Glutaraldehyde-induced occupational asthma: BALF components and BALF and serum Clara cell protein (CC16) changes due to specific inhalatory provocation test.

OBJECTIVES: The purpose of this study was to evaluate bronchoalveolar lavage fluid (BALF) components and Clara cell protein (CC16) concentration in serum and BALF in patients with glutaraldehyde (GA)-induced asthma, before and after a specific inhalatory provocation test (SIPT) with GA, in comparison to atopic asthmatics and healthy individuals. METHODS: Spirometry and bronchoalveolar lavage were performed before and after SIPT. The serum and BALF concentrations of CC16 and cytogram content in BALF were evaluated. RESULTS: In GA-sensitized asthmatics, the level of CC16 in BALF and serum was significantly lower at 24 h after SIPT in comparison with the values recorded prior to the experiment. There was a significant increase in the proportion of eosinophils, basophils and lymphocytes in BALF of GA-sensitized asthmatics obtained after SIPT. CONCLUSIONS: The determination of CC16 either in serum or in BALF is a non-invasive test to detect Clara cell damage.

Occupational eosinophilic bronchitis without asthma due to chloramine exposure.

A case is discussed of eosinophilic bronchial inflammation without asthma due to chloramine T (CLT) exposure in a nurse. She reported a non-productive chronic cough on contact with CLT during workshifts. She had negative results of skin prick testing to CLT. However, sensitisation to CLT was confirmed by the presence of specific anti-chloramine IgE. Airway responsiveness to histamine was normal before and after CLT challenge. Eosinophil proportion in sputum was increased at 6 and 24 h after CLT challenge.

Nasal lavage fluid examination in diagnostics of occupational allergy to chloramine.

OBJECTIVES: Chloramine T is a known sensitising agent in the occupational environment of health care workers. In cases of occupational hazards induced by this agent, a clinical history may be far from conclusive, hence appropriate provocation tests are absolutely essential. The aim of the study was to evaluate the usefulness of the nasal challenge test in diagnostics of respiratory allergy to chloramine T. MATERIALS AND METHODS: A single-blind, placebo-controlled study was conducted in 6 subjects with chloramine T asthma and rhinitis. Two control groups comprised 7 atopic subjects with asthma and rhinitis and 6 healthy persons. All the controls had negative results of skin prick tests with chloramine T and none displayed any respiratory symptoms under exposure to the agent. A "nasal pool" technique was used to evaluate morphological and biochemical parameters (mast cell tryptase, eosinophil cationic protein, permeability index) in nasal washings before and 30 min, 4 h and 24 h after the provocation with chloramine T and placebo. RESULTS: A significant increase was found in the total count and percentage of eosinophils and basophils, albumin, tryptase and eosinophil cationic protein levels in the nasal lavage fluid from patients with chloramine T respiratory allergy when compared to both control groups. Also a dual asthmatic reaction in 4 patients and an isolated late reaction in 2 cases were observed in chloramine-sensitive subjects. CONCLUSIONS: The results indicate the applicability of the "nasal pool" technique as a diagnostic procedure in chloramine T-induced airway allergy.

Nasal lavage fluid examination and rhinomanometry in the diagnostics of occupational airway allergy to laboratory animals.

OBJECTIVES: The purpose of this studywas to compare the cellular and biochemical findings in the nasal lavage fluid (NALF) and nasal resistance changes due to a challenge with laboratory animal allergens in 25 patients with occupational asthma and rhinitis, in 22 patients with atopic asthma and rhinitis sensitized to house dust mite, and in 15 healthy subjects. METHODS: Skin prick tests with common and occupational allergens, total serum IgE level, specific anti-allergens IgE, spirometry and nasal lavages were performed. RESULTS: In patients with occupational airway allergy, nasal symptoms of varying severity developed directly after specific nasal challenge. The total symptom score immediately and 24 h after specific challenge was significantly correlated with expiratory nasal resistance (ENR). The percentage of eosinophils and basophils in NALF increased significantly 5 and 24 h after specific challenge in patients with occupational asthma and it was correlated with ENR. The authors did not observe any significant increase in the percentage of eosinophils, basophils and in the level of albumin in NALF of patients with non-occupational allergy and healthy subjects at any time-point after specific challenge. None of the healthy subjects and patients with non-occupational allergy developed either allergic symptoms or increased ENR after the challenge with laboratory animal allergens and placebo. CONCLUSIONS: The prolonged increase in the percentage of eosinophils, basophils and in the level of albumin seems to reflect allergic inflammation. The intensity of inflammation during the specific reaction is related to the symptom score and to ENR in occupational allergics.

[Risk factors of occupational hypersensitivity in apprentice bakers]. / Czynniki ryzyka nadwrazliwosci na alergeny zawodowe u uczniów szkól piekarskich.

The aim of the study was to evaluate the risk factors for hypersensitivity to occupational allergens in apprentice bakers. The study group comprised 287 persons. A questionnaire survey, as well as skin prick tests (SPT) with common and occupational allergens were performed in all subjects prior to occupational exposure and one and two years after starting vocational training. In addition, the total IgE level was evaluated in all of them at the beginning of the study. In selected cases, specific anti-flour and alpha-amylase IgE were estimated. Almost 2% of the study subjects showed positive SPT with occupational allergens before vocational training. After two years of occupational exposure, the occurrence of at least one positive SPT increased from 19.2 to 30.7%, including common (from 18.8 to 30%) and occupational (from 1.7 to 12.9%) allergens. In 18.1% of subjects, hypersensitivity to occupational allergens assessed by positive SPT, and/or the presence of antigen specific IgE developed during the study period. Logistic regression analysis revealed that positive SPT with common allergens is a significant risk factor for the development of hypersensitivity to occupational allergens (OR = 9.06, 95% CI: 2.53-32.46). The results of the study suggest that skin prick tests with common and occupational allergens should be performed in bakers prior to occupational exposure. The outcome of the tests should enable better identification of subjects at the highest risk of occupational allergy and their referral to more frequent screening. A relatively high prevalence of positive SPT with occupational allergens (2%) at the beginning of vocational training should be taken into account to avoid possible future diagnostic mistakes.