Outcome of asbestos exposure (lung fibrosis and antinuclear antibodies) with respect to skin reactivity: an 8-year longitudinal study

Our plain-English summary of Outcome of asbestos exposure (lung fibrosis and antinuclear antibodies) with respect to skin reactivity: an 8-year longitudinal study, by A. Lange, D. Garncarek, J. Tomeczko, et al (Environmental Research, 1986).

The study

• Authors: A. Lange, D. Garncarek, J. Tomeczko, G. Ciechanowski, R. Bisikiewicz
• Journal: Environmental Research
• Published: 1986;41(1):1-13
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Two hundred seventy asbestos workers were examined during an 8-year period. During this time five consecutive surveys were completed. Skin tests with streptokinase-streptodornase (SK-SD), tuberculin (PPD), and phytohemagglutinin (PHA) were performed in the middle of this period. The results of these tests were related to X-ray chest film results and the appearance of antinuclear antibodies (ANA). In all surveys, except the first, X-ray films with small irregular opacities with a profusion greater than or equal to 1/1 belonged more frequently to asbestos workers who did not respond to SK-SD or PHA. Thirty-one cases of asbestosis were diagnosed at that time, 23 of them became asbestotic after the skin tests were performed. Asbestotic cases contributed more frequently to the group with anergy as compared to asbestos workers lacking asbestosis. Furthermore, asbestosis was correlated with lack of response to second strength of SK-SD in males and PHA in both sexes. Lack of response to these activators was predictive of asbestosis. Asbestos workers with ANA frequently displayed a lack of response to the first strength of SK-SD, PPD, and PHA. This was partly due to the presence of asbestotic cases in the group. However, low responders to all these activators were found more frequently in the group with ANA independent of the presence of asbestosis.

In plain English

This longitudinal study followed two hundred seventy workers from an asbestos textile factory, examined by researchers in Wrocław, Poland, in five surveys between January 1973 and December 1980. The article does not name the asbestos fiber type. At the third survey (December 1977 to January 1978), workers had skin tests with two recall antigens, streptokinase-streptodornase (SK-SD) and tuberculin (PPD), and with phytohemagglutinin (PHA), as a measure of cell-mediated immunity. Two readers reread the chest X-rays blind, and blood was tested for antinuclear antibodies (ANA). Thirty-one workers had X-ray-evident asbestosis, and 23 of them were diagnosed after the skin tests. Among workers over 35, a larger share of those with asbestosis than of those without fell in the group with no skin response, called anergy (0.20 vs 0.04). Of 17 men who did not respond to the stronger SK-SD dose, 5 developed asbestosis within 2 years. Among the 52 men who did respond, 2 did. Workers with ANA more often had weak skin reactions, and this was only partly explained by asbestosis cases. Smoking habits did not differ between responders and nonresponders. The authors concluded that lack of skin reactivity could predict asbestosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Longitudinal study over 8 years with five consecutive surveys. Skin tests were done once, at the third survey. Chest X-rays were reread blind.
• Who was studied: Two hundred seventy asbestos textile factory workers, women and men. They comprised 177 of 250 active workers employed over 10 years, 29 retired workers, and 64 of 160 workers employed under 10 years. They were examined in hospitals in Wrocław, Poland, from 1973 to 1980.
• Exposure: Employment in an asbestos textile factory. Mean duration of exposure ranged from 7.0 to 18.8 years across the age, sex and retirement subgroups in Table 1. Fiber type and dose are not stated.
• Main results:
  • X-ray films with small irregular opacities of profusion at least 1/1 belonged to 31 workers.
  • Six workers already had asbestosis on their first available film. Of the 25 who became asbestotic during the study, 23 were diagnosed after the skin tests.
  • Among workers over 35, those with asbestosis made up a higher proportion of the anergy group than workers without asbestosis (0.20 vs 0.04, P less than 0.01).
  • Among men, 5 of 17 who did not respond to the second strength of SK-SD developed radiologically apparent asbestosis within 2 years. Among the 52 who responded to this antigen, 2 did (P less than 0.02, with Yates' correction).
  • In both sexes, 5 of 21 workers who did not respond to the stronger PHA dose developed asbestosis, compared with 17 of 181 responders (0.24 vs 0.09, P less than 0.2).
  • Among workers over 35, women were more often nonresponders to both doses of tuberculin (PPD) than men (0.44 vs 0.17, P less than 0.001).
  • Impaired skin reactivity was more common among ANA-positive workers. This was partly due to asbestosis cases, but it remained true when those cases were excluded.
  • Among workers with asbestosis, 13 of 18 with ANA failed to respond to the first strength of SK-SD, compared with 3 of 12 without ANA (0.72 vs 0.25, P less than 0.05).
  • Smoking habits did not differ between responders and nonresponders to SK-SD, PPD or PHA.
  • Lack of response was more frequent in the older group, but these differences were not statistically significant.
• The authors' conclusion: The authors concluded that lung fibrosis was significantly correlated with impaired skin reactivity, and that this longitudinal study showed lack of skin reactivity can predict asbestosis.
• Limitations the authors state:
  • The authors state that this type of study cannot judge the relationship between delayed-type hypersensitivity and the presence of ANA.
  • The authors state that their work does not explain the sex differences they found (women more prone to tuberculin anergy; SK-SD nonresponse more closely linked to asbestosis in men).

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Fibrosis, Chest X-Ray.

Related studies

• The follow-up study of skin reactivity to recall antigens and E- and EAC-RFC profiles in blood in asbestos workers — A. Lange, G. Skibiński, et al. (1980)
• Circulating rheumatoid and antinuclear factors in asbestos workers — M. Turner-Warwick, W.R. Parkes (1970)
• beta-Carotene fails to act as a tumor promoter, induces RAR expression, and prevents carcinoma formation in a two-stage model of skin carcinogenesis in male Sencar mice — R.M. Ponnamperuma, Y. Shimizu, et al. (2000)
• Epithelioid malignant mesothelioma metastatic to the skin: A case report and review of the literature — R.E. Ward, S.A. Ali, et al. (2017)
• An 11-year longitudinal study of the occupational dust exposure and lung function of polyvinyl chloride, cement and asbestos cement factory workers — A. Siracusa, A. Forcina, et al. (1988)
• Increased incidence of DNA double-strand breaks and anti-ds DNA antibodies in blood of workers occupationally exposed to asbestos — B. Marczynski, A.B. Czuppon, et al. (1994)

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