Evolution of occupational asthma: Does cessation of exposure really improve prognosis?

Muñoz, Xavier; Viladrich, M. C.; Manso, L.; Pozo, Victora del; Quirce, Santiago; Cruz, María Jesús; Carmona, Francesc; Sánchez-Pla, Álex; Sastre, Joaquı́n

doi:10.1016/j.rmed.2014.08.001

Cited by 18 publications

(3 citation statements)

References 32 publications

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“…Several studies of workplace interventions for OA were published after the 2011 review. With a comprehensive approach of including recently published studies, [9][10][11][12] along with those studies already identified in the 2011 Cochrane review, we produced an updated systematic review of evidence on the effectiveness of workplace interventions for the treatment of OA. 13…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of removal from exposure and reduction of exposure for managing occupational asthma: Summary of an updated Cochrane systematic review

Henneberger

Patel

Groene

et al. 2020

American J Industrial Med

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Background: The objective was to update the 2011 Cochrane systematic review on the effectiveness of workplace interventions for the treatment of occupational asthma. Methods: A systematic review was conducted with the selection of articles and reports through 2019. The quality of extracted data was evaluated, and metaanalyses were conducted using techniques recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Results: Data were extracted from 26 nonrandomized controlled before-and-after studies. The mean number of participants per study was 62 and the mean follow-up time was 4.5 years. Compared with continued exposure, removal from exposure had an increased likelihood of improved symptoms and change in spirometry. Reduction of exposure also had more favorable results for symptom improvement than continued exposure, but no difference for change in spirometry. Comparing exposure removal to reduction revealed an advantage for removal with both symptom improvement and change in spirometry for the larger group of patients exposed to low-molecular-weight agents. Also, the risk of unemployment was greater for exposure removal versus reduction. Conclusions: Exposure removal and reduction had better outcomes than continued exposure. Removal from exposure was more likely to improve symptoms and spirometry than reduction among patients exposed to low-molecular-weight agents. The potential benefits associated with exposure removal versus reduction need to be weighed against the potential for unemployment that is more likely with removal from exposure. The findings are based on data graded as very low quality, and additional studies are needed to generate higher quality data.

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Section: Introductionmentioning

confidence: 99%

The effectiveness of removal from exposure and reduction of exposure for managing occupational asthma: Summary of an updated Cochrane systematic review

Henneberger

Patel

Groene

et al. 2020

American J Industrial Med

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“…It is generally accepted that when an allergic pathology of occupational origin is diagnosed, and in particular OA, patients should be removed from their work-place. However, some studies suggest that this decision should be individualized for each patient [31][32]. A recent multicenter study in patients with diagnosed OA showed that predisposing factors for progression to severe asthma are, in this order, the existence of asthma prior to occupation, expectoration, persistence of exposure to high doses, aphonia at work, and diagnostic delay [33].…”

Section: Discussionmentioning

confidence: 99%

Occupational respiratory allergy to reactive dyes

Muñoz

Clofent

Cruz

2022

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewReactive dyes have been shown to cause respiratory sensitization in workers with occupational exposure. The present review analyzes the current knowledge of the role of reactive dyes in promoting occupational respiratory allergy. We discuss the current classification of reactive dyes as well as the potential development of occupational respiratory diseases after exposure to these substances. Recent findingsFew descriptions of the role of reactive dyes in the development of occupational allergy have been published in recent years. Several reactive dyes are considered causes of occupational asthma (OA), mainly in workers in textile industries. Positive skin tests and the presence of specific serum IgE antibodies to reactive dyes suggest that respiratory symptoms provoked by reactive dyes may be immunoglobulin E (IgE)-mediated reactions. It was suggested that airborne dye molecules may act as haptens and induce IgEmediated hypersensitivity reactions. SummaryReactive dyes are widely used in the textile industry, owing to their ability to produce strong covalent bonds to textile fibers. These substances have been identified as potential respiratory sensitizers causing OA and occupational rhinitis. The clinical presentation and phenotype of patients with OA due to reactive dyes is very similar to those presented by patients with OA to high molecular weight agents. The extensive use of reactive dyes in industry means that it is particularly important to describe their implications for health, which in fact are probably underestimated.

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“…It is well established that patients with OA generally become less responsive to the sensitizer after complete exposure removal [ 4 ]. Nevertheless, there is insufficient scientific evidence to assert that cessation of exposure improves asthma symptoms, and many patients do not become completely unresponsive to the sensitizer [ 28 ]. In our study, asthma symptoms and functional airway abnormalities had disappeared after 90 days.…”

Section: Discussionmentioning

confidence: 99%

Persistence of respiratory and inflammatory responses after dermal sensitization to persulfate salts in a mouse model of non-atopic asthma

Cruz

Ollé-Monge

Vanoirbeek

et al. 2016

Allergy Asthma Clin Immunol

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BackgroundExposure to ammonium persulfate (AP) has been reported to be the main cause of occupational asthma in hairdressers. The aim of this study is to assess how long the asthmatic response to AP can be induced after dermal sensitization in a mouse model.MethodsBALB/c mice received dermal applications of AP or dimethylsulfoxide (DMSO) (control) on days 1 and 8. They then received a single nasal instillation (challenge) of AP or saline on days 15, 22, 29, 36, 45, 60 and 90. Respiratory responsiveness to methacholine was measured 24 h after the challenge using a non-specific methacholine provocation test. Pulmonary inflammation was analysed in bronchoalveolar lavage (BAL), and total serum immunoglobulin (Ig) E, IgG1 and IgG2a were measured in serum samples. Histological analysis of lung slides was performed.ResultsMice dermally sensitized and intranasally challenged with AP showed respiratory responsiveness to methacholine as long as 45 days after initial sensitization, as well as increased percentage of neutrophils in BAL compared with the control group. At day 60, dermally sensitized mice still presented bronchial hyperresponsiveness, while the percentage of neutrophils returned to baseline levels similar to those of controls. Total serum IgE increased significantly on day 22 after dermal sensitization. Total serum IgG1 and IgG2a increased from 45 days after dermal sensitization and remained high at 90 days.ConclusionsBoth respiratory responsiveness to methacholine and airway inflammation responses decrease with increasing time between sensitization and challenge. Respiratory responsiveness to methacholine tends to persist longer than inflammation.

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Evolution of occupational asthma: Does cessation of exposure really improve prognosis?

Abstract: Avoiding exposure to the causative agent in patients with OA does not seem to improve prognosis in this disease. Despite these findings, there is insufficient evidence to recommend a change in current management guidelines.

Cited by 18 publications

References 32 publications

The effectiveness of removal from exposure and reduction of exposure for managing occupational asthma: Summary of an updated Cochrane systematic review

The effectiveness of removal from exposure and reduction of exposure for managing occupational asthma: Summary of an updated Cochrane systematic review

Occupational respiratory allergy to reactive dyes

Persistence of respiratory and inflammatory responses after dermal sensitization to persulfate salts in a mouse model of non-atopic asthma

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