Renata De Zotti

Prospective study of work related respiratory symptoms in trainee bakers.

OBJECTIVES To investigate the occurrence of work related respiratory symptoms and to assess the effect of atopy in a group of trainee bakers. METHODS A prospective study of work related respiratory symptoms among 125 trainee bakers who were investigated with a questionnaire plus skin prick test with wheat flour and α-amylase allergens at baseline and then after 6, 18, and 30 months. RESULTS At the baseline examination, four students (3.2%) complained of respiratory symptoms (cough and rhinitis) when working with flours and four were skin positive to wheat flour or α-amylase. The incidence of work related respiratory symptoms was 3.4% at 6 months, and the cumulative incidence was 4.8% and 9.0% at 18 and 30 months, respectively. The incidence of skin sensitisation to occupational allergens was 4.6% at 6 months and the cumulative incidence was 4.6% at 18 months and 10.1% at 30 months. The generalised estimating equation approach to longitudinal data showed that work related respiratory symptoms in the study population was significantly associated with a personal history of allergic disease (odds ratio (OR) 5.8, 95% confidence interval (95% CI) 1.8 to 18.2) and skin sensitisation to wheat flour or α-amylase (OR 4.3, 95% CI 1.2 to 14.9). Atopy based on prick test was not related to the occurrence of work related respiratory symptoms over time (OR 1.1, 95% CI 0.3 to 3.8). CONCLUSIONS Personal history of allergic disease is a predisposing factor for the development of symptoms caused by exposure to wheat flour and may be a criterion of unsuitability for starting a career as a baker. Atopy based on the skin prick test is useful for identifying subjects with allergic disease, but should not be used to exclude non-symptomatic atopic people from bakery work.

Pleural malignant mesothelioma epidemic: incidence, modalities of asbestos exposure and occupations involved from the Italian National Register.

Due to the large scale use of asbestos (more than 3.5 million tons produced or imported until its definitive banning in 1992), a specific national surveillance system of mesothelioma incident cases is active in Italy, with direct and individual anamnestic etiological investigation. In the period between 1993 and 2004, a case‐list of 8,868 pleural MM was recorded by the Italian National Register (ReNaM) and the modalities of exposure to asbestos fibres have been investigated for 6,603 of them. Standardized incidence rates are 3.49 (per 100,000 inhabitants) for men and 1.25 for women, with a wide regional variability. Occupational asbestos exposure was in 69.3% of interviewed subjects (N = 4,577 cases), while 4.4% was due to cohabitation with someone (generally, the husband) occupationally exposed, 4.7% by environmental exposure from living near a contamination source and 1.6% during a leisure activity. In the male group, 81.5% of interviewed subjects exhibit an occupational exposure. In the exposed workers, the median year of first exposure was 1957, and mean latency was 43.7 years. The analysis of exposures by industrial sector focuses on a decreasing trend for those traditionally signaled as “at risk” (asbestos‐cement industry, shipbuilding and repair and railway carriages maintenance) and an increasing trend for the building construction sector. The systematic mesothelioma surveillance system is relevant for the prevention of the disease and for supporting an efficient compensation system. The existing experience on all‐too‐predictable asbestos effects should be transferred to developing countries where asbestos use is spreading.

Incidence of extrapleural malignant mesothelioma and asbestos exposure, from the Italian national register

Objectives The epidemiology of extrapleural malignant mesothelioma is rarely discussed and the risk of misdiagnosis and the very low incidence complicate the picture. This study presents data on extrapleural malignant mesothelioma from the Italian National Mesothelioma Register (ReNaM). Methods ReNaM works on a regional basis, searching for cases and interviewing subjects to investigate asbestos exposure. Classification and code criteria for certainty of diagnosis and exposure modalities are set by national guidelines. Between 1993 and 2004, 681 cases were collected. Incidence measures and exposure data refer to the ReNaM database. Age-standardised rates were estimated by the direct method using the Italian resident population in 2001. Correlations between the incidence of pleural and non-pleural malignant mesothelioma for the 103 Italian provinces were analysed. Results Standardised incidence rates (Italy, 2004, per million inhabitants) were 2.1 and 1.2 cases for the peritoneal site (in men and women, respectively), 0.2 cases for the tunica vaginalis testis, and 0.1 in the pericardial site, varying widely in different parts of the country. Mean age at diagnosis for all extrapleural malignant mesothelioma cases was 64.4 years and the men/women ratio was 1.57:1. Median latency was over 40 years for all extrapleural sites combined. The correlation between pleural and peritoneal mesothelioma was 0.71 (Pearsons r coefficient, p<0.001). Modalities of exposure to asbestos fibres were investigated for 392 cases. Conclusions The rarity of the disease, the low specificity of diagnosis and difficulties in identifying the modalities of asbestos exposure call for caution in discussing aetiological factors other than asbestos.

The relationships between the concentrations of airborne pollen and allergic symptoms in Trieste (Northern Italy) in 1989

SummaryConcentrations of airborne pollens recorded in Trieste in 1989 are evaluated in relation to allergic complaints in 113 patients with skin prick tests positive to one pollen species. Analysis of the result enable the two most important allergens to be confirmed as: Poaceae in 70.7% of patients and Parietaria in 18.6%. Few people had monosensitation to Compositae (Artemisia), Corylaceae and Fagaceae.Sympotoms are related to the flowering period when pollen levels climbed to daily averages of 15–20 grains/m3 but they started later than airborne peak concentrations and finished later than pollen decline. Pollen concentration recording can be a useful way to predict the clinical manifestation in sensitive patients but other factors are involved in determining symptoms like subjective mucosal reactions, polysensitization, patients living and working environment.

Atopy and occupational asthma

SummaryWe evaluated atopy in 206 white collars and housewives with seasonal and perennial respiratory symptoms and in 58 workers occupationally exposed to isocyanate and flour with symptoms at work. Atopy was much less common among people with symptoms at work, but there was no significant difference in the frequency of atopics between varnishers and bakers. Self selection of atopic employees who leave their job because of respiratory symptoms may account for these results, but further studies are needed to clarify the relationship between atopic status and occupational asthma.

Storage mites sensitivity and allergic respiratory disease

SummaryIn order to evaluate the frequency of skin sensitivity to Storage Mites and the role of such sensitization in respiratory allergic disease in workers with occupational exposure to stored items we studied 217 dock workers, 93 farmers and 104 white collars.From the results of skin prick tests the sensitization to sole Storage Mites appears significantly higher among people working in docks or farms, compared with a control group. This confirms the role of the working environment in inducing sensitization to Storage Mites. Rhinitis and asthma however affect nearly always (27/29 cases) people with an associated sensitization to House Dust Mites. Further studies are needed to define the allergenic importance of Storage Mites in working environments.