Occupational asthma due to carrot in a cook.

BACKGROUND: Few previous reports of carrot-induced asthma have been confirmed by objective tests. Hypersensitivity to carrot is frequently associated with allergy to Apiaceae spices and sensitization to birch and mugwort pollens. CLINICAL CASE: A 40-year-old cook woman was seen with sneezing, rhinorrhea, contact urticaria and wheezing within few minutes of handling or cutting raw carrots. She needed to leave out of the kitchen while the other cooks cut raw carrots. METHODS AND RESULTS: Skin tests were positive to carrot, celery, aniseed and fennel. Rubbing test with fresh carrot was positive. Specific IgE to carrot was 4.44 kU/L. Determinations of specific IgE to mugwort, grass and birch pollens were negative. Inhalative provocation test, performed as a handling test, was positive. The IgE-immunoblotting showed two bands in carrot extract: a band with apparent molecular weight of 30 kd and other band of 18 kd. This band of 18 kd was Dau c 1. The band of 30 kd could correspond a phenylcoumaran benzylic ether reductase. Dau c 1 did not appear to be the unique allergen in this case. Additional allergens may induce the sensitization. Primary sensitization due to airborne allergens of foods and the lack of pollen allergy in this patient are notorious events.

Hypersensitivity pneumonitis due to occupational inhalation of fungi-contaminated corn dust.

Hypersensitivity pneumonitis or extrinsic allergic alveolitis can be defined as a lung disease caused by a wide group of antigens that reach the lung by inhalation of organic and/or inorganic dust of various sources. The dust of the stored maize corn has been reported as cause of respiratory symptoms. During the storage process, maize corn dust can be contaminated by moulds and thermophilic actinomycetes, which have not been described until now as the causing antigens of these symptoms. We present a case of occupational hypersensitivity pneumonitis in an agricultural worker who cultured and stored maize corn. Clinical findings, precipitating antibodies, and evolution after having removed him from his work, confirmed the diagnosis. In our case, Aspergillus species contaminating the maize corn dust are probably the antigens that caused the disease.

Bread eating induced oral angioedema due to alpha-amylase allergy.

Inhalation of dust from different enzymes can be the cause of occupational asthma in exposed workers. Enzymes from different sources are being increasingly used in food. Few cases of food allergy to alpha-amylase induced by eating bread have been reported. Those cases were reported in bakery-related patients and in a pharmaceutical-industry worker. A 25-year-old farmer suffered sneezing, rhinorrhea, oropharyngeal itching, hoarseness, cough, and non-wheezy dyspnea after eating white bread. Skin prick tests (SPT) with common aeroallergens and food allergens revealed only sensitization to Olea europaea pollen. SPT response was positive to Aspergillus oryzae alpha-amylase. Specific IgE against alpha-amylase was positive. A double-blind placebo-controlled challenge with 5 mg of uncooked -amylase induced sneezing, cough, oral angioedema within 10 minutes. The provocation test with 50 g of white bread gave similar findings. This case indicates that alpha-amylase contained in bread may provoke IgE-mediated food allergy. It is worth noting that in this case, the only source of alpha-amylases sensitization was bread.

Anaphylactoid reaction to carboplatin: successful "desensitization".

Carboplatin (CP) hypersensitivity reactions have been reported in nearly 12 % of patients treated with this drug. The pathophysiologic mechanisms of these reactions have not been entirely elucidated. Various hypotheses are under discussion. CP hypersensitivity reactions could be IgE-mediated, caused by low-molecular platinum compounds acting as haptens. Platinum salts are also able to release histamine from basophils and mast cells, and some events seem to be non-immune-mediated direct histamine release. We report a case of CP tolerance induction in a 65-year-old man. During the third course of CP he experienced an anaphylactic reaction. Skin testing was negative. Suspecting the possibility of an anaphylactoid reaction due to histamine release, we developed a protocol to induce tolerance. Pre-medication with corticosteroid and antihistaminic was performed before intravenous CP infusion. The bag with CP was first infused 60 ml/h for 30 minutes; the infusion was well tolerated and infusion was continued at 100 ml/h for the next 60 minutes and thereafter at 120 ml/h until the bag was finished. Following this "desensitization", monthly courses of CP using the same protocol have been well tolerated.

Familial presentation of occupational hypersensitivity pneumonitis caused by aspergillus-contaminated esparto dust.

Esparto grass (Stipa tenacissima), which is commonly found in the Mediterranean area, has a wide variety of uses. Five plaster workers from the same family developed cough, dyspnea, malaise, and fever after exposure to the esparto fiber used in their work for the previous few years. They showed a significant decrease in symptoms when away from work. Precipitating antibodies against an esparto extract were found in the sera of all patients. Specific IgG antibodies against Aspergillus fumigatus were detected. A. fumigatus was identified after microbiologic evaluation of esparto fiber samples. The dust derived from fungi-contaminated esparto fibers can cause hypersensitivity pneumonitis in exposed subjects. The causative antigen is A. fumigatus. When esparto fibers were strongly contaminated by fungi, all the workers developed a clinical picture compatible with hypersensitivity pneumonitis. The coincidental finding of an occupational and a familiar condition is unusual.

Anafilaxia en el norte de Extremadura / Anaphylaxis in northern Estremadura

Fundamento: La exposición antigénica difiere en cada área geográfica y ello depende de los diversos alergenos presentes en cada zona y de los hábitos (alimentarios, laborales, ingesta de fármacos) de la población. Métodos: Durante dos años se realizó un estudio epidemiológico (Plasencia 98-99) observacional, prospectivo y transversal, en el que se incluyeron 1.450 pacientes consecutivos, de cualquier edad, atendidos por primera vez en nuestra consulta de Alergología y procedentes del norte de Extremadura (España), con la finalidad de conocer la incidencia de los distintos procesos alérgicos, su importancia según la edad y el sexo y la etiología de los mismos. Resultados: Se estudiaron 820 mujeres (59,3 por ciento) y 630 varones (40,7 por ciento). La edad media fue de 25,9 años. En 58 pacientes (4 por ciento) se diagnosticó anafilaxia. No hubo predilección por el sexo. La edad media fue de 35,6 años. La mayor incidencia ocurrió entre los 25 y los 45 años. En 36 pacientes (62 por ciento) fue debida a medicamentos, especialmente de las familias betalactámicos (amoxicilina 15,5 por ciento, penicilina G 15,5 por ciento) y pirazolonas (dipirona magnésica 13,7 por ciento). En 14 (24,1 por ciento) la causa fue un alimento (miel 6,8 por ciento, lenteja 6,8 por ciento, judía verde 6,8 por ciento, guisante 5,17 por ciento, alubia 5,17 por ciento, garbanzo 5,17 por ciento, pipas de girasol 5,17 por ciento). En 5 (8,6 por ciento) se debió a alergia a veneno de himenópteros, 4 por abeja (6,8 por ciento) y uno por avispa (1,7 por ciento). En 2 casos (3,4 por ciento) no se encontró ninguna etiología. Un paciente (1,7 por ciento) tuvo anafilaxia inducida por ejercicio y otro (1,7 por ciento) urticaria "a frígore" con síntomas sistémicos tras un baño en agua fría. Conclusiones: En el norte de Extremadura los fármacos son la principal causa de anafilaxia, en algo más de la mitad de los casos, seguido de los alimentos en la cuarta parte. Los tres antígenos que causaron más reacciones fueron amoxicilina, penicilina G y dipirona magnésica (AU)

Allergy to foods in patients monosensitized to Artemisia pollen.

It is known that patients with pollinosis may display clinical characteristics caused by allergy to certain fruits and vegetables, but subjects allergic to Artemisia seem to show particularly peculiar characteristics. The clinical features of 84 patients with rhinitis, asthma, urticaria, and/or anaphylaxis whose inhalant allergy was exclusively to Artemisia vulgaris were studied and compared with a control group of 50 patients monosensitized to grass pollen. The mean age for the beginning of symptoms was 30.2 years, and this was higher than in the control group (P < 0.05). We found the main incidence to be in women (70.2%). Some 42.3% had family history of atopia, lower than in the control group (P < 0.05), while the prevalence of asthma and urticaria was significantly higher (P < 0.05). Food hypersensitivity was reported by 23 patients (27.3%) allergic to Artemisia. The foods responsible (with respective numbers of cases) were honey (14), sunflower seeds (11), camomile (four), pistachio (three), hazelnut (two), lettuce (two), pollen (two), beer (two), almond (one), peanut (one), other nuts (one), carrot (one), and apple (one). None of the patients monosensitized to grass had food allergy. CAP inhibition experiments were carried out on a single patient. Results showed the existence of common antigenic epitopes in pistachio and Artemisia pollen for this patient. We concluded that mugwort hay fever can be associated with the Compositae family of foods, but that it is not normally associated with other foods.