Airway irritation among indoor swimming pool personnel: trichloramine exposure, exhaled NO and protein profiling of nasal lavage fluids

Fornander, Louise; Ghafouri, Bijar; Lindahl, Mattias; Graff, Pål

doi:10.1007/s00420-012-0790-4

Cited by 30 publications

(36 citation statements)

References 42 publications

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“…It is possible that this is related to different functions of the two S100 proteins as, in mice, S100-A8 acts as an activator of Toll-like receptor 4 promoting endotoxin induced inflammation while S100-A9 appear to have a more regulatory role [30]. Notably, the levels of S100-A8 were not significantly altered in the subjects with symptoms although we recently have found decreased levels of S100-A8, but unaltered levels of S100-A9, in swimming pool personnel with similar upper airway symptoms as the MWF exposed workers [31]. This may indicate that a disturbed balance between the two S100 proteins is a common feature of upper respiratory mucosal inflammation.…”

Section: Discussionmentioning

confidence: 69%

Airway Symptoms and Biological Markers in Nasal Lavage Fluid in Subjects Exposed to Metalworking Fluids

Fornander

Graff²,

Wåhlén³

et al. 2013

PLoS ONE

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BackgroundsOccurrence of airway irritation among industrial metal workers was investigated. The aims were to study the association between exposures from water-based metal working fluids (MWF) and the health outcome among the personnel, to assess potential effects on the proteome in nasal mucous membranes, and evaluate preventive actions.MethodsThe prevalence of airway symptoms related to work were examined among 271 metalworkers exposed to MWF and 24 metal workers not exposed to MWF at the same factory. At the same time, air levels of potentially harmful substances (oil mist, morpholine, monoethanolamine, formaldehyde) generated from MWF was measured. Nasal lavage fluid was collected from 13 workers and 15 controls and protein profiles were determined by a proteomic approach.ResultsAirway symptoms were reported in 39% of the workers exposed to MWF although the measured levels of MWF substances in the work place air were low. Highest prevalence was found among workers handling the MWF machines but also those working in the same hall were affected. Improvement of the ventilation to reduce MWF exposure lowered the prevalence of airway problems. Protein profiling showed significantly higher levels of S100-A9 and lower levels of SPLUNC1, cystatin SN, Ig J and β2-microglobulin among workers with airway symptoms.ConclusionsThis study confirms that upper airway symptoms among metal workers are a common problem and despite low levels of MWF-generated substances, effects on airway immune proteins are found. Further studies to clarify the role of specific MWF components in connection to airway inflammation and the identified biological markers are warranted.

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Section: Discussionmentioning

confidence: 69%

Airway Symptoms and Biological Markers in Nasal Lavage Fluid in Subjects Exposed to Metalworking Fluids

Fornander

Graff²,

Wåhlén³

et al. 2013

PLoS ONE

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“…All of these studies have shown increased ocular and upper respiratory symptoms, and all but the French and Swiss studies [11,15] found increased lower respiratory symptoms in individuals who work at pools. Some studies found a correlation between symptoms and exposure levels of trichloramine [12][13][14]. None of these cross-sectional studies performed peak flow or spirometric measures in association with work, nor did they identify whether individuals with preexisting asthma had more symptoms after beginning work in a pool setting in comparison to before working at a pool.…”

Section: Discussionmentioning

confidence: 93%

“…Six previous cross-sectional studies of swimming pool personnel were identified and are consistent with our finding of aggravation of pre-existing asthma. These studies have been conducted in France [11], Italy [12], the Netherlands [13], Sweden [14], Switzerland [15] and the United States [16]. All of these studies have shown increased ocular and upper respiratory symptoms, and all but the French and Swiss studies [11,15] found increased lower respiratory symptoms in individuals who work at pools.…”

Section: Discussionmentioning

confidence: 97%

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Swimming facilities and work-related asthma

et al. 2014

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Swimming pool workers were identified from three states where the pool environment was either a trigger of preexisting asthma or associated with new onset of WRA. Regulations to require air monitoring and improvements in ventilation are recommended to reduce exposure levels of chloramines, the presumed etiologic agents. Clinical assessment of patients with asthma should include consideration of the effect on respiratory symptoms from exposures in a swimming pool environment.

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“…8,[14][15][16][17] Hypersensitivities to fungus and mites are aggravated by the time spent within the pool area, which leads to cytological changes. The concentrations of chlorine by-products in indoor air, such as trihalomethanes and trichloramine, have been found to be correlated with the concentrations found in the pool water.…”

Section: Discussionmentioning

confidence: 99%

Effects of indoor swimming pools on the nasal cytology of pool workers

Erkul

Yaz²,

Cingi

et al. 2014

J. Laryngol. Otol.

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Objective: We aimed to evaluate the relationship between swimming pool pollutants and allergic rhinitis in swimming pool workers.Materials and methods: Twenty-seven indoor pool workers (group 1) and 49 control subjects (group 2) were enrolled in the study. A skin prick test was performed and a nasal smear was obtained from each subject to evaluate rhinitis.Results: When the groups were compared in terms of epithelial cells, group 1 had significantly more epithelial cells than group 2. When the groups were compared with regard to eosinophils, group 1 had significantly more eosinophils than group 2. The skin prick test results for both groups were not significantly different.Conclusion: Indoor pool workers showed severe symptoms of rhinitis and eosinophilic nasal cytology, likely due to chlorine. Nasal cytology is an easy-to-administer diagnostic test and can be used to follow up rhinitis in indoor pool workers, along with nasal endoscopy, a detailed clinical history and a skin prick test. IntroductionUnder optimal nasal breathing conditions, air passes over the nasal mucosa resulting in warming, humidification and cleansing. However, these conditions can be influenced by several factors. Indoor air quality may negatively affect the sinonasal mucosa and is associated with occupational and smoking irritants, which can cause chronic or allergic rhinitis. 1 To maintain proper nasal functions, the optimal indoor air temperature should be approximately 23°C with 50 per cent humidity. 2 Indoor air is often cleaned to limit the levels of pollutants by modifying temperature and humidity in houses and offices. 2 However, the improper maintenance, design and operating of air-conditioning systems in non-industrial indoor areas contributes to an increased prevalence of rhinitis. 3 In Turkey, smoking is prohibited indoors and in common social areas.Allergic rhinitis is a symptomatic disorder caused by immunoglobulin E-mediated inflammation of the nasal membranes, which is induced by exposure to an allergen or allergens. Allergic rhinitis frequently causes symptoms that include sneezing, nasal obstruction,

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Airway irritation among indoor swimming pool personnel: trichloramine exposure, exhaled NO and protein profiling of nasal lavage fluids

Cited by 30 publications

References 42 publications

Airway Symptoms and Biological Markers in Nasal Lavage Fluid in Subjects Exposed to Metalworking Fluids

Airway Symptoms and Biological Markers in Nasal Lavage Fluid in Subjects Exposed to Metalworking Fluids

Swimming facilities and work-related asthma

Effects of indoor swimming pools on the nasal cytology of pool workers

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