title: The persistence of allergen exposure favors pulmonary function decline in workers with allergic occupational asthma.
abstract: BACKGROUND
  In asthmatics, a rapid decline in pulmonary function is observed, likely as a consequence of airways remodeling. Persistence of allergen exposure in patients with occupational asthma (OA) maintains chronic bronchial inflammation, resulting in a more severe lung function decline. Few studies were performed on the effects of allergen exposure cessation.
  
  
  OBJECTIVE
  This study aims at evaluating the influence of allergen exposure cessation on respiratory decline in allergic asthmatic workers.
  
  
  METHODS
  Two groups of workers with allergic OA were selected. The first group (30 workers) changed job after the diagnosis and was no more exposed to sensitizing allergens, and the second group (28 subjects) did not and, as a consequence of preventive measures in the work place, was exposed to a lower level of allergens. All were treated with conventional therapy, according to GINA protocols. FEV1 changes during a 12-year period were evaluated.
  
  
  RESULTS
  Despite pharmacological therapy, the pulmonary function decay slope was steeper in workers continuously exposed to the sensitizing agent (even at reduced level) than in those with a complete cessation of exposure: final FEV1 loss was 512.5 ± 180 ml versus 332.5 ± 108 ml, respectively. The difference became significant after 4 years from the cessation of the exposure.
  
  
  CONCLUSIONS
  The study shows that the cessation of the exposure to allergen in the work place appears the most effective measure in limiting pulmonary function decline in asthmatic workers and underlines the importance of allergic risk assessment and control in the management of occupational asthma.
authors.affiliation: Allergy and Immunotoxicology Unit, CeSI, G. d'Annunzio University Foundation, Via Colle dell'Ara, 66100, Chieti, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Di Giampaolo
authors.forename: E
authors.initials: E
authors.lastname: Cavallucci
authors.forename: M
authors.initials: M
authors.lastname: Braga
authors.forename: A
authors.initials: A
authors.lastname: Renzetti
authors.forename: C
authors.initials: C
authors.lastname: Schiavone
authors.forename: C
authors.initials: C
authors.lastname: Quecchia
authors.forename: C
authors.initials: C
authors.lastname: Petrarca
authors.forename: M
authors.initials: M
authors.lastname: Di Gioacchino
mesh_terms: D000328:Adult; D000485:Allergens / Q000009:adverse effects*; D000704:Analysis of Variance; D059366:Asthma, Occupational / Q000276:immunology / Q000503:physiopathology*; D005541:Forced Expiratory Volume; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects* / Q000517:prevention & control; D012129:Respiratory Function Tests; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D000485:Allergens