Ocular and airway symptoms related to organic acid anhydride exposure--a prospective study.

BACKGROUND: Organic acid anhydrides (OAA) are used as hardeners in epoxy resin systems. They are powerful sensitizers giving frequent rhinitis and asthma in exposed workers. Incidence of symptoms is unknown. Here we present the first prospective study on the associations between OAA exposure, symptoms, and effects of confounding factors. METHODS: All new employees in three plants handling OAA were followed for up to 8.5 years. Before the employment, a questionnaire reporting about symptoms of eyes and airways, smoking habits, and atopy was answered. The subjects were asked at regular medical examinations about work tasks and work-related symptoms. Serum was analysed for specific OAA antibodies. RESULTS: Mean exposures varied between 6 and 39 microg/m3. The incidence for work-related symptoms of the eyes, nose, pharynx, and lower airways was 91, 64, 46, and 31 per 1000 years of exposure, respectively. Symptoms were found frequently, even at mean exposure level at <10 microg/m3. Smoking and atopy increased the risk of symptoms. Immunoglobulin (Ig)E sensitized workers had a significant increased risk for symptoms of the eyes and pharynx and for running nose/sneezing. CONCLUSIONS: Organic acid anhydrides exposure is associated with frequent ocular and airway symptoms even at mean exposure levels at <10 microg/m3. There is an important need for establishment of an occupational threshold limit. A limit value of below 5 microg/m3 is proposed.

Association of HLA-DQ5 and HLA-DR1 with sensitization to organic acid anhydrides.

BACKGROUND: Organic acid anhydrides are low molecular weight industrial chemicals, able to cause rhinoconjunctivitis and asthma associated with specific IgE against hapten-carrier protein conjugate. Only a proportion of exposed workers develop IgE-associated allergy to acid anhydrides. OBJECTIVE: We determined whether genetic susceptibility, in particular, HLA Class II alleles may be a risk factor. METHODS: We undertook HLA typing in 52 cases who had confirmed specific IgE and in 73 referents matched on site, age and duration of acid anhydride exposure identified in cross-sectional studies of workers exposed to hexahydrophthalic (HHPA), methylhexahydrophthalic (MHHPA) and methyltetrahydrophthalic (MTHPA) anhydrides. RESULTS: The linked alleles DQ5 (odds ratio [OR]=4.3; 95% confidence interval [95% CI]=1.7, 11) and DR1 (OR 3.0; 95% CI 1.2, 11) were more prevalent in cases than in referents. Within DQ5, DQB1(*)0501 was particularly frequent (OR 3.0; 95% CI 1.2, 7.4). CONCLUSION: DQB1(*)05 gene confers susceptibility to develop specific IgE antibodies against HHPA, MHHPA and a non-significant trend with MTHPA. DQB1(*)0501 is protective for other low molecular chemical sensitizers (isocyanates and plicatic acid) which may indicate varying affinities for the corresponding specific class II molecules.

Cadmium levels in kidney cortex in Swedish farmers.

The cadmium levels in kidney cortex (K-Cd) did not differ statistically between 10 nonsmoking farmers from the south of Sweden, who had a high intake of locally produced food and who were affected by acid precipitation (as indicated by low pH in the drinking water from their private wells) and 10 farmers less affected (medians: K-Cd, 18 vs. 14 microg/g; water pH, 5.2 vs. 7.8). Neither did 10 farmers selected because of "high" blood cadmium (B-Cd) differ from 10 with "low" [medians: K-Cd, 15 vs. 9 microg/g; B-Cd, 2.6 vs. 1.3 nmol/L (0.29 vs. 0.14 microg/L)]. In all 40 farmers, there was an increase of urinary cadmium levels (U-Cd) with decreasing drinking water pH (r(s) = -0.32, P = 0.045). Further, K-Cd increased with rising B-Cd (r(s) = 0.33, P = 0.037), and both B-Cd (r(s) = 0.73, P = 0.0005), and U-Cd (r(s) = 0.74, P = 0.0005) rose with increasing age. Further, there was an association between U-Cd and B-Cd (r(s) = 0.68, P = 0.0005). We could not demonstrate with certainty any effect of the acid precipitation on the cadmium retention in the farmers, although the association between U-Cd and drinking water pH deserves further study.

Nasal challenge shows pathogenetic relevance of specific IgE serum antibodies for nasal symptoms caused by hexahydrophthalic anhydride.

Hexahydrophthalic anhydride (HHPA) is a component of some epoxy resin systems. A high fraction of HHPA-exposed workers display nasal symptoms, and some of them have specific serum antibodies. To test the pathogenetic relevance of the antibodies nasal challenge tests were performed with a conjugate of HHPA and human serum albumin (HSA) at three increasing concentrations. Eleven subjects, who were IgE-sensitized against HHPA (positive in RAST and in skin-prick test against the HHPA-HSA conjugate), and who reported work-related nasal symptoms, had a significant increase of nasal symptoms and a decrease of nasal inspiratory peak flow after the challenges. The symptoms were associated with specific serum IgE, but with IgG. Further, significant increases were found in eosinophil and neutrophil counts, and in levels of tryptase, and albumin, whereas no clear rise was recorded for eosinophil cationic protein in nasal lavage fluid. Nine subjects, who were not sensitized, but who complained of work-related nasal symptoms, and 11 subjects, who were not sensitized and had no symptoms, displayed no significant change in any of these parameters. It is concluded that the symptoms in some of the workers were caused by an IgE-mediated mast cell degranulation, followed by an inflammatory reaction, engaging eosinophil and neutrophil cells.

Effect of acid precipitation on retention and excretion of elements in man.

From a population of 8918 farmers, 237 were selected whose consumption of locally produced foods was high. The subjects' water sources, private wells, were of different degrees of acidity. Significant associations between pH (median 6.7, range 4.7-8.6) of the drinking water and element concentrations were found. The correlation was negative for aluminium (Al; median 0.07 mumol/l), cadmium (Cd; 0.44 nmol/l), copper (Cu; 0.24 mumol/l) and lead (Pb; 1.9 nmol/l), and positive for calcium (Ca; 0.62 mmol/l) and magnesium (Mg; 0.21 mmol/l). Associations could not be found between the pH of, or element concentrations in, the water and concentrations of A1 (0.17 mumol/l), Mg (0.86 mmol/l) and selenium (Se; 1.0 mumol/l) in plasma, Cd (2.0 nmol/l), Pb (0.19 mumol/l) and mercury (Hg; 13 nmol/l) in blood, or A1 (12 mumol/mol creatinine) and Cu (11 mumol/mol creatinine) in urine. The concentrations of Hg in blood and Se in plasma were related to fish consumption, Cd and Pb in blood to smoking, A1 in urine to antacid intake, Pb in blood to rifle activities and hunting, and Hg in blood to hunting. Acid precipitation has an effect on element concentrations in drinking water, but not on the retention of those elements in the subjects investigated.

Symptoms and immunologic markers induced by exposure to methyltetrahydrophthalic anhydride.

A study was performed in 43 workers exposed to methyltetrahydrophthalic anhydride (MTHPA) used as a hardener in an epoxy resin system. Ten workers sensitized to MTHPA (group SS; presence of serum IgE antibodies against a conjugate of MTHPA and human serum albumin (HSA) detected by RAST) had significantly higher levels of tryptase in nasal lavage fluid than 19 nonsensitized workers with work-related nasal symptoms (group NS) and 14 nonsensitized workers without nasal symptoms (group NN). This suggests an ongoing mast-cell-mediated reaction in the sensitized group. No statistically significant differences were found in the three groups concerning eosinophil cationic protein (ECP) and TAME-activity in lavage fluid. However, there was a significant increase in serum ECP in the SS group, as compared with a group of unexposed controls. Nasal challenge with MTHPA-HSA, performed in a subsequent study in seven workers from the SS group, six from the NS group, and seven from the NN, caused a larger increase of symptom score and a more pronounced decrease in nasal inspiratory peak flow in the SS group than in the other two groups. No significant rise was recorded for tryptase and ECP in lavage fluid in any of the three groups after challenge. The combined results of the two studies indicate that specific IgE antibodies play a pathogenetic role in at least some of the cases of work-related nasal symptoms associated with MTHPA exposure.

Indoor radon-daughter concentration and gamma radiation in urban and rural homes on geologically varying ground.

The radon (Rn)-daughter level (track film, 3 months) was lower in 129 urban than in 197 rural houses (geometric means, (GM) 18 versus 40 Bq/m3; P < 0.001; range 3-416). In rural dwellings higher levels were found in those built over deposits of alum shale occurrences (P = 0.04; 12 on porous glaciofluvial cover 94 Bq/m3; 127 others 43 Bq/m3; significant interaction, P = 0.01), than in 158 others (37 Bq/m3). There was no systematic effect of the type of water supply, neither of indoor smoking. One hundred twenty three homes with a complete cellar were lower than 200 with no or part cellar (18 versus 40 Bq/m3; P < 0.001). There was only a weak association between log-transformed gamma radiation (GM 10, range 33-50 microR/h) and Rn-daughter levels (r = 0.18; 95% confidence interval 0.07-0.28). Our results show the importance for indoor Rn-daughter levels of the bedrock and cover beneath the house, and the need for Rn-daughter measurements in epidemiological studies.

Exposure to environmental tobacco smoke in the household and urinary cotinine excretion, heavy metals retention, and lung function.

The relationship between urinary levels of cotinine (U-cotinine) and arsenic (U-As), blood levels of cadmium (B-Cd), blood levels of lead (B-Pb), lung function, and questionnaire data on smoking habits were studied in 107 parents and their 46 children (7-10 y of age). There was a statistically significant relationship between the reported amount of tobacco smoked and U-cotinine levels. Nonsmokers who were married to persons who smoked had three times higher U-cotinine levels than nonsmokers whose spouses did not smoke. There was a significant association between the number of parents who smoked in the family and the U-cotinine levels of children. If only one parent smoked, maternal smoking was of greater importance than paternal smoking. There was also an association between U-cotinine and B-Cd. A study of lung function in the children revealed that vital capacity and functional residual capacity (corrected for sex, age, and height) increased as the number of parents who smoked increased. Therefore, the present study showed that (1) U-cotinine was a useful index of active smoking and environmental tobacco smoke exposure in adults and children, (2) U-cotinine was associated with the blood concentration of cadmium, and (3) environmental tobacco smoke exposure was associated with changes in lung function of children.

Chelated lead and bone lead.

In this study a close correlation [correlation coefficient (r) = 0.86, P less than 0.001] was found between the blood lead level of 20 lead workers and their urinary excretion of lead for 24 h after intravenous infusion with 1 g of the chelating agent calcium disodium edetate. In addition, there were significant associations between lead levels in different bones (tibia/calcaneus: r = 0.93, P less than 0.001; tibia/phalanx: r = 0.67, P less than 0.002; calcaneus/phalanx: r = 0.80, P less than 0.001), as measured by in vivo X-ray fluorescence. Chelation produced no significant change in the lead level in either tibia or calcaneus. There was a significant correlation between chelated lead and bone lead (eg, for calcaneus, r = 0.62) in currently exposed workers. However, there was no significant relationship when a retired worker and an inactive worker were included (r = 0.14). It was concluded that chelatable lead mainly reflects the blood and soft-tissue lead pool, which is only partly dependent upon the skeletal lead content that comprises the biggest share of the total body burden.

Serum IgE and lung function in workers exposed to phthalic anhydride.

A total of 23 phthalic anhydride (PA)-exposed workers (air levels up to 17 mg/m3) showed significantly (P less than 0.01) more workrelated symptoms in their eyes (48% vs 6%) and nose (39% vs 0) than did 18 unexposed control subjects. Two of the exposed workers had PA-associated asthma. Surprisingly, the control group exhibited significantly (P less than 0.05) more symptoms of nonspecific bronchial hyperreactivity (44% vs 13%). The exposed workers showed significantly higher levels of total serum IgE (medians, 32 vs 15 kIU/l, P less than 0.05), although values for specific IgE against PA did not differ. This may indicate that such exposure can facilitate the entry of common allergens. There was a significant difference in PA-specific IgG [enzyme-linked immunosorbent assay (ELISA) ratios 0.21 vs 0.12; P less than 0.01]. There were no differences in lung function with regard to vital capacity (VC) and forced expiratory volume (FEV1), closing volume expressed as a percentage of VC (CV%), volume of trapped gas (VTG) before and after inhalation of metacholine, or carbon monoxide transfer factor (TLCO), whereas exposed workers displayed significantly higher late expiratory flow rates (MEF50 and MEF25). In a [99mTc]-diethylenetriamine penta-acetate (DTPA) clearance test, there was no difference between exposed subjects and controls. In summary, exposure to PA did not cause subclinical effects of the lungs. Subjects with lower-airway symptoms showed lower FEV1, MEF50, and MEF25 values and higher VTG (after metacholine) than did those without symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Specific antibodies to methyltetrahydrophthalic anhydride in exposed workers.

A group of 145 workers exposed to methyltetrahydrophthalic anhydride (MTHPA) was investigated. They were working in a plant which, since 1983, handled an epoxy resin with MTHPA as a hardener. Specific IgE antibodies (RAST) to a conjugate between MTHPA and human serum albumin (HSA) were statistically significantly increased (P = 0.001; 26 subjects = 18% positive) in the exposed group, compared to a non-exposed control group (n = 33). One positive worker was only exposed for 2 months. Twenty-three exposed subjects were also skin-prick test positive to MTHPA-HSA. The exposed group was divided into three different exposure categories, according to their contact with the epoxy resin. The average exposure levels at the time of the investigation were, in zone I 0.085 mg/m3, in zone II 0.014 mg/m3, and in zone III 0.010 mg/m3, though the exposure probably had been higher earlier. There was an association between exposure intensity and RAST-positive persons (P = 0.0025, chi-square trend test). Forty-four persons (30%) were smokers, and 16 (11%) atopics. No association between sensitization and either atopy or smoking was found. There was an association between exposure intensity and specific IgG antibodies (P = 0.0003, chi-square trend test). Specific IgG4 antibodies were closely related to specific total IgG antibodies (P = 0.0001). These findings demonstrate that MTHPA is a sensitizing agent at low levels of exposure.

Small airways function in workers processing polyvinylchloride.

In a polyvinyl chloride (PVC) processing plant, 20 workers employed as machine attendants and calender operators, and thus exposed to PVC thermal degradation products (PTDP) and phthalic acid esters (PAE; up to 2 mg/m3), were studied. The control group was 19 unexposed workers. The exposed subjects had more symptoms from eyes and upper airways than the controls, probably mainly associated with PTDP. Two (10%) exposed workers had mild work-related asthma vs no control; five (25%) vs one (5%) symptoms of unspecific bronchial hyperreactivity. One exposed subject had a significantly raised level of IgG against phthalic anhydride, indicating that sensitization can occur in PVC processing. No significant differences were found between exposed and control subjects with regard to spirometry (VC, FEV1, FEF50, FEF75) or volume of trapped gas (VTG, an indicator of small airways disease) before or after metacholine inhalation. Thus, we could not find effects of PTDP or PAE on the small airways.

IgG antibodies against polyisocyanates in car painters.

A group of thirty car painters exposed to vapours and aerosols of paint containing prepolymer andmonomer of hexametylene diisocyanate (HDI) was investigated. Specific antibodies against monomer HDI and prepolymerized HDI were analysed with RAST (IgE) and ELISA (IgG) assays after conjugation of the haptens with human serum albumin. There was no significant increase of serum IgG antibodies against HDI monomer, nor of specific IgE antibodies against HDI monomer or prepolymer. Specific IgG antibodies against prepolymerized HDI were significantly increased, as compared with non-exposed referents (medians 0.11 vs 0.03 absorbance (A]. Six car painters were found to have specific IgG antibodies of subclass 4 against HDI prepolymer, four also against HDI monomer. This shows an association between exposure and specific IgG antibodies. Thirteen subjects had suffered symptoms of rhinitis and/or conjunctivitis, and ten had symptoms from the bronchi (two asthma). There was no significant association between symptoms and levels of specific antibodies. Most of the symptoms were slight and unspecific, probably due to irritative effects of the exposure.