In what unit Authors expressed Ig-A and Nasal Mucociliary clearance time

values?  Do the Authors measured Ig-A protein expression or gene expression ?

In should be clearly wrote in manuscript.

Author should add more discussion and the preference of this article

Comparison of Immunoglobulin A Level and

Nasal Mucociliary Clearance Times in Textile Industry
Workers Exposed by Occupational Air Pollutant

Abstract

Background : The number of cases of occupational diseases in Indonesia was 40,694 cases
in 2014, with the highest percentage being respiratory system diseases. Textile factory
workers are exposed to volatile organic compounds (VOC) while working, thus increasing
the risk of disruption to the respiratory system. This study is centerd on effect of VOC
exposure on immunoglobulin A and nasal mucocilliary transport time. Objectives: To know
if the occupational air pollution affects the increasing of IgA level on nasal wash and
decrease nasal mucocilliary transport time Methods : This study used an analytical
observational design with cross-sectional method. It was conducted on 22 male workers of
garment industry in Bawen, Semarang, Indonesia. Divided into two groups: the dyeing and
non-dyeing area with 11 workers each group. The workers exposed to the occupational air
pollutant for 5 years or more. The aquabidest will be injected to subject’s nosetril using the
20cc spuit. The nasal wash’s sample on the 1.5ml eppendorf tubes will be examined using
ELISA method to determine the IgA level. Nasal mucociliary transport times were measured
using saccharin test. The occupational air pollution indicators will be measured by Envilab
Semarang. Findings : The measurements of direct PM10 and PM2.5 in dyeing and non-
dyeing area were higher than the regulatory limit. The mean IgA level on dyeing and non-
dyeing workers were 59.58±0.91 dan 58.87±0.57, whereas there no significant difference
(p=0.557). The mean nasal mucociliary transport time on dyeing and non-dyeing workers
were 1141.45±368.08 and 1004.64±717.28, whereas there no significant difference
(p=0.148). Conclusion : there were no differences in levels of IgA and nasal mucocilliary
significant time to workers in the area of non-dyeing and dyeing.

Keyword : Textile workers, IgA level, nasal mucociliary transport time

1. Background
Industrial development has a negative impact, such as occupational disease.[1] The
number of cases of occupational disease in Indonesia was 40.694 cases in 2014, [2] the largest
percentage being occupational lung disease.[3] Asthma and COPD became the most frequent
diseases found in textile factory workers.[4] Volatile Organic Compound (VOC) released in
the textile production process can increase the incidence of Sino nasal cancer and
adenocarcinoma in the workplace other than wood dust, and nickel. [5] Workers in dyeing area
are exposed to azo dyes, antraquinon derivatives, CH3COOH, HCOOH, NaOH, H2CO,
NaHS, SO2, dan CO, which make they having very high risk of respiratory inflammation. [6]
Occupational asthma is related to IgA levels in the body.[7]
Immunoglobulin A (IgA) is the main immunoglobulin that works in the mucosal area,
it is often called secretory immunoglobulin A (SIgA).[8] Decreased levels of IgA can increase
the risk of mucosal infection. In sinonasal, decreased levels of IgA cause increased
sensitization of host dust mites (HDM) which causes asthma. [7] In environmental conditions
with high air pollution, it causes a decrease in levels immunoglobulin A.[9]
In addition, air pollution can cause necrosis of epithelial cells of the nasal mucosa and
goblet cell metaplasia that decreased functions of nasal mucociliary transport system. [10],[11]
Nasal mucociliary transport protect the respiratory system from damage by inhaled
substances. When the ciliary movement slows, that increase time of the saccharin test, it
makes the function of cleaning the foreign material ineffective.[12]
Previous research on the effect of work and length of working in wood furniture
found an increase in clearance time for wood furniture employees compared to non-wood
furniture employees. The higher the clearance time is due to the high exposure to wood dust
in furniture factories.[13] Research on nasal mucociliary system is also carried out on general
fuel filling station workers. Based on this research, the cutoff value using the mean time of
clearance from the gas station staff is 1386.5 seconds. [10]
The objective of this study is to know increasing of nasal mucociliary clearance time and
decreasing IgA levels related to exposure to hazardous chemicals that can affect the immune
system of the nasal mucosa of workers.

2. Material and method

2.1 Samples and Variable
This study used analytical observational design with cross sectional method. The study
was conducted at PT Apac Inti Corpora, Bawen. The subjects of this study were 22 male
textile industry workers. Divided into two groups: the dyeing and non-dyeing area with 11 in
each group . Subject were selected according to inclusion and exclusion criteria using a
questioner.
1. Inclusion criteria :
(a) PT. Apac Inti Corpora’s dyeing and non-dyeing male workers
(b) In good condition
(c) Five year or more of service
(d) Signing the informed level
2. Exclusion criteria: history of cardiovascular and autoimmune disease.
Nasal mucociliary transport times were measured using saccharin test. Immunoglobulin A
were measured by nasal wash sample using ELISA method. The ELISA fine test will be
measured by Biomolecular laboratory in University of Muhammadiyah Semarang. The air
pollution indicators used to determine the air quality in PT. Apac Inti Corpora will be
measured by Enviromental Laboratory and Consulting Service Company (Envilab
Semarang). This study has received ethical approval by number 166/EC/KEPK/FK-
UNDIP/V/2019.

2.2 Data Analysis

The data normality test from each group was analysed using the Saphiro-Wilk test. The
Mann-Whitney test was used for the abnormally distributed data. The difference test is
significant if p < 0.05. The data’s correlation test was used the Spearman’s correlation test.
The correlation is significant if p < 0.05.

3. Result
3.1 Characteristic of Research Subject
Table 1. Characteristics of research subject
Characteristic n % Mean ±SD (min-max)
Gender
Male 22 100
-
Female 0 0
Age 22 41.77 ± 5.58 (30-56)
Length of work 22 20.14 ± 4.92 (5-27)
Duration of work
8 hours 22 100 -
Length of work
5 days 3 13.6
5.86 ± 0.35 (5-6)
6 days 19 86.4
Other occupation exposed
by irritant
Yes 0 0
-
No 22 100
Respiratory disorder
Yes 0 -
-
No 22 100
Smoking history
Yes 7 31.8
-
No 15 68.2
3.2 Pollutants Measurement Results
Table 2. Results of measurements of air pollutants
No Regulatory
Parameter Area Test Result Unit Method
. limit
Dyeing <0.0003 IKM-EI-SML-21
1. Sulphur dioxide (SO2) 0.5 ppm
Sizing <0.0001 Spektofotometri
Dyeing <0.0032 IKM-EI-SML-22
2. Nitrogen Dioxide (NO2) 0.2 ppm
Sizing <0.0032 Spektofotometri
Dyeing <0.007 IKM-EI-SML-24
3. Oxidant (O3) 0.08 ppm
Sizing <0.007 Spektofotometri
Dyeing <0.012 IKM-EI-SML-6
4. Hydrogen Sulfide (H2S) 1 ppm
Sizing <0.012 Spektofotometri
Dyeing 0.0001 IKM-EI-SML-23
5. Ammonia (NH3) 25 ppm
Sizing 0.0005 Spektofotometri
Dyeing <1
6. Carbon Monoxide (CO) 25 ppm NIOSH 6604:1996
Sizing <1
Dyeing <0.0003
7. Leed (Pb) 0.05 mg/m3 OSHA ID-121:2002
Sizing <0.0003
Dyeing 5.36
8. Dust 10 mg/m3 SNI 16-7058-2004
Sizing 1.33
Dyeing 64 IKM-EI-SML-28
9. PM10 50 µg/Nm3
Sizing 72 (Particle counter)
Dyeing 34 IKM-EI-SML-28
10. PM2.5 25 µg/Nm3
Sizing 33 (Particle counter)
Dyeing 65.4
11. Noise 85 dBA SNI 7231:2009
Sizing 66.3

3.3 Differences in levels of immunoglobulin A

Figure 1. Boxplot IgA levels groups and non-dyeing dyeing

 Data were different test using Mann-Whitney showed no significant difference in the
levels of IgA in the group of non-dyeing and dyeing (p = 0.577). The average value of IgA
levels in the group of non-dyeing dyeing and there is a difference. The median value at 59.75
dyeing group with the lowest value 57.21 and the highest value 60.61. The median value in
the non-dyeing 59.71, the lowest value 58.71 and the highest value 60.83.

3.4 Difference in Nasal mucocilliary time

Nasal mucocilliary time measurement data normality test showed normal distributed data
on dyeing group p = 0.24. While in the group of non-dyeing is not normally distributed data
obtained with p = 0.001.

The result of this study at PT Apac Inti Corpora, concluded that no significant difference of
IgA level in both areas. Nasal mucocilliary time had increase in both area but no significant
difference.

Figure 2. Boxplot time TMSH groups and non-dyeing dyeing

The data is then performed using a different test Mann-Whitney showed no significant
difference in the nasal mucocilliary time groups and non-dyeing dyeing (p = 0.148).
The average value of nasal mucocilliary time groups and non-dyeing dyeing there is a
difference. The median value of the group in 1245 with dyeing is the lowest value 451 and
the highest value 1595. The median value in the non-dyeing is 715, with the lowest value 451
and the highest value in 2400.
3.5 Analysis of confounding factors

Table 3. Confounding factors

Confounding IgA levels Mucociliary time
p p
Smoking 0.329 0.249
Age 0.112 0.301
Prolonged 0.096 0.262
exposure

Results of correlation test confounding factors using the Spearman rank test, found no
association between smoking history, age, and length of exposure to the levels of IgA and
nasal mucocilliary time.

4. Discussion
The measurement results showed that the concentrations of pollutants SO2, NH3, dust, and
PM2.5 in the area of dyeing higher than non-dyeing area. While the concentration of PM 10 in
the area of higher non-dyeing. The results showed that in the dyeing and non-dyeing area, the
direct PM10 and PM2.5 measurements is above the regulatory limit standard for 24-hour.
The SO2, NO2, O3, H2S, NH3, Dust, CO, Lead, and noise are below the regulatory limit as
shown in Table 2.
Chronic exposure to SO2 can cause a decrease in IgA levels and increased nasal
mucocilliary time. Epithelial layer of the mucous membranes damaged by exposure to SO2
causes IgA secretion into decreased.[14] Improved nasal mucocilliary time on chronic
exposure to SO2 through mucous adhesive enhancement mechanism that causes the cilia
become rigid.[15] Mucous adhesive enhancement mechanisms also occur in chronic exposure
to NH3, dust, and PM.[12],[16] Chronic exposure to NH3 at a concentration of 30 ppm can
increase oxidative stress and lowered immunity, [17] One of which is indicated by a decrease in
IgA levels. It also occurs on exposure to PM 10 at a concentration of 300μg/m 3, and the
concentration of PM2.5 in 116.98μg/m3. [18],[19]
The results showed that workers in the area of dyeing had higher levels of IgA less
than workers in non-dyeing area. Statistical analysis IgA levels did not have significant
difference between workers in the area of dyeing and nondyeing. These results differ from
previous studies that compared the levels of IgA populations exposed to pollution and
exposure to pollution. Earlier studies found a significant reduction in the population exposed
to air pollution.[9]
The difference may be caused by differences in the concentration and composition of
pollutants. In this study, the concentration of pollutants is still below the threshold value.
Pollutant concentrations above the threshold value are more at risk to cause damage to the
respiratory tract.[20] Worker exposure to pollutants outside the plant that can not be rated also
can affect the outcome. The risk of exposure to PM on motorcyclists higher than car drivers.
[21]

At the time of measurement obtained nasal mucocilliary longer time to workers in the
area of dyeing. However, the results of data analysis showed no significant difference. This
result does not correspond with previous studies. In a previous study noted that the higher the
concentration of exposure is proportional to the nasal mucociliary disorders, as indicated by
lengthening the time of nasal mucocilliary. This difference may be caused by differences in
the concentration and composition of pollutants. In this study, the concentration of pollutants
is still below the threshold value.[20] Pollutant concentrations above the threshold. value are
more at risk to cause damage to the respiratory tract.
IgA level and nasal mucocilliary time in this study was not influenced by smoking
history. These results contradict previous studies in Saudi Arabia stating that a history of
smoking can lower levels of IgA.[22] Other studies have also stated that there is a significant
relationship between nasal mucocilliary time with a history of smoking. Smoking leads to a
decrease in mucociliary function characterized by increased nasal mucocilliary time.[23] This
difference results can be affected by smoking intensity and duration of smoking subjects.
Changes in nasal mucociliary transport can occur after smoking for 12 years.[24]
IgA levels in this study were not affected by age. These results contradict previous
studies in Iran which suggested a link between age and IgA levels. IgA levels increased up to
age 60 years, and the decline in the age of 61-70 years. [25] Another study in India stated that
the highest IgA levels are at the age of 51-60 years.[26] Differences in results may be caused
by differences in the samples tested. In a previous study, IgA levels were measured from
saliva fluids, whereas this research IgA levels were measured from the nasal wash
respondents.[27]
Nasal mucocilliary time in this study was not influenced by the age of the subject. The
results of this study are supported by previous studies. Previous research suggested an
increase of nasal mucocilliary time occurs at the age decade 6 th and 7th. This happens because
the incidence of chronic sinusitis, bronchitis, pneumonia, and lung infections increase in the
elderly.[28] Age of subjects in this study were in the age range 37-56 years.
Seeing the results of these studies, it is important to do interventions on factory workers in
the area of dyeing and nondyeing. One intervention that can be done is to advice the use of
masks when direct contact with irritants. The use of masks is expected to prevent further
damage mucociliary that cause interference with mucociliary transport and decreased levels
of IgA

5. Conclussion
Based on the research results can be concluded there were no differences in levels of IgA and
nasal mucocilliary significant time to workers in the area of non-dyeing and dyeing, there is
no decrease in IgA levels, and there is an increased nasal mucocilliary time in both workers
in the area of non-dyeing and dyeing.

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