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Detergent protease exposure and respiratory disease: case–referent analysis of a retrospective cohort
  1. A Brant1,
  2. S Upchurch1,
  3. M van Tongeren2,
  4. C Zekveld1,
  5. J Helm1,
  6. F Barnes1,
  7. A J Newman Taylor1,
  8. P Cullinan1
  1. 1
    Department of Occupational and Environmental Medicine, Imperial College (NHLI) and Royal Brompton Hospital, London, UK
  2. 2
    Institute of Occupational Medicine, Edinburgh, UK
  1. Correspondence to Paul Cullinan, Department of Occupational and Environmental Medicine, 1b Manresa Road, London SW3 6LR, UK; p.cullinan{at}


Objectives: To examine the relationship between protease exposure and respiratory disease in a cohort of detergent enzyme manufacturers.

Methods: Case–referent analysis of a cohort of employees working in a European detergent factory between 1989 and 2002. Cases with new lower or upper respiratory disease were ascertained by examination of occupational health records and matched to referents on date of first employment. Personal exposures to airborne detergent protease were estimated, using a job exposure matrix, from >12 000 measurements taken in the factory during the period of study.

Results: We found clear, monotonic relationships between estimated protease exposure and both lower and upper respiratory disease. After control for age, sex and smoking, the odds ratio of lower respiratory disease was significantly elevated (1.98, 95% CI 1.04 to 3.79) in those employees working in jobs in the highest quartile of protease exposure (geometric mean 7.9 ng.m−3). For employees with upper respiratory disease, the risk was significantly elevated at a lower level of estimated protease exposure (geometric mean 2.3 ng.m−3).

Conclusions: These findings provide strong evidence of an association between detergent enzyme exposure and the development of respiratory disease in an occupational setting. Using the routinely collected information on specific sensitisation and the close attention to workplace exposures that are characteristic of this industry, it should be possible to derive meaningful occupational exposure standards for most detergent enzymes.

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  • Funding Funding for the study was provided by the British Occupational Health Research Foundation (BOHRF) who had no involvement in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

  • Competing interests FB and JH are employed in the detergent manufacturing sector but do not have any financial interests in the findings of this study. The remaining authors do not have competing interests.

  • Ethics approval Approval for the study was provided by the Ethics Committee of Royal Brompton and Harefield Hospital NHS Trust (#02-129).

  • Provenance and peer review Not commissioned; externally peer reviewed.