Reference

Vandenplas O, BinardVanCangh F, Brumagne A et al, Occupational Asthma In Symptomatic Workers Exposed To Natural Rubber Latex: Evaluation Of Diagnostic Procedures, J Allergy Clin Immunol, 2001;107:542-547,

BOHRF Original Authors' Main Conclusions

The original authors' main conclusions are taken from Abstract, Results and Discussion. They are decided upon by the authors of the BOHRF occupational asthma guidelines and form part of the guidelines.

Study examined the accuracy of the clinical history, immunologic tests and non-specific bronchial hyper-responsiveness (BHR) in diagnosing latex occupational asthma compared with specific inhalation challenge (SIC). 45 consecutive patients underwent an open medical questionnaire, skin prick testing against latex, measurement of BHR to histamine, and inhalation challenge with latex gloves. The clinical history, skin prick testing against latex, and assessment of non-specific BHR showed high sensitivity but low specificity when compared with the results of the SIC. The clinical history and immunologic tests were the most useful procedures in diagnosing latex occupational asthma, although combining the 2 procedures remained less accurate than SIC. Further examination of the predictive values of available tests is warranted to recommend diagnostic strategies that are specific to the various agents causing occupational asthma.

BOHRF Associated Evidence Statements

The BOHRF occupational asthma guidelines state that this reference is associated with the following evidence statements

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2+

In the clinical setting questionnaires that identify symptoms of wheeze and/or shortness of breath which improve on days away from work or on holiday have a high sensitivity, but relatively low specificity for occupational asthma.

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3

Free histories taken by experts have high sensitivity, but their specificity may be lower.

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2++

A large number of concordant studies from different centres using different methodologies demonstrated that increased non-specific reactivity is often found in workers with occupational asthma. There are however many reports of normal methacholine or histamine reactivity within 24 hours of exposure in workers with confirmed occupational asthma.