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145 Cytokines enhance epithelial cell (EC) damage caused by rhinovirus
Abstracts
J ALLERGY CLIN IMMUNOL VOLUME 105, NUMBER 1. PART 2
145
Cytokines Enhance Eptihelial Cell (EC) Damage Caused by Rhinovirus DM Galagao, MK Schroth. ED Dick, WW Busse, JE Gem UW Hospital and Clinics, Madison, WI Since the major group rhinovirus (RV) receptor, ICAM-I, is inducible with cytokines that may be present in the allergic airway, we examined the separate and combined effects on RV, TNFa. IFNGg and IL-4 on EC viability in vitro. EC isolated from nasal polyp tissue were incubated withe either serum-free medium. TNFa (100 U/ml), IFNg (IOU/ml) or IL-4 (IOnM). After 24 hours, EC were inoculated with RV49 (106TCID50/ml), a minor group RV which binds to the low density lipoprotein receptor. RV16. Cytokines alone also decreased cell viability to varying degrees. Pre-incubating cells with these cytokines before RV inoculation, however, produced additive epithelial cell damage. Thus patients with pre-existing airway allergic inflammation may develop increased epithelial cell damage following RV infection.
146 Extrinsic Aspergillus Naviof.
Allergic Alveolitis Due to Esparto fumigatus Miguel Hinojosa*, Santiago
Quirce,
MD,
PhD#,
Fibers
Is Caused
by
Teresa Alfaya*. Pilar Javier Gauddf, Anronio
*Allergy Department Ramon y Cajal Hospital Madrid. Spain tPneumology Department% Allergy Department Fundaci6n Jimenez Diaz, Madrid, Spain Esparto fibers may cause hypersensitivity pneumonitis, but the offending agent has not been identified yet. We report two non smoker stucco maker patients, aged 50 and 48, who suffered from recurrent episods of fever, cough, dyspnea and malaise related to the manipulation of esparto in their jobs. Bilateral infiltrates were appreciated on chest radiograph. Aspergillus fumigatus grew in two different samples of esparto. in the two patients. Precipitins to both esparto extract (EE) and Aspergillus fumigatus extract (AFE) were found in the patients sera. Pulmonary provocation tests were performed to each patient with EE and AFE, with a positive clinical response (dyspnea, cough, fever, malaise), physiologic response (decrease > 20% FVC and FEV,) and immunological response (leukocytosis) after 6 hours of the allergenic extract inhalation. Bronchoalveolar lavage after challenge showed marked lymphocitosis and CD4KD8 ratio lower than I. The results of specific IgG determinations and ELISA inhibition assays reflected cross reactivity between EE and AFE. Aspergillus fumigatus was identified as the etiologic agent causing hypersensitivity pneumonitis due to esparto grass fibers.
Sueiro
147
Bendirof
Occupational Asthma Assembly Operator Ruth Bnrranco, riago
Qrrirce,
MD, MD,
Primarily
Caused
by Cyanoacrylate
Victoria Fuentes, MD, Victor Marheu, Pilar Tornero, MD, Manolo Barrio. MD.
PhD,
ML Baeza,
in an MD, San-
MD
Acrylic compounds are widely used in industry and have been shown to give rise, as other low-molecular weight chemicals, to occupational contact and respiratory symptoms. A 24 year-old nonatopic woman was a rubber industry worker. She used cyanoacrylate adhesive in the assembly of windows’ rubber shapes. One year and a half after starting her work she developed daily naso-conjuntival pruritus nasal stuffmess, rhinorrhea and sneezing Three months later nocturnal dry cough. shortness of breath and wheezing appeared. Symptoms became progressively worse during the working week, improved at weekends and disappeared during
949
holidays. Blood analysis and x-ray were normal. Nasal cytology revealed 10% eosinophils. Spirometry was normal and methacholine inhalation test demonstrated bronchial hyperresponsiveness (PC20: 0.27 mg/ml). Skinprick responses to common aeroallergens were negative. Serial monitoring of PEFR improved by 12% and 24% during weekends and vacation days respectively. A single blind inhalation test with cyanoacrylate in a 7 m3 chamber during twenty minutes produced. in 40 minutes. rhinitis and a progressive fall in FEV, that peaked (50%) in four hours. It totally resolved with steroids and bronchodilators in a few hours. Induced sputum samples during the test revealed 70% of eosinophils. No asthmatic reaction occurred after testing with a non-cyanoacrylate glue on a separate control day. She stopped using the adhesive at work and is so far free of symptoms. The patient developed occupational asthma caused by cyanoacrylate with an intense eosinophilic inflammation in the airways. The pathogenic mechanism is currently unknown. 148
Metal Working A Case Series Bernstein*&
Fluid
Associated
Hypersensitivity
Pneumonitls:
James Lockey*f, Andrew Freeman*?. David Douglas Linz*f, Anna Lummus$.$ *Department of
Environmental Health tuniversity of Cincinnati *Department of Internal Medicine SUniversity of Cincinnati Sixteen patients employed in industries with regular exposures to aerosolized metalworking fluids (MWF) were evaluated at our institution and diagnosed with Hypersensitivity Pneumonitis(HP). Water soluble, synthetic MWFs may become contaminated with microorganisms. HP associated with exposure to MWF is believed to be reahed to inhalation of microbial antigens in the aerosolized MWF. The average time the workers were exposed to aerosol&d MWF prior to symptom onset was 3.6 years. The most common symptoms related to workplace MWF exposures. in order of prevalence were dyspnea on exertion, cough, fevers, myalgias, and chills. The mean time from symptoms onset to diagnosis was about 8 months. Eleven of the sixteen workers had been diagnosed with recurrent bronchitis or pneumonia in the months prior to the diagnosis of HP. The diagnosis of hypersensitivity was confirmed with high-resolution computerized axial tomography of the chest, pulmonary function testing, and in some cases with lung biopsy or bronchoscopy with broncho-alveolar lavage. Serum precipitating antibodies are commonly used to assess exposure to thermophilic actinomycetes in Farmer’s Lung, and this test may have similar utility in MWF-associated HP. Samples of the synthetic MWF and two oil-based MWFs from one workplace were cultured. In exposed workers at one plant, precipitating antibodies were detected to Staphylococcus warneri, a Bacillus sp., a Gram + diplococcus, Trichophyton and Chaeromium spp. isoluted from the synthetic MWF and to Acdnomycete, Penicillium, Gliocladium, and Curvularia spp. cultured from the oil-based MWFs. In a second outbreak of MWFassociated HP, workers produced precipitating antibodies to Bacillus spp., Morganella morganii. Agmbacterium tumefaciens. Shewanella putrefaciens, a Gram + coccus, and Fusarimn sp. isolated from the MWF. In the second plant studied, immunoblots of antigen extracts showed that sera from symptomatic workers reacted with antigens present both in microbial isolates and whole metalworking fluid. These cases illustrate most common clinical presentations of workers with MWF-associated Hypersensitivity Pneumonitis, and outlines some of the techniques currently being developed to aid in the diagnosis and to determine the etiologic agents most likely to be responsible for the disease. This disease is probably underdiagnosed in the community and potentially impacts more than one million workers currently exposed to MWFs in the United States.
J ALLERGY CLIN IMMUNOL VOLUME 105, NUMBER 1. PART 2
145
Cytokines Enhance Eptihelial Cell (EC) Damage Caused by Rhinovirus DM Galagao, MK Schroth. ED Dick, WW Busse, JE Gem UW Hospital and Clinics, Madison, WI Since the major group rhinovirus (RV) receptor, ICAM-I, is inducible with cytokines that may be present in the allergic airway, we examined the separate and combined effects on RV, TNFa. IFNGg and IL-4 on EC viability in vitro. EC isolated from nasal polyp tissue were incubated withe either serum-free medium. TNFa (100 U/ml), IFNg (IOU/ml) or IL-4 (IOnM). After 24 hours, EC were inoculated with RV49 (106TCID50/ml), a minor group RV which binds to the low density lipoprotein receptor. RV16. Cytokines alone also decreased cell viability to varying degrees. Pre-incubating cells with these cytokines before RV inoculation, however, produced additive epithelial cell damage. Thus patients with pre-existing airway allergic inflammation may develop increased epithelial cell damage following RV infection.
146 Extrinsic Aspergillus Naviof.
Allergic Alveolitis Due to Esparto fumigatus Miguel Hinojosa*, Santiago
Quirce,
MD,
PhD#,
Fibers
Is Caused
by
Teresa Alfaya*. Pilar Javier Gauddf, Anronio
*Allergy Department Ramon y Cajal Hospital Madrid. Spain tPneumology Department% Allergy Department Fundaci6n Jimenez Diaz, Madrid, Spain Esparto fibers may cause hypersensitivity pneumonitis, but the offending agent has not been identified yet. We report two non smoker stucco maker patients, aged 50 and 48, who suffered from recurrent episods of fever, cough, dyspnea and malaise related to the manipulation of esparto in their jobs. Bilateral infiltrates were appreciated on chest radiograph. Aspergillus fumigatus grew in two different samples of esparto. in the two patients. Precipitins to both esparto extract (EE) and Aspergillus fumigatus extract (AFE) were found in the patients sera. Pulmonary provocation tests were performed to each patient with EE and AFE, with a positive clinical response (dyspnea, cough, fever, malaise), physiologic response (decrease > 20% FVC and FEV,) and immunological response (leukocytosis) after 6 hours of the allergenic extract inhalation. Bronchoalveolar lavage after challenge showed marked lymphocitosis and CD4KD8 ratio lower than I. The results of specific IgG determinations and ELISA inhibition assays reflected cross reactivity between EE and AFE. Aspergillus fumigatus was identified as the etiologic agent causing hypersensitivity pneumonitis due to esparto grass fibers.
Sueiro
147
Bendirof
Occupational Asthma Assembly Operator Ruth Bnrranco, riago
Qrrirce,
MD, MD,
Primarily
Caused
by Cyanoacrylate
Victoria Fuentes, MD, Victor Marheu, Pilar Tornero, MD, Manolo Barrio. MD.
PhD,
ML Baeza,
in an MD, San-
MD
Acrylic compounds are widely used in industry and have been shown to give rise, as other low-molecular weight chemicals, to occupational contact and respiratory symptoms. A 24 year-old nonatopic woman was a rubber industry worker. She used cyanoacrylate adhesive in the assembly of windows’ rubber shapes. One year and a half after starting her work she developed daily naso-conjuntival pruritus nasal stuffmess, rhinorrhea and sneezing Three months later nocturnal dry cough. shortness of breath and wheezing appeared. Symptoms became progressively worse during the working week, improved at weekends and disappeared during
949
holidays. Blood analysis and x-ray were normal. Nasal cytology revealed 10% eosinophils. Spirometry was normal and methacholine inhalation test demonstrated bronchial hyperresponsiveness (PC20: 0.27 mg/ml). Skinprick responses to common aeroallergens were negative. Serial monitoring of PEFR improved by 12% and 24% during weekends and vacation days respectively. A single blind inhalation test with cyanoacrylate in a 7 m3 chamber during twenty minutes produced. in 40 minutes. rhinitis and a progressive fall in FEV, that peaked (50%) in four hours. It totally resolved with steroids and bronchodilators in a few hours. Induced sputum samples during the test revealed 70% of eosinophils. No asthmatic reaction occurred after testing with a non-cyanoacrylate glue on a separate control day. She stopped using the adhesive at work and is so far free of symptoms. The patient developed occupational asthma caused by cyanoacrylate with an intense eosinophilic inflammation in the airways. The pathogenic mechanism is currently unknown. 148
Metal Working A Case Series Bernstein*&
Fluid
Associated
Hypersensitivity
Pneumonitls:
James Lockey*f, Andrew Freeman*?. David Douglas Linz*f, Anna Lummus$.$ *Department of
Environmental Health tuniversity of Cincinnati *Department of Internal Medicine SUniversity of Cincinnati Sixteen patients employed in industries with regular exposures to aerosolized metalworking fluids (MWF) were evaluated at our institution and diagnosed with Hypersensitivity Pneumonitis(HP). Water soluble, synthetic MWFs may become contaminated with microorganisms. HP associated with exposure to MWF is believed to be reahed to inhalation of microbial antigens in the aerosolized MWF. The average time the workers were exposed to aerosol&d MWF prior to symptom onset was 3.6 years. The most common symptoms related to workplace MWF exposures. in order of prevalence were dyspnea on exertion, cough, fevers, myalgias, and chills. The mean time from symptoms onset to diagnosis was about 8 months. Eleven of the sixteen workers had been diagnosed with recurrent bronchitis or pneumonia in the months prior to the diagnosis of HP. The diagnosis of hypersensitivity was confirmed with high-resolution computerized axial tomography of the chest, pulmonary function testing, and in some cases with lung biopsy or bronchoscopy with broncho-alveolar lavage. Serum precipitating antibodies are commonly used to assess exposure to thermophilic actinomycetes in Farmer’s Lung, and this test may have similar utility in MWF-associated HP. Samples of the synthetic MWF and two oil-based MWFs from one workplace were cultured. In exposed workers at one plant, precipitating antibodies were detected to Staphylococcus warneri, a Bacillus sp., a Gram + diplococcus, Trichophyton and Chaeromium spp. isoluted from the synthetic MWF and to Acdnomycete, Penicillium, Gliocladium, and Curvularia spp. cultured from the oil-based MWFs. In a second outbreak of MWFassociated HP, workers produced precipitating antibodies to Bacillus spp., Morganella morganii. Agmbacterium tumefaciens. Shewanella putrefaciens, a Gram + coccus, and Fusarimn sp. isolated from the MWF. In the second plant studied, immunoblots of antigen extracts showed that sera from symptomatic workers reacted with antigens present both in microbial isolates and whole metalworking fluid. These cases illustrate most common clinical presentations of workers with MWF-associated Hypersensitivity Pneumonitis, and outlines some of the techniques currently being developed to aid in the diagnosis and to determine the etiologic agents most likely to be responsible for the disease. This disease is probably underdiagnosed in the community and potentially impacts more than one million workers currently exposed to MWFs in the United States.