Respiratory Health Risks in Hairdressing: A Cross-sectional Study of Occupational Subgroups
Abstract
Occupational exposure in hairdressing is associated with significant respiratory health risks, including impaired lung function and respiratory symptoms. This study aimed to evaluate and compare respiratory symptoms and pulmonary function across subgroups of hairdressers categorized by their specific exposure profiles.
A cross-sectional analysis was conducted involving 152 female hairdressers in Tehran, Iran, who were stratified into four subgroups: (1) individuals with direct exposure to hair dyes, dechlorinating agents, and keratinizing substances; (2) individuals exposed to varnish, acetone, and nail implant materials; (3) individuals exposed to adhesives for hair and eyelash extensions; and (4) individuals with minimal or no direct chemical exposure. Respiratory and nasal symptoms were assessed using the European Community Respiratory Health Survey (ECRHS) III questionnaire. Spirometric measurements, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, and forced expiratory flow at 25–75% of FVC (FEF25–75), were performed to evaluate pulmonary function.
Overall, 42.1% of participants reported respiratory symptoms, with subgroup 1 exhibiting the highest prevalence. Cough (64.3%), wheezing (35.7%), and dyspnea (64.3%) were the most commonly reported symptoms, while 22.4% reported nasal symptoms. Subgroup 1 demonstrated significantly lower pulmonary function indices and a higher prevalence of obstructive lung patterns (40.5%). Bronchodilator responsiveness indicative of asthma was observed in 34.2% of participants.
In conclusion, direct occupational exposure to hairdressing chemicals, particularly hair dyes and bleaching agents, is associated with substantial respiratory impairment. Implementation of regular health surveillance, personal protective equipment, and enhanced workplace ventilation is strongly recommended.
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15. Tsui HC, Ronsmans S, Sadeleer L, et al. Skin exposure contributes to chemical-induced asthma: what is the evidence? A systematic review of animal models. Allergy Asthma Immunol Res. 2020;12(4):579–98.
16. Hiller J, Greiner A, Drexler H. Respiratory afflictions during hairdressing jobs: case history and clinical evaluation of a large symptomatic case series. J Occup Med Toxicol. 2022;17:10.
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20. Espuga M, Muñoz X, Plana E, et al. Prevalence of possible occupational asthma in hairdressers working in hair salons for women. Int Arch Allergy Immunol. 2011;155:379–88.
21. Akpinar-Elci M, Cimrin A, Elci O. Prevalence and risk factors of occupational asthma among hairdressers in Turkey. J Occup Environ Med. 2002;44:585–90.
22. Nemer M, Kristensen P, Nijem K, et al. Lung function and respiratory symptoms among female hairdressers in Palestine: a 5-year prospective study. BMJ Open. 2015;5:e007857.
23. Gupta K, Thapa B, Gupta S, Singh B, Sharma B, Tiwari R, et al. Lung function tests in hairdressers of Gangtok: a cross-sectional study. Indian J Occup Environ Med. 2022;26(2):91–4.
24. Bradshaw L, Harris-Roberts J, Bowen J, Rahman S, Fishwick D. Self-reported work-related symptoms in hairdressers. Occup Med (Lond). 2011;61:328–34.
25. Acevedo-Prado A, Seoane-Pillado T, López-Silvarrey-Varela A, et al. Association of rhinitis with asthma prevalence and severity. Sci Rep. 2022;12:6389.
26. Brożek JL, Bousquet J, Baena-Cagnani CE, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines—2016 revision. J Allergy Clin Immunol. 2017;140(4):950–8.
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28. Karjalainen A, Martikainen R, Klaukka T, et al. Risk of asthma among Finnish patients with occupational asthma. Chest. 2003;123(1):283–8.
29. Gautrin D, Ghezzo H, Infante-Rivard C, et al. Natural history of sensitization, symptoms and diseases in apprentices exposed to laboratory animals. Eur Respir J. 2001;17:904–8.
30. Beach J, Russell K, Blitz S, et al. A systematic review of the diagnosis of occupational asthma. Chest. 2007;131(2):569–78.
31. Rachiotis G, Savani R, Brant A, et al. Outcome of occupational asthma after cessation of exposure: a systematic review. Thorax. 2007;62(2):147–52.
32. Boskabady M, Taheri E, Ahmadi S, Ebrahimi K, et al. Pulmonary function tests and work-related respiratory and allergic symptoms in Iranian bakers. Iran J Allergy Asthma Immunol. 2009;8(2):107–10.
33. Bagheri Hosseinabadi M, Krozhdeh J, Khanjani N, Zamani A, Yazdi Z, Akbari H, et al. Relationship between lung function and flour dust in flour factory workers. J Community Health Res. 2013;2(2):138–46.
34. Soltanzadeh A, Eskandari D, Gholami A, Malakuti J. Respiratory problems caused by occupational exposure to flour dust among flour mill workers in Razavi and South Khorasan provinces. Occup Med Q J. 2012;4(1):73–80.
35. Halvani GH, Ebrahimzade M, Hobobati H. Evaluation of the respiratory symptoms and pulmonary function tests capacities in Yazd tile workers. Occup Med Q J. 2011;3(2):46–53.
36. Taghizadeh S, Moradiniya M. Comparison of respiratory complaints and impaired spirometric pattern between professional hairdresser women and housewives of Bandar Abbas city, southern Iran. J Prev Med. 2016;3(1):52–8.
37. Hashemi N, Boskabady MH, Nazari A. Occupational exposures and obstructive lung disease: a case-control study in hairdressers. Respir Care. 2010;55(7):895–900.
38. European Community Respiratory Health Survey. Questionnaires and protocols [Internet]. Available from: https://www.ecrhs.org/questionnaires-and-protocols
39. Stanojevic S, Kaminsky DA, Miller MR, Thompson B, Culver BH, MacIntyre NR, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022;60(2):2101499.
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2. Helaskoski E, Suojalehto H, Virtanen H, et al. Occupational asthma, rhinitis, and contact urticaria caused by oxidative hair dyes in hairdressers. Ann Allergy Asthma Immunol. 2014;113(1):46–52.
3. Hoy R, Burdon J, Chen L, et al. Work-related asthma: a position paper from the Thoracic Society of Australia and New Zealand and the National Asthma Council Australia. Respirology. 2020;25(11):1183–92.
4. Moscato G, Pignatti P, Yacoub MR, et al. Occupational asthma and occupational rhinitis in hairdressers. Chest. 2005;128(5):3590–8.
5. Foss-Skiftesvik MH, Winther L, Johnsen CR, et al. High occurrence of rhinitis symptoms in hairdressing apprentices. Int Forum Allergy Rhinol. 2017;7(1):43–9.
6. Shendell D, Mapou A, Kelly S. Younger cosmetology workers and environmental and occupational asthma triggers at training sites and in salons. J Asthma Allergy Educ. 2013;4(2):67–70.
7. Heibati B, Jaakkola M, Lajunen T, Ducatman A, Bamshad Z, Eslamizad S, et al. Occupational exposures and respiratory symptoms and lung function among hairdressers in Iran: a cross-sectional study. Int Arch Occup Environ Health. 2021;94(5):877–87.
8. Villalobos V, Rial MJ, Pastor-Vargas C, et al. Occupational asthma and rhinitis due to yellow and red henna in a hairdresser. J Investig Allergol Clin Immunol. 2020;30(2):133–4.
9. Parra FM, Igea JM, Quirce S, et al. Occupational asthma in a hairdresser caused by persulphate salts. Allergy. 1992;47(12):656–60.
10. Schwaiblmair M, Vogelmeier C, Fruhmann G. Occupational asthma in hairdressers: results of inhalation tests with bleaching powder. Int Arch Occup Environ Health. 1997;70:419–23.
11. Ameille J, Pauli G, Calastreng-Crinquand A, et al. Reported incidence of occupational asthma in France, 1996–99: the ONAP programme. Occup Environ Med. 2003;60(4):136–41.
12. Uter W, Johansen JD, Macan J, et al. Diagnostics and prevention of occupational allergy in hairdressers. Curr Allergy Asthma Rep. 2023;23(11):267–75.
13. Tossa P, Bohadana A, Demange V, et al. Early markers of airways inflammation and occupational asthma: rationale, study design and follow-up rates among bakery, pastry and hairdressing apprentices. BMC Public Health. 2009;9(2):113.
14. Diab K, Truedsson L, Albin M, Nielsen J. Persulfate challenge in female hairdressers with nasal hyperreactivity suggests immune cell, but no IgE reaction. Int Arch Occup Environ Health. 2009;82:771–7.
15. Tsui HC, Ronsmans S, Sadeleer L, et al. Skin exposure contributes to chemical-induced asthma: what is the evidence? A systematic review of animal models. Allergy Asthma Immunol Res. 2020;12(4):579–98.
16. Hiller J, Greiner A, Drexler H. Respiratory afflictions during hairdressing jobs: case history and clinical evaluation of a large symptomatic case series. J Occup Med Toxicol. 2022;17:10.
17. Lantto J, Suojalehto H, Lindström I. Long-term outcome of occupational asthma from irritants and low-molecular-weight sensitizers. J Allergy Clin Immunol Pract. 2023;11:1224–32.
18. Yucesoy B, Kaufman KM, Lummus ZL, Johnson VJ, Gautrin D, Cartier A, et al. Genome-wide association study identifies novel loci associated with diisocyanate-induced occupational asthma. Toxicol Sci. 2015;146(1):192–201.
19. Yucesoy B, Kashon MK, Johnson VJ, Lummus ZL, Gautrin D, Cartier A, et al. Genetic variants in TNFα, TGFB1, PTGS1 and PTGS2 genes are associated with diisocyanate-induced asthma. J Immunotoxicol. 2016;13(1):119–26.
20. Espuga M, Muñoz X, Plana E, et al. Prevalence of possible occupational asthma in hairdressers working in hair salons for women. Int Arch Allergy Immunol. 2011;155:379–88.
21. Akpinar-Elci M, Cimrin A, Elci O. Prevalence and risk factors of occupational asthma among hairdressers in Turkey. J Occup Environ Med. 2002;44:585–90.
22. Nemer M, Kristensen P, Nijem K, et al. Lung function and respiratory symptoms among female hairdressers in Palestine: a 5-year prospective study. BMJ Open. 2015;5:e007857.
23. Gupta K, Thapa B, Gupta S, Singh B, Sharma B, Tiwari R, et al. Lung function tests in hairdressers of Gangtok: a cross-sectional study. Indian J Occup Environ Med. 2022;26(2):91–4.
24. Bradshaw L, Harris-Roberts J, Bowen J, Rahman S, Fishwick D. Self-reported work-related symptoms in hairdressers. Occup Med (Lond). 2011;61:328–34.
25. Acevedo-Prado A, Seoane-Pillado T, López-Silvarrey-Varela A, et al. Association of rhinitis with asthma prevalence and severity. Sci Rep. 2022;12:6389.
26. Brożek JL, Bousquet J, Baena-Cagnani CE, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines—2016 revision. J Allergy Clin Immunol. 2017;140(4):950–8.
27. Tohidinik HR, Mallah N, Takkouche B. History of allergic rhinitis and risk of asthma: a systematic review and meta-analysis. World Allergy Organ J. 2019;12(10):100069.
28. Karjalainen A, Martikainen R, Klaukka T, et al. Risk of asthma among Finnish patients with occupational asthma. Chest. 2003;123(1):283–8.
29. Gautrin D, Ghezzo H, Infante-Rivard C, et al. Natural history of sensitization, symptoms and diseases in apprentices exposed to laboratory animals. Eur Respir J. 2001;17:904–8.
30. Beach J, Russell K, Blitz S, et al. A systematic review of the diagnosis of occupational asthma. Chest. 2007;131(2):569–78.
31. Rachiotis G, Savani R, Brant A, et al. Outcome of occupational asthma after cessation of exposure: a systematic review. Thorax. 2007;62(2):147–52.
32. Boskabady M, Taheri E, Ahmadi S, Ebrahimi K, et al. Pulmonary function tests and work-related respiratory and allergic symptoms in Iranian bakers. Iran J Allergy Asthma Immunol. 2009;8(2):107–10.
33. Bagheri Hosseinabadi M, Krozhdeh J, Khanjani N, Zamani A, Yazdi Z, Akbari H, et al. Relationship between lung function and flour dust in flour factory workers. J Community Health Res. 2013;2(2):138–46.
34. Soltanzadeh A, Eskandari D, Gholami A, Malakuti J. Respiratory problems caused by occupational exposure to flour dust among flour mill workers in Razavi and South Khorasan provinces. Occup Med Q J. 2012;4(1):73–80.
35. Halvani GH, Ebrahimzade M, Hobobati H. Evaluation of the respiratory symptoms and pulmonary function tests capacities in Yazd tile workers. Occup Med Q J. 2011;3(2):46–53.
36. Taghizadeh S, Moradiniya M. Comparison of respiratory complaints and impaired spirometric pattern between professional hairdresser women and housewives of Bandar Abbas city, southern Iran. J Prev Med. 2016;3(1):52–8.
37. Hashemi N, Boskabady MH, Nazari A. Occupational exposures and obstructive lung disease: a case-control study in hairdressers. Respir Care. 2010;55(7):895–900.
38. European Community Respiratory Health Survey. Questionnaires and protocols [Internet]. Available from: https://www.ecrhs.org/questionnaires-and-protocols
39. Stanojevic S, Kaminsky DA, Miller MR, Thompson B, Culver BH, MacIntyre NR, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022;60(2):2101499.
40. Ponce MC, Sankari A, Sharma S, Brown T, Collins A, Rodriguez E, et al. Pulmonary function tests. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. [updated 2023 Aug 28; cited 2025 May 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482339.
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| Asthma Hairdressers Lung function tests Occupational exposure Respiratory tract diseases | ||
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How to Cite
1.
Choroom Kheirabadi M, Hesari E, Shariat M, Gharagozlou M. Respiratory Health Risks in Hairdressing: A Cross-sectional Study of Occupational Subgroups. Iran J Allergy Asthma Immunol. 2025;:1-12.
