Occupational asthma among hairdressers has been recognised for some years and cases of work related asthma due to hair bleaches containing persulphates and hair dyes have been reported. The extent of the disease among hairdressers remains unknown. An investigation was carried out on an entire hairdressing salon, which specialised in hair bleaching and colouring and which employed 23 staff. On the basis of history and specific and non-specific bronchial provocation testing, four out of 23 staff were found to have occupational asthma due to the persulphate salts contained in hair bleaches. Only one of these had a positive skinprick test response to persulphate salts. Tests for non-specific bronchial reactivity to histamine in this work force were more sensitive for the diagnosis of asthma than simple lung function tests or recordings of peak flow rates performed four times daily for three weeks. The response to these agents was studied in greater detail by specific bronchial provocation tests in 14 members of the salon as well as one hairdresser from elsewhere with occupational asthma, three individuals with non-occupational asthma, and four normal subjects. Only those with a history of work related asthma and bronchial hyperreactivity responded positively, confirming that the response to bleach powders was specific. Studies of pulmonary mechanics after challenge showed that the response arose from changes in airway calibre not lung volumes. Measurement of neutrophil chemotactic activity after challenge showed significant rises in those affected, suggesting that mast cells may play a part in the pathogenesis of occupational asthma due to persulphates.Hairdressers may be exposed to various chemicals capable of producing respiratory symptoms and disease. Some are known to have irritant properties and acute respiratory reactions have been described after exposure to hair sprays,' but others can produce asthma. Persulphate salts, which are widely used as constituents of hair bleaches, have been shown to cause asthma in hairdressers2 4 and chemical workers5; henna6 and other hair dyes containing paraphenylenediamine7 are also thought to be capable of producing asthma in some individuals. Little is known about the prevalence of asthma due to these agents or the mechanisms underlying asthma caused by these highly reactive, low molecular weight chemicals.We report the results of an investigation conducted in a hairdressing salon that specialised in bleaching and colouring hair, in which the employees were frequently exposed to high concentrations of bleaching

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Hyposensitization with a tyrosine adsorbed extract of Dermatophagoides pteronyssinus was effective in relieving symptoms in selected patients with perennial rhinitis due to this allergen who had responded poorly to topical application of steroids. There was a significant reduction in the nasal response to allergen after six weekly injections only in the actively treated group, but symptomatic improvement greater than that produced by placebo therapy was only evident after a further 10 months of monthly injections. Significantly more placebo-treated patients considered that therapy was ineffective and withdrew from the study. Only one patient developed significant unwanted effects from the injection therapy and had to be withdrawn from the study. We conclude that hyposensitization with a tyrosine adsorbed extract of Dermatophagoides pteronyssinus can be a safe and effective treatment for adults with perennial rhinitis due to this allergen who have responded poorly to nasal corticosteroids, and that those patients who eventually respond clinically are likely to have a diminished nasal response to allergen after the first 6 weeks of therapy.

The efficacy of hyposensitization with a standardised extract of Dermatophagoides pteronyssinus (D. pteronyssinus) conjugated to alginate and containing known amounts of antigen P1 (Conjuvac) was tested in a double blind, placebo controlled, multi-centre study in 66 adult patients with perennial rhinitis. Patients received 11 weekly injections of increasing concentrations of Conjuvac containing from 56 x 10(1) to 448 10(3) IU D. pteronyssinus or placebo injections of the alginate diluent to some of which 5 micrograms of histamine has been randomly added. This was followed by 15 monthly injections of Conjuvac or placebo. The severity of nasal blockage, sneezing and rhinorrhoea was recorded twice daily in a diary and visual analogue assessments (VAS) made at each clinic visit. Nasal provocation testing (NPT) was performed with increasing concentrations of the same extract of D. pteronyssinus as used in the hyposensitization injections, and changes in nasal airways resistance measured by passive anterior rhinomanometry. VAS was recorded and NPT was performed on entry to the study and after the fifth, ninth and final monthly injection. Conjuvac injections were well tolerated. Large local reactions (greater than 5 cm) occurred within 30 min in only 1% of patients but later in 23%. No systemic reactions or anaphylaxis occurred within 30 min of injections, but urticaria or worsening of asthma and rhinitis was reported later in 3% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)