Nicolas Migueres1, Charlotte Debaille2, Jolanta Walusiak-Skorupa3, Agnieszka Lipińska-Ojrzanowska3, Xavier Munoz4, Vera van Kampen5, Hille Suojalehto6, Katri Suuronen6, Martin Seed7, Sewon Lee7, Catherine Rifflart2, Julien Godet8, Frédéric de Blay9, Olivier Vandenplas10. 1. Groupe Méthode Recherche Clinique, Pôle de Santé Publique, Strasbourg University, Strasbourg, France; Division of Asthma and Allergy, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine translationnelle, Strasbourg University, Strasbourg, France. 2. Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium. 3. Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland. 4. Servei Pneumologia, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona and CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain. 5. Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Ruhr University, Bochum, Germany. 6. Occcupational Health, Finnish Institute of Occupational Health, Helsinki, Finland. 7. Centre for Occupational and Environmental Health, The University of Manchester, Manchester, United Kingdom. 8. Groupe Méthode Recherche Clinique, Pôle de Santé Publique, Strasbourg University, Strasbourg, France. 9. Division of Asthma and Allergy, Department of Chest Diseases, University Hospital of Strasbourg and Fédération de Médecine translationnelle, Strasbourg University, Strasbourg, France. 10. Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium. Electronic address: olivier.vandenplas@uclouvain.be.
Abstract
BACKGROUND: Quaternary ammonium compounds (QACs) are used extensively for cleaning and disinfection and have been documented in scattered reports as a cause of occupational asthma (OA) through bronchoprovocation tests (BPT). OBJECTIVE: To examine the clinical, functional, and inflammatory profile of QAC-induced OA compared to OA caused by other low-molecular-weight (LMW) agents. METHODS: The study was conducted in a retrospective multicenter cohort of 871 subjects with OA ascertained by a positive BPT. Subjects with QAC-induced OA (n=22) were identified based on a positive BPT to QACs, after exclusion of those challenged with cleaning products or disinfectants that contained other potential respiratory sensitizers, and they were compared to 289 subjects with OA caused by other LMW agents. RESULTS: Most subjects with QAC-induced OA were working in the healthcare sector (n=14). A ≥2-fold increase in the postchallenge level of nonspecific bronchial hyperresponsiveness was recorded in 8 of 11 (72.7%) subjects with QAC-induced OA, and in 49.7% of those with OA due to other LMW agents. Although sputum assessment was available in only 8 subjects with QAC-induced OA, they showed a significantly greater median (interquartile) increase in sputum eosinophils (18.1% [12.1 to 21.1]) compared to those with OA due to other LMW agents (2.0% [0 to 5.2], P<0.001). CONCLUSION: This study indicates that QAC-induced OA is associated with a highly eosinophilic pattern of airway response and provides further evidence supporting the sensitizing potential of QACs. The findings highlight the heterogeneous nature of the pathobiological pathways involved in OA caused by LMW agents.
BACKGROUND:Quaternary ammonium compounds (QACs) are used extensively for cleaning and disinfection and have been documented in scattered reports as a cause of occupational asthma (OA) through bronchoprovocation tests (BPT). OBJECTIVE: To examine the clinical, functional, and inflammatory profile of QAC-induced OA compared to OA caused by other low-molecular-weight (LMW) agents. METHODS: The study was conducted in a retrospective multicenter cohort of 871 subjects with OA ascertained by a positive BPT. Subjects with QAC-induced OA (n=22) were identified based on a positive BPT to QACs, after exclusion of those challenged with cleaning products or disinfectants that contained other potential respiratory sensitizers, and they were compared to 289 subjects with OA caused by other LMW agents. RESULTS: Most subjects with QAC-induced OA were working in the healthcare sector (n=14). A ≥2-fold increase in the postchallenge level of nonspecific bronchial hyperresponsiveness was recorded in 8 of 11 (72.7%) subjects with QAC-induced OA, and in 49.7% of those with OA due to other LMW agents. Although sputum assessment was available in only 8 subjects with QAC-induced OA, they showed a significantly greater median (interquartile) increase in sputum eosinophils (18.1% [12.1 to 21.1]) compared to those with OA due to other LMW agents (2.0% [0 to 5.2], P<0.001). CONCLUSION: This study indicates that QAC-induced OA is associated with a highly eosinophilic pattern of airway response and provides further evidence supporting the sensitizing potential of QACs. The findings highlight the heterogeneous nature of the pathobiological pathways involved in OA caused by LMW agents.