Alessandra Marabini

Smoking and occupational asthma

Cigarette smoking is a known risk factor for many chronic illnesses such as coronary heart and chronic obstructive pulmonary diseases. Smoking is often described as a risk factor for occupational asthma even though its effect on the development of asthma is still under debate and the links between smoking and occupational asthma, occupational rhinitis or occupational sensitization are elusive, controversial and contradictory. This review describes these relationships in a wide range of occupations, from laboratory, farm, brewery and hospital workers, to bakers, printers, cleaners, fish processors and others as observed in cross‐sectional, cohort, and case‐control studies published over the past thirty‐five years i.e. from 1970 to 2005. Surprisingly, the data show there is little to support the view that the risk of occupational asthma is increased in workers who are smokers. However, evidence emerges of an increased risk of occupational sensitization in smoking workers exposed to several high and low molecular weight agents. This in‐depth review confirms the relationship between smoking and occupational asthma is complex and contradictory. It deserves more attention and further studies, which need to be conducted without being influenced by selection bias or by the justifiable prejudice against smoking.

Work-related late asthmatic response induced by latex allergy

BACKGROUND The occupational uses of latex gloves may be associated with asthma. Hypersensitivity to latex has been shown to be IgE-mediated. The asthmatic reaction to latex is usually early; however, the natural history of latex asthma is still unknown. OBJECTIVE The purposes of this study were to investigate asthmatic responses induced by natural rubber latex and to assess the long-term respiratory consequences of latex-induced asthma after removal from exposure. METHODS This report describes the clinical and immunologic study of six nurses with work-related respiratory and skin disorders induced by the use of latex gloves. To determine whether the symptoms induced by latex gloves were IgE-mediated, we assessed latex IgE antibody levels by skin prick tests (SPTs) and RASTs with latex extracts. To confirm work-related latex reactions, we assessed respiratory symptoms, skin reactions, and FEV1 after a glove exposure test and an inhalation provocation test with latex gloves. All subjects were followed up for 7 months to 7 years after the first observation. RESULTS All subjects had positive SPT and RAST responses to latex extracts, positive double prick test responses to latex gloves, and negative SPT responses to cornstarch and common allergens. Ten atopic and 10 nonatopic control subjects had negative SPT responses to latex and cornstarch extracts and negative double prick test responses to latex gloves. In three subjects latex allergy was associated with allergy to fruit (banana and chestnut). After the glove exposure test, four of six subjects had contact urticaria, all had rhinoconjunctivitis, and two had a late asthmatic response. The inhalation provocation test was performed on four subjects: all had rhinoconjunctivitis, two had urticaria and late asthmatic response, and one had laryngeal edema. A late asthmatic response was recorded in four subjects. Three subjects continued to have chronic asthma, and four subjects had increased nonspecific bronchial responsiveness 7 months to 7 years after being assigned to duties not involving latex gloves. CONCLUSIONS This study of six nurses shows that latex is a potential cause of occupational asthma, rhinoconjunctivitis, and urticaria-angioedema. Latex seems to include antigens that elicit IgE-mediated hypersensitivity and may cause a late asthmatic reaction. Occupational asthma caused by latex may lead to permanent respiratory disability, even after removal from exposure.

Troleandomycin in the treatment of difficult asthma

BACKGROUND For difficult asthma, treatment is aimed at improving airway obstruction and minimizing adverse effects of systemic corticosteroids. The combination of troleandomycin (TAO) with methylprednisolone (MP) reportedly has a beneficial steroid-sparing effect on difficult asthma. METHODS To test the steroid-sparing effect of TAO, 14 subjects with severe corticosteroid-dependent asthma were studied before and during treatment with MP and TAO. RESULTS Treatment with MP and TAO resulted in a clear reduction in respiratory symptoms, asthmatic attacks, corticosteroid and hospitalization requirements, improvement in pulmonary function tests, and a remarkable decrease in peak expiratory flow rate circadian variability when compared with the period before TAO treatment (with corticosteroids). Treatment with MP and TAO was fairly well tolerated. Only a reduction (-5.2%, p < 0.01) in bone mineral content and an increase in plasma glucose levels (from 81.7 to 94.3 mg/dl, p < 0.05) were found, in comparison with pre-TAO values. One subject discontinued MP-TAO treatment because of a mild but persistent increase in serum alanine aminotransferase. In an evaluation of the clinical and pulmonary function test results, eight of the 14 subjects were responders and six were nonresponders. During follow-up three subjects discontinued TAO and consequently had an asthmatic attack after 4, 7, or 15 days, respectively. CONCLUSIONS This study confirms that treatment with MP and TAO has a beneficial effect in a subgroup of severely steroid-dependent asthma patients.

Prevalence of occupational allergy due to live fish bait

Background Larvae of insects and worms, used as live fish bait (LFB), are a common source of allergy in anglers and occupationally exposed workers, but the prevalence and predictors have not yet been investigated.

Does an Asthma Education Program Improve Quality of Life? A Two-Year Randomized Trial

Asthma education programs result in clinical improvement. However, most studies involved programs of up to 1 year of follow-up, and their efficacy in improving quality of life (QoL) is still controversial. The aim of this study was to evaluate the effectiveness of a program of patient education in asthmatics over 2 years. Thirty-seven asthmatic patients were randomly allocated to group A (usual treatment) and 32 to group B (usual treatment plus patient education program). The effectiveness of the education program was evaluated by comparing morbidity outcomes at baseline and 12 and 24 months afterwards. At baseline, no intergroup difference emerged in age, sex, smoking, asthma severity, atopy, FEV1, symptom-free days, use of rescue salbutamol, and QoL. One year later, group B subjects had an improvement in the overall QoL (from 5.8 ± 0.8 to 6.1 ± 0.7, p< 0.005), and in “Activities” (from 5.3 ± 0.9 to 5.7 ± 0.8, p< 0.05) and “Environment” (from 6.4 ± 1.0 to 6.8 ± 0.4, p< 0.05) domains. Two years later the “Activities” domain score increased in group B (from 5.3 ± 0.9 to 5.7 ± 1.1, p< 0.05). QoL did not vary in group A. The education program was ineffective in all other parameters at both follow-up time-points. In group A, a significant increase in medication expenses and a significant decrease in rescue salbutamol use was found 1 and 2 years after baseline, respectively. In conclusion, this education program improved QoL for 1 year, but the improvement was not sustained in the 2nd year.

Epidemiology of asthma and rhinitis due to grass pollen allergy

SummaryBackgroundRecent reports have suggested that exposure to high pollen counts can be life-threatening, not only for allergics, but also for patients with heart and lung diseases.Patients and methodsThis study evaluated the prevalence of asthma and rhinitis due to pollen allergy, particularly to grass pollen, in a randomized sample of the general population of Perugia, Italy. 1,048 subjects aged 3–69 years answered a modified version of the American Thoracic Society and National Heart and Lung Institute (ATS-DLD-78) questionnaire and 796 subjects (76% of the sample) underwent skin prick tests with eight common aeroallergens (grass, Parietaria, olive, cypress, house dust mite, cat, dog and rabbit dander).ResultsThe prevalence of current asthma or rhinitis was 5.1% or 14.3%, respectively. Positive skin tests were found in 21.9% of asymptomatic subjects, in 58.0% of asthmatic and in 65.0% of rhinitic subjects. Sensitization to grass was present in 46.0% of individuals with positive skin tests, in 62.0% of patients with allergic asthma, and in 58.0% of those with allergic rhinitis. In the 79 subjects who were sensitized to grass the prevalence of asthma and rhinitis increased fourfold compared with the overall prevalence. Symptoms of rhinitis developed before those of asthma in nearly 2/3 of cases with the two diseases, starting simultaneously in the others. The spring symptoms tended to start in March or April in rhinitic and asthmatic subjects, and peaked in May for rhinitis and in June for asthma.ConclusionsIn this study we confirmed grass pollen as the primary cause of respiratory allergy in central Italy and provided indirect evidence that different threshold concentrations of grass pollen could influence the onset of asthma and/or rhinitis in allergic subjects.ZusammenfassungHintergrundAktuelle Veröffentlichungen legen die Vermutung nahe, dass hohe Pollenkonzentrationen nicht nur für Allergiker, sondern auch für Patienten mit Herz- und Lungen-Erkrankungen lebensbedrohlich sein können.Patienten und MethodenWir untersuchten die Prävalenz von Asthma und Rhinitis bei Pollen-Allergie, insbesondere auf Gräserpollen, in einer randomisierten Stichprobe der Allgemeinbevölkerung von Perugia, Italien. Es wurden 1.048 Personen (Alter: 3–69 Jahre) mittels eines modifizierten Fragebogens (ATS-DLD-78) der „American Thoracic Society“ und des „National Heart and Lung Institute“ befragt. Bei 796 Studienteilnehmern (76% der Stichprobe) führten wir Prick-Tests mit acht häufigen Aero-Allergenen durch.ErgebnisseDie Prävalenz von Asthma bronchiale bzw. Rhinitis war 5,1% bzw. 14,3%. Der Hauttest fiel bei 21,9% der asymptomatischen Probanden, bei 58,0% der Asthma-Patienten und bei 65,0% derjenigen mit allergischer Rhinitis positiv aus. Eine Sensibilisierung gegenüber Gräserpollen zeigte sich bei 46,0% der Probanden mit positivem Pricktest, bei 62,0% der Asthma- und bei 58,0% der Rhinitis-Patienten. Bei Personen mit einer Sensibilisierung gegenüber Gräserpollen war die Prävalenz von Asthma und Rhinitis vierfach höher als in der Gesamtpopulation. Zwei Drittel der Patienten mit Rhinitis und Asthma litten zuerst an Rhinitis und erst später an Asthma, bei einem Drittel traten beide Erkrankungen gleichzeitig in Erscheinung. Die Frühjahrsbeschwerden begannen im März/April und erreichten bei Rhinitis im Mai und bei Asthma im Juni ihren Höhepunkt.SchlussfolgerungenDiese Studie bestätigt, dass Gräserpollen die Hauptursache allergischer Erkrankungen der Atemwege in Zentral-Italien sind. Zudem lieferte sie Hinweise, dass unterschiedliche Gräserpollen-Konzentrationen den Beginn der asthmatischen bzw. rhinitischen Symptome beeinflussen können.

Epidemiologie von Asthma und Rhinitis aufgrund einer Gräserpollen-Allergie

SummaryBackgroundRecent reports have suggested that exposure to high pollen counts can be life-threatening, not only for allergics, but also for patients with heart and lung diseases.Patients and methodsThis study evaluated the prevalence of asthma and rhinitis due to pollen allergy, particularly to grass pollen, in a randomized sample of the general population of Perugia, Italy. 1,048 subjects aged 3–69 years answered a modified version of the American Thoracic Society and National Heart and Lung Institute (ATS-DLD-78) questionnaire and 796 subjects (76% of the sample) underwent skin prick tests with eight common aeroallergens (grass, Parietaria, olive, cypress, house dust mite, cat, dog and rabbit dander).ResultsThe prevalence of current asthma or rhinitis was 5.1% or 14.3%, respectively. Positive skin tests were found in 21.9% of asymptomatic subjects, in 58.0% of asthmatic and in 65.0% of rhinitic subjects. Sensitization to grass was present in 46.0% of individuals with positive skin tests, in 62.0% of patients with allergic asthma, and in 58.0% of those with allergic rhinitis. In the 79 subjects who were sensitized to grass the prevalence of asthma and rhinitis increased fourfold compared with the overall prevalence. Symptoms of rhinitis developed before those of asthma in nearly 2/3 of cases with the two diseases, starting simultaneously in the others. The spring symptoms tended to start in March or April in rhinitic and asthmatic subjects, and peaked in May for rhinitis and in June for asthma.ConclusionsIn this study we confirmed grass pollen as the primary cause of respiratory allergy in central Italy and provided indirect evidence that different threshold concentrations of grass pollen could influence the onset of asthma and/or rhinitis in allergic subjects.ZusammenfassungHintergrundAktuelle Veröffentlichungen legen die Vermutung nahe, dass hohe Pollenkonzentrationen nicht nur für Allergiker, sondern auch für Patienten mit Herz- und Lungen-Erkrankungen lebensbedrohlich sein können.Patienten und MethodenWir untersuchten die Prävalenz von Asthma und Rhinitis bei Pollen-Allergie, insbesondere auf Gräserpollen, in einer randomisierten Stichprobe der Allgemeinbevölkerung von Perugia, Italien. Es wurden 1.048 Personen (Alter: 3–69 Jahre) mittels eines modifizierten Fragebogens (ATS-DLD-78) der „American Thoracic Society“ und des „National Heart and Lung Institute“ befragt. Bei 796 Studienteilnehmern (76% der Stichprobe) führten wir Prick-Tests mit acht häufigen Aero-Allergenen durch.ErgebnisseDie Prävalenz von Asthma bronchiale bzw. Rhinitis war 5,1% bzw. 14,3%. Der Hauttest fiel bei 21,9% der asymptomatischen Probanden, bei 58,0% der Asthma-Patienten und bei 65,0% derjenigen mit allergischer Rhinitis positiv aus. Eine Sensibilisierung gegenüber Gräserpollen zeigte sich bei 46,0% der Probanden mit positivem Pricktest, bei 62,0% der Asthma- und bei 58,0% der Rhinitis-Patienten. Bei Personen mit einer Sensibilisierung gegenüber Gräserpollen war die Prävalenz von Asthma und Rhinitis vierfach höher als in der Gesamtpopulation. Zwei Drittel der Patienten mit Rhinitis und Asthma litten zuerst an Rhinitis und erst später an Asthma, bei einem Drittel traten beide Erkrankungen gleichzeitig in Erscheinung. Die Frühjahrsbeschwerden begannen im März/April und erreichten bei Rhinitis im Mai und bei Asthma im Juni ihren Höhepunkt.SchlussfolgerungenDiese Studie bestätigt, dass Gräserpollen die Hauptursache allergischer Erkrankungen der Atemwege in Zentral-Italien sind. Zudem lieferte sie Hinweise, dass unterschiedliche Gräserpollen-Konzentrationen den Beginn der asthmatischen bzw. rhinitischen Symptome beeinflussen können.