Published ahead of print on January 24, 2008, doi:10.1164/rccm.200707-991OC Am. J. Respir. Crit. Care Med., Volume 177, Number 8, April 2008, 871-879 A more recent version of this article appeared on April 15, 2008
Submitted on July 6, 2007 Long-term Outcomes in a Prospective Cohort of Apprentices Exposed to High-Molecular-Weight AgentsDenyse Gautrin1*,1 The Axe de recherche en sante respiratoire, Sacre-Coeur Hospital, Montreal, Quebec, Canada, 2 The Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada, 3 The Axe de recherche en sante respiratoire, Sacre-Coeur Hospital, Montreal, Quebec, Canada; Environmental Epidemiology Division, IRAS (Institute for Risk Assessment Sciences), Utrecht University, Utrecht, The Netherlands * To whom correspondence should be addressed. E-mail: d.gautrin{at}umontreal.ca.
Rationale We conducted a long-term (8-year) follow-up of 408 apprentices enrolled when entering a program involving exposure to high-molecular-weight allergens. The objectives were to: 1) assess the frequency of new and persisting sensitization, symptoms and bronchial hyperresponsiveness in relation with job history after ending apprenticeship; 2) 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 a methacholine challenge were administered. The association between incidence or remission of these outcomes and individual characteristics at baseline and end of apprenticeship was examined. 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 respectively 1.3, 1.7, 0.7 and 2.0 per 100 person-years (PY). The remission of these outcomes acquired during apprenticeship was 18.5, 9.6, 9.6 and 12.4 per 100 PY 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. Conclusion: 1) the incidence of sensitization, symptoms and bronchial hyperresponsiveness was lower while at work by comparison with the apprenticeship period; 2) among subjects in a job not related to training, a very high proportion experienced remission of features acquired during apprenticeship. Key words: occupational sensitization, bronchial responsiveness, work-related chest symptoms, work-related rhinoconjunctivitis symptoms, asthma in the workplace.
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