Andrew Brant

Publications of Andrew Brant

• 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.

• Baker's asthma.

  Authors: Andrew Brant

  Current opinion in allergy and clinical immunology. 05/2007; 7(2):152-5.

  PURPOSE OF REVIEW: Baker's asthma is one of the leading causes of occupational asthma and this review describes recent developments in the field. RECENT FINDINGS: The location of bakery productionPURPOSE OF REVIEW: Baker's asthma is one of the leading causes of occupational asthma and this review describes recent developments in the field. RECENT FINDINGS: The location of bakery production has undergone change and, subsequently, so has the location of baker's asthma. Innovations in the baking industry have also led to new, potentially allergenic, ingredients. A new family of cereal allergens has been identified, including wheat thioredoxin hb (Tri a25). New enzymes are being added to bread that may have allergic potential. The relationship of specific sensitization and baker's asthma has been confirmed in further studies. Measuring specific sensitization to bakery allergens is an essential part of making the diagnosis but there is a lack of standardization of allergen tests. Advancements are being made in the measurement of airborne allergens through the Measurement of Occupational Allergen Exposure project and the development of novel measurement techniques. This will enable better exposure-response relationships and more accurate risk assessment. SUMMARY: Progress is being made to better identify bakery allergens and measure exposures accurately. Changes in the location of bread production and new allergens mean that the distribution and determinants of baker's asthma are changing.

• Outcome of occupational asthma after cessation of exposure: a systematic review.

  Authors: George Rachiotis, Rashna Savani, Andrew Brant, Stephanie J MacNeill, Anthony Newman Taylor, Paul Cullinan

  Thorax. 03/2007; 62(2):147-52.

  BACKGROUND: Patients with occupational asthma, and their medical advisers, need valid information about the prognosis of their disease. METHODS: A systematic review of the published literature on theBACKGROUND: Patients with occupational asthma, and their medical advisers, need valid information about the prognosis of their disease. METHODS: A systematic review of the published literature on the symptomatic and functional outcomes of occupational asthma was carried out after avoidance of exposure to the causative agent. Through a full search of electronic and bibliographic sources, original studies documenting complete recovery from asthma (n = 39,1681 patients) or improvement in non-specific bronchial hyper-responsiveness (NSBHR; n = 28,695 patients) were identified. The median duration of follow-up was 31 (range 6-240) months for studies of symptomatic recovery and 37 (6-240) months for studies of NSBHR. Most studies were of patients recruited from special clinics. RESULTS: Reported rates of symptomatic recovery varied from 0% to 100%, with a pooled estimate of 32% (95% CI 26% to 38%). These rates were lower with increasing age (p = 0.019) and among clinic based populations (p = 0.053). Patients with the shortest durations of exposure (< or =76 months) had the highest rate of recovery (36%; 95% CI 25% to 50%), but the effect was not linear. The pooled prevalence of persistent NSBHR at follow-up was 73% (95% CI 66% to 79%). This figure was higher among patients whose disease was due to high-molecular-weight agents (p = 0.006) and, less clearly, those from clinic-based populations (p = 0.561). In between-study comparisons, no clear patterns of improvement relating to total duration of exposure or follow-up were found. From within-study comparisons there was some evidence that a shorter duration of symptoms was associated with a higher rate of symptomatic recovery. CONCLUSION: The available data on the prognosis of occupational asthma are insufficiently consistent to allow confident advice to be given to patients with the disease. Clinicians and epidemiologists with an interest in this disease should consider a collaborative and carefully standardised study of the prognosis of occupational asthma.