Cow hair allergen concentrations in dairy farms with automatic and conventional milking systems: From stable to bedroom.

Bovine hair and dander are considered to be a notable risk factor for sensitization and allergic symptoms in occupationally exposed cattle farmers due to various IgE binding proteins. Farmers are suspected not only to be exposed during their work inside the stables but also inside their homes as allergens could be transferred via hair and clothes resulting in continued bovine allergen exposure in private areas. In recent years a new sensitive sandwich ELISA (enzyme linked immunosorbent assay) test has been developed to measure the cow hair allergen (CHA) concentration in dust. The aim of the present study was to determine the CHA concentration in airborne and settled dust samples in stables and private rooms of dairy cattle farms with automatic milking systems (AM) and conventional milking systems (CM), also with respect to questionnaire data on farming characteristics. For this purpose different sampling techniques were applied, and results and practicability of the techniques were compared. Dust sampling was performed in the stable, computer room (only AM), changing room, living room and bedroom (mattress) of 12 dairy farms with automatic milking systems (AM group) and eight dairy farms with conventional milking systems (CM group). Altogether, 90 samples were taken by ALK filter dust collectors from all locations, while 32 samples were collected by an ion charging device (ICD) and 24 samples by an electronic dust fall collector (EDC) in computer rooms (AM) and/or changing and living rooms (not stables). The dust samples were extracted and analyzed for CHA content with a sandwich ELISA. At all investigated locations, CHA concentrations were above the limit of detection (LOD) of 0.1 ng/ml dust extract. The median CHA concentrations in dust collected by ALK filters ranged from 63 to 7154 µg/g dust in AM farms and from 121 to 5627 µg/g dust in CM farms with a steep concentration gradient from stables to bedrooms. ICD sampling revealed median CHA contents of 112 µg/g airborne dust in the computer rooms of the AM farms and median CHA loads of 5.6 µg/g (AM farms) and 19.8 µg/g (CM farms) in the living rooms. Passive dust sampling by EDC was performed only at two locations in the AM group resulting in median CHA values of 116 µg/m(2) (computer room) and 55.0 µg/m(2) (changing room). Except for the stable samples the median CHA load was lower in AM farms compared to CM farms. The CHA contents of ALK filter samples were significantly correlated in most locations. Differences between the farming types were not significant. Although allergen transfer to the private area of the farmers has been found and results from several locations were correlated, differences in CHA concentrations were not significant with respect to questionnaire data such as the wearing of stable clothes in living room, free access of pets to stable and home, frequency of hair washing. All sampling techniques seem to being practicable for simple and effective CHA measurement.

Evaluation of commercial skin prick test solutions for selected occupational allergens.

BACKGROUND: Skin prick testing (SPT) is an important step in the diagnosis of IgE-mediated occupational allergic diseases. The outcome of SPT is related to the quality of allergen extracts. Thus, the aim of the study was to assess different commercially available SPT solutions for selected occupational allergens. METHODS: SPT was performed in 116 bakers, 47 farmers and 33 subjects exposed to natural rubber latex (NRL), all with work-related allergic symptoms. The SPT solutions from different manufacturers (n = 3-5) for wheat flour, rye flour, soy, cow hair/dander, storage mites (Tyrophagus putrescentiae, Lepidoglyphus destructor, Acarus siro) and NRL were analysed with respect to their protein and antigen contents. SPT was carried out in 16 allergy centres in six European countries using standardized procedures. Specific IgE values were used as the gold standard to calculate the sensitivity and specificity of SPT solutions. The optimal cut-point for each SPT solution was determined by Youden Index. RESULTS: Protein and antigen contents and patterns of the SPT solutions varied remarkably depending on the manufacturer. While SPT solutions for wheat flour and soy reached overall low sensitivities, sensitivities of other tested SPT solutions depended on the manufacturer. As a rule, solutions with higher protein and antigen content showed higher sensitivities and test efficiencies. CONCLUSIONS: There is a wide variability of SPT solutions for occupational allergens, and the sensitivity of several solutions is low. Thus, improvement and standardization of SPT solutions for occupational allergens is essential.

Educational intervention in farmers with occupational asthma: long-term effect on exhaled nitric oxide.

BACKGROUND: The fraction of exhaled nitric oxide (FE(NO)) has been found reduced 4 to 6 weeks after an educational intervention in farmers with occupational asthma. OBJECTIVE: To reveal whether long-term changes in FE(NO) would still be detectable a year after the intervention. METHODS: We evaluated airway inflammation and obstruction at baseline and after 1 year in animal farmers with occupational asthma (n = 43, 16 women, mean [SD] age, 46.5 [8.9] years) who participated in a 1-day educational program, and in a control group of farmers without intervention (n = 15, 3 women, mean age, 44.1 [10.7] years). FE(NO), spirometry results, and questionnaire data were compared between measurements and between the intervention and control group. RESULTS: In the intervention group, geometric mean (SEM) FE(NO) decreased from 31.5 (1.1) to 25.0 (1.1) parts per billion (ppb) (P = .001), whereas in the control group there was a slight but not statistically significant increase from 27.2 (1.2) to 30.7 (1.2) ppb. Spirometric values remained unchanged in both groups. CONCLUSIONS: We found that FE(NO) was still decreased 1 year after an educational intervention in farmers with occupational asthma. It would thus seem that FE(NO), a noninvasive marker of airway inflammation that can be easily assessed in occupational field work, may be suitable for the evaluation of both short-term and long-term effects of preventive measures in occupational asthma.

Educational intervention decreases exhaled nitric oxide in farmers with occupational asthma.

Allergic occupational asthma is frequent in farming populations. As educational interventions can improve disease management, the short-term effect of an educational intervention in asthmatic farmers was evaluated on the basis of spirometric indices and exhaled nitric oxide fraction (F(eNO)). Farmers with occupational asthma (n = 81), mostly sensitised against cow dander and storage mites, participated in a 1-day educational programme. Outcome measures were assessed at baseline and after 4-6 weeks, using F(eNO), lung function and a questionnaire. Results were compared with those of a control group without intervention (n = 24). In the educational group, the proportion of subjects reporting work-related symptoms was reduced after the intervention. The F(eNO) decreased from a geometric mean of 28.2 to 25.7 ppb, and, in subjects with an elevated (>35 ppb) baseline F(eNO) (n = 32), from 59.7 to 49.2 ppb. The corresponding changes in the control group were 25.6 versus 27.7 ppb and 49.5 versus 48.1 ppb. Spirometric results were unaltered in the two groups. Thus exhaled nitric oxide fraction, a marker of allergic airway inflammation, indicated a beneficial effect of a short-term educational intervention in farmers with occupational asthma. This suggests a potential for exhaled nitric oxide fraction in assessing the efficacy of preventive measures within a short time with higher sensitivity than spirometry.

Portable fluoroscopy in the management of zygomatic arch fractures.

Operative methods that do not allow intraoperative visualization of the fracture fragments in patients with isolated zygomatic arch fractures often result in inadequate reduction. This article describes a technique using a portable, surgeon-operated fluoroscopic machine that can be used preoperatively, intraoperatively, and postoperatively in patients with isolated zygomatic arch fractures. Using the portable fluoroscopic unit, reduction of isolated zygomatic arch fractures was performed in 9 consecutive patients over a period of 1.5 years. Postoperative alignment was confirmed using computed tomography (CT). These CT images were compared with the fluoroscopic images in several of the patients. Eight of the nine fractures were reduced via an intraoral approach and one through a Gillies approach. All nine fractures were easily visualized and their reductions were confirmed with intraoperative dynamic visualization using a portable fluoroscopic unit. Postoperative CT revealed images of the reduction that were comparable with intraoperative and postoperative fluoroscopic images. The use of portable fluoroscopy intraoperatively allows for dynamic visualization of instrumentation and the immediate confirmation of the adequacy of fracture reduction. Moreover, this technique may eliminate the need for postoperative CT in isolated zygomatic arch fractures. Portable fluoroscopy may also have a place in the management of certain zygomatic complex fractures.

[Preoperative autologous blood donation in thoracic surgery]. / Die präoperative Eigenblutspende in der Thoraxchirurgie.

The donation by the patient of two units of his own blood shortly before (on average on the 9th and 7th day) scheduled major surgery on the chest is feasible in 70 to 80% of patients. In our group (n = 170) it resulted in a highly significant reduction in the use of banked blood units: a 76% reduction vis-a-vis the number of units transfused in a group operated on in the previous year and comprising comparable patients receiving comparable procedures, in whom no autologous blood was administered. The procedure is cost-effective.

[Hermansky-Pudlak syndrome in 2 brothers with lung fibrosis]. / Hermansky-Pudlak-Syndrom bei zwei Brüdern mit Lungenfibrose.

This is a report on two brothers with the Hermansky-Pudlak syndrome who developed pulmonary fibrosis. In the first, a gradual course lasting 13 years was observed, the patient finally died of long-standing colitis. His brother died of progressive respiratory failure 15 months after the subjective onset of the disease. Immunosuppressive therapy proved ineffective.