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73 Isolated late asthmatic reaction after exposure to a high-molecular-weight occupational agent
J ALLERGYCLIN IMMUNOL VOLUME97, NUMBER 1, PART3 73
Isolated late asthmatic reaction after exposure to a
Abstracts
75
high-molecular-weight occupational agent. A. Cartier. M.D.C. Lemi~re. M.D.. J.-L. Malo. M.D, Montreal, Canad,x High-molecular-weight agents are known to induce immediate asthmatic reactions, i.e., reactions that arc maximum 10 to 20 minutes after exposure and that resolve in the first hour. We report the case of a subject who experienced an isolated late asthmatic reaction, i.e, a reaction which started after the first hour following exposure to subtilisn, a high-molecular-weight agent. Case renort: A 4l-year-old subject had been working since 1991 in a surgical department. His work consisted of washing surgical instruments with a liquid containing a proteolytic enzyme, subtilisin. He was atopic. He developed asthma as well as conjunctivitis one year after beginning this job. Skin-prick tests with pure diluted subtilisin (1,mg/l,10 and 100ml) showed immediate weal diameters of 9, 8 and 5 mm respectively. We also found increased specific IgE to subtilisin (19.8% bound). Specific inhalation challenges, exposing the subject to diluted subtilisin for a 50-minute period by asking him to breathe the vapor, induced a late asthmatic reaction (25% fall in FEVI) without any immediate component. PC20 was significantly reduced at the end of the day (1.4 mg/ml compared to 6.8 mg/ml) Occurrence of an immediate asthmatic reaction was ruled out by performing measurements of both FEVi and lung volumes every ten minutes in the first hour. Conclusion: Isolated asthmatic reaction can, therefore, be induced by a high-molecular-weight agent although it is a very uncommon occurrence.
74
Occupational asthma to lobster and shrimp. J. Vallte. RX.. A Desiardins M.D..C Lemi~re M.D. S Lehrer Ph.D.. J.-L. Malo M.D., Montreal, Canada, New Orleans LA. Seafoods are known causesof occupational asthma (OA). However, to our knowledge, OA to lobster has been reported in only one instance, We report here a case of OA to both lobster and shrimp. Case reoort: A 34-year-old woman who had been a fishmonger since 1991 developed rhinitis, urticaria and asthma 2 years after beginning her work. She was atopic. She reported symptoms when she handled lobster and shrimp. She also reported food allergy to shrimp. Skin tests to seafoods showed immediate reactivity to lobster, shrimp and crab. We also found increased specific IgE levels to shrimp, lobster, crab and crawfish. Specific inhalation challenges to lobster were performed using a nebulized aqueous extract. The subject experienced an immediate asthmatic reaction after an 18-minute period of exposure (23% fall in FEV1). PC20 was significantly decreased at the end of the day (3 mg/ml compared to 16 mg/ml before exposure). Two days later, we performed specific inhalation challenges to shrimp by exposing the subject to a dry aerosol of shrimp powder. She expericnced an immediate asthmatic reaction after a one-hour period of exposure (26% fall in FEVI). Although lobster is a shellfish frequently used in the food industry, OA to lobster is rare. Sensitization to both lobster and shrimp can be explained by cross-reactivity between these two shellfish as demonstrated by RAST inhibition. The prevalence of immunological sensitization and of occupational rhinoconjunctivitis and asthma to lobster remains to be assessed in the primary processing industry as well as in fishmongers.
76
201
Allergen Cross-Reactivity between a-Amylase ( A s p e r g i l l u s O r y z a e ) , H e m i c e U u l a s e (A. n i g e r ) a n d A m y l o g l y c o s i d a s e (A. n i g e r ) , g Wiewrodt. K Spix. U Biller. K Viel. J Bare,on. W Casnarv. R Buhl. Pulmonary & Allergy Department, I.)niversity Hospital, Frankfurt/Main, Germany Immediate type allergies to enzymes occur frequently in enzyme manufactoring plants and finishing industries. Since aspergillus-derivcd enzymes are potent inhalant allergens with an IgE-dependend mechanism, we evaluated the allergen crossreactivity of the most important enzymes used in the baking industry: -,-amylase, derived from asporgillus oryzae (a-A) and amylogiyeosidase (AG) and hemicellulase (HC), both derived from asp. niger, a-A, AG and HC were separated by SDSPAGE and lgE binding was detected by immunobloting with six patients sera that were skin prick test and RAST positive to all three enzymes. Cross-wise inhibition of lgE binding was performed with a serum pool containing IgE antibodies to all three enzymes. This serum was preincubated with serial dilutions of all three extracts, and incubated with strips containlg separated allergen. IgE bindipg was quantified by densitometric scanning. All enzymes showed various bands in the range of 20 - I00 kD. In the homologous system, all enzymes showed complete inhibition, lgE binding to AG was completely inhibited by HC, and vice versa. Further, IgE binding to =-A was strongly inhibited by AG and HC, resp. In contrast, IgE binding to AG or HC was only partly inhibited by a-A. The same results could obtained using IEF-electrophoresis and immunoprinting. In conclusion, amyloglycosldase and hemicellulase are highly crossreactive allergens, and sensitizations to these enzymes always include a-amylase. In contrast, sensitization to a-amylase does not necessesarly indicates sensitizations to the other two enzymes.
Inhalative
and ingestive
occupational
A l l e r g y t o B o l e t u s e d u l i s R Torricelli MD. B W0thrich MD. Z0rich - Switzerland A 35 year old cook, in good general health and with no history of atopy, experienced rhinoconjunctivits and asthma over the past 2 years, only while he was at work. In the past few months, the frequency of the asthma attacks increased dramatically at his place of work when in contact with the steam of Boletusedulis(bolet), a common edible mushroom. He also had several anaphylactic reactions after eating these mushrooms. Both skin tests and IgE antibody to Boletusedulis(a special RAST Disk was prepared from Prof. SGO Johansson, Stockolm) were strongly positive (4.9 PRU, RAST-CIass 3). A inhalative provocation test with mushrooms was also positive with a strong bronchoconstriclive response leading to a 60% drop of the FE'Vl. Laboratory investigations showed no increase in the levels of histamine, tryptase, IL-1, IL-2, IL-4. TNF and slL-2-Rezeptor, but a significantly increase of IL-6 2 and 8 hours after exposure. No other sensitizations could be found. Together with the typical history, these findings confirmed the diagnosis of an inhaiative and ingestive Type I allergy to
Boletusedulis. In our region, bolets are very common mushrooms. Allergic reactions are indeed very seldom. No case reports were found in the literature. In our allergy unit we have observed only 3 cases in the last past 30 years: 2 patients had anaphylactic reactions after eating bolets; the other patient, working for a fool company, had an occupational asthma.
Isolated late asthmatic reaction after exposure to a
Abstracts
75
high-molecular-weight occupational agent. A. Cartier. M.D.C. Lemi~re. M.D.. J.-L. Malo. M.D, Montreal, Canad,x High-molecular-weight agents are known to induce immediate asthmatic reactions, i.e., reactions that arc maximum 10 to 20 minutes after exposure and that resolve in the first hour. We report the case of a subject who experienced an isolated late asthmatic reaction, i.e, a reaction which started after the first hour following exposure to subtilisn, a high-molecular-weight agent. Case renort: A 4l-year-old subject had been working since 1991 in a surgical department. His work consisted of washing surgical instruments with a liquid containing a proteolytic enzyme, subtilisin. He was atopic. He developed asthma as well as conjunctivitis one year after beginning this job. Skin-prick tests with pure diluted subtilisin (1,mg/l,10 and 100ml) showed immediate weal diameters of 9, 8 and 5 mm respectively. We also found increased specific IgE to subtilisin (19.8% bound). Specific inhalation challenges, exposing the subject to diluted subtilisin for a 50-minute period by asking him to breathe the vapor, induced a late asthmatic reaction (25% fall in FEVI) without any immediate component. PC20 was significantly reduced at the end of the day (1.4 mg/ml compared to 6.8 mg/ml) Occurrence of an immediate asthmatic reaction was ruled out by performing measurements of both FEVi and lung volumes every ten minutes in the first hour. Conclusion: Isolated asthmatic reaction can, therefore, be induced by a high-molecular-weight agent although it is a very uncommon occurrence.
74
Occupational asthma to lobster and shrimp. J. Vallte. RX.. A Desiardins M.D..C Lemi~re M.D. S Lehrer Ph.D.. J.-L. Malo M.D., Montreal, Canada, New Orleans LA. Seafoods are known causesof occupational asthma (OA). However, to our knowledge, OA to lobster has been reported in only one instance, We report here a case of OA to both lobster and shrimp. Case reoort: A 34-year-old woman who had been a fishmonger since 1991 developed rhinitis, urticaria and asthma 2 years after beginning her work. She was atopic. She reported symptoms when she handled lobster and shrimp. She also reported food allergy to shrimp. Skin tests to seafoods showed immediate reactivity to lobster, shrimp and crab. We also found increased specific IgE levels to shrimp, lobster, crab and crawfish. Specific inhalation challenges to lobster were performed using a nebulized aqueous extract. The subject experienced an immediate asthmatic reaction after an 18-minute period of exposure (23% fall in FEV1). PC20 was significantly decreased at the end of the day (3 mg/ml compared to 16 mg/ml before exposure). Two days later, we performed specific inhalation challenges to shrimp by exposing the subject to a dry aerosol of shrimp powder. She expericnced an immediate asthmatic reaction after a one-hour period of exposure (26% fall in FEVI). Although lobster is a shellfish frequently used in the food industry, OA to lobster is rare. Sensitization to both lobster and shrimp can be explained by cross-reactivity between these two shellfish as demonstrated by RAST inhibition. The prevalence of immunological sensitization and of occupational rhinoconjunctivitis and asthma to lobster remains to be assessed in the primary processing industry as well as in fishmongers.
76
201
Allergen Cross-Reactivity between a-Amylase ( A s p e r g i l l u s O r y z a e ) , H e m i c e U u l a s e (A. n i g e r ) a n d A m y l o g l y c o s i d a s e (A. n i g e r ) , g Wiewrodt. K Spix. U Biller. K Viel. J Bare,on. W Casnarv. R Buhl. Pulmonary & Allergy Department, I.)niversity Hospital, Frankfurt/Main, Germany Immediate type allergies to enzymes occur frequently in enzyme manufactoring plants and finishing industries. Since aspergillus-derivcd enzymes are potent inhalant allergens with an IgE-dependend mechanism, we evaluated the allergen crossreactivity of the most important enzymes used in the baking industry: -,-amylase, derived from asporgillus oryzae (a-A) and amylogiyeosidase (AG) and hemicellulase (HC), both derived from asp. niger, a-A, AG and HC were separated by SDSPAGE and lgE binding was detected by immunobloting with six patients sera that were skin prick test and RAST positive to all three enzymes. Cross-wise inhibition of lgE binding was performed with a serum pool containing IgE antibodies to all three enzymes. This serum was preincubated with serial dilutions of all three extracts, and incubated with strips containlg separated allergen. IgE bindipg was quantified by densitometric scanning. All enzymes showed various bands in the range of 20 - I00 kD. In the homologous system, all enzymes showed complete inhibition, lgE binding to AG was completely inhibited by HC, and vice versa. Further, IgE binding to =-A was strongly inhibited by AG and HC, resp. In contrast, IgE binding to AG or HC was only partly inhibited by a-A. The same results could obtained using IEF-electrophoresis and immunoprinting. In conclusion, amyloglycosldase and hemicellulase are highly crossreactive allergens, and sensitizations to these enzymes always include a-amylase. In contrast, sensitization to a-amylase does not necessesarly indicates sensitizations to the other two enzymes.
Inhalative
and ingestive
occupational
A l l e r g y t o B o l e t u s e d u l i s R Torricelli MD. B W0thrich MD. Z0rich - Switzerland A 35 year old cook, in good general health and with no history of atopy, experienced rhinoconjunctivits and asthma over the past 2 years, only while he was at work. In the past few months, the frequency of the asthma attacks increased dramatically at his place of work when in contact with the steam of Boletusedulis(bolet), a common edible mushroom. He also had several anaphylactic reactions after eating these mushrooms. Both skin tests and IgE antibody to Boletusedulis(a special RAST Disk was prepared from Prof. SGO Johansson, Stockolm) were strongly positive (4.9 PRU, RAST-CIass 3). A inhalative provocation test with mushrooms was also positive with a strong bronchoconstriclive response leading to a 60% drop of the FE'Vl. Laboratory investigations showed no increase in the levels of histamine, tryptase, IL-1, IL-2, IL-4. TNF and slL-2-Rezeptor, but a significantly increase of IL-6 2 and 8 hours after exposure. No other sensitizations could be found. Together with the typical history, these findings confirmed the diagnosis of an inhaiative and ingestive Type I allergy to
Boletusedulis. In our region, bolets are very common mushrooms. Allergic reactions are indeed very seldom. No case reports were found in the literature. In our allergy unit we have observed only 3 cases in the last past 30 years: 2 patients had anaphylactic reactions after eating bolets; the other patient, working for a fool company, had an occupational asthma.