Andrea Siracusa

EAACI position paper on occupational rhinitis

The present document is the result of a consensus reached by a panel of experts from European and non-European countries on Occupational Rhinitis (OR), a disease of emerging relevance which has received little attention in comparison to occupational asthma. The document covers the main items of OR including epidemiology, diagnosis, management, socio-economic impact, preventive strategies and medicolegal issues. An operational definition and classification of OR tailored on that of occupational asthma, as well as a diagnostic algorithm based on steps allowing for different levels of diagnostic evidence are proposed. The needs for future research are pointed out. Key messages are issued for each item.

Asthma and exposure to cleaning products – a European Academy of Allergy and Clinical Immunology task force consensus statement

Professional and domestic cleaning is associated with work‐related asthma (WRA). This position paper reviews the literature linking exposure to cleaning products and the risk of asthma and focuses on prevention. Increased risk of asthma has been shown in many epidemiological and surveillance studies, and several case reports describe the relationship between exposure to one or more cleaning agents and WRA. Cleaning sprays, bleach, ammonia, disinfectants, mixing products, and specific job tasks have been identified as specific causes and/or triggers of asthma. Because research conclusions and policy suggestions have remained unheeded by manufactures, vendors, and commercial cleaning companies, it is time for a multifaceted intervention. Possible preventive measures encompass the following: substitution of cleaning sprays, bleach, and ammonia; minimizing the use of disinfectants; avoidance of mixing products; use of respiratory protective devices; and worker education. Moreover, we suggest the education of unions, consumer, and public interest groups to encourage safer products. In addition, information activities for the general population with the purpose of improving the knowledge of professional and domestic cleaners regarding risks and available preventive measures and to promote strict collaboration between scientific communities and safety and health agencies are urgently needed.

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.

EAACI position paper: Irritant-induced asthma

The term irritant‐induced (occupational) asthma (IIA) has been used to denote various clinical forms of asthma related to irritant exposure at work. The causal relationship between irritant exposure(s) and the development of asthma can be substantiated by the temporal association between the onset of asthma symptoms and a single or multiple high‐level exposure(s) to irritants, whereas this relationship can only be inferred from epidemiological data for workers chronically exposed to moderate levels of irritants. Accordingly, the following clinical phenotypes should be distinguished within the wide spectrum of irritant‐related asthma: (i) definite IIA, that is acute‐onset IIA characterized by the rapid onset of asthma within a few hours after a single exposure to very high levels of irritant substances; (ii) probable IIA, that is asthma that develops in workers with multiple symptomatic high‐level exposures to irritants; and (iii) possible IIA, that is asthma occurring with a delayed‐onset after chronic exposure to moderate levels of irritants. This document prepared by a panel of experts summarizes our current knowledge on the diagnostic approach, epidemiology, pathophysiology, and management of the various phenotypes of IIA.

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.

EAACI consensus statement for investigation of work‐related asthma in non‐specialized centres

Work‐related asthma (WRA) is a relevant problem in several countries, is cause of disability and socioeconomic consequences for both the patient and the society and is probably still underdiagnosed. A correct diagnosis is extremely important to reduce or limit the consequences of the disease. This consensus document was prepared by a EAACI Task Force consisting of an expert panel of allergologists, pneumologists and occupational physicians from different European countries. This document is not intended to address in detail the full diagnostic work‐up of WRA, nor to be a formal evidence‐based guideline. It is written to provide an operative protocol to allergologists and physicians dealing with asthma useful for identifying the subjects suspected of having WRA to address them to in‐depth investigations in a specialized centre. No evidence‐based system could be used because of the low grade of evidence of published studies in this area, and instead, ‘key messages’ or ‘suggestions’ are provided based on consensus of the expert panel members.

EAACI position paper: prevention of work-related respiratory allergies among pre-apprentices or apprentices and young workers.

To cite this article: Moscato G, Pala G, Boillat MA, Folletti I, Gerth van Wijk R, Olgiati‐Des Gouttes D, Perfetti L, Quirce S, Siracusa A, Walusiak‐Skorupa J, Tarlo SM. EAACI Position Paper: Prevention of work‐related respiratory allergies among pre‐apprentices or apprentices and young workers. Allergy 2011; 66: 1164–1173.

Effect of corticosteroid treatment on interleukin-1 and tumour necrosis factor secretion by monocytes from subjects with asthma

Peripheral blood monocytes (PBM) may be activated in asthmatic patients, a condition usually reverted by corticosteroid (CS) treatment. In the present research we have evaluated the spontaneous or lipopolysaccharide (LPS)‐induced production of interleukin 1 (IL‐1) and tumour necrosis factor (TNF) by PBM obtained from 14 asthmatic subjects during an asthmatic attack and after 1 week of CS treatment. The control group included 20 healthy volunteers. PBM obtained during severe asthma showed a pattern of IL‐1 and TNF secretion similar to that of normal subjects. After CS treatment, IL‐1 levels did not change significantly in comparison to baseline values, while LPS‐induced TNF production was apparently related to the degree of airway obstruction after CS treatment. In fact, TNF production by PBM from CS‐responsive subjects was significantly decreased in comparison to the levels determined before CS treatment, while PBM from CS‐resistant subjects produced the same cytokine levels regardless of CS treatment. The present study suggests that the determination of LPS‐induced TNF secretion by PBM could be used to confirm the effectiveness of CS treatment in asthma.

Have the prevalence and incidence of occupational asthma and rhinitis because of laboratory animals declined in the last 25 years

Background:  Data for time trends in the prevalence of occupational asthma (OA) and rhinitis (OR) are not known.

Asthma caused by live fish bait.

BACKGROUND Larvae of insects and worms are commonly used as live fish bait (LFB) by anglers. Asthma, rhinoconjunctivitis, and urticaria related to various kinds of LFB have been reported. METHODS We studied 14 subjects with respiratory symptoms associated with exposure to LFB. Skin prick tests and RASTs with Lucilia caesar, Galleria mellonella, and Tenebrio molitor extracts were carried out in all subjects. Monitoring of peak expiratory flow rate and evaluation of bronchial responsiveness to methacholine before and after exposure to LFB were performed in seven subjects. RESULTS Thirteen subjects had asthma, all 14 had rhinoconjunctivitis, and three had contact urticaria. Eleven subjects had respiratory symptoms after fishing with LFB, and the other three subjects had symptoms during their work in a commercial fish bait farm. Positive skin prick test results or significant RAST binding to L. caesar extract were observed in 13 subjects, to G. mellonella extract in four subjects, and to T. molitor extract in three subjects. After exposure to LFB, two subjects had an early asthmatic response, three had a late asthmatic response, and two had no asthmatic response. Late asthmatic response was associated with a long-lasting increase in bronchial responsiveness. CONCLUSIONS This study demonstrates that emanations from LFB are sensitizers, which have the potential to elicit IgE-mediated asthma. Exposure to LFB is common and LFB should be considered as a possible sensitizing agent for asthma.