Abstract
Purpose
Medical surveillance of workers in precious metals refineries and catalyst production plants is well established in many countries as a measure to prevent occupational asthma due to platinum (Pt) salts. It was the aim of this study to evaluate the impact of medical surveillance and to define prognostic factors with an emphasis on exposure determinants.
Methods
As part of an observational longitudinal study, 96 workers from German precious metals refineries and catalyst production plants with Pt salt allergy underwent a second examination several years (median 67 months) after the initial diagnosis was made.
Results
When the second examination was conducted, 92 subjects (96 %) had already been transferred to jobs with very low or no exposure to Pt salts. The number of subjects with sensitization to Pt salt as assessed by skin prick test (SPTPt) decreased from 86 to 52 %, and there was a clear improvement for rhinitis, conjunctivitis and contact urticaria between both examinations. Although the number of subjects with asthma symptoms decreased significantly, at the second examination 74 subjects (77 %) continued to suffer from asthma and 51 subjects (53 %) received asthma medication. Airway obstruction or bronchial hyperresponsiveness persisted in 83 subjects (86 %).
Conclusions
Secondary prevention in subjects with occupational exposure to Pt salts, as practiced for over 25 years in Germany could not avoid persistent asthma in the majority of cases, although improvements occurred. This study reveals the limitations of the concept that removal from exposure after the occurrence of respiratory symptoms may prevent chronic asthma. It is recommended that removal from exposure should be done immediately after the occurrence of a positive SPTPt, irrespective of symptoms.
Similar content being viewed by others
Abbreviations
- CI:
-
Confidence interval
- IgE:
-
Immunoglobulin E
- FEV1 :
-
Forced expiratory volume in one second
- IPA:
-
Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum
- OA:
-
Occupational asthma
- OR:
-
Odds ratio
- Pt:
-
Platinum
- SPT:
-
Skin prick test
- sRt:
-
Specific airway resistance
References
Ameille J, Descatha A (2005) Outcome of occupational asthma. Curr Opin Allergy Clin Immunol 5:125–128
Anonymus (1995) Standardization of spirometry, 1994 update. American Thoracic Society. Am J Respir Crit Care Med 152:1107–1136
Heederik D, Jacobs J, Samadi S, van Rooy F, Portengen L, Houba R (2016) Exposure-response analyses for platinum salt-exposed workers and sensitization: a retrospective cohort study among newly exposed workers using routinely collected surveillance data. J Allergy Clin Immunol 137:922–929
Malo JL, Ghezzo H (2004) Recovery of methacholine responsiveness after end of exposure in occupational asthma. Am J Respir Crit Care Med 169:1304–1307
Merget R, Schultze-Werninghaus G, Bode F, Bergmann EM, Zachgo W, Meier-Sydow J (1991) Quantitative skin prick and bronchial provocation tests with platinum salt. Br J Ind Med 48:830–837
Merget R, Reineke M, Rueckmann A, Bergmann EM, Schultze-Werninghaus G (1994) Nonspecific and specific bronchial responsiveness in occupational asthma caused by platinum salts after allergen avoidance. Am J Respir Crit Care Med 150:1146–1149
Merget R, Schulte A, Gebler A, Breitstadt R, Kulzer R, Berndt ED et al (1999) Outcome of occupational asthma due to platinum salts after transferal to low-exposure areas. Int Arch Occup Environ Health 72:33–39
Merget R, Kulzer R, Dierkes-Globisch A, Breitstadt R, Gebler A, Kniffka A et al (2000) Exposure-effect relationship of platinum salt allergy in a catalyst production plant: conclusions from a 5-year prospective cohort study. J Allergy Clin Immunol 105:364–370
Merget R, Caspari C, Dierkes-Globisch A, Kulzer R, Breitstadt R, Kniffka A et al (2001) Effectiveness of a medical surveillance programme for the prevention of occupational asthma due to platinum salts. A nested case-control study. J Allergy Clin Immunol 107:707–712
Merget R, Jörres RA, Heinze E, Haufs MG, Taeger D, Brüning T (2009) Development of a 1-concentration-4-step dosimeter protocol for methacholine testing. Respir Med 103:607–613
Padoan M, Pozzato V, Simoni M, Zedda L, Milan G, Bononi I et al (2003) Long-term follow-up of toluene diisocyanate-induced asthma. Eur Respir J 21:637–640
Pisati G, Baruffini A, Bernabeo F, Cerri S, Mangili A (2007) Rechallenging subjects with occupational asthma due to toluene diisocyanate (TDI), after long-term removal from exposure. Int Arch Occup Environ Health 80:298–305
Polychronakis I, Thanasias E, Raulf-Heimsoth M, Merget R (2013) Occupational non-immediate type allergic asthma due to ammonium persulfate. Adv Exp Med Biol 755:79–83
Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC (1993) Lung volumes and forced ventilatory flows. Report working party standardization of lung function tests European community for steel and coal. Eur Respir J 6(Suppl 16):5–40
Rachiotis G, Savani R, Brant A, MacNeill SJ, Newman Taylor A et al (2007) Outcome of occupational asthma after cessation of exposure: a systematic review. Thorax 62:147–152
Rosenberg N, Garnier R, Rousselin X, Mertz R, Gervais P (1987) Clinical and socio-professional fate of isocyanate-induced asthma. Clin Allergy 17:55–61
Tarlo SM, Liss GM (2001) Can medical surveillance measures improve the outcome of occupational asthma? J Allergy Clin Immunol 107:583–585
Vandenplas O, Dressel H, Wilken D, Jamart J, Heederik D, Maestrelli P et al (2011) Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence. Eur Respir J 38:804–811
Vandenplas O, Dressel H, Nowak D, Jamart J (2012) ERS task force on the management of work-related asthma. What is the optimal management option for occupational asthma? Eur Respir Rev 21:97–104
Wilken D, Baur X, Barbinova L, Preisser A, Meijer E, Rooyackers J et al (2012) What are the benefits of medical screening and surveillance? Eur Respir Rev 21(124):105–111
Acknowledgments
We thank the plant physicians and all the workers who agreed to participate in this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Merget, R., Pham, N., Schmidtke, M. et al. Medical surveillance and long-term prognosis of occupational allergy due to platinum salts. Int Arch Occup Environ Health 90, 73–81 (2017). https://doi.org/10.1007/s00420-016-1172-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00420-016-1172-0