Occupational allergy to Spagulax®(Plantago ovata seed).

SUMMARY: We report the case of a 36-year-old male pharmaceutical laboratory worker. On handling Spagulax® sachets whose content is a laxative called Plantago ovata, he immediately presented rhinoconjunctivitis. Methods. Specific allergy study included SDS-PAGE with Western Blot and specific nasal challenge to Plantago ovata extract. Results. Prick by prick for Spagulax® was negative. Total IgE: 126.5 U/mL. Western Blot recognized two proteins of 15 and 20 kDa in the extract of Plantago ovata and three proteins of 15, 18 and 50 kDa in the extract of Plantago lanceolata. Conclusions. We present a case of occupational allergy due to inhalation of and/or contact with Plantago ovata seeds.

Development of phytophotodermatitis in two cases related to Plantago lanceolata.

Plantago lanceolata, also known as snake's tongue, is a perennial herbaceous plant from the family Plantaginaceae. It is a species widely distributed both in Turkey and all over the world. Today, its fresh leaves are still used to soothe and suppress cough, externally for wound healing and draining abscesses. Phytophotodermatitis (PPD) is a dermal photosensitive reaction induced by the contact to or oral intake of a plant and subsequent exposure to sunlight. Its acute course is called phototoxic. In this paper, two cases developed phototoxic reaction with the consumption of Plantago lanceolata and subsequent exposure to the sunlight. These cases were presented since such effect of the plant has not been known previously and there is no resembling case in the literature.

Associations among pollen sensitizations from different botanical species in patients living in the northern area of Madrid.

OBJECTIVE: To determinate the existence of associations among sensitizations to antigens produced by pollen grains of different botanical species as assessed by skin prick tests in patients with respiratory disorders. METHODS: Six hundred twenty nine consecutive patients living in the northern area of Madrid who underwent clinical evaluation because of rhinoconjunctivitis, and/or asthma were studied. All patients were tested with a skin prick test using a battery of inhalants including pollens, dust mites, molds and danders. The exploratory multivariate technique of Multiple Correspondence Analysis was used to compare the homogeneity of sensitizations between groups. Of the 629 patients, 459 (73.0%) had positive skin prick tests to pollen and were selected as the study group. RESULTS: The most prevalent pollen sensitization was to Gramineae pollen (83.7%) followed by Oleaceae sensitisation (75.8%). Multiple Correspondence Analysis revealed the existence of an association among pollen sensitizations, showing that they clustered two groups: sensitizations to Gramineae, Oleaceae, Cupressaceae, Chenopodiaceae, Plantaginaceae (group I), and sensitizations to Betulaceae, Platanaceae, Compositae (group II). Sensitization to Parietaria was not included in any of the sensitization groups and showed an independent behaviour. CONCLUSION: Pollen sensitizations in our area cluster into two association groups which have not previously been reported.

Adult syncytial giant cell chronic hepatitis due to herbal remedy.

Syncytial giant cell hepatitis is an uncommon form of chronic hepatitis in adults, although it has been reported in association with viral infection (including HCV and HIV infection), drug reactions and autoimmune disorders. We here report a very unusual case of giant cell chronic hepatitis in a 26-old-woman, who had been taking a herbal remedy (ISABGOL) for chronic constipation. The presence of viral and metabolic diseases has been excluded; an autoimmune etiology was very unlikely as the autoimmunity test remained negative during the year of follow-up and the total disease score normalized (from 13 to 8) without corticosteroid treatment. The causative role of the herbal remedy was further supported by the spontaneous and dramatic clinical, biochemical and histologic improvement observed following its withdrawal, despite the absence of any treatment.

Asma ocupacional y anafilaxia por semillas de plantago ovata / Occupational asthma and anaphylaxis due to seeds of Plantago ovata

Fundamento: Las semillas de Plantago ovata (Psyllium, Ispaghula), utilizadas en la preparación de laxantes de volumen, son conocidas como causantes de asma ocupacional y anafilaxia. Se presenta el estudio inmunológico de un trabajador de una industria farmacéutica que desarrolló asma ocupacional en relación con la exposición a semillas de Plantago ovata y una reacción anafiláctica posterior a su ingesta. Observación clínica: Varón de 31 años de edad que consultó por presentar rinitis asociada a sibilantes, en relación con la jornada laboral y la exposición a semillas de Plantago ovata. También refirió un episodio de broncospasmo, dolor abdominal, angioedema facial y urticaria generalizada posterior a la ingesta del laxante. Resultados: Las pruebas cutáneas a neumoalergenos ambientales (ácaros del polvo doméstico, epitelio de perro y gato) fueron positivas, así como las realizadas frente a extracto de Plantago ovata. La IgE específica (EIA y CAP-System) frente a Plantago ovata fue positiva y el SDS-PAGE Immnoblotting (Western blot) mostró bandas fijadoras de IgE de pesos moleculares 78, 59, 34, 25,6 y 17,6, kDa respectivamente. Una rinomanometría basal y una prueba de provocación nasal específico a Plantago ovata positivo. Conclusiones: La sensibilización a Plantago ovata es relativamente frecuente en trabajadores expuestos por vía inhalatoria (personal sanitario y de la industria farmacéutica). Existe un riesgo importante de reacciones graves anafilácticas tras su ingesta en individuos sensibilizados. (AU)

Asma ocupacional por polvo de psyllium (Plantago ovata) / Occupational Asthma due to psyllium (Plantago ovata) dust

El polvo de psyllium (Plantago ovata) se utiliza como laxante de volumen y puede producir reacciones alérgicas cuando es inhalado por personas expuestas ocupacionalmente. Se presentan dos casos de enfermeras de una residencia geriátrica que presentaban asma ocupacional al inhalar el polvo de psyllium que administraban como laxante a sus pacientes. Se realizaron pruebas cutáneas en prick con un extracto de psyllium (1:10 p/v) que fueron positivos en ambos casos. En uno de ellos se detectaron cifras elevadas de IgE específica frente a psyllium (CAP System). En las pruebas de exposición a polvo de psyllium que se realizaron se obtuvieron una respuesta bronquial inmediata y otra dual. Una paciente tenía un test de hiperreactividad bronquial inespecífica con metacolina positivo; en el otro caso este test fue negativo (esta paciente llevaba un año asintomática y sin exponerse a polvo de psyllium). Estos dos nuevos casos de asma ocupacional por laxantes que contienen psyllium confirman la necesidad de cambiar la presentación en polvo por otra que no contenga partículas inhalables (p.e. gránulos). En el caso de pacientes asmáticos expuestos a polvo de psyllium (de forma ocupacional o tomadores del fármaco) se debe descartar una hipersensibilidad a psyllium. (AU)