Occupational formalin asthma.

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Abstract
Hypersensitivity to formalin used to sterilize artificial kidney machines was shown by inhalation provocation tests to be responsible for attacks of wheezing accompanied by productive cough in 2 members of the nursing staff of a hemodialysis unit. Three further members of the staff of 28 who were continually exposed to this substance occupationally had developed similar recurrent but less frequent episodes since joining the unit. Two underwent inhalation provocation tests with formalin which did not reproduce these symptoms. Single episodes of these symptoms had been noted by 3 additional staff members so that altogether 8 (29%) had experienced attacks described as bronchitic since becoming exposed to formalin. While exposure to formalin did not seem to be directly responsible in all cases, it might have increased susceptibility to other provoking agents or induced a hyper-reactive responsiveness of the airways. The responses observed in the 2 nurses after inhalation provocation tests with formalin were predominantly of airways obstruction. Wheezing began between 2-3 h after exposure, and peak expiratory flow rates fell maximally by approximately 50%. Reactions persisted for 10 h to 10 days depending on the exposure dose. A productive cough was a prominent feature. The sputum appeared to be mucopurulent, but culture produced a scanty growth of Haemophilus influenzae only, together with upper respiratory tract commensals. The cellular content was not homogeneous, neutrophil leukocytes and eosinophil leukocytes variably dominating. Variable responses of neutrophil and eosinophil leukocytes were also seen in the peripheral blood.