title: Prevalence of IgE against neuromuscular blocking agents in hairdressers and bakers.
abstract: BACKGROUND
  Allergic IgE-mediated reactions to neuromuscular blocking agents (NMBAs) are the main cause of immediate hypersensitivity reactions in anaesthesia; their predominant occurrence in the absence of previous exposure to NMBAs suggests a risk related to environmental exposure.
  
  
  OBJECTIVE
  To investigate the prevalence of specific IgE to quaternary ammonium ions in two populations professionally exposed to quaternary ammonium compounds, in the north-eastern France.
  
  
  METHODS
  The study had a retrospective follow-up design whereby apprentices were assessed after their 2-year training period as apprentices. The professionally exposed hairdresser populations (n = 128) were compared with baker/pastry makers (n = 108) and 'non-exposed' matched control subjects (n = 379).
  
  
  RESULTS
  We observed a 4.6-fold higher frequency of positive IgE against quaternary ammonium ions in hairdressers (HD), compared with baker/pastry makers (BP) and control (C) groups. The competitive inhibition of quaternary ammonium Sepharose radioimmunoassay (QAS-IgE RIA) with succinylcholine was significantly higher in HD, compared with BP and C groups, with inhibition percentage of 66.2 ± 7.4, 39.7 ± 6.0 and 43.8 ± 9.9, respectively (P < 0.001). The specific IgE against quaternary ammonium ions recognized also two compounds widely used by hairdressers, benzalkonium chloride and polyquaternium-10, in competitive inhibition of IgE RIA. When considering the whole study population, hairdresser professional exposure and total IgE > 100 kU/L were the two significant predictors of IgE-sensitization against quaternary ammonium ions in the multivariate analysis of a model that included age, sex, professional exposure, increased concentration of total IgE (IgE > 100 kU/L) and positive IgE against prevalent allergens (Phadiatop(®) ; P = 0.019 and P = 0.001, respectively).
  
  
  CONCLUSIONS
  The exposure to hairdressing professional occupational factors increases IgE-sensitization to NMBAs and quaternary ammonium ion compounds used in hairdressing. Besides the pholcodine hypothesis, our study suggests that repetitive exposure to quaternary ammonium compounds used in hairdressing is a risk factor for NMBAs sensitization.
authors.affiliation: Faculty of Medicine, Nutrition-Genetics and Risks to Environmental Exposure, Inserm-U954, University of Lorraine, Nancy, France; Inserm U 961 - Groupe Choc, Nancy, France.
authors.forename: S
authors.initials: S
authors.lastname: Dong
authors.forename: D S
authors.initials: DS
authors.lastname: Acouetey
authors.forename: R-M
authors.initials: RM
authors.lastname: Guéant-Rodriguez
authors.forename: D
authors.initials: D
authors.lastname: Zmirou-Navier
authors.forename: T
authors.initials: T
authors.lastname: Rémen
authors.forename: M
authors.initials: M
authors.lastname: Blanca
authors.forename: P M
authors.initials: PM
authors.lastname: Mertes
authors.forename: J-L
authors.initials: JL
authors.lastname: Guéant
mesh_terms: D000328:Adult; D000777:Anesthetics / Q000276:immunology*; D000918:Antibody Specificity / Q000276:immunology; D004342:Drug Hypersensitivity / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology*; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000276:immunology*; D016273:Occupational Exposure / Q000009:adverse effects*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000777:Anesthetics; D009466:Neuromuscular Blocking Agents; D007073:Immunoglobulin E
keywords: IgE; Rh quaternary ammonium ion complex; allergy; anaesthesia; baker/pastry make; cosmetics; hairdresser; neuromuscular blocking agents