Occupational asthma caused by high-molecular-weight substances

Wild, Laurianne G.; Lopez, Manuel

doi:10.1016/s0889-8561(02)00083-8

Cited by 25 publications

(23 citation statements)

References 75 publications

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“…The use of powdered high-protein NRL gloves is recognized as the major environmental risk factor for latex sensitization and allergy in the health care field (Levy et al 1999; Wild and Lopez 2003). The widespread use of NRL gloves in the health care industry started in the 1980s as health care facilities complied with Universal Precautions [Occupational Safety and Health Administration (OSHA) 1991].…”

Section: Discussionmentioning

confidence: 99%

“…Atopic individuals may have a personal or family history of eczema, asthma, or hay fever or a tendency to develop specific IgE antibodies after exposure to common environmental substances, although many do not. The tendency to develop some form of allergy is inherited, but the specific clinical form, such as hay fever, asthma, or eczema, is not (Wild and Lopez 2003). Skin tests to common environmental allergens such as pollen, animal dander, molds, and house dust mites are used to evaluate atopic status.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, skin testing is done with unstandardized office-prepared latex extracts, which vary widely in allergen content (Ownby 2003). Specific IgE antibodies can also be studied in vitro using a blood test, the RAST assay (Wild and Lopez 2003). Tests for latex-specific IgE such as the RAST are less sensitive and specific than are skin prick tests, with sensitivity ranging between 73 and 80% and specificity ranging between 90 and 97% (Ownby 2003).…”

Section: Discussionmentioning

confidence: 99%

“…OA differs from preexisting asthma, which is exacerbated by exposure to agents in the workplace (Wild and Lopez 2003). However, OA may occur in conjunction with preexisting asthma, because OA involves the new onset of sensitization to a workplace antigen or allergen with the development of respiratory disease.…”

Section: Discussionmentioning

confidence: 99%

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Grand Rounds: Latex-Induced Occupational Asthma in a Surgical Pathologist

Green-McKenzie¹,

Hudes²

2005

Environ Health Perspect

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Context: Latex allergy and sensitization have been an important problem facing health care workers. Providing a latex-safe environment is the intervention of choice.Case Presentation: A 46-year-old surgical pathologist presented with increasing shortness of breath for the previous 4 years. Twenty years before presentation, he noted a pruritic, erythematous rash on his hands, associated with latex glove use. Fourteen years before presentation, during pathology residency, he developed a nonproductive cough, wheezing, and an urticarial rash, temporally associated with use of powdered latex gloves. These symptoms improved while away from work. At presentation, he had one-flight dyspnea. His skin prick test was positive for latex, and pulmonary function testing showed mild obstruction, which was reversible with bronchodilator use. Because the patient was at risk for worsening pulmonary function and possible anaphylaxis with continued exposure, he was removed from the workplace because no reasonable accommodation was made for him at that time.Discussion: The patient’s presentation is consistent with latex-induced occupational asthma. Initially noting dermal manifestations, consistent with an allergic contact dermatitis secondary to accelerators present in latex gloves, he later developed urticaria, flushing, and respiratory symptoms, consistent with a type I hypersensitivity reaction to latex. He also has reversible airways disease, with significant improvement of peak expiratory flow rate and symptoms when away from work.Relevance to Clinical or Professional Practice: The ideal treatment for latex sensitization is removal from and avoidance of exposure. Clinicians should consider occupational asthma when patients present with new-onset asthma or asthmatic symptoms that worsen at work.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Grand Rounds: Latex-Induced Occupational Asthma in a Surgical Pathologist

Green-McKenzie¹,

Hudes²

2005

Environ Health Perspect

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“…The mechanism by which LMW chemicals cause asthma due to sensitisation tends to differ from that of high molecular weight (HMW) substances in that the latter group is often associated with pre-existing atopy and detectable serum IgE antibodies to the allergen. 4 Specific IgE antibodies (to chemical-protein conjugates) are commonly found in cases due to some LMW agents (for example, acid anhydrides), but rarely in others (for example, isocyanates). 2 The chemical mechanism by which LMW chemicals cause asthma remains generally poorly defined.…”

mentioning

confidence: 99%

Relationship between chemical structure and the occupational asthma hazard of low molecular weight organic compounds

Jarvis

Seed²,

Elton³

et al. 2005

Occup Environ Med

169

115

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Aims: To investigate quantitatively, relationships between chemical structure and reported occupational asthma hazard for low molecular weight (LMW) organic compounds; to develop and validate a model linking asthma hazard with chemical substructure; and to generate mechanistic hypotheses that might explain the relationships. Methods: A learning dataset used 78 LMW chemical asthmagens reported in the literature before 1995, and 301 control compounds with recognised occupational exposures and hazards other than respiratory sensitisation. The chemical structures of the asthmagens and control compounds were characterised by the presence of chemical substructure fragments. Odds ratios were calculated for these fragments to determine which were associated with a likelihood of being reported as an occupational asthmagen. Logistic regression modelling was used to identify the independent contribution of these substructures. A post-1995 set of 21 asthmagens and 77 controls were selected to externally validate the model. Results: Nitrogen or oxygen containing functional groups such as isocyanate, amine, acid anhydride, and carbonyl were associated with an occupational asthma hazard, particularly when the functional group was present twice or more in the same molecule. A logistic regression model using only statistically significant independent variables for occupational asthma hazard correctly assigned 90% of the model development set. The external validation showed a sensitivity of 86% and specificity of 99%. Conclusions: Although a wide variety of chemical structures are associated with occupational asthma, bifunctional reactivity is strongly associated with occupational asthma hazard across a range of chemical substructures. This suggests that chemical cross-linking is an important molecular mechanism leading to the development of occupational asthma. The logistic regression model is freely available on the internet and may offer a useful but inexpensive adjunct to the prediction of occupational asthma hazard.

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Inhalation Exposure Toxicity Testing and Safety Evaluation

Sadekar

2024

Reference Module in Biomedical Sciences

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Occupational asthma caused by high-molecular-weight substances

Cited by 25 publications

References 75 publications

Grand Rounds: Latex-Induced Occupational Asthma in a Surgical Pathologist

Grand Rounds: Latex-Induced Occupational Asthma in a Surgical Pathologist

Relationship between chemical structure and the occupational asthma hazard of low molecular weight organic compounds

Inhalation Exposure Toxicity Testing and Safety Evaluation

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