Skip to main content
Occupational and Environmental Medicine logoLink to Occupational and Environmental Medicine
. 2004 Oct;61(10):831–837. doi: 10.1136/oem.2003.011593

A strategy for health surveillance in laboratory animal workers exposed to high molecular weight allergens

E Meijer 1, D Grobbee 1, D Heederik 1
PMCID: PMC1740663  PMID: 15377769

Abstract

Aims: To develop a health surveillance strategy with the use of diagnostic and prognostic prediction models to detect and predict occupational allergic diseases efficiently.

Methods: Data from laboratory animal workers (n = 351) participating in an ongoing cohort study were used to develop diagnostic and prognostic models with logistic regression analyses. A diagnostic model was developed from questionnaire items, and exposure measurements to find predictors for the estimation of the probability of sensitisation to workplace allergens. With the resulting questionnaire model workers were divided into subgroups (high/low probability). A prognostic model was established in workers initially low sensitised using follow up data over a 2–3 year period. The accuracy of the models was evaluated by the concordance (c) statistic, and by comparison of the predicted and observed prevalence.

Results: A diagnostic rule, containing five questionnaire items, identified workers with a high risk of sensitisation. These workers showed high rates of work related asthma, allergic symptoms, doctor's visit, and absenteeism. A prognostic rule based on four questionnaire items predicted workers at high risk of near future sensitisation with high rates of future (allergic) respiratory symptoms, and asthmatic attacks.

Conclusion: The risk of (future) sensitisation and the severity of laboratory animal allergy can be predicted accurately with diagnostic and prognostic prediction models based on questionnaire items. Workers with an increased risk of future sensitisation also showed serious allergic symptoms at follow up. Workers with a low risk have a low risk of becoming diseased in the future.

Full Text

The Full Text of this article is available as a PDF (130.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Balmes J. R. Surveillance for occupational asthma. Occup Med. 1991 Jan-Mar;6(1):101–110. [PubMed] [Google Scholar]
  2. Burge S. Respiratory symptoms. Occup Med (Lond) 1997 Jan;47(1):55–56. doi: 10.1093/occmed/47.1.55. [DOI] [PubMed] [Google Scholar]
  3. Bush R. K., Wood R. A., Eggleston P. A. Laboratory animal allergy. J Allergy Clin Immunol. 1998 Jul;102(1):99–112. doi: 10.1016/s0091-6749(98)70060-0. [DOI] [PubMed] [Google Scholar]
  4. Doekes G., Douwes J., Wouters I., de Wind S., Houba R., Hollander A. Enzyme immunoassays for total and allergen specific IgE in population studies. Occup Environ Med. 1996 Jan;53(1):63–70. doi: 10.1136/oem.53.1.63. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Gautrin D., Ghezzo H., Infante-Rivard C., Malo J. L. Natural history of sensitization, symptoms and occupational diseases in apprentices exposed to laboratory animals. Eur Respir J. 2001 May;17(5):904–908. doi: 10.1183/09031936.01.17509040. [DOI] [PubMed] [Google Scholar]
  6. Hanley J. A., McNeil B. J. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982 Apr;143(1):29–36. doi: 10.1148/radiology.143.1.7063747. [DOI] [PubMed] [Google Scholar]
  7. Heederik D. Are we closer to developing threshold limit values for allergens in the workplace? Curr Opin Allergy Clin Immunol. 2001 Apr;1(2):185–189. doi: 10.1097/01.all.0000011005.74653.dd. [DOI] [PubMed] [Google Scholar]
  8. Heederik D., Doekes G., Nieuwenhuijsen M. J. Exposure assessment of high molecular weight sensitisers: contribution to occupational epidemiology and disease prevention. Occup Environ Med. 1999 Nov;56(11):735–741. doi: 10.1136/oem.56.11.735. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Heederik D., Venables K. M., Malmberg P., Hollander A., Karlsson A. S., Renström A., Doekes G., Nieuwenhijsen M., Gordon S. Exposure-response relationships for work-related sensitization in workers exposed to rat urinary allergens: results from a pooled study. J Allergy Clin Immunol. 1999 Apr;103(4):678–684. doi: 10.1016/s0091-6749(99)70242-3. [DOI] [PubMed] [Google Scholar]
  10. Houba R., van Run P., Doekes G., Heederik D., Spithoven J. Airborne levels of alpha-amylase allergens in bakeries. J Allergy Clin Immunol. 1997 Mar;99(3):286–292. doi: 10.1016/s0091-6749(97)70044-7. [DOI] [PubMed] [Google Scholar]
  11. Malo J. L., Ghezzo H., L'Archevêque J., Lagier F., Perrin B., Cartier A. Is the clinical history a satisfactory means of diagnosing occupational asthma? Am Rev Respir Dis. 1991 Mar;143(3):528–532. doi: 10.1164/ajrccm/143.3.528. [DOI] [PubMed] [Google Scholar]
  12. Meijer E., Grobbee D. E., Heederik D. Detection of workers sensitised to high molecular weight allergens: a diagnostic study in laboratory animal workers. Occup Environ Med. 2002 Mar;59(3):189–195. doi: 10.1136/oem.59.3.189. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Moscato G., Godnic-Cvar J., Maestrelli P., Malo J. L., Burge P. S., Coifman R. Statement on self-monitoring of peak expiratory flows in the investigation of occupational asthma. Subcommittee on Occupational Allergy of the European Academy of Allergology and Clinical Immunology. American Academy of Allergy and Clinical Immunology. European Respiratory Society. American College of Allergy, Asthma and Immunology. Eur Respir J. 1995 Sep;8(9):1605–1610. [PubMed] [Google Scholar]
  14. Portengen L., Hollander A., Doekes G., de Meer G., Heederik D. Lung function decline in laboratory animal workers: the role of sensitisation and exposure. Occup Environ Med. 2003 Nov;60(11):870–875. doi: 10.1136/oem.60.11.870. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Quanjer P. H., Tammeling G. J., Cotes J. E., Pedersen O. F., Peslin R., Yernault J. C. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl. 1993 Mar;16:5–40. [PubMed] [Google Scholar]
  16. Steyerberg E. W., Eijkemans M. J., Harrell F. E., Jr, Habbema J. D. Prognostic modeling with logistic regression analysis: in search of a sensible strategy in small data sets. Med Decis Making. 2001 Jan-Feb;21(1):45–56. doi: 10.1177/0272989X0102100106. [DOI] [PubMed] [Google Scholar]
  17. Vandenplas O., Binard-Van Cangh F., Brumagne A., Caroyer J. M., Thimpont J., Sohy C., Larbanois A., Jamart J. Occupational asthma in symptomatic workers exposed to natural rubber latex: evaluation of diagnostic procedures. J Allergy Clin Immunol. 2001 Mar;107(3):542–547. doi: 10.1067/mai.2001.113519. [DOI] [PubMed] [Google Scholar]
  18. Venables K. M. Prevention of occupational asthma. Eur Respir J. 1994 Apr;7(4):768–778. doi: 10.1183/09031936.94.07040768. [DOI] [PubMed] [Google Scholar]
  19. Vergouwe Yvonne, Steyerberg Ewout W., Eijkemans Marinus J. C., Habbema J. Dik F. Validity of prognostic models: when is a model clinically useful? Semin Urol Oncol. 2002 May;20(2):96–107. doi: 10.1053/suro.2002.32521. [DOI] [PubMed] [Google Scholar]

Articles from Occupational and Environmental Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES