Spoon the powder … To limit the amount of aerosolized dust, the powder should only be spooned into cups. While this recommendation is in the package insert, most health care workers are unaware of the guideline.
… or pour solvent over powder. Even better, our experiments showed there was less dust produced if the solvent (water or orange juice) was poured slowly over the powder than if the powder was put into solvent.
… or immerse powder in liquid. Alternatively, a device such as a scoop with a lid could be used that would submerge the powder into solution and then release it, creating virtually no dust.
2. Ventilate properly … Respiratory protection must be offered to the preparer and anyone else in the area. One maneuver to prevent exposure to psyllium dust would be to prepare the product in a chemical hood to ventilate dust away from the preparer.
… or use a mask. A simple mask, as is used to prevent the spread of communicable diseases, would offer some protection, though incomplete. The Material Safety Data Sheets for psyllium recommends that personnel wear powered purifying respirators with HEPA (high-efficiency particulate air) filters and Tyvek face seals while cleaning up a psyllium spill. In our query, however, these items were not readily available.
3. Substitute other preparations? A third alternative to prevent psyllium dust exposure would be to use other forms of psyllium, such as granules, capsules, or wafers. The drawback to this alternative, clearly, is greater cost. As already mentioned, the cost of a psyllium product is inversely proportional to the number of antigenic components.
4. Assess risk beforehand. A final means of preventing serious hypersensitivity reactions is to screen staff for their degree of risk: pre-employment screening as well during subsequent review of systems by a physician. Stratify risk based on such factors as history of allergies, atopy or asthma, and frequency of respiratory symptoms, particularly as may be related to work.
5. Consider cross-reactivity. For example, there is evidence that reactivity to psyllium may be seen in those with dust and grass allergies.15
Social history should focus on employment and exposure both at work and at home (eg, those who care for elderly relatives in the home). Smoking status is also important, as cigarette smoke increases the risk of bronchial hyper-responsiveness. Appropriate precautions and warnings could then be offered based on perceived risk.
CORRESPONDENCE
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