Laboratory animal allergy in a pharmaceutical company.

A cross sectional survey was carried out on 138 workers exposed to laboratory animals. Sixty (44%) had symptoms in a self completed questionnaire that were consistent with laboratory animal allergy (LAA) of whom 15 (11%) had chest symptoms. There was a positive skin prick test to one or more animal urine extracts (rat, mouse, guinea pig, rabbit) in 13% and 38% had a positive radioallergosorbent test to urine extract. LAA chest symptoms were almost five times more common in atopic than non-atopic subjects (who were distinguished by skin test response to common, non-animal aeroallergens). A positive skin test to animal urine was associated with LAA chest symptoms and with atopy. Nose, eye, or skin symptoms without chest symptoms were not associated with atopy. There was an inverse relation between duration of employment at the firm and LAA chest symptoms, suggesting selection of affected people out of employment with animals.     

Laboratory animal allergy in a pharmaceutical company

A cross sectional survey was carried out on 138 workers exposed to laboratory animals. Sixty (44%) had symptoms in a self completed questionnaire that were consistent with laboratory animal allergy (LAA) of whom 15 (11%) had chest symptoms. There was a positive skin prick test to one or more animal urine extracts (rat, mouse, guinea pig, rabbit) in 13% and 38% had a positive radioallergosorbent test to urine extract. LAA chest symptoms were almost five times more common in atopic than non-atopic subjects (who were distinguished by skin test response to common, non-animal aeroallergens). A positive skin test to animal urine was associated with LAA chest symptoms and with atopy. Nose, eye, or skin symptoms without chest symptoms were not associated with atopy. There was an inverse relation between duration of employment at the firm and LAA chest symptoms, suggesting selection of affected people out of employment with animals.     

Laboratory animal allergy: a clinical survey of an exposed population.

A clinical survey of workers exposed to laboratory animals in a pharmaceutical company was designed to discover the prevalence and severity of symptoms of laboratory animal allergy (LAA). The overall prevalence of the condition was 30%, and two distinguishable LAA syndromes, termed regional and progressive LAA, were found. The first is characterised by rhinitis with negative skin prick tests. The second consists of rhinitis leading progressively to asthma with positive prick tests. Prick tests were useful diagnostically only in the latter. Atopes were shown not to be at special risk of developing LAA, but if they did so were more likely to progress to asthma. The implications for selection and management policy are outlined and specific measures for the further study of LAA are proposed.     

Laboratory animal; allergy; asthma

Laboratory animal allergy (LAA) may develop when susceptible persons are exposed to allergens produced by laboratory animals. LAA is associated with exposure to urine, fur, and salivae of rats, guinea pigs, dogs and rabbits. Approximately 30% of persons who are exposed to laboratory animals may develop LAA and some will also develop asthma. LAA is most likely to occur in persons with previously known allergies, especially to domestic pets. The majority of LAA sufferers experience symptoms within six months their first exposure to laboratory animals; almost all develop symptoms within three years. The most common symptoms are watery eyes and an itchy, runny nose, although skin symptoms and lower respiratory tract symptoms may also occur. Feeding and handling laboratory animals or cleaning their cages generates ten times the amount of allergens compared with undisturbed conditions. Prevention of animal allergy depends on control of allergenic material in the work environment and on organizational and individual protection measures. Pre-placement evaluation and periodic medical surveillance of workers are important pieces of the overall occupational health programme. The emphasis of these medical evaluations should be on counselling and early disease detection.     

Crisis management during anaesthesia: anaphylaxis and allergy

Background: Anaphylactic and anaphylactoid reactions during anaesthesia are a major cause for concern for anaesthetists. However, as individual practitioners encounter such events so rarely, the rapidity with which the diagnosis is made and appropriate management instituted varies considerably.

Objectives: To examine the role of a previously described core algorithm "COVER ABCD–A SWIFT CHECK", supplemented by a specific sub-algorithm for anaphylaxis, in the management of severe allergic reactions occurring in association with anaesthesia.

Methods: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual performance as reported by the anaesthetists involved.

Results: There were 148 allergic reactions among the first 4000 incidents reported to AIMS. It was considered that, properly applied, the structured approach would have led to a quicker and/or better resolution of the problem in 30% of cases, and would not have caused harm had it been applied in all of them.

Conclusion: An increased awareness of the diverse clinical manifestations of allergy seen in anaesthetic practice, together with the adoption of a structured approach to management should improve and standardise the treatment and improve follow up of patients suspected of having suffered a significant allergic reaction under anaesthesia.

     

Smoking, atopy, and laboratory animal allergy.

This study examined data from three cross sectional surveys of 296 laboratory workers exposed to small mammals. Four indices of laboratory animal allergy were studied: symptoms suggestive of occupational asthma, symptoms suggestive of any occupational allergy, skin weals to animal urine extracts, and serum binding in radioallergosorbent tests with urine extracts. Pooled data from the three surveys showed an association between smoking and all indices except radioallergosorbent tests; the association was significant for symptoms of occupational asthma. One of the three surveys consistently showed a stronger association of allergy indices with smoking than with atopy (defined on skin tests with non-animal aeroallergens). Associations with smoking persisted after stratifying by atopic status, suggesting that smoking may be a risk factor for laboratory animal allergy.     

Vaccination-associated anaphylaxis in adults: Diagnostic testing ruling out IgE-mediated vaccine allergy

Re-vaccinations in patients with a history of anaphylaxis after vaccine injection have to be avoided because of the potential risk of recurrent anaphylaxis. However, without diagnostic work-up vaccine allergy remains a presumption and necessary vaccinations may be unjustified withheld. In the last 7 years all patients referred to our allergy clinic with a diagnosis of vaccination-induced anaphylaxis were subjected to allergologic diagnostic procedures to identify IgE-mediated allergy. We evaluated 38 patients with a history of vaccination-associated anaphylaxis. The diagnostic procedure included skin testing and challenge tests, i.e. re-vaccination with the suspected vaccine. In all 38 patients negative skin tests and tolerated challenge tests ruled out IgE-mediated allergic anaphylaxis to vaccine components. Diagnostic testing after suspected vaccination-induced anaphylaxis should be performed to rule out IgE-mediated allergy to the incriminated vaccine and its constituents and to enable future vaccinations with the tested compounds. Therefore, a history of anaphylaxis after vaccination may not be an absolute contraindication for re-vaccination.     

Respiratory allergy in laboratory animal workers: a retrospective cohort study using pre-employment screening data.

OBJECTIVES: To study the role of exposure, atopy, and smoking in the development of laboratory animal allergy (LAA) in a retrospective cohort study. METHODS: Between 1977 and 1993, 225 people received a pre-employment screening when they started a job at a Dutch research institute where they were going to work with laboratory animals. After active follow up 136 of them (60.4%) could be traced and were sent a questionnaire with extensive questions on allergic symptoms, smoking habits, and job history. 122 people (89.7%) sent back a completed questionnaire. Those who were accepted for a job at the institute and did not have allergic symptoms at the start of the job were selected as cohort members. After selecting people with complete data on start and end date of jobs, exposure intensity, atopy, and smoking, the cohort consisted of 99 people with an average time of follow up of 9.7 years. LAA was defined as a positive response to a set of questions in the questionnaire. The mean number of hours a week a person was exposed to laboratory animals at entry of the cohort was used as a surrogate for exposure, and was divided into four categories. RESULTS: 19 cohort members (19.2%) reported LAA. More people with asthmatic symptoms were found in the high exposure categories. More atopic than non-atopic people reported asthmatic symptoms (13% v 6%). The mean time until development of symptoms of LAA was about 109 months in non-atopic people (n = 9), and 45 months in atopic people (n = 10) (t test; P < 0.05). Time until development of symptoms of LAA was shorter at a higher intensity of exposure, except for those exposed for less than two hours a week. A proportional hazard regression analysis showed that exposure and atopy were significant determinants of LAA. An increased relative risk (RR) was found for non-atopic people exposed to laboratory animal allergens for more than two hours a week. Atopic people had an even higher risk when exposed to laboratory animals for more than two hours a week (RR above 7.3). Sex, smoking, and age were not risk factors. More atopic than non-atopic people were absent from work or transferred because of allergies. CONCLUSIONS: This study showed that exposure and atopy are significant predictors of LAA and that the risk of developing LAA remained present for a much longer period (> 3 y) than considered before.     

Predisposing factors in laboratory animal allergy: a study of atopy and environmental factors

A population of 101 laboratory technicians handling laboratory animals was studied with regard to predisposing factors for allergy. Twenty-seven had symptoms indicating laboratory animal allergy (LAA); of these, nine had asthma and were skin prick test positive for animal allergens. The LAA asthmatics had an increased frequency of a family history of allergy (relative risk, RR = 3.8); the predictive value was 0.27. There was also an increase of skin prick positivity against common nonanimal allergens (RR = 15); the predictive value was 0.60. All persons with marked positive skin prick tests (greater than or equal to +2) to environmental allergens had developed animal-test-positive LAA asthma. In 56% of the LAA asthma cases the serum IgE levels were elevated (greater than 100kU/L). In preemployment screening of susceptible individuals two important selection criteria emerged, viz., family history of allergy and positive skin prick reactions against environmental allergens.     

Cow's milk allergy: a critical review.

Foods which are ingested frequently, and cow's milk in particular, are a common cause of delayed-in-onset allergy. Difficulty in diagnosing milk allergy is encountered because: (1) skin tests are unreliable; (2) the symptoms of milk allergy are frequently delayed in appearing, thereby obscuring their connection with the previously ingested food; (3) when such symptoms do appear, they often fail to suggest allergy as etiologic; and (4) the offending antigen may be present in a milk product not obviously associated with milk per se such as sherbet or cheese. Contrary to common belief, most milk (and other food) allergy is not reagin (IgE) mediated. Milk allergy is not confined to infancy, but is frequently seen in children and adults, often persisting as an allergy which had supposedly been "outgrown." Since milk allergy is often a familial disorder, its presence in a patient can assist the physician in possibly discovering it in other members of the family. A two or three-week trial elimination of milk, in conjunction with written dietary instructions for the patient, is presently the only reliable diagnostic procedure.     

Laboratory support for poliomyelitis eradication: memorandum from a WHO meeting.

This Memorandum summarizes the conclusions and recommendations of the participants at the Consultation on Strategy for Isolation and Characterization of Poliovirus Strains and Surveillance of Wild Polioviruses held in Geneva, 28-30 November 1988.     

Human leukocyte antigens in occupational allergy: A possible protective effect of HLA-B16 in laboratory animal allergy

Human leukocyte antigens (HLA-A, -B, -C, and -DR loci) and possible associations with occupational allergy to laboratory animals and atopy indicators were studied in laboratory animal workers with airway symptoms (n = 92) and in those who were symptom free (n = 27), as well as in a population reference group of blood donors in good health (n = 123). The laboratory animal workers, but not the population reference group, were allergologically examined with skin prick testing to common environmental and animal allergens together with measurement of total serum IgE levels. Seven HLA antigens, i.e., HLA-A9, -B5, -B12, -B16, -DR4, -DR5, and -Drw6, suggested possible associations with symptoms and/or atopy indicators. When correcting the p-values for the number of studied antigens, only the HLA-B16 differences remained statistically significant. HLA-B16 was elevated in symptom-free subjects compared to the population reference group and in subjects with serum IgE <10 kU/L. Subjects with serum IgE >100 kU/L and sensitized against environmental and/or laboratory animals, including LAA asthmatics, lacked HLA-B16. It is suggested that HLA-B16 or an immunosuppressive gene linked to HLA-B16 reduce the risk of producing IgE antibodies against animal protein allergens. However, our a priori hypothesis of a possible risk associated with HLA B15-DR4 could not be confirmed. © 1996 Wiley-Liss, Inc.     

Acupuncture: from needle to laser

Acupuncture has been used in the treatment of a variety of illnesses for more than 2000 years. The practice of acupuncture is based on a theoretical system different from our understanding of human anatomy and physiology, and has developed through experience and observation. Stimulation of selective acupoints (situated along 'meridians' in the body) by inserting needles is believed to restore bodily functions by promoting the flow of 'vital energy', throughout the system. Other forms of stimulation which have been developed are heat, electrical stimulation, magnetism and, recently, laser. Laser acupuncture offers distinct advantages over the traditional method because the procedure is pain-free and non-traumatic. Clinical applications include the control of pain in osteoarthritis, lumbago and migraine, and anaesthesia for certain surgical procedures, as well as other ailments of the cardiovascular, respiratory and nervous systems. The technique is easy to learn and there is no need for sophisticated instruments. Thus it is especially useful in developing countries where health resources are limited.     

Lessons learned from a peri-urban needle exchange

Background  

Injection drug users continue to be at high risk of HIV and HCV. Research has shown that needle exchange programs (NEP) decrease injection frequency, reduce syringe reuse, and reduce needle sharing, though some results have been mixed.     

Natural latex allergy. Patient management: from clinic to prevention. A review

The widespread use of latex devices has been followed, in the last 25 years, by an increase in IgE mediated sensitization. The clinical manifestations of latex allergy affect the skin (urticaria and angioneurotic oedema), the lower and the upper respiratory tracts (rhinoconjunctivitis, asthma and glottis oedema), and the cardiovascular system (anaphylaxis). There is also an anaphylactic risk during surgery and invasive diagnostic procedures. Vegetable food cross-reacts with latex so that more than half of the patients show specific IgE against some food. Further than traditional groups at risk, as health care workers, other work categories have to be protected, because of the inappropriate use of latex gloves (food or drug industry workers, mechanics, panel beaters and so on). Recently the latex most important allergenic fractions have been characterized and recombinant allergens are now available. The recombinant allergens allow a better standardization of the extracts for diagnostic use, the production of safer extracts for immunotherapy as well as a more accurate evaluation of food cross-reactions. The recombinant allergens will allow a more accurate dosage of latex concentrations in air and in objects and, in future, to establish threshold limit values. The main aims of prevention are the replacement of latex with alternative elastomers, the reduction of work and extra work exposure and an efficient health survey in working environment. The use of latex gloves and devices among general population has to be discouraged. Specific immunotherapy has to be considered a second choice and restricted to highly qualified workers in order to realize a rehabilitation to their previous jobs. The actually obtained protection must be verified.