Occupational Asthma in Antibiotic Manufacturing Workers : Case Reports and Systematic Review

Abstract EN

Background.

The risks of occupational asthma (OA) from antibiotics are uncertain.

We report 4 new cases and a systematic review of the literature.

Methods.

Cases were identified through a specialist clinic, each underwent specific provocation testing (SPT).

We subsequently reviewed the published literature.

Results.

The patients were employed in the manufacture of antibiotics; penicillins were implicated in three cases, in the fourth erythromycin, not previously reported to cause OA.

In two, there was evidence of specific IgE sensitisation.

At SPT each developed a late asthmatic reaction and increased bronchial hyperresponsiveness.

36 case reports have been previously published, 26 (citing penicillins or cephalosporins).

Seven cross-sectional workplace-based surveys found prevalences of 5–8%.

Conclusions.

OA in antibiotic manufacturers may be more common than is generally recognised.

Its pathogenesis remains unclear; immunological tests are of uncertain value and potential cases require confirmation with SPT.

Further study of its frequency, mechanisms, and diagnosis is required.