SOMMAIRE

Mise-à-jour
14-Mar-2006

Métiers/Occupation/Jobs

Substances/Agents

Cleaning staff, Refinery worker , Steel industry

Vanadium, Vanadium chloroplatinate, Vanadium pentoxide

Incidence

Conditions

Symptom

Incidence: directly related to the quantity of dust to which the subject is exposed.

The mechanism is probably not IgE-dependent.

Positive skin tests results have been reported when the measurement is taken late.

Atopy does not play a role in this condition. However, a predisposition to bronchial hyperreactivity and/or smoking have been identified as aggravating factors. Avoidance of the risk does not always result in the disappearance of the bronchial hyperreactivity.

In the industries listed the exposure to the risk occurs particularly during the manufacture of catalysts and during the cleaning of various heating units.

Inhalation of V₂O₅ (the most toxic form) can result in bronchial hyperreactivity in subjects with no other respiratory pathology. Very high doses are dangerous.

Dyspnoea and cough associated with localised crackles, nasal and conjunctival haemorrhage. Serious asthenia. Symptoms are delayed.

Diagnostic

References

Skin tests: with 2% sodium vanadate, read after 48 hours.

Measurement of vanadium levels in urine is the most reliable measure of exposure..

J. Toxicol. Clin. Toxicol. 1999,37:266 - Barceloux D.G. et al.
Am. J. Ind. Med. 1999,35:366 - Irsigler G.B. et al.
Eur. Resp. J. 1990,3:202
Med. J. Austr. 1982,1:183
Arch. Env. Hlth. 1967,14:709

1. [Medline] Barceloux DG.
   Vanadium J Toxicol Clin Toxicol. 1999;37(2):265-78. Review. PMID: 10382561

2. [Medline] Irsigler GB, Visser PJ, Spangenberg PA.
   Asthma and chemical bronchitis in vanadium plant workers. Am J Ind Med. 1999 Apr;35(4):366-74. PMID: 10086213 

3. [Medline] Nemery B.
   Metal toxicity and the respiratory tract. Eur Respir J. 1990 Feb;3(2):202-19. Review. PMID: 2178966 

Métiers/Occupation/Jobs

Substances/Agents

Cosmetics industry, Food industry, Perfumer, Tobacco manufacturer

Vanillin

Incidence

Conditions

Symptom

Incidence: rare - proportional to the preventative measures taken.

Type I mechanism (IgE-dependent).

The allergen is an electrophilic terpenic aldehyde.

Rhinitis and asthma symptoms may go into spontaneous remission.

Rhinitis and asthma symptoms sometimes accompanied by contact eczema.

Diagnostic

References

Bronchial provocation test with the raw material (in Hospital).

Immunological assay: RAST/CAP RAST vanilla .

Masson 1968, Coll. Méd. Lég. Tox. vol. n° 39

• [Medline]

Métiers/Occupation/Jobs

Substances/Agents

Herbalist, Pharmacist

Amaryllis, Banha, Cascara, Gentian, Ginseng, Henna, Ipecacuanha, Liquorice, Papaver somniferum, Passion flower, Pyrethrum, Quinine, Sanyak, Sarsaparilla

Incidence

Conditions

Symptom

Incidence: increasing with the trend for natural medicines.

The allergens are glycoprotein complexes.

The dried roots of the ipecacuanha plant contain an alkaloid (emetine).

In the case of liquorice, the allergen is an extract concentrated from the roots of the glycyrrhiza glarba used in confectionary and as an ulcer treatment.

Glycyrrhizine causes retention of sodium and potassium. Pyrethrum, extracted from chrysanthemums, is used in various insecticides. Ginseng is used as an aphrodisiac and has anti-diabetic properties. Cascara is a purging agent. A new chapter is beginning with asian medicine. Banha (Pinellia Ternata) which is a member of the Araceae family is a medicinal herb which is widely used in Korea. In the manufacturing areas of these herbal medicines, IgE- dependent asthmas have been described with Chukung (Cnidii rhizoma), Banha (Pinellia Ternata) and above all with Sanyak (Dioscorea radix):

Sensitization to these products is due to work place conditions, packaging and handling.

Rhinitis, conjunctivitis and classic asthma sometimes accompanied by contact dermatitis (pyrethrum) or urticaria. The upper respiratory pathologies may be extremely violent.

Diagnostic

References

Skin tests: extracts are not commercially available.

Bronchial provocation test using the raw material (in hospital).

Clin. Exp. Allergy 2001,31:779 - Kim SH. et al.
Ann. Allergy Asthma Immunol. 2001,86:469 - Lee SK. et al.
Allergy 1996,51:847 - Jansen A.P.H.
Ann. Allergy Asthma Immunol. 1997,79:449 - Giavina-Bianchi P. et al.
J. Allergy Clin. Immunol.1996,97:1416 - Van den Plas O. et al.
Clin. Exp. Allergy 1994,24:575
Allergol. Immun. Path. 1993,31:145
J. Allergy Clin. Immunol.1991,88(5)731
Clin. Allergy 1984,14:169
Ann. Int. Med. 1975,83:361
Ann. of Allergy 1965,23:332

1. Clin. Ex Allergy 2001,31:779 Kim S hy et al.
   

2. Ann. Allergy Asthma Immunol. 2001,86:469 Lee S K et al.
   

3. [Medline] Jansen AP, Visser FJ, Nierop G, de Jong NW, Waanders-de Lijster de Raadt J, Vermeulen A, van Toorenenbergen AW. Occupational asthma to amaryllis. Allergy. 1996 Nov;51(11):847-9. No abstract available. PMID: 8947345 

4. [Medline] Giavina-Bianchi PF Jr, Castro FF, Machado ML, Duarte AJ.
   Occupational respiratory allergic disease induced by Passiflora alata and Rhamnus purshiana. Ann Allergy Asthma Immunol. 1997 Nov;79(5):449-54. PMID: 9396980 

5. [Medline] Vandenplas O, Depelchin S, Toussaint G, Delwiche JP, Weyer RV, Saint-Remy JM.
   Occupational asthma caused by sarsaparilla root dust. J Allergy Clin Immunol. 1996 Jun;97(6):1416-8. No abstract available. PMID: 8648042 

Métiers/Occupation/Jobs

Substances/Agents

Toy manufacture, Hospital staff, Manufacture of surgical gloves, Medical personnel, Nurse, Surgeon, Textile industry, Toy manufacture

Latex

Incidence

Conditions

Symptom

Incidence: the proportion of hospital personnel reported as being sensitized to latex (PT+) varies from 2.9% to 5.5% depending upon the authors and attains 8% in subjects who are regularly exposed to this product. The influence of atopy has yet to be established. IgE-dependent mechanism.

Occupational urticaria (surgeons and nurses) and anaphylactic reactions to latex during surgical operations have been described . On the other hand, an antigenic cross reactivity has been demonstrated between latex, banana, chestnuts and kiwis (and perhaps also with melon). There is a partial cross-reactivity with ficus benjamina.

In South Africa, a programme on the incidence of occupational asthma demonstrated that latex is the principle causative agent of such asthma.

Exposure during the manufacture or use of latex surgical gloves made with latex from Hevea Braziliensis. In hospitals, this risk is greatest for surgical staff, since latex particles remain airborne. A similar pathology exists amongst cleaning staff wearing gloves. Together with glutaraldehyde, latex is responsible for the majority of work-related asthma amongst medical staff as shown by epidemiological studies. . New cases have been reported in the textile industry in seamstresses sewing the elastic of clothing. Measurement of latex airborne particles have been made in dental surgeries. The level of allergens in the waiting room varies between 6 and 25 ng per cubic meter of air and in the treatments room the levels are between 25 and 90 ng per cubic meter of air during working periods. With the use of non-powdered gloves, the levels become undetectable (less than 5 ng per cubic meter of air). The risk of sensitisation to latex manifests itself during the first 3 years of exposure as a function of the workplace and the levels of allergen present in the atmosphere. Whilst there is exposure cutaneous sensitisation and rhinitis, the risk of occupational asthma becomes greater and greater. Preventative measures, such as the use of non-powdered gloves, and the use of latex gloves only when necessary, is the best avoidance measure possible in hospital settings.

Asthma in the work place frequently associated with pruritus and ENT symptoms. Two cases of recurrent anaphylaxis to hidden latex at work have been reported, with ingestion of a food item acting as a trigger.

Diagnostic

References

Skin prick test: not commercially available.

Immunological assay: RAST:CAP RASR with latex.

Bronchial provocation test using the raw materials (in hospital).

Peak flow measurements in the work place.

The combination of skin tests and clinical history is less precise in the diagnosis of occupational asthma than bronchial provocation tests.

J. Allergy Clin. Immunol. 2001,107:542 - Vandenplas O. et al.
J. Allergy Clin. Immunol. 2001,107:921 - Archambault S. et al.
Ann. Allergy Asthma Immunol. 2000,85:285 Lauren Charous B. et al.
Clin. Exp. Allergy 2001,31:32 Hnizdo E. et al.
Fiche INRS 1999 numéro 80 - Rosenberg N.
Allergy 1999,54:290 - Weytjens K. et al.
J. Allergy Clin. Immunol. 1998,101:327 Pisati G. et al.
Gen. Dent. 1996,44:4224 - Clifford D. et al.
Thorax 1996,51:1281 - Ho A. et al.
Eur. Respir. J. 1995,8:1957
Ann. Allergy Asthma Immunol. 1996,76:51
Ann. Allergy Asthma Immunol. 1995,74:415
Ann. Allergy Asthma Immunol. 1995,74:311
Am. J. Respir. Crit. Care Med. 1995,151:887
Am. J. Respir. Crit. Care Med. 1995,151:54
J. Allergy Clin. Immunol. 1995,96:457
J. Allergy Clin. Immunol. 1994,94:826
Br. J. Ind. Med. 1992,49:596
Rev. Fr. Allergol. 1990,30(3):157
Allergy 1992,42:579
Contact Dermatitis 1987,17:270
Rev. Fr. Allergol. 1989,29:187
J. Allergy Clin. Immunol. 1990,85:626

1. J. Allergy Clin. Immunol. 2001,107:542 - Vandenplas O. et al.

2. J. Allergy Clin. Immunol. 2001,107:921 - Archambault S. et al.

3. [Medline] Charous BL, Schuenemann PJ, Swanson MC.
   Passive dispersion of latex aeroallergen in a healthcare facility. Ann Allergy Asthma Immunol. 2000 Oct;85(4):285-90. PMID: 11061471 

4. [Medline] Hnizdo E, Esterhuizen TM, Rees D, Lalloo UG.
   Occupational asthma as identified by the Surveillance of Work-related and Occupational Respiratory Diseases programme in South Africa. Clin Exp Allergy. 2001 Jan;31(1):32-9. PMID: 11167948

5. Fiche INRS 1999 nro 80 Rosenberg N.

6. [Medline] Weytjens K, Labrecque M, Malo JL, Cartier A.
   Asthma to latex in a seamstress. Allergy. 1999 Mar;54(3):290-1. No abstract available. PMID: 10321571 

7. [Medline] Pisati G, Baruffini A, Bernabeo F, Falagiani P.
   Environmental and clinical study of latex allergy in a textile factory. J Allergy Clin Immunol. 1998 Mar;101(3):327-9. No abstract available. PMID: 9525447

8. [Medline] Friesen CD, O'Connell M, Schkade PA, Dyer PD.
   Latex-induced asthma in a dental assistant. Gen Dent. 1996 Sep-Oct;44(5):424-6. PMID: 9171040 

9. [Medline] Ho A, Chan H, Tse KS, Chan-Yeung M.
   Occupational asthma due to latex in health care workers. Thorax 1996,51:1281 - Ho A. et al. PMID: 8994533

Métiers/Occupation/Jobs

Substances/Agents

Pharmaceutical industry

Cynorhodon, Dog rose

Incidence

Conditions

Symptom

Incidence: probably low since only a few case have been reported and the vitamins industry is very large.

Cynorhodon is used in a spray form and therefore the risk is dose dependent.

Atopic subjects are more susceptible.

IgE-dependent mechanism.

The ripe hip (fruit) of the dog rose going to seed after flowering is an important source of vitamin C and is used in the pharmaceutical and food industries.

Rhinitis and asthma. Urticaria and anaphylactic reactions have been reported.

Diagnostic

References

Skin prick test: 0.1 and 1mg/ml (not commercially available).

Immunological assay: ELISA (not commercially available).

Bronchial provocation test (in Hospital) with an extract at 1/100 m/v.

Chest 1985,88:8
J. Allergy Clin. Immunol. 1990,85:704

• [Medline] Kwaselow A, Rowe M, Sears-Ewald D, Ownby D.
  Rose hips: a new occupational allergen. J Allergy Clin Immunol. 1990 Apr;85(4):704-8. PMID: 2324410 

Jobs/Métiers

Substances/Agents

Bath enamelling, Laboratory staff, Metallurgist, Pulping/Paper industry

Chlorine, Hydrochlorid acid, Hydrofluoric acid, Nitric acid, Perchloric acid, Sulphuric acid

Incidence

Conditions

Symptom

Incidence: low.

Symptoms often appear in subjects with a predisposition to bronchial hyperreactivity, however this is not always the case.

Recovery to normal FEV1 values can take from 9 months to a year after exposure to the risk has ceased. The normalisation of the FEV1 value seems to be more rapid in these cases than in classical occupational asthma.

This type of asthma has been reported in inorganic analysis laboratories. Other cases include: metal industries (nickel and chrome plating).

Coating of sanitation ware, such as baths, can result in severe cases following exposure to hydrofluoric acid fumes.

Acute asthma, epidemic following exposure to acid fumes in large quantities RADS (Reactive airways dysfunction syndrome or asthma caused by irritants – Brooks syndrome). Cough and breathing difficulties may precede the asthmatic symptoms.
ENT symptoms may be signs of an impending bronchial pathology.
.

Diagnostic

References

Measurement of respiratory parameters in the work place (decrease of 20% in the FEV1 value).

INRS 2000 DMT 82 TR 25 page 153 Rosenberg N
Hautarzt 1999,50:665 Meier H. et al.
Occup. Environ. Med. 1999,56:334 - Leroyer C. et al.
J. Allergy Clin. Immunol. 1994,93:12
Am. Rev. Resp.Dis. 1991,143:74
Br. Ind. Med. 1988,45:381

1. [Medline] Meier H, Elsner P, Wuthrich B.
   Occupationally-induced contact dermatitis and bronchial asthma in a unusual delayed reaction to hydroxychloroquine. Hautarzt. 1999 Sep;50(9):665-9. German. PMID: 10501684
2. [Medline] Leroyer C, Malo JL, Girard D, Dufour JG, Gautrin D.
   Chronic rhinitis in workers at risk of reactive airways dysfunction syndrome due to exposure to chlorine. Occup Environ Med. 1999 May;56(5):334-8. PMID: 10472308

Métiers/Occupation/Jobs

Substances/Agents

Food industry

Tea

Incidence

Conditions

Symptom

Incidence: rare - a few cases have been described. The mechanism remains to be established, but may be due to a type of irritation. There are no reports that IgE is involved. Smoking has sometimes been desribed as a co-factor.

The cause is the leaf dust and debris from dry tea and a type of packaging material used when the tea is put into sacks. Of the many components of the tea leaf, epigallocatechine gallate (EGCg;mw:458 daltons) appears to be the most allergenic.

Rhinitis, cough, sporadic coryza, breathing difficulty and asthma.

Diagnostic

References

Skin tests are negative. RAST/CAP RAST with tea . Bronchial provocation test (in hospital) with tealeaf dust is positive with both an immediate and a delayed reaction. Both skin prick tests and bronchial provocation tests with EGCg give rise to an immediate reaction.

Chest 1994,106:1801
Int. Arch. Occup. Environ Health 1985,56:57
Thorax 1990,45:203
Eur. Resp. J. 1988,1:769
Br. J. Ind. Med. 1970,27:181

• [Medline]

Métiers/Occupation/Jobs

Substances/Agents

Chemical industry, Cosmetics industry, Doctor, Hospital staff, Medical personnel, Nurse, Paper industry

Benzalkonium chloride, Chloramine t, Chlorhexidine, Ethylene oxide, Formaldehyde, Glutaraldehyde, Hexachlorophene, Isothiazolinone, Proteolytic enzymes, Quaternary ammonium compounds

Incidence

Conditions

Symptom

Incidence : the number of reported cases is increasing. Atopy does not appear to play a role. No immunological mechanism has been demonstrated to date. Eczema symptoms following contact with chlorohexidine have been reported for many years, but they are not associated in all cases. Similarly, eczemas are frequently associated with isothiazolinone

The incidence rate of contact eczemas due to benzalkonium is 5 %. At present, 5 cases of asthma caused by quaternary ammonium compounds have been reported in the literature.

All of these disinfectants can cause asthma e.g. usage of aerosols of chlorohexidine in alcohol as a cleaning agent for large surface areas. Glutaraldehyde is used in bronchoscopy suites and ethylene oxide is used to sterilize dialysis facilities. Some latex gloves are sterilised using ethylene oxide which can provoke additional sensitization. In addition these agents are used as developers and fixers in radiology and in certain installations of air conditioning. The exposure levels set by the OES for glutaraldehyde were reduced from 0.2 ppm to 0.05 ppm in 1998.

Quaternary ammonium compounds are well known for their ability to cause skin sensitisations. They can also cause asthma, particularly in the case of benzalkonium chloride. Proteolytic enzymes used in the disinfection of endoscopy equipment can induce IgE-dependent sensitisations.

Rhinitis, sporadic coryza and conjunctivitis are often associated with coughing. Breathing difficulties and asthma may also occur.

In the case of benzalkonium chloride, swelling of the joints may also develop.

Diagnostic

References

Bronchial provocation test with raw materials (in hospital).

No skin tests or immunological dosage CAP/RAST for chroramine T and ethylene oxide and glutaraldehyde are possible, but rarely give a positive result. The use of tryptase or ECP assays and measurement of ECP levels in nasal lavage fluid could be a novel approach.

Allergy 2001,56:1186 - Palczynski C. et al.
INRS 2000 DMT 84 Rosenberg
Int. Arch. Occup. Environ. Health 2000,73:423 Purohit A. et al.g
Monaldi Arch. Chest Dis. 1998,53:50 - Di Stephano F. et al.
Thorax 1997,52:746 - Bourke S.J et al.
Occup. Med. 1997,47:249 - Moscato G. et al.
Lancet 1995,346:1434
Thorax 1995,50:156
Respiratory Medicine 1995,89:693
Rev. Fr. Allergol. 1991,31:41
Presse Med. 1991,20,30:1455
J. Allergy Clin. Immunol. 1993,91(5):974
Br. J. Ind. Med. 1992,49:523
Br. Med. J. 1989,298:929

1. [Medline]  Purohit A, Kopferschmitt-Kubler MC, Moreau C, Popin E, Blaumeiser M, Pauli G.
   Quaternary ammonium compounds and occupational asthma. Int Arch Occup Environ Health. 2000 Aug;73(6):423-7. PMID: 11007347 
2. [Medline] Di Stefano F, Siriruttanapruk S, McCoach JS, Burge PS. Occupational asthma due to glutaraldehyde. Monaldi Arch. Chest Dis. 1998,53:50 - PMID: 9632908
3. [Medline] Bourke SJ, Convery RP, Stenton SC, Malcolm RM, Hendrick DJ. Occupational asthma in an isothiazolinone manufacturing plant. Thorax 1997,52:746 - PMID: 9337839
4. [Medline] Moscato G, Omodeo P, Dellabianca A, Colli MC, Pugliese F, Locatelli C, Scibilia J. Occupational asthma and rhinitis caused by 1,2-benzisothiazolin-3-one in a chemical worker. Occup. Med. 1997,47:249 - PMID: 9231500

Métiers/Occupation/Jobs

Substances/Agents

Pharmaceutical industry

Hydralazine

Incidence

Conditions

Symptom

Incidence: undetermined - a single case has been described.

No immunological mechanism has been reported for this one, atopic subject.

The symptoms appeared 24 hours after contact with the allergen in the case described.

Sporadic coryza, breathing difficulties and asthma.

Diagnostic

References

Skin test: negative at 0.1 and 1mg/ml.

Bronchial provocation test (in Hospital) produces both immediate and delayed reactions.

Thorax 1990, 45:980

• [Medline] Perrin B, Malo JL, Cartier A, Evans S, Dolovich J.
  Occupational asthma in a pharmaceutical worker exposed to hydralazine. Thorax. 1990 Dec;45(12):980-1. PMID: 2281435 

Métiers/Occupation/Jobs

Substances/Agents

Abattoir employees, Poulterer

Animal foodstuffs, Feathers, Mites, Ornithonyssus, Poultry dust

Incidence

Conditions

Symptom

Incidence: relatively rare. Atopy is often a factor, but non-atopic subjects can be affected. IgE-dependent mechanism. In the case of alveolitis : presence of avian precipitins.

Working in intensive poultry farms. Many allergens are involved: poultry skin, foodstuffs and a particular species of mite: Ornithonyssus. Working in poultry abattoirs (4 cases have been reported).

Rhinitis and Asthma develop after several years of exposure to the risk. Alveolitis may also occur.

Diagnostic

References

Skin tests: with the suspect mite (not commercially available). Immunological assay: RAST with Ornithonyssus extract (special coupling) has been developed, but is not yet commercially available. Skin prick tests may be positive for chickens and turkey feathers. Immunological measurements: the RAST Ornithonyssus (special binding) has been performed but is not commercially available at present. Bronchial provocation test with raw materials (in Hospital).

Allergy 1997,52:594 - Perfetti L.
Environ Res. 1995,70:11
J. Allergy Clin. Immunol. 1984,73:265
J. Allergy Clin. Immunol. 1984,73:56

• [Medline] Perfetti L, Cartier A, Malo JL.
  Occupational asthma in poultry-slaughterhouse workers. Allergy. 1997 May;52(5):594-5. No abstract available. PMID: 9201376 

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