Interest Group on Occupational Allergy

Board Members
Chairman
Moscato Gianna
E-mail: gianna.moscato@fsm.it
Secretary
Raulf-Heimsoth Monika
E-mail: raulf@bgfa.de

1. Hot topics in Section’s or Interest Group’s area

1. Burden of occupational exposure in asthma
10-25% of cases of adult asthma is attributable to occupational factors, and a significant role of exposure to occupational asthmogens has also been found in severe adult-onset asthma. Since occupational exposure is a modifiable risk factor, prevention strategies in this field are mandatory.

2. Occupational Rhinitis (OR)
Available data indicate that OR is usually 2-4 times more prevalent than occupational asthma (OA), however the prevalence and incidence of OR in the general population have almost never been specifically investigated. Symptoms of rhinitis are common among subjects with OA, and, especially in subjects exposed to high-molecular weight agents, usually develop 6-12 months before symptoms of asthma, so that rhinitis is considered an early marker of OA. OR and OA share common etiologic agents, and a common inflammatory mechanism, thus it is postulated that the concept of “united airway disease” may also be applied to the occupational field. The impact of OR on OA deserves further evaluations.

3. Changing occupations and new agents related to OA
Recent epidemiological studies indicate that at present OA is more frequent in some occupations like cleaners which have never been considered in the past as at high risk for OA. Besides, other jobs like hairdressers and health workers are confirmed as at high risk of developing OA. Furthermore, the reports of the literature indicate a bulk of new agents able to provoke OA and OR. The mechanisms of action should be clarified.

4. Work Exacerbated Rhinitis (WER) and Work Exacerbated Asthma (WEA)
The burden of WER and WEA, i.e. pre-existing or concurrent (allergic or non-allergic) rhinitis or asthma that is worsened by workplace exposures, is not well known. Data indicate that WEA may represent 15% of all work-related asthma conditions, however further studied are needed to clarify the role of occupation on worsening of rhinitis or asthma.

5. Role of inflammation in diagnosis of OR and OA
The monitoring of nasal and bronchial inflammation in subject evaluated for OR and OA is relevant to the objective confirmation of diagnosis and should be included in the diagnostic pathway of these diseases.

6. Specific Challenge as the Gold Standard for diagnosis of OA and OR?
Specific bronchial provocation tests and nasal provocation tests are still considered the gold standard for confirming the diagnosis of OA and OR, respectively. However, these tests have several limitations, therefore alternative methods are proposed and are still under evaluation

7. Skin diseases and occupational allergic diseases
Atopic dermatitis (AD) affects from 2 up to 10% of adult people, and represents a risk factor for the development of contact dermatitis. Moreover, exposure to both chemical and physical agents at the workplace could worsen skin symptoms of patients with AD. The presence of AD may limit occupational choices in a large percentage of affected people, and cause job avoidance and job changing, particularly if hands are involved. The management of workers with AD should provide adequate professional advice. The relationship between skin exposure to occupational asthmogens and the onset of respiratory allergy is another topic of relevance in this field.

2. Related new books published within the last one year

Environmental Factors and Asthma; What We Learned from Epidemiological Studies. Immunology and Allergy Clinics of North America editor Dr Mark Eisner. 2008; vol 28 . This book has some interesting chapters, such a very good review on indoor mould and asthma.

3. Related current European/International projects

ERS Assembly/Group: Assembly 6: Occupation & Epidemiology / Group: 6.2 Occupational and Environmental Health. Evidence-Based Guideline for the Management of Work-Related Asthma.
Standard of diagnosis for occupational allergy – type I (STADOCA 1) with the focus on Skin Prick testing. A multi-centre study to standardize the diagnosis of occupational IgE-mediated allergies carried out in 9 European Countries coordinated by the Research Institute for Occupational Medicine of the Ruhr-University Bochum, Germany (BGFA).

4. Related Tips and Resources

a) A copy of the slides from the 3rd Jack Pepys Workshop on Work-related Asthma, from Montreal 2007 is available at the website www.asthma-workplace.com
b) Slide set on occupational asthma slide on the AAAAI website, developed by the AAAAI Occupational Disease Committee.
c) An algorithm for diagnosis of occupational Rhinitis had been developed by the ad hoc EAACI Task Force on Occupational Rhinitis. Position Paper. Allergy 2008; 63: 969-980 (Figure 1)

5. Related Upcoming events and postgraduate courses
An Occupational Disease issue including 8 review on the area co-edited by P. Maestrelli & S. Tarlo will be published in Current Opinion in Allergy and Clinical Immunology, Vol 8 no 2,.April 2009

6. Comments on the must read paper of the last 3-6 months

* Tarlo SM, Balmes J, Balkissoon R, Beach J, BeckettW, Bernstein D, Blanc PD, Brooks SM, Cowl CT, Daroowalla F, Harber P, Lemiere C, Liss GM, Pacheco KA, Redlich CA, Rowe B, Heitzer J. ACCP Consensus Statement: Diagnosis and Management of Work-related Asthma. Chest 2008; 134(suppl):1S–41S.
* Fishwick et Al. Standards of care for occupational asthma. British Thoracic Society Standards of Care Subcommittee Guidelines on Occupational Asthma. Thorax 2008; 63:240-250.
* EAACI Task Force on Occupational Rhinitis: Moscato G , Vandenplas O , Gerth Van Wijk R , Malo JL, Quirce S , Walusiak J, Castano R, De Groot H , Folletti I, Gautrin D, Yacoub MR , Perfetti L, Siracusa A. Occupational Rhinitis. Position Paper. Allergy 2008; 63: 969-980
* Crippa M, Balbiani L, Baruffini A, Belleri L, Draicchio F, Feltrin G, Larese F, Maggio GM, Marcer G, Micheloni GP, Montomoli L, Moscato G, Previdi M, Sartorelli P, Sossai D, Spatari G, Zanetti C. Consensus Document. Update on latex exposure and use of gloves in Italian health care settings. Med Lav. 2008 Sep-Oct;99(5):387-99
* Sastre B, Fernández-Nieto M, Mollá R, López E, Lahoz C, Sastre J, del Pozo V, Quirce S.Increased prostaglandin E2 levels in the airway of patients with eosinophilic bronchitis.Allergy. 2008 Jan;63(1):58-66. Epub 2007 Oct 24
* Swierczyñska-Machura D, Krakowiak A, Wiszniewska M, Dudek W, Walusiak J, Pa³czyñski C.Exhaled Nitric Oxide Levels After Specific Inahalatory Challenge Test in Subjects with Diagnosed Occupational Asthma.Int J Occup Med Environ Health. 2008 Oct 8:1-7.
* van Kampen V, Rabstein S, Sander I, Merget R, Brüning T, Broding HC, Keller C, Müsken H, Overlack A, Schultze-Werninghaus G, Walusiak J, Raulf-Heimsoth M.Prediction of challenge test results by flour-specific IgE and skin prick test in symptomatic bakers. Allergy. 2008 Jul;63(7):897-902.
* Malo JL, Newman Taylor A.Defining occupational asthma and confirming the diagnosis: what do experts suggest? Occup Environ Med. 2007 Jun;64(6):359-60.
* Cullinan P. Occupational asthma.Occup Environ Med. 2008 Mar;65(3):151.
* Nawrot TS, Alfaro-Moreno E, Nemery B. Update in occupational and environmental respiratory disease 2007.Am J Respir Crit Care Med. 2008 Apr 1;177(7):696-700. Review.
* Folletti I, Forcina A, Marabini A, Bussetti A, Siracusa A. Have the prevalence and incidence of occupational asthma and rhinitis because of laboratory animals declined in the last 25 years? Allergy. 2008 Jul;63(7):834-41. Review.
* Vandenplas O, D'Alpaos V, Van Brussel P. Rhinitis and its impact on work. Curr Opin Allergy Clin Immunol. 2008 Apr;8(2):145-9.
* Castano R, Gautrin D, Theriault G, Trudeau C, Ghezzo H, Malo JL. Occupational Rhinitis In Workers Investigated For Occupational Asthma. Thorax. 2008 Oct 3.

7. Important relevant research centers across Europe

1. Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College, 1b Manresa Road, London SW3 6LR, UK.
2. Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK.
3. Lung and Allergy Research, Institute of Environmental Medicine, Karolinska Institutet (KI), Stockholm, Sweden.
4. Service de Pneumologie, Cliniques de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium.
5. Occupational and Environmental Medicine, School of Public Health, KULeuven, Leuven, Belgium.
6. Occupational Allergology, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
7. Allergy and Immunology Unit, Fondazione "Salvatore Maugeri," Institute of Care and Research, Scientific Institute of Pavia, Pavia, Italy.
8. Department of Environmental Medicine and Public Health, University of Padova, Padova, Italy.
9. Hospital Universitario La Paz, Servicio de Alergia, P. Castellana, 261, 28046 Madrid, Spain.
10. Fundación Jiménez Díaz, Servicio de Alergia, Avda. Reyes Católicos, 2 - 28040 Madrid, Spain.
11. Research Institute of Occupational Medicine of the Berufsgenossenschaften (BGFA), Ruhr-University Bochum, Bochum, Germany.
12. Department of Occupational Diseases, Institute of Occupational Medicine, Lodz, Poland.
13. Département de Pneumologie, Hôpital Lyautey, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.

8. Task forces and other scientific activities

Task Force Occupational rhinitis
Coordinator: G. Moscato
Task Force. Noninvasive methods for assessment of airway inflammation in occupational settings
Coordinator: S. Quirce

Figure 1. Diagnostic algorithm of Occupational Rhinitis (from Ref Moscato et Al, Allergy 2008; 63: 969)