Occupational Asthma Reference

Decuyper II, Gasse AV, Faber MA, Mertens C, Elst J, Rihs H, Sabato V, Lapeere H, Hagendorens M, Bridts C, Clerck LD, Ebo D, Occupational cannabis exposure and allergy risks, Occup Environ Med, 2019;76:78-82,http://dx.doi.org/10.1136/oemed-2018-105302

Keywords: Cannabis, Belgium, Police, Basophil activation, IgE,

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Cannabis allergy has mainly been described following recreational use but some cases also point to cannabis sensitisation as a result of occupational exposure. As a consequence, little is known on the prevalence and clinical phenotype of occupational cannabis allergy. Therefore, this study aims to explore the allergy-associated health risks of occupational cannabis exposure in Belgian police force personnel.

81 participants, active in the police force, reporting regular occupational cannabis exposure during the past 12?months, were included. History was combined with a standardised questionnaire on allergies and cannabis exposure. Basophil activation tests (BATs) with a crude cannabis extract and rCan s 3 were performed. In addition, specific (s)IgE rCan s 3 as well as sIgE to house dust mite, six pollen and three mould allergens were quantified.

Although 42% of the participants reported respiratory and/or cutaneous symptoms on occupational cannabis exposure, all cannabis diagnostics were entirely negative, except one symptomatic case demonstrating a borderline result. Furthermore, there is no significant difference between the groups with and without symptoms on cannabis exposure in terms of allergenic sensitisations.

The origins of the reported respiratory and cutaneous symptoms during cannabis exposure remain elusive but are probably due to non-immune reactions. It should be noted that the study was volunteer-based possibly reflecting an excessive number of symptomatic individuals. Nevertheless, as only one participant reported using fully protective gear, much improvement is needed for reducing the number of symptoms reported on duty, independent of their origin.

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From the paper
The majority (89%, 72/81) of participants report entering cannabis plantations five times a year or more; 43% (35/81) even report monthly exposure to cannabis. Many (53%, 43/81) are actively involved in the dismantling of plantations with manual removal of the cannabis plants; the remainder enter cannabis plantations to perform forensic research, to make an inventory/supervise dismantling, or are exposed to cannabis during drug arrests and/or at the police academy. Only 3/81 reported asymptomatic recreational use of cannabis dating back more than 12?months. Notwithstanding recommendations, only one participant reported the use of fully protective clothing.
Thirty-four participants (42%) reported respiratory and/or cutaneous symptoms (up)on occupational exposure to cannabis. Thirty-three of them (97%) reported these symptoms in relation to entering cannabis plantations, the remainder experienced these symptoms when handling the drug outside of these environments. Eight individuals (10%) reported other symptoms such as headache, tiredness or facial flushing which were not specific for occupational cannabis contact. Twenty individuals reported respiratory symptoms, mainly rhinoconjunctivitis (44%), throat irritation (41%), and over 40% reported mild to moderate dyspnoea. Cutaneous symptoms were reported by eight individuals and mainly comprised local or generalised pruritus and erythema. Six individuals (7%) reported both respiratory and cutaneous symptoms on exposure. When comparing the symptomatic and tolerant participants, the number of participants with asthma or atopic dermatitis did not significantly differ.

Respiratory and cutaneous symptoms after exposure to cannabis plants are commonly reported by police and forensic workers, but evidence from challenge testing is lacking. This paper reports the results from 81 symptomatic workers dismantling illegal cannabis plantations or collecting forensic evidence. Basophil activation tests with a crude cannabis extract and rCan s 3 were negative, making an IgE-related mechanism to these antigens unlikely. Positive basophil activation tests to cannabis antigens have been described previously.

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