Asma da cloramina T nel personale sanitario: descrizione di un caso [Asthma induced by Chloramine T in nurses: case report]

Background: The Chloramine T is used in hospital as a disinfectant and in sterilizing of endoscopic instruments. Objectives: A case of a nurse suffering from asthma due to Chloramine T is presented in order to focus attention on this occupational disease. Methods and results: The patient (male, 43 years) was nurse since 1993 carrying out activities in various departments and operating rooms where he was exposed to glutaraldehyde and chloramine T in disinfecting surgical and endoscopic instruments. In 2007 he noticed the beginning of asthmatic reactions after the exposure to disinfectant. Skin tests with common allergens gave positive reactions and the skin test with Chloramine T showed a positive result. The inhalation test with Glutaraldehyde gave negative results for both asthma and rhinitis. During the inhalation test with Chloramine T 0,5% a significant biphasic decrease of FEV1 was observed. The score of subjective symptoms for rhinitis was negative. Conclusions: The case confirms the existent difficulty in diagnosing occupational asthma due to Chloramine T in professional health workers, which results from the frequent presence of late reactions and from the exposure to many respiratory allergens and irritants in the workplace. The specific inhalation challenge represents the golden standard in the diagnosis of asthma induced by Chloramine T and in occupational asthma in general. It can be assumed that the frequency of the occupational asthma due to sensitization to Chloramine T in nurses should be underestimated.