title: A cross-sectional study among detergent workers exposed to liquid detergent enzymes.
abstract: OBJECTIVE
  To investigate sensitisation and respiratory health among workers who produce liquid detergent products and handle liquid detergent enzymes.
  
  
  METHODS
  We performed a cross-sectional study among 109 eligible workers of a detergent products plant. 108 were interviewed for respiratory and allergic symptoms and 106 blood samples were taken from them to examine sensitisation to enzymes. Those sensitised to > or = 1 enzymes were referred for clinical evaluation. Workers and representatives were interviewed to characterise exposure qualitatively and estimate exposure semi-quantitatively. Workers were classified into three exposure groups with varying exposure profiles to enzymes, based on frequency, duration, and level of exposure.
  
  
  RESULTS
  Workers were exposed to proteases, alpha-amylase, lipase and cellulase. The highest exposures occurred in the mixing area. Liquid spills with concentrated enzyme preparations and leakage of enzymes during weighing, transportation and filling were causing workplace contaminations and subsequently leading to both dermal and inhalation exposure for workers. Workers with the highest exposures reported significantly more work-related symptoms of itching nose (prevalence ratio (PR) = 4.2, 95% CI 1.5 to 12.0) and sneezing (PR = 4.0, 95% CI 1.5 to 10.8) and marginally significant more symptoms of wheezing (PR = 2.9, 95% CI 0.9 to 8.7) compared with the least exposed group. Fifteen workers (14.2%) were sensitised to > or = 1 enzymes. A marginally statistically significant gradient in sensitisation across the exposure categories was found (p = 0.09). There was a clinical case of occupational asthma and two others with probable occupational rhinitis.
  
  
  CONCLUSIONS
  Workers exposed to liquid detergent enzymes are at risk of developing sensitisation (14%) and respiratory allergy.
authors.affiliation: Netherlands Expertise Centre for Occupational Respiratory Disorders, Utrecht, The Netherlands. f.vanrooy@uu.nl
authors.forename: F G B G J
authors.initials: FG
authors.lastname: van Rooy
authors.forename: R
authors.initials: R
authors.lastname: Houba
authors.forename: N
authors.initials: N
authors.lastname: Palmen
authors.forename: M M
authors.initials: MM
authors.lastname: Zengeni
authors.forename: I
authors.initials: I
authors.lastname: Sander
authors.forename: J
authors.initials: J
authors.lastname: Spithoven
authors.forename: J M
authors.initials: JM
authors.lastname: Rooyackers
authors.forename: D J J
authors.initials: DJ
authors.lastname: Heederik
mesh_terms: D000328:Adult; D001249:Asthma / Q000139:chemically induced; D003902:Detergents / Q000737:chemistry / Q000633:toxicity*; D004391:Dust / Q000032:analysis; D004784:Environmental Monitoring / Q000379:methods; D004798:Enzymes / Q000032:analysis / Q000633:toxicity*; D004812:Epidemiologic Methods; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000139:chemically induced*; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis; D012130:Respiratory Hypersensitivity / Q000139:chemically induced*; D012996:Solutions; D055815:Young Adult
chemical_list: D003902:Detergents; D004391:Dust; D004798:Enzymes; D012996:Solutions; D007073:Immunoglobulin E