[Painting in construction and exposure to carcinogenic chemical agents: an Italian study in Lombardy]. / Esposizione ad agenti chimici e cancerogeni nelle attività di verniciatura in edilizia: i'esperienza dello Studio PPTP-Verniciatura.

The risk associated with exposure to chemical carcinogens (as classified by International Agency for Research on Cancer and/or the European Union), during painting activities in construction seems controversial. This study included all 43 activities of professional painting in this sector existing in the area of Cremona, in Lombardy region. The aim was to consider and promote preventive technical and medical solutions, basing on efficacy. The occupational exposure and the already adopted preventive measures were evaluated by investigations at workplaces, supported by standardized questionnaires and registrations. 860 commercial products (402 chemical substances) were classified: in 38% of cases the ingredients were not listed in the Material Safety Data Sheets (retrieved by the manufacturer). The real possibility of a risk exposure to carcinogens has been reported in a small proportion of situations. In all companies the presence of carcinogens was unrecognized or at least had not been taken into account in the risk assessment of workers.

[Nickel dermatitis, systemic nickel allergy syndrome, immuno-genesis, immune-tolerance: an Italian study]. / Dermatiti da nichel, sindrome sistemica, immunogenesi e immunotolleranza: studio Italiano.

Subjects with Nickel sensitization proved by patch test may suffer of contact eczema, but also of a Sistemic Nickel Allergy Syndrome (SNAS) consisting of urticaria-like troubles, itch, erythema, cutaneous rush, headache, intestinal symptoms, recurrent vesicular palmar dermatitis. 160 subjects (130 F, 30 M) were classified into three groups and underwent dosage of Nickel in urines (U-Ni) and blood (B-Ni). The two groups with SNAS showed an higher indicators of Nickel absorption, while the only-eczema group did not. 95 subjects with SNAS were enrolled for a Nickel-scanty diet: most of them improved. 24 ones again symptomatic were admitted to an experimental treatment, by a schedule of oral increasing microdose (nanograms) of Nickel sulphate: all of them improved. In conclusion Nickel pathology is changing, allergy seems to be due to different mechanism, dietary intake is important, an immune-tolerance can be induced.

[Asthma and baker's allergy: experience with health programs]. / Asma e allergopatie del panificatore: dalle esperienze alla programmazione sanitaria.

Wheat flour sensitization may lead to several occupational diseases: persistent rhinitis, intermittent or persistent asthma, conjunctivitis, urticaria, and contact dermatitis. The main allergenic components of wheat have been identified, the prevalent mechanism is IgE-mediated, the worsening after starting of sensitization shows the characters of the "allergy march" till the respiratory functional impairment and disability. Nowadays the occupational rhinitis is the first important step to begin to start prevention, but its relevance is also for quality of life of subjects. Data about the prevalence of the sensitization in Italy seem to be spread, ranging from 4% to 24% in the literature and till 32% in a recent our investigation. A complete and early diagnosis is essential to manage the allergic bakers, aiming relocation in their own activity. A specific immunotherapy by allergenic vaccine has been studied and it is now possible. In our experience 43 bakers and pastry makers were treated by the same vaccine (Lofarma Laboratories, Milan) and revalued after many years; 83% were still at work and 70% claimed only poor or no-symptoms during work, in any way with a tolerable condition. At present the baker's disease may be managed by included interventions "man-environment" avoiding the extreme choice of leaving the working activity. The Lombardy Government published specific Guide Lines on the prevention and proposed a planned project for three years, to be adopted according to local needs in collaboration with the public health service.

[Nickel risk in metal processing workers. Highlights on toxic and allergic effects]. / Rischio chimico da Nichel e lavorazioni metalmeccaniche: vecchie e nuove acquisizoni sugl effetti tossi e allergici.

Nowadays nickel is a global problem, related to occupations (mainly metalworkers) and to life habits. The dietary intake, more than environments, is the source of a basic immune identification and also of possible complications after occupational inhalation or contact. Nickel insoluble compounds are proved to be cancerogenic. Nickel ions are very reactive with proteins and oxidant, then also potential irritant for the airways. Metallic nickel and soluble compounds are sensitizers, causing dermatitis, rhinitis and asthma. Recently a Systemic Nickel Allergy Syndrome (SNAS) has been identified in allergic subjects, with a clinical picture of urticaria, general hitching, headache, gastrointestinal troubles. SNAS may affect allergic occupational or non-occupational ones. Studies are in progress aimed to an oral treatment inducing immunotolerance. Nickel in urine seems to be the best tool for monitoring nickel absorption.

[Assessment of exposure to cancerogenic aromatic hydrocarbon during controlled-access highways management activities]. / Valutazione dell'esposizione ad idrocarburi aromatici cancerogeni nell'attività di gestione autostradale.

The purpose of this study was an integrated assessment of exposure to benzene and Polycyclic Aromatic Hydrocarbons (PAH) in 29 workers employed to manage a controlled-access highways. A campaign was performed in summertime by environmental monitoring (active and passive airborne personal sampler), as well as by biological monitoring (urine samples of the beginning and of the end of daily shift, baseline after two days of vacation). The measured environmental levels did not differ from background environmental concentrations found in a metropolitan area (i.e. benzo[a]pyrene < 1 ng/m3; benzene < 5 mcg/m3), and the results of biological monitoring were in agreement and were compatible with extra-professional habits of the investigated subjects (1-hydroxipyrene 50-990 ng/g creatinine; unmetabolized benzene 15-2010 ng/I; t-t muconic acid < 4-222 mcg/g creatinine).

[The medical management of the allergic worker in small industries and for craftsmen]. / Il lavoratore allergico e la sua gestione nell'artigianato e nella piccola impresa.

This report is aimed to suggest how allergic subjects can be admitted to activities at risk and how workers affected by occupational allergy can be relocated. Allergy is a mechanism strictly joined with the individuality trough the immunologic system of protection of the organism Works are the background of a possible exposure to agents able to rouse a specific hypersensitivity, but also the purposes of everyone for having a normal way of life. Population studies demonstrated that 70% of adults that present themselves for working as craftsmen or in small industries are normally reactive, but about 30% have a condition of a diagnosed allergy or are hyperreactive to the environment. Therefore it is unfeasible to exclude the allergic ones from work even for preventive aims. The true prevention is linked to manage a methodology of assessing and grading the allergologic risk at the workplaces (four levels are proposed) and of classifying the subjects by medical parameters (five class are proposed). The individual job fitness may be so defined, either at the first examination or periodically during working activity, monitoring self-reported symptoms and changement of used materials or of specific tasks. Informal guidelines are proposed to manage three possible situations of occupational allergic diseases and the engagement of the occupational physician also to be connected with allergy specialists and family doctors is recommended.

[Biological monitoring in the molding of plastics and rubbers]. / Monitoraggio biologico nello stampaggio di plastiche e gomme.

This survey was carried out in the molding of plastics and rubbers, in the "Professional Cancer Prevention Project" sponsored by the Lombardy region with the objective of developing and implementing protocols for evaluating exposure to carcinogens through the biological monitoring. The realities of molding the thermoplastic polymer ABS, rubber, and thermosetting plastics containing formaldehyde were examined. The carcinogenic substances identified in these processes were: 1,3-butadiene, acrylonitrile and styrene in molding ABS, polycyclic aromatic hydrocarbons (PAH) in molding rubber, and formaldehyde in molding the thermosetting plastics. Only for some of these substances biological indicators are available. The limited exposure to airborne chemicals in molding ABS and the intrinsic characteristics of biological indicators available for 1-3 butadiene have determined the non applicability of biological monitoring to this situation. The absence of a biological indicator of exposure to formaldehyde has made this situation not investigable. Exposure in the rubber molding was studied in 19 subjects applying the determination not metabolized PAH in urine. The levels of these indicators were similar to those measured in other groups of subjects without occupational exposure to PAH, confirming a low airborne contamination in this workplace.

[Exposure to polycyclic aromatic hydrocarbons (PAH) in rubber forming industry]. / Esposizione ad idrocarburi policiclici aromatici nello stampaggio della gomma.

Among various chemical agents present at the workplaces in the rubber industry, a particular attention was adressed to the Polycyclic Aromatic Hydrocarbons (PAH) contained in oil and carbon black, but some questions regarding level of exposure are also controversially discussed. The literature reports that PAH may have irritant effects; moreover some of these have been recognized as probably or possibly carcinogenic to human by the International Agency for Research on Cancer, the European Union, and other institutions. In Lombardy, a study aimed to evaluate the occupational exposure in Benzo[b]fluorantene the rubber forming industry was planned during last two years. The results of environmental air monitoring (the 16 most relevant, according to the American Environmental Protection Agency, EPA) and biological monitoring (urinary 1-hydroxypyrene excretion) show that PAH exposure in these workers is not higher than that observed in other study regarding low level and acceptable exposure.

[Rubber industry and exposure to carcinogenic chemical agents: an Italian Multicentric Study in Lombardy]. / Stampaggio della gomma ed agenti chimici cancerogeni: l'esperienza dello Studio PPTP-Gomma.

Evaluating the chemical risks at the workplaces, the potential carcinogenic risk is a primary interest. Particularly, in the rubber forming industry the main attention was directed to the hot processing as a possible source of exposure to chemical agents, several of which were classified as carcinogens by the International Agency for Research on Cancer (IARC) and/or the European Union (EU). A study on occupational exposure to chemical carcinogens in the rubber forming industry was planned during last two years, involving a representative sample of firms. In the first step the occupational exposure and the use of preventive measures were evaluated by an investigation at workplace supported with standardized questionnaires. The presence of above 100 chemical agents was registered; 15 agents were classified to carcinogenic or probably carcinogenic to human. The evaluation of exposure by air sampling and monitoring of most substances of interest (acrylonitrile, 1,3-butadiene, styrene, Polycyclic Aromatic Hydrocarbons), demonstrated a low level of occupational exposure, the common hygienic prevention measure being applied.

[Analysis of work accidents during the years 1999-2006 in a hospital company in Lombardia]. / Analisi del fenomeno infortunistico 1999-2006 in un'Azienda Ospedaliera Lombarda.

This study describe accidents occurred in the period between 1999 and 2006 in the Hospital of Cremona, in which about 2400 subjects operate. The analysis of Accident Register showed a reduction of about 30% of the total number of accidents during the examined period and a non homogeneous distribution of the various types of accidents. The most frequent accidents were prick (25.8%), trauma (22.9%) and "in itinere" accidents (7.8%). One type of accident has been little considered up to now: the aggressions. Professional nurses were the most frequently involved and the most affected units were those that belong to the Internal Medicine Department. "In itinere" accidents had the longest average prognosis (11.6 days). The repetition of accidents occurred to the same operator hasn't been analysed before now: a professional nurse had nine accidents (of various type) in the seven years considered. Probably the reduction of accident must be attributed to the effectiveness of the prevention activities undertaken during the reviewed period. Biological accidents, for which it was possible to implement prevention programs, have been markedly reduced; it was not the same for "In Itinere" accidents, that depend significantly on external factors that are not easily dismissed.

[Specific immunotherapy and relocation in occupational allergic bakers]. / Recupero professionale di panificatori allergici mediante vaccino verso farina di frumento.

Occupational allergy to components of wheat flour is the main cause of rhinitis and asthma of workers in bakeries and similar activities. An immunological mechanism IgE-mediated is involved and the sensitising properties of some proteins of wheat where assessed. Nowadays it is possible to have an extract to be used for specific immunotherapy. The aim of this treatment should be a reduction of individual immunological reactivity and the possibility of going on the particular activity of allergic bakers, pastry makers or pizza makers. An observational crossectional retrospective study was performed on 41 sensitised workers that were diagnosed in the same occupational health unit. All underwent a subcutaneous specific immunotherapy (SCIT) with the same schedule and the same extract (Lofarma Allergeni, Milan) for 4 or more years, without avoiding their work activity. The outcome was investigated after five or ten years. Data were collected by a questionnaire. 34 subjects on 41 are still at work with an acceptable quality of life and a normal working efficiency, mainly in their small enterprises. In the "old" subgroup (19 cases), treated in the past, several bakers still at work stopped SCIT even from 4-10 years. In the "new" subgroup (15 cases), still in treatment, symptoms and drug use during the work activity resulted to be reduced or absent in the majority of cases. According to results of other immunotherapies by allergenic vaccines (pollens, mites) also for wheat flour occupational allergy a specific treatment seems to be possible and SCIT may be an useful tool to reduce and control the biological individual effects of allergy. By the occupational point of view wheat flour SCIT allows a relocation in many of cases and may be associated to other intervention of environmental prevention at workplaces, improving the relocation of occupational allergic subjects when requested.

A pre-seasonal birch/hazel sublingual immunotherapy can improve the outcome of grass pollen injective treatment in bisensitized individuals. A case-referent, two-year controlled study.

BACKGROUND: The study tests the hypothesis of a reduction of priming due to tree allergy in patients sensitised to both birch/hazel and grass pollen undergoing an associated preseasonal Sublingual/Injective immunotherapy. METHODS: 36 out of 49 bisensitized candidates were pair-matched into 18 case-referent couples. During two years all patients were administered preseasonal grass-SIT and one patient in each couple received also birch/hazel-SLIT. Diary cards were fulfilled for three consecutive grass pollen seasons. Specific Nasal Provocation Test (NPT) for grass and aspecific bronchial challenge were done; sera were analyzed for specific IgE and IgG. RESULTS: During the peak of the grass pollen season both groups showed a significant improvement in total symptom-score. Conjunctivitis and cough improved significantly more in patients with associated therapies. While antihistamine score decreased significantly in both groups, antiasthmatics did only in the SLIT-SIT group. The follow-up documented a significant increase in grass- and birch-specific IgG and a decrease in grass-specific IgE. Grass-NPT threshold was clearly higher in SLIT-SIT-group (p = 0.01) and only in this group PD20 methacholine improved significantly (p < 0.05). CONCLUSIONS: Combined birch/hazel-SLIT and grass-SIT are safe and improve clinical outcomes of SIT alone in young bisensitized patients. Priming reduction is supported by specific NPT and bronchial hyperresponsiveness.

[A model of occupational, environmental and community medicine. History and evolution of the Hospital Unit of Occupational Medicine (UOOML) in Lombardia]. / Un modello di "Occupational, Environmental and Community Medicine". Storia ed evoluzione delle Unità Operative Ospedaliere di Medicina del Lavoro (UOOML) in Lombardia.

The authors describe the historical evolution of the prevention in Lombardia, and the role of the Hospital Units for Occupational Medicine, not only on the clinical oriented fields, but also on the areas of formation and training. Hospital Units for Occupational Medicine are today the best synthesis of "occupational-environmental-community health". There development is based on adequate standards of human and instrumental resources, as so as a real financial budget. At last, it's important that these Units are allocated in a so-called "bipolar department", open to the hospital and also open to the territorial structures for prevention and safety (department of occupational health).

Preseasonal intranasal immunotherapy in birch-alder allergic rhinitis. A double-blind study.

A double-blind, placebo-controlled study was carried out to test the clinical efficacy and safety of local nasal immunotherapy (LNIT) in powder form. Twenty-two patients suffering from allergic rhinitis strictly associated with early spring symptoms, with positive skin prick tests and RAST for birch-alder, all responders to a specific nasal provocation test (NPT), received randomly active or placebo treatment for 4 months. Immunotherapy consisted of administration of a set of capsules containing progressively increasing amounts of birch (Betula pendula) and speckled alder (Alnus incana) allergens in powder form with controlled granulometry. The active (birch-alder) and placebo (lactose) group completed the treatment according to a similar schedule. During the pollen season (March-April), the patients who took the active treatment reported less sneezing and rhinorrhea than the placebo group, on the basis of a symptoms score, and the differences were statistically significant; the need for drugs (terfenadine) was also significantly reduced. These findings agreed well with the results of specific NPT after the treatment; only patients in the active group had a higher threshold dose of nasal specific reactivity to birch-alder allergens than in tests before the LNIT.

Cobalt-related asthma: clinical and immunological aspects.

Several clinical and experimental findings point to cobalt as the only sensitizer and causal agent of hard metal asthma. The clinical features have been clearly defined by bronchial provocation tests, with a prevalence of late phase responses. Epidemiology is still insufficient to configure prevalence and incidence rates for cobalt asthma. IgE and IgG antibodies with cobalt specificity have been demonstrated, but T-lymphocytes and eosinophils involvement seem to be important in the mechanism of an allergic inflammation in the airways. Such an immunological pathogenesis links cobalt asthma with other manifestation of hard metal disease.

[Occupational exposure to volatile anesthetics and reproductive effects: a bibliographic review of epidemiological studies]. / Esposizione professionale ad anestetici volatili ed effetti riproduttivi: rassegna bibliografica degli studi epidemiologici.

Up to the early eighties, a variety of epidemiological studies suggest that chronic exposure to low doses of anesthetic gases, as occurs in operating rooms, is an occupational risk factor for spontaneous abortion and congenital defects. Numerous and more recent epidemiologic studies are reviewed; currently it is suggested that there is inadequate evidence to conclude that occupational exposure to anesthetic gases causes increased rates of spontaneous abortion or congenital anomalies. The improvement of environmental conditions, that has reduced airborne levels of anesthetic gases in operating rooms, has been critical in reducing the risk of abortion and congenital defects. In agreement with recent epidemiological reports, we believe that the health surveillance of exposed workers must include the study of pregnancy outcome.

[Evaluation of the risk of anesthetic gases to exposed subjects with different tasks in operating rooms]. / Valutazione del rischio da gas anestetici in soggetti esposti con differente mansione in sala operatoria.

A research was carried out on risk evaluation of workers with different tasks in operating theatre. The airborne concentrations were determined by an IR analyzer with two distinct sampling lines: the first was placed in surgical zone and the second one in anesthesiological zone. The anesthetists resulted more at risk than surgical team. Nevertheless when the evaluation was based on N2O urinary concentration and data were stratified according to task a prevalent inhalation absorption resulted for non medical staff (instrumentist and professional nurse). Our data concerning N2O ranged between 95-764 ppm indoor and between 3-92 mcg/l in the urines of exposed subjects.

[Risk of infectious hepatitis and risk of anesthetic gases in operating rooms: considerations on 3 cases of chronic hepatic pathology]. / Rischio di epatite infettiva e rischio da gas anestetici in sala operatoria; considerazioni su tre casi di patologia epatica cronica.

Three subject with professional activity in operating theatre and with a diagnosis of chronic viral "C" hepatitis are considered. All cases (Two surgeons and an anesthetist) had been continuously exposed to low level of airborne anesthetic compounds (Nitrous oxide and halogenated compounds). According to possible, but not proved, synergic effects, two cases with a clinical picture of active chronic hepatitis were classified as unqualified to specific work. The third case, affected by a persistent chronic hepatitis, was admitted to operating activities only for four hours a week, i.e. only an operating session a week. Hepatitis B and C markers must be always monitored during the medical surveillance in exposed people of operating theatre.

Cross-reaction between aromatic isocyanates (TDI and MDI): a specific bronchial provocation test study.

A study was performed on twenty-five workers exposed to polyurethane varnishes exclusively catalysed with TDI, who developed asthma to this substance. The aim of the study was to establish, using bronchial provocation tests, whether a cross-response to MDI exists. The results were positive but no definitive evidence has been reached because there was cross-response in only 48% of cases. It is interesting, however, that cross-responders did not predominate among the subjects with a late reaction to TDI (P = 0.0038), whereas cross-responders were in the majority among the subjects with a dual reaction to TDI (P = 0.0334). It is possible that the pattern of the asthmatic reaction to BPT with TDI influences the cross-reaction to other isocyanates.