Complex work exposures may not be reproduced in the laboratory. Workplace inhalation Excludes OA if negative when performed in Much more expensive than SIC. challenge the usual work conditions. No precise identification of the causal agent. May help to confirm OA when SIC are not Requires authorization from the employer for feasible due to complex workplace exposures performing the measurements at work. or absence of identified sensitizer at work. Concomitant exposure to irritants at the workplace cannot be controlled. Table 2. Validity of the clinical history Positive Negative Predictive Predictive Causal Prevalence Sensitivity Specificity Value Value agent of OA* Outcome (%) (%) (%) (%) Reference Various 75/162 Global clinical 87 22 63 83 Malo, 1991 (19) (46%) history : Latex 31/45 87 14 75 50 Vandenplas, 2001 (34) (69%) 19/30 89 50 77 71 Quirce, 2003 (35) (63%) Various 72/212 Sx worse at work 90 8 37 63 Vandenplas, 2005 (20) (34%) Sx worse on 75 21 33 62 specific exposure Sx improvement 74 57 57 74 during vacations Wheezing at 40 85 89 32 work Nasal itching at 48 74 53 70 work Ocular itching at 41 72 58 56 work Legend: Sx: symptoms. * OA defined by a positive specific inhalation challenge 3. Validity of nonspecific bronchial hyperresponsiveness assessment Positive Negative Predictive Predictive Single assessment of Prevalence Sensitivity Specificity Value Value Reference NSBH of OA* (%)† (%)† (%) (%)
Complex work exposures may not be reproduced in the laboratory. Workplace inhalation challenge Excludes OA if negative when performed in the usual work conditions. May help to confirm OA when SIC are not feasible due to complex workplace exposures or absence of identified sensitizer at work. Much more expensive than SIC. No precise identification of the causal agent. Requires authorization from the employer for performing the measurements at work. Concomitant exposure to irritants at the workplace cannot be controlled. Table 2. Validity of the clinical history Causal agent Prevalence of OA* Outcome Sensitivity (%) Specificity (%) Positive Predictive Value (%) Negative Predictive Value (%) Reference Various 75/162 (46%) Global clinical history : 87 22 63 83 Malo, 1991 (19) Latex 31/45 (69%) 87 14 75 50 Vandenplas, 2001 (34) 19/30 (63%) 89 50 77 71 Quirce, 2003 (35) Various 72/212 (34%) Sx worse at work 90 8 37 63 Vandenplas, 2005 (20) Sx worse on specific exposure 75 21 33 62 Sx improvement during vacations 74 57 57 74 Wheezing at work 40 85 89 32 Nasal itching at work 48 74 53 70 Ocular itching at work 41 72 58 56 Legend: Sx: symptoms. * OA defined by a positive specific inhalation challenge 3. Validity of nonspecific bronchial hyperresponsiveness assessment Single assessment of NSBH Prevalence of OA* Sensitivity (%)† Specificity (%)† Positive Predictive Value (%) Negative Predictive Value (%) Reference
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