February 2023 additions to NERDB

February 2023 additions to NERDB

NERDB is the New and emerging risks database. This bibliographic database is an initiative of Nicole Palmen and Annet Lenderink with the support of Modernet and is currently powered by Airtable.

More information on this database is on the NERDB page

We will publish regular updates on new disease-exposure combinations we added to the database on the website. Currently, we have 372 entries. Ordered by the year in which the abstract is published

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New entries:

Picture by Kreingkrai Luangchaipreeda via Pixabay

Ganseman E, Gouwy M, Bullens DMA, Breynaert C, Schrijvers R, Proost P. Reported Cases and Diagnostics of Occupational Insect Allergy: A Systematic ReviewInternational Journal of Molecular Sciences. 2023; 24(1):86. https://doi.org/10.3390/ijms24010086

A significant part of adult-onset asthma is caused by occupational exposure to both high- and low-molecular-mass agents. Insects are occasionally described to cause occupational allergy in professions including anglers and fishers, laboratory workers, employees of aquaculture companies, farmers, bakers, sericulture workers and pet shop workers.

Occupational insect allergies are often respiratory, causing asthma or rhinoconjunctivitis, but can be cutaneous as well. The European Union recently approved three insect species for human consumption, enabling an industry to develop where more employees could be exposed to insect products.

This review overviews knowledge on occupational insect allergy risks and the tools used to diagnose employees. Despite the limited availability of commercial occupational insect allergy diagnostics, 60.9% of 164 included reports used skin prick tests and 63.4% of reports used specific IgE tests. In 21.9% of reports, a more elaborate diagnosis of occupational asthma was made by specific inhalation challenges or peak expiratory flow measurements at the workplace.

In some work environments, 57% of employees were sensitized, and no less than 60% of employees reported work-related symptoms. Further development and optimization of specific diagnostics, together with strong primary prevention, may be vital to the health conditions of workers in the developing insect industry.

Hollywood A, Bourke JF. Occupational allergic contact dermatitis to Piperamido Nitrotoluene in pharmaceutical workers: A case series. Contact Dermatitis. 2022 Nov;87(5):447-450. doi: 10.1111/cod.14189. Epub 2022 Jul 28. PMID: 35837878.

Background: Imatinib mesylate is a first-generation tyrosine kinase inhibitor. Piperamido Nitrotoluene, also known as F5, is an intermediate used in the manufacturing of imatinib. We present a case series of allergic contact dermatitis to F5 in pharmaceutical workers.

Methods: Four male pharmaceutical workers were referred between 2007 and 2021 with new dermatitis predominantly affecting the periorbital region. All were involved in the production of imatinib and particularly exposed to F5. Following medical history and examination, they underwent patch testing to standard series and F5 diluted in white soft paraffin (WSP).

Results: All patients tested positive, confirming a diagnosis of contact allergy to F5. The first case tested positive for F5 diluted to 1% in WSP, the second to F5 diluted to 10% in WSP and the third and fourth to F5 diluted to 1% and 10% in WSP. In all four cases, dermatitis resolved when they were removed from exposure to F5.

Conclusions: To the best of our knowledge, these are the first cases of allergic contact dermatitis to F5 confirmed by patch testing in the literature. In February 2016, a generic formulation of imatinib entered the market. Globalized production of imatinib may result in further cases presenting to dermatology departments worldwide.

Anttila A, Uuksulainen S, Rantanen M, Sallmén M. Lung cancer incidence among workers biologically monitored for occupational exposure to lead: a cohort study. Scand J Work Environ Health. 2022 Sep 1;48(7):540-548. doi: 10.5271/sjweh.4046. Epub 2022 Jun 26. PMID: 35753006.

Earlier studies have reported increased risks of lung, kidney, and brain cancers from exposure to lead. The International Agency for Research on Cancer (IARC) Working Group evaluated inorganic lead and its compounds as probably carcinogenic to humans. This study aimed to assess the association between blood lead levels in occupational exposure and the risk of lung cancer.

The study was based on the follow-up of lung cancer incidence during 1973-2014 among 20 729 employees biologically monitored for their occupational lead exposure in 1973-1983. Duration of employment in the monitored work was assessed using records from the Finnish Centre for Pensions; and potential confounding by other occupational carcinogens using longitudinal information on the occupation in censuses and the Finnish National Job-Exposure Matrix (FINJEM). Occupation- and gender-specific prevalence of regular tobacco smoking and socioeconomic status were also utilized in the adjustments for potential confounding.

Positive trends were found for the elevated blood lead levels on the lung cancer risk. Among employees with a duration of employment of ≥60 months, the relative risk (RR) of lung cancer was 1.72 [95% confidence interval (CI) 1.28-2.31] for mean blood lead 1.0-1.9 µmol/L and RR 2.63 (95% CI 1.71-4.05) for mean blood lead ≥2.0 µmol/L, compared with mean lead <0.5 µmol/L. The studied potential confounders did not explain the findings on the increased risk for lead exposure.

The authors conclude that the current study supports the findings that exposure to lead increases lung cancer risk. Increased risks were seen already at rather low blood lead levels.

Purdue M, Zhang L, Vermeulen R, Smith MT, Hu W, Rhee J, Wen C, Huang Y, Tang X, Berndt SI, Frazer-Abel AA, Deane KD, Rothman N, Lan Q. Occupational trichloroethylene exposure and antinuclear antibodies: a cross-sectional study in China. Occup Environ Med. 2022 Oct;79(10):717-720. doi: 10.1136/oemed-2022-108266. Epub 2022 May 3. PMID: 35504721.

There has been concern over the possible risk of autoimmune diseases from exposure to trichloroethylene (TCE), an industrial solvent and common pollutant near hazardous waste sites. Studies of TCE-exposed lupus-prone mouse strains have reported increases in serum antinuclear antibodies (ANAs), a marker of autoimmunity, and autoimmune pathologic changes, while epidemiologic studies have provided limited support for an association between TCE exposure and scleroderma.

To investigate exposure-related biologic evidence of autoimmunity in humans, we measured ANA levels in sera from a cross-sectional study of TCE-exposed (n=80) and TCE-unexposed (n=96) workers in Guangdong, China. Full-shift personal air exposure measurements for TCE were taken prior to blood collection. Serum ANAs were detected by immunofluorescence on HEp-2 cells. We calculated ORs and 95% CI relating levels of TCE exposure (categorised using tertiles as cut-points) and ANA positivity (1+ intensity at 1:320 dilution) using multivariable logistic regression.

Samples from 16 of 176 participants were ANA-positive. We found higher levels of TCE exposure (concentrations>17.27 ppm) to be associated with an elevated odds of ANA positivity (OR 4.7, 95% CI 1.3 to 16.8) compared with unexposed controls. This association remained after excluding two subjects with diagnosed autoimmune disease (OR 4.5, 95% CI 1.2 to 16.2). We did not observe an association with ANAs at lower exposure levels.

Our findings, to our knowledge the first direct human evidence of an association between TCE exposure and systemic autoimmunity, provide biologic plausibility to epidemiologic evidence relating TCE and autoimmune disease.



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