Burrow and McLarnon’s paper is a valuable review of a neglected hazard (Occup Env Med 2006;63:713–16); however, the following points deserve additional emphasis.

There is limited evidence that exposure to keratin nail dust can cause allergic conditions. Guinea pigs inhaling aerosolised nail dust produced IgE against Trichophyton rubrum and developed lung lesions similar to hypersensitivity pneumonitis.1 A high prevalence of wheeze has been reported in chiropodists.2 They also have precipitating antibodies to nail dust, raised IgE,3 and positive skin tests and IgE radioallergosorbent test (RAST) for T rubrum.1 The finding that 70% of nail dust particles were of less than 7 μm in diameter raises concerns of high deposition rates in the lung.4

Occupational infections arising from inhalation are relatively uncommon, but pulmonary tuberculosis, aspergillosis and ocular Chlamydia trachomatis have all …