Latex-fruit syndrome: A study on health care workers allergic to natural rubber latex

J ALLERGY CLIN IMMUNOL VOLUME 109, NUMBER 1

ed. Air samples and powder from the salamis were collected during work hours and cultured. Single colonies ofPenicillium miczynski were isolated. This antigen was used for skin and serologic tests. Twenty-two (75.8%) of the workers had symptoms, cough was the most common. 10% were atopic subjects. Prick test was negative in all the workers while intradermal skin testing was positive in 14 (immediate or delayed reaction), 9 workes had precipitating antibodies against Penicillium miczynski. Two subjects, in acute phase, underwent a complete pulmonary function study, BAL and chest radiographs. All these explorations were normal. Most of the workes in the salami factory had symptoms of ODTS when they "washed" seasoned salamis. The differential diagnosis of this occupational disease includes hypersensitivity pneumonitis, but this disease affects pulmonary function tests and chest x-ray. Hypersensitivity pneumonitis is immunologically mediated and occurs in a small number of exposed workers in contrast with the 75.8% of the symtomatic workers in this study. Aerobiological analyses of the work environment lead to identify Penicillium miczynski as the probable etiological agent of this ODTS. Precipitins and intradermal test may be cosidered as marker of exposure to the antigen. Despite its common occurrence among agricultural workers, ODTS may often be misdiagnosed in other occupational environments as salami factories. Protective measures such as ventilation, wet dust suppression and respirators should be used to prevent or minimize exposure to airbone contaminants at workplace. 8 ~ Respiratory Sensitization to House Fly (Musca Oomestica) ~ll~Jl Allergens in a Farmer

Wolfgang Hemmer*, Heinz Kofler§, Margarete Focke*, Manfred GOtz*, Reinhart Jarisch* *FAZ - Floridsdorf Allergy Center, Vienna, Austria §Allergy Clinic Hall, Hall/Tirol, Austria A 30 year-old female farmer with a long-standing history of grass pollen allergy noticed since two years worsening of rhino-conjunctivitis when entering livestock stables and barns. Allergy retesting revealed sensitization to various pollens but not to animal danders. Common house flies (Musca domestica, MD) occurring on the farm in great quantity were suspected by the farmer herself as the causative agent. Skin prick testing with an alcoholic extract prepared from flies collected in the patient's house was positive in the patient and negative in 4 controls. Experimental RAST (Pharmacia) was class 3 positive. Western blot analysis using aqueous MD extracts revealed IgE antibody binding in the patient to bands of 75, 50, and below 20 kDa. Tropomyosin in the housfly extract (35 kDa) was recognized by a tropomyosin-positive control serum but not by the patient's serum. ELISA inhibition with MD as the solid phase was done using extracts from MD and other Diptera. IgE-binding in the patient was inhibited by 75% by MD and by 44% by the closely related Small house fly (Fannia sp.) but not by extracts from blowfly (Lucilia sp.), Drosophila sp., horsefly (Haematopota pluvialis) and mosquito (Culex pipiens). IgE-binding to the MD tropomyosin in the tropomyosin control serum was inhibited by 60 to 80% by all species. In summary, we describe a rare case of clinically relevant respiratory sensitization to house fly not related to tropomyosin sensitization and with only very limited cross-reactivity with other Diptera species. Airborne allergens from arthropods other than mites and cockroaches may be a poorly recognized source of indoor allergy. 8 ~ Latex-Fruit Syndrome: A Study on Health Care Workers Allergic q,FIU; to Natural Rubber Latex

M Ferndmdez-Nieto, Santiago Quirce, M De Las Heras, Javier Cuesta, A Alemdn, Joaqu(n Sastre Fundaci6n Jim6nez Dfaz, Madrid, Spain We conducted a study on 30 health care workers with latex allergy diagnosed by skin prick test with a non-anunortiated latex extract 100 HEP/ml (ALK-AbeI16, Madrid, Spain). Of these patieo~s, 9 had asthma, 6 rhinoconjunctivitis and 15 contact urticaria frotn l~tex products, mainly latex gloves. The results of inhalation challenge and cutaneous provocation tests with latex gloves confirmed the diagnosis of latex allergy. Skin tests were performed using the "prick by p:ick" method with fresh kiwi, avocado, banana

Abstracts

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and chestnut. Specific IgE against latex and the aforementioned fruits or nuts was determined by the CAP method (Pharmacia, Uppsala, Sweden). A positive skin test to kiwi was observed in 66.6% of the patients and specific IgE to kiwi was confirmed in 13.3% of them. Nine out of the 30 patients (30%) presented with allergic symptoms after kiwi ingestion: 6 had oral allergy syndrome (OAS), 1 urticaria and angioedema, 1 anaphylaxis and 1 epigastralgia and diarrhea. Three patients had never eaten kiwi and the remaining patients tolerated kiwi ingestion without any reaction. A positive skin prick test with avocado was found in 50% of the patients and 20% of them had positive specific IgE to avocado. Seven patients (23.3%) presented with allergic reactions after eating avocado: 5 OAS and 2 urticaria and angioedema. Three patients did not eat avocado. The remaining patients could eat avocado without any ill effect. A positive skin test to banana was observed in 60% of the patients and 16.6% of them had positive specific IgE to this fruit. After banana ingestion, 9 patients (30%) suffered from allergic symptoms: 2 0 A S , 4 urticaria and angioedema and 3 other symptoms. A positive skin test to chestnut was found in 53.3% of the patients and in 10% of them specific IgE was positive. Five patients (16.7%) showed allergic symptoms after eating chestnut: 1 anaphylaxis, 1 OAS, 2 urticaria and angioedema and 1 other symptoms. One patient had never eaten chestnut. The remaining patients tolerated chestnut ingestion. In our study, between 17% and 30% of the latex-allergic health care workers showed allergy symptoms after eating fruits. However, the prevalence of positive skin tests to these fruits ranged between 50 and 67%. The fruits most frequently implicated in the latex-fruit syndrome were kiwi and banana. ' i Individual Latex Allergen Sensitization Profiles in Spina Bifida l ~ / P a t i e n t s and Health Care Workers Using a Panel of Recombinant Latex Allergens Coupled to ImmunoCAP

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Monika Raulf-Heimsoth*, Peter Rozynek*, Maria Lundberg§, Reinhold Cremer~, Silke Maryska*, Thomas Briining*, Hans-Peter Rihs* *Berufsgenossenschaftliches Forschungsinstitut fttr Arbeitsmedizin (BGFA), Bochum, Germany §MIAB, Uppsala, Sweden ¥Children's Hospital, KOln, Germany The determination of the individual response to latex allergens using well-characterized allergens, could be very important for diagnosis but are certainly necessary for successful immunotherapy. One possibility to study the latex allergen sensitization profile is testing with a panel of single recombinant latex allergens coupled to ImmunoCAP (Pharmacia Diagnostics AB). We studied the specific IgE-response of latex-allergic subjects including nine spina bifida patients (SB) (latex specific IgE antibodies, (k82) range from 0.85 to 47.9 kU/L; Mn: 15.6 kU/L) and 40 latex allergic health care workers (HCWs) (latex specific IgE antibodies, (k82) range from 0.4 to >100 kU/L; Mn: 11.85 kU/L; all of them were skin test positive to latex) to the following allergens: rHev b 1, rHev b 3, rHev b 5, rHev b 6.01, rHev b 8 and rHev b 10 using the CAP-FEIA method. The results are summarized in the table. Four out of the 40 sera were negative to all six single recombinant latex allergens. From these data we conclude that rHev b 1 and rI-lev b 3 are major latex allergens (more than 50% positive IgE response) in SB. rHev b 1 is an intermediate (20%-50% positive response) allergen in the HCWs and rHev b 3 is of minor relevance (<20% positive response) in this group, rHev b 5 and rHev b 6.01 are the major latex allergen in HCWs and intermediate allergens for SB. In both groups, rHev b 8 and rHev b 10 are only minor latex allergens. Although the majority of the HCWs responsed to one or more of the recombinant latex allergens for a small group of them the addition of further latex allergen for the complete determination of the latex sensitization profile will be necessary. Profile to Recombinant Latex Allergens

Patients rHevb 1

rHev b 3

rHev b 5

rHevb 6.01 rHevb 8 rHevb 10

SB 9/9 (100%) 7/9 (78%) 3/9 (33%) 4/8 (44%) 0/9 (0%) 0/9 (0%) HCWs 9/40(22.5%) 5/40(12.5%) 27/40(67.5%) 30/40(75%) 2/40(10%) 1/40(2.5%)