Occupational asthma caused by bacillary amylase used in the detergent industry

• Published in: Occupational and environmental medicine (London, England) Vol. 57; no. 12; pp. 840 - 842
• Main Authors: Hole, A M, Draper, A, Jolliffe, G, Cullinan, P, Jones, M, Taylor, A J Newman
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.12.2000; BMJ Publishing Group; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adult; Allergic diseases; Allergies; amylase; Amylases - adverse effects; Asthma; Asthma - chemically induced; Bacillus; Bacillus - enzymology; Bacillus licheniformis; Biological and medical sciences; Bronchial Provocation Tests; Cellulase; detergent enzyme; Detergent industry; Detergents; Detergents - adverse effects; Enzymes; Histamines; Humans; Immunology; Immunopathology; Inhalation; Male; Medical sciences; Middle Aged; occupational asthma; Occupational diseases; Occupational Diseases - chemically induced; Respiratory and ent allergic diseases; respiratory tract diseases; Short Report; Single-Blind Method; Soap industry; Washing; Allergy; Prick test; Toxicity; Washing; Bacillaceae; Occupational exposure; Powder; Incidence; Bacillales; Bacteria; Bronchus disease; Diagnosis; Skin test; Human; Immunopathology; Chemical industry; Detergent; Amylase; Respiratory disease; Enzyme; Bacillus licheniformis; Asthma; Case study; Occupational medicine; Provocation test
• ISSN: 1351-0711; 1470-7926
• DOI: 10.1136/oem.57.12.840

Four cases are reported of occupational asthma due to amylase derived from Bacillus licheniformis, used in detergent washing powders. It is thought that these are the first reported cases of asthma due to this enzyme in the detergent industry. All four employees (men) were from the same factory and none had a history of asthma or atopy. All developed symptoms of wheeze at work after an initial symptom free period. Symptoms improved during periods away from work. All undertook serial peak flow recordings (not diagnostic) and underwent skin prick tests, radio allergosorbent test (RAST) measurement, and specific bronchial provocation testing. The bronchial provocation testing was performed by a dust tipping method in a single blind manner, with lactose as an inert control and powdered amylase, provided by the employer, as an active agent. Serial measurements of forced expiratory volume in 1 second (FEV1) were recorded and histamine provocative concentration causing a 20% fall in FEV1 (PC20) tests were determined before and 24 hours after each challenge. Patient 1 developed an isolated early reaction, patient 2 an isolated late reaction, and patients 3 and 4 developed dual reactions. All showed an increased non-specific bronchial responsiveness after active challenge. The introduction of encapsulated enzymes in the detergent industry was followed by a reduction in the incidence of respiratory sensitisation. These patients developed occupational asthma despite working only with encapsulated enzymes. This highlights the importance of careful surveillance after the introduction of new agents in the workplace.