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Airway inflammation and ammonia exposure among female Palestinian hairdressers: a cross-sectional study
  1. Maysaa Nemer1,2,
  2. Liv I B Sikkeland3,
  3. Mayes Kasem4,
  4. Petter Kristensen2,5,
  5. Khaldoun Nijem1,
  6. Espen Bjertness2,
  7. Øivind Skare5,
  8. Berit Bakke4,
  9. Johny Kongerud3,6,
  10. Marit Skogstad5
  1. 1Occupational Epidemiology and Biological Research Lab, Department of Biology, Hebron University, Hebron, Palestine
  2. 2Section for Preventive Medicine and Epidemiology, Institute of Health and Society, University of Oslo, Oslo, Norway
  3. 3Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
  4. 4Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway
  5. 5Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
  6. 6Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  1. Correspondence to Maysaa Nemer, Occupational Epidemiology and Biological Research Lab, Department of Biology, Hebron University, P.O.Box 40, Hebron, Palestine; maysa.nemer{at}


Objectives Little is known about the working conditions and airway inflammation in hairdressers in Palestine. We aimed to investigate if hairdressers in Palestine have a higher level of airway inflammation as compared to a control group. We also assessed the hairdressers’ physical working conditions and exposure to ammonia gases at the hair salons. Lastly, we investigated the association between ammonia levels and inflammation markers in the airways and the blood.

Methods Our study participants were 33 non-smoking hairdressers (aged 19–50 years) and 35 non-smoking control subjects (aged 18–49 years). Both groups answered a questionnaire on respiratory symptoms, and performed lung function and exhaled nitric oxide (eNO) tests. Blood and sputum samples were collected from all participants and air concentration levels of ammonia were measured in 13 salons.

Results Hairdressers had a higher level of sputum neutrophil count (absolute numbers/mg sputum (median (25th–75th centiles)) compared to controls, 376 (183–980) and 182 (96–358), respectively. Hairdressers also had significantly elevated eNO and blood C reactive protein (CRP) levels compared to the control subjects, controlled for age and body mass index. Exposure measurements showed that the hairdressers in salons with scarce ventilation were exposed to ammonia concentration, ranging from 3 to 61 mg/m3.

Conclusions Compared to unexposed controls, the hairdressers had signs of neutrophilic airway inflammation, higher eNO levels and higher CRP. The hairdressers were exposed to high concentrations of ammonia from hairdressing chemicals and their working conditions were unsatisfactory.

  • Hairdressers
  • Occupational exposure
  • Sputum analysis
  • Exhaled nitric oxide

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