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Current Allergy and Asthma Reports
Published in: Current Allergy and Asthma Reports 8/2016

01-08-2016 | Occupational Allergies (J Poole, Section Editor)

Hypersensitivity Pneumonitis Due to Metalworking Fluid Aerosols

Author: P. Sherwood Burge

Published in: Current Allergy and Asthma Reports | Issue 8/2016

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Abstract

Purpose of Review

This review summarises the clinical knowledge of hypersensitivity pneumonitis in workers exposed to aerosols of metalworking fluid, reviewing published outbreaks and clinical cases.

Recent Findings

Metalworking fluid exposure has become the commonest recognised cause of occupational hypersensitivity pneumonitis, having been rare before 2000. There are many possible agents in the metalworking fluid which may be the cause of disease including bacteria, mycobacteria, fungae, biocides, emulsifiers, reodorants and dissolved chrome and cobalt. Causes are likely to be different in different outbreaks. Mycobacteria growing in the metalworking fluid have generated immune responses in some workers, but their role in disease causation is not yet established. Many outbreaks have been identified in large workplaces using common sumps.

Summary

It is not possible to prevent microbial contamination of metalworking fluids in use. Disease prevention should focus on stopping inhalation of aerosols, particularly by re-engineering to remove recirculation.
Literature
1.
Bernstein DI, Lummus ZL, Santilli G, Siskosky J, Bernstein IL. Machine operator’s lung. A hypersensitivity pneumonitis disorder associated with exposure to metalworking fluid aerosols. Chest. 1995;108:636–41.CrossRefPubMed
2.
Muilenberg ML, Burge HA, Sweet T. Hypersensitivity pneumonitis and exposure to acid-fast bacilli in coolant aerosols. J Allergy Clin Immunol. 1993;91:311.
3.
Data from the SWORD and OPRA surveillance schemes from the department of occupational and environmental medicine, Manchester University, UK; 2016.
4.
Thomeer MJ, Costabel U, Rizzato G, Poletti V, Demedts M. Comparison of registries of interstitial lung diseases in three European countries. Eur J Respir Dis Suppl. 2001;32:114s–8.
5.
Burge G, Ghani S, Petkova D, Reynolds J, Djearman M, Hussain S, et al. Development of the interstitial lung disease multidisciplinary team meeting 2005–2013. Eur Respir J. 2015;46 Suppl 5:PA333.CrossRef
6.
Fink JN, Ortega HG, Reynolds HY, Cormier YF, Fan LL, Franks TJ, et al. Needs and opportunities for research in hypersensitivity pneumonitis. Am J Respir Crit Care Med. 2005;171:792–8.CrossRefPubMed
7.••
Lacasse Y, Selman M, Costabel U, Dalphin J, Ando M, Morell F, et al. Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med. 2003;168:952–8. The new classification of HP.CrossRefPubMed
8.•
Bourke SJ, Banham SW, Carter R, Lynch P, Boyd G. Longitudinal course of extrinsic allergic alveolitis in pigeon breeders. Thorax. 1989;44:415–8. An important paper showing that continued exposure does not necessarily lead to progressive deterioration.CrossRefPubMedPubMedCentral
9.•
Ohtani Y, Saiki S, Kitaichi M, Usui Y, Inase N, Costabel U, et al. Chronic bird fancier’s lung: histopathological and clinical correlation. An application of the 2002 ATS/ERS consensus classification of the idiopathic interstitial pneumonias. Thorax. 2005;60:665–71. An important paper showing that prognosis of chronic HP is related to histology, and that precipitins may be negative when challenge and lymphocyte proliferation assays are positive.CrossRefPubMedPubMedCentral
10.••
Robertson W, Robertson A, Burge CB, Moore V, Jaakkola MS, Dawkins PA, et al. Clinical investigation of an outbreak of alveolitis and asthma in a car engine manufacturing plant. Thorax. 2007;62:981–90. A comprehensive account of the largest outbreak of metalworking fluid HP recorded.11.CrossRefPubMedPubMedCentral
11.
Hodgson MJ, Bracker A, Yang C, Storey E, Jarvis BJ, Milton D, et al. Hypersensitivity pneumonitis in a metal-working environment. Am J Industr Med. 2001;39:616–28.CrossRef
12.
Dawkins P, Robertson AS, Robertson W, Moore V, Reynolds J, Langman G, et al. An outbreak of extrinsic alveolitis at a car engine plant. Occup Med. 2006;56:559–65.CrossRef
13.
Burge GA, Okiror L, Trotter S, Langman G, Payyappilly S, Naidoo P, et al. Interstitial lung disease multidisciplinary team presentations post VATS lung biopsy changes the original histological diagnosis in 30%. Thorax. 2015;70 Suppl 1:A27.
14.•
Barber CM, Burton CM, Hendrick DJ, Pickering CA, Robertson AS, Robertson W, et al. Hypersensitivity pneumonitis in workers exposed to metalworking fluids. Am J Industr Med. 2014;57:872–80. The development of a scoring system for identifying cases of HP during outbreaks.CrossRef
15.
Burge PS, Moore VC, Burge CBSG, Vellore AD, Roberton AS, Robertson W. Can serial PEF measurements separate occupational asthma from allergic alveolitis? Occup Med. 2015;65:251–5.CrossRef
16.
Fox J, Anderson H, Moen T, Gruetzmacher G, Hanrahan L, Fink J. Metal working fluid-associated hypersensitivity pneumonitis: an outbreak investigation and case-control study. Am J Ind Med. 1999;35:58–67.CrossRefPubMed
17.
Walters GI, McGrath EE, Ayres JG. Audit of the recording of occupational asthma in primary care. Occup Med. 2012;62:570–3.CrossRef
18.
Davison AG, Haslam PL, Corrin B, Coutts II, Dewar A, Riding WD, et al. Interstitial lung disease and asthma in hard metal workers: bronchoalveolar lavage, ultrastructural and analytical findings and results of bronchial provocation tests. Thorax. 1983;38:119–28.CrossRefPubMedPubMedCentral
19.
Lison D, Lauwerys R, Demedts M, Nemery B. Experimental research into the pathogenesis of cobalt/hard metal lung disease. Eur Respir J. 1996;9:1024–8.CrossRefPubMed
20.•
Park D, Stewart PA, Coble JB. Determinants of exposure to metalworking fluid aerosols: a literature review and analysis of reported measurements. Ann Occup Hyg. 2009;53:271–88. The best account of measurements of metal-working fluid in air.CrossRefPubMedPubMedCentral
21.••
Burton CM, Crook B, Scaife H, Evans GS. Systematic review of respiratory outbreaks associated with exposure to water-based metalworking fluids. Ann Occup Hyg. 2012;56:374–88. The most up-to-date systematic review of outbreaks of HP due to metal-working fluid.CrossRefPubMed
22.
Senior H, Evans G. RR1044 Consultation on monitoring of water-miscible metalworking fluid (MWF) mists. Health Safety Exexutive. 2015;RR1044:1–43.
23.
Gilbert Y, Veillette M, Duchaine C. Metalworking fluids biodiversity characterization. J Applied Microbiol. 2010;108:437–49.
24.
Meza F, Chen C, Hudson N. Investigation of respiratory and dermal symptoms associated with metal working fluids at an aircraft engine manufacturing facility. Am J Industr Med. 2013;56:1394–401.
25.
Fornander L, Graff P, Wåhlén K, Wåhlén K, Flodin U, Leanderson P, et al. Airway symptoms and biological markers in nasal lavage fluid in subjects exposed to metalworking fluids. Plos One. 2013;8, e83089.CrossRefPubMedPubMedCentral
26.
Merget R, Sander I, van Kampen V, Raulf-Heimsoth M, Rabente T, Kolk A, et al. Hypersensitivity pneumonitis due to metalworking fluids: how to find the antigens. Neurobiology of respiration. 2013;788:335–40.CrossRef
27.
Wu J, Franzblau A, Xi C. Molecular characterization of microbial communities and quantification of Mycobacterium immunogenum in metal removal fluids and their associated biofilms. Environ Sci Pollut Res. 2016;23:4086–94.CrossRef
28.•
Murat JB, Grenouillet F, Reboux G, Penven E, Batchili A, Dalphin JC, et al. Factors influencing the microbial composition of metalworking fluids and potential implications for machine operator’s lung. Appl Environ Microbiol. 2012;78:34–41. An interesting review of the factors influencing microbial growth in metal-working fluids.CrossRefPubMedPubMedCentral
29.
30.
Trout D, Reh B, Weber A. Health Hazard Evaluation Report 1996 HETA 96-0156-2712. Health Hazard Evaluation Report HETA 96-0156-2712; 1996
31.
Trout D, Harney J. Health Hazard Evaluation Report: HETA-2002-0155-2886. Health Hazard Evaluation Report. 2002. HETA-2002-0155-2886
32.
Tillie-Leblond I, Grenouillet F, Reboux G, Roussel S, Chouraki B, Lorthois C, et al. Hypersensitivity pneumonitis and metalworking fluids contaminated by mycobacteria. Eur Respir J. 2011;37:640–7.CrossRefPubMed
33.
Trout D, Weissman DN, Lewis D, Brundage RA, Franzblau A, Remick D. Evaluation of hypersensitivity pneumonitis among workers exposed to metal removal fluids. Appl Environ Microbiol. 2003;18:953–60.
34.•
Hendrick DJ, Marshall R, Faux JA, Krall JM. Positive alveolar responses to inhalation provocation tests: their validity and recognition. Thorax. 1980;35:415–27. The classical paper of specific inhalation challenge testing in HP.CrossRefPubMedPubMedCentral
35.
Vellore AD, Moore VC, Robertson AS, Robertson W, Jaakkola MS, Burge PS. Specific bronchial challenge testing to metal working fluid. Eur Respir J Suppl. 2006;28:245s.
36.
37.
38.
Walters GI, Moore VC, Robertson AS, McGrath EE, Parkes E, Burge PS. Occupational asthma from sensitization to 4,4-methylene bismorpholine in clean metalworking fluid. Eur Respir J. 2013;42:1137–9.CrossRefPubMed
39.
Piipari R, Tuppurainen M, Tuomi T, Mantyla L, HenriksEckerman ML, Keskinen H, et al. Diethanolamine-induced occupational asthma, a case report. Clin Exp Allergy. 1998;28:358–62.CrossRefPubMed
40.
Savonius B, Keskinen H, Tuppurainen M, Kanerva L. Occupational asthma caused by ethanolamines. Allergy. 1994;49:877–81.CrossRefPubMed
41.
Walters GI, Robertson AS, Moore VC, Burge PS. Cobalt asthma in metalworkers from an automotive engine valve manufacturer. Occup Med. 2014;64:358–64.CrossRef
42.
Walters GI, Moore VC, Robertson AS, Burge CBSG, Vellore A-D, Burge PS. An outbreak of occupational asthma due to chromium and cobalt. Occup Med. 2012;62:533–40.CrossRef
43.
Burge PS. Occupational asthma, rhinitis and alveolitis due to colophony. Clin Immunol Allergy. 1984;4:55–82.
44.
Barrera C, Reboux G, Warfolomeow I, Rognon B, Millon L, Roussel S. External validation of recombinant antigens for serodiagnosis of machine operator’s lung. Am J Industr Med. 2014;57:195–201.CrossRef
45.
Chandra H, Lockey J, Yadav JS. Novel antigens of Mycobacterium immunogenum relevant in serodiagnosis of occupational hypersensitivity pneumonitis in machinists. Ann Allergy Asthma Immunol. 2015;114:525–6.CrossRefPubMed
46.
Kapoor R, Selvaraju SB, Yadav JS. Extended tracking of the microbial community structure and dynamics in an industrial synthetic metalworking fluid system. FEMS Microbiol Ecol. 2014;87:664–7.CrossRefPubMed
47.•
Veillette M, Thorne PS, Gordon T, Duchaine C. Six month tracking of microbial growth in a metalworking fluid after system cleaning and recharging. Ann Occup Hyg. 2004;48:541–6. A longitudinal account of metalworking fluid microbiology showing that recolonisation occurs quickly after cleaning and replacement of metalworking fluid.CrossRefPubMed
48.
Ilgaz A, Moore VC, Robertson W, Robertson AS, Burge PS. Is respiratory protective equipment effective in abolishing the work effect in patients sensitised to metal working fluid? Thorax. 2015;70(suppl1):A108.
49.
Shokrani A, Dhokia V, Newman ST. A techno-health study of the use of cutting fluids and future alternatives. 24th International Conference on Flexible Automation and Intelligent Manufacturing (FAIM 2014), 2014
50.
Sreejith P, Ngoi B. Dry machining: machining of the future. J Mater Process Technol. 2000;101:287–91.CrossRef
Metadata
Title
Hypersensitivity Pneumonitis Due to Metalworking Fluid Aerosols
Author
P. Sherwood Burge
Publication date
01-08-2016
Publisher
Springer US
Published in
Current Allergy and Asthma Reports / Issue 8/2016
Print ISSN: 1529-7322
Electronic ISSN: 1534-6315
DOI
https://doi.org/10.1007/s11882-016-0639-0

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