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

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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 (AU)

En cerca del 12 por ciento de los pacientes tratados con carboplatino (CP) se han descrito reacciones de hipersensibilidad a este fármaco. Los mecanismos patofisiológicos de estas reacciones no se han esclarecido del todo, y se barajan varias hipótesis. Las reacciones de hipersensibilidad a la CP podrían ser mediadas por la IgE, o provocadas por compuestos de platino de bajo peso molecular que actúen como haptenos. Las sales de platino son asimismo capaces de liberar histamina de los basófilos y mastocitos, y algunas reacciones parecen proceder de una liberación directa de histamina no inmunomediada. Se expone el caso de una inducción de tolerancia a la CP en un varón de 65 años. Durante el 3.er tratamiento con CP, el paciente experimentó una reacción anafiláctica. La prueba cutánea resultó negativa. Pensando en la posibilidad de una reacción anafilactoide debida a la liberación de histamina, desarrollamos un protocolo para inducir la tolerancia. Se realizó una premedicación con corticosteroides y antihistamínicos previa a la infusión intravenosa de CP. La primera infusión con una bolsa de CP se realizó a 60 ml/h durante 30 minutos; la infusión fue bien tolerada y procedimos a administrar 100 ml/h durante 60 minutos más, para después pasar a 120 ml/h hasta terminar la bolsa. Los ciclos mensuales con CP han sido bien tolerados tras esta "desensibilización" mediante la aplicación del mismo protocolo (AU)

Familiar 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 (AU)

La planta de esparto (Stipa tenacissima), habitual en la región mediterránea, tiene una amplia variedad de usos. Cinco escayolistas de la misma familia presentaron tos, disnea, malestar y fiebre después de la exposición a la fibra de esparto utilizada en su trabajo en los últimos años. Estos pacientes experimentaron una disminución significativa de los síntomas cuando dejaron el trabajo. Se descubrieron anticuerpos precipitantes contra un extracto de esparto en el suero de todos los pacientes. Se detectaron anticuerpos IgG específicos contra Aspergillus fumigatus. Se pudo identificar Aspergillus fumigatus después de la evaluación microbiológica de las muestras de fibra de esparto. El polvo derivado de fibras de esparto contaminadas por hongos puede causar neumonitis por hipersensibilidad en sujetos expuestos. Aspergillus fumigatus es el antígeno responsable. Cuando las fibras de esparto están muy contaminadas por hongos, todos los trabajadores pueden sufrir un cuadro clínico compatible con neumonitis por hipersensibilidad. En este artículo, la peculiaridad es el hallazgo concurrente de un proceso familiar y laboral (AU)