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12-Mar-2006
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Mise-à-jour |
rev. oct/2002 evidence-based analysis rely upon
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Asmapro available on CD-rom :This Asmanet Web service is under construction, with a CD for off-line usage. Medline abstracts have been added to the CD off-line version in order to have them without an Internet web access. The service is available for Mac & PC in French and in English. The AsthmaPro version uses Metacard and is very handy thanks to its excellent integrated search engine - the HTML version uses Google as an off-shore search engine, which implies then a web online access - april2003); CD can be obtained free of charge for eligible people (limited stocks); just send your request and professionnal data to Mr L. Mousseau (Phadia). You may also write to Croisix who shall forward your request whenever eligible. |
Jobs/Métiers |
Substances/Agents |
Animal breeder, Chemist, Doctor, Laboratory staff, Medical personnel, Nurse, Pharmaceutical industry, Surgeon, Veterinary surgeon |
6-apa ampicillin, Amoxycillin, Benzylpénicillin, Cefadroxil, Ceftazidime, Cephalosporins, Penicillins, Piperacillin |
Incidence |
Conditions |
Symptom |
Incidence: given current awareness of this problem and methods of prevention this condition is rare. Atopic subjects do not show a predisposition for sensitization. IgE-dependent mechanism, the betalactamine molecule is an hapten. Sensitisation to cefadroxil is due to the dihydrothiazine molecule. |
Subject becomes sensitive during the preparation or use of the product. |
Classic asthma sometimes with severe attacks associated with conjunctivitis, rhinitis and even urticaria. Anaphylactic episodes are possible when the drugs are ingested by subjects who are already sensitive. Eczema is rarely associated with asthma in such cases. Skin rashes are associated with handling of antibiotic powders. |
Diagnostic |
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References |
Skin prick tests with allergens conjugated for minor and major determinants. RAST/CAP RAST for PENI.G and PENI.V, AMOXICILLIN and AMPICILLIN. Provocation test (in hospital), generally administered orally. Early and late phase reactions may be observed (CEFTAZIDIME). |
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Eur. Respir. J. 1999,13:1189 Sastre J. et al. Allergy 1998,53:104 - Jimenez I. et al. |
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Jobs/Métiers |
Substances/Agents |
Builder, Carpenter, Joiner, Model builder, Paper industry, Polisher, Sander, Saw mill employee, Woodcutter |
Abiruana, Acacia, Antiaris, Ash, Box tree, Coniferes, Ebony, Gaboon/Okoume, Imbuia, Iroko, Kotibe, Mahogany, Makoré, Mansonia, Maple, Mukali, Neurospora, Oak, Obeche (triplochiton scleroxylon), Okoumé (marine plywood), Pau, Perbora, Samba, Sequoia, Spruce, Teak, Western red cedar, White cedar |
Incidence |
Conditions |
Symptom |
Incidence: variable. It has been estimated that between 3.4 and 13.5 % of subjects in the USA are allergic to Thuya P. For certain types of tree, an IgE-dependent mechanism may be implicated e.g. in red cedar the allergen is plicatic acid (PA and TCPA). For the Samba, there are many major allergens, the predominant one being of 28 kDa (SDS, PAGE, IgE, BLOT). In the case of tropical woods a role for quinones has been implicated. Reactions with immunocomplexes can occur.Anti-parasitics used may also play a role on occasion e.g. pentachlorophenol and as well as moulds such as Neurospora (plywood) |
Sensitization is directly linked to the size of the sawdust particles inhaled. Glues, varnishes, isocyanates and wood treatments may also play a role. In Canadian sawmills, the typical level for symptoms due to dust is 1.35 mg/m3. On the other hand, MDI (methylene-diisocyanate ) is used in the fabrication of laminates and workers exposed to this product (2 year study) can develop a large number of asthma-like symptoms (30%). In plywood factories and in woodcutting, the neurospora mould has been implicated in the development of asthma. |
Asthma may appear between 1 and10 years after initial exposure to the risk. It is often preceded or accompanied by rhinitis, conjunctivitis and urticaria (mukali). Attacks may be immediate or delayed and may continue for a long time after the subject has stopped working. The patient may develop concomitant eczema. Recent studies have demonstrated that the bronchial inflammation found in asthma caused by red cedar is identical in atopic and non-atopic subjects. |
Diagnostic |
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References |
Skin prick and intradermal tests. In the case of Thuya P: PA conjugated with HSA or TCPA-HSA; in the case of other woods test are performed with sawdust extract. Immunological assays: ELISA, PTRIA with PA-HAS. In the case of Samba, a skin prick test can be performed with extracts in weight/volume. |
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J. Allergy Clin. Immunol. 2001,107:554 Cabañes Higuero N. et al. |
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Jobs/Métiers |
Substances/Agents |
Animal breeder, Baker, Cook, Flour milling, Food industry, Pancake maker, Pastry cook, Pizza maker |
Alpha amylase, Alternaria, Arthropodes, Aspergillus, Barley, Buckwheat, Ephestia, Glucoamylase, Hemicellulase, Lupin, Oats, Pollens, Rye, Saccharomyces cerevisiae, Sesame, Soya, Tribulium confusum, Wheat, Xylanase |
Incidence |
Conditions |
Symptom |
Incidence: between 5 to 24% of subjects may be affected according to different researchers. Atopy is an almost constant factor. The mechanism is IgE-dependent, however, there are other phenomena causing irritation and some which release histamine directly (lectins). In Europe, bakers' asthma is the second most frequent cause of occupational asthma. The use of monoclonal antibodies for the detection of allergens in the workplace environment seems to be reliable. It could be used in the design of preventive meAsures. Smoking and the concentration of dust in the workplace are aggravating factors. |
The exposure to the risk is greater in poorly ventilated traditional bakeries than in modern industrial bakeries. The measurement of flour antigens in the bakery is the most specific test for occupational exposure levels. After wheat flour (alpha amylase), soya flour is the most frequent cause. Sensitization to Ephestia and other arthropods are due to contamination. Cross-reactivity exists between Ephestia (lepidoptera) and Dermatophagoides pteronyssinus. Allergy to tribolium (coleptera) is due to its presence in old flour. The characterization of different allergens found at the workplace has permitted the identification of alpha-amylase (14 to 18 kDa) as well as Acyl-CoA oxydase (26 kDa), a peroxydase (36 kDa) and a fructose diphosphate aldolase (37 kDa). Demand for different types of bread leads to new sensitisations to unexpected allergens, such as lupin, sesame and poppy. Amongst the most frequently used additives, xylanase and cellulase can give rise to true sensitisations with reactions to alpha amylase. Occupational asthma due to lupin flour has been described in agronomy researchers. |
Asthma is almost always preceded by rhinitis. Classical asthma, associated with a cough, initially linked to the work place, but becoming permanent, frequently associated with conjunctivitis. Tribolium sensitisation appears as intense urticaria on the exposed parts of the skin. |
Diagnostic |
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References |
Skin prick test or IDR for flour and alpha-amylases. Immunological assays: RAST/CAP RAST to alpha-amylase, various flours and moulds. Bronchial provocation tests (in hospital) is important.. |
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Allergy 2001,56:696 - Mäkinen-Kiljunen S. et al. |
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Jobs/Métiers |
Substances/Agents |
Animal breeder, Agriculteur, Farmer, Food industry, Groom (Palefrenier), Jockey, Shepherd, Stable hand (Lad), Veterinary surgeon, |
Incidence |
Conditions |
Symptom |
Incidence: on the increase in large farms. Use of milking machines can aggravate the condition. Subjects are almost always atopic. The mechanism is IgE-dependent. For mink farming, the risk is greater during the reproductive periods. |
Sensitization to skin, urine and/or epithelia. Other allergens may be responsible for the asthma: flours; moulds, medicines, foodstuffs or fur. |
Besides less significant symptoms such as chronic cough and dyspnoea, classical asthma may occur, initially appearing to be uniquely linked to contact with animals then becoming more permanent. A recurrent coryza, urticaria and pruritus may also be present. According to some studies, 18% of animal breeders complain of work-associated rhinitis. |
Diagnostic |
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References |
Skin prick test with the allergens encountered at work (in Hospital). A bronchial provocation test with the allergen in question is definitive for the diagnosis. RAST/CAP RAST. |
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J. Occup. Environ. Med. 2001, 43:576 - Mustajbegovic J. et al. |
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Jobs/Métiers |
Substances/Agents |
Castor bean (Ricin), Coffee leaves, Green coffee beans, Hemileia vastatrix |
Incidence |
Conditions |
Symptom |
Incidence: approximately 10% of exposed subjects. The manner of conditioning the coffee is the critical factor (new or disposable sacks are necessary). Subject are almost always atopic. The asthma is typically IgE-dependent, but reactions of types III and IV may occur. There is a cross-antigenicity between coffee beans and castor beans (15 common antigens). |
Packing and transport of sacks containing (green) coffee. Contamination of sacks by castor bean may be another cause of asthma. Green coffee beans and roasted coffee contain the same allergen but the levels are much lower in roasted coffee. A mould, Hemileia vastatrix, also known as coffee leaf rust, has been identified as a causative agent for asthma in coffee-producing regions |
Classic asthma, may be severe, initially it subsides after stopping work but the condition can deteriorate. The symptoms are often accompanied by rhinitis, conjunctivitis and urticaria. |
Diagnostic |
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References |
IDR using a green coffee bean extract. Immunological assay: RAST/CAP RAST green coffee bean. Bronchial provocation test (in Hospital) and clinical history are the two other means of diagnosis. In the case of the mould Hemileia vastatrix, the mechanism is IgE dependent, but there is no commercially available skin test, nor assay for measuring these IgE. |
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Allergy 2001,56:684 - Croce M.A. et al. |
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Jobs/Métiers |
Substances/Agents |
Incidence |
Conditions |
Symptom |
Incidence: significant numbers of workers are affected, however there are only a few factories involved in this activity. Mechanism is almost always type I IgE-dependent. Subjects are almost always atopic. There are some common antigens between Candida tropicalis and Candida albicans. |
Sensitization to the Candida tropicalis bacteria in petrochemical products, occurring when the powdered product is bagged. This pathology remains rare. |
Cough, asthma and occasional coryza during working hours with symptom-free periods when away from the factory. |
Diagnostic |
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References |
IDR with Candida tropicalis at 1/10000 and 1/1000 m/v. No known immunological assay. Use of bronchial provocation tests has not been reported. |
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Rev. Fr. Allergol. 1976, 16:17 |
Jobs/Métiers |
Substances/Agents |
Incidence |
Conditions |
Symptom |
Incidence: directly proportional to the exposure to the risk. Subjects are often atopic. An IgE-dependent mechanism has been demonstrated for some metals. The most useful of the metal carbides are: cobalt, tungsten, titanium and tantalum. Cobalt has been the most widely studied and in this case the pathology of the metal carbides is identical to the occupational allergy to cobalt dust. A cross reactivity may exist between cobalt and nickel. |
All work in which these carbide dusts may be inhaled (e.g. mixture of powders) is dangerous. All the surrounding work areas are also likely to be exposed. In the glass industry, the greatest risk occurs when powders are mixed. |
Rhinitis, coryza, spasmodic cough and dyspenoea. These symptoms may be complicated by concurrent bronchial obstruction which may manifest functional changes due to alveolitis and/or fibrosis. In 2001, a case of severe cardiac arrhythmia was reported in a diamond polisher, who had continued in his work for economic reasons despite being diagnosed as suffering from occupational asthma. It was suggested that there was a cause and effect relationship between the cardiac disease and the length of exposure. |
Diagnostic |
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References |
Skin tests are not used in current practice. Tests have been carried out using CoSO4. Skin prick tests were negative and IDR tests positive at a concentration of 10 mg/ml. A bronchial provocation test (in hospital) is the only diagnostic method for Co. The bronchial response may be immediate or delayed. |
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Environ. Health Perspect. 2001,109:1303 - Wilk-Rivard E. et al. |
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Jobs/Métiers |
Substances/Agents |
Biologist, Cosmetics industry, Dyeing industry, Food industry, Pharmaceutical industry, Textile industry |
Incidence |
Conditions |
Symptom |
Incidence: very low. Atopy does not play an important role. The mechanism is possibly IgE-dependent. |
Sensitization occurs during the fabrication of the colouring agent prepared from the dried Coccus cactus flower and the female cochineal sensitization to Monascus rubber occurs during preparation of asian foods containing colourants (red or yellow). The colouration is derived from the action of the fungus Monascus rubber on Chinese “red rice”. |
Classical asthma during working hours, as well as rhinitis and conjunctivitis. . Ingestion of foodstuffs containing the colouring agent such as red coloured drinks may trigger the illness , and 2 cases of anaphylactic reactions following ingestion of carmin have been reported.. |
Diagnostic |
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References |
Skin prick tests using the whole dried insect, made into a solution in PBS may be performed, as well as using, carminic acid and cochineal powder. A specific assay of IgE for RAST has been suggested. A brochial provocation test (in Hospital) with the suspect allergen is definitive. For “red rice” and Monascus rubber, skin prick tests have been performed but these are not commercially available. Specific IgEs are not measured routinely, but in the case of carmin, a major allergen has been identified using SDS PAGE (Phadia). 3 major allergens have been described, these being carmin, cochineal and carminic acid. |
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J. Allergy Clin. Immunol. 2000,105:1241 Vandenplas O. et al. |
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Jobs/Métiers |
Substances/Agents |
Incidence |
Conditions |
Symptom |
Incidence: very low. The subjects are almost always atopic. IgE-dependent mechanism. |
The illness is associated with certain regions in Africa (Sudan) where the bats nest in roofs and ceilings. |
Asthma and rhinitis symptoms appear when the subject stays in an infested building. |
Diagnostic |
Tableau |
References |
Skin prick test with an extract prepared from bat's droppings. Immunological assay: RAST/CAP RAST bat (special coupling). |
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Lancet 1987, 7:316 |
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Adhesives industry, Beautician, Electronics, Poulterer, Tyre industry, Welder |
Incidence |
Conditions |
Symptom |
Incidence: between 4 and 20% of exposed subjects (depending on the literature). Subjects do not become atopic, but those who are already atopic are more severely affected. No immunological mechanism has been demonstrated to date, however direct toxicity has been shown in rats (Altman L.C. Studies on the pathogenenis of pine resin and wood induced lung disease Am. Rev. Resp. Dis. 1989). The threshold set by ACGIH for solder decomposition products is 0.1 mg/m3 expressed in terms of the formaldehyde concentration. |
Fumes produced during the pyrolysis of solders or other materials containing colophony. Telux¨ which is used as a replacement product in subjects allergic to colophony may also induce asthma. These pyrolysis aldehydes may also give rise to RADS (Reactive airways dysfunction syndrome or asthma caused by irritants – Brook´s Syndrome). |
Conjunctivitis, rhinitis and asthma symptoms develop after several years of exposure to the risk. Fever and myalgia symptoms may also occur. Dermatological problems due to colophony and resins can occur - eczema. |
Diagnostic |
Tableau |
References |
A bronchial provocation test (in Hospital) by inhalation is the only definitive test. It is also important to study the respiratory parameters in the work place. Measurement of dehydroabietic acid in the urine would also be a good diagnostic tool. The level of this acid (an oxidation product of abietic acid) is proportional to the exposure to the risk. |
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Occup. Med. 2001,51:507 - Jones K. et al. |
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