Allergy to ortho-phthalaldehyde in the healthcare setting: advice for clinicians.

This study summarizes and reviews the available health information on ortho-phthalaldehyde (OPA), a recently introduced and widespread disinfectant for heat-sensitive medical equipment, particularly focusing on its possible immunological effects in the healthcare setting. OPA properties derived from laboratory and clinical studies, and in vivo and in vitro tests for the diagnosis of OPA allergy are described. The available evidence suggests the spreading of OPA as disinfectant in endoscopy units despite the little available scientific evidence on its safety. Indeed, some papers reported on serious adverse reactions to OPA in patients and, to a lesser extent, in exposed workers, and in vivo studies suggested that OPA is a dermal and respiratory sensitizer. Finally, until more definite safety data become available only suggestions on possible preventive measures can be provided.

Acute inflammation and immunoresponses induced by ortho-phthalaldehyde in mice.

ortho-Phthalaldehyde (OPA) has been used as a safe alternative disinfectant instead of glutaraldehyde; however, recently some adverse effects of OPA were reported in patients and medical professions. We examined the acute toxicity of OPA in male ICR mice injected with 0.125-0.5% OPA and killed some animals 1 day after a single OPA injection, and others 1 or 13 days after two OPA injections 5 days apart. Hematology, blood cell counts, specific antibody production, organ weights, hepatic enzymes, hepatic histopathology and gene expression of cytochrome P450 (CYP) mRNA in liver were examined. Single OPA injections elevated leukocyte counts, the proportion of neutrophils, alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Two OPA injections dose-dependently increased leukocyte counts, the proportion of neutrophils, ALT and AST, and decreased alkaline phosphatase. Leukocyte counts and proportions of neutrophils normalized 13 days after the second of two injections. However, both ALT and AST remained high in mice given higher OPA doses. Significant increased liver-to-body weight ratio and mild hepatic lesions were observed. Gene expression of CYP1a1 and CYP2e1 revealed a tendency of up-regulation 1 day after two OPA injections. However, expression of these genes was then down-regulated 13 days after OPA injections. OPA induced specific IgE and IgG significantly in the sera, suggesting that OPA acts as a hapten. Overall, OPA caused acute inflammation and acted as a haptenic allergen, although it caused only mild liver injury. Such evidence suggested that careful washing and prevention of exposure were needed after OPA disinfection of medical instruments.

Three cases of ortho-phthalaldehyde-induced anaphylaxis after laryngoscopy: detection of specific IgE in serum.

BACKGROUND: Ortho-phthalaldehyde (OPA) has recently been used as a disinfectant for various medical apparatuses. OPA is not generally recognized as a potential allergen. CASE SUMMARY: Subsequent to our recent report describing a patient presenting with OPA-induced anaphylaxis following laryngoscopy, we experienced two more such cases. In all three cases, the basophil histamine release test was useful for identifying the allergen as OPA. OPA-specific IgE was successfully detected in the serum of the patients by ELISA. DISCUSSION: Physicians and co-medical workers need to be aware of potential allergens to which patients may be exposed during routine medical procedures.

[Relationship between the chemical structure and the biological activity of antibodies against the foot-and-mouth disease virus]. / Zavisimost mezhdu khimichna struktura i biologichna aktivnost na antitelata sresht virusa na shapa.

Investigated was the effect of various amino agents (stained and phthalic anhydride and sulfopicric acid) on the complement-and antigen-fixing activity of IgG and IgM antibodies isolated from guinea pig sera, the donor animals being hyperimmunzed with type O, strain Polyana, of the foot-and-mouth disease virus, At the moderate modification (75-86 per cent acetylation, and 36-40 per cent 'phthalation') of the primary amino groups the foot-and-mouth disease antibodies retained only half of the conjugation caused greater and complete loss of this activity. IgG and IgM showed almost equal specificity with regard to the antigen that had induced them. The lowered complement-fixing capacity was shown to have no specific effect on the primary relation of the foot-and-mouth disease virus to the antibody. Chemical modifying agents inactivated the specific small, strongly defined complement-fixing zones in the Fc-fragment of the foot-and-mouth disease antibody molecule.