Veterinary practice and occupational health. An epidemiological study of several professional groups of Dutch veterinarians. I. General physical examination and prevalence of allergy, lung function disorders, and bronchial hyperreactivity.

The prevalence of allergy, lung function disorders, and bronchial hyperreactivity was studied in 102 Dutch veterinarians, subdivided into five professional groups (predominantly working with either swine, cattle, poultry, companion animals, or as a non-practitioner). The mean age of the participants was 43 years; 6 participants were females. Twenty-two per cent of the participants were overweight, and relatively more non-practitioners than practitioners were overweight. Approximately 23% of the vets reported complaints of prolonged fatigue. The data suggest a relationship between complaints of prolonged fatigue and a more than average number of daily working hours. Only a small proportion of vets were sensitized against several allergens. There were no significant differences in prevalence of distinct lung function disorders or bronchial hyperreactivity between professional groups. It is hypothesized that the respiratory complaints (chronic coughing, chronic phlegm production, stuffed nose, sneezing) reported by the vets predominantly working in swine and/or poultry practice could be caused by irritation and/or inflammation of the first part of the trachea-bronchial tree that has no measurable and permanent consequences for changes in lung function or increased bronchial hyperreactivity. The results of a skin test against allergens and determination of allergen-specific IgE in blood indicated that the respiratory complaints were probably not related to allergy against the panel of allergens tested.

Veterinary practice and occupational health. An epidemiological study of several professional groups of Dutch veterinarians. II. Peak expiratory flow variability, dust and endotoxin measurements, use of respiratory protection devices, and time distribution of professional activities.

Dust and endotoxin exposure was measured in the Spring and Autumn in 96 veterinary practitioners, subdivided in four professional groups ((predominantly working with either swine, cattle, poultry, or companion animals). Furthermore, peak expiratory flow (PEF) variability was measured four times a day over a week in Spring and Autumn in order to detect occupation-related respiratory disorders. The participants kept a log book in which they recorded their activities during these periods. Practitioners working with swine, cattle, or poultry had a significantly higher exposure to dust (+/- 5 times) and endotoxin (+/- 10 times) than companion animal practitioners. PEF variability measurements gave no indications for an increased prevalence of bronchial hyperreactivity related to occupational activities. Respiratory protective devices (RPD) were used selectively. Only a small proportion of the practitioners used them at any time when entering a animal confinement building. Swine and cattle practitioners worked for approximately 3.6 hours per day in animal buildings, whereas poultry practitioners worked in the environment of poultry buildings for approximately 2.8 hours per day.

The value of an in-hospital insect sting challenge as a criterion for application or omission of venom immunotherapy.

BACKGROUND: Venom immunotherapy is a generally accepted treatment for serious allergy to bee and yellow jacket venom. However, it is not precisely known to whom venom immunotherapy should be offered. OBJECTIVE: The purpose of this study was to determine whether an in-hospital insect sting challenge (IHC) can be used as a criterion for application or omission of venom immunotherapy. METHODS: An IHC was carried out in a group of 479 patients (136 sensitized to bee venom and 343 sensitized to yellow jacket venom). The patients with a negative IHC response were interviewed about their experience with subsequent stings under natural circumstances. RESULTS: A total of 76 of 136 bee-sensitized patients (56%) and 284 of 343 yellow jacket-sensitized patients (83%) had a negative IHC response. All of the patients who had a systemic reaction after the IHC were advised to receive venom immunotherapy. The success rate of this therapy was 96.4% for patients allergic to bee venom (54 of 56) and 91.4% for patients allergic to yellow jacket venom (53 of 58). Of a total of 76 bee-sensitized patients with negative IHC responses, 41 were subsequently stung in the field; six patients had a mild (Mueller grade I) systemic reaction (14.6%). Of a total of 284 yellow jacket-sensitized with negative IHC responses, 127 were subsequently stung in the field; nine patients had a mild (Mueller grades I and II) systemic reaction (7.1%), and four patients had a severe (Mueller grades III and IV) systemic reaction (3.1%). Without an IHC as a selection criterion for venom immunotherapy, the percentage of patients unnecessarily treated was calculated to be 48% for bee venom-sensitized patients and 74% for yellow jacket-sensitized patients. However, with a negative test IHC response as a selection criterion for the omission of venom immunotherapy, 14.6% of the bee venom-sensitized patients and 10.2% of the yellow jacket-sensitized patients were proven to be at risk for systemic reactions on subsequent field stings. CONCLUSION: Venom immunotherapy with bee or yellow jacket venom is justifiable only after a positive response to an IHC is observed.