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The role of lymphocyte proliferation tests in assessing occupational sensitization and disease

Hines, Stella E.; Pacheco, Karin; Maier, Lisa A.

Current Opinion in Allergy and Clinical Immunology: April 2012 - Volume 12 - Issue 2 - p 102–110
doi: 10.1097/ACI.0b013e3283511396
OCCUPATIONAL DISEASE: Edited by Susan M. Tarlo and Piero Maestrelli

Purpose of review Lymphocyte proliferation testing (LPT) is used in diagnosing occupationally acquired delayed-type hypersensitivity. It has been used in beryllium-health effects, and its role is expanding in metal allergy. It may find application in diagnosis of other sensitizers.

Recent findings Use of the beryllium LPT (BeLPT) in medical surveillance identifies beryllium sensitization at low exposure with chronic beryllium disease (CBD) that leads to physiologic impairment and need for immunosuppressive medications. New studies indicate that both beryllium exposure and genetic variation are associated with increased risk of CBD. Borderline positive BeLPTs warrant inclusion into diagnostic algorithms. Furthermore, use of LPTs to diagnose metal allergy is being proposed in diagnosis of chromium allergy and hypersensitivity to surgical implants. New occupational sensitizers continue to be identified including metalworking fluids, the sterilizing agent ortho-phthalaldehyde and the solvent para-chlorobenzotrifluoride. Use of LPT in occupational surveillance to these agents and other known sensitizers may play expanding roles.

Summary Lymphocyte proliferation testing serves a valuable role in diagnosing occupational sensitization, as demonstrated with beryllium-health effects, as cases continue to be found at low exposure levels. The use of LPTs in diagnosing contact allergy is expanding, and new applications may be identified in human and animal studies.

aOccupational Health Program, Division of General Internal Medicine

bDivision of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland

cDivision of Environmental and Occupational Health Sciences, Department of Medicine, National Jewish Health

dDepartment of Environmental and Occupational Health, Colorado School of Public Health

eDivision of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, University of Colorado Denver, Denver, Colorado, USA

Correspondence to Stella E. Hines, MD, MSPH, Assistant Professor, Occupational Health Program, Department of Medicine, The University of Maryland School of Medicine, 11 South Paca Street, Second Floor, Baltimore, MD 21201, USA. Tel: +1 410 706 7464; fax: +1 410 706 4078; e-mail: shines@medicine.umaryland.edu

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