Metal worker’s lung: spatial association with Mycobacterium avium

Background Outbreaks of hypersensitivity pneumonitis (HP) are not uncommon in workplaces where metal working fluid (MWF) is used to facilitate metal turning. Inhalation of microbe-contaminated MWF has been assumed to be the cause, but previous investigations have failed to establish a spatial relationship between a contaminated source and an outbreak. Objectives After an outbreak of five cases of HP in a UK factory, we carried out blinded, molecular-based microbiological investigation of MWF samples in order to identify potential links between specific microbial taxa and machines in the outbreak zone. Methods Custom-quantitative PCR assays, microscopy and phylogenetic analyses were performed on blinded MWF samples to quantify microbial burden and identify potential aetiological agents of HP in metal workers. Measurements and main results MWF from machines fed by a central sump, but not those with an isolated supply, was contaminated by mycobacteria. The factory sump and a single linked machine at the centre of the outbreak zone, known to be the workstation of the index cases, had very high levels of detectable organisms. Phylogenetic placement of mycobacterial taxonomic marker genes generated from these samples indicated that the contaminating organisms were closely related to Mycobacterium avium. Conclusions We describe, for the first time, a close spatial relationship between the abundance of a mycobacterium-like organism, most probably M. avium, and a localised outbreak of MWF-associated HP. The further development of sequence-based analytic techniques should assist in the prevention of this important occupational disease

ALLERGY METHODS AND PROTOCOLS

ix, 347 hlm ; 15,5 x 23 c

ALLERGY METHODS AND PROTOCOLS

ix, 349 hlm ; 15,5 x 23 c

Immunological methods for diagnosis and monitoring of IgE‐mediated allergy caused by industrial sensitizing agents (IMExAllergy)

Industrial sensitizing agents (allergens) in living and working environments play an important role in eliciting type 1 allergic disorders including asthma and allergic rhinitis. Successful management of allergic diseases necessitates identifying their specific causes (ie, identify the causative agent(s) and the route of contact to allergen: airborne, or skin contact) to avoid further exposure. Identification of sensitization by a sensitive and validated measurement of specific IgE is an important step in the diagnosis. However, only a limited number of environmental and occupational allergens are available on the market for use in sIgE testing. Accordingly, specific in-house testing by individual diagnostic and laboratory centers is often required. Currently, different immunological tests are in use at various diagnostic centers that often produce considerably divergent results, mostly due to lack of standardized allergen preparation and standardized procedures as well as inadequate quality control. Our review and meta-analysis exhibited satisfactory performance of sIgE detection test for most high molecular weight (HMW) allergens with a pooled sensitivity of 0.74 and specificity of 0.71. However, for low molecular weight (LMW) allergens, pooled sensitivity is generally lower (0.28) and specificity higher (0.89) than for HMW tests. Major recommendations based on the presented data include diagnostic use of sIgE to HMW allergens. A negative sIgE result for LMW agents does not exclude sensitization. In addition, the requirements for full transparency of the content of allergen preparations with details on standardization and quality control are underlined. Development of standard operating procedures for in-house sIgE assays, and clinical validation, centralized quality control and audits are emphasized. There is also a need for specialized laboratories to provide a custom service for the development of tests for the measurement of putative novel occupational allergens that are not commercially available

Immunological methods for diagnosis and monitoring of IgE-mediated allergy caused by industrial sensitizing agents (IMExAllergy)

WOS: 000473592800001PubMed ID: 30953599Industrial sensitizing agents (allergens) in living and working environments play an important role in eliciting type 1 allergic disorders including asthma and allergic rhinitis. Successful management of allergic diseases necessitates identifying their specific causes (ie, identify the causative agent(s) and the route of contact to allergen: airborne, or skin contact) to avoid further exposure. Identification of sensitization by a sensitive and validated measurement of specific IgE is an important step in the diagnosis. However, only a limited number of environmental and occupational allergens are available on the market for use in sIgE testing. Accordingly, specific in-house testing by individual diagnostic and laboratory centers is often required. Currently, different immunological tests are in use at various diagnostic centers that often produce considerably divergent results, mostly due to lack of standardized allergen preparation and standardized procedures as well as inadequate quality control. Our review and meta-analysis exhibited satisfactory performance of sIgE detection test for most high molecular weight (HMW) allergens with a pooled sensitivity of 0.74 and specificity of 0.71. However, for low molecular weight (LMW) allergens, pooled sensitivity is generally lower (0.28) and specificity higher (0.89) than for HMW tests. Major recommendations based on the presented data include diagnostic use of sIgE to HMW allergens. A negative sIgE result for LMW agents does not exclude sensitization. In addition, the requirements for full transparency of the content of allergen preparations with details on standardization and quality control are underlined. Development of standard operating procedures for in-house sIgE assays, and clinical validation, centralized quality control and audits are emphasized. There is also a need for specialized laboratories to provide a custom service for the development of tests for the measurement of putative novel occupational allergens that are not commercially available.EU-COST-Action DiMoPEx [CA-15129]; EU Framework Program Horizon 2020All authors are salaried staff members of their respective institutions (XB is retired University Professor and chair for occupational medicine, University of Hamburg). The guideline was prepared with financial support from the EU-COST-Action (CA-15129, DiMoPEx), which is supported by the EU Framework Program Horizon 2020

ORIGINALES Smoking cessation and associated factors during pregnancy on behalf of the AMICS study group* 185

Abstract Objective: To examine smoking habits before and during pregnancy, as well as factors associated with smoking cessation, in three European settings. Methods: Women seeking antenatal care in Ashford (UK), Minorca and Barcelona (Spain) were recruited to the Asthma Multicenter Infant Cohort Study (AMICS). Questionnaires inquiring into the smoking habits of each woman and her partner, demographic data, occupation, educational level, number of previous children, breast feeding, alcohol intake, and history of asthma and of other allergic diseases were completed during pregnancy and in the first year after delivery. Results: A total of 1 572 pregnant women were included in the three cohorts. Smoking prior to pregnancy was more common in Barcelona (46.2%) than in Minorca (39.8%) or Ashford (31.6%). Cessation rates during pregnancy also differed: 18% of women in Ashford, 20.4% in Minorca and 31.9% in Barcelona were still smoking during the first trimester. In a multivariate regression model, the factors showing a significant (negative) association with smoking cessation during pregnancy were having older children, having a partner who smoked and starting smoking at a young age. Conclusions: Baseline smoking habits and changes in smoking habits during pregnancy significantly differed between the three communities studied. Women pregnant with their first child, those who had started smoking at a later age and those whose partners were non-smokers were more likely to stop smoking when pregnant. Key words: Smoking. Smoking cessation. Pregnancy. Resumen Objetivo: Describir el hábito tabáquico antes y durante el embarazo y los factores asociados con su cese con relación al embarazo en distintos entornos europeos. Métodos: Se ha incluido en el estudio a las mujeres captadas durante el embarazo para participar en el estudio AMICS (Asthma Multicentre Infant Cohort Study) en Ashford (Reino Unido), Barcelona y Menorca (España). Se administró un cuestionario durante el embarazo y otro durante el primer año posparto, que incluía los siguientes aspectos: hábito tabáquico de la mujer y de su compañero, datos demográficos, ocupación, nivel de estudios, número de hijos previos, lactancia materna, consumo de alcohol e historia de asma y otras enfermedades alérgicas. Resultados: Entre las 3 cohortes se incluyó a un total de 1.572 mujeres. Antes del embarazo, el porcentaje de mujeres fumadoras fue mayor en Barcelona (46,2%) que en Menorca (39,8%) o Ashford (31,6%). Las tasas de abandono del há-bito tabáquico en relación con el embarazo también variaron en cada cohorte, de manera que durante el primer trimestre de embarazo continuaron fumando el 18% en Ashford, el 20,4% en Menorca y el 31,9% en Barcelona. En un modelo de regresión múltiple, tener hijos previos, que el compañero sea fumador y haber empezado a fumar más joven muestran una asociación (negativa) con la probabilidad de abandonar el tabaco en relación con el embarazo. Conclusiones: El consumo de tabaco antes y durante el embarazo muestra importantes diferencias en las 3 comunidades estudiadas. Las mujeres en su primer embarazo, que empezaron a fumar más tardíamente y cuyo compañero no fuma son las que con mayor frecuencia abandonan el tabaco al quedarse embarazadas. Palabras clave: Hábito tabáquico. Abandono del hábito tabáquico. Embarazo