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PubMed1994

Seasonal occupational asthma in an agricultural products merchant--a case report.

A 52-year-old agricultural products merchant reported mild occupational asthma and rhinitis throughout the year, with severe asthma from February to May. He had been exposed to various substances, particularly grain, insecticides, fungicides, and fertilizers over 35 years. We identified a castor-bean-containing fertilizer as the cause of the disease by skin prick test and bronchial provocation test. Specific IgE against castor bean was detected by enzyme allergosorbent test, and proteins with mol. mass of less than 14.4 kDa and masses of 15.5, 29.5, and 30.5 kDa were identified as allergens by Western blot analysis. The seasonal character of symptoms could be explained by a more frequent use of the fertilizer during spring. Six months after avoidance of the allergen, the patient reported chronic bronchitis without asthma. Occupational allergy to castor bean should be considered in subjects with seasonal asthma and exposure to "natural" fertilizers.

Asthma↗

PubMed1986

Occupational asthma caused by African maple (Obeche) and Ramin: evidence of cross reactivity between these two woods.

Four patients with occupational asthma were studied. All patients were exposed to African maple dust and two of them were also exposed to Ramin dust. Skin tests and bronchial provocation tests with African maple extracts revealed an immediate response in all patients, and the same tests performed with Ramin extracts again revealed an immediate reaction in either exposed or non-exposed patients to Ramin wood dust. Specific IgE antibodies against African maple extracts were demonstrated in all patients as measured by a reverse enzyme immunoassay. Cross reactivity between both woods was demonstrated by a reverse enzyme immunoassay inhibition study. Unexposed persons and exposed asymptomatic workers did not exhibit reactivity to both woods in any of the tests listed above. To the best of our knowledge, this is the first article in which occupational asthma due to Ramin is defined, and cross sensitivity between two different woods is demonstrated.

Adult↗

PubMed1981

Efficacy of rush immunotherapy in decreasing bronchial sensitivity to inhaled antigens in perennial childhood asthma.

Rush Immunotherapy (IT) was given to 13 children with asthma, positive skin tests (ST), bronchial provocation tests (BPT) and compatible histories. ST was done by prick or intradermal technique, using commercially available antigens (Ag). BPT was done after an eight-hour medication hold for oral bronchodilators (BD) and four hours for inhaled BD. A Fisons/Vaponephrine nebulizer with an air compressor was used to deliver the Ag. A persistent 25% decrease in peak expiratory flow rate was considered a positive test. Rush IT consisted of four Ag dilutions: 10, 100, 1000 and 5000 pnu/ml. The maintenance dose of 0.5 ml of the 5000 pnu/ml solution was achieved in from seven to 18 weeks (mean 12 weeks). The total cumulative dose of Ag ranged from 3000--14000 pnu (mean 7200 pnu) when the BPT was repeated. Two patients had mild wheezing post-injections and rush IT was discontinued; one of these was later restarted and tolerated the IT well. Three were discharged from the Center prior to repeat BPT. Nine completed the protocol to a total of 14 Ags. One had increased bronchial sensitivity (BS) to both Ags tested. One had no change in BS. Seven subjects had decreased BS on 11 post-rush IT BPTs, four by an unknown degree as the BPT was negative on re-challenge. The mean pre-rush IT BPT was positive at 900 pnu (range 190--2200 pnu); the mean post-RI BPT was positive at 2600 pnu (range 20--7200 pnu). Five patients who had repeat BPT's to the same Ag without IT served as controls. The results showed that (1) Rush IT is a safe and effective method of IT and (2) a marked change in BS can be achieved rapidly and after a relatively low administered dose of Ag in a majority of patients.

Adolescent↗

PubMed2004

Respiratory allergy to peach leaves and lipid-transfer proteins.

BACKGROUND: Several lipid-transfer proteins (LTPs) have been identified as important food allergens, especially in fruits of the Rosaceae family. The major peach (Prunus persica) allergen has been identified, sequenced and designated Pru p 3. OBJECTIVE: To present Pru p 3 as an aeroallergen able to induce occupational asthma. METHODS: A thorough investigation was performed in a fruit grower with occupational asthma. Skin prick-prick tests with peach leaves and prick tests with perennial respiratory allergens and pollens, fruits and peach leaf extracts were done. Serum-specific IgE was tested for peach leaf, peach fruit, peach skin and respiratory allergens that were positive in skin prick tests. Specific bronchial provocation tests (BPTs) with extracts of peach leaf were also done. Before and 24 h after the BPT, BPTs with methacholine and sputum induction were done. The IgE reactivity pattern to peach leaf and fruit extracts and to Pru p 3 was identified by using SDS-PAGE and immunoblotting. Blotting inhibition of peach leaf extract by Pru p 3 was also performed. The putative allergen was quantified in leaf and fruit skin extracts with ELISA based on an anti-Pru p 3 antibody. RESULTS: Skin tests were positive for peach leaf and fruit. The BPT was positive, with immediate and delayed response. This test induced a decrease in PD20 (dose of agonist that induces a 20% fall in FEV1) methacholine and an increase in eosinophils and eosinophil cationic protein in sputum. Peach leaf extract contained concentrations of Pru p 3 similar to those found in peach skin. Specific IgE immunodetection showed that patient's sera reacted with Pru p 3, and with a single major band from the peach leaf extract fully inhibited by Pru p 3. CONCLUSION: Pru p 3 from peach leaves can act as a respiratory allergen and cause occupational rhinoconjunctivitis and asthma.

Adult↗

PubMed1991

[Carbachol inhalation provocation test using a reservoir method. 4-step test for the assessment of bronchial hyperreactivity].

Inhalative bronchial provocation tests with pharmacodynamic substances, such as histamine, methacholine or carbachol are performed to confirm or exclude bronchial hyperreactivity. The provocation schemas employed so far are often very tedious, with 8 or 9 inhalation steps, or include the danger of severe or hazardous obstructions in case of 1-step or 2-step tests. A provocation test is presented that can be conducted in about 30 minutes' time comprising only 4 inhalation steps. In a separate group of 44 clinically defined healthy subjects and patients suffering from asthma bronchiale, we determined the minimal concentration and cumulative total dose of carbachol to find a non-hazardous initial concentration on the one hand and to arrive at a best possible separation of healthy subjects and asthmatics on the other. Subsequently, 20 patients suspected of bronchial hyperreactivity were provoked by inhalation, using a commercial reservoir method 1. We used carbachol provocative solutions of 0.1 and 0.5% (0.1% 5 1, 0.1% 5 1, 0.5% 5 1, 0.5% 5 1, 0.5% 10 1). At the beginning and at the end of the study, whole body plethysmography was performed (Raw, FEV1, ITGV). A peak flow meter was employed for the intermediate steps. 13 of the 20 patients showed bronchial hyperreactivity. 11 of these 13 patients were provoked according to the schema mentioned above; an intermediate step was introduced in 2 patients. The peak flow dropped on the average by 28% and the FEV1 on the average by 33%. The airway resistance increased by 300% on the average compared with the initial value. There were no severe obstructions that required parenteral treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Asthma↗

PubMed1985

[Frequency of sensitization to D. pteronyssinus or D. farinae in children with perennial bronchial asthma].

Bronchial sensitization against house dust mites (dermatophagoides farinae, dermatophagoides pteronyssinus) was investigated in 48 children. The therapeutic effect of hyposensitization and removal of house dust mite allergen was evaluated. The diagnosis was established by skin-prick-test, RAST and bronchial provocation. The bronchial provocation test was carried out by a whole body plethysmograph with breath by breath registration of the airway resistance. We found a bronchial reaction against both mites in 70% of the children; 18% showed bronchial reaction only against d. farinae, 10% only against d. pteronyssinus. There was a better correlation between RAST and bronchial provocation (69,5%) than between skin-prick-test and bronchial provocation (65%). The correlation concerning the skin-brick-test and RAST was 55% with d. farinae and 59% with d. pteronyssinus. There was no correlation between PRIST and RAST, RAST and eosinophiles, therapeutic effects of hyposensitization and positive allergen tests. After one year of therapy, the conditions of 87,5% (only mite sensitization) respectively 92% (mixed sensitization) of patients improved. Another group of sensitized children was only treated by removal of house dust mite allergen and anti-allergic and bronchodilating drugs. 43% (mixed allergy) respectively 54% (only mite sensitization) had less asthma problems. After the hyposensitization the children showed a significant improvement. There was no difference in the therapeutic effect after hyposensitization against d. farinae or d. pteronyssinus.

Adolescent↗

PubMed1991

[Occupational asthma: current and future perspectives. The point of view of an expert].

Occupational asthma remains a difficult problem for physicians and for experts. The prevalence of occupational asthma is underestimated and depends on industrial agent and conditions of work. Diagnosis is made based on detailed description of the patient's work environment, on skin and serological tests, and on lung function tests including non-specific bronchial provocation tests. Rhinomanometry, and peak flow rate measurements may also be useful. Bronchial provocation tests should be performed by experienced staff in a hospital setting with facilities for resuscitation. The prognosis of occupational asthma is variable: --some patients with short and limited exposure may fully recover if their disease is early recognized and appropriate measures are taken; --however, many patients do not recover completely after removal of the responsible agents. Clinical symptoms and bronchial hyperreactivity persist and respiratory insufficiency may develop. The patterns of occupational asthma are changing rapidly, in parallel with industrial evolution: nowadays, bakers's asthma is less frequent than it used to be. Asthma triggered by wood dust and in particular western red cedar (which is exported all over the world) is increasingly recognized. Isocyanates and, in particular toluene isocyanate, are widely used in plastics and paints. Preventive measures have succeeded in decreasing the incidence of asthma caused by exposure to isocyanates. Computer industry has recently developed in many countries. It requires the use of numerous hazardous and highly toxic materials that are potentially responsible for occupational asthma; attention should be given to respiratory diseases especially in industrializing countries (such as Eastern Asian countries). Preventive measures include safety rules, replacement of harmful materials by less toxic agents and detection of susceptible workers. Regulation must be defined under experts' control to continuously match the rapid changes in modern industry.

Asthma↗

PubMed1983

Clinical significance of specific IgE determination on nasal secretion.

The clinical use of RAST on the nasal secretions was investigated in seventeen atopic patients, with asthma or rhinitis, who had shown at a first diagnostic screening, some difficulties in the identification of the responsible allergen(s). The results of the skin tests, of the RAST on the serum and on the nasal secretions and of the specific provocation test (bronchial or nasal) were compared. In some cases the basophil degranulation test was performed. The results of the RAST on the nasal secretions were in perfect agreement with the provocation test. The skin tests and the RAST on the serum showed many discrepancies, particularly for Dermatophagoides, epidermal derivatives of cat and dog and moulds, and less frequently for Graminaceae and other pollens. It is concluded that RAST analysis on nasal secretions is useful in clinical diagnosis of allergy especially for Dermatophagoides, epidermal derivatives and moulds. Most false positive results were observed with the RAST on serum; in fifteen cases it was positive, while all the other tests, basophil degranulation test included, were negative. The data suggest that IgE may have a low affinity for basophil receptors.

Adolescent↗

PubMedDate not supplied

Efficacy and safety of oral immunotherapy in respiratory allergy to Parietaria judaica pollen. A double-blind study.

Two groups of 15 patients with respiratory allergy due to the pollen of Parietaria judaica were studied; one received a treatment of oral specific hyposensitization, the other one a placebo. All of them were monosensitized and clinically matched according to age, gender, score symptoms, drug consumption, skin test and RAST, and nasal or bronchial provocation test. The pollen counts were the same during this period. The study was double-blind and lasted 2 years. The clinical tests including score symptoms, drug consumption, and nasal or bronchial provocation test, revealed a statistically significant improvement in the treated group as compared to the placebo group. No side effects were observed.

Administration, Oral↗

PubMed2000

[The effect of local specific bronchial immunotherapy (LIT) on specific and non-specific bronchial hyperreactivity in patients with bronchial asthma sensitive to housedust mites].

The aim of the study was to evaluate the effect of LIT with mite allergens given by dry powder inhalation on bronchial hyperreactivity after histamine and allergen inhalation in patients suffering from atopic mite asthma. The study was conducted in a group of 17 asthmatics (9 patients Hypoinhal Dermatophagoides, 8 patients placebo). A decrease in specific (early asthmatic reaction during specific bronchial provocation test) and non-specific bronchial hyperreactivity has been revealed in the group treated with Hypoinhal Dermatophagoides. No changes were observed in placebo group. A slight improvement in LAR (late asthmatic reaction during specific bronchial provocation test) was observed, but the results were not statistically significant.

Administration, Inhalation↗

PubMed1997

[The effect of bronchial inhalation provocation tests on levels of interleukin-8 in material from broncho-alveolar fluid of patients with atopic bronchial asthma].

Airway inflammation is a very important feature of asthma and occurs simultaneously with increased hyperreactivity. We have examined whether the local inflammation provoked by histamine and allergen challenge of patients with atopic bronchial asthma is associated with the appearance, in vivo interleukin-B (IL-8) in bronchoalveolar lavage fluid (BAL). Bronchoscopy and BAL for further IL-8 investigation were performed before and 24 h after challenge test with histamine (n = 11), grass pollen antigen (n = 8) and PBS (n = 5). ELISA test was used to measure IL-8 concentration (pg/ml) (kits from R&D, USA). There was observed increased level of IL-8 (p < 0.05) after histamine and allergen challenge test. This increased level of IL-8 was correlated with neutrophils in BAL (Kendall's correlation coefficient = +0.5). We conclude that IL-8 may participate in creation of bronchial hyperreactivity in atopic bronchial asthma.

Adult↗

PubMed1990

[Allergy and bronchial hyperreactivity in chronic obstructive lung disease].

In 630 patients with various forms of chronic obstructive pulmonary disease (COPD) an attempt was made to determine the nature of bronchial reactivity and to find out the participation of allergy in the pathogenesis of the disease with the help of clinical observations, skin-allergic test and inhalatory bronchial provocation test (specific and nonspecific). Clinical manifestations of hypersensitivity were found in a great number of patients (320). All of them were with nonspecific bronchial hyperreactivity and most of them were with specific skin hyperreactivity (75%) and with specific bronchial hyperreactivity (67.2%). These data show that allergy and bronchial hyperreactivity take part in the pathogenesis of COPD. The tests for allergy and bronchial hyperreactivity should find place in the diagnostic scheme for COPD.

Asthma↗

PubMedDate not supplied

Asthma and systemic toxic reaction due to cabreuva (Myrocarpus fastigiatus Fr. All.) wood dust.

A 48-year-old parquet floor layer suffered from an attack of asthma at work and systemic toxic reaction after exposure to cabreuva wood dust (Myrocarpus fastigiatus Fr. All.). Exposure to the same dust in hospital produced a late asthmatic reaction with fever, vomiting and myalgia. Leucocytosis with neutrophilia was present after a bronchial provocation test but no radiological changes were observed. A control bronchial provocation test with fir wood dust was negative. It was not possible to study the systemic toxic reaction further due to non-collaboration of the patient; nevertheless, these findings show that systemic reactions to wood dust should always be investigated even though their occurrence is fortunately rare.

Asthma↗

PubMed2001

Determinants of allergen-induced late bronchial responses in mild asthmatics.

STUDY OBJECTIVE: To examine the baseline factors influencing the occurrence and magnitude of immediate- and late-phase responses in asthmatic patients after an allergen-induced bronchial provocation test (A-BPT). DESIGN: Cross-sectional analysis in a homogenous group of 31 mild, Dermatophagoides pteronyssinus-allergic patients with asthma. SETTING: Allergy Department, Hospital Virgen del Camino, Pamplona, Spain. INTERVENTIONS AND MEASUREMENTS: Patients completed an asthma symptom questionnaire and underwent skin tests, sputum induction, and methacholine bronchial provocation test. The A-BPT was performed on a separate day. Sputum cell profile and eosinophil cationic protein (ECP), tryptase, albumin, and interleukin-5 levels were quantified in the entire sputum supernatant. Assays were done for eosinophils in blood, and/or ECP, and total and specific IgE levels in serum. Exposure to D pteronyssinus major allergens (Der p1 and Der 2) was measured by an assay based on monoclonal antibodies. RESULTS: A-BPT findings were positive in all patients, and late-phase responses were detected in 29%. Late responders were exposed to higher levels of Der p1 (p = 0.028), had greater levels of ECP (p = 0.007) and albumin (p = 0.019) in sputum, and showed a trend toward higher lymphocyte numbers (p = 0.053) in sputum than isolated early responders. The allergen-induced provocative dose that induced a fall in FEV(1) values > or =20% from the postdiluent values correlated with bronchial hyperresponsiveness (r = 0.36). The late-phase response magnitude correlated with Der p1 exposure (r = 0.49) and showed a trend toward correlation with sputum ECP levels (r = 0.38). CONCLUSION: Factors involved in the development of allergen-induced immediate- and late-phase responses are different. Allergen natural exposure might prime the infiltration of the airway by activated inflammatory cells enhancing the appearance and the severity of late-phase responses.

Adult↗

PubMed1993

Effects of a bronchoprovocation challenge test with cigarette sidestream smoke on sensitive and healthy adults.

In order to study the acute effects of environmental tobacco smoke on lung function, a cigarette sidestream smoke provocation test (analogous to a nonspecific bronchial provocation test) was performed. Ten persons with airways hyperreactive to methacholine and ten normoreactive persons were tested. A dose-response relationship was found for symptoms. The lung function of the normoreactive persons was not altered by short-time inhalation of sidestream smoke. The hyperreactive subjects, however, experienced significant decreases in FEV1, FVC, and MEF50. The decrease was most pronounced after the lowest dose of 2 ppm smoke-induced CO, leading to a mean fall of 6.3 percent in FEV1. Five of ten subjects with hyperreactive airways showed a decrease in FEV1 of more than 10 percent during the sidestream smoke provocation, one of them a decrease of over 20 percent after inhalation of 16 ppm CO sidestream smoke. We conclude that even short exposure to low concentrations of cigarette sidestream smoke causes significant impairment of lung function in sensitive persons.

Adult↗

PubMed1997

Occupational allergy in greenhouse workers: sensitization to Tetranychus urticae.

BACKGROUND: Tetranychus urticae (TU) is a macroscopic mite which is found infesting a large number of plants of economic interest. It has rarely been described as a cause of occupational allergic disease in agricultural workers. OBJECTIVE: To describe TU sensitization in greenhouse workers attending the outpatient allergy unit and its clinical associations, and to characterize the allergens involved. MATERIALS AND METHODS: Twenty-four consecutive carnation greenhouse workers with allergy-related symptoms, referred to our outpatient clinic during a 6-month period, were included. We made the diagnostic extract from carnation leaves heavily infested with TU. Skin-prick test, specific IgE measurement and bronchial provocation test with TU extract were carried out in all subjects. Allergen characterization was achieved by SDS-PAGE (sodium dodecylsulfate-polyacrylamide gel electrophoresis) and immunoblotting. RESULTS: Sixteen patients (66%) presented positive skin-prick test and specific IgE and were diagnosed allergic to TU. Fifteen patients suffered from bronchial asthma, 14 rhinitis and five urticaria. Twelve exhibited positive bronchial provocation test to the TU extract. On RAST-inhibition studies, there was no evidence of crossreactivity between TU extract and D. pteronyssinus. An allergen at 19 kDa was determined in the TU extract by SDS-PAGE immunoblotting studies. CONCLUSION: TU could be an important occupational allergen in greenhouse workers showing allergic symptomatology. There is no crossreactivity between this mite and the house dust mite D. pteronyssinus.

Adolescent↗

PubMed1989

[Change in the lymphocyte subpopulations in bronchoalveolar lavage 72 hours after the allergen provocation test in the asthmatic].

Fourteen patients suffering from perennial allergic asthma linked to mono-sensitivity to the house dust mite were studied. An initial bronchoalveolar lavage with standard cytology as well as a study of the T lymphocyte subpopulations (CD3, CD4, CD8, Leu 7) and B cells (CD19) was carried out, representing the basal situation. Four weeks later an allergic bronchial provocation test to purified extracts of the house dust mite was performed taking care to monitor the occurrence of any delayed bronchial response (8 out of 14). A second bronchoalveolar lavage was performed 72 hours after the bronchial provocation test. A significant rise of eosinophils in the bronchoalveolar fluid was registered 72 hours after the provocation test; m +/- sem (%): 3.07 +/- 1.31 vs 7.78 +/- 1.22; p less than or equal to 0.005, Student t test for paired series. This large rise in eosinophils was observed independently of the type of response, whether immediate or biphasic. The CD4 lymphocyte subpopulations were significantly decreased after bronchial provocation tests m +/- sem (%) 12.21 +/- 2.79 vs 6.47 +/- 1.62; p less than or equal to 0.05 Student t test for paired series. There was no overall significant difference after the provocation tests in the CD8 lymphocyte subpopulation. However, a remarkable and significant rise was noted in the CD8 populations after bronchial provocation in 6 subjects presenting with an immediate isolated asthmatic reaction; m +/- sem (%) 10.17 +/- 4.01 vs 34 +/- 7.32, p less than 0.05, paired Wilcoxon test.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2006

[Comparison of unspecific bronchial provocation during controlled and spontaneous inhalation].

Using controlled breathing patterns during inhalation of drugs is characterized by a high dose reproducibility which may be of advantage for bronchial provocation testing. In this study 30 healthy subjects with an anamnesis of atopy underwent in a randomized cross-over design bronchial provocation testing with methacholine either with the Viasys-Jäger-APS system or with controlled inhalations (AKITA-System) (controlled inhalation volume and flow). Measured was the frequency of positive test results. Positive test results were defined by a 20 % decline of FEV (1) or a 100 % increase of specific airway resistance (sRaw). There were no significant differences in the prevalence of positive test results obtained with both techniques: APS-FEV (1) : 8, AKITA-FEV (1) : 9; APS-sRaw: 18, AKITA-sRaw: 17. More subjects showed a 100 % increase of sRaw as compared to a 20 % decrease of FEV (1), which may be interesting in order to understand differences in the diagnostic information given by both parameters. However, there were some discrepancies: only in 25 of 30 cases (sRaw: 21 of 30 cases) the results (positive or negative) agreed between both techniques. Although the two techniques for bronchial provocation test showed some discrepancies, these data suggest that controlled inhalations may be an alternative to the APS-system.

Bronchial Provocation Tests↗