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Medical surveillance and long-term prognosis of occupational allergy due to platinum salts

International Archives of Occupational and Environmental Health volume 90, pages 73–81 (2017)Cite this article

Abstract

Purpose

Medical surveillance of workers in precious metals refineries and catalyst production plants is well established in many countries as a measure to prevent occupational asthma due to platinum (Pt) salts. It was the aim of this study to evaluate the impact of medical surveillance and to define prognostic factors with an emphasis on exposure determinants.

Methods

As part of an observational longitudinal study, 96 workers from German precious metals refineries and catalyst production plants with Pt salt allergy underwent a second examination several years (median 67 months) after the initial diagnosis was made.

Results

When the second examination was conducted, 92 subjects (96 %) had already been transferred to jobs with very low or no exposure to Pt salts. The number of subjects with sensitization to Pt salt as assessed by skin prick test (SPTPt) decreased from 86 to 52 %, and there was a clear improvement for rhinitis, conjunctivitis and contact urticaria between both examinations. Although the number of subjects with asthma symptoms decreased significantly, at the second examination 74 subjects (77 %) continued to suffer from asthma and 51 subjects (53 %) received asthma medication. Airway obstruction or bronchial hyperresponsiveness persisted in 83 subjects (86 %).

Conclusions

Secondary prevention in subjects with occupational exposure to Pt salts, as practiced for over 25 years in Germany could not avoid persistent asthma in the majority of cases, although improvements occurred. This study reveals the limitations of the concept that removal from exposure after the occurrence of respiratory symptoms may prevent chronic asthma. It is recommended that removal from exposure should be done immediately after the occurrence of a positive SPTPt, irrespective of symptoms.

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Fig. 1

Abbreviations

CI:

Confidence interval

IgE:

Immunoglobulin E

FEV1 :

Forced expiratory volume in one second

IPA:

Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum

OA:

Occupational asthma

OR:

Odds ratio

Pt:

Platinum

SPT:

Skin prick test

sRt:

Specific airway resistance

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Acknowledgments

We thank the plant physicians and all the workers who agreed to participate in this study.

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Affiliations

  1. Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany

    Rolf Merget, Ngoc Pham, Maike Schmidtke, Swaantje Casjens, Vera van Kampen, Ingrid Sander, Olaf Hagemeyer, Kirsten Sucker, Monika Raulf & Thomas Brüning

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  1. Rolf Merget
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  2. Ngoc Pham
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  3. Maike Schmidtke
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  4. Swaantje Casjens
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  5. Vera van Kampen
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  6. Ingrid Sander
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  7. Olaf Hagemeyer
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  8. Kirsten Sucker
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  9. Monika Raulf
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  10. Thomas Brüning
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Correspondence to Rolf Merget.

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Merget, R., Pham, N., Schmidtke, M. et al. Medical surveillance and long-term prognosis of occupational allergy due to platinum salts. Int Arch Occup Environ Health 90, 73–81 (2017). https://doi.org/10.1007/s00420-016-1172-0

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  • DOI: https://doi.org/10.1007/s00420-016-1172-0

Keywords

  • Asthma
  • Exposure cessation
  • Platinum salts
  • Occupational
  • Prognosis
  • Surveillance