Respiratory afflictions during hairdressing jobs: case history and clinical evaluation of a large symptomatic case series

Abstract

Objectives Respiratory symptoms at work are common among hairdressers. Various working materials, most notably bleaching ingredients such as ammonium persulfate, have been made responsible. The objective of this study is to achieve a better understanding of work-related respiratory symptoms of hairdressers by describing common features in a large affected collective. Methods One hundred forty-eight hairdressers with respiratory symptoms at work presenting between 2012 and 2019 were consecutively included in a case series. Anamnestic and diagnostic data including pulmonary function and allergy testing were retrospectively compiled from records and analysed. Additionally, cases were categorised in five groups with respect to occupational causation certainty. Results 30% of the predominantly female collective had changed jobs or were on longer sick-leave. Besides respiratory symptoms, 10% also reported contact urticaria to blonde dyes. In 60% an obstructive airway disease was confirmed. A specific hypersensitivity reaction to ammonium persulfate was found in 15%. Group 1 with a proven immunological occupational causation showed significantly lower age (p < 0.001) and tenure time (p = 0.001), higher sensitization rates against environmental allergens as well as a higher total IgE (p = 0.015), compared to group 4 (obstructive airway disease, specific occupational causation unlikely). Conclusions This case series contributes to a better characterization of work-related respiratory symptoms in hairdressing as one of the largest examined collectives of symptomatic hairdressers. Ammonium persulfate as the most common specific cause showed signs of a type-I-like hypersensitivity reaction with typical risk factors for atopy. Prick testing is recommended in all symptomatic cases. However, a specific occupational causation often cannot be proved.

Occupational respiratory morbidity and associated factors among hairdressers in Ethiopia: a cross-sectional study

“…Hairdressers are among the higher-risk occupational groups for respiratory problems due to unsafe working conditions, a lack of training and awareness, the use of different chemicals, a lack of regular monitoring and inspections and poor accessibility and use of PPE 15 38–41. In addition, this group of workers belongs to the informal economy, in which work-related exposure is unregulated and working conditions are substandard.…”

Recent developments in occupational asthma

“…Exposure to bleaching products was shown to be the most important factor for the development of respiratory symptoms, lung function decline and leaving the profession. In their retrospective descriptive study on 148 hairdressers with respiratory symptoms at work, Hiller et al [23] showed that 30% had changed jobs or were on longer sick leave. Sixty percent of patients had evidence of an obstructive lower airway disease and 15% were considered to have ammonium persulfate induced OA.…”

Diagnostics and Prevention of Occupational Allergy in Hairdressers

“…However, pathophysiological mechanism(s) of respiratory inflammation caused by PS are not yet clarified. Beside non-specific immunological pathways including chemical irritation with possible epithelial damage and histamine liberation, specific immunological reactions like IgE- or non-IgE-mediated immediate types of allergic reactions were suggested [ 8 •, 36 ]. Diagnostic procedures in this respect are, so far, hampered by the lack of commercially available standardized APS/PPS preparations for skin prick testing (SPT), and standardized reagents and methods for measuring specific IgE to PSs.…”

“…SPT results vary between studies, mostly being negative in hairdressers with respiratory disorders. Recently, among 148 hairdressers seen in a German occupational medicine university clinic between 2012 and 2019, positive SPT to APS with clinical relevance was found in 15% [ 36 ]. Specific IgE antibodies to PSs have been measured even more rarely, only with “in-house” methods, and yielding positive results sporadically [ 37 , 39 ].…”