Pałczyński C

Respiratory allergy in apprentice bakers: do occupational allergies follow the allergic march?

Background:  This prospective study describes the incidence, risk factors and natural history of occupational respiratory allergy in apprentice bakers.

Occupational asthma and rhinitis due to glutaraldehyde: changes in nasal lavage fluid after specific inhalatory challenge test.

Background: Glutaraldehyde (GA) is a known respiratory sensitizers, and some studies have reported occupational asthma in exposed workers. Specific changes in nasal lavage fluid (NLF) induced by high‐molecular‐weight allergen provocation in sensitized subjects were described previously. The purpose of this study was to evaluate the changes in cytogram, protein content, eosinophil cationic protein (ECP), and mast‐cell tryptase concentrations in NLF after GA inhalation challenge in patients with a positive history of GA‐induced asthma and late or dual asthmatic response due to exposure to low‐level GA.

Nasal provocation test in the diagnosis of natural rubber latex allergy

Background: Natural rubber latex (NRL) allergy in workers using rubber gloves has been an occupational health problem for the last 10 years. In the case of the occupational agents, clinical history may be far from conclusive; hence, appropriate provocation should be carried out. The objective was to evaluate the usefulness of the nasal challenge test in the diagnosis of allergic rhinitis in subjects occupationally exposed to NRL.

Exhaled Nitric Oxide Levels After Specific Inahalatory Challenge Test in Subjects with Diagnosed Occupational Asthma

OBJECTIVES Measuring exhaled nitric oxide (eNO) is a useful method for the assessment of bronchial inflammation in asthmatic subjects. The aim of the study was to evaluate the changes in eNO level in the subjects with suspected occupational asthma (OA) after a specific inhalation test (SIT) with occupational agents. MATERIALS AND METHODS Forty two patients, including 17 farmers, 15 bakers and 10 health care workers had a physical examination, skin prick tests with common and occupational allergens, total serum IgE level, specific anti-allergen IgE determinations, spirometry and SIT. Also, morphological changes in induced sputum (ISP) and nasal lavage fluid (NLF) were analysed and eNO measurements were performed. RESULTS SIT revealed a significant increase in the proportion of eosinophils in NLF and in ISP in the cases with diagnosed OA. Moreover, these cases showed significantly increased eNO levels only 24 h after SIT, compared to the measurements before SIT. We also found a significant correlation between eNO level at 24 h after SIT and the percentage of eosinophils in NLF before, and 4 and 24 h after SIT, as well as in ISP before and 24 h after SIT in all subjects with diagnosed OA. CONCLUSION The findings may confirm the usefulness of exhaled nitric oxide measurements for diagnosing OA.

Chlorhexidine—still an underestimated allergic hazard for health care professionals

Chlorhexidine is a low molecular weight occupational sensitizer that can cause different delayed and immediate-type allergic reactions including anaphylaxis. It is widely used as an antiseptic and disinfectant and not only in the occupational environment as it is present in toothpaste, mouthwash, nose and eye drops and ointments. We present three cases of occupationally exposed workers with airway allergy to chlorhexidine. The role of chlorhexidine as an occupational allergen was confirmed by placebo-controlled specific inhalative challenge tests monitored by spirometry and analysis of induced sputum (influx of eosinophils after provocation has been observed). One of these patients presented with a systemic reaction with ordinary environment exposure. These findings are a reminder to clinicians of chlorhexidines ability to cause various hypersensitivity reactions and the potential risk of this widely used antiseptic.

Occupational exposure and sensitization to fungi among museum workers

BACKGROUND Museum employees are exposed to fungi and storage mites in the workplace. AIMS To evaluate the prevalence and risk factors of sensitization to moulds, as well as clinical symptoms associated with allergy in museum workers. METHODS A total of 103 employees of the Polish National Museum (NM) in Warsaw, potentially exposed to fungi during their work, were assessed using a questionnaire and skin prick tests to common allergens and fungal extracts. The level of total and serum-specific IgE to moulds was evaluated, and spirometry was performed in all subjects. Mycological analysis of the workplace was also performed. RESULTS Penicillium, Aspergillus, Cladosporium, Alternaria, Trichoderma, Acremonium and Paecilomyces were the most frequent species isolated from investigated exhibits of NM. Thirty per cent of museum employees were sensitized to at least one of the fungal allergens. Logistic regression analysis revealed that duration of occupational exposure lasting >5 years, family history of atopy, presence of a cat at home, sinusitis, allergic rhinitis and a history of frequent respiratory infections were risk factors for the development of sensitization to fungi in this working group. CONCLUSIONS This study suggests an important role of fungi as occupational allergens for museum workers. The prevalence of allergic symptoms among employees of NM was relatively high. Further studies are necessary to elucidate the importance of particular fungal species in the development of occupational allergy.

Dysregulation of Autonomic Control of Cardiac Function in Workers at am Broadcasting Stations (0.738–1.503 MHz)

Ninety-three adult males working at AM broadcasting stations (0.738–1.503 MHz) or radio line stations volunteered for cardiological examinations. The examinations included routine electrocardiogram (ECG) at rest, analysis of heart rate variability (HRV), Holter 24-h ECG, and 24-h ambulatory blood pressure (ABP). Results of cardiological examinations were correlated with individual exposure to EM fields (maximum exposure levels during working shift, daily exposure dose, and cumulative lifetime exposure). Of the 93 subjects qualified for the study, 71 (76.3%) experienced occupational RF exposure, while the remaining 22 (23.7%) had no history of regular EM exposure. ECG abnormalities or pathological changes were recorded quite frequently (50–70%) in both exposed and control populations. There was no correlation with exposure levels. We found measurable effects in the HRV and ABP parameters in the EM-exposed population, but none could be assigned clinical significance. The results suggest that exposure of wor...

Eotaxin but not MCP−3 induces eosinophil influx into nasal fluid in allergic patients

Background: Eotaxin and MCP‐3 (CC chemokines), owing to their preferential action on eosinophils, seem to be the very importance in the patophysiology of allergic rhinitis and asthma. The purpose of this study was to examine the effect of intranasally administered eotaxin and MCP‐3 after specific allergen priming on the influx of inflammatory cells and their soluble mediators into the nasal mucosa.

Cobalt‐induced anaphylaxis, contact urticaria, and delayed allergy in a ceramics decorator

A 39-year-old non-atopic woman, employed as a ceramics decorator from 2000, developed eczematous skin lesions on the back of her hands and forearms 3 months after starting thework. The conditionwas recurrent but disappeared during prolonged periods off work. After 5 years of working, she developedgeneralizedurticaria; angioedema of the face, lips, and tongue and general fatigue after using the blue paint containing cobalt chloride (Glass and Ceramics Institute, Warsaw, Poland). She was moved to a different job at the same factory, and all the symptoms receded. In 2007, (i) she was patch tested with the European baseline series of contact allergens (Chemotechnique Diagnostics, Malmö, Sweden) according to International Contact Dermatitis Research Group criteria; (ii) she was prick tested with common aeroallergens (commercial kit; Allergopharma, Reinbek, Germany); (iii) she was prick tested with cobalt chloride (1 and 0.1 mg CoCl2/ml), potassium dichromate (1 and 0.1 mgK2CrO4/ml) and nickel sulfate (10 and 1 mg NiSO4/ml) dissolved in water and performed as described by Kanerva et al. (2), the same tests with metals were also performed in 10 healthy volunteers; (iv) serum samples from the patient were analysed for metalspecific immnoglobulin E (IgE) using the HY-TEC specific and total IgE enzyme immunoassay (Hycor Biomedical Inc., Irvine, CA, USA); and (v) a challenge test with the patient painting pottery using the blue paint containing cobalt chloride from the workplace was carried out. Patch tests showed reactions to cobalt chloride and nickel sulfate (both þþþ at 2 and 4 days). Prick testswere negativewith commonaeroallergens, potassium dichromate and nickel sulfate, whereas positive with cobalt chloride (both 1 and 0.1 mg/ml dilutions). All prick tests with metals were negative in the healthy volunteers. The level of cobalt-specific IgE was 2.97 IU/ml (class 2), while chromiumor nickel-specific IgE was not found in patient’s serum. The challenge test was also positive. After 30 min of painting, the patient developed the first symptoms of urticaria: thewheals appearedonherhands and forearms, followed by oedema of her face, lips, and tongue and hands 20 min later (Figs. 1 and 2). Despite stopping exposure, an anaphylactic reaction developed over the next 30 min: blood pressure fall (from 120/ 80 mmHg to 80/60 mm Hg); tachycardia 110/min (75/min before challenge) andpale skinwith sweating, abdominal cramps, nausea, vomiting, diarrhoea and dizziness. After administration of intravenous corticosteroids, the symptoms receded.

Metal-induced asthma and chest X-ray changes in welders

ObjectivesThe aim of this study was to evaluate the coexisting factors and usefulness of diagnostic methods in metal-induced asthma in Polish welders.Materials and MethodsExamination of 50 welders occupationally exposed to metals and with suspicion of metal-induced asthma (group A), 100 welders occupationally exposed to metals but without suspicion of metal-induced asthma (group B), and two control groups (10 patients with atopic asthma and 10 healthy subjects) was carried out. Questionnaire survey, clinical examination, skin prick tests to common aeroallergens and metal salts, rest spirometry tests, X-ray, metacholine challenge and a single-blind, placebo controlled specific inhalation challenge tests with metals (or work-like conditions challenge tests) were performed.ResultsIn group A — in 9 cases we obtained positive results of specific inhalation challenge tests with metals (in 3 cases with nickel, in 4 cases with chromium, in 1 case with cobalt and in 1 case with manganese). Nine cases of metal-induced occupational asthma were recognized. In group B — only in one case we obtained positive results of work-like conditions challenge test (clinical and spirometry changes, eosinophil influx in induced sputum), which confirmed the diagnosis of occupational asthma. In most of examined welders (62%), pulmonary changes in chest X-ray images were noted. The statistical analysis revealed that working as a welder for more than 10 years is the coexisting factor of presence of chest X-ray changes (p- or q-type nodular changes or interstitial changes). Positive results of skin prick tests with metal salts were the coexisting factors of occupational asthma due to metals among examined group of welders.ConclusionsSpecific inhalation challenge plays the key role in diagnostics of metal-induced asthma in welders. Pulmonary changes in chest X-ray were found in a significant percentage of examined welders.