Asthma allergy and laboratory work Mathias Holm M

Asthma, allergy and laboratory work Mathias Holm, M. D. , Ph. D Occupational and Environmental Medicine (Arbets- och miljömedicin) Sahlgrenska academy and University Hospital 2013 -03 -21

Inflammation – allergic or non-allergic Mucous membranes – Eyes itching, red, edema, secretion – Nose edema, secretion, sneezing – Airways edema, secretion, constriction (asthma) Skin eczema, nettle rash

Allergy Reaction in the immune system. Specificity, “memory”, host factors of importance. Reactions in mucous membranes mediated by immunoglobuline E (Ig. E, type I). Eczema by cells (type IV), nettle rash by Ig. E.

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.

Allergen in Ig. E-mediated reactions High molecular allergen Often protein mw 5 -100 k. D Low molecular chemical Hapten Human protein

What causes allergy? Ig. E-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

High molecular agents can cause asthma, rhinitis

Ig. E- mediated reactions Skin prick test

Low molecular agents can cause asthma, rhinitis

Symptoms from airways by irritants - vapour, gas, dust, fumes

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.

Irritation/corrosion on skin and eyes and airway irritation 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.

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.

Patch test

Chemical irritation Mechanical irritation Irritative eczema Trigger factors Heat, perspiration “Dry skin” Infection? Stress Climate factors (e g time of year)

Accident with 4 liters acetic acid in room ca 12 m 2

Asthma after accident Follow up of 51 persons, 36 previously without airway disease, exposure was estimated. Exposure Fraction with asthma Percent with asthma Low 0/6 0 Mean 4/21 19 High 4/9 44

Substance CAS-nr Acetic acid 64 -19 -7 Year 1990 Occupational exposure limit (8 hour) Occupational exposure limit (15 min) ppm mg/m 3 5 20 10 25

Extract from CLP-regulation H 332 Harmful if inhaled (skadligt vid inandning) H 334 May cause allergy or asthma symptoms or breathing difficulties if inhaled (kan orsaka allergieller astmasymtom eller andningssvårigheter vid inandning) H 335 May cause respiratory irritation (kan orsaka irritation i luftvägarna)

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.

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.