Blood eosinophils and World Trade Center exposure predict surgery in chronic rhinosinusitis: a 13.5-year longitudinal study

Details

• Personal Author:
  Aldrich TK ; Cohen HW ; Hall CB ; Huie M ; Kelly KJ ; Kwon S ; Morrison D ; Nolan A ; Olivieri B ; Prezant DJ ; Putman B ; Schwartz T ; Shohet MR ; Singh A ; Weakley J ; Webber MP ; Weiden MD ; Zeig-Owens R
• Description:
  Rationale: The World Trade Center (WTC) collapse generated caustic airborne particulates that caused chronic rhinosinusitis in exposed Fire Department of New York firefighters. Surgery was performed when symptoms remained uncontrolled despite medical management. Objectives: To identify predictors of surgical intervention for chronic rhinosinusitis in firefighters exposed to airborne irritants at the WTC collapse site. Methods: We assessed in 8,227 firefighters with WTC exposure between September 11, 2001 (9/11), and September 25, 2001, including WTC-site arrival time, months of rescue and recovery work, and eosinophil concentration measured between 9/11 and March 10, 2003. We assessed the association of serum cytokines and immunoglobulins with eosinophil concentration and surgery for rhinosinusitis in 112 surgical cases and 376 control subjects with serum available from the first 6 months after exposure to the WTC collapse site. Measurements and Main Results: Between 9/11 and March 10, 2015, the surgery rate was 0.47 cases per 100 person-years. In the first 18 months post-9/11, surgical patients had higher mean blood eosinophil levels than study cohort patients (219+/-155 vs. 191+/-134; P <0.0001). Increased surgery risk was associated with increasing blood eosinophil counts [hazard ratio (HR) 1.12 per 100 cells/microL; 95% confidence interval (CI) 1.07-1.17; P <0.001]; arriving at the WTC site 9/11 or September 12, 2001 (HR, 1.43; 95% CI, 1.04-1.99; P=0.03); and working 6 months or longer at the WTC site (HR, 1.48; 95% CI, 1.14-1.93; P<0.01). Median blood eosinophil levels for surgical patients were above levels for the cohort in all 18-month intervals March 11, 2000, through March 10, 2015, using 51,163 measurements representing 97,733 person-years of observation. Increasing age, increasing IL-17A, and low IgA in serum from 2001 to 2002 predicted blood eosinophil concentration in surgical patients but not in control subjects (R2=0.26, P<0.0001; vs. R2=0.008, P=0.56). Conclusions: Increasing blood eosinophil concentration predicts surgical intervention for chronic rhinosinusitis, particularly in those with intense acute and prolonged exposure to airborne irritants. WTC-exposed Fire Department of New York firefighters who underwent irritant-associated sinus surgery are immunologically different from the cohort. Surgical patients have a higher blood eosinophil levels that is associated with mediators of mucosal immunity. [Description provided by NIOSH]
• Subjects:
  Air Pollutants, Occupational Blood Delivery Of Health Care Dust Emergencies Emergency Responders Environmental Exposure Firefighters Men Occupational Health Particulate Matter Risk Assessment Risk Factors Safety Women

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• Keywords:
  Airborne Dusts Airborne Particulates Author Keywords: Sinusitis Cell Biology Cell Function Cellular Function Cellular Structures Cohort Studies Cytokines Emergency Responders Emergency Response Eosinophils Exposure Levels Fire Fighters First Responders Health Care Humans Medical Care Otolaryngology Surgery Particulate Matter Rescue Measures Rescue Workers Risk Factors Statistical Analysis

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• ISSN:
  2329-6933
• Document Type:
  Text
• Funding:
  Cooperative Agreement ; Contract
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  13
• Issue:
  8
• NIOSHTIC Number:
  nn:20047916
• Citation:
  Ann Am Thorac Soc 2016 Aug; 13(8):1253-1261
• Contact Point Address:
  Michael D. Weiden, M.D., M.S., Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Environmental Medicine, New York University School of Medicine, Bellevue Hospital, 7N24, 550 First Avenue, New York, NY 10016
• Email:
  michael.weiden@nyumc.org
• Federal Fiscal Year:
  2016
• Performing Organization:
  New York University School of Medicine
• Peer Reviewed:
  True
• Start Date:
  20140701
• Source Full Name:
  Annals of the American Thoracic Society
• End Date:
  20170630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:a37f339e30d90f1e933df61fad3b6f7f946b2049ae7aef3911236f9a2dd32e77d37b56b43c31582fe176b1ee9920cf6e5ef11f419bbff4b72444ba7053460901
• Download URL:
  https://stacks.cdc.gov/view/cdc/202855/cdc_202855_DS1.pdf
• File Type:
  [PDF - 743.41 KB ]