Occupational Allergy to Aquarium Fish Food: Red Midge Larva, Freshwater Shrimp, and Earthworm. A Clinical and Immunological Study

Background: Chironomids seem to be the main cause of occupational allergy to aquarium fish food. Objective: The aim of this study was to investigate the pattern of occupational sensitization to 3 different arthropod species used as components of aquarium fish food. Methods: The study sample comprised 8 workers from a fish food packing department. The control group comprised 40 atopic patients (20 of whom were allergic to mites). We performed prick tests with extracts of red midge larva (Chironomus thummi), freshwater shrimp (Gammarus species), earthworm (Tubifex species), and other arthropod species and a battery of common inhalant allergens. We measured peak expiratory flow rate (PEFR) and specific immunoglobulin (Ig) E and performed a methacholine challenge test, nasal challenge test, and immunoblotting. Cross-reactivity analyses were completed using immunoblotting and CAP inhibition. Results: Prick test results were positive to red midge larvae in 7 patients (87.5%), Gammarus in 5 (62.5%), Tubifex in 3 (37.5%), and mites in 6 (75%). In the mite-allergic controls, 30% had positive prick test results to red midge larvae. PEFR decreased 􀀪20% during the packing process in all patients, and in 1 patient it indicated a dual asthmatic response. Methacholine challenge test results were positive in all participants. Nasal challenge tests were performed in 4 patients, and the results were positive. Specific IgE to red midge larvae was detected in 62.5%, Gammarus in 50%, and Tubifex in 16%. Bands of approximately 14-15 kDa and 31 kDa were observed in Gammarus and red midge larvae extracts. Cross-reactivity assays demonstrated that Gammarus totally inhibited red midge larvae, while Tubifex did so partially. Dermatophagoides pteronyssinus showed very low inhibitory capacity. Conclusions: Aquarium fish food arthropods are potent allergens with an elevated prevalence of sensitization and variable degree of cross-reactivity. This is the first report of occupational allergy to Tubifex. More data are necessary to identify and characterize the responsible allergens (AU)

Introducción: Los quironómidos parecen ser la principal causa de alergia ocupacional a la comida para peces de acuario. Objetivo: El objetivo de este estudio fue investigar el patrón de sensibilización ocupacional a tres diferentes especies de artrópodos que componen la comida para peces de acuario en 8 de 10 trabajadores expuestos con rinitis y asma en el lugar del trabajo. Métodos: Se realizaron prick-tests con extractos de Chironomus thummi, Gammarus y Tubifex, otras especies de artrópodos y batería de alérgenos inhalantes comunes. Cuarenta pacientes atópicos (20 de ellos alérgicos a ácaros) fueron utilizados como controles. Se realizaron mediciones de peak-flow, test de metacolina, pruebas de provocación nasal, determinación de IgE específica e inmunoblotting. El estudio de la reactividad cruzada se completó mediante inmunoblotting y CAP-inhibición. Resultados: 87.5% de los pacientes presentaron prick-tests positivos a larva roja (Chironomus thummi), 62.5% a Gammarus y 37.5% a Tubifex. El prick-test fue también positivo a ácaros en el 75% de los pacientes. El 30% de los pacientes controles alérgicos a ácaros tuvieron prick-tests positivos a larva roja. El peak-flow cayó ≥ 20% en todos los pacientes durante el proceso de empaquetado. En un paciente el peak-flow demostró una respuesta asmática dual. El test de metacolina fue positivo en todos. Las provocaciones nasales fueron realizadas en cuatro pacientes con resultados positivos. 62.5% de los pacientes tuvieron IgE específica positiva a larva roja, 50% a Gammarus y 16% a Tubifex. Se observaron bandas de 14-15 y 31 kDa en los extractos de Gammarus y larva roja. Las pruebas de reactividad cruzada demostraron que Gammarus inhibía totalmente a larva roja mientras que Tubifex solo lo hacía parcialmente y el extracto de D. pteronyssinus demostró muy baja capacidad de inhibición. Conclusiones: Los artrópodos componentes de la comida para peces de acuario son potentes alérgenos con una elevada prevalencia de sensibilización. Presentan un grado variable de reactividad cruzada. Es el primer caso descrito de alergia ocupacional a Tubifex. Se necesitan más datos para identificar los alérgenos responsables y su naturaleza (AU)

Shock anafilático por hidatidosis en el postoperatorio inmediato / Anaphylactic shock of hydatidosis during recovery from surgery

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Determination of eosinophil rate after nasal provocation test in allergic rhinitis diagnosis.

After nasal provocation test in patients with allergic rhinitis, using the allergen they were sensitized to, we have observed: 1) an increase in the percentage of nasal eosinophils after 2, 3, 24 and 48 hours; 2) sneezes, mainly in the first 30 minutes; 3) nasal obstruction in the first three hours; 4) absence of rhinorrhea, but not in all the patients; and 5) no predominance of nasal, auricular and/or palatine pruritus at any time. When patients without rhinitis, or with allergic rhinitis were stimulated using a pneumoallergen they were not sensitized to, no significative increase in the nasal eosinophils percentage was found. No symptoms were observed either. So, we can conclude that nasal secretion samples, for eosinophilia percentage determination, should be taken from 2 to 48 hours after nasal provocation, and that the most frequent symptoms, which are probably related to cellular changes, are nasal obstruction and sneezes.