July 2019 additions to NERDB

July 2019 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 Obvibase.

More information on this database on the NERDB page

On the website we will publish from this month on regular updates on new disease – exposure combinations we added to the database. Currently, we have 205 entries. Ordered by year in which the abstract is published

20093unknown year6

Last new entries


A 27-year-old female worker, production manager and responsible for the area of alginates in a manufacturing company for the dental industry for 6 years, with inhalation exposure to inorganic powders and alginate vapors whose composition is calcined diatomaceous flow. Begins current dis-ease after entering the alginate area, presenting dry cough, burning sensation in the nose and epistaxis, without going to medical attention. 5 years later she presented dyspnea of great efforts and non-productive cough, evolving at 5 months to dyspnea of moderate efforts and tachycardia; with spirometry that concluded severe restriction. Pneumoconiosis was diagnosed 10 months later by Pneumology, presenting severe dyspnea, tachycardia and nail cyanosis at moderate efforts, requiring the use of home and ambulatory oxygen and treatment with bronchodilators. High exposure and no personal protective equipment suitable for alginates within industrial processes can lead to the accelerated development of pneumoconiosis; in the company visit, the inhalation exposure to composite powders with calcined diatomaceous flow was corroborated, which together with the paraclinical studies and the symptomatology presented demonstrated the cause-effect relationship, work-injury.

Brie Hawley Kristin J. Cummings, Mohammed Mohammed, Anne E. Dimmock, and Rebecca Bascom, Allergic sinusitis and severe asthma caused by occupational exposure to locust bean gum: Case report. Am J Ind Med. 2017 July; 60(7): 658–663. doi:10.1002/ajim.22725

A 35-year-old man with no significant past medical history began working at a creamery in 1986. He held several ancillary positions before becoming directly involved in cheesemaking in 1995. His tasks as a cheesemaker’s assistant and later as a cheese-room processor included obtaining and measuring finely powdered locust bean gum (LBG) from bulk containers in storage areas and adding the LBG to cream cheese mixtures. In early 1996, he presented with the complaint of wheezing upon exposure to cold air. Subsequently, he was seen repeatedly over the course of 8 years for recurrent episodes of acute respiratory illness, with listed diagnoses including rhinitis, sinusitis, acute bronchitis, and cold-induced asthma. Due to medical treatment including operations, a prolonged at-home convalescence was required, during which he noted complete resolution of his respiratory symptoms. After his return to work, his acute and chronic upper and lower respiratory symptoms gradually returned, as did the eosinophilia, peaking at 800 in 2010. Initial pulmonary consultation indicated possible mild allergic triggers, but testing for workplace allergy was not pursued.

He was referred in 2011 to a second pulmonologist. Discussion of possible symptom triggers revealed that his eyes and skin would sometimes itch at work and he had difficulty breathing when performing tasks that involved scooping a powder and adding the powder to cheese mixtures. Consultation with a colleague with training in occupational medicine led to immediate initiation of portable peak expiratory flow rate monitoring. Incidentally, he was scheduled for a 10-day holiday work break later that month. Evaluation in January showed that when he was away from work his peak expiratory flow improved from 200 lpm to 400 lpm. Referral to a pulmonologist with training in occupational medicine led to further discussion of his work tasks and review of Safety Data Sheets (SDS’s) requested from the workplace identified the powder as LBG. A subsequent fluorescent enzyme-linked immunosorbent assay (ImmunoCAP, Thermo Fisher Scientific-Phadia AB, Uppsala, Sweden) quantified high levels (85 kU per L) of LBG specific IgE (Table 2). Consequently, the patient was removed from job duties that required the use of LBG in mid-2012. At that point, he had worked for 16 years as a cheesemaker at a creamery.

His need for emergency room care ended as soon as he was removed from contact with the LBG powder. Additionally, his FEV1 increased by almost a liter and a half over the next 2 years. Because his tasks as a cheesemaker required the use of LBG powder, he had to be removed from work in the cheese room. His subsequent relocation, however, included job duties that required the use of cleaning chemical irritants and sensitizers. Although LBG was identified as the primary sensitizer, he had developed generalized airway reactivity to chemicals. Cleaning tasks associated with symptoms included floor stripping and surface cleaning with quaternary ammonium compounds. Subsequently, he was reassigned to custodial tasks in office areas which did not require the use of these triggers and his symptoms improved.

Soile Jungewelter, Liisa Airaksinen, Maria Pesonen Occupational rhinitis, asthma, and contact urticaria from IgE-mediated allergy to pork Am J Ind Med.2019;62:80–84

Four cases of occupational immediate allergy to raw pork allergens, confirmed by positive skin prick testing and specific immunoglobulin E (IgE) antibodies in slaughterhouse workers are described. Our first patient was diagnosed with occupational asthma from raw pork allergens. Two patients were diagnosed with occupational rhinitis caused by raw pork allergens, which was confirmed by a nasal provocation test. One of these also had occupational contact urticaria caused by raw pork meat. We were unable to diagnose an occupational respiratory or skin disease in the fourth patient, despite signs of immediate sensitization to raw pork meat from occupational exposure. Based on proper diagnoses, measures to prevent allergen exposure were taken, which led to the improvement of symptoms in these four patients. The present patient cases highlight the importance of recognition of early signs of occupational allergy and identification of causative allergens in order to allow avoidance of allergens, with the aim of preventing persistence and worsening of symptoms



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