Concerns for asthma at pre-placement assessment and health surveillance in platinum refining--a personal approach.

Platinum, a noble metal, is inert in the body and has an important use in medical applications. It is used in autocatalysts to control harmful vehicular emissions and the catalytic effects improve efficiencies of pharmaceutical and petrochemical processes. The refining process involves exposure to halogeno complex salts of platinum which are potent allergens. They induce symptoms typical of a type I allergy, the most significant of which is asthma. Platinum refining not only exposes employees to the risk of sensitization to these salts but also to respiratory irritants. Inhalation of these aggravates pre-existing asthma. The increasing incidence of asthma in the community requires that prospective employees for platinum refining be assessed carefully to establish their respiratory health status in relation to the risk of sensitization or aggravation of pre-existing asthma. Routine medical surveillance has been shown to reduce persistence of asthma in sensitized workers who cease exposure to the platinum salts upon diagnosis. Skin prick test using dilute platinum salt solutions can detect sensitization at an early stage and this has become the mainstay of surveillance programmes as it is objective and reproducible as well as predictive for the development of symptoms when exposure is allowed to continue. Symptoms are not sensitive or specific. Smoking is a significant risk factor.