Asthma and exposure to cleaning products - a European Academy of Allergy and Clinical Immunology task force consensus statement

Abstract

Professional and domestic cleaning is associated with work-related asthma (WRA). This position paper reviews the literature linking exposure to cleaning products and the risk of asthma and focuses on prevention. Increased risk of asthma has been shown in many epidemiological and surveillance studies, and several case reports describe the relationship between exposure to one or more cleaning agents and WRA. Cleaning sprays, bleach, ammonia, disinfectants, mixing products, and specific job tasks have been identified as specific causes and/or triggers of asthma. Because research conclusions and policy suggestions have remained unheeded by manufactures, vendors, and commercial cleaning companies, it is time for a multifaceted intervention. Possible preventive measures encompass the following: substitution of cleaning sprays, bleach, and ammonia; minimizing the use of disinfectants; avoidance of mixing products; use of respiratory protective devices; and worker education. Moreover, we suggest the education of unions, consumer, and public interest groups to encourage safer products. In addition, information activities for the general population with the purpose of improving the knowledge of professional and domestic cleaners regarding risks and available preventive measures and to promote strict collaboration between scientific communities and safety and health agencies are urgently needed.In Europe, the fraction of adult asthma attributable to occupational exposure ranges between 10% and 25% (1). Workrelated asthma (WRA) includes occupational asthma (OA), caused by exposure to high or low molecular weight agents in the workplace, and work-exacerbated asthma (WEA), in which pre-existing or concurrent asthma is exacerbated by various work-related factors, such as accidental spills, second-hand cigarette smoke, or exertion (2, 3).Cleaners constitute a large professional group in developed countries. In industrial cleaning, about 30% are migrant workers and about 40% of women are domestic cleaners (4, 5). Professional and domestic cleaning has been associated with new-onset OA due to sensitizers and irritant exposure as well as WEA and respiratory symptoms without asthma (5-7).It is likely that nonoccupational physicians (general practitioners, allergologists, and pneumologists) frequently see Allergy 68 (2013) 1532-1545

Are safety data sheets for cleaning products used in Norway a factor contributing to the risk of workers exposure to chemicals?

“…Cleaning workers are among the occupational groups with the highest incidence of contact dermatitis [6,7], and they have an increased risk of asthma and rhinitis [8]. Increasingly, fingers are pointed towards cleaning products as the reason for up to 12% of the reported asthma cases in several countries across Europe [9]. The aim of this study was to qualitatively assess available information on cleaning chemicals in the form of SDS in order to establish its usefulness and clarity, i.e., utility and uniformity of purpose.…”

EAACI position paper: irritant‐induced asthma

“…The most persuasive evidence for chronic IIA related to chronic moderate irritant exposure asthma is provided by the epidemiologic studies of workers exposed to cleaning agents (47). The frequent use of bleach (hypochlorite), ammonia, and degreasing sprays has been consistently associated with asthma among workers exposed to cleaning agents (42,44,48), although the precise chemical exposures and the mechanisms responsible for the increased incidence of asthma have not been clarified since cleaning materials typically contain a wide variety of ingredients, some of which are respiratory irritants, while others are potential airway sensitizers (Table 6).…”

“…The frequent use of bleach (hypochlorite), ammonia, and degreasing sprays has been consistently associated with asthma among workers exposed to cleaning agents (42,44,48), although the precise chemical exposures and the mechanisms responsible for the increased incidence of asthma have not been clarified since cleaning materials typically contain a wide variety of ingredients, some of which are respiratory irritants, while others are potential airway sensitizers (Table 6). Other occupations associated with increased risk of asthma that cannot be readily or completely explained on the basis of a clear sensitizing exposure are presented in Table 6 (47,(49)(50)(51)(52)(53)(54)(55)(56).…”

Occupational exposures and fluorescent oxidation products in 723 adults of the EGEA study

“…The role of exposure to cleaning products and disinfectants in work-related asthma is increasingly recognised, although the specific substances that increase asthma risk are not well identified [2]. Some of the numerous agents contained in these products are chemical sensitisers, but most are hypothesised to act as respiratory irritants [2].…”