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Long-Term Outcomes in a Prospective Cohort of Apprentices Exposed to High-Molecular-Weight Agents

¹ Axe de Recherche en Santé Respiratoire, Sacré-Coeur Hospital, Montreal, Canada; ² The Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; and ³ Institute for Risk Assessment Sciences, Environmental Epidemiology Division, Utrecht University, Utrecht, The Netherlands

Correspondence and requests for reprints should be addressed to Denyse Gautrin, Ph.D., Axe de Recherche en Santé Respiratoire, Sacré-Coeur Hospital, 5400 Gouin Blvd West, Montreal, Canada H4J 1C5. E-mail: d.gautrin{at}umontreal.ca

Rationale: We conducted a long-term (8-yr) follow-up of 408 apprentices entering programs involving exposure to high-molecular-weight allergens.

Objectives: The objectives were to assess the frequency of new and persisting sensitization, symptoms, and bronchial hyperresponsiveness in relation with job history after ending apprenticeship and to examine characteristics significantly associated with the incidence and remission of these occupational outcomes.

Methods: A respiratory symptom questionnaire, skin prick tests with work-related allergens (laboratory animals, flour, and latex), spirometry, and methacholine challenge were administered. The association between incidence or remission of these outcomes and individual characteristics at baseline and end of apprenticeship was examined.

Measurements and Main Results: In subjects who at any time during follow-up held a job related to their training (78%), the incidence of sensitization, rhinoconjunctival and chest symptoms, and bronchial hyperresponsiveness at follow-up was 1.3, 1.7, 0.7, and 2.0 per 100 person-years, respectively. The remission of these outcomes acquired during apprenticeship was 18.5, 9.6, 9.6, and 12.4 per 100 person-years, respectively, in subjects no longer in a job related to training. Several clinical, immunological, and functional characteristics at baseline and acquired during apprenticeship were found to be significantly associated with the incidence and remission of the outcomes.

Conclusions: The incidence of sensitization, symptoms, and bronchial hyperresponsiveness was lower while at work than during the apprenticeship period. A high proportion of subjects in a job not related to training experienced remission of symptoms acquired during apprenticeship.

Key Words: occupational sensitization • bronchial responsiveness • work-related chest symptoms • work-related rhinoconjunctivitis symptoms • asthma in the workplace

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject No long-term, entirely prospective study of apprentices at risk of symptoms, immunological reactivity, and hyperresponsiveness, and entering a workplace related to training or working in a different field has ever been performed. What This Study Adds to the Field The incidence of sensitization, symptoms, and bronchial hyperresponsiveness was lower while at work than during the apprenticeship period. A high proportion of subjects in a job not related to training experienced remission of symptoms acquired during apprenticeship.

 

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