Bernstein J A, Bernstein D I, Stauder T, Lummus Z, Bernstein I L
Division of Immunology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
J Allergy Clin Immunol. 1999 Jun;103(6):1153-7. doi: 10.1016/s0091-6749(99)70192-2.
The presence of IgE-mediated occupational respiratory sensitization to microbial enzymes has been well documented in a variety of industries. Aspergillus oryzae -derived lactase is used as a dietary aid for patients with lactose intolerance.
In 1993, a cross-sectional survey of 94 pharmaceutical workers exposed to lactase for a mean duration of 23 months and 24 nonexposed recently hired employees was initiated to identify lactase-sensitized workers and potential risk factors that could be used in making recommendations for preventing future cases of lactase sensitization.
The survey included a physician-administered questionnaire, skin prick testing to lactase enzyme and a panel of common aeroallergens, and spirometry.
Twenty-seven of 94 lactase-exposed workers (29%) had positive skin test responses to lactase. These workers were 9 times more likely to have upper or lower respiratory symptoms compared with workers with negative skin test responses. Atopic workers were 4 times more likely to have lactase skin sensitivity than nonatopic workers. However, atopy was not a risk factor for the development of upper and/or lower respiratory symptoms. Lactase skin reactivity was not observed in the 24 nonexposed employees.
This cross-sectional survey revealed that atopic workers were more likely to have lactase sensitization and that lactase-sensitized workers were more likely to have upper and/or lower respiratory symptoms, but atopy was not a risk factor for upper or lower respiratory symptoms. In spite of these findings, the company allowed only nonatopic, nonlactase-sensitized workers to continue working in high lactase-exposure areas with careful symptom monitoring and use of protective clothing. Although this strategy was successful in total prevention of new cases of occupational respiratory disease after 5 years, the results of this cross-sectional survey do not support exclusion of atopic workers from working with industrial enzymes.
IgE介导的对微生物酶的职业性呼吸道致敏在多种行业中已有充分记录。米曲霉衍生的乳糖酶用作乳糖不耐受患者的饮食辅助剂。
1993年，对94名平均接触乳糖酶23个月的制药工人和24名近期入职的未接触者进行了横断面调查，以确定乳糖酶致敏工人以及可用于预防未来乳糖酶致敏病例的潜在风险因素。
该调查包括医生填写的问卷、对乳糖酶和一组常见气传变应原进行皮肤点刺试验以及肺功能测定。
94名接触乳糖酶的工人中有27名（29%）对乳糖酶皮肤试验呈阳性反应。与皮肤试验阴性的工人相比，这些工人出现上呼吸道或下呼吸道症状的可能性高9倍。特应性工人对乳糖酶皮肤敏感的可能性是非特应性工人的4倍。然而，特应性并非上呼吸道和/或下呼吸道症状发生的风险因素。24名未接触者未观察到乳糖酶皮肤反应性。
这项横断面调查显示，特应性工人更易发生乳糖酶致敏，而乳糖酶致敏工人更易出现上呼吸道和/或下呼吸道症状，但特应性并非上呼吸道或下呼吸道症状的风险因素。尽管有这些发现，该公司仅允许非特应性、非乳糖酶致敏的工人在密切监测症状并使用防护服的情况下继续在高乳糖酶暴露区域工作。尽管该策略在5年后成功全面预防了新的职业性呼吸道疾病病例，但这项横断面调查的结果并不支持将特应性工人排除在工业酶工作之外。
