The value of inhalation provocation tests as an adjunct to a carefully taken occupational history in the investigation of airways obstruction is well illustrated by these two cases. The suspected aetiological role of formalin was confirmed in one patient but excluded in the other. As a result measures of environmental control were introduced where appropriate, with good effect.
The responses observed in case 1 seemed to be specific asthmatic reactions to formalin fumes. They began between two and four hours after exposure was begun. The greater the exposure the longer the reaction persisted, though the maximum percentage fall in ventilatory function was similar, provided exposure was sufficiently prolonged to provoke a positive response. Similar late asthmatic reactions have been described after the inhalation of fumes of other chemicals, including tolylene di-isocyanate (Pepys et al., 1972) and aminoethyl ethanolamine (Sterling, 1967; Pepys and Pickering, 1972). Such reactions may be inhibited by the prior inhalation of corticosteroid aerosols (Pepys et al., 1974), and this was confirmed in our patient though subsequent treatment did not in the event prove
We thank the medical illustration department, Radcliffe Infirmary, for the illustrations.
Kotin, P., and Falk, H.L. (1964). Annual Review of Medicine, 15, 233.
Pepys, J., et al. (1972). Clinical Allergy, 2, 225.
Pepys, J., and Pickering, C.A.C. (1972). Clinical Allergy, 2, 197.
Pepys, J., et al. (1974). Clinical Allergy, 4, 13.
Popa, V., et al. (1969). Diseases of the Chest, 56, 395.
Sterling, G.M. (1967). Thorax, 22, 533.
Vaughan, W.T. (1939). The Practice of Allergy, p. 677. St. Louis, Mosby.
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Case Study 15: Formalin Asthma in Hospital Staff ."
Environmental Medicine: Integrating a Missing Element into Medical Education . Washington, DC: The National Academies Press,
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