TY - JOUR

T1 - Allergy Development in Adulthood

T2 - An Occupational Cohort Study of the Manufacturing of Industrial Enzymes

AU - Larsen, Anders Ingemann

AU - Cederkvist, Luise

AU - Lykke, Anne Mette

AU - Wagner, Poul

AU - Johnsen, Claus R

AU - Poulsen, Lars K

N1 - Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

PY - 2020

Y1 - 2020

N2 - BACKGROUND: Occupational allergy may serve as a model of allergy development in adults.OBJECTIVE: We aimed at describing respiratory allergy and IgE sensitization across different exposure strata defined by time, technology, and exposure control.METHODS: In a retrospective (1970-2017) cohort of industrial enzyme production employees, monitored by an occupational medical center, 5024 individuals were surveyed. Five exposure groups and risk levels for sensitization and allergic disease were analyzed on the basis of demographic characteristics, hiring decade, and smoking status.RESULTS: Of all persons entering the company 47 years from 1970, 149 developed occupational allergy (incidence rate, 2.72/1000 person-years). In a multivariate cause-specific Cox proportional hazards model, the hazard of allergy was significantly related to decade of recruitment. Compared with the 1970s, the hazard ratio (HR) uniformly decreased from 0.85 (95% CI, 0.57-1.27) in the 1980s to 0.16 (95% CI, 0.05-0.52) in the 2010s. Compared with expected highest exposed group, the HRs were 0.48 (95% CI, 0.31-76) and 0.13 (95% CI, 0.06-0.30) in less exposed production areas and 0.92 (95% CI, 0.48-1.73) and 0.23 (95% CI, 0.10-0.53) in different laboratory areas. The HR of smoking was 2.03 (95% CI, 1.41-2.93). The pattern of sensitizations also showed clear associations to recruitment decade, exposure, and smoking. Among individuals sensitized but not yet allergic, a high IgE level was the only risk factor (HR, 3.03; 95% CI, 1.82-5.04) for subsequent allergy development.CONCLUSIONS: The impact of exposure is dose-related and linked to the sensitization step, which may subsequently lead to allergy development. For primary prevention of enzyme allergy, exposure control is mandatory and achievable despite increasing production volumes.

AB - BACKGROUND: Occupational allergy may serve as a model of allergy development in adults.OBJECTIVE: We aimed at describing respiratory allergy and IgE sensitization across different exposure strata defined by time, technology, and exposure control.METHODS: In a retrospective (1970-2017) cohort of industrial enzyme production employees, monitored by an occupational medical center, 5024 individuals were surveyed. Five exposure groups and risk levels for sensitization and allergic disease were analyzed on the basis of demographic characteristics, hiring decade, and smoking status.RESULTS: Of all persons entering the company 47 years from 1970, 149 developed occupational allergy (incidence rate, 2.72/1000 person-years). In a multivariate cause-specific Cox proportional hazards model, the hazard of allergy was significantly related to decade of recruitment. Compared with the 1970s, the hazard ratio (HR) uniformly decreased from 0.85 (95% CI, 0.57-1.27) in the 1980s to 0.16 (95% CI, 0.05-0.52) in the 2010s. Compared with expected highest exposed group, the HRs were 0.48 (95% CI, 0.31-76) and 0.13 (95% CI, 0.06-0.30) in less exposed production areas and 0.92 (95% CI, 0.48-1.73) and 0.23 (95% CI, 0.10-0.53) in different laboratory areas. The HR of smoking was 2.03 (95% CI, 1.41-2.93). The pattern of sensitizations also showed clear associations to recruitment decade, exposure, and smoking. Among individuals sensitized but not yet allergic, a high IgE level was the only risk factor (HR, 3.03; 95% CI, 1.82-5.04) for subsequent allergy development.CONCLUSIONS: The impact of exposure is dose-related and linked to the sensitization step, which may subsequently lead to allergy development. For primary prevention of enzyme allergy, exposure control is mandatory and achievable despite increasing production volumes.

U2 - 10.1016/j.jaip.2019.06.007

DO - 10.1016/j.jaip.2019.06.007

M3 - Journal article

C2 - 31233941

VL - 8

SP - 210-218.e5

JO - The Journal of Allergy and Clinical Immunology: In Practice

JF - The Journal of Allergy and Clinical Immunology: In Practice

SN - 2213-2198

IS - 1

ER -