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Response to Dr. Reich's letter: "'Sarcoid-like' granulomatous pulmonary disease in World Trade Center disaster responders: influence of incidence computation methodology in inferring airborne dust causation."
Crowley LE; Herbert R; Moline JM; Wallenstein S; Shukla G; Schechter C; Skloot GS; Udasin I; Luft BJ; Harrison D; Shapiro M; Wong K; Sacks HS; Teirstein AS; Landrigan PJ
Am J Ind Med 2011 Nov; 54(11):894-895
This letter to the editor is in response to Dr. Reich attempts to discount our finding of increased "Sarcoid-like" granulomatous disease in World Trade Center responders, a pattern of disease that peaked 2-3 years after the attacks of September 11, 2001 and then resolved. He argues that our observation reflects a combination of ascertainment bias and accrual of previously unrecognized cases [Reich, 2011].We disagree with his conclusions for the following six reasons: 1. Our findings are biologically plausible; 2. Our findings parallel those observed in two other cohorts exposed to airborne dust and smoke in New York City after the September 11 attacks; 3. Our diagnostic approaches are closely similar to those employed in previous studies that have sought to ascertain population prevalence of sarcoidosis, in that most of our cases were identified through population-based chest radiographic screening during initial or follow-up examination; 4. Selection bias appears unlikely to account for our findings and even less likely to account for the peak in occurrence of sarcoidosis that we observed 2-3 years after the attacks; 5. Inclusion of previously diagnosed cases of sarcoidosis in our series is not likely; and 6. Ethnic and gender bias provide an unlikely explanation for our findings.
Emergency-responders; Fire-fighters; Medical-monitoring; Medical-rescue-services; Paramedical-services; Psychological-effects; Psychological-reactions; Pulmonary-disorders; Pulmonary-system-disorders; Quantitative-analysis; Respiratory-infections; Respiratory-irritants; Respiratory-system-disorders; Statistical-analysis; Surveillance-programs
Laura E. Crowley, MD, The Mount Sinai Medical Center, P.O. Box 1057, One Gustave L. Levy Place, New York, NY 10029
Cooperative-Agreement-Number-U10-OH-008232; Cooperative-Agreement-Number-U10-OH-008225; Cooperative-Agreement-Number-U10-OH-008239; Cooperative-Agreement-Number-U10-OH-008275; Cooperative-Agreement-Number-U10-OH-008216; Cooperative-Agreement-Number-U10-OH-008223; Contract-200-2011-39377; Contract-200-2011-39356
Issue of Publication
American Journal of Industrial Medicine
Mount Sinai School of Medicine - New York
Page last reviewed: May 15, 2020
Content source: National Institute for Occupational Safety and Health Education and Information Division