Allergy Department, Hospital La Paz Health Research Institute (IdiPAZ), Madrid, Spain.
J Investig Allergol Clin Immunol. 2010;20(7):542-50; quiz 2p following 550.
Although cleaners represent a significant part of the working population worldwide, they remain a relatively understudied occupational group. Epidemiological studies have shown an association between cleaning work and asthma, but the risk factors are uncertain. Cleaning workers are exposed to a large variety of cleaning products containing both irritants and sensitizers, as well as to common indoor allergens and pollutants. Thus, the onset or aggravation of asthma in this group could be related to an irritant-induced mechanism or to specific sensitization. The main sensitizers contained in cleaning products are disinfectants, quaternary ammonium compounds (such as benzalkonium chloride), amine compounds, and fragrances.The strongest airway irritants in cleaning products are bleach (sodium hypochlorite), hydrochloric acid, and alkaline agents (ammonia and sodium hydroxide), which are commonly mixed together. Exposure to the ingredients of cleaning products may give rise to both new-onset asthma, with or without a latency period, and work-exacerbated asthma. High-level exposure to irritants may induce reactive airways dysfunction syndrome. Cleaning workers may also have a greater relative risk of developing asthma due to prolonged low-to-moderate exposure to respiratory irritants. In addition, asthma-like symptoms without confirmed asthma are also common after exposure to cleaning agents. In many cleaners, airway symptoms induced by chemicals and odors cannot be explained by allergic or asthmatic reactions. These patients may have increased sensitivity to inhaled capsaicin, which is known to reflect sensory reactivity, and this condition is termed airway sensory hyperreactivity.
尽管清洁工人在全球劳动力中占很大比例，但他们仍然是一个相对研究不足的职业群体。流行病学研究表明，清洁工作与哮喘之间存在关联，但风险因素尚不确定。清洁工人会接触到各种含有刺激性和致敏性物质的清洁产品，以及常见的室内过敏原和污染物。因此，该人群中哮喘的发作或加重可能与刺激性诱导机制或特定致敏有关。清洁产品中主要的致敏物质是消毒剂、季铵化合物（如苯扎氯铵）、胺化合物和香料。清洁产品中最强的气道刺激性物质是漂白剂（次氯酸钠）、盐酸和碱性物质（氨和氢氧化钠），它们通常混合在一起。接触清洁产品的成分可能会导致新发作的哮喘，无论是否有潜伏期，以及工作加重的哮喘。高水平暴露于刺激性物质可能会导致反应性气道功能障碍综合征。由于长期接触低至中等水平的呼吸道刺激性物质，清洁工人也可能有更高的相对风险患上哮喘。此外，接触清洁剂后也会出现常见的无明确哮喘的哮喘样症状。在许多清洁工人中，化学物质和气味引起的气道症状不能用过敏或哮喘反应来解释。这些患者可能对吸入辣椒素的敏感性增加，这被称为气道感觉高反应性，这种情况被称为气道感觉超敏性。
