Occupational Asthma without Nonspecific Bronchial Hyperresponsiveness.
(2026) The journal of allergy and clinical immunology. In practice — Vol. 14, n° 6, p. 1342-1350 (2026)
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- The absence of nonspecific bronchial hyperresponsiveness (NSBH) has been documented in a substantial proportion of workers with occupational asthma (OA). We investigated the clinical and inflammatory characteristics associated with the absence of baseline NSBH in a cohort of subjects with OA ascertained by a positive specific inhalation challenge (SIC). A retrospective study was conducted among 1068 subjects who completed an SIC with various occupational agents at three tertiary centers. Among 377 subjects with a positive SIC, 63 (16.7%) did not exhibit baseline NSBH. Upon post-challenge assessment of these 63 subjects, 45 developed NSBH, while 18 still lacked demonstrable NSBH. Multivariate analysis revealed that quiescent asthma -defined by untreated asthma associated with the absence of airway obstruction- was the predominant clinical feature associated with undetectable NSBH at baseline (odds ratio: 3.59, 95% confidence interval: 1.86-6.93). Subjects with and without baseline NSBH exhibited similar rates of post-challenge increases in fractional exhaled nitric oxide ≥13 ppb (47.8% and 43.6%, respectively) and sputum eosinophil count ≥2% (72.2% and 74.2%, respectively). Baseline NSBH assessment identified positive SICs with a substantially lower sensitivity (68%) and negative predictive value (71%) among subjects with quiescent asthma (n=211) than among those (n=857) with active disease (87% and 88%, respectively). The absence of NSBH does not allow OA to be ruled out without further investigation in subjects with quiescent asthma. On the other hand, a negative NSBH test has a high negative predictive value for OA among subjects with active disease.
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Doyen, V., Godet, J., Walusiak-Skorupa, J., Wiszniewska, M., Sastre, J., Valverde-Monge, M., Suojalehto, H., Munoz, X., Romero-Mesones, C., van Kampen, V., Eisenhawer, C., Walters, G., Moore, V., Mason, P., de Blay, F., Quirce, S., Folletti, I., RIFFLART, C., & Vandenplas, O. (2026). Occupational Asthma without Nonspecific Bronchial Hyperresponsiveness. The journal of allergy and clinical immunology. In practice, 14(6), 1342-1350. https://doi.org/10.1016/j.jaip.2026.02.031 (Original work published 2026)