title: Airway inflammation and ammonia exposure among female Palestinian hairdressers: a cross-sectional study.
abstract: OBJECTIVE
  Little is known about the working conditions and airway inflammation in hairdressers in Palestine. We aimed to investigate if hairdressers in Palestine have a higher level of airway inflammation as compared to a control group. We also assessed the hairdressers' physical working conditions and exposure to ammonia gases at the hair salons. Lastly, we investigated the association between ammonia levels and inflammation markers in the airways and the blood.
  
  
  METHODS
  Our study participants were 33 non-smoking hairdressers (aged 19-50 years) and 35 non-smoking control subjects (aged 18-49 years). Both groups answered a questionnaire on respiratory symptoms, and performed lung function and exhaled nitric oxide (eNO) tests. Blood and sputum samples were collected from all participants and air concentration levels of ammonia were measured in 13 salons.
  
  
  RESULTS
  Hairdressers had a higher level of sputum neutrophil count (absolute numbers/mg sputum (median (25th-75th centiles)) compared to controls, 376 (183-980) and 182 (96-358), respectively. Hairdressers also had significantly elevated eNO and blood C reactive protein (CRP) levels compared to the control subjects, controlled for age and body mass index. Exposure measurements showed that the hairdressers in salons with scarce ventilation were exposed to ammonia concentration, ranging from 3 to 61 mg/m(3).
  
  
  CONCLUSIONS
  Compared to unexposed controls, the hairdressers had signs of neutrophilic airway inflammation, higher eNO levels and higher CRP. The hairdressers were exposed to high concentrations of ammonia from hairdressing chemicals and their working conditions were unsatisfactory.
authors: Occupational Epidemiology and Biological Research Lab, Department of Biology, Hebron University, Hebron, Palestine Section for Preventive Medicine and Epidemiology, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors: Maysaa
authors: M
authors: Nemer
authors: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors: Liv I B
authors: LI
authors: Sikkeland
authors: Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway.
authors: Mayes
authors: M
authors: Kasem
authors: Section for Preventive Medicine and Epidemiology, Institute of Health and Society, University of Oslo, Oslo, Norway Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway.
authors: Petter
authors: P
authors: Kristensen
authors: Occupational Epidemiology and Biological Research Lab, Department of Biology, Hebron University, Hebron, Palestine.
authors: Khaldoun
authors: K
authors: Nijem
authors: Section for Preventive Medicine and Epidemiology, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors: Espen
authors: E
authors: Bjertness
authors: Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway.
authors: Øivind
authors: Ø
authors: Skare
authors: Department of Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway.
authors: Berit
authors: B
authors: Bakke
authors: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors: Johny
authors: J
authors: Kongerud
authors: Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway.
authors: Marit
authors: M
authors: Skogstad
mesh_terms: D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000032:analysis; D000641:Ammonia / Q000032:analysis / Q000633:toxicity*; D018912:Arabs; D001461:Barbering; D001505:Beauty Culture; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007249:Inflammation / Q000139:chemically induced; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology / Q000187:drug effects; D009569:Nitric Oxide / Q000378:metabolism; D009784:Occupational Diseases / Q000139:chemically induced*; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis; D012140:Respiratory Tract Diseases / Q000139:chemically induced*; D013183:Sputum / Q000737:chemistry; D055815:Young Adult
chemical_list: D015415:Biomarkers; D009569:Nitric Oxide; D000641:Ammonia; D002097:C-Reactive Protein
keywords: Exhaled nitric oxide; Hairdressers; Occupational exposure; Sputum analysis