Hairdressers demonstrate increased IgE sensitisation to neuromuscular blocking drugs due to occupational exposure to quaternary ammonium ion compounds.

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• S Dong, D S Acouetey, R-M Guéant-Rodriguez, D Zmirou-Navier, T Rémen, M Blanca, P M Mertes, and J-L Guéant.
• Faculty of Medicine, Nutrition-Genetics and Risks to Environmental Exposure, Inserm-U954, University of Lorraine, Nancy, France; Inserm U 961 - Groupe Choc, Nancy, France.
• Clin. Exp. Allergy. 2013 Nov 1;43(11):1256-62.

BackgroundAllergic 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.ObjectiveTo investigate the prevalence of specific IgE to quaternary ammonium ions in two populations professionally exposed to quaternary ammonium compounds, in the north-eastern France.MethodsThe study had a retrospective follow-up design whereby apprentices were assessed after their 2-year training period as apprentices. The professionally exposed hairdresser populations (n = 128) were compared with baker/pastry makers (n = 108) and 'non-exposed' matched control subjects (n = 379).ResultsWe 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 (P < 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(®) ; P = 0.019 and P = 0.001, respectively).Conclusion And Clinical RelevanceThe 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.© 2013 John Wiley & Sons Ltd.

This article appears in the collection: What is the significance of Pholcodine for anesthesia?.

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