ABSTRACT
Aerogen lactase exposure carries a risk for the development of allergic asthma and rhinitis; only a few occupationally affected patients have been reported. The authors report the results of allergy testing with employees of a lactase tablets manufacturing plant. The survey involved 13 workers, including a questionnaire, spirometry, basophil activation test (BAT), and skin prick tests (SPTs) with lactase and a panel of common aeroallergens. Furthermore, lactase-specific immunoglobulin E (IgE) antibodies were analyzed. Sensitization to lactase could be proven for 9 workers by SPT and BAT; specific IgE antibodies could be detected in serum samples of all sensitized. However, IgE levels ≥0.35 kU/L were only found in 4 sera. These data confirm that occupational exposure to lactase can induce IgE-mediated respiratory sensitization resulting in allergic diseases. Protective measures should thus be obligatory when working with lactase.
Subject(s)
Allergens/immunology , Food-Processing Industry , Hypersensitivity/etiology , Lactase/immunology , Occupational Exposure , Adult , Dietary Supplements , Female , Humans , Middle Aged , TabletsABSTRACT
Lactose intolerance related to primary or secondary lactase deficiency is characterized by abdominal pain and distension, borborygmi, flatus, and diarrhea induced by lactose in dairy products. The biological mechanism and lactose malabsorption is established and several investigations are available, including genetic, endoscopic and physiological tests. Lactose intolerance depends not only on the expression of lactase but also on the dose of lactose, intestinal flora, gastrointestinal motility, small intestinal bacterial overgrowth and sensitivity of the gastrointestinal tract to the generation of gas and other fermentation products of lactose digestion. Treatment of lactose intolerance can include lactose-reduced diet and enzyme replacement. This is effective if symptoms are only related to dairy products; however, lactose intolerance can be part of a wider intolerance to variably absorbed, fermentable oligo-, di-, monosaccharides and polyols (FODMAPs). This is present in at least half of patients with irritable bowel syndrome (IBS) and this group requires not only restriction of lactose intake but also a low FODMAP diet to improve gastrointestinal complaints. The long-term effects of a dairy-free, low FODMAPs diet on nutritional health and the fecal microbiome are not well defined. This review summarizes recent advances in our understanding of the genetic basis, biological mechanism, diagnosis and dietary management of lactose intolerance.
Subject(s)
Dairy Products/adverse effects , Diet, Carbohydrate-Restricted , Gastrointestinal Tract , Lactase/deficiency , Lactose Intolerance/diet therapy , Lactose/adverse effects , Adult , Digestion , Fermentation , Gastrointestinal Absorption , Gastrointestinal Microbiome , Gastrointestinal Tract/enzymology , Gastrointestinal Tract/microbiology , Genetic Predisposition to Disease , Humans , Lactase/genetics , Lactase/immunology , Lactase/metabolism , Lactose/metabolism , Lactose Intolerance/diagnosis , Lactose Intolerance/genetics , Lactose Intolerance/immunology , Lactose Intolerance/microbiology , Phenotype , Predictive Value of Tests , Risk Factors , Treatment OutcomeSubject(s)
Food Hypersensitivity/immunology , Food Hypersensitivity/metabolism , Lactose Intolerance/immunology , Lactose Intolerance/metabolism , Female , Food Hypersensitivity/physiopathology , Humans , Infant , Infant, Newborn , Lactase/deficiency , Lactase/immunology , Lactase/metabolism , Lactose/immunology , Lactose/metabolism , Lactose Intolerance/physiopathology , MaleABSTRACT
Enzymes are high-molecular-weight proteins and highly sensitizing occupational allergens used widely in industrial processes. Lactase has been described to cause work-related respiratory and conjunctival immunoglobulin (Ig)-E-mediated sensitizations in workers in the pharmaceutical industry. In these previous reports, allergic rhinoconjunctivitis or asthma was confirmed with prick tests but not by challenge tests. Lactase previously has not been described as a cause of immediate or delayed contact skin reaction. Furthermore, there are no previous reports of lactase-specific IgE. We report a case of protein contact dermatitis and allergic rhinoconjunctivitis from occupational exposure to lactase in a pharmaceutical worker. The patient exhibited strong positive responses to lactase in prick tests. In an open application test, lactase elicited whealing, and in patch testing, lactase elicited an eczematous reaction. Serum lactase-specific IgE antibodies were demonstrated in immunospot and radioallergosorbent test assays, and lactase-IgE-binding fractions and their specificities were examined in immunoblot and immunoblot inhibition assays. The chamber challenge test was performed to detect the association between lactase sensitization and rhinoconjunctival symptoms. Our results have confirmed the previous observations that lactase can induce occupational IgE-mediated respiratory and conjunctival sensitizations, but they show that contact skin reactions caused by lactase may also occur.
