INTRODUCTIONHelicobacter pylori has been recognised as a major cause of gastroduodenal diseases, including gastric and duodenal ulcers with faeco-oral, oro-oral and gastro-oral transmission occurring. With the close personal contact inherent in patient care, health care workers may be at an increased risk of acquiring H. pylori and subsequent development of associated conditions. The objective of this review was to review the transmission and the occupational risk for health care workers.

METHODSA literature search was performed using Pubmed (January 1990 to May 2001). Relevant key words were used and additional manual searches were made using the reference lists from the selected articles to retrieve other papers relevant to the topic.

RESULTSCurrent knowledge implies various pathways of agent transmission, favouring person-to-person mode of transmission early in life. Faeco-oral, oro-oral and gastro-oral transmissions are proposed and may be of different relevance among various populations. As for health care workers, after elimination of the methodological weak studies, the risk seems to be increased in gastroenterologists, endoscopy staff and intensive care nurses. Results in other groups are conflicting.

CONCLUSIONSH. pylori infection is an occupational risk in some groups of health care workers. Studies are needed to elucidate the risk in other occupational groups.

Helicobacter Infections ; epidemiology ; microbiology ; transmission ; Helicobacter pylori ; physiology ; Humans ; Infectious Disease Transmission, Patient-to-Professional ; Medical Staff ; Occupational Diseases ; epidemiology ; microbiology ; Risk Factors

Immunoglobulin E (IgE) can be highly elevated in the airway mucosa independently of IgE serum levels and atopic status. Mostly, systemic markers are assessed to investigate inflammation in airway disease for research or clinical practice. A more accurate but more cumbersome approach to determine inflammation at the target organ would be to evaluate markers locally. We review evidence for local production of IgE in allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps (CRSwNP). Diagnostic and therapeutic consequences in clinical practice are discussed. We describe that the airway mucosa has the intrinsic capability to produce IgE. Moreover, not only do IgE-positive B cells reside within the mucosa, but all tools are present locally for affinity maturation by somatic hypermutation (SHM), clonal expansion, and class switch recombination to IgE. Recognizing local IgE in the absence of systemic IgE has diagnostic and therapeutic consequences. Therefore, we emphasize the importance of local IgE in patients with a history of AR or CRSwNP.
B-Lymphocytes ; Humans ; Immunoglobulin E* ; Immunoglobulins* ; Inflammation ; Mucous Membrane ; Nasal Mucosa* ; Nasal Polyps ; Recombination, Genetic ; Rhinitis