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01-04-2021 | Cough | INHALED IRRITANT-INDUCED PULMONARY DISEASE

Irritant-induced Asthma Caused by Aerotoxic Syndrome

Authors: Jorge Roig, Christian Domingo, Jonathan Burdon, Susan Michaelis

Published in: Lung | Issue 2/2021

Abstract

Purpose

Case series on respiratory features of Aerotoxic Syndrome (AS). The term AS has been coined to describe the spectrum of clinical manifestations after aircraft fume events. Among these manifestations, neurological and respiratory symptoms are the most frequently reported complaints.

Methods

Three cases of AS with relevant respiratory features are presented.

Results

Cough and shortness of breath for 6 to12 months were the predominant symptoms in the first two cases. The first case also developed neurological symptoms affecting his central nervous system. In the third case, the patient complained for nine years about an unbearable cough triggered by odors, smells, and a variety of indoor and outdoor irritants, among other symptoms of multiple chemical sensitivity. In all three cases, the respiratory symptoms resolved after appropriate treatment.

Conclusion

Our report aims at raising awareness on AS and calls for actions to improve the management of patients suffering from this syndrome.

Michaelis S, Burdon J, Howard CV (2017) Aerotoxic syndrome: a new occupational disease? Public Health Panorama (WHO) 3:141–356

Winder C, Balouet JC (2002) The toxicity of commercial jet oils. Environ Res 89:146–164. https://doi.org/10.1006/enrs.2002.4346CrossRefPubMed

Howard CV, Michaelis S, Watterson A (2017) The aetiology of ‘aerotoxic syndrome’- A toxico pathological viewpoint. Open Acc J Toxicol 1:555575. https://doi.org/10.19080/OAJT.2017.01.555575.002CrossRef

Harrison V, Mackenzie Ross SJ (2016) An emerging concern: toxic fumes in airplane cabins. Cortex 74:297–302. https://doi.org/10.1016/j.cortex.2015.11.014CrossRefPubMed

Hageman G, Pal TM, Nihom J, Mackenzie Ross SJ, van den Berg M (2020) Three patients with probable aerotoxic syndrome. Clin Toxicol (Phila) 58:139–142. https://doi.org/10.1080/15563650.2019.1616092CrossRef

Shehadi M, Jones B, Hosni M (2016) Characterization of the frequency and nature of bleed air contamination events in commercial aircraft. Indoor Air 26:478–488. https://doi.org/10.1111/ina.12211CrossRefPubMed

Liyasova M, Li B, Schopfer LM, Nachon F, Masson P, Furlong C et al (2011) Exposure to tri-o-cresyl phosphate detected in jet airplane passengers. Toxicol Appl Pharmacol 256:337–347. https://doi.org/10.1016/j.taap.2011.06.016CrossRefPubMedPubMedCentral

Schopfer LM, Furlong CE, Lockridge O (2010) Development of diagnostics in the search for an explanation of aerotoxic syndrome. Anal Biochem 404:64–74. https://doi.org/10.1016/j.ab.2010.04.032CrossRefPubMedPubMedCentral

Hageman G, Pal TM, Nihom J, Mackenzie Ross SJ, Berg MVD (2019) Aerotoxic syndrome, discussion of possible diagnostic criteria. Clin Toxicol (Phila) 58:414–416. https://doi.org/10.1080/15563650.2019.1649419CrossRef

10.

Quanjer PH, Stanojevic S, Cole TJ et al (2012) Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations. Eur Respir J 40(6):1324–1343. https://doi.org/10.1183/09031936.00080312CrossRefPubMedPubMedCentral

11.

Abou-Donia MB, Abou-Donia MM, ElMasry EM, Monro JA, Mulder MF (2013) Autoantibodies to nervous system-specific proteins are elevated in sera of flight crew members: biomarkers for nervous system injury. J Toxicol Environ Health A 76:363–380. https://doi.org/10.1080/15287394.2013.765369CrossRefPubMed

12.

Shaffo FC, Grodzki AC, Fryer AD, Lein PJ (2018) Mechanisms of organophosphorus pesticide toxicity in the context of airway hyperreactivity and asthma. Am J Physiol Lung Cell Mol Physiol 2018(315):L485–L501. https://doi.org/10.1152/ajplung.00211.2018CrossRef

13.

Alberts WM, do Pico GA (1996) Reactive airways dysfunction syndrome. Chest 109:1618–1626. https://doi.org/10.1378/chest.109.6.1618CrossRefPubMed

14.

Lemière C, Boulet LP, Cartier A 2020 Reactive airways dysfunction syndrome and irritant -induced asthma. Section Editor: Barnes PJ (ed) UpToDate Inc, Waltham, MA. https://www.uptodate.com. Accessed 17 Jan 2021

15.

Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R et al (2005) Interpretative strategies for lung function tests. Eur Respir J 26:948–968. https://doi.org/10.1183/09031936.05.00035205CrossRefPubMed

16.

Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL et al (2019) Standardization of spirometry 2019 update. An official american thoracic society and european respiratory society technical statement. Am J Respir Crit Care Med 200:e70–e88. https://doi.org/10.1164/rccm.201908-1590STCrossRefPubMedPubMedCentral

17.

Kaminsky AD (2019) What is a significant bronchodilator response? Ann Am Thorac Soc 16:1495–1503. https://doi.org/10.1513/AnnalsATS.201908-604EDCrossRefPubMed

18.

Irwin CG (2020) Pulmonary function testing in asthma. In Barnes PJ (ed). UpToDate Inc, Waltham, MA. https://www.uptodate.com. Accessed 17 Jan 2021

19.

Hansen JE, Dilektasli AG, Porszasz J, Stringer WW, Pak Y, Rossiter HB et al (2019) A new bronchodilator response grading strategy identifies distinct patient populations. Ann Am Thorac Soc 16(12):1504–1517. https://doi.org/10.1513/AnnalsATS.201901-030OCCrossRefPubMedPubMedCentral

20.

Harper A (2005) A survey of health effects in aircrew exposed to airborne contaminants. J Occup Health Saf Aust N Z 21:433–439

21.

Idiopathic environmental intolerances (1999) American Academy of Allergy, Asthma and Immunology (AAAAI) Board of Directors. J Allergy Clin Immunol 103(1 Pt 1):36–40 (PMID: 9893182)

22.

Tuuminen T (2018) Multiple chemical sensitivity: review of the state of the art in epidemiology, diagnosis, and future perspectives. J Occup Environ Med 60(8):e429. https://doi.org/10.1097/JOM.0000000000001369CrossRefPubMed

23.

Black DW, Temple S (2020) Idiopathic environmental intolerance (multiple chemical sensitivity). Dimsdale J (ed). UpToDate Inc, Waltham, MA. https://www.uptodate.com. Accessed 17 Jan 2021

24.

Furlong CE (2011) Exposure to triaryl phosphates: metabolism and biomarkers of exposure. J Biol Phys Chem. https://doi.org/10.4024/28FU11A.jbpc.11.04.10.4024/28FU11A.jbpc.11.04CrossRefPubMedPubMedCentral

25.

Megson D, Ortiz X, Jobst KJ, Reiner EJ, Mulder MF, Balouet JC (2016) A comparison of fresh and used aircraft oil for the identification of toxic substances linked to aerotoxic syndrome. Chemosphere 158:116–123. https://doi.org/10.1016/j.chemosphere.2016.05.062CrossRefPubMed

26.

Baker PE, Cole TB, Cartwright M, Suzuki SM, Thummel KE, Lin YS et al (2013) Identifying safer anti-wear triaryl phosphate additives for jet engine lubricants. Chem Biol Interact 25(203):257–264. https://doi.org/10.1016/j.cbi.2012.10.005CrossRef

27.

Costa LG (2018) Organophosphorus compounds at 80; some old and new issues. Toxicol Sci 162:24–35. https://doi.org/10.1093/toxsci/kfx266CrossRefPubMed

28.

Van Netten C, Leung V (2001) Hydraulic fluids and jet engine oils: pyrolysis and aircraft air quality. Arch Environ Health 56:181–186. https://doi.org/10.1080/00039890109604071CrossRefPubMed

29.

Howard CV, Johnson DW, Morton J, Michaelis S, Supplee D, Burdon J (2018) Is a cumulative exposure to a background aerosol of nanoparticles part of the causal mechanism of aerotoxic syndrome? J Nanomedicine Nanosci. https://doi.org/10.29011/JNAN-139CrossRef

30.

Schindler BK, Weiss T, Schütze A, Koslitz S, Broding HC, Bünger J, Brüning T (2013) Occupational exposure of air crews to tricresyl phosphate isomers and organophosphate flame retardants after fume events. Arch Toxicol 87:645–648. https://doi.org/10.1007/s00204-012-0978-0CrossRefPubMed

31.

Pombal R, Hosegood I, Powell D (2020) Risk of COVID-19 during air travel. JAMA 324:1798. https://doi.org/10.1001/jama.2020.19108CrossRefPubMed

32.

Baker MG, Thornley CN, Mills C, Roberts S, Perera S, Peters J et al (2010) Transmission of pandemic A/H1N1 2009 influenza on passenger aircraft: retrospective cohort study. BMJ 21(340):c2424. https://doi.org/10.1136/bmj.c2424CrossRef

33.

Wilson ME (2020) What goes on board aircraft? . Travel Med Infect Dis 33:101572. https://doi.org/10.1016/j.tmaid.2020.101572CrossRefPubMedPubMedCentral

34.

Heutelbeck AR, Baur X, Belpoggi F, Budnik T, Burdon J, Gee D, et al (2017) On the need for a standardized human biomonitoring protocol for in-flight incidents (called “fume events”) (Abstract). J H & P. 2nd International Conference Pollution in living and working environments and health. DiMoPEx Working Groups Meeting; Abstracts Conference Proceedings. S36-S38

35.

Reinen J, Nematollahi L, Fidder A, Vermeulen NP, Noort D, Commandeur JN (2015) Characterization of human cytochrome p450s involved in in the bioactivation of tri-ortho-cresyl phosphate (ToCP). Chem Res Toxicol 28:711–721. https://doi.org/10.1021/tx500490vCrossRefPubMed

36.

Costa LG, Giordano G, Cole TB, Marsillach J, Furlong CE (2013) Paraoxonase 1 (PON1) as a genetic determinant of susceptibility to organophosphate toxicity. Toxicology 307:115–122. https://doi.org/10.1016/j.tox.2012.07.011CrossRefPubMed

37.

Costa LG, Giordano G, Furlong CE (2011) Pharmacological and dietary modulators of paraoxonase 1 (PON1) activity and expression: the hunt goes on. Biochem Pharmacol 81:337–344. https://doi.org/10.1016/j.bcp.2010.11.008CrossRefPubMed

Title: Irritant-induced Asthma Caused by Aerotoxic Syndrome
Authors: Jorge Roig
Christian Domingo
Jonathan Burdon
Susan Michaelis
Publication date: 01-04-2021
Publisher: Springer US
Keywords: Cough
Bronchial Asthma
Cough
Cough
Published in: Lung / Issue 2/2021
Print ISSN: 0341-2040
Electronic ISSN: 1432-1750
DOI: https://doi.org/10.1007/s00408-021-00431-z

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Abstract

Purpose

Methods

Results

Conclusion

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