Vol 62, No 3 (2010)
Case report
Published online: 2010-12-06
A case of occupational asthma from metabisulphite in a fisherman
Int Marit Health 2010;62(3):180-184.
Abstract
Background. The objective was to describe a case of occupational asthma in a fisherman linked to the inhalation of metabisulphites, then to discuss the history and actions for prevention.
Material and methods. We report the case of a fisherman fishing for Dublin bay prawn (Nephrops), who suffered from asthma after being exposed to metabisulphites. This case is compared with other cases in the occupational medical literature. He was a 53-year-old male and a former smoker, who presented with dyspnoea and a very productive cough, due to both chronic exposure to metabisulphites and acute exposure to contamination due to the breakdown of the ventilation system in the trawler on which he was fishing. The symptoms appeared to be occupational. Tests carried out in the following months revealed reversible airway obstruction with non-specific bronchial hyperreactivity, while allergy tests were negative. A visit to the trawler allowed us to determine the unusual cause of exposure in the case. Other reported cases concern normal working processes causing reversible airway obstruction.
Discussion. Metabisulphites are antioxidants and preservatives used in the food industry which have been identified as the causative agent in occupational asthma since the 1980s. Only two other cases have been previously reported in fishermen, however. The clinical presentation of our subject was notable for the productive nature of his cough. The appearance of symptoms after combined acute and chronic exposure made us consider an irritative pathophysiology in this asthma, as opposed to sensitization. The negative allergy testing in this subject was similar to other cases reported in the literature. Our subject alone was submitted to patch testing, which was also negative.
Conclusions. Our case represents occupational asthma caused by metabisulphites with clinical signs notable for the productive nature of the cough. Few cases have been reported amongst fishermen despite the significant use of this substance with irritant and sensitizing characteristics in the workplace.
Keywords: occupational diseasesasthmasulphites
References
- Merget R, Korn M. Metabisulphite-induced occupational asthma in a radiographer. Eur Respir J. 2005; 25(2): 386–388.
- Agard C, Nicolet-Akhavan F, Bouillard J, et al. Asthme professionnel aux métabisulfites : trois observations. Rev Mal Respir. 1998; 15: 537–540.
- Rosenberg N, Reygagne A, Gervais P. Asthme professionnel aux sulfites. Documents pour le Médecin du Travail fiche d’allergologie-pneumologie professionnelle n. 1990.
- Miltgen J, Marotel C, Natali F, et al. L’her P. Aspects cliniques et diagnostic de l’intolérance aux sulfites: à propos de 9 patients. Rev Pneumol Clin. 1996; 52: 363–371.
- Hernández García J, Negro Alvarez JM, García Sellés FJ, et al. [Adverse reactions to food preservatives]. Allergol Immunopathol (Madr). 1986; 14(1): 55–63.
- Jamieson DM, Guill MF, Wray BB, et al. Metabisulfite sensitivity: case report and literature review. Ann Allergy. 1985; 54(2): 115–121.
- Lucas D, Lucas R, Boniface K, et al. Occupational asthma in the commercial fishing industry: a case series and review of the literature. Int Marit Health. 2010; 61(1): 13–16.
- Steiner M, Scaife A, Semple S, et al. Sodium metabisulphite induced airways disease in the fishing and fish-processing industry. Occup Med (Lond). 2008; 58(8): 545–550.
- Madsen J, Sherson D, Kjøller H, et al. Occupational asthma caused by sodium disulphite in Norwegian lobster fishing. Occup Environ Med. 2004; 61(10): 873–874.
- Lucas D, Jegaden D, Lodde B, et al. Occupational asthma in maritime environment. Int Marit Health. 2006; 57(1-4): 177–187.
- Malo JL, Cartier A, Desjardins A. Occupational asthma caused by dry metabisulphite Thorax. 1995; 55: 585–586.
- Marks GB, Yates DH, Sist M, et al. Respiratory sensation during bronchial challenge testing with methacholine, sodium metabisulphite, and adenosine monophosphate. Thorax. 1996; 51(8): 793–798.
- Valero AL, Bescos M, Amat P, et al. [Bronchial asthma caused by occupational sulfite exposure]. Allergol Immunopathol (Madr). 1993; 21(6): 221–224.
- Twarog FJ, Leung DY. Anaphylaxis to a component of isoetharine (sodium bisulfite). JAMA. 1982; 248(16): 2030–2031.
- Brooks SM, Weiss MA, Bernstein IL. Reactive airways dysfunction syndrome (RADS). Persistent asthma syndrome after high level irritant exposures. Chest. 1985; 88(3): 376–384.
