Spotlight on the diagnosis of extrinsic allergic alveolitis (hypersensitivity pneumonitis)

Repeated inhalative exposures to antigenic material from a variety of sources, mainly from moulds, thermophilic Actinomycetes, and avians, respectively, can induce immune responses with the clinical picture of extrinsic allergic alveolitis (EAA) or hypersensitivity pneumonitis. Delays of years or even decades till the diagnosis is made are not uncommon; frequent misdiagnoses include allergic asthma, COPD, recurrent flue and other infections. We provide here the state of the art references, a detailed case description and recommend a current diagnostics schema

Exposure to fumigants in containers: a questionnaire assessment on 125 French dockers

Background: Cases of intoxications to gas from container’s atmosphere have been described. For diagnosis, Fum Ex 2 questionnaire has been developed by the European Society for Environmental and Occupational Medicine. The aim of this study was to enhance knowledge on health effects of toxic substances in containers and to validate this questionnaire in medical follow-up and diagnosis. Materials and methods: In 2014, 125 French dockers answered the questionnaire in a face-to-face interview. Results: 83.5% declared no exposure to fumigants or pesticides. Most frequently declared symptoms were fatigue and neurological disorders for dockers and respiratory irritation for refrigeration technicians. Only 28 workers wore regularly individual protection equipment. Conclusions: A “healthy worker” effect could explain low level of symptoms. Fum Ex 2 questionnaire is relevant for diagnosis. Workers in all steps of the logistic transport chain and consumers are exposed to containers’ atmosphere

Health effects due to fumigated freight containers and goods: how to detect, how to act

Headache, concentration and memory disorders, dizziness and nausea, skin irritation, respiratory distress, and muscle cramps — isolated or in various combinations — may be the result of acute or chronic intoxication by fumigants. The occurrence of these symptoms in workers who are engaged in the opening and unloading of containers, unpacking of imported goods, ventilating of containers, or working on bulk carriers are urgent indications of intoxication by fumigants or other toxic chemical residues in the transported goods. The severity of the disorder depends on the concentration and duration of exposure, distribution and release of the fumigant, its kinetics, the individual susceptibility of the person, as well as any simultaneous exposure to other toxic substances. Physical symptoms, acute and chronic health effects due to contact with fumigants, are complex and difficult to discover. In this article we explain how to identify the guiding symptoms and describe the appropriate diagnostic steps and the prevention of such events on cargo vessels as well as in the logistics and the handling of imported goods

Phospholipase D treatment enhances gonadotrophin receptor-coupled adenylate cyclase activity in isolated bovine luteal cells

AbstractLH-stimulated adenylate cyclase activity in membrane preparations of bovine luteal cells could be enhanced by treating the cells with either phospholipase D or its hydrolysis product, phosphatidic acid. Similar augmentary effects were also produced following treatment of the cells with EGF. Moreover, EGF could stimulate the formation of [3H]phosphatidic acid in [3H]myristic acid preloaded cells, suggesting that EGF is able to activate cellular phospholipase D. Also, PMA was able to increase the phosphatidic acid formation with a parallel increase in the adenylate cyclase activity. We propose, therefore, that phosphatidic acid may act as an intracellular second messenger linking EGF-mediated activation of phospholipase D with the sensitization of LH receptor-coupled adenylate cyclase signalling system

Elimination kinetics of diisocyanates after specific inhalative challenges in humans: mass spectrometry analysis, as a basis for biomonitoring strategies

Background: Isocyanates are some of the leading occupational causes of respiratory disorders, predominantly asthma. Adequate exposure monitoring may recognize risk factors and help to prevent the onset or aggravation of these aliments. Though, the biomonitoring appears to be most suitable for exposure assessment, the sampling time is critical, however. In order to settle the optimal time point for the sample collection in a practical biomonitoring approach, we aimed to measure the elimination of isocyanate urine metabolites. Methods: A simple biomonitoring method enabling detection of all major diamine metabolites, from mono-, poly- and diisocyanates in one analytical step, has been established. Urine samples from 121 patients undergoing inhalative challenge tests with diisocyanates for diagnostic reasons were separated by gas chromatography and analyzed with mass spectrometry (GC-MS) at various time points (0-24 h) after the onset of exposure. Results: After controlled exposures to different concentrations of diisocyanates (496 +/- 102 ppb-min or 1560 +/- 420 ppb-min) the elimination kinetics (of respective isocyanate diamine metabolites) revealed differences between aliphatic and aromatic isocyanates (the latter exhibiting a slower elimination) and a dose-response relationship. No significant differences were observed, however, when the elimination time patterns for individual isocyanates were compared, in respect of either low or high exposure or in relation to the presence or absence of prior immunological sensitization. Conclusions: The detection of isocyanate metabolites in hydrolyzed urine with the help of gas chromatography combined with mass spectrometric detection system appears to be the most suitable, reliable and sensitive method to monitor possible isocyanate uptake by an individual. Additionally, the information on elimination kinetic patterns must be factored into estimates of isocyanate uptake before it is possible for biomonitoring to provide realistic assessments of isocyanate exposure. The pathophysiological elimination of 1,6-hexamethylene diamine, 2,4-diamine toluene, 2,6-diamine toluene, 1,5-naphthalene diamine, 4,4'-diphenylmethane diamine and isophorone diamines (as respective metabolites of: 1,6-hexamethylene diisocyanate, 2,4-toluene diisocyanate and 2,6 toluene diisocyanate, 1,5-naphthalene diisocyanate, 4,4'-diphenylmethane diisocyanate and isophorone diisocyanates) differs between individual isocyanates' diamines

Protocol for a systematic review and meta-analysis of human exposure to pesticide residues in honey and other bees' products

Background: The presence of pesticides in honey and related products is an increasing concern for consumers and producers, although there is lack of data on the current burden of exposure of the general human population through these products. We present a protocol for a systematic review and meta-analysis of contamination to insecticides, herbicides and fungicides of products from honeybees, and an estimation of how much the consumption of these products contributes to the ADI (Acceptable Daily Intake) of selected substances. Objectives: We aim to systematically review and meta-analyse studies on the contamination to plant protection products in honey, royal jelly, beeswax and propolis, applying the Navigation Guide and WHO-ILO systematic review methodology as an organizing framework. Data sources: We will search electronic academic databases for potentially relevant records from PubMed, TOXNET and EMBASE. We will include quantitative studies analysing the contamination from insecticides, herbicides and fungicides in honey, propolis, royal jelly and beeswax. In particular, we will evaluate the presence of the following substances and classes of pesticides: Glyphosate, Chlorpyrifos, pyrethroid and neonicotinoid pesticides, fungicides and acaricides. Study appraisal and synthesis methods: At least two authors will independently screen titles and abstracts at a first stage of review, and full texts at a second stage, of potentially eligible records against the eligibility criteria; data extraction of included studies will then be performed by at least two authors, in blind. At least two authors will assess risk of bias and the quality of evidence, using the most suited tools currently available. The data on prevalence of contaminated samples and concentration of pesticides in the products will be combined using meta-analysis: when more than three studies reporting the necessary measures to fit the models are available, meta-analysis will be performed separately by product and by exposure; otherwise, weighted descriptive analysis will be performed. We will report the results using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA)

Differences in the carcinogenic evaluation of glyphosate between the International Agency for Research on Cancer (IARC) and the European Food Safety Authority (EFSA)

The International Agency for Research on Cancer (IARC) Monographs Programme identifies chemicals, drugs, mixtures, occupational exposures, lifestyles and personal habits, and physical and biological agents that cause cancer in humans and has evaluated about 1000 agents since 1971. Monographs are written by ad hoc Working Groups (WGs) of international scientific experts over a period of about 12 months ending in an eight-day meeting. The WG evaluates all of the publicly available scientific information on each substance and, through a transparent and rigorous process,1 decides on the degree to which the scientific evidence supports that substance's potential to cause or not cause cancer in humans. For Monograph 112,2 17 expert scientists evaluated the carcinogenic hazard for four insecticides and the herbicide glyphosate.3 The WG concluded that the data for glyphosate meet the criteria for classification as a probable human carcinogen. The European Food Safety Authority (EFSA) is the primary agency of the European Union for risk assessments regarding food safety. In October 2015, EFSA reported4 on their evaluation of the Renewal Assessment Report5 (RAR) for glyphosate that was prepared by the Rapporteur Member State, the German Federal Institute for Risk Assessment (BfR). EFSA concluded that ?glyphosate is unlikely to pose a carcinogenic hazard to humans and the evidence does not support classification with regard to its carcinogenic potential?. Addendum 1 (the BfR Addendum) of the RAR5 discusses the scientific rationale for differing from the IARC WG conclusion. Serious flaws in the scientific evaluation in the RAR incorrectly characterise the potential for a carcinogenic hazard from exposure to glyphosate. Since the RAR is the basis for the European Food Safety Agency (EFSA) conclusion,4 it is critical that these shortcomings are corrected