Letter to the Editor
Workplace-Specific Bronchial Challenge and Occupational Asthma Due To Persulfate Salts
Provocación bronquial específica en el trabajo y asma ocupacional por sales de persulfato
Patricia Pérez-Ferrer, Pedro Landete, Eusebi Chiner
Corresponding author
Sección de Neumología, Hospital Universitario San Juan de Alicante, Alicante, Spain
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FEV1%: percentage compared to predicted forced expiratory volume in first second; post: post-bronchodilator FEV1; pre: baseline FEV1.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Persulfate salts are the agents most commonly associated with occupational asthma (OA) among hairdressers.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Although the first cases were described decades ago, the prevalence, mechanism, value of diagnostic tests and the progress of these patients remain poorly defined. We present the case of a hairdresser with respiratory symptoms associated with exposure to persulfate salts in whom a specific bronchial challenge (use or exposure test) performed in the workplace was useful for confirming the diagnosis of OA.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 30-year-old woman who began working as hairdresser at the age of 20. Rhinitis and bronchial asthma in childhood, subsequently asymptomatic. She presented with asthma, onset one year previously and poor control despite treatment. She had had several exacerbations while at work, requiring hospital care, for which reason she was referred to the Respiratory Medicine department.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Initial physical examination was normal. Of note on biochemistry was IgE 456<span class="elsevierStyleHsp" style=""></span>IU/ml. Specific IgE (RAST/CAP method) was positive for <span class="elsevierStyleItalic">Dermatophagoides farinae</span>, <span class="elsevierStyleItalic">Dermatophagoides pteronyssinus</span>, <span class="elsevierStyleItalic">Felis domesticus</span>, <span class="elsevierStyleItalic">Canis familiaris</span> and <span class="elsevierStyleItalic">Olea europea.</span> Paranasal sinus and chest X-rays showed no pathological findings. Spirometry results were normal with FVC 3250<span class="elsevierStyleHsp" style=""></span>ml (94%), FEV1 2670<span class="elsevierStyleHsp" style=""></span>ml (97%) and FEV1/FVC 82, and post-bronchodilator test was negative. A non-specific bronchial challenge test was performed with increasing methacholine concentrations. FEV1 fell by 30% with a 1.56<span class="elsevierStyleHsp" style=""></span>mg/l dilution, corresponding to a PC20 of 1<span class="elsevierStyleHsp" style=""></span>mg/ml. Diurnal variability in peak expiratory flow (PEF) over one month was greater than 20%.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Correct treatment compliance adapted to her level of severity was confirmed, but the patient continued to show symptoms at work. She was asked again about the products she used and she indicated that it was the decolorizing agents that triggered the crises. The patient was asked to bring some along to the clinic and they were determined to contain persulfate salts. In view of suspected OA caused by persulfate salts, an “exposure test” was performed, consisting of monitoring lung function in her workplace using a portable spirometer. After baseline spirometry was shown to be normal, the patient began to use the bleaching agent as usual, lightening a client's hair (washing, decolorizing), while carrying out spirometries every 15<span class="elsevierStyleHsp" style=""></span>min throughout the process. A fall in FEV1 >20% was observed, confirming the suspected diagnosis of OA due to persulfate salts (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">OA is the most common job-related respiratory disease in developed countries.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> One of the causative agents is persulfate salts, low molecular weight compounds that act as oxidants, accelerating the bleaching of hair with hydrogen peroxide. Hairdressers are the most exposed professional group.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The mechanism appears to be immunologic, probably IgE-mediated, and there is a latent period between onset of exposure and the appearance of symptoms.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> With regard to diagnosis, specific bronchial challenge in the laboratory is considered the gold standard. When this is not available, specific bronchial challenge in the workplace is very useful.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> These patients progress well if exposure is avoided.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> However, 70% of them may continue to present symptoms and require treatment, even in the absence of exposure.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pérez-Ferrer P, Landete P, Chiner E. Provocación bronquial específica en el trabajo y asma ocupacional por sales de persulfato. Arch Bronconeumol. 2014;50:497–498.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1195 "Ancho" => 2215 "Tamanyo" => 146718 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Specific bronchial challenge in the workplace: monitoring of lung function during work showed a fall in FEV1 >20%. FEV1%: percentage compared to predicted forced expiratory volume in first second; post: post-bronchodilator FEV1; pre: baseline FEV1.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occupational asthma and occupational rhinitis in hairdressers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Moscato" 1 => "P. Pignatti" 2 => "M.R. Yacoub" 3 => "C. Romano" 4 => "S. Spezia" 5 => "L. 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| 2021 December | 39 | 43 | 82 |
| 2021 November | 48 | 39 | 87 |
| 2021 October | 42 | 46 | 88 |
| 2021 September | 35 | 45 | 80 |
| 2021 August | 26 | 36 | 62 |
| 2021 July | 31 | 28 | 59 |
| 2021 June | 36 | 30 | 66 |
| 2021 May | 42 | 36 | 78 |
| 2021 April | 128 | 84 | 212 |
| 2021 March | 54 | 29 | 83 |
| 2021 February | 25 | 15 | 40 |
| 2021 January | 30 | 10 | 40 |
| 2020 December | 37 | 19 | 56 |
| 2020 November | 18 | 11 | 29 |
| 2020 October | 27 | 11 | 38 |
| 2020 September | 22 | 8 | 30 |
| 2020 August | 25 | 13 | 38 |
| 2020 July | 26 | 17 | 43 |
| 2020 June | 17 | 0 | 17 |
| 2020 May | 19 | 13 | 32 |
| 2020 April | 41 | 17 | 58 |
| 2020 March | 17 | 10 | 27 |
| 2020 February | 30 | 15 | 45 |
| 2020 January | 42 | 14 | 56 |
| 2019 December | 22 | 14 | 36 |
| 2019 November | 24 | 23 | 47 |
| 2019 October | 19 | 9 | 28 |
| 2019 September | 21 | 5 | 26 |
| 2019 August | 26 | 14 | 40 |
| 2019 July | 30 | 17 | 47 |
| 2019 June | 18 | 6 | 24 |
| 2019 May | 31 | 7 | 38 |
| 2019 April | 60 | 11 | 71 |
| 2019 March | 38 | 14 | 52 |
| 2019 February | 32 | 16 | 48 |
| 2019 January | 29 | 16 | 45 |
| 2018 December | 27 | 10 | 37 |
| 2018 November | 53 | 20 | 73 |
| 2018 October | 62 | 18 | 80 |
| 2018 September | 25 | 7 | 32 |
| 2018 May | 11 | 0 | 11 |
| 2018 April | 27 | 6 | 33 |
| 2018 March | 13 | 2 | 15 |
| 2018 February | 26 | 7 | 33 |
| 2018 January | 54 | 6 | 60 |
| 2017 December | 59 | 7 | 66 |
| 2017 November | 32 | 2 | 34 |
| 2017 October | 26 | 9 | 35 |
| 2017 September | 26 | 8 | 34 |
| 2017 August | 49 | 11 | 60 |
| 2017 July | 43 | 5 | 48 |
| 2017 June | 47 | 15 | 62 |
| 2017 May | 48 | 5 | 53 |
| 2017 April | 39 | 6 | 45 |
| 2017 March | 31 | 9 | 40 |
| 2017 February | 22 | 4 | 26 |
| 2017 January | 22 | 4 | 26 |
| 2016 December | 33 | 7 | 40 |
| 2016 November | 36 | 8 | 44 |
| 2016 October | 30 | 19 | 49 |
| 2016 September | 34 | 16 | 50 |
| 2016 August | 40 | 11 | 51 |
| 2016 July | 28 | 5 | 33 |
| 2016 June | 1 | 0 | 1 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 44 | 2 | 46 |
| 2015 September | 42 | 8 | 50 |
| 2015 August | 138 | 15 | 153 |
| 2015 July | 30 | 5 | 35 |
| 2015 June | 28 | 5 | 33 |
| 2015 May | 32 | 10 | 42 |
| 2015 April | 16 | 10 | 26 |
| 2015 March | 18 | 7 | 25 |
| 2015 February | 26 | 14 | 40 |
| 2015 January | 1 | 1 | 2 |
| 2014 November | 0 | 3 | 3 |
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