Chemical respiratory allergy and occupational asthma: what are the key areas of uncertainty?

There is increasing concern about the association of respiratory disease with indoor air quality and environmental atmospheric pollution. Associated with this is the fact that in many countries there has been a significant increase in the prevalence of asthma. Against this background there is a need to address the toxicological, occupational and public health problems associated with the ability of some chemicals to cause allergic sensitization of the respiratory tract and occupational asthma. By definition allergic sensitization of the respiratory tract to chemicals is dependent upon the stimulation of an adaptive immune response that leads to development of respiratory allergy and/or asthma. Although IgE antibody is associated typically with respiratory sensitization to protein allergens, there is less certainty about the role played by antibodies of this type in chemical respiratory allergy and occupational asthma. There are currently no validated or widely accepted methods/models for the identification and characterization of chemicals that have the potential to induce allergic sensitization of the respiratory tract. These and other areas of uncertainty were debated during the course of and following a two day Workshop. The primary purpose of the Workshop was to consider the important clinical and toxicological issues associated with chemical respiratory allergy, and to identify key questions that need to be answered if real progress is to be made.