An outbreak of asthma in a modern detergent factory

Cullinan, Paul; Jm, Harris; Aj, Taylor; Hole, A; Jones, Meinir; Barnes, Fiona; Jolliffe, G

doi:10.1016/s0140-6736(00)03264-5

Cited by 141 publications

(89 citation statements)

References 3 publications

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“…Fungi are also implicated in allergic disease, and as shown in this study and elsewhere (62,63), are potent sources of active protease. Intriguingly, occupational outbreaks of asthma are associated with the handling of bacterial-derived proteases used in the manufacture of detergent products, although it is not clear from these investigations which of several bacterial products were etiologic (64,65).…”

Section: Discussionmentioning

confidence: 99%

A Protease-Activated Pathway Underlying Th Cell Type 2 Activation and Allergic Lung Disease

Kheradmand

Kiss

et al. 2002

The Journal of Immunology

290

292

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The respiratory allergens that induce experimental Th cell type 2-dependent allergic lung inflammation may be grouped into two functional classes. One class of allergens, in this study termed type I, requires priming with adjuvants remote from the lung to overcome airway tolerogenic mechanisms that ordinarily preclude allergic responses to inhaled Ags. In contrast, the other, or type II, allergen class requires neither remote priming nor additional adjuvants to overcome airway tolerance and elicit robust allergic lung disease. In this study, we show in an experimental model that diverse type II allergens share in common proteolytic activity that is both necessary and sufficient for overcoming airway tolerance and induction of pulmonary allergic disease. Inactivated protease and protease-free Ag fragments showed no allergenic potency, demonstrating that only active protease acting on endogenous substrates was essential. Furthermore, induction of airway tolerance could be aborted and allergic lung disease established by simply adding purified protease to a type I allergen. Thus, exogenous proteases are common to type II allergens and may be generally required to overcome the innate resistance of the airway to Th cell type 2 activation and allergic inflammation, raising concern for their potential contribution to diseases such as asthma.

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Section: Discussionmentioning

confidence: 99%

A Protease-Activated Pathway Underlying Th Cell Type 2 Activation and Allergic Lung Disease

Kheradmand

Kiss

et al. 2002

The Journal of Immunology

290

292

View full text Add to dashboard Cite

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“…In workers exposed to enzymes, preventive measures have been found to reduce the onset of asthma (1859)(1860)(1861). The primary prevention of natural rubber latex allergy is still a matter of discussion although widely proposed (1435,1862).…”

Section: Occupational Agentsmentioning

confidence: 99%

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

Bousquet¹,

Khaltaev²,

Cruz³

et al. 2008

Allergy

3,859

1,761

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“…In addition, since the introduction of encapsulated enzymes, no cases of enzyme allergy attributable to the use of enzyme detergents have been reported among consumers. The risk does seem to persist in workers, however, as demonstrated by a recent outbreak of asthma in a modern detergent factory in northern Europe [85]. The factory had used only encapsulated enzymes (protease, cellulase and bacterial amylase) since starting production in the early 19909s, yet it experienced an outbreak of OA at least equal in magnitude to those experienced in the late 19609s.…”

Section: What Still Needs To Be Learntmentioning

confidence: 99%

Controversies in epidemiology of occupational asthma

Gautrin¹,

Aj²,

Nordman³

et al. 2003

Eur Respir J

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high-risk workplaces, medicolegal statistics and sentinel programmes indicate that y10% of adult-onset asthma is attributable to the workplace. The strategy to identify cases through questionnaires and tools that address functional, immunological and physiopathological issues needs to be improved.Although few in number and limited to a handful of workplaces, cohort studies found that the risk of developing occupational asthma is determined less by individual susceptibility (e.g. atopy, tobacco smoking, human leukocyte antigen phenotype) and more by the level of exposure to its causes; in general, the higher the exposure, the greater the risk, and, by implication, lowering the level of exposure reduces the incidence of disease.Occupational asthma can be used as a satisfactory model for the development of adult-onset asthma. There is a great need to develop intervention strategies through adequate surveillance programmes in high-risk workplaces. Eur Respir J 2003; 22: 551-559. Epidemiology of occupational asthma: general considerations on various study designs and methodological approachesEpidemiology is the study of the distribution, determinants and outcome of disease. In this article, the authors will describe recently acquired knowledge of the epidemiology of occupational asthma, as well as current areas of controversy.BECKLAKE et al.[1] have discussed the features, strengths and weaknesses of several designs used in epidemiological studies. These designs include the randomised control trial, the prospective cohort, the case-referent study, the crosssectional (prevalence) study and the case series. Which design to use in any particular situation is a matter of judgment, determined by a number of factors that may include resources, cost, collaboration of employers and employees, and the question under study. So far, primarily for practical convenience, most epidemiological studies of occupational asthma have been cross-sectional in type. As discussed in several reviews [1,2], this type of study, primarily in the case of occupational asthma (OA), suffers from survivor bias, whose magnitude can be difficult to quantify. Randomised control trials are usually not feasible and are probably unethical in workplace studies, but quasi-experimental studies can provide results of high internal and external validity. Prospective cohort studies are more expensive than cross-sectional studies but are more powerful and less likely to be affected by selection or survivor biases; in particular, it is often possible to track the participants who leave the cohort and determine the possible effect of attrition on the estimates of both the frequency of OA and exposure/effect relationships [3]. This type of study has recently been successfully applied in cohorts of young apprentices [4][5][6][7][8][9][10]. Some case-referent studies have been carried out in the field of OA [11,12]. These studies are valuable in identifying and quantifying risk factors. Finally, there are many case series that mainly describe clinical cases (often si...

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An outbreak of asthma in a modern detergent factory

Cited by 141 publications

References 3 publications

A Protease-Activated Pathway Underlying Th Cell Type 2 Activation and Allergic Lung Disease

A Protease-Activated Pathway Underlying Th Cell Type 2 Activation and Allergic Lung Disease

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008*

Controversies in epidemiology of occupational asthma

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