A Systematic Review of the Diagnosis of Occupational Asthma


      Background:This study systematically reviews literature regarding the diagnosis of occupational asthma (OA) and compares specific inhalation challenge (SIC) testing with alternative tests.
      Methods:Electronic databases and trials registries were searched; additional references were identified from bibliographic searches of included studies, hand searches of conferences, and author contacts. Various study designs (clinical trials, cohorts, cross-sectional, or case series) were included involving workers with suspected OA. All diagnostic tests were compared to a “reference standard,” and two researchers independently extracted 2 × 2 data. Pooled sensitivities and specificities (95% confidence intervals [CIs]) were derived.
      Results:Seventy-seven studies were included. For high molecular weight (HMW) agents, the nonspecific bronchial provocation (NSBP) test, skin-prick test (SPT), and serum-specific IgE had sensitivities > 73% when compared to SIC. Specificity was highest for specific IgE vs SIC (79.0%; 95% CI, 50.5 to 93.3%). The highest sensitivity among low molecular weight asthmagens occurred between combined NSBP and SPT vs SIC (100%; 95% CI, 74.1 to 100%). When compared to SIC, specific IgE and SPT had similar specificities (88.9%; 95% CI, 84.7 to 92.1%; and 86.2%; 95% CI, 77.4 to 91.9%, respectively). For HMW agents, high specificity was demonstrated for positive NSBP tests and SPTs alone (82.5%; 95% CI, 54.0 to 95.0%) or when combined with specific IgE (74.3%; 95% CI, 45.0 to 91.0%) vs SIC. Sensitivity was somewhat lower (60.6% and 65.2%, respectively).
      Conclusions:In appropriate clinical situations when SIC is not available, the combination of a NSBP test with a specific SPT or specific IgE may be an appropriate alternative to SIC in diagnosing OA. While positive results of single NSBP test, specific SPT, or serum-specific IgE testing would increase the likelihood of OA, a negative result could not exclude OA.

      Key words


      AHRQ (Agency for Healthcare Research and Quality), CI (confidence interval), HMW (high molecular weight), LMW (low molecular weight), NSBP (nonspecific bronchial provocation), OA (occupational asthma), PEF (peak expiratory flow), SIC (specific inhalation challenge), SPT (skin-prick test)
      To read this article in full you will need to make a payment
      Subscribe to CHEST
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • van Kampen V
        • Merget R
        • Baur X
        Occupational airway sensitizers: an overview on the respective literature..
        Am J Ind Med. 2000; 38: 164-218
        • Chan-Yeung M
        • Malo JL
        Occupational asthma..
        N Engl J Med. 1995; 333: 107-112
        • Blanc PD
        • Toren K
        How much adult asthma can be attributed to occupational factors?.
        Am J Med. 1999; 107: 580-587
        • Chan-Yeung M
        • Malo JL
        • Tarlo SM
        • et al.
        Proceedings of the first Jack Pepys Occupational Asthma Symposium..
        Am J Respir Crit Care Med. 2003; 167: 450-471
        • Ortega HG
        • Weissman DN
        • Carter DL
        • et al.
        Use of specific inhalation challenge in the evaluation of workers at risk for occupational asthma: a survey of pulmonary, allergy, and occupational medicine residency training programs in the United States and Canada..
        Chest. 2002; 121: 1323-1328
        • Lijmer JG
        • Mol BW
        • Heisterkamp S
        • et al.
        Empirical evidence of design-related bias in studies of diagnostic tests..
        JAMA. 1999; 282: 1061-1066
        • Moses LE
        • Shapiro D
        • Littenberg B
        Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations..
        Stat Med. 1993; 12: 1293-1316
        • Alvarez MJ
        • Estrada JL
        • Gozalo F
        • et al.
        Oilseed rape flour: another allergen causing occupational asthma among farmers..
        Allergy. 2001; 56: 185-188
        • Tarlo SM
        • Liss G
        • Corey P
        • et al.
        A workers'compensation claim population for occupational asthma..
        Chest. 1995; 107: 634-641
        • Tarlo S
        Laboratory challenge testing for occupational asthma..
        J Allergy Clin Immunol. 2003; 111: 692-694
        • Moscato G
        • Godnic-Cvar J
        • Maestrelli P
        Statement on self-monitoring of peak expiratory flows in the investigation of occupational asthma: Subcommittee on Occupational Allergy of European Academy of Allergy and Clinical Immunology..
        J Allergy Clin Immunol. 1995; 96: 295-301
      1. Lemiere C. Evaluation of the patient with occupational asthma: physiologic basis of respiratory disease. Hamilton, ON, Canada: BC Decker, 2005; 727–732