Abstract

Lessons
SIC tests to the chlorine-releasing agent and urine individually produced negative results. However, the combination of urine with the chlorine-releasing agent, replicating the actual workplace exposure, produced a positive asthmatic reaction. It is likely that the chlorine and urine mixture produced chloramines. Chloramines are known sensitisers causing occupational asthma in swimming pool attendants and teachers, where SICs have shown chloramines to be the cause.3 We believe that this explains the previous negative tests to chlorine-releasing agents alone in healthcare workers, where chloramines produced in cleaning operations at work are the likely cause of much of their occupational asthma. Any SIC tests to chlorine tablets should be performed with a nitrogen source when exposures to the chlorine-releasing substance alone do not elicit an asthmatic reaction. The optimal management of a worker with occupational asthma requires identification of the specific cause, so that exposures can be reduced for others and eliminated for the sensitised worker. In this case, the cause was identified but unfortunately removal from direct exposure was insufficient to eliminate all work-related symptoms and small changes in peak flow (as shown by the positive timepoint analysis). With the help of her occupational health department, our patient decided to retire on medical grounds, which is sometimes the best solution.

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