Objective-To test the hypothesis that smoking increases the risk of sensitisation by occupational allergens.Design-Historical prospective cohort study. IntroductionAbout 5-10% of the population has asthma, and a recent report from the Tucson longitudinal study suggests that IgE dependent allergic mechanisms are important in asthma at all ages.' Little is known about the aetiology of asthma and that of related allergic conditions, such as hay fever, but studies of asthma induced by occupation are likely to be informative because occupational exposures are important "natural experiments." Smoking seems to promote the development of asthma and of specific IgE antibody in occupational settings.2-4 These studies, including our previous study of workers exposed to tetrachlorophthalic anhydride,! were cross sectional and possibly subject to survivor bias. We now report a longitudinal study in the platinum refining industry of the development of respiratory symptoms and of responses to platinum salts on skin prick testing in relation to smoking habit and atopic state.Charged halogenated platinum salts stimulate an IgE response", and cause allergic asthma. They are intermediates in the process of refining platinum, a corrosion resistant metal used as a catalyst and in jewellery. 9 In the past workers in refineries had a high
Dally, M. B., Kurrle, S., and Breslin, A. B. X. (1978). Thorax, 33,[54][55][56] Seven subjects, all from the asthmatic group, developed at least one immediate FEV1 fall of 20% or more. The reactions ranged up to 71% and occurred to both test solutions. There was a trend towards greater reactions to the vehicle. In two subjects pretreatment with salbutamol and sodium cromoglycate did not modify these reactions. In three of the seven, inhalation of 2 ml normal saline produced FEV1 falls of 25% to 30%, but these falls were not as great as each subject's reactions to the test solutions. Skin prick tests using the gentamicin solution were negative in all subjects. These results show that substantial obstructive reactions may occur in some asthmatic subjects after inhalation of gentamicin. The reactions appear to be non-immunological in nature and may be due to an irritant effect of the drug vehicle.
An outbreak of occupational asthma, of unknown cause and extent, was detected in a steel coating plant. In 1979 a cross-sectional study which defined occupational asthma in terms of respiratory symptoms detected 21 people with suggestive symptoms among the 221 studied. They all worked in the coating shop, but the plastic coatings used at the plant contained many potential sensitising agents that might have caused the asthma. All 21 developed their symptoms after 1971, and it was found that in this year a supplier had modified a coating allowing, at the temperatures used in the process, toluene di-isocyanate to be liberated. Two of the symptomatic subjects were tested by inhalation of the isocyanate and showed asthmatic reactions and other subjects were found to have asthma related to periods spent at work by records of peak expiratory flow rate. Over half the 21 had a symptom free latent period after first exposure of three years or less, a pattern not seen in other subjects with respiratory symptoms. After the isocyanate had been removed from the process 17 of these subjects became asymptomatic or improved, a greater proportion than in other subjects with respiratory symptoms.Two men working in a steel coating plant developed symptoms suggestive of occupational asthma. It was necessary to establish if others were affected and to identify the cause in order to recommend appropriate remedial action. An epidemiological investigation was undertaken and the firm was asked to obtain information from its suppliers. ProcessThe factory coated rolled steel sheets with coloured plastic by a continuous process on two lines. After rolling, cleaning, and brushing, the steel received a base or prime coat that was cured by passage through an oven, after which a main coat was applied and, again, oven cured. The coated steel, after embossing, was cut up in lengths. The coatings were known to contain epoxy resins, acrylics, phenol formaldehyde, chromates, and polyvinyl chloride. All these and other agents were considered as potential causes of the asthma. The ovens were ventilated during normal operation by an extraction system that discharged into the atmosphere through a
complex describes a hallux valgus which touches or overrides the second toe and is associated with an inflamed bursa around the metatarsal joint. Other toe deformities such as overriding and clawing were common but associated with inflammation over joints only in four patients.Most patients had more than one foot problem; the range was from none to eight problems with a modal value of between three and four problems per patient. Women had significantly more foot problems than men (y2 -9.5 (dof---2) p<001). The 14 patients with diabetes mellitus or peripheral arterial disease did not have appreciably more foot problems. CommentThe patients surveyed had a high prevalence of foot problems and most were unable to attend to their own foot care. Foot disabilities are a common cause of unreported disability in the elderly and are often accepted as an inescapable accompaniment of aging.4 Careful assessment of foot problems is an important part of the examination of the elderly patient. Problems such as nail cutting, dirt, and maceration could be dealt with easily without skilled training, but many problems require a chiropodist's attention. Chiropody services which are provided on a referral basis should be extended to include both inpatients and outpatients. Despite the emphasis on early mobilisation of these patients only 35 had walking shoes with them in hospital. A 35-year-old production research chemist had for two years had a dry irritating cough which improved when away from work. He had also had short-lived attacks of sneezing and chest tightness when weighing out small quantities of 7-aminocephalosporanic acid (7ACA) and its tosyalate dihydrate derivative (7CTD). He had no history of asthma, rhinitis, or eczema but skin-prick tests were positive to cat, housedust, and house-dust mite extracts.Bronchial provocation testing was carried out. The patient weighed 50 g amounts of 7ACA and 7CTD. This reproduced his symptoms and provoked immediate falls in forced expiratory volume in Is ( figure). No reactions were provoked by challenge with cephalexin powder or a control challenge with magnesium stearate. Skin-prick test results were positive to solutions of 7ACA and 7CTD at dilutions of 1 g/l but negative to cephalexin at 10 g/l.CASE 2A 36-year-old production worker had been intermittently exposed to cephalexin over 10 years before starting work on a process in which cephalexin monohydrate powder was dried. An airline hood was provided for this work but he did not always wear it. After one month he developed tightness in the chest and breathlessness, which resolved spontaneously during a two-week absence from work but recurred shortly after his return while donning overalls contaminated with cephalexin. These symptoms also resolved spontaneously, but on returning to work 10 days later he had an anaphylactic reaction and was admitted to hospital. He returned to work only once, when he developed chest tightness after spending 20 minutes in the canteen. He had no history of asthma, rhinitis, or eczema but a skin-prick t...
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