Enzyme Asthma: Fourteen Years' Clinical Experience of a Recently Prescribed Disease

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Abstract
Enzyme asthma (EA) was experienced by 62 of 1642 subjects (3.7%) producing enzyme detergent powders from 1968-1975. The differing clinical nature of the EA and the progress of 55 patients were studied from 1968-1982. Four distinct patterns of EA were observed; an immediate response lasting 1-2 h (96% of subjects); a non-immediate reaction at 6-8 h (82%); a dual response being an immediate followed by a 6-8 h reaction (82%); and a nocturnal asthma at 10-15 h (56%). The severity of the clinical picture and time taken to recover from the asthmatic attack diminished with reducing environmental dust levels. Atopics and nonatopics had a similar symptom pattern, and the allergic reaction did not differ with the atopic status. There was a higher incidence of EA in atopics. The respiratory function measurements FEV1.0 [force expiratory volume in 1 s] and FVC [forced vital capacity] returned to pre-asthma levels in all patients, but those with chest disease (chronic bronchitis, asthma or emphysema) before any exposure to enzymes took 12 mo., against 6 mo. for the others. Fourteen men, 8 of whom had established chest illness before their EA, continued to have intermittent symptoms but seldom required time off from work. Seven who had pre-EA bronchitic episodes appeared to be symptom-free. Subjects with previous chest disease should not be exposed to occupational allergens, but exclusion of asymptomatic atopics from this type of work was of doubtful value.
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