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A Systematic Review of the Diagnosis of Occupational Asthma
Abstract
Background This study systematically reviews literature regarding the diagnosis of occupational asthma (OA) and compares specific inhalation challenge (SIC) testing with alternative tests.Methods Electronic databases and trials registries were searched; additional references were identified from bibliographic searches of included studies, hand searches of conferences, and author contacts. Various study designs (clinical trials, cohorts, cross-sectional, or case series) were included involving workers with suspected OA. All diagnostic tests were compared to a "reference standard," and two researchers independently extracted 2 x 2 data. Pooled sensitivities and specificities (95% confidence intervals [CIs]) were derived.Results Seventy-seven studies were included. For high molecular weight (HMW) agents, the nonspecific bronchial provocation (NSBP) test, skin-prick test (SPT), and serum-specific IgE had sensitivities > 73% when compared to SIC. Specificity was highest for specific IgE vs SIC (79.0%; 95% CI, 50.5 to 93.3%). The highest sensitivity among low molecular weight asthmagens occurred between combined NSBP and SPT vs SIC (100%; 95% CI, 74.1 to 100%). When compared to SIC, specific IgE and SPT had similar specificities (88.9%; 95% CI, 84.7 to 92.1%; and 86.2%; 95% CI, 77.4 to 91.9%, respectively). For HMW agents, high specificity was demonstrated for positive NSBP tests and SPTs alone (82.5%; 95% CI, 54.0 to 95.0%) or when combined with specific IgE (74.3%; 95% CI, 45.0 to 91.0%) vs SIC. Sensitivity was somewhat lower (60.6% and 65.2%, respectively).Conclusions In appropriate clinical situations when SIC is not available, the combination of a NSBP test with a specific SPT or specific IgE may be an appropriate alternative to SIC in diagnosing OA. While positive results of single NSBP test, specific SPT, or serum-specific IgE testing would increase the likelihood of OA, a negative result could not exclude OA.
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“A diagnosis of WRA requires the objective diagnosis of asthma with symptoms temporally related to the individual's place of employment (141).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [141]
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Hassan, W., Wang, R., Mohammedalhadi, A., Badri, H., Daines, L., Aaron, S. D., Gaillard, E. A., Fowler, S. J., & Satia, I. (2026) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(26)00143-8 · Cited by 2
Poussel, M., Thaon, I., Penven, E., & Tiotiu, A. I. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18052325 · Cited by 2
Identification of allergens by IgE‐specific testing improves outcomes in atopic dermatitis
Will, B. M., Severino, R., & Johnson, D. W. (2017) · International Journal of Dermatology · doi:10.1111/ijd.13673 · Cited by 2
Occupational Allergy and Asthma
Lemière, C., & Vandenplas, O. (2014) · Elsevier eBooks · doi:10.1016/b978-0-323-08593-9.00060-7 · Cited by 2
Lemière, C., & Vandenplas, O. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-37579-5.00014-3 · Cited by 2
Lemière, C., & Vandenplas, O. (2015) · Elsevier eBooks · doi:10.1016/b978-1-4557-3383-5.00072-5 · Cited by 2
Prevalence of work-related asthma among Egyptian farmers in Great Cairo
Ahmed, O., El-shayeb, M., Shahin, R. Y., Fouad, S. H., Yosef, M., Fahim, N. A. E.-D. M., & Mohamed, M. F. (2022) · Egyptian journal of Immunology · doi:10.55133/eji.290302 · Cited by 2
Assessing and Treating Work-Related Asthma
Stoughton, T. R., Prematta, M. J., & Craig, T. (2008) · Allergy Asthma and Clinical Immunology · doi:10.1186/1710-1492-4-4-164 · Cited by 1
Metadata
- Authors
- Beach, J., Russell, K., Blitz, S., Hooton, N., Spooner, C., Lemiere, C., Tarlo, S. M., & Rowe, B. H.
- Affiliations
- University of Alberta (CA)
- University of Toronto (CA)
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2007-02
- Volume
- 131
- Issue
- 2
- Pages
- 569-578
- ISSN
- 0012-3692 (ISSN-L)
- OpenAlex
- W2037203787
- Cited by
- 128
- References
- 12
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 7 · 2022: 3 · 2021: 2 · 2020: 11 · 2019: 8 · 2018: 5 · 2017: 6 · 2016: 8 · 2015: 10 · 2014: 10 · 2013: 10 · 2012: 8
- FWCI
- 1.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- CHEST Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational Health and Safety in Workplaces
- Keywords
- occupational asthma, diagnosis, specific inhalation challenge, skin prick test, serum specific IgE, diagnostic accuracy
- MeSH terms
- Asthma, Humans, Immunologic Tests, Occupational Diseases, Respiratory Function Tests
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