• Clin. Exp. Allergy · Nov 2013

    Prevalence of IgE against neuromuscular blocking agents in hairdressers and bakers.

    Hairdressers demonstrate increased IgE sensitisation to neuromuscular blocking drugs due to occupational exposure to quaternary ammonium ion compounds.

    • S Dong, D S Acouetey, R-M Guéant-Rodriguez, D Zmirou-Navier, T Rémen, M Blanca, P M Mertes, and J-L Guéant.
    • Faculty of Medicine, Nutrition-Genetics and Risks to Environmental Exposure, Inserm-U954, University of Lorraine, Nancy, France; Inserm U 961 - Groupe Choc, Nancy, France.
    • Clin. Exp. Allergy. 2013 Nov 1;43(11):1256-62.

    BackgroundAllergic 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.ObjectiveTo investigate the prevalence of specific IgE to quaternary ammonium ions in two populations professionally exposed to quaternary ammonium compounds, in the north-eastern France.MethodsThe 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).ResultsWe 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).Conclusion And Clinical RelevanceThe 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.© 2013 John Wiley & Sons Ltd.

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    This article appears in the collection: What is the significance of Pholcodine for anesthesia?.



    Hairdressers demonstrate increased IgE sensitisation to neuromuscular blocking drugs due to occupational exposure to quaternary ammonium ion compounds.

    Daniel Jolley  Daniel Jolley
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