Among subjects with work-related asthma, the uncontrolled course of the disease is significantly more frequent (p = 0.012). Subjects with WRA more often report sickness absenteeism due to asthma than those without WRA (9.6% vs. 3.2%, respectively), but the observed differences did not reach the statistical significance. Conclusions Short 5-question questionnaire seems to be a promising tool to detect individuals with possible work-related asthma in the outpatient setting for further evaluation and additional attention.
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