Occupational asthma, rhinitis and contact urticaria from greenhouse work.

BACKGROUND: The current knowledge about occupational allergic diseases among greenhouse workers is scant. AIMS: To describe greenhouse workers' occupational allergic diseases. METHODS: We identified 28 greenhouse workers with occupational allergic diseases in 2002-2020 by conducting a systematic search in the patient register of the Finnish Institute of Occupational Health. All the patients worked in tomato- or cucumber-growing greenhouses and showed immunoglobulin-E-mediated sensitization to occupational agents. Specific inhalation challenges or workplace peak expiratory flow monitoring confirmed occupational asthma (OA), nasal allergen challenges confirmed occupational rhinitis (OR) and open skin tests confirmed occupational contact urticaria (OCU). RESULTS: Most patients had more than one occupational disease and were sensitized to several workplace agents. Tomato plants were the most common cause of occupational diseases and induced 22 allergic diseases in 14 patients. Cucumber plants caused occupational diseases in 10 patients (3 OA, 7 OR and 6 OCU). The pest control mite Amblyseius swirskii and a mixture of parasitic wasps Encarsia formosa and Eretmocerus eremicus both induced two OA cases. Three patients had an occupational disease caused by storage mites and three others had a work-related systemic reaction to a bumblebee sting. CONCLUSIONS: The greenhouse workers typically suffered from several occupational allergic diseases and were sensitized to cultivated plants, various pest control organisms and storage mites. All these can cause OA and OR, but in this study, OCU was only induced by cultivation plants. Cucumber plant is a novel cause of OA and OR, and A. swirskii is a novel cause of OA.

Characterization of relevant bovine dander allergen components.

BACKGROUND: The diagnostics of allergic occupational diseases is highly dependent on the quality of the allergen extracts and specific IgE tests available. To enhance the diagnostics of bovine-related occupational rhinitis, asthma and urticaria, we produced an in-house cow dander extract, assessed its allergen profile and performance in clinical tests, and compared it to commercial bovine dander extracts. METHODS: One hundred patients with a suspected bovine-related occupational disease underwent skin prick tests (SPTs) with in-house and one to two commercial bovine dander extracts. Nasal allergen provocation tests were performed on 31 patients with suspected occupational rhinitis. We used Western blot to study the specific IgE-protein reactions from the serums of the patients with positive provocation tests, and identified allergens from immunoblot bands using tandem mass spectrometry. RESULTS: Odorant-binding protein Bos d OBP, bovine serum albumin Bos d 6, and lipocalin Bos d 2 were identified as the major allergens. We found altogether 24 bovine dander allergens, of which several were formerly unknown. The in-house extract sensitivity and specificity in SPTs were 100% and 94%, in 87 patients respectively and SPTs appeared negative in 20 healthy controls. Nasal allergen provocation tests with inhouse extract detected occupational rhinitis with 100% sensitivity in 21 patients. Five healthy controls remained negative in the provocation tests. CONCLUSIONS: Three major and several minor allergens were found from bovine dander as a cause of occupational rhinitis. A sufficient concentration and variety of tested allergens were essential in the diagnostics of bovine-related occupational diseases.

EAACI Position paper on the standardization of nasal allergen challenges.

Nasal allergen challenge (NAC) is an important tool to diagnose allergic rhinitis. In daily clinical routine, experimentally, or when measuring therapeutic success clinically, nasal allergen challenge is fundamental. It is further one of the key diagnostic tools when initiating specific allergen immunotherapy. So far, national recommendations offered guidance on its execution; however, international divergence left many questions unanswered. These differences in the literature caused EAACI to initiate a task force to answer unmet needs and find a consensus in executing nasal allergen challenge. On the basis of a systematic review containing nasal allergen challenges of the past years, task force members reviewed evidence, discussed open issues, and studied variations of several subjective and objective assessment parameters to propose a standardized way of a nasal allergen challenge procedure in clinical practice. Besides an update on indications, contraindications, and preparations for the test procedure, main recommendations are a bilaterally challenge with standardized allergens, with a spray device offering 0.1 mL per nostril. A systematic catalogue for positivity criteria is given for the variety of established subjective and objective assessment methods as well as a schedule for the challenge procedure. The task force recommends a unified protocol for NAC for daily clinical practice, aiming at eliminating the previous difficulty of comparing NAC results due to unmet needs.

Characterization of Relevant Bovine DanderAllergen Components

Background: Diagnostic tests in occupational allergic diseases are highly dependent on the quality of available allergen extracts and specific IgE tests. To enhance diagnostic testing in cattle-related occupational rhinitis, asthma, and urticaria, we produced an in- house cow dander extract, assessed its allergen profile and performance in clinical tests, and compared it with commercial bovine dander extracts. Methods: One hundred patients with a suspected cattle-related occupational disease underwent skin prick tests (SPTs) with in-house and 1 or 2 commercial bovine dander extracts. Nasal allergen provocation tests were performed on 31 patients with suspected occupational rhinitis. We used Western blot to study the specific IgE-protein reactions from the sera of the patients with positive provocation test results and identified allergens from immunoblot bands using tandem mass spectrometry. Results: The odorant-binding protein Bos d OBP, bovine serum albumin (Bos d 6), and the lipocalin (Bos d 2) were identified as the major allergens. We found a total of 24 bovine dander allergens, of which several were formerly unknown. The sensitivity and specificity of the in-house extract in SPTs were 100% and 94%, respectively, in 87 patients. The SPT results were negative in 20 healthy controls. Nasal allergen provocation tests with in-house extract detected occupational rhinitis with 100% sensitivity in 21 patients. The provocation results remained negative in 5 healthy controls. Conclusions: Three major and several minor allergens in bovine dander caused occupational rhinitis. Diagnosis of bovine allergen–related occupational diseases requires a sufficient concentration and variety of tested allergens (AU)

Antecedentes : las pruebas de diagnóstico en enfermedades alérgicas profesionales dependen en gran medida de la calidad de los extractos de alérgenos disponibles y de las pruebas de IgE específicas. Para mejorar las pruebas de diagnóstico en rinitis, asma y urticaria ocupacional relacionadas con el ganado, produjimos un extracto de caspa de vaca internamente, evaluamos su perfil de alérgenos y su desempeño en pruebas clínicas, y lo comparamos con extractos de caspa bovina comerciales. Métodos : Cien pacientes con sospecha de enfermedad profesional relacionada con el ganado se sometieron a pruebas cutáneas (SPT) con extractos de caspa bovina internos y 1 o 2 comerciales. Se realizaron pruebas de provocación con alérgenos nasales a 31 pacientes con sospecha de rinitis ocupacional. Utilizamos Western blot para estudiar las reacciones específicas de la proteína IgE de los sueros de los pacientes con resultados positivos en la prueba de provocación e identificamos alérgenos a partir de bandas de inmunotransferencia mediante espectrometría de masas en tándem.Resultados : La proteína fijadora de olores Bos d OBP, la albúmina sérica bovina (Bos d 6) y la lipocalina (Bos d 2) se identificaron como los principales alérgenos. Encontramos un total de 24 alérgenos de la caspa bovina, de los cuales varios eran desconocidos hasta el momento. La sensibilidad y especificidad del extracto interno en los SPT fueron del 100% y 94%, respectivamente, en 87 pacientes. Los resultados del SPT fueron negativos en 20 controles sanos. Las pruebas de provocación de alérgenos nasales con extracto interno detectaron rinitis ocupacional con una sensibilidad del 100% en 21 pacientes. Los resultados de la provocación siguieron siendo negativos en 5 controles sanos(AU)

Human spumaretrovirus in the etiology of sudden hearing loss.

The etiology of sudden sensorineural hearing loss, so called sudden deafness, has for long puzzled researchers. Recently we have studied the possibility that a hitherto relatively unknown retrovirus group consisting of human spumaretroviridae (HSRV) might be the causative agent of sudden deafness. During the last 3 months we have screened about 30 cases of sudden deafness. In 4 of them antibodies against HSRV were detected. Three of them had suffered from a flu-like condition about 2 weeks before the onset of hearing loss. In 2 cases the hearing of both ears was involved, in 1 case a relapsing hearing loss was observed, and 1 case developed a Meniere-like symptomatology with a fluctuant hearing loss. Vertigo was present in 3 patients and all suffered from tinnitus. Full recovery of hearing was observed in 4 of 6 affected ears whereas 2 ears became practically deaf with poor speech discrimination. At present it seems likely that a significant part of sudden deafness is caused by HSRV infection. The course of infection follows the spontaneous course of sudden deafness described by many authors. We encourage otologic units to screen for HSRV when assessing the etiology of sudden deafness.

Myelitis associated with influenza A virus infection.

We report a patient presenting with myelitis after respiratory symptoms. A high level of antibodies to influenza A virus was measured in serum and cerebrospinal fluid (CSF), and the serum/CSF antibody ratio was 1.7, suggesting specific antibody production in the central nervous system. Magnetic resonance imaging of the spinal canal showed a contrast-enhanced swelling on the cervical medulla. Such a case would have warranted the use of antiviral therapy and calls to mind the neurotropic potential of influenza A viruses.

Lack of calbindin-D28k does not affect hearing level or survival of hair cells in acoustic trauma.

Calbindin is a cytosolic calcium-binding protein abundant in the hair cells of the inner ear and in distinct neurons of the auditory pathway. It is suggested to speed the return of potentially toxic calcium levels to normal. In this study, we show the basic hearing functions and the result of noise trauma from the calbindin null mutant mice generated by gene targeting. Auditory brainstem evoked response and distortion product otoacoustic emissions appear similar as in the control group. A moderate noise-induced trauma produced a similar loss of hair cells in calbindin null mutant mice than in wild-type controls. The result suggests that although calbindin is abundant in hair cells, it is not essential for the main hearing function and it does not provide physiological protection against a moderate noise-induced inner ear trauma in mice.