Occupational asthma induced by fish exposure.

Occupational asthma triggered by inhaling fish-derived aerosols is estimated to affect 2-8% of exposed individuals. This primarily affects workers in the fish processing industry. Fishmongers, rarely experience this issue, as recent research found no significant difference in asthma rates compared to a control group. We report the case of a fishmonger who presented with a 1-year history of rhinoconjunctivitis and asthma. The patient attributed these symptoms to his occupational exposure within the fish market environment, which worsened in the cold storage warehouse. Symptoms improved during holidays. Diagnosis involved skin-prick tests, sIgE (ImmunoCAP-specific IgE) measurements, and bronchial challenge tests, confirming occupational asthma from fish bioaerosol exposure. Parvalbumins, common fish proteins, share structural similarities, leading to cross-reactivity in fish allergy sufferers. In this case, sensitivity to rGad c1 (cod parvalbumin) was identified as the primary trigger for the patient's asthma, and responsible for sensitizations observed across various tested fish species.

Disease severity impairs sleep quality in allergic rhinitis (The SOMNIAAR study).

BACKGROUND: Sleep is impaired in allergic rhinitis (AR) patients, with subsequent effects on daytime performance and health-related quality of life (QOL). Sleep quality in AR has rarely been considered through validated tools and consensus classifications. OBJECTIVE: To evaluate sleep quality and daytime somnolence in AR patients, and to estimate its relationship to disease severity according to Allergic Rhinitis and Its Impact on Asthma (ARIA) conventional and modified classifications, as well as in terms of QOL and comorbidities. METHODS: Allergic rhinitis adult patients were evaluated through a prospective, observational, multicentre survey in Spain. Symptoms were assessed using the Total Symptoms Score (TSS), specific QOL by the Rhinitis Quality of Life Questionnaire (RQLQ), sleep quality by Pittsburgh scale, and diurnal somnolence by a scale based on Epworth's, all recorded in a unique visit. RESULTS: A total of 2275 patients were included. According to ARIA criteria, 50.2% had persistent and 49.8% intermittent rhinitis, whereas 87.6% were classified as moderate-severe and 12.4% as mild; 52.8% had poor sleep quality, with a global median score for Pittsburgh scale of 6 (normal < 5) and 21.1% suffered from excessive diurnal somnolence. Correlation between Pittsburgh scale and RQLQ was moderate (r = 0.54). Among symptoms, nasal obstruction and concomitant asthma mainly, contributed to bad sleep quality. In a logistic regression model, moderate-severe rhinitis and nasal obstruction were all associated with a worse sleep quality. CONCLUSIONS AND CLINICAL RELEVANCE: Sleep quality is altered in AR patients. Sleep quality was worse in moderate-severe, and particularly in severe AR. Nasal obstruction and RQLQ deterioration are associated with a poorer sleep quality. Sleep impairment is common in allergic rhinitis, particularly in more severe forms. Nasal obstruction and concomitant asthma should be considered as contributing factors. CAPSULE SUMMARY: This is a large epidemiological survey of patients with allergic rhinitis showing a strong relationship between disease severity, as assessed by a consensus classification, and sleep impairment, as measured by a validated sleep quality tool.

Involvement of hidden allergens in food allergic reactions.

BACKGROUND: Hidden allergens in foods can induce allergic reactions. Currently it is not possible to estimate the exact prevalence of these reactions but they are clearly a growing problem. OBJECTIVE: The purpose of this study was to provide an overview of the role of hidden allergens (their importance, the types of food involved, and the severity of reactions) in allergic reactions in our geographical area. METHODS: A retrospective study was carried out in an adult population. Over a five year period, a total of 530 food reactions were reviewed. RESULTS: One hundred nineteen reactions (22.4%) were considered to be due to hidden allergens. Thirty-two percent of these were anaphylactic reactions. The most common hidden allergen was the Anisakis simplex larvae present in fish and shellfish. Fish allergens hidden in other foods caused reactions in 35% of fish-allergic patients. Twenty-two per cent of allergic reactions caused by eggs were due to egg allergens hidden in foods. All but one of the reactions caused by hidden legume allergens occurred in soy-allergic patients. Reactions caused by hidden fruits and hidden nuts were very uncommon. CONCLUSION: Hidden allergens were the cause of a quarter of all food allergic reactions, mainly as a result of contamination and carelessness on the part of the patient. A simplex was the hidden allergen most frequently involved. Fruits and nuts were not frequent hidden allergens in our area. Reactions due to other uncommon foods such as soy, mustard, flavourings, and honey were multiple and usually went unnoticed. Only if the sources of hidden allergens are determined will it be possible to avoid such substances and thus guarantee the safety of the allergic patient.

Allergy to freshwater shrimp (Gammarus).

We report three new cases of allergy to Gammarus, two of them involving cutaneous symptoms, and the third one with occupational asthma. The results showed exposure to feed containing Gammarus shrimp to be the main cause of the allergic symptoms in the three patients. In all cases the intervention of IgE was demonstrated, with the absence of cross-reactions with other common allergenic arthropods.

Immediate rhinoconjunctivitis induced by metamizole and metronidazole.

OBJECTIVE: To report a case of immediate rhinoconjunctivitis induced by both metamizole and metronidazole. METHODS: Skin-tests (prick and intradermal) were performed with metamizole, metronidazole, and espyramicine. Standard RAST was carried out with metamizole and metronidazole. Oral challenge tests were performed single blind with Rhodogil, metronidazole, espyramicine, metamizole, aspirin, and propyfenazone. RESULTS: Both skin tests and RAST were negative. We also found that the patient tolerated therapeutic doses of espyramicine, aspirin, and propyfenazone. Challenges with Rhodogil, metamizole, and metronidazole elicited immediate rhinoconjunctivitis. CONCLUSION: This is an exceptional case of immediate rhinoconjunctivitis induced by two unrelated drugs (metamizole and metronidazole). The pathogenic mechanism implicated in this process remains unclear. Inhibition of the cyclooxygenase pathway was excluded and we could not demonstrate the presence of specific IgE antibodies. Nevertheless, an immunologic or idiosyncratic mechanism could be responsible.

Sulfadiazine-induced sialadenitis.

OBJECTIVE: To present a case of sialadenitis induced by sulfadiazine. CASE SUMMARY: A 50-year-old man with bronchitis developed swelling of the parotid glands and floor of the mouth as well as plugging in his ears 2 hours after ingestion of Bronco-aseptilex (sulfadiazine, cyclamate, and guaiacol). Skin-prick tests performed with serial dilutions of sulfadiazine and Bronco-aseptilex were all negative. We then performed oral challenge tests with Bronco-aseptilex, sulfadiazine, and other compounds of the commercial syrup. Enlargement of the salivary glands was observed after oral challenge tests with Bronco-aseptilex and sulfadiazine. CONCLUSIONS: We describe a patient who developed drug-induced sialadenitis. The oral challenge test confirmed that sulfadiazine was the etiologic agent.

Occupational asthma induced by garlic dust.

BACKGROUND: Garlic dust has not been a frequently encountered cause of IgE-mediated disease. OBJECTIVE: We report on 12 patients (all of them garlic workers) with the clinical criteria for occupational asthma. METHODS: Skin prick tests and serum-specific IgE determinations were performed with common inhalants, garlic, and other members of the Liliaceae family (onion, leek, and asparagus). Bronchial challenge test with garlic powder was performed in all patients. Garlic and onion extract proteins were separated by sodium dodecylsulfate-polyacrylamide gel electrophoresis. Immunoblot and IgE immunoblot inhibition analyses were performed with patients' sera on extracts of garlic, onion, and pollens of Phleum pratense and Chenopodium album. RESULTS: Garlic sensitization was demonstrated by bronchial challenge test in seven patients (group 1) and ruled out in the remaining five (group 2). Clinical data were similar in both groups. The patients with garlic allergy had a mean age of 27 years, and all of them had pollen allergy; sensitization to other members of the Liliaceae family was also common. Electrophoresis of garlic extract revealed two major protein bands at approximately 12 and 54 kd. During IgE immunoblotting, the pool of sera reacted with garlic proteins mainly at 54 kd. Preincubation with onion, Phleum, and Chenopodium partially abolished the IgE binding to several allergens of garlic. CONCLUSION: We report on seven patients in whom an occupational garlic allergy was demonstrated. Garlic allergy is relatively rare but seems to affect young subjects with pollen allergy, and sensitization to other members of the Liliaceae family is common. The results of this study confirm the presence of some structurally similar allergens in garlic, onion, and certain pollens.

Allergy to eggs from duck and goose without sensitization to hen egg proteins.

BACKGROUND: Eggs are among the foods most frequently causing allergy. Hen eggs are the most important. Those of other birds are of lesser significance. OBJECTIVE: We report an unusual case of food allergy after consumption of eggs from duck and goose in an adult patient without hen egg allergy. METHODS: Skin prick tests were performed with fresh white and yolk from eggs of duck and goose and egg white, egg yolk, ovalbumin, and ovomucoid from hen egg. Specific serum IgE was measured to hen egg proteins. SDS-PAGE and IgE immunoblotting were carried out with egg white extracts from hen, duck, and goose. RESULTS: Skin tests were positive to egg whites from duck and goose. The skin tests and specific serum IgE were negative to hen egg proteins. Immunoblotting demonstrated the presence of specific IgE to a proteic band of molecular weight around 45 kd. CONCLUSIONS: We report a patient with an IgE-mediated allergy to egg white from duck and goose without hen egg allergy. Ovalbumin seems to be the responsible protein. The antigenic determinant of this protein seems to be specific of order Anseriforme and it is not present in the ovalbumin of order Galliforme.

Asthma with sulfite intolerance in children: a blocking study with cyanocobalamin.

Sulfites have been implicated as the cause of bronchospasm in some subjects with asthma. However, there is still no universally accepted explanation of the pathogenesis of these reactions. We have studied five children with asthma with metabisulfite intolerance confirmed by oral challenge testing. The challenge test with metabisulfite was repeated after premedication of all the patients with 1.5 mg of oral cyanocobalamin. In four of the five patients treated with cyanocobalamin, bronchospasm did not develop in the second metabisulfite challenge. The possible mechanisms are discussed.

Nonspecific bronchial hyperresponsiveness and development of asthma in children with hay fever.

It has been suggested that patients with allergic rhinitis who present nonspecific bronchial hyperresponsiveness (BHR) are those most likely to develop asthma. Therefore, a study was conducted in children with rhinoconjunctivitis to ascertain whether BHR to methacholine might predict the development of asthma in these patients. Fifteen patients with hay fever and no previous symptoms of asthma were selected. All underwent clinical symptom tests and methacholine tests, during the pollen season in the 4 consecutive years following the start of the study. At the end of this period, 5 patients had developed asthma. It may thus be affirmed that, in this group, neither the presence nor the degree of previous BHR was useful for predicting which patients would later develop asthma.