Journal Articles
Journal Articles
Milton DK, Solomon GM, Rosiello RA, Risk and incidence of asthma attributable to occupational exposure among HMO members. Am J Ind Med 1997; 33:1-10.
Occupational asthma attributable to occupational exposure is far more common than previously reported and accounts for a sizable proportion of adult-onset asthma, according to this research from the Harvard School of Public Health in Boston.
The researchers conducted a prospective cohort study of 79,204 health maintenance organization members between the ages of 15 and 55, who were at risk for asthma. Overall, the annual incidence of clinically significant, new-onset asthma was 1.3 per 1,000 workers, increasing to 3.7 per 1,000 workers when including the reactivation of previously quiescent asthma.
Of that number, 21% met the criteria for attributing the asthma onset to occupational exposure. That means the incidence of occupational-related asthma is 71 per 100,000 workers. Evidence for asthma attributable to occupational exposure was determined from work-related symptoms and workplace exposure.
Ask work-related questions
Physicians may not be asking about work-related symptoms often enough, according to the researchers. In this study, the doctors documented physicians' questions about work-related symptoms in only 15% of the charts. They recorded suggestive symptoms in three cases, but they did not obtain occupational medicine consultations, diagnose occupational asthma, report the case to the state surveillance system, or bill workers' compensation for those cases.
In at least one case, the asthma clearly was occupational because it involved a carpenter with heavy exposure to red cedar dust, a known cause of occupational asthma.
The researchers advise physicians to be more suspicious of work-related factors when diagnosing adult-onset asthma.
Baur X, Huber H, Degens PO, Relation between occupational asthma case history, bronchial methacholine challenge, and specific challenge tests in patients with suspected occupational asthma. Amer J Ind Med 1998; 33:114-122.
A negative methacholine challenge (MC) test result can almost rule out a positive specific challenge test result in patients suspected with occupational asthma, reducing the need to perform the more laborious specific challenge test. That's the conclusion of German researchers who studied the different methods of diagnosing occupational asthma.
They performed inhalative MC in 229 patients presumed to suffer occupational asthma due to exposure to airborne latex allergens, flour, isocyanates, or irritants in hairdressers' salons. The patients also were subjected to specific challenges with the occupational agents they were exposed to. The researchers personally administered questionnaires and conducted interviews.
Bronchial hyperresponsiveness in MC was defined with a threshold cumulative MC dose of 0.3 mg. In 40% to 72% of the patients, workplace-related asthma complaints occurred with bronchial hyperreactivity in the MC ranging from 48% to 61%. But only 12% to 25% of the patients demonstrated a significant bronchoconstructive reaction in the specific challenge test.
The researchers note that MC results are only moderately associated with workplace-related asthma case histories, while positive outcomes of challenges with occupational agents are well correlated with positive MC results plus occupational asthma case histories.
"We conclude that in most cases, occupational asthma . . . is combined with bronchial hyperresponsiveness and workplace-related asthmatic symptoms," the researchers say. "However, subjects of each exposure group demonstrated bronchial hyperresponsiveness and complained of workplace-related asthmatic symptoms, but occupational asthma could not be proved in the specific challenge test."
Anibarro B, Fontela JL, De La Hoz F. Occupational asthma induced by garlic dust. J Allergy Clin Immunol 1997; 100:734-738.
Garlic-induced occupational allergy is a relatively rare problem but seems to affect young people with pollen allergy, and sensitization to other members of the Liliaceae family also is common with these patients. These researchers from Madrid, Spain, suggest that occupational health professionals watch for symptoms of occupational asthma in workers exposed to garlic dust, as well as onions, leeks, and asparagus.
Garlic is known to be a potent contact allergen, causing contact dermatitis among professional cooks or others handling garlic bulbs, but it has not previously been considered a common cause of immunoglobulin E-mediated disease. In this report, the authors discuss the cases of 12 patients with rhinitis and asthma in whom garlic occupational allergy was suspected. Nine patients worked as harvesters in garlic fields, 10 worked in garlic storage facilities, and five worked in spice-manufacturing factories.
Skin prick tests with commercial extracts of garlic, onion, leek, and asparagus were negative in all but one patient who was extremely sensitive to garlic. However, the skin test responses using garlic dust and fresh bulbs were positive in seven of the 12 patients. Skin test responses were positive - four patients with onion and asparagus and in three patients with leek. Skin prick tests to commercial extracts of onion, leek, and asparagus were all negative.
"The diagnosis of garlic-induced occupational allergy should be based on a detailed medical history, on in vivo and in vitro demonstration of specific IgE, and on challenge test results," the researchers write.
"In our experience, commercial garlic extracts are not useful. Positive [skin prick test] responses to appropriate garlic extracts, dust, or fresh samples, seem much more specific and correlate with the presence of specific IgE. However, the gold standard for specific diagnosis remains the inhalation provocation test."
Leigh JP, Miller TM. Ranking occupations based upon the costs of job-related injuries and diseases. J Occup Environ Med 1997; 40:1,170-1,179.
Timber cutting and logging operations top the list of occupations with the highest costs for job-related injuries and diseases, according to these researchers. The data are drawn from large nationally representative data sets, using information on occupation categories and workers' compensation costs.
The researchers describe the per-worker cost of job-related injuries and illnesses for six broad categories and 223 specific occupations. "Operators and laborers" is the broad category responsible for the highest total and average cost. Some specific occupations that contributed the most to total costs include truck drivers, nonconstruction laborers, machine operators, janitors, nursing orderlies, construction laborers, assemblers, retail workers, carpenters, mechanics, press apprentices, welders, stone cutters, and warehouse workers.
Secretaries, RNs in high-cost group
Cost and injury data are broken down in several different ways, providing different lists of high-injury and high-cost workers. Among white collar workers, for instance, the highest costs are associated with retail sales workers, managers and administrators, sales supervisors, registered nurses, shipping and receiving clerks, secretaries, teachers, and licensed practical nurses.
Information on the relative costs of injuries among different employee groups can be useful when determining the need for occupational health services with particular employers, the researchers suggest.
Gunnarsdottir H, Aspelund T, Karlsson T, Occupational risk factors for breast cancer among nurses. Int J Occ and Envir Health 1997; 3:254-258.
Handling cytotoxic drugs and working in pediatric wards appear to be associated with a higher risk of breast cancer among nurses, though the researchers in this study express some hesitancy to declare their findings indicative of actual occupational risks.
The research was conducted by comparing the records of 2,159 female Icelandic nurses to the files of the Icelandic Cancer Registry. After accounting for working in different wards, the highest odds ratios (OR) for breast cancer were found among nurses handling cytotoxic drugs (an OR of 1.65) and nurses working in pediatrics (an OR of 1.47).
The lowest OR, 0.44, was found among nurses working in primary health. While the odds ratios might seem to indicate that cytotoxic drugs and pediatrics increase a nurse's chance of getting breast cancer, the researchers say that is not necessarily the case.
"It came as a surprise to us that specialization in pediatric, psychiatric, general (surgical and medical), geriatric and primary care nursing, and in `other kinds of nursing' gave higher ORs than specialization in intensive care, cancer, X-ray, operating room, and anesthesia nursing, which had been expected to involve hazards," the researchers write. "The elevated ORs among the nurses who had handled cytotoxic drugs indicate possible occupational hazards connected with these substances.
"As to specialization in pediatric nursing or having worked in pediatric wards, we would like to point out that those who work in pediatric wards are likely to be exposed to various children's diseases. Whether this is important for the etiology of breast cancer among adult nurses is uncertain, and we are not aware of any studies indicating this.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.