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EN
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.
EN
Nail art (creation and decoration of artificial nails) is a growing fashion trend. Proportionally to its popularity, the number of allergic reactions to the materials used has recently increased. We report the case of a nail art operator who developed occupational allergy to acrylates, manifested with the unusual simultaneous presence of asthma and dermatitis. Cutaneous lesions only affected areas not covered by individual protection devices or clothes, even if such areas were not in direct contact with acrylates, suggesting airborne allergic contact dermatitis. While respiratory problems were solved with the correct use of a mask at the workplace, facial dermatitis proved impossible to avoid or control and, for this reason, the patient had to change her work.
EN
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.
EN
Objectives: Diisocyanates (DIC) are highly reactive, low-molecular-weight chemicals which are the leading cause of occupational asthma (OA). The aim of the study was to analyze certain aspects of the pathogenesis of allergic infl ammation in the airways induced by toluene diisocyanate (TDI) in an experimental model in mice. Materials and Methods: The experiment was carried out on 50 female BALB/cJ/Han/IMP mice, which were exposed by inhalation (intranasal and in the inhalation chamber) to toluene diisocyanate (2,4-TDI). After the experiment, the bronchoalveolar lavage fluid (BALF) was collected from the animals, and the composition of the induced infl ammatory cells, and the concentrations of certain cytokines (IL-4, IL-5, TNF-α) were evaluated. Results: The total number of cells in BALF of the examined group of mice was signifi cantly higher compared to the control mice. There was also a signifi cant increase in neutrophils and eosinophils in the study group compared to the controls. The number of lymphocytes and macrophages did not differ signifi cantly between the two groups. A statistically signifi cant increase in the level of TNF-α was shown to occur in the group exposed to toluene diisocyanate in comparison to the control group. The concentration of IL-4 increased in the study group, compared to the control one, but the differences did not reach the level of signifi cance, p > 0.05. Such difference was not observed for IL-5. Conclusions: We developed a murine model of TDI-induced asthma which caused the infl ux of infl ammatory cells like eosinophils and neutrophils in the bronchoalveolar lavage fl uid (BALF) in the TDI-treated mice. The increase of the concentration of some proinfl ammatory cytokines (TNF-α, IL-4) in BALF from the exposed mice was also observed.
EN
Objectives: Wood dust is a known occupational allergen that may induce, in exposed workers, respiratory diseases including asthma and allergic rhinitis. Samba (obeche, Triplochiton scleroxylon) is a tropical tree, which grows in West Africa, therefore, Polish workers are rarely exposed to it. This paper describes a case of occupational asthma caused by samba wood dust. Material and Methods: The patient with suspicion of occupational asthma due to wood dust was examined at the Department of Occupational Diseases and Clinical Toxicology in the Nofer Institute of Occupational Medicine. Clinical evaluation included: analysis of occupational history, skin prick tests (SPT) to common and occupational allergens, determination of serum specific IgE to occupational allergens, serial spirometry measurements, metacholine challenge test and specific inhalation challenge test with samba dust. Results: SPT and specific serum IgE assessment revealed sensitization to common and occupational allergens including samba. Spirometry measurements showed mild obstruction. Metacholine challenge test revealed a high level of bronchial hyperactivity. Specific inhalation challenge test was positive and cellular changes in nasal lavage and induced sputum confirmed allergic reaction to samba. Conclusions: IgE mediated allergy to samba wood dust was confirmed. This case report presents the first documented occupational asthma and rhinitis due to samba wood dust in wooden airplanes model maker in Poland.
EN
Objectives: Exposure to latex allergens in latex gloves can cause occupational health problems in nurses, yet latex gloves are still widely used in Thai hospitals. Therefore, we conducted a study to determine the prevalence of latex sensitization in nurses and identify risk factors associated with sensitization. Methods: A questionnaire, providing information on personal characteristics, ill-health, working conditions and symptoms related to latex product use, was administered to 363 female nurses working in two tertiary hospitals in southern Thailand. Latex sensitization was confirmed using a solid phase immunoassay to detect anti-latex IgE antibodies. Total glove protein levels were determined by using a modified Lowry method and latex aeroallergens by a competitive inhibition immunoassay. Results: The overall prevalence of latex sensitization was 4.4%. Respiratory symptoms related to latex glove use were significantly associated with latex sensitization (OR = 5.5, 95% CI: 1.57-19). Total glove protein levels ranged 87.8-250.8 μg protein/dm². The prevalence of latex sensiti- zation was higher (6.6% vs. 2.2%) in the hospital where gloves with higher protein levels (82-438 μg/g vs. 86-170 μg/g) were used. Furthermore, latex sensitization prevalence increased from 3% to 5% with increased average departmental aeroallergen concentrations. Conclusions: Latex sensitization prevalence in Thai nurses was higher than previously reported. Respiratory exposure seems to play an important role, in addition to dermal exposure. If latex gloves cannot be replaced by non-latex alternatives, replacement with gloves with lower protein content should be considered.
EN
Objectives: To search for optimal markers in the exhaled breath condensate (EBC), plasma and urine that would reflect the activity/ severity of occupational asthma (OA) after the withdrawal from the exposure to the allergen. Material and Methods: Markers of oxidative stress: 8-iso-prostaglandin $ \text{F}_\text{2α}$ (8-isoprostane, 8-ISO), malondialdehyde (MDA), 4-hydroxy-trans-2-nonenale (HNE), cysteinyl leukotrienes (LT) and LTB₄ were determined using liquid chromatography and mass spectrometry in 43 subjects with immunological OA (49.3±11.8 years), removed from the exposure to the sensitizing agent 10.5±6.5 years ago; and in 20 healthy subjects (49.0±14.9 years). EBC was harvested both before and after the methacholine challenge test. In parallel, identical markers were collected in plasma and urine. The results were analyzed together with forced expiratory volume in one second (FEV1), blood eosinophils, immunoglobulin E (IgE) and eosinophilic cationic protein (ECP) and statistically evaluated (Spearman rank correlation $r_S$, two- or one-sample t tests and alternatively Kruskal Wallis or pair Wilcoxon tests). Results: Several parameters of lung functions were lower in the patients (FEV₁% predicted, MEF25% and MEF50%, Rtot%, p < 0.001). Shorter time interval since the removal from the allergen exposure correlated with higher ECP ($r_S$ = 0.375) and lower FEV1%, MEF25% and MEF50% after methacholine challenge ($r_S$ = -0.404, -0.425 and -0.532, respectively). In the patients, IgE (p < 0.001) and ECP (p = 0.009) was increased compared to controls. In EBC, 8-ISO and cysteinyl LTs were elevated in the asthmatics initially and after the challenge. Initial 8-ISO in plasma correlated negatively with FEV₁ ($r_S$ = -0.409) and with methacholine PD₂₀ ($r_S$ = -0.474). 8-ISO in plasma after the challenge correlated with IgE ($r_S$ = 0.396). Conclusions: The improvement in OA is very slow and objective impairments persist years after removal from the exposure. Cysteinyl LTs and 8-ISO in EBC and 8-ISO in plasma might enrich the spectrum of useful objective tests for the follow-up of OA.
EN
ObjectivesVarious indirect or direct airway challenge tests are used to measure nonspecific bronchial hyper-responsiveness (NSBHR). The evaluation of NSBHR in diagnosing occupational asthma (OA) is performed, e.g., to monitor the specific inhalation challenge test (SICT). The aim of this study was to preliminarily compare the results of methacholine and mannitol inhalation challenge tests in SICT monitoring in bakers with work-related airway symptoms.Material and MethodsFour bakery workers with a suspicion of OA underwent single-blind placebo-controlled SICTs involving workplace allergens, accompanied by the evaluation of NSBHR with mannitol and methacholine, both before and after SICTs. Clinical examinations, spirometry tests, skin prick tests (SPTs) to common aeroallergens and occupational allergens, as well as tests to determine serum specific IgE antibodies to occupational aeroallergens were also performed.ResultsPositive SPTs results to occupational aeroallergens were found in all bakery workers, and specific IgE antibodies to flour were detected in 2 subjects. Three patients displayed positive SICT reactions. In all of these 3 patients, airway responsiveness to methacholine increased significantly. In 2 patients, airway reaction to mannitol was significant, whereas in 1 subject there was no increase in NSBHR after mannitol inhalation. The patient with a negative SICT result did not reveal any changes in NSBHR before and after the test, either to methacholine or mannitol.ConclusionsThe data obtained by the authors show that there is no clear correlation between the methacholine and mannitol inhalation challenge tests in SICT monitoring. Preliminary results indicate the need for further investigations to evaluate the usefulness of the mannitol challenge test in the diagnostics of OA.
EN
A diagnosis of occupational diseases implicates some medical and legal consequences; therefore, the most specific and objective methods are needed in the diagnostic process. Specific inhalation challenge (SIC) tests currently play an irreplaceable role in diagnosing allergic airway diseases (e.g., allergic rhinitis, asthma) as well as allergic conjunctivitis and systemic reactions, also the occupational ones. In 2014, a team of the European Respiratory Society experts published a statement that provides practical recommendations for performing SIC tests in diagnosing occupational asthma. In the current publication, the authors discuss the European guidelines in the context of Polish experience of the reference center – the Department of Occupational Diseases and Environmental Health, the Nofer Institute of Occupational Medicine in Łódź. The article describes the procedures and diagnostic criteria employed during SIC tests in diagnosing occupational asthma.
PL
W procesie diagnostyczno-orzeczniczym bardzo istotne jest zastosowanie metod obiektywnych o jak największej swoistości, ponieważ rozpoznanie choroby zawodowej implikuje konsekwencje natury medycznej i prawnej. Swoiste wziewne testy prowokacyjne (specific inhalation challenge – SIC) są niezastąpionym narzędziem diagnostycznym w rozpoznawaniu schorzeń alergicznych układu oddechowego (takich jak nieżyt nosa, astma) oraz alergicznego zapalenia spojówek i ostrych uogólnionych reakcji alergicznych, także o etiologii zawodowej. W 2014 r. zespół ekspertów Europejskiego Towarzystwa Chorób Układu Oddechowego (European Respiratory Society) opublikował wytyczne do przeprowadzania SIC stosowanych w diagnostyce chorób zawodowych układu oddechowego. Autorzy niniejszej publikacji omawiają europejskie wytyczne w kontekście polskich doświadczeń z ośrodka referencyjnego, tj. z Kliniki Chorób Zawodowych i Zdrowia Środowiskowego Instytutu Medycyny Pracy w Łodzi. W artykule szczegółowo opisano przebieg SIC oraz kryteria oceny otrzymanych wyników w diagnostyce astmy zawodowej.
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