Torgeir Storaas

Occupational rhinitis: diagnostic criteria, relation to lower airway symptoms and IgE sensitization in bakery workers

Conclusions. The use of different diagnostic criteria has considerable consequences for the prevalence estimates of occupational rhinitis. There is a strong relationship between occupational rhinitis and lower airway symptoms. Storage mites appear to be important occupational allergens in Norwegian bakeries. Objectives. To study the consequences of various diagnostic criteria on the prevalence of occupational rhinitis, assess the prevalence of IgE sensitization and explore the relationships between upper and lower airway symptoms and between symptoms and IgE sensitization. Material and methods. A total of 197 employees in 6 bakeries were interviewed and completed a questionnaire. A skin prick test was performed, total and specific IgE were determined and a histamine release test was performed for relevant allergens. The criteria for the diagnosis of occupational rhinitis were based on the 1994 International Consensus Report on Rhinitis. Results. The prevalence of occupational rhinitis varied between 23% and 50%, depending on the criteria used. The occurrence of nasal symptoms was found to precede the development of lower airway symptoms. Occupational rhinitis, both IgE- and non-IgE-mediated, was associated with asthma symptoms. The most frequent causes of sensitization (20%) were different species of storage mites. Storage mite sensitization was related to occupational rhinitis and work exposure.

Effects of Benzalkonium Chloride on Innate Immunity Physiology of the Human Nasal Mucosa In Vivo

Objective Benzalkonium chloride (BC) is a preservative commonly used in nasal decongestant sprays. It has been suggested that BC may be harmful to the nasal mucosa. The present study, involving healthy volunteers, examines effects of BC on nasal mucosal end‐organ functions.

Incidence and prevalence of chronic bronchitis : impact of smoking and welding. The RHINE study

OBJECTIVE To investigate the prevalence and incidence rate of chronic bronchitis (CB) in relation to smoking habits and exposure to welding fumes in a general population sample. METHODS Subjects from Northern Europe born between 1945 and 1971 who participated in Stage 1 (1989-1994) of the European Community Respiratory Health Survey were mailed a respiratory questionnaire in 1999-2001 (the RHINE study); 15,909 answered the questionnaire and gave complete data on smoking. CB was defined as chronic productive cough of at least 3 months a year for 2 consecutive years. The questionnaire comprised an item about age when CB started and items about exposure to welding fumes. The incidence of CB was retrospectively assessed for the observation period 1980-2001. RESULTS CB had a prevalence of 5.4%, and was associated with current smoking and welding exposure. The incidence rate of CB was 1.9 per 1000 person-years, and was increased in relation to welding exposure (low exposure HR 1.4, 95%CI 1.1-1.8; high exposure HR 2.0, 95%CI 1.6-2.7) and in relation to smoking (HR 2.1, 95%CI 1.8-2.5). CONCLUSION Smoking and occupational exposure to welding fumes are both associated with an increased risk of CB.

Drug allergy passport and other documentation for patients with drug hypersensitivity - An ENDA/EAACI Drug Allergy Interest Group Position Paper

The strongest and best‐documented risk factor for drug hypersensitivity (DH) is the history of a previous reaction. Accidental exposures to drugs may lead to severe or even fatal reactions in sensitized patients. Preventable prescription errors are common. They are often due to inadequate medical history or poor risk assessment of recurrence of drug reaction. Proper documentation is essential information for the doctor to make sound therapeutic decision. The European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology have formed a task force and developed a drug allergy passport as well as general guidelines of drug allergy documentation. A drug allergy passport, a drug allergy alert card, a certificate, and a discharge letter after medical evaluation are adequate means to document DH in a patient. They are to be handed to the patient who is advised to carry the documentation at all times especially when away from home. A drug allergy passport should at least contain information on the culprit drug(s) including international nonproprietary name, clinical manifestations including severity, diagnostic measures, potential cross‐reactivity, alternative drugs to prescribe, and where more detailed information can be obtained from the issuer. It should be given to patients only after full allergy workup. In the future, electronic prescription systems with alert functions will become more common and should include the same information as in paper‐based documentation.

Nocturnal GERD – a risk factor for rhinitis/rhinosinusitis: the RHINE study

It has been suggested that gastroesophageal reflux disease (GERD) is a risk factor for developing rhinitis/rhinosinusitis, but data are lacking. This is a prospective 10‐year follow‐up study of a large multicenter cohort from Northern Europe, evaluating the relationship between nocturnal GERD and noninfectious rhinitis (NIR).

Nasal indices of eosinophilic and exudative inflammation in bakery-workers

Aims:  Rhinitis symptoms frequently occur in bakery‐workers. Yet, little is known about the pathophysiology of this condition. The objective of the present study was to examine nasal indices of inflammation in relation to occupational dust exposure, occupational rhinitis according to defined criteria, rhinitis symptoms associated to the workplace, and occupational sensitization in bakery‐workers.

Incidence of rhinitis and asthma related to welding in Northern Europe

Welding-related asthma is well recognised but less is known about rhinitis in relation to welding. The aim here, was to study associations between welding, rhinitis and asthma in a general population sample, and factors influencing selection into and out of a welding occupation. Adult-onset asthma and non-infectious rhinitis were investigated in the international multicentre population-based Respiratory Health in Northern Europe (RHINE) study, including 16 191 responders aged 26–54 years. Ever welding (n=2181), welding >25% of working time (n=747), and welding in stainless steel >6 months (n=173) were assessed by questionnaire. Subjects with rhinitis or asthma onset when aged <18 years were excluded. Incidence rates for asthma and rhinitis were calculated from year of disease onset, and start and end of welding job. Coxs proportional hazard models adjusting for age, sex, parental education and study centre, and Kaplan–Meier curves were used. Rhinitis incidence was higher among welders (hazard ratio (HR) 1.4, 95% CI 1.3–1.6), consistent in men and women, and across centres (pheterogeneity=0.4). In men, asthma incidence was higher among welders (HR 1.4, 95% CI 1.04–1.97). Quitting welding was indicated higher after adult-onset rhinitis (HR 1.1, 95% CI 1.0–1.3). Adult-onset rhinitis and asthma was higher among welders, consistent across population samples from Northern Europe. No pre-employment selection was found, whereas selection out of welding jobs was suggested. Welding activity increases risk of development of rhinitis, highlighting concerns in this occupation http://ow.ly/Owdqp

Predictors of respiratory sickness absence: an international population-based study.

BACKGROUND Respiratory tract-related occupational disability is common among adults of working age. We examined occupational vapors, gas, dust, or fume (VGDF) exposure as a predictor of disability, based on respiratory sickness absence among the actively employed, at an early point at which prevention may be most relevant. METHODS Currently employed European Community Respiratory Health Survey II participants (n = 6,988) were classified into three mutually exclusive, condition/symptom-based categories: physician-diagnosed asthma, self-reported rhinitis, and wheeze/breathlessness (n = 4,772). Logistic regression analysis estimated the odds of respiratory sickness absence (past 12 months) by VGDF exposure. RESULTS In the condition/symptom groups, 327 (6.9%) reported respiratory sickness absence. Exposure to VGDF was associated with increased odds of respiratory sickness absence: asthma odds ratio [OR] 2.0 (95% confidence interval [CI] 1.1-3.6), wheeze/breathlessness OR 2.2 (95% CI 1.01-4.8); rhinitis OR 1.9 (95% CI 1.02-3.4). CONCLUSION One in 15 currently employed with asthma, breathlessness, or rhinitis reported respiratory sickness absence. VGDF exposure doubled the odds of respiratory sickness absence, suggesting a focus for disability prevention.

Bronchial responsiveness in bakery workers: relation to airway symptoms, IgE sensitization, nasal indices of inflammation, flour dust exposure and smoking

Background  Bronchial hyperresponsiveness (BHR) is common in bakery workers. The relation between bronchial responsiveness measured with a tidal breathing method and smoking, airway symptoms, IgE‐sensitization, nasal indices of inflammation and flour dust exposure have been studied with bronchial responsiveness expressed as a continuous outcome.