title: Occupational asthma and rhinitis due to detergent enzymes in healthcare.
abstract: BACKGROUND
  The use of proteolytic enzymes to improve the cleaning efficacy of washing powders was introduced in the mid 1960s. Many microbial enzymes are known to be potent respiratory sensitizers but previously there has been only one case of occupational asthma associated with workplace exposure in a healthcare worker.
  
  
  OBJECTIVE
  To report two cases of occupational asthma associated with exposure to biological enzymes in health-care workers and related occupational cases.
  
  
  METHODS
  Reporting of clinical case reports from three different work places.
  
  
  RESULTS
  One case of occupational asthma and three other cases with work-related asthma or rhinitis occurred in one workplace. A single case of probable occupational asthma presented at a second workplace with another case of work-related asthma at a third workplace. Exposures occurred in areas used for cleaning medical instruments and endoscopy suites. Hygiene measurements confirmed the potential for exposure. Control measures were not in place and recognition of the hazard was missing in these workplaces.
  
  
  CONCLUSIONS
  Detergent enzymes when used in healthcare settings should be recognized as potential respiratory sensitizers. Healthcare institutions and professional bodies that recommend the use of detergent enzymes should review their risk assessments to ensure that the most appropriate methods for preventing or reducing exposure are in place.
authors.affiliation: Centre for Workplace Health, Health and Safety Laboratory, Buxton SK17 9JN, UK. anil.adisesh@hsl.gov.uk
authors.forename: A
authors.initials: A
authors.lastname: Adisesh
authors.forename: E
authors.initials: E
authors.lastname: Murphy
authors.forename: C M
authors.initials: CM
authors.lastname: Barber
authors.forename: J G
authors.initials: JG
authors.lastname: Ayres
mesh_terms: D001249:Asthma / Q000139:chemically induced* / Q000517:prevention & control; D003902:Detergents / Q000009:adverse effects; D004798:Enzymes / Q000009:adverse effects*; D005069:Evaluation Studies as Topic; D006282:Health Personnel; D006801:Humans; D009784:Occupational Diseases / Q000139:chemically induced* / Q000517:prevention & control; D016273:Occupational Exposure / Q000009:adverse effects*; D010366:Peak Expiratory Flow Rate; D012220:Rhinitis / Q000139:chemically induced*; D017751:Safety Management / Q000592:standards
chemical_list: D003902:Detergents; D004798:Enzymes