Occupational asthma in female factory worker resulting from exposure to savinase in dishwashing tablets-a case study

Journal of Occupational Health
Vol. 55 (2013) No. 4 p. 318-321

Agnieszka Lipińska-Ojrzanowska¹⁾, Dominika Świerczyńska-Machura²⁾, Diana Tymoszuk¹⁾, Ewa Nowakowska-Świrta²⁾, Jolanta Walusiak-Skorupa¹⁾

1) Department of Occupational Diseases, Nofer Institute of Occupational Medicine 2) Centre of Occupational Allergy and Environmental Health, Nofer Institute of Occupational Medicine

 Released on J-STAGE 20140206   [Advance Publication] Released 20130502

Keywords: Detergents, Dishwashing tablet, Occupational asthma (OA), Savinase, Sensitization to enzymes, Subtilisin

Language:      English     Japanese   

http://dx.doi.org/10.1539/joh.12-0169-CS

 

DN/JST.JSTAGE/joh/12-0169-CS

Case Study


Abstract:
Objectives: Savinase is one of the endopeptidases widely used in washing detergents. Its ability to cause respiratory allergy has been known. Up to now, most cases of occupational asthma (OA) to savinase have been described among workers involved in the manufacture of laundry detergents. We present a case study of 51-year-old female worker of a dishwashing tablets factory, who had been packaging ready-made tablets into foil wrappers for 4 years and developed respiratory symptoms, such as cough, dyspnoea and wheezing. Methods: A number of clinical procedures were performed, including the clinical examination, routine laboratory tests, evaluation of total and allergen-specific serum IgE (asIgE) to enzymes, skin prick tests for common allergens, rest spirometry, inhalation methacholine challenge test and a single-blind, placebo-controlled specific inhalation challenge test (SICT) with dishwashing tablets. Results: Clinical findings and results of routine laboratory tests were within normal limits. Baseline nonspecific bronchial hyperreactivity was revealed. In patient's serum blood we found significantly elevated asIgE to savinase. Decline of FEV₁ and PEF in late phase of asthmatic reaction was observed during the specific challenge test. The patient reported chest tightness between 5-12 hours after exposure to dishwashing tablet ingredients. Cytological assessment of an induced sputum revealed increase in the percentage of eosinophils 24 hours after specific challenge in comparison to values noted before the SICT.Conclusions: Positive clinical response to the challenge confirmed in objective method tests validated the diagnosis of OA.(J Occup Health 2013; 55: 318-321)

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