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Irritant-induced asthma

Labrecque, Manon

Current Opinion in Allergy & Clinical Immunology: April 2012 - Volume 12 - Issue 2 - p 140–144
doi: 10.1097/ACI.0b013e32835143b8
OCCUPATIONAL DISEASE: Edited by Susan M. Tarlo and Piero Maestrelli

Purpose of review: To describe the recent insights into the definition, causes, natural outcome, and key elements of irritant-induced asthma (IIA) management.

Recent findings: IIA is a subtype of occupational asthma without immunologic sensitization and includes the typical reactive airway dysfunction syndrome (RADS) and a more gradual form called not-so-sudden IIA, when onset of asthma follows repeated low-dose exposure to irritants. The World Trade Center tragedy brought new insight in the understanding of IIA, suggesting that it can exhibit a prolonged interval between exposure and recognition of clinical symptoms and disease. Dimethyl sulfate has been recently reported to cause RADS and repeated diesel exhaust exposure to cause not-so-sudden IIA in patients who worked in a bus garage. Cleaning workers who are exposed to a large variety of irritants and sensitizers are especially at risk of occupational asthma and IIA.

Summary: IIA includes RADS and not-so-sudden IIA. Outcome of IIA is as poor as occupational asthma with sensitization. Treatment of IIA does not differ from standard asthma treatment, but high-dose vitamin D could be assessed further for possible therapeutic benefit.

Département de médecine, Centre de Recherche de l’hôpital Sacré-Cœur de Montréal, Université de Montréal, Montréal, Québec, Canada

Correspondence to Professor Manon Labrecque, MD, MSC, Centre de Recherche de l’hôpital Sacré-Cœur de Montréal, 5400 Gouin ouest, Montréal, QC, Canada H4J 1C5. Tel: +1 514 338 2796; fax: +1 514 338 3699; e-mail: manon.labrecque@umontreal.ca

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