Anthony J Newman Taylor

Publications of Anthony J Newman Taylor

• Cryptogenic fibrosing alveolitis and lung cancer: the BTS Study.

  Authors: Jessica M Harris, Ian D A Johnston, Robin Rudd, Anthony J Newman Taylor, Paul Cullinan

  Thorax. 12/2009;

  INTRODUCTION: Risk of lung cancer is often reported as elevated for patients with cryptogenic fibrosing alveolitis (CFA). METHODS: Vital status was sought for all 588 members of the British ThoracicINTRODUCTION: Risk of lung cancer is often reported as elevated for patients with cryptogenic fibrosing alveolitis (CFA). METHODS: Vital status was sought for all 588 members of the British Thoracic Society (BTS) cryptogenic fibrosing alveolitis (CFA) study eleven years after entry to the cohort. Observed deaths due to lung cancer were compared to expected, using age-, sex- and period-adjusted national rates. The roles of reported asbestos exposure and smoking were also investigated. RESULTS: 488 (83%) cohort members had died; 46 (9%) were certified to lung cancer (ICD9 162). The standardised mortality ratio (SMR) was 7.4 (95% ci [5.4, 9.9]). Stratified analysis demonstrated increased lung cancer mortality amongst younger subjects, males and ever smokers. Using an independent expert panel, 25 (4%) cohort members were considered to have at least moderate exposure to asbestos; lung cancer risk was elevated for these subjects (SMR 13.1 [3.6, 33.6]) versus 7.2 (5.2, 9.7) for those with less, or no, asbestos exposure. Ever smoking was reported by 448 (73%) of the cohort and was considerably higher in males (92%) than females (49%); p<0.001. Most (87%) lung cancer decedents were male and all but two (96%) lung cancer decedents ever smoked. Ever smokers presented at a younger age (mean 67 versus 70 years; p<0.001) and with less breathlessness (12% smokers reported no breathlessness versus 5% never smokers; p=0.02). DISCUSSION: These findings confirm an association between CFA and lung cancer although this relationship may not be causal. The high rate of smoking, and evidence that smokers present for medical attention earlier than non-smokers, suggest that smoking could be confounding this association.

• Detergent protease exposure and respiratory disease: case-referent analysis of a retrospective cohort.

  Authors: Andrew Brant, Susan Upchurch, Martie van Tongeren, Cornelia Zekveld, Janet Helm, Fiona Barnes, Anthony J Newman Taylor, Paul Cullinan

  Occupational and environmental medicine. 07/2009;

  OBJECTIVES: To examine the relationship between protease exposure and respiratory disease in a cohort of detergent enzyme manufacturers. METHODS: Case-referent analysis of a cohort of employeesOBJECTIVES: To examine the relationship between protease exposure and respiratory disease in a cohort of detergent enzyme manufacturers. METHODS: Case-referent analysis of a cohort of employees working in a European detergent factory between 1989 and 2002. Cases, with new lower or upper respiratory disease were ascertained by examination of occupational health records and matched to referents on date of first employment. Personal exposures to airborne detergent protease were estimated, using a job exposure matrix, from >12,000 measurements made in the factory during the period of study. RESULTS: We found clear, monotonic relationships between estimated protease exposure and both lower and upper respiratory disease. After control for age, sex and smoking the odds ratio of lower respiratory disease was significantly elevated (1.98, 95% confidence interval 1.04-3.79) in those employees working in jobs in the highest quartile of protease exposure (geometric mean 7.9ng.m-3). For employees with upper respiratory disease the risk was significantly elevated at a lower level of estimated protease exposure (geometric mean 2.3ng.m-3). CONCLUSIONS: These findings provide strong evidence of an association between detergent enzyme exposure and the development of respiratory disease in an occupational setting. Using the routinely collected information on specific sensitisation and the close attention to workplace exposures that are characteristic of this industry it should be possible to derive meaningful occupational exposure standard for most detergent enzymes.

• Early-life allergen exposure and atopy, asthma, and wheeze up to 6 years of age.

  Authors: Matias Torrent, Jordi Sunyer, Raquel Garcia, Jessica Harris, Maria V Iturriaga, Carme Puig, Oriol Vall, Josep M Anto, Anthony J Newman Taylor, Paul Cullinan

  American journal of respiratory and critical care medicine. 10/2007; 176(5):446-53.

  RATIONALE: Although it is widely assumed that the incidence of childhood respiratory allergies to common aeroallergens is directly related to allergen exposure in early life, few longitudinal studiesRATIONALE: Although it is widely assumed that the incidence of childhood respiratory allergies to common aeroallergens is directly related to allergen exposure in early life, few longitudinal studies have investigated this issue, and available data are scarce and mainly limited to high-risk groups. OBJECTIVES: To assess, in a prospective manner and in a general population, the role of early life exposures to Der p1 and Fel d1 on the inception of sensitization and asthma. METHODS: Pregnant women and their children were recruited for the Asthma Multicentre Infant Cohort Study. Overall, 1,611 newborns were initially enrolled in three cohorts in the United Kingdom and Spain. Der p1 and Fel d1 allergens were measured in household dust samples at 3 months of age for 1,474 (91.5%) participants, and skin prick tests were performed at 6 years of age on 1,182 (80.2%) participants. Wheeze and diagnosed asthma were reported in yearly questionnaires. MEASUREMENTS AND MAIN RESULTS: Exposure to Der p1 early in life was not related to a positive specific prick test or to asthma or persistent wheeze at 6 years of age. Fel d1 showed an association with all these outcomes (third vs. first tertile; odds ratio, 4.43 for positive specific prick test and 2.6 for diagnosed asthma). CONCLUSIONS: Dose-response relationships between allergen exposure and sensitization or asthma may be allergen specific and nonlinear; a minimum threshold level is needed to induce sensitization, but no dose-response relationship exists above this level. The effect of a particular allergen seems to be similar on atopy and asthma inception.

• Recorded infections and antibiotics in early life: associations with allergy in UK children and their parents.

  Authors: Jessica M Harris, Pamela Mills, Carol White, Susan Moffat, Anthony J Newman Taylor, Paul Cullinan

  Thorax. 08/2007; 62(7):631-7.

  BACKGROUND: It is suggested that the inverse relationship between allergic disease and family size reflects reduced exposure to early life infections, and that antibiotic treatment in childhoodBACKGROUND: It is suggested that the inverse relationship between allergic disease and family size reflects reduced exposure to early life infections, and that antibiotic treatment in childhood diminishes any protective effect of such infection. METHODS: A birth cohort study was undertaken in 642 children recruited before birth and seen annually until the age of 8 years. Reported infections and prescribed antibiotics by the age of 5 years were counted from GP records and comparisons were made with a previous study of their parents. RESULTS: At the age of 8 years, 104 children (19%) were atopic, 79 (13%) were currently wheezy and 124 (21%) had seasonal rhinitis. 577 children (97%) had at least three infections recorded by age 5, a figure much higher than that of their parents (69%). By the age of 5 only 11 children (2%) had never received a prescription for antibiotics; the corresponding figure for the parents was 24%. Higher numbers of infections were recorded for firstborn children. After adjusting for parental atopy and birth order, there was no association between infection counts and atopy (OR 1.01 (95% CI 0.99 to 1.03) per infection). Significant positive associations were found for wheeze and seasonal rhinitis. An increased risk of current wheeze was found for each antibiotic prescription (adjusted OR 1.07 (95% CI 1.03 to 1.10)) but not for atopy. This was primarily explained by prescriptions for respiratory infections. Similar patterns were observed for seasonal rhinitis. CONCLUSIONS: Despite very high rates of recorded early life infections and antibiotic prescriptions, no plausibly causative relationships were found with subsequent respiratory allergies.

• Asbestos-induced and smoking-related disease: apportioning pulmonary function deficit by using thin-section CT.

  Authors: Susan J Copley, Y C Gary Lee, David M Hansell, Pathmanathan Sivakumaran, Michael B Rubens, Anthony J Newman Taylor, Robin M Rudd, A William Musk, Athol U Wells

  Radiology. 01/2007; 242(1):258-66.

  PURPOSE: To retrospectively correlate the extent of individual diseases seen at thin-section computed tomography (CT) with pulmonary function in an initial group of patients with asbestos-relatedPURPOSE: To retrospectively correlate the extent of individual diseases seen at thin-section computed tomography (CT) with pulmonary function in an initial group of patients with asbestos-related parenchymal disease (asbestosis) and to test these findings in a subsequent group of patients whose CT scans were retrospectively identified. MATERIALS AND METHODS: This retrospective study had Institutional Review Board approval; informed consent was not required. The study included 133 individuals who had been exposed to asbestos. In the initial study group (81 patients; 79 men, two women; median age, 67 years), two observers used a CT scoring system to quantify the extent of pulmonary fibrosis, diffuse pleural thickening, small-airways disease, and emphysema. Multivariate equations were formulated by using independent CT variables to predict changes in total lung capacity (TLC) and carbon monoxide diffusing capacity (Dlco). The validity of these equations was then tested in a subsequent group of patients (52 patients; all men; median age, 60 years). RESULTS: At thin-section CT, the extent of asbestos-induced pleuropulmonary disease and emphysema correlated significantly with physiologic impairment (P<.001). Combined CT variables predicted 58% and 57% of the variability in TLC and Dlco, respectively, despite considerable variation in the proportion of coexisting pathologic conditions. When predictive equations with CT variables derived from the initial study group were applied to the subsequent study group, predicted TLC (rho=0.75, P<.001) and Dlco (rho=0.64, P<.001) correlated strongly with measured values. CONCLUSION: The proposed CT system provides a semiquantitative method for assessing the relative contribution of asbestos-induced pleuropulmonary disease and smoking-related emphysema to functional impairment.

• Specific IgE to isocyanates: A useful diagnostic role in occupational asthma

  Authors: Rosemary D. Tee, Paul Cullinan, Jennifer Welch, P.Sherwood Burge, Anthony J. Newman-Taylor

  Journal of Allergy and Clinical Immunology.

  Background: Isocyanates are the most frequent cause of occupational asthma in industrialized countries. Objective: We sought to investigate the utility of specific IgE measurement in the diagnosis ofBackground: Isocyanates are the most frequent cause of occupational asthma in industrialized countries. Objective: We sought to investigate the utility of specific IgE measurement in the diagnosis of isocyanate-induced asthma. Methods: Fifty-eight of 101 patients referred for investigation were diagnosed as having isocyanate-induced occupational asthma by means of history, serial peak flow records, and bronchial provocation tests. Specific IgE antibodies to toluene diisocyanate:human serum albumin (HSA), diphenylmethane diisocyanate:HSA, and hexamethylene diisocyanate:HSA were measured in all patients by Phadebas RAST. Results: Twenty patients had a RAST ratio of 2 or greater to at least one isocyanate. Thirteen (28%) of the 46 patients with a positive provocation test response had a RAST ratio of 2 or greater, and nine (20%) had a RAST ratio of 3 or greater. Raising the RAST cut-off from 2 or greater to 3 or greater reduced its sensitivity but increased the specificity of the test to 100%. RAST measurement was most likely to be positive within 30 days of exposure. Serial measurements suggested that the half-life of the IgE antibodies was approximately 6 months. Evidence of cross-reactivity between isocyanate RAST responses was found in eight subjects. Conclusion: Specific IgE to isocyanates is a more specific than sensitive index of occupational asthma. With a RAST score of 3 or greater, it is wholly specific and therefore diagnostic of isocyanate-induced asthma. The sensitivity of specific IgE measurement is highest when blood is taken less than 30 days from last exposure, which is consistent with the observed half-life.(J Allergy Clin Immunol 1998;101:709-15.)