BACKGROUND: While acrylates are well-known skin sensitizers, they are not classified as respiratory sensitizers although several cases of acrylate-induced occupational asthma (OA) have been reported. OBJECTIVE: To evaluate the characteristics of acrylate-induced OA in a large series of cases and compare those with OA induced by other low-molecular-weight (LMW) agents. METHODS: Jobs and exposures, clinical and functional characteristics, and markers of airway inflammation were analyzed in an international, multicenter, retrospective cohort of subjects with OA ascertained by a positive inhalation challenge to acrylates (n = 55) or other LMW agents (n = 418) including isocyanates (n = 125). RESULTS: Acrylate-containing glues were the most prevalent products, and industrial manufacturing, dental work, and beauty care were typical occupations causing OA. Work-related rhinitis was more common in acrylate-than in isocyanate-induced asthma (P < .001). The increase in postchallenge fractional exhaled nitric oxide was significantly greater in acrylate-induced OA (26.0; 8.2 to 38.0 parts per billion [ppb]) than in OA induced by other LMW agents (3.0; -1.0 to 10.0 ppb; P < .001) or isocyanates (5.0; 2.0 to 16.0 ppb; P = .010). Multivariable models confirmed that OA induced by acrylates was significantly and independently associated with a postchallenge increase in fractional exhaled nitric oxide (≥17.5 ppb). CONCLUSIONS: Acrylate-induced OA shows specific characteristics, concomitant work-related rhinitis, and exposure-related increases in fractional exhaled nitric oxide, suggesting that acrylates may induce asthma through different immunologic mechanisms compared with mechanisms through which other LMW agents may induce asthma. Our findings reinforce the need for a reevaluation of the hazard classification of acrylates, and further investigation of the pathophysiological mechanisms underlying their respiratory sensitizing potential.

Cardio Thoracic and Vascular Department University of Pisa Pisa Italy

Centre for Occupational and Environmental Health The University of Manchester Manchester United Kingdom

Department of Allergy Fundacion Jimenez Dıaz and CIBER de Enfermedades Respiratorias Madrid Spain

Department of Allergy Hospital La Paz Institute for Health Research Madrid Spain

Department of Cardiac Thoracic Vascular Sciences and Public Health University of Padova Padova Italy

Department of Chest Medicine Centre Hospitalier Universitaire UCL Namur Université Catholique de Louvain Yvoir Belgium

Department of Medicine Section of Occupational Medicine Respiratory Diseases and Occupational and Environmental Toxicology University of Perugia Perugia Italy

Department of Occupational and Environmental Medicine Royal Brompton Hospital and Imperial College London United Kingdom

Department of Occupational Diseases and Environmental Health Nofer Institute of Occupational Medicine Lodz Poland

Department of Occupational Medicine 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Occupational Medicine Haukeland University Hospital Bergen Norway

Department of Public Health Experimental and Forensic Medicine Specialization School in Occupational Medicine University of Pavia Pavia Italy

Department of Pulmonary Medicine and Occupational Medicine Odense University Hospital Odense Denmark

Department of Respiratory Medicine North Manchester General Hospital Manchester United Kingdom

Division of Asthma and Allergy Department of Chest Diseases University Hospital of Strasbourg Strasbourg France; Fédération de Médecine translationnelle Strasbourg University Strasbourg France

Finnish Institute of Occupational Health Helsinki Finland

Groupe Méthode Recherche Clinique Pôle de Santé Publique Strasbourg University Strasbourg France

Hospital Vall d'Hebron Universitat Autonoma de Barcelona and CIBER de Enfermedades Respiratorias Barcelona Spain

Institute for Occupational and Maritime Medicine University Medical Center Hamburg Eppendorf Hamburg Germany

Institute for Prevention and Occupational Medicine of the German Social Accident Insurance Ruhr University Bochum Germany

Occupational Lung Disease Unit Birmingham Heartlands Hospital Birmingham United Kingdom

J Allergy Clin Immunol Pract. 2021 Aug;9(8):3234. doi: 10.1016/j.jaip.2021.06.001. PubMed

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