鸽-Occupational Asthma.pptVIP

Occupational Asthma Tee L. Guidotti The George Washington University Presentation of Occ Asthma Immediate hypersensitivity reaction Immediate bronchospasm Isolated late response (usually sensitizer-induced) Sleep disorder Variable/dual response Types of Occupational Asthma New Onset - Sensitizer-induced - Irritant induced Aggravation of underlying asthma Reactive airways dysfunction syndrome (RADS) Cold air- or exercise-induced syndrome Airways reactivity secondary to hypersensitivity pneumonitis Occupational Asthma Sensitizer-induced Specific antigen Minimal exposure Stereotyped response PPE often insufficient to control symptoms Medical removal usually necessary Irritant-induced Any irritant Moderate to heavy exposure Often variable PPE often effective in preventing episodes Medical removal the last resort Sensitizer-Induced Occ Asthma Sensitization to a specific antigen - low molecular-weight, “hapten” - high molecular weight Reaginic Ab, mostly IgE, mediated Presentation variable - late phase reactivity - immediate sensitivity - dual or variable responsiveness Sensitizer-Induced Asthma 2 Sensitization may occur at OEL Sensitizers may also be irritants (e.g. TDI,TMA) Prior history of atopy does not predict risk of asthma! Therefore no basis of exclusion of persons with allergies from workplace Common Sensitizers(Incomplete List!) Low MW Isocyanates Anhydrides Metal salts Epoxy resins Fluxes Persulfate Aldehydes High MW Pharmaceuticals Animal proteins Latex Cereals Seafood Proteolytic enzymes Wood constituents Irritant-Induced Occupational Asthma More common, clinically, than sensitizer-induced Often represents clinical expression of airways hyperactivity + irritant exposure May be induced by any irritating exposure Usually history of intolerance to second-hand tobacco smoke Some irritant exposures may also be sensitizing: CHO, TDI,TMA Classic example is “hot wire” asthma RADS Acute onset following exposure t