Induced sputum evaluation in restorers and conservators of cultural heritage.

The objective of this study was to examine induced sputum (IS) cells profile from restorers/conservators of cultural heritage (restorers) with no lower airway symptoms and normal ventilatory lung function. The study involved 22 restorers and 48 control workers. Medical interview, physical examination, spirometry, skin prick testing to inhalatory allergens, and IS collection were performed. Compared with control workers, restorers demonstrated higher percentage of neutrophils (34% vs 15.5%; p = .004). This pattern was found only in male workers. They had almost 9 times greater chance to have increased proportion of sputum neutrophils than male controls (odds ratio [OR] 8.98, 95% confidence interval [CI] 1.98-40.7). The mobilization of eosinophils or macrophages into the airways was not established regardless of workers sex. Additional gender difference in sputum cells distribution was found for occupationally unexposed subjects, with higher proportion of sputum neutrophils in women.

Pyroglyphid mites as a source of work-related allergens.

Pyroglyphid mites are primarily associated with allergen exposure at home; hence the name house dust mites. However, we have found numerous studies reporting pyroglyhid mite levels in public and occupational settings. This review presents the findings of house dust mite allergens (family Pyroglyphidae, species Dermatophagoides) as potential work-related risk factors and proposes occupations at risk of house dust mite-related diseases. Pyroglyphid mites or their allergens are found in various workplaces, but clinically relevant exposures have been observed in hotels, cinemas, schools, day-care centres, libraries, public transportation (buses, trains, taxies, and airplanes), fishing-boats, submarines, poultry farms, and churches. Here we propose a classification of occupational risk as low (occasional exposure to mite allergen levels up to 2 µg g(-1)), moderate (exposure between 2 µg g(-1) and 10 µg g(-1)), and high (exposure >10 µg g(-1)). The classification of risk should include factors relevant for indoor mite population (climate, building characteristics, and cleaning schedule). To avoid development or aggravation of allergies associated with exposure to house dust mites at work, occupational physicians should assess exposure risk at work, propose proper protection, provide vocational guidance to persons at risk and conduct pre-employment and periodic examinations to diagnose new allergy cases. Protection at work should aim to control dust mite levels at work. Measures may include proper interior design and regular cleaning and building maintenance.

[Allergotoxicology: research of pollutant influence on the development of allergic reactions]. / Alergotoksikologija: Istrazivanja Utjecaja Polutanata na Pojavu Alergijskih Reakcija.

Allergotoxicology studies the influence of pollutants on the development of allergic reactions and diseases. At the beginning, the research was focused on outdoor air pollutants, while recently it turns to the indoor environment, mainly because people this is where people spend most of their time. Air pollutants may be solid, soluble, or gaseous particles in nature, and they can differ in size, structure, and sources. Pollutants can be of biological or nonbiological origin. Currently interesting air pollutants include particulate matter, ozone, nitrogen oxides, and bioaerosols. The mechanisms of pollutant activity depend on the particle size, solubility, site of deposition, and specific chemical properties. Recent studies have shown that different pollutants provoke different immunological and nonimmunological responses in exposed persons. Interaction between air pollutants and allergens can take place outside the exposed person i.e. with allergen itself, or inside the organism on mucous membranes and skin. Pollutants may be the carriers of allergens and may exacerbate allergic reactions and diseases. This review presents recent views about the mechanisms of pollutant activity on allergens and immune system response in exposed persons, based on epidemiological population studies, clinical studies of exposure under controlled conditions, and experimental tests in vitro and in vivo.

Association of neuroticism with sick building syndrome, quality of life and psychomotor performance.

In a group of 221 healthy employees of both sexes the relationship between neuroticism, and perceived quality of life (WHOQOL), inadequate work organization (IWO), Sick Building Syndrome (SBS) and speed and accuracy of simple reaction time was studied. The level of neuroticism was assessed by Cornell Index (C.I.), and psychomotor speed and accuracy by electronic psychodiagnostic instrument Complex Reactionmeter Drenovac (CRD). All subjects underwent the same testing procedure completing C.I., SBS, IWO and WHOQOL-BREF questionnaires. The obtained results revealed that persons with more pronounced emotional stability perceive their life better in quality, their work environment with less SBS symptoms, and report more adequate work organization. Furthermore, they have better simple reaction time scores to visual stimuli.

[Immunological aspects of asbestos-related diseases]. / Imunoloski aspekti bolesti izazvanih azbestom.

Asbestos is a generic name for a group of silicate minerals. The most common are chrysotile, crocidolite, amosite, tremolite and anthophyllite. Exposure to asbestos may cause asbestos-related non-malignant diseases of the lung and pleura, including asbestosis, pleural plaques, diffuse pleural fibrosis, small airway disease, and malignant diseases such as lung cancer and malignant mesothelioma. Inhaled asbestos fibres deposit in the distal regions of the respiratory system where they interact with epithelial cells and alveolar macrophages, and trigger active immunological response which leads to a slowly progressing lung fibrosis. Asbestos may affect immunocompetent cells and induce malignant transformation of mesothelial cells. It is still not clear whether asbestos causes mesothelioma directly or indirectly. There is a general opinion that malignant mesothelioma is a complex tumour that results from the accumulation of multiple genetic alterations over many years. There is no specific antibody for malignant mesothelioma as yet which could act as a single diagnostic tool. Recent studies have demonstrated that asbestos acts on peripheral T cells as superantigen and that in malignant mesothelioma patients there is an overexpression of the Bcl-2 gene on peripheral CD4+ T cells. These findings contribute to better understanding of biological effects of asbestos in respect to the duration and intensity of exposure.

Association of toxic and essential metals with atopy markers and ventilatory lung function in women and men.

The association of age, smoking, alcohol, superoxide dismutase (SOD), glutathione peroxidase (GPx), blood lead (BPb) and cadmium (BCd) levels, and serum levels of copper (SCu), zinc (SZn) and selenium (SSe) with atopic status and ventilatory function was examined in the groups of 166 women and 50 men with no occupational exposure to metals or other xenobiotics. Markers of atopy included serum total IgE, skin prick test (SPT) to common inhalatory allergens, non-specific nasal reactivity (NNR) and non-specific bronchial reactivity (NBR). Parameters of ventilatory function included forced vital capacity (FVC) and forced expiratory volume in the first second (FEV(1)). Significantly higher BPb, SZn, IgE and prevalence of positive SPT, and lower SCu and NNR was found in men than in women. Fifteen women taking female sex hormones (HT) had significantly higher SCu than women without HT. Regression models showed significant inverse associations between IgE and SCu (P=0.021) and NNR and SCu (P=0.044) in women. When excluding women with HT, the association of SCu and total IgE became of borderline significance (P=0.051), association between SCu and NNR disappeared, and significant positive association between total IgE and BPb emerged (P=0.046). In men, significant inverse association was found between positive SPT and SSe, and between NBR and SSe. A decrease in FVC% and FEV(1)% was associated with an increase in smoking intensity (P<0.001) and a decrease in SZn (P=0.043 and P=0.053, respectively). These results were observed at the levels of the metals comparable to those in general populations worldwide. The observed differences between men and women may partly be explained by different levels of relevant toxic and essential metals, and their combination. The role of female HT in associations of atopy markers and SCu should be further investigated.

Allergic rhinitis and asthma in southern Croatia: impact of sensitization to Ambrosia elatior.

AIM: To identify pollen types in southern Croatia and investigate the impact of sensitization to Ambrosia elatior (A. elatior) on symptoms and treatment of patients with seasonal allergic rhinitis and/or asthma. METHODS: The study recruited 120 patients from Split-Dalmatian County with seasonal rhinitis and asthma symptoms and positive skin prick test to one or more common inhaled allergens. Patients with positive skin prick test and increased specific IgE to A. elatior (n=56) were included in the follow-up study during the A. elatior pollen season. Rhinitis and asthma symptoms were scored and drug treatment recorded using standardized questionnaires. Also, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), and eosinophil count in peripheral blood were measured. Type and pollen concentration of A. elatior in the air over the nine-week pollen season were determined on the glass slides using the gravimetric method. The results were expressed as the proportion of A. elatior pollen in the total pollen. RESULTS: Fifty-six of 120 patients (46.7%) were sensitized to A. elatior. Its proportion in total pollen peaked to 12% in the first week of September. Forty-one patients who completed the follow-up study showed a significantly higher score of symptoms during this peak period than in the beginning of the pollen season for seasonal allergic rhinitis (median +/-interquartile range, 50+/-11 vs 7+/-4; P<.001) and for seasonal allergic asthma (12+/-2 vs 0+/-0; P<.001). CONCLUSION: A. elatior is an important cause of seasonal allergic rhinitis and asthma and must be included in the routine diagnostic procedures in southern Croatia.

Occupational allergic contact dermatitis from azithromycin in pharmaceutical workers: a case series.

BACKGROUND: Reports on hypersensitivity reactions to azithromycin associated with therapy or occupational exposure have been rare. OBJECTIVES: A case series describing clinical characteristics, diagnostic pathways and risk factors in occupational allergic contact dermatitis (ACD) caused by azithromycin in pharmaceutical workers is presented. PATIENTS/METHODS: 7 out of 21 pharmaceutical workers exposed to powdered intermediate and final substances in azithromycin synthesis were referred with workplace-related skin and respiratory symptoms. They all underwent diagnostic procedure involving medical history and examination, patch testing with standard allergens and azithromycin, prick testing with inhalatory allergens and total immunoglobulin E measurement. RESULTS: Airborne ACD caused by azithromycin was established in 4 examined workers with positive patch test to azithromycin. 2 workers additionally had positive patch test to intermediate substances. Occupation-related symptoms of urticaria, rhinoconjunctivitis, laryngitis and/or dyspnoea were described in additional 2 workers without clearly positive patch test to azithromycin. 2 atopic workers had a shorter asymptomatic period between the beginning of the exposure to azithromycin and occurrence of skin symptoms than non-atopics (2-3 months versus 1-3 years, respectively). CONCLUSIONS: Our results suggest that daily manipulation with powdered azithromycin and intermediates is a main route of sensitization. Besides contact sensitization, other possible workplace-related azithromycin hypersensitivity reactions are indicated.

Sick building syndrome: psychological, somatic, and environmental determinants.

The authors aimed to examine potential relationships between work-related symptoms attributed to sick building syndrome (SBS) and certain psychological, somatic, and environmental factors. The multidisciplinary, cross-sectional study comprised 171 female subjects working in air-conditioned and naturally ventilated nonindustrial office buildings. The authors collected information concerning symptoms related to SBS and made assessments of quality of life by using appropriate questionnaires. They assessed the women's levels of emotional stability or neuroticism using the Cornell Index. They determined skin and airway reactivity markers and indoor microclimate data by using standardized methods. The study showed that the subjects had a high prevalence of fatigue (60.2%), sore and dry eyes (57.9%), and headache (44.4%), as well as a generally high score according to the SBS Index. Neuroticism and subjectively estimated physical health as well as the type of building ventilation significantly contributed to the prediction of the SBS Index, explaining 15% of the variance.

Analysis of dust samples from urban and rural occupational environments in Croatia.

This study estimated the exposure to dust mites in various occupational environments in Croatia. In total, 29 occupational dust samples were collected: 10 from urban areas (offices, archive of an insurance company, tobacco, paper-recycling, fish-processing and textile plants, animal unit for experimental rats, winery), nine from rural areas (barley, hay, animal food and flour warehouses, tailor's shops, wood processing plant, swine confinement house, grocer's storeroom), and 10 samples from cabins of five fishing boats (five floor and five bed samples). Mites were microscopically identified, and the levels of Der p 1, Der f 1, and Der 2 allergens measured using the DUSTSCREEN test (Heska AG, Switzerland). Microscopy showed no mites in urban areas. Pyroglyphid mites (D. pteronyssinus) were found in all bed samples from fishing boats. Non-pyroglyphid mites were found in samples taken from barley, hay and animal food warehouses, the swine confinement house, grocer's storeroom, and fishing boats. Pyroglyphid mite allergens were detected in eight of 10 dust samples from the fishing boats. Median levels of Der p 1, Der f 1, and Der 2 in cabin bed samples were 10 microg g(-1), 0.2 microg g(-1), and 3.5 microg g(-1), respectively. Our findings on fishing boats suggests that pyroglyphid mites could be considered work-related allergens for fishermen. The results of this study confirmed non-pyroglyphid mites as occupational risk factors in various rural environments.

[Current views on allergic diseases]. / Suvremeni pogledi na alergijske bolesti.

Allergic diseases are an increasing health problem in the industrialised and developed countries especially in children and young adult persons. They are considered diseases of modern civilisation. The reported cumulative prevalence of allergic diseases in childhood of 25-30% includes allergic rhinoconjunctivitis, asthma and dermatitis. The reasons for this increasing prevalence are unknown. The main risk factors are genetic predisposition, allergen exposure, environmental pollutants, decreased stimulation of immune system during the critical period of development and lifestyle. Allergic diseases must be treated as common health disorder. They can express themselves in any age groups and in many different organs. IgE antibody is the main connection between involved organs. Specific IgE is still being identified using the 100 years old skin testing method and quantitative immunoenzymatic method in serum. In spite of the permanent improvement of both methods, neither skin reactivity to allergens nor measurable specific IgE necessarily mean a clinically manifested disease. The interpretation of these findings is still in the clinician's domain. Allergic diseases rarely have a fatal outcome, but have a long duration. They need a complex treatment and are a substantial individual and public socio-economic burden. Studies of factors influencing the ontogeny and maturation of the immune system in the early human development as well as studies of interaction between environment and genetic predisposition will provide a new insight in the aetiology of allergic diseases. This rewiev presents curent views on the epidemiology, pathogenesis, diagnosis, therapy and prevention of allergic diseases.

Exercise and allergic diseases.

The aim of this study was to compare exercise-induced bronchial reaction between healthy control subjects and subjects with allergic rhinitis (AR) and allergic asthma (AA). It included 16 controls, 16 subjects with AR and 19 subjects with AA. A skin prick test, pulmonary function test, histamine challenge test and exercise challenge test (ECT) were performed in all subjects. Bronchial reaction to exercise was expressed as the fall index FEV1 (%), AUC(0-30) (min x %), and fall index FEF(25-75) (%). After ECT, subjects with AA had a significantly greater bronchial reaction to exercise than subjects with AR and controls (respective fall index FEV1 8.4, 2.9, and 2.4%, P=0.0083; AUC(0-30) 127.7, 29.6, and 33.1 min x %, P=0.025; and fall index FEF(25-75) 14.6, 0.06, and 1.9%, P<0.001). No difference was found between subjects with AR and controls. In conclusion, ECT induced a significantly greater bronchial reaction in patients with AA and bronchial hyperreactivity to histamine than in patients with AR and bronchial normoreactivity to histamine and controls. This difference was not found between subjects with AR and controls.

Organic aerosols and the development of allergic disorders.

The aim of this study was to investigate skin reactivity to organic dust extracts and total serum IgE and their relation to the prevalence of respiratory symptoms and ventilatory capacity in workers occupationally exposed to organic aerosols. It included workers employed in processing coffee, tea, dried fruits, spices, animal food, soy, hemp, cotton, swine farmers, and control groups of workers non-exposed to organic dust. All underwent a skin prick test (SPT) with water extracts of organic dust 1:10 w/v, Dermatophagoides pteronyssinus, mixed moulds, bacteria, histamin solution (1 mg/ml) and buffer solution. SPT was considered positive if the diameter of the observed wheal was 3 mm greater than that of buffer solution. The total IgE was measured by the PRIST method (Pharmacia Diagnostics AB, Upsala) and the values > 125 kU/L were considered increased. Data on respiratory symptoms were collected by standardized questionnaire. Ventilatory capacity was measured by recording MEFV curve. Airborne industrial dust were measured as total and respirable fraction. The exposed workers had a greater prevalence of positive SPT to organic dust extracts, except in soy processing. Increased IgE was found in workers processing coffee, tea, hemp, cotton and animal food, compared to non-exposed workers (P<0.05). Workers with positive SPT had a significantly higher total IgE. As there was no correlation between acute and chronic changes in ventilatory function, positive SPT, and level of total IgE, our findings could not predict objective respiratory impairment.

[Allergic disorders of the respiratory system and skin as a public health problem]. / Alergijski poremecaji disnog sustava i koze kao javnozdravstveni problem.

The prevalence of allergic diseases is rapidly increasing over the last 40 years, especially in most industrialized countries of the world. Manifestations of allergic diseases are observed in about 35% of the general population. In this paper, the most frequent allergic respiratory and skin diseases are described (rhinitis, asthma, atopic eczema/dermatitis syndrome, contact eczema/dermatitis, urticaria). The most important individual and environmental factors involved in the occurrence of allergic diseases are described: genetic predisposition, exposure to allergens, environmental pollution and modern life style are discussed. The results of our investigations related to the prevalence of allergy markers in general and working population are presented. The preventive measures concerning allergic diseases are considered.

Pre-employment evaluation of atopy and contact sensitisation in the prevention of allergy-related diseases.

The aim of this study was to determine the prevalence of markers of atopy and contact sensisation in asymptomatic young adults and to assess their role in pre-employment screening. The study included 351 subjects, of whom166 women (mean age 28.0 + / - 6/4 years) and 185 men (mean age 26.3 + / - 5.4 years). The pre-employment examination commissioned by a pharmaceutical company included a questionnaire, the patch test with the European standard series of contact allergens prick test with common inhalatory allergens, and the serum-specific IgE measurement. According to the medical history 115/166 (69.3%) women and 142/185 (76.8%) men were asymptomatic, but 28 (24.3%) asymptomatic women and 40 (28.2%) showed atopy and/or contact sensitization. Pre-employment allergy examination can be considered a reliable detection procedure for the majority of asymptomatic persons with atopy and contact sensitization. The knowledge of these conditions gives the opportunity for secondary prevention and better diagnostic validation of occupational allergic diseases.