OBJECTIVE--To measure the incidence of platinum salt sensitivity (PSS) in refinery workers and examine the influence of cigarette smoking and exposure to platinum salts on sensitisation. DESIGN--A prospective cohort study with examination of workers at quarterly intervals for 18 months, and again at 24 months. SETTING--A South African primary platinum refinery. SUBJECTS--78 new recruits, selected by the refinery's usual procedure, without apparent atopy and in good respiratory health. RESULTS--After 24 months 32 (41%) subjects had been diagnosed PSS and were subsequently medically separated. Twenty two (28%) cases were confirmed by positive skin prick test to platinum salts, 10 (13%) cases were symptomatic but skin prick negative. Incidence of cases per 100 person-months was 1.9 skin prick positive and 0.8 negative. Risk of sensitisation was about eight times greater for smokers than non-smokers, and six times greater for high exposure than low exposure. CONCLUSION--Smoking and intensity of exposure were definitely associated with development of PSS. Positive responses to platinum salt skin prick test had a 100% positive predictive value for symptoms and signs of PSS if exposure continued.
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