title: Exposure to hexahydrophthalic and methylhexahydrophthalic anhydrides--dose-response for sensitization and airway effects.
abstract: OBJECTIVE
  This study clarified the exposure-response relationships for the organic acid anhydrides (OAA) hexahydrophthalic (HHPA) and methylhexahydrophthalic (MHHPA) anhydrides and the development of specific immunoglobulin (IG) E and G antibodies and work-related symptoms.
  
  
  METHODS
  In an epoxy resin-using factory, air levels of OAA were determined by gas chromatography-mass spectrometry. Occupational, smoking, and medical histories (questionnaire) were obtained for 154 exposed workers and 57 referents. Work-related symptoms of the eyes and airways were recorded, and OAA metabolites were analyzed in urine. A skin-prick test with common allergens and conjugates of OAA were performed. Specific IgE (radioallergosorbent test) and IgG (enzyme-linked immumosorbent assay) antibodies were determined in serum, and spirometry was performed.
  
  
  RESULTS
  Air levels of the OAA were low (HHPA < 1 to 94, MHHPA < 3 to 77 microg/m3) and associated with the concentrations of the OAA metabolites in urine. Furthermore, for the exposed workers, there were high prevalences of sensitization (IgE 22%, IgG 21%), which correlated with the exposure. Neither atopy nor smoking increased this risk significantly. Furthermore, work-related symptoms were more prevalent among the exposed workers than among the referents (eyes 23% versus 14%, nose 28% versus 16%, nose bleeding 8% versus 0%, lower airways 10% versus 4%), and they were related to the exposure (adjusted prevalence odds ratios (POR) in the highest group 7.7, 3.6 and 17, respectively) and the IgE levels (POR 4.9, 3.1 and 5.6, respectively).
  
  
  CONCLUSIONS
  In spite of the very low OAA levels in the air and metabolites in the urine, there were high and exposure-related risks of specific IgE and IgG sensitization and of work-related symptoms for the eyes, nose (especially bleeding), and lower airways.
authors.affiliation: Department of Occupational and Environmental Medicine, University Hospital, Lund, Sweden. Jorn.Nielsen@Ymed.LU.SE
authors.forename: J
authors.initials: J
authors.lastname: Nielsen
authors.forename: H
authors.initials: H
authors.lastname: Welinder
authors.forename: B
authors.initials: B
authors.lastname: Jönsson
authors.forename: A
authors.initials: A
authors.lastname: Axmon
authors.forename: L
authors.initials: L
authors.lastname: Rylander
authors.forename: S
authors.initials: S
authors.lastname: Skerfving
mesh_terms: D000328:Adult; D000395:Air Pollutants, Occupational / Q000032:analysis*; D016902:Air Pollution, Indoor / Q000009:adverse effects* / Q000032:analysis; D002617:Chemical Industry; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D004853:Epoxy Resins / Q000032:analysis*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000096:biosynthesis*; D007074:Immunoglobulin G / Q000096:biosynthesis*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis; D010795:Phthalic Acids / Q000032:analysis*; D010796:Phthalic Anhydrides / Q000032:analysis*; D015995:Prevalence; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires; D017132:Workplace
chemical_list: D000395:Air Pollutants, Occupational; D004853:Epoxy Resins; D007074:Immunoglobulin G; D010795:Phthalic Acids; D010796:Phthalic Anhydrides; C005752:araldite; D007073:Immunoglobulin E; C106919:methylhexahydrophthalic acid