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185. Investigation of coffee worker's asthma with the use of radioallergosorbent test
?
American
AcacIamy of Allergy
20 pg/mI. A singIe dose of theophylline anhydrous (TA) modified EIA significantly. Higher submaximal heart rate (HR) was observed when the subjects were on medication. There were no significant differences in maximal HR. However, the maximal HR with medication was higher than those observed with the control subjects. Theophylline resulted in higher endurance time: peak ventilation, HR, and OZ consumption (qOZ), but not in a statistically significant degree. With the TA the vOZ maximum approached that observed w-ith the control group. No significant electrocardiographic findings were recorded in most of the patients. The results indicate that: (1) The inhibitory effect of TA on EIA obtained during maximal physical effort is similar to that observed during standardized submaximal exercise testing. (2) TA improves some of the cardiorespiratory responses of asthmatic patients to exercise without altering the physical performance above normal levels. (3) The recommended levels of TA are safe for children participating in vigorous athletic events.
parison -asthma
of bronchial provocation and extrinsic allergic
asthrma* F. L. Martinez-Catinchi,
M.D., G. M. Fleming, M.D., H. J. Schwartz, M.D., E. H. Chester, M.D., A A. Gerblich, M.D., and J. Horowitz, Ph.D.# Cleveland, Ohio. Inhalation chaIlenge tests with controlled doses of TDI and methacholine were performed in 18 symptomatic subjects who worked with TDI in the manufacture of plastics, and their responses were compared with those of 5 normal subjects and 5 extrinsic asthmatic patients without occupational TDI exposure. Airway responses to TDI were assessed by plethysmography and spirometry at 0, 15, and 30 min and 1, 2, 3, 4, 5,6, and 24 hr. Inhalation of TDI (0.02 ppm for 20 mm) failed to elicit a change in specific airway resistance (ASRaw 2 50%) in normal or asthmatic subjects. Eight of the TDI workers (group 1) responded to challenge-5 with dual and 3 with late responses-while 10 workers (group 2) had no response. Rechallenge of 5 group 1 workers with a lower dose of TDI (0.005 ppm for 20 mm) elicited a response in 3 of 5. Bronchial reactivity to cumulative doses of methacholine aerosol was increased in 8 of 8 in group 1, 7 of 10 in group 2, and 5 of 5 extrinsic asthmatic patients. The methacholine reactivity of group I, group 2, and asthmatic patients was similar (p = NS); reactivity of group 1 and asthmatic patients was greater than the normal group (p < 0.01). We conclude: (1) Methacholine reactivity is a feature of TDI-asthma but does not predict TDI reactivity in workers or asthmatic patients. (2) The induction of bronchoconstriction at the tested concentrations seem to be a specific phenomenon in some workers and not an irritant event in subjects with hyperreactive airways. (3) The mechanism of TDI bronchial reactivity is different from that of methacholine reactivity.
J. ALLERGY CLN. IMMUNOL, MARCH 1978
185. Investigation of coffee with the use of radioallergo R. M. Karr, M.D., S. B. T. Butcher, Ph.D., and J. E. Salvaggio, New Orleans, La. In a previous report we confirmed the findings of others that coffee workers with job-related allergic symptoms demonstrate positive wheal and flare skin tests with soluble green coffee bean (GCB) and factory dust (FD) antigens. In the present study, we analyzed serum samples from 8 symptomatic coffee workers and 6 matched control subjects for IgE antibodies specific for castor bean (CaB) and GCB antigens using the radioallergosorbent test (RAST). Six of the 8 coffee workers described job-related allergic manifestations (conjunctivitis, rhinitis, urticaria, asthma) and demonstrated positive skin tests to GCB (0.02 ml, 1 wg/ml) and FD (0.02 ml, I pg/ml) antigens. Serum RAST indices ranged from 3 to 15 for GCB and 28 to 60 for CaB antigens. The other 2 coffee workers denied allergic symptoms but described chronic intermittent productive cough and dyspnea. These 2 workers and the 6 control subjects demonstrated negative skin tests with GCB and FD antigens, and serum RAST indices less than 2 for GCB and CaB antigens. RAST inhibition studies indicated that GCB and CaB preparations were antigenically distinct. Preincubation of allergic serum with cholorogenic acid did not remove IgE antibodies specific for GCB or CaB. We conclude that reagins in the serum of coffee workers with occupationally related allergic symptoms are IgE antibodies specific for either GCB or CaB antigens but not chlorogenic acid. Symptomatic workers can be identified by detection of these antibodies using either skin tests or RAST.
186. Nasal polypectomy in patients asthma and aspirin intolerance B. L. Brown, M.D., S. G. Harrier, M.D., an R. G. Van Dellen, M.D., Rochester, IMinn. To assess the risk, benefit, and the effect on asthma of nasal polypectomy in patients with aspirin intolerance, nasal polyps, and asthma, we reviewed retrospectively the course of 101 patients with this triad who had nasal polypectomy between 1970 and 1974. In addition to the nasal polypectomy, 57 intranasal ethmoidectomies, 12 sphenoid sinus exenterations, and 37 nasoantral window procedures were done. Ninety-six percent of the surgical procedures were done under topical and/or regional anesthesia. Thirty-nine patients with active asthma were hospitalized preoperatively for control of the asthma. Of this group 19 had wheezing postoperatively, mostly mild. In the 62 patients with inactive asthma, 3 developed wheezing postoperatively. No patient developed status asthmaticns postoperatively. Comparing the year before the poiypectomy with the year following, 30 patients noted improvement of
American
AcacIamy of Allergy
20 pg/mI. A singIe dose of theophylline anhydrous (TA) modified EIA significantly. Higher submaximal heart rate (HR) was observed when the subjects were on medication. There were no significant differences in maximal HR. However, the maximal HR with medication was higher than those observed with the control subjects. Theophylline resulted in higher endurance time: peak ventilation, HR, and OZ consumption (qOZ), but not in a statistically significant degree. With the TA the vOZ maximum approached that observed w-ith the control group. No significant electrocardiographic findings were recorded in most of the patients. The results indicate that: (1) The inhibitory effect of TA on EIA obtained during maximal physical effort is similar to that observed during standardized submaximal exercise testing. (2) TA improves some of the cardiorespiratory responses of asthmatic patients to exercise without altering the physical performance above normal levels. (3) The recommended levels of TA are safe for children participating in vigorous athletic events.
parison -asthma
of bronchial provocation and extrinsic allergic
asthrma* F. L. Martinez-Catinchi,
M.D., G. M. Fleming, M.D., H. J. Schwartz, M.D., E. H. Chester, M.D., A A. Gerblich, M.D., and J. Horowitz, Ph.D.# Cleveland, Ohio. Inhalation chaIlenge tests with controlled doses of TDI and methacholine were performed in 18 symptomatic subjects who worked with TDI in the manufacture of plastics, and their responses were compared with those of 5 normal subjects and 5 extrinsic asthmatic patients without occupational TDI exposure. Airway responses to TDI were assessed by plethysmography and spirometry at 0, 15, and 30 min and 1, 2, 3, 4, 5,6, and 24 hr. Inhalation of TDI (0.02 ppm for 20 mm) failed to elicit a change in specific airway resistance (ASRaw 2 50%) in normal or asthmatic subjects. Eight of the TDI workers (group 1) responded to challenge-5 with dual and 3 with late responses-while 10 workers (group 2) had no response. Rechallenge of 5 group 1 workers with a lower dose of TDI (0.005 ppm for 20 mm) elicited a response in 3 of 5. Bronchial reactivity to cumulative doses of methacholine aerosol was increased in 8 of 8 in group 1, 7 of 10 in group 2, and 5 of 5 extrinsic asthmatic patients. The methacholine reactivity of group I, group 2, and asthmatic patients was similar (p = NS); reactivity of group 1 and asthmatic patients was greater than the normal group (p < 0.01). We conclude: (1) Methacholine reactivity is a feature of TDI-asthma but does not predict TDI reactivity in workers or asthmatic patients. (2) The induction of bronchoconstriction at the tested concentrations seem to be a specific phenomenon in some workers and not an irritant event in subjects with hyperreactive airways. (3) The mechanism of TDI bronchial reactivity is different from that of methacholine reactivity.
J. ALLERGY CLN. IMMUNOL, MARCH 1978
185. Investigation of coffee with the use of radioallergo R. M. Karr, M.D., S. B. T. Butcher, Ph.D., and J. E. Salvaggio, New Orleans, La. In a previous report we confirmed the findings of others that coffee workers with job-related allergic symptoms demonstrate positive wheal and flare skin tests with soluble green coffee bean (GCB) and factory dust (FD) antigens. In the present study, we analyzed serum samples from 8 symptomatic coffee workers and 6 matched control subjects for IgE antibodies specific for castor bean (CaB) and GCB antigens using the radioallergosorbent test (RAST). Six of the 8 coffee workers described job-related allergic manifestations (conjunctivitis, rhinitis, urticaria, asthma) and demonstrated positive skin tests to GCB (0.02 ml, 1 wg/ml) and FD (0.02 ml, I pg/ml) antigens. Serum RAST indices ranged from 3 to 15 for GCB and 28 to 60 for CaB antigens. The other 2 coffee workers denied allergic symptoms but described chronic intermittent productive cough and dyspnea. These 2 workers and the 6 control subjects demonstrated negative skin tests with GCB and FD antigens, and serum RAST indices less than 2 for GCB and CaB antigens. RAST inhibition studies indicated that GCB and CaB preparations were antigenically distinct. Preincubation of allergic serum with cholorogenic acid did not remove IgE antibodies specific for GCB or CaB. We conclude that reagins in the serum of coffee workers with occupationally related allergic symptoms are IgE antibodies specific for either GCB or CaB antigens but not chlorogenic acid. Symptomatic workers can be identified by detection of these antibodies using either skin tests or RAST.
186. Nasal polypectomy in patients asthma and aspirin intolerance B. L. Brown, M.D., S. G. Harrier, M.D., an R. G. Van Dellen, M.D., Rochester, IMinn. To assess the risk, benefit, and the effect on asthma of nasal polypectomy in patients with aspirin intolerance, nasal polyps, and asthma, we reviewed retrospectively the course of 101 patients with this triad who had nasal polypectomy between 1970 and 1974. In addition to the nasal polypectomy, 57 intranasal ethmoidectomies, 12 sphenoid sinus exenterations, and 37 nasoantral window procedures were done. Ninety-six percent of the surgical procedures were done under topical and/or regional anesthesia. Thirty-nine patients with active asthma were hospitalized preoperatively for control of the asthma. Of this group 19 had wheezing postoperatively, mostly mild. In the 62 patients with inactive asthma, 3 developed wheezing postoperatively. No patient developed status asthmaticns postoperatively. Comparing the year before the poiypectomy with the year following, 30 patients noted improvement of