Allergy to asticot maggots. Identification of allergens.

UNLABELLED: There are some written reports of allergic reactions after contact with Asticot larvae in anglers and occupationally exposed workers. Clinical and immunological studies were performed to confirm the allergens involved in the case of a 12-year-old male who developed respiratory symptoms shortly after contact with Asticot maggots used as fish bait. METHODS AND RESULTS: Aqueous extracts of Asticot maggots were taken for in vivo and in vitro tests. The protein concentration as determined by turbidimetric assay was 1.4 mg/ml. Skin prick test with Asticot extract was positive with an immediate response. Ten atopic and ten nonatopic control subjects did not react to the extract. Specific serum IgE antibodies against Asticot were found in the patient's serum (ELISA). Coomasie staining after SDS-PAGE separation of Asticot extract showed three protein bands of 30, 40 and 60 kDa. IgE immunoblot showed one antigenic band of 60 kDa specifically recognized by the patient's IgE. Specific nasal challenge test with Asticot extract using a Rhinospir 164 rhinomanometer showed immediate response (1/10 w/v), with a 200% increase in nasal resistances from baseline. CONCLUSIONS: One main allergen of MW 60 kDa was specifically recognized by our patient's IgE. There are no previous reports in the literature that characterize the allergens involved in Asticot hypersensitivity. Asticot maggots should be taken into account as a possible causative agent of respiratory symptoms due to a type I hypersensitivity mechanism in anglers who are exposed to emanations of these live fish baits.

[Anterior rhinomanometry as a diagnostic test in occupational allergy caused by Liliaceae]. / Rinomanometría anterior como test diagnóstico en alergia ocupacional por liliáceas.

UNLABELLED: The Liliacea family has been implicated as a cause of occupational rhinoconjunctivitis and bronchial asthma. We report a patient who presented symptoms when he manipulated spices including garlic and onion dusts. Nasal challenge test with active anterior rhinomanometry was used for the diagnosis. MATERIAL AND METHODS: Skin-prick tests with common inhalants, commercial spices, fresh Liliaceae and powdered spices diluted in saline solution (10 mg/ml) were performed. Immunoblot and specific IgE (CAP-Pharmacia) were determined. Control peak expiratory flow was monitored during a period at work in an area where spices were manipulated and in an area where they were transported. Nasal challenge test with garlic and onion powder was performed. The resulting nasal obstruction was measured as nasal airway resistance and was determined by rhinomanometry. RESULTS: Skin-prick tests were positive for onion, garlic powder and fresh Liliacea. Specific IgE were positive for garlic and onion. IgE immunoblotting showed very strong bands at 14 and 40 kD with garlic extract. Nasal challenge showed an increase in inspiratory nasal resistance which was higher than 100 % of the basal value for both onion extract and garlic.

Angioedema as a single manifestation of carcinoid syndrome in a bronchial carcinoid tumor.

BACKGROUND: The association of bronchial carcinoid tumours with carcinoid syndrome is extremely rare especially in the absence of metastasic disease, and the angioedema is not a typical sign of this syndrome. METHODS AND RESULTS: We report the case of a 39 year-old woman referred to our allergy department with recurrent episodes of angioedema. The aetiological study of angioedema did not show evidence of hypersensitivity to common inhalants, food allergens and latex. C1-inhibitor, C3, C4, C1q, proteinogram and immunoglobulins (IgA, IgG, IgM) all were normal. TSH determination gave normal results, too. Faecal analyses for parasites were negative. The haemogram showed moderate leucocytosis and hypocromic mycrocitic anaemia. The thoracic radiography showed a mediastinal node image in the right paratracheal region. Histology analyses of the samples were diagnostic of a typical carcinoid tumor. Levels of 5-hydroxyindolacetic acid (5-HIIA) were slightly increased. A superior lobectomy was performed and no new episodes of angioedema appeared after surgical intervention. CONCLUSIONS: We report the first case of typical bronchial carcionid tumour, without metastasic disease, with angioedema as a single manifestation of carcinoid syndrome. In our knowledge, only one case of Quincke's edema as part of typical carcinoid syndrome has been reported, in a case of primary midgut carcinoid tumor with metastasic disease to liver. It is very important to include complementary tests, as thoracic radiography, in the routine study of angioedema to reject malignant diseases.