Specific inhalation challenge: the relationship between response, clinical variables and lung function

Hu, Chunshao; Cruz, María Jesús; Ojanguren, Íñigo; Homdedeu, Miquel de; Barcala, Francisco Javier González; Muñoz, Xavier

doi:10.1136/oemed-2016-103806

Cited by 9 publications

(2 citation statements)

References 35 publications

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“…Most studies have been with IgE-mediated reactions in which pre-challenge nonspecific reactivity is greater in dual than immediate reactors, and the magnitude of the immediate reaction is a determinant of the subsequent late reaction [19]. A population similar to ours from Barcelona showed that workers exposed to high molecular weight agents had increased SIC reactions compared to workers exposed to low molecular weight agents, and that bronchial responsiveness pre-SIC was the major determinant of the dose needed to elicit a reaction [20]. In our study with predominantly low molecular weight agents (and only two out of 53 with IgE antibodies to high molecular weight antigens), we found that larger immediate reactions did not predispose to dual reactions; all responses were allowed to resolve spontaneously without extra treatment, removing rescue treatment during SIC as a confounding factor.…”

Section: Discussionsupporting

confidence: 52%

Do laboratory challenge tests for occupational asthma represent what happens in the workplace?

et al. 2018

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Specific inhalation challenge (SIC) is the diagnostic reference standard for occupational asthma; however, a positive test cannot be considered truly significant unless it can be reproduced by usual work exposures. We have compared the timing and responses during SIC in hospital to Oasys analysis of serial peak expiratory flow (PEF) during usual work exposures.All workers with a positive SIC to occupational agents between 2006 and 2015 were asked to measure PEF every 2 h from waking to sleeping for 4 weeks during usual occupational exposures. Responses were compared between the laboratory challenge and the real-world exposures at work.All 53 workers with positive SIC were included. 49 out of 53 had records suitable for Oasys analysis, 14 required more than one attempt and all confirmed occupational work-related changes in PEF. Immediate SIC reactors and deterioration within the first 2 h of starting work were significantly correlated with early recovery, and late SIC reactors and a delayed start to workplace deterioration were significantly correlated with delayed recovery. Dual SIC reactions had features of immediate or late SIC reactions at work rather than dual reactions.The concordance of timings of reactions during SIC and at work provides further validation for the clinical significance of each test.

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Section: Discussionsupporting

confidence: 52%

Do laboratory challenge tests for occupational asthma represent what happens in the workplace?

et al. 2018

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“…38,39 The authors argue that DMHS is primarily a mycotoxicosis. Evaluation of the SIC test [40][41][42][43] shows that it lacks safety considerations and a careful assessment by independent clinicians of medical ethics, and may cause possible long-term adverse effects and even iatrogenic damage. The future directions for diagnosing and treating HP with an incidence of 0.3-0.9 per 100,000, irrespective of its cause, were highlighted by Vasakova et al 44 Based on the presented arguments, the authors challenge current practices related to the interpretation of occupational DMHS.…”

Section: Discussionmentioning

confidence: 99%

Revising the Criteria for Occupational Mould-Related Disease: Arguments, Misconceptions, and Facts

Tuuminen

Lohi

2018

EMJ Allergy Immunol

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Occupational exposure to indoor air moulds and the consequent development of dampness and mould hypersensitivity syndrome (DMHS) may cause lung damage; in most cases, this is not allergic asthma mediated by specific immunoglobulin E-class antibodies. Instead, it is often a hypersensitivity pneumonitis or bronchopneumonitis. In Finland, the current diagnostic criteria for occupational DMHS have been adapted from knowledge of immunoglobulin E-mediated asthma; however, the safety of the methods used in occupational medicine have been insufficiently addressed in the literature. Accordingly, the aim of this paper is to raise awareness about the safety of current methods: specific inhalation challenge, workplace peak expiratory flow monitoring, and histamine provocation tests, by illustrating four cases. The medical records of these four cases with documented occupational DMHS were reviewed. The presented evidence suggests that the methods applied to study the occupational nature of lung damage are not suitable and the current ethics are questionable. The authors claim that, in particular, serial inhalation challenge with extracts from moulds, workplace serial peak expiratory flow leading to continuous exposure to mycotoxins, and histamine provocation tests may irreversibly damage the health of DMHS patients. Therefore, there is a prompt need to revise current practice guidelines to assess occupational DMHS. The guidelines should not be based on old dogmas, nor should they be influenced by insurance considerations. Instead, they should be based solely on medical evidence and, crucially, they should be safe for the patient and, therefore, should be implemented with caution.

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Berufsbedingtes Asthma

Ochmann¹,

Nowak²

2017

Pneumologe

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Specific inhalation challenge: the relationship between response, clinical variables and lung function

Abstract: The scale of the response to SIC is influenced mainly by the degree of bronchial hyper-responsiveness, regardless of whether the causative agent is HMW or LMW, or whether the response is early or late.

Cited by 9 publications

References 35 publications

Do laboratory challenge tests for occupational asthma represent what happens in the workplace?

Do laboratory challenge tests for occupational asthma represent what happens in the workplace?

Revising the Criteria for Occupational Mould-Related Disease: Arguments, Misconceptions, and Facts

Berufsbedingtes Asthma

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