Environmental, Occupational and Population Health

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Selected Specialized Clinical Tests In EOH Evaluation

1a. Occupational Asthma: Specific Inhalational Challenge tests are used to confirm the diagnosis of Occupational Asthma

Gage Occupational and Environmental Health Unit, University of Toronto,
Toronto, Canada
Dr. Susan M. Tarlo, Pulmonary Medicine
Hopital du Sacre-Coeur de Montreal,
Montreal, Quebec, Canada
Drs. Jean-Luc Malo and Alain Desjardins, Pulmonary and Critical Care
University of Alberta Occupational Health Program
Edmonton, Alberta, Canada
Dr. Jeremy Beach, Occupational Medicine
Hamilton Health Sciences,
Hamilton, Ontario, Canada
Dr F.E. Hargreave, Pulmonary Medicine
University of Saskatchewan,
Saskatchewan, Canada
Dr Don Cockcroft, Pulmonary Medicine

Many of the centers offer only a limited number of specific challenges, so detailed discussion of the individual case prior to referral is essential.

1. b) Occupational Asthma: Serological tests

Northwestern University Department of Medicine, Division of Allergy,
Chicago, Illinois
IgE & IgG antibodies against isocyanates, phthalic anhydride, trimellitic anhydride Dr. Leslie C. Grammer
University of Cincinnati College of Medicine, Division of Immunology and Allergy,
Cincinnati, Ohio
IgE & IgG antibodies against isocyanates Dr. David I. Bernstein

Yale Occupational and Environmental Medicine Program,
New Haven, Connecticut

Occupational Medicine: Isocyanate inhalational challenge chamber Carrie Redlich

Other reference laboratories listed in section 4 also provide extensive testing for IgE antibodies against several occupational and environmental causes.

2. Chronic beryllium Lung Disease: Beryllium lymphocyte transformation test

Beryllium lymphocyte transformation testing can be done on blood and broncho-alveolar lavage fluid to evaluate sensitization to beryllium in suspected cases of chronic beryllium lung disease. It also helps to detect sensitization to beryllium exposure in the past or present; and demonstrate the effectiveness of exposure control efforts.

National Jewish Medical and Research Center, Denver, Colorado Lisa Maier, MD
The Cleveland Clinic Foundation, Cleveland, Ohio Dr. Raed Dweik
In addition, Los Alamos National Laboratory, Los Alamos, New Mexico, and Oak Ridge Institute for Science and Education (ORISE), Tennessee are conducting testing for the U.S. Department of Energy facilities.

3) Pneumoconiosis: Analytical Electron microscopy for inorganic dusts

Several laboratories in North America provide analytical electron microscopy services for documenting inorganic dust content.

Durham VA Medical Center Department of Pathology, Duke University, Durham, North Carolina Dr. Victor Roggli
University of British Columbia Department of Pathology & Laboratory Medicine, Vancouver, British Columbia, Canada Dr. Andrew Churg
State University of New York Department of Pathology, Syracuse, New York Dr. Jerrold Abraham
McGill University Department of Pathology, Montreal, Quebec, Canada Dr. Bruce W. Case

4) Hypersensitivity Pneumonitis: Serological tests for precipitins

Precipitins are usually of the IgG or IgM antibody classes, and result from exposure of the patient's immune system to an antigen. Among other things, the measurement of precipitins may be useful in diagnosis of hypersensitivity pneumonitis. These laboratories offer a comprehensive panel of test against various antigens, including those that are unusual and 'exotic'. If the desired antigen is not on this list, please call the laboratory to see if it can be obtained.

National Jewish Medical and Research Center, Denver, Colorado also performs assessment of environmental antigens such as dust analysis
Specialty Laboratories, Santa Monica, California provides an extensive array of RAST testing
Northwestern University Department of Medicine, Division of Allergy, Chicago, Illinois offers testing for IgG antibodies against isocyanates, phthalic anhydride, trimellitic anhydride
Mayo Medical Laboratory, Mayo Clinic, Rochester, Minnesota has an on-line catalog of specialized diagnostic tests
Associated Regional and University Pathologists (ARUP) Laboratories at the University of Utah Health Sciences Center, Salt Lake City, Utah has a market focus to perform esoteric testing that supplements the testing available in local communities.