Astrid Heutelbeck

Acetylcholinesterase and neuropathy target esterase activities in 11 cases of symptomatic flight crew members after fume events

ABSTRACT In modern aviation, so-called fume events such as exposure to an unknown mixture of chemicals introduced into the aircraft cabin with bleed air drawn off at the engines may occur. Human exposure may result in (neuro)toxic symptoms described as so-called “aerotoxic syndrome.” Currently, among other agents organophosphates (OP) are regarded as a likely cause of the observed adverse effects. After fume events 11 flight crew members (9 female/2 male; ages 23–58 yr) were admitted for a medical examination within 5 d post exposure. Individual acetylcholinesterase (AChE) and neuropathy target esterase (NTE) activities were determined. Anamnesis and clinical findings confirmed prominent symptoms of an intoxication, including headache, cognitive difficulties, and neurological disorders, among others. Patient AChE activities ranged from 37 to 50 U/g hemoglobin (reference values: 26.7–50.9 U/g hemoglobin). Ten individuals showed NTE activities ranging from 3.14 to 6.3 nmol phenyl valerate/(min × mg protein) (reference values: 3.01–24), with one patient exhibiting low NTE activity of 1.4. Biochemical effect monitoring was applied to encompass a broad range of AChE-inhibiting compounds such as OP, carbamates, and isocyanates, or to detect inhibition of NTE. The measured AChE activities indicated a subordinate contribution of OP or related compounds to the observed symptoms. All noted NTE activities were clustered at low levels. Our data suggest a likely inhibition of NTE activities in patients after fume events, which warrants further investigation. The observed symptoms may be linked to known chemical compounds in fume events, and it is not possible to infer a direct correlation between manifestations and AChE -inhibiting compounds at this time.

Cytotoxicity of carbon nanohorns in different human cells of the respiratory system

ABSTRACT One of the new synthetic carbon-based nanomaterials is carbon nanohorns (CNH). A potential risk for employees of production processes is an unintentional intake of these nanomaterials via inhalation. Once taken up, nanoparticles might interact with cells of different tissues as well as with intercellular substances. These interactions may have far-reaching consequences for human health. Currently, many gaps in available information on the CNH toxicological profile remain. The aim of this study was to determine the cytotoxicity of CNH particles on human epithelial cells of the respiratory system with special consideration given to different particle sizes. In all cell lines, cell viability was reduced after 24 h of exposure up to 60% and metabolic activity as evidenced by mitochondrial activity was lowered to 9% at a concentration of 1 g/L. The three respiratory cell lines differed in their sensitivity. The most robust cells were the bronchial epithelial cells. Further, particle size fractions induced different adverse effect strength, whereby no correlation between particle size fraction and toxicity was found. These findings demonstrate the need for further information regarding the behavior and effect strength of nanomaterial. To avoid the production of new harmful materials, a more comprehensive integration of results from toxicity studies in the development processes of engineered nanomaterials is recommended not only from an occupational viewpoint but also from an environmental perspective.

Prävention allergischer Atemwegserkrankungen durch Katzenallergene

ZusammenfassungKatzen geben quantitativ relevante Allergene in Innenräumen ab, und das nicht nur in der privaten Wohnumgebung, sondern auch in Bereichen des öffentlichen Lebens. Gute Schwebeeigenschaften erleichtern eine weite Verschleppung der Allergene bis in primär unbelastete Räume. Zahlreiche Arbeiten belegen die Bedeutung der Katzenallergene bei der Auslösung allergischer Atemwegserkrankungen, von denen nicht nur Katzenhalter betroffen sind; bei der Hälfte der Katzenallergiker bestand niemals direkter Katzenkontakt.Spezifische Maßnahmen zur effektiven Primärprävention sind derzeit noch unzureichend belegt und werden kontrovers diskutiert. Das therapeutische Augenmerk richtet sich im Wesentlichen auf Maßnahmen der Sekundärprävention, wobei eine Kombination verschiedener Karenz- und Reinigungskonzepte wie beispielsweise Meidung von direktem Katzenkontakt, Staubsaugen und Luftfiltration empfohlen wird. Allerdings gibt es nur wenige Studien, welche die klinische Effektivität dieser Maßnahmen belegen. Aufgrund der weiten Verbreitung der Katzenallergene sollte eine Umsetzung entsprechender Sanierungskonzepte nicht nur in der privaten Wohnumgebung, sondern auch in öffentlichen Räumen erfolgen. Nach derzeitigem Kenntnisstand liegt der beste Weg, eine Katzenallergie zu behandeln, in der Kombination von Umgebungssanierung und antientzündlicher Medikation. Ergänzend ist die Möglichkeit der spezifischen Immuntherapie gegeben.SummaryCats can be regarded as an important source of allergens, not only in private, but also in public environments. Due to their physical characteristics cat allergens can be carried from homes with cats into such without cats. Several studies revealed the importance of cat allergens in the development of allergic airway diseases, which affect not only cat holders; half of the cases of cat-allergic patients had never had a cat.Specific strategies of primary prevention have not yet proven to be effective and are discussed controversially. The main focus in therapy lies on strategies of secondary prevention, and a combination of various strategies of allergen avoidance and cleansing such as cat avoidance, vacuuming and air filtration are recommended. However, there are only few studies to prove the clinical effectiveness of these strategies. Due to the wide dispersion of cat allergens, not only in private areas, but also in public environments corresponding actions have to be established. Currently, the best way to treat cat allergic disease is to combine environmental control and antiinflammatory medication. Additionally, specific immunotherapy can be helpful.

Aktuelles zur Prävention der berufsbedingten Rinderallergie in der Landwirtschaft: Erfahrungen mit allergendichter Arbeitskleidung

ZusammenfassungAllergische Atemwegserkrankungen durch landwirtschaftstypische Stoffe sind von großer sozioökonomischer Bedeutung für den Agrarsektor und betreffen zu einem erheblichen Anteil noch junge Landwirte. Daher sind effektive Präventionsstrategien erforderlich, um Auftreten und Chronifizierung der berufsbedingten Atemwegsallergien zu verhindern. Der Arbeitsschutz in der Landwirtschaft ist traditionell eher auf bauliche und technische Schutzmaßnahmen zur Lüftungsoptimierung und Staubminimierung ausgerichtet. Neuere präventivmedizinische Erkenntnisse rücken nun insbesondere die Schaffung einer konsequenten Trennung von Arbeits- und Wohnbereich zur Minderung des Allergeneintrages in den häuslichen Bereich in den Focus. Ebenso kommt Maßnahmen des persönlichen Körperschutzes wie geeignetem Atemschutz und körperbedeckender Arbeitskleidung eine zunehmende Bedeutung zu. Ziel der vorliegenden Untersuchung war die Evaluation erster Erfahrungen mit allergendichter Arbeitskleidung bei 24 Rinderallergikern. Die Ergebnisse zeigen, dass ein allergendichter Arbeitsanzug neben herkömmlicher Arbeitskleidung eine geeignete Ergänzung im Präventionskonzept darstellt und bei von einer Allergie betroffenen Landwirten zu einer Besserung der Symptome beitragen kann.AbstractAllergic reactions caused by animals are a common and significant occupational health concern in agriculture, as a large share of farmers is affected by manifest respiratory dysfunction at an early age. In a large population-based study on occupational asthma in Europe, farming was among the occupations with the highest risk. For ethical and economical reasons, utmost effort should be undertaken to implement and validate practical prevention strategies. Traditionally, occupational health and safety has focused on construction and technical measures to optimize ventilation and dust reduction. Newer findings draw attention to a strict separation of the working and living environments. This is a still insufficiently implemented concept that helps to avoid a significant diversion of agricultural materials into the living environment and thereby reduces after work exposure to allergens. Additionally, personal protective measures such as breathing masks and covering work clothes must be used consequently to reduce allergen contact with the skin and the airways. Our study evaluates first experience with allergen impermeable working clothes in 24 cattle-allergic farmers. The results showed that work clothes which are impermeable to occupational allergens can be a suitable supplement to traditional work clothes and may lead to an improvement of symptoms in cattle allergic farmers.

Biomonitoring von Alkohol- und Tabakkonsum: Stellenwert in der arbeitsmedizinischen Vorsorge

ZusammenfassungDer Konsum Lebensstil-bedingter Noxen wie Alkohol und Nikotin stellt ein relevantes soziales und volkswirtschaftliches Problem dar. Im Rahmen der arbeitsmedizinischen Vorsorge gilt es den konkurrierenden Einfluss außerberuflicher Risikofaktoren wie Rauchen und Alkoholkonsum von beruflichen Noxen abzugrenzen sowie riskante Verhaltensmuster beim Alkoholkonsum zu identifizieren. Die vorliegende Untersuchung erfolgte an einer Kohorte von Beschäftigten (n=998) in der Baubranche im Rahmen der ersten Querschnitterhebung von 1998 bis 2000 einer als prospektive Kohortenstudie angelegten Erhebung zum kanzerogenen Risiko in Mundhöhle, Rachen und Kehlkopf. Ziel war es, die Aussagekraft der Anamnese im Vergleich zu biologischen Markern von Lebensstil-bedingtem Alkohol-oder Tabakkonsum im Rahmen der arbeitsmedizinischen Vorsorgeuntersuchungen zu evaluieren. Die vorliegenden Ergebnisse zeigen, dass der Tabakkonsum durch eine einfache Erhebung der Anamnese verlässlich erfasst werden kann. Hinsichtlich der Noxe Alkohol ist die Objektivierung der Anamnese durch biologische Alkoholmarker aufgrund vielfach vorbeschriebener Dissimulationstendenzen unabdingbar. Hierbei rückt insbesondere das CDT bzgl. seiner Geeignetheit in den Vordergrund, wobei die konventionellen Marker flankierend einen chronischen Alkoholeffekt abbilden können. Hinsichtlich der Anamneseerhebung empfehlen sich kurze und effiziente, standardisierte Fragebögen. Die vorgestellte Diagnosestrategie sollte in prospektiven Studien evaluiert werden, um besondere Fragestellungen in arbeitsmedizinischen Vorsorgeuntersuchungen unter Nutzung aktueller wissenschaftlicher Erkenntnisse beantworten zu können.AbstractAlcohol and nicotine consumption poses a substantial socio-economic problem. In terms of occupational prevention it is essential to discriminate between non-occupational risk factors, e.g. tobacco smoking and alcohol consumption, and occupational risks. In addition, hazardous behavioral patterns of alcohol consumption need to be identified. The recent study includes a cohort of employees of the building-trade (n=998). This is an initial cross-sectional study (time course: 1998 — 2000) — designed as a prospective cohort study — to describe cancer risks of the oral cavity, pharynx and larynx. Aim of the study is to evaluate medical history data collection versus biological markers of life-style, e.g. biomarkers of alcohol and nicotine consumption, embedded in occupational medical examinations of prevention. The study results indicate, that collection of medical history data collection can easily and reliably describe nicotine consumption. In contrast, the value of collection of medical history data for the the risk factor alcohol needs to be further substantiated due to previously described dissimulation tendencies. In this context the biological marker CDT offers certain benefits; in addition conventional biomarkers may reveal chronic alcohol effects. With respect to medical history data collection short, efficient and standardized questionnaires are recommended. The new diagnostic strategy presented herein shall be further evaluated in prospective studies to become a routine tool in occupational medical examinations of prevention.

Gesundheitspolitische Relevanz von Landwirten mit Rinderallergie in Deutschland

BackgroundCattle allergic patients with rhinitis and asthma are of major relevance to the Occupational Accident Insurance (Berufsgenossenschaft) in Germany as they provoke extensive prevention measures. With decreasing lung function, costs are magnified considerably. The objective of this epidemiologic study was to compare the number of cattleallergic patients in all regions of Germany especially on the basis of reported and confirmed occupational disease cases and the extent of occupational disability (Minderung der Erwerbsfähigkeit [MdE]).MethodsAccording to data of the Berufsgenossenschaft all patients recorded in the last decade with a suspected occupational airway disease caused by cattle husbandry were included in this study. Their files were evaluated with regard to individual medical history, allergologic and pneumologic diagnostic results, work history, technical conditions of individual farming surroundings, and aspects of the occupational disease liability compensation case.ResultsIn Germany 513 symptomatic patients (54% males), almost all of them farmers, have been registered since the beginning of 1990. The cattle-related symptoms of 42% of these patients had been officially acknowledged as an occupational disease. 63% showed an initial MdE of ≥ 20%. Interestingly, higher numbers of such cases of cattle allergy were observed in Southern Germany (three regions, range 55–81%) than in the north (45%), considering only the four regions with more than 25 cases with recorded MdE.ConclusionCattle-allergic farmers are of major quantitative relevance to the Occupational Accident Insurance in Germany. The results of this study underline the high public health relevance of cattle allergy. The high initial occupational disability indicates the need to improve preventive strategies such as risk screening and early diagnostic methods to reduce the degree of health impairment.