A review of bio-aerosol exposures and associated health effects in veterinary practice
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Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, the Netherlands
Department of Occupational Health, Arak University of Medical Sciences, Arak, Iran
Ann Agric Environ Med. 2013;20(2):206–221
Occupational exposure to bio-aerosols has been linked to various health effects. This review presents an overview of bio-aerosol exposure levels in veterinary practices, and investigates the possibility of health effects associated with bio-aerosol exposure.

Material and Methods:
A systematic literature search was carried out in PubMed. Publications were included if they provided information on bio-aerosol exposure and related health effects through veterinary practice and other professions with similar exposures, occupationally exposed to animals.

Few studies in veterinary settings showed that substantial bio-aerosol exposure levels (e.g. endotoxin and β(1→3)-glucan) were likely occur when handling farm animals and horses. Exposure levels are comparable to those levels observed in farming which have been associated with respiratory health effects. Animal specific allergen exposures have hardly been studied, but showed to be measurable in companion animal clinics and dairy barns. The findings of the few studies available among veterinary populations, particularly those working with farm animals and horses, are indicative of an elevated risk for developing respiratory symptoms. Studies among pig farmers, exposed to similar environments as veterinarians, strongly confirm that veterinary populations are at an increased risk of developing respiratory diseases in relation to bio-aerosol exposure, in particular endotoxin. Exposure to animal allergens during veterinary practice may cause allergic inflammation, characterized by IgE-mediated reactions to animal allergens. Nonetheless, the occurrence of sensitization or allergy against animal allergens is poorly described, apart from laboratory animal allergy, especially known from exposure to rats and mice.

Veterinary populations are likely exposed to elevated levels of bio-aerosols such as endotoxins, β(1→3)-glucans, and some specific animal allergens. Exposures to these agents in animal farmers are associated with allergic and non-allergic respiratory effects, proposing similar health effects in veterinary populations.

Moore RM Jr, Davis YM, Kaczmarek RG. An overview of occupational hazards among veterinarians, with particular reference to pregnant women. Am Ind Hyg Assoc J. 1993; 54(3): 113–20.
Wiggins P, Schenker MB, Green R, Samuels S. Prevalence of hazardous exposures in veterinary practice. Am J Ind Med. 1989; 16(1): 55–66.
Jeyaretnam J, Jones H. Physical, chemical and biological hazards in veterinary practice. Aust Vet J. 2000; 78(11): 751–8.
Wingfield WE, Ruby DL, Buchan RM, Gunther BJ. Waste anesthetic gas exposures to veterinarians and animal technicians. J Am Vet Med Assoc. 1981; 178(4): 399–402.
Weese JS, Jack DC. Needlestick injuries in veterinary medicine. Can Vet J. 2008; 49(8): 780–4.
Smith DR, Leggat PA, Speare R. Musculoskeletal disorders and psychosocial risk factors among veterinarians in queensland, australia. Aust Vet J. 2009; 87(7): 260–5.
Lucas M, Day L, Fritschi L. Injuries to australian veterinarians working with horses. Vet Rec. 2009; 164(7): 207–9.
Landercasper J, Cogbill TH, Strutt PJ, Landercasper BO. Trauma and the veterinarian. J Trauma. 1988; 28(8): 1255–9.
Knubben JM, Furst A, Gygax L, Stauffacher M. Bite and kick injuries in horses: Prevalence, risk factors and prevention. Equine Vet J. 2008; 40(3): 219–23.
Gabel CL, Gerberich SG. Risk factors for injury among veterinarians. Epidemiology (Cambridge, Mass. 2002 Jan;13(1):80–6.
Kimbell-Dunn MR, Fishwick RD, Bradshaw L, Erkinjuntti-Pekkanen R, Pearce N. Work-related respiratory symptoms in new zealand farmers. Am J Ind Med. 2001; 39(3): 292–300.
Kirychuk S, Senthilselvan A, Dosman JA, Zhou C, Barber EM, Rhodes CS, et al. Predictors of longitudinal changes in pulmonary function among swine confinement workers. Can Respir J. 1998; 5(6): 472–8.
Zejda JE, Barber E, Dosman JA, Olenchock SA, McDuffie HH, Rhodes C, et al. Respiratory health status in swine producers relates to endotoxin exposure in the presence of low dust levels. J Occup Med. 1994; 36(1): 49–56.
Radon K, Danuser B, Iversen M, Jorres R, Monso E, Opravil U, et al. Respiratory symptoms in european animal farmers. Eur Respir J. 2001; 17(4): 747–54.
II L, Baum GL, Teichtahl H, Mazar A, Aizer F, Bar-Sela S. Respiratory disease in animal house workers. Eur J Respir Dis. 1986; 69(1): 29–35.
Donham KJ, Zavala DC, Merchant JA. Respiratory symptoms and lung function among workers in swine confinement buildings: A crosssectional epidemiological study. Arch Environ Health. 1984; 39(2): 96–101.
Donham KJ. Health effects from work in swine confinement buildings. Am J Ind Med. 1990; 17(1): 17–25.
Eduard W, Douwes J, Omenaas E, Heederik D. Do farming exposures cause or prevent asthma? results from a study of adult norwegian farmers. Thorax. 2004; 59(5): 381–6.
Choudat D, Goehen M, Korobaeff M, Boulet A, Dewitte JD, Martin MH. Respiratory symptoms and bronchial reactivity among pig and dairy farmers. Scand J Work Environ Health. 1994; 20(1): 48–54.
Hjorth N, Roed-Petersen J. Allergic contact dermatitis in veterinary surgeons. Contact Dermatitis. 1980; 6(1): 27–9.
Susitaival P, Kirk J, Schenker MB. Self-reported hand dermatitis in california veterinarians. Am J Contact Dermat. 2001; 12(2): 103–8.
Schnurrenberger PR, Hanson LE, Martin RJ. Infections with erysipelothrix, leptospira, and chlamydia in illinois veterinarians. Int J Zoonoses. 1978; 5(1): 55–61.
Schuchman SM, Frye FL, Barrett RP. Toxicities and harzards for clinicians in small animal practice. Vet Clin North Am. 1975; 5(4): 727–35.
Blair A, M. HH,Jr. Cancer and other causes of death among U.S. veterinarians, 1966–1977. Int J Cancer. 1980; 25(2): 181–5.
Blair A, M. HH,Jr. Mortality patterns among US veterinarians, 1947– 1977: An expanded study. Int J Epidemiol. 1982; 11(4): 391–7.
Fritschi L. Cancer in veterinarians. Occup Environ Med. 2000; 57(5): 289–97.
Travier N, Gridley G, Blair A, Dosemeci M, Boffetta P. Cancer incidence among male swedish veterinarians and other workers of the veterinary industry: A record-linkage study. Cancer Causes Control. 2003; 14(6): 587–93.
Miller JM, Beaumont JJ. Suicide, cancer, and other causes of death among california veterinarians, 1960–1992. Am J Ind Med. 1995; 27(1): 37–49.
Jeyaretnam J, Jones H, Phillips M. Disease and injury among veterinarians. Aust Vet J. 2000; 78(9): 625–9.
Fritschi L, Day L, Shirangi A, Robertson I, Lucas M, Vizard A. Injury in australian veterinarians. Occup Med. (Oxford, England). 2006; 56(3): 199–203.
Vogelzang PF, van der Gulden JW, Folgering H, van Schayck CP. Organic dust toxic syndrome in swine confinement farming. Am J Ind Med. 1999; 35(4): 332–4.
Cormier Y, Boulet LP, Bedard G, Tremblay G. Respiratory health of workers exposed to swine confinement buildings only or to both swine confinement buildings and dairy barns. Scand J Work Environ Health. 1991; 17(4): 269–75.
Donham KJ, Rubino M, Thedell TD, Kammermeyer J. Potential health hazards to agricultural workers in swine confinement buildings. J Occup Med. 1977; 19(6): 383–7.
Eduard W, Pearce N, Douwes J. Chronic bronchitis, COPD, and lung function in farmers: The role of biological agents. Chest. 2009; 136(3): 716–25.
Douwes J, Thorne P, Pearce N, Heederik D. Bioaerosol health effects and exposure assessment: Progress and prospects. Ann Occup Hyg. 2003; 47(3): 187–200.
Donham KJ, Popendorf W, Palmgren U, Larsson L. Characterization of dusts collected from swine confinement buildings. Am J Ind Med. 1986; 10(3): 294–7.
Chang CW, Chung H, Huang CF, Su HJ. Exposure of workers to airborne microorganisms in open-air swine houses. Appl Environ Microbiol. 2001; 67(1): 155–61.
Duchaine C, Grimard Y, Cormier Y. Influence of building maintenance, environmental factors, and seasons on airborne contaminants of swine confinement buildings. AIHAJ. 2000; 61(1): 56–63.
Samadi S, Wouters IM, Houben R, Jamshidifard AR, Van Eerdenburg F, Heederik DJ. Exposure to inhalable dust, endotoxins, beta(1->3)- glucans, and airborne microorganisms in horse stables. Ann Occup Hyg. 2009; 53(6): 595–603.
Nehme B, Letourneau V, Forster RJ, Veillette M, Duchaine C. Cultureindependent approach of the bacterial bioaerosol diversity in the standard swine confinement buildings, and assessment of the seasonal effect. Environ Microbiol. 2008; 10(3): 665–75.
Nehme B, Gilbert Y, Letourneau V, Forster RJ, Veillette M, Villemur R, et al. Culture-independent characterization of archaeal biodiversity in swine confinement building bioaerosols. Appl Environ Microbiol. 2009; 75(17): 5445–50.
Samadi S, Rietbroek NN, Dwars RM, Jamshidifard AR, Heederik DJ, Wouters IM. Endotoxin and beta-(1 --> 3)-glucan exposure in poultry and ruminant clinics. J Environ Monit. 2011; 13(11): 3254–61.
Elbers AR, de Vries M, van Gulick PJ, Gerrits RP, Smithuis OL, Blaauw PJ, et al. Veterinary practice and occupational health. an epidemiological study of several professional groups of dutch veterinarians. II. peak expiratory flow variability, dust and endotoxin measurements, use of respiratory protection devices, and time distribution of professional activities. Vet Q. 1996; 18(4): 132–6.
Samadi S, Heederik DJ, Krop EJ, Jamshidifard AR, Willemse T, Wouters IM. Allergen and endotoxin exposure in a companion animal hospital. Occup Environ Med. 2010; 67(7): 486–92.
Adhikari A, Gupta J, Wilkins JR,3rd, Olds RL, Indugula R, Cho KJ, et al. Airborne microorganisms, endotoxin, and (1-->3)-beta-D-glucan exposure in greenhouses and assessment of respiratory symptoms among workers. Ann Occup Hyg. 2011; 55(3): 272–85.
Wouters I. Endotoxin and beta-(1-->3)-glucan exposure in household waste collectors and compost workers: A relation with upper airway inflammation. Schriftenreihe des Vereins fur Wasser-, Boden- und Lufthygiene. 1999; 104: 546–50.
Wouters IM, Spaan S, Douwes J, Doekes G, Heederik D. Overview of personal occupational exposure levels to inhalable dust, endotoxin, beta(1-->3)-glucan and fungal extracellular polysaccharides in the waste management chain. Ann Occup Hyg. 2006; 50(1): 39–53.
Almqvist C, Larsson PH, Egmar AC, Hedren M, Malmberg P, Wickman M. School as a risk environment for children allergic to cats and a site for transfer of cat allergen to homes. J Allergy Clin Immunol. 1999; 103(6): 1012–7.
Custovic A, Green R, Taggart SC, Smith A, Pickering CA, Chapman MD, et al. Domestic allergens in public places. II: Dog (can f1) and cockroach (bla g 2) allergens in dust and mite, cat, dog and cockroach allergens in the air in public buildings. Clin Exp Allergy. 1996; 26(11): 1246–52.
Zahradnik E, Sander I, Bruckmaier L, Flagge A, Fleischer C, Schierl R, et al. Development of a sandwich ELISA to measure exposure to occupational cow hair allergens. Int Arch Allergy Immunol. 2011; 155(3): 225–33.
Elfman L, Brannstrom J, Smedje G. Detection of horse allergen around a stable. Int Arch Allergy Immunol. 2008; 145(4): 269–76.
Castellan RM, Olenchock SA, Kinsley KB, Hankinson JL. Inhaled endotoxin and decreased spirometric values. an exposure-response relation for cotton dust. New England J Med. 19873; 317(10): 605–10.
Chaudemanche H, Monnet E, Westeel V, Pernet D, Dubiez A, Perrin C, et al. Respiratory status in dairy farmers in france; cross sectional and longitudinal analyses. Occup Environ Med. 2003; 60(11): 858–63.
Donham KJ, Cumro D, Reynolds SJ, Merchant JA. Dose-response relationships between occupational aerosol exposures and cross-shift declines of lung function in poultry workers: Recommendations for exposure limits. J Occup Environ Med. / Am College Occup Environ Med. 2000; 42(3): 260–9.
Douwes J, Wouters I, Dubbeld H, van Zwieten L, Steerenberg P, Doekes G, et al. Upper airway inflammation assessed by nasal lavage in compost workers: A relation with bio-aerosol exposure. Am J Ind Med. 2000; 37(5): 459–68.
Morris PD, Lenhart SW, Service WS. Respiratory symptoms and pulmonary function in chicken catchers in poultry confinement units. Am J Ind Med. 1991; 19(2): 195–204.
Smid T, Heederik D, Houba R, Quanjer PH. Dust- and endotoxin-related acute lung function changes and work-related symptoms in workers in the animal feed industry. Am J Ind Med. 1994; 25(6): 877–88.
Smit LA, Wouters IM, Hobo MM, Eduard W, Doekes G, Heederik D. Agricultural seed dust as a potential cause of organic dust toxic syndrome. Occup Environ Med. 2006; 63(1): 59–67.
Smit LA, Zuurbier M, Doekes G, Wouters IM, Heederik D, Douwes J. Hay fever and asthma symptoms in conventional and organic farmers in the netherlands. Occup Environ Med. 2007; 64(2): 101–7.
Draper A, Newman Taylor A, Cullinan P. Estimating the incidence of occupational asthma and rhinitis from laboratory animal allergens in the UK, 1999–2000. Occup Environ Med. 2003; 60(8): 604–5.
Jang JH, Kim DW, Kim SW, Kim DY, Seong WK, Son TJ, et al. Allergic rhinitis in laboratory animal workers and its risk factors. Ann Allergy Asthma Immunol. 2009; 102(5): 373–7.
Bourke SJ, Dalphin JC, Boyd G, McSharry C, Baldwin CI, Calvert JE. Hypersensitivity pneumonitis: Current concepts. Eur Respir J Suppl. 2001; 32: 81s-92s.
Larsson BM, Larsson K, Malmberg P, Palmberg L. Airways inflammation after exposure in a swine confinement building during cleaning procedure. Am J Ind Med. 2002; 41(4): 250–8.
Hill DJ, Langley RL, Morrow WM. Occupational injuries and illnesses reported by zoo veterinarians in the united states. J Zoo Wildl Med. 1998; 29(4): 371–85.
Abe T, Yamaki K, Hayakawa T, Fukuda H, Ito Y, Kume H, et al. A seroepidemiological study of the risks of Q fever infection in japanese veterinarians. Eur J Epidemiol. 2001; 17(11): 1029–32.
Nowotny N, Deutz A, Fuchs K, Schuller W, Hinterdorfer F, Auer H, et al. Prevalence of swine influenza and other viral, bacterial, and parasitic zoonoses in veterinarians. J Infect Dis. 1997; 176(5): 1414–5.
Macellaro A, Akesson A, Norlander L. A survey of Q-fever in sweden. Eur J Epidemiol. 1993; 9(2): 213–6.
Ergonul O, Zeller H, Kilic S, Kutlu S, Kutlu M, Cavusoglu S, et al. Zoonotic infections among veterinarians in turkey: Crimean-congo hemorrhagic fever and beyond. Int J Infect Dis. 2006; 10(6): 465–9.
Richardus JH, Donkers A, Dumas AM, Schaap GJ, Akkermans JP, Huisman J, et al. Q fever in the netherlands: A sero-epidemiological survey among human population groups from 1968 to 1983. Epidemiol Infect. 1987; 98(2): 211–9.
van Kolfschooten F. Dutch veterinarian becomes first victim of avian influenza. Lancet. 2003; 361(9367): 1444.
Koopmans M, Wilbrink B, Conyn M, Natrop G, van der Nat H, Vennema H, et al. Transmission of H7N7 avian influenza A virus to human beings during a large outbreak in commercial poultry farms in the netherlands. Lancet. 2004; 363(9409): 587–93.
Blair A, Malker H, Cantor KP, Burmeister L, Wiklund K. Cancer among farmers. A review. Scand J Work Environ Health. 1985; 11(6): 397–407.
Bulcke DM, Devos SA. Hand and forearm dermatoses among veterinarians. J Eur Acad Dermatol Venereol. 2007; 21(3): 360–3.
Leggat PA, Smith DR, Speare R. Hand dermatitis among veterinarians from queensland, australia. Contact dermatitis. 2009; 60(6): 336–8.
Ljubojevic S, Pastar Z, Lipozencic J, Milavec-Puretic V. Allergic contact dermatitis to cow’s hair. Contact dermatitis. 2007; 56(1): 50–2.
Downs SH, Marks GB, Mitakakis TZ, Leuppi JD, Car NG, Peat JK. Having lived on a farm and protection against allergic diseases in australia. Clin Exp Allergy. 2001; 31(4): 570–5.
Eriksson J, Ekerljung L, Lotvall J, Pullerits T, Wennergren G, Ronmark E, et al. Growing up on a farm leads to lifelong protection against allergic rhinitis. Allergy. 2010; 65: 1397–1403.
Portengen L, Preller L, Tielen M, Doekes G, Heederik D. Endotoxin exposure and atopic sensitization in adult pig farmers. J Allergy Clin Immunol. 2005; 115(4): 797–802.
Andersen CI, Von Essen SG, Smith LM, Spencer J, Jolie R, Donham KJ. Respiratory symptoms and airway obstruction in swine veterinarians: A persistent problem. Am J Ind Med. 2004; 46(4): 386–92.
Tielen MJ, Elbers AR, Snijdelaar M, van Gulick PJ, Preller L, Blaauw PJ. Prevalence of self-reported respiratory disease symptoms among veterinarians in the southern netherlands. Am J Ind Med. 1996; 29(2): 201–7.
Jolie R, Backstrom L, Thomas C. Health problems in veterinary students after visiting a commercial swine farm. Can J Vet Res. 1998; 62(1): 44–8.
Samadi S, Spithoven J, Jamshidifard AR, Berends BR, Lipman L, Heederik DJ, et al. Allergy among veterinary medicine students in the netherlands. Occup Environ Med. 2012; 69(1): 48–55.
Kullman GJ, Thorne PS, Waldron PF, Marx JJ, Ault B, Lewis DM, et al. Organic dust exposures from work in dairy barns. Am Ind Hyg Assoc J. 1998; 59(6): 403–13.
Spaan S, Wouters IM, Oosting I, Doekes G, Heederik D. Exposure to inhalable dust and endotoxins in agricultural industries. J Environ Monit. 2006; 8(1): 63–72.
Simpson JC, Niven RM, Pickering CA, Oldham LA, Fletcher AM, Francis HC. Comparative personal exposures to organic dusts and endotoxin. Ann Occup Hyg. 1999; 43(2): 107–15.
Schwartz DA, Donham KJ, Olenchock SA, Popendorf WJ, Van Fossen DS, Burmeister LF, et al. Determinants of longitudinal changes in spirometric function among swine confinement operators and farmers. Am J Respir Crit Care Med. 1995; 151(1): 47–53.
Palmberg L, Larssson BM, Malmberg P, Larsson K. Airway responses of healthy farmers and nonfarmers to exposure in a swine confinement building. Scand J Work Environ Health. 2002; 28(4): 256–63.
Larsson KA, Eklund AG, Hansson LO, Isaksson BM, Malmberg PO. Swine dust causes intense airways inflammation in healthy subjects. Am J Respir Crit Care Med. 1994; 150(4): 973–7.
Larsson BM, Palmberg L, Malmberg PO, Larsson K. Effect of exposure to swine dust on levels of IL-8 in airway lavage fluid. Thorax. 1997; 52(7): 638–42.
Hoffmann HJ, Iversen M, Brandslund I, Sigsgaard T, Omland O, Oxvig C, et al. Plasma C3d levels of young farmers correlate with respirable dust exposure levels during normal work in swine confinement buildings. Ann Agric Environ Med. 2003; 10(1): 53–60.
Hoffmann HJ, Iversen M, Takai H, Sigsgaard T, Omland O, Dahl R. Exposure to work-related levels of swine dust up-regulates CD106 on human alveolar macrophages. Am J Ind Med. 2004; 46(4): 378–80.
Dosman JA, Lawson JA, Kirychuk SP, Cormier Y, Biem J, Koehncke N. Occupational asthma in newly employed workers in intensive swine confinement facilities. Eur Respir J. 2004; 24(4): 698–702.
Dosman JA, Lawson JA, Kirychuk SP, Cormier Y, Biem J, Koehncke N. Three new cases of apparent occupational asthma in swine confinement facility employees. Eur Respir J. 2006; 28(6): 1281–2.
Heederik D, Brouwer R, Biersteker K, Boleij JS. Relationship of airborne endotoxin and bacteria levels in pig farms with the lung function and respiratory symptoms of farmers. Int Arch Occup Environ Health. 1991; 62(8): 595–601.
Holness DL, O’Blenis EL, Sass-Kortsak A, Pilger C, Nethercott JR. Respiratory effects and dust exposures in hog confinement farming. Am J Ind Med. 1987; 11(5): 571–80.
Von Essen S, Robbins RA, Thompson AB, Rennard SI. Organic dust toxic syndrome: An acute febrile reaction to organic dust exposure distinct from hypersensitivity pneumonitis. J Toxicol. 1990; 28(4): 389–420.
Vogelzang PF, van der Gulden JW, Folgering H, Kolk JJ, Heederik D, Preller L, et al. Endotoxin exposure as a major determinant of lung function decline in pig farmers. Am J Respir Crit Care Med. 1998; 157(1): 15–8.
Gainet M, Thaon I, Westeel V, Chaudemanche H, Venier AG, Dubiez A, et al. Twelve-year longitudinal study of respiratory status in dairy farmers. Eur Respir J. 2007; 30(1): 97–103.
Kronqvist M, Johansson E, Pershagen G, Johansson SG, van HageHamsten M. Increasing prevalence of asthma over 12 years among dairy farmers on gotland, sweden: Storage mites remain dominant allergens. Clin Exp Allergy. 1999; 29(1): 35–41.
Choma D, Westeel V, Dubiez A, Gora D, Meyer V, Pernet D, et al. Respective influence of occupational and personal factors on respiratory function in dairy farmers. Rev Mal Respir. 1998; 15(6): 765–72.
Dalphin JC, Dubiez A, Monnet E, Gora D, Westeel V, Pernet D, et al. Prevalence of asthma and respiratory symptoms in dairy farmers in the french province of the doubs. Am J Respir Crit Care Med. 1998; 158(5 Pt 1): 1493–8.
Dalphin JC, Maheu MF, Dussaucy A, Pernet D, Polio JC, Dubiez A, et al. Six year longitudinal study of respiratory function in dairy farmers in the doubs province. Eur Respir J. 1998; 11(6): 1287–93.
Mauny F, Polio JC, Monnet E, Pernet D, Laplante JJ, Depierre A, et al. Longitudinal study of respiratory health in dairy farmers: Influence of artificial barn fodder drying. Eur Respir J. 1997; 10(11): 2522–8.
Rylander R, Carvalheiro MF. Airways inflammation among workers in poultry houses. Int Arch Occup Environ Health. 2006; 79(6): 487–90.
Mazan MR, Svatek J, Maranda L, Christiani D, Ghio A, Nadeau J, et al. Questionnaire assessment of airway disease symptoms in equine barn personnel. Occup Med. (Oxford, England). 2009; 59(4): 220–5.
Mackiewicz B, Prazmo Z, Milanowski J, Dutkiewicz J, Fafrowicz B. Exposure to organic dust and microorganisms as a factor affecting respiratory function of workers of purebred horse farms. Pneumonol Alergol Pol. 1996; 64 Suppl 1: 19–24.
Tutluoglu B, Atis S, Anakkaya AN, Altug E, Tosun GA, Yaman M. Sensitization to horse hair, symptoms and lung function in grooms. Clin Exp Allergy. 2002; 32(8): 1170–3.
Liebers V, Raulf-Heimsoth M, Bruning T. Health effects due to endotoxin inhalation (review). Arch Toxicol. 2008; 82(4): 203–10.
Douwes J. (1-->3)-beta-D-glucans and respiratory health: A review of the scientific evidence. Indoor air. 2005; 15(3): 160–9.
Donham K, Haglind P, Peterson Y, Rylander R, Belin L. Environmental and health studies of farm workers in swedish swine confinement buildings. Br J Ind Med. 1989; 46(1): 31–7.
Schwartz DA, Thorne PS, Yagla SJ, Burmeister LF, Olenchock SA, Watt JL, et al. The role of endotoxin in grain dust-induced lung disease. Am J Respir Crit Care Med. 1995; 152(2): 603–8.
Kennedy SM, Christiani DC, Eisen EA, Wegman DH, Greaves IA, Olenchock SA, et al. Cotton dust and endotoxin exposure-response relationships in cotton textile workers. Am Rev Respir Dis. 1987; 135(1): 194–200.
Smit LA, Heederik D, Doekes G, Lammers JW, Wouters IM. Occupational endotoxin exposure reduces the risk of atopic sensitization but increases the risk of bronchial hyperresponsiveness. Int Arch Allergy Immunol. 2010; 152(2): 151–8.
Williams DL. Overview of (1-->3)-beta-D-glucan immunobiology. Mediators Inflamm. 1997; 6(4): 247–50.
Thorn J, Rylander R. Airways inflammation and glucan in a rowhouse area. Am J Respir Crit Care Med. 1998; 157(6 Pt 1): 1798–803.
Douwes J, Zuidhof A, Doekes G, van der Zee SC, Wouters I, Boezen MH, et al. (1-->3)-beta-D-glucan and endotoxin in house dust and peak flow variability in children. Am J Respir Crit Care Med. 2000; 162(4 Pt 1): 1348–54.
Mandryk J, Alwis KU, Hocking AD. Effects of personal exposures on pulmonary function and work-related symptoms among sawmill workers. Ann Occup Hyg. 2000; 44(4): 281–9.
Gladding T, Thorn J, Stott D. Organic dust exposure and work-related effects among recycling workers. Am J Ind Med. 2003; 43(6): 584–91.
Rusca S, Charriere N, Droz PO, Oppliger A. Effects of bioaerosol exposure on work-related symptoms among swiss sawmill workers. Int Arch Occup Environ Health. 2008; 81(4): 415–21.
Fogelmark B, Sjostrand M, Rylander R. Pulmonary inflammation induced by repeated inhalations of beta(1,3)-D-glucan and endotoxin. Int J Exp Pathol. 1994; 75(2): 85–90.
Fogelmark B, Goto H, Yuasa K, Marchat B, Rylander R. Acute pulmonary toxicity of inhaled beta-1,3-glucan and endotoxin. Agents Actions. 1992; 35(1–2): 50–6.
Samadi S, Heederik DJ, Krop EJ, Jamshidifard AR, Willemse T, Wouters IM. Allergen and endotoxin exposure in a companion animal hospital. Occup Environ Med. 2010; 67(7): 486–92.
Liccardi G, Salzillo A, Dente B, Piccolo A, Lobefalo G, Noschese P, et al. Horse allergens: An underestimated risk for allergic sensitization in an urban atopic population without occupational exposure. Respir Med. 2009; 103(3): 414–20.
Berger I, Schierl R, Ochmann U, Egger U, Scharrer E, Nowak D. Concentrations of dust, allergens and endotoxin in stables, living rooms and mattresses from cattle farmers in southern bavaria. Ann Agric Environ Med. 2005; 12(1): 101–7.
Chapman MD, Wood RA. The role and remediation of animal allergens in allergic diseases. J Allergy Clin Immunol. 2001; 107(3 Suppl): S414–21.
Cullinan P, Cook A, Gordon S, Nieuwenhuijsen MJ, Tee RD, Venables KM, et al. Allergen exposure, atopy and smoking as determinants of allergy to rats in a cohort of laboratory employees. Eur Respir J. 1999; 13(5): 1139–43.
Chapman MD, Wood RA. The role and remediation of animal allergens in allergic diseases. J Allergy Clin Immunol. 2001; 107(3 Suppl): S414–22.
Harrison DJ. Controlling exposure to laboratory animal allergens. ILAR J. 2001; 42(1): 17–36.
Chan-Yeung M, Malo JL. Aetiological agents in occupational asthma. Eur Respir J. 1994; 7(2): 346–71.
Aoyama K, Ueda A, Manda F, Matsushita T, Ueda T, Yamauchi C. Allergy to laboratory animals: An epidemiological study. Br J Ind Med. 1992; 49(1): 41–7.
Susitaival P, Kirk JH, Schenker MB. Atopic symptoms among california veterinarians. Am J Ind Med. 2003; 44(2): 166–71.
Hunskaar S, Fosse RT. Allergy to laboratory mice and rats: A review of the pathophysiology, epidemiology and clinical aspects. Lab Anim. 1990; 24(4): 358–74.
Bush RK, Wood RA, Eggleston PA. Laboratory animal allergy. J Allergy Clin Immunol. 1998; 102(1): 99–112.
Krakowiak A, Wiszniewska M, Krawczyk P, Szulc B, Wittczak T, Walusiak J, et al. Risk factors associated with airway allergic diseases from exposure to laboratory animal allergens among veterinarians. Int Arch Occup Environ Health. 2007; 80(6): 465–75.
Seward JP. Occupational allergy to animals. Occup Med. (Philadelphia, Pa). 1999; 14(2): 285–304.
Gross NJ. Allergy to laboratory animals: Epidemiologic, clinical, and physiologic aspects, and a trial of cromolyn in its management. J Allergy Clin Immunol. 1980; 66(2): 158–65.
Bryant DH, Boscato LM, Mboloi PN, Stuart MC. Allergy to laboratory animals among animal handlers. Med J Aust. 1995; 163(8): 415–8.
Fuortes LJ, Weih L, Jones ML, Burmeister LF, Thorne PS, Pollen S, et al. Epidemiologic assessment of laboratory animal allergy among university employees. Am J Ind Med. 1996; 29(1): 67–74.
Heederik D, Venables KM, Malmberg P, Hollander A, Karlsson AS, Renstrom A, et al. Exposure-response relationships for work-related sensitization in workers exposed to rat urinary allergens: Results from a pooled study. J Allergy Clin Immunol. 1999; 103(4): 678–84.
Agrup G, Belin L, Sjostedt L, Skerfving S. Allergy to laboratory animals in laboratory technicians and animal keepers. Br J Ind Med. 1986; 43(3): 192–8.
Cockcroft A, Edwards J, McCarthy P, Andersson N. Allergy in laboratory animal workers. Lancet. 1981; 1(8224): 827–30.
Hollander A, Heederik D, Doekes G. Respiratory allergy to rats: Exposure-response relationships in laboratory animal workers. Am J Respir Crit Care Med. 1997; 155(2): 562–7.
Matsui EC, Krop EJ, Diette GB, Aalberse RC, Smith AL, Eggleston PA. Mouse allergen exposure and immunologic responses: IgE-mediated mouse sensitization and mouse specific IgG and IgG4 levels. Ann Allergy Asthma Immunol. 2004; 93(2): 171–8.
Bland SM, Levine MS, Wilson PD, Fox NL, Rivera JC. Occupational allergy to laboratory animals: An epidemiologic study. J Occup Med. 1986; 28(11): 1151–7.
Venables KM, Upton JL, Hawkins ER, Tee RD, Longbottom JL, Newman Taylor AJ. Smoking, atopy, and laboratory animal allergy. Br J Ind Med. 1988; 45(10): 667–71.
Cullinan P, Lowson D, Nieuwenhuijsen MJ, Gordon S, Tee RD, Venables KM, et al. Work related symptoms, sensitisation, and estimated exposure in workers not previously exposed to laboratory rats. Occup Environ Med. 1994; 51(9): 589–92.
Hollander A, Doekes G, Heederik D. Cat and dog allergy and total IgE as risk factors of laboratory animal allergy. J Allergy Clin Immunol. 1996; 98(3): 545–54.
Kruize H, Post W, Heederik D, Martens B, Hollander A, van der Beek E. Respiratory allergy in laboratory animal workers: A retrospective cohort study using pre-employment screening data. Occup Environ Med. 1997; 54(11): 830–5.
Santa H, Saarela JT, Laatikainen R, Rautianen J, Virtanen T, Rytkonen M, et al. A bovine dander allergen, comparative modeling, and similarities and differences in folding with related proteins. J Protein Chem. 1998; 17(7): 657–62.
Prahl P. Allergens in cow hair and dander. origin of cow allergens in the environment. Allergy. 1981; 36(8): 561–71.
Zeiler T, Taivainen A, Mantyjarvi R, Tukiainen H, Rautiainen J, Rytkonen-Nissinen M, et al. Threshold levels of purified natural bos d 2 for inducing bronchial airway response in asthmatic patients. Clin Exp Allergy. 2002; 32(10): 1454–60.
Zeiler T, Taivainen A, Mantyjarvi R, Tukiainen H, Rautiainen J, Rytkonen-Nissinen M, et al. Threshold levels of purified natural bos d 2 for inducing bronchial airway response in asthmatic patients. Clin Exp Allergy. 2002; 32(10): 1454–61.
Heutelbeck AR, Janicke N, Hilgers R, Kutting B, Drexler H, Hallier E, et al. German cattle allergy study (CAS): Public health relevance of cattle-allergic farmers. Int Arch Occup Environ Health. 2007; 81(2): 201–8.
Karjalainen A, Kurppa K, Virtanen S, Keskinen H, Nordman H. Incidence of occupational asthma by occupation and industry in finland. Am J Ind Med. 2000; 37(5): 451–8.
Doekes G, Wouters I, Vries, Omland Q, Sigsgaard T, Virtanen T, Heederik D. IgE antibodies to cow allergens and respiratory health in dairy farmers in denmark and the netherlands. J Agric Safety Health. 2000; 5(3): 309–316.
Terho EO, Husman K, Vohlonen I, Rautalahti M, Tukiainen H. Allergy to storage mites or cow dander as a cause of rhinitis among finnish dairy farmers. Allergy. 1985; 40(1): 23–6.
Virtanen T, Vilhunen P, Husman K, Mantyjarvi R. Sensitization of dairy farmers to bovine antigens and effects of exposure on specific IgG and IgE titers. Int Arch Allergy Appl Immunol. 1988; 87(2): 171–7.
Ylonen J, Mantyjarvi R, Taivainen A, Virtanen T. IgG and IgE antibody responses to cow dander and urine in farmers with cow-induced asthma. Clin Exp Allergy. 1992; 22(1): 83–90.
Spiewak R. [Sensitization to cow and pig allergens among farmers in eastern poland]. Med Pr. 2001; 52(5): 351–4.
Immonen A, Kinnunen T, Sirven P, Taivainen A, Houitte D, Perasaari J, et al. The major horse allergen equ c 1 contains one immunodominant region of T cell epitopes. Clin Exp Allergy. 2007; 37(6): 939–47.
Felix K, Ferrandiz R, Einarsson R, Dreborg S. Allergens of horse dander: Comparison among breeds and individual animals by immunoblotting. J Allergy Clin Immunol. 1996; 98(1): 169–71.
Dandeu JP, Rabillon J, Divanovic A, Carmi-Leroy A, David B. Hydrophobic interaction chromatography for isolation and purification of, the horse major allergen. J Chromatogr. 1993; 621(1): 23–31.
Kim JL, Elfman L, Mi Y, Johansson M, Smedje G, Norback D. Current asthma and respiratory symptoms among pupils in relation to dietary factors and allergens in the school environment. Indoor Air. 2005; 15(3): 170–82.
Ronmark E, Perzanowski M, Platts-Mills T, Lundback B. Different sensitization profile for asthma, rhinitis, and eczema among 7–8-year old children: Report from the obstructive lung disease in northern sweden studies. Pediatr Allergy Immunol. 2003; 14(2): 91–9.
Wood RA, Laheri AN, Eggleston PA. The aerodynamic characteristics of cat allergen. Clin Exp Allergy. 1993; 23(9): 733–9.
Luczynska CM, Li Y, Chapman MD, Platts-Mills TA. Airborne concentrations and particle size distribution of allergen derived from domestic cats (felis domesticus). measurements using cascade impactor, liquid impinger, and a two-site monoclonal antibody assay for fel d I. Am Rev Respir Dis. 1990; 141(2): 361–7.
de Blay F, Heymann PW, Chapman MD, Platts-Mills TA. Airborne dust mite allergens: Comparison of group II allergens with group I mite allergen and cat-allergen fel d I. J Allergy Clin Immunol. 1991; 88(6): 919–26.
Custovic A, Simpson A, Pahdi H, Green RM, Chapman MD, Woodcock A. Distribution, aerodynamic characteristics, and removal of the major cat allergen fel d 1 in british homes. Thorax. 1998; 53(1): 33–8.
Custovic A, Green R, Fletcher A, Smith A, Pickering CA, Chapman MD, et al. Aerodynamic properties of the major dog allergen can f 1: Distribution in homes, concentration, and particle size of allergen in the air. Am J Respir Crit Care Med. 1997; 155(1): 94–8.
De Lucca SD, O’Meara T J, Tovey ER. Exposure to mite and cat allergens on a range of clothing items at home and the transfer of cat allergen in the workplace. J Allergy Clin Immunol. 2000; 106(5): 874–9.
Karlsson AS, Renstrom A. Human hair is a potential source of cat allergen contamination of ambient air. Allergy. 2005; 60(7): 961–4.
Almqvist C, Egmar AC, Hedlin G, Lundqvist M, Nordvall SL, Pershagen G, et al. Direct and indirect exposure to pets – risk of sensitization and asthma at 4 years in a birth cohort. Clin Exp Allergy. 2003; 33(9): 1190–7.
Apfelbacher CJ, Ollert M, Ring J, Behrendt H, Kramer U. Contact to cat or dog, allergies and parental education. Pediatr Allergy Immunol. 2010; 21(2 Pt 1): 284–91.
Chen CM, Gehring U, Wickman M, Hoek G, Giovannangelo M, Nordling E, et al. Domestic cat allergen and allergic sensitisation in young children. Int J Hyg Environ Health. 2008; 211(3–4): 337–44.
Ronmark E, Perzanowski M, Platts-Mills T, Lundback B. Fouryear incidence of allergic sensitization among schoolchildren in a community where allergy to cat and dog dominates sensitization: Report from the obstructive lung disease in northern sweden study group. J Allergy Clin Immunol. 2003; 112(4): 747–54.
Lutsky I, Baum GL, Teichtahl H, Mazar A, Aizer F, Bar-Sela S. Occupational respiratory disease in veterinarians. Ann Allergy. 1985; 55(2): 153–6.
Nienhaus A, Skudlik C, Seidler A. Work-related accidents and occupational diseases in veterinarians and their staff. Int Arch Occup Environ Health. 2005; 78(3): 230–8.
Occupational asthma a risk for veterinarians. J Am Vet Med Assoc. 2008; 233(2): 212–3. 179.Will LA, Nassif EG, Engen RL, Patterson RA, Zimmerman D. Allergy and pulmonary impairment in iowa veterinarians. N Engl Reg Allergy Proc. 1987; 8(3): 173–7.
Will LA, Nassif EG, Engen RL, Patterson RA, Zimmerman D. Allergy and pulmonary impairment in iowa veterinarians. N Engl Reg Allergy Proc. 1987; 8(3): 173–7.
Von Ehrenstein OS, Von Mutius E, Illi S, Baumann L, Bohm O, von Kries R. Reduced risk of hay fever and asthma among children of farmers. Clin Exp Allergy. 2000; 30(2): 187–93.
Riedler J, Braun-Fahrlander C, Eder W, Schreuer M, Waser M, Maisch S, et al. Exposure to farming in early life and development of asthma and allergy: A cross-sectional survey. Lancet. 2001; 358(9288): 1129–33.
Leynaert B, Neukirch C, Jarvis D, Chinn S, Burney P, Neukirch F, et al. Does living on a farm during childhood protect against asthma, allergic rhinitis, and atopy in adulthood? Am J Respir Crit Care Med. 2001; 164(10 Pt 1): 1829–34.
Koskela HO, Happonen KK, Remes ST, Pekkanen J. Effect of farming environment on sensitisation to allergens continues after childhood. Occup Environ Med. 2005; 62(9): 607–11.
Portengen L, Sigsgaard T, Omland O, Hjort C, Heederik D, Doekes G. Low prevalence of atopy in young danish farmers and farming students born and raised on a farm. Clin Exp Allergy. 2002; 32(2): 247–53.
Radon K, Schulze A, Nowak D. Inverse association between farm animal contact and respiratory allergies in adulthood: Protection, underreporting or selection? Allergy. 2006; 61(4): 443–6.
Douwes J, Cheng S, Travier N, Cohet C, Niesink A, McKenzie J, et al. Farm exposure in utero may protect against asthma, hay fever and eczema. Eur Respir J. 2008; 32(3): 603–11.
Gehring U, Bischof W, Schlenvoigt G, Richter K, Fahlbusch B, Wichmann HE, et al. Exposure to house dust endotoxin and allergic sensitization in adults. Allergy. 2004; 59(9): 946–52.
Smit LA, Heederik D, Doekes G, Blom C, van Zweden I, Wouters IM. Exposure-response analysis of allergy and respiratory symptoms in endotoxin-exposed adults. Eur Respir J. 2008; 31(6): 1241–8.
Romagnani S. Immunologic influences on allergy and the TH1/TH2 balance. J Allergy Clin Immunol. 2004; 113(3): 395–400.
Schaub B, Lauener R, von Mutius E. The many faces of the hygiene hypothesis. J Allergy Clin Immunol. 2006; 117(5): 969,77; quiz 978.
Woolhouse ME, Gowtage-Sequeria S. Host range and emerging and reemerging pathogens. Emerg Infect Dis. 2005; 11(12): 1842–7.
McQuiston JH, Childs JE. Q fever in humans and animals in the united states. Vector Borne Zoonotic Dis. 2002; 2(3): 179–91.
Hill DJ, Langley RL, Morrow WM. Occupational injuries and illnesses reported by zoo veterinarians in the united states. J Zoo Wildl Med. 1998; 29(4): 371–86.
Baker WS, Gray GC. A review of published reports regarding zoonotic pathogen infection in veterinarians. J Am Vet Med Assoc. 2009; 234(10): 1271–8.
Whitney EA, Massung RF, Candee AJ, Ailes EC, Myers LM, Patterson NE, et al. Seroepidemiologic and occupational risk survey for coxiella burnetii antibodies among US veterinarians. Clin Infect Dis. 2009; 48(5): 550–7.
Dorko E, Kalinova Z, Weissova T, Pilipcinec E. Seroprevalence of antibodies to coxiella burnetii among employees of the veterinary university in kosice, eastern slovakia. Ann Agric Environ Med. 2008; 15(1): 119–24.
Qi X, Lu C. Swine influenza virus: Evolution mechanism and epidemic characterization--a review. Wei Sheng Wu Xue Bao. 2009; 49(9): 1138– 45. 198.Myers KP, Setterquist SF, Capuano AW, Gray GC. Infection due to 3 avian influenza subtypes in united states veterinarians. Clin Infect Dis. 2007; 45(1): 4–9.
Myers KP, Olsen CW, Setterquist SF, Capuano AW, Donham KJ, Thacker EL, et al. Are swine workers in the united states at increased risk of infection with zoonotic influenza virus? Clin Infect Dis. 2006; 42(1): 14–20.
Myers KP, Olsen CW, Setterquist SF, Capuano AW, Donham KJ, Thacker EL, et al. Are swine workers in the united states at increased risk of infection with zoonotic influenza virus? Clin Infect Dis. 2006; 42(1): 14–21.
Vanderhaeghen W, Hermans K, Haesebrouck F, Butaye P. Methicillinresistant staphylococcus aureus (MRSA) in food production animals. Epidemiol Infect. 2010; 138(5): 606–25.
Weese JS, DaCosta T, Button L, Goth K, Ethier M, Boehnke K. Isolation of methicillin-resistant staphylococcus aureus from the environment in a veterinary teaching hospital. J Vet Intern Med. 2004; 18(4): 468–70.
Seguin JC, Walker RD, Caron JP, Kloos WE, George CG, Hollis RJ, et al. Methicillin-resistant staphylococcus aureus outbreak in a veterinary teaching hospital: Potential human-to-animal transmission. J Clin Microbiol. 1999; 37(5): 1459–63.
O’Mahony R, Abbott Y, Leonard FC, Markey BK, Quinn PJ, Pollock PJ, et al. Methicillin-resistant staphylococcus aureus (MRSA) isolated from animals and veterinary personnel in ireland. Vet Microbiol. 2005; 109(3–4): 285–96.
Vandenbroucke-Grauls CM, Beaujean DJ. Methicillin-resistant staphylococcus aureus in pig breeders and cattle breeders. Ned Tijdschr Geneeskd. 2006; 150(31): 1710–2.
Smith TC, Pearson N. The emergence of staphylococcus aureus ST398. Vector Borne Zoonotic Dis. 2011; 11(4): 327–39.
Wulf M, van Nes A, Eikelenboom-Boskamp A, de Vries J, Melchers W, Klaassen C, et al. Methicillin-resistant staphylococcus aureus in veterinary doctors and students, the netherlands. Emerg Infect Dis. 2006; 12(12): 1939–41.
King MD, Humphrey BJ, Wang YF, Kourbatova EV, Ray SM, Blumberg HM. Emergence of community-acquired methicillin-resistant staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med. 2006; 144(5): 309–17.
Wertheim HF, Vos MC, Boelens HA, Voss A, Vandenbroucke-Grauls CM, Meester MH, et al. Low prevalence of methicillin-resistant staphylococcus aureus (MRSA) at hospital admission in the netherlands: The value of search and destroy and restrictive antibiotic use. J Hosp Infect. 2004; 56(4): 321–5.
Rylander R, Haglind P, Lundholm M. Endotoxin in cotton dust and respiratory function decrement among cotton workers in an experimental cardroom. Am Rev Respir Dis. 1985; 131(2): 209–13. 210.Haglind P, Rylander R. Exposure to cotton dust in an experimental cardroom. Br J Ind Med. 1984; 41(3): 340–5.
Haglind P, Rylander R. Exposure to cotton dust in an experimental cardroom. Br J Ind Med. 1984; 41(3): 340–6.
Smid T, Heederik D, Houba R, Quanjer PH. Dust- and endotoxinrelated respiratory effects in the animal feed industry. Am Rev Respir Dis. 1992; 146(6): 1474–9.
Health Council of the Netherlands. Endotoxins. health-based recommended occupational exposure limit. The Hague: Health Council of the Netherlands; 1998. Report No.: 1998/03WGD.
Health Council of the Netherlands. Endotoxins. health-based recommended occupational exposure limit. The Hague: Health Council of the Netherlands; 2010. Report No.: 2010/04OSH.
Post W, Heederik D, Houba R. Decline in lung function related to exposure and selection processes among workers in the grain processing and animal feed industry. Occup Environ Med. 1998; 55(5): 349–55.
Rijnkels JM, Smid T, Van den Aker EC, Burdorf A, van Wijk RG, Heederik DJ, et al. Prevention of work-related airway allergies; summary of the advice from the health council of the netherlands. Allergy. 2008; 63(12): 1593–6.
Schierl R, Heise A, Egger U, Schneider F, Eichelser R, Neser S, et al. Endotoxin concentration in modern animal houses in southern bavaria. Ann Agric Environ Med. 2007; 14(1): 129–36.
Berger I, Schierl R, Ochmann U, Egger U, Scharrer E, Nowak D. Concentrations of dust, allergens and endotoxin in stables, living rooms and mattresses from cattle farmers in southern bavaria. Ann Agric Environ Med. 2005; 12(1): 101–8.
Szadkowska-Stanczyk I, Brodka K, Buczynska A, Cyprowski M, Kozajda A, Sowiak M. Exposure to bioaerosols among CAFO workers (swine feeding). Med Pr. 2010; 61(3): 257–69.
Ko G, Simmons Iii OD, Likirdopulos CA, Worley-Davis L, Williams CM, Sobsey MD. Endotoxin levels at swine farms using different waste treatment and management technologies. Environ Sci Technol. 2010; 44(9): 3442–8.
Preller L, Heederik D, Kromhout H, Boleij JS, Tielen MJ. Determinants of dust and endotoxin exposure of pig farmers: Development of a control strategy using empirical modelling. Ann Occup Hyg. 1995; 39(5): 545–57.
Roger A, Guspi R, Garcia-Patos V, Barriga A, Rubira N, Nogueiras C, et al. Occupational protein contact dermatitis in a veterinary surgeon. Contact dermatitis. 1995; 32(4): 248–9.
Smit LA, Heederik D, Doekes G, Wouters IM. Exhaled nitric oxide in endotoxin-exposed adults: Effect modification by smoking and atopy. Occupational and environmental medicine. 2009; 66(4): 251–5.
Vogelzang PF, van der Gulden JW, Folgering H, Heederik D, Tielen MJ, van Schayck CP. Longitudinal changes in bronchial responsiveness associated with swine confinement dust exposure. Chest. 2000; 117(5): 1488–95.
Rautalahti M, Terho EO, Vohlonen I, Husman K. Atopic sensitization of dairy farmers to work-related and common allergens. Eur J Respir Dis Suppl. 1987; 152: 155–64.
Clark S, Rylander R, Larsson L. Airborne bacteria, endotoxin and fungi in dust in poultry and swine confinement buildings. Am Ind Hyg Assoc J. 1983; 44(7): 537-41.
Rimac D, Macan J, Varnai VM, Vucemilo M, Matkovic K, Prester L, et al. Exposure to poultry dust and health effects in poultry workers: Impact of mould and mite allergens. Int Arch OccupEnviron Health. 2010; 83(1): 9-19.