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Post-Hire Asthma Among Insect-Rearing Workers

Suarthana, Eva MD, PhD; Shen, Angela MPH, ScD; Henneberger, Paul K. ScD, MPH; Kreiss, Kathleen MD; Leppla, Norman C. PhD; Bueller, David MA; Lewis, Daniel M. PhD; Bledsoe, Toni A. MS; Janotka, Erika MUDr; Petsonk, Edward L. MD

Journal of Occupational and Environmental Medicine: March 2012 - Volume 54 - Issue 3 - p 310–317
doi: 10.1097/JOM.0b013e31823fe098
Original Articles

Objective: To evaluate the incidence of post-hire asthma (PHA) among insect-rearing workers, defined as asthma, the symptoms of which appeared after hire at the current workplace.

Methods: We surveyed the health of workers at three insect-rearing facilities and an associated office facility. We calculated the incidence and estimated hazard ratios for PHA.

Results: Post-hire asthma incidence in 157 insect-rearing workers was 16.2 per 1000 person-years compared with 9.2 per 1,000 person-years in 70 office workers. Workers with predominant exposure to Lepidoptera had an incidence of 26.9 per 1000 person-years and a hazard ratio of 5.5 (95% confidence interval: 1.6 to 23.9) adjusted for sex, race, and parental asthma. In contrast, the presence of specific immunoglobulin E to Lepidoptera antigens was not associated with PHA.

Conclusion: Insect-rearing workers had a high incidence of PHA, primarily accounted for by workplace exposure to Lepidoptera.

From the Division of Respiratory Disease Studies (Drs Suarthana, Henneberger, Kreiss, and Petsonk, and Ms Shen and Mr Bueller), National Institute for Occupational Safety and Health, Morgantown, WVa; Epidemic Intelligence Service Program (Dr Suarthana), Centers for Disease Control and Prevention, Atlanta, Ga; Faculty of Medicine University of Indonesia (Dr Suarthana), Jakarta, Indonesia; Health Effects Laboratory Division (Drs Lewis and Janotka, and Ms Bledsoe), National Institute for Occupational Safety and Health, Morgantown, WVa; and Institute of Food and Agricultural Sciences (Dr Leppla), Entomology and Nematology Department, University of Florida, Gainesville, Fla.

Address correspondence to: Edward Lee Petsonk, MD, Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, 1095 Willowdale Rd, Morgantown WV 26505 (

Mention of a specific product or company does not constitute endorsement by the Centers for Disease Control and Prevention. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health.

To the best of the authors' knowledge, no study reported the incidence of new onset of asthma among insect-rearing workers. We found that insect-rearing workers had a remarkably high incidence of post-hire asthma, which was accounted for by workplace exposure to Lepidoptera.

The authors do not have competing interests to declare.

©2012The American College of Occupational and Environmental Medicine