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)

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.

Patients' perceptions of medicines information received at hospital discharge in Norway: a qualitative interview study.

Background Insufficient transfer of medicines information is a common challenge at discharge from hospital. Following discharge, home dwelling patients are expected to manage their medicines themselves and adequate counselling is an important prerequisite for patient empowerment and self-efficacy for medicines management. Objective The aim was to identify patients' needs for medicines information after discharge from hospital, including the patients' perception and appraisal of the information they received at discharge. Setting The study enrolled patients discharged from three medical wards at a secondary care hospital in Oslo, Norway. Method Patients were included at the hospital, at or close to the day of discharge and qualitative, semi-structured interviews were performed during the first 2 weeks after discharge. Eligible patients were receiving medicines treatment on admission and after discharge, were handling the medicines themselves, and discharged to their own home. Data were collected in 2017. Interviews were analysed with thematic analysis inspired by Systematic Text Condensation. Main outcome measure Patients' perceptions of medicines information. Results In total, 12 patients were interviewed. They were discharged in equal numbers from the three wards, representing both sexes and a broad age range. Patients perceive medicines information as a continuum and not limited to specific encounters, like the discharge conversation. They gain information in several ways; by receiving information from health care professionals, through observations, and by seeking it themselves. Some thought they could have been better informed about adverse reactions and how to manage life while being a medicines user. Others felt they did not want or need more information. Patients employ various strategies for coping with their use of medicines, influencing their self-efficacy towards medicine management. Conclusion Medicines information should focus on empowering the patients throughout the hospital stay and not solely at discharge, taking into account the individual patient's needs for information, preferences and prior knowledge.

Nasal mucosa and blood cell transcriptome profiles do not reflect respiratory symptoms associated with moisture damage.

Upper and lower respiratory symptoms and asthma are adverse health effects associated with moisture-damaged buildings. Quantitative measures to detect adverse health effects related to exposure to dampness and mold are needed. Here, we investigate differences in gene expression between occupants of moisture-damaged and reference buildings. Moisture-damaged (N = 11) and control (N = 5) buildings were evaluated for dampness and mold by trained inspectors. The transcriptomics cohort consisted of nasal brushings and peripheral blood mononuclear cells (PBMCs) from 86 teachers, with/without self-perceived respiratory symptoms. Subject categories comprised reference (R) and damaged (D) buildings with (S) or without (NS) symptoms, that is, R-S, R-NS, DS, and D-NS. Component analyses and k-means clustering of transcriptome profiles did not distinguish building status (R/D) or presence of respiratory symptoms (S/NS). Only one nasal mucosa gene (YBX3P1) exhibited a significant change in expression between D-S and D-NS. Nine other nasal mucosa genes were differentially expressed between R-S and D-S teachers. No differentially expressed genes were identified in PBMCs. We conclude that the observed mRNA differences provide very weak biological evidence for adverse health effects associated with subject occupancy of the specified moisture-damaged buildings. This emphasizes the need to evaluate all potential factors (including those not related to toxicity) influencing perceived/self-reported ill health in moisture-damaged buildings.

Nutrient conversions by photosynthetic bacteria in a concentrated animal feeding operation lagoon system.

A diurnal examination was conducted to determine the effect of photosynthetic bacteria on nutrient conversions in a two-stage concentrated animal feeding operation (CAFO) lagoon system in west-central Oklahoma. Changes in nutrients, microbial populations, and physical parameters were examined at three depths (0, 1.5, and 3.0 m) every 3 h over a 36-h period. The south lagoon (SL) was anaerobic (dissolved oxygen [DO] = 0.09 +/- 0.12 mg/L) while the north lagoon (NL) was facultative (DO ranged from 4.0-0.1 mg/L over 36-h period). Negative sulfide-sulfate (-0.85) and bacteriochlorophyll a (bchl a)-sulfate (-0.83) correlations, as well as positive bchl a-sulfide (0.87) and light intensity (I)-bchl a (0.89) correlations revealed that the SL was dominated by sulfur conversions driven by the photosynthetic purple sulfur bacteria (PSB). The correlation data was supported by diurnal trends for sulfate, sulfide, and bchl a. Both nitrogen and sulfur conversions played a role in the NL; however, nitrogen conversions appeared to dominate this system because of the activity of cyanobacteria. This was shown by positive chlorophyll a (chl a)-I (0.91) and chl a-nitrate (0.98) correlations and the negative correlation between ammonium and nitrite (-0.88). Correlation data was further supported by diurnal trends observed for chl a, DO, and ammonium. For both lagoons, the dominant photosynthetic microbial species determined which nutrient conversion processes were most important.

Case management in an integrated delivery system.

A case management program is designed so that the nurses could work with any client within the health system, regardless of the diagnosis of provider. A variety of challenges surfaced: maintaining visibility within a large health care system; working with varied approaches to client care issues; and being clinically knowledgeable in the variety of chronic illnesses. Hospital admissions, physician and emergency department visits and costs are measured after establishing a nurse case management program.