Cordula Bittner

IgE Reactivity, Work Related Allergic Symptoms, Asthma Severity, and Quality of Life in Bakers with Occupational Asthma

In Germany, bakers with occupational asthma willing to stay in their job are included in an interdisciplinary program of the Social Accident Insurance for Foodstuff and Catering Industry (BGN). The primary aim is to reduce flour dust exposure, and to provide adequate medical treatment. Our aim was to evaluate the programs effect on the diseases course using routinely collected data. Forty three bakers with allergic occupational asthma and with the available baseline level of IgE (f4, f5) were investigated. Changes in IgE related to wheat and rye flour exposure were measured by ImmunoCAP test during follow-up visits. A questionnaire on work-related allergic complaints (WRAC), the Asthma Control Test (ACT), a 10-point scale of asthma severity grade, and quality of life instruments (EQ-5D-5L, Mini-AQLQ) were administered. We found an improvement of asthma severity in 88.4 % of the bakers. WRAC were reported by 65 %; 77 % had good asthma control (ACT ≥ 20); and 81 % had regular asthma medication. A relevant reduction of ≥2 CAP-classes for both allergens was seen in 12 % of the subjects. Health-related and asthma-specific quality of life was high. We conclude that satisfactory asthma control is probably the result of adequate medical management. In a subgroup of bakers with decreased specific IgE, it may also be attributed to reduced allergen exposure.

Identification of two metallothioneins as novel inhalative coffee allergens cof a 2 and cof a 3.

Background Dust of green coffee beans is known to be a relevant cause for occupational allergic disorders in coffee industry workers. Recently, we described the first coffee allergen (Cof a 1) establishing an allergenic potential of green coffee dust. Objective Our aim was to identify allergenic components of green coffee in order to enhance inhalative coffee allergy diagnosis. Methods A Coffea arabica pJuFo cDNA phage display library was created and screened for IgE binding with sera from allergic coffee workers. Two further coffee allergens were identified by sequence analysis, expressed in E. coli, and evaluated by Western blots. The prevalence of sensitization to recombinant Cof a 1, Cof a 2, and Cof a 3 and to commercially available extract was investigated by ELISA (enzyme-linked immunosorbent assay) respectively CAP (capacity test) screening in 18 sera of symptomatic coffee workers. Results In addition to the previously described chitinase Cof a 1, two Coffea arabica cysteine-rich metallothioneins of 9 and 7 kDa were identified and included in the IUIS Allergen Nomenclature as Cof a 2 and Cof a 3. Serum IgE antibodies to at least one of the recombinant allergens were found in 8 out of 18 symptomatic coffee workers (44%). Only 2 of the analysed sera (11%) had reacted previously to the commercial allergy test. Conclusions In addition to the previously described Cof a 1 we have identified two further coffee proteins to be type I coffee allergens (Cof a 2 and Cof a 3) which may have a relevant potential for the specific diagnosis and/or therapy of coffee allergy.

Gradual Versus Continuous Increase of Load in Ergometric Tests: Are the Results Comparable?

Standard exercise testing (ET) comprises progressive exercise provocation with cardiovascular monitoring. Exercise tolerance is estimated by workload. Cardiopulmonary exercise testing (CPX) is a non-invasive measurement of ventilatory gas exchange which provides more accurate quantifications of cardiorespiratory fitness (CRF). Workload is usually increased stepwise in ET and continuously (ramp) in CPX. Our aim was to examine the comparability of the results. Thirty two healthy volunteers (17 females/15 males, age 26.8±6.1 years, BMI 24.5±3.0) underwent exercise testing on a bicycle ergometer up to maximum physical exhaustion; under ramp protocol (CPX) and 2-7 days later with a stepwise increase of workload (ET). We compared the physical work capacity under both methods at maximum workload, at heart rate of 150 and 170 beats/min (PWC150 and PWC170), and the exercise duration. We found that there were no statistically significant differences in the maximum heart rate (CPX: 177.1±11.7/min vs. ET: 178.5±11.2/min) or maximal workload (CPX: 219.8±50.6 vs. ET: 209.4±42.5). PWC150 and PWC150/kg were higher with CPX than those with ET (156.6±51 vs. 146.4±42.3, p<0.001 and 2.1±0.5 vs. 1.9±0.4, respectively, p<0.001). Exercise duration was almost equal (12.1 vs. 11.3 min). We conclude that overall physical performance was higher with CPX. Since the results are similar, we recommend the CPX: wattage and other parameters in performance assessment are to be determined directly, interpolations are obsolete.