Manon Labrecque1. 1. Département de médecine, Centre de Recherche de l'hôpital Sacré-Cœur de Montréal, Université de Montréal, Montréal, Québec, Canada. manon.labrecque@umontreal.ca
Abstract
PURPOSE OF REVIEW: To describe the recent insights into the definition, causes, natural outcome, and key elements of irritant-induced asthma (IIA) management. RECENT FINDINGS: IIA is a subtype of occupational asthma without immunologic sensitization and includes the typical reactive airway dysfunction syndrome (RADS) and a more gradual form called not-so-sudden IIA, when onset of asthma follows repeated low-dose exposure to irritants. The World Trade Center tragedy brought new insight in the understanding of IIA, suggesting that it can exhibit a prolonged interval between exposure and recognition of clinical symptoms and disease. Dimethyl sulfate has been recently reported to cause RADS and repeated diesel exhaust exposure to cause not-so-sudden IIA in patients who worked in a bus garage. Cleaning workers who are exposed to a large variety of irritants and sensitizers are especially at risk of occupational asthma and IIA. SUMMARY: IIA includes RADS and not-so-sudden IIA. Outcome of IIA is as poor as occupational asthma with sensitization. Treatment of IIA does not differ from standard asthma treatment, but high-dose vitamin D could be assessed further for possible therapeutic benefit.
PURPOSE OF REVIEW: To describe the recent insights into the definition, causes, natural outcome, and key elements of irritant-induced asthma (IIA) management. RECENT FINDINGS: IIA is a subtype of occupational asthma without immunologic sensitization and includes the typical reactive airway dysfunction syndrome (RADS) and a more gradual form called not-so-sudden IIA, when onset of asthma follows repeated low-dose exposure to irritants. The World Trade Center tragedy brought new insight in the understanding of IIA, suggesting that it can exhibit a prolonged interval between exposure and recognition of clinical symptoms and disease. Dimethyl sulfate has been recently reported to cause RADS and repeated diesel exhaust exposure to cause not-so-sudden IIA in patients who worked in a bus garage. Cleaning workers who are exposed to a large variety of irritants and sensitizers are especially at risk of occupational asthma and IIA. SUMMARY: IIA includes RADS and not-so-sudden IIA. Outcome of IIA is as poor as occupational asthma with sensitization. Treatment of IIA does not differ from standard asthma treatment, but high-dose vitamin D could be assessed further for possible therapeutic benefit.
Authors: Feng-Chiao Su; Melissa C Friesen; Michael Humann; Aleksandr B Stefaniak; Marcia L Stanton; Xiaoming Liang; Ryan F LeBouf; Paul K Henneberger; M Abbas Virji Journal: Int J Hyg Environ Health Date: 2019-04-19 Impact factor: 5.840