Background: Reports on hypersensitivity reactions to azithromycin associated with therapy or occupational exposure have been rare.
Objectives: A case series describing clinical characteristics, ...diagnostic pathways and risk factors in occupational allergic contact dermatitis (ACD) caused by azithromycin in pharmaceutical workers is presented.
Patients/Methods: 7 out of 21 pharmaceutical workers exposed to powdered intermediate and final substances in azithromycin synthesis were referred with workplace‐related skin and respiratory symptoms. They all underwent diagnostic procedure involving medical history and examination, patch testing with standard allergens and azithromycin, prick testing with inhalatory allergens and total immunoglobulin E measurement.
Results: Airborne ACD caused by azithromycin was established in 4 examined workers with positive patch test to azithromycin. 2 workers additionally had positive patch test to intermediate substances. Occupation‐related symptoms of urticaria, rhinoconjunctivitis, laryngitis and/or dyspnoea were described in additional 2 workers without clearly positive patch test to azithromycin. 2 atopic workers had a shorter asymptomatic period between the beginning of the exposure to azithromycin and occurrence of skin symptoms than non‐atopics (2–3 months versus 1–3 years, respectively).
Conclusions: Our results suggest that daily manipulation with powdered azithromycin and intermediates is a main route of sensitization. Besides contact sensitization, other possible workplace‐related azithromycin hypersensitivity reactions are indicated.
Pyroglyphid mites are primarily associated with allergen exposure at home; hence the name house dust mites. However, we have found numerous studies reporting pyroglyhid mite levels in public and ...occupational settings. This review presents the findings of house dust mite allergens (family Pyroglyphidae, species Dermatophagoides) as potential work-related risk factors and proposes occupations at risk of house dust mite-related diseases. Pyroglyphid mites or their allergens are found in various workplaces, but clinically relevant exposures have been observed in hotels, cinemas, schools, day-care centres, libraries, public transportation (buses, trains, taxies, and airplanes), fishing-boats, submarines, poultry farms, and churches. Here we propose a classification of occupational risk as low (occasional exposure to mite allergen levels up to 2 μg g-1), moderate (exposure between 2 μg g-1 and 10 μg g-1), and high (exposure >10 μg g-1). The classification of risk should include factors relevant for indoor mite population (climate, building characteristics, and cleaning schedule). To avoid development or aggravation of allergies associated with exposure to house dust mites at work, occupational physicians should assess exposure risk at work, propose proper protection, provide vocational guidance to persons at risk and conduct pre-employment and periodic examinations to diagnose new allergy cases. Protection at work should aim to control dust mite levels at work. Measures may include proper interior design and regular cleaning and building maintenance.
Piroglifidne grinje smatraju se prvenstveno izvorom alergena u našim domovima. Postoji, međutim, sve više studija koje upućuju na izloženost piroglifidnim grinjama u javnim i radnim prostorima. Cilj je ovog pregleda prikazati alergene piroglifidnih grinja kao potencijalne štetnosti vezane uz radna mjesta i utvrditi rizična zanimanja za pojavu i progresiju bolesti uzrokovanih piroglifidnim grinjama. Iz baze PubMed izdvojene su studije koje su istraživale izloženost piroglifidnim grinjama (porodica Pyroglyphidae, rod Dermatophagoides) u različitim javnim i radnim prostorima. Piroglifidne grinje ili njihovi alergeni pronađeni su na različitim radnim mjestima, ali klinički značajne izloženosti zabilježene su u hotelima, kinima, školama, vrtićima, knjižnicama, vozilima (autobusima, vlakovima, taksi-vozilima), avionima, ribarskim brodovima, podmornicama, peradarnicima i crkvama. Predloženo je stupnjevanje rizika na radnim mjestima sa značajnom izloženosti alergenima piroglifidnih grinja kao niskog (povremena izloženost razinama >2 μg g-1), umjerenog (izloženost pretežno između 2 μg g-1 i 10 μg g-1) i visokog rizika (izloženost pretežno >10 μg g-1). Pri procjeni razine rizika treba uvijek uzeti u obzir čimbenike koji značajno utječu na populaciju grinja (klimatska regija, karakteristike zgrade, način čišćenja). Specijalisti medicine rada trebali bi razmotriti moguću profesionalnu izloženost piroglifidnim grinjama pri procjeni opasnosti za radna mjesta i provedbi mjera zaštite na radu, pri profesionalnoj orijentaciji, prethodnim i periodskim pregledima te dijagnostici bolesti vezanih uz rad, u svrhu prevencije pojave ili pogoršanja alergijskih bolesti uzrokovanih piroglifidnim grinjama. Mjere zaštite na radu trebaju biti usmjerene kontroli populacije grinja na radnom mjestu, uključujući odgovarajuće uređenje interijera, te redovito čišćenje i održavanje zgrade.
Alergotoksikologija je znanstvenoistraživačko područje koje se bavi ispitivanjem utjecaja polutanata (onečišćivača zraka) na nastanak alergijskih reakcija i bolesti. Ispitivanja su prvobitno bila ...usmjerena na polutante vanjskih prostora, a u novije vrijeme sve više na polutante unutarnjih prostora u kojima ljudi provode većinu vremena. Polutanti po svojoj prirodi mogu biti krute, tekuće ili plinovite čestice, koje se razlikuju s obzirom na veličinu, sastav i izvor iz kojeg nastaju. S obzirom na izvor mogu biti biološkog i
nebiološkog podrijetla. Polutanti koji su predmet suvremenih istraživanja s gledišta nastanka alergijskih bolesti su respirabilne krute čestice, ozon, dušični oksidi i bioaerosoli. Mehanizam djelovanja polutanata ovisi o veličini čestica, njihovoj topljivosti i mjestu ulaska u organizam. Dosadašnja ispitivanja su pokazala
da različite čestice uvjetuju različite imunosne i neimunosne odgovore u organizmu. Interakcija polutanata i alergena može se zbivati izvan eksponirane osobe, tj. sa samim alergenom ili u eksponiranoj osobi na sluznicama i koži. Polutanti mogu biti nosioci alergena i mogu interferirati na različitim nivoima u nastanku alergijske reakcije. U ovom prikazu razma raju se dosadašnja saznanja o mehanizmima djelovanja polutanata na alergene, na imunosni sustav izloženih osoba na osnovi epidemioloških populacijskih istraživanja, kliničkih studija ekspozcije u kontroliranim uvjetima i eksperimentalnih testnih sistema in vivo i in vitro.
The association of age, smoking, alcohol, superoxide dismutase (SOD), glutathione peroxidase (GPx), blood lead (BPb) and cadmium (BCd) levels, and serum levels of copper (SCu), zinc (SZn) and ...selenium (SSe) with atopic status and ventilatory function was examined in the groups of 166 women and 50 men with no occupational exposure to metals or other xenobiotics. Markers of atopy included serum total IgE, skin prick test (SPT) to common inhalatory allergens, non-specific nasal reactivity (NNR) and non-specific bronchial reactivity (NBR). Parameters of ventilatory function included forced vital capacity (FVC) and forced expiratory volume in the first second (FEV
1). Significantly higher BPb, SZn, IgE and prevalence of positive SPT, and lower SCu and NNR was found in men than in women. Fifteen women taking female sex hormones (HT) had significantly higher SCu than women without HT. Regression models showed significant inverse associations between IgE and SCu (
P
=
0.021) and NNR and SCu (
P
=
0.044) in women. When excluding women with HT, the association of SCu and total IgE became of borderline significance (
P
=
0.051), association between SCu and NNR disappeared, and significant positive association between total IgE and BPb emerged (
P
=
0.046). In men, significant inverse association was found between positive SPT and SSe, and between NBR and SSe. A decrease in FVC% and FEV
1% was associated with an increase in smoking intensity (
P
<
0.001) and a decrease in SZn (
P
=
0.043 and
P
=
0.053, respectively). These results were observed at the levels of the metals comparable to those in general populations worldwide. The observed differences between men and women may partly be explained by different levels of relevant toxic and essential metals, and their combination. The role of female HT in associations of atopy markers and SCu should be further investigated.
The objective of this study was to examine induced sputum (IS) cells profile from restorers/conservators of cultural heritage (restorers) with no lower airway symptoms and normal ventilatory lung ...function. The study involved 22 restorers and 48 control workers. Medical interview, physical examination, spirometry, skin prick testing to inhalatory allergens, and IS collection were performed. Compared with control workers, restorers demonstrated higher percentage of neutrophils (34% vs 15.5%; p = .004). This pattern was found only in male workers. They had almost 9 times greater chance to have increased proportion of sputum neutrophils than male controls (odds ratio OR 8.98, 95% confidence interval CI 1.98-40.7). The mobilization of eosinophils or macrophages into the airways was not established regardless of workers sex. Additional gender difference in sputum cells distribution was found for occupationally unexposed subjects, with higher proportion of sputum neutrophils in women.
To identify pollen types in southern Croatia and investigate the impact of sensitization to Ambrosia elatior (A. elatior) on symptoms and treatment of patients with seasonal allergic rhinitis and/or ...asthma.
The study recruited 120 patients from Split-Dalmatian County with seasonal rhinitis and asthma symptoms and positive skin prick test to one or more common inhaled allergens. Patients with positive skin prick test and increased specific IgE to A. elatior (n=56) were included in the follow-up study during the A. elatior pollen season. Rhinitis and asthma symptoms were scored and drug treatment recorded using standardized questionnaires. Also, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), and eosinophil count in peripheral blood were measured. Type and pollen concentration of A. elatior in the air over the nine-week pollen season were determined on the glass slides using the gravimetric method. The results were expressed as the proportion of A. elatior pollen in the total pollen.
Fifty-six of 120 patients (46.7%) were sensitized to A. elatior. Its proportion in total pollen peaked to 12% in the first week of September. Forty-one patients who completed the follow-up study showed a significantly higher score of symptoms during this peak period than in the beginning of the pollen season for seasonal allergic rhinitis (median +/-interquartile range, 50+/-11 vs 7+/-4; P<.001) and for seasonal allergic asthma (12+/-2 vs 0+/-0; P<.001).
A. elatior is an important cause of seasonal allergic rhinitis and asthma and must be included in the routine diagnostic procedures in southern Croatia.
Alergotoksikologija je znanstvenoistraživa _ko podru _je koje se bavi ispitivanjem utjecaja polutanata (one _išćiva _a zraka) na nastanak alergijskih reakcija i bolesti. Ispitivanja su prvobitno bila ...usmjerena na polutante vanjskih prostora, a u novije vrijeme sve više na polutante unutarnjih prostora u kojima ljudi provode većinu vremena. Polutanti po svojoj prirodi mogu biti krute, tekuće ili plinovite _estice, koje se razlikuju s obzirom na veli _inu, sastav i izvor iz kojeg nastaju. S obzirom na izvor mogu biti biološkog i nebiološkog podrijetla. Polutanti koji su predmet suvremenih istraživanja s gledišta nastanka alergijskih bolesti su respirabilne krute _estice, ozon, duši _ni oksidi i bioaerosoli. Mehanizam djelovanja polutanata ovisi o veli _ini _estica, njihovoj topljivosti i mjestu ulaska u organizam. Dosadašnja ispitivanja su pokazala da razli _ite _estice uvjetuju razli _ite imunosne i neimunosne odgovore u organizmu. Interakcija polutanata i alergena može se zbivati izvan eksponirane osobe, tj. sa samim alergenom ili u eksponiranoj osobi na sluznicama i koži. Polutanti mogu biti nosioci alergena i mogu interferirati na razli _itim nivoima u nastanku alergijske reakcije. U ovom prikazu razmatraju se dosadašnja saznanja o mehanizmima djelovanja polutanata na alergene, na imunosni sustav izloženih osoba na osnovi epidemioloških populacijskih istraživanja, klini _kih studija ekspozcije u kontroliranim uvjetima i eksperimentalnih testnih sistema in vivo i in vitro.
Allergotoxicology studies the influence of pollutants on the development of allergic reactions and diseases. At the beginning, the research was focused on outdoor air pollutants, while recently it turns to the indoor environment, mainly because people this is where people spend most of their time. Air pollutants may be solid, soluble, or gaseous particles in nature, and they can differ in size, structure, and sources. Pollutants can be of biological or nonbiological origin. Currently interesting air pollutants include particulate matter, ozone, nitrogen oxides, and bioaerosols. The mechanisms of pollutant activity depend on the particle size, solubility, site of deposition, and specific chemical properties. Recent studies have shown that different pollutants provoke different immunological and nonimmunological responses in exposed persons. Interaction between air pollutants and allergens can take place outside the exposed person i.e. with allergen itself, or inside the organism on mucous membranes and skin. Pollutants may be the carriers of allergens and may exacerbate allergic reactions and diseases. This review presents recent views about the mechanisms of pollutant activity on allergens and immune system response in exposed persons, based on epidemiological population studies, clinical studies of exposure under controlled conditions, and experimental tests in vitro and in vivo.
In a group of 221 healthy employees of both sexes the relationship between neuroticism, and perceived quality of life (WHOQOL), inadequate work organization (IWO), Sick Building Syndrome (SBS) and ...speed and accuracy of simple reaction time was studied. The level of neuroticism was assessed by Cornell Index (C.I.), and psychomotor speed and accuracy by electronic psychodiagnostic instrument Complex Reactionmeter Drenovac (CRD). All subjects underwent the same testing procedure completing C.I., SBS, IWO and WHOQOL-BREF questionnaires. The obtained results revealed that persons with more pronounced emotional stability perceive their life better in quality, their work environment with less SBS symptoms, and report more adequate work organization. Furthermore, they have better simple reaction time scores to visual stimuli.
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