An ATS/ERS report: 100 key questions and needs in occupational asthma

Tarlo, Susan M.

doi:10.1183/09031936.06.00062105

Cited by 37 publications

(15 citation statements)

References 46 publications

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“…Although it is difficult to be certain, there are indications that in an occupational setting skin contact with chemical respiratory allergens may result in sensitisation of the respiratory tract, particularly in those circumstances where there is acute dermal exposure to high concentrations of chemicals resulting from accidental spillages or splashes. It is possible also that sensitisation of the respiratory tract is acquired from a combination of both skin and inhalation exposure (Karol, 1986;Nemery and Lenaerts, 1993;Kimber, 1996;Tarlo and Malo, 2006;Bello et al, 2007;Redlich and Herrick, 2008;Redlich, 2010).…”

Section: Routes Of Exposurementioning

confidence: 98%

Thresholds in chemical respiratory sensitisation

et al. 2015

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There is a continuing interest in determining whether it is possible to identify thresholds for chemical allergy. Here allergic sensitisation of the respiratory tract by chemicals is considered in this context. This is an important occupational health problem, being associated with rhinitis and asthma, and in addition provides toxicologists and risk assessors with a number of challenges. In common with all forms of allergic disease chemical respiratory allergy develops in two phases. In the first (induction) phase exposure to a chemical allergen (by an appropriate route of exposure) causes immunological priming and sensitisation of the respiratory tract. The second (elicitation) phase is triggered if a sensitised subject is exposed subsequently to the same chemical allergen via inhalation. A secondary immune response will be provoked in the respiratory tract resulting in inflammation and the signs and symptoms of a respiratory hypersensitivity reaction. In this article attention has focused on the identification of threshold values during the acquisition of sensitisation. Current mechanistic understanding of allergy is such that it can be assumed that the development of sensitisation (and also the elicitation of an allergic reaction) is a threshold phenomenon; there will be levels of exposure below which sensitisation will not be acquired. That is, all immune responses, including allergic sensitisation, have threshold requirement for the availability of antigen/allergen, below which a response will fail to develop. The issue addressed here is whether there are methods available or clinical/epidemiological data that permit the identification of such thresholds. This document reviews briefly relevant human studies of occupational asthma, and experimental models that have been developed (or are being developed) for the identification and characterisation of chemical respiratory allergens. The main conclusion drawn is that although there is evidence that the acquisition of sensitisation to chemical respiratory allergens is a dose-related phenomenon, and that thresholds exist, it is frequently difficult to define accurate numerical values for threshold exposure levels. Nevertheless, based on occupational exposure data it may sometimes be possible to derive levels of exposure in the workplace, which are safe. An additional observation is the lack currently of suitable experimental methods for both routine hazard characterisation and the measurement of thresholds, and that such methods are still some way off. Given the current trajectory of toxicology, and the move towards the use of non-animal in vitro and/or in silico) methods, there is a need to consider the development of alternative approaches for the identification and characterisation of respiratory sensitisation hazards, and for risk assessment.

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Section: Routes Of Exposurementioning

confidence: 98%

Thresholds in chemical respiratory sensitisation

et al. 2015

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“…For example, occupational exposures in hairdressers (with persulfate sensitization as a major cause, and other causes being paraphenyldiamine and henna) are commonly reported causes of OA in some countries but not in other countries. 44 It is speculated that geographical variations in reported asthma may be a result of variations in occupational exposures, differences in coexposures (allergens, pollutants, and susceptibility), or differences in recognition of exposures or relation of exposure to OA.…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

Occupational asthma: Current concepts in pathogenesis, diagnosis, and management

Dykewicz

2009

Journal of Allergy and Clinical Immunology

130

103

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“…Recent reviews identify some of the key issues 2,5 ; of particular relevance is a report that highlights 100 key questions and needs in OA. 6 Issues that frequently stimulate debate are the characteristics of immune responses induced by chemical respiratory allergens and the nature of the important immunologic effector mechanisms.…”

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confidence: 99%