Mathias Holm, M. D., PhD Occupational and Environmental Medicine (Arbets- och miljömedicin)

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

4. 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

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

6. 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.

7. Allergen in IgE-mediated reactions Highmolecular allergen Lowmolecular Often protein mw 5-100 kDchemical Hapten Human protein

8. What causes allergy? • IgE-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

9. High molecular agents can cause asthma, rhinitis

10. IgE- mediated reactions Skin prick test

11. Low molecular agents can cause asthma, rhinitis

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

13. Irritation/corrosion on skin and eyes and airway irritation Irritation and corrosion - localisedeffects at the place of contactbetween the agent and the skin, eyes or airwaymucousmembrane. Corrosivesubstancesmaydestroytissues at firstcontact. Irritating substancesare non-corrosivesubstancesthatmay cause inflammation in tissues at firstcontact.

14. 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. Irritation/corrosion on skin and eyes and airway irritation

15. 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.

16. Patch test

17. Irritative eczemaTrigger factors • Chemical irritation • Mechanical irritation • Heat, perspiration • “Dry skin” • Infection? • Stress • Climate factors (e g time of year)

18. Accident with 4 liters acetic acid in room ca 12 m2

19. Follow up of 51 persons, 36 previously without airway disease, exposure was estimated. Asthma after accident

23. Extract from CLP-regulation • H332 Harmful if inhaled (skadligt vid inandning) • H334 May cause allergy or asthma symptoms or breathing difficulties if inhaled (kan orsaka allergi- eller astmasymtom eller andningssvårigheter vid inandning) • H335 May cause respiratory irritation (kan orsaka irritation i luftvägarna)