Effects of Interventions to Prevent Work-Related Asthma, Allergy, and Other Hypersensitivity Reactions in Norwegian Salmon Industry Workers (SHInE): Protocol for a Pragmatic Allocated Intervention Trial and Related Substudies

Anje Christina Höper, Jorunn Kirkeleit, Marte Renate Thomassen, Kaja Irgens-Hansen, Bjørg Eli Hollund, Carl Fredrik Fagernæs, Sindre Rabben Svedahl, Thor Eirik Eriksen, Miriam Grgic, Berit Elisabeth Bang, Anje Christina Höper, Jorunn Kirkeleit, Marte Renate Thomassen, Kaja Irgens-Hansen, Bjørg Eli Hollund, Carl Fredrik Fagernæs, Sindre Rabben Svedahl, Thor Eirik Eriksen, Miriam Grgic, Berit Elisabeth Bang

Abstract

Background: Workers in the salmon processing industry have an increased risk of developing respiratory diseases and other hypersensitivity responses due to occupational exposure to bioaerosols containing fish proteins and microorganisms, and related allergens. Little is known about effective measures to reduce bioaerosol exposure and about the extent of skin complaints among workers. In addition, while identification of risk factors is a core activity in disease prevention strategies, there is increasing interest in health-promoting factors, which is an understudied area in the salmon processing industry.

Objective: The overall aim of this ongoing study is to generate knowledge that can be used in tailored prevention of development or chronification of respiratory diseases, skin reactions, protein contact dermatitis, and allergy among salmon processing workers. The main objective is to identify effective methods to reduce bioaerosol exposure. Further objectives are to identify and characterize clinically relevant exposure agents, identify determinants of exposure, measure prevalence of work-related symptoms and disease, and identify health-promoting factors of the psychosocial work environment.

Methods: Data are collected during field studies in 9 salmon processing plants along the Norwegian coastline. Data collection comprises exposure measurements, health examinations, and questionnaires. A wide range of laboratory analyses will be used for further analysis and characterization of exposure agents. Suitable statistical analysis will be applied to the various outcomes of this comprehensive study.

Results: Data collection started in September 2021 and was anticipated to be completed by March 2023, but was delayed due to the COVID-19 pandemic. Baseline data from all 9 plants included 673 participants for the health examinations and a total of 869 personal exposure measurements. A total of 740 workers answered the study's main questionnaire on demographics, job characteristics, lifestyle, health, and health-promoting factors. Follow-up data collection is not completed yet.

Conclusions: This study will contribute to filling knowledge gaps concerning salmon workers' work environment. This includes effective workplace measures for bioaerosol exposure reduction, increased knowledge on hypersensitivity, allergy, respiratory and dermal health, as well as health-promoting workplace factors. Together this will give a basis for improving the work environment, preventing occupational health-related diseases, and developing occupational exposure limits, which in turn will benefit employees, employers, occupational health services, researchers, clinicians, decision makers, and other stakeholders.

Trial registration: ClinicalTrials.gov NCT05039229; https://www.clinicaltrials.gov/study/NCT05039229.

International registered report identifier (irrid): DERR1-10.2196/48790.

Keywords: allergy; bioaerosols; exposure-response; health promotion; hypersensitivity; occupational asthma; occupational skin disease; psychosocial work environment; salmon processing industry.

Conflict of interest statement

Conflicts of Interest: None declared.

©Anje Christina Höper, Jorunn Kirkeleit, Marte Renate Thomassen, Kaja Irgens-Hansen, Bjørg Eli Hollund, Carl Fredrik Fagernæs, Sindre Rabben Svedahl, Thor Eirik Eriksen, Miriam Grgic, Berit Elisabeth Bang. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 19.07.2023.

Figures

Figure 1
Figure 1
Overview of the study with its core, the intervention trial (left side), and its substudies (right side), covering the main topics (middle). Change in health-promoting factors are not part of the intervention study. *Cross-shift and cross-week examinations to be carried out with the same individual before and after shift on Monday and after shift on Thursday; **acute questionnaires to be filled out by the same individual before and after their shift, registering possible symptoms before and during their shift, as well as work tasks. PEF: peak expiratory flow; PPE: personal protective equipment.
Figure 2
Figure 2
Overview of the different modes of data collection for both baseline and follow-up visits. Main questionnaires are to be filled out by all available plant staff, whereas exposure measurements and health examinations are restricted in number. All individuals carrying out cross-week exposure measurements on Monday and Thursday also undergo basic health examinations. *These staff carry out cross-shift exposure measurements on Tuesday and Wednesday; they can or cannot undergo basic health examinations.

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