Specific challenge testing for occupational asthma: revised handbook
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HilleÂ Suojalehto,Â KatriÂ Suuronen,Â PaulÂ Cullinan
European Respiratory JournalÂ 2019Â 54:Â 1901026;Â DOI:Â 10.1183/13993003.01026-2019
Specific inhalation challenge is considered a reference standard in the diagnosis of occupational asthma. An updated handbook of challenge techniques for a large number of sensitising agents from 11 European centres is now available.http://bit.ly/2XVpW1P
When undertaken carefully, and in experienced hands, specific inhalation challenge (SIC) testing is widely considered to be the reference standard in the diagnosis of occupational asthma. In 2013 the European Respiratory Society commissioned a pan-European task force to produce standards for the conduct and interpretation of SIC with the aim of sharing expertise among those centres who offer the service and with centres who wish to develop a new service. The findings and recommendations of the taskforce were published in theÂ European Respiratory JournalÂ .
Alongside the main report, we produced a handbook of challenge techniques for a large number of different sensitising agents, including both those of high and low molecular mass. We committed ourselves to provide an update within 5â€…years; this has been completed, as planned, and is presented as aÂ supplementary fileÂ to this editorial. The techniques are those used in 11 specialist centres and are listed by agent category with contact information for each centre should practitioners require more detailed information; the occupational asthma community in Europe prides itself on being collaborative, and collectively is happy to share its experience and expertise.
Controlled, experimental SIC was first developed â€“ formally, as a diagnostic tool for occupational asthma â€“ around 50â€…years ago, in a single centre. Its practice has flourished and spread since but it is fair to say that access remains patchy, with some European countries, and many regions within them, having no provision at all. This disadvantages patients who require the highest standard of diagnostic accuracy, employers who need to know which of the agents in their workplaces is giving rise to disease in their workers, and regulators charged with controlling what is essentially a preventable disease. Moreover, it hampers the identification of novel sensitisers and the exploration of the mechanisms behind their sensitising properties; this is, perhaps, especially important in the study of chemical sensitisers and particularly so since, rightly or wrongly, they are now considered Substances of Very High Concern under REACH. For these reasons we encourage respiratory physicians and the commissioners of healthcare to familiarise themselves with the relevant guidelines and to consider the equitable provision of SIC across Europe wherever the resources to perform SIC safely and with high quality can be ensured.
Please note:Â supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.
Supplementary materialÂ ERJ-01026-2019.SUPPLEMENT
This one-page PDF can be shared freely online.
Shareable PDFÂ ERJ-01026-2019.Shareable
This article has supplementary material available fromÂ erj.ersjournals.com
Conflict of interest: H. Suojalehto has nothing to disclose.
Conflict of interest: K. Suuronen has nothing to disclose.
Conflict of interest: P. Cullinan has nothing to disclose.
- ReceivedÂ May 23, 2019.
- AcceptedÂ July 2, 2019.
- Copyright Â©ERS 2019