Thorax 1992;47:759 759

Occupational asthma * Polyethylene + Control due to polyethylene Thorax: first published as 10.1136/thx.47.9.759 on 1 September 1992. Downloaded from shrink wrapping (paper

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Paul F G Gannon, P Sherwood Burge, G F A Benfield 1212

Abstract Figure 2 Results of specific bronchial challenge testing Occupational asthma due to the pyrolysis wvith polyethylene. products of polyvinyl chloride (PVC) produced by shrink wrapping processes days when he was away from work. He had has previously been reported. The first several periods of illness that kept him off work case of occupational asthma in a shrink and on the last occasion required hospital wrap worker using a different plastic, admission after 30 minutes at work. After polyethylene, is reported; the association initial recovery his forced expiratory volume in was confirmed by specific bronchial pro- one second (FEV,) and forced vital capacity vocation testing. (FVC) were 2 2 (predicted 3-6) 1 and 2 44 (predicted 4-28) 1 respectively; histamine challenge testing showed the provocative dose Meat wrapper's asthma due to the thermal of histamine causing a 20% fall in FEV, (PD20) degradation products produced by polyvinyl to be 0-083 ,umol, indicating pronounced chloride (PVC) used for shrink wrapping was bronchial hyperreactivity. first described in 1973.' Subsequent work has Serial peak flow measurements showed a implicated acid anhydrides (from label adhe- pronounced fall on his return to work (fig 1). sives) and pyrolysis products from soyabean oil Specific bronchial challenge testing consisting incorporated into the PVC wrapping2 as pos- of an eight minute exposure to polyethylene sible causative agents. Occupational asthma heated to 76'C in a heating block caused a caused by the pyrolysis products of polyeth- transitory early bronchoconstrictor response ylene has been suggested3 but not confirmed. followed by a more pronounced late response We describe a worker with occupational (fig 2). No reaction was seen on a control day. asthma due to polyethylene, the association Occupational asthma was diagnosed and the http://thorax.bmj.com/ being confirmed by specific bronchial provoca- worker was removed from exposure. His symp- tion testing. toms and spirometric values improved con- siderably (FEV, 4 01 1 and FVC 4-271 six Case report months after exposure ceased). His PD, An 18 year old paper packer, who was atopic histamine is unchanged (0-08 ,mol 18 months and a non-smoker and had pre-existing well after exposure ceased). He now has minimal controlled asthma, started work on a shrink asthma and is in full time employment.

wrap machine. The machine heats paper goods on September 23, 2021 by guest. Protected copyright. sealed in pure polyethylene sheeting (EXL Discussion Shrink 1, CFS 450/900 Sanders Polyfilm) The agent causing this patient's occupational briefly to 166'C, when the wrapping partially asthma is unknown. The manufacturers sug- shrinks. The polyethylene contained no fillers, gest that carbon monoxide and formaldehyde stabilisers, or bonding agents. Two weeks after could be released at temperatures above 300'C starting to use this machine he began to get and acrolein and acetic acid at temperatures attacks of asthma six to seven hours after above 400'C. Formaldehyde is recognised as starting work. The symptoms improved on causing occupation asthma.4 These tem- Work Hospital Work peratures may be reached if the polyethylene 400- film adheres to the shrink wrap machine heater. 380- This would not explain why an asthmatic - 360- reaction was observed after bronchial challenge E 340- at lower temperatures, however. = 320- Polyethylene shrink wrapping is used widely o 300- as a final stage of packaging products in many It >- 280- manufacturing processes. should be borne in 0 mind in the search for a cause of work related ° 260- symptoms in workers from manufacturing a 240- industries. x 220 , 200- Occupational Lung a) 1 Sokal WN, Aclony Y, Beall GN. Meat wrapper's asthma-a Disease Unit, East XL 180- new syndrome? JAMA 1973;226:639-4 1. Birmingham Hospital, 160- 2 Pauli G, Bessot JC, Kofferschmitt MC, Lingot G, Wendling Birmingham B9 5ST R, Ducos P, et al. Meat wrapper's asthma: identification of P F G Gannon causal agents. Clin Allergy 1980;1O:236-9. P S Burge Time (days) 3 Skerfving S, Akesson B, Simonsson BG. "Meat wrapper's G F A Benfield asthma" caused by thermal degradation products of Figure 1 Results of occupational type serial peakflow polyethylene [letter]. Lancet 1980;i:21 1. Reprint requests to: tests: maximum, mean, and minimum values on work 4 Vaughan WT. The practice of allergy. St Louis: Mosby, Dr P F G Gannon days, during a hospital visit, and at home. 1939:677.