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Cleaning Agents and Asthma


S Quirce, P Barranco

Allergy Department, Hospital La Paz Health Research Institute (IdiPAZ), Madrid, Spain

J Investig Allergol Clin Immunol 2010; Vol. 20(7): 542-550



Although cleaners represent a significant part of the working population worldwide, they remain a relatively understudied occupational group. Epidemiological studies have shown an association between cleaning work and asthma, but the risk factors are uncertain. Cleaning workers are exposed to a large variety of cleaning products containing both irritants and sensitizers, as well as to common indoor allergens
and pollutants. Thus, the onset or aggravation of asthma in this group could be related to an irritant-induced mechanism or to specific sensitization. The main sensitizers contained in cleaning products are disinfectants, quaternary ammonium compounds (such as benzalkonium chloride), amine compounds, and fragrances. The strongest airway irritants in cleaning products are bleach (sodium hypochlorite), hydrochloric
acid, and alkaline agents (ammonia and sodium hydroxide), which are commonly mixed together.
Exposure to the ingredients of cleaning products may give rise to both new-onset asthma, with or without a latency period, and workexacerbated asthma. High-level exposure to irritants may induce reactive airways dysfunction syndrome. Cleaning workers may also have a greater relative risk of developing asthma due to prolonged low-to-moderate exposure to respiratory irritants. In addition, asthma-like symptoms without confirmed asthma are also common after exposure to cleaning agents.
In many cleaners, airway symptoms induced by chemicals and odors cannot be explained by allergic or asthmatic reactions. These patients may have increased sensitivity to inhaled capsaicin, which is known to reflect sensory reactivity, and this condition is termed airway sensory hyperreactivity.

Key words: Asthma. Cleaning agents. Cleaners. Bronchial hyperresponsiveness. Irritant-induced asthma.