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Allergens causing occupational asthma: an evidence-based evaluation of the literature

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International Archives of Occupational and Environmental Health Aims and scope Submit manuscript

Abstract

Purpose

The aim of this work is to provide an evidence-based evaluation and overview of causative substances in order to improve disease management.

Methods

We conducted a database search with MEDLINE via PubMed, screened reference lists of relevant reviews and matched our findings with a list of agents denoted as “may cause sensitisation by inhalation” by the phrase H334 (till 2011 R42). After exclusion of inappropriate publications, quality of the selected studies was rated with the Scottish Intercollegiate Guideline Network (SIGN) grading system. The evidence level for each causative agent was graded using the modified Royal College of General Practitioners (RCGP) three-star system.

Results

A total of 865 relevant papers were identified, which covered 372 different causes of allergic work-related asthma. The highest level achieved using the SIGN grading system was 2++ indicating a high-quality study with a very low risk of confounding or bias and a high probability of a causal relationship. According to the modified RCGP three-star grading system, the strongest evidence of association with an individual agent, profession or worksite (“***”) was found to be the co-exposure to various laboratory animals. An association with moderate evidence level (“**”) was obtained for α-amylase from Aspergillus oryzae, various enzymes from Bacillus subtilis, papain, bakery (flour, amylase, storage mites), western red cedar, latex, psyllium, farming (animals, cereal, hay, straw and storage mites), storage mites, rat, carmine, egg proteins, atlantic salmon, fishmeal, norway lobster, prawn, snow crab, seafood, trout and turbot, reactive dyes, toluene diisocyanates and platinum salts.

Conclusion

This work comprises the largest list of occupational agents and worksites causing allergic asthma. For the first time, these agents are assessed in an evidence-based manner. The identified respiratory allergic agents or worksites with at least moderate evidence for causing work-related asthma may help primary care physicians and occupational physicians in diagnostics and management of cases suffering from work-related asthma. Furthermore, this work may possibly provide a major contribution to prevention and may also initiate more detailed investigations for broadening and updating these evidence-based evaluations.

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Abbreviations

OA:

Occupational asthma

RADS:

Reactive airways dysfunction syndrome

RCGP:

Royal College of General Practitioners

SIGN:

Scottish Intercollegiate Guideline Network

WRA:

Work-related asthma

LFT:

Lung function tests

sPFT:

Serial lung function tests

SIC:

Specific inhalation challenge

NSBHR:

Non-specific bronchial hyperresponsiveness

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Institut für Arbeitsmedizin, Charite Universitätsmedizin Berlin, Thielallee 69, 14195, Berlin, Germany

    Xaver Baur

  2. Institut für Arbeitsmedizin und Maritime Medizin, Seewartenstr. 10, 20459, Hamburg, Germany

    Prudence Bakehe

Authors
  1. Xaver Baur
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  2. Prudence Bakehe
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Correspondence to Xaver Baur.

Additional information

Xaver Baur and Prudence Bakehe contributed equally to this work.

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Baur, X., Bakehe, P. Allergens causing occupational asthma: an evidence-based evaluation of the literature. Int Arch Occup Environ Health 87, 339–363 (2014). https://doi.org/10.1007/s00420-013-0866-9

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