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Bronchopulmonary challenge test in workers suffering from occupational asthma
S328
Abstracts
1 0 1 5 SystemicReactionFollowingLaboratoryRatExposure Michael B Levy, Jordan N Fink Medical College of Wisconsin, Milwaukee, WI INTRODUCTION: The prevalence of laboratory animal allergy to rats and mice has been reported to range from 10-32%, with a higher incidence in animal cage handlers than in technicians or investigators. The allergic symptoms include rhinoconjunctivitis, contact urticaria, and asthma. Systemic reactions have rarely been reported, and have been related to animal bites or needle punctures. We report a laboratory researcher who experienced systemic symptoms via inhalation of antigen after entering an animal holding area where rats were housed. CASE REPORT: A 23 year old lab researcher presented to the Allergy and Asthma Clinic of the Medical College of Wisconsin in July 2001 for evaluation of systemic symptoms related to rat exposure. Seven months prior she began performing cardiac studies on rats, usually limited to one or two per session. After four months she began to note nasal congestion and itchy eyes while working. A mask did not help relieve her symptoms. In June, 2001 she assisted work in a holding area which housed approximately 200 rats. Within ten minutes she developed intense nasal itching, multiple sneezes, itchy eyes, pruritis, cough, wheezing, flushing, sweating and dizziness. She was removed from the room, given 50 mg of diphenhydramine, and rested. Emergent medical care was not sought. She recovered after several hours. Past medical history was remarkable for spring seasonal rhinitis. As a high school student she had exercise induced asthma but was asymptomatic the past several years. Physical exam one week following the above episode revealed congested, pale nasal mucosa. Chest was clear. Spirometry was within normal limits. RAST testing revealed 2.84 KU (Class 3) IgE to rat urine; serum IgE levels to rat epithelia and serum were not detected. CONCLUSION: Inhalation of high amounts rat urinary proteins may result in systemic reactions in susceptible individuals. Awareness of this possibility and knowledge of appropriate treatment is important.
t I l t j~ Sronchop.lmonaryChallengeTest in WorkersSuffering IUI lid FromOccupationalAsthma Milan Pavlovic, N Miladinovic-Djukanovic Institute of Occupational Health, Belgrade, Serbia Occupational asthma is recognized as a professional disability by the law of Federal Republic of Yugoslavia. Bronchopulmonary challenge tests are the main tool used in diagnosis and assessment of occupational asthma. The objective of this work was to perform bronchopulmonary challenge test on patients who were diagnosed with professional asthma. MATERIALS AND METHODS: Spirometry tests were performed on 102 patients (49 male and 53 female), and the values before and after the challenge test (with an assortment of allergens from the work site) were recorded. Specific allergen mixtures were prepared by the laboratory for Immunology, according to the international standards. A nebulizer (with a compressor) was used to produce the aerosol containing particle size of 2-7 micrometers. Patients inhaled this allergen mixture for 15-20 minutes, and the process was intercepted if an asthmatic attack was provoked. Spirometry was performed before, immediately after, and 4-6 hours after the challenge test. The results were considered positive if FEV 1 was decreased by 20% or more compared to the base value. Spirometry was performed on an electronic spirometer (Jaeger) according to the European guidelines from 1989. Average age of patients was 40.7+/-7.2 years, with a range from 23 to 55 years of age. The average length of exposure to occupational allergens was 15.8+/-7.6, with a range from 2 to 33 years. RESULTS: Majority of patients were employed in metallic industry 41 (40.2%), textile - 23 (22.5%), food - 10 (9.8%), and chemical industry - 7 (6.9%). The most common causes of asthmatic attacks were: textile dust -
J ALLERGY CLIN IMMUNOL JANUARY 2002
23 (22.5%), organic solvents - 17 (16.6%), flour and its compounds - 8 (7.8%), and flour 5 (4.9%). Late asthmatic reaction (after 5-6 hours) was seen in 7 (6.9%) patients. In two patients (1.9%), FEV 1 after the challenge was reduced to 30%-35% of the starting value, so that the necessary measurements had to be implemented. Table 1: Average values of spirometry tests and there decrease after a bronchopulmonary challenge test Base values (% of normal) After challenge compared to base value) Test Mean S.D. Mean S.D. FVC 95.6 12.4 77.4 12.7 FEV1 91.6 16.1 71.3 11.4 FEVI/FVC%94.6 12.4 91.8 7.7 PEF 93.6 18.9 69.2 14.2 FEF50 69.1 27.2 65.5 15.7 FEF25 57.1 25.7 63.1 19.6 FEF25-7564.9 24.8 63.2 16.2. CONCLUSION: The spirometry values of our patients who suffer from occupational asthma are within the normal limits and their decrease when patients are exposed to occupational allergens is not significant enough to endanger patient's well being. Therefore, it can be concluded that the occupational health specialists are recognizing the signs of occupational asthma in the early phase and are successfully assigning the change of work place to inflicted workers so that further exposure to occupational antigens can be avoided.
n l '7 Effectof Long-TermTreatmentWith InhaledCorticosteroids I V II Jr andBronchodilatorsin SubjectsWithOccupationalAsthma Andrea Siracusa*, Alessandra Marabini§, Maria Laura Pace§, Maria Stella Polticchia§, Roberta Stopponi* *Occupational Medicine, Terni, Italy §Occupational Medicine and Toxicology, Perugia, Italy This study evaluated the effect of beclomethasone dipropionate (500 mcg bid) and salmeterol (50 mcg bid) on lung function and respiratory symptoms in 20 subjects with occupational asthma (OA) who were still exposed to the work environment cause of their disease. At enrolment and every 6 months for 3 years, respiratory symptoms score (from 0 - no symptoms - to 2 - moderate-severe symptoms), spirometry, methacholine challenge test. diurnal variation (DV) in peak expiratory flow (PEF) and the use of rescue salbutamol were evaluated. Within the 3 years of follow-up 10 subjects were excluded from the study because they retired or moved to another job. Six of the subjects were lost to follow-up within the first year and 4 within the second year. Subjects who completed the study were older than drop-outs (p<0.05); no other differences in baseline characteristics, symptoms and lung function between the two groups were found. Workrelated asthmatic symptoms had started 12.6 _ 13.1 years (mean _+ SD) before diagnosis. At baseline mean FEV 1 was 80.2% of predicted values and PD20 methacholine 1001 mcg _ 1275 mcg (mean _ SD). The workers reported using 1.8 _ 2.2 puffs of salbutamol a day (mean _ SD). After 3 years' treatment no significant deterioration was found in any of the morbidity outcomes investigated (FEV1, PD20 methacholine, DV in PEF, use of rescue salbutamoL respiratory symptoms score) as compared with baseline values. Downward trends were observed in the use of rescue salbutamol (1.8 vs 0.6 puffs a day) and in the total symptoms score (2.1 vs 1.5 a day). In conclusion, regular treatment with inhaled corticosteroids and bronchodilators seems to prevent respiratory deterioration in workers with OA who are still exposed to the work environment cause of their disease.
1 0 1 8 A Monoclona'Antibody-BasedELISAfor Ratn I Allergen Trang D Duong*, William M Sutherland§, Jenny P Chen¥, Peyton A Eggleston* *Johns Hopkins University, Baltimore, MD §University of Virginia, Charlottesville, VA ¥Maryland State Department of Public Health and Mental Hygiene, Division of Molecular Biology, Baltimore, MD We developed a two-site capture ELISA assay using monoclonal antibodies against Rat n 1 in order to examine rat allergen exposures among inner city children who are sensitized to rat allergens, m/J mice were immu-
Abstracts
1 0 1 5 SystemicReactionFollowingLaboratoryRatExposure Michael B Levy, Jordan N Fink Medical College of Wisconsin, Milwaukee, WI INTRODUCTION: The prevalence of laboratory animal allergy to rats and mice has been reported to range from 10-32%, with a higher incidence in animal cage handlers than in technicians or investigators. The allergic symptoms include rhinoconjunctivitis, contact urticaria, and asthma. Systemic reactions have rarely been reported, and have been related to animal bites or needle punctures. We report a laboratory researcher who experienced systemic symptoms via inhalation of antigen after entering an animal holding area where rats were housed. CASE REPORT: A 23 year old lab researcher presented to the Allergy and Asthma Clinic of the Medical College of Wisconsin in July 2001 for evaluation of systemic symptoms related to rat exposure. Seven months prior she began performing cardiac studies on rats, usually limited to one or two per session. After four months she began to note nasal congestion and itchy eyes while working. A mask did not help relieve her symptoms. In June, 2001 she assisted work in a holding area which housed approximately 200 rats. Within ten minutes she developed intense nasal itching, multiple sneezes, itchy eyes, pruritis, cough, wheezing, flushing, sweating and dizziness. She was removed from the room, given 50 mg of diphenhydramine, and rested. Emergent medical care was not sought. She recovered after several hours. Past medical history was remarkable for spring seasonal rhinitis. As a high school student she had exercise induced asthma but was asymptomatic the past several years. Physical exam one week following the above episode revealed congested, pale nasal mucosa. Chest was clear. Spirometry was within normal limits. RAST testing revealed 2.84 KU (Class 3) IgE to rat urine; serum IgE levels to rat epithelia and serum were not detected. CONCLUSION: Inhalation of high amounts rat urinary proteins may result in systemic reactions in susceptible individuals. Awareness of this possibility and knowledge of appropriate treatment is important.
t I l t j~ Sronchop.lmonaryChallengeTest in WorkersSuffering IUI lid FromOccupationalAsthma Milan Pavlovic, N Miladinovic-Djukanovic Institute of Occupational Health, Belgrade, Serbia Occupational asthma is recognized as a professional disability by the law of Federal Republic of Yugoslavia. Bronchopulmonary challenge tests are the main tool used in diagnosis and assessment of occupational asthma. The objective of this work was to perform bronchopulmonary challenge test on patients who were diagnosed with professional asthma. MATERIALS AND METHODS: Spirometry tests were performed on 102 patients (49 male and 53 female), and the values before and after the challenge test (with an assortment of allergens from the work site) were recorded. Specific allergen mixtures were prepared by the laboratory for Immunology, according to the international standards. A nebulizer (with a compressor) was used to produce the aerosol containing particle size of 2-7 micrometers. Patients inhaled this allergen mixture for 15-20 minutes, and the process was intercepted if an asthmatic attack was provoked. Spirometry was performed before, immediately after, and 4-6 hours after the challenge test. The results were considered positive if FEV 1 was decreased by 20% or more compared to the base value. Spirometry was performed on an electronic spirometer (Jaeger) according to the European guidelines from 1989. Average age of patients was 40.7+/-7.2 years, with a range from 23 to 55 years of age. The average length of exposure to occupational allergens was 15.8+/-7.6, with a range from 2 to 33 years. RESULTS: Majority of patients were employed in metallic industry 41 (40.2%), textile - 23 (22.5%), food - 10 (9.8%), and chemical industry - 7 (6.9%). The most common causes of asthmatic attacks were: textile dust -
J ALLERGY CLIN IMMUNOL JANUARY 2002
23 (22.5%), organic solvents - 17 (16.6%), flour and its compounds - 8 (7.8%), and flour 5 (4.9%). Late asthmatic reaction (after 5-6 hours) was seen in 7 (6.9%) patients. In two patients (1.9%), FEV 1 after the challenge was reduced to 30%-35% of the starting value, so that the necessary measurements had to be implemented. Table 1: Average values of spirometry tests and there decrease after a bronchopulmonary challenge test Base values (% of normal) After challenge compared to base value) Test Mean S.D. Mean S.D. FVC 95.6 12.4 77.4 12.7 FEV1 91.6 16.1 71.3 11.4 FEVI/FVC%94.6 12.4 91.8 7.7 PEF 93.6 18.9 69.2 14.2 FEF50 69.1 27.2 65.5 15.7 FEF25 57.1 25.7 63.1 19.6 FEF25-7564.9 24.8 63.2 16.2. CONCLUSION: The spirometry values of our patients who suffer from occupational asthma are within the normal limits and their decrease when patients are exposed to occupational allergens is not significant enough to endanger patient's well being. Therefore, it can be concluded that the occupational health specialists are recognizing the signs of occupational asthma in the early phase and are successfully assigning the change of work place to inflicted workers so that further exposure to occupational antigens can be avoided.
n l '7 Effectof Long-TermTreatmentWith InhaledCorticosteroids I V II Jr andBronchodilatorsin SubjectsWithOccupationalAsthma Andrea Siracusa*, Alessandra Marabini§, Maria Laura Pace§, Maria Stella Polticchia§, Roberta Stopponi* *Occupational Medicine, Terni, Italy §Occupational Medicine and Toxicology, Perugia, Italy This study evaluated the effect of beclomethasone dipropionate (500 mcg bid) and salmeterol (50 mcg bid) on lung function and respiratory symptoms in 20 subjects with occupational asthma (OA) who were still exposed to the work environment cause of their disease. At enrolment and every 6 months for 3 years, respiratory symptoms score (from 0 - no symptoms - to 2 - moderate-severe symptoms), spirometry, methacholine challenge test. diurnal variation (DV) in peak expiratory flow (PEF) and the use of rescue salbutamol were evaluated. Within the 3 years of follow-up 10 subjects were excluded from the study because they retired or moved to another job. Six of the subjects were lost to follow-up within the first year and 4 within the second year. Subjects who completed the study were older than drop-outs (p<0.05); no other differences in baseline characteristics, symptoms and lung function between the two groups were found. Workrelated asthmatic symptoms had started 12.6 _ 13.1 years (mean _+ SD) before diagnosis. At baseline mean FEV 1 was 80.2% of predicted values and PD20 methacholine 1001 mcg _ 1275 mcg (mean _ SD). The workers reported using 1.8 _ 2.2 puffs of salbutamol a day (mean _ SD). After 3 years' treatment no significant deterioration was found in any of the morbidity outcomes investigated (FEV1, PD20 methacholine, DV in PEF, use of rescue salbutamoL respiratory symptoms score) as compared with baseline values. Downward trends were observed in the use of rescue salbutamol (1.8 vs 0.6 puffs a day) and in the total symptoms score (2.1 vs 1.5 a day). In conclusion, regular treatment with inhaled corticosteroids and bronchodilators seems to prevent respiratory deterioration in workers with OA who are still exposed to the work environment cause of their disease.
1 0 1 8 A Monoclona'Antibody-BasedELISAfor Ratn I Allergen Trang D Duong*, William M Sutherland§, Jenny P Chen¥, Peyton A Eggleston* *Johns Hopkins University, Baltimore, MD §University of Virginia, Charlottesville, VA ¥Maryland State Department of Public Health and Mental Hygiene, Division of Molecular Biology, Baltimore, MD We developed a two-site capture ELISA assay using monoclonal antibodies against Rat n 1 in order to examine rat allergen exposures among inner city children who are sensitized to rat allergens, m/J mice were immu-