Johnsen C R, Sorensen T B, Ingemann Larsen A, Bertelsen Secher A, Andreasen E, Kofoed G S, Fredslund Nielsen L, Gyntelberg F
Clinic of Occupational Medicine, National University Hospital, Copenhagen, Denmark.
Occup Environ Med. 1997 Sep;54(9):671-5. doi: 10.1136/oem.54.9.671.
To investigate the risk of enzyme sensitisation and clinical allergy in workers exposed to enzymes at Novo Nordisk A/S.
The study was a retrospective follow up study based on medical history and test data originally collected at routine screenings for enzyme allergy by the Occupational Health Service (OHS) of Novo Nordisk A/S during the period 1970-92. Workers were exposed to proteases, lipases, cellulases, and carboxyhydrases. Medical records of 3815 subjects were registered in the OHS database. According to criteria including possible enzyme exposure, allergy tests at the time of engagement, and participation in the allergy screening programme 1064 were selected for the present study. Outcomes were allergy symptoms, specific IgE test (radioallergosorbent test (RAST)) to enzymes, skin test reactions to common allergens and enzymes, forced expiratory volume in one second (FEV1), and forced vital capacity (FVC). Potential risk factors were smoking habits, workplace, type of job, age, and sex.
Sensitisation occurred to all types of enzymes handled in the plant, most often in production areas and laboratories; 8.8% developed clinical enzyme allergy during the first three years of employment. The risk declined during the period. The frequency of enzyme sensitisation, expressed as RAST values > 0.5 SU, was 36%, and the frequency of significant RAST values > or = 2 SU was 8%. Ranking diagnoses of enzyme allergy by severity, the frequency of asthma was 5.3%, rhinitis 3.0%, and urticaria 0.6%. Half of the cases occurred within the first 15 months of exposure. Smoking was an independent risk factor for clinical enzyme allergy (odds ratio (OR) = 2.3 (95% exact confidence interval (95% CI) 1.4 to 3.9), measurable RAST > or = 0.5 SU (OR = 1.5 (95% CI 1.1 to 2.1)), and RAST > or = 2 SU (OR = 4.5 (95% CI 2.2 to 8.4)). Atopic predisposition at the time of engagement was not a significant risk factor for enzyme allergy. This could be due to various selection mechanisms.
调查诺和诺德公司（Novo Nordisk A/S）接触酶的工人发生酶致敏和临床过敏的风险。
本研究是一项回顾性随访研究，基于诺和诺德公司职业健康服务部（OHS）在1970 - 1992年期间进行的酶过敏常规筛查中最初收集的病史和检测数据。工人接触蛋白酶、脂肪酶、纤维素酶和羧基水解酶。3815名受试者的医疗记录被登记在OHS数据库中。根据包括可能接触酶、入职时的过敏检测以及参与过敏筛查计划等标准，选择了1064名受试者进行本研究。观察指标为过敏症状、针对酶的特异性IgE检测（放射变应原吸附试验（RAST））、对常见变应原和酶的皮肤试验反应、一秒用力呼气量（FEV1）和用力肺活量（FVC）。潜在风险因素为吸烟习惯、工作场所、工作类型、年龄和性别。
工厂处理的所有类型的酶都发生了致敏，最常见于生产区域和实验室；8.8%的工人在入职的前三年出现临床酶过敏。在此期间风险有所下降。以RAST值>0.5 SU表示的酶致敏频率为36%，显著RAST值>或 = 2 SU的频率为8%。按酶过敏严重程度排列诊断，哮喘的频率为5.3%，鼻炎为3.0%，荨麻疹为0.6%。一半的病例发生在接触的前15个月内。吸烟是临床酶过敏的独立风险因素（优势比（OR） = 2.3（95%精确置信区间（95% CI）1.4至3.9））、可测量的RAST>或 = 0.5 SU（OR = 1.5（95% CI 1.1至2.1））以及RAST>或 = 2 SU（OR = 4.5（95% CI 2.2至8.4））。入职时的特应性体质不是酶过敏的显著风险因素。这可能归因于各种选择机制。
