Occupational Agents in Bronchial Provocation Tests

  • L. M. Fabbri
  • A. Papi
  • C. E. Mapp
  • A. Ciaccia


In 1700 Bernardino Ramazzini, Professor of Medicine at the University of Padova, Italy, firstly described grain dust asthma and baker’s asthma [1]. Some 200 years later, in 1911, Karasek and Karasek [2] described asthma caused by exposure to platinum salts in photographic workers. This interest in occupation as a cause of asthma was continued in the late 1960s, mainly through the work of Jack Pepys, in London, England, who conducted routine bronchoprovocation tests with occupational agents and established their importance in the diagnosis of the disease [3]. Around the same time, the problem of occupational asthma was noted by several investigators, including Massimo Crepet, Professor of Occupational medicine at the University of Padova from 1954 until 1980, who organized a pioneering meeting in Padova on “Le allergie professionali” in 1963 [4].


Airway Responsiveness Peak Expiratory Flow Rate Occupational Asthma Inhalation Challenge Occupational Agent 
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  1. 1.
    Ramazzini B (1713) Be morbis artificum. Diatriba. Edition Novissima. Ex typographya Caroli Columbi Romae MCMLIII (A reprint of the edition published in Padova in 1713 )Google Scholar
  2. 2.
    Karasek Sr, Karasek M (1911) Preliminary report on the injurious effects of metal platinum, chromates, cyanides, hydrofluoridric acid, and of material used by silver miners. Report of the Illinois State Commission on occupational diseases, p 97Google Scholar
  3. 3.
    Pepys J, Hutchroft BJ (1975) Bronchial provocation tests in etiologic diagnosis and analysis of asthma. Am Rev Respir Dis 112: 829–859PubMedGoogle Scholar
  4. 4.
    Crepet M, Gaffuri E, Vallerani G (1966) Aspetti Clinici e diagnostici dell’ asma allergico professionale. In: Le allergie professionali. Atti del XXVI Congresso Nazionale di Medicina del Lavoro tenutosi a Padova dal 11 al 13 Ottobre 1963. Cedam Editrice, PadovaGoogle Scholar
  5. 5.
    Chan-Yeung M, Lam S (1986) Occupational asthma. Am Rev Respir Dis 133: 686–803PubMedGoogle Scholar
  6. 6.
    Brooks SM, Weiss MA, Bernstein IL (1985) Reactive Airways Disfunction Syndrome (RADS). Persistent asthma syndrome after high level irritant exposures. Chest 86: 376–384Google Scholar
  7. 7.
    Venable KM (1987) Epidemiology and the prevention of occupational asthma. Br J Ind Med 44: 73–75Google Scholar
  8. 8.
    Keskinen H (1983) Epidemiology of occupational lung diseases: asthma and allergic alveolitis. In: Kerr JW and Gandertone MA (eds). Proceedings of XI International Congress of Allergology and Clinical Immunology. McMillan, London, pp 403–407Google Scholar
  9. 9.
    Sears M (1990) Epidemiology of asthma. In: O’Byrne PM (ed). Asthma as an inflammatory disease. Dekker, New York, chap 2Google Scholar
  10. 10.
    Mapp CE, Boschetto P, Dal Vecchio L, Maestrelli P, Fabbri LM (1988) Occupational asthma due to isocyanates. Eur Respir J 1: 273–279PubMedGoogle Scholar
  11. 11.
    Burge PS, Perks WH, O’Brien IM et al. (1979) Occupational asthma in an electronic factory: a case-control study to evaluate aetiological factors. Thorax 34: 300–307PubMedCrossRefGoogle Scholar
  12. 12.
    Thiel H (1983) Baker’s asthma. Epidemiological and clinical findings — need for prospective studies. In: Kerr JW, Gandertone MA (eds) Proceedings of the XIth international congress of allergology and clinical immunology. McMillan, London, pp 429–433Google Scholar
  13. 13.
    Bernstein DI (ed) (1989) Guidelines for the diagnosis and evaluation of occupational lung diseases. J Allergy Clin Immunol 84: 5 (part 2)Google Scholar
  14. 14.
    Cartier A, Bernstein IL, Burge PS et al. (1989) Guidelines for bronchoprovocation on the investigation of occupational asthma. J Allergy Clin Immunol 84: 823–828PubMedCrossRefGoogle Scholar
  15. 15.
    Cockcroft AE (1988) Occupational asthma and alveolitis — unanswered questions. J R Soc Med 81: 255–257PubMedGoogle Scholar
  16. 16.
    Burge PS, O’Brien IM, Harries MG (1979) Peak flow rate records in the diagnosis of occupational asthma due to colophony. Thorax 34: 308–316PubMedCrossRefGoogle Scholar
  17. 17.
    Hargreave FE, Woolcock AJ (eds) (1985) Airway responsiveness. Measurement and interpretation. Astra Pharmaceutical CanadaGoogle Scholar
  18. 18.
    Hargreave FE, Ramsdale EH, Pugsly SO (1984) Occupational asthma without bronchial hyperresponsiveness. Am Rev Respir Dis 130: 513–515PubMedGoogle Scholar
  19. 19.
    Mapp CE, Dal Vecchio L, Boschetto P, De Marzo N, Fabbri LM (1986) Toluene diisocyanate-induced asthma without airway hyperresponsiveness. Eur J Respir Dis 68: 89–95PubMedGoogle Scholar
  20. 20.
    Mapp C, Polato R, Maestrelli P, Hendrick DJ, Fabbri LM (1985) Time course of the increase of airway responsiveness associated with delayed asthmatic reactions to toluene diisocyanate in sensitized subjects. J Allergy Clin Immunol 75: 568–572PubMedCrossRefGoogle Scholar
  21. 21.
    Cartier A, L’Archeveque J, Malo’ JL (1986) Exposure to a sensitizing occupational agent can cause a long lasting increase in bronchial responsiveness to histamine in the absence of significant changes of airway caliber. J Allergy Clin Immunol 78: 1185–1190PubMedCrossRefGoogle Scholar
  22. 22.
    Hammad YY, Rando RJ, Abdel-Kader H (1985) Considerations in the design and use of human inhalation challenge delivery system. Folia Allergol Immunol Clin 32: 37–44Google Scholar
  23. 23.
    Cloutier Y, Lagier F, Lemieux R et al. (1989) New methodology for specific inhalation challenges with occupational agents in powder form. Eur Respir J 2: 769–777PubMedGoogle Scholar
  24. 24.
    Mapp CE, Di Giacomo R, Broseghini C et al. (1986) Late, but not early, asthmatic reactions induced by toluene diisocyanate ( TDI) are associated with increased airway responsiveness. Eur J Respir Dis 68: 276–284Google Scholar
  25. 25.
    Chan-Yeung M, Lam S (1990) Evidence for mucosal inflammation in occupational asthma. Clin Exp Allergy 20: 1–5PubMedCrossRefGoogle Scholar
  26. 26.
    Fabbri LM, Mapp CE, Saetta M, Allegra L (1990) Occupational asthma. In: O’Byrne PM (ed) Asthma as an inflammatory disease. Dekker, New York, chap 6Google Scholar
  27. 27.
    Cote’ J, Kennedy S, Chan-Yeung M (1990) Sensitivity and specificity of PC20 and peak expiratory flow rate in cedar asthma. J Allergy Clin Immunol 85: 592–598CrossRefGoogle Scholar
  28. 28.
    Fabbri LM, De Rose V, Godard Ph, Boschetto P, Rossi GA (1992) Guidelines and recommendations for the clinical use of bronchoalveolar lavage in asthma. Eur Respir Rev 2: 116–123Google Scholar
  29. 29.
    Novey HS, Bernstein IL, Mihalas LS, Terr AI, Yunginger JW (1989) Guidelines for the clinical evaluation of occupational asthma due to high molecular weight ( HMW) allergens. J Allergy Clin Immunol 84: 829–833Google Scholar
  30. 30.
    Butcher BT, Bernstein IL, Schwartz HI (1989) Guidelines for the clinical evaluation of occupational asthma due to low molecular weight ( LMW) chemicals. J Allergy Clin Immunol 84: 834–838Google Scholar
  31. 31.
    Yeung M, Grzybowski S (1985) Prognosis of occupational asthma. Thorax 40: 241–243PubMedCrossRefGoogle Scholar
  32. 32.
    Cote’ J, Kennedy S, Chan Yeung M (1990) Outcome of patients with cedar asthma with continuous exposure. Am Rev Respir Dis 141: 373–376Google Scholar
  33. 33.
    Mapp CE, Chiesura-Corona P, De Marzo N, Fabbri LM (1988) Persistent asthma due to isocyanates. A follow-up study of subjects with occupational asthma due to toluene diisocyanate. Am Rev Respir Dis 137: 1326–1329Google Scholar
  34. 34.
    Fabbri LM, Danieli D, Crescioli S, Bevilacqua P, Meli S, Saetta M, Mapp CE (1988) Fatal asthma in a toluene diisocyanate sensitized subject. Am Rev Respir Dis 137: 1494–1498PubMedGoogle Scholar
  35. 35.
    Paggiaro PL, Paoletti P, Bacci E et al. (1990) Eosinophils in bronchoalveolar lavage (BAL) of patients with toluene diisocyanate ( TDI) asthma after cessation of work. Chest 98: 536–542Google Scholar
  36. 36.
    Banks DE, Rando RJ, Barkman HW (1990) Persistence of toluene diisocyanate induced asthma despite negligible workplace exposures. Chest 97: 121–125PubMedCrossRefGoogle Scholar
  37. 37.
    Allard C, Cartier A, Ghezzo H, Malo JL (1989) Occupational asthma due to various agents. Absence of clinical and functional improvement at an interval of four or more years after cessation of exposure. Chest 96: 1046–1049Google Scholar
  38. 38.
    Hargreave FE, Dolovich J, Newhouse MT (eds) (1990) The assessment and treatment of asthma: a conference report. J Allergy Clin Immunol 85: 1098–1111Google Scholar
  39. 39.
    Mapp CE, Boschetto P, Dal Vecchio L et al. (1987) Protective effect of antiasthma drugs on late asthmatic reactions and increased responsiveness induced by toluene-diisocyanate in sensitized subjects. Am Rev Respir Dis 136: 1403–1407PubMedCrossRefGoogle Scholar
  40. 40.
    Tossin L, De Marzo N, Crescioli S, Mapp CE, Fabbri LM (1989) Ketotifen does not inhibit asthmatic reactions induced by toluene diisocyanate in sensitized subjects. Clin Exper Allergy 19: 177–182CrossRefGoogle Scholar
  41. 41.
    Chan-Yeung M (1988) Occupational asthma update. Chest 93: 407–411PubMedCrossRefGoogle Scholar
  42. 42.
    Warren CPW, Boulet L-P, Broder I et al. (1989) Occupational asthma: recommendations for diagnosis, management, and assessment of impairment. Can Med Assoc J 140: 1029–1032Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • L. M. Fabbri
    • 1
  • A. Papi
    • 1
  • C. E. Mapp
    • 2
  • A. Ciaccia
    • 1
  1. 1.Institute of Infections and Respiratory DiseasesUniversity of FerraraFerraraItaly
  2. 2.Institute of Occupational MedicineUniversity of PadovaPadovaItaly

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