Irritant-induced asthma.
OBJECTIVE
To describe the recent insights into the definition, causes, natural outcome, and key elements of irritant-induced asthma (IIA) management.


RESULTS
IIA is a subtype of occupational asthma without immunologic sensitization and includes the typical reactive airway dysfunction syndrome (RADS) and a more gradual form called not-so-sudden IIA, when onset of asthma follows repeated low-dose exposure to irritants. The World Trade Center tragedy brought new insight in the understanding of IIA, suggesting that it can exhibit a prolonged interval between exposure and recognition of clinical symptoms and disease. Dimethyl sulfate has been recently reported to cause RADS and repeated diesel exhaust exposure to cause not-so-sudden IIA in patients who worked in a bus garage. Cleaning workers who are exposed to a large variety of irritants and sensitizers are especially at risk of occupational asthma and IIA.


CONCLUSIONS
IIA includes RADS and not-so-sudden IIA. Outcome of IIA is as poor as occupational asthma with sensitization. Treatment of IIA does not differ from standard asthma treatment, but high-dose vitamin D could be assessed further for possible therapeutic benefit.
Département de médecine, Centre de Recherche de l'hôpital Sacré-Cœur de Montréal, Université de Montréal, Montréal, Québec, Canada. manon.labrecque@umontreal.ca
Manon
M
Labrecque
D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D059366:Asthma, Occupational / Q000139:chemically induced* / Q000188:drug therapy; D003902:Detergents / Q000009:adverse effects; D006801:Humans; D007509:Irritants / Q000009:adverse effects; D016273:Occupational Exposure; D047851:September 11 Terrorist Attacks; D013463:Sulfuric Acid Esters / Q000009:adverse effects; D016896:Treatment Outcome; D001335:Vehicle Emissions / Q000633:toxicity; D014807:Vitamin D / Q000627:therapeutic use
D018927:Anti-Asthmatic Agents; D003902:Detergents; D007509:Irritants; D013463:Sulfuric Acid Esters; D001335:Vehicle Emissions; D014807:Vitamin D; C007482:dimethyl sulfate