Occupational Exposure and Co-Occurrence of Work-Related Skin and Respiratory Disorder in Cleaner: A Case Report

Main Article Content

Jordan Minov
Jovanka Karadzinska-Bislimovska
Engin Tutkun
Sasho Stoleski
Dragan Mijakoski


BACKGROUND: Despite the connection between skin and respiratory system in occupational disease is growing area of research interest, there is still a limited evidence for the effects of both airborne and skin exposures together with skin and respiratory outcomes.

CASE PRESENTATION: This report describes a 32-years old female with no previous history of atopy, asthma or skin disorders working as an office cleaner for three years. About two years after entering the actual workplace she developed episodic wheezing, shortening of breath and chest tightness. At the same time, she noticed eczematous lesions on the skin of both hands. She reported work-relatedness of both respiratory and skin symptoms, i.e. the symptoms improved during weekends and holidays and worsened when she returned to work. The patient was referred to Institute for Occupational Health of R. Macedonia for assessment of possible occupational asthma (OA) and occupational contact dermatitis (OCD). Diagnosis of asthma was confirmed by standard diagnostic procedure, while the diagnosis of sensitizer-induced OA was established by positive result of serial peak expiratory flow rate (PEFR) measurements at and away from work. Diagnosis of allergic OCD was confirmed by positive patch test to formaldehyde. The management of both diseases included complete removal from the harmful workplace exposure, as well as pharmacological treatment according to the actual recommendations.

CONCLUSIONS: This case report represents a description of a co-occurrence of work-related skin and respiratory symptoms in a female working as an office cleaner. Formaldehyde is found to be a causative factor of allergic OCD, and it also may be a causative factor of sensitive-induced OA in the same patient, but other occupational sensitizers cannot be excluded.


Download data is not yet available.

Plum Analytics

Article Details

How to Cite
Minov J, Karadzinska-Bislimovska J, Tutkun E, Stoleski S, Mijakoski D. Occupational Exposure and Co-Occurrence of Work-Related Skin and Respiratory Disorder in Cleaner: A Case Report. SEE J Immunol [Internet]. 2016 Jan. 8 [cited 2024 May 20];2(1):1-4. Available from: https://seejim.eu/index.php/seejim/article/view/seejim.2016.20006
Clinical Immunology
Author Biography

Jordan Minov, Institute for Occupational Health of Republic of Macedonia - Skopje, WHO Collaborating Center, Ga2len Collaborating Center, Skopje,

Personal data

Date of birth: 9 July 1960

Home address: Vladimir Komarov 16-1/7, 1000 Skopje, R. Macedonia

Office address: Institute of Occupational Health of R. Macedonia - WHOCollaborativeCenter and GA2LEN Collaborative Center, II Makedonska brigada 43, 1000 Skopje, R. Macedonia

Tel: + 389 2 2461 387

Fax: + 389 2 2621 428

E-mail: minovj@hotmail.com


Education and key qualifications

"¢ Specialist in internal medicine

"¢ Specialist in occupational medicine

"¢ Subspecialist in pulmonology and allergology


Present appointment

"¢ Head of the Department for Physiology of Work at the Institute for Occupational Health of R. Macedonia – WHO Collaborative Centre and GA2LEN Collaborative Centre

"¢ Professor at the Medical Faculty, University "St. Cyril and Methodius" Skopje


Scientific field of interest

"¢ Chronic obstructive airway diseases, functional lung diagnostics, occupationally-related respiratory and allergic diseases


Research activities

"¢ Researcher (co-operator) of the long-term scientific project funded by Ministry of Education and Science "Epidemiology of Allergic Rhinitis in the Republic of Macedonia in Correlation with Pollen Microflora" (2001-2003);

"¢ Co-operator of the Regional HESME Workshop "Work-Related Diseases" (June 2003);

"¢ Investigator in a phase III, parallel, comparative, partially blinded, placebo-controlled study on the efficacy and safety of FORMOTEROL SMB AXAHALERR DPI 12 mg and FORADILR AEROLIZERR DPI 12 mg in patients with moderate persistent asthma sponsored by Laboratoires SMB S.A. Belgium (November 2006 – May 2007);

"¢ Investigator in a phase III, randomized, parallel group study on the efficacy and safety of SMB BUDESONIDE-SALMETEROL DPI capsule 150/25μg BID delivered by the AXAHALER® versus SYMBICORT® TURBUHALER® 200/12μg BID in patients with moderate to severe persistent asthma (February 2009-March 2010);

"¢ Researcher in the GA2LEN survey and Survey Follow up Study from the Skopje centre (November 2007 – August 2010);

"¢ Nominated represent by Ministry of Health of R. Macedonia in the activities of the WHO Regional Office for Europe aimed at the development of national programmes for the elimination of asbestos-related diseases (ARDs) (June 2011-to date);

"¢ Member of the Management Committee of the COST Action TDI 1206 Development and Implementation of European Standards on Prevention of Occupational Skin Diseases (StanDerm);    

"¢ Investigator in a HZC113782: A Clinical Outcomes Study to compare the effect of Fluticasone Furoate/Vilanterol Inhalation Powder 100/25mcg with placebo on Survival in Subjects with Moderate Chronic Obstructive Pulmonary Disease (COPD) and a history of or at increased risk for cardiovascular disease (March 2012 – to date).


Member of Editorial Boards

"¢ Member of the Editorial Board of the American Journal of Immunology and Global Journal of Allergy



"¢ Member of the Editorial Board and one of the authors of the monograph "Allergic Diseases in R. Macedonia", ed. V. Cvetanov; Skopje, 2006

"¢ Author of the monograph "Lung and Pleural Diseases Related to Occupational Exposures"; Skopje, 2009

"¢ Author of the monograph "Spirometry"; Skopje 2010

"¢ One of the authors of the monograph "Occupational Medicine", ed. J. Karadzinska-Bislimovska; Skopje 2011

"¢ Author of the monograph "Smoking among Macedonian Workers"; Saarbrí¼cken 2013

"¢ Author and co-author of more than 150 papers published in domestic and international journals



International: European Respiratory Society, EuropeanAcademy of Allergology and Clinical Immunology, World Allergy Organization

National: Macedonian Respiratory Society, Macedonian Society of Basic and Clinical Immunology and Allergology, Macedonian Society of Occupational Medicine Specialists


 Languages spoken: English (fluent), German (less fluent)


Computer Literacy: Good


Moulin P, Magnan A, Lehucher-Michel MP. Occupational allergic contact dermatitis and asthma due to a single low molecular weight agent. J Occup Health. 2009; 51(1):91-96.



Jacobs JH, Meijster T, Meijer E, Suarthana E, Heederik D. Wheat allergen exposure and the prevalence of work-related sensitization and allergy in bakery workers. Allergy. 2008;63(12):1597-604.



Heldal KK, Madso L, Huser PO, Eduard W. Exposure, symptoms, and airway inflammation among sewage workers. Ann Agric Environ Med. 2010;17(2): 263-268.


de Joode Bv, Vermeulen R, Heederik D, van Ginkel K, Kromhout H. Evaluation of 2 self-administered questionnaires to ascertain dermatitis among metal workers and its relation with exposure to metalworking fluids. Contact Dermatitis. 2007;56(6):311-7.



De Raeve H, Vandecasteele C, Demedts M, Nemery B. Dermal and respiratory sensitization to chromate in a cement floorer. Am J Ind Med. 1998;34(2):169-176.


Lynde CB, Obadia M, Liss GM, et al. Cutaneous and respiratory symptoms among professional cleaners. Occup Med. 2009;59(4):249-254.



Bousquet J, Heinzerling L, Bachert C, et al. Practical guide to skin prick tests in allergy to aeroallergens. Allergy. 2012;67:18-24.



Frew AJ. Allergic basis of asthma. Eur Respir Mon. 2003;23(8):74-83.

Sterk PJ, Fabbri LM, Quanjer PhH, et al. Airways Responsiveness. Standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Report Working Party for the Standardization of Lung Function Tests. European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J. 1993;6(16):58-83.

American Thoracic Society. Guidelines for Metacholine and Exercise Challenge Testing -1999. Am Respir Crit Care Med. 2000;161(1):309-329.



Global Initiative for Asthma. Global strategy for asthma management and prevention. NHLBI/WHO Workshop Report 2015. Available at: www.ginasthma.com (Assessed 26.10.2015).

Gannon PFG, Sherwood Burge P. Serial peak expiratory flow measurement in the diagnosis of occupational asthma. Eur Respir J. 1997;10(24):57-63.

Moore VC, Jaakkola MS, Sherwood Burge P. A systematic review of serial peak expiratory flow measurements in the diagnosis of occupational asthma. Annals of Respiratory Medicine. 2010;1:31-44.

Tarlo SM, Balmes J, Balkisson R, et al. Diagnosis and management of work-related asthma. American College of Chest Physicians Consensus Statement. Chest. 2008;134:15-41.



Rietschel RL, Mathias CG, Fowler Jr. JF, et al. Relation of occupation to contact dermatitis: Evaluation of patients tested from 1998 to 2002. Am J Contact Dermat. 2002;13(4):170-176.



Uter W, Ramsch S, Aberer W, et al. The European baseline series in 10 European countries, 2005-2006--Results of the European Surveillance System on Contact Allergens (ESSCA). Contact Derm. 2009;61(1):31-38.



European Society of Contact Dermatitis guideline for diagnostic patch testing. Available at: http://www.escd.org/education/guidelines/ (Assessed 26.10.2016).

Arrandale VH. Occupational exposures and co-occurrence of work-related skin and respiratory symptoms. Available at: https://tspace.library.utoronto.ca/handle/ (Accessed 30.10.2015).

Bernstein IL, Chan-Yeung M, Malo J, Bernstein DI (eds). Asthma in the Workplace. 3rd ed. New York: Taylor and Francis, 2006.


Cleaning agent. Available at: http://www.escd.org/education/guidelines/ (Assessed 27.10.2015).

Formaldehyde. Available at: www.truetest.com (Assessed 27.10.2015).

Mapp CE. Agents, old and new, causing occupational asthma. Occup Environ Med. 2001;58:354-360.


PMid:11303086 PMCid:PMC1740131

Maestrelli P, Saetta M, Mapp CE, et al. Occupational asthma due to low-molecular weight compounds. In: Banks DE, Parker JE, eds. Occupational lung disease: an international perspective. New York: Chapman & Hall Medical, 1998.

Sastre J, Vandenplas O, Park HS. Pathogenesis of occupational asthma. Eur Respi J. 2003;22:551-559.


Wolkoff P, Schneider T, Kildeso J, et al. Risk in cleaning: chemical and physical exposure. The Science of the Total Environment. 1998;215:135-156.


IARC. Wood dust and formaldehyde. Lyon, International Agency for research on Cancer (IARC Monographs on the Evaluation of Carcinogenic Risk on Humans. 1995;62.

Most read articles by the same author(s)