Brant A, Zekveld C, Welch J, Jones M, Taylor A Newman, Cullinan P
Department of Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College, Royal Brompton Hospital, London, UK.
Clin Exp Allergy. 2006 Apr;36(4):483-8. doi: 10.1111/j.1365-2222.2006.02465.x.
Little is known about the prognosis of occupational asthma induced by high molecular weight proteins.
Our objective was to measure the clinical, immunological and employment outcomes of individuals with occupational asthma induced by detergent enzymes.
We undertook a workforce-based follow-up study in 35 (78%) of the 45 ex-employees from a single factory with occupational asthma. In each case the diagnosis was supported by evidence of specific sensitization and characteristic changes in peak flow or a positive response to specific bronchial provocation testing.
This group had left the factory on average 37 months before study. On review 25 (71%) reported chest symptoms during the last month. Compared with when working at the factory, most (86%) reported that their symptoms had improved. Twenty continued to attend their general practitioner for respiratory symptoms and 19 still used asthma medications. Since leaving the factory 16 (46%) and four (11%) had found full-time or part-time employment, respectively; of these 16 found they were paid less than when they worked at the factory. The remaining 15 subjects had not had any paid employment. All but two had positive skin prick tests to one or more three detergent enzymes. The estimated half-life of serum-specific IgE antibodies was 20 months for protease, and 21 months for cellulase and amylase.
Population-based follow-up studies of the prognosis of occupational asthma are rare but probably avoid the bias in clinic-derived surveys. This study demonstrates that 3 years after the avoidance of exposure with detergent enzymes most patients continue to be troubled by, albeit improved, symptoms and experience difficulty in re-employment.
关于高分子量蛋白质诱发的职业性哮喘的预后情况，人们了解甚少。
我们的目的是评估由洗涤剂酶诱发职业性哮喘的个体的临床、免疫学及就业结局。
我们对一家工厂的45名患有职业性哮喘的离职员工中的35名（78%）进行了基于劳动力的随访研究。每例病例的诊断均有特异性致敏证据以及峰值流速的特征性变化或对特异性支气管激发试验的阳性反应作为支持。
该组员工平均在研究前37个月离开工厂。复查时，25名（71%）报告在过去一个月有胸部症状。与在工厂工作时相比，大多数（86%）报告症状有所改善。20人仍因呼吸道症状就诊于全科医生，19人仍使用哮喘药物。自离开工厂以来，16人（46%）找到了全职工作，4人（11%）找到了兼职工作；其中16人发现他们的收入比在工厂工作时少。其余15名受试者没有任何有偿工作。除两人外，所有人对一种或多种三种洗涤剂酶的皮肤点刺试验均为阳性。蛋白酶血清特异性IgE抗体的估计半衰期为20个月，纤维素酶和淀粉酶为21个月。
基于人群的职业性哮喘预后随访研究很少见，但可能避免了临床调查中的偏差。本研究表明，在避免接触洗涤剂酶3年后，大多数患者的症状虽有所改善，但仍受困扰，且在重新就业方面存在困难。
