Table 1. Recommendations.

Recommendations	Strength of recommendation	Level of evidence
Questionnaire-based identification of all workers at risk of developing work-related asthma is recommended as basis for surveillance	Strong	High
Pre-placement screening for specific cross-reacting, work-associated sensitisation among potentially HMW allergen-exposed subjects is recommended in order to identify those at higher risk for work-related asthma	Strong	Moderate
Detection of sensitisation either by specific IgE or SPT should be included in surveillance (not only pre-placement) for identification of subjects at risk of work-related asthma with foreseeable regular exposure to HMW agents (such as laboratory animals, bakery dust, enzymes or latex)	Strong	Moderate
In atopics and subjects with pre-existing asthma or sensitisation, pre-employment investigation should be performed in order to inform them about their increased work-related asthma risk Because of the low PPV, exclusion of asymptomatic atopics or sensitised subjects from exposure to potential occupational allergens or irritant agents cannot be recommended	Weak	Moderate
In all workers with confirmed occupational rhinitis and/or NSBHR, medical surveillance programmes should be performed They should include periodic administration of a questionnaire, detection of sensitisation by standardised SPT or serum specific IgE antibodies, early referral of symptomatic and/or sensitised subjects for specialised medical assessment and assessment of asthma Surveillance programmes should already be implemented during vocational training of individuals at risk	Strong	Moderate
Identification of symptoms or sensitisation during surveillance should result in an investigation to confirm or exclude occupational asthma, work-related asthma, rhinitis and COPD	Strong	High
Risk stratification by diagnostic models can be used in medical surveillance to select exposed workers for further medical evaluation	Strong	Moderate
As a secondary prevention measure, a comprehensive medical surveillance programme should, in addition to early detection of sensitisation, allergic symptoms and occupational asthma, comprise exposure assessment and intervention targeted both at workers and exposure	Strong	Moderate

HMW: high molecular weight; Ig: immunoglobulin; SPT: skin-prick test; PPV: positive predictive value; NSBHR: nonspecific bronchial hyperresponsiveness; COPD: chronic obstructive pulmonary disease.