Original Articles: Environmental and Occupational Disorders
Occupational asthma caused by natural rubber latex: Outcome according to cessation or reduction of exposure,☆☆

https://doi.org/10.1067/mai.2002.120760Get rights and content

Abstract

Background: The long-term effects of reducing exposure to latex in subjects with latex-induced asthma remain unknown. Objective: The purpose of this study was to compare the health and socioeconomic outcomes of subjects with latex-induced asthma before and after reduction or cessation of exposure to latex. Methods: Thirty-six subjects with latex-induced asthma as ascertained by specific inhalation challenges were investigated after a median follow-up of 56 months (range, 12 to 92 months). Initial and follow-up visits included use of a detailed questionnaire and measurement of the concentration of histamine causing a 20% fall in FEV1 (PC20). At follow-up, information on employment, financial status, and quality of life was collected. Results: At follow-up, 16 subjects were no longer exposed to latex, whereas 20 subjects had reduced exposure. In the subjects who avoided exposure, asthma severity decreased from a median score of 8.5 to 3.5 (P = .001) and the median histamine PC20 value increased from 0.4 mg/mL to 2.3 mg/mL (P = .002). In the subjects who reduced their exposure, asthma-severity score improved from 6.5 to 2.5 (P < .001) and PC20 values rose from 0.5 mg/mL to 2.4 mg/mL (P < .001). Cessation of exposure to latex was associated with asthma-related work disability (69%) and loss of income (62%) more frequently than was reduction of exposure (35% and 30%, respectively). Conclusion: Reduction of exposure to latex should be considered a reasonably safe alternative that is associated with fewer socioeconomic consequences than removal from exposure. (J Allergy Clin Immunol 2002;109:125-30.)

Section snippets

Subjects

The study included 36 subjects who met the following criteria: (1) a diagnosis of LOA had been confirmed by specific inhalation challenge with latex gloves; (2) an initial assessment of lung function tests within 48 hours of exposure to the causative workplace was available; (3) the subject had either completely avoided or markedly reduced exposure to airborne latex at follow-up; and (4) the duration of follow-up since the initial examination was at least 12 months. The subjects were initially

Baseline characteristics

The subjects who ceased exposure to latex did not differ from those with reduced exposure for most demographic features (Table I).

. Baseline demographic and clinical characteristics of the subjects

Empty CellCessation of latex exposure (n = 16)Reduction of latex exposure (n = 20)
Female sex: n (%)15 (94)17 (85)
Age* (y)32 (29-36)32 (30-35)
Occupation: n (%)
 Health care workers11 (69)19 (95)
 Non–health care workers5 (31)1 (5)
Smokers and exsmokers: n (%)2 (12)2 (10)
Positive skin test results to aeroallergens: n

Discussion

We found that in the subjects who reduced their exposure to latex, the improvement in asthma and rhinitis symptoms, as well as in the level of nonspecific bron-chial hyperresponsiveness, was similar to what was observed in the subjects who avoided exposure to latex. However, removal from exposure was associated with more pronounced work disability, income loss, and perceived impairment of professional and social activities. When compensation benefits were taken into account, the final income

Acknowledgements

We thank Lori Schubert for reviewing the manuscript.

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    Supported by the Services Fédéraux des Affaires Scientifiques, Techniques et Culturelles, Programme d’appui scientifique à la protection des travailleurs (grant SSTC PS/10/44).

    ☆☆

    Reprint requests: Olivier Vandenplas, MD, Service de Pneumologie, Cliniques Universitaires de Mont-Godinne, 5530 Yvoir, Belgium.

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