As might be expected, the review did demonstrate a good relationship between positive SIC findings and a single positive methacholine test result. Both a positive methacholine test result and a change with work exposure have been reported to significantly influence expert opinion for a high-probability diagnosis of OA. In contrast, a methacho-line challenge result can revert to normal away from exposure and can be normal in a worker with OA who then has a positive SIC finding. There have been a few case reports of negative methacholine challenge results in patients soon after an SIC finding that is positive for diisocyanates, but this appears to be a rare occurrence. 

Some agents responsible for WEA (eg, common allergens at work and to a lesser extent agents such as ozone) may also cause some work-induced changes in airway responsiveness, and an improvement in methacho-line responsiveness off work has been reported in those who have WEA in whom sensitizer-induced OA was excluded by SIC. A patient with irritant-induced OA would not be expected to have significant worsening of airway hyperresponsiveness on a return to work. In summary, despite inadequate numbers of studies to allow formal evidence-based analyses to assess the sensitivity and specificity of serial testing of nonspecific airway responsiveness for the diagnosis of sensitizer-induced OA, the available literature and clinical experience supports the use of this method when carefully performed as an additional approach to document functional airway changes related to workplace exposures.

Panel Consensus in Viagra Australia

6. In individuals with suspected sensitizer-induced OA, working at the job in question, conduct a methacholine challenge test or a comparable measure of nonspecific airway responsiveness during a period of work exposure and repeat it during a period (optimally, at least 2 weeks) away from the work exposure to identify work-related changes.

Specific Immunologic Testing

OA and rhinitis caused by HMW proteins in the work environment are associated with specific IgE antibody production. SPTs detect tissue-bound IgE antibodies, and are highly sensitive and specific for identifying a specific IgE antibody response to protein allergens.

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