Bronchial asthma and rhinitis in hairdressers exposed to persulphates

Introduction: Occupational asthma may be caused by persulphates contained in the bleaching and may be preceded by episodes of allergic rhinitis. The aim of the study was to assess how is the onset of respiratory symptoms in relation to the type of awareness, and to identify which of the various persulphates were most frequently involved in occupational asthma within a population of hairdressers.  

Methods: From 1985 to 2009 at the Unit of Occupational Medicine and Toxicology of the University of Siena, 47 hairdresser were examined for suspected persulphates asthma. The protocol included medical visit, prick tests with standard series and persulphates, chest X-rays, pulmonary function tests (PFTs) with residual volume, Non Specific Bronchial Hyperresponsiveness (NSBH) measurement by methacholine, control challenge test with talc and occupational challenge test with bleach.  

Results: PFTs were within the normal variability in 31 cases. The test with methacholine was positive in 21 cases out of 44, while the occupational challenge test with bleach was positive in 11 subjects out of 40. In 5 subjects with positive occupational challenge test, the test was repeated with single persulphates. This was positive for ammonium persulphate in all cases and for potassium persulphate in two cases. The nasal occupational challenge test was positive in 14 subjects out of 22 examined. 20 of 46 subjects observed were positive to standard series prick tests and 6 cases were positive to persulphates.

Discussion: The results confirm the occupational challenge test with bleach (or better with single persulphates) as the gold standard for the diagnosis of occupational asthma in hairdressers.