Occupational Asthma Reference

Biagini RE, Bernstein DM, Klincewicz SL, Mittman R, Bernstein IL, Henningsen GM, Evaluation of cutaneous responses and lung function from exposure to opiate compounds among ethical narcotics-manufacturing workers, J Allergy Clin Immunol, 1992;89:108-118,https://doi.org/10.1016/S0091-6749(05)80047-8.

Keywords: oa, morphine, prick tear, FEV1, cs, USA

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David Bernstein, Cincinatti David Bernstein

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We recently demonstrated morphine-6-hemisuccinate-human serum albumin conjugate (M-6-HS-HSA)—specific IgG in serum from ethic narcotics-manufacturing workers. In this article, we present results of epicutaneous tests to opiate compounds and lung-function studies in these same workers. Thirty-nine workers, exposed to opiates, were evaluated for possible work-related changes in lung function and were administered a questionnaire concerning opiate exposure and health history in February 1988. In December 1988, 33 employees with occupational exposure to opiates, six other workers (New Jersey referent) employed at the same factory with minimal exposure to opiate compounds, and 17 nonexposed individuals from Cincinnati, Ohio, were subjected to epicutaneous threshold testing with a panel of six opiate compounds and nine common aeroallergens. In opiate-exposed workers, significantly lower epicutaneous threshold concentrations were detected (compared to New Jersey referent and Cincinnati control subjects) for dihydrocodeine (p<0.01), hydrocodone (p<0.05), codeine (p<0.01), and morphine (p<0.05). Significant associates existed among epicutaneous threshold concentrations between the agents tested; that is, individuals with a positive morphine skin test would generally have a positive codeine skin test, etc. Atopic status (positive cutaneous test results to two or more of nine common aeroallergens) was not significantly associated (p>0.05) with positive opiate skin sensitivity. Although the mean cross-shift decrements in FEV1 for all workers were nonsignificant, five opiate-exposed individuals demonstated cross-shift decrements in FEV1 of >10%. Daily maximum-minus-minimum changes in workweek PEFR (PEFRmax-min) were significantly reduced for Monday through Thursday (p<0.05) compared to PEFRmax-min changes during a nonwork, nonexposure 3-day weekend. Ten exposed workers demonstrated daily PEFRmax-min changes of >20%, suggesting acute airway obstruction. Increased cutaneous reactivity to opiate compounds among opiate-exposed workers may reflect development of pharmacologic hyperresponsiveness to opiate compounds.
Keywords: Hypersensitivity; asthma; morphine; codeine; dihydrocodeine; oxycodone; hydrocodone; antibodies; lung function

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