sign in sign up
<<
Home , Chemical pneumonitis

Allergology International 65 (2016) 343e344

Contents lists available at ScienceDirect

Allergology International

journal homepage: http://www.elsevier.com/locate/alit

Letter to the Editor Reactive airways dysfunction syndrome after hydrofluoric acid inhalation

Dear Editor, symptoms are present for 1e2 days after exposure, fever, cough, dyspnea, cyanosis, and may occur later.1 There A 44-year-old man who had been working in a glass washing are few reports of adverse health effects from inhalation exposure factory visited our hospital with cough, sputum, and dyspnea after to a consumer product containing HF. One report described a single accidental exposure to hydrofluoric acid of 50% concentration 10 case of chemical and adult respiratory distress syn- days ago. drome following household use of an HF-containing rust stain He was ex-smoker who quit smoking 10 years ago and had 5 remover. Another reported a case of adult-onset immedi- pack years smoking history. He had usually been working in the ately following use of the same household rust stain remover.4 glass washing factory in position of office based job. At this time Reactive airways dysfunction syndrome (RADS), or irritant he was exposed to 50% concentration of HF during opening of cap induced asthma without latency, is characterized by the immediate of HF bottle. After opening for approximately 1e2 min, he experi- onset of asthma following a single exposure (or possibly several ex- e enced a burning sensation in his eyes, nose, and mouth and he posures) to irritating vapor, fume, or smoke.5 7 developed chest tightness and dyspnea. He had persistent prob- RADS was originally described by Brooks and Lockers5 in 1981 as lems on breathing for previous 10 days, and he finally came to sudden onset of non-immunological asthma resulting from an hospital. exposure to high-level irritant gases. Many cases occurred after His initial blood pressure was 130/70 mmHg, pulse rate 70/min, the 9/11 collapse of the New York World Trade Center, resulting respiratory rate 20/min, and body temperature 36.8 C. There were from the inhalation of fumes and particulate matters.8 Symptoms no abnormal findings in physical examinations. Chest radiography persist for at least 12 weeks but there is no previously documented and PNS water's view showed normal findings. White blood cell evidence of asthma or other chronic lung disease.8 count was 9590 cells/mL (neutrophil, 65.1%; lymphocyte, 24.5%; According to ACCP9 RADS can be diagnosed by following condi- monocyte, 8.6%; eosinophil, 1.5%) and other laboratory measure- tions: (1) A documented absence of preceding respiratory com- ments were within normal ranges. Measuring bronchodilator plaints; (2) Onset of symptoms after a single exposure incident; response with pulmonary function test was done; FEV1/FVC 89%; (3) Exposure to very high concentrations of a mixture of sodium hy- FVC 5.10L (101%); FEV1 4.56L (121%). He showed positive reaction pochlorite and hydrochloric acid; (4) Onset of symptoms within to Dermatophagoides farinae and Dermatophagoides pteronyssinus 24 h after the exposure, with persistence of symptoms for at least on allergen skin prick test. A non-specific bronchial challenge test 12 weeks; (5) Symptoms simulating asthma with cough, wheeze, with methacholine was performed to evaluate airway hyperres- and dyspnea; (6) Presence of airflow obstruction; and (7) Absence ponsiveness and the result was positive (PC20 ¼ 7.78 mg/ml). of all other pulmonary diseases. RADS is also a subcategory of HF (hydrofluoric acid) is a weak acid and is colorless, potent res- irritant-induced occupational asthma (OA), and irritant-induced piratory irritant with an unpleasant odor.1,2 The boiling point of OA can be classified by exposure concentration and duration of anhydrous HF is 19.5 C and it is miscible with water, and HF fumes exposure.8,10 RADS is characterized by extremely high exposure strongly in moist air.2 The odor threshold is reported to be concentration which is over occupational exposure limit and the 0.5e3.0 parts per million.2 HF is a toxic substance used widely in duration of exposure is below one day.8,10 both industrial and domestic settings, and is used to produce a va- The patient described in this report developed adult onset riety of chemicals and in numerous industrial processes.1,2 It is most asthma based on his history of symptoms, dyspnea improvement largely used in production of fluorocarbon compounds.2 HF is with inhaled steroid medication, and the positive tests for non- unique among acids because its toxicity is mostly attributed to an specific bronchial hyperreactivity. His asthma had immediate onset anion and fluoride, not to a cation and a hydrogen ion responsible following the exposure of high concentration of HF, and the symp- for toxicity in many other acids.2 Most acids cause burns and necro- toms had persisted for at least 3 months. Therefore, based on the sis from liberated hydrogen ions. Generally, HF is produced by the history and medical findings he appears to be suitable for the reaction of sulfuric acid with calcium fluoride.2 criteria for RADS. In conclusion, we report a 44-year old man HF is strong irritant to eyes, nose, throat, and skin. HF causes var- with RADS including bronchial asthma with cough, sputum, and iable symptoms tears, eye redness, , sore throat, cough, dyspnea after exposure to high concentration of hydrofluoric acid. headache, and dermatalgia.1,3,4 Even in cases in which no He was educated from avoiding exposure of HF, and now well controlled treated with normal lung function by step downing inhaled steroids. Peer review under responsibility of Japanese Society of Allergology. http://dx.doi.org/10.1016/j.alit.2016.02.002 1323-8930/Copyright © 2016, Japanese Society of Allergology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/). 344 Letter to the Editor / Allergology International 65 (2016) 343e344

Acknowledgements 2. Carolyn AT, Dennis J, Lisa I, Gloria S, Lara C. Toxicological Profile for Fluorides, Hydrogen Fluoride, and Fluorine. U.S. Department of Health and Human Ser- vices, Public Health Service, Agency for Toxic Substances and Disease Registry; This study was supported by Soonchunhyang University September 2003. Available from: http://www.atsdr.cdc.gov/ToxProfiles/tp11. Research Fund. pdf. 3. Bennion JR, Franzbiau A. following household exposure to hydrofluric Acid. Am J Ind Med 1997;31:474e8. Conflict of interest 4. Franzbiau A, Sanhakian N. Asthma following household exposure to hydroflu- fl The authors have no con ict of interest to declare. oric acid. Am J Ind Med 2003;44:321e4. 5. Brooks SM, Lockey J. Reactive airways dysfunction syndrome (RADS): a newly defined . Am Rev Respir Dis 1981;123(Suppl):A133. Tae-Kyu Lee, Hae-Won Yoo, Seong-Hwan Bae, Min-Jung Kim, 6. Bardana EJ. Reactive airways dysfunction syndrome (RADS): fact or fantasy? Al- * lergy 1999;54:33e5. Gyu-Hyung Kim, An-Soo Jang 7. Brooks SM, Hammad Y, Richards I, Giovireo-Barbas J, Jenkins K. The spectrum of irritant-induced asthma: sudden and not-so-sudden onset and the role of al- Division of Allergy and Respiratory Medicine, Department of Internal Medicine, lergy. Chest 1998;113:42e9. Soonchunhyang University Bucheon Hospital, Bucheon, South Korea 8. Varney VA, Evans J, Bansal AS. Successful treatment of reactive airways dysfunction syndrome by high-dose vitamin D. J Asthma Allergy 2011;4:87e91. * Corresponding author. Division of Allergy and Respiratory Medicine, Department 9. Chan-Yeung M. Assesment of asthma in the workplace. Chest 1995;108: of Internal Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, 1084e117. Wonmi-gu, Bucheon , Gyeonggi-do 420-767, South Korea. 10. Baur X, Bakehe P, Vellguth H. Bronchial asthma and COPD due to irritants in the E-mail address: [email protected] (A.-S. Jang). workplace e an evidence-based approach. J Occup Med Toxicol 2012;7:19.

References Received 21 December 2015 Received in revised form 28 January 2016 1. Wing JS, Brender JD, Sanderson LM, Perrotta DM, Beauchamp RA. Acute health Accepted 3 February 2016 effects in a community after a release of hydrofluoric acid. Arch Environ Health Available online 2 March 2016 1991;46:155e60.