title: Occupational asthma in antibiotic manufacturing workers: case reports and systematic review.
abstract: 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.
authors: Centro Medico de Asturias, Avendia José María Richard, Oviedo, 33193 Asturias, Spain.
authors: Sara
authors: S
authors: Díaz Angulo
authors: Joanna
authors: J
authors: Szram
authors: Jenny
authors: J
authors: Welch
authors: Julie
authors: J
authors: Cannon
authors: Paul
authors: P
authors: Cullinan
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