Occupational asthma due to acrylates in a graphic arts worker.

BACKGROUND: Acrylates are used in a wide variety of products such as solvents, adhesives, paints, printing ink, soft contact lenses, porcelain nails, and methacrylates (used by dentists and orthopedists). Currently there are various types of acrylic compounds: acrylates, cyanoacrylates (such as tissue adhesives and home glues), and methacrylates (prostheses and dental and orthopedic fillings). The sensitization mechanism is unknown, but the allergy is believed to be due to a non-IgE mediated phenomenon, since a late asthmatic response occurs. Various cases of acrylate-induced asthma have been reported, especially in dentists and persons using glues or paints containing this substance. MATERIAL AND METHODS: We present the case of a 52-year-old man who had been working in graphic arts for the previous 7 years. For the previous 2 years he had experienced persistent cough with a sensation of drowning, dyspnea that increased with moderate exertion, and nasal obstruction despite continuous treatment. The symptoms first appeared after an episode of acute respiratory difficulty associated with weight loss, pulmonary infiltrates, and eosinophilia. Peak expiratory flow (PEF) was measured during work and sick leave, and specific bronchial challenge with acrylates was performed in a bronchial chamber. RESULTS: The PEF improved on weekends and sick leave. The challenge test provoked a late asthmatic response and the non-specific bronchial hyperreactivity increased after the test. As well in the sputum samples there was a increase of eosinophil amount.

Occupational asthma due to acrylates in a graphic arts worker / Asma ocupacional por acrilatos en un trabajador de artes gráficas

Background: Acrylates are used in a wide variety of products such as solvents, adhesives, paints, printing ink, soft contact lenses, porcelain nails, and methacrylates (used by dentists and orthopedists). Currently there are various types of acrylic compounds: acrylates, cyanoacrylates (such as tissue adhesives and home glues), and methacrylates (prostheses and dental and orthopedic fillings). The sensitization mechanism is unknown, but the allergy is believed to be due to a non-IgE mediated phenomenon, since a late asthmatic response occurs. Various cases of acrylate-induced asthma have been reported, especially in dentists and persons using glues or paints containing this substance. Material and methods: We present the case of a 52-year-old man who had been working in graphic arts for the previous 7 years. For the previous 2 years he had experienced persistent cough with a sensation of drowning, dyspnea that increased with moderate exertion, and nasal obstruction despite continuous treatment. The symptoms first appeared after an episode of acute respiratory difficulty associated with weight loss, pulmonary infiltrates, and eosinophilia. Peak expiratory flow (PEF) was measured during work and sick leave, and specific bronchial challenge with acrylates was performed in a bronchial chamber. Results: The PEF improved on weekends and sick leave. The challenge test provoked a late astmatic response and the non-specifc bronchial hyperreactivity increased after the test. As well in the sputum samples there was a increase of eosinophil amount

Antecedentes: Los acrilatos se usan en una amplia variedad de productos, como solventes, adhesivos, pinturas, tinta de imprenta, lentes de contacto blandas y uñas de porcelana, mientras que los metacrilatos los usan dentistas y ortopedas. Hay varios tipos de compuestos acrílicos: acrilatos, cianoacrilatos (como adhesivos de tejidos y pegamentos de uso doméstico), así como de metacrilatos usados en prótesis dentales y rellenos ortopédicos. Los mecanismos de sensibilización se desconocen, pero se piensa que la reacción alérgica no está mediada por IgE, ya que la reacción asmática se produce tardíamente. Hay publicados varios casos de asma inducida por acrilato, especialmente en dentistas y personas que usan colas o pinturas que contienen esas sustancias. Material y métodos: Se presenta el caso de un varón de 52 años de edad que había trabajado en artes gráficas en los últimos 7 años. En los dos últimos años había presentado tos persistente con sensación de ahogo, disnea que aumentaba con el ejercicio moderado y obstrucción nasal, a pesar del tratamiento continuado. Los síntomas aparecieron primero tras un episodio agudo de dificultad respiratoria asociada con pérdida de peso, infiltrados pulmonares y eosinofilia. El flujo espiratorio punta (PEF) se midió durante el trabajo y los días de baja laboral. Se llevó a cabo prueba de provocación con acrilatos en cámara bronquial. Resultados: El PEF mejoró en los fines de semana y los días de baja laboral. El test de provocación dio lugar a una crisis de asma tardía. Después de la prueba, aumentó la hiperreactividad bronquial no específica. Al mismo tiempo, en las muestras de esputo se constató un aumento del contenido en eosinófilos

Flare up to betalactams.

BACKGROUND: The flare up phenomenon has most frequently been described with nickel. Not many cases of flare up to drugs have reported in the literature, however we have reported it with different medications. METHODS AND RESULTS: A 31-year-old woman developed an adverse reaction with an antibiotic during her childhood. Prick test with penicillin (100,000 IU/ml), penicilloyl polylysine (PPL), minor determinant mixture (MDM), amoxicillin (200 mg/ml), ampicillin (200 mg/ml) and cephalotin (200 mg/ml), and intradermal test to the same substances diluted in saline were all negative immediately. We performed an oral challenge test with 500 mg of amoxicillin. Twelve hours later, the intradermal test to PPL and MDM became positive (PPL 10 x 10 mm, MDM 8 x 7 mm). All patch tests were positive after 72 hours with erythema, vesicles and infiltration and the patient also had exanthema with pruritus on her entire body. CONCLUSIONS: We present one patient with delayed allergic reaction caused by amoxicillin and penicillin, that we all know as Flare up. We suggest that this phenomenon of Flare up occurs by a Type IV mechanism mediated by T-cells without participation of IgE antibodies. The betalactam hypersensitivity mechanism which has usually been described is an IgE mediated reaction, but there are other not very well known mechanisms that are responsible for the delayed reactions.

Flare up to betalactams

Background: The flare up phenomenon has most frequently been described with nickel. Not many cases of flare up to drugs have reported in the literature, however we have reported it with different medications. Methods and results: A 31-year-old woman developed an adverse reaction with an antibiotic during her childhood. Prick test with penicillin (100,000 IU/ml), penicilloyl polylysine (PPL), minor determinant mixture (MDM), amoxicillin (200 mg/ml), ampicillin (200 mg/ml) and cephalotin (200 mg/ml), and intradermal test to the same substances diluted in saline were all negative immediately. We performed an oral challenge test with 500 mg of amoxicillin. Twelve hours later, the intradermal test to PPL and MDM became positive (PPL 10 x 10 mm, MDM 8 x 7 mm). All patch tests were positive after 72 hours with erythema, vesicles and infiltration and the patient also had exanthema with pruritus on her entire body. Conclusions: We present one patient with delayed allergic reaction caused by amoxicillin and penicillin, that we all know as Flare up. We suggest that this phenomenon of Flare up occurs by a Type IV mechanism mediated by T-cells without participation of IgE antibodies. The betalactam hypersensitivity mechanism which has usually been described is an IgE mediated reaction, but there are other not very well known mechanisms that are responsible for the delayed reactions

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