ASTHMA AND ALLERGIES

Prevention of Occupational Asthma: Introduction

What can I find on this Web site?

This site consists of two sections: a text primer on the prevention of OA and a set of query tables with details about the studies described in the primer.

The primer contains information distilled from 94 articles by 70 first authors, detailing 96 primary or secondary OA prevention activities, published from 1977- October 2003. It describes the current state of OA prevention work, and highlights gaps in research that need to be filled.

Since the first literature search in 2003, new articles are sought several times each year. By February 2012, there were 132 articles by 100 first authors, detailing 134 primary or secondary OA prevention activities.

The query tables allow a user to view the studies through several different filters. Users interested in intervention research can view the studies categorized by the level of prevention, either primary or secondary, or by the type of intervention activity used in the study. Users interested in a particular type of agent can view the studies by molecular weight ( high, low, both), by the category of the agent, or by the specific type of agent.

Who will benefit from this Web site?

This site can be used by a variety of individuals. It is designed to provide a background to the work being conducted in the field of OA prevention. It will give occupational health researchers the ability to quickly identify gaps in current knowledge, to judge which interventions appear most effective and which should be examined for their use in additional studies, and to find basic information on study designs used in research on the prevention of OA. Additionally, policymakers will be able to quickly prioritize prevention research goals.

Details on Studies in Query Tables

Intervention Activity

Activity	Number of studies
Comprehensive program	39
Education/Training	12
Medical screening	23
Medication	2
Not specified	3
Removal from exposure	67
Reduction in exposure	56

High-Molecular-Weight Agents

Category	Agent	Prevention Activity Type (N) Primary	Prevention Activity Type (N) Secondary
Animals		5	10
	Cow dander/hair allergen	0	4
	Crab	0	2
	Laboratory animal allergens	4	3
	Salmon	1	1

Baking allergens		1	2
	Baking allergens	1	1
	Fungal amylase	0	1

Biological enzyme		8	3
	Detergent enzyme	8	2
	Phytase	0	1

Mold
	Aspergillus niger	1	0

Plants		3	8
	Grain	0	1
	Latex	9	5
	Wheat, buckwheat	0	2
	Flour dust	2

Low-Molecular-Weight Agents

Category	Agent	Prevention Activity Type (N) Primary	Prevention Activity Type (N) Secondary
Anhydrides		1	11
	Hexahydro-phthalic anhydride (HHPA)	1	2
	Maleic anhydride	0	1
	Methyltetrahydrophthalic anhydride (MTHPA)	0	1
	Phthalic anhydride	0	1
	Pyromellitic dianhydride (PMDA)	0	1
	Tetracholaphthalic anhydride (TCPA)	0	2
	Trimellitic anhydride (TMA)	0	3

Other Chemicals		3	4
	Persulfate salts	0	2
	Ortho-phthaladehyde	1	1
	Reactive dye	0	1
	Sulfur dioxide	1	0
	Various	1	0

Diisocyanates		3	20
	Diphenylmethane diisocyanate (MDI)	3	2
	Hexamethylene diisocyanate (HDI)	0	1
	Isocyanates (unspecified)	0	3
	Napthylene diisocyanate (NDI)	0	1
	Toluene diisocyanate (TDI)	0	13

Fluxes
	Colophony	0	1

Metals		3	13
	Aluminum	3	7
	Chromium	0	1
	Cobalt	0	2
	Platinum	0	3

Wood dust or bark
	Red cedar (western)	0	5

Smoke
	Second hand smoke	1	1

Both Molecular Weights

Category	Agent	Prevention Activity Type (N) Primary	Prevention Activity Type (N) Secondary
Various		0	25
	N/A	0	21
	Flour, Latex, wood dust, isocyanates etc.	0	1
	Small particles of oil mist	0	1
	Indoor environmental quality (IEQ)		2

Review Articles and Editorials

The references in this section are editorials and review articles that provide summaries of findings from existing studies. They are included as another source of information about the prevention of work-related asthma.

Cowl CT. Occupational asthma: review of assessment, treatment, and compensation. Chest. 2011 Mar;139(3):674-81.

Dykewicz MS. Occupational asthma: current concepts in pathogenesis, diagnosis, and management. J Allergy Clin Immunol 2009;123:519-28.

Folletti I, Forcina A, Marabini A, Bussetti A, Siracusa A. Have the prevalence and incidence of occupational asthma and rhinitis because of laboratory animals declined in the last 25 years? Allergy. 2008 Jul; 63(7):834-41.

Gore JC, Schal C. Cockroach Allergen Biology and Mitigation in the Indoor Environment. Annu Rev Entomol. 2007; 52:439-63.

de Groene GJ, Pal TM, Beach J, Tarlo SM, Spreeuwers D, Frings-Dresen MH, Mattioli S, Verbeek JH. Workplace interventions for treatment of occupational asthma. Cochrane Database Syst Rev. 2011 May 11;5:CD006308.

Heederik D, Van Rooy F. Exposure assessment should be integrated in studies on the prevention and management of occupational asthma. Occup Environ Med. 2008 Mar; 65(3):149-50.

Hendrick DJ. Recognition and surveillance of occupational asthma: a preventable illness with missed opportunities. Br Med Bull. 2010;95:175-92.

Henneberger PK, Redlich CA, Callahan DB, Harber P, Lemière C, Martin J, Tarlo SM, Vandenplas O, Torén K. An official American Thoracic Society statement: work-exacerbated asthma. ATS Ad Hoc Committee on Work-Exacerbated Asthma. Am J Respir Crit Care Med. 2011 Aug 1;184(3):368-78.

Jeebhay MF, Quirce S. Occupational asthma in the developing and industrialised world: a review. Int J Tuberc Lung Dis 2007;11:122-33.

LaMontagne AD, Radi S, Elder DS, Abramson MJ, and Sim M. Primary prevention of latex related sensitisation and occupational asthma: a systematic review. Occup Environ Med 2006, 63:359–364.

Lee SM, Koh D. Lessons from an isocyanate tragedy. Singapore Med J. 2008 May; 49(5):372-5. Review. PMID: 18465044.

Maestrelli P, Saetta M. Recovery from adult-onset asthma and airway remodeling. Clin Exp Allergy. 2007 Dec;37(12):1733-5.

Malo JL, Chan-Yeung M. Asthma in the workplace: a Canadian contribution and perspective. Can Respir J. 2007 Oct; 14(7):407-13.

Moscato G, Pala G, Boillat MA, Folletti I, Gerth van Wijk R, Olgiati-Des Gouttes D, Perfetti L, Quirce S, Siracusa A, Walusiak-Skorupa J, Tarlo SM. EAACI position paper: prevention of work-related respiratory allergies among pre-apprentices or apprentices and young workers. Allergy. 2011 Sep;66(9):1164-73.

Pacheco KA, Tarlo SM. Work-related asthma: a case-based approach to management. Immunol Allergy Clin North Am. 2011 Nov;31(4):729-46.

Quint J, Beckett WS, Campleman SL, Sutton P, Prudhomme J, Flattery J, Harrison R, Cowan B, Kreutzer R. Primary prevention of occupational asthma: identifying and controlling exposures to asthma-causing agents. American Journal of Industrial Medicine. 2008; 51:477–491.

Redlich, CA. Lung/skin connections in occupational lung disease. Curr Opin Allergy Clin Immunol. 2008 Apr;8(2):115-9.

Smith AM.The epidemiology of work-related asthma. Immunol Allergy Clin North Am. 2011 Nov;31(4):663-75.

Smith AM, Bernstein DI. Management of work-related asthma. J Allergy Clin Immunol. 2009 Mar;123(3):551-7.

Tarlo SM, Liss GM.Prevention of occupational asthma. Curr Allergy Asthma Rep. 2010 Jul;10(4):278-86.

Tarlo SM, Balmes J, Balkissoon R, Beach J, Beckett W, Bernstein D, Blanc PD, Brooks SM, Cowl CT, Daroowalla F, Harber P, Lemiere C, Liss GM, Pacheco KA, Redlich CA, Rowe B, Heitzer J. Diagnosis and Management of Work-Related Asthma: American College of Chest Physicians Consensus Statement. Chest Sep 2008: 1S–41S. DOI 10.1378/chest.08-020.

Tarlo SM. Prevention of Occupational Asthma in Ontario. Can J Physiol Pharmacol. 2007 Jan; 85(1):167-72.

Vandenplas O. Reduction of exposure in the management of occupational asthma. Curr Opin Allergy Clin Immunol. 2011 Apr;11(2):75-9.

Vandenplas O, Dressel H, Wilken d, Jamart J, Heederik D, Maestrelli P, Sigsgaard T, Henneberger P, and Baur X. Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence. Eur Respir J 2011; 38:804-811.

Selected Links

The following links provide further guidance on the prevention of work-related asthma.

Disclaimer: Linking to a non-federal site does not constitute an endorsement by NIOSH or any of its employees of the sponsors or the information and products presented on the site.

Asthma: A Business Case for Employers and Health Care Purchasers. Polly Hoppin, ScD; Laurie Stillman, MMHS; Molly Jacobs, MPH. The Lowell Center for Sustainable Production, University of Massachusetts Lowell; and Asthma Regional Council. February 2010.

Summary – The Executive Summary begins with the following statement: “The purpose of this report is twofold: to revisit the robust body of evidence demonstrating positive health outcomes and economic benefits of comprehensive asthma programs, and to analyze its implications for employers.” The chapter “Promoting Best Practices for Asthma: Strategies and Recommendations” highlights three strategies for reducing the burden of asthma. Of particular interest for work-related asthma is Strategy #3 Ensuring Healthy Work Environments. The document recommends the following to accomplish Strategy #3: “Employers should consider two strategies to improve the quality of the work environment for asthma: a) Good housekeeping practices to minimize exposures to ubiquitous allergens and irritants. b) Workplace-specific measures to minimize exposures to asthmagens and asthma triggers, including adopting safer products and practices.” The document also encourages making appropriate accommodations for individual employees with asthma.