Olaf Hagemeyer

How to diagnose mould allergy? Comparison of skin prick tests with specific IgE results.

Diagnosis of mould allergy is complicated due to the heterogeneity of the test material and the decrease in the number of commercial mould skin test solutions that are currently available.

Occupational allergic respiratory diseases in garbage workers: relevance of molds and actinomycetes.

Exposures to molds and bacteria (especially actinomycetes) at workplaces are common in garbage workers, but allergic respiratory diseases due to these microorganisms have been described rarely. The aim of our study was a detailed analysis of mold or bacteria-associated occupational respiratory diseases in garbage workers. From 2002 to 2011 four cases of occupational respiratory diseases related to garbage handling were identified in our institute (IPA). Hypersensitivity pneumonitis (HP) was diagnosed in three subjects (cases 1-3, one smoker, two non-smokers), occupational asthma (OA) was diagnosed in one subject (case 4, smoker), but could not be excluded completely in case 2. Cases 1 and 2 worked in composting sites, while cases 3 and 4 worked in packaging recycling plants. Exposure periods were 2-4 years. Molds and actinomycetes were identified as allergens in all cases. Specific IgE antibodies to Aspergillus fumigatus were detected exclusively in case 4. Diagnoses of HP were essentially based on symptoms and the detection of specific IgG serum antibodies to molds and actinomycetes. OA was confirmed by bronchial provocation test with Aspergillus fumigatus in case 4. In conclusion, occupational HP and OA due to molds occur rarely in garbage workers. Technical prevention measures are insufficient and the diagnosis of HP is often inconclusive. Therefore, it is recommended to implement the full repertoire of diagnostic tools including bronchoalveolar lavage and high resolution computed tomography in the baseline examination.

Serial measurements of exhaled nitric oxide at work and at home: a new tool for the diagnosis of occupational asthma.

Whereas serial measurements of lung function at work and at home are a well-known diagnostic tool for the diagnosis of occupational asthma (OA), little is known about the serial measurements of non-invasive parameters such as exhaled nitric oxide (eNO). A 51-year-old baker with variable shortness of breath without relation to work was examined for suspected OA. Skin prick test showed weak sensitizations to wheat and rye flour (without sensitizations to environmental allergens) that were corroborated by in vitro testing (CAP class 3). Baseline FEV1 of 58% predicted and a decrease of forced expiratory volume in 1 s (FEV1) after placebo (sugar powder) of 17% did not allow inhalational challenge testing. The patient performed daily measurements of FEV1 and eNO for about a month during a holiday at home and at work. Whereas symptoms and FEV1 did not show differences between holidays and work periods, eNO showed a clear increase from below 10 ppb to a maximum of 75 ppb. A diagnosis of bakers asthma was made, and the patient quit his job immediately after medical advice. A year afterwards, the patient was still taking asthma medication, but his symptoms had improved, FEV1 had increased to 73% predicted, and eNO was 25 ppb. We conclude that serial measurements of eNO at home and at work may be a useful tool for the diagnosis of OA.

Clinically significant lung function impairment due to current levels of respirable quartz

Mohner et al 1 suggest that allowable levels of respirable quartz should be lowered. Current levels would be associated with a decline in pulmonary function parameters and an increase in chronic obstructive pulmonary disease (COPD) incidence. We appreciate the work of Mohner et al because information about exposure-response relation of quartz and COPD is sparse. However, we believe that the study quality is insufficient for use in quantitative risk assessment: 1. Timing and …

Exhaled Nitric Oxide in Specific Inhalation Challenge

Exhaled nitric oxide (eNO) is a biological mediator in human lungs and can be measured easily in exhaled air. Increasing eNO concentrations after specific inhalation testing (SIT) have been described for subjects with occupational asthma. Nevertheless, interpreting eNO concentrations after SIT is still a challenge because eNO concentrations depend on various confounding factors. In this study, 24 women and 43 men with suspected occupational asthma were examined by a questionnaire, physical examination, routine laboratory testing, skin prick testing (atopy: at least one wheal reaction >3 mm), lung function including methacholine testing, and SIT with various occupational allergens. Exhaled NO was measured before SIT (t0), 2 h (t1) and 20-22 h (t2) afterwards (NIOX Flex, Aerocrine, Sweden). At baseline we observed significantly lower eNO concentrations in smokers than in non-smokers and in non-atopics than in atopics (significant only in SIT non-responders). In the SIT non-responders (n = 45), eNO concentrations showed no change after SIT (t0: 16.0, t1: 12.3, t2: 16.0 ppb). In the SIT responders (n = 22), eNO was elevated significantly at t2 (t0: 22.9, t1: 19.9, t2: 42.0 ppb). In addition to positive responder status and measuring time, missing atopy and exposure to isocyanates were the essential factors leading to increased eNO concentrations. We conclude that the measurements of eNO after SIT may provide valuable information concerning the allergenic status of a patient.

Is there a lung cancer risk in US coal miners

Recently, the 37-years follow-up of the US coal miners’ cohort was published in this journal.1 We would like to comment on the presentation and interpretation of this study, especially on the lung cancer results. First, the non-significant lung cancer standardised mortality ratio (SMR) does not differ from the SMR after the 23-year follow-up.2 Even the SMRs of the five regions were similar between both follow-ups. Emphasising a ‘significant’ relationship with lung cancer mortality …

Prediagnostic detection of mesothelioma by circulating calretinin and mesothelin – a case-control comparison nested into a prospective cohort of asbestos-exposed workers

Malignant mesothelioma (MM) is strongly associated with a previous asbestos exposure. To improve timely detection of MM in asbestos workers, better screening tools – like minimally-invasive biomarkers – are desirable. Between 2008 and 2018 2,769 patients with benign asbestos-related diseases were recruited to participate in annual screens. Using a nested case-control design the protein markers calretinin and mesothelin were determined by enzyme-linked immunosorbent assays in prediagnostic plasma samples of 34 MM cases as well as 136 matched controls from the cohort. Conditional on a pre-defined specificity of 98% for calretinin and 99% for mesothelin the markers reached individual sensitivities of 31% and 23%, respectively, when including the incident cases with samples taken between one and 15 months before diagnosis. The combination of both markers increased the sensitivity to 46% at 98% specificity. Marker complementation increased with earlier sampling. The marker combination improves the sensitivity of the individual markers, indicating a useful complementation and suggesting that additional markers may further improve the performance. This is the first prospective cohort study to evaluate a detection of MM by calretinin and its combination with mesothelin up to about a year before clinical diagnosis. Whether an earlier diagnosis will result in reduced mortality has yet to be demonstrated.