Occupational Asthma and Occupational Rhinitis in Hairdressers

Gianna Moscato, MD; Patrizia Pignatti, PhD; Mona-Rita Yacoub, MD; Canzio Romano, MD; Sandro Spezia; Luca Perfetti, MD


CHEST. 2005;128(5):3590-3598. 

In This Article

Abstract and Introduction

Background: Hairdressers are at risk for occupational respiratory diseases, but the risk factors, causal agents, and underlying mechanisms are not completely defined.
Aim: To describe the features of a large group of hairdressers consecutively referred to our center for suspected occupational asthma (OA) over an 8-year period, the type of occupational respiratory diseases, the etiologic agents, and the diagnostic tests.
Results: Forty-seven hairdressers (mean age, 25 years; range, 17 to 52 years) were studied. On the basis of the response to the specific inhalation challenge (SIC), 24 patients received a diagnosis of OA (51.1%), which was due to persulfate salts in 21 patients (87.5%), permanent hair dyes in 2 patients (8.3%), and latex in 1 patient (4.2%). Thirteen of these 24 patients (54.2%) also received a diagnosis of occupational rhinitis, which was due to persulfate salts in 11 patients (84.6%) and to paraphenylenediamine in two patients (15.4%). Patients with persulfate asthma had a long period of exposure to bleaching agents, a long latent period between the start of exposure and the onset of symptoms, and a prevalent eosinophilic airway inflammation in induced sputum. The skin-prick test with ammonium persulfate performed in a subset of patients gave negative results.
Conclusions: In the present study, we confirmed that persulfate salts are the major agents involved in OA and occupational rhinitis in hairdressers. The positive response to the SIC in only a part of the population of symptomatic exposed workers, the period between the starting of exposure and the onset of symptoms, the type of response to the SIC, and the high frequency of association of asthma with other diseases such as dermatitis and rhinitis suggest an immunologic mechanism that remains to be elucidated.

Hairdressers are exposed to several reactive agents with potentially irritant and sensitizing effects on the airways and on the skin. Several data from population[1,2,3,4,5] and clinical studies[6,7,8,9,10,11,12,13,14,15,16,17,18,19] show that these workers are at high risk for occupational asthma (OA). In France, according to the Observatoire National des Asthmes Professionnels data in 1996 to 1999, hairdressing represents, among patients with OA, the fourth most frequent occupation (both sexes), and the second most frequent occupation in women, accounting for 6.8% of cases.[1]

Bleaching agents and particularly persulfate salts are considered the major cause of respiratory symptoms,[1,2,3,6,7,8,9,10,11,12,13,14,15,16,17,18,19] although the mechanism in inducing asthma is not understood. The risk factors for sensitization and development of OA in exposed workers are not known, and the diagnostic workup is not defined.

Clinical studies[6,7,8,9,10,11,12,13,14,15,16,17,18,19] on airway symptoms in hairdressers are all based on a few exposed cases or on small numbers of hospital patients. In the present article, we describe the clinical features of a large group of hairdressers observed in our institute between 1996 and June 2004, the type of occupational respiratory diseases, the etiologic agents, and the diagnostic tests. To our knowledge, this is the largest group of hairdressers observed in a clinical unit to date.


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