Occupational rhinitis and asthma due to crickets.

BACKGROUND: Insects may cause airborne hypersensitivity reactions. However, few reports exist on specific allergy to crickets. OBJECTIVE: To report a case of occupational rhinitis and bronchial asthma in a cricket farm worker. METHODS: A 28-year-old woman developed rhinitis and bronchial asthma related to her job in a farm where she was exposed to crickets: Gryllus campestris, Gryllus bimaculatus, and Acheta domestica. Extracts were prepared from whole and crushed bodies and analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Skin prick tests, specific IgE assays (enzyme allergosorbent test [EAST], immunoblotting, EAST inhibition assays), serial peak expiratory flow monitoring at work, and specific (A domestica) and nonspecific bronchial challenge tests were performed. RESULTS: Skin prick test results were positive for G campestris, G bimaculatus, and A domestica. Levels of specific IgE were 2.9, 2.4, and 5.4 kU/L, respectively. The total IgE level was 131 kU/L. Serial peak expiratory flow monitoring at work was consistent with occupational asthma. The result of a bronchial challenge test with A domestica was positive with a dual response and elicited an increase in nonspecific bronchial hyperresponsiveness. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis immunoblotting revealed a similar pattern of IgE-binding bands with the 3 cricket extracts (bands of 78 and 64 kDa appeared in nonreducing conditions, whereas bands of 107 to 80, 58, and 52 kDa appeared in reducing conditions). None of these bands was detected by control sera. EAST inhibition studies showed a high degree of cross-reactivity among the 3 species. CONCLUSION: Crickets are responsible for occupational rhinitis and asthma by an IgE mechanism. Cross-reactivity among the crickets tested in our study was found.     

T-cell activation in occupational asthma and rhinitis

BACKGROUND: Allergic asthma and rhinitis are described as associated with a Th2 activation. However, recent works indicate that a Th1 activation can also be associated with these diseases, concomitantly to a defect in regulatory T (Treg) cell activation. Occupational asthma (OA) and occupational rhinitis (OR) are peculiar cases of these diseases in which the T-cell activation profile is largely unknown. OBJECTIVE: To characterize T-cell activation induced after a specific inhalation test (SIT) in OA and OR. MATERIAL AND METHODS: A total of 21 subjects with OA, 10 subjects with OR, 10 exposed nonallergic (ENA) subjects, and 14 healthy volunteers were included. The SIT with the incriminated substance was performed in patients and ENA subjects. Blood and induced sputum were obtained before and after SIT. T cells were analysed for CD69, CD25, IL-13, and IFN-gamma expression by flow cytometry. IL-4 and IFN-gamma were assayed by enzyme-linked immunosorbent assay (ELISA) in cell culture supernatants. Treg cells were identified as CD4(+)CD25(+high)CD45RO(+)CD69(-) T cells in peripheral blood. RESULTS: Baseline IFN-gamma production was decreased in OA and OR compared with controls. The SIT induced an increase in both Th1 and Th2 cells in blood and sputum from OA. In this group, the proportion of peripheral Treg cells decreased after SIT. Similar results were found in the CD8(+) population. ELISA assays were concordant with flow cytometry. In OR, an attenuated activation profile was found, with an increase in the proportion of IL-13-producing T cells after SIT. By contrast, in ENA subjects, SIT induced Th2 activation, with an increase in Treg cells and a decrease in Th1 cells. CONCLUSIONS: Our results demonstrate a gradient of T-cell activation from a tolerating profile in ENA subjects to an inflammatory profile in OA, with an intermediate stage in OR.     

Occupational asthma and IgE sensitization to grain dust.

To evaluate type I hypersensitivity to grain dust (GD), its prevalence and relationship to respiratory dysfunction, we studied clinical and immunologic features, including skin prick tests (SPT), serum specific IgE, and bronchoprovocation tests of 43 employees working in the animal feed industry. To further characterize IgE-mediated reaction, SDS-PAGE and electroblot studies were performed. Our survey revealed that 15 (34.9%) subjects had work-related skin response (> or =2+ of A/H ratio) to GD, thirteen (30.2%) had high specific IgE antibody against GD. The specific IgE antibody was detected more frequently in symptomatic workers (40%) than in asymptomatic workers (11%). Significant association was found between specific IgE antibody and atopy or smoking (p<0.05). The ELISA inhibition test of GD revealed significant inhibitions by GD extract and minimal inhibitions by the house dust mite, storage mite and corn dust. Immunoblot analysis showed 8 IgE binding components within GD ranging from 13.5 to 142.5 kDa. Two bands (13.5, 33 kDa) were bound to the IgE from more than 50% of the 14 sera tested. In conclusion, these findings suggest that GD inhalation could induce IgE-mediated bronchoconstriction in exposed workers.     

Occupational asthma caused by soybean hull: a workplace equivalent to epidemic asthma

A case showing that soya hull exposure at work causes occupational asthma without flour-related bronchoconstriction.     

Relevance of sensitization to occupational allergy and asthma in the detergent industry

There exists considerable historic experience of the relationship between exposure and both the induction of sensitization and the elicitation of respiratory symptoms from industrial enzymes of bacterial and fungal origin used in a wide variety of detergent products. The detergent industry in particular has substantial experience of how the control of exposure leads to limitation of sensitization with low risk of symptoms. However, the experience also shows that there are substantial gaps in knowledge, even when the potential occupational allergy problem is firmly under control, and also that the relationship between exposure and sensitization can be hard to establish. The latter aspect includes a poor appreciation of how peak exposures and low levels of exposure over time contribute to sensitization. Furthermore, while a minority of workers develop specific IgE, essentially none appear to have symptoms, a situation which appears to contradict the allergy dogma that, once sensitized, an individual will react to much lower levels of exposure. For enzymes, the expression of symptoms occurs at similar or higher levels than those that cause induction. In spite of some knowledge gaps, medical surveillance programs and constant air monitoring provide the tools for successful management of enzymes in the occupational setting. Ultimately, the knowledge gained from the occupational setting facilitates the completion of safety assessments for consumer exposure to detergent enzymes. Such assessments have been proven to be correct by the decades of safe use both occupationally and in consumer products.     

Relevance of sensitization to occupational allergy and asthma in the detergent industry

There exists considerable historic experience of the relationship between exposure and both the induction of sensitization and the elicitation of respiratory symptoms from industrial enzymes of bacterial and fungal origin used in a wide variety of detergent products. The detergent industry in particular has substantial experience of how the control of exposure leads to limitation of sensitization with low risk of symptoms. However, the experience also shows that there are substantial gaps in knowledge, even when the potential occupational allergy problem is firmly under control, and also that the relationship between exposure and sensitization can be hard to establish. The latter aspect includes a poor appreciation of how peak exposures and low levels of exposure over time contribute to sensitization. Furthermore, while a minority of workers develop specific IgE, essentially none appear to have symptoms, a situation which appears to contradict the allergy dogma that, once sensitized, an individual will react to much lower levels of exposure. For enzymes, the expression of symptoms occurs at similar or higher levels than those that cause induction. In spite of some knowledge gaps, medical surveillance programs and constant air monitoring provide the tools for successful management of enzymes in the occupational setting. Ultimately, the knowledge gained from the occupational setting facilitates the completion of safety assessments for consumer exposure to detergent enzymes. Such assessments have been proven to be correct by the decades of safe use both occupationally and in consumer products.     

Allergic rhinitis and asthma in southern Croatia: impact of sensitization to Ambrosia elatior

Aim

To identify pollen types in southern Croatia and investigate the impact of sensitization to Ambrosia elatior (A. elatior) on symptoms and treatment of patients with seasonal allergic rhinitis and/or asthma.

Methods

The study recruited 120 patients from Split-Dalmatian County with seasonal rhinitis and asthma symptoms and positive skin prick test to one or more common inhaled allergens. Patients with positive skin prick test and increased specific IgE to A. elatior (n = 56) were included in the follow-up study during the A. elatior pollen season. Rhinitis and asthma symptoms were scored and drug treatment recorded using standardized questionnaires. Also, forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), peak expiratory flow (PEF), and eosinophil count in peripheral blood were measured. Type and pollen concentration of A. elatior in the air over the nine-week pollen season were determined on the glass slides using the gravimetric method. The results were expressed as the proportion of A. elatior pollen in the total pollen.

Results

Fifty-six of 120 patients (46.7%) were sensitized to A. elatior. Its proportion in total pollen peaked to 12% in the first week of September. Forty-one patients who completed the follow-up study showed a significantly higher score of symptoms during this peak period than in the beginning of the pollen season for seasonal allergic rhinitis (median±interquartile range, 50 ± 11 vs 7 ± 4; P<0.001) and for seasonal allergic asthma (median±interquartile range, 12 ± 2 vs 0 ± 0; P<0.001).

Conclusion

A. elatior is an important cause of seasonal allergic rhinitis and asthma and must be included in the routine diagnostic procedures in southern Croatia.Ambrosia artemisiifolia L. (Ambrosia elatior L., obični limunđik in Croatian) is short ragweed, which belongs to the family of Asteraceae (Compositae). In 1941, an investigation identified A. elatior in northern Croatia (Podravina, Posavina, Slavonija) and along the Adriatic coast: Zadar, Istria, the island of Krk, Neretva River Delta, and in uncultivated areas in the valley of Sinjsko Polje (1). A. elatior arrived in Croatia from North America (2), with the port of Rijeka being one of the possible routes of its arrival (1).A. elatior has meanwhile spread all over Europe, from the eastern and central European countries, particularly Poland (3,4), Hungary, and Czech Republic (3,5), to Switzerland (6), North Italy (7), and the east of France (8). Over the last four years, several studies investigated the distribution of A. elatior pollen in northern Croatia, confirming its presence in clinically significant concentrations and a declining tendency from East to West (9,10). Although the prevalence of seasonal allergic rhinitis and asthma by sensitization to A. elatior pollen in northern Croatia is on the increase, there have been no epidemiological studies about this issue. There are actions under way to eliminate A. elatior from yards, uncultivated fields, and areas by the rivers and creeks in Osijek (11) and Zagreb.In our earlier studies of pollen allergy in adult inhabitants of southern Croatia, we investigated sensitization to different pollens specific for the Adriatic coast, particularly Parietaria species (12-14). Until recently, we did not investigate sensitization to A. elatior pollen because it was not expected to be present in this region in clinically relevant concentrations. Therefore, this allergen was not included in the routine panel of inhaled allergens in allergy diagnosis. As a number of patients with seasonal allergic rhinitis and asthma showed negative skin tests with the routine panel of inhaled allergens between late summer and early autumn, we suspected that the panel did not include some relevant allergens.The aim of this study was to identify the types of airborne pollen of A. elatior, monitor its concentrations in the pollen season (mid-August, September, and October), establish the prevalence of sensitization to its pollen in patients with seasonal allergic rhinitis and asthma, and relation between pollen concentrations, respiratory symptoms, and the use of medications in their treatment.     

Association between asthma and rhinitis according to atopic sensitization in a population-based study

BACKGROUND: Although asthma and rhinitis often occur together, the reason for this common comorbidity is still a matter of debate. OBJECTIVE: We sought to assess whether the coexistence of asthma and rhinitis could be explained by common risk factors. METHODS: International cross-sectional study of representative samples of young adults, who completed a detailed questionnaire and underwent lung function tests, bronchoprovocation challenge, IgE measurements, and skin prick tests. RESULTS: In all countries, asthma and bronchial hyperreactivity were more frequent in subjects with rhinitis than in those without (odds ratio [OR], 6.63; 95% CI, 5.44-8.08; and OR, 3.02 95% CI, 2.66-3.43, respectively). Seventy-four percent to 81% of subjects with asthma reported rhinitis, depending on sensitization to specific allergens. Conversely, the risk of asthma increased from 2.0% in subjects without rhinitis to 6.7% in subjects with rhinitis only when exposed to pollen, 11.9% in subjects with rhinitis when exposed to animals, and 18.8% in subjects with rhinitis either when exposed to pollen or to animals. The association between rhinitis and asthma remained significant after adjustment for total IgE, parental history of asthma, and allergen sensitization (OR, 3.41; 95% CI, 2.75-4.2 suggesting that the coexistence of asthma and rhinitis is not solely due to atopic predisposition to these 2 diseases. CONCLUSIONS: Although there were some variations in the association between asthma and rhinitis according to sensitization to individual allergens, the strong association between asthma and rhinitis was not fully explained by shared risk factors, including atopy. Our findings are consistent with the hypothesis that rhinitis might increase the risk of asthma.     

Trends in eczema,rhinitis, and rye grass sensitization in a longitudinal asthma cohort

BackgroundAtopic conditions are prevalent in the Western world, with limited long-term data on atopic trends in patients with asthma.ObjectiveTo describe the trends in eczema, rhinitis, and allergic sensitization in a longitudinal childhood asthma cohort.MethodsFour hundred eighty-four patients were recruited at 7 years of age and followed regularly to 50 years of age. Subjects completed an interviewer-administered questionnaire to define current eczema and rhinitis. Skin prick testing to rye grass also was performed.ResultsThe participation rate over the past 4 decades has been maintained at 72% to 91%. There was a decrease in the prevalence of eczema in the past 12 months in groups with viral-associated wheeze (21% to 8%, P = .002), asthma (47% to 18%, P < .001), and severe asthma (69% to 28%, P < .001) from 14 to 21 years of age. Conversely, there was an increase in the prevalence of rhinitis in the previous 12 months in groups without asthma (1% to 6%, P = .04; 1% to 20%, P = .008), with viral-associated wheeze (16% to 28%, P = .006; 16% to 49%, P < .001), and with asthma (45% to 56%, P = .2; 45% to 73%, P = .014) from recruitment to 10 and 14 years of age, respectively. There were 2 peaks in prevalence in the sensitization to rye grass in this cohort from 7 to 10 years of age and from 14 to 21 years of age in all groups.ConclusionThe adolescence phase appears to be an important period in the body's response to allergens whereby eczema decreases in prevalence, whereas rhinitis and rye grass sensitization increase in prevalence.     

New sensitization to house dust mites in cefteram-induced occupational asthma: a case report

Occupational asthma (OA) can improve after cessation of exposure; however, some patients suffer from persistence or aggravation of their asthmatic symptoms. Here we report a case of a new sensitization to house dust mites during the follow-up period in a 37-year-old female patient with OA induced by cefteram pivoxil powder (cefteram powder). She was previously diagnosed with OA caused by inhalation of cefteram powder. Consequently, she left her job and had been well for 9 subsequent years. She began to experience aggravation of her rhinitis and asthmatic symptoms again several months prior to presentation. Her skin-prick test results had converted to strongly positive responses to two types of house dust mites. The serum levels of eosinophil cationic protein (ECP) and the total and specific immunoglobulin (Ig)E levels against the two types of house dust mites were elevated. An inhalation challenge test with Dermatophagoides farinae was performed, and significant bronchoconstriction (21.1% reduction in the forced expiratory volume in the first second) with asthma symptoms was observed at 10 minutes. To our knowledge, this is the first case demonstrating a new sensitization to house dust mites in a patient with OA caused by cefteram powder. Regular monitoring, including skin-prick tests and measurement of specific serum IgE/ECP levels, may help to screen potential cases.