SOMMAIRE

Mise-à-jour
14-Mar-2006

Jobs/Métiers

Chemical laboratory staff, Dry cleaner, Dyeing industry, Photographic processing, Tanner, Textile industry

Acryolamine, Hetrocyclic nitrogen and halogen compounds, Pyrazolon, Vinylsulfone

Incidence: 5 to15% of exposed subjects.

Asthma occurs 2 to 6 years after contact. Sensitization occurs during the mixing of the powders. The hapten is fixed either by substitution (heterocyclic halides and vinylsulphones) or by addition (acrylamine).

IgE-dependent mechanism. There is a heterogenicity of epitopes with regard to the RD-HSA, complex.

Colouring agents associated with chromophores act as electrophilic haptens. They are attached to the fibres by strong covalent bonds. The reactive groups which have the highest association with allergic reactions are: bromoacrylamide, dichlorotriazin, monochlorotriazin, monochlorodifluoropyrimidin, vinyl sulfone, fluorotriazine and pyrazolon. In the case of personnel working in the photographic industry, it is a suspension of a powder containing pyrazolon which, following several minutes exposure, gives rise to clinical signs of bronchoconstriction.

A spasmodic cough (due to chlorine and sulphuric acid anhydride fumes) is often present. Asthma is preceded by rhinitis and is linked with work initially, but becomes permanent. Urticaria and eczema may develop at the same time.

Diagnostic

Skin prick test with extracts of the combined colouring agents. Skin tests using 10 mg/ml of colouring agent with vinyl sulfone in 0.4 % phenol and 0.9 % saline have been proposed.

Measurement of specific IgE titre by RAST or by ELISA technique, with the conjugated HSA allergens. These 2 tests are complementary.

Bronchial provocation test (in Hospital).

Occup. Environ. Med. 2001,58:411 - Park JW. et al.
Clin. Exp. Allergy 2001,31:1779 - Park JW. et al.
Chest 2000,118:246 Nakano Y. et al.
Rev. Mal. Respir. 1999,16:384 - Spirlet F. et al.
Occup. Med. 1997,47:491 - Palmer K. et al.
Eur. Respir. J. 1997,10:238 - Convery RP. et al.
Fiche All. Prof. INRS
Contact Dermatitis 1988,18:290;
Contact Dermatitis 1986,15:186;
Clin. Allergy 1978,8:25;
Br. J. Ind. Med. 1987,44:534;
Br. J. Ind. Med. 1977,44:534;

• [Medline] Park JW, Kim CW, Kim KS, Choi SY, Kang DB, Ko SH, Won JU, Yang JY, Hong CS.
  Role of skin prick test and serological measurement of specific IgE in the diagnosis of occupational asthma resulting from exposure to vinyl sulphone reactive dyes.
  Occup Environ Med. 2001 Jun;58(6):411-6. PMID: 11351058

• [Medline] Park JW, Kang DB, Choi SY, Kim CW, Kim KS, Hong CS.
  Heterogeneity of IgE epitopes of vinyl sulphone reactive dye: human serum albumin that react with IgE.
  Clin Exp Allergy. 2001 Nov;31(11):1779-86. PMID: 11696055

• [Medline] Nakano Y, Tsuchiya T, Hirose K, Chida K.
  Occupational asthma caused by pyrazolone derivative used in silver halide photographic paper.
  Chest. 2000 Jul;118(1):246-8. PMID: 10893388

• [Medline] Spirlet F, Kopferschmitt-Kubler MC, Bessot JC, Blaumeiser-Kapps M, Pauli G.
  Occupational asthma caused by a coloring reagent.
  Rev Mal Respir. 1999 Jun;16(3):384-6. French. PMID: 10472648

• [Medline] Convery RP, Ward RJ, Hendrick DJ.
  Occupational asthma due to a widely used soft solder flux not containing colophony.
  Eur Respir J. 1997 Jan;10(1):238-40. PMID: 9032520 

• [Medline] Palmer K, Crane G.
  Respiratory disease in workers exposed to colophony solder flux fumes: continuing health concerns.
  Occup Med (Lond). 1997 Nov;47(8):491-6. PMID: 9604483

Jobs/Métiers

Organic chemist

Diazomethane

Incidence: low since the product is now only handled in a closed environment in order to prevent occupational exposures. Diazomethane is used as a methylating agent. It will cause symptoms when present as an airborne contaminant (level >0.1mg/m3). No pre-disposing factors.

Through loss of nitrogen, diazomethane forms a carbene which possesses a highly electrophilic double free radical.

Severe asthma (in all exposed subjects). Cases of airways cancer have also been reported

Diagnostic

The clinical symptoms appearing in the work place are the only means of diagnosis.

Zentralbl. Arbeitmed. Arbeitschutz 1952, 2:132

• [Medline]

Jobs/Métiers

Animal foodstuffs industry, Laboratory staff, Service Personnel, Manure spreader, Sewage worker

Punaise, Chironomid midges, Drosophila melanogaster, Echynodorus plasmosus, Fly, Fruit fly, Lucinia cuprina, Meat fly, Mosquito larvae, Psychoda alternata, Sewage fly

Incidence: Significant amongst exposed subjects, in particular in breeders of exotic fish. IgE type allergy. The allergen is present in the whole body of the animal (adult or larva). Debris and dust from the breeding areas may also contain the allergen.

Sensitization of subjects who work in laboratories which breed insects, in fish food manufacture (mosquito larvae) or in anglers using them as bait. Sensitization is associated with humid environments. Both the larvae and adult insects represent sources of allergens. In the case of chironomid midges, the principle allergen is Chi t 1. Some people react to other antigenic fractions which may show cross-reactivity with other insects or crustacea.

Rhinitis and asthma linked to work.

Diagnostic

IDR using available extracts depending on the case: Debris and dust from breeding areas and/or extracts from the animal 10^-6, 10^-5 and 10^-4 m/v. Immunological dosage. RAST/CAP RAST mosquito and fly. Bronchial provocation test (in hospital). Specific IgE available for chronomids: CAP, RAST

Invest. Allergol. Clin. Immunol. 1999,9:117 - Gaundo P.A. et al.
J. Allergy Clin. Immunol.1997,99:267 Garcia Làzaro M.A.
Int. Arch. Allergy Immunol. 1995,106:271
J. Allergy Clin. Immunol. 1994, 93:424
J. Allergy Clin. Immunol. 1986,77:108
Clin. Allergy 1986,16:65
Am. Rev. Resp. Dis. 1985,131:949
Med. Del. Lavoro 1982,3:234

• [Medline] Garcia Lazaro MA, Abengozar Muela R, Arias Irigoyen J, Cabanes Higuero N, Ventas Alguacil P, Moral de Gregorio A, Senent CJ.  Occupational asthma caused by hypersensitivity to ground bugs. J Allergy Clin Immunol. 1997 Feb;99(2):267-8. No abstract available. PMID: 9042059 

Jobs/Métiers

Cosmetics industry, Dairy worker, Detergents manufacturer, Dry cleaner, Food industry, Laboratory staff, Laundry cleaner, Nurse, Pharmaceutical industry, Pharmacist, Surgeon, Tanner, Textile industry

Amylase, Beta glucanase, Bromelin, Cellulase, Chymotrypsin, Esperase, Flaviastase, Lyzozyme, Macerozyme, Pancreatic enzymes, Papain, Pepsin, Phytase, Pronase E, Serrapeptase, Subtilisine, Trypsin

Incidence: originally very high (50% of exposed subjects) when enzymes were first used commercially. Current risk is strongly linked to working conditions. The allergic response is caused by the protein structure. The enzymatic activity is responsible for acute symptoms. IgE-depedent mechanism. Symptoms may appear within days or years of the initial contact. Atopic subjects are more prone to sensitization (7 out of 10 cases). Non-atopic subjects may become sensitized (3 out of 10).

The number of enzymes being used in industry is steadily increasing. In a study performed in 1977, the frequency of sensitization was 8 out of 10 cases for trypsin, 8 out of 10 for chymotrypsin, 7 out of 10 for bromelin and lower for amylase (3 out of 10) and lipase (3 out of 10). These data were collected by the pharmaceutical industry. The enzymes are additives which are also used in preparation of animal foods; a case of occupational asthma was reported in 2001 in a factory preparing these foodstuffs. In the detergent industry, the Bacillus subtilus enzyme has been implicated since the 1960s. The industry eliminated this enzyme and replaced it by encapsulated enzymes in the 1970s. Amongst these, an amylase derived form Bacillus licheniformis is frequently used. Four cases of asthma caused by this encapsulated enzyme have now been reported. Thus, encapsulation alone is insufficient to eliminate the risk of this occupational asthma.

In cases of extensive exposure: possible hemoptysis, chest pain, dyspenoea and acute rhinitis. Normal exposure: rhinitis, conjunctivitis and asthma. An allergy to food may also be associated (bromelin).

Diagnostic

Skin prick test: allergens must be prepared for each individual enzyme, e.g. Bacillus subtilis: 0.05, 0.5 and 5mg/ml. Immunological essay: RAST/CAP RAST papain, bromelin, lysozyme, . Bronchial provocation test (in Hospital) by inhalation.

COccup. Environ. Med.2001,58:417 - O'Connor T.M. et al.
Clin. Exp. Allergy 2000,30:1511 Schweigert M.K. et al.
Occup. Environ. Med. 2000,57:840 Hole A.M. et al.
Lancet 2000,356:1899 Cullinan P. et al.
Occup. Environ. Med. 1999,56:454 - Doekes G. et al.
Am. Allergy Asthma Immunol. 1999,82:174 Kim H. et al.
J. Allergy Clin. Immunol. 1999,104:700 - Kempf W. et al.
Allergol. Immunopathol. 1999,27(5):273 - Quinones D. et al.
Ann. Allergy Asthma Immunol. 1997,78:225 - Park H.S.
Allergy 1997,52:928 - Zentner A. et al.
Occup. Environ. Med. 1997,54:762 - Aiken T.C. et al.
Allergy 1996,51:959 - Marcer G. et al.
J. Allergy Clin. Immunol. 1992,89,1:118
Chest 1993,103:532;
Eur. J. Respir. Dis. 1985,66:13;
Br. J. Ind. Med. 1991,48:335;
Allergy 1981,36:513;
J. Allergy Clin. Immun. 1992,89:118;
J. Allergy Clin. Immun. 1971,48:262;
J. Allergy Clin. Immun. 1986,77:635;
J. Soc. Occup. Med. 1984,127;
New Engl. J. Med. 1961,265:332;
New Engl. J. Med. 1975,292;1050;
Lancet 1970,1:689;
Lancet 1969,1:1117;
Clin. Allergy 1982,12:9;
Clin. Allergy 1980,10:721;
Clin. Allergy 1979,9:75;
Clin. Allergy 1973,48:262;

1. [Medline] O'Connor TM, Bourke JF, Jones M, Brennan N.
   Report of occupational asthma due to phytase and beta-glucanase.
   Occup Environ Med. 2001 Jun;58(6):417-9. PMID: 11351059
2. [Medline] Schweigert MK, Mackenzie DP, Sarlo K.
   Occupational asthma and allergy associated with the use of enzymes in the detergent industry--a review of
   the epidemiology, toxicology and methods of prevention. Clin Exp Allergy. 2000 Nov;30(11):1511-8. Review. No abstract available. PMID: 11069558
3. [Medline] Hole AM, Draper A, Jolliffe G, Cullinan P, Jones M, Taylor AJ.
   Occupational asthma caused by bacillary amylase used in the detergent industry.
   Occup Environ Med. 2000 Dec;57(12):840-2. PMID: 11077014 
4. [Medline] Cullinan P, Harris JM, Newman Taylor AJ, Hole AM, Jones M, Barnes F, Jolliffe G.
   An outbreak of asthma in a modern detergent factory. Lancet. 2000 Dec 2;356(9245):1899-900. PMID: 11130389 
5. [Medline] Doekes G, Kamminga N, Helwegen L, Heederik D.
   Occupational IgE sensitisation to phytase, a phosphatase derived from Aspergillus niger.
   Occup Environ Med. 1999 Jul;56(7):454-9. PMID: 10472316
6. [Medline] Kim HY, Nahm DH, Park HS, Choi DC.
   Occupational asthma and IgE sensitization to cellulase in a textile industry worker.
   Ann Allergy Asthma Immunol. 1999 Feb;82(2):174-8. PMID: 10071521
7. [Medline] Kempf W, Oman H, Wuthrich B.
   Allergy to proteases in medical laboratory technicians: A new occupational disease?
   J Allergy Clin Immunol. 1999 Sep;104(3 Pt 1):700-1. No abstract available. PMID: 10482849 
8. [Medline] Quinones D, Alonso S, Lopez R, Sanchez I, Rodriguez F, Fernandez L, Jerez J.
   Contact urticaria, rhinoconjunctivitis and bronchial asthma from occupational use of papain.
   Allergol Immunopathol (Madr). 1999 Sep-Oct;27(5):273-5. Spanish. PMID: 10568879
9. [Medline] Park HS, Nahm DH.
   New occupational allergen in a pharmaceutical industry: serratial peptidase and lysozyme chloride.
   Ann Allergy Asthma Immunol. 1997 Feb;78(2):225-9. PMID: 9048533
10. [Medline] Zentner A, Jeep S, Wahl R, Kunkel G, Kleine-Tebbe J.
    Multiple IgE-mediated sensitizations to enzymes after occupational exposure: evaluation by skin prick test,
    RAST, and immunoblot. Allergy. 1997 Sep;52(9):928-34. PMID: 9298178 
11. [Medline] Aiken TC, Ward R, Peel ET, Hendrick DJ.
    Occupational asthma due to porcine pancreatic amylase. Occup Environ Med. 1997 Oct;54(10):762-4. PMID: 9404326
12. [Medline] Marcer G, Franchini M, Gemignani C, Zancanaro A, Semenzato G, Tassinari C, Cipriani A, Festi G, Saia B.
    Cheese workers' lung. Allergy. 1996 Dec;51(12):959-60. No abstract available. PMID: 9020428

Jobs/Métiers

Carpenter, Chemical industry, Cosmetics industry, Foundry worker, Hairdresser, Laboratory staff, Medical personnel, Mortician Thanatopracteur, Nurse, Paper industry, Plastics industry, Rubber industry, Tanner

Formaldehyde, Formol, Paraformaldehyde

Incidence: 30% of exposed subjects may be affected.

The product causes irritation and liberation of histamine.

An IgE-dependent mechanism and the production of antibodies have been suggested by some researchers, however, both of these claims have been disputed by others.

The airborne concentration of the substance is important. The permissible level (2ppm for 15 minutes) will cause problems for subjects with a bronchial hyperactivity. Both resin powders and gaseous forms of the product can induce symptoms. Recent studies (2001 – 2002) have demonstrated that an exposure level of 60 µg per m3 or above, increases the risk of the development of asthma in children.

Asthma attacks in the evening following exposure at work. The attacks may intensify for several nights after exposure (work) has been stopped. Cough, expectoration, rhinitis and conjunctivitis may be associated. Contact eczema, urticaria and Quincke's oedema may occur.

Diagnostic

Skin prick test: not commercially available.

Immunological dosage: RAST/CAP RAST Formalin.

Bronchial provocation test (in Hospital) by inhalation.

The monitoring of peak flow rates at home and work can be useful.

Yonsei Med. J. 2001,42:440 - Kim CW et al.
Eur. Respir. J. 2002,20:403 -Rumchev KB et al.
Eur. Respir. J. 1995,8:861
Fiche All. Prof n°2 INRS.
Gigtr. Prof. Zabol. 1976,20:17;
J. Allergy. Clin. Immunol. 1985,75:91;
J. Allergy. Clin. Immunol. 1990,86:177;
J. Allergy. Clin. Immunol. 1987,79:705;
Lancet 1987,2:164;
Chest 1983,833:584;
Br. J. Ind. Med. 1977,34:11;
Poumon-Coeur 1966,22:497;

1. [Medline]  Rumchev KB, Spickett JT, Bulsara MK, Phillips MR, Stick SM.
   Domestic exposure to formaldehyde significantly increases the risk of asthma in young children.
   Eur Respir J. 2002 Aug;20(2):403-8. PMID: 12212974

2. [Medline]  Kim CW, Song JS, Ahn YS, Park SH, Park JW, Noh JH, Hong CS.
   Occupational asthma due to formaldehyde.
   Yonsei Med J. 2001 Aug;42(4):440-5. PMID: 11519088

Jobs/Métiers

Cheese finer, Cheese maker, Cheese washer

Acarus siro, Chymosin, House dust mite, Lysozyme, Mite, Penicillium casei, Pepsin, Tyrophagus casei

Incidence: 10% of the work force may be affected.

Most of the asthmatic subjects are also atopic.

Various immunological reactions can be involved depending upon whether the subject is suffering from asthma or alveolitis.

Cheeses may be contaminated by mites in addition to the moulds normally present and by the addition of enzymes in semi-industrial preparations (egg lysozyme).

Classic asthma and/or pseudo flu symptoms with cough, dyspenoea and fever. In the case of asthma, rhinitis symptoms may also be present. Whilst there is an IgE-dependant mechanism, the most common symptoms are : rhinitis, rhino-conjunctivitis, dysphonia and even oedema of the glottis.

Diagnostic

Skin prick test and/or IDR with house dust mites and moulds.

Immunological dosage: RAST/CAP RAST and precipitins.

Bronchial provocation test (in hospital) in the case of asthma.

Allergy 1996,51:959 - Marcer G. et al.
Chest 1983,83:584
Schweiz. Med. Wochenschr. 1969,99:872;
Rev. Fr. Mal. Resp. 1979,7:41;
Rev. Fr. AllergoL. 1977,17:235;

• [Medline] Marcer G, Franchini M, Gemignani C, Zancanaro A, Semenzato G, Tassinari C, Cipriani A, Festi G, Saia B.
  Cheese workers' lung. Allergy. 1996 Dec;51(12):959-60. No abstract available. PMID: 9020428

Jobs/Métiers

Foundry worker, Metallurgist

Furfural, Furfuryl alcohol

Incidence: 5 to 30% of exposed subjects.

The risk is directly proportional to the concentration of the agent(s) in ambient air. The risk is directly related to the substance (and not to bronchial hyperreactivity), no immunolological mechanism has been demonstrated to date.

Atopy does not play a role in the condition.

Risk of occupational exposure during the polymerisation of resins in the presence of sulphuric acid and butanol.

Asthma associated with rhinitis. Smoking and/or chronic obstructive bronchitic disease are aggravating factors. There is a delay in the appearance of symptoms following the initial exposure to the risk.

Diagnostic

Monitoring of respiratory parameters during and after work.

Bronchial provocation test (in hospital).

J. Allergy Clin. Immmunol. 1980, 66:458;
Am. Rev. Resp. Dis. 1983, 128:226

• [Medline]

Jobs/Métiers

Animal breeder, Animal foodstuffs industry, Baker, Combine harvester driver, Docker, Miller, Seed packer, Coffee packer

Alternaria, Aspergillus, Cladosporium, Flours, Granarius, Dust mite, Meal, Microbial toxins, Mite, Mycotoxins, Seed debris, Sitophilus granarius, Tenobrio, Ustilago, Weevil, Wheat

Incidence: Frequent in subjects having a predisposition to bronchial hyperreactivity, atopic subjects and smokers. Several immunological mechanisms can be involved: IgE and precipitins depending on the allergen. The production of grain dust, drying in a silo, contamination with insects and bacteria are factors which all contribute to the wide aetiology of this disease. Monitoring of respiratory volumes and flow rates over a long time scale is very important. Smoking may be important.

Other than during grain loading/unloading processes using grain blowers (i.e. when much grain dust is produced), it is usually the drying/mixing process inside grain silos that causes the problem. In the case of millers, the exposure to flour is variable depending upon the precise nature of their work. Similarly, the packers who work in grain silos can become sensitized to wheat dust by an IgE-dependant mechanism and by sacks contaminated by different seed debris. In warehouses, a number of other contaminants are also present: rodent urine, cockroaches and bacteria in addition to the usual allergens which include dust mites. Nordic countries and the USA are more affected than Mediterranean countries..

Rhinitis, breathing difficulties, cough, wheezing and sometimes conjunctivitis are the principal symptoms. Equally, pseudo flu like symptoms may be observed. The wide diversity of symptoms is due to the large number of allergens that may be encountered. The increased prevalence of cough and chronic bronchitis over asthma is clear. There are major inflammatory phenomena.

Diagnostic

Skin prick tests : (mite and grains), PT and IDR for moulds.

Immunological dosage: RAST/CAP RAST and precipitins.

Monitoring respiratory parameters at home and in the work place.

Arch. Hig. Rada. Toksikol. 2001,52:43 - Korunic Z.
Clin. Exp. Allergy 1998,28:1159 Such Ch. et al.
Ann. Allergy Asthma Immunol. 1997,79:75 - Park H.S. et al.
Document IRNS 1996,n°66:109
Clin. Exp. Allergy 1996,26:128
Clin. Invest. Med. 1988,11:193
Ann. Allergy 1983,50:30
Ann. Allergy 1985,54:65
J. Allergy Clin. Immunol. 1990,86:182
J. Allergy Clin. Immunol. 1989,83:296
Allergy 1988,43:545
Chest 1985,87:452
Chest 1984,85:782
Br. J. Ind. Med. 1986,43:396

1. [Medline] Korunic Z.
   Allergenic components of stored agro products.
   Arh Hig Rada Toksikol. 2001 Mar;52(1):43-8. PMID: 11370298

2. [Medline] Suh CH, Park HS, Nahm DH, Kim HY.
   Oilseed rape allergy presented as occupational asthma in the grain industry.
   Clin Exp Allergy. 1998 Sep;28(9):1159-63. PMID: 9761021 

3. [Medline] Park HS, Nahm DH.
   Identification of IgE-binding components in occupational asthma caused by corn dust.
   Ann Allergy Asthma Immunol. 1997 Jul;79(1):75-9. PMID: 9236505 

Jobs/Métiers

Pharmaceutical industry

Glycine

The mechanism remains to be established, but may be due to a beta-blocking or an immunological reaction.

Glycine is a reagent used in the manufacture of salbutamol.

Asthma develops after a long period of exposure to the product. The attacks occur as a late reaction.

Diagnostic

Bronchial provocation test (in Hospital) by inhalation: 100mg of glycine in 250g of lactose.

Clin. Allergy 1976, 6:405

• [Medline]

Jobs/Métiers

Carpet manufacturing, Cosmetics industry, Explosives manufacturer, Food industry, Hairdresser, Lithography, Mining, Pharmaceutical industry, Printer, Textile industry

Acacia gum, Adragante gum, Alginate, Guar gum, Gum arabic, Karaya gum, Larch gum, Psyllium, Tamarind gum

Incidence: during certain asthma epidemics up to 50% of exposed subjects (USA 1935).

The allergen is a macromolecule which can easily be inhaled (as a powder or an aerosol).

Subjects are almost always atopic.

The mechanism is IgE-dependent.

If asthma caused by gum arabic in print workers is decreasing, respiratory problems due to vegetable gums are on the increase.

Rhinitis is more frequent and often precedes asthma. It is often associated with conjunctivitis. Cough and attacks of dyspnoea are closely linked to work, symptoms re-occur with each repeated exposure. There is a risk of an anaphylactic reaction caused by ingestion of the allergen, particularly in a hidden form e.g. in ice cream.

Diagnostic

Skin prick test or IDR with the antigen (commercially available in the case of gum arabic and adragante). Immunological dosage: RAST/CAP RAST Psyllium (Ispaghule) and guar gum, special couplings (Phadia). Bronchial provocation test (in hospital).

J. Allergy Clin. Immunol. 1990,86:562
J. Allergy Clin. Immunol. 1990,85:785;
INRS fiche All. Resp. Prof. n°8;
Chest 1987,91,2,A:296;
J. Am. Med. Assoc. 1980,243:5432 ;
Am. Rev. Resp. Dis. 1990 (Abst.) 452;
Am. Rev. Resp. Dis. 1986,133:935;
Lancet 1952,i:755;

• [Medline]

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Date de création: 3 Février 1999    mise à jour 14-Mar-2006  
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