Riassunto

Objective The objective is to provide an evidence-based compendium of allergenic and irritant agents that are known to cause occupational asthma in order to improve diagnostics and disease management.

Methods Two previously published reviews from our group utilized database searches to identify studies which were then rated according to the Scottish Intercollegiate Guideline Network (SIGN) grading system. The evidence level for each causative agent or worksite was graded using the Royal College of General Practitioners (RCGP) three-star system.

Results Approximately 3,000 relevant papers were identified, which covered 372 different causes of allergic and 184 different causes of irritant occupational asthma. The highest level achieved using the SIGN grading system was 2++, indicating a high quality study with a very low risk of confounding or bias and a high probability of a causal relationship. Using the modified RCGP three-star grading system, the strongest evidence of association with an individual agent or worksite ('***') was found for exposure to laboratory animals. Associations with moderate evidence level (‘**’) were obtained for a) the allergenic agents or worksites: alpha-amylase from Aspergillus oryzae, various enzymes from Bacillus subtilis, papain, bakeries, western red cedar, latex, psyllium, storage mites, rat, carmine, egg proteins, Atlantic salmon, fishmeal, Norway lobster, prawn, snow crab, seafood, trout and turbot, reactive dyes, b) the irritant agents or worksites: benzene-1,2,4-tricarboxylic acid, 1,2- anhydride [trimellitic anhydride], chlorine, cobalt, cement, environmental tobacco smoke, grain, welding fumes, construction work, swine confinement, World Trade Center disaster 2001, and c) agents or worksites causing allergic as well as irritant occupational asthma, included farming, poultry confinement, various isocyanates and platinum salts. A low evidence level (RCGP) was obtained for 84 agents or worksites (42 from each group), providing a total of 141 conditions with a low, moderate or strong evidence level.

Conclusion This work comprises the largest compendium and evaluation of agents and worksites causing allergic or irritant occupational asthma from the literature assessed in an evidence-based manner.

Commento

L'asma professionale è una patologia caratterizzata da una limitazione variabile del flusso d'aria e/o da uno stato di iper-reattività ed infiammazione delle vie aeree attribuibili a cause e a condizioni presenti in un particolare ambiente di lavoro, ma non a stimoli incontrati al di fuori di esso. Questa patologia professionale deve essere differenziata da tutte le altre forme di asma aggravato dall’ambiente lavoro, che è caratterizzato da un peggioramento per frequenza o gravità di un asma precedentemente esistente. Dati derivati da precedenti studi e rapporti sul tema hanno accumulato prove sperimentali che collegano l’asma professionale a circa 300 differenti agenti causali, divisi in sostanze ad alto peso e a basso peso molecolare.

Quirce e Sastre hanno recentemente riassunto in un loro studio i principali agenti causali professionali, allergizzanti o irritanti, pubblicati in letteratura tra il 2009 e il 2011 e in grado di causare asma professionale. Tale classificazione è inoltre in costante aggiornamento da parte dell’American Conference of Governmental Industrial Hygienists (ACGIH), della Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area (MAK Commission) tedesca, della Health and Safety Executive (HSE) britannica e della Comunità Europea.

La presente ricerca si concentra sulla identificazione delle cause di asma professionale e si basa su due revisioni di recente pubblicazione, valutando in una vasta panoramica tutti i principali allergeni ed irritanti professionali e fornendo un utile spunto per i programmi di sorveglianza sanitaria dei lavoratori esposti.

Keywords

compendium, diagnostics management, disease management, occupational asthma

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