Reviews and feature articleMechanisms of occupational asthma
Section snippets
Characteristics of the allergen
More than 350 agents have been reported to cause OA. Although there are fewer LMW chemicals than HMW agents in the lists of occupational respiratory sensitizers, LMW chemicals still represent an important subset of etiologic agents, including approximately 100 separate chemical entities.7 The most important chemicals that cause OA include acid anhydrides, polyisocyanates and their prepolymers, plicatic acid (from Western red cedar), colophony fume, and metals such as chlorinated platinum salts,
Genetic aspects
Occupational asthma, a phenotype of adult-onset asthma, might provide a means to understand better the interaction between a susceptible genotype and multiple environmental factors. The expanding evidence for gene-environmental interactions in asthma highlights the importance of measuring environmental exposure in genetic studies of occupational and nonoccupational asthma.33 It is often hard to define environmental exposures, but among subjects with OA there is the advantage that exposure,
Specific IgE antibodies
The pathophysiology of immunologic OA usually involves an IgE-dependent mechanism. OA induced by IgE-dependent agents is similar to allergic asthma that is unrelated to work.2, 3, 4, 5, 73, 74, 75, 76 Many occupational sensitizers, particularly HMW agents (eg, flour and animal proteins), induce asthma by producing specific IgE antibodies. For some LMW agents (eg, chlorinated platinum salts, sulfonechloramide, trimellitic anhydride, and other acid anhydrides), the development of OA is
Nonimmunologic OA
Establishing mechanisms of irritant-induced asthma is challenging. One reason is that unintentional exposure to high concentrations of respiratory irritants, whether particulates or chemicals, at or outside the workplace can induce the new onset of asthma.134 Respiratory health consequences of these exposures can occur from both occupational exposure and environmental disasters.135 For example, irritant-induced asthma is one of the respiratory consequences observed in workers in the New York
Conclusion
Understanding the pathogenesis of OA is a crucial step toward optimal prevention and management of the disease. Identification of structure-activity relationships for causal agents of OA shows great promise for understanding induction of airway sensitization. A dose-response relationship between the level of exposure and the development of OA is well established for several sensitizing agents. Recent evidence indicates that chemical respiratory allergens may induce respiratory tract
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Cited by (0)
(Supported by an educational grant from Merck & Co., Inc.)
Series editors: Joshua A. Boyce, MD, Fred Finkelman, MD, William T. Shearer, MD, PhD, and Donata Vercelli, MD
Supported by the Ministry of University and Scientific Research; University of Padova; University of Ferrara; Consorzio Ferrara Ricerche; the Associazione per la Ricerca e Cura dell' Asma, Padova; and the Associazione per lo Studio dei Tumori e delle Malattie Polmonari, Padova.
Terms in boldface and italics are defined in the glossary on page 532.
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These authors contributed equally to this work.