Current best practice for the health surveillance of enzyme workers in thesoap and detergent industry

This study defines current best practice for the health surveillance of wor kers who are potentially exposed to enzymes in the manufacture of enzymatic detergent products. It is recommended that health surveillance is performe d 6-monthly for the first 2 years and annually thereafter. The health surve illance programme should include a respiratory questionnaire to detect symp toms, assessment of lung function to detect pre-symptomatic changes and an immunological test to detect specific immunoglobulin E (IgE) to enzymes. Th e International Union Against Tuberculosis and Lung Disease respiratory que stionnaire should be used since it has been validated extensively for detec ting asthma. Operators should observe the American Thoracic Society perform ance criteria for spirometers and standardized procedures for conducting sp irometry. Since current airborne monitoring techniques for enzymes do not d etect short-duration peak exposures, the incidence of employee sensitizatio ns remains the most reliable measure of the integrity of environmental cont rol. The Pepys skin prick test has been validated as a sensitive, specific and practical test for detecting specific IgE to many inhalant allergens in cluding enzymes. For newly sensitized workers, a multi-cause investigation should be conducted to identify potential sources of exposure. Group result s of immunological test results assist in the evaluation of workplace contr ol measures, and should be used to monitor the effectiveness of hygiene and engineering programmes and to help prioritize areas for improvement. Posit ive responses to a questionnaire or abnormal spirometry should be assessed further. Occupational asthma should be excluded in any case of adult-onset asthma that starts or deteriorates during working life. This is particularl y important because an accurate diagnosis of occupational asthma with early avoidance of exposure to its cause can result in remission of symptoms and restoration of lung function.