[Malignant mesothelioma (MM) in women: findings of the Mesothelioma Register of the Friuli Venezia Giulia Region]. / Mesotelioma maligno (MM) nel sesso femminile: dati del Registro Mesoteliomi della Regione Friuli Venezia Giulia.

During the period 2000-2003, the Mesothelioma Register of the Friuli Venezia Giulia identified 248 cases of MM, 44 of which (18%) were female. In 36 cases the diagnosis was "certain" and in 8 "probable" or "possible". Mean age at diagnosis was 72.8 years (SD = 12.7), and the site of the disease was the pleura in 93% of cases. Information about previous exposure to asbestos was collected in accordance with the guidelines of the National Mesothelioma Register Occupational exposure to asbestos was documented in only 8 cases and family exposure in 6 others. In the remaining cases the source of exposure was "unknown" because of insufficient data, or there were no data at all. The study highlights the role played by extra-occupational exposure to asbestos among women and the need for careful investigation into previous asbestos exposure in all females with MM. In order to improve our knowledge of the part played by factors other than occupational exposure to asbestos in triggering the disease, it is crucial to reduce he number of cases with no information or "unknown" exposure to this dangerous substance.

[Respiratory function and smoking habit among shipyard and dock workers]. / Funzionalità respiratoria e fumo di sigaretta in lavoratori della navalmeccanica e del porto.

The aim of the study is to compare the loss of lung function in a group of 196 male workers employed in shipbuilding/repairing and port activities ("cases") with a group of 109 healthcare workers ("controls"). "Cases" were grouped by radiological examination (chest X-ray/HRCT) depending on the presence or absence of pleural plaques. Smoking habit was assessed in all subjects. Lung function assessment included two measures of VC, FEV1 and TLC (the latter for "cases" only). The mean interval between the two examinations was five years; changes in spirometric results (value at second examination minus value at first) were expressed as ml/year. The results showed that there was no difference in loss of lung function in the three groups over the follow-up period, even when differences in smoking habit were taken into account. The results suggest that radiological findings of pleural plaques had no bearing on deterioration in lung function. Lung function testing is widely accepted as an integral part of medical surveillance of occupational lung diseases, but the high inter and intra-subjects variability of spirometric data underlines the difficulties and limitations of lung function follow-up studies.

[Follow-up of symptoms, parameters of respiratory function, and data on specific sensitization in a group of subjects with latex-induced asthma and rhinitis]. / Follow up dei sintomi, dei parametri di funzionalità respiratoria e dei dati di sensibilizzazione specifica in un gruppo di soggetti con asma e rinite da lattice.

We re-investigated 13 workers 6 years (SD 2) after the first diagnosis of asthma or rhinitis caused by latex, to update the exposure to latex, the eventual symptoms, respiratory function (spirometry and metacholine PD20 FEV1), skin prick test to common allergens and latex, RAST to latex, total IgE levels and eosinophils count in the blood. At the follow up, all the workers stopped wearing powdered latex gloves, but for 10 an indirect exposure to latex was still possible. All cases referred improvement of respiratory symptoms at work, but 7 workers occasionally complained of mild symptoms. No statistically significant variations of respiratory function test and of the immunological parameters were found. The workers with persistent respiratory symptoms at work had a longer duration of symptoms before the diagnosis (p = 0.02), if compared with workers without symptoms.

[Pleural plaques and ventilatory function: follow-up study]. / Placche pleuriche e funzionalità ventilatoria: indagine di follow up.

We have evaluated, over a mean follow up period of 3.7 (SD 1.8) years, the lung function in a group of 103 workers, according to the presence (36 workers) or absence (67 workers) of pleural plaques at chest Rx-films/HRCT. A Generalized Estimating Equation (GEE) approach was used to investigate the relation between the loss of pulmonary function and (i) presence/absence of pleural plaques, (ii) smoking status, and (iii) work seniority in work places with exposure to asbestos. The mean age, at the first examination, was 49 (SD 6) years and work seniority 25 (SD 7) years. Multivariate GEE approach to age- and height-adjusted spirometric data (236 measures of VC, FEV1 and 234 determinations of TLC), showed that pleural plaques were not associated with significant loss of pulmonary function. Smokers (> or = 15 py), when compared with no-smokers, showed significant loss of VC (-5.3%, p < 0.05), FEV1 (-8.4%, p < 0.001) and TLC (-4.0%, p < 0.05). An occupational history in work places with exposure to asbestos (ship building/repairing) was significantly associated with a slight, but significant (p < 0.05), 10-year decrease in VC (-3.1%) and FEV1 (-4.9%).

[Chronic obstructive pulmonary disease (COPD) and occupational exposure to mineral dust]. / Broncopneumopatia cronica ostruttiva (BPCO) ed esposizione professionale a polveri minerali.

The relationship between chronic obstructive pulmonary disease (COPD) and occupational exposure to mineral dust is still conflicting because COPD is multifactorial disease, relatively common in the general population. A number of studies have shown that in population exposed to mineral dust there is a greater prevalence of chronic bronchitis, even in the absence of radiographic evidence of pneumoconiosis. There is no agreement, however, that dust alone will induce significant chronic airflow limitation and increase in mortality. It is unlikely that medical evidence could ever provide conclusive "proof" of the work related less of COPD in the singular patient, but it is possible to provide evidence for reasonable statment of probability.

Features and severity of occupational asthma upon diagnosis: an Italian multicentric case review.

BACKGROUND: The severity of occupational asthma (OA) at the time of diagnosis is not known. In this study we aimed to evaluate some features of the disease at the time of diagnosis, particularly looking at severity and treatment before diagnosis. METHODS: Medical records of subjects (n = 197) who had received a diagnosis of OA in six specialized centres of Northern and Central Italy in the period 1992-97 were reviewed. The severity of the disease at the time of diagnosis was determined on the basis of symptoms, peak expiratory flow (PEF, percentage predicted), forced expiratory volume in one second (FEV1, percentage predicted), and PEF variability, following the criteria of the National Institutes of Health and World Health Organizaton (NIH/WHO) guidelines on asthma. Medications used in the month before diagnosis were recorded. RESULTS: The most common etiological agents were isocyanates (41.6%), flours (19.8%), woods (9.7%) and natural rubber latex (7.6%). The level of asthma severity (AS) was mild intermittent in 23.9% patients, mild persistent in 28.9%, moderate in 41.6%, and severe in 5.6%. Asthma severity was positively associated with current or previous smoking (P < 0.05), and was not related to atopy and current exposure. A relationship with bronchial reactivity to methacholine was shown in subjects at work. Treatment before diagnosis was consistent with the NIH/WHO guidelines in only 13.2% patients, whereas 75.6% were undertreated and 11.2% were overtreated. CONCLUSIONS: In this study we found that the majority of patients had mild asthma at the time of diagnosis and that cigarette smoking was associated with a greater severity. Moreover, the majority of patients were undertreated before etiological diagnosis.

Two cases of paraoccupational asthma due to toluene diisocyanate (TDI).

Two cases of paraoccupational asthma caused by toluene diisocyanate (TDI) are reported. The first patient was a metal worker in a machine shop situated near a factory producing polyurethane foam. Symptoms at work were not explainable by any specific exposure to irritants or allergens in the work site. As the patient recalled previous occasional work in the adjacent polyurethane factory with accompanying worsening of respiratory symptoms, a specific inhalation (SIC) test was performed with TDI, which confirmed the diagnosis of TDI asthma. The second case was a woman working part time as a secretary in the offices of her son's factory for varnishing wooden chairs. TDI was present in the products used in the varnishing shed. The SIC test confirmed the diagnosis of TDI asthma, despite the fact that the patient's job did not present risk of exposure to the substance. In both patients, symptoms disappeared when further exposure was avoided. These two cases confirm that paraoccupational exposure to TDI must be considered when evaluating patients with asthma not mediated by immunoglobulin E. They also suggest the need for more prospective studies evaluating the health risk for the general population living near polyurethane factories or other firms that use TDI.

[Follow-up of allergic symptoms in a group of health workers sensitized to latex]. / Follow-up dei sintomi allergici in un gruppo di operatori sanitari sensibilizzati al lattice.

We studied 28 health care workers sensitised to latex and complaining of respiratory symptoms at work. All were females, aged 32 y (median), and had worked in the hospital for 12 y, in departments with high exposures (22 cases), moderate exposure (4 cases) or low exposure (2 cases) to rubber gloves. Twenty also complained of latex skin symptoms. Twenty-five (89%) were atopical (by prick test), and 16 (57%) had a personal history of allergic disease. Nine (32%) also had symptoms from exposure to latex outside work and 3 (10%) from food cross-reacting with latex. The specific inhalation test with latex gloves confirmed the diagnosis of asthma in 4 cases (14%) and of rhinitis in 13 cases (46%). We reinvestigated the workers 14 months (median) after the first examination to update exposure to latex, any allergic symptoms and adverse effects of relocation. At the follow-up, 3 workers (11%) had retired, all the others had stopped wearing powdered latex gloves, and 12 had changed their duties or the work-place. Ten (40%) of the 25 subjects still at work were without symptoms, 14 (56%) occasionally complained of mild symptoms and one of frequent rhinitis. Overall, we observed improvement of skin symptoms in 74% (14/19) of the cases and of respiratory symptoms in 56% (14/25) of the cases. Symptoms from exposure to latex outside work were still present in 6 subjects. The persistence of symptoms at work was significantly higher among workers who continued to work in departments with high/moderate latex glove exposure. The results of the study show that skin and respiratory symptoms among health care workers are related to the use of powdered latex gloves and confirm the importance of primary prevention.

Prospective study of work related respiratory symptoms in trainee bakers.

OBJECTIVES: To investigate the occurrence of work related respiratory symptoms and to assess the effect of atopy in a group of trainee bakers. METHODS: A prospective study of work related respiratory symptoms among 125 trainee bakers who were investigated with a questionnaire plus skin prick test with wheat flour and alpha-amylase allergens at baseline and then after 6, 18, and 30 months. RESULTS: At the baseline examination, four students (3.2%) complained of respiratory symptoms (cough and rhinitis) when working with flours and four were skin positive to wheat flour or alpha-amylase. The incidence of work related respiratory symptoms was 3.4% at 6 months, and the cumulative incidence was 4.8% and 9.0% at 18 and 30 months, respectively. The incidence of skin sensitisation to occupational allergens was 4.6% at 6 months and the cumulative incidence was 4.6% at 18 months and 10.1% at 30 months. The generalised estimating equation approach to longitudinal data showed that work related respiratory symptoms in the study population was significantly associated with a personal history of allergic disease (odds ratio (OR) 5.8, 95% confidence interval (95% CI) 1.8 to 18.2) and skin sensitisation to wheat flour or alpha-amylase (OR 4.3, 95% CI 1.2 to 14.9). Atopy based on prick test was not related to the occurrence of work related respiratory symptoms over time (OR 1.1, 95% CI 0.3 to 3.8). CONCLUSIONS: Personal history of allergic disease is a predisposing factor for the development of symptoms caused by exposure to wheat flour and may be a criterion of unsuitability for starting a career as a baker. Atopy based on the skin prick test is useful for identifying subjects with allergic disease, but should not be used to exclude non-symptomatic atopic people from bakery work.

Specific inhalation challenge with wheat flour in workers with suspected baker's asthma.

OBJECTIVE: The aim of this study was to evaluate the outcome of the specific inhalation challenge test (SIC) in 160 subjects with suspected baker's asthma and to assess its relation to total flour dust levels and to personal characteristics such as specific skin sensitisation, non-specific bronchial hyper-responsiveness (NSBH) and atopy. METHODS: We investigated the outcome of SIC tests performed with wheat flour in six Italian laboratories. For each subject, data was available regarding skin sensitisation to wheat flour, NSBH, atopy, forced expiratory volume at 1 s (FEV1) monitoring and airborne flour dust in the challenge chamber measured by the gravimetric method (total dust in mg/m(3)). RESULTS: The SIC test was positive for early asthma in 42 subjects (26%) and for late/dual asthma in 18 (11%). Positive outcome to SIC was significantly associated with NBSH (odds ratio, OR: 3.5, 95% CI: 1. 6-7.7) and skin sensitisation to wheat flour (OR: 3.1, 95% CI: 1.3-7. 0). Exposure level to wheat flour was less than or equal to 10 mg/m(3 )in 12% of individuals, ranged between 11 and 30 mg/m(3) in 43% and exceeded 30 mg/m(3) in 45%. The outcome of SIC was always negative among workers not skin sensitised to wheat flour and without NSBH and atopy. An increasing prevalence of positive SIC was observed among workers with one or more of the above-mentioned personal characteristics whose challenge exposure was greater than 10 mg/m(3) (P < 0.001). CONCLUSION: Procedures currently adopted for wheat flour dust exposure during SIC need to be better standardised in order to avoid excessive airborne dust exposure. Over-exposure seems to be of no use for the diagnosis and risks making the asthmatic reaction worse, particularly in patients who are both sensitised to wheat allergens and have NSBH and/or atopy.

[Respiratory symptoms and occupational sensitization in a group of trainee bakers: results of a 6-month follow up]. / Sintomi respiratori e sensibilizzazioni professionali in un gruppo di allievi panificatori: risultati di un follow-up a 6 mesi.

We investigated the prevalence of atopy by 4 different criteria (personal and family atopy, atopy by prick test and by serum IgE levels), and sensitization to wheat flour and alpha amylase in a group of trainee bakers and in a group of trainee graphic artists as controls (baseline check-up). The follow-up was performed 6 months later only among trainee bakers (90 cases), based on an updating questionnaire and on repeated skin prick test with wheat flour and alpha amylase extracts. Trainee bakers and controls were similar with respect to age, number of smokers, atopy evaluated by 4 different criteria, and detection of serum IgE (RAST) and IgG specific to wheat flour. Positive skin prick test to wheat flour (4%) and alpha amylase (1%) were found only among trainee bakers. At the baseline control 4 students (4.4%) complained of respiratory symptoms when working with wheat flour (WRS). At the six month follow up 6.6% of the trainee bakers complained of WRS: 3.3% had persistent symptoms, 3.3% were new cases and 1.1% had become asymptomatic. Five cases (5.5%) were skin positive to wheat flour or alpha amylase, but only one was unchanged, while 4.4% were new cases and 3.3% turned negative. None of these changes was statistically significant (McNemar test). The trainee bakers complaining of WRS at the baseline or at follow-up (7 cases, when compared with the non-symptomatics, showed a higher prevalence of personal atopy and skin sensitization to occupational allergens; there were no differences, however, with regard to atopy by prick test, IgE levels or the presence of wheat specific IgE and IgG. The trainee bakers skin positive to the occupational allergens (8 cases) showed prevalences of personal atopy and atopy by prick test significantly higher than trainee bakers skin negative to wheat flour or alpha amylase (p < or = 0.01). Evaluating wheat flour specific IgE and IgG in the serum of trainee bakers and controls provided us with more information about the specificity of such tests and suggests caution in attributing the presence of these immunoglobulins in the serum to specific occupational exposure or to specific occupational sensitization. A six-month follow up is likely to be too short an interval to observe significant changes in work-related symptoms and in skin sensitization to occupational allergens. The results, however, emphasize the important role of personal atopy as a predisposing factor in the development of occupational disease among trainee bakers.

Asthma and rhinitis in wooding workers.

We present some cases of rhinitis and asthma in wooding workers exposed to hard or soft woods. The specific provocation test confirmed the diagnosis of rhinitis in three patients and of asthma in four. Rhinitis was caused by oak, beech, and pine, while asthma was caused by obeche, chestnut, acacia, and iroko. Occupational exposure to the specific wood, before onset of symptoms (symptom latency) was shorter for patients with asthma. All seven patients with respiratory symptoms were nonsmokers; three were atopics and four, all with asthma, had nonspecific bronchial hyperreactivity. Twenty-four hours after the test, PD20FEV1 had decreased in two cases with rhinitis and two with asthma, although the data did not reach statistical significance (Wilcoxon matched-pairs test: NS). After the SBPT, blood eosinophils increased in two cases with rhinitis and three with asthma, and the data were at the limit of statistical significance (P = 0.046). The study confirms that not only hard essences, but also soft woods can cause respiratory symptoms, although the pathogenetic mechanisms are still unclear. A specific provocation test is still the best and sometimes only means of diagnosing wood asthma; standardized protocols with repeated measurements of nonspecific airway responsiveness and of eosinophils in the blood may be helpful for a better understanding of the pathogenetic mechanism and predisposing factors.

[Changes in blood eosinophils and nonspecific bronchial reactivity after exposure tests to wheat flour and TDI]. / Variazioni degli eosinofili ematici e della reattività bronchiale aspecifica dopo test di esposizione a farina di frumento e a TDI.

We studied non-specific bronchial responsiveness (NSBR) and blood eosinophils before and 24 hours after a bronchoprovocation test (SBPT) with wheat flour (22 cases) and TDI (32 cases). Twelve patients developed asthma after exposure to wheat flour (7 early and 5 dual/late asthma), and 12 after exposure to TDI (6 early and 6 late/dual asthma). Responders and non responders to wheat flour exposure were similar for all general characteristics except IgE levels (p = 0.036) and NSBR (p = 0.047). A higher degree of airway responsiveness to methacholine was the only characteristic which differentiated responders from non responders to TDI exposure (p = 0.043). Airway responsiveness, assessed 24 hours after the SBPT (44 cases), did not show any change compared to pretest values; the data were similar both among non responders to wheat flour (Wilcoxon p = 0.1) or to TDI (p = 0.2) and responders to TDI (p = 0.6) or wheat flour (p = 0.3); also no significant changes were observed among early and dual/late asthma caused by wheat flour and TDI. Twenty-four hours after the SBPT, blood eosinophils were higher than pretest, but only among the 24 patients with asthma (Wilcoxon p = 0.002); the blood eosinophil increase was statistically significant among patients with early and late/dual asthma caused by wheat flour, and among those with early and late/dual TDI asthma. In our study, NSBR was confirmed as a common feature of occupational asthma, either IgE mediated (wheat flour) or non-IgE mediated (TDI). Twenty four hours after the specific exposure, among patients with asthma induced by wheat flour and TDI, there was an increase in blood eosinophils while in the same time interval no variation in non-specific bronchial responsiveness was observed.

Pre-employment screening among trainee bakers.

OBJECTIVES: To assess the prevalence of atopy in a vocational school so as to evaluate the feasibility of pre-employment screening. METHODS: The prevalence of atopy by family diathesis, prick tests, immunoglobulin E (IgE) concentrations, and personal history of allergic respiratory diseases was investigated in 144 trainee bakers and 81 students on a graphic artists course (mean age 15.4 years). Skin sensitisation to wheat, rye, and barley flours, to alpha amylase, and to storage mites was also evaluated. RESULTS: Personal allergic symptoms were reported by 13.2% of the bakers and 14.7% of the graphic artists and there was a significant association between symptoms and atopy by prick tests (odds ratio (OR) 17.2; 95% confidence interval (95% CI) 5.27-56.4) and by family history (OR 3.11; 95% CI 1.02-9.53). When bakers were grouped according to the presence of allergic symptoms and results of immunological tests, 6.9% had asthma, 6.3% had rhinoconjunctivitis, and a high percentage (28.5%) were without symptoms but scored positive on prick tests or family symptoms. Skin sensitisation to storage mites had similar prevalences (16%) in the two groups of trainees and occurred nearly always in atopic people. Positive skin tests to wheat flour (3.5%), rye (0.7%), and alpha amylase (0.7%) were specific to bakers. CONCLUSIONS: Pre-employment screening is a useful source of medical information and allows for counseling. The presence of asthma, or of another allergic disease in a severe form, is suggested as a criterion for excluding students of a vocational school from training as bakers. Student bakers without allergic symptoms but atopic by other criteria should be informed about their risks of developing occupational asthma, and periodic check ups must be recommended. Screening studies in vocational school provide a better understanding of specificity of skin sensitisation to occupational allergens.

Allergic airway disease in Italian bakers and pastry makers.

A survey was carried out on respiratory symptoms and skin prick test response to common allergens (atopy), storage mites, and occupational allergens among 226 bakers and pastry makers from 105 small businesses in northern Italy. Atopy was present in 54 workers (23.4%); 40 workers (17.7%) were skin positive to at least one storage mite, 27 (11.9%) to wheat flour and 17 (7.5%) to alpha-amylase. Work related asthma was reported by 11 (4.9%) workers and rhinoconjunctivitis by 31 (17.7%); 22 workers (10.2%) complained of chronic bronchitis. The distribution of skin prick test results among bakers and among 119 white collar workers did not indicate (by logistic analysis) an increased risk for bakers to skin sensitisation to common allergens, storage mite, or to a group of five flours. Sensitisation to wheat flour, on the other hand, was present only among exposed workers. Skin sensitisation to occupational allergens was significantly associated with atopy (p < 0.001), smoking habit (p = 0.015), and work seniority (p = 0.027). The risk of work related symptoms was associated with sensitisation to wheat or alpha-amylase, and with atopy, but not with sensitisation to storage mites, work seniority, or smoking habit. The results of the study indicate that there is still a significant risk of allergic respiratory disease among Italian bakers. Not only wheat allergens, but also alpha-amylase must be considered as causative agents, although sensitisation to storage mites is not important in the occupational allergic response. Atopy must be regarded as an important predisposing factor for skin sensitisation to occupational allergens and for the onset of symptoms at work. The data confirm that for effective prevention, greater care should be taken not only in limiting environmental exposure, but also in identifying susceptible people.

[Alpha-amylase as an occupational allergen in baking industry employees]. / L'alfa amilasi come allergene professionale negli addetti alla panificazione.

In a group of 226 bakers and pastry makers and in 88 students of a training school for bakers, we evaluated skin sensitization to the common allergens, wheat and alpha amylase. Skin prick tests were positive to the enzyme in 17 exposed subjects (7.5%) and in one student with previous occupational exposure as a baker; 27 exposed subjects (11.9%) and 2 students were sensitized to wheat. Among the 42 exposed workers who complained of work-related symptoms, 12 (28.6%) cases were skin positive to amylase and 17 (42.9%) to wheat. Among the 17 workers who were positive to amylase, 16 were also sensitized to wheat and/or common allergens, 12 complained of symptoms at work but since in many cases there was a positive response to wheat, too, it is impossible to speculate on the role of each allergen in inducing symptoms. One case, with work-related rhinoconjunctivitis, had skin sensitization only to alpha amylase but no specific IgE in the serum. These findings confirm that bakers are at risk of sensitization not only to wheat allergen but also to amylase from Aspergillus oryzae. The enzyme should be included in the list of substances to be tested among bakers in whom an occupational allergy is suspected, but particular care should be taken in evaluating the cutaneous response, especially if compared to wheat wheals. Further investigations are also needed to identify the source of risk and to better define the characteristics of the enzyme and the relationship between skin reaction to amylase, sensitization to wheat and atopy.(ABSTRACT TRUNCATED AT 250 WORDS)

The possible haematological effects of glycol monomethyl ether in a frame factory.

Haemopoietic effects of ethylene glycol monomethyl ether (EGME) are described in three young women employed in a frame factory where the substance was applied under apparently safe hygienic conditions. In a ventilated room they used a mixture of acetone (70%) and EGME (30%) to glue together cellulose acetate frame components. During a periodic medical examination their white blood cell count was found to be abnormally low, with a relative lymphocytosis, macrocytosis with red blood cells, and haemoglobin at borderline normal values. These findings persisted over the exposure period but the haematological parameters returned to normal on stopping exposure. The subjects remained clinically healthy during the exposure period. This exposure to EGME occurred in an industry where such toxicity had not been previously reported and describes a situation in which the risk did not come from the exposure to vapour but most likely from an insufficient skin protection.

Allergic manifestations due to castor beans: an undue risk for the dock workers handling green coffee beans.

The main cause of allergic manifestations among workers handling green coffee beans (GCB) is sensitization to castor beans (CB), which are considered a common contaminant of the sacks used to transport coffee beans. The RAST inhibition test was used to evaluate the presence of GCB and CB allergens on the surface of the sacks coming from the major world producers of coffee and to ascertain the presence of the CB allergen in coffee beans. A significant concentration of the two allergens, i.e., GCB and CB, on the sacks was demonstrated, with the highest values found on sacks from Brazil, while the hypothesis of a significant CB contamination in coffee beans was not confirmed. We believe the presence of the CB allergen on the surface of the sacks is due to contamination occurring during stocking and transport and could easily be prevented. Appropriate measures taken during transport could effectively prevent this "undue" risk in dockers and probably also in coffee industry workers.

[Asthma caused by cyanoacrylic glues]. / Asma da collanti cianoacrilici.

Cyanoacrylate-based glues have been reported as producing dermatitis and bronchial asthma. The paper describes the case of a patient occupationally exposed to Loctite 406, who developed irritation of the skin and mucosae of the face and late bronchial asthma. Preventive measures for subjects exposed to cyanoacrylic instant glues are discussed.