Are high‐ and low‐molecular‐weight sensitizing agents associated with different clinical phenotypes of occupational asthma?

• DOI: 10.1111/all.13542
• Publication Date: 2018-06-29T06:54:43Z
• Authors: Olivier Vandenplas; Julien Godet; Laura Hurdubaea; Catherine Rifflart; Hille Suojalehto; Marta Wiszniewska; Xavier Munoz; Joaquin Sastre; Pavlina Klusackova; Vicky Moore; Rolf Merget; Donatella Talini; Cecilie Svanes; Paola Mason; Marco dell'Omo; Paul Cullinan; Gianna Moscato; Santiago Quirce; Jennifer Hoyle; David L. Sherson; Paula Kauppi; Alexandra Preisser; Nicolas Meyer; Frédéric de Blay
• Keywords: Adult; Male; Allergy; phenotype; asthma; bronchial provocation tests; occupational diseases; phenotype; Immunology; 610; European network for the PHenotyping of OCcupational ASthma (E-PHOCAS) investigators; GUIDELINES; ta3111; bronchial provocation tests; Leukocyte Count; 03 medical and health sciences; 0302 clinical medicine; MARKERS; SPUTUM; Occupational Exposure; MANAGEMENT; Odds Ratio; Humans; DIAGNOSTIC-ACCURACY; EXPOSURE; Asthma, Occupational; Retrospective Studies; WD300 Hypersensitivity. Allergy; COUNTS; WF Respiratory system. Respiratory medicine; Science & Technology; EOSINOPHILIA; asthma; bronchial provocation tests; occupational diseases; phenotype; Immunology and Allergy; Immunology; asthma; Allergens; Middle Aged; Asthma; Respiratory Function Tests; 3. Good health; Molecular Weight; SEVERITY; DEFINITION; 1107 Immunology; occupational diseases; Female; Immunization; Life Sciences & Biomedicine; Biomarkers

AbstractBackgroundHigh‐molecular‐weight (HMW) proteins and low‐molecular‐weight (LMW) chemicals can cause occupational asthma (OA) although few studies have thoroughly compared the clinical, physiological, and inflammatory patterns associated with these different types of agents. The aim of this study was to determine whether OA induced by HMW and LMW agents shows distinct phenotypic profiles.MethodsClinical and functional characteristics, and markers of airway inflammation were analyzed in an international, multicenter, retrospective cohort of subjects with OA ascertained by a positive inhalation challenge response to HMW (n = 544) and LMW (n = 635) agents.ResultsMultivariate logistic regression analysis showed significant associations between OA caused by HMW agents and work‐related rhinitis (OR [95% CI]: 4.79 [3.28‐7.12]), conjunctivitis (2.13 [1.52‐2.98]), atopy (1.49 [1.09‐2.05]), and early asthmatic reactions (2.86 [1.98‐4.16]). By contrast, OA due to LMW agents was associated with chest tightness at work (2.22 [1.59‐3.03]), daily sputum (1.69 [1.19‐2.38]), and late asthmatic reactions (1.52 [1.09‐2.08]). Furthermore, OA caused by HMW agents showed a higher risk of airflow limitation (1.76 [1.07‐2.91]), whereas OA due to LMW agents exhibited a higher risk of severe exacerbations (1.32 [1.01‐1.69]). There were no differences between the two types of agents in the baseline sputum inflammatory profiles, but OA caused by HMW agents showed higher baseline blood eosinophilia and a greater postchallenge increase in fractional nitric oxide.ConclusionThis large cohort study describes distinct phenotypic profiles in OA caused by HMW and LMW agents. There is a need to further explore differences in underlying pathophysiological pathways and outcome after environmental interventions.