This consensus statement provides practical recommendations for specific inhalation challenge (SIC) in the diagnosis of occupational asthma. They are derived from a systematic literature search, a census of active European centres, a Delphi conference and expert consensus. This article details each step of a SIC, including safety requirements, techniques for delivering agents, and methods for assessing and interpreting bronchial responses. The limitations of the procedure are also discussed.Testing should only be carried out in hospitals where physicians and healthcare professionals have appropriate expertise. Tests should always include a control challenge, a gradual increase of exposure to the suspected agent, and close monitoring of the patient during the challenge and for at least 6 h afterwards. In expert centres, excessive reactions provoked by SIC are rare.A positive response is defined by a fall in forced expiratory volume in 1 s o15% from baseline. Equivocal reactions can sometimes be clarified by finding changes in nonspecific bronchial responsiveness, sputum eosinophils or exhaled nitric oxide. The sensitivity and specificity of SIC are high but not easily quantified, as the method is usually used as the reference standard for the diagnosis of occupational asthma. @ERSpublications ERS Task Force: a statement on specific inhalation challenges in the diagnosis of occupational asthma
Allergic contact dermatitis caused by to epoxy products cannot always be diagnosed by the use of commercial test substances. Workplace products need to be tested.
Commercial dental restorative materials were analysed in order to obtain information about the occurrence of sensitizing acrylates. Acetone-soluble methacrylates of 7 bonding materials, 8 composite resins and 2 glass ionomers were identified by gas chromatography with mass-selective detection and quantified by liquid chromatography with ultraviolet detection. The most frequently occurring methacrylates in the bonding materials were 2-hydroxyethyl methacrylate (2-HEMA) and 2,2-bis-[4-(2-hydroxy-3-methacryloxypropoxy)phenyl]-propane (bis-GMA). Bis-GMA and triethyleneglycol dimethacrylate were the most frequently occurring methacrylates in composite resins. The main methacrylate of the 2 glass ionomers was 2-HEMA or trimethylolpropane trimethacrylate. Information about methacrylates was given in the safety data sheets (SDSs) for about half of the products that according to the analysis results contained methacrylates. SDSs need to be improved so that the health risks for dental personnel can be reliably assessed and controlled.
Contact dermatitis is a common occupational health problem in metalworking machinists, whereas occupational respiratory disease is rare. Only a few specific chemicals in the metalworking have thus far been identified as respiratory allergens. Specific skin tests and inhalation challenge tests with MWFs and their ingredients are recommended if an OSD or a respiratory disease is suspected.
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