Environmental and Occupational DisordersOccupational asthma in symptomatic workers exposed to natural rubber latex: Evaluation of diagnostic procedures☆,☆☆
Section snippets
Subjects
The study included 45 consecutive patients who were referred for investigation of possible OA between 1993 and 1998, and who were exposed at work to airborne NRL allergens from NRL gloves. All patients underwent a standardized diagnostic assessment that included a medical and occupational questionnaire, skin prick tests (SPTs) with NRL, assessment of NSBH to histamine, and SIC.
Clinical history
The clinical history was collected by one physician (O.V.) using an open questionnaire, which included the following
Results
The baseline demographic and clinical features of the subjects are presented in Table I.
Empty Cell Positive SIC result with NRL gloves (n = 31) Negative SIC result with NRL gloves (n = 14) Sex, M/F 2/29 0/14 Age, y* 32 ± 5 37 ± 8† Occupation, n Nurse 22 7 Physician 4 0 Medical secretary 1 0 Laboratory technician 1 0 Housekeeper 0 5 Pharmaceutical worker 1 2 Glove manufacturer 1 0 Food processor 1 0 Claim to Worker’s Compensation Board, n (%) 12 (39) 7 (50) Smokers and
Discussion
Few studies have evaluated the reliability of questionnaires in the clinical assessment of OA. Malo et al8 examined the accuracy of an open medical questionnaire compared with the results of peak expiratory flow monitoring, SICs for various agents causing OA, or both. These authors found that the sensitivity and specificity of the clinical history were 87% and 22%, respectively. The positive predictive value of the clinical history was only 63%, whereas the negative predictive value was a more
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2009, Journal of Allergy and Clinical ImmunologyThe diagnosis and management of occupational asthma
2008, Revue des Maladies RespiratoiresDiagnosis and management of work-related asthma: American College of Chest Physicians consensus statement
2008, ChestCitation Excerpt :OA and rhinitis caused by HMW proteins in the work environment are associated with specific IgE antibody production. SPTs detect tissue-bound IgE antibodies, and are highly sensitive and specific for identifying a specific IgE antibody response to protein allergens.132,133 When the results are positive in a worker with a history of sensitizer-induced OA and documented asthma, a positive SPT response to an allergen that is present at work helps to identify a suspected cause and supports a diagnosis of sensitizer-induced OA.
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Supported in part by the Programme d’appui scientifique à la protection des travailleurs, Services fédéraux des affaires scientifiques, techniques et culturelles (grant SSTC PS/10/44).
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Reprint requests: Olivier Vandenplas, MD, Service de Pneumologie, Cliniques universitaires de Mont-Godinne, 5530 Yvoir, Belgium.