Síntomas respiratorios en agentes civiles de tránsito expuestos a smog en Quito en el año 2021 / Respiratory symptoms in civil traffic police agents exposed to smog in Quito in 2021

INTRODUCCIÓN. Existe relación entre la exposición de contaminantes en el aire y problemas respiratorios que van desde síntomas leves en vías respiratorias altas hasta enfermedades que pueden comprometer la vida de los pacientes como: neumonía, enfermedad pulmonar obstructiva crónica y cáncer pulmonar. OBJETIVO. Registrar los síntomas respiratorios presentados por agentes civiles de tránsito expuestos a smog. MATERIALES Y MÉTODOS. Estudio analítico transversal. Población de 3 458 y muestra de 454 participantes entre agentes civiles de tránsito, fiscalizadores de tránsito y personal administrativo de la Agencia Metropolitana de Tránsito en el año 2021, seleccionados por muestreo aleatorio simple estratificado para los dos grupos de participantes; se aplicó un sondeo digital basado en las encuestas: European Community Respiratory Health Survey y condiciones de trabajo. Para el análisis de datos se utilizó la herramienta EPI INFO, donde se realizó pruebas estadísticas bivariadas de Chi2 y análisis multivariado como regresiones logísticas crudas y ajustadas. RESULTADOS. Se observó que la población de trabajadores operativos en vía tuvo alrededor de dos veces más riesgo de desarrollar sibilancias en comparación a la población administrativa OR=2,1 (IC 95% 1,01­4,39); el personal operativo tuvo más del doble de riesgo de desarrollar bronquitis crónica versus la población administrativa OR=2,5 (IC 95% 1,14­5,73). Los resultados fueron ajustados mediante regresión logística con variables de condiciones de trabajo y salud (p=<0,05). CONCLUSIÓN. Se registró una relación significativa entre la contaminación ambiental por smog y enfermedades respiratorias a largo plazo.

INTRODUCTION. There is a relationship between exposure to air pollutants and respiratory problems ranging from mild upper respiratory symptoms to life-threatening diseases such as pneumonia, chronic obstructive pulmonary disease and lung cancer is evident. OBJECTIVE. To record the respiratory symptoms presented by civilian traffic officers exposed to smog. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 3 458 and sample of 454 participants among civilian traffic agents, traffic inspectors and administrative personnel of the Metropolitan Traffic Agency in the year 2021, selected by simple stratified random sampling for the two groups of participants; a digital survey was applied based on the European Community Respiratory Health Survey and working conditions. For data analysis, the EPI INFO tool was used, where bivariate Chi2 statistical tests and multivariate analysis such as crude and adjusted logistic regressions were performed. RESULTS. It was observed that the population of operational track workers had about twice the risk of developing wheezing compared to the administrative population OR=2,1 (95% CI 1,01-4,39); operational personnel had more than twice the risk of developing chronic bronchitis versus the administrative population OR=2,5 (95% CI 1,14­5,73). Results were adjusted by logist regression with working conditions and health variables (p=<0,05). CONCLUSION. There was a significant relationship between smog pollution and long-term respiratory diseases.

Work-related asthma / Asma relacionada ao trabalho

ABSTRACT Work-related asthma (WRA) is highly prevalent in the adult population. WRA includes occupational asthma (OA), which is asthma caused by workplace exposures, and work-exacerbated asthma (WEA), also known as work-aggravated asthma, which is preexisting or concurrent asthma worsened by workplace conditions. In adults, the estimated prevalence of OA is 16.0%, whereas that of WEA is 21.5%. An increasing number of chemicals used in industrial production, households, and services are associated with the incidence of adult-onset asthma attributable to exposure to chemicals. This review article summarizes the different types of WRA and describes diagnostic procedures, treatment, prevention, and approaches to patient management. It is not always easy to distinguish between OA and WEA. It is important to establish a diagnosis (of sensitizer-/irritant-induced OA or WEA) in order to prevent worsening of symptoms, as well as to prevent other workers from being exposed, by providing early treatment and counseling on social security and work-related issues.

RESUMO A asma relacionada ao trabalho (ART) é um acometimento com elevada prevalência na população adulta. A ART inclui a asma ocupacional (AO), desencadeada pela exposição a um agente presente em um determinado ambiente de trabalho, e a asma agravada ou exacerbada pelo trabalho (AA/ET), que acomete indivíduos com antecedentes de asma ou que iniciaram um quadro de asma concomitante, mas sem relação causal com o ambiente de trabalho. Estima-se que 16,0% e 21,5% da asma no adulto sejam AO e AA/ET, respectivamente. O elevado e crescente número de substâncias químicas usadas na produção industrial, no uso domiciliar ou em serviços é responsável pela incidência de asma associada à exposição a agentes químicos na vida adulta. Este artigo de revisão descreve os principais tipos de ART, os procedimentos para seu diagnóstico, tratamento e prevenção e as condutas frente ao diagnóstico. Nem sempre é fácil a distinção entre AO e AA/ET. A importância do diagnóstico (AO ou AA/ET e asma induzida por sensibilizantes ou irritantes) tem relação com a adoção de medidas de prevenção para evitar que novos indivíduos sejam expostos e que os acometidos apresentem agravamento da doença, utilizando tratamento precoce e fornecendo orientação sobre aspectos previdenciários e trabalhistas.

Comparação entre fatores sociodemográficos e ocupacionais com sintomas respiratórios e pico de fluxo expiratório em trabalhadores de uma indústria de cerâmica do Sul do Brasil / Comparison between socio-demographic and occupational factors with respiratory symptoms and peak expiratory flow in workers of a ceramic industry in Southern Brazil

Objetivo: avaliar a prevalência dos sintomas respiratórios ocupacionais, pico de fluxo expiratório (PFE) e fatores associados em trabalhadores de uma indústria de cerâmica do sul do Brasil. Métodos: estudo transversal. Foram avaliados trabalhadores de uma indústria de cerâmica do Sul do Brasil. Como instrumentos de pesquisa, foram aplicados questionários relacionados a aspectos ocupacionais, sintomas respiratórios, hábitos tabágicos e medida do PFE. As variáveis sociodemográficas e ocupacionais foram comparadas com os sintomas respiratórios e PFE. Resultados: foram avaliados 151 trabalhadores, sendo, predominantemente, do sexo masculino (87,4%), com média (±DP) de idade de 30,4 (±8,4) anos e histórico de tabagismo em 23,8% dos participantes. Entre os sintomas respiratórios, 23% relataram tosse diária e noturna e dispneia, 21% confirmaram escarro durante o dia/noite, e apenas 7% referiram chiado ou sibilos. O PFE abaixo de 80% do previsto foi encontrado em 37,1% dos trabalhadores, com média (±DP) de 84(±16,7)%. Ao comparar os fatores ocupacionais com os desfechos, foi observado que o menor tempo de trabalho esteve relacionado à maior prevalência de tosse (p=0,024). Conclusão: os sintomas respiratórios mais prevalentes foram a tosse e a dispneia, seguidos por escarro e sibilância. Aproximadamente, 1/3 dos trabalhadores demonstraram PFE<80%. Contudo, a relação inversa entre tempo de trabalho e sintomas merece maior investigação.

Objective: To evaluate the prevalence of occupational respiratory symptoms, peak expiratory flow (PEF) and associated factors in workers from a ceramic industry in southern Brazil. Methods: Cross-sectional study. Workers from a ceramic industry in southern Brazil were evaluated. The research instruments were questionnaires related to occupational aspects, respiratory symptoms, smoking habits, and PEF measurements. Sociodemographic and occupational variables were compared with respiratory symptoms and PEF. Results: We evaluated 151 workers, predominantly male (87.4%), with a mean (±DP) age of 30.4 (±8.4) years and a history of smoking in 23.8% of participants. Among the respiratory symptoms, 23% reported daily and nocturnal cough and dyspnea, 21% confirmed sputum during the day / night, and only 7% reported wheezing. PEF below 80% of predicted was found in 37.1% of workers, with a mean (± DP) of 84 (± 16.7) %. When comparing the occupational factors with outcomes, it was observed that the shorter working time was related to higher cough prevalence (p=0.024). Conclusion: The most prevalent respiratory symptoms were coughing and dyspnea, followed by sputum and wheezing. Approximately 1/3 of workers showed PEF <80%. However, the inverse relationship between working time and symptoms merits further investigation.

Bronchial Response to High and Low Molecular Weight Occupational Inhalant Allergens

PURPOSE: Occupational asthma may be induced by high- or low-molecular weight allergens (HMWA or LMWA, respectively). The study was conducted to compare the pattern of bronchial response in 200 HMWA-induced asthmatics (n = 130) and LMWA-induced asthmatics (n = 70). METHODS: The study participants underwent a single-blind, placebo-controlled specific inhalation challenge (SIC) with workplace allergens, accompanied by evaluation of non-specific bronchial hyperresponsiveness (NSBHR) with methacholine before and after the SIC. RESULTS: A single early bronchial response more frequently occurred in HMWA-induced asthmatics than in LMWA-induced asthmatics (86.2% vs. 20%). An isolated late bronchial response or atypical patterns were more frequently observed in LMWA-induced asthmatics than in LMWA-induced asthmatics (45.7% vs. 3.8% or 34.3% vs. 10%, respectively). Baseline NSBHR before SIC was more often detected in LMWA-induced asthmatics than in HMWA-induced asthmatics (81.4% vs. 54.6%), and the median value of the provocation concentration of methacholine was relevantly lower in these patients before and after SIC. A significant 3-fold increase in NSBHR after SIC was observed more often in LMWA-induced asthmatics than in HMWA-induced asthmatics (82.8% vs. 66.1%). In addition, compared to LMWA-induced asthmatics, HMWA-induced asthmatics were older, were more frequently active smokers, showed lower level of NSBHR, and more frequently continued their work in harmful occupational exposure. CONCLUSIONS: The results of this study suggest that HMWA-induced asthmatics may have milder clinical courses and that there is a possibility of job continuation despite asthma exacerbation requiring medical surveillance.

Clinical Implications of Single Nucleotide Polymorphisms in Diagnosis of Asthma and its Subtypes

For the past three decades, a large number of genetic studies have been performed to examine genetic variants associated with asthma and its subtypes in hopes of gaining better understanding of the mechanisms underlying disease pathology and to identify genetic biomarkers predictive of disease outcomes. Various methods have been used to achieve these objectives, including linkage analysis, candidate gene polymorphism analysis, and genome-wide association studies (GWAS); however, the degree to which genetic variants contribute to asthma pathogenesis has proven to be much less significant than originally expected. Subsequent application of GWAS to well-defined phenotypes, such as occupational asthma and non-steroidal anti-inflammatory drugexacerbated respiratory diseases, has overcome some of these limitations, although with only partial success. Recently, a combinatorial analysis of single nucleotide polymorphisms (SNPs) identified by GWAS has been used to develop sets of genetic markers able to more accurately stratify asthma subtypes. In this review, we discuss the implications of the identified SNPs in diagnosis of asthma and its subtypes and the progress being made in combinatorial analysis of genetic variants.

Occupational Asthma as a Differential Diagnosis of Adult-Onset Asthma – A Case Report

@#Bronchial asthma causes great morbidity and mortality worldwide. Certain occupations especially those exposed to known triggers of asthma such as animal fur, dusts or solvents may trigger asthma attacks in a previously undiagnosed individual or worsen its’ control in a known asthmatic. This is especially true for adult-onset asthma. This may in turn the health of the affected workers and affect their productivity. Affected workers may be given job reassignment and eligible for medical compensation from Social Security Organisation (SOSCO). This case report will look at how two individuals in very distinct occupation were diagnosed with suspected occupational asthma

Risk Assessment for Metalworking Fluids and Respiratory Outcomes

BACKGROUND: Metalworking fluids (MWFs) are mixtures with inhalation exposures as mists, dusts, and vapors, and dermal exposure in the dispersed and bulk liquid phase. A quantitative risk assessment was performed for exposure to MWF and respiratory disease.METHODS: Risks associated with MWF were derived from published studies and NIOSH Health Hazard Evaluations, and lifetime risks were calculated. The outcomes analyzed included adult onset asthma, hypersensitivity pneumonitis, pulmonary function impairment, and reported symptoms. Incidence rates were compiled or estimated, and annual proportional loss of respiratory capacity was derived from cross-sectional assessments.RESULTS: A strong healthy worker survivor effect was present. New-onset asthma and hypersensitivity pneumonitis, at 0.1 mg/m3 MWF under continuous outbreak conditions, had a lifetime risk of 45%; if the associated microbiological conditions occur with only 5% prevalence, then the lifetime risk would be about 3%. At 0.1 mg/m3, the estimate of excess lifetime risk of attributable pulmonary impairment was 0.25%, which may have been underestimated by a factor of 5 or more by a strong healthy worker survivor effect. The symptom prevalence associated with respiratory impairment at 0.1 mg/m3 MWF was estimated to be 5% (published studies) and 21% (Health Hazard Evaluations).CONCLUSION: Significant risks of impairment and chronic disease occurred at 0.1 mg/m3 for MWFs in use mostly before 2000. Evolving MWFs contain new ingredients with uncharacterized long-term hazards.

Update on the Management of Occupational Asthma and Work-Exacerbated Asthma

Work-related asthma is the most common occupational lung disease encountered in clinical practice. In adult asthmatics, work-relatedness can account for 15%–33% of cases, but delays in diagnosis remain common and lead to worse outcomes. Accurate diagnosis of asthma is the first step to managing occupational asthma, which can be sensitizer-induced or irritant-induced asthma. While latency has traditionally been recognized as a hallmark of sensitizer-induced asthma and rapid-onset a defining feature of irritant-induced asthma (as in Reactive Airway Dysfunction Syndrome), there is epidemiological evidence for irritant-induced asthma with latency from chronic moderate exposure. Diagnostic testing while the patient is still in the workplace significantly improves sensitivity. While specific inhalational challenges remain the gold-standard for the diagnosis of occupational asthma, they are not available outside of specialized centers. Commonly available tests including bronchoprovocation challenges and peak flow monitoring are important tools for practicing clinicians. Management of sensitizer-induced occupational asthma is notable for the central importance of removal from the causative agent: ideally, removal of the culprit agent; but if not feasible, this may require changes in the work process or ultimately, removal of the worker from the workplace. While workers' compensation programs may reduce income loss, these are not universal and there can be significant socio-economic impact from work-related asthma. Primary prevention remains the preferred method of reducing the burden of occupational asthma, which may include modification to work processes, better worker education and substitution of sensitizing agents from the workplace with safer compounds.

Serum Periostin Levels: A Potential Serologic Marker for Toluene Diisocyanate-Induced Occupational Asthma

PURPOSE: Toluene diisocyanate (TDI) is a leading cause of occupational asthma (OA). Periostin is a matricellular protein implicated in type 2 immunity-driven asthma. Its pathogenic role in TDI-OA has not been completely elucidated. The present study was performed to investigate the role of periostin in TDI-OA. MATERIALS AND METHODS: Serum periostin levels were measured in subjects with TDI-OA, asymptomatic TDI-exposure controls (AECs), non-occupational asthmatics (NAs), and unexposed normal controls (NCs). To understand the mechanism by which TDI induces periostin production, primary small airway epithelial cells (SAECs) were cultured under stimulation of TDI and neutrophils from asthmatic patients. RESULTS: Fifty-three subjects with TDI-OA, 71 AECs, 67 NAs, and 83 NCs were enrolled. Serum periostin levels were significantly higher in TDI-OA subjects than in AECs (p=0.001), NAs (p < 0.001), and NCs (p < 0.001). In TDI-exposed subjects (TDI-OA and AEC), the PC20 methacholine levels were significantly lower in subjects with a higher periostin level than in those with a lower periostin level. TDI exposure did not increase periostin production directly by SAECs; however, periostin production increased significantly after co-culture with TDI and neutrophils, which was suppressed by an antioxidant. In addition, increased release of TGF-β1 was noted from SAECs when exposed to TDI and neutrophils, which was also suppressed by an antioxidant. CONCLUSION: These results suggest that an increased periostin level may contribute to the progression of airway inflammation to remodeling in TDI-exposed workers. A high serum periostin level is a potential serologic marker of the phenotype of TDI-OA.

The KAAACI Standardization Committee Report on the procedure and application of the bronchial provocation tests

Bronchial provocation tests are of value in the evaluation of airway hyperresponsiveness. Nonspecific bronchial challenge (methacholine, mannitol, exercise, etc.) is used when the symptoms, physical examination, and measurements of pulmonary function are unremarkable in the diagnosis of asthma, when a patient is suspected of having occupational asthma or exercise-induced bronchoconstriction (EIB), and when a screening test for asthma or EIB is required for some occupational groups in whom bronchospasm would pose an unacceptable hazard. Methacholine inhalation challenge is most widely used pharmacologic challenge and highly sensitive. For appropriate interpretation of the results of methacholine provocation, it is important to perform the test with the standardized protocol and to recognize that inhalation methods significantly influence the sensitivity of the procedure. Indirect challenges (e.g., mannitol and exercise) correlate with airway inflammation and are more specific but less sensitive for asthma. Indirect provocation tests are used to confirm asthma, to differentiate asthma from other airway diseases, and to evaluate EIB.

Doença alérgica ocupacional: aspectos socioepidemiológicos em ambulatório especializado na cidade de São Paulo / Occupational allergic disease: socio-epidemiological aspects from a specialized outpatient clinic at the city of Sao Paulo

Introdução: Doença ocupacional envolvendo o sistema imunológico é considerada doença alérgica ocupacional (DAO). Das doenças ocupacionais, 15% são alérgicas. As consequências sociais do diagnóstico de DAO são importantes para o trabalhador e empregador. Objetivos: Descrever características demográficas e clínicas dos pacientes estudados com DAO e seus desfechos sociais. Métodos: Estudo descritivo, retrospectivo dos prontuários de pacientes do ambulatório de alergia ocupacional de hospital universitário em São Paulo, com diagnóstico de DAO. Resultados: 72 pacientes apresentaram DAO, com idades entre 21 e 89 anos; 52% do sexo masculino. Antecedentes atópicos foram descritos em 35% dos pacientes. A maioria dos pacientes trabalhava nas áreas de indústria química (17%), limpeza (15%), construção civil (11%) e saúde (8%). Rinite ocupacional foi vista em 26% dos pacientes; asma relacionada ao trabalho, em 18%; asma e rinite, em 25%; dermatite de contato alérgica, em 13%. Sobre o desfecho social, 36 (50%) mantiveram-se em seus cargos, 19 (26%) mudaram de função, 7 (10%) mudaram de área, 7 (10%) foram afastados e 3 (4%) se aposentaram. Conclusões: Na casuística estudada, a DAO prevaleceu no sexo masculino, em faixa etária condizente com faixa trabalhadora; com maior número de casos de rinite ocupacional. Metade dos pacientes continuou exercendo a mesma função mesmo após o diagnóstico.

Background: Occupational diseases involving the immune system are considered as occupational allergic diseases (OAD); 15% of occupational diseases are allergic. The social consequences of OAD are significant for both workers and employers. Objectives: To describe demographic and clinical characteristics of patients with OAD and their social outcomes. Methods: Descriptive and retrospective study of the medical records of patients diagnosed with OAD and cared at the occupational allergy clinic of a university hospital in São Paulo, Brazil. Results: A total of 72 patients exhibited OAD, with age from 21 to 89 years old; 52% were male. Atopic antecedents were described for 35% of patients. Most patients worked in the chemical industry (17%), cleaning (15%), construction (11%) and health (8%). Occupational rhinitis was found in 26% of the patients, work-related asthma in 18%, asthma and rhinitis in 25%, and allergic contact dermatitis in 13%. In regard to the social outcomes, 36 (50%) remained in their job, 19 (26%) changed function, 7 (10%) changed work area, 7 (10%) were fired and 3 (4%) retired. Conclusions: In the present study, OAD prevailed in males and the economically active age; cases of occupational rhinitis were the most frequent. Half of the employees remained in the same function even after diagnosis.

Association of MBL With Work-Related Respiratory Symptoms in Bakery Workers

Baker's asthma is the most prevalent occupational asthma, and IgE-mediated response is known as a major pathogenesis. However, recent studies have suggested the involvement of innate immune response because wheat flour contains bacterial endotoxins or lipopolysaccharides. To further understand a role of innate immune response in the development of work-related respiratory symptoms (WRS) in bakery workers, we investigated mannose-binding lectin (MBL), one of the initiating components of the complement cascade in a single cohort of bakery workers. A total of 373 bakery workers completed a questionnaire regarding WRS. The bakery workers were divided into 2 groups according to previous history of allergic rhinitis (AR)/bronchial asthma (BA): those with history of AR/BA (group I) and those without (group II). We measured serum MBL levels by using enzyme-linked immunosorbant assay and genotyped 4 single nucleotide polymorphisms of the MBL2 gene (226G>A in exon 1, -554G>C, -431A>C, and -225G>C in the promoter) by using TaqMan assays. Fifty-nine subjects (15.5%) were previously diagnosed with AR/BA, and 64 subjects (16.8%) complained of WRS. No significant differences were found in serum MBL levels between groups I and II. However, in group II subjects, but not in group I subjects, the serum MBL levels were significantly higher in bakery workers with WRS than in those without. In addition, the serum MBL levels were significantly different according to genetic polymorphisms of the MBL2 gene and its haplotypes. In conclusion, serum MBL, affected by genetic polymorphisms, may be associated with WRS in bakery workers with no previous history of AR/BA.

Epithelial folliculin is involved in airway inflammation in workers exposed to toluene diisocyanate

Toluene diisocyanate (TDI) exposure can directly activate and damage airway epithelium. Folliculin (FLCN) is a protein expressed by human airway epithelial cells (HAECs) to maintain airway epithelial integrity and survival. This study investigated the involvement of FLCN in the pathogenesis of TDI-induced occupational asthma (OA). Enzyme-linked immunosorbent assay was used to measure serum levels of FLCN in TDI-exposed subjects (93 TDI-OA patients and 119 asymptomatic exposed controls (AEC)), 200 non-occupational asthma (NOA) patients and 71 unexposed healthy normal controls (NCs). Significantly more subjects in the TDI-OA and AEC groups had high serum levels of FLCN compared to those in the NOA group (P=0.002 and P=0.001, respectively), all of which were higher than the NC group (all P<0.001). The serum level of FLCN was positively correlated with TDI exposure duration (r=0.251, P=0.027), but was negatively correlated with asthma duration of TDI-OA patients (r=−0.329, P=0.029). TDI-exposed subjects with high FLCN levels had higher serum levels of total IgE than those with lower levels. The effects of TDI exposure on FLCN production was investigated by treating HAECs (A549 cells) with TDI-human serum albumin conjugate, which showed increased expression and release of FLCN and interleukin-8 from HAECs. Co-culture with peripheral blood neutrophils also induced FLCN expression and release from HAECs. In conclusion, TDI exposure and TDI-induced neutrophil recruitment into the airways can activate and stimulate HAECs to produce FLCN, which could be involved in airway inflammation in workers exposed to TDI.

Toluene diisocyanate exposure induces airway inflammation of bronchial epithelial cells via the activation of transient receptor potential melastatin 8

Toluene diisocyanate (TDI) is the most important cause of occupational asthma (OA), and various pathogenic mechanisms have been suggested. Of these mechanisms, neurogenic inflammation is an important inducer of airway inflammation. Transient receptor potential melastatin 8 (TRPM8) is a well-established cold-sensing cation channel that is expressed in both neuronal cells and bronchial epithelial cells. A recent genome-wide association study of TDI-exposed workers found a significant association between the phenotype of TDI-induced OA and the single-nucleotide polymorphism rs10803666, which has been mapped to the TRPM8 gene. We hypothesized that TRPM8 located in airway epithelial cells may be involved in the pathogenic mechanisms of TDI-induced OA and investigated its role. Bronchial epithelial cells were treated with TDI in a dose- and time-dependent manner. The expression levels of TRPM8 mRNA and protein were determined by quantitative real-time polymerase chain reaction and western blotting. TDI-induced morphological changes in the cells were evaluated by immunocytochemistry. Alterations in the transcripts of inflammatory cytokines were examined in accordance with TRPM8 activation by TDI. TRPM8 expression at both the mRNA and protein levels was enhanced by TDI in airway epithelial cells. TRPM8 activation by TDI led to significant increases in the mRNA of interleukin (IL)-4, IL-13, IL-25 and IL-33. The increased expression of the cytokine genes by TDI was partly attenuated after treatment with a TRPM8 antagonist. TDI exposure induces increased expression of TRPM8 mRNA in airway epithelial cells coupled with enhanced expression of inflammatory cytokines, suggesting a novel role of TRPM8 in the pathogenesis of TDI-induced OA.

Exposición a polvo de harina de trigo en panaderías de la Región Metropolitana / Bakers' exposure to wheat flour dust in Santiago, Chile

Wheat flour is a known sensitizer for humans. Bakers exposed to flour dust may develop occupational rhinitis and asthma. In Chile there is no current permissible limit for occupational exposure to wheat flour. To propose such a limit, 9 bakeries located in 6 districts of Santiago de Chile were evaluated, 6 bakeries were semi-industrial and 3 were small business. Twenty-eight environmental personal samples were obtained by standard sampling methods and they were analyzed at the Institute of Public Health of Chile. No significant differences were found (p = 0,2915, Kruskall-Wallis' test) between air concentrations of flour particles in the working environment of semi-industrial (geometric mean: MG = 0.88 mg/m³,geometric deviation: DEG = 2,68) and small business (MG = 1.39 mg/m³, DEG = 2,31). A permissible limit of wheat flour dust exposure is recommended.

Se conoce que la harina de trigo es un sensibilizador en seres humanos. Los panaderos expuestos a polvo de harina pueden desarrollar rinitis y asma ocupacional. En Chile actualmente no existe un límite permisible para la exposición ocupacional a polvo de harina. Con el objetivo de proponer un límite, fueron evaluadas 9 panaderías de 6 comunas de Santiago de Chile, de las cuales 6 fueron semi-industriales y 3 pequeñas. Un total de veintiocho muestras personales de aire fueron obtenidas según método estándar de muestreo y analizadas en el Instituto de Salud Pública de Chile. No se encontraron diferencias significativas (p = 0,2915, prueba de Kruskall-Wallis) en la concentración de partículas de harina en el ambiente de trabajo semi-industrial (media geométrica: MG = 0,88 mg/m³, desviación geométrica: DEG = 2,68) y en el de panaderías pequeñas (MG = 1,39 mg/m³, DEG = 2,31). En base a las observaciones realizadas se recomienda establecer un límite permisible de exposición para polvo de harina de trigo.

Asma ocupacional / Occupational asthma

El asma ocupacional (AO) es la enfermedad laboral más frecuente en los países industrializados y se estima que aproximadamente un 15% del asma del adulto puede ser de origen ocupacional. En los Estados Unidos se estima que el 5-15% de los casos de asma pueden tener un origen relacionado con el trabajo. Según lo evaluado en diferentes estudios, la proporción de casos nuevos de asma en el adulto que se deben a la exposición ocupacional se desconoce por la ausencia de programas efectivos de vigilancia epidemiológica de las enfermedades de trabajo. Las diferencias en el diseño de los estudios epidemiológicos, la definición de AO, el tipo de población y el país donde se realiza el estudio son algunas de las razones de estas discrepancias y de la dificultad de realizar comparaciones. El AO puede desarrollarse tanto por un mecanismo inmunológico como no inmunológico. En su desarrollo influyen el tipo de agente al que está expuesto el individuo, el nivel y modo de exposición y factores genéticos de susceptibilidad. Dado que el tratamiento de elección en el AO es retirar al paciente de la exposición a su ambiente laboral, el número de personas que puede requerir un cambio de trabajo y las consecuencias económicas para la sociedad son considerables así como el impacto social y económico por la incapacidad laboral tanto temporal como permanente que produce. Por dicho motivo, una historia clínica detallada y personalizada de asma en el individuo juega un papel relevante, aportando conocimientos sobre los posibles desencadenantes (aeroalérgenos, irritantes ambientales), visualizando al trabajador in situ o inmerso en su lugar de trabajo y permitiendo comprender las diferentes situaciones suscitadas. Casi todos los agentes que llevan a otras enfermedades ocupacionales respiratorias también pueden causar asma laboral. Por consiguiente, son menos prevalentes los trabajos sin exposición de riesgo, y considerando que se trata de una patología muy frecuente y en incremento en países industrializados, deberían tomarse medidas preventivas eficaces.(AU)

Occupational asthma (OA) is the most common occupational disease in industrialized countries and it is estimated that approximately 15% of adult asthma may be of occupational origin. In the United States, it is estimated that 5-15% of asthma cases can have a work-related origin.As evaluated in different studies, the proportion of new cases of asthma in adults that are due to occupational exposure is unknown by the absence of effective epidemiological surveillance programs of occupational diseases.The differences in the design of epidemiological studies, the definition of OA, the type of population and the country where the study is conducted are some of the reasons for these discrepancies and the difficulty of making comparisons. The OA can be developed by an immune mechanism so as not immune. In its development influence the type of agent that is exposed individual, level and mode of exposure and genetic susceptibility factors. Since the treatment of choice in the OA is to remove the patient from exposure to their work environment, the number of people who may require a change of job and economic consequences for society are significant and the social and economic impact of both permanent and temporary incapacity produced.For this reason, a detailed and personalized medical history of asthma in the individual plays an important role, providing insights into possible triggers (airborne allergens, environmental irritants), visualizing the worker in situ or immersed in his workplace and allowing understand the different situations arising.Almost all the agents that lead to other occupational respiratory diseases can also cause occupational asthma. Therefore, works without risk exposure are less prevalent, and considering that this is a very common disease andis increasing in industrialized countries, effective preventive measures should be taken.(AU)

Effect of Wenyang Decoction on the Differentiation of CD34+ Progenitor Cells in Occupational Asthma Model Rats / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the effect of Wenyang Decoction (WD) on the differentiation of CD34+ progenitor cells of occupational asthma (OA) model rats.</p><p><b>METHODS</b>Fifty healthy male SD rats were randomly divided into five groups, i.e., the model group, the blank control group,the WD group,the Western medicine group,the combined group, 10 in each group. Prednisone suspension (10 mg/kg) was administered to rats in the Western medicine group by gastrogavage. WD (20 g/kg) was administered to rats in the WD group by gastrogavage. Prednisone suspension plus WD was administered to rats in the combined group by gastrogavage. Normal saline was administered to rats in the model group and the blank control group by gastrogavage. The general condition of rats was observed. Expression levels of peripheral blood IL-5 and eotaxin, eosinophils (EOS), CD34+, CC chemokine receptor 3 (CCR3+) in bone marrow suspension were detected by ELISA, Wirght-Giemsa, and flow cytometry, respectively.</p><p><b>RESULTS</b>Compared with the blank control group,expression levels of IL-5 and eotaxin in peripheral blood were significantly higher (P < 0.01), and the count of EOS and CD34+ cells, as well as CD34+ /CCR3+ significantly increased (P < 0.01) in the model group. Compared with the model group, expression levels of IL-5 and eotaxin, the count of EOS, CD34+ cells, CD34+ / CCR3+ were lowered in three treated groups (P < 0.01). Compared with the Western medicine group, the count of EOS and CD34+ / CCR3+ decreased in the combined group (P < 0.01). The count of EOS was significantly lower in the combined group than in the WD group (P < 0.01).</p><p><b>CONCLUSION</b>WD could reduce levels of in vivo inflammatory factors, and restrain the differentiation and recruitment of EOS,thereby alleviating the differentiation of CD34 progenitor cells to EOS.</p>

Papain Induced Occupational Asthma with Kiwi and Fig Allergy

Papain is a proteolytic enzyme which is widely used in food industry, pharmaceuticals, and cosmetics. Occupational and non-occupational papain allergies have previously been documented; however, there are limited publications about papain allergy with its relative fruit allergy. Here, we present a case of occupational, IgE-mediated papain allergy with kiwi fruit and fig fruit allergy. A 53-year-old man suffered from rhinitis for several years, with the onset of his symptoms coinciding with the time he started to work at a sausage processing plant where papain is often used as a meat tenderizer. He began to experience symptoms of chest tightness, shortness of breath and wheezing shortly after starting work 5 years ago. Furthermore, he experienced several episodes of oral itching, and tongue and oropharyngeal angioedema after injestion of kiwi fruit and fig fruit. The patient had a lifelong history of allergic conjunctivitis, allergic rhinitis, and childhood asthma. Specific IgE was positive to kiwi fruit, papain and chymopapain (2.95 kUA/L, >100 kUA/L, and 95.0 kUA/L, respectively). Similar bands at 10-15 kDa in blotting with papain and kiwi fruit extracts were found. This patient showed a potential association between papain allergy and sensitization to kiwi fruit. We also reviewed 13 patients with papain allergy published in the literature, with 85% (11/13) of the patients sensitized through the respiratory tract, and 40% (4/11) having atopy. Further studies should focus on the determination of cross-reactive allergens between papain and its fruit relatives, and the prevalence of food allergy in patients with papain allergy should be investigated in a relatively large cohort.

Enfermedades respiratorias ocupacionales / Occupational pulmonary diseases

Las enfermedades ocupacionales son aquellas producidas directamente por el ejercicio de la profesión. Estas se encuentran reguladas por la Ley 16.744 y son de cargo de prestadores de servicios denominados habitualmente mutuales. En este artículo se describen los principales aspectos epidemiológicos, fisiopatológicos, clínicos, de criterios diagnósticos y principios terapéuticos, de cuatro enfermedades respiratorias, las más relevantes en el medio nacional: Silicosis, asma, enfermedades por asbesto y enfermedades por hipobaria.

Occupational diseases are those produced directly by work activities. In Chile, occupational diseases are regulated by the law 16.744 and the service providers are called, mutualidades. In this paper is described epidemiology, physiopathology, clinical aspects, diagnostic criteria and therapeutic principles of the four most important occupational respiratory diseases in Chile: Silicosis, occupational asthma, asbestos diseases and altitude sickness.

Effects of MBL2 polymorphisms in patients with diisocyanate-induced occupational asthma

Diisocyanate (DI) is the most common cause of occupational asthma (OA) in Korea. Mannose-binding lectin (MBL) initiates the lectin complement activation pathway following oxidative stress and plays an important role in the regulation of inflammatory processes. To determine whether there is a genetic association between MBL2 polymorphisms and DI-OA, 99 patients with DI-OA, 99 asymptomatic exposed controls (AECs) and 144 unexposed normal controls were enrolled in this study. Three polymorphisms (-554 G>C, - 431A>C and - 225 G>C) in the MBL2 promoter were genotyped, and serum MBL levels were determined by enzyme-linked immunosorbent assay. Functional variabilities in the promoter polymorphisms were analyzed by a luciferase reporter assay and electrophoretic mobility shift assay (EMSA). A significantly higher frequency of haplotype (ht) 2 [CAG] was noted in the DI-OA group compared with the AEC group (P=0.044). The patients with DI-OA carrying ht2 [CAG] had significantly lower PC20 methacholine levels (P<0.001) than the non-carriers. The serum MBL levels were significantly higher in the DI-exposed subjects (both the DI-OA patients and AECs) carrying ht1 [GAG] (P=0.028). Luciferase activity was significantly enhanced in ht1 [GAG] compared with ht2 [CAG] in human hepatocarcinoma cells (Hep3B) (P=0.002). The EMSA showed that a - 554G probe produced a specific shifted band compared with the - 554C probe. These findings suggest that decreased serum MBL levels due to polymorphisms of the MBL2 gene may increase susceptibility to the development of DI-OA in DI-exposed individuals.