SOMMAIRE

Mise-à-jour
14-Mar-2006

Jobs/Métiers

Substances

Adhesives industry, Automotive industry, Biologist, Building industry, Chemical industry, Manicurist, Painter, Prosthesis manufacture, Surgeon

Cyanoacrylate, Diacrylate, Methyl methacrylate

Incidence

Conditions

Symptom

Incidence: low in comparison to the widespread usage of these resins.

The mechanism resembles an irritative and toxic type of eczema except for the absence of lesions.

Smoking is an established aggravating factor.

No immunological mechanism has been demonstrated.

The acrylate family can be divided into resins and glues. Methyl methacrylate is the monomer for acrylic resin polymers. Inhalation of cyanoacrylate glues may provoke an asthmatic attack. Hardening agents such as polyfunctional aziridine (PFA) may also give rise to asthma. Ventilation (in particular by increasing the downdraft air volume) protects the subjects at risk (e.g. during application of artificial fingernails). Ventilation systems reduce the concentration of methyl methacrylate but not the concentration of acrylic resin dusts.

Asthma is associated with serious ENT symptoms: rhinitis, sinusitis, laryngitis and conjunctivitis. Urticaria (glues) and/or recurrent eczema may occur. Recurrent eczema may be observed. Headache, sensations of inebriation and digestive problems have been described.

Diagnostic

References

Bronchial provocation test (in Hospital) and monitoring of respiratory parameters in the work place are decisive arguments. Skin tests can be performed and specific IgE looked for, but these are rarely positive. There is no cross reactivity between different acrylates which can be demonstrated by bronchial provocation tests. Levels of eosinophils in induced sputum are increased following occupational exposure or tests performed using cyanoacrylate..

Allergy 2001,56:446 - Kuirce S. et al.
Allergy 1999,54:289 - Weytjius K. et al.
Aerugi 1999,48:1238 - Susuki K. et al
Am. Ind. Hyg. Assoc. J. 1999, 60:625 - Nayebzadeh A. et al.
Am. Ind. Hyg. Assoc. J. 1997,58:214 - Spencer A.B. et al.
Rev. Mal. Resp. 1996,13:305 - Kopferschmit-kubler M.C. et al.
Clin. Exp. Allergy 1995,25:423
Presse Med. 1991,20,8:386
J. Ital. Med. Lav. 1984,6:225;
Br. Med. J. Clin. Resp. 1986,292:1362;
Br. Med. J. Clin. Resp. 1986,292:1597;
Thorax 1985,40:836;
Arch. Mal. Prof. 1975,36:58;

1. [Medline] Allergy 2001,56:446 Quirce S, Baeza ML, Tornero P, Blasco A, Barranco R, Sastre J.
   Occupational asthma caused by exposure to cyanoacrylate.Allergy 2001 May;56(5):446-9 PMID: 11350310

2. < [Medline] Weytjens K, Cartier A, Lemiere C, Malo JL.
   Occupational asthma to diacrylate. Allergy. 1999 Mar;54(3):289-90. No abstract available. PMID: 10321570

3. [Medline] Suzuki K, Fujimori K, Kobayashi O, Suzuki E, Gejyo F.
   A case of occupational asthma due to cyanoacrylate. Arerugi. 1999 Nov;48(11):1238-41. Japanese. No abstract available. PMID: 10630024

4. [Medline] Nayebzadeh A, Dufresne A.
   Evaluation of exposure to methyl methacrylate among dental laboratory technicians. Am Ind Hyg Assoc J. 1999 Sep-Oct;60(5):625-8. PMID: 10529992

5. [Medline] Spencer AB, Estill CF, McCammon JB, Mickelsen RL, Johnston OE.
   Control of ethyl methacrylate exposures during the application of artificial fingernails. Am Ind Hyg Assoc J. 1997 Mar;58(3):214-8. PMID: 9075312 

6. [Medline] Kopferschmit-Kubler MC, Stenger R, Blaumeiser M, Eveilleau C, Bessot JC, Pauli G.
   Asthma, rhinitis and urticaria following occupational exposure to cyanoacrylate glues.
   Rev Mal Respir. 1996 Jul;13(3):305-7. French. PMID: 8765925 

7. [Medline] Bjornsson E, Norback D, Janson C, Widstrom J, Palmgren U, Strom G, Boman G.
   Asthmatic symptoms and indoor levels of micro-organisms and house dust mites.
   Clin Exp Allergy. 1995 May;25(5):423-31. PMID: 7553245 

Jobs/Métiers

Substances

Bricklayer, Building industry, Ceramic industry, Chrome plater, Metallurgist, Painter, Photographic processing, Tanner, Textile industry, Welder

Chromic acid, Chromium oxide, Hexavalent chromium, Potassium dichromate, Zinc chromate

Incidence

Conditions

Symptom

Incidence: asthma is much less common than dermatitis and nasal complaints caused by chromates, amongst these workers.

Sensitization can take from several days to several years to develop.

Atopic predisposition has yet to be established.

IgE-dependent mechanism, however skin tests with unstable conjugates are often negative.

Chromium salts are very caustic. Subjects suffering from alveolitis caused by chromium's toxicity have been noted as well as RADS (Reactive airways dysfunction syndrome or asthma caused by irritants – Brooks syndrome)..

Chrome plating, polishing, chrome yellow paint, aluminium production, stainless steel welding and production of chromium metal. The cement used by bricklayers can cause asthma.

Asthma attacks at and/or after work with cough and

tight chest, sometimes severe and developing into permanent dyspenoea. Hemorrhagic rhinitis and nasal pain. Eruption of facial oedema and urticaria, contact eczema. ENT cancers have also been reported.

Diagnostic

References

Skin prick test: 0.1, 1, 5, 10mg/ml Cr₂(SO4)3. Immunological dosage: RAST with Cr₂(SO4)₃ coupled to HSA . Bronchial provocation tests (in Hospital) are sometimes performed with potassium bichromate. The bichromate is used at 0.3% over 60 seconds. In addition to the recognized risks associated with BPT, problems with arterial tension may also occur.

INRS 2000 DMT 82 TR 25 page 153 Rosenberg N.
Thorax 1997,52:28 - Bright P. et al.
Am. J. Ind. Med 1998,34:169 - De Raeve H. et al.
Fiche All. Resp. Prof. n°14 INRS
Fol. All. Imm. and Clin. 1985,32:21;
Clin. All. 1980,10:151;
Jap. J. Allergy 1972,21:665;
Arch. Mal. Prof. 1989 ;1957,18:284;
J. Allergy Clin. Immunol. 1986,77:451;
J. Allergy Clin. Immunol. 1983,72:407;

1. [Medline] INRS 2000 DMT 82 TR 25 page 153 Rosenberg N.    http://www.inrs.fr/produits/revues/dmt82.htm 

2. [Medline] Bright P, Burge PS, O'Hickey SP, Gannon PF, Robertson AS, Boran A.
   Occupational asthma due to chrome and nickel electroplating. Thorax. 1997 Jan;52(1):28-32. PMID: 9039236 

3. [Medline] De Raeve H, Vandecasteele C, Demedts M, Nemery B.
   Dermal and respiratory sensitization to chromate in a cement floorer. Am J Ind Med. 1998 Aug;34(2):169-76. PMID: 9651627 

Jobs/Métiers

Substances

Baker, Cook, Food industry, Pastry cook

Eggs, Ovalbumine, Vitellus, Yolk

Incidence

Conditions

Symptom

Incidence: low as few people are involved in this precise type of work.

Subjects are not always atopic.

IgE-dependent mechanism. Specific forms of IgE have been demonstrated to be present at significant levels, in particular for ovomucoid and ovalbumin.

Spraying and brushing of foodstuffs with solutions containing egg yolk. Manufacture of egg powder.

An American study performed in bakers and confectioners and published in 2001 demonstrated that it is possible to measure protein levels (ovalbumin, the ovomucoid fraction and lysozyme) in the workplace. The highest levels were found in those parts of the factory where the eggs are broken (breaking room).

Asthma, cough and breathing difficulties, initially occurring at the start and at the end of the working day. Risk of anaphylactic reactions occurring after ingestion of egg products , similarly after occupational exposure, an “egg-egg” syndrome may be observed...

Diagnostic

References

Skin prick test with whole egg or its constituents (unreliable).

Immunological dosage: RAST/CAP RAST.

Bronchial provocation test (in Hospital) and monitoring bronchial flow rates during work.

J. Investig. Allergol. Clin. Immunol. 2001,11:89 - Leser C. et al.
Appl. Occup. Environ. Hyg. 2001,16:660 - Boeninger MF et al.
Jap. J. Allergol. 1972,21:665
Ann. Intern. Med. 1973,78:888;
MMWR 1987,36:23;
J. Allergy Clin. Immunol. 1987,80:791;
J. Allergy Clin. Immunol. 1982,69:55;
Jama 1987,20:257;
Am. J. Ind. Med. 1987,12:205;
Chest 1985,88:740;
Clin. Allergy 1983,13:427;

1. J. Investig. Allergol. Clin. Immunol. 2001,11:89 Leser C. et al.
   

2. Appl. Occup. Environ. Hyg. 2001,16:660 Beoeninger M F et al.
   

3. [Medline] Edwards JH, McConnochie K, Trotman DM, Collins G, Saunders MJ, Latham SM.
   Allergy to inhaled egg material. Clin Allergy. 1983 Sep;13(5):427-32. PMID: 6627620 

4. [Medline] Gheysens B, Auwerx J, Van den Eeckhout A, Demedts M.
   Cobalt-induced bronchial asthma in diamond polishers. Chest. 1985 Nov;88(5):740-4. PMID: 2996839

5. [Medline] Smith AB, Bernstein DI, Aw TC, Gallagher JS, London M, Kopp S, Carson GA.
   Occupational asthma from inhaled egg protein. Am J Ind Med. 1987;12(2):205-18. PMID: 3661573

Jobs/Métiers

Substances

Farmer, Gardener, Horticulturist, Landscape gardener, Service Personnel, Wine grower

Chlorothion, Diazinon, Dichlorvos, Malathion, Parathion

Incidence

Conditions

Symptom

Incidence: rare.

Mechanism: inhibition of cholinesterases.

Specific treatment with Contrathion RP.

Use of insecticides in confined spaces or without adequate precaution, most commonly during disinfection.

Acute paroxysms of dyspnoea may develop into pulmonary oedema and can continue after work has ceased.

Diagnostic

References

No skin or bronchial provocation tests available.

Investigation of work activities and measurement of plasma and total cholinesterase levels are the only diagnostic tools available.

Ann. Allergy 1961, 19:397

• [Medline]

Jobs/Métiers

Substances

Cellarman, Chemical industry, Dyeing industry, Food industry, Hairdresser, Laundry worker, Paper industry, Pharmaceutical industry, Tanner

Bisulphites, Persulphates, Potassium metabisulphites, Sodium metabisulphites, Sulphites

Incidence

Conditions

Symptom

Incidence: increasing - probably due to the proportion of atopic subjects working in these areas. 50% of affected subjects are atopic. IgE-dependent mechanism although there may also be an interference with arachidonic acid metabolism. The limits recommended for occupational exposure to sulphite and metabisulphite is 5mg/m3. There are also limits set for the food industry. The gravity of the problem lies in the constant risk of triggering an asthmatic attack through the inadvertent consumption of the allergen. In a factory producing persulphates, it was demonstrated that the drop in bronchial flow was greater in those subjects who has a positive skin prick test.

The role of sulphites as occupational inhaled allergens is less well known and its description more recent than that of preservatives in food allergy. In contrast, persulphates are widely used as bleaching agents.

Asthma and rhinitis are frequently associated with urticaria, eczema, flush and hypotension. Ingestion of sulphites may cause anaphylactic shock in sensitized subjects.

Diagnostic

References

Skin tests are possible, but extracts are not commercially available.

Bronchial provocation test (in hospital).

Monitoring respiratory parameters in the work place. Patch tests with ammonium persulphate are frequently positive in the case of eczema, but persulphates also often give positive skin- prick tests.

Allergy 1999,54:893 - Borelly S. et al.
Int. Arch. Occup. Environ Health 1995,67:413
Thorax 1989,44:12
Respiration 1979,38:144
Rev. fr. Allergol.1966,8:150;
Clin. Allergy 1976,6:399;
Ann. Allergy 1985,54:213;
J. Allergy Clin. Immunol.1986,78:191;
J. Allergy Clin. Immunol.1984,74:469;
J. Allergy Clin. Immunol.1984,74:511;

1. [Medline] Borelli S, Wuthrich B.
   Immediate and delayed hypersensitivity to ammonium persulfate. Allergy. 1999 Aug;54(8):893-4. No abstract available. PMID: 10485397

2. [Medline] Wrbitzky R, Drexler H, Letzel S.
   Early reaction type allergies and diseases of the respiratory passages in employees from persulphate production. Int Arch Occup Environ Health. 1995;67(6):413-7. PMID: 8567091 

3. [Medline] Nichol GM, Nix A, Chung KF, Barnes PJ.
   Characterisation of bronchoconstrictor responses to sodium metabisulphite aerosol in atopic subjects with
   and without asthma. Thorax. 1989 Dec;44(12):1009-14. PMID: 2533410

Jobs/Métiers

Substances

Ceramic industry, Métallurgist, Petrochemical industry, Welder

Nickel, Nickel salts

Incidence

Conditions

Symptom

Incidence: low, however all subjects who are exposed to nickel and develop asthma symptoms must be investigated because the disease is severe and can develop into chronic bronchopathy.

IgE-dependent mechanism.

Atopy does not appear to play an important role. A positive nickel patch test has no predictive value to judge the likelihood of developing asthma. Skin tests producing an immediate result are not always reliable and may be dangerous.

Manufacture of stainless steel, enamelling of steel, production of fats, edible oils and batteries.

Cough and breathing difficulties at first followed by asthma during and after work. Initially, symptoms are associated with work but become permanent. Urticaria and angioneurotic oedema are observed in addition to classic eczema lesions.

Diagnostic

References

Skin prick test: 0.1, 1, 10 and 100mg/ml NiSO4 or 0.1mg/ml NiSO4.6H2O.

Immunological assay: RAST (special coupling) with NiSO4-HSA.

A bronchial provocation test (in Hospital) is the most reliable diagnostic tool.

Eur. Resp. J. 1990,3:202
Fiche All. Resp. Prof. n°13 INRS
IARC. Sci. Publ.1984,403
Br. Ind. Med. 1984,41:51
J. Allergy. Clin. Immunol. 1983,72:407;
J. Allergy. Clin. Immunol. 1982,69:55;
Int. Arch. Occup. Environ. Health 1975,36:137;
Int. Arch. Occup. Environ. Health 1985 56:11;

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

• [Medline] Novey HS, Habib M, Wells ID.
  Asthma and IgE antibodies induced by chromium and nickel salts. J Allergy Clin Immunol. 1983 Oct;72(4):407-12. PMID: 6413567 

Jobs/Métiers

Substances

Pharmaceutical industry

Phenylglycine, Phenylglycine acid chloride

Incidence

Conditions

Symptom

Incidence: up to 25% of exposed subjects.

30% of affected subjects are atopic.

IgE-dependent mechanism.

Phenylglycine acid chloride plays the role of an electrophilic hapten.

Working in clean conditions (e.g. fume cabinet) almost totally cures this type of asthma.

Compound used in the synthesis of ampicilline and other betalactamines.

Asthma associated with rhinitis and conjunctivitis.

Diagnostic

Tableau

References

Skin tests and bronchial provocation test (in Hospital) with some conjugates (phenylglycine-polylysine and human serum albumin) have been performed.

J. Allergy Clin. Immunol.1973, 52:73

• [Medline] Kammermeyer JK, Mathews KP.
  Hypersensitivity to phenylglycine acid chloride. J Allergy Clin Immunol. 1973 Aug;52(2):73-84. No abstract available. PMID: 4124984

Jobs/Métiers

Substances

Chemist, Pharmaceutical industry, Veterinary surgeon

Piperazine, Piperazine dichlorohydrate

Incidence

Conditions

Symptom

Incidence: low - only a few cases have been described.

Atopy does not appear to play an important role.

No immunological mechanism has been demonstrated to date.

Workers engaged in production of the compounds are the most frequently exposed, however, veterinary staff can also have significant levels of exposure (preparation of large quantities of purgatives).

Asthma symptoms appear several hours after initial exposure to the risk, often during the night following contact. Rhinitis is often associated.

Diagnostic

References

Skin prick test: 100mg/ml (always negative).

Bronchial provocation test (in Hospital) with lactose 4mg/kg

Am. J. Ind. Med. 1984,6:347
J. Occ. Méd. 1982,24:193
Clin. Allergy 1972,2:189
Br. J. Ind. Med. 1968,25:319

1. [Medline] Hagmar L, Bellander T, Ranstam J, Skerfving S.
   Piperazine-induced airway symptoms: exposure-response relationships and selection in an occupational setting. Am J Ind Med. 1984;6(5):347-57. PMID: 6517066

2. [Medline] Hagmar L, Bellander T, Bergoo B, Simonsson BG.
   Piperazine-induced occupational asthma. J Occup Med. 1982 Mar;24(3):193-7. PMID: 7062155 

Jobs/Métiers

Substances

Chemist, Dentist, Electronic components industry, Electronics industry, Jeweller, Metallurgist, Nurse, Photographer, Refinery worker

Hexachloroplatinates, Palladium salts, Platinum salts, Tetrachloroplatinates

Incidence

Conditions

Symptom

Incidence: originally very high (>50% of exposed subjects) when first reported. With appropriate precautions in the work place this figure is now 10%. Most sufferers are atopic. The sensitization period takes from 15 days to several years. IgE-dependent mechanism, however platinum salts will cause release of histamine in vitro (cutaneous basophils and mast cells behave differently). The immunological assay of specific IgE molecules remains the most usual area of research: but conflicting results have been obtained. Skin tests with palladium have proved positive in dentistry; palladium being contained in dental alloys. Cross-reactivity between nickel and palladium frequently occurs.

The first reported cases involved subjects who worked in photographic studios. Precious metals industry: platinum refining.

Metals of the platinum group, the so called “precious metals” include ruthenium, palladium, osmium and irridium

Asthma is sometimes preceded by eczema, urticaria and angioneurotic oedema. Rhinitis may be the only symptom for a long time or it may be immediately associated with asthma. It occurs at work and may continue during the night with or without a spasmodic cough. Respiratory parameters and bronchial hyperreactivity only partially regain their normal values after work has stopped. Changes in the workstation of the subject to a less exposed area does not result in an improvement in airway parameters.

Diagnostic

References

Skin prick test: using large dilutions of ammonium hexachloroplatinate from 10-9 to 10-3. Bronchial provocation test (in hospital) is very reliable but difficult to conduct successfully. The response is almost always an immediate reaction. Measurement of specific IgE : phadezym (Germany). Skin tests with Pd(NH₃)₄Cl₂ are positive where there is an IgE-dependent mechanism. In the case of eczemas, patch tests are positive for the causative metal.

J. Allergy Clin. Immunol. 2001, 107:707 - Merget R. at al.
J. Allergy Clin. Immunol. 1999,103:1211 - Yoshida S. et al.
Eur. Resp. J. 1999,13:213 - Deanen M. et al.
Int. Arch. Occup. Environ. Health 1999,72:33 - Merget R. et al.
Int. Arch. Allergy Appl. Immunol. 1995,107:406
Am. J. Respir. Crit. Care Med. 1994,150:1146
Fiche Allerg. Resp. Prof. INRS n°12
Presse Méd. 1967,75,55:2817
Eur. Respir. J. 1990,3:202
Chest 1990,97:1401
J. Allergy Clin. Immunol.1985,76:794
J. Allergy Clin. Immunol.1980,66:179
Clin. Allergy 1988,18:569
Clin. Allergy 1979,9:109

1. J. Allergy Immunol. 2001,107:707 Merget R et al.

2. [Medline] Yoshida S, Sakamoto H, Mikami H, Onuma K, Shoji T, Nakagawa H, Hasegawa H, Amayasu H.
   Palladium allergy exacerbating bronchial asthma. J Allergy Clin Immunol. 1999 Jun;103(6):1211-2. No abstract available. PMID: 10359908

3. [Medline] Daenen M, Rogiers P, Van de Walle C, Rochette F, Demedts M, Nemery B.
   Occupational asthma caused by palladium. Eur Respir J. 1999 Jan;13(1):213-6. PMID: 10836351 

4. [Medline] Merget R, Schulte A, Gebler A, Breitstadt R, Kulzer R, Berndt ED, Baur X, Schultze-Werninghaus G.
   Outcome of occupational asthma due to platinum salts after transferral to low-exposure areas. Int Arch Occup Environ Health. 1999 Jan;72(1):33-9. PMID: 10029228 

5. [Medline] Merget R, Caspari C, Kulzer R, Breitstadt R, Rueckmann A, Schultz-Werninghaus G.
   The sequence of symptoms, sensitization and bronchial hyperresponsiveness in early occupational asthma due to platinum salts. Int Arch Allergy Immunol. 1995 May-Jun;107(1-3):406-7. No abstract available. PMID: 7613192 

Jobs/Métiers

Substances

Agronomist, ESPARTO INDUSTRY, Florist, Gardner, Horticulturist, Landscape gardner, Pharmacist

Amaryllis pollen, Beetroot pollen, Carnation, Diplotaxis erucoides, Esparto, Grass pollens, Gypsophila pollen, Jasmin pollen, Lathyrus odoratus pollen, Liliaceae, Lime tree pollen, Limonium tataricum, Paprika pollen, Phoenix pollen, Pyrethrum Pollen, Rapseed Pollens, Stathiphyllum, Stephanotis, Strawberry pollen, Sunflower pollen, Tulip, Weeping fig (ficus benjamina)

Incidence

Conditions

Symptom

Directly related to the number of atopic subjects in the work force. IgE-dependent mechanism.

Employees working in intensive culture greenhouses (especially jasmine). Agricultural research workers (especially sunflowers) and all persons whose job brings them into contact with plants: florists (tulips) and the esparto industry (Stipa tenacissima),. The allergens are the pollens but the leaves, bulbs and seeds may also be involved. Work in greenhouses can increase the risk as compared with work in the open air. Pollens of the cruciferous family are also the cause of sensitisations in cultivation areas. For example, Diplotaxis erucoides or wall rocket, may cause asthma in wine-growers. Pollination of this crucifera plant occurs between March and April in between the vines. Other crucifera plants may also be implicated in different agricultural practices such as Brassica oleifera in rapeseed cultivation. Farmers may also become sensitised to the mould Aspergillus Niger if it contaminates the crops.

In general, pollen induced asthma is typically associated with episodes of coryza. Symptoms occur due to the specific pollen present in the work place outside of the natural pollen season. Asthma can be caused by preparation of bouquets of dried flowers, cleaning leaves (ficus) or pruning (stathiphyllum). Gardeners may experience asthma attacks whilst mowing lawns (aerosol of grass pollen allergens). The phoenix plant can cause contact urticaria and asthma.

Urticaria of the forearms is on the increase. In 2001, a case of Hypersensitivity pneumonitis and extrinsic allergic alveolitis was described following contact with Stipa tenacissima (Esparto grass).

Diagnostic

References

Skin prick test and bronchial provocation test (in Hospital). RAST/CAP RAST depending upon the pollen in question.

J. Allergy Clin. Immunol. 2001,108:125 - Brito FF. et al.
Allergy 2001,56:679 - Garcia-Ortega P. et al.
Med. Lav. 2001,92:203 - Ferrugia E. et al.
J. Investig. Allergol. Clin. Immunol. 200,11:67 - Hinojosa M.
J. Allergy Clin. Immunol. 1999,103:950 - van der Zee J.S. et al.
J. Allergy Clin. Immunol. 1999,104:181 - Sanchez-Guerrero I. et al.
Allergy 1999,54:78 - Baz et al.
Allergy 1999,54:273 - Piirilä P.et al.
Allergy 1998,53,907, Vandeplas O.et al.
Allergy 1996,51:847
J. Allergy Clin. Immunol. 1995,96:693
Allergy Proc. 1995,16(3):415
Allergy 1995,50:277
Allergy 1995,50:174
Allergy 1993,43:285
Clin. Exper. Allergy 1992,22:501;
Clin. Exper. Allergy 1992,22:423;
Int. Arch. Allergy Appl. Immun.1984,75:44;
Rev. Fr. Allergol.1990,30(3):185;
J. Allergy Clin. Immunol.1990,86:199;
J. Allergy Clin. Immunol.1985,75:268;
J. Allergy Clin. Immunol.1985,75:164;
Frazier Cl. A." Occupational Asthma"Van Nostrand Reihold Ed., N.Y. 1980;

1. J. Allergy Clin. Immunol. 2001,108:125 Brito F F
   

2. Allergy 2001,56:679 Garcia-Ortega P. et al.
   

3. Med. Lav. 2001,92:203 Ferrugia E. et al.
   

4. J. Investig. Allergol. Clin. Immunol. 2001,11:67 Hinojosa M.
   

5. [Medline] van der Zee JS, de Jager KS, Kuipers BF, Stapel SO. Outbreak of occupational allergic asthma in a Stephanotis floribunda nursery. J Allergy Clin Immunol. 1999 May;103(5 Pt 1):950-2. No abstract available. Van der Zee J. S. et al.

6. [Medline] Sanchez-Guerrero IM, Escudero AI, Bartolom B, Palacios R. Occupational allergy caused by carnation (Dianthus caryophyllus). J Allergy Clin Immunol. 1999 Jul;104(1):181-5.

7. [Medline] Baz G, Hinojosa M, Quirce S, Cuevas M. Occupational asthma caused by esparto grass (Stipa tenacissima) fibers. Allergy. 1999 Jan;54(1):86-7. Baz G. et al.

8. [Medline] Piirila P, Kanerva L, Alanko K, Estlander T, Keskinen H, Pajari-Backas M, Tuppurainen M. Occupational IgE-mediated asthma, rhinoconjunctivitis, and contact urticaria caused by Easter lily (Lilium longiflorum) and tulip. Allergy. 1999 Mar;54(3):273-7. Piirilä P. et al.

9. [Medline] Vandenplas O, Vander Borght T, Delwiche JP.
   Occupational asthma caused by sunflower-seed dust. Allergy. 1998 Sep;53(9):907-8. No abstract available. PMID: 9788698 

10. [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 1996,51-847 - Jansen A.P.H. et al.

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