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Mathias Holm, M. D., PhD Occupational and Environmental Medicine (Arbets- och miljmedicin) Sahlgrenska academy and University Hospital 2013-03-21 Asthma, allergy and laboratory work Slide 2 Slide 3 Slide 4 Inflammation allergic or non-allergic Mucous membranes Eyesitching, red, edema, secretion Noseedema, secretion, sneezing Airwaysedema, secretion, constriction (asthma) Skineczema, nettle rash Slide 5 Allergy Reaction in the immune system. Specificity, memory, host factors of importance. Reactions in mucous membranes mediated by immunoglobuline E (IgE, type I). Eczema by cells (type IV), nettle rash by IgE. Slide 6 Non-allergic reactions Hypersensitivity Other specific immunologic mechanism (not type I or IV)? Other, non-immunologic mechanism?? Irritation Non-specific mechanism No specificity, no memory? Host factors important, variable sensitivity Corrosion Very strong irritation, irreversible tissue damage. Slide 7 Allergen in IgE-mediated reactions High molecular allergenLow molecular Often protein mw 5-100 kDchemical Hapten Human protein Slide 8 What causes allergy? IgE-mediated reactions High molecular agents Pollen, furred animals, mites Plants, fish and shellfish, enzymes, latex, lab animals, insects Low molecular agents (also other mechanisms) Diisocyanats, acid-anhydrids, cyanoacrylate, some amines, glutaraldehyde, persulfates Slide 9 High molecular agents can cause asthma, rhinitis Slide 10 IgE- mediated reactions Skin prick test Slide 11 Low molecular agents can cause asthma, rhinitis Slide 12 Symptoms from airways by irritants - vapour, gas, dust, fumes Slide 13 Irritation/corrosion on skin and eyes and airway irritation Irritation and corrosion - localised effects at the place of contact between the agent and the skin, eyes or airway mucous membrane. Corrosive substances may destroy tissues at first contact. Irritating substances are non-corrosive substances that may cause inflammation in tissues at first contact. Slide 14 Irritating chemicals - irritation in airways. Irritation reversible changes (usually obs! asthma). Also toxic effects (interaction with autonomic nervous system) leading to reflexes (sneezes, cough, etc). These effects are reversible. Irritation/corrosion on skin and eyes and airway irritation Slide 15 Allergic contact eczema Delayed, cell mediated reaction Nickel, chrome, cobalt Rubber chemicals Pharmaceutical drugs, cosmetics (Kathon) Colophony, perfume, plants Chemicals R-phrase 43 Epoxy, acrylates, resins, plastic chemicals, organic dyes, amines etc. Slide 16 Patch test Slide 17 Irritative eczema Trigger factors Chemical irritation Mechanical irritation Heat, perspiration Dry skin Infection? Stress Climate factors (e g time of year) Slide 18 Accident with 4 liters acetic acid in room ca 12 m 2 Slide 19 Asthma after accident ExposureFraction with asthma Percent with asthma Low0/60 Mean4/2119 High4/944 Follow up of 51 persons, 36 previously without airway disease, exposure was estimated. Slide 20 SubstanceCAS-nrYearOccupational exposure limit (8 hour) Occupational exposure limit (15 min) ppmmg/m3ppmmg/m3 Acetic acid64-19-719905201025 Slide 21 Slide 22 Slide 23 Extract from CLP-regulation H332 Harmful if inhaled (skadligt vid inandning) H334 May cause allergy or asthma symptoms or breathing difficulties if inhaled (kan orsaka allergi- eller astmasymtom eller andningssvrigheter vid inandning) H335 May cause respiratory irritation (kan orsaka irritation i luftvgarna) Slide 24 Harmful Acut toxicity (oral, dermal, inhalation) Skin irritation Eye irritation Skin sensitisation Specific organ toxicity single exposure Airway irritation Narcotic effects Product is harmful by inhalation, skin contact or ingestion. Also used for products causing allergy at skin contact, irritating skin, eyes or airways or having narcotic effects. Slide 25 Health hazard Respiratory sensitisation Germ cell mutagenicity Carcinogenicity Reproductive toxicity Specific Target Organ Toxicity Single exposure, Specific Target Organ Toxicity Repeated exposure Aspiration hazard Product may cause hereditary genetic damage, cancer, be teratogenic or impair reproduction. Also used for products causing allergy when inhaled, chemical pneumonitis at ingestion or other serious damages at single or repeated exposure.