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We read with interest the letter by Burge et al related to our publication on occupational exposure to irritants and asthma endotypes.1 Burge et al comment on the definition of irritants, an issue regularly discussed in the field of work-related asthma.2
A concern expressed by Burge et al is that the Occupational Asthma Job-Exposure Matrix (OAsJEM), used to evaluate exposure to irritant agents in our study, includes among the list of irritants some agents well-known as low molecular weight sensitisers, namely isocyanates, acrylates, epoxy resins and amines. We would like to take this opportunity to clarify some aspects of the OAsJEM. The OAsJEM, a revised version of the former asthma-specific JEM, evaluates exposure to 30 specific agents, classified in several large groups such as ‘high molecular weight’, ‘low molecular weight’ or ‘irritant’, based on a consensus from international experts, as described previously.3 Because for many agents, the exact mechanism(s) involved in occupational asthma still needs to be elucidated, the experts choose a sensitive classification approach to assign agents to large groups, considering sensitising or irritant potential according to most recent …
Contributors OD wrote the response letter and all the other coauthors revised it and gave their consent for submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.