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Are high- and low-molecular-weight sensitizing agents associated with different clinical phenotypes of occupational asthma?

Vandenplas, O and Godet, J and Hurdubaea, L and Rifflart, C and Suojalehto, H and Wiszniewska, M and Munoz, X and Sastre, J and Klusackova, P and Moore, V and Merget, R and Talini, D and Svanes, C and Mason, P and dell'Omo, M and Cullinan, P and Moscato, G and Quirce, S and Hoyle, J and Sherson, D and Kauppi, P and Preisser, A and Meyer, N and de Blay, F (2018) Are high- and low-molecular-weight sensitizing agents associated with different clinical phenotypes of occupational asthma? Allergy. ISSN 1398-9995. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Official URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/al...

Abstract

BACKGROUND

High-molecular-weight (HMW) proteins and low-molecular-weight (LMW) chemicals can cause occupational asthma (OA) although few studies have thoroughly compared the clinical, physiological, and inflammatory patterns associated with these different types of agents. The aim of this study was to determine whether OA induced by HMW and LMW agents show distinct phenotypic profiles.

METHODS

Clinical and functional characteristics, and markers of airway inflammation were analyzed in an international, multicenter, retrospective cohort of subjects with OA ascertained by a positive inhalation challenge response to HMW (n=544) and LMW (n=635) agents.

RESULTS

Multivariate logistic regression analysis showed significant associations between OA caused by HMW agents and work-related rhinitis (OR [95% CI]: 4.79 [3.28-7.12]), conjunctivitis (2.13 [1.52-2.98]), atopy (1.49 [1.09-2.05]), and early asthmatic reactions (2.86 [1.98-4.16]). By contrast, OA due to LMW agents was associated with chest tightness at work (2.22 [1.59-3.03]), daily sputum (1.69 [1.19-2.38]), and late asthmatic reactions (1.52 [1.09-2.08]). Furthermore, OA caused by HMW agents showed a higher risk of airflow limitation (1.76 [1.07-2.91]) whereas OA due to LMW agents exhibited a higher risk of severe exacerbations (1.32 [1.01-1.69]). There were no differences between the two types of agents in the baseline sputum inflammatory profiles, but OA caused by HMW agents showed higher baseline blood eosinophilia and a greater post-challenge increase in fractional nitric oxide.

CONCLUSION

This large cohort study describes distinct phenotypic profiles in OA caused by HMW and LMW agents, There is a need to further explore differences in underlying pathophysiological pathways and outcome after environmental interventions. This article is protected by copyright. All rights reserved.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: WD Diseases and disorders of systemic, metabolic or environmental origin > WD300 Hypersensitivity. Allergy
WF Respiratory system. Respiratory medicine
Divisions: Planned IP Care > Respiratory Medicine
Related URLs:
Depositing User: Mrs Yolande Brookes
Date Deposited: 06 Jul 2018 14:26
Last Modified: 06 Jul 2018 14:26
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1695

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