Article Text

Download PDFPDF
Exposure assessment should be integrated in studies on the prevention and management of occupational asthma
  1. Dick Heederik1,
  2. Frits van Rooy1,2
  1. 1
    Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, University Utrecht, The Netherlands
  2. 2
    Netherlands Expertise Centre for Occupational Respiratory Disorders, Utrecht, The Netherlands
  1. Dr D Heederik, Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, University Utrecht, PO Box 80198, 3508 TD, The Netherlands; d.j.j.heederik{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Evidence-based medicine (EBM) approaches have recently been applied to occupational asthma.1 2 The EBM document by Newman Taylor et al1 for occupational asthma evaluates, among other issues, the existence of exposure-response relations for sensitisation and asthma. The cited references indeed provide evidence that exposure-response curves exist for certain high molecular weight allergens. The risk for allergen-specific sensitisation and asthma increases steeply with increasing allergen exposure, especially in atopics.3 More sensitised individuals express respiratory symptoms at higher exposure than at low exposure.4 The time to development of allergy is shorter at higher exposures than at lower exposure.5

The question arises of what the implications of all these findings are with regard to primary prevention of allergic respiratory disease? Exposure-response relations suggest that lowering the exposure will reduce the burden of disease. Some direct evidence exists which illustrates that reduction of exposure leads to reduction of disease burden. Reduction of the exposure, by introducing powder-free gloves, led to a reduction in the number of sensitised and asthmatic workers.6 This conclusion is based on ecological evidence as well as longitudinal intervention studies. The effect of exposure reductions on sensitisation in more complex situations, with multiple determinants of exposure, is not as clearly established. Uncertainty exists as to whether the risk for developing enzyme-related sensitisation and asthma …

View Full Text


  • Competing interests: None declared.

Linked Articles

  • Commentary
    Paul Cullinan