Original Articles: Environmental and Occupational Disorders
Effectiveness of a medical surveillance program for the prevention of occupational asthma caused by platinum salts: A nested case-control study

https://doi.org/10.1067/mai.2001.113564Get rights and content

Abstract

Background: Exposure reduction has proven to be effective in the prevention of occupational asthma. Few data are available on the effectiveness of secondary prevention programs, including medical examinations and removal of workers from exposure sources after detecting symptoms or signs indicative of a beginning disease. Objective: We sought to assess the effectiveness of a medical surveillance program in workers with exposure to platinum salts. Methods: A nested case-control study was performed in 14 workers of a catalyst production plant whose skin prick test (SPT) responses to platinum salt converted from negative to positive during a 5-year prospective cohort study with yearly medical examinations and 42 matched control subjects from the plant who did not experience SPT response conversion. With the exception of 2 subjects, the workers showing SPT response conversion were removed completely from exposure sources and followed for up to 42 months. Results: Work-related new symptoms were reported by 9 of the 14 subjects, and new symptoms without relation to work were reported by 3 subjects at the time of SPT response conversion. Symptoms were not accompanied by a change in FEV1 or bronchial responsiveness to histamine. Symptoms resolved after transferral, but occasional shortness of breath or wheeze persisted in 4 subjects. SPT reactions decreased or became negative in all workers after complete removal but remained unchanged in a craftsman with ongoing occasional exposure to contaminated materials. Conclusion: Although no randomized intervention was performed, this study proves the effectiveness of a medical surveillance program for the prevention of occupational asthma caused by platinum salts. (J Allergy Clin Immunol 2001;107:707-12.)

Section snippets

Methods

A total of 159 catalyst production workers, 50 craftsmen and 66 control subjects, were enrolled in a 5-year prospective cohort study.8 The present study was designed as a nested case-control study describing the course of symptoms, sensitization, total IgE, FEV1, and bronchial hyperresponsiveness of subjects with conversion of skin prick test (SPT) responses to platinum salt from negative to positive during the study period (n = 14) and control subjects without SPT conversion matched after

Results

Although maximal soluble platinum values in high exposure areas were above the current threshold limit value of 2 μg/m3, they were 90 pg/m3 (980 pg/m3 total platinum) in areas considered free from exposure to platinum.8 Thus removal resulted in an approximately 10,000-fold exposure reduction, with airborne platinum values being only marginally higher than reported values in the environment.10

Personal data, symptoms, and results of the initial survey did not differ between patients and control

Discussion

There is convincing evidence from a South African longitudinal study (in which workers with sensitization to platinum were not removed from contact with the substance until they demonstrated symptoms of asthma) that those without symptoms but with a positive SPT response to platinum salts will inevitably have symptoms of asthma at follow-up.11 In addition, exposed workers with work-related symptoms being referred to our department for diagnosis (thus later in the course of the disease)

Acknowledgements

We thank the workforce of Degussa Rheinfelden for participation and Mrs I. Santo (Rheinfelden), Mrs B. Aulbach (Frankfurt), and Mrs B. Schaerling (Bochum) for their excellent technical assistance.

References (14)

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Reprint requests: Rolf Merget, MD, BGFA, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.

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