Occupational
asthma from sensitization to a chlorine-containing triclosan
cleaner
Gareth Walters1, Alastair
Robertson1, Vicky Moore1 and Sherwood Burge1
1Occupational Lung Disease
Unit, Birmingham Heartlands Hospital, Birmingham, West Midlands, United
Kingdom
We present evidence for respiratory sensitization to
the
chlorine-releasing antimicrobial compound triclosan, in a nursery nurse
with occupational asthma. A 26-year old female was referred to the
occupational lung disease clinic with a 7-month history of asthma
symptoms progressively worse throughout the working week and better on
days away from work. She required treatment with a combination
corticosteroid and long-acting beta agonist inhaler. She had
experienced previous childhood asthma, mild hay fever and an allergy to
peanuts and hazelnuts. Her job required her to care for 30 infants and
also to mop the floor daily using trisodium nitrilo-triacetate cleaner
(Versatile) and clean tables while wearing nitrile gloves using
triclosan-containing cleaner (Antibac). Serial peak flow readings
showed evidence of occupational asthma (OASYS score=3.5) and spirometry
was normal in clinic (FEV1=3.55L /103%;
FVC=4.05/103%) while exposed at work. She underwent specific
inhalational challenge to 70% alcohol gel (normal), Versatile cleaner
(immediate irritant reaction) and to Antibac cleaner by painting on to
cardboard for 30-38 minutes. Antibac caused an immediate asthmatic
reaction with a maximum fall from baseline FEV1
(3.48L) of 24%. Non-specific bronchial reactivity and FENO
remained normal throughout the challenge. The worker was partially
relocated, and Antibac was substituted for an alternative cleaning
agent. There is evidence from epidemiological study that triclosan
exposure is associated with allergic sensitization to personal care
products and cleaners (Bertelsen et al. Allergy 2013;68:84-91); however
this is the first reported case of respiratory sensitization to a
triclosan-containing cleaner.
http://erj.ersjournals.com/content/44/Suppl_58/P4541
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