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Point-of-Sale Printers May Trigger Asthma

Chemical on receipts, coupons, tickets the likely culprit, report suggests

WEDNESDAY, May 27 (HealthDay News) -- A 62-year-old Spanish woman who for 20 years sold lottery tickets in a kiosk in Madrid developed asthma soon after she started using a point-of-sale terminal to print the winning or losing tickets.

The cause, researchers suggest in the May 28 issue of the New England Journal of Medicine, was exposure to chemicals emitted by the new device.

"These machines are used everywhere, for example, to pay with credit cards in a restaurant or in any shopping center, said Dr. Joaquin Sastre, senior author of the study and a professor at Fundacio Jimenez Diaz Allergy Service in Madrid. These terminals are used everywhere in the world."

The machines print on thermal paper coated with a chemical called N-propyl-acrylamide and acrylate tints. "After performing all tests, we demonstrated that our patient was sensitized, meaning she is allergic to a specific substance, in this case, acrylates contained in the thermal paper," Sastre said.

According to the researchers, acrylates have caused occupational asthma affecting printing-facility employees, among others.

Although the context is new, one expert said, the report is really no different from other reports of chemicals that are known to precipitate asthma.

"This wasn't that surprising to me because chemical irritants are a trigger for asthma," said Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City.

Cases of asthma in printing-facility workers have been documented, Horovitz said, and that "is basically what she was doing."

Also, many people sneeze just when opening the morning newspaper, he said. And certain hobbies, such as developing pictures in a home darkroom or working with ceramics and glazes, can also trigger asthma.

"We know that all these things evaporate and give off chemical irritation and precipitate asthma," Horovitz said.

Though the woman did not smoke, she had experienced coughing, shortness of breath, wheezing and other symptoms typical of asthma for more than two years before visiting the clinic. The problems started within an hour of her arriving at work at the tiny kiosk and vanished on her days off.

On three occasions, the symptoms became so severe that the woman sought emergency treatment.

When the woman was first examined in the clinic, bronchial, breathing and other tests turned up normal. But then the researchers had the woman paint on cardboard for 30 seconds using a special acrylate tint from the lottery company. Very quickly, her airway function decreased by 19 percent, the researchers reported.

Painting for 90 seconds resulted in a 45 percent decrease in her breathing function, although there was no actual asthmatic reaction, the team added.

A week later, she was asked to print tickets on her usual point-of-sale terminal for 90 seconds. Again, a decrease in the same measure of airflow function occurred, this time a drop of 15 percent. Her respiratory function eventually returned to normal.

The woman has now left her long-time job, leaving behind her symptoms, the team said.

"The message for doctors is that in cases of adult asthma in patients working with point-of-sale terminals in close environments (kiosks, closed booths), it is recommended to keep in mind sensitization to acrylates released from thermal paper, Sastre said.

Horovitz said the finding fits the general picture of chemical irritants triggering asthma. But, he added, "if I was printing a large number of winning lottery tickets, I'd be a lot more interested."

More information

The U.S. National Heart, Lung and Blood Institute has more on asthma.

SOURCES: Len Horovitz, M.D., pulmonary specialist, Lenox Hill Hospital, New York City; Joaquin Sastre, M.D., Ph.D., professor, Fundacio Jimenez Diaz Allergy Service, Madrid, Spain; May 28, 2009, New England Journal of Medicine

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