Giulia Paolocci

Update on asthma and cleaning agents.

Purpose of reviewAsthma due to cleaning products has been known for 20 years, and the interest in this topic is still large because of the number of cleaning workers with respiratory problems. In this review, we sought to highlight the most recent findings on the relationship between exposure to cleaning products and asthma and to summarize the specific literature published between 2013 and 2016. Recent findingsWomen are confirmed as most of workers exposed to cleaning products and have a higher frequency than men of work-related respiratory symptoms and diseases. Many cases of asthma due to cleaning products occur in healthcare occupations. The increased risk of asthma has been shown to be related to the number of years in the job and to early life disadvantage. Recent evidence suggests that predisposition to adult-onset asthma may be related to interaction between genes and occupational exposure to low-molecular weight agents/irritants. There is some evidence that an irritant mechanism is more common, although several case reports showed animmunologic mechanism (e.g. disinfectants, amine compounds, aldehydes and fragrances). SummaryThe review updated recent findings on epidemiology, cleaning agents and their mechanism, and prevention of asthma due to cleaning agents. This article provides new information on the level of exposure, which is still high in professional cleaners and even more in domestic cleaners, and on the frequency of asthma in professional and domestic cleaners. An irritant mechanism is more common, although an immunological mechanism is possible, especially in healthcare workers exposed to disinfectants.

Hymenoptera venom allergy: work disability and occupational impact of venom immunotherapy

Objectives Little is known about the Hymenoptera venom allergy impact on work ability and the effect of venom immunotherapy (VIT) on work. The objective of this study was to evaluate the prevalence and predictors of work disability in patients treated with VIT and the effects of VIT on occupational functioning. Methods 181 patients, aged 18–71 years, treated with VIT while working, were investigated by questionnaire. Participants were classified into employed and self-employed and, based on work exposure to Hymenoptera, into three risk categories: high risk, occasionally high risk and low risk. Work disability was defined as having to have changed jobs/tasks and/or suffered economic loss because of Hymenoptera venom allergy. Predictors of work disability were assessed in logistic regression models. Results 31 (17%) patients reported work disability. Being self-employed and having the severe reaction at work were associated with work disability (p<0.01). Having a high-risk job for exposure to Hymenoptera was a significant predictor of work disability (OR 2.66, 95% CI 1.04 to 6.75). 24% of patients referred a positive effect of VIT on work. Determinants of the positive effect of VIT on work were having a high-risk job for exposure to hymenoptera (OR 3.60, 95% CI 1.52 to 8.51) and having already concluded VIT (OR 2.82, 95% CI 1.30 to 6.14). Conclusions Hymenoptera venom allergy could determine work disability. Patients with Hymenoptera venom allergy having a high-risk job for exposure to Hymenoptera seem to have higher risk of work disability and refer more frequently a positive effect of VIT on work.

Occupational risk factors for idiopathic pulmonary fibrosis in Southern Europe: a case-control study

BackgroundIdiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing interstitial pneumonia of unknown cause associated with the histopathologic and/or radiologic pattern of usual interstitial pneumonia (UIP). Occupational risk factors have been proposed to be associated with UIP. The aim of this case-control study is to evaluate the relationship between UIP pattern and occupational exposure in Southern Europe.MethodsSixty nine cases with a UIP radiological pattern at CT-scan were selected from a clinical database of the University Hospital of Perugia, Umbria, between January 2010 and December 2013. Controls (n = 277) not reporting doctor diagnosed pulmonary fibrosis, were ascertained casually among general population from the same catching area of cases. Data were collected by a questionnaire used previously in a similar study. Logistic regression models, adjusted for gender, age and smoking, were performed to evaluate the association between UIP and occupational exposure.ResultsFarmers, veterinarians and gardeners (OR = 2.73, 95%CI = 1.47–5.10), metallurgical and steel industry workers (OR = 4.80, 95%CI = 1.50–15.33) were occupations associated with UIP. Metal dust and fumes and organic dust were risk factors for UIP. Increasing the length of occupational exposure in jobs at risk of pulmonary fibrosis, increased the risk of having UIP.ConclusionsThis case control study confirm partially the results from previous similar studies. Some discrepancies could be explained by the different geographical origins of the population under study, reflecting also different occupational exposures.

Non‐industrial Indoor Environments and Work‐Related Asthma

Work-related asthma is one of the most relevant work-related diseases worldwide, causing a high socio-economical burden. In the last decades, many countries experienced huge modifications in work organisations. These changes made people to move from traditional sectors to the tertiary sectors and non-industrial indoor working environments. Non-industrial indoor workplaces are characterised by a new concept of building, with a new structure, new materials, forced ventilation, tight construction and a potential exposure to new risk factors for work-related asthma, such as new chemicals and biological agents able to cause or exacerbate asthma. The actual scientific evidence suggests an increased risk of asthma among workers exposed to cleaning agents in indoor working environment and moulds in damp buildings. Also volatile organic compounds (VOCs) and environmental tobacco smoke could be considered triggers of asthma, even if their role is still under debate. Because of the increasing numbers of subjects working in non-industrial indoor environments and the scientific evidence of an increased risk of asthma in indoor environment, there is a need of public health intervention towards the prevention of work-related asthma, also in this specific setting.

United Airway Disease in Occupational Allergy

Opinion StatementThe term “united airway disease” has been used since 2000 to describe the strong association between asthma and rhinitis. Although this term is not extensively used, it refers to the fact that asthma and rhinitis are frequently associated and share common risk factors, causal agents and mechanisms. Similarly, since 2010 the term occupational united airway disease has been used to describe the strong association between occupational asthma and rhinitis. Rhinitis and occupational rhinitis are less severe diseases but more frequent than asthma and occupational asthma, respectively. Every year several case reports and epidemiological studies enhance the long list of agents responsible for occupational asthma and rhinitis with new agents or occupations. Primary, secondary and tertiary prevention strategies are aimed at reduction of the onset and severity of work-related respiratory diseases. Primary prevention mainly includes avoiding/reducing exposure to known sensitizing/irritant agents. Secondary prevention or early detection should focus on medical surveillance of individuals at risk, health and safety education and training of workers, and recognition of early bronchial/nasal symptoms. Tertiary prevention includes early recognition and diagnosis, appropriate removal from further exposure and pharmacologic treatment. Unfortunately, pharmacologic treatment has seldom been studied in occupational asthma and rhinitis, and it usually refers to the international guidelines of management of asthma and rhinitis aimed to achieve control of the two diseases. For simultaneous treatment of asthma and rhinitis, the anti-IgE monoclonal antibody omalizumab, effective in occupational asthma and rhinitis, is available. Immunotherapy has been shown to be effective in health care workers with occupational asthma due to natural rubber latex, in workers with occupational asthma due to laboratory animals and in baker’s asthma. A limitation of immunotherapy, however, can be systemic reactions after subcutaneous injections of sometimes non-standardized and non-purified extracts.