Lung/skin connections in occupational lung disease.
OBJECTIVE
Exposure to occupational and environmental agents can cause a spectrum of lung diseases that are predominantly immune-mediated. Research and prevention have focused primarily on the respiratory tract. Recent studies, however, suggest that the skin may also be an important route of exposure and site of sensitization. This article highlights key findings, focusing on isocyanate asthma and chronic beryllium disease.


RESULTS
Occupational lung diseases such as isocyanate asthma and chronic beryllium disease continue to occur despite reduced airborne exposures. Although challenging to quantify, recent studies have documented isocyanate and beryllium skin exposure, even with the use of personal protective clothing. Factors that impair skin barrier function, such as trauma, may promote sensitization to such agents. Animal studies demonstrate that skin exposure to isocyanates and protein allergens is highly effective at inducing sensitization, with subsequent inhalation challenge eliciting asthmatic responses. Limited clinical studies suggest a similar role for human skin exposure to certain sensitizing agents.


CONCLUSIONS
Recent findings support a greater focus on the role of skin exposure in the development of certain occupational and environmental lung diseases. Although further research is needed, it is prudent to reduce both skin and inhalation exposures.
Redlich
Carrie A
CA
Occupational and Environmental Medicine and Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, Connecticut, USA. carrie.redlich@yale.edu
Herrick
Christina A
CA
D000395:Air Pollutants, Occupational / Q000633:toxicity; D000818:Animals; D001249:Asthma / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control; D001607:Berylliosis / Q000209:etiology / Q000517:prevention & control; D002908:Chronic Disease; D004306:Dose-Response Relationship, Immunologic; D006801:Humans; D017953:Isocyanates / Q000276:immunology / Q000633:toxicity; D008171:Lung Diseases / Q000139:chemically induced* / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology / Q000517:prevention & control; D023421:Models, Animal; D016273:Occupational Exposure / Q000009:adverse effects* / Q000517:prevention & control; D011481:Protective Clothing; D012867:Skin / Q000473:pathology / Q000503:physiopathology; D012869:Skin Absorption / Q000276:immunology; D018418:Th2 Cells / Q000473:pathology
D000395:Air Pollutants, Occupational; D017953:Isocyanates