Health insurance claims of petrochemical company employees.

This paper describes a morbidity data base for epidemiologic studies which uses information from health insurance claims. Strengths of the data base include completeness and relatively low cost. A limitation is the length of time needed for all claims to be received and processed: rates generated using current information are lower than they will be after all claims are processed. Nevertheless, internal comparisons can presently be made using such rates. Examples illustrate differences in claims experience according to employees' smoking habits and according to kind of job.

Smoking habits of oil refinery employees.

Smoking habits of White male employees of a large oil company were analyzed. There were only slight differences in smoking habits between refinery and nonrefinery employees. Salaried employees, both at refineries and elsewhere, smoked much less than hourly employees.

The relationship of total serum IgE and blocking antibody in trimellitic anhydride--induced occupational asthma.

Clinical and immunologic evaluations were performed on workers who manufacture trimellitic anhydride (TMA), a chemical used widely in the plastics industry. Serum samples of 29 workers exposed to TMA dust and fumes were assayed for total IgE, as well as specific IgE and total antibody binding to radiolabeled trimellityl human serum albumin (TM-HSA). Fifteen workers were determined to have significant specific IgE to TM-HSA (greater than or equal to 1 ng of 125I-TM-HSA bound per milliliter). Of these 15 individuals, seven workers had immediate asthma and rhinitis and positive cutaneous prick tests and eight were nonasthmatic and skin test negative. Mean peak total serum IgE was significantly higher in the prick test positive group (p less than 0.02) and higher than in 12 exposed asymptomatic IgE antibody-negative workers (p less than 0.001). Total serum IgE followed rises and falls in TM-HSA--Specific IgE binding, correlating to the onset of allergic symptoms in all seven workers. Total antibody binding of 125I-TM-HSA, as determined by the ammonium sulfate precipitation technique, was higher in the skin test-negative group of eight (mean 12,062 ng per milliliter 125I-TM-HSA bound) than in the seven symptomatic skin test-positive workers (mean 2930, p less than 0.004). Determinations of total antibody divided by specific IgE (both in nanograms of 125I-TM-HSA bound per milliliter) or blocking ratios clearly discriminated the seven skin test-positive workers with TMA-induced asthma (range 10 to 666) from the eight skin test-negative workers (range 1580 to 16,000).(ABSTRACT TRUNCATED AT 250 WORDS)

Syndromes in workers exposed to trimellitic anhydride. A longitudinal clinical and immunologic study.

A longitudinal study of workers involved in the manufacture of trimellitic anhydride has been in progress since 1977. Trimellitic anhydride is a low-molecular-weight, reactive chemical used in the manufacture of plastics. Initial studies done in 1976 defined three syndromes due to inhalation of trimellitic anhydride: asthma-rhinitis, a late respiratory systemic syndrome, and an irritant response. Also, serologic techniques were developed to measure total antibody and IgE antibody to trimellityl human serum albumin. From 1977 to 1981, 64 workers were assessed. Six workers presented with asthma-rhinitis, high levels of IgE antibody, and skin test reactivity to trimellityl human serum albumin; five workers developed the late respiratory systemic syndrome; and one worker had both immunologic syndromes. These serologic measurements detected or were predictive of an immunologic respiratory illness and were useful in monitoring workers involved in the manufacture of trimellitic anhydride.

Clinical and immunologic evaluation of trimellitic anhydride workers in multiple industrial settings.

This article described our clinical and immunologic experience in assessing workers exposed to trimellitic anhydride (TMA) in three industrial settings. Since 1977 we have had engaged in a prospective study of workers involved at the site of manufacture of TMA. These studies demonstrate that serologic measurements of total antibody to trimellityl human serum albumin (TM-HSA) and IgE antibody to TM-HSA are predictive of the development of an immunologically mediated respiratory illness and are useful in monitoring workers removed from TMA exposure, in identifying asymptomatic workers who may be at risk in the future, and in defining the nature of sensitization of the work force. In a different industrial setting, we have been able to study workers who mixed previously manufactured TMA powder with epoxy resins. This study indicated that clinical assessments by a plant physician with a standardized questionnaire, along with serologic tests, could establish the presence or absence of an immunologic respiratory illness caused by the inhalation of TMA dust. In a third industrial situation, workers were exposed to both TMA and phthalic anhydride (PA). Here workers were interviewed by a local physician with minimal experience with TMA-related respiratory illness. In this situation a more detailed questionnaire was utilized, along with serologic tests utilizing the enzyme-linked immunosorbent assay to establish the presence of a TMA- or PA-related syndrome. Immunologic studies demonstrated in workers exposed to both TMA and PA that the antibody responses elicited showed little crossreactivity between antibodies directed against TM-HSA or PA-HSA.

The industrial physician and occupational lung disease.

Prevention and management of chronic occupational illnesses requires that they first be recognized as such. This appears to be particularly difficult in the case of occupational lung disease and doubly so in the case of occupational immunologic lung disease. It took years to recognize asbestosis, byssinosis, and other chronic lung diseases as being occupational in origin. Trimellitic anhydride is particularly interesting in that it took a variety of purely clinical perceptions to arouse the suspicion that an immunologic response was involved. Increased cooperation of industry managements, occupational physicians, and researchers can lead to the elucidation of causes, which, in turn, can led to the goals we all share, the discovery, the treatment, and, even better, the prevention of disease.

Human antihapten antibodies in trimellitic anhydride inhalation reactions. Immunoglobulin classes of anti-trimellitic anhydride antibodies and hapten inhibition studies.

Inhalational exposure to trimellitic anhydride (TMA) produces an immediate-type asthmatic or a late respiratory systemic syndrome in certain workers after a latent period of work exposure. TMA has been found to react with proteins to produce a hapten-protein complex (trimellitate [TM] protein) or become hydrolyzed in aqueous, alkaline solutions to produce a salt, NaTM. Using a solid-phase radioimmunoassay technique, antibodies of different Ig classes were detected against TM-protein conjugates. IgE antibody was detected in three of five workers with asthma. IgG and IgA antibodies were detected in most exposed workers but higher levels of antibody were found in symptomatic workers even after long periods without direct TMA exposure. IgM antibody activity against TM-human serum albumin (TM-HSA) was detected but did not differentiate symptomatic from asymptomatic workers. NaTM served as a hapten for study because it does not react with proteins to form a hapten-protein complex as TMA does. The NaTM only partially inhibited IgG antibody activity against TM-HSA and much smaller amounts of TM-HSA than of NaTM were required to neutralize IgG antibody. A similar result was found with TM-ovalbumin. The latter results suggest that some IgG antibody is directed against a TM-protein moiety, probably a TM-amino acid determinant. In contrast to IgG, marked inhibition by NaTM of IgA and IgM antibody against TM-HSA was found in the sera studied.