[Work performance as a risk factor for carpal tunnel syndrome]. / Sposób wykonywania pracy jako czynnik ryzyka zespolu ciesni nadgarstka.

Certification of carpal tunnel syndrome (CTS) as an occupational disease should be based on evidence that the job performance is a dominant factor responsible for its development. Features of the way the job is performed, which can increase the constriction in carpal tunnel and their quantitative analysis are presented. They include a specific position of the hand during the job performance (dorsal bending, alternate bending and extension), e.g., overcoming resistance with fingers, pincher grip, object catching and holding, exerting pressure on the hand, repeated movements or work with vibratory tools. These features characterize work of persons employed in meat processing, fitting of sub-assemblies, packing of products, or employed as supermarket cashiers. CTS occurrence in persons working with computers and thus using a keyboard or a mouse is now greatly limited owing to the improvement in ergonomic parameters of computer-equipped workposts. The paper indicates CTS risk factors (carpal tunnel size, post-traumatic lesions, rheumatoid arthritis, female gender, hormonal changes during menopause and pregnancy, and other hormonal disorders like hypothyreosis, diabetes, obesity, hypercholesterolemia, cigarette smoking, high alcohol consumption), which have been very well evidenced. In the summary, the attention was also paid to improper estimation of burden to upper limbs by listing jobs performed and stressing the need to quantitatively define hand burdening factors and estimate duration of such burdens.

Glutaraldehyde-induced occupational asthma: BALF components and BALF and serum Clara cell protein (CC16) changes due to specific inhalatory provocation test.

OBJECTIVES: The purpose of this study was to evaluate bronchoalveolar lavage fluid (BALF) components and Clara cell protein (CC16) concentration in serum and BALF in patients with glutaraldehyde (GA)-induced asthma, before and after a specific inhalatory provocation test (SIPT) with GA, in comparison to atopic asthmatics and healthy individuals. METHODS: Spirometry and bronchoalveolar lavage were performed before and after SIPT. The serum and BALF concentrations of CC16 and cytogram content in BALF were evaluated. RESULTS: In GA-sensitized asthmatics, the level of CC16 in BALF and serum was significantly lower at 24 h after SIPT in comparison with the values recorded prior to the experiment. There was a significant increase in the proportion of eosinophils, basophils and lymphocytes in BALF of GA-sensitized asthmatics obtained after SIPT. CONCLUSIONS: The determination of CC16 either in serum or in BALF is a non-invasive test to detect Clara cell damage.

Changes in cellular and biochemical profiles of induced sputum after allergen-induced asthmatic response: method for studying occupational allergic airway inflammation.

OBJECTIVES: The purpose of the study was to analyze morphological and biochemical changes in induced sputum after the provocation with occupational allergens (mixture of flours and grains) in subjects with diagnosed occupational asthma. MATERIALS AND METHODS: Subjects with occupational asthma and healthy volunteers had physical examination, skin prick tests with common and occupational allergens, and spirometry. Specific IgE against common and occupational allergens was also measured. Bronchial inflammation was characterized by the percentage of cells, levels of eosinophil cationic protein (ECP), and changes in mucosal permeability index. RESULTS: There was a significant increase in the proportion of eosinophils, basophils, lymphocytes, and in the ECP level in induced sputum of occupational allergics after the specific provocation. CONCLUSION: Sputum induction is a reliable method for measuring allergen-induced airway inflammation.

[Allergyto alpha-amylase in apprentice bakers--prevalence, incidence, risk factors and clinical symptoms]. / Uczulenie na alpha-amylaze u uczniów szkól piekarskich-- zapadalnosc, czynniki ryzyka i obraz kliniczny.

BACKGROUND: The aim of the study was to evaluate the prevalence, incidence and risk factors of hypersensitivity to alpha-amylase as well as to identify allergy-related clinical symptoms in apprentice bakers. MATERIALS AND METHODS: A group of 287 apprentice bakers was examined by using a questionnaire, performing skin prick tests to common and occupational allergens, and evaluating total serum IgE level, specific anti-flour and alpha-amylase IgE before, 1 year and 2 years after the onset of vocational training. To diagnose occupational respiratory disease, spirometry, histamine and allergen specific inhalation challenge tests were performed. RESULTS: None of the apprentices displayed the presence of alpha-amylase-specific IgE before starting vocational training. After the first year of occupational exposure, one subject developed hypersensitivity to alpha-amylase, and other 27 subjects after the second year. Generally, 28 (9.8%) apprentices showed hypersensitivity to alpha-amylase after two years of occupational exposure. Of those subjects, 17 (60.7%) had occupational allergic rhinitis recognized and 15 (53.6%) occupational asthma. Logistic regression analysis revealed that the positive results of SPT to common allergens and moulds are significant risk factor for the development of hypersensitivity to alpha-amylase (OR = 11.98, 95% CI: 2.60-55.08 and OR = 7.45, 95% CI: 1.12-49.61, respectively). CONCLUSION: The incidence of allergy to alpha-amylase increases with increasing duration of exposure. Hypersensitivity to common allergens, especially to moulds, is a risk factor of occupational allergy to alpha-amylase. The study results confirm that skin prick tests to common allergens, particularly to moulds, should be performed in bakers before starting occupational exposure and subjects with positive results should be considered as a group of high risk of occupational allergy.

Occupational allergy to wheat flour. Nasal response to specific inhalative challenge in asthma and rhinitis vs. isolated rhinitis: a comparative study.

OBJECTIVES: The purpose of the study was to compare cytological and biochemical changes in nasal lavage fluid induced by wheat flour inhalatory challenge in bakers with allergic rhinitis and with asthma accompanied by rhinitis. MATERIALS AND METHODS: A single-blind, placebo controlled study was conducted in 64 bakers with allergic rhinitis (n = 17), bronchial asthma and rhinitis (n = 24) and without occupational allergy (n = 23). Nasal washings were examined before, 30 min, 4 and 24 h after the specific provocation, wheras non-specific bronchial hyperreactivity (PC20) before and after 24 h. RESULTS: A significant decrease in PC20 after the challenge test was observed only in patients with asthma and rhinitis. Eosinophil count and percentage, basophil count and the permeability index induced by specific provocation were significantly increased in both rhinitis patients and asthmatics. Moreover, the increase especially in total count and proportion of eosinophils as well as in the permeability index was more pronounced in subjects suffering from asthma and rhinitis than in those with rhinitis alone, although the changes were not statistically significant. CONCLUSIONS: The results indicate the applicability of the "nasal pool" technique as a simple diagnostic procedure in flour-induced airway allergy. However, the evaluation of nasal lavage fluid, although a very sensitive and specific method of diagnosing respiratory allergic disease, cannot be used to distinguish patients with upper and lower airway allergy.