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Clinical & Experimental Allergy

Prevalence of IgE against neuromuscular blocking agents in hairdressers and bakers

Authors

  • S. Dong,

    1. Faculty of Medicine, Nutrition-Genetics and Risks to Environmental Exposure, Inserm-U954, University of Lorraine, Nancy, France
    2. Inserm U 961 – Groupe Choc, Nancy, France
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  • D. S. Acouetey,

    1. Faculty of Medicine, Nutrition-Genetics and Risks to Environmental Exposure, Inserm-U954, University of Lorraine, Nancy, France
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  • R.-M. Guéant-Rodriguez,

    1. Faculty of Medicine, Nutrition-Genetics and Risks to Environmental Exposure, Inserm-U954, University of Lorraine, Nancy, France
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  • D. Zmirou-Navier,

    1. Faculty of Medicine, Nutrition-Genetics and Risks to Environmental Exposure, Inserm-U954, University of Lorraine, Nancy, France
    2. Ecole des Hautes Etudes en Santé Publique, Rennes, France
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  • T. Rémen,

    1. Faculty of Medicine, Nutrition-Genetics and Risks to Environmental Exposure, Inserm-U954, University of Lorraine, Nancy, France
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  • M. Blanca,

    1. Faculty of Medicine, Nutrition-Genetics and Risks to Environmental Exposure, Inserm-U954, University of Lorraine, Nancy, France
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  • P. M. Mertes,

    1. Inserm U 961 – Groupe Choc, Nancy, France
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    • These authors have equal contribution to this article.
  • J.-L. Guéant

    Corresponding author
    1. Faculty of Medicine, Nutrition-Genetics and Risks to Environmental Exposure, Inserm-U954, University of Lorraine, Nancy, France
    • Correspondence:

      Jean-Louis Guéant, Faculté de medicine, Inserm U954, 9 Avenue de la Forêt de Haye, Vandoeuvre-Lès-Nancy 54505, France.

      E-mail: Jean-louis.gueant@univ-lorraine.fr

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    • These authors have equal contribution to this article.

Summary

Background

Allergic 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.

Objective

To investigate the prevalence of specific IgE to quaternary ammonium ions in two populations professionally exposed to quaternary ammonium compounds, in the north-eastern France.

Methods

The study had a retrospective follow-up design whereby apprentices were assessed after their 2-year training period as apprentices. The professionally exposed hairdresser populations (= 128) were compared with baker/pastry makers (= 108) and ‘non-exposed’ matched control subjects (= 379).

Results

We 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 (< 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®; = 0.019 and = 0.001, respectively).

Conclusion and Clinical Relevance

The 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.

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