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December 10, 1997, Vol 278, No. 22 >
ARTICLE | December 10, 1997

Allergic Reactions to Workplace Allergens FREE

David I. Bernstein, MD
JAMA. 1997;278(22):1907-1913. doi:10.1001/jama.1997.03550220113015
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Article
References

Allergic sensitization to workplace allergens can result in occupational asthma (OA), rhinitis, and dermatoses. Occupational asthma, accounting for 2% to 15% of all new cases of asthma, is caused by more than 240 reactive chemicals or natural proteins. Diisocyanates, used in urethane production and spray painting, are the leading causes of OA. Occupational asthma must be objectively confirmed by demonstrating significant decreases in lung function associated with exposure to a causative agent. An early diagnosis of OA followed by elimination of exposure to a causative agent may be curative and prevent progression to chronic asthma. In the last decade, protein allergens in natural rubber latex gloves have emerged as the leading cause of work-related cutaneous and respiratory allergic disorders in health care workers. In the workplace, occupational allergic contact dermatitis is almost always caused by chemicals, including nickel, chromates, and epoxy resins, whereas contact urticarial reactions are most often due to protein allergens. The primary treatment of occupational allergic disorders is strict avoidance of exposure to the inciting agent.

REFERENCES

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2 +
Bernstein DI, Bernstein IL.  Occupational asthma . In: Middleton E, Reed CE, Elliot E, eds. Allergy: Principles and Practice . 4th ed. St Louis, Mo: Mosby-Year Book; 1993;:1369-1393.
3 +
Bernstein IL, Bernstein DI.  Definition and classification of asthma . In: Bernstein IL, Chan-Yeung M, Malo J-L, et al, eds. Asthma in the Workplace . New York, NY: Marcel Dekker Inc; 1993;:1-4.
4 +
Introna F.  L'asme bronchiale allergica come malattia professionale . Minerva Med . 1966;;86:176-181.
5 +
Blank P.  Occupational asthma in a national disability survey . Chest . 1987;;92:613-617.
6 +
Thiel H, Ulmer WT.  Baker's asthma: development and possibility for treatment . Chest . 1980;;78:400-405.
7 +
Thiel H.  Problems of occupationally induced respiratory allergies as exemplified by baker's asthma . Occup Environ Dermatoses . 1987;;35:81-91.
8 +
Slovak AJM, Hill RN.  Laboratory animal allergy: a clinical survey of an exposed population . Br J Ind Med . 1981;;38:38-41.
9 +
Becklake MR.  Epidemiology: prevalence and determinants . In: Bernstein IL, Chan-Yeung M, Malo J-L, eds. Asthma in the Workplace . New York, NY: Marcel Dekker Inc; 1993;:29-59.
10 +
Meredith SK, Taylor VM, McDonald JC.  Occupational respiratory disease in the United Kingdom 1989: a report to the British Thoracic Society and the Society of Occupational Medicine by the SWORD project group . Br J Ind Med . 1991;;48:292.
11 +
Tarlo SM, Liss G, Corey P, Broder I.  A workers compensation claim population for occupational asthma: comparison of subgroups . Chest . 1995;;107:634-641.
12 +
Bernstein IL.  Isocyanate-induced pulmonary diseases: a current perspective . J Allergy Clin Immunol . 1982;;7:24-31.
13 +
Bernstein DI, Korbee L, Stauder T, et al.  The low prevalence of occupational asthma and antibody dependent sensitization to MDI in a plant engineered for minimal exposure to diisocyanates . J Allergy Clin Immunol . 1993;;92:387-396.
14 +
Yassin MS, Lierl MB, Fischer TJ, et al.  Latex allergy in hospital employees . Ann Allergy . 1994;;72:245-249.
15 +
Bernstein DI, Malo J-L.  High molecular weight agents . In: Bernstein IL, Chang-Yeung M, Malo J-L, eds. Asthma in the Workplace . New York, NY: Marcel Dekker Inc; 1993;:373-398.
16 +
Venables KM, Upton JL, Hawkins ER, et al.  Smoking, atopy and laboratory animal allergy . Br J Ind Med . 1988;;45:667-671.
17 +
Cartier A, Malo J-L, Forest F, et al.  Occupational asthma in snow crab processing workers . J Allergy Clin Immunol . 1984;;74:261-269.
18 +
Venables KM.  Low molecular weight chemicals, hypersensitivity, and direct toxicity: the acid anhydrides . Br J Ind Med . 1989;;46:222-232.
19 +
Venables KM, Daily MB, Nunn AJ, et al.  Smoking and occupational allergy in workers in a platinum refinery . BMJ . 1989;;298:939-942.
20 +
Chan-Yeung M, Desjardins A.  Bronchial hyperresponsiveness and level of exposure in occupational asthma due to western red cedar (Thuja plicata): serial observations before and after development of symptoms . Am Rev Respir Dis . 1992;;146:1606-1607.
21 +
Liss GM, Kominsky JR, Gallagher JS, et al.  Failure of enzyme encapsulation to prevent sensitization of workers in the dry bleach industry . J Allergy Clin Immunol . 1984;;73:348-355.
22 +
Perrin B, Cartier A, Ghezzo H, et al.  Reassessment of the temporal patterns of bronchial obstruction after exposure to occupational sensitizing agents . J Allergy Clin Immunol . 1991;;87:630-639.
23 +
Bernstein DI, Gallagher JS, D'Souza L, Bernstein IL.  Heterogeneity of specific IgE responses in workers sensitized to acid anhydride compounds . J Allergy Clin Immunol . 1984;;74:794-801.
24 +
Patterson R, Zeiss CR, Pruzansky JJ.  Immunology and immunopathology of trimellitic anhydride pulmonary reactions . J Allergy Clin Immunol . 1982;;70:19-23.
25 +
Herd Z, Bernstein DI.  Antigen specific histamine releasing factors in diisocyanate induced occupational asthma . Am J Respir Crit Care Med . 1994;;150:988-994.
26 +
Lummus ZL, Alam R, Bernstein JA, Bernstein DI.  Characterization of histamine releasing factors in diisocyanate-induced occupational asthma . Toxicology . 1996;;111:191-206.
27 +
Maestrelli D, di Stafano A, Occari P, et al.  Cytokines in the airway mucosa of subjects with asthma induced by toluene diisocyanate . Am J Respir Crit Care Med . 1995;;151:607-612.
28 +
Siracusa A, Vecchiarelli A, Brugnami G, et al.  Changes in interleukin-1 and tumor necrosis factor production by peripheral blood monocytes after specific bronchoprovocation test in occupational asthma . Am Rev Respir Dis . 1992;;146:408-412.
29 +
Bignon JS, Aron Y, Ju LY.  HLA class II alleles in isocyanate-induced asthma . Am J Respir Crit Care Med . 1994;;149:71-75.
30 +
Young RP, Barker RD, Pile KD, et al.  The association of HLA-DR3 with specific IgE to inhaled acid anhydrides . Am J Respir Crit Care Med . 1995;;151:219-221.
31 +
Bentley AM, Maestrelli P, Saetta M, et al.  Activated T-lymphocytes and eosinophils in the bronchial mucosa in isocyanate-induced asthma . J Allergy Clin Immunol . 1992;;89:821-828.
32 +
Frew AJ, Chan H, Lam S, Chan-Yeung M.  Bronchial inflammation in occupational asthma due to western red cedar . Am J Respir Crit Care Med . 1995;;151:340-344.
33 +
Saetta M, Maestrelli P, Turato G, et al.  Airway wall remodeling after cessation of exposure to isocyanates in sensitized asthmatic subjects . Am J Respir Crit Care Med . 1995;;151:489-494.
34 +
Brooks SM, Bernstein IL.  RADS or irritant induced asthma . In: Bernstein IL, Chan-Yeung M, Malo J-L, et al, eds. Asthma in the Workplace . New York, NY: Marcel Dekker Inc; 1993;:533-549.
35 +
Brooks SM, Weiss MA, Bernstein IL, et al.  Reactive airways dysfunction syndrome (RADS): persistent asthma syndrome after high level irritant exposures . Chest . 1985;;88:376-384.
36 +
Gautrin D, Boulet LP, Boutet M, et al.  Is reactive airways dysfunction syndrome a variant of occupational asthma? J Allergy Clin Immunol . 1994;;93:12-22.
37 +
Chan-Yeung M, Maclean L, Paggiaro PL.  Follow-up study of 232 patients with occupational asthma caused by western red cedar (Thuja plicata) . J Allergy Clin Immunol . 1987;;79:792-796.
38 +
Moller DR, Brooks SM, McKay RT, et al.  Chronic asthma due to toluene diisocyanate . Chest . 1986;;90:494-499.
39 +
Merget R, Stollfuss J, Wiewrodt R, et al.  Diagnostic tests in enzyme allergy . J Allergy Clin Immunol . 1993;;92:264-277.
40 +
Malo J-L, Ghezzo H, L'Archeveque J, et al.  Is the clinical history a satisfactory means of diagnosing occupational asthma? Am Rev Respir Dis . 1991;;143:528-532.
41 +
Bernstein DI.  Clinical assessment and management of occupational asthma . In: Bernstein IL, Chang-Yeung M, Malo J-L, et al, eds. Asthma in the Workplace . New York, NY: Marcel Dekker Inc; 1993;:103-119.
42 +
Cockcroft DW, Murdock KY, Bersheid BA, Gore BP.  Sensitivity and specificity of histamine PC20 determination in a random selection of young college students . J Allergy Clin Immunol . 1992;;89:23.
43 +
Liss GR, Bernstein DI, Moller DR, et al.  Pulmonary and immunologic evaluation of foundry workers exposed to methylene diphenyldiisocyanate (MDI) . J Allergy Clin Immunol . 1988;;82:55-61.
44 +
Bernstein DI, Smith AB, Gallagher JL, et al.  Clinical and immunologic studies among egg processing workers with occupational asthma . J Allergy Clin Immunol . 1987;;80:791-797.
45 +
Moscato G, Godnic-Cvar J, Maestrelli P.  Statement on self-monitoring of peak expiratory flows in the investigation of occupational asthma: Subcommittee on Occupational Allergy of European Academy of Allergy and Clinical Immunology . J Allergy Clin Immunol . 1995;;96:295-301.
46 +
Smith AB, Bernstein DI, Aw TC, et al.  Occupational asthma from inhaled egg protein . Am J Ind Med . 1987;;12:205-218.
47 +
Quirce S, Contreras G, Dybuncio A, Chan-Yeung M.  Peak expiratory flow monitoring is not a reliable method for establishing the diagnosis of occupational asthma . Am J Respir Crit Care Med . 1995;;152:1100-1102.
48 +
Butcher BT, Karr RM, O'Neil CE, et al.  Inhalation challenge and pharmacologic studies of toluene diisocyanate (TDI) sensitive workers . J Allergy Clin Immunol . 1977;;64:146-152.
49 +
Pepys J.  Inhalation challenge tests in asthma . N Engl J Med . 1975;;192:758-759.
50 +
Cartier A, Bernstein IL, Burge PS, et al.  Guide-lines for bronchoprovocation on the investigation of occupational asthma . J Allergy Clin Immunol . 1990;;84:823-829.
51 +
Cartier A, Grammer L, Malo J-L, et al.  Specific serum antibodies against isocyanates: association with occupational asthma . J Allergy Clin Immunol . 1989;;84:507-514.
52 +
Burge PS.  Occupational asthma in electronics workers caused by colophony fumes: follow-up of affected workers . Thorax . 1982;;37:348-353.
53 +
Block G, Tse K, Kijek K, et al.  Baker's asthma: clinical and immunological studies . Clin Allergy . 1983;;13:359-370.
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Klaustermeyer WB, Bardana EJ, Hale FC.  Pulmonary hypersensitivity to Alternaria and Aspergillus in baker's asthma . Clin Allergy . 1977;;7:227-233.
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Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Chan-Yeung M, Malo J-L.  Occupational asthma . N Engl J Med . 1995;;333:107.
2 +
Bernstein DI, Bernstein IL.  Occupational asthma . In: Middleton E, Reed CE, Elliot E, eds. Allergy: Principles and Practice . 4th ed. St Louis, Mo: Mosby-Year Book; 1993;:1369-1393.
3 +
Bernstein IL, Bernstein DI.  Definition and classification of asthma . In: Bernstein IL, Chan-Yeung M, Malo J-L, et al, eds. Asthma in the Workplace . New York, NY: Marcel Dekker Inc; 1993;:1-4.
4 +
Introna F.  L'asme bronchiale allergica come malattia professionale . Minerva Med . 1966;;86:176-181.
5 +
Blank P.  Occupational asthma in a national disability survey . Chest . 1987;;92:613-617.
6 +
Thiel H, Ulmer WT.  Baker's asthma: development and possibility for treatment . Chest . 1980;;78:400-405.
7 +
Thiel H.  Problems of occupationally induced respiratory allergies as exemplified by baker's asthma . Occup Environ Dermatoses . 1987;;35:81-91.
8 +
Slovak AJM, Hill RN.  Laboratory animal allergy: a clinical survey of an exposed population . Br J Ind Med . 1981;;38:38-41.
9 +
Becklake MR.  Epidemiology: prevalence and determinants . In: Bernstein IL, Chan-Yeung M, Malo J-L, eds. Asthma in the Workplace . New York, NY: Marcel Dekker Inc; 1993;:29-59.
10 +
Meredith SK, Taylor VM, McDonald JC.  Occupational respiratory disease in the United Kingdom 1989: a report to the British Thoracic Society and the Society of Occupational Medicine by the SWORD project group . Br J Ind Med . 1991;;48:292.
11 +
Tarlo SM, Liss G, Corey P, Broder I.  A workers compensation claim population for occupational asthma: comparison of subgroups . Chest . 1995;;107:634-641.
12 +
Bernstein IL.  Isocyanate-induced pulmonary diseases: a current perspective . J Allergy Clin Immunol . 1982;;7:24-31.
13 +
Bernstein DI, Korbee L, Stauder T, et al.  The low prevalence of occupational asthma and antibody dependent sensitization to MDI in a plant engineered for minimal exposure to diisocyanates . J Allergy Clin Immunol . 1993;;92:387-396.
14 +
Yassin MS, Lierl MB, Fischer TJ, et al.  Latex allergy in hospital employees . Ann Allergy . 1994;;72:245-249.
15 +
Bernstein DI, Malo J-L.  High molecular weight agents . In: Bernstein IL, Chang-Yeung M, Malo J-L, eds. Asthma in the Workplace . New York, NY: Marcel Dekker Inc; 1993;:373-398.
16 +
Venables KM, Upton JL, Hawkins ER, et al.  Smoking, atopy and laboratory animal allergy . Br J Ind Med . 1988;;45:667-671.
17 +
Cartier A, Malo J-L, Forest F, et al.  Occupational asthma in snow crab processing workers . J Allergy Clin Immunol . 1984;;74:261-269.
18 +
Venables KM.  Low molecular weight chemicals, hypersensitivity, and direct toxicity: the acid anhydrides . Br J Ind Med . 1989;;46:222-232.
19 +
Venables KM, Daily MB, Nunn AJ, et al.  Smoking and occupational allergy in workers in a platinum refinery . BMJ . 1989;;298:939-942.
20 +
Chan-Yeung M, Desjardins A.  Bronchial hyperresponsiveness and level of exposure in occupational asthma due to western red cedar (Thuja plicata): serial observations before and after development of symptoms . Am Rev Respir Dis . 1992;;146:1606-1607.
21 +
Liss GM, Kominsky JR, Gallagher JS, et al.  Failure of enzyme encapsulation to prevent sensitization of workers in the dry bleach industry . J Allergy Clin Immunol . 1984;;73:348-355.
22 +
Perrin B, Cartier A, Ghezzo H, et al.  Reassessment of the temporal patterns of bronchial obstruction after exposure to occupational sensitizing agents . J Allergy Clin Immunol . 1991;;87:630-639.
23 +
Bernstein DI, Gallagher JS, D'Souza L, Bernstein IL.  Heterogeneity of specific IgE responses in workers sensitized to acid anhydride compounds . J Allergy Clin Immunol . 1984;;74:794-801.
24 +
Patterson R, Zeiss CR, Pruzansky JJ.  Immunology and immunopathology of trimellitic anhydride pulmonary reactions . J Allergy Clin Immunol . 1982;;70:19-23.
25 +
Herd Z, Bernstein DI.  Antigen specific histamine releasing factors in diisocyanate induced occupational asthma . Am J Respir Crit Care Med . 1994;;150:988-994.
26 +
Lummus ZL, Alam R, Bernstein JA, Bernstein DI.  Characterization of histamine releasing factors in diisocyanate-induced occupational asthma . Toxicology . 1996;;111:191-206.
27 +
Maestrelli D, di Stafano A, Occari P, et al.  Cytokines in the airway mucosa of subjects with asthma induced by toluene diisocyanate . Am J Respir Crit Care Med . 1995;;151:607-612.
28 +
Siracusa A, Vecchiarelli A, Brugnami G, et al.  Changes in interleukin-1 and tumor necrosis factor production by peripheral blood monocytes after specific bronchoprovocation test in occupational asthma . Am Rev Respir Dis . 1992;;146:408-412.
29 +
Bignon JS, Aron Y, Ju LY.  HLA class II alleles in isocyanate-induced asthma . Am J Respir Crit Care Med . 1994;;149:71-75.
30 +
Young RP, Barker RD, Pile KD, et al.  The association of HLA-DR3 with specific IgE to inhaled acid anhydrides . Am J Respir Crit Care Med . 1995;;151:219-221.
31 +
Bentley AM, Maestrelli P, Saetta M, et al.  Activated T-lymphocytes and eosinophils in the bronchial mucosa in isocyanate-induced asthma . J Allergy Clin Immunol . 1992;;89:821-828.
32 +
Frew AJ, Chan H, Lam S, Chan-Yeung M.  Bronchial inflammation in occupational asthma due to western red cedar . Am J Respir Crit Care Med . 1995;;151:340-344.
33 +
Saetta M, Maestrelli P, Turato G, et al.  Airway wall remodeling after cessation of exposure to isocyanates in sensitized asthmatic subjects . Am J Respir Crit Care Med . 1995;;151:489-494.
34 +
Brooks SM, Bernstein IL.  RADS or irritant induced asthma . In: Bernstein IL, Chan-Yeung M, Malo J-L, et al, eds. Asthma in the Workplace . New York, NY: Marcel Dekker Inc; 1993;:533-549.
35 +
Brooks SM, Weiss MA, Bernstein IL, et al.  Reactive airways dysfunction syndrome (RADS): persistent asthma syndrome after high level irritant exposures . Chest . 1985;;88:376-384.
36 +
Gautrin D, Boulet LP, Boutet M, et al.  Is reactive airways dysfunction syndrome a variant of occupational asthma? J Allergy Clin Immunol . 1994;;93:12-22.
37 +
Chan-Yeung M, Maclean L, Paggiaro PL.  Follow-up study of 232 patients with occupational asthma caused by western red cedar (Thuja plicata) . J Allergy Clin Immunol . 1987;;79:792-796.
38 +
Moller DR, Brooks SM, McKay RT, et al.  Chronic asthma due to toluene diisocyanate . Chest . 1986;;90:494-499.
39 +
Merget R, Stollfuss J, Wiewrodt R, et al.  Diagnostic tests in enzyme allergy . J Allergy Clin Immunol . 1993;;92:264-277.
40 +
Malo J-L, Ghezzo H, L'Archeveque J, et al.  Is the clinical history a satisfactory means of diagnosing occupational asthma? Am Rev Respir Dis . 1991;;143:528-532.
41 +
Bernstein DI.  Clinical assessment and management of occupational asthma . In: Bernstein IL, Chang-Yeung M, Malo J-L, et al, eds. Asthma in the Workplace . New York, NY: Marcel Dekker Inc; 1993;:103-119.
42 +
Cockcroft DW, Murdock KY, Bersheid BA, Gore BP.  Sensitivity and specificity of histamine PC20 determination in a random selection of young college students . J Allergy Clin Immunol . 1992;;89:23.
43 +
Liss GR, Bernstein DI, Moller DR, et al.  Pulmonary and immunologic evaluation of foundry workers exposed to methylene diphenyldiisocyanate (MDI) . J Allergy Clin Immunol . 1988;;82:55-61.
44 +
Bernstein DI, Smith AB, Gallagher JL, et al.  Clinical and immunologic studies among egg processing workers with occupational asthma . J Allergy Clin Immunol . 1987;;80:791-797.
45 +
Moscato G, Godnic-Cvar J, Maestrelli P.  Statement on self-monitoring of peak expiratory flows in the investigation of occupational asthma: Subcommittee on Occupational Allergy of European Academy of Allergy and Clinical Immunology . J Allergy Clin Immunol . 1995;;96:295-301.
46 +
Smith AB, Bernstein DI, Aw TC, et al.  Occupational asthma from inhaled egg protein . Am J Ind Med . 1987;;12:205-218.
47 +
Quirce S, Contreras G, Dybuncio A, Chan-Yeung M.  Peak expiratory flow monitoring is not a reliable method for establishing the diagnosis of occupational asthma . Am J Respir Crit Care Med . 1995;;152:1100-1102.
48 +
Butcher BT, Karr RM, O'Neil CE, et al.  Inhalation challenge and pharmacologic studies of toluene diisocyanate (TDI) sensitive workers . J Allergy Clin Immunol . 1977;;64:146-152.
49 +
Pepys J.  Inhalation challenge tests in asthma . N Engl J Med . 1975;;192:758-759.
50 +
Cartier A, Bernstein IL, Burge PS, et al.  Guide-lines for bronchoprovocation on the investigation of occupational asthma . J Allergy Clin Immunol . 1990;;84:823-829.
51 +
Cartier A, Grammer L, Malo J-L, et al.  Specific serum antibodies against isocyanates: association with occupational asthma . J Allergy Clin Immunol . 1989;;84:507-514.
52 +
Burge PS.  Occupational asthma in electronics workers caused by colophony fumes: follow-up of affected workers . Thorax . 1982;;37:348-353.
53 +
Block G, Tse K, Kijek K, et al.  Baker's asthma: clinical and immunological studies . Clin Allergy . 1983;;13:359-370.
54 +
Klaustermeyer WB, Bardana EJ, Hale FC.  Pulmonary hypersensitivity to Alternaria and Aspergillus in baker's asthma . Clin Allergy . 1977;;7:227-233.
55 +
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To understand the clinical management of acute heart failure syndromes.
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BMJ 2010;341:c5893-c1494.
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