Occupational Exposure and Co-Occurrence of Work-Related Skin and Respiratory Disorder in Cleaner: A Case Report

Jordan Minov, Jovanka Karadzinska-Bislimovska, Engin Tutkun, Sasho Stoleski, Dragan Mijakoski


BACKGROUND: Despite the connection between skin and respiratory system in occupational disease is growing area of research interest, there is still a limited evidence for the effects of both airborne and skin exposures together with skin and respiratory outcomes.

CASE PRESENTATION: This report describes a 32-years old female with no previous history of atopy, asthma or skin disorders working as an office cleaner for three years. About two years after entering the actual workplace she developed episodic wheezing, shortening of breath and chest tightness. At the same time, she noticed eczematous lesions on the skin of both hands. She reported work-relatedness of both respiratory and skin symptoms, i.e. the symptoms improved during weekends and holidays and worsened when she returned to work. The patient was referred to Institute for Occupational Health of R. Macedonia for assessment of possible occupational asthma (OA) and occupational contact dermatitis (OCD). Diagnosis of asthma was confirmed by standard diagnostic procedure, while the diagnosis of sensitizer-induced OA was established by positive result of serial peak expiratory flow rate (PEFR) measurements at and away from work. Diagnosis of allergic OCD was confirmed by positive patch test to formaldehyde. The management of both diseases included complete removal from the harmful workplace exposure, as well as pharmacological treatment according to the actual recommendations.

CONCLUSIONS: This case report represents a description of a co-occurrence of work-related skin and respiratory symptoms in a female working as an office cleaner. Formaldehyde is found to be a causative factor of allergic OCD, and it also may be a causative factor of sensitive-induced OA in the same patient, but other occupational sensitizers cannot be excluded.


allergic occupational contact dermatitis; cleaner; formaldehyde; patch test; sensitizer-induced occupational asthma; skin prick test

Full Text:



Moulin P, Magnan A, Lehucher-Michel MP. Occupational allergic contact dermatitis and asthma due to a single low molecular weight agent. J Occup Health. 2009; 51(1):91-96.



Jacobs JH, Meijster T, Meijer E, Suarthana E, Heederik D. Wheat allergen exposure and the prevalence of work-related sensitization and allergy in bakery workers. Allergy. 2008;63(12):1597-604.



Heldal KK, Madso L, Huser PO, Eduard W. Exposure, symptoms, and airway inflammation among sewage workers. Ann Agric Environ Med. 2010;17(2): 263-268.


de Joode Bv, Vermeulen R, Heederik D, van Ginkel K, Kromhout H. Evaluation of 2 self-administered questionnaires to ascertain dermatitis among metal workers and its relation with exposure to metalworking fluids. Contact Dermatitis. 2007;56(6):311-7.



De Raeve H, Vandecasteele C, Demedts M, Nemery B. Dermal and respiratory sensitization to chromate in a cement floorer. Am J Ind Med. 1998;34(2):169-176.


Lynde CB, Obadia M, Liss GM, et al. Cutaneous and respiratory symptoms among professional cleaners. Occup Med. 2009;59(4):249-254.



Bousquet J, Heinzerling L, Bachert C, et al. Practical guide to skin prick tests in allergy to aeroallergens. Allergy. 2012;67:18-24.



Frew AJ. Allergic basis of asthma. Eur Respir Mon. 2003;23(8):74-83.

Sterk PJ, Fabbri LM, Quanjer PhH, et al. Airways Responsiveness. Standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Report Working Party for the Standardization of Lung Function Tests. European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J. 1993;6(16):58-83.

American Thoracic Society. Guidelines for Metacholine and Exercise Challenge Testing -1999. Am Respir Crit Care Med. 2000;161(1):309-329.



Global Initiative for Asthma. Global strategy for asthma management and prevention. NHLBI/WHO Workshop Report 2015. Available at: www.ginasthma.com (Assessed 26.10.2015).

Gannon PFG, Sherwood Burge P. Serial peak expiratory flow measurement in the diagnosis of occupational asthma. Eur Respir J. 1997;10(24):57-63.

Moore VC, Jaakkola MS, Sherwood Burge P. A systematic review of serial peak expiratory flow measurements in the diagnosis of occupational asthma. Annals of Respiratory Medicine. 2010;1:31-44.

Tarlo SM, Balmes J, Balkisson R, et al. Diagnosis and management of work-related asthma. American College of Chest Physicians Consensus Statement. Chest. 2008;134:15-41.



Rietschel RL, Mathias CG, Fowler Jr. JF, et al. Relation of occupation to contact dermatitis: Evaluation of patients tested from 1998 to 2002. Am J Contact Dermat. 2002;13(4):170-176.



Uter W, Ramsch S, Aberer W, et al. The European baseline series in 10 European countries, 2005-2006--Results of the European Surveillance System on Contact Allergens (ESSCA). Contact Derm. 2009;61(1):31-38.



European Society of Contact Dermatitis guideline for diagnostic patch testing. Available at: http://www.escd.org/education/guidelines/ (Assessed 26.10.2016).

Arrandale VH. Occupational exposures and co-occurrence of work-related skin and respiratory symptoms. Available at: https://tspace.library.utoronto.ca/handle/ (Accessed 30.10.2015).

Bernstein IL, Chan-Yeung M, Malo J, Bernstein DI (eds). Asthma in the Workplace. 3rd ed. New York: Taylor and Francis, 2006.


Cleaning agent. Available at: http://www.escd.org/education/guidelines/ (Assessed 27.10.2015).

Formaldehyde. Available at: www.truetest.com (Assessed 27.10.2015).

Mapp CE. Agents, old and new, causing occupational asthma. Occup Environ Med. 2001;58:354-360.


PMid:11303086 PMCid:PMC1740131

Maestrelli P, Saetta M, Mapp CE, et al. Occupational asthma due to low-molecular weight compounds. In: Banks DE, Parker JE, eds. Occupational lung disease: an international perspective. New York: Chapman & Hall Medical, 1998.

Sastre J, Vandenplas O, Park HS. Pathogenesis of occupational asthma. Eur Respi J. 2003;22:551-559.


Wolkoff P, Schneider T, Kildeso J, et al. Risk in cleaning: chemical and physical exposure. The Science of the Total Environment. 1998;215:135-156.


IARC. Wood dust and formaldehyde. Lyon, International Agency for research on Cancer (IARC Monographs on the Evaluation of Carcinogenic Risk on Humans. 1995;62.

DOI: http://dx.doi.org/10.3889/seejim.2016.20006

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM


  • There are currently no refbacks.

Comments on this article

View all comments

Copyright (c) 2016 Jordan Minov, Jovanka Karadzinska-Bislimovska, Engin Tutkun, Sasho Stoleski, Dragan Mijakoski

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


Published by: Id Design 2012/DOOEL Skopje, Republic of Macedonia