Enzyme Asthma: Fourteen Years' Clinical Experience of a Recently Prescribed Disease

Juniper, C. P.; Roberts, D. M.

doi:10.1093/occmed/34.4.127

Cited by 23 publications

(7 citation statements)

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“…The pharmacological treatment of work-related asthma should be adapted to the level of asthma control, in accordance with the general recommendations for asthma Strong Moderate work-related asthma or respiratory occupational allergy (***) [124,129,[133][134][135][136].…”

Section: Strong Lowmentioning

confidence: 99%

Guidelines for the management of work-related asthma

Baur

Sigsgaard²,

Aasen³

et al. 2012

European Respiratory Journal

181

182

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Work-related asthma, which includes occupational asthma and work-aggravated asthma, has become one of the most prevalent occupational lung diseases. These guidelines aim to upgrade occupational health standards, contribute importantly to transnational legal harmonisation and reduce the high socio-economic burden caused by this disorder.A systematic literature search related to five key questions was performed: diagnostics; risk factors; outcome of management options; medical screening and surveillance; controlling exposure for primary prevention. Each of the 1,329 retrieved papers was reviewed by two experts, followed by Scottish Intercollegiate Guidelines Network grading, and formulation of statements graded according to the Royal College of General Practitioners' three-star system.Recommendations were made on the basis of the evidence-based statements, which comprise the following major evidence-based strategic points. 1) A comprehensive diagnostic approach considering the individual specific aspects is recommended. 2) Early recognition and diagnosis is necessary for timely and appropriate preventative measures. 3) A stratified medical screening strategy and surveillance programme should be applied to at-risk workers. 4) Whenever possible, removing exposure to the causative agent should be achieved, as it leads to the best health outcome. If this is not possible, reduction is the second best option, whereas respirators are of limited value. 5) Exposure elimination should be the preferred primary prevention approach.

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Section: Strong Lowmentioning

confidence: 99%

Guidelines for the management of work-related asthma

Baur

Sigsgaard²,

Aasen³

et al. 2012

European Respiratory Journal

181

182

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“…In the detergent industry, the introduction of work practices and a medical surveillance programme decreased sensitisation rates to enzymes among workers within almost 20 yrs [45]. Significant reductions in the prevalence of occupational asthma have been reported after introducing granulated proteases [44,48]. In the study of CATHCART et al [44], during the observation period, atmospheric enzyme concentrations and the reported incidence of enzyme asthma fell considerably.…”

Section: Natural Rubber Latexmentioning

confidence: 99%

Primary prevention: exposure reduction, skin exposure and respiratory protection

Heederik¹,

Henneberger²,

Redlich³

2012

European Respiratory Review

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Interventions for the primary prevention of occupational asthma have been reported in the medical literature, understanding the effectiveness of these efforts could help future interventions. The aim of our study was to evaluate the existing knowledge regarding the impact of controlling work exposure on the prevention of occupational asthma. We conducted systematic literature searches through April 2010 to examine if control of workplace exposures is effective for primary prevention of sensitisation and occupational asthma. The literature search for primary prevention of occupational asthma yielded 29 studies. Assessment of the available information led to the following conclusions and recommendations concerning primary prevention of occupational asthma. Exposure elimination is the strongest and preferred primary preventive approach to reduce the burden of occupational asthma. If elimination is not possible, exposure reduction is the second best option for primary prevention of occupational asthma. The evidence for the effectiveness of respirators in preventing occupational asthma is limited, and other options higher in the list of controls for occupational exposures, notably eliminating or minimising exposures at the source or in the environment, should be used preferentially. There is strong evidence to recommend not using powdered allergen-rich natural rubber latex gloves. There is weak evidence that suggests workers should minimise skin exposure to asthma-inducing agents.

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“…We have estimated that protease and amylase enzyme levels in our facilities may have been in the hundreds of nanograms to low microgram/m 3 range in the late 1960s. Lowering the enzyme dust levels to low nanogram/m 3 range in the early 1970s eliminated much of the asthma and allergy symptoms [8, 10, 16, 19]. The American Conference of Governmental Industrial Hygienists (ACGIH) established a threshold limit value (TLV) for the enzyme subtilisin (protease) of 60 ng of pure crystalline protein/m 3 .…”

Section: Exposure Guidelines For Detergent Enzymesmentioning

confidence: 99%

“…Occupational asthma (OA) associated with the use of proteolytic enzymes in the manufacture of detergents was reported by Flindt and Pepys in 1969 [1, 2]. The medical community rapidly recognized the risk of allergic antibody‐mediated OA associated with enzyme use in the detergent industry [3–16] as well as during the manufacture of enzymes [17–19]. The first enzyme to be associated with adverse respiratory health affects was a serine protease derived from Bacillus species.…”

Section: Introductionmentioning

confidence: 99%