A cross-sectional study among detergent workers exposed to liquid detergent enzymes

Abstract

Objectives: To investigate sensitisation and respiratory health among workers who produce liquid detergent products and handle liquid detergent enzymes. Methods: We performed a cross-sectional study among 109 eligible workers of a detergent products plant. 108 were interviewed for respiratory and allergic symptoms and 106 blood samples were taken from them to examine sensitisation to enzymes. Those sensitised to >1 enzymes were referred for clinical evaluation. Workers and representatives were interviewed to characterise exposure qualitatively and estimate exposure semiquantitatively. Workers were classified into three exposure groups with varying exposure profiles to enzymes, based on frequency, duration, and level of exposure. Results: Workers were exposed to proteases, a-amylase, lipase and cellulase. The highest exposures occurred in the mixing area. Liquid spills with concentrated enzyme preparations and leakage of enzymes during weighing, transportation and filling were causing workplace contaminations and subsequently leading to both dermal and inhalation exposure for workers. Workers with the highest exposures reported significantly more work-related symptoms of itching nose (prevalence ratio (PR) = 4.2, 95% CI 1.5 to 12.0) and sneezing (PR = 4.0, 95% CI 1.5 to 10.8) and marginally significant more symptoms of wheezing (PR = 2.9, 95% CI 0.9 to 8.7) compared with the least exposed group. Fifteen workers (14.2%) were sensitised to >1 enzymes. A marginally statistically significant gradient in sensitisation across the exposure categories was found (p = 0.09). There was a clinical case of occupational asthma and two others with probable occupational rhinitis. Conclusions: Workers exposed to liquid detergent enzymes are at risk of developing sensitisation (14%) and respiratory allergy.Occupational asthma (OA) in the detergent industry was first reported in 1969 and associated with exposure to dust of proteolytic enzymes. Occupational allergies were considered to be under control as a result of encapsulation of enzymes and improved hygiene in the 1970s 3 4 and evidence exists for a reduction of OA risk.5 6 Despite these measures, sensitisation could not be totally prevented 4 and new outbreaks of OA have been reported due to detergent enzymes exposure. 7 8 This study was occasioned by the occupational health service of a liquid detergent production plant which, in a pilot study, reported that three out of 12 highly exposed workers were sensitised to detergent protease (Savinase).As far as we know, no occupational respiratory allergies have been reported in detergent production industries related to liquid detergent enzymes. The novelty of the present study is that it was conducted in a detergent plant producing liquid detergents using only liquid enzymes. The plant never produced powdered detergent products and neither used powdered nor encapsulated enzymes. This study was conducted among all workers in the plant who were potentially exposed to liquid detergent enzymes. The first aim of this study ...

Occupational Rhinitis

“…Risk of OR symptoms and sensitization are increased in consistently exposed workers. In a cross-sectional study of detergent manufacturing workers, those who handled concentrated enzyme products during the entire work shift had significantly more work-related nasal symptoms of itching nose (prevalence ratio [PR], 4.2; 95% CI, 1.5-12), sneezing (PR, 4; 95% CI, 1.5-10.8), and elevated enzyme serum-specific IgE (PR, 3.8; 95% CI, 1-14.1) compared with workers with incidental exposure [22]. In cross-sectional studies of bakers, the prevalence of work-related symptoms and of specific IgE antibodies to wheat flour antigens was directly associated with measured flour dust concentrations [15,16].…”

“…In a large, retrospective cohort study of 1064 workers exposed to multiple enzymes (proteases, lipases, cellulases, carboxyhydrases), 3% of sensitized workers reported rhinoconjunctivitis symptoms [21]. Two crosssectional studies have noted that 4.6% to 19% of workers sensitized to enzymes reported upper respiratory symptoms [22,23].…”

“…It has been reported that the risk of IgE-mediated sensitization to HMW agents is directly related to the level as well as duration of exposure in workers exposed to laboratory animals [7,10,11], detergent enzymes [22,23], flour [14][15][16], and α-amylase [15]. Risk of OR symptoms and sensitization are increased in consistently exposed workers.…”

“…Workers are exposed to microbial enzymes during manufacture of detergents, animal feed, fuel alcohol, textile, paper products, and pharmaceuticals. Uncontrolled exposure to enzymes can result in OR and occupational asthma [1, [21][22][23]. In a large, retrospective cohort study of 1064 workers exposed to multiple enzymes (proteases, lipases, cellulases, carboxyhydrases), 3% of sensitized workers reported rhinoconjunctivitis symptoms [21].…”

Occupational Rhinitis and Asthma: Where Do We Stand, Where Do We Go?

“…The association between exposure to liquid detergent enzymes and upper and lower airway symptoms was examined in a cross-sectional study of 108 differentially exposed workers. Highly exposed detergent workers reported significantly more nasal symptoms and marginally significant more wheezing than the least exposed group [24].…”