Javier Cuesta

Egg white proteins as inhalant allergens associated with baker's asthma

Background:u2002 Bakery workers may develop IgE‐mediated allergy to liquid and aerosolized hens egg proteins that are commonly used in the baking and confectionery industries.

Bronchial responsiveness to bakery-derived allergens is strongly dependent on specific skin sensitivity

Background:u2002 Quantitative relationships between immunological reactivity, non‐specific bronchial responsiveness and bronchial responsiveness to allergens have scarcely been investigated in occupational asthma.

An Odorant-Binding Protein as a New Allergen from Siberian Hamster (Phodopus sungorus)

A case of anaphylaxis following a bite from a Siberian hamster (SH; Phodopus sungorus) is described. Skin prick tests with hair, urine and salivary gland extracts from SH were positive, while the tests were negative for hair extracts from other rodents. IgE immunoblotting with the patient serum revealed 3 IgE-binding bands of about 18, 21 and 23 kDa. When the patient’s serum was preincubated with rabbit, mouse and gerbil hair extracts, no inhibition of the 3 SH IgE-binding bands was demonstrated. Proteins extracted from the 3 bands were analyzed by N-terminal sequencing and matrix-assisted laser desorption/ionization time-of-flight tandem mass spectrometry, and peptides were sequenced. IgE-binding bands were identified as being an odorant-binding protein belonging to the lipocalin family. Analysis of the 3 IgE-binding bands found in the hair, urine and salivary glands of SH showed a new allergenic protein lacking cross-reactivity with allergens from other rodents. The 3 bands likely correspond to isoforms of a single allergen.

Occupational asthma from dried flowers of Carthamus tinctorious (safflower) and Achillea millefolium (yarrow)

References 1. Saarinen KM, Pelkonen AS, Mäkelä MJ, Savilahti E. Clinical course and prognosis of cow’s milk allergy are dependent on milk-specific IgE status. J Allergy Clin Immunol 2005;116:869–875. 2. Wilson DR, Lima MT, Durham SR. Sublingual immunotherapy for allergic rhinitis: systematic review and metaanalysis. Allergy 2005;60:4–12. 3. Meglio P, Bartone E, Plantamura M, Arabito E, Giampietro PG. A protocol for oral desensitization in children with IgEmediated cow’s milk allergy. Allergy 2004;59:980–987. 4. Patriarca G, Nucera E, Roncallo C, Pollastrini E, Bartolozzi F, De Pasquale T et al. Oral desensitizing treatment in food allergy: clinical and immunological results. Aliment Pharmacol Ther 2003;17: 459–465. 5. Enrique E, Pineda F, Malek T, Bartra J, Basagana M, Tella R et al. Sublingual immunotherapy for hazelnut food allergy: a randomized, double-blind, placebocontrolled study with a standardized hazelnut extract. J Allergy Clin Immunol 2005;116:1073–1079. 6. Mempel M, Rakoski J, Ring J, Ollert M. Severe anaphylaxis to kiwi fruit: immunologic changes related to successful sublingual allergen immunotherapy. J Allergy Clin Immunol 2003;111:1406–1409.

Generalized dermatitis due to pseudoephedrine

. PSEUDOEPHEDRINE is a sympathomimetic drug (SD), a widely used as a nasal decongestant that seldom causes an allergic reaction. We report a patient who complained of a generalized eczematous dermatitis after oral intake of a drug containing pseudoephedrine. A 77-year-old woman presented a generalized, itchy erythematous eruption after starting oral treatment with Clamoxyl (amoxycillin) and Rinoebastel (ebastine 10 mg plus pseudoephedrine 120 mg). The lesions cleared without further desquamation within one week of stopping this medication. The same symptoms had occurred in this patient twice previously with other drugs taken for a common cold. Skin tests with penicilloyl polylysine (PPL), minor determinant mixture (MDM), penicillin G and amoxycillin, and oral challenge with amoxycillin, were negative. Patch tests were carried out with Rinoebastel (0.1 and 1% in petrolatum (pet.)) and elicited a negative reaction at 48 and 96 h. A single-blind, placebo-controlled oral challenge with Rinoebastel was also performed. Within five hours, the patient developed an itchy erythematous generalized micropapular rash, which disappeared after treatment. Oral administration of ebastine produced no reaction. A posterior oral challenge with pseudoephedrine hydrochloride (60 mg) was also followed by similar lesions. Two months later the patient agreed to be patch tested again with pseudoephedrine (10% pet. and aqueous solution (aq.)), phenylephrine (10% pet. and aq.), epinephrine (1 : 1000), terbutaline (1% aq.) and albuterol (0.5% aq.). These tests revealed a positive reaction (++), in both petrolatum and aqueous solution, to pseudoephedrine, ephedrine, and phenylephrine at day 2, persisting to day 4. The remaining tests were negative. Ten healthy controls did not react to the same patch tests. Subsequent separated challenges were carried out with epinephrine 1 : 1000 (0.3 ml), terbutaline (2.5 mg), albuterol (2 mg), ephedrine (40 mg) and phenylephrine (20 mg). All were negative, except for ephedrine, which provoked the same symptoms. Despite extensive oral use of pseudoephedrine, allergic reactions seem to be unusual3/4a nonpigmenting fixed drug eruption being the most common cutaneous reaction (1,2). Also reported have been eczematous dermatitis (3,4), an unspecified rash with joint swelling (5), scarlatiniform eruptions (6), a recurrent toxic shock syndrome (7) and a vacuolar interface dermatitis (4). In order to verify the cause of a suspected drug eruption, a challenge test is usually required. Patch tests are not usually a reliable diagnostic method; a literature search revealed only four cases of positive patch tests to pseudoephedrine (1,3,4). Positive results have been obtained at 1% concentration and with the use of petrolatum as a vehicle. However, in our patient, the patch tests were positive for both types of vehicles, but only when a higher concentration (10%) was used. Cross-sensitivity among SDs has been rarely reported. We have found crossreactivity between pseudoephedrine and ephedrine, which have a closely related chemical structure derived from the phenylpropanolamine skeleton. On the contrary, no cross-reaction has been observed in provocation tests with other SDs (phenylephrine, epinephrine/ adrenaline) which are phenylethanolamine-derived. Although our patient’s patch test with phenylephrine was positive, she tolerated it well. Thus (with the exception of ephedrine) all SDs should not be routinely prohibited in cases of sensitization to pseudoephedrine. In summary, the challenge and patch-testing results suggest a delayed hypersensitivity mechanism to pseudoephedrine in our patient’s dermatitis. In our study, pseudoephedrine 10% was a suitable concentration with which to perform the patch test.

Causative agents of baker's asthma: A clinical and immunologic study

Abstract Rationale The causative role of cereal flour, glycolitic enzymes, and egg proteins in bakers with work-related rhinitis and asthma was investigated. Methods Sensitization to baking ingredients was assessed by immunologic tests and confirmed by specific inhalation challenge (SIC). Results Twenty-one bakery workers (20 males; 22 to 60 year-old) with work-related respiratory symptoms were evaluated. They had been working in the baking industry between 2.6 and 46 years. The mean duration of rhinitis and asthma symptoms was 7.66 and 7.05 years, respectively. Sixty-seven percent were atopic and 52% were non-smokers. Methacholine inhalation tests revealed bronchial hyperresponsiveness in all patients but one. Seventeen patients (81%) had positive skin tests (ST) to wheat flour, 76.2% to rye flour, 47.6% to soybean flour, 61.9% to alpha-amylase, 33.3% to hemicellulase, 19% to glucoamylase and 33.3% to storage mites. Twelve patients were exposed to egg aerosols at work. Five of them (41.7%) had positive ST to egg white, 33.3% to ovalbumin, 16.7% to ovomucoid, 41.7% to lysozyme and 25% to egg yolk. SIC tests were performed with wheat flour (n=10), rye flour (n=1), soybean flour (n=6), alpha-amylase (n=12), hemicellulase (n=4), glucoamylase (n=3), ovalbumin (n=2), ovomucoid (n=1) and lysozyme (n=5) in some sensitized workers. Eighty-four percent SIC tests were positive. SIC elicited isolated early asthmatic responses (AR) in 62.1% cases, isolated late AR in 5.4% cases, and dual AR in 32.4% cases. Conclusions Inhalation of cereal flour and baking additives may induce asthmatic reactions in sensitized workers. However, not all bakers sensitized to these agents experienced an asthmatic reaction during SIC.