Article Text

Download PDFPDF
Original article
Long-term occupational outcomes of endotoxin exposure and the effect of exposure cessation
  1. Marit Skogstad1,
  2. Liv Ingunn Bjoner Sikkeland2,
  3. Reidun Øvstebø3,
  4. Kari Bente Foss Haug3,
  5. Kari Kulvik Heldal1,
  6. Øivind Skare4,5,
  7. Johny Kongerud2,6,
  8. Peter Kierulf3,
  9. Wijnand Eduard1
  1. 1National Institute of Occupational Health, Oslo, Norway
  2. 2Department of Respiratory Medicine, Faculty Division Rikshospitalet, University of Oslo, Oslo, Norway
  3. 3The R&D Group, Department of Medical Biochemistry, Oslo University Hospital, Ullevaal, Norway
  4. 4Norwegian Institute for Public Health, Oslo, Norway
  5. 5Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
  6. 6Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Norway
  1. Correspondence to Dr Marit Skogstad, National Institute of Occupational Health, PO Box 8149 Dep., N-0033 Oslo, Norway; marit.skogstad{at}


Objective To study the possible respiratory and haematological effects of endotoxin exposure to bacterial single-cell protein (BSCP) in workers during a follow-up period of 5 years including 4 years of exposure and 1 year without exposure.

Methods The study included 28 workers examined in 2002–2005 and 1 year after exposure termination in 2007. The arithmetic mean endotoxin exposure was 5800–11 000 EU/m3 among the high exposure group and 390 EU/m3 in the low exposure group. Assessment of lung function included spirometry and gas diffusion in 2003, 2004 and 2007. Rhinometry was performed in 2004 and 2007. Blood analysis included leukocyte cell count and measurement of the acute phase proteins: C-reactive protein, interleukin-6, eosinophilic cationic protein, macrophage inflammatory protein-1α, monocyte chemoattractant protein-1, chemoattractant protein RANTES, platelet-derived growth factor BB, fibrinogen and D-dimer.

Results In the low exposure group, but not in the high exposure group, there were significant improvements in both forced vital capacity (FVC) (290 ml) and forced expiratory volume in 1 s (FEV1) (180–210 ml) (p=0.004–0.03) 1 year after the end of exposure. The number of leukocytes and eosinophilic cationic protein and D-dimer levels increased significantly with increasing endotoxin exposures and decreased significantly 1 year after exposure termination. Changes in acute phase proteins suggested exposure-related tolerance.

Conclusions An inflammatory tendency during an exposure period of 4 years seems to reverse 1 year after cessation of exposure to endotoxins from a single species. Lung function improved significantly among workers exposed to low levels of endotoxin but not among the highly exposed workers.

  • Endotoxins
  • long-term
  • rhinometry
  • occupational exposure
  • lung function
  • inflammation
  • epidemiology
  • microbiology
  • respiratory
  • longitudinal studies

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.


  • Funding This study was supported financially by Statoil's 'Fund for Research in Occupational Medicine' and the Working Environment Fund, Confederation of Norwegian Enterprise, Oslo, Norway.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Regional Ethics Committees for Medical Research in both Trondheim and Oslo.

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