A review of bio-aerosol exposures and associated health effects in veterinary practice.

INTRODUCTION 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. 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. RESULTS 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. CONCLUSION 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.

[1]  E A Eisen,et al.  Cotton dust and endotoxin exposure-response relationships in cotton textile workers. , 2015, The American review of respiratory disease.

[2]  D. Heederik,et al.  Endotoxin and β-(1 → 3)-glucan exposure in poultry and ruminant clinics. , 2011, Journal of environmental monitoring : JEM.

[3]  D. Heederik,et al.  Allergy among veterinary medicine students in The Netherlands , 2011, Occupational and Environmental Medicine.

[4]  Wytse J. Wadman,et al.  Health Council of the Netherlands: No need to change from SAR to time-temperature relation in electromagnetic fields exposure limits , 2011, International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group.

[5]  Tara C Smith,et al.  The emergence of Staphylococcus aureus ST398. , 2011, Vector borne and zoonotic diseases.

[6]  A. Adhikari,et al.  Airborne microorganisms, endotoxin, and (1→3)-β-D-glucan exposure in greenhouses and assessment of respiratory symptoms among workers. , 2011, The Annals of occupational hygiene.

[7]  T. Brüning,et al.  Development of a Sandwich ELISA to Measure Exposure to Occupational Cow Hair Allergens , 2011, International Archives of Allergy and Immunology.

[8]  G. Wennergren,et al.  Growing up on a farm leads to lifelong protection against allergic rhinitis , 2010, Allergy.

[9]  D. Heederik,et al.  Allergen and endotoxin exposure in a companion animal hospital , 2010, Occupational and Environmental Medicine.

[10]  M. Sobsey,et al.  Endotoxin levels at Swine farms using different waste treatment and management technologies. , 2010, Environmental science & technology.

[11]  J. Ring,et al.  Contact to cat or dog, allergies and parental education , 2010, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[12]  F. Haesebrouck,et al.  Methicillin-resistant Staphylococcus aureus (MRSA) in food production animals , 2010, Epidemiology and Infection.

[13]  J. Lammers,et al.  Occupational Endotoxin Exposure Reduces the Risk of Atopic Sensitization but Increases the Risk of Bronchial Hyperresponsiveness , 2009, International Archives of Allergy and Immunology.

[14]  Neil Pearce,et al.  Chronic bronchitis, COPD, and lung function in farmers: the role of biological agents. , 2009, Chest.

[15]  Chengping Lu,et al.  [Swine influenza virus: evolution mechanism and epidemic characterization--a review]. , 2009, Wei sheng wu xue bao = Acta microbiologica Sinica.

[16]  D. Heederik,et al.  Exposure to inhalable dust, endotoxins, beta(1->3)-glucans, and airborne microorganisms in horse stables. , 2009, The Annals of occupational hygiene.

[17]  R. Speare,et al.  Musculoskeletal disorders and psychosocial risk factors among veterinarians in Queensland, Australia. , 2009, Australian veterinary journal.

[18]  R. Forster,et al.  Culture-Independent Characterization of Archaeal Biodiversity in Swine Confinement Building Bioaerosols , 2009, Applied and Environmental Microbiology.

[19]  D. Christiani,et al.  Questionnaire assessment of airway disease symptoms in equine barn personnel. , 2009, Occupational medicine.

[20]  R. Speare,et al.  Hand dermatitis among veterinarians from Queensland, Australia , 2009, Contact dermatitis.

[21]  G. Gray,et al.  A review of published reports regarding zoonotic pathogen infection in veterinarians. , 2009, Journal of the American Veterinary Medical Association.

[22]  J. Jang,et al.  Allergic rhinitis in laboratory animal workers and its risk factors. , 2009, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[23]  G. D'Amato,et al.  Horse allergens: An underestimated risk for allergic sensitization in an urban atopic population without occupational exposure. , 2009, Respiratory medicine.

[24]  R. Berkelman,et al.  Seroepidemiologic and occupational risk survey for Coxiella burnetii antibodies among US veterinarians. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[25]  L. Day,et al.  Injuries to Australian veterinarians working with horses , 2009, Veterinary Record.

[26]  D. Heederik,et al.  Exhaled nitric oxide in endotoxin-exposed adults: effect modification by smoking and atopy , 2008, Occupational and Environmental Medicine.

[27]  H. van Loveren,et al.  Prevention of work‐related airway allergies; summary of the advice from the Health Council of the Netherlands , 2008, Allergy.

[28]  J. Douwes,et al.  Farm exposure in utero may protect against asthma, hay fever and eczema , 2008, European Respiratory Journal.

[29]  J. Weese,et al.  Needlestick injuries in veterinary medicine. , 2008, The Canadian veterinary journal = La revue veterinaire canadienne.

[30]  B. Brunekreef,et al.  Domestic cat allergen and allergic sensitisation in young children. , 2008, International journal of hygiene and environmental health.

[31]  D. Heederik,et al.  Exposure–response analysis of allergy and respiratory symptoms in endotoxin-exposed adults , 2008, European Respiratory Journal.

[32]  L. Gygax,et al.  Bite and kick injuries in horses: prevalence, risk factors and prevention. , 2008, Equine veterinary journal.

[33]  T. Brüning,et al.  Health effects due to endotoxin inhalation (review) , 2008, Archives of Toxicology.

[34]  R. Forster,et al.  Culture-independent approach of the bacterial bioaerosol diversity in the standard swine confinement buildings, and assessment of the seasonal effect. , 2008, Environmental microbiology.

[35]  P O Droz,et al.  Effects of bioaerosol exposure on work-related symptoms among Swiss sawmill workers , 2008, International archives of occupational and environmental health.

[36]  L. Elfman,et al.  Detection of Horse Allergen around a Stable , 2007, International Archives of Allergy and Immunology.

[37]  H. Bickeböller,et al.  German cattle allergy study (CAS): public health relevance of cattle-allergic farmers , 2007, International archives of occupational and environmental health.

[38]  J. Dalphin,et al.  Twelve-year longitudinal study of respiratory status in dairy farmers , 2007, European Respiratory Journal.

[39]  A. Capuano,et al.  Infection due to 3 avian influenza subtypes in United States veterinarians. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[40]  D. Houitte,et al.  The major horse allergen Equ c 1 contains one immunodominant region of T cell epitopes , 2007, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[41]  A. Krakowiak,et al.  Risk factors associated with airway allergic diseases from exposure to laboratory animal allergens among veterinarians , 2007, International archives of occupational and environmental health.

[42]  DM Bulcke,et al.  Hand and forearm dermatoses among veterinarians , 2007, Journal of the European Academy of Dermatology and Venereology : JEADV.

[43]  J. Lipozenčić,et al.  Allergic contact dermatitis to cow’s hair , 2007, Contact dermatitis.

[44]  J. Lawson,et al.  Three new cases of apparent occupational asthma in swine confinement facility employees , 2006, European Respiratory Journal.

[45]  W. Melchers,et al.  Methicillin-resistant Staphylococcus aureus in Veterinary Doctors and Students, the Netherlands , 2006, Emerging infectious diseases.

[46]  H. Zeller,et al.  Zoonotic infections among veterinarians in Turkey: Crimean-Congo hemorrhagic fever and beyond. , 2006, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[47]  J. Douwes,et al.  Hay fever and asthma symptoms in conventional and organic farmers in The Netherlands , 2006, Occupational and Environmental Medicine.

[48]  C. Vandenbroucke-Grauls,et al.  [Methicillin-resistant Staphylococcus aureus in pig breeders and cattle breeders]. , 2006, Nederlands tijdschrift voor geneeskunde.

[49]  L. Day,et al.  Injury in Australian veterinarians. , 2006, Occupational medicine.

[50]  E. von Mutius,et al.  The many faces of the hygiene hypothesis. , 2006, The Journal of allergy and clinical immunology.

[51]  D. Nowak,et al.  Inverse association between farm animal contact and respiratory allergies in adulthood: protection, underreporting or selection? , 2006, Allergy.

[52]  S. Ray,et al.  Emergence of Community-Acquired Methicillin-Resistant Staphylococcus aureus USA 300 Clone as the Predominant Cause of Skin and Soft-Tissue Infections , 2006, Annals of Internal Medicine.

[53]  R. Rylander,et al.  Airways inflammation among workers in poultry houses , 2006, International archives of occupational and environmental health.

[54]  Suzanne Spaan,et al.  Exposure to inhalable dust and endotoxins in agricultural industries. , 2006, Journal of environmental monitoring : JEM.

[55]  D. Heederik,et al.  Agricultural seed dust as a potential cause of organic dust toxic syndrome , 2005, Occupational and Environmental Medicine.

[56]  Mark E.J. Woolhouse,et al.  Host Range and Emerging and Reemerging Pathogens , 2005, Emerging infectious diseases.

[57]  B. Markey,et al.  Methicillin-resistant Staphylococcus aureus (MRSA) isolated from animals and veterinary personnel in Ireland. , 2005, Veterinary microbiology.

[58]  J. Pekkanen,et al.  Effect of farming environment on sensitisation to allergens continues after childhood , 2005, Occupational and Environmental Medicine.

[59]  A. Renström,et al.  Human hair is a potential source of cat allergen contamination of ambient air , 2005, Allergy.

[60]  D. Nowak,et al.  Concentrations of dust, allergens and endotoxin in stables, living rooms and mattresses from cattle farmers in southern Bavaria. , 2005, Annals of agricultural and environmental medicine : AAEM.

[61]  D Norbäck,et al.  Current asthma and respiratory symptoms among pupils in relation to dietary factors and allergens in the school environment. , 2005, Indoor air.

[62]  J. Douwes.  (1→3)‐β‐D‐glucans and respiratory health: a review of the scientific evidence , 2005 .

[63]  L. Portengen,et al.  Endotoxin exposure and atopic sensitization in adult pig farmers. , 2005, The Journal of allergy and clinical immunology.

[64]  A. Seidler,et al.  Work-related accidents and occupational diseases in veterinarians and their staff , 2005, International archives of occupational and environmental health.

[65]  Kelley J Donham,et al.  Respiratory symptoms and airway obstruction in swine veterinarians: a persistent problem. , 2004, American journal of industrial medicine.

[66]  R. Dahl,et al.  Exposure to work-related levels of swine dust up-regulates CD106 on human alveolar macrophages. , 2004, American journal of industrial medicine.

[67]  J. Lawson,et al.  Occupational asthma in newly employed workers in intensive swine confinement facilities , 2004, European Respiratory Journal.

[68]  H. Wichmann,et al.  Exposure to house dust endotoxin and allergic sensitization in adults , 2004 .

[69]  G. Diette,et al.  Mouse allergen exposure and immunologic responses: IgE-mediated mouse sensitization and mouse specific IgG and IgG4 levels. , 2004, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[70]  J. Weese,et al.  Isolation of methicillin-resistant Staphylococcus aureus from the environment in a veterinary teaching hospital. , 2004, Journal of veterinary internal medicine.

[71]  J. Douwes,et al.  Do farming exposures cause or prevent asthma? Results from a study of adult Norwegian farmers , 2004, Thorax.

[72]  H. Wertheim,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. , 2004, The Journal of hospital infection.

[73]  Sergio Romagnani,et al.  Immunologic influences on allergy and the TH1/TH2 balance. , 2004, The Journal of allergy and clinical immunology.

[74]  A. Osterhaus,et al.  For Personal Use. Only Reproduce with Permission from the Lancet , 2022 .

[75]  J. Dalphin,et al.  Respiratory status in dairy farmers in France; cross sectional and longitudinal analyses , 2003, Occupational and environmental medicine.

[76]  T. Platts-Mills,et al.  Four-year 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. , 2003, The Journal of allergy and clinical immunology.

[77]  H. Wichmann,et al.  Exposure to house dust endotoxin and allergic sensitization in adults. , 2003, Allergy.

[78]  M. Wickman,et al.  Direct and indirect exposure to pets – risk of sensitization and asthma at 4 years in a birth cohort , 2003, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[79]  M. Dosemeci,et al.  Cancer incidence among male Swedish veterinarians and other workers of the veterinary industry: a record-linkage study , 2003, Cancer Causes & Control.

[80]  M. Schenker,et al.  Atopic symptoms among California veterinarians. , 2003, American journal of industrial medicine.

[81]  P. Cullinan,et al.  Estimating the incidence of occupational asthma and rhinitis from laboratory animal allergens in the UK, 1999–2000 , 2003, Occupational and environmental medicine.

[82]  Toni Gladding,et al.  Organic dust exposure and work-related effects among recycling workers. , 2003, American journal of industrial medicine.

[83]  I. Brandslund,et al.  Plasma C3d levels of young farmers correlate with respirable dust exposure levels during normal work in swine confinement buildings. , 2003, Annals of agricultural and environmental medicine : AAEM.

[84]  Frank van Kolfschooten.  Dutch veterinarian becomes first victim of avian influenza , 2003, The Lancet.

[85]  J. Douwes,et al.  Bioaerosol health effects and exposure assessment: progress and prospects. , 2003, The Annals of occupational hygiene.

[86]  T. Platts-Mills,et al.  Different sensitization profile for asthma, rhinitis, and eczema among 7‐8‐year‐old children: Report from the Obstructive Lung Disease in Northern Sweden studies , 2003, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[87]  R. Mäntyjärvi,et al.  Threshold levels of purified natural Bos d 2 for inducing bronchial airway response in asthmatic patients , 2002, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[88]  S. Atiş,et al.  Sensitization to horse hair, symptoms and lung function in grooms , 2002, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[89]  Kjell Larsson,et al.  Airway responses of healthy farmers and nonfarmers to exposure in a swine confinement building. , 2002, Scandinavian journal of work, environment & health.

[90]  L. Palmberg,et al.  Airways inflammation after exposure in a swine confinement building during cleaning procedure. , 2002, American journal of industrial medicine.

[91]  T. Sigsgaard,et al.  Low prevalence of atopy in young Danish farmers and farming students born and raised on a farm , 2002, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[92]  S. Gerberich,et al.  Risk Factors for Injury among Veterinarians , 2002, Epidemiology.

[93]  D. Jarvis,et al.  Does living on a farm during childhood protect against asthma, allergic rhinitis, and atopy in adulthood? , 2001, American journal of respiratory and critical care medicine.

[94]  Dennis Nowak,et al.  Exposure to farming in early life and development of asthma and allergy: a cross-sectional survey , 2001, The Lancet.

[95]  J. Dalphin,et al.  Hypersensitivity pneumonitis: current concepts. , 2001, The European respiratory journal. Supplement.

[96]  M. Schenker,et al.  Self-reported hand dermatitis in California veterinarians. , 2001, American journal of contact dermatitis : official journal of the American Contact Dermatitis Society.

[97]  B. Danuser,et al.  Respiratory symptoms in European animal farmers. , 2001, The European respiratory journal.

[98]  G. Marks,et al.  Having lived on a farm and protection against allergic diseases in Australia , 2001, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[99]  M. Chapman,et al.  The role and remediation of animal allergens in allergic diseases. , 2001, The Journal of allergy and clinical immunology.

[100]  N. Pearce,et al.  Work-related respiratory symptoms in New Zealand farmers. , 2001, American journal of industrial medicine.

[101]  H. Chung,et al.  Exposure of Workers to Airborne Microorganisms in Open-Air Swine Houses , 2001, Applied and Environmental Microbiology.

[102]  E. Tovey,et al.  Exposure to mite and cat allergens on a range of clothing items at home and the transfer of cat allergen in the workplace. , 2000, The Journal of allergy and clinical immunology.

[103]  J. Jeyaretnam,et al.  Physical, chemical and biological hazards in veterinary practice. , 2000, Australian veterinary journal.

[104]  B. Brunekreef,et al.  (1 → 3)- β -d-Glucan and Endotoxin in House Dust and Peak Flow Variability in Children , 2000 .

[105]  J. Jeyaretnam,et al.  Disease and injury among veterinarians. , 2000, Australian veterinary journal.

[106]  A. Hocking,et al.  Effects of personal exposures on pulmonary function and work-related symptoms among sawmill workers. , 2000, The Annals of occupational hygiene.

[107]  J. Douwes,et al.  Upper airway inflammation assessed by nasal lavage in compost workers: A relation with bio-aerosol exposure. , 2000, American journal of industrial medicine.

[108]  K. Kurppa,et al.  Incidence of occupational asthma by occupation and industry in Finland. , 2000, American journal of industrial medicine.

[109]  L. Fritschi.  Cancer in veterinarians , 2000, Occupational and environmental medicine.

[110]  H. Folgering,et al.  Longitudinal changes in bronchial responsiveness associated with swine confinement dust exposure. , 2000, Chest.

[111]  S. Reynolds,et al.  Dose-response relationships between occupational aerosol exposures and cross-shift declines of lung function in poultry workers: recommendations for exposure limits. , 2000, Journal of occupational and environmental medicine.

[112]  E. Mutius,et al.  Reduced risk of hay fever and asthma among children of farmers , 2000, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[113]  T. Sigsgaard,et al.  IgE antibodies to cow allergens and respiratory health in dairy farmers in Denmark and the Netherlands , 1999 .

[114]  M. Wickman,et al.  School as a risk environment for children allergic to cats and a site for transfer of cat allergen to homes. , 1999, The Journal of allergy and clinical immunology.

[115]  P. Cullinan,et al.  Allergen exposure, atopy and smoking as determinants of allergy to rats in a cohort of laboratory employees. , 1999, The European respiratory journal.

[116]  Ronald N. Jones,et al.  Methicillin-Resistant Staphylococcus aureus Outbreak in a Veterinary Teaching Hospital: Potential Human-to-Animal Transmission , 1999, Journal of Clinical Microbiology.

[117]  H. Folgering,et al.  Organic dust toxic syndrome in swine confinement farming. , 1999, American journal of industrial medicine.

[118]  K. Venables,et al.  Exposure-response relationships for work-related sensitization in workers exposed to rat urinary allergens: results from a pooled study. , 1999, The Journal of allergy and clinical immunology.

[119]  Seward Jp.  Occupational allergy to animals. , 1999 .

[120]  C. Pickering,et al.  Comparative personal exposures to organic dusts and endotoxin. , 1999, The Annals of occupational hygiene.

[121]  Johansson,et al.  Increasing prevalence of asthma over 12 years among dairy farmers on Gotland, Sweden: storage mites remain dominant allergens , 1999, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[122]  J. Dalphin,et al.  [Respective influence of occupational and personal factors on respiratory function in dairy farmers]. , 1998, Revue des maladies respiratoires.

[123]  Langley Rl,et al.  OCCUPATIONAL INJURIES AND ILLNESSES REPORTED BY ZOO VETERINARIANS IN THE UNITED STATES , 1998 .

[124]  A. Senthilselvan,et al.  Predictors of longitudinal changes in pulmonary function among swine confinement workers. , 1998, Canadian respiratory journal.

[125]  J. Dalphin,et al.  Prevalence of asthma and respiratory symptoms in dairy farmers in the French province of the Doubs. , 1998, American journal of respiratory and critical care medicine.

[126]  R. Laatikainen,et al.  A bovine dander allergen, comparative modeling, and similarities and differences in folding with related proteins , 1998, Journal of protein chemistry.

[127]  R. Rylander,et al.  Airways inflammation and glucan in a rowhouse area. , 1998, American journal of respiratory and critical care medicine.

[128]  P. Siegel,et al.  Organic dust exposures from work in dairy barns. , 1998, American Industrial Hygiene Association journal.

[129]  J. Dalphin,et al.  Six year longitudinal study of respiratory function in dairy farmers in the Doubs province. , 1998, The European respiratory journal.

[130]  D. Heederik,et al.  Decline in lung function related to exposure and selection processes among workers in the grain processing and animal feed industry. , 1998, Occupational and environmental medicine.

[131]  A. Woodcock,et al.  Distribution, aerodynamic characteristics, and removal of the major cat allergen Fel d 1 in British homes. , 1998, Thorax.

[132]  J. Dalphin,et al.  Longitudinal study of respiratory health in dairy farmers: influence of artificial barn fodder drying. , 1997, The European respiratory journal.

[133]  H. Auer,et al.  Prevalence of swine influenza and other viral, bacterial, and parasitic zoonoses in veterinarians. , 1997, The Journal of infectious diseases.

[134]  H Kruize,et al.  Respiratory allergy in laboratory animal workers: a retrospective cohort study using pre-employment screening data. , 1997, Occupational and environmental medicine.

[135]  David L. Williams.  Overview of (1→3)-β-D-glucan immunobiology , 1997, Mediators of inflammation.

[136]  L. Palmberg,et al.  Effect of exposure to swine dust on levels of IL-8 in airway lavage fluid. , 1997, Thorax.

[137]  G. Doekes,et al.  Respiratory allergy to rats: exposure-response relationships in laboratory animal workers. , 1997, American journal of respiratory and critical care medicine.

[138]  M. Tielen,et al.  Veterinary practice and occupational health , 1996 .

[139]  A. Woodcock,et al.  Domestic allergens in public places II: dog (Can f 1) and cockroach (Bla g 2) allergens in dust and mite, cat, dog and cockroach allergens in the air in public buildings , 1996, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[140]  G. Doekes,et al.  Cat and dog allergy and total IgE as risk factors of laboratory animal allergy. , 1996, The Journal of allergy and clinical immunology.

[141]  R. Einarsson,et al.  Allergens of horse dander: comparison among breeds and individual animals by immunoblotting. , 1996, The Journal of allergy and clinical immunology.

[142]  L. Preller,et al.  Prevalence of self-reported respiratory disease symptoms among veterinarians in the Southern Netherlands. , 1996, American journal of industrial medicine.

[143]  L. Boscato,et al.  Allergy to laboratory animals among animal handlers , 1995, The Medical journal of Australia.

[144]  H. Kromhout,et al.  Determinants of dust and endotoxin exposure of pig farmers: development of a control strategy using empirical modelling. , 1995, The Annals of occupational hygiene.

[145]  D. Schwartz,et al.  The role of endotoxin in grain dust-induced lung disease. , 1995, American journal of respiratory and critical care medicine.

[146]  A. Castells,et al.  Occupational protein contact dermatitis in a veterinary surgeon , 1995, Contact dermatitis.

[147]  L. Hansson,et al.  Swine dust causes intense airways inflammation in healthy subjects. , 1994, American journal of respiratory and critical care medicine.

[148]  P. Cullinan,et al.  Work related symptoms, sensitisation, and estimated exposure in workers not previously exposed to laboratory rats. , 1994, Occupational and environmental medicine.

[149]  T. Smid,et al.  Dust- and endotoxin-related acute lung function changes and work-related symptoms in workers in the animal feed industry. , 1994, American journal of industrial medicine.

[150]  R. Rylander,et al.  Pulmonary inflammation induced by repeated inhalations of beta(1,3)-D-glucan and endotoxin. , 1994, International journal of experimental pathology.

[151]  D. Choudat,et al.  Respiratory symptoms and bronchial reactivity among pig and dairy farmers. , 1994, Scandinavian journal of work, environment & health.

[152]  M. Chan-yeung,et al.  Aetiological agents in occupational asthma. , 1994, The European respiratory journal.

[153]  B. David,et al.  Hydrophobic interaction chromatography for isolation and purification of Equ.cl, the horse major allergen. , 1993, Journal of chromatography.

[154]  R. Wood,et al.  The aerodynamic characteristics of cat allergen , 1993, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[155]  A. Åkesson,et al.  A survey of Q-fever in Sweden , 1993, European Journal of Epidemiology.

[156]  R. Kaczmarek,et al.  An overview of occupational hazards among veterinarians, with particular reference to pregnant women. , 1993, American Industrial Hygiene Association journal.

[157]  T. Smid,et al.  Dust- and endotoxin-related respiratory effects in the animal feed industry. , 1992, The American review of respiratory disease.

[158]  C. Yamauchi,et al.  Allergy to laboratory animals: an epidemiological study. , 1992, British journal of industrial medicine.

[159]  R. Mäntyjärvi,et al.  IgG and IgE antibody responses to cow dander and urine in farmers with cow‐induced asthma , 1992, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[160]  M. Chapman,et al.  Airborne dust mite allergens: comparison of group II allergens with group I mite allergen and cat-allergen Fel d I. , 1991, The Journal of allergy and clinical immunology.

[161]  F. Davidoff,et al.  Occupational and environmental medicine. Meeting the growing need for clinical services. , 1991, The New England journal of medicine.

[162]  L. Boulet,et al.  Respiratory health of workers exposed to swine confinement buildings only or to both swine confinement buildings and dairy barns. , 1991, Scandinavian journal of work, environment & health.

[163]  A. Blair,et al.  Cancer among farmers. , 1991, Occupational medicine.

[164]  S. Hunskaar,et al.  Allergy to laboratory mice and rats: a review of the pathophysiology, epidemiology and clinical aspects , 1990, Laboratory animals.

[165]  M. Chapman,et al.  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. , 1990, The American review of respiratory disease.

[166]  R Rylander,et al.  Environmental and health studies of farm workers in Swedish swine confinement buildings. , 1989, British journal of industrial medicine.

[167]  R D Tee,et al.  Smoking, atopy, and laboratory animal allergy. , 1988, British journal of industrial medicine.

[168]  J L Hankinson,et al.  Inhaled endotoxin and decreased spirometric values. An exposure-response relation for cotton dust. , 1987, The New England journal of medicine.

[169]  J. Landercasper,et al.  Trauma and the veterinarian. , 1987, The Journal of trauma.

[170]  D. Zimmerman,et al.  Allergy and pulmonary impairment in Iowa veterinarians. , 1987, New England and regional allergy proceedings.

[171]  H. Valkenburg,et al.  Q fever in the Netherlands: a sero-epidemiological survey among human population groups from 1968 to 1983 , 1987, Epidemiology and Infection.

[172]  A. Mazar,et al.  Respiratory disease in animal house workers. , 1986, European journal of respiratory diseases.

[173]  S. Skerfving,et al.  Allergy to laboratory animals in laboratory technicians and animal keepers. , 1986, British journal of industrial medicine.

[174]  K. Wiklund,et al.  Cancer among farmers. A review. , 1985, Scandinavian journal of work, environment & health.

[175]  A. Mazar,et al.  Occupational respiratory disease in veterinarians. , 1985, Annals of allergy.

[176]  R. Rylander,et al.  Endotoxin in cotton dust and respiratory function decrement among cotton workers in an experimental cardroom. , 1985, The American review of respiratory disease.

[177]  K. Husman,et al.  Allergy to Storage Mites or Cow Dander as a Cause of Rhinitis among Finnish Dairy Farmers , 1985, Allergy.

[178]  R Rylander,et al.  Exposure to cotton dust in an experimental cardroom. , 1984, British journal of industrial medicine.

[179]  A. Groot,et al.  Laboratory animal allergy , 1984 .

[180]  K. Donham,et al.  Respiratory symptoms and lung function among workers in swine confinement buildings: a cross-sectional epidemiological study. , 1984, Archives of environmental health.

[181]  R Rylander,et al.  Airborne bacteria, endotoxin and fungi in dust in poultry and swine confinement buildings. , 1983, American Industrial Hygiene Association journal.

[182]  A. Blair,et al.  Mortality patterns among US veterinarians, 1947-1977: an expanded study. , 1982, International journal of epidemiology.

[183]  P. Prahl.  Allergens in Cow Hair and Dander , 1981, Allergy.

[184]  A. Cockcroft,et al.  ALLERGY IN LABORATORY ANIMAL WORKERS , 1981, The Lancet.

[185]  Wingfield We,et al.  Waste anesthetic gas exposures to veterinarians and animal technicians. , 1981 .

[186]  N. Gross,et al.  Allergy to laboratory animals: epidemiologic, clinical, and physiologic aspects, and a trial of cromolyn in its management. , 1980, The Journal of allergy and clinical immunology.

[187]  A. Blair,et al.  Cancer and other causes of death among U.S. veterinarians, 1966–1977 , 1980, International journal of cancer.

[188]  N. Hjorth,et al.  Allergic contact dermatitis in veterinary surgeons , 1980, Contact dermatitis.

[189]  L. E. Hanson,et al.  Infections with Erysipelothrix, Leptospira, and Chlamydia in Illinois veterinarians. , 1978, International journal of zoonoses.

[190]  Martin Rj,et al.  Infections with Erysipelothrix, Leptospira, and Chlamydia in Illinois veterinarians. , 1978 .

[191]  K J Donham,et al.  Potential health hazards to agricultural workers in swine confinement buildings. , 1977, Journal of occupational medicine. : official publication of the Industrial Medical Association.

[192]  F. Frye,et al.  Toxicities and Hazards for Clinicians in Small Animal Practice , 1975 .

[193]  M. Cyprowski,et al.  [Exposure to bioaerosols among CAFO workers (swine feeding)]. , 2010, Medycyna pracy.

[194]  J. Macan,et al.  Exposure to poultry dust and health effects in poultry workers: impact of mould and mite allergens , 2010, International archives of occupational and environmental health.

[195]  Occupational asthma a risk for veterinarians. , 2008, Journal of the American Veterinary Medical Association.

[196]  E. Dorko,et al.  Seroprevalence of antibodies to Coxiella burnetii among employees of the Veterinary University in Kosice, eastern Slovakia. , 2008, Annals of agricultural and environmental medicine : AAEM.

[197]  D. Nowak,et al.  Endotoxin concentration in modern animal houses in southern Bavaria. , 2007, Annals of agricultural and environmental medicine : AAEM.

[198]  Suzanne Spaan,et al.  Overview of personal occupational exposure levels to inhalable dust, endotoxin, beta(1-->3)-glucan and fungal extracellular polysaccharides in the waste management chain. , 2006, The Annals of occupational hygiene.

[199]  E. Thacker,et al.  Are swine workers in the United States at increased risk of infection with zoonotic influenza virus? , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[200]  J. Douwes.  (1-->3)-Beta-D-glucans and respiratory health: a review of the scientific evidence. , 2005, Indoor air.

[201]  R. Rylander,et al.  Acute pulmonary toxicity of inhaledβ-1,3-glucan and endotoxin , 2005, Agents and Actions.

[202]  T. Komiya,et al.  A seroepidemiological study of the risks of Q fever infection in Japanese veterinarians , 2004, European Journal of Epidemiology.

[203]  Frank van Kolfschooten.  Dutch veterinarian becomes first victim of avian influenza. , 2003, Lancet.

[204]  J. Childs,et al.  Q fever in humans and animals in the United States. , 2002, Vector borne and zoonotic diseases.

[205]  R. Spiewak.  [Sensitization to cow and pig allergens among farmers in Eastern Poland]. , 2001, Medycyna pracy.

[206]  D. J. Harrison.  Controlling exposure to laboratory animal allergens. , 2001, ILAR journal.

[207]  B. Brunekreef,et al.  (1-->3)-beta-D-glucan and endotoxin in house dust and peak flow variability in children. , 2000, American journal of respiratory and critical care medicine.

[208]  Y. Cormier,et al.  Influence of building maintenance, environmental factors, and seasons on airborne contaminants of swine confinement buildings. , 2000, AIHAJ : a journal for the science of occupational and environmental health and safety.

[209]  I. Wouters.  Endotoxin and beta-(1-->3)-glucan exposure in household waste collectors and compost workers: a relation with upper airway inflammation. , 1999, Schriftenreihe des Vereins fur Wasser-, Boden- und Lufthygiene.

[210]  J. Seward.  Occupational allergy to animals. , 1999, Occupational medicine.

[211]  H. Folgering,et al.  Endotoxin exposure as a major determinant of lung function decline in pig farmers. , 1998, American journal of respiratory and critical care medicine.

[212]  R. Jolie,et al.  Health problems in veterinary students after visiting a commercial swine farm. , 1998, Canadian journal of veterinary research = Revue canadienne de recherche veterinaire.

[213]  R. Langley,et al.  Occupational injuries and illnesses reported by zoo veterinarians in the United States. , 1998, Journal of zoo and wildlife medicine : official publication of the American Association of Zoo Veterinarians.

[214]  A. Woodcock,et al.  Aerodynamic properties of the major dog allergen Can f 1: distribution in homes, concentration, and particle size of allergen in the air. , 1997, American journal of respiratory and critical care medicine.

[215]  M. Tielen,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. , 1996, The Veterinary quarterly.

[216]  J. Milanowski,et al.  [Exposure to organic dust and microorganisms as a factor affecting respiratory function of workers of purebred horse farms]. , 1996, Pneumonologia i alergologia polska.

[217]  L. Fuortes,et al.  Epidemiologic assessment of laboratory animal allergy among university employees. , 1996, American journal of industrial medicine.

[218]  O. Haenen,et al.  Diseases of freshwater fish. , 1996, The Veterinary quarterly.

[219]  J. Beaumont,et al.  Suicide, cancer, and other causes of death among California veterinarians, 1960-1992. , 1995, American journal of industrial medicine.

[220]  D. Schwartz,et al.  Determinants of longitudinal changes in spirometric function among swine confinement operators and farmers. , 1995, American journal of respiratory and critical care medicine.

[221]  J. Dosman,et al.  Respiratory health status in swine producers relates to endotoxin exposure in the presence of low dust levels. , 1994, Journal of occupational medicine. : official publication of the Industrial Medical Association.

[222]  P. Malmberg,et al.  Organic Dust Toxic Syndrome , 1993 .

[223]  R. Rylander,et al.  Acute pulmonary toxicity of inhaled beta-1,3-glucan and endotoxin. , 1992, Agents and actions.

[224]  D. Heederik,et al.  Relationship of airborne endotoxin and bacteria levels in pig farms with the lung function and respiratory symptoms of farmers , 1991, International archives of occupational and environmental health.

[225]  S W Lenhart,et al.  Respiratory symptoms and pulmonary function in chicken catchers in poultry confinement units. , 1991, American journal of industrial medicine.

[226]  S. V. Von Essen,et al.  Organic dust toxic syndrome: an acute febrile reaction to organic dust exposure distinct from hypersensitivity pneumonitis. , 1990, Journal of toxicology. Clinical toxicology.

[227]  K J Donham,et al.  Health effects from work in swine confinement buildings. , 1990, American journal of industrial medicine.

[228]  S. Samuels,et al.  Prevalence of hazardous exposures in veterinary practice. , 1989, American journal of industrial medicine.

[229]  K. Husman,et al.  Sensitization of dairy farmers to bovine antigens and effects of exposure on specific IgG and IgE titers. , 1988, International archives of allergy and applied immunology.

[230]  A. Sass-Kortsak,et al.  Respiratory effects and dust exposures in hog confinement farming. , 1987, American journal of industrial medicine.

[231]  K. Husman,et al.  Atopic sensitization of dairy farmers to work-related and common allergens. , 1987, European journal of respiratory diseases. Supplement.

[232]  M. S. Levine,et al.  Occupational allergy to laboratory animals: an epidemiologic study. , 1986, Journal of occupational medicine. : official publication of the Industrial Medical Association.

[233]  K. Donham,et al.  Characterization of dusts collected from swine confinement buildings. , 1986, American journal of industrial medicine.

[234]  F. Frye,et al.  Toxicities and harzards for clinicians in small animal practice. , 1975, The Veterinary clinics of North America.