Occupational asthma in salbutamol process workers.

Agius, Raymond; Davison, AG; Hawkins, E R; Taylor, A J Newman

doi:10.1136/oem.51.6.397

Cited by 11 publications

(3 citation statements)

References 10 publications

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“…No less than 200 compounds that cause occupational asthma were known at the end of the 1980s and several further compounds with similar activity have been discovered more recently. During the first half of 1994 for instance, occupational asthma in workers involved in the manufacture of the drug salbutamol was recognised [9]. Also, the risk of asthma from exposure to bio-aerosols in the potato-processing industry [10] was described.…”

Section: Pharmacological Bronchoconstrictionmentioning

confidence: 99%

Diagnostic Criteria for Occupational Asthma: Special Problems in Hungary

Mándi

1995

Indoor Environment

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The obligatory diagnostic criteria for occupational asthma are: the patient's history including the working history, the clinical symptoms and the positive result(s) of a specific bronchial challenge test(s) performed with the suspected working material(s). Monitoring the peak expiratory flow rate at home and at work, skin tests (prick test) and the airway's hyperresponsiveness determined by histamine or methacholine challenge constitute useful complementary data. Occupational asthma in Hungary is a registered but not a compensated disease, and, consequently, the number of the registered cases does not reflect the true incidence and prevalence of the disease. These are both underestimated and the data for them from Hungary are not comparable with those from other countries.

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Section: Pharmacological Bronchoconstrictionmentioning

confidence: 99%

Diagnostic Criteria for Occupational Asthma: Special Problems in Hungary

Mándi

1995

Indoor Environment

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“…No less than 200 compounds that cause occupational asthma were known at the end of the 1980s and several further compounds with similar activity have been discovered more recently. During the first half of 1994 for instance, occupational asthma in workers in volved in the manufacture of the drug salbutamol was recognised [9], Also, the risk of asthma from exposure to bio-aerosols in the potato-processing industry [10] was described. High-molecular-weight materials, as a rule, cause IgE-mediated immediate reactions -i.e.…”

Section: Immunological Bronchoconstrictionmentioning

confidence: 99%

Diagnostic Criteria for Occupational Asthma: Special Problems in Hungary

Mándi¹

1995

Indoor Built Environ

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The obligatory diagnostic criteria for occupational asthma are: the patient’s history including the working history, the clinical symptoms and the positive result(s) of a specific bronchial challenge test(s) performed with the suspected working material(s). Monitoring the peak expiratory flow rate at home and at work, skin tests (prick test) and the airway’s hyperresponsiveness determined by histamine or methacholine challenge constitute useful complementary data. Occupational asthma in Hungary is a registered but not a compensated disease, and, consequently, the number of the registered cases does not reflect the true incidence and prevalence of the disease. These are both underestimated and the data for them from Hungary are not comparable with those from other countries.

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“…(1) report a case of bronchoconstriction in a patient caused by inhalation of short‐acting β2‐agonists. In an occupational setting, exposures to such agents can be even greater than those encountered therapeutically and there have been at least two reported cases of occupational asthma attributed to salbutamol exposure in pharmaceutical process workers (2). However, in the above‐mentioned report the authors postulated that the mechanism might be tachyphylactic rather than IgE‐mediated.…”

mentioning

confidence: 99%

Paradoxical asthma hazard of short‐acting β2‐agonists

Seed

Agius

2008

Allergy

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Paradoxical asthma hazard of short-acting b2-agonists Bonniaud et al. (1) report a case of bronchoconstriction in a patient caused by inhalation of short-acting b2-agonists. In an occupational setting, exposures to such agents can be even greater than those encountered therapeutically and there have been at least two reported cases of occupational asthma attributed to salbutamol exposure in pharmaceutical process workers (2). However, in the above-mentioned report the authors postulated that the mechanism might be tachyphylactic rather than IgE-mediated. Thus, salbutamol was one of the 78 low molecular weight (LMW) organic chemicals known to cause occupational asthma from which a quantitative structure-activity relationship (QSAR) model was developed (3). This asthma hazard prediction program is freely available through the internet (4), and we have previously illustrated how a positive Ôasthma hazard indexÕ can help corroborate evidence of potential asthmagenicity of LMW organic chemicals (3,5).Although designed for the purpose of predicting the asthma hazard of industrial chemicals, this QSAR model has been used by others, in clinical pharmacology. Thus an independent user of the model found that a chemical ingredient of salmeterol inhalers, xinafoate, had an asthma hazard index of 0.73. This index is expressed on a scale of 0-1 with a value of 0.5 or higher indicating asthmagenic potential. Based on a validation set containing 21 asthmagens this cutpoint results in a sensitivity of 86% and specificity 99%. It was postulated that xinafoate might be the cause of severe asthma exacerbations observed in some patients using this long-acting b2-agonist (6).In the case reported by Bonniaud et al.(1) the b-agonist drugs themselves were clearly demonstrated to cause bronchoconstriction, perhaps through an IgE-mediated mechanism. Salbutamol has an asthma hazard index of 0.84. Interestingly, terbutaline, and pirbuterol, which were not in the QSAR model development set, have hazard indices of 0.79 and 0.97, respectively. Common structural features might explain why these three chemicals are capable of sharing reactive features potentially leading to asthmagenicity (Fig. 1), such as by reacting with native proteins resulting in IgE neoepitopes. Proof (or otherwise) that the mechanism is IgE-mediated would however require in vivo and in vitro studies to search for specific IgE antibodies.

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Occupational asthma in salbutamol process workers.

Cited by 11 publications

References 10 publications

Diagnostic Criteria for Occupational Asthma: Special Problems in Hungary

Diagnostic Criteria for Occupational Asthma: Special Problems in Hungary

Diagnostic Criteria for Occupational Asthma: Special Problems in Hungary

Paradoxical asthma hazard of short‐acting β2‐agonists

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