美发从业者职业性哮喘的表型异质性及临床特征
2025/06/16
摘要
研究背景：目前染发剂中过硫酸盐（PS）诱发的职业性哮喘（occupational asthma, OA）的临床及炎症特征仍未被全面阐明。
研究目的：作者旨在比较过硫酸盐诱发的OA与其他由低分子量（LMW）化合物所致职业性哮喘表型特征的差异。
研究方法：回顾性多中心队列研究设计，纳入经特异性吸入激发试验（SIC）阳性确诊的OA患者。将过硫酸盐诱发OA的美发从业者（n=107）的临床特征及炎症指标与异氰酸酯组（n=128）及其他低分子量制剂组（n=164）进行对比分析。
研究结果：过硫酸盐诱发OA患者的致敏潜伏期（自暴露至哮喘发病时间）较其他低分子量制剂组显著延长。与异氰酸酯组（36%, P<0.001；35 ppb [21-80], P<0.001）及其他低分子量制剂组（53%, P<0.001；27 ppb [14-52], P<0.001）相比，过硫酸盐诱发OA患者的职业性鼻炎发生率更高（76%），且特异性吸入激发试验后FeNO水平更低（中位数为18 ppb [第25-75百分位数：13-26 ppb]）。此外，过硫酸盐诱发OA患者迟发哮喘反应发生率最高（49%），但仅在与异氰酸酯组以外的其他低分子量制剂组（31%，P < 0.002）比较时具有统计学差异。
研究结论：过硫酸盐诱发的OA与职业性鼻炎的高发病率和较低的FeNO水平有关，提示不同制剂所致OA存在显著的表型异质性。
关键词：FENO；低分子量化合物；职业性哮喘；职业性鼻炎；过硫酸盐；特异性吸入激发试验
文献来源：（Doyen V, Thirionet R, et, al.; Phenotypic Characteristics of Occupational Asthma Caused by Persulfate Salts in Hairdressers: A Multicenter Cohort Study. J Allergy Clin Immunol Pract. 2025 Mar 20:S2213-2198(25)00263-6. doi: 10.1016/j.jaip.2025.03.015. Epub ahead of print. PMID: 40120807.）
Abstract
Background:The clinical and inflammatory characteristics of occupational asthma (OA) caused by persulfate salts (PS) in hair bleaches have not yet been comprehensively characterized.
Objective: This study aimed to compare the phenotypic characteristics of PS-induced OA with those of OA due to other low-molecular-weight (LMW).
Methods: This study was conducted in a retrospective multicenter cohort of subjects with OA ascertained by a positive specific inhalation challenge (SIC). The clinical and inflammatory characteristics of hairdressers with PS-induced OA (n=107) were compared with those of subjects who showed a positive SIC to isocyanates (n=128) or various other LMW agents (n=164).
Results: Subjects with PS-induced OA had a longer duration of exposure to the offending agent before the onset of asthma than those with OA caused the other LMW agents. They reported more frequently work-related rhinitis (76%) and showed a lower post-SIC level of fractional exhaled nitric oxide (FeNO) (median, 18 ppb [25th-75th percentile, 13-26]) compared with OA caused by both isocyanates (36%, P<0.001 and 35 ppb [21-80], P<0.001, respectively) and the other LMW agents (53%, P<0.001 and 27 ppb [14-52], P<0.001). Subjects with PS-induced OA showed the highest rate of isolated late asthmatic reactions (49%), but the difference reached statistical significance only when compared to LMW agents other than isocyanates (31%, P<0.002).
Conclusions: PS-induced OA is associated with a higher prevalence of work-related rhinitis and lower levels of FeNO compared with OA caused by other LMW agents. These findings further indicate substantial phenotypic heterogeneity among this broad category of agents.
Keywords: Fractional exhaled nitric oxide; low-molecular-weight agents; occupational asthma; occupational rhinitis; persulfate salts; specific inhalation challenge.
研究背景：目前染发剂中过硫酸盐（PS）诱发的职业性哮喘（occupational asthma, OA）的临床及炎症特征仍未被全面阐明。
研究目的：作者旨在比较过硫酸盐诱发的OA与其他由低分子量（LMW）化合物所致职业性哮喘表型特征的差异。
研究方法：回顾性多中心队列研究设计，纳入经特异性吸入激发试验（SIC）阳性确诊的OA患者。将过硫酸盐诱发OA的美发从业者（n=107）的临床特征及炎症指标与异氰酸酯组（n=128）及其他低分子量制剂组（n=164）进行对比分析。
研究结果：过硫酸盐诱发OA患者的致敏潜伏期（自暴露至哮喘发病时间）较其他低分子量制剂组显著延长。与异氰酸酯组（36%, P<0.001；35 ppb [21-80], P<0.001）及其他低分子量制剂组（53%, P<0.001；27 ppb [14-52], P<0.001）相比，过硫酸盐诱发OA患者的职业性鼻炎发生率更高（76%），且特异性吸入激发试验后FeNO水平更低（中位数为18 ppb [第25-75百分位数：13-26 ppb]）。此外，过硫酸盐诱发OA患者迟发哮喘反应发生率最高（49%），但仅在与异氰酸酯组以外的其他低分子量制剂组（31%，P < 0.002）比较时具有统计学差异。
研究结论：过硫酸盐诱发的OA与职业性鼻炎的高发病率和较低的FeNO水平有关，提示不同制剂所致OA存在显著的表型异质性。
关键词：FENO；低分子量化合物；职业性哮喘；职业性鼻炎；过硫酸盐；特异性吸入激发试验
文献来源：（Doyen V, Thirionet R, et, al.; Phenotypic Characteristics of Occupational Asthma Caused by Persulfate Salts in Hairdressers: A Multicenter Cohort Study. J Allergy Clin Immunol Pract. 2025 Mar 20:S2213-2198(25)00263-6. doi: 10.1016/j.jaip.2025.03.015. Epub ahead of print. PMID: 40120807.）
（南方医科大学南方医院 樊可可 朱邦 赵海金）
Abstract
Background:The clinical and inflammatory characteristics of occupational asthma (OA) caused by persulfate salts (PS) in hair bleaches have not yet been comprehensively characterized.
Objective: This study aimed to compare the phenotypic characteristics of PS-induced OA with those of OA due to other low-molecular-weight (LMW).
Methods: This study was conducted in a retrospective multicenter cohort of subjects with OA ascertained by a positive specific inhalation challenge (SIC). The clinical and inflammatory characteristics of hairdressers with PS-induced OA (n=107) were compared with those of subjects who showed a positive SIC to isocyanates (n=128) or various other LMW agents (n=164).
Results: Subjects with PS-induced OA had a longer duration of exposure to the offending agent before the onset of asthma than those with OA caused the other LMW agents. They reported more frequently work-related rhinitis (76%) and showed a lower post-SIC level of fractional exhaled nitric oxide (FeNO) (median, 18 ppb [25th-75th percentile, 13-26]) compared with OA caused by both isocyanates (36%, P<0.001 and 35 ppb [21-80], P<0.001, respectively) and the other LMW agents (53%, P<0.001 and 27 ppb [14-52], P<0.001). Subjects with PS-induced OA showed the highest rate of isolated late asthmatic reactions (49%), but the difference reached statistical significance only when compared to LMW agents other than isocyanates (31%, P<0.002).
Conclusions: PS-induced OA is associated with a higher prevalence of work-related rhinitis and lower levels of FeNO compared with OA caused by other LMW agents. These findings further indicate substantial phenotypic heterogeneity among this broad category of agents.
Keywords: Fractional exhaled nitric oxide; low-molecular-weight agents; occupational asthma; occupational rhinitis; persulfate salts; specific inhalation challenge.
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