[Asthma induced by chloramine T in nurses: case report].
BACKGROUND
Chloramine T is used in hospitals as a disinfectant and for sterilization of endoscopy instruments.


OBJECTIVE
A case of a nurse suffering from asthma due to Chloramine T is presented in order to focus attention on this occupational disease.


RESULTS
The patient (male, 43 years) had been a nurse since 1993, working in various departments and operating rooms where he was exposed to glutaraldehyde and Chloramine T to disinfect surgical and endoscopy instruments. In 2007 he noticed the beginning of asthmatic reactions after exposure to the disinfectant. Skin tests with common allergens gave positive reactions and a skin test with Chloramine T gave a positive result. An inhalation test with glutaraldehyde gave negative results for both asthma and rhinitis. During the inhalation test with Chloramine T 0.5%, a significant biphasic decrease in FEVI was observed. The score of subjective symptoms for rhinitis was negative,


CONCLUSIONS
The case confirms the current difficulty in diagnosing occupational asthma due to Chloramine T in health care workers, which is due to the frequent presence of late reactions and to exposure to several respiratory allergens and irritants in the workplace. The specific inhalation challenge is thus confirmed as the gold standard for the diagnosis of asthma induced by Chloramine T and in occupational asthma in general. It may very well be that the frequency of occupational asthma due to sensitization to Chloramine T in nurses is underestimated.
Sartorelli
P
P
Dipartimento di Medicina Clinica e Scienze Immunologiche, Sezione di Medicina del Lavoro e Tossicologia Occupazionale, Università degli Studi di Siena. sartorelli@unisi.it
Paolucci
Valentina
V
Rendo
S
S
Romeo
R
R
Murdaca
F
F
Mariano
A
A
D000328:Adult; D001249:Asthma / Q000139:chemically induced*; D001985:Bronchial Provocation Tests; D002700:Chloramines / Q000009:adverse effects*; D004202:Disinfectants / Q000009:adverse effects*; D005541:Forced Expiratory Volume; D005976:Glutaral; D006801:Humans; D008297:Male; D009727:Nurses, Male; D009741:Nursing Staff, Hospital; D009784:Occupational Diseases / Q000139:chemically induced*; D013147:Spirometry; D014105:Tosyl Compounds / Q000009:adverse effects*
D002700:Chloramines; D004202:Disinfectants; D014105:Tosyl Compounds; C016300:chloramine-T; D005976:Glutaral