Miguel Hinojosa

Anaphylactic reaction after the ingestion of chamomile tea: A study of cross-reactivity with other composite pollens

We report a case of an 8-year-old atopic boy in whom ingestion of a chamomile-tea infusion precipitated a severe anaphylactic reaction. The patient suffers from hay fever and bronchial asthma caused by a variety of pollens (grass, olive, and mugwort). This severe reaction was developed after his first ingestion of chamomile tea. Studies revealed the presence of immediate skin test reactivity and a positive passive transfer test to chamomile-tea extract. Moreover, both specific antichamomile-tea extract and anti-Matricaria chamomilla-pollen extract IgE antibodies were detected by an ELISA technique. Cross-reactivity among chamomile-tea extract and the pollens of Matricaria chamomilla, Ambrosia trifida (giant ragweed), and Artemisia vulgaris (mugwort), was demonstrated by an ELISA-inhibition study. These findings suggest a type I IgE-mediated immunologic mechanism as being responsible for the patients anaphylactic symptoms and also suggest that the patient cross-reacted the pollens of Matricaria chamomilla contained in the chamomile tea because he was previously sensitized to Artemisia pollen.

Occupational asthma caused by cellulase

Inhalation of enzyme dusts can cause occupational asthma, and the list of enzymes able to induce asthma is increasing. We report two patients with asthma induced by occupational exposure to cellulase powder derived from Aspergillus niger. A type I hypersensitivity to this enzyme was demonstrated by means of skin test reactivity, positive passive transfer test, positive reverse enzyme immunoassay for specific IgE, and immediate bronchial provocation test response to cellulase dust. Skin tests with an A. niger extract were positive. Cross-reactivity between cellulase dust and an entire A. niger extract was also demonstrated.

Occupational asthma caused by α-amylase inhalation: Clinical and immunologic findings and bronchial response patterns

Inhalation of dust from different enzymes can be the cause of occupational asthma in exposed workers. alpha-Amylase, derived from Aspergillus oryzae, is one of these enzymes, although there are few studies in the medical literature that refer to its allergologic properties and to clinical studies in sensitized patients. The results obtained in a study performed in 83 pharmaceutical-industry workers exposed to powdered alpha-amylase are described in this article. The existence of sensitization to this enzyme was demonstrated in 26 of the workers by positive skin tests. Specific IgE values were significantly higher in workers with positive skin tests than in workers with negative skin tests (p less than 0.001). The bronchial provocation test with alpha-amylase was positive in six of the 14 patients challenged, and only immediate bronchial responses were observed; the same type of response was obtained by nasal provocation. One of the workers had a positive response to oral provocation with this enzyme, presenting abdominal, skin, and respiratory symptoms a few minutes after ingestion. Consequently, we consider that the bronchial asthma presented by the workers was due to an immediate-type, IgE-dependent, immunologic mechanism.

Housewives with raw potato-induced bronchial asthma.

Allergy to white potato has rarely been described. We report two cases of atopic patients, housewives, in whom peeling raw potatoes precipitated rhinoconjunctivitis and asthmatic attacks, and, in one of them, contact urticaria. Type I hypersensitivity to raw potato antigens was demonstrated by means of immediate skin test reactivity, specific IgE determination by RAST, basophil degranulation, histamine release test and an immediate bronchial provocation test response to raw potato extract. The controls did not react to any of these tests. Potato allergenic constituent is currently being investigated but, as far as we know, it is heat‐labile and has an MW of more than 10 Kd.

Asthma caused by African maple (Triplochiton scleroxylon) wood dust

Inhalation of wood dusts can cause immediate and/or late onset asthma, and the list of woods responsible for such reactions is increasing. We report two patients with asthma induced by exposure to the dust of African maple wood (Triplochiton scleroxylon). Type I hypersensitivity to this dust was demonstrated by means of immediate skin test reactivity, positive passive transfer test, positive reverse enzyme immunoassay for specific IgE, and an immediate bronchial provocation test response to an African maple-dust extract. Unexposed persons did not exhibit reactivity to this wood in any of the tests listed above.

Occupational asthma caused by Brazil ginseng dust

The inhalation of different substances of plant origin can cause immediate and late onset asthma. The list of these agents responsible for such reactions is continuously increasing. We discuss a patient who developed symptoms of asthma after exposure to Pfaffia paniculata root powder used in the manufacturing of Brazil ginseng capsules. Airway hyperreactivity was confirmed by a positive bronchial challenge to methacholine. Sensitivity to this dust was confirmed by immediate skin test reactivity, a positive bronchial challenge (immediate response), and the presence of specific IgE detected by ELISA technique to an aqueous extract. The bronchial response was inhibited by sodium cromoglycate. Unexposed subjects did not exhibit reactivity to this ginseng extract with any of the tests referred to above. The same study performed with Korean ginseng (Panax ginseng) elicited negative results. This study is the first, to our knowledge, that links ginseng-root dust to occupational asthma.

The Relevance of IgE in the Pathogenesis of Allergy: The Effect of an Anti-IgE Drug in Asthma and Other Diseases

The frequency of allergic diseases has increased in recent decades. Asthma is one of the most prevalent conditions and a leading cause of morbidity. It affects 3-4% of the population in our geographical setting and extrinsic allergens are detected as the diseases etiological agent in around half of these cases. IgE is one of the molecules involved in the allergic process. Most of the time and resources at asthma units are devoted to corticosteroid-dependent patients. International guidelines for asthma treatment recommend a stepwise therapeutic approach; in the last step, the use of oral corticosteroids is advised when control is not achieved with long-acting beta-2-agonists and high doses of inhaled corticosteroids. No alternatives or complements to oral corticosteroids had been proposed until November 2006, when the latest GINA update included the IgE blocker omalizumab in the last step of asthma treatment. In this paper we discuss the pathogenesis of the allergic reaction and the key importance of IgE in this process in order to highlight the beneficial effects of a drug able to block the circulation of the free form of this immunoglobulin. We also review the most important studies and patents for the efficacy and effectiveness of the drug in the treatment of adults and pediatric patients with asthma and other diseases.

Occupational asthma caused by grass juice

their hardness and dust-generat ing capacity taust be studied. W e think that onion seeds can be considered as occupat iona! allergens. Having proven that bo th in vivo and in vitro methods are useful tools for the diagnosis of this IgE-media ted disease, we expect to find new hypersensitivities to this al lergen among workers in the same factory and to have informat ion about the prevalence of sensitization. Othe r cases may be found elsewhere.

Occupational asthma caused by Voacanga africana seed dust

We report a case of a nonatopic patient in whom exposure to Voacanga africana (VA) dust precipitated asthma. The patient was indirectly exposed to this dust by her husband, a chemist working in a pharmaceutical plant in which VA is used for the production of vinburnine, an alkaloid derivative. Vinburnine (Cervoxan) is widely used in conditions associated with cerebral circulatory insufficiency. Studies revealed the presence of immediate skin test reactivity to VA dust, and specific anti-VA antibodies were detected in the patients serum by the reverse enzyme immunoassay technique. Bronchial challenge with a VA extract also resulted in an immediate asthmatic response without late reaction. These findings suggest a type I IgE-mediated immunologic mechanism as being responsible for the patients respiratory symptoms. Unexposed persons did not exhibit reactivity to this seed with any of the tests referred to above. To the best of our knowledge, this is the first reported case of occupational asthma caused by VA seeds.

Corn‐induced hypersensitivity pneumonitis

We studied a 50-year-old male farmer, non-smoker, who had worked harvesting corn for 17 years. For the last 4 years, he had recurrent episodes of fever, dyspnea and chest pain during the corn harvest season, 4–5 h after corn dust exposure. The patient associated these symptoms with the handling of corn and showed marked relief when exposure to this material was avoided. Several corn samples were sent to our laboratory by the patient. These samples were ground to obtain a very thin dusty material and 5 g were extracted by magnetic stirring in 50 ml of phosphate-buffered saline (PBS, pH 7.3), for 24 h, passed through filter paper, dialyzed against PBS for 24 h, and then filtered through a 0.22 lM Millipore filter for sterilization. Different samples of corn provided by the patient were studied in order to identify the presence of microorganisms: Penicillium sp., Fusarium sp., and Rhizopus spp. were able to be isolated. Double immunodiffusion tests for precipitin antigens were performed according to Ouchterlony’s method (1). Precipitation bands were shown between our patient’s serum and Aspergillus fumigatus, P. notatum, P. nompactum, P. brevicompactum, P. roqueforti, the corn extract and corn flour extracts. Specific IgG antibodies against A. fumigatus, P. notatum, A. alternata, C. herbarum and corn flour extracts were also found in the patient’s serum using the ELISA method. Pulmonary inhalation provocation test (PIPT) was performed with the corn extract at 1/10 p/v, following the method previously described (2). Five minutes after PIPT, a bronchoconstriction reaction was detected. Four hours afterwards, the patient suffered clinical symptoms similar to those reported in his occupational environment. The patient presented a significant decrease in PaO2 from baseline blood gas and marked leukocytosis 6 h after PIPT. Spirometric values are expressed in Fig. 1. Twentyfour hours after PIPT, bronchoalveolar lavage (BAL) studies and transbronchial biopsy were carried out. The histopathological examination of transbronchial biopsy specimens revealed interstitial alveolitis with lymphocyte-macrophage infiltrate. The lymphocytes included in the BAL were subtyped according to their expression of different surface markers. For this purpose, all cells in the BAL were washed in saline and stained with fluorochrome-conjugated monoclonal antibodies, specific for the different surface markers, prior to their analysis in a FACScan flow cytometer. By means of flow cytometry, we obtained the following results: lymphocytes, 19.5%; mean CD4/CD8, 1.3; natural killer cells, 6.6%; B lymphocytes, 2.4%; neutrophils, 29%; monocytes/macrophages, 5.5% and eosinophils, 2%. We have described a case of hypersensitivity pneumonitis (HP) caused by corn reported by our patient. His clinical history suggested a possible subacute form of HP. We have found precipitating antibodies in the patient’s serum using diffusion techniques and ELISA IgG. Also, we performed the PIPT with the corn extract supplied by our patient. BAL fluid revealed an acute inflammatory infiltrate with prevalence of neutrophils and lymphocytes, an increase of the CD8 subpopulation and a decreased CD4/CD8 ratio compared with the normal population. There is only one case described in the medical literature of HP caused by corn contaminated with A. flavus (3). No pulmonary functional Corn flour: a new allergen related to hypersensitivity pneumonitis. P er ce nt ag e fa ll in F E V 1 an d F V C 0