Cases reported "Asthma"

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1/14. asthma and rhinitis induced by exposure to raw green beans and chards.

    BACKGROUND: Although the vast majority of IgE-mediated allergic reactions to foods occurs through ingestion, a few cases of unexpected allergic reactions to foods may occur through the exposure to airborne food allergen particles. methods: case reports. Skin prick tests and serum-specific IgE (CAP-FEIA) were used to identify specific IgE antibodies. bronchial provocation tests were performed to determine the clinical relevance of inhaled exposure to raw and cooked green beans and raw chards. After demonstrating specific reactivity to them, SDS-PAGE and immunoblotting of raw and cooked green beans were carried out to identify relevant antigens. RESULTS: Three women developed bronchial asthma and rhinitis after exposure to raw green beans, and one of them also when exposed to raw chards. All women tolerated ingestion of green beans. patients reported multiple episodes while handling these vegetables for cooking activities. Allergy to green beans and chards was demonstrated by skin testing and serum-specific IgE. Bronchial challenge test with these allergens showed positive responses to raw, but not cooked, green beans and chards. Oral food challenges with green beans (raw and cooked) and chards were negative in all patients. In order to further characterize the allergenic components of these extracts, SDS-PAGE and electroblotting studies were also performed. Immunoblots of raw and cooked green beans extract showed two IgE-binding bands with apparent molecular weights of 41.1 and 70.6 kD. Interestingly, a 47-kD IgE-binding protein was detected only in raw green bean extracts. CONCLUSIONS: We report three patients who developed asthma and rhinitis caused by exposure to raw, but not to cooked, green beans and chards in a non-occupational environment. Only minor differences of IgE reactivity between nitrocellulose-blotted raw and boiled green bean extract were found.
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2/14. Occupational asthma caused by soybean hull: a workplace equivalent to epidemic asthma.

    A case showing that soya hull exposure at work causes occupational asthma without flour-related bronchoconstriction.
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3/14. Lupine inhalation induced asthma in a child.

    The ingestion of lupine seed flour has been reported as a cause of allergic reactions. There is some evidence of its allergenic potential after inhalation. An 8-year-old asthmatic child, who was allergic to peanut, was studied in our clinic with the suspicion of an adverse drug reaction due to salbutamol. He suffered an asthma attack while playing with his brother, who had been eating lupine seed as snack; surprisingly, the asthma attack worsened with salbutamol. The skin tests showed a positive result with lupinus albus extract, peanut, garbanzo bean, navy bean, pea, green bean, lentil, soy, olea europea pollen, grass pollen and plantago lanceolata pollen. The prick-by-prick tests both from dried seeds and those preserved in salt and water were strongly positive. serum specific IgE antibodies were positive to Lupine albus (1.43 kU/l), peanut (4.32 kU/l), soy (2.15 kU/l), lentil (3.12 kU/l) and garbanzo (0.7 kU/l). After informed consent salbutamol was well tolerated but the patient had asthma in 5 min of manipulation of the lupine seeds. In our case, reactivity with other legumes was also demonstrated, but only peanut allergy was relevant because boiled legumes were tolerated. It is also notorious that anamnesis is so important to assess the true etiological agents of asthma.
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4/14. Immunologic and clinical responses to parenteral immunotherapy in peanut anaphylaxis--a study using IgE and IgG4 immunoblot monitoring.

    BACKGROUND: Specific desensitisation to food allergens, which produce anaphylaxis after ingestion, has not been considered as a treatment for food allergy until recently. The purpose of this study was to assess if a parenteral immunotherapy program, using a partially characterised crude peanut extract, could induce a state of immunological tolerance in a patient who exhibited anaphylaxis, asthma and urticaria on exposure to peanut and other legumes. A further aim was to measure the serum antibody responses to the immunotherapy. methods AND RESULTS: We report the successful desensitisation towards all of the legumes tested of a male patient on parenteral immunotherapy using a partially characterised peanut extract. The immunologic parameters measured during treatment included specific IgE and IgG4 for peanut, soybean, pea and lentil extracts. Immunoblots of specific IgE and IgG4 were made before and after therapy. The antibody response followed the same pattern seen in successful desensitisation of patients with bee venom anaphylaxis. The IgG4 levels increased strongly from a low pre-treatment level in proportion to the antigen dose received. The antigen-specific IgE levels gradually fell from a high pretreatment level, but remained significantly elevated. immunoblotting for specific IgE and IgG4 demonstrated that acquisition of clinical tolerance after therapy was associated with declines in the number and intensity of bands in IgE blots and the development of more bands of increasing density in the IgG4 blots. CONCLUSIONS: Parenteral immunotherapy may offer an alternative treatment to lifelong dietary restriction and epinephrine injections in patients who exhibit life-threatening IgE-mediated anaphylaxis to peanut. Cross desensitisation to other legumes appears to have occurred in this study. The quality and potency of the extract used is an important factor in achieving the desired acquisition of clinical tolerance. In our patient this tolerance correlated with his ability to maintain high levels of specific IgG4, which acted as a marker of protection against anaphylaxis. The use of IgG4 immunoblotting may provide an improved level of discrimination in the assessment of correlation of clinical efficacy with the immunologic response.
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5/14. Buckwheat anaphylaxis: an unusual allergen in taiwan.

    IgE-mediated hypersensitivity to buckwheat is common in korea, japan, and some other Asian countries. However, buckwheat is not a common allergen in taiwan. We report a woman with asthma who had anaphylactic shock, generalized urticaria, and an acute exacerbation of asthma five minutes after ingesting buckwheat. The patient underwent skin prick and Pharmacia CAP testing (Uppsala, sweden) for specific IgE to buckwheat, white sesame and soybean as well as other common allergens in taiwan including dermatophagoides pteronyssinus (Dp), D. farinae (Df), cat and dog dander, cockroach, egg white, cow milk and codfish. The patient had a strongly positive skin prick test response to buckwheat and positive reactions to Dp and latex. Specific IgE results were class 6 for buckwheat, class 4 for Dp and Df, and class 2 for dog dander, wheat, sesame and soybean. Results of an open food challenge with white sesame and soybean were negative. Although buckwheat is a rare allergen in taiwan, it can cause extremely serious reactions and should be considered in patients presenting with anaphylaxis after exposure to buckwheat.
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6/14. Soybean flour asthma: detection of allergens by immunoblotting.

    A 43-year-old woman developed asthma 6 years after beginning work in a food-processing plant in which soybean flour was used as a protein extender. Symptoms of sneezing, coughing, and wheezing would begin within minutes of exposure to soybean flour and resolve 2 hours after exposure ceased. skin tests were positive to a soy extract prepared from the flour. Airway hyperreactivity was confirmed by a positive bronchial challenge to methacholine. Bronchial challenge with soybean flour produced an immediate increase in specific airway resistance from 5.0 to 22.7 L. cm of H2O/L/sec. There was no response to challenge with lactose. The patient's allergic response to soy-flour extract was further characterized by several immunologic methods. IgE binding to soy-flour protein by direct RAST was 5.98 times that of a normal control serum. The soy-flour extract was separated by dodecyl sulfate-polyacrylamide gel electrophoresis. Twenty-four protein bands were detected in the crude soy-flour extract. After immunoblotting and subsequent autoradiography, nine proteins with molecular weights ranging from 54,500 to 14,875 were found. Cross-reactivity studies with other legumes demonstrated apparent immunologic identity between a component in green pea extract and a soybean protein with a molecular weight of 17,000. The clinical significance of this cross-reactivity is not known. We conclude that in this case of occupational asthma to soybean flour, multiple allergens were involved. immunoblotting may be useful in identifying the allergens involved in occupational asthma.
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7/14. Syngamosis, an unusual cause of asthma: the first reported case in canada.

    The first case of syngamosis in a human in canada is reported. The patient, a traveller to the Caribbean islands, presented with a chronic dry cough. The nematode Syngamus laryngeus is found in wild and domestic birds and mammals in the tropics and subtropics. humans are only accidental hosts. The diagnosis of syngamosis is usually made by fibreoptic bronchoscopic examination, which reveals the Y-shaped worms in the bronchi or the characteristic eggs in the sputum or feces. physicians must be alerted to the possibility of syngamosis in patients with symptoms of asthma who have recently travelled to south america or the Caribbean islands.
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8/14. Immediate and late onset asthma from occupational exposure to soybean dust.

    Most patients sensitive to soybean experience gastrointentinal symptoms, urticaria, angioedema, and asthma after ingestion. However, we report here a previously non-allergic patient who developed immediate and late onset asthma after breathing soybean flour used in the manufacture of food supplements. She exhibited positive immediate and late skin test sensitivity as well as a positive bronchial challenge to a soybean flour extract. In contrast to another patient with an anaphylactic response after soybean ingestion, the radioallergosorbent test (RAST) to soybean antigen was negative in our patient.
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9/14. asthma in merchant seamen and laboratory workers caused by allergy to castor beans: analysis of allergens.

    Three merchant seamen and two laboratory workers who developed allergic symptoms following exposure to castor beans have been investigated. Bronchial-provocation testing with castor beans in the merchant seamen demonstrated a late reaction in two. Specific IgE against whole castor-bean extract and ricin, ricinus agglutinin and dericinated extracts of castor bean were found in the patients' sera using radioallergosorbent tests (RAST). RAST inhibition, toxocological and haemagglutination tests suggest that the ricin and dericinated extracts contain distinct allergens.
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10/14. meat wrapper's asthma: identification of the causal agent.

    meat wrapper's asthma is a typical example of occupational asthma due to emissions from chemical products. The authors report three new cases due to the use of the now classic meat packaging techniques in supermarkets. The chemical agents involved were identified. inhalation tests have been carried out in one patient with the complete wrappings, i.e. the PVC film and the price labels, and separate tests were performed with eight additives of the PVC film, and with phthalic anhydride and di-cyclohexylphthalate emitted from heated price labels. These tests incriminate two products: phthalic anhydride seems to be the principal causal agent and epoxidized soybean oil can be suspected as a secondary agent causing this occupational asthma.
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